Search

Abstract: Obtaining detailed data on gender identity and sex in population-based sexual health studies is important. We convened a group to develop consensus survey items. We identified 2 items to capture data on gender identity and sex that can be used in diverse settings. [ABSTRACT FROM AUTHOR]

Background: Institutional research mentorship is a form of mentorship whereby institutions foster mentor-mentee relationships. Research mentorship improves research effectiveness and supports relationships. However, resources are needed in order to institutionalize research mentorship tailored to low- and middle- income countries (LMICs). The aim of this study was to develop a consensus document on institutionalizing research mentorship through a modified Delphi process as part of the practical guide development process. Methods: This study used a two-round modified Delphi process, which is an iterative, structured approach of consensus decision making. Each participant was asked about a series of items related to research mentorship using Likert scale questions. Agreement for each item was pre-defined as ≥80% of participants rating the item as "agree" or "strongly agree." The items that reached agreement, were then discussed during round two at an in-person conference in Ethiopia. A separate group of individuals only participated virtually. For the final consensus survey, response rates and commenting rates (participants who wrote two or more comments) were compared among conference and non-conference participants. Results: The Delphi process led to the inception of three main themes in terms of developing research mentorship: leveraging existing resources, measuring and evaluating institutional mentorship, and encouraging a research mentorship life cycle. During the virtual first round, 59% (36/61) participants who were emailed completed the survey. In the second round, conference participants had a response rate of 79% (11/14) compared to non-conference participants with a response rate of 45% (21/47). Conference participants had a 100% (11/11) commenting rate whereas non-conference participants had a 38% (8/21) commenting rate. This study achieved consensus in both survey rounds for all 35 items on the consensus document. Conclusions: The data suggest that an in-person conference may increase participant engagement. The consensus developed through a modified Delphi method directly informed a practical guide on institutionalizing research mentorship in LMICs. [ABSTRACT FROM AUTHOR]

The authors address study by Kosenko and Polianski about the use of unique communication tools to attract attention to syphilis in the first half of the 20th century in the Union of Soviet Socialist Republics (USSR) and the U.S. Topics discussed include use of stage plays called "Living Newspapers" during the Great Depression in the U.S., two major components of the Spirochete Living Newspaper, and other public strategies in which syphilis control was heavily prioritized and collectivized.

The World Health Organization recommends HIV self-testing (HIVST) as an additional approach to HIV testing and the Nigerian government is supportive of this policy recommendation. However, effectively increasing uptake and sustainability among Nigerian youth is unknown. The goal of this study is to conduct a full-powered type I hybrid effectiveness-implementation trial to test the effectiveness of youth-friendly implementation science strategies in increasing uptake and sustainability of HIVST led by and for Nigerian youth. Our 4 Youth by Youth (4YBY) strategy combines four core elements: 1) HIVST bundle consisting of HIVST kits and photo verification system; 2) a participatory learning community; 3) peer to peer support and technical assistance; and 4) on-site supervision and performance feedback to improve uptake and sustainability of HIVST and enhance linkage to youth-friendly health clinics for confirmatory HIV testing where needed, sexually transmitted infection (STI) testing (i.e. syphilis, gonorrhea, chlamydia, and hepatitis, STI treatment, and PrEP referral. Utilizing a stepped-wedge, cluster-randomized controlled trial, a national cohort of youth aged 14–24 recruited from 32 local government areas across 14 states and four geo-political zones in Nigeria will receive the 4YBY implementation strategy. In addition, an economic evaluation will explore the incremental cost per quality adjusted life year gained. This study will add to the limited "how-to-do it literature" on implementation science strategies in a resource-limited setting targeting youth population traditionally underrepresented in implementation science literature. Study findings will also optimize uptake and sustainability of HIVST led by and for young people themselves. Trial registration: This study is registered in ClinicalTrials.gov NCT04710784 (on January 15, 2021). [ABSTRACT FROM AUTHOR]

Background: Longitudinal monitoring of PrEP use, STIs, and sex behaviors in Chinese PrEP users are limited. Here we reported self-reported newly diagnosed STIs and sex behaviors among MSM PrEP users in China, and identified potential influence from study sites, PrEP provision modes, and dosing strategies. Methods: MSM in Guangzhou and Wuhan were recruited by online ads, clinic flyers, and community referrals. Behavioral survey data were collected at baseline and quarterly follow-ups over 6 months. MSM were prescribed oral PrEP by pick-up or mail delivery. Univariate and multivariate logistic regression with Firth's correction was conducted in Stata 15.0. Notably, the 3-month follow-up in Wuhan took place in October-November 2022 during the city's widest COVID-19 lockdown since early 2020. Results: From September 2021 to December 2022, 775 MSM were enrolled and initiated PrEP (Table 1). Overall, 57 (8.6%) dropped out, including four adverse events and one HIV seroconversion. We detected significant between-city differences in PrEP and condom use habits at Month3 (n=520, 316 in Guangzhou, 204 in Wuhan): Compared to Guangzhou, participants in Wuhan reported a lower rate of newly diagnosed STI since baseline assessment (2.4% vs. 8.9%, p=0.003) and higher prevalence of "never using condoms in sex" at Month 3 (8.3% vs. 3.5%, p=0.02). Multivariate analyses indicated participants in Wuhan were more likely to choose mail-delivered PrEP (81.9% vs. 19.2%, aOR=18.5, 95%CI: 11.2-30.7) and on-demand dosing (72.5% vs. 24.6%, aOR=7.7, 95%CI: 4.7-12.8). Month6 follow-up data (n=232, Guangzhou only) showed the prevalence of having sex under substance influence slightly decreased from baseline (57.8%) but remained common (48.7%) at Month6. Neither PrEP dosing strategies nor provision modes were not found significantly associated with the occurrence of new STIs, never using condoms in sex, or sex under the influence of substance over time. Conclusion: Remote PrEP is highly promising in facilitating PrEP scale-up in China, especially among individuals with limited healthcare during the "Zero- COVID" era, as overall study retention remained high with infrequent dropouts. Neither mail-delivered PrEP nor on-demand dosing was found significantly increasing risks of STIs or sex behavioral changes. Nevertheless, ongoing HIV/STIs testing among PrEP users remains critical in controlling the epidemic. [ABSTRACT FROM AUTHOR]

Background: HIV partner notification services (HIV PS) have been poorly implemented in most low- and middle-income countries, including China. Understanding the social context of partner services for key populations is important for scaling up HIV testing services. This study aims to examine facilitators and barriers of HIV PS using qualitative analysis.Methods: This article qualitatively analyzed the texts obtained from a crowdsourcing open call and adopted the socioecological framework to understand the social context of Chinese men who have sex with men (MSM) living with HIV that influenced their uptake of HIV partner services. Crowdsourcing means collecting ideas from and sharing solutions with the public. The open call was held to solicit ideas to enhance HIV partner services for Chinese MSM. Two coders conducted a content analysis of the texts from the submissions using inductive and deductive coding methods to identify facilitators and barriers of HIV PS.Results: Textual data from 53 submissions were analyzed. The most mentioned barrier, stigma associated with HIV PS, was deeply embedded at several levels, highlighting the urgent need for stigma reduction. Among the facilitators, many people mentioned anonymous online notification could protect the privacy and avoid social harm for index partners. Differentiated partner services may improve HIV PS uptake by providing tailored intervention according to the individual circumstances. Some people suggested implicit notification, which meant testing the attitude of the partner before direct disclosure. This was feasible and acceptable in many settings.Conclusions: The unique social context of MSM living with HIV provides opportunities for embedding HIV partner services. More clinical trials that test the acceptability and effectiveness of the HIV PS interventions are needed. [ABSTRACT FROM AUTHOR]

There is a rich literature on sexualized drug use (i.e., drug use before or during sex) for men who have sex with men but less data from female sex workers (FSW), particularly from low- and middle-income countries. We describe the sexual and reproductive health outcomes in FSW reporting sexualized drug use. In 2019, we conducted a cross-sectional study in eight cities from seven provinces in China. We recruited FSW through community organizations working with sex workers and included those aged 18 years or above, exchanged sex at least once for money or goods in the past three months, and had traded sex for longer than a year. Multivariable logistic regression models were used. In total, 650 women participated: average age was 38.8 years (SD 10.2), 57.1% reported a monthly income over 5000 RMB ($USD 707), and 12.8% completed high school or above. Among participants, 65 (10.0%, 95% confidence interval (CI) 7.8–12.6) reported a history of sexualized drug use. Compared to FSW who never reported a history of sexualized drug use, FSW who reported a history of sexualized drug use had greater odds of working for a manager compared to being self-employed (adjusted odds ratio (AOR) 4.04, 95% CI 2.12–7.69), work in a sauna (AOR 2.43, 95% CI 1.09–5.41), charging a higher price for vaginal sex (AOR 2.15, 95% CI 1.14–4.06), and ever diagnosed with STIs (AOR 4.51, 95% CI 2.61–7.80). One in ten FSW reported sexualized drug use. Although they had similar risk profiles in terms of consistency of condom use and reproductive health outcomes, these women were more likely to report past STIs than those who reported no sexualized drug use. Health workers who work with substance users should devote attention to the sexual practices of their clients to make sure that they have safer sex. [ABSTRACT FROM AUTHOR]

Background: HIV self-testing (HIVST) was recommended to improve HIV testing services. China initiated some of the first HIVST pilots in the world, providing a unique opportunity for implementation research. We aim to investigate HIVST adoption and its following linkage to care among Chinese men who have sex with men (MSM). Methods: Data were collected using an online questionnaire distributed on major social media platforms in 2018, one year after HIVST was officially endorsed and allowed for sale. MSM who were at least 16 years old, assigned as male at birth, and ever tested for HIV were eligible. Primary outcome, adoption was defined as ever use of HIVST. Bivariate and multivariable logistic regressions were performed to explore the association between HIVST adoption and sociodemographic and behavioral factors. Linkage to care was also described via the following sequential events as indicators: (1) receiving result after recent test (2), seeking care from healthcare facility if test result was positive or indeterminate, and (3) delayed time before seeking care. Results: A total of 540 participants were included with an average age of 27.4 ± 6.6. Most were never married (87.4%) and half completed college (52.2%). Overall, 75.2% had adopted HIVST. Self-test kits were commonly obtained from community-based organizations (54.4%) and from online (46.6%). HIVST adoption was positively associated with having college or higher education (OR = 1.66, 95%CI: 1.07–2.57), and negatively associated with age older than 30 (AOR = 0.52, 95%CI: 0.32–0.84). Adoption was not associated with other socio-demographic or behavioral factors. After receiving HIV-positive or indeterminate results, 25/25 of HIVST adopters sought care while 3 out of 7 (42.9%) non-adopters sought care (p < 0.001). Delays before seeking care were not significantly different between HIVST adopters compared to non-adopters (P = 0.366). Conclusion: Many MSM adopted HIVST shortly after its launch. Our findings suggested that HIVST linkage to care is promising among MSM in China. Integration of HIVST with other essential sexual health services is needed. [ABSTRACT FROM AUTHOR]

Background: Many adolescents and young adults (AYAs; 10-24 years old) are excluded from HIV research because of social, ethical, and legal challenges with informed consent, resulting in limited AYA-focused data. We use a participatory approach to identify strategies for improving AYA consent processes in HIV research in low- and middle-income countries (LMICs). Methods: We conducted a digital crowdsourcing open call for ideas to improve AYA consent to HIV research in LMICs. Crowdsourcing involves engaging a group of people in problem-solving, then sharing emergent solutions. Submissions were evaluated by 3 independent judges using predefined criteria, with exceptional strategies receiving prizes. Demographic data were collected, and textual data were qualitatively analyzed for emergent themes in barriers and facilitators for improving AYA consent in HIV research, guided by a socioecological model. Results: We received 110 strategies total; 65 were eligible for evaluation, 25 of which were identified as finalists. Fifty-eight participants from 10 LMICs submitted the 65 eligible submissions, of which 30 (52%) were 18 to 24 years old. Thematic analysis identified 10 barriers to AYA consent, including HIV stigma, limited education, and legal/regulatory barriers. Strategies for improving AYA consent processes revealed 7 potential facilitators: enhancing AYA engagement in research, involving parents/guardians, improving education/awareness, improving institutional practices/policy, making research participation more AYA-friendly, enhancing engagement of other key communities of interest, and empowering AYA. Conclusions: Diverse communities of interest in LMICs developed compelling strategies to enhance informed consent that may improve AYA inclusion in HIV research. These data will be used to develop practical guidance on improving AYA consent processes. [ABSTRACT FROM AUTHOR]

Research on social innovations in health has increased in recent years. However, little training is geared toward enhancing social innovation research capacity. Most health training for low- and middle-income countries (LMICs) is developed by individuals in high-income countries, disregarding LMIC researchers' wisdom and insights and the communities' needs. Our team organized a multi-phase investigation involving a series of surveys and co-creation group discussions to assess individuals' training needs that directly informed a subsequent co-created training workshop series. We conducted a Hennessy–Hicks Training Needs Assessment among the Social Innovation in Health Initiative (SIHI) network and formed a co-creation group comprising SIHI fellows to design related training workshops. We ran a final evaluation survey and analyzed the workshop series' strengths, weaknesses and threats. Descriptive and thematic analysis were employed to analyze survey data and open-ended responses. The final evaluation survey captured data from 165 learners in 35 countries, including 26 LMICs. Most participants (67.3%, 111/165) rated the training workshop series as excellent, and 30.3% (50/165) rated it as good on a five-point scale. The need for writing research grants and manuscripts was rated the highest priority. Learners were interested in community-engaged research and diversity, equity and inclusion. This workshop illustrated how co-creation could be an effective tool for developing training materials tailored for LMIC researchers. We also offer a template for conducting a needs assessment and subsequent training workshops for LMICs. The ground-up, locally developed courses may be more effective than externally developed training programs intended for LMICs. [ABSTRACT FROM AUTHOR]

Background: Sexual function is an important yet understudied aspect of overall health and well‐being in older adults. We aimed to examine sexual function and its correlates among people 50 years and older in China. Methods: We enrolled people aged 50 years and older recruited from four regions in China between September 2021 and July 2022 in a multicenter cross‐sectional study. Data were collected through an investigator‐administered questionnaire about demographic characteristics, health characteristics, and sexual function status. Logistic regression was used to assess correlates of lower sexual function (the highest quintile of the sex‐specific population distribution of Natsal‐SF scores [i.e., lower functioning compared with the remaining]). Results: A total of 465 women and 832 men who were sexually active in the past year were included in the analysis (mean age: 60.4 ± 7.2) [Correction added after first online publication on 12 Feb 2024. The word "years" has been changed to "year" in this sentence.]. Over a quarter of all participants were dissatisfied with their sex life. Notably, 92 women and 167 men were categorized as having a lower sexual function. Age (in men only), living in urban areas, general health status, being underweight or overweight (in men only), and having depressive symptoms were associated with lower sexual function. Among all participants, 43.1% of men and 54.0% of women experienced sexual response problems lasting 3 months or more. Less than one‐third of all participants had sought help or advice for sex life in the past year. Conclusions: Sexual dysfunction and sexual dissatisfaction are prevalent among older adults in China and are associated with self‐assessed poor health. More efforts are needed to better understand sexual health needs and tailor service provision. [ABSTRACT FROM AUTHOR]

Homoprejudiced violence is a type of aggression against an individual or a community based on their actual or perceived sexual orientation. It may be linked to risks of acquiring HIV/STI via psychosocial variables. This study explored the association between homoprejudiced violence experiences and high-risk sexual behaviors, and potential psychosocial mediators. Using cross-sectional survey data collected in China through Blued among men who have sex with men (MSM) in January 2021, this study conducted multiple mediation analyses. Standard instruments were used to collect data on depressive symptoms in the last two weeks (PHQ-9), recreational drug usage in the last three months, and ever experiencing homoprejudiced violence (12-item survey instrument). Dependent variables were having condomless anal sex and having three or more sexual partners in the last three months. Among 1828 MSM, nearly half (847, 46%) had experienced homoprejudiced violence. Twenty-three percent (427) reached a score that suggested moderate or severe depression and 35% (644) had used recreational drugs. In the last three months, 40% (731) had condomless anal sex and 34% (626) had three or more sexual partners. The indirect mediational coefficients through depression on condomless anal sex and multiple sexual partners were 0.04 (95% CI: [0.02, 0.07]) and 0.02 (95% CI: [0.001, 0.05]), respectively. The indirect mediational coefficient of homoprejudiced violence experience on multiple sexual partners through recreational drug use was 0.05 (95% CI: [0.03, 0.08]). These findings suggest that more comprehensive interventions are needed to address the syndemic of homoprejudiced violence, mental health issues, and HIV/STI-related risks. [ABSTRACT FROM AUTHOR]

Background: Oral pre-exposure prophylaxis (PrEP) as a safe and effective antiretroviral medicine-based prevention against HIV has not been widely adopted by gay, bisexual, and other men who have sex with men (MSM) in China. A deeper understanding of barriers and facilitators to PrEP uptake is needed to inform the development of effective interventions. Method: During July–August 2020, we conducted one-on-one semi-structured interviews with 31 Chinese MSM with varied PrEP use experiences (PrEP-naïve, former, and current PrEP users). Interviews were digitally recorded and transcribed in Chinese. Informed by the Information-Motivation-Behavioral Skills Model (IMB), we analyzed the data using a thematic analysis approach to identify the barriers and facilitators to PrEP uptake among Chinese MSM. Results: Major barriers to PrEP uptake among MSM in the sample included uncertainty about PrEP efficacy and lack of PrEP education (information), concerns over potential side effects and cost (motivation), and difficulties in identifying authentic PrEP medications and managing PrEP care (behavioral skills). Facilitators include the perceived benefit of PrEP in improving the quality of sex life and control over health. At the contextual level, we also identified barriers to PrEP access from a thriving informal PrEP market and stressors related to being MSM. Conclusion: Our findings identified a need to invest in non-discriminatory public health messaging of PrEP, explore options for MSM-friendly provision of PrEP outside of traditional HIV care settings, and be attentive to the unique context of an established informal PrEP market in future PrEP initiatives. [ABSTRACT FROM AUTHOR]

Background: Syphilis is a sexually transmitted infection causing significant global morbidity and mortality. To inform policymaking and economic evaluation studies for syphilis, we summarised utility and disability weights for health states associated with syphilis. Methods: We conducted a systematic review, searching six databases for economic evaluations and primary valuation studies related to syphilis from January 2000 to February 2022. We extracted health state utility values or disability weights, including identification of how these were derived. The study was registered in the international prospective register of systematic reviews (PROSPERO, CRD42021230035). Findings: Of 3401 studies screened, 22 economic evaluations, two primary studies providing condition-specific measures, and 13 burden of disease studies were included. Fifteen economic evaluations reported outcomes as disability-adjusted life years (DALYs) and seven reported quality-adjusted life years (QALYs). Fourteen of 15 economic evaluations that used DALYS based their values on the original Global Burden of Disease (GBD) study from 1990 (published in 1996). For the seven QALY-related economic evaluations, the methodology varied between studies, with some studies using assumptions and others creating utility weights or converting them from disability weights. Interpretation: We found a limited evidence base for the valuation of health states for syphilis, a lack of transparency for the development of existing health state utility values, and inconsistencies in the application of these values to estimate DALYs and QALYs. Further research is required to expand the evidence base so that policymakers can access accurate and well-informed economic evaluations to allocate resources to address syphilis and implement syphilis programs that are cost-effective. [ABSTRACT FROM AUTHOR]

Background: Chinese gay, bisexual, and other men who have sex with men (GBMSM) face discrimination in many facility-based health services, thus increasing the importance of online engagement. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/sexually transmitted disease prevention services. Methods: We conducted a total of 6 online focus group discussions with Chinese GBMSM from Guangdong province on the chat-based platform WeChat in 2021. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis. Results: Overall, 48 participants participated. Most were mainly sexually attracted to men (n = 43; 90.0%) and never participated in in-person LGBTQ-related events (n = 29; 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaceswere Chinese platforms (vs. non-Chinese) orwhether theywereGBMSM-specific (vs. non-GBMSMspecific). Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information, and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, lack of safety measures for youth, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces. Conclusions: Although broad-based, GBMSM-specificmessaging can be implemented in Chinese, GBMSM-specific spaces, sexual health messaging may also reach niche GBMSM communities in a variety of non-GBMSM spaces. [ABSTRACT FROM AUTHOR]

Background: Adolescent girls in China have a low HPV vaccination rate. Although vaccination is recommended by the Chinese health authorities, the cost is not covered by the national immunisation programme. Vaccination delay, among other reasons such as supply shortage and poor affordability, may contribute to low uptake. This sequential mixed methods study aimed to identify potential factors of delayed HPV vaccination among Chinese adolescent girls. Methods: Quantitative data about the attitudes and perceptions of HPV vaccination were collected from 100 caregivers of 14–18-year-old girls using an online survey in Chengdu, China. The survey data informed a subsequent qualitative study using four focus group discussions. We conducted a descriptive analysis of the survey data and a thematic analysis of the qualitative data. The findings were interpreted using a health behaviour model adapted from the Health Belief Model and the Andersen's Behavioural Model for Health Services Use. Results: A total of 100 caregivers – 85 were mothers and 15 were fathers – participated in the survey; 21 caregivers joined focus group discussions. When asked about their intended course of action if the 9vHPV vaccine was out-of-stock, 74% chose to delay until the 9vHPV vaccine is available while 26% would consider 2vHPV or 4vHPV vaccines or seek alternative ways to procure the vaccine. Qualitative results confirmed that caregivers preferred delaying HPV vaccination for adolescent girls. The intent to delay was influenced by systemic barriers such as supply shortage and individual-level factors such as a preference for the 9vHPV vaccine, safety concerns, inadequate health communication, and the belief that adolescents were unlikely to be sexually active. Conclusion: In urban areas, Chinese caregivers' intent to delay vaccination in favour of 9vHPV vaccine over receiving the more accessible options was influenced by a mix of individual and contextual factors. Focussed health communication strategies are needed to accelerate HPV vaccination among adolescents. [ABSTRACT FROM AUTHOR]

A Chinese clinical trial has demonstrated that a prosocial pay-it-forward intervention that offered subsidized vaccination and postcard messages effectively increased influenza vaccine uptake and vaccine confidence. This secondary analysis explored the potential mediating role of vaccine confidence on the association between a pay-it-forward intervention and influenza vaccine uptake, and how this might vary by individual annual income levels. Data from 300 participants (150 standard-of-care and 150 pay-it-forward participants) were included in the analysis. We conducted descriptive analysis of demographic and vaccine confidence variables. Multivariable regression and mediation analysis on interventions, vaccine confidence and vaccine uptake were conducted. A sub-group analysis was conducted to further understand whether associations between these variables vary by income levels (<=$1860 or >$1860). The pay-it-forward intervention was significantly associated with greater levels of perceived influenza vaccine importance (adjusted odds ratio (aOR) = 3.60, 95 %CI: 1.77–7.32), effectiveness (aOR = 3.37, 95 %CI: 1.75–6.52) and safety (aOR = 2.20, 95 %CI: 1.17–4.15). Greater perceived influenza vaccine importance was associated with increased vaccine uptake (aOR = 8.51, 95 %CI: 3.04–23.86). The indirect effect of the pay-it-forward intervention on vaccination was significant through improved perceived influenza vaccine importance (indirect effect 1 = 0.07, 95 %CI: 0.02–0.11). This study further revealed that, irrespective of the individual income level, the pay-it-forward intervention was associated with increased vaccine uptake when compared to the standard-of-care approach. Pay-it-forward intervention may be a promising strategy to improve influenza vaccine uptake. Perceived confidence in vaccine importance appears to be a potential mediator of the association between pay-it-forward and vaccine uptake. [ABSTRACT FROM AUTHOR]

Background Two crowdsourcing open calls were created to enhance community engagement in dengue control in Sri Lanka. We analyzed the process and outcomes of these digital crowdsourcing open calls. Methods We used standard World Health Organization methods to organize the open calls, which used exclusively digital methods because of coronavirus disease 2019 (COVID-19). We collected and analyzed sociodemographic information and digital engagement metrics from each submission. Submissions in the form of textual data describing community-led strategies for mosquito release were coded using grounded theory. Results The open calls received 73 submissions. Most people who submitted ideas spoke English, lived in Sri Lanka, and were 18 to 34 years old. The total Facebook reach was initially limited (16 161 impressions), prompting expansion to a global campaign, which reached 346 810 impressions over 14 days. Diverse strategies for the distribution of Wolbachia -infected mosquito boxes were identified, including leveraging traditional festivals, schools, and community networks. Fifteen submissions (21%) suggested the use of digital tools for monitoring and evaluation, sharing instructions, or creating networks. Thirteen submissions (18%) focused on social and economic incentives to prompt community engagement and catalyze community-led distribution. Conclusions Our project demonstrates that digital crowdsourcing open calls are an effective way to solicit creative and innovative ideas in a resource-limited setting. [ABSTRACT FROM AUTHOR]

Background: In Africa, little is known about the role of telephone hotlines in outbreak response. We systematically reviewed the role and effectiveness of hotlines on outbreak response in Africa. Method: We used the Cochrane handbook and searched five databases. The protocol was registered on PROSPERO (CRD42021247141). Medline, Embase, PsycINFO, Global Health and Web of Science were searched from 30 June 2020 to August 2020 for studies on the use of telephone hotlines in outbreak response in Africa published between January 1995 and August 2020. The search was also repeated on 16 September 2022. Data on effectiveness (alerts generated, cases confirmed) were extracted from peer-reviewed studies. Meta-analysis of alerts generated, and proportion of cases confirmed was done using the random effects model. The quality of studies was assessed using the Joanna Briggs Institute (JBI) tools. The heterogeneity and publication bias were assessed using the Galbraith and funnel plots, respectively. Results: Our search yielded 1251 non-duplicate citations that were assessed. 41 full texts were identified, and 21 studies were included in the narrative synthesis, while 12 were included in the meta-analysis. The hotlines were local (seven studies) or national (three studies). A combination of a local and national hotline was used in one study. The hotlines were set up for unusual respiratory events (one study), polio (one study), Ebola (10 studies), COVID-19 (two studies), malaria (one study), influenza-like illnesses (ILI) (one study) and rift valley fever in livestock (one study). Hotlines were mainly used for outbreak surveillance at the local level. A total of 332,323 alerts were generated, and 67,658 met the case definition, corresponding to an overall pooled proportion of alerts generated(sensitivity) of 38% (95%CI: 24–52%). The sensitivity was 41% (95% CI: 24–59%) for local hotlines and 26%(95%CI:5–47%) for national hotlines. Hotlines were also used for surveillance of rift valley fever in livestock (one study) vaccination promotion (one study), death reporting (five studies), rumour tracking and fighting misinformation (two studies) and community engagement (five studies). The studies were of low to moderate quality with high publication bias and heterogeneity(I2 = 99%). The heterogeneity was not explained by the sample size. Conclusion: These data suggest that telephone hotlines can be effective in outbreak disease surveillance in Africa. Further implementation research is needed to scale up telephone hotlines in rural areas. [ABSTRACT FROM AUTHOR]

Background: Mobile health (mHealth) is a promising intervention mode for HIV prevention, but little is known about its feasibility and effects in promoting pre-exposure prophylaxis (PrEP) uptake among Chinese gay, bisexual and other men who have sex with men (GBMSM). Methods: We evaluated an instant messaging application using a WeChat-based mini-app to promote PrEP uptake among GBMSM via a mixed-methods design that includes a 12-week, two-arm randomized controlled pilot trial and in-depth progress interviews in Guangzhou, China. Primary outcomes include the number of PrEP initiations, individual-level psychosocial variables related to PrEP initiation, and usability of the PrEP mini-app. Results: Between November 2020 and April 2021, 70 GBMSM were successfully enrolled and randomized into two arms at 2:1 ratio (46 to the intervention arm, 24 to the control arm). By the end of 12-week follow-up, 22 (31.4%) participants completed the initial consultation and lab tests for PrEP, and 13 (18.6%) filled their initial PrEP prescription. We observed modest but non-significant improvements in participants' intention to use PrEP, actual PrEP initiation, PrEP-related self-efficacy, stigma, and attitudes over 12 weeks when comparing the mini-app and the control arms. Qualitative interviews revealed the key barriers to PrEP uptake include anticipated stigma and discrimination in clinical settings, burden of PrEP care, and limited operating hours of the PrEP clinic. In-person clinic navigation support was highly valued. Conclusions: This pilot trial of a mobile phone-based PrEP mini-app demonstrated feasibility and identified limitations in facilitating PrEP uptake among Chinese GBMSM. Future improvements may include diversifying the content presentation in engaging media formats, adding user engagement features, and providing off-line in-clinic navigation support during initial PrEP visit. More efforts are needed to understand optimal strategies to identify and implement alternative PrEP provision models especially in highly stigmatized settings with diverse needs. Trial registration: Trial registration: The study was prospectively registered on clinicaltrials.gov (NCT04426656) on 11 June, 2020. [ABSTRACT FROM AUTHOR]

Background: This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them. Methods: We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included. Results: In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV‐focused care, and 14 reporting non‐HIV‐focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9–43%, I2 = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12–74%, I2 = 90%) refused hospitalization when needed in the previous year. Barriers to HIV‐focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician–patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non‐HIV‐focused care were financial constraints and the perceived need for medical services at individual‐level factors; and discrimination from physicians, and medical distrust at the community/social level. Conclusion: This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity. [ABSTRACT FROM AUTHOR]

Background Many people who have a positive hepatitis C virus (HCV) antibody (Ab) test never receive a confirmatory HCV RNA viral load (VL) test. Reflex VL testing may help address this problem. We undertook a systematic review to evaluate the effectiveness of reflex VL testing compared with standard nonreflex approaches on outcomes across the HCV care cascade. Methods We searched 4 databases for studies that examined laboratory-based reflex or clinic-based reflex VL testing approaches, with or without a nonreflex comparator, and had data on the uptake of HCV RNA VL test and treatment initiation and turnaround time between Ab and VL testing. Both laboratory- and clinic-based reflex VL testing involve only a single clinic visit. Summary estimates were calculated using random-effects meta-analyses. Results Fifty-one studies were included (32 laboratory-based and 19 clinic-based reflex VL testing). Laboratory-based reflex VL testing increased HCV VL test uptake versus nonreflex testing (RR: 1.35; 95% CI: 1.16–1.58) and may improve linkage to care among people with a positive HCV RNA test (RR: 1.47; 95% CI:.81–2.67) and HCV treatment initiation (RR: 1.03; 95% CI:.46–2.32). The median time between Ab and VL test was <1 day for all laboratory-based reflex studies and 0–5 days for 13 clinic-based reflex testing. Conclusions Laboratory-based and clinic-based HCV reflex VL testing increased uptake and reduced time to HCV VL testing and may increase HCV linkage to care. The World Health Organization now recommends reflex VL testing as an additional strategy to promote access to HCV VL testing and treatment. Clinical Trials Registration PROSPERO CRD42021283822. [ABSTRACT FROM AUTHOR]

Community participation in research involving stigmatized populations has been sub-optimal, and digital tools could potentially increase participation in qualitative research. This study aims to describe the implementation of an online chat-based FGD (Focus Group Discussion) with men who have sex with men (MSM) in China as part of formative research for the PIONEER project, determine the advantages and limitations associated with the approach, and assess the feasibility of deepening community participation in STI research. Participants were involved in four days of asynchronous FGDs on sexually transmitted diseases and answered questions about the online FGD method. Online FGDs allowed us to deepen participant engagement through bidirectional communication channels. Data from online FGDs directly informed recruitment strategies and community participation for a clinical trial. Overall, 63% (29/46) of men who had never participated in offline LGBTQ + activities joined online FGDs. Many participants (89%, 41/46) noted that online FGDs were more convenient, less socially awkward, and more anonymous than in-person qualitative research. We highlighted potential risks as well as mitigation strategies when using online FGDs. Online FGDs were feasible among this group of sexual minorities and may be particularly useful in many cities where stigma limits in-person research participation. [ABSTRACT FROM AUTHOR]

Background: HCV self-testing (HCVST) may be an effective strategy to address low rates of HCV test uptake among men who have sex with men (MSM). We evaluated the effectiveness and cost of providing HCVST to increase HCV test uptake among MSM in China. Methods: Two parallel, unmasked, individual-level randomized controlled trials were conducted. HIV-negative MSM and MSM living with HIV were enrolled from 22 cities in China. Men in both trials were randomly assigned (1:1) into standard-of-care (SOC) or HCVST arms. The primary outcome was the proportion of participants who tested for HCV during the trial period. Intervention effects were estimated using multiply imputed data in the main analysis. Costs were measured using a micro-costing approach. Results: A total of 84 men who were HIV-negative (trial 1) and 84 men living with HIV were enrolled (trial 2). Overall, the proportion of individuals who underwent HCV testing during the trial period was higher in the HCVST arm compared to SOC in trial 1 (estimated risk difference (RD): 71.1%, 95% CI: 54.6 to 87.7%) and trial 2 (estimated RD: 62.9%, 95% CI: 45.7 to 80.1%). Over half (58.6%, 34/58) of HCV self-testers reported the self-test was their first HCV test. The cost per person tested in trial 1 was $654.52 for SOC and $49.83 for HCVST, and in trial 2 was $438.67 for SOC and $53.33 for HCVST. Conclusions: Compared to the standard of care, providing HCVST significantly increased the proportion of MSM testing for HCV in China, and was cheaper per person tested. Trial registration: Chinese Clinical Trial Registry. Registration number: ChiCTR2100048379. [ABSTRACT FROM AUTHOR]

Background: Maternal vaccinations against Influenza, Pertussis, and Covid-19 are recommended in the UK, and vaccines against further infections may become available soon. However, many pregnant women, especially in socially and ethnically diverse areas, have low vaccine uptake. Qualitative studies on the reasons and possible solutions are needed that are inclusive of disadvantaged and minority ethnic groups. We therefore aimed to understand the complex interplay between structural and behavioural factors contributing to the low maternal vaccine uptake in socially and ethnically diverse areas in London in the Covid-19 context. Methods: In 2022, we conducted semi-structured interviews and a focus group discussion among a purposive sample of 38 pregnant/recently pregnant women and 20 health service providers, including 12 midwives. Participants were recruited in ethnically diverse London boroughs. We followed a critical realist paradigm and used a thematic analysis approach. Results: The sample included participants who took all, some or none of the maternal vaccines, with some participants unsure whether they had taken or been offered the vaccines. Decision-making was passive or active, with the expectation for pregnant women to do their 'own research'. Participants described various individual, social and contextual influences on their decision-making as they navigated the antenatal care system. Missing or conflicting information from providers meant knowledge gaps were sometimes filled with misinformation from unreliable sources that increased uncertainties and mistrust. Both pregnant women and providers described structural and organisational factors that hindered access to information and vaccinations, including lack of training, time and resources, and shortcomings of health information systems and apps. Some participants described factors that facilitated vaccination uptake and many made recommendations for improvements. Conclusions: Our study showed how structural and organisational factors can compound uncertainties around maternal vaccination among socially and ethnically diverse populations. Results highlight the need for more reliable resources, streamlined workflows, improved electronic information systems and training in their use. Roles and responsibilities should be clarified with potential greater involvement of nurses and pharmacists in vaccine provision. Education and communication should consider individual (language/digital) skills and needs for information and reassurance. Further research is needed to co-produce solutions with service users and providers. [ABSTRACT FROM AUTHOR]

Syphilis testing uptake is low among men who have sex with men (MSM) around the world. Syphilis self-testing (SST) may complement facility-based testing; the distribution model is yet to be explored. This study aimed to investigate the effectiveness of peer distribution of syphilis self-testing on promoting syphilis testing. We conducted a three-arm, unblinded, parallel individually randomized controlled trial among MSM in three cities in Guangdong, China. Inclusion criteria were: men who were born biologically male, aged 18 or above, have ever had sex with a man, will refer the interventions to peers, and will take the three-month follow-up survey. Enrolled indexes were randomly assigned in a 1:1:1 ratio into standard-of-care arm (SOC arm), standard SST delivery arm (S-SST arm), and a web-based referral link SST delivery arm (RL-SST arm). The primary outcome was the number of returned photograph-verified syphilis testing results per index. A total number of 300 indexes were enrolled, with 100 indexes in each arm. The number of verified syphilis tests per index conducted by alters was 0.05 in the control arm, 0.51 in the S-SST arm, and 0.31 in the RL-SST arm. The cost per alter tested was $760.60 for SOC, $83.78 for S-SST, and $93.10 for RL-SST. Minimal adverse event was reported among both indexes and alters during the study. This study showed that peer distribution of SST could improve syphilis testing uptake among MSM in China compared to facility-based testing. This approach warrants further consideration as part of expanding syphilis self-testing. [ABSTRACT FROM AUTHOR]

Background: Gonorrhea and chlamydia are the most common sexually transmitted diseases (STDs) among men who have sex with men (MSM) in China. Previous studies have shown pay-it-forward (PIF) interventions to be associated with a substantial increase in gonorrhea and chlamydia test uptake compared to standard-of-care. We propose a 'pay-it-forward' gonorrhea and chlamydia testing randomized controlled trial (PIONEER). The trial would evaluate the effectiveness of two pay-it-forward strategies in promoting testing uptake compared to the standard of care (in which men pay for their tests out-of-pocket) among MSM and male STD patients in China. Methods: PIONEER will be a three-armed, pragmatic cluster randomized controlled trial (RCT), conducted across 12 clinics (six MSM-led and six public STD clinics) to compare the effectiveness of three implementation strategies. Each facility will be randomized to a standard pay-it-forward intervention of gonorrhea/ chlamydia testing with minimal encouragement for testing, a community-engaged pay-it-forward arm, or a control arm where men pay for their tests out-of-pockets. The primary outcome will be dual gonorrhea/chlamydia test uptake. Secondary outcomes will include syphilis testing, amount donated in pay-it-forward, number of positive gonorrhea and chlamydia tests, and measures of antimicrobial resistance. A sequential transformative mixed methods design will be used to evaluate the implementation process in type 2 effectiveness-implementation hybrid design. Data sources will include survey on acceptability, and feelings and attitudes towards the interventions among participants; testing and treatment uptake data from clinic records, WeChat records, and qualitative data to gain insights into men's perceptions and attitudes towards the pay-it-forward, mechanisms driving uptake, and donating behaviors. Implementers and organizers will be interviewed about fidelity and adherence to protocol, sustainability of pay-it-forward intervention, and barriers and facilitators of implementing the intervention. Discussion: PIONEER will substantially increase gonorrhea/chlamydia testing among MSM in China, providing an innovative and new financial mechanism to sustain STD screening among sexual minorities in low- and middle-income countries. This study will answer compelling scientific questions about how best to implement pay-it-forward and the individual and organizational characteristics that moderate it. Trial registration: The study with identification number NCT05723263 has been registered on clinicaltrials.gov/. [ABSTRACT FROM AUTHOR]

Secondary distribution of HIV self-test is promising to increase testing uptake while the facilitators and barriers of secondary distribution remain unclear. In-depth interviews were conducted with 22 MSM who had participated in secondary distribution of HIVST in southern China. Data were thematically analyzed to capture participants' motivations, procedures, and challenges when accessing and distributing self-tests. MSM in China are willing to distribute HIVST to members in their social network, but their decision-making is impacted by their ability to broach sexual health conversations, evaluations of the recipients, and perceived trustworthiness of the self-test. Our study suggested that several strategies, including creating a friendly environment for sexual health conversations and establishing nationwide policies related to quality assured self-tests and standardized self-testing protocols, may be helpful to advance this approach in China. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) may have been exacerbated during the COVID-19 pandemic. This analysis aimed to determine how employment disruption during COVID-19, including working from home, was associated with IPV experience among cis-gendered women. Methods: The International Sexual Health and Reproductive health (I-SHARE) study is a cross-sectional online survey implemented in 30 countries during the pandemic. Samples used convenience, online panel, and population-representative methods. IPV was a pre-specified primary outcome, measured using questions from a validated World Health Organisation instrument. Conditional logistic regression modelling was used to quantify the associations between IPV and changes to employment during COVID-19, adjusted for confounding. Results: 13,416 cis-gender women, aged 18–97, were analysed. One third were from low and middle income countries, and two thirds from high income countries. The majority were heterosexual (82.7%), educated beyond secondary-level (72.4%) and childless (62.7%). During COVID-19 33.9% women worked from home, 14.6% lost employment, and 33.1% continued to work on-site. 15.5% experienced some form of IPV. Women working from home experienced greater odds of IPV than those working on-site (adjusted OR 1.40, 95% CI 1.12–1.74, p = 0.003). This finding was robust independent of sampling strategy and country income. The association was primarily driven by an increase in psychological violence, which was more prevalent than sexual or physical violence. The association was stronger in countries with high gender inequality. Conclusions: Working from home may increase IPV risk globally. Workplaces offering working from home should collaborate with support services and research interventions to strengthen resiliency against IPV. [ABSTRACT FROM AUTHOR]

Background: Influenza vaccination is the key to prevent influenza-related disease, especially among high-risk populations. However, influenza vaccine uptake in China is low. This secondary analysis of a quasi-experimental trial aimed to understand factors associated with influenza vaccine uptake among children and older people stratified by funding context. Methods: A total of 225 children (aged 0.5-8 years) and 225 older people (aged 60 years or above) were recruited from three clinics (rural, suburban and urban) in Guangdong Province. Participants were allocated into two groups based on funding contexts: a self-paid group (N = 150, 75 children and 75 older adults) in which participants paid full price for their vaccination; and a subsidized group (N = 300, 150 children and 150 older adults) in which varying levels of financial support was provided. Univariate and multivariable logistic regressions were conducted stratified by funding contexts. Results: Overall, 75.0% (225/300) of participants in the subsidized group and 36.7% (55/150) in the self-paid group got vaccinated. Older adults had lower vaccination rates than children in both funding groups, while both age groups showed much higher uptake in the subsidized group than in the self-paid group (aOR = 5.96, 95% CI: 3.77–9.42, p = 0.001). In the self-paid group, having prior influenza vaccination history of children (aOR:2.61, 95%CI: 1.06–6.42) or older people (aOR:4.76, 95%CI: 1.08–20.90) was associated with increased influenza vaccine uptake compared to those who had no prior vaccination experiences in the family. While in the subsidized group, participants who got married or lived with partners (aOR = 0.32, 0.10–0.98) had lower vaccination uptake than single ones. Trust in providers' advice (aOR = 4.95, 95%CI:1.99, 12.43), perceived effectiveness of the vaccine (aOR: 12.18, 95%CI: 5.21–28.50), and experienced influenza-like illnesses in the family in the past year (aOR = 46.52, 4.10, 533.78) were associated with higher vaccine uptake. Conclusions: Older people had suboptimal vaccine uptake compared to children in both contexts and need more attention to enhance influenza vaccination. Tailoring interventions to different vaccine funding contexts may help improve influenza vaccination: In self-paid context, motivating people to accept their first ever influenza vaccination may be a promising strategy. In subsidized context, improving public confidence in vaccine effectiveness and providers' advice would be useful. [ABSTRACT FROM AUTHOR]

Background: Many syphilis infected pregnant women do not receive treatment, representing a major missed opportunity to reduce the risk of syphilis-related adverse pregnancy outcomes. This study explored correlates of treatment among pregnant women with syphilis in Guangzhou, China. Methods: Pregnant women with a diagnosis of syphilis in Guangzhou between January 2014 and December 2016 were included. Information of syphilis treatment and correlates were extracted from a comprehensive national case-reporting system. Multivariate logistic regression was used to identify the correlations between information on the demographic characteristics, previous history, clinical characteristics about current syphilis, information of diagnosing hospital, and receiving no treatment or inadequate treatment among syphilis-seropositive pregnant women. A causal mediation analysis was used to explore the potential mediating role of the timing of syphilis diagnosis in the correlates. Results: Among 1248 syphilis-seropositive pregnant women, 379 (30.4%) women received no treatment or inadequate treatment. Migrant pregnant women (adjusted OR = 1.83, 95% CI: 1.25–2.73), multiparous participants (adjusted OR = 3.68, 95% CI: 2.51–5.50), unmarried participants (adjusted OR = 3.21, 95% CI: 1.97–5.28) and unemployed participants (adjusted OR = 2.43, 95% CI: 1.41–4.39) were more likely to receive no treatment or inadequate treatment. Participants who with history of syphilis infection (adjusted OR = 0.59, 95% CI: 0.42–0.82) and with high school and higher education participants (adjusted OR = 0.69, 95% CI: 0.49–0.97) were less likely to receive untreated or inadequately treatment. And that the impact of all these factors (except for the migrants) on treatment status are fully mediated through the syphilis diagnosis time, with the direct effect of migrants that would have resulted in a higher rate of no or inadequate treatment (OR = 2.34, 95% CI: 1.08–5.32) was partially cancelled out by the syphilis diagnosis time. Conclusions: Pregnant women who were migrant without local residence and women with syphilis diagnosed at a later gestational age were more likely to slip through the cracks of the existing antenatal care system. More programs should focus on eliminating these gaps of residence-related health inequalities. This research highlights actionable elements for health services interventions that could increase syphilis treatment rates among pregnant women. [ABSTRACT FROM AUTHOR]

Fewer than half of the world's infants have access to the birth dose of hepatitis B vaccine (HBV), which prevents mother-to-child transmission of HBV and subsequent liver cancer. Now is the time to expand access for infants born in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: The HIV epidemic is still expanding among men who have sex with men (MSM) in China, but HIV testing rates remain suboptimal. Network-based interventions, such as secondary distribution, have shown promise to expand HIV self-testing (HIVST) among partners of MSM living with HIV (MLWH) but have not been widely implemented. Monetary incentives could enhance the secondary distribution of HIVST in some settings. We will conduct a randomized controlled trial to examine the effectiveness of monetary incentives in expanding the secondary distribution of HIVST among MLWH in China. Methods: We will recruit 200 eligible participants at three antiretroviral therapy (ART) clinics in China. Participants are eligible if they are 18 years of age or over, assigned as male at birth, have had anal sex with men, are living with HIV, are willing to apply for the HIVST kit at ART clinics, and are willing to provide personal contact information for follow-up. Eligible participants will be randomly assigned in a 1:1 ratio to one of two groups: standard secondary distribution group and secondary distribution group with monetary incentives. Participants (defined as "index") will distribute the HIVST kits to members of their social network (defined as "alter") and will be required to complete a baseline survey and a 3-month follow-up survey. All alters will be encouraged to report their testing results by taking photos of used kits and completing an online survey. The primary study outcomes will compare the mean number of alters and newly-tested alters motivated by each index participant in each group. Secondary study outcomes will include the mean number of alters who tested positive, the cost per person tested, and the cost per HIV diagnosed for each group. Discussion: Few studies have evaluated interventions to enhance the implementation of secondary distribution. Our study will provide information on the effectiveness of monetary incentives in expanding HIVST secondary distribution among MLWH. The findings of this trial will contribute to implementing HIVST secondary distribution services among MLWH in China and facilitating HIV case identifications. Trial registration: Chinese Clinical Trial Registry ChiCTR2200064517; http://www.chictr.org.cn/showproj.aspx?proj=177896. Registered on 10th October 2022. [ABSTRACT FROM AUTHOR]

Background: Human papillomavirus (HPV) vaccination could prevent cervical and other HPV-associated cancers attributable to vaccine-associated HPV types. However, HPV vaccination coverage among women aged 9–18 years old is low in China. Common barriers include poor financial affordability, minimal public engagement, and low confidence in domestically produced HPV vaccines. Pay-it-forward offers an individual a free or subsidized service then an opportunity to voluntarily donate and/or create a postcard message to support future people. This study aims to assess the effectiveness of pay-it-forward as compared to standard-of-care self-paid vaccination to improve HPV vaccine uptake among adolescent girls aged 15–18 years, who are left out in the current pilot free HPV vaccination task force in some parts of China. Methods: This is a two-arm randomized controlled trial in Chengdu, China. Eligible adolescent girls (via caregivers) will be randomly selected and recruited through four community health centers (one in the most developed urban areas, one in higher middle-income and one in lower middle-income suburban areas, and one in the least developed rural areas) using the resident registration list. A total of 320 participants will be randomized into two study arms (user-paid versus pay-it-forward vaccination) in a 1:1 ratio. The intervention assignment will be blinded to recruiters and participants using envelop concealment until the research assistants open the envelop to determine which treatment to deliver to each individual. The primary outcome of the study will be HPV vaccine uptake by administrative data. Secondary outcomes include costs, vaccine hesitancy, and the completion rates of the 3-dose HPV vaccination series. Discussion: This study will investigate an innovative pay-it-forward strategy's effectiveness and economic costs to improve HPV vaccination among 15–18-year-old adolescent girls. Study findings will have implications for increasing HPV vaccine uptake in places where HPV vaccines are provided for a fee. Trial registration: Chinese Clinical Trial Registry (ChiCTR), ChiCTR2200055542. Registered on 11 January 2022. [ABSTRACT FROM AUTHOR]

Background: To inform policy and implementation that can enhance prevention and improve tuberculosis (TB) care cascade outcomes, this review aimed to summarize the impact of various interventions on care cascade outcomes for active TB. Methods and findings: In this systematic review and meta-analysis, we retrieved English articles with comparator arms (like randomized controlled trials (RCTs) and before and after intervention studies) that evaluated TB interventions published from January 1970 to September 30, 2022, from Embase, CINAHL, PubMed, and the Cochrane library. Commentaries, qualitative studies, conference abstracts, studies without standard of care comparator arms, and studies that did not report quantitative results for TB care cascade outcomes were excluded. Data from studies with similar comparator arms were pooled in a random effects model, and outcomes were reported as odds ratio (OR) with 95% confidence interval (CI) and number of studies (k). The quality of evidence was appraised using GRADE, and the study was registered on PROSPERO (CRD42018103331). Of 21,548 deduplicated studies, 144 eligible studies were included. Of 144 studies, 128 were from low/middle-income countries, 84 were RCTs, and 25 integrated TB and HIV care. Counselling and education was significantly associated with testing (OR = 8.82, 95% CI:1.71 to 45.43; I2 = 99.9%, k = 7), diagnosis (OR = 1.44, 95% CI:1.08 to 1.92; I2 = 97.6%, k = 9), linkage to care (OR = 3.10, 95% CI = 1.97 to 4.86; I2 = 0%, k = 1), cure (OR = 2.08, 95% CI:1.11 to 3.88; I2 = 76.7%, k = 4), treatment completion (OR = 1.48, 95% CI: 1.07 to 2.03; I2 = 73.1%, k = 8), and treatment success (OR = 3.24, 95% CI: 1.88 to 5.55; I2 = 75.9%, k = 5) outcomes compared to standard-of-care. Incentives, multisector collaborations, and community-based interventions were associated with at least three TB care cascade outcomes; digital interventions and mixed interventions were associated with an increased likelihood of two cascade outcomes each. These findings remained salient when studies were limited to RCTs only. Also, our study does not cover the entire care cascade as we did not measure gaps in pre-testing, pretreatment, and post-treatment outcomes (like loss to follow-up and TB recurrence). Conclusions: Among TB interventions, education and counseling, incentives, community-based interventions, and mixed interventions were associated with multiple active TB care cascade outcomes. However, cost-effectiveness and local-setting contexts should be considered when choosing such strategies due to their high heterogeneity. Author summary: Why was this study done?: Developing new and innovative interventions to improve tuberculosis (TB) care services use and successful treatment are essential to the global efforts to end TB. There is a limited scope on the overall impact of these interventions because most studies focus on interventions' capacity to enhance specific TB care outcomes. Evaluating existing evidence to ascertain the effect TB interventions on overall care cascade outcomes is paramount to informing holistic TB control strategies What did the researchers do and find?: We systematically reviewed and meta-analyzed evidence on TB interventions and their effects on the TB care cascade for active TB from 144 peer-reviewed studies. In this study, the 5 out of 12 identified TB interventions associated with multiple care cascade outcomes were education and counseling, incentives, digital interventions, community-based, multisector collaborations, and mixed interventions. Among LMIC studies, education and counseling, incentives, community-based interventions, and multisector collaborations were the interventions associated with at least three TB care cascade outcomes. What do these findings mean?: A wide range of relatively simple interventions could substantially improve TB care outcomes. Multistep efficient interventions like education and counseling, incentives, and mixed interventions should be keenly considered in expanding active TB control programs. Researchers should revise multistage effective interventions to incorporate local context needs due to their high heterogeneity. [ABSTRACT FROM AUTHOR]

Community participation in research involving stigmatized populations has been sub-optimal, and digital tools could potentially increase participation in qualitative research. This study aims to describe the implementation of an online chat-based FGD (Focus Group Discussion) with men who have sex with men (MSM) in China as part of formative research for the PIONEER project, determine the advantages and limitations associated with the approach, and assess the feasibility of deepening community participation in STI research. Participants were involved in four days of asynchronous FGDs on sexually transmitted diseases and answered questions about the online FGD method. Online FGDs allowed us to deepen participant engagement through bidirectional communication channels. Data from online FGDs directly informed recruitment strategies and community participation for a clinical trial. Overall, 63% (29/46) of men who had never participated in offline LGBTQ + activities joined online FGDs. Many participants (89%, 41/46) noted that online FGDs were more convenient, less socially awkward, and more anonymous than in-person qualitative research. We highlighted potential risks as well as mitigation strategies when using online FGDs. Online FGDs were feasible among this group of sexual minorities and may be particularly useful in many cities where stigma limits in-person research participation. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral therapy (ART) adherence is still suboptimal among some key populations, highlighting the need for innovative tailored strategies. This randomized controlled trial (RCT) aimed to evaluate the effect of a differentiated digital intervention on ART adherence among men who have sex with men (MSM) living with HIV in China.Methods: The two-armed parallel RCT was conducted at one HIV clinic in Jinan of China from October 19, 2020, to June 31, 2021. Men were referred by health providers to join the study and then choose one of three digital strategies-text message, only instant message, or instant message plus social media. They were assigned in a 1:1 ratio to the intervention arm or control arm using block randomization, and inside each arm, there were three groups depending on the type of delivering the message. The groups were divided according to participants' preferred digital strategies. The intervention arm received ART medication messages, medication reminders, peer education, and involved in online discussion. The control arm received messages on health behavior and nutrition. The primary outcome was self-reported optimal ART adherence, defined as not missing any doses and not having any delayed doses within a one-month period. Secondary outcomes included CD4 T cell counts, viral suppression, HIV treatment adherence self-efficacy, and quality of life. Intention-to-treat analysis with generalized linear mixed models was used to evaluate the intervention's effect.Results: A total of 576 participants were enrolled, including 288 participants assigned in the intervention arm and 288 assigned in the control arm. Most were ≤ 40 years old (79.9%) and initiated ART ≤ 3 years (60.4%). After intervention, the proportion of participants achieving optimal ART adherence in the intervention arm was higher than in the control arm (82.9% vs 71.1%). The differentiated digital intervention significantly improved ART adherence (RR = 1.74, 95%CI 1.21-2.50). Subgroup analysis showed one-to-one instant message-based intervention significantly improved ART adherence (RR = 2.40, 95% CI 1.39-4.17).Conclusions: The differentiated digital intervention improved ART adherence among MSM living with HIV in China, which could be integrated into people living with HIV (PLWH) management and further promoted in areas where PLWH can access text messaging and instant messaging services.Trial Registration: ChiCTR2000041282. Retrospectively registered on 23 December 2020. [ABSTRACT FROM AUTHOR]

In summary, given the experiences obtained from HIVST programmes, we are recommending integrated HIV and STI self-testing models to facilitate simultaneous HIV and STI testing. Third, the integrated self-testing model can decentralize STI testing, improving the coverage of STI testing. HIV self-testing (HIVST) refers to the process in which individuals collect their own specimens (e.g. blood, saliva and urine), perform the test and interpret the results at a convenient time and place [[1]]. However, previous self-testing research and implementation programmes focused on HIVST or STI self-testing separately [[5]], which lost the opportunity to promote HIV and STI testing simultaneously. [Extracted from the article]

Background: As progress accelerates towards a syphilis vaccine, understanding stakeholder perspectives regarding vaccine development is important to help anticipate organizational, social, and ethical issues which may impact participation in clinical trials. This study examined barriers and facilitators of participation in syphilis vaccine trials among priority groups for early phase vaccine studies. Methods: We conducted audio-recorded interviews over Zoom with English-speaking individuals > 18 years old recruited from an infectious disease clinic, STI testing site, online research database, and HIV community advisory boards in North Carolina, USA from April 2021 -- June 2022. Eligibility criteria included STI diagnosis within 12 months, people living with HIV (PLWH), men who have sex with men, or people who exchange sex for money/drugs. The semi-structured interview guide examined views on a future syphilis vaccine, trial participation barriers/facilitators, and community involvement in vaccine research. Demographic data were collected via post-interview online survey. Interviews were transcribed verbatim and coded using MAXQDA software by two independent coders, followed by thematic analyses of coded data using a socioecological model. Results: We interviewed 30 individuals in total, including 8 (27%) women, 13 (43%) Black/African American individuals, 19 (63%) PLWH, and 19 (63%) with a previous STI. While 19 (63%) participants indicated immediate interest in future syphilis vaccine trial participation, 10 (33%) noted participation would depend on trial parameters; one person expressed no interest. Trial participation barriers included physical risks of the vaccine and time commitments, two barriers commonly reported in preventative vaccine literature; however, negative interpersonal research relationships also were identified as a barrier. Facilitators included advancing science and syphilis prevention, but also factors relevant to informing trial design and conduct, including positive research relationships and a perception of safety regarding trial procedures and syphilis as a curable infection. Participants emphasized the importance of community involvement to inform vaccine trials given stigmas surrounding syphilis, lack of knowledge about syphilis, and the impact of its sordid research history on community trust. Conclusions: While stakeholders expressed strong interest in a syphilis vaccine, community engagement on syphilis and syphilis vaccine research is crucial. Further mixed methods research is needed to inform syphilis vaccine trials. [ABSTRACT FROM AUTHOR]

Background: The pay-it-forward approach is an effort to increase rates of gonorrhea and chlamydia testing among gay, bisexual and other men who have sex with men (GBMSM). In the pay-it-forward approach, the participant is given the gift of an STD test, paid for by a member in their community. The participant is then given the opportunity to pay for another individual's STD test. We conducted a pay-it-forward feasibility study to increase gonorrhea and chlamydia testing among GBMSM. This study aims to understand the participant experience in the pay-itforward approach and the mechanism by which it motivates testing. Methods: Semi-structured interviews were conducted at two different STD testing sites in Guangzhou, China. The responses were translated verbatim, and a coding framework was developed based on the questions and responses we were receiving. We conducted a theoretical thematic analysis to form overall themes and overarching factors from each of the two clinics. The responses were analyzed to thematically describe the experience of the participants at four steps of implementation. We sought to understand the payit- forward related barriers and facilitators to test uptake and donating money or writing a message. Results: 31 MSM were interviewed. We identified four sequential steps in implementation: before participation, PIF impression, receiving and/or writing the postcard, decision to pay it forward. The themes that emerged from this analysis were worry surrounding STD testing, detachment from the LGBTQ community, unspecified gratitude, connection to the recipient, and a sense of social responsibility and altruism. Conclusions: Based on this thematic analysis, we conclude that the pay-it-forward model highlights the need for connection, support, and health services for gay men in China. The pay-it-forward model has the potential to be effective in increasing rates of STD testing, and this qualitative analysis provides a deeper understand for how participation affects these men. [ABSTRACT FROM AUTHOR]

Introduction: Chinese gay, bisexual and other men who have sex with men (GBMSM) face discrimination in many health services, decreasing health seeking at facilities and increasing the importance of online engagement. Few studies have determined how Chinese GBMSM navigate online spaces, including websites, apps, and platforms, in their everyday lives. The purpose of this study was to examine online GBMSM community spaces and implications for HIV/STIs prevention services. Methods: We conducted a total of six online focus group discussions on the chat-based platform WeChat in 2021. Inclusion criteria for participants were self-identified GBMSM aged 18 and above and living in Guangdong Province, China recruited through research and community group networks. Focus group discussions were asynchronous, and participants were able to provide and map out online spaces that they had participated in and share their perspectives on online engagement. Data were analyzed through framework analysis. Results: Overall, 48 participants participated, of whom most were mainly sexually attracted to men (n=43, 90.0%), and had never participated in inperson LGBTQ-related activities (n=29, 60.4%). Participants articulated a typology of online spaces along the axes of whether such spaces were localized platforms (vs. non-localized) or whether they were GBMSM-specific (vs. non-GBMSM-specific). Localized, GBMSM-specific spaces including local gay dating apps were suited for HIV/STIs prevention outreach, but participants articulated how other non-conventional spaces can be leveraged for such purposes. Participants articulated several advantages of online spaces, including greater anonymity, opportunities for community building, sharing of sexual health information and being able to meet other GBMSM more efficiently. Drawbacks included the lack of personal connection, concerns around safety for minors, encountering deception and the use of fake profile pictures, and needing a virtual proxy network to access some websites. Participants provided suggestions to further improve their experiences of online spaces, including ways to deepen community engagement, diversify content apart from sexual health, as well as to integrate safeguard to protect underaged individuals from sexual predators. Conclusions: Findings of this study have implications for differentiated messaging for HIV/STI interventions. More research on GBMSM-specific online spaces (e.g., gay dating apps), and the interface between online and offline spaces for Chinese GBMSM, is warranted. [ABSTRACT FROM AUTHOR]

Background: HIV oral pre-exposure prophylaxis (PrEP) was approved by the Chinese National Medical Products Administration (NMPA) in 2020. However, the experiences of PrEP use among Chinese men who have sex with men (MSM) remain unclear. We purposefully sampled MSM with various PrEP use history from a PrEP demonstration project in Guangzhou, China, to their PrEP use experiences and perspectives on PrEP related stigma. Methods: Based on the self-reported PrEP use history and current adherence in quarterly follow-up surveys, we conducted one-to-one semi-structured in-depth interviews with a purposeful sample of MSM on daily PrEP in Guangzhou, China. We recruited MSM who 1) completely discontinued, 2) continuously using PrEP with different levels of selfreported adherence, 3) intermittently using PrEP. We also sampled MSM using an on-demand dosing strategy. The interview guide included questions on PrEP using experience, perceived barriers, and facilitators to PrEP initiation, continuation, and discontinuation. All interviews were conducted in Chinese by native speakers, in-person or online. We then conducted a thematic analysis with an iterative inductive and deductive coding process using Dedoose. Results: Participants mainly viewed PrEP as an additional protection to using condoms. Positive experiences include reducing HIV-related anxieties and concerns about irrational behaviors such as unplanned sex. However, participants expressed doubts about PrEP regarding how it was commercialized in social media and that PrEP is not 100% efficacious. Some participants viewed PrEP as a class status for those with higher socioeconomic status due to its financial barrier, while others weighed on the importance of official approval of the drug to trust it. Experiences of stigma included 1): PrEP is linked to promiscuity; 2): PrEP is mistaken for ART; 3): PrEP could lead to the disclosure of sexual orientation. Participants also reported concealment of PrEP in response to stigma and hopes for a more stable form of PrEP such as long acting injectables. Conclusion: Patient education, especially when provided by credible organizations, about PrEP efficacy and side effects management is key to reducing misinformation and doubts about PrEP. Structural interventions, including destigmatizing HIV, PrEP, and minority groups, are highly needed to achieve the sustainability of PrEP implementation. [ABSTRACT FROM AUTHOR]

Background: Limited evidence is available for PrEP persistence in China. This study investigated the PrEP uptake and discontinuation among Chinese PrEP users during 2021-2022. Methods: A PrEP demonstration trial was conducted in Guangzhou and Wuhan, China, providing PrEPeligible people with 12-month dosages of daily Truvada® for free. We adopted a hybrid communityclinic- partnership model for recruitment, medication delivery, and follow-up, where participants can complete all study procedures online except for lab/clinical examinations. Here we reported the PrEP uptake, retention, and PrEP discontinuation (defined as loss-to-follow-up, voluntary stop using PrEP, quitting PrEP due to adverse events). Results: We enrolled 849 people, and 776 people initiated PrEP (91.4 %, median age= 29.2, range 18.5- 59.6). 99.5% (765/766) were males, and 94.5% (724/766) self-identified as gay or bisexual. Over 70% are working, and about 60% earn ≥700 USD per month. 43.5%(n=338) received PrEP through the mail (mean delivery time= 1.67 days). 88.8% (447/503), 84.4% (196/232), 81% (120/148), and 27.6% (21/76) completed in-person or remote follow-ups at 3, 6, 9, and 12 months, respectively. A total of 57 participants (7.3%) discontinued PrEP before the study ended, of whom 52.6% discontinued within the 1st month, and another 19 (33.3%) discontinued within 3 months (Fig1). No statistically significant differences were detected between participants who discontinued PrEP and those who retained on age, gender, and monthly income. Common reasons for discontinuation include moving (n=12, 21.1%), low perceived risk of HIV infection (n=14, 24.6%), and limited mobility during the pandemic lockdowns (n=5, 8.8%). Overall, 17 participants (2.2% of the total sample) reported adverse events, and 4 (7% of discontinuations and 0.5% of the total sample) discontinued PrEP due to adverse events. The most frequently reported events were skin rash (n=5), nausea (n=5), and diarrhea(n=2). Conclusion: Our project demonstrated the feasibility and safety of PrEP in China with high persistence after 3-6 months. However, persistence remains a challenge due to both individual and structural factors. Disruptions from the COVID-19 pandemic and related public health responses may have increased the risk of discontinuation among PrEP users in China. Diversifying modalities of PrEP provision is also highly warranted in the PrEP care continuum. [ABSTRACT FROM AUTHOR]

Project: Co-creation is an engaged design process that values beneficiary knowledge and experience. It aims to create equal leadership between beneficiaries and researchers. Co-creation methods encourage early and deeper community involvement in intervention design and could facilitate peoplecentered research and implementation. Issue: While co-creation approaches are increasingly used for community engagement, few studies focus on co-creation methods to develop contextually appropriate and acceptable STI testing strategies for vulnerable populations, especially in low- and middle-income countries (LMICs). Therefore, we evaluated a co-creation approach for developing a strategy to enhance STI testing among MSM in China. Each member of a co-creation group completed a written survey that assessed acceptance and appropriateness on a 1-5 scale (1 not appropriate, 5 highly appropriate). Results: Following Leask et al.'s five steps for cocreation of public health interventions, we conducted a hybrid of in-person and online format co-creation activities with key stakeholders. A total of eight anonymous sessions were conducted with 17 co-creators: one co-creation lead (researcher), two co-chairs (one MSM influencer and one researcher), eight MSM end-users, four health workers (two health professionals and two lay health workers), and implementers. Every theme was negotiated and agreed based upon the co-creators' needs, experience as end-users, and knowledge. Co-created content for the STI testing intervention included intervention materials, user journeys, recruitment strategies, implementation processes, participant engagement strategies, and risk mitigation techniques. Co-creators perceived high acceptance and appropriateness of the co-created intervention (median 4, IQR 0). Lessons Learned: Co-creation differs from community advisory boards in several key ways (Table 1). MSM and researchers effectively shared leadership, one of the key components of cocreation. People-centered co-creation created a safe and comfortable space for active participation without concerns about inadvertent disclosure among a stigmatized population and contributed to developing a contextually acceptable and appropriate STI testing intervention. [ABSTRACT FROM AUTHOR]

Introduction: Community engagement is a key principle to guide HIV prevention work with marginalized communities, including men who have sex with men (MSM). A recent study to measure HIV stigma and homophobia employed local MSM to work as standardized patients (SP) and to conduct unannounced visits with consenting doctors to observe and report on enacted healthcare stigma. This qualitative study reports on the experiences of MSM who took part in this novel opportunity for community engagement between researchers and MSM. Methods: Interviewees were current SPs employed in the parent study which was carried out in Guangzhou, China. Each SP took part in two rounds of in-depth interviews to describe their experiences both before and after the SP experience. A socialecological model informed the interviews and data analysis. Participants also took part in a single focus group discussion where group feedback and reflections on the project experience were documented. Audio-recorded and de-identified data were transcribed, and three team members doublecoded each interview in Dedoose. Results: 11 SPs took part in study activities, yielding 22 in-depth interviews and one focus group discussion. Three key themes emerged. First, the study experience imparted to SPs a sense of personal empowerment and community connection. Second, SP training and clinic visits provided SPs with new knowledge on STIs and provider-patient communication, prompting conversations about sexual health with peers in their personal lives. Lastly, most SPs reported relatively high satisfaction with the quality of care received by providers. Discussion: Findings suggest that in a healthcare stigma reduction setting, the SP experience empowered MSM who served as actors and the experience improved their community engagement level. SP project offered a unique and safe space where the participants could discuss a sensitive issue (HIV/ STI) without revealing their actual sexual health history to ease the self-stigma surrounding HIV and STI that persists within the community. Our study also provides insights and suggestions for future HIV/STI intervention design and MSM community engagement research in LMICs setting. [ABSTRACT FROM AUTHOR]

Background: Little research has examined differences between gay, bisexual, and other MSM (GBMSM) who attend community-led clinics versus GBMSM who attend public STI clinics. Understanding these differences is vital in designing relevant and people-centred service delivery strategies for GBMSM in China. This study examined GBMSM who attended GBMSM-led clinics compared to those who attended public STI clinics. Methods: Data used in this analysis were derived from a cross-sectional formative research study among GBMSM aged ≥18 years in Guangzhou, China. The study was conducted from May to August 2022. Participants were enrolled from a GBMSM-led clinic run by a community-based organization staffed by GBMSM volunteer or, a public STI clinic staffed by physicians. Chi-squared tests were used to compare sociodemographic characteristics, and linear regression was used to compare community engagement, community connectedness, social cohesion, internalized homonegativity, and perceived homonegativity among all GBMSM. Results: We recruited 94 participants (including 45 at the GBMSM-led clinic and 49 GBMSM at the public STI clinic). The overall mean age was 26.8 years old. Most of the participants had never been married (89/94, 95%), and self-identified as gay (79/94, 84%). Table 1 summarizes our main study findings. Our analysis showed no large differences in sociodemographic characteristics or other factors between the two groups. Men at the GBMSM-led clinic may be more likely to self-identify as gay than bisexual or another sexual orientation (p=0.22). Men who were tested at the public clinic were more likely than those at the GBMSM-led clinic to present with symptoms (p=0.007). We observed a trend of higher internalised homonegativity in GBMSM at the public STI clinic (β=-1.52, p=0.10). Community engagement may be higher among men presenting to GBMSMled clinics (β=0.58, p=0.065). Conclusion: Our data suggest that men in GBMSMled clinics may be more willing to engage in community activities and have less internalised homonegativity compared to men in public STI clinics. These data have implications for designing community engagement strategies for GBMSM, delivering anti-stigma interventions, and promotion of asymptomatic STI testing. [ABSTRACT FROM AUTHOR]

Project: In a pay-it-forward approach, an individual receives a gift (i.e., STI testing) and then provides the person with an opportunity to give a gift to another person. Previous studies have shown that pay-itforward interventions increase STI testing uptake. Issue: The existing literature focuses on a recipient glow, defined as positive feelings or a sense of gratitude a recipient feels due to participating in prosocial behavior. Despite evidence supporting the pay-it-forward concept, the biological mechanism underpinning the recipient glow has not been investigated. We sought to operationalize and measure the recipient glow through oxytocin, one of the theorized biomarkers. Oxytocin is a hormone popularly associated with its effects on prosocial behaviors like trust, generosity, and affection. In a quasi-experimental study, we measured and compared salivary oxytocin concentrations between men who have sex with men (MSM) receiving free STI testing in a public STI clinic and MSM receiving STI testing through a pay-it-forward approach in a community-led clinic. Participants provided saliva samples using a passive drool method, before they received details about the source of funding for their test (baseline) and after undergoing STI testing. The saliva samples were stored at -80°C until processed. An ELISA was conducted using a commercially available oxytocin test kit, and oxytocin concentration was calculated using a microplate reader and standard curves. Results: We recruited 48 participants (n=22 standard of care vs. n=26 pay-it-forward) with a mean age of 25.7 (SD=4.55). Most participants earned >737USD per month (n=28), had a bachelors/associate degree (n=36), and identified as gay (n=39). Prior to any intervention, participants in the pay-it-forward arm had a lower mean salivary oxytocin concentration (50.5 pg/mL) than participants in the standard of care arm (76.4 pg/mL). After accepting and undergoing STI testing, oxytocin concentrations decreased from baseline among 31 participants (mean = -20.8pg/mL). Although not statistically significant, the drop in oxytocin levels was smaller among participants receiving pay-it-forward (- 16.0pg/mL vs. -26.6pg/mL) than among standard-ofcare participants. Lessons Learned: Our data suggest that entering STI clinics and receiving testing is associated with decreases in salivary oxytocin. This has implications for designing public health interventions in STI clinics. [ABSTRACT FROM AUTHOR]

Background: Adolescents and young adults (AYA, age 10-24 years) face unique ethical, social, structural, and legal challenges with informed consent to research participation, resulting in systematic AYA exclusion from HIV prevention and treatment studies. We describe the development of a stakeholder-driven consensus statement on strategies for improving AYA informed consent to HIV research participation in low- and middle-income countries (LMICs). Methods: The VOICE (HIV Youth Informed Consent & Ethics in Research) Working Group brought together a diverse, multi-disciplinary team of young people, HIV/AYA researchers, community organizers, advocates, research ethics committee members, and bioethicists. The Working Group initially drafted statement items drawing on themes identified in a previous open call, supplemented with a scoping review. We then implemented an adapted Delphi process consisting of two rounds of online survey questionnaires and a hybrid (online and in-person) consensus summit in Lagos, Nigeria. The questionnaire used Likert scale responses to measure agreement on whether to include each statement item and textboxes for feedback. Results: Consensus survey round one was sent to VOICE Working Group members and affiliates of a multinational research consortium focused on AYA HIV research. Of the 53 invitees, 44 completed the survey (83%). All 27 initial statement items achieved consensus, defined as ≥80% of participants responding "agree" or "strongly agree" to an item's inclusion in the statement. Round one results were brought to a hybrid consensus summit for discussion and further revision, condensing to 26 items. The resulting revised statement items were then used in survey round two, completed online by 73 consensus summit participants. Of the 26 items, 23 achieved consensus. Conclusion: While parental involvement in AYA consent is a contentious point, there is widespread agreement among key stakeholders on actionable strategies to improve AYA consent processes, and thereby increase AYA inclusion in HIV research in LMICs. The resulting consensus statement provides practical guidance for implementation at the organizational, community, and policy levels. [ABSTRACT FROM AUTHOR]