IntroductionAdolescent girls and young women (AGYW) face a high burden of gender-based violence (GBV) worldwide. The COVID-19 pandemic and associated policies led to global increases in GBV, decreased access to resources, and disruptions of pathways to care. We aimed to understand the effects of COVID-19 on AGYW affected by GBV in Kisumu, Kenya, as well as to identify possible interventions to mitigate those effects.MethodsFocus group discussions (FGDs) were conducted with AGYW aged 15–25 with a history of exposure to GBV. AGYW were split into age-matched groups; aged 15–19 for younger groups and 19–25 for older groups. Discussions focused on how COVID-19 affected experiences of GBV, access to care services, economic and social outcomes, and opportunities for interventions to mitigate negative impacts of COVID-19 and violence.ResultsFive FGDs with 46 AGYW were completed in June-September 2021. AGYW described increases in all types of GBV, particularly sexual abuse and intimate partner violence. Early marriage and subsistence transactional sex also increased. AGYW described violence as both a cause and effect of poor economic, social and health consequences related to the pandemic. Notably, AGYW emphasized stress, lack of mental health support and increased substance use as risk factors for violence, and discussed the deleterious mental health effects of violence—particularly in the wake of disruption of mental health services. COVID-19 disrupted referrals to violence-related services, and reduced access to both medical services and psychosocial services. AGYW believed that interventions focused on improving mental health as well as economic empowerment would be the most feasible and acceptable in mitigating the negative effects of COVID-19 and related exacerbations in violence.DiscussionAGYW reported increases in almost all forms of GBV during the pandemic, with related exacerbation in mental health. Concurrently, AGYW endorsed decreased access to care services. As there is no evidence that violence and mental health challenges will quickly resolve, there is an urgent need to identify and implement interventions to mitigate these negative effects.

We aimed to determine whether a Case-Based Collaborative Learning (CBCL) curriculum, developed from the clinical experience of U.S.-based clinicians in collaboration with Rwandan medical faculty, is acceptable, feasible to implement, and effective as a virtual educational tool for medical students in a resource-limited, global health setting. In this CBCL distance learning education, students were actively engaged and understood the case material and asked probing and insightful questions. Course evaluations showed that 106 of the 120 total student responses (88.3%) said that the difficulty level was “about right”, while only 11/120 (9.2%) said it was “too easy” and 3/120 (2.5%) said it was “too hard” providing evidence that even though the cases were largely based on clinical encounters at an American academic medical center, they are understandable, and at the appropriate level of difficulty for Rwanda-based medical students. Qualitative analysis from student comments found the CBCL method most helpful for students to develop diagnostic frameworks, and the practice of clinical reasoning using CBCL was engaging and interactive. This method of a virtual, international CBCL approach, was feasible, effective, and acceptable for students. A large majority of students found the sessions to be of appropriate difficulty and engaging. From the global health and inter-cultural exchange perspective, this collaboration demonstrates feasibility and acceptability of international partnerships. Using virtual, video conferencing technology, similar future collaborations can improve capacity building in lower-resource settings.

Effectively addressing social determinants of health in clinical care can be challenging, and screening for such social needs is often overlooked. The COVID-19 pandemic has exacerbated health disparities and the impacts of social determinants of health, increasing the importance of both effective screening and intervention to address social needs. In response, the student-run free clinics at Stanford University sought to meet this need amongst our patient population by developing an evidence-based social needs screening (SNS) and referral protocol and integrating it into our novel telehealth model. The new protocol was implemented significantly more consistently compared to our previous checklist-based SNS, and more need was identified amongst our patient population than with the checklist-based, pre-pandemic screen. The new screening and referral protocol facilitated comprehensive patient care that addresses the social determinants of health in the clinical setting by improving our ability to identify patient social needs and refer such patients to community organizations. In describing the development, design, and implementation of this SNS, we hope to provide an example strategy for addressing social determinants of health within a student-run free clinic setting, and to encourage other student-run clinics and/or free clinics to similarly expand locally relevant social needs services.

The onset of the COVID-19 pandemic and subsequent county shelter-in-place order forced the Cardinal Free Clinics (CFCs), Stanford University's 2 student-run free clinics, to close in March 2020. As student-run free clinics adhering to university-guided COVID policies, we have not been able to see patients in person since March of 2020. However, the closure of our in-person operations provided our student management team with an opportunity to innovate. In consultation with Stanford's Telehealth team and educators, we rapidly developed a telehealth clinic model for our patients. We adapted available telehealth guidelines to meet our patient care needs and educational objectives, which manifested in 3 key innovations: reconfigured clinic operations, an evidence-based social needs screen to more effectively assess and address social needs alongside medical needs, and a new telehealth training module for student volunteers. After 6 months of piloting our telehealth services, we believe that these changes have made our services and operations more robust and provided benefit to both our patients and volunteers. Despite an uncertain and evolving public health landscape, we are confident that these developments will strengthen the future operations of the CFCs.