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IntroductionNearly 40 years into the HIV epidemic, the persistence of HIV stigma is a matter of grave urgency. Discrimination (i.e. enacted stigma) in healthcare settings is particularly problematic as it deprives people of critical healthcare services while also discouraging preventive care seeking by confirming fears of anticipated stigma. We review existing research on the effectiveness of stigma interventions in healthcare settings of low- and middle-income countries (LMIC), where stigma control efforts are often further complicated by heavy HIV burdens, less developed healthcare systems, and the layering of HIV stigma with discrimination towards other marginalized identities. This review describes progress in this field to date and identifies research gaps to guide future directions for research.MethodsWe conducted a scoping review of HIV reduction interventions in LMIC healthcare settings using Embase, Ovid MEDLINE, PsycINFO and Scopus (through March 5, 2020). Information regarding study design, stigma measurement techniques, intervention features and study findings were extracted. We also assessed methodological rigor using the Joanna Briggs Institute checklist for systematic reviews.Results and discussionOur search identified 8766 studies, of which 19 were included in the final analysis. All but one study reported reductions in stigma following the intervention. The studies demonstrated broad regional distribution across LMIC and many employed designs that made use of a control condition. However, these strengths masked key shortcomings including a dearth of research from the lowest income category of LMIC and a lack of interventions to address institutional or structural determinants of stigma. Lastly, despite the fact that most stigma measures were based on existing instruments, only three studies described steps taken to validate or adapt the stigma measures to local settings.ConclusionsCombating healthcare stigma in LMIC demands interventions that can simultaneously address resource constraints, high HIV burden and more severe stigma. Our findings suggest that this will require more objective, reliable and culturally adaptable stigma measures to facilitate meaningful programme evaluation and comparison across studies. All but one study concluded that their interventions were effective in reducing healthcare stigma. Though encouraging, the fact that most studies measured impact using self-reported measures suggests that social desirability may bias results upwards. Homogeneity of study results also hindered our ability to draw substantive conclusions about potential best practices to guide the design of future stigma reduction programmes.

People's beliefs in supernatural explanatory models of health and illness - beliefs in divine and/or supernatural forces to inform how they perceive, interpret, and respond to health and illness - may have important implications for their use of healthcare services, especially among individuals with lower socioeconomic status (SES). However, the relevance of such research for contexts with strong Confucian and Buddhist traditions and sexual minority subpopulations remains unclear. We conducted a nation-wide survey in China of 503 men who have sex with men (MSM) to test hypotheses examining how supernatural beliefs impact commitment to a primary healthcare provider and testing history for HIV and syphilis. We also tested hypotheses regarding how SES may moderate such effects. Results indicate that strength of supernatural beliefs is associated with less commitment to a primary care provider and lower likelihood of HIV testing, particularly among men with lower educational attainment. However, among men with low income, supernatural belief was associated with higher likelihood of testing for HIV and syphilis. Belief in supernatural explanatory models of health and illness may have substantial influence on healthcare use among MSM in China. As religion and spirituality evolves within China, additional research concerning supernatural beliefs and healthcare use is warranted.

BackgroundCrowdsourcing method is an excellent tool for developing tailored interventions to improve sexual health. We evaluated the implementation of an innovation contest for sexual health promotion in China.MethodsWe organized an innovation contest over three months in 2014 for Chinese individuals

Community-based sexual health services are recommended to increase sexually transmitted disease (STD) testing among men who have sex with men (MSM). Pilot study data from multiple sites found that MSM in Guangzhou who use public STD clinics were found to have different sociodemographic characteristics, lower community engagement, and increased social cohesion, compared to MSM who use MSM-led clinics. [ABSTRACT FROM AUTHOR]

Background Point-of-care (PoC) hepatitis B virus (HBV) DNA viral load (VL) assays represent an alternative to laboratory-based standard-of-care (SoC) VL assays to accelerate diagnosis and treatment. We evaluated the impact of using PoC versus SoC approaches on the uptake of VL testing, treatment, and turnaround times from testing to treatment across the HBV care cascade. Methods We searched 5 databases, 6 conference websites, and contacted manufacturers for unpublished reports, for articles with or without a comparator (SoC VL testing), and had data on the uptake of VL testing, treatment, or turnaround times between hepatitis B surface antigen (HBsAg) testing, VL testing, and treatment in the cascade. We performed a random-effects meta-analysis on rates of VL testing and treatment initiation. Results Six studies, composing 9 arms, were included. Three PoC arms reported less than 1 day between screening for HBsAg positivity and VL testing, and the other one (2 arms) reported it between 7 and 11 days. Five arms reported the time to available VL test results (<1 day). Three studies reported 1–8 days between VL testing results and treatment initiation. Two studies reported the turnaround times between a positive HBsAg screening and treatment initiation (the same day and 27 days). Overall, 84.1% of those with HBsAg positivity were tested for DNA VL and 88.3% of eligible people initiated treatment. Conclusions HBV PoC DNA testing appears to be associated with a turnaround time of <1 day for receipt of VL results and appears associated with high rates of DNA testing and initiation of treatment among those eligible. Clinical Trials Registration PROSPERO CRD42023398440. [ABSTRACT FROM AUTHOR]

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 [...]

Background: Food insecurity, a pervasive global issue exacerbated by the COVID-19 pandemic, has been linked to adverse mental health outcomes. However, the role of social capital in mitigating this relationship remains understudied, particularly in the Chinese context. Aims: This study investigated the associations between food insecurity and psychological distress (depressive and anxiety symptoms) and examined the potential moderating effects of bonding and bridging social capital among Chinese adults in Shanghai. Methods: This cross-sectional study included 3,220 Chinese adults (mean age: 34.45; 51.5% male) in Shanghai. Food insecurity was assessed using the modified Household Food Insecurity Access Scale, psychological distress was measured using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7, and social capital was evaluated using the Revised Personal Social Capital Scale. Results: Multivariable linear regression analyses revealed that food insecurity was significantly positively associated with both depressive (β = 0.449, SE = 0.024) and anxiety symptoms (β = 0.391, SE = 0.022), after adjusting for sociodemographic characteristics, health status, and COVID-19-related factors. Higher levels of bonding and bridging social capital were significantly associated with fewer depressive and anxiety symptoms. Significant interactions (p <.001) between bonding social capital and food insecurity indicated that the associations between food insecurity and psychological distress were less pronounced among adults with higher bonding social capital. Conclusions: These findings highlight the critical role of food insecurity as a risk factor for psychological distress and the importance of bonding social capital in mitigating its impact on mental health. Policies and interventions targeting food insecurity prevention and bonding social capital enhancement may promote better mental health outcomes among Chinese adults. [ABSTRACT FROM AUTHOR]

Introduction: HIV self-testing (HIVST) is a useful strategy to promote HIV testing among key populations. This study aimed to understand HIV testing behaviours among men who have sex with men (MSM) and specifically how HIVST was used during the coronavirus disease 2019 (COVID-19) measures in China when access to facility-based testing was limited. Methods: An online cross-sectional study was conducted to recruit men who have sex with men (MSM) in China from May to June of 2020, a period when COVID-19 measures were easing. Data on socio-demographic characteristics, sexual behaviours and HIV testing in the three months before and during COVID-19 measures (23 January 2020) were collected. Chi-square test and logistic regression were used for analyses. Results: Overall, 685 MSM were recruited from 135 cities in 30 provinces of China, whose mean age was 28.8 (SD: 6.9) years old. The majority of participants self-identified as gay (81.9%) and had disclosed their sexual orientation (66.7%). In the last three months, 69.6% ever had sex with men, nearly half of whom had multiple sexual partners (47.2%). Although the overall HIV testing rates before and during COVID-19 measures were comparable, more MSM self-tested for HIV during COVID-19 measures (52.1%) compared to before COVID-19 measures (41.6%, p = 0.038). Fewer MSM used facility-based HIV testing during COVID-19 measures (42.9%) compared to before COVID-19 measures (54.1%, p = 0.038). Among 138 facility-based testers before COVID-19 measures, 59.4% stopped facility-based testing during COVID-19 measures. Among 136 self-testers during COVID-19 measures, 58.1% had no HIV self-testing before COVID-19 measures. Multivariable logistic regression showed that having sex with other men in the last three months (adjusted odds ratio, aOR = 2.04, 95% CI: 1.38 to 3.03), self-identifying as gay (aOR = 2.03, 95% CI: 1.31 to 3.13), ever disclosing their sexual orientation (aOR = 1.72, 95% CI: 1.19 to 2.50) and tested for HIV in three months before COVID-19 measures (aOR = 4.74, 95% CI: 3.35 to 6.70) were associated with HIV testing during COVID-19 measures. Conclusions: Facility-based HIV testing decreased and HIVST increased among MSM during COVID-19 measures in China. MSM successfully accessed HIVST as substitute for facility-based testing, with no overall decrease in HIV testing rates. Keywords: men who have sex with men; HIV self-testing; facility-based HIV testing; COVID-19, 1 | INTRODUCTION In response to coronavirus disease 2019 (COVID-19), China issued comprehensive COVID-19 measures on 23 January, 2020. Shortly thereafter, the highest response level to the public health emergency [...]

Introduction: The COVID-19 pandemic is impacting HIV care globally, with gaps in HIV treatment expected to increase HIV transmission and HIV-related mortality. We estimated how COVID-19-related disruptions could impact HIV transmission and mortality among men who have sex with men (MSM) in four cities in China, over a one- and five-year time horizon. Methods: Regional data from China indicated that the number of MSM undergoing facility-based HIV testing reduced by 59% during the COVID-19 pandemic, alongside reductions in ART initiation (34%), numbers of all sexual partners (62%) and consistency of condom use (25%), but initial data indicated no change in viral suppression. A mathematical model of HIV transmission/treatment among MSM was used to estimate the impact of disruptions on HIV infections/HIV-related deaths. Disruption scenarios were assessed for their individual and combined impact over one and five years for 3/4/6-month disruption periods, starting from 1 January 2020. Results: Our model predicted new HIV infections and HIV-related deaths would be increased most by disruptions to viral suppression, with 25% reductions (25% virally suppressed MSM stop taking ART) for a three-month period increasing HIV infections by 5% to 14% over one year and deaths by 7% to 12%. Observed reductions in condom use increased HIV infections by 5% to 14% but had minimal impact ( Conclusions: The overall impact of COVID-19 on new HIV infections and HIV-related deaths is dependent on the nature, scale and length of the various disruptions. Resources should be directed to ensuring levels of viral suppression and condom use are maintained to mitigate any adverse effects of COVID-19-related disruption on HIV transmission and control among MSM in China. Keywords: COVID-19 pandemic; men who have sex with men; modelling; HIV transmission; key and vulnerable populations; People's Republic of China, 1 | INTRODUCTION Globally, 37.9 million people are living with HIV (PLHIV) [1], with men who have sex with men (MSM) disproportionally affected [2]. In China, a recent systematic review [...]

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; I.sup.2 = 99.9%, k = 7), diagnosis (OR = 1.44, 95% CI:1.08 to 1.92; I.sup.2 = 97.6%, k = 9), linkage to care (OR = 3.10, 95% CI = 1.97 to 4.86; I.sup.2 = 0%, k = 1), cure (OR = 2.08, 95% CI:1.11 to 3.88; I.sup.2 = 76.7%, k = 4), treatment completion (OR = 1.48, 95% CI: 1.07 to 2.03; I.sup.2 = 73.1%, k = 8), and treatment success (OR = 3.24, 95% CI: 1.88 to 5.55; I.sup.2 = 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(s): Gifty Marley 1,2, Xia Zou 3, Juan Nie 4, Weibin Cheng 5,6, Yewei Xie 2, Huipeng Liao 2, Yehua Wang 2, Yusha Tao 2, Joseph D. Tucker 2,7, Sean [...]

Introduction: Kazakhstan has one of the fastest‐growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self‐testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study. Methods: From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13−19 or 20−29 years) and judged by a panel composed of AYA (n = 23), healthcare professionals (n = 12), and representatives from the local government and non‐governmental organizations (n = 17). Each entry was reviewed by at least four judges and ranked on a 5‐point scale. The top 20 open call contestants were asked to submit self‐recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding. Results: We received 96 submissions from 77 youth across Kazakhstan. Roughly, three‐quarters (n = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (n = 39/75) scored 3.5 or higher on a 5‐point scale (70.0%). The most frequent types of entries were video (n = 36/96, 37.5%), image (n = 28/96, 29.2%) and text (n = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations. Conclusions: Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex health and social challenges facing communities today. [ABSTRACT FROM AUTHOR]

Purpose: Culture and stigma-relevant issues discourage transgender individuals in China from gender identity disclosure, which may limit their access to comprehensive health care services. This study evaluates how gender identity disclosure to healthcare professionals would facilitate healthcare services in China. Methods: A cross-sectional study was conducted in nine cities across mainland China from December 2019 to June 2020 among transgender individuals. Participants completed questions covering socio-demographic information, Human Immuno-Deficiency Virus and Sexually Transmitted Infections (HIV/STI) testing habits, sexual risk behaviors, and access to medical and mental health services for the past 3 months. Results: A total of 277 eligible transgender individuals with a mean age of 29 ± 8 years old completed the survey. Overall, 56.0% (155/277) had disclosed their gender identity to health professionals. 83.9% had ever tested for HIV (with HIV prevalence of 12.9%), 54.2% had tested for STIs, 62.6% had used hormone therapy, and 12.3% had undergone gender-affirming surgery. Multivariable logistic regression showed that participants who had ever disclosed their gender identity to healthcare professionals were more likely to have tested for STIs (aOR = 1.94, 95%CI: 1.12–3.39) and HIV (aOR = 1.72, 95% CI 0.82–3.39), received hormone intervention therapy (aOR = 2.81, 95%CI: 1.56–5.05), and used pre-exposure prophylaxis (PrEP) (aOR= 3.51, 95%CI: 1.12–10.97) compared to non-disclosers. Conclusions: Our study demonstrated strong correlations between gender identity disclosure and healthcare services usage among Chinese transgender individuals. Facilitating the gender identity disclosure of transgender individuals to healthcare professionals with caution would be useful for improving their access to care. [ABSTRACT FROM AUTHOR]

Introduction: Youth engagement in HIV research is generally recognized as essential, but often neglected or minimally implemented in practice. Engagement is a process of working collaboratively with diverse groups of people to address common issues. We conducted a scoping review of youth HIV prevention interventions in sub-Saharan Africa to identify and categorize forms and levels of youth engagement across the lifespan of intervention research. Methods: We followed Arksey and O'Malley's framework for organizing a scoping review. We searched seven databases for related articles on identified intervention studies through May 28th 2020. Included studies focused on youth (10 to 24 years old) HIV prevention interventions in sub-Saharan Africa. Two reviewers independently examined citations and full manuscripts for inclusion. Data were extracted on study characteristics, location, description of youth engagement and extent of engagement. Youth engagement approaches were categorized based on Hart's ladder as substantial engagement (strong youth decision-making power), moderate engagement (shared decision making with adults), minimal engagement (no youth decisionmaking power) or no engagement. Results: We identified 3149 citations and included 112 studies reporting on 74 unique HIV interventions. Twenty-two interventions were in low-income countries, 49 in middle-income countries, and three were in both. Overall, only nine interventions (12%) had substantial or moderate youth engagement, two-thirds (48, 65%) had minimal youth engagement and 17 interventions (23%) had no youth engagement. We also identified specific engagement strategies (e.g. youth-led research, crowd-sourcing) that were feasible in multiple settings and resulted in substantial engagement. Conclusions: We found limited youth engagement in youth HIV prevention intervention studies in sub-Saharan Africa. However, several activities resulted in substantial youth engagement and could be relevant in many low-and-middle-income-country (LMIC) settings. Keywords: HIV; youth; engagement; research; Sub-Saharan Africa, 1 | INTRODUCTION Young people (15-24 years old) in sub-Saharan Africa accounted for 19% of the estimated 1.7 million new HIV infections globally in 2019, whereas adolescents (10 to 19 [...]