Over a decade since its introduction, pre-exposure prophylaxis (PrEP) has significantly expanded the HIV prevention toolkit. However, although more than 3.5 million people received PrEP globally in 2023, this remains well below the global target of 10 million users by 2025, and global implementation reveals persistent disparities, particularly affecting women, including both cisgender women (CW) and transgender women (TW). Despite World Health Organization (WHO)-endorsed recommendations, PrEP uptake among these populations remains disproportionately low across multiple regions, including sub-Saharan Africa, the Americas, Southeast Asia, the Eastern Mediterranean, Europe, and the Western Pacific. This narrative review synthesizes regional patterns and identifies epidemiologic, legal, and structural factors that perpetuate both inequalities, quantifiable differences in access, and deeper inequities rooted in stigma, exclusion from health systems, and gender-based vulnerability. Although many CW are formally eligible for PrEP, their uptake remains low due to low-risk perception, limited outreach, and sociocultural constraints. TW may have higher levels of PrEP awareness in some contexts, yet continue to face layered structural barriers including criminalization, healthcare discrimination, and lack of gender-affirming services. Across regions, surveillance often fails to disaggregate data by gender identity, clinical trials exclude female participants, and provider bias persists. However, promising models such as community-led delivery in Thailand and South Africa, integrated sexually transmitted infection (STI) services in Cambodia, and long-acting injectable PrEP, highlight pathways to more inclusive prevention. By framing access through the lens of inequity, this review emphasizes that improving coverage requires more than policy expansion: it demands tailored, context-sensitive strategies that center the needs of the most underserved. Ensuring equitable PrEP access for all genders requires more than policy expansion: it demands coordinated efforts in data collection, health system reform, legal advocacy, and community-led innovation.
Background Artificial intelligence (AI) is increasingly influencing healthcare practice, delivery, organizations, and patient experiences. This review uses a sociotechnical perspective to understand social transformation as interdependent changes in professional authority, relationships and trust, organizational routines, ethics and equity, access to care, and the culture of human–AI collaboration. Qualitative evidence is needed because most technical evaluations do not capture how stakeholders experience or anticipate these changes. Aim This systematic review aimed to synthesize qualitative evidence on how stakeholders experience or anticipate AI‐related changes in the social dimensions of healthcare, with particular emphasis on professional roles, patient–provider relationships, trust and transparency, ethical challenges, organizational and workforce change, healthcare access, and sociotechnical culture. Methods A qualitative systematic review was conducted in accordance with PRISMA 2020. PubMed, Scopus, Web of Science, CINAHL, PsycINFO, and Embase were searched for English‐language peer‐reviewed studies published from January 2010 through April 30, 2026. Two reviewers independently screened records, extracted qualitative findings, and appraised eligible studies with the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research; disagreements were resolved by consensus or a third reviewer. Two reviewers independently conducted a combined inductive–deductive thematic synthesis. Results The synthesis of 49 studies identified seven interconnected themes. Stakeholders described or anticipated changes in professional roles and decision authority, patient–provider relationships, trust and acceptance, ethical and equity concerns, organizational and workforce arrangements, healthcare access, and sociotechnical culture. Healthcare professionals emphasized autonomy, accountability, training, and workflow integration; patients emphasized understandable explanations, privacy, and preservation of human contact; and organizational stakeholders emphasized infrastructure, governance, and implementation capacity. These findings represent perceptions and experiences and do not establish clinical effectiveness or complete system‐wide transformation. Conclusion Available qualitative evidence indicates that stakeholders perceive or anticipate substantial AI‐related changes in healthcare roles, relationships, organizations, and access. These perceptions should not be interpreted as proof of clinical benefit or completed social transformation. Responsible implementation requires transparent governance, human accountability, representative validation, context‐specific evaluation, workforce preparation, and sustained protection of human‐centered care and equity. Trial Registration: The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420261411745).
Objectives To assess the level of intention to use youth‐friendly reproductive health services (YFRHS) and identify its predictors using the theory of planned behavior (TPB). Methods An institution‐based cross‐sectional study was conducted from May 23 to June 12, 2022, in the East Belesa district. The stratified simple random sampling technique was used. Data was entered using EpiData version 4.6 and analyzed using STATA version 14. Standardized β and R 2 values were used to interpret effects and variability with intention to use youth‐friendly services, respectively. Simple and multiple linear regression analysis were performed. Statistical significance was declared at a p ‐value of <0.05 with a 95% confidence interval. Results A total of 511 respondents participated in the study giving a response rate of 99.8%. The variance in intention to use YFRHS explained by all predictors was 40%. Around half of the participants were males (52.8%). The mean score of intention to use youth‐friendly services was 3.39 ± 1.14. Direct perceived behavioral control ( β = 0.25, 95% CI: 0.05, 0.45), subjective norm ( β = 0.28: 95% CI: 0.09, 0.47), attitude ( β = 0.20; 95% CI: 0.03, 0.36), educated mothers ( β = 1.65, 95% CI: 0.21, 3.09), and female sex ( β = −1.77; 95% CI: −3.09, −0.44) were significant predictors of intention to use youth‐friendly services. Conclusion and Recommendation The magnitude of intention to use youth‐friendly services was low. Perceived behavioral control, attitude, subjective norm, educated mothers, and sex were the predictors of intention to use youth‐friendly services. The study informed that the TPB could be applied to predict the intention of youths to use youth‐friendly services.
Background Unintentional injuries in school children are a major public health issue. In Iran, school health instructors (SHIs) are the frontline responders to school injuries, yet their preparedness is understudied. This study aimed to assess SHIs’ knowledge of emergency management, using dental trauma as a representative example. Methods A descriptive cross‐sectional study was conducted in 2025 among 450 SHIs who completed an updated online questionnaire based on current evidence‐based recommendations. The instrument assessed knowledge related to immediate response, first aid measures, and referral decisions following traumatic injuries in school environments. Data were analyzed using descriptive statistics, comparative tests (independent t ‐test and one‐way ANOVA), and multiple linear regression in SPSS version 21. Knowledge scores were compared according to prior training, gender, and work experience. Results The mean knowledge score indicated a moderate level of preparedness (55.7 ± 6.7 out of 90). Notable gaps were observed in critical aspects of emergency response, including awareness of tetanus prophylaxis following trauma (19.6%). SHIs who had received prior training demonstrated significantly higher knowledge scores compared with those without training (60.2 ± 5.9 vs. 52.3 ± 7.1, p = 0.01). No significant associations were found with gender or work experience. Conclusions Iranian elementary SHIs demonstrate suboptimal preparedness for emergency management of school‐related traumatic injuries. Standardized training programs represent a key modifiable strategy to strengthen school health services, enhance injury prevention, and improve emergency response capacity in school settings.
Background Although global progress has reduced stunting and wasting, progress remains uneven across countries and is insufficient in many settings, including parts of Iran, to achieve Sustainable Development Goal 2.2 by 2030. Data on malnutrition prevalence and determinants among under‐five children in Iran, particularly in large urban settings, are limited. The aim of this study was to determine the prevalence and factors associated with malnutrition among under‐five children in Mashhad, Iran. Methods This cross‐sectional study was a secondary analysis of baseline screening data from a community‐based nutritional intervention study conducted in Mashhad, Iran. The sample included 219 children aged 12–60 months from economically at‐risk households attending primary healthcare centers. Anthropometric measurements were converted to Z‐scores based on the World Health Organization (WHO) 2006 Child Growth Standards. Parental questionnaires collected sociodemographic, birth, feeding, and economic data. Results Overall prevalence of underweight, stunting, and wasting were 22.8%, 16%, and 24.7%, respectively. Only the crude prevalence of stunting decreased significantly across age groups, from 29.4% in children aged 12–24 months to 9.5% in those aged 36–60 months ( p = 0.007). In contrast, after adjustment for potential confounders, children aged 36–60 months had higher odds of stunting than those aged 12–24 months (OR = 5.68, 95% CI: 1.56–20.65, p = 0.008). Paternal unemployment was a risk factor for underweight (OR = 4.40, 95% CI: 1.18–16.29, p = 0.02). Maternal employment was protective against stunting (OR = 0.09, 95% CI: 0.13–0.65, p = 0.02). Delayed complementary feeding initiation was protective against wasting (OR = 0.19, 95% CI: 0.04–0.87, p = 0.03). Conclusion Malnutrition was prevalent among under‐five children in economically vulnerable areas of Mashhad. Socioeconomic factors, parental occupation, and timely complementary feeding should be considered in designing targeted interventions to eliminate childhood malnutrition.
