Implementation preferences for the management of sexually transmitted infections in the South African health system: a discrete choice experiment.

OBJECTIVES: Despite strengthening HIV prevention with the introduction of pre-exposure prophylaxis (PrEP), STI services have remained relatively unchanged and the standard of care remains syndromic management. We used a discrete choice experiment to investigate service users' preferences for the diagnosis and treatment of STIs in South Africa. METHODS: Between 1 March 2021 and 20 April 2021, a cross-sectional online questionnaire hosted on REDCap was administered through access links sent to WhatsApp support groups for HIV PrEP users and attendees of two primary healthcare clinics and two mobile facilities in the Eastern Cape and Gauteng provinces aged between 18 and 49 years. Participants either self-completed the questionnaire or received support from a research assistant. We used a conditional logit model for the initial analysis and latent class model (LCM) to establish class memberships, with results displayed as ORs and probabilities. RESULTS: We enrolled 496 individuals; the majority were female (69%) and <30 years (74%). The LCM showed two distinct groups. The first group, comprising 68% of the participants, showed a strong preference for self-sampling compared with no sampling (OR 2.16, 95% CI 1.62 to 2.88). A clinic follow-up appointment for treatment was less preferable to same-day treatment (OR 0.78, 95% CI 0.63 to 0.95). Contact slip from index patient (OR 0.86, 95% CI 0.76 to 0.96) and healthcare professional (HCP)-initiated partner notification (OR 0.63, 95% CI 0.55 to 0.73) were both less preferable than expedited partner treatment (EPT). The second group included 32% of participants with a lower preference for self-sampling compared with no sampling (OR 0.65, 95% CI 0.41 to 1.04). There was no treatment option that was significantly different from the others; however, there was a strong preference for HCP-initiated partner notification to EPT (OR 1.53, 95% CI 1.10 to 2.12). CONCLUSIONS: Our results suggest that service users preferred STI testing prior to treatment, with the majority preferring self-taken samples and receiving aetiology-based treatment on the same day.

"HIV has taught us that you can survive anything": findings from auto-ethnographic video diaries exploring resilience among people living with HIV during the Covid pandemic in five countries.

This study aimed to elucidate the intrinsic and extrinsic resilience resources among people living with HIV (PLWH) during the Covid pandemic. Autoethnographic video diaries from 29 PLWH from Argentina, UK, Philippines, Zimbabwe, and Trinidad and Tobago were included. Data were thematically analysed and validated with community partners and a video was co-produced. PLWH displayed a readiness to adopt healthy behaviours and engage in optimistic and constructive thinking about the future. Hobbies and daily activities, supportive relationships with peers living with HIV, family and friends, opportunities to mobilise and contribute to their communities in meaningful ways, supportive healthcare providers and reliable access to antiretroviral treatment helped foster psychological resilience among PLWH. The extrinsic resilience resources also supported positive physical health outcomes among PLWH through improved medication adherence.

Factors associated with the sexual transmission of Strongyloides stercoralis in men who have sex with men: A systematic review.

Strongyloides stercoralis is a parasitic worm with a complex life cycle and can cause significant morbidity, including a proctocolitis and life-threatening hyperinfection syndrome. Limited reports from non-endemic areas, including in men who have sex with men (MSM), suggest sexual transmission of S. stercoralis. In this systematic review of the published literature, we aimed to explore the associated factors of S. stercoralis in MSM. We systematically searched three bibliographical databases (MEDLINE, CINAHL and EMBASE) up to November 2022. We used a two-stage process to assess eligibility: the primary author conducted an initial screen of abstracts, and then three authors conducted independent full manuscripts to determine the final eligible manuscripts. We only included manuscripts written in English that contained data on specific factors associated with sexual transmission in MSM. We used the STROBE checklist to assess the risk of bias and synthesized the narrative data using the SWiM method. Seven manuscripts were eligible for this review (four case reports, one case series, one cross-sectional study and one experimental study), which included 22 individuals from Europe and the Americas. From these studies, S. stercoralis in MSM was associated with living with HIV (including having a low CD4 count and not using antiretrovirals), having a concomitant sexually transmitted infection (Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum and hepatitis C) and a concomitant (sexually transmitted) protozoal infection (Entamoeba histolytica, Giardia lamblia), travel to the S. stercoralis endemic area, multiple sexual partners from endemic areas, oro-anal sexual contact and chemsex. Although limited by the number of cases in the literature, we have highlighted some possible biological and behavioural risk factors associated with the sexual transmission of S. stercoralis in MSM that could be used to both target future research and S. stercoralis public health control interventions.

Factors and presenting symptoms associated with intestinal spirochaetosis in men who have sex with men: A systematic review.

The transmission dynamics and presenting symptoms of intestinal spirochaetosis (Brachyspira pilosicoli, Brachyspira aalborgi) are poorly understood but is seen more frequently in men who have sex with men (MSM) where sexual transmission may occur. We aimed to systemically review the literature to define the factors and presenting symptoms associated with intestinal spirochaetosis in MSM. We systematically searched three bibliographical databases (MEDLINE, EMBASE and Scopus) for manuscripts written in English up to November 2022. The primary author conducted an initial screen and three authors conducted independent reviews to determine the final eligible manuscripts. We only included manuscripts where there were specific data on factors and presenting symptoms associated with intestinal spirochaetosis in MSM. Fifteen manuscripts published between 1981 and 2022 met the inclusion criteria that included 188 MSM. Sexually transmitted intestinal spirochaetosis in MSM was associated with-living with HIV (including having a low CD4 count <200 mm3), having a concomitant sexually transmitted infection, a history of a sexually transmitted infection, co-infection with intestinal parasites; and sexual behaviour including oro-anal sexual contact, oro-genital contact, fisting, condom-less anal sex, receptive anal sex, multiple non-regular sexual partners and increased number of lifetime sexual partners. The presenting symptoms of MSM with intestinal spirochaetosis were diarrhoea, abdominal pain, constitutional symptoms and proctitis, including rectal pain, rectal bleeding rectal discharge, flatulence and tenesmus. We have highlighted some biological and behavioural factors and presenting symptoms associated with intestinal spirochaetosis in MSM which provide insight for clinicians, guidelines and future public health control strategies.

Factors associated with sexually transmitted shigella in men who have sex with men: a systematic review.

BACKGROUND: Outbreaks of sexually transmitted shigella have been reported in men who have sex with men (MSM) since the 1970s and present a major public health issue. Understanding the factors associated with the sexual transmission of shigella may inform future control strategies. METHODS: We systematically searched four bibliographical databases (January 2000-February 2022) for manuscripts in English. We used a two-stage process to assess eligibility: the primary author conducted an initial screen and then three authors conducted independent full-text reviews to determine the final eligible manuscripts. We only included manuscripts that included MSM diagnosed with sexually transmitted shigella where specific factors associated with transmission were identified. RESULTS: Thirteen manuscripts met the inclusion criteria that included 547 individuals. Sexually transmitted shigella in MSM was associated with: residing in a capital city/urban region, living with HIV (including engaging in seroadaptive sexual behaviour, having a low CD4 count, having a HIV viral load >100 000 and not engaging with HIV care), using HIV pre-exposure prophylaxis, use of geospatial mobile phone applications to meet sexual partners, visiting sex on premises venues, chemsex and recreational drug use, sexual behaviour (including multiple non-regular sexual partners and oral-anal sexual contact) and concomitant STIs. CONCLUSION: We have highlighted some important risk behaviours and factors that are associated with sexually transmitted shigella in MSM that can be used to target future shigella control interventions.

Barriers and facilitators to seeking and accessing mental health support in primary care and the community among female migrants in Europe: a "feminisms" systematic review.

BACKGROUND: Recent years have seen record levels of migration to Europe. Female migrants are at heightened risk of developing mental health disorders, yet they face barriers to accessing mental health services in their host countries. This systematic review aims to summarise the barriers and facilitators to accessing mental health support for female migrants in Europe. METHODS: The review follows PRISMA guidelines, and the protocol was pre-published on PROSPERO. Six electronic databases were searched: CINAHL, Global Health Database, Medline, PsycARTICLES, PsycINFO and Web of Science. Thematic analysis was undertaken on the identified studies. A feminist quality appraisal tool was applied. RESULTS: Eight qualitative, six quantitative and five mixed methods studies were identified. Barriers included a lack of information, stigma, religious and cultural practices and beliefs, and a lack of consideration of gender-specific needs within the health system. Gender-sensitive services, supportive general practitioners and religious leaders facilitated access. CONCLUSIONS: The design of mental health research, services, policies, and commissioning of support for migrants must consider female migrant needs. Mental health support services must be culturally aware and gender sensitive. REGISTRATION: The review protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO, registration number CRD42021235571.

Que(e) rying undergraduate medical curricula: a cross-sectional online survey of lesbian, gay, bisexual, transgender, and queer content inclusion in UK undergraduate medical education.

BACKGROUND: Lesbian, Gay, Bisexual, and Transgender (LGBT) individuals are more likely to have negative healthcare experiences and worse health outcomes when compared with their heterosexual and cisgender counterparts. A key recommendation of the 2018 Stonewall-commissioned "LGBT in Britain" report was that the curricula, standards, and training provided by medical schools should be reviewed in order to encompass mandatory teaching about LGBT health inequalities and discrimination, LGBT-inclusive care and the use of appropriate language. The aim of our study was to conduct an in-depth national review of the content of LGBT teaching within the curricula of UK Medical Schools. METHODS: Course leads at all 37 UK Medical Schools with students currently enrolled in a primary undergraduate medical training course were asked between December 2019-March 2020 to complete a cross-sectional online survey comprised of 30 questions; divided into three sections relating to the current LGBT teaching (Part 1), any planned or future LGBT teaching (Part 2), and the opinions of the survey respondent about the coverage of LGBT topics (Part 3) at their institution. Responses were analysed using descriptive statistics. RESULTS: Questionnaires were received from 19/37 institutions (response rate: 51%). The median estimated number of hours of LGBT-teaching across the entire undergraduate course was 11.0 (IQR: 12.25). Teaching on LGBT mental health, gender identity, sexual orientation, awareness of LGBT-health inequalities, and LGBT discrimination in healthcare were reported by almost all respondents, whilst maternity and childbirth, chronic disease and LGBT adolescent health were least represented within the curriculum. Almost all (18 medical schools; 95%) responding institutions were considering implementing new LGBT teaching within the next three academic years. A lack of space within the curriculum is a universally reported barrier to the implementation of LGBT teaching. Only 5 (26%) survey respondents consider their institution's current coverage of LGBT topics to be "Good" or "Very good". CONCLUSION: Our study demonstrates a significant variation in the amount and breadth of content within the undergraduate curricula of UK medical schools. Recommendations for increasing the quantity and quality of LGBT content are provided, based upon areas of good practice.

Medical students' awareness of health issues, attitudes, and confidence about caring for lesbian, gay, bisexual and transgender patients: a cross-sectional survey.

BACKGROUND: Lesbian, gay, bisexual and transgender (LGBT) patients have an increased incidence of a range of health problems, and face many barriers to accessing healthcare. Our research aimed to explore the awareness of health issues and attitudes of medical students towards LGBT patients' health including barriers to health services, their attitudes towards inclusion of LGBT content in the curriculum and their confidence with providing care for their LGBT patients in the future. METHODS: Medical students were recruited to take part in a cross-sectional survey. We used a 28-item survey to explore views about the undergraduate medical curriculum. RESULTS: 252 surveys were analysed from 776 eligible participants. Attitudes towards LGBT patients were positive but awareness and confidence with respect to LGBT patients were variable. Confidence discussing sexual orientation with a patient significantly increased with year of study but confidence discussing patient gender identity did not. The majority of participants (n = 160; 69%) had not received specific training on LGBT health needs, and 85% (n = 197) wanted to receive more training. CONCLUSIONS: Increasing the amount of LGBT teaching in undergraduate medical curricula could help to increase the quality of doctor-patient interactions, to facilitate patients' disclosure of sexual orientation and gender identity in healthcare and increase the quality of healthcare.

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK.

OBJECTIVE: Behavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM) internationally, but evidence from England is limited. We aimed to explore service provider and user experiences and perspectives on behavioural interventions to reduce sexual behaviour risks, and the use of automated methods to triage individuals to these services. METHODS: We conducted a sequential mixed methods study with sexual health service providers and users in 2015/2016. Qualitative interviews with providers and service users (heterosexual young people and MSM) in London and Brighton allowed us to explore a range of experiences and expectations. A subsequent national web-survey of service providers measured the feasibility of delivery within existing resources and preferences for intervention attributes. RESULTS: We conducted 35 service user (15 heterosexual young people; 20 MSM) and 26 provider interviews and had 100 web-survey responses. We found considerable heterogeneity in prevention services offered. Service users and providers were broadly supportive of tailoring interventions offered, but service users raised concerns about automated, data-driven triage, particularly around equity and fairness of service delivery. Digital technologies, including social media or apps, were appealing to providers, being less resource intensive. However, one-to-one talking interventions remained popular with both service users and providers, being familiar, trustworthy and personal. Key tensions between desirability of interventions and availability of resources to deliver them were acknowledged/recognised by providers and users. CONCLUSION: Overall, behavioural interventions to reduce sexual behaviour risks were viewed favourably by service providers and users, with key considerations including: privacy, personalisation and convenience. However, introducing desirable targeted interventions within heterogeneous sexual health settings will require resources to adapt interventions and research to fully understand the barriers and facilitators to use within routine services.

A decline in patient disclosure of heterosexuality in the English General Practice Patient Survey: a longitudinal analysis of cross-sectional data.

BACKGROUND: Persistent health inequalities in relation to both health care experiences and health outcomes continue to exist among patients identifying with a marginalized sexual orientation (MSO). OBJECTIVE: To compare the patterns of sexual orientation disclosure within primary care in England over a 5-year period. METHODS: Descriptive analysis of cross-sectional, repeat measure, fully anonymized survey data of adults responding to the General Practice Patient Survey (GPPS) January 2012 to 2017. Participants from each year varied between 808 332 (2017) and 1 037 946 (2011/2012). RESULTS: The analysis samples comprised between 396 963 and 770 091 individuals with valid sexual orientation data depending on the year. For males, heterosexual disclosure decreased consistently from 92.3% to 91.2% from 2012 to 2017. Male patients reporting gay, bisexual and/or 'other' sexual orientations increased from 3.1% to 3.9%. For females, a larger reduction in heterosexual disclosure was recorded from 94% to 92.5%. Those reporting as lesbian, bisexual and/or 'other' increased from 1.82% to 2.68%, with the largest increase seen in the reporting of bisexuality, which nearly doubled from 2012 until 2017 (0.56-0.99%). CONCLUSION: We found a year-on-year decline in patients reporting a heterosexual identity and an increase in the proportions of people reporting being either gay, bisexual, 'other sexual orientation' or preferring not to say. Heteronormative environments extend to health care settings, which may put increased stress on MSO individuals attending a GP practice. The introduction of environmental signs/symbols to show that a practice is inclusive of MSOs could reduce the potential stress experienced by patients.

Preferences for HIV testing services among men who have sex with men in the UK: A discrete choice experiment.

BACKGROUND: In the UK, approximately 4,200 men who have sex with men (MSM) are living with HIV but remain undiagnosed. Maximising the number of high-risk people testing for HIV is key to ensuring prompt treatment and preventing onward infection. This study assessed how different HIV test characteristics affect the choice of testing option, including remote testing (HIV self-testing or HIV self-sampling), in the UK, a country with universal access to healthcare. METHODS AND FINDINGS: Between 3 April and 11 May 2017, a cross-sectional online-questionnaire-based discrete choice experiment (DCE) was conducted in which respondents who expressed an interest in online material used by MSM were asked to imagine that they were at risk of HIV infection and to choose between different hypothetical HIV testing options, including the option not to test. A variety of different testing options with different defining characteristics were described so that the independent preference for each characteristic could be valued. The characteristics included where each test is taken, the sampling method, how the test is obtained, whether infections other than HIV are tested for, test accuracy, the cost of the test, the infection window period, and how long it takes to receive the test result. Participants were recruited and completed the instrument online, in order to include those not currently engaged with healthcare services. The main analysis was conducted using a latent class model (LCM), with results displayed as odds ratios (ORs) and probabilities. The ORs indicate the strength of preference for one characteristic relative to another (base) characteristic. In total, 620 respondents answered the DCE questions. Most respondents reported that they were white (93%) and were either gay or bisexual (99%). The LCM showed that there were 2 classes within the respondent sample that appeared to have different preferences for the testing options. The first group, which was likely to contain 86% of respondents, had a strong preference for face-to-face tests by healthcare professionals (HCPs) compared to remote testing (OR 6.4; 95% CI 5.6, 7.4) and viewed not testing as less preferable than remote testing (OR 0.10; 95% CI 0.09, 0.11). In the second group, which was likely to include 14% of participants, not testing was viewed as less desirable than remote testing (OR 0.56; 95% CI 0.53, 0.59) as were tests by HCPs compared to remote testing (OR 0.23; 95% CI 0.15, 0.36). In both classes, free remote tests instead of each test costing £30 was the test characteristic with the largest impact on the choice of testing option. Participants in the second group were more likely to have never previously tested and to be non-white than participants in the first group. The main study limitations were that the sample was recruited solely via social media, the study advert was viewed only by people expressing an interest in online material used by MSM, and the choices in the experiment were hypothetical rather than observed in the real world. CONCLUSIONS: Our results suggest that preferences in the context we examined are broadly dichotomous. One group, containing the majority of MSM, appears comfortable testing for HIV but prefers face-to-face testing by HCPs rather than remote testing. The other group is much smaller, but contains MSM who are more likely to be at high infection risk. For these people, the availability of remote testing has the potential to significantly increase net testing rates, particularly if provided for free.

Acceptability and feasibility of using digital vending machines to deliver HIV self-tests to men who have sex with men.

OBJECTIVE: Technology-based approaches to distribute HIV self-tests (HIVST) have the potential to increase access to HIV testing in key populations. We evaluate the acceptability and feasibility of using vending machines (VMs) in a community setting to distribute HIVST to men who have sex with men at high-risk of HIV. METHODS: First, a predevelopment survey of targeted potential users explored attitudes towards HIVST and the use of a VM to deliver HIVST. Second, participatory design workshops between designers and community volunteers informed the production of a bespoke VMs dispensing free BioSureHIVST. Uptake of HIVST and user experiences were evaluated using information supplied directly from the machines interface (number of tests dispensed, user demographics), an online questionnaire and semistructured interviews. RESULTS: The predevelopment survey found that 32% of 232 sauna users had never tested for HIV, despite high-risk behaviours. A total of 265 testing kits were dispensed: mean age 31 range (18-70); 4%(n = 7) had never tested for HIV before and 11% (n = 22) had tested within the last 1-5 years. Uptake of tests was significantly higher via the VMs compared with outreach testing by community workers in the same venue during a comparable period (34 vs 6 tests per month). Qualitative interviews and online questionnaires demonstrated high acceptability for this intervention, which was considered accessible and appropriately targeted. CONCLUSIONS: VMs to distribute HIVST was feasible and acceptable. This intervention could be used in different settings to improve access to HIV testing for key populations.

Syndemics of stigma, minority-stress, maladaptive coping, risk environments and littoral spaces among men who have sex with men using chemsex.

There has been a steep rise in the use of drugs during sex (chemsex) by some men who have sex with men in economically developed countries, with associated increases in sexual risk for HIV and other STIs. This paper presents data from telephone interviews with 15 men attending sexual health clinics for post-exposure prophylaxis following a chemsex-related risk for HIV and discusses some of the theoretical approaches that have been employed to understand chemsex and inform interventions. Interviews were conducted as part of a larger intervention study, which used an adapted version of motivational Interviewing to explore risk behaviour and support change. Participants conceptualised their chemsex and HIV-related risks in a psycho-social context, highlighting the influences of psycho-socio-cultural challenges of homophobic marginalisation and the 'gay scene' on behaviour. Multiple influences of stigma, marginalisation, minority stress and maladaptive coping (including drug-use) contribute to syndemic 'risk-environments' and 'littoral spaces' in which chemsex and risk behaviours are played out.

A systematic review of patients', parents' and healthcare professionals' adrenaline auto-injector administration techniques.

INTRODUCTION: In order to enable fast treatment response to anaphylactic reactions, adrenaline auto-injectors (AAI) have been developed and manufactured. It has been reported in several studies that administration technique is suboptimal. The primary purpose of this study was to review the nature and extent of the deficiencies in administration technique among patients, parents/caregivers and healthcare professionals. METHODS: Relevant publications were identified between 1998 and 2015 using two search methods: a keyword search in Embase, PubMed, British Nursing Index and Cumulative Index to Nursing and Allied Health Literature and a search of reference lists of relevant articles. RESULTS: Twenty-three studies met the inclusion criteria. Overall, 37% of patients, 32% of parents/caregivers and 21% of healthcare professionals demonstrated correct administration technique. For studies which employed a before-and-after training study design, correct technique was achieved in 77% of patients, 79% of caregivers and 65% of healthcare professionals. The most consistently observed error was the failure to hold the device in place for the recommended time. For patients, factors associated with good technique were being aged over 18 years, trained in AAI administration by an allergist, prescribed an AAI for more than 30 months, having a history of severe anaphylaxis and membership of a support group. For parents/caregivers in addition to those mentioned, being given a training device with which to practice, improved technique. DISCUSSION: There was wide variation in administration techniques reported. However, studies designed using before-and-after training show that even a brief demonstration and educational intervention can improve technique. Further studies are required to design and pilot acceptable and cost-effective educational materials.

Sexual healthcare professionals' views on HPV vaccination for men in the UK.

BACKGROUND: Human Papillomavirus (HPV) vaccination for men could prevent anal cancers amongst men who have sex with men (MSM). METHODS: An e-survey of attitudes towards vaccination for men in the UK was conducted in July-August 2014. RESULTS: Among 325 sexual health professionals, 14% were already vaccinating men against HPV, 83% recommended gender-neutral HPV vaccination and 65% recommended targeting MSM. Over 50% reported having poor knowledge about the use of HPV vaccine for MSM and the skills to identify MSM likely to benefit from HPV vaccination. CONCLUSIONS: Clear advice and guidelines on HPV vaccine use for men at sexual health clinics are required to ensure equitable opportunities for vaccination.

Factors associated with good adherence to self-care behaviours amongst adolescents with food allergy.

BACKGROUND: Our understanding of factors which affect adherence to health sustaining self-care behaviours in adolescents with food allergy is limited. This study used the Health Belief Model to explore the relationship between food allergic adolescents' health beliefs, demographic, structural and social psychological factors with adherence to self-care behaviours, including allergen avoidance and carrying emergency medication. METHODS: A cross-sectional study of 188 13- to 19- olds identified from hospital prescribed auto-injectable epinephrine for food allergy. Data were collected on demographics, structural factors, social psychological factors, health beliefs and current adherence behaviour using a postal questionnaire. RESULTS: Full adherence was reported by 16% of participants. Multivariate analysis indicated that adherence was more likely to be reported if the adolescents belonged to a support group (OR = 2.54, (1.04, 6.20) 95% CI), had an anaphylaxis management plan (OR = 3.22, (1.18, 8.81) 95% CI), perceived their food allergy to be more severe (OR = 1.24, (1.01, 1.52) 95% CI) and perceived fewer barriers to disease management (OR = 0.87, (0.79, 0.96) 95% CI). CONCLUSIONS: Membership of a patient support group and having an anaphylaxis management plan were associated with good adherence to self-care behaviours in adolescents with food allergy. Our results suggest that interventions to improve provision and utilisation of management plans, address adolescents' perceptions of the severity of anaphylaxis and reduce barriers to disease management may facilitate good adherence behaviours than focussing on knowledge-based interventions.

Human papillomavirus and vaccine-related perceptions among men who have sex with men: a systematic review.

BACKGROUND: Targeted human papillomavirus (HPV) vaccine could prevent HPV-related cancers and genital warts among men who have sex with men (MSM). In order to develop effective vaccination programmes for MSM, it is crucial to understand their knowledge, beliefs about HPV and attitudes towards HPV vaccine. METHODS: A systematic search of 10 databases examined articles investigating HPV knowledge and HPV-related perceptions among MSM. Each paper was assessed to identify potential research directions in the context of targeted HPV vaccination for MSM. RESULTS: We identified 16 studies that included 5185 MSM and conducted mainly in North America. Generally, participants were over 26 years old, had poor-to-moderate knowledge about HPV and were not concerned about HPV-related diseases. Over a half of MSM were willing to accept HPV vaccine, if offered. However, there was large variability in HPV vaccine acceptability, partially due to inconsistencies in methods of ascertainment but also different levels of HPV vaccine awareness. CONCLUSIONS: Despite several misconceptions and poor knowledge of HPV infection, MSM might be receptive to HPV vaccination. However, further research is needed to identify which factors contribute to potential vaccine uptake in hypothetical MSM-targeted HPV vaccination. Future studies need to target those MSM with little sexual experience, who would benefit most from HPV vaccination.

Universal-offer HIV testing in primary care: A mixed-methods evaluation of a pilot study.

BACKGROUND: Offering HIV tests to all patients undergoing blood tests in primary care has been recommended by the National Institute for Health and Care Excellence (NICE) in the UK since 2016 but has not been fully adopted. We sought to evaluate the acceptability and feasibility of such a service in primary care. METHODS: A 3-weeks pilot of offering HIV tests to all patients undergoing blood tests was conducted in a general practice in the UK and evaluated using a mixed-methods approach. Whether patients were offered and accepted tests was recorded and any differences by patient's age and gender assessed. All patients and HCPs offering testing were approached for semi-structured interviews. RESULTS: Two-hundred-and-51 patients (mean [range] 57.5 years [18 to 97], 58% female) attended blood test appointments with 117 being offered a HIV test (46.6%). 78.6% (n = 92) accepted testing with 91 negative results. The proportion of patients offered testing was associated with the HCP offering the test. No associations between the age or gender of the patient and their odds of being offered or accepting a test were observed. Patient semi-structured interviews (n = 13) revealed a range of previous HIV testing experiences, patients felt the "offer" of a test to be routine and non-judgemental and felt that receiving negative results via SMS was appropriate. Several participants reported not fully considering the implications of a positive result when they accepted the test. Interviews with HCPs (n = 3) identified no significant service-level barriers. CONCLUSIONS: Offering HIV tests to patients undergoing blood tests in primary care is feasible and acceptable. The principal barrier to uptake was HCPs not offering testing.

The experiences of transgender and nonbinary adults in primary care: A systematic review.

BACKGROUND: Transgender and nonbinary (TNB) people face barriers to primary care, which remains the main entry point for accessing gender-affirming healthcare in the UK. OBJECTIVES: This systematic review aims to summarise the evidence regarding TNB people's experiences of primary care to inform improvements in service and patient outcomes. METHODS: This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. A systematic literature search was conducted across articles from 2005 to April 2023 across Ovid Medline, Ovid Embase and PsychInfo using established keywords relating to gender identity, primary care and experiences. Qualitative data were thematically analysed and quantitative data were compiled using a descriptive narrative. RESULTS: Following eligibility criteria, 16 articles were included in this review. This review identified both facilitators and limitations and barriers experienced by TNB people related to primary care provider knowledge; the patient-provider relationship, and healthcare settings. Quantitative findings reported up to 54.4% of participants were uncomfortable discussing TNB issues with their physician. Overall findings suggest TNB people face discrimination on a systemic level utilising primary care services, though positive healthcare encounters at a local level were reported. Participants expressed a desire for primary care-led gender-affirming healthcare services, with involvement from local TNB communities. CONCLUSION: This review demonstrates TNB people's mixed experiences of primary care alongside their recommendations for service improvement. This is the first systematically reviewed evidence on the topic, emphasising the need for clinicians and policymakers to centre the voices of the TNB community in service design and improvement.

Many TNB participants had negative experiences in primary care, attributed to a lack of healthcare provider knowledge and medical gatekeeping.Many TNB participants desired gender-affirming healthcare services to be more primary care-led.Primary care services should consult local TNB communities in service design, evaluation and improvement.

Achieving health equity through conversational AI: A roadmap for design and implementation of inclusive chatbots in healthcare.

BACKGROUND: The rapid evolution of conversational and generative artificial intelligence (AI) has led to the increased deployment of AI tools in healthcare settings. While these conversational AI tools promise efficiency and expanded access to healthcare services, there are growing concerns ethically, practically and in terms of inclusivity. This study aimed to identify activities which reduce bias in conversational AI and make their designs and implementation more equitable. METHODS: A qualitative research approach was employed to develop an analytical framework based on the content analysis of 17 guidelines about AI use in clinical settings. A stakeholder consultation was subsequently conducted with a total of 33 ethnically diverse community members, AI designers, industry experts and relevant health professionals to further develop a roadmap for equitable design and implementation of conversational AI in healthcare. Framework analysis was conducted on the interview data. RESULTS: A 10-stage roadmap was developed to outline activities relevant to equitable conversational AI design and implementation phases: 1) Conception and planning, 2) Diversity and collaboration, 3) Preliminary research, 4) Co-production, 5) Safety measures, 6) Preliminary testing, 7) Healthcare integration, 8) Service evaluation and auditing, 9) Maintenance, and 10) Termination. DISCUSSION: We have made specific recommendations to increase conversational AI's equity as part of healthcare services. These emphasise the importance of a collaborative approach and the involvement of patient groups in navigating the rapid evolution of conversational AI technologies. Further research must assess the impact of recommended activities on chatbots' fairness and their ability to reduce health inequalities.