Human papillomavirus (HPV) screening can be used as an early detector for cervical cancer. The newly US Food and Drug Administration-approved HPV self-sampling tests can be used by safety net practices in the USA to help mitigate the current screening disparities seen in patients. As patient acceptability and capability have already been established, this scoping review synthesizes the barriers and facilitators of implementing HPV self-sampling from the perspective of safety net providers and leadership, and the upstream factors not yet explored in current research. Following PRISMA-ScR guidelines, a literature search was conducted exploring peer-reviewed publications and grey literature to establish the current landscape of HPV self-sampling. Findings were organized using the Consolidated Framework for Implementation Research. From the 57 works included, it was found that safety net practices are capable of implementing HPV self-sampling by utilizing current workflows and team members. However, outer setting guidelines and policies heavily influence the implementation process, likely causing a delay in uptake by safety net practices. Recent guideline endorsements and forthcoming insurance coverage address several of these barriers, making post-approval implementation research in safety net settings an urgent priority.
Background Generative artificial intelligence chatbots are increasingly used for health information, including sensitive conditions, such as erectile dysfunction (ED), but their safety and quality remain uncertain. To compare six large language model chatbot interfaces for ED information across safety, accuracy, empathy, information quality, source-related transparency, readability and response length. Methods Thirty-eight standardized ED questions were submitted once to six chatbot interfaces, yielding 228 responses. Five independent raters assessed Safety, Accuracy, Empathy, DISCERN, Ensuring Quality Information for Patients, the Journal of the American Medical Association benchmark and Global Quality Score. Readability and response length were also evaluated. Between-interface differences were tested using Cochran’s Q or Friedman tests. Results Twenty-six responses (11.4%) were safety-flagged. Safety-flag frequency differed across interfaces (Q = 11.765, P = 0.038), but the effect size was small (0.062; 95% CI, 0.026–0.148), and no pairwise difference remained significant after multiplicity correction. Accuracy was generally high (median 4.00/5 for all interfaces), but differed slightly overall (P = 0.010, Kendall’s W = 0.080). Empathy (P < 0.001, W = 0.160), DISCERN (P = 0.003, W = 0.508), Ensuring Quality Information for Patients (P < 0.001, W = 0.576), and Journal of the American Medical Association benchmark scores (P < 0.001, W = 0.888) differed significantly, whereas Global Quality Score did not (P = 0.146). Readability and response length also differed (all P < 0.001). Conclusion Large language model chatbots generally provided accurate ED-related information, but performance varied across clinically relevant dimensions. They may support information seeking, but should not replace individualized clinical assessment.
Background Evidence of declining condom use over time among adolescents across diverse settings underscores the need to understand sexual health indicators among this population. Few studies have examined trends in lifetime sexual activity and condom use self-efficacy over time among adolescents in Arctic or remote settings. This study assessed changes and sociodemographic patterns in these outcomes across 7 years among Northern and Indigenous adolescents in the Northwest Territories, Canada. Methods We conducted repeated cross-sectional surveys among secondary school students aged 13–18 years across 17 Northwest Territories communities from 2018 to 2024. Outcomes included lifetime sexual activity (ever having engaged in vaginal, anal or oral sex) and condom use self-efficacy. Linear and logistic mixed-effects regression models estimated unadjusted and adjusted associations with time, gender, sexual orientation, Indigenous identity, and rural residence, including interaction terms. Results Among n = 2745 participants (mean age 13.68 years, standard deviation 1.49; gender: 45.65% cisgender girls, 50.27% cisgender boys and 4.08% gender diverse), 19.06% identified as lesbian, gay, bisexual or queer (LGBQ), 72.62% as Indigenous and 71.17% lived in rural settings. From 2018 to 2024, condom use self-efficacy decreased (adjusted beta coefficient −0.25; 95% CI: −0.36, −0.15; P < 0.001), and was lower among LGBQ and rural youth. Sexual activity also declined (adjusted beta coefficient −0.01; 95% CI: −0.02, −0.01; P < 0.001), but remained higher among cisgender girls, LGBQ youth, Indigenous adolescents and rural youth. Conclusion Condom use self-efficacy and sexual activity declined over time, with persistent disparities across groups. Findings highlight the need for sustained, culturally grounded, equity-focused sexual health programming for Northwest Territories adolescents.
Background Female sex workers (FSWs) face disproportionately high rates of unintended pregnancy and unmet family planning needs. Peer-led interventions offer a promising strategy to expand access to contraceptives for populations such as FSWs that are routinely stigmatized or otherwise left behind by traditional healthcare facilities. Methods We trained 50 peer educators across four divisions of Nansana Municipality in Uganda to deliver contraceptive education and provide free short-acting contraceptives directly to FSWs. Peer educators also facilitated referrals as needed to a stigma-free clinic offering long-term contraceptives, and comprehensive sexual and reproductive health services. Peer educators were trained in destigmatizing sexual and reproductive health service provision for FSWs specifically. Providing these services at a designated clinic minimized structural barriers, such as stock-outs and disrespectful provider attitudes, enabling effective referrals and service uptake. Results Over 12 months, 787 FSWs received contraceptive education: 5420 male and 510 female condoms were distributed, 232 FSWs accepted oral contraceptives, and 179 were referred for and received long-acting methods, with 74 receiving injectables and 105 implants or intrauterine devices. Conclusions Peer-led models can expand contraceptive access among FSWs in designated stigma-free facilities with reliable supply chains. To achieve sustainable contraceptive access among FSWs more broadly, this approach should be integrated into government sexual and reproductive health systems.
Background This exploratory study aimed to investigate differences between metropolitan and regional people living with HIV (PLHIV) in relation to experiences of stigma and openness about HIV status. Methods PLHIV attending publicly funded sexual health services in metropolitan Sydney or regional NSW completed an anonymous, cross-sectional survey about experiences of HIV-related stigma in the past year. Multivariable logistic regression analysis identified differences between metropolitan and regional participants. Results Among 89 participants, 79.8% (n = 71) were from metropolitan Sydney and 20.2% (n = 18) were from regional NSW. Approximately 50% of both groups reported any past-year experience of HIV-related stigma. Multivariable analysis found that regional participants were older than metropolitan participants (aOR 2.26, 95% CI: 1.18–4.32), were less likely to report sexual or intimate partner rejection (aOR 0.11, 95% CI: 0.02–0.64) and were more likely to report any past-year stigma from doctors (aOR 5.57, 95% CI: 1.05–29.66). Conclusions Although similar proportions of regional and metropolitan participants experienced HIV-related stigma, results suggest that these experiences were contextually different. Initiatives to reduce stigma and promote healthcare engagement among PLHIV may benefit from considering demographic differences and regional contexts (including healthcare settings). Opportunities may also exist to expand sexual health services (e.g. telehealth) to alleviate concerns about disclosing HIV status in smaller communities.
