Background: Adolescent and young adult (AYA; 14-24 years old) engagement in HIV programs is often transient, and socioeconomically marginalized AYA are less engaged. Few studies have examined whether engagement can be sustained over time in HIV prevention programs. This study examines correlates of sustained AYA engagement over 24 months in an HIV prevention program in Nigeria. Methods: We conducted a secondary data analysis of longitudinal data from an HIV prevention program among AYA in 32 local communities in Nigeria from 2021 to 2023. In the study, participants were invited to join crowdsourcing open calls, peer-led support meetings, and other activities. Engagement was assessed using a modified 12-item Tiffany-Eckenrode Program Participation Scale (0-4 per item) at months 3, 6, 12, 18, and 24. Sustained AYA engagement was defined as a mean score >/= 3.0/4.0 in at least three consecutive contacts (approximately 12 months). Longitudinal analysis was conducted using generalized estimating equations, and state-level contextual analysis was done using a linear mixed model. Results: A total of 1,259 AYA were included. The mean age was 19.8 years; most were students (n=954,75.8%) and unemployed (n=810,64.3%). The mean participation score remained consistently high throughout the 24 months (3.245 +/-0.535 to 3.319 +/-0.556), with 73.0% demonstrating sustained engagement. Students were less likely to sustain engagement compared to non-students (aRR = 0.91; 95% CI: 0.84-0.97). Unemployed AYA were more likely to sustain engagement than employed AYA (aRR= 1.09; 95% CI:1.03-1.14). States with higher poverty had significantly greater sustained AYA engagement. All the main findings were robust in sensitivity analyses. Conclusion: AYA engagement in the HIV self-testing implementation was high and sustained over 24 months, especially among socio-economically disadvantaged populations. This study supports the use of a participatory, AYA-led approach in sustaining AYA engagement in HIV prevention programs and has implications for the equity of HIV programs.

BACKGROUND:Youth participation is critical to improving HIV prevention outcomes, yet evidence on the quality of adolescent and young adult (AYA) participation in HIV self-testing programs in low- and middle-income countries remains limited. This study assessed levels and correlates of AYA participation in HIV self-testing interventions implemented in Nigeria. METHODS:We conducted a secondary analysis of data from the Innovative Tools to Expand Youth-friendly HIV Self-Testing study, which recruited AYA aged 14-24 years from four Nigerian sites (September 2019-March 2020). Participation was measured using an adapted 12-item Tiffany-Eckenrode Program Participation Scale across four domains: ownership, voice/influence, support and community participation. Scores ranged from 0 (strongly disagree) to 4 (strongly agree) and were categorized as minimal (<3.5), moderate (3.5-4.0) or substantial (>4.0). Chi-squared tests examined associations between participation levels and sociodemographic variables, with Cramér's V summarizing effect sizes. RESULTS:Among 388 AYA (mean age 21 ± 2 years; 58% male), overall participation was high (M = 4.04 ± 0.24). Domain-specific analyses showed substantial participation in support (M = 4.08 ± 0.23), community participation (M = 4.04 ± 0.24) and ownership (M = 3.94 ± 0.27), whereas voice/influence was moderate (M = 3.87 ± 0.32). Education (χ2 = 43.23, P < 0.001; V = 0.33), employment (χ2 = 122.70, P < 0.001; V = 0.56) and income (χ2 = 119.68, P < 0.001; V = 0.55) were significantly associated with participation, whereas age, sex and marital status were not. CONCLUSION:These findings highlight generally high AYA participation in HIV self-testing interventions, but underscore socioeconomic disparities that may shape participation quality. Programs should prioritize equitable engagement strategies for youth with fewer resources.

INTRODUCTION:The engagement of youth in the design of services that promote and increase the uptake of essential services to reduce HIV and other sexually transmitted infections is vital to sustaining these preventive services. The study objective is to identify strategies for sustaining HIV prevention services among Nigerian youth, in partnership with community-based organizations, through a crowdsourced open call and designathon in Nigeria. MATERIALS AND METHODS:From February to March 2024, Nigerian youth (ages 14-24) submitted ideas to an open crowdsourcing call on how community-based organizations in Nigeria might sustain HIV self-testing and youth-friendly preventive services for at-risk youth. The submissions were scored in each domain: relevance, novelty, scalability, replicability, potential for sustainability, and promotion of equity and fairness, with an integer score of 1 (low) to 3 (high)(S1). Ten teams were selected to participate in the 72-hour designathon. Both quantitative and qualitative analysis was conducted. The study used thematic analysis and the PEN 3-Cultural Model to categorize qualitative data into six themes. Descriptive statistics were used to calculate participants' demographic characteristics. RESULTS:One hundred and seventy-eight participants submitted entries; 161 were online entries, and 17 were received via WhatsApp. The majority of participants were female (57.1%) and aged 19-23 years (55.0%), with a mean age of 21.7 (±4.1). Most participants were from the southwest of Nigeria (53.8%), had secondary education (68.9%), and were students (67.9%). About one-third of teams (31.1%) indicated collaborating with non-governmental organizations as a promising way to sustain preventive services. Six themes emerged: Adapted Intervention Design and Delivery, Youth Engagement and Education, Organization Setting, Socio-cultural and Community Context, Community Leadership Through Training and Financial Resources, and Sustainment Through Community Collaboration. CONCLUSION:The crowdsourcing contest open call and designathon engaged youth from diverse backgrounds, and it is a practical way to generate solutions from key stakeholders affected by the community's prevailing health issues. Developing service delivery strategies that engage, educate, and collaborate with youth on HIV prevention could be sustainable. However, this will not be conclusive without implementing them over time to test their feasibility and sustainability.

Adolescents and young adults (AYA) in Nigeria with increased HIV risk, such as those who engage in multiple sexual partnerships (i.e., more than one sexual partner within a specified period), transactional sex (i.e., exchange of money or gifts for sex), or needle-sharing (i.e., needles or other injection equipment are shared by multiple people), are eligible for pre-exposure prophylaxis (PrEP). One strategy that has the potential to reach PrEP-eligible AYA is HIV self-testing, which can expand existing HIV testing services and support differentiated PrEP programs. However, little is known about HIV self-testing in these AYA populations. We examined associations between these three high-risk behaviors and HIV self-testing. We analyzed data from Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST), a stepped-wedge trial examining the impact of a combination intervention package on HIV self-testing among AYA aged 14-24 years in Nigeria. We fit generalized linear models, with an identity link and a binomial error distribution, using generalized estimating equations. We generalized trial estimates to all AYA in Nigeria using a two-stage weighted approach. Of 1,429 participants, the median age was 20 years (IQR: 18-22), 50.3% were female, and 69.4% reported secondary school as their highest education level completed. AYA who engaged in transactional sex had higher HIV self-testing uptake (8.1% [4.8, 11.5]) than AYA with no history of transactional sex. There were no statistically significant differences in recent HIV self-testing uptake among AYA by sexual partnerships or needle-sharing history. The trial estimates were similar in the adjusted models. The estimates for the trial and generalized samples were in the same direction, except for AYA with two recent sexual partners. There was a high level of HIV self-testing uptake across all categories of sexual partnerships, transactional sex, and needle-sharing, with significantly higher uptake among those who engaged in transactional sex, indicating that HIV self-testing strategies are reaching these various AYA populations and the need to sustain access for these groups.

BackgroundImplementation strategies are dynamic and multi-faceted, and may require adaptations to fit implementation contexts, especially in lower-and-middle income countries. We report the adaptations for an ongoing late-stage implementation science trial (R01HL147811) that integrates hypertension management into HIV care in Lagos, Nigeria - a country with a high dual-disease burden - through the Task Strengthening Strategy for Hypertension (TASSH) intervention and Practice Facilitation implementation strategy.MethodsFRAME (Framework for Reporting Adaptations and Modifications-Enhanced) modules were used to record adaptations to the intervention (i.e., TASSH) respectively, enhance participant recruitment and retention rates, and increase frequency of trainings. Data collection sources included (not limited to) patient records, nurses' logs, and minutes of implementation review meetings. Data across these sources was coded retrospectively by trained research staff and triangulated during virtual meeting discussions. Once consensus was reached, data was mapped onto the relevant framework modules using Microsoft Excel.ResultsWe modified FRAME to include an additional component on 'what was originally planned' for the context of the adaptations. There were twelve adaptations identified during the implementation of the study. The adaptations characterized by using the frameworks included reordering recruitment start dates of study cohorts, providing patients incentives to attend follow-up visits, adding feeder sites to the study sites, and increasing the frequency of training to account for the high nurse turnover in the primary healthcare centers. Overall, 25% of the adaptations involved expanding the structure of the intervention and implementation strategies, and 33% involved adding new elements to the strategies. All adaptations occurred in the implementation phase of the trial.ConclusionBased on our experiences, the characterization of the adaptations using FRAME demonstrates their combined applicability to an ongoing trial that can be tailored to fit the local context.Trial registrationClinicalTrials.gov ( NCT04704336). Registered on 11 January 2021.

Incorporating culturally relevant music can enhance awareness and control in hypertension management and stroke preparedness. The Music4Health initiative created music-driven campaigns focused on youth and their caregivers. We outlined the components of songs developed through community participation to raise awareness about hypertension and stroke preparedness. The project was conducted in three phases: an open call, a designathon, and a bootcamp. From October 2023 to July 2024, a crowdsourcing open call was launched online and in person. Teams and individuals submitted ideas for creatively disseminating evidence-based prevention strategies for hypertension and stroke through music. Fifteen participants were invited to a 3-day designathon to refine their songs with expert mentors. The final phase, a bootcamp, involved community assessment and intensive workshops with the top six teams to develop and record complete songs with experts and producers. The lyrics from the bootcamp were analyzed using rapid thematic analysis guided by the PEN-3 cultural model, focusing on Relationships and Expectations and Cultural Empowerment domains. Thematic analysis of the seven finalist songs from the bootcamp identified themes using two PEN-3 model domains. The Relationship and Expectations domains included perceptions of hypertension severity, myths about hypertension (like the role of “juju”), and the necessity for healthy coping strategies. Enablers focused on the availability of hypertension prevention strategies, such as healthy diets, stress management, and avoidance of smoking. Nurturers emphasized raising awareness about hypertension among families, adopting healthy practices for loved ones, and the role of peers in promoting healthy habits. Unique cultural aspects included using Afrobeat and Fuji beats, pidgin English, and references to spirituality in adopting health practices. Culturally centered music may be an appealing channel for promoting the uptake of evidence-based health interventions. This study highlights the feasibility of using participatory approaches to co-create health dissemination strategies, leveraging music's cultural relevance and appeal to engage youth and their caregivers in hypertension and stroke prevention.

IntroductionThe timely administration of the birth-dose hepatitis B (HepB-BD) vaccine is recommended by global and national guidelines to effectively prevent perinatal transmission. In high-disease-burden countries, such as Nigeria, the adoption of the HepB-BD vaccine remains limited. Emerging global policy discussions highlight the need to examine healthcare workers’ (HCWs’) perceptions of pediatric vaccination guidelines, the safety and effectiveness of the HepB-BD vaccine, and how family, social support, and community factors influence vaccine delivery.MethodsA convergent mixed-methods study of HCWs was conducted in Nigeria between July and August 2024. Using the PEN-3 Cultural Model as our framework, we concurrently administered quantitative surveys and conducted in-depth qualitative interviews and focus group discussions to assess knowledge, beliefs, and peer influences related to HepB-BD vaccinations. We also explored HCWs’ perceptions, enabling factors, and social influences that impact vaccine delivery. Data were analyzed using descriptive statistics and thematic analysis.ResultsMost participants were women (87.8%), nurses (24.4%), and community extension workers (14.6%), with an average age of 32.5 years. Over half perceived HepB-BD vaccines as extremely safe (61%) and effective (63.4%). Participants strongly agreed that birth vaccination is recommended (80.5%), ethically appropriate (68.3%), and that its benefits outweigh side effects (63.4%). Most respondents reported professional autonomy in birth-dose decisions: 51.2% strongly disagreed that family opinions influenced their decisions, and 48.8% strongly disagreed that family/friends were concerned about their administering the vaccine. Qualitative themes included perceptions of barriers (poor knowledge, limited vaccine stock, misinformation), enablers (transportation and cold chain reliability), and nurturing factors (the role of training and collaboration with traditional birth attendants). Misconceptions included linking vaccines to sexually transmitted infections and concerns about fragile newborn immunity.ConclusionHepB-BD vaccine delivery by HCWs is influenced by a complex interplay of multiple factors, including perceptions, structural enablers, and social relationships. As global policies continue to evolve, programs should adopt culturally responsive, context-specific strategies to address these multi-level influences and foster HCW trust, thereby ensuring the timely delivery of the HepB-BD vaccine.

Background HIV incidence remains high among Nigerian youth aged 14–24 years. We evaluated the impact and cost-effectiveness of youth-led HIV self-testing (HIVST) interventions tailored to this population. Methods We developed a dynamic HIV transmission and disease progression model for people aged 14–49 years, using cost and intervention data from a Nigerian youth-led HIVST trial involving youth in design, implementation, and evaluation. Scale-up was projected across 18 implementation scenarios varying by schedule and coverage during 2023–2050. Cost-effectiveness was assessed from a healthcare provider perspective using incremental cost-effectiveness ratios (ICERs). Sensitivity analyses were conducted to assess robustness. Findings Maintaining the status quo was projected to result in 2,819,873 HIV acquisitions and 142,352 AIDS-related deaths among youth during 2023–2050. Scaling up youth-led HIVST interventions showed potential to reduce the burden. On the cost-effectiveness frontier, intervention every two years over five years with 80% coverage was the preferred strategy at the 1-time per-capita gross domestic product (GDP) reference threshold, with an ICER of US$1678.6/QALY and a 90% probability of being cost-effective. Under this strategy, annual HIV-related healthcare expenditures were projected to become lower than under the status quo from around 2040 onward. At lower willingness-to-pay (WTP) thresholds, less intensive implementation or the status quo was more likely to be preferred. Interpretation Scaling up youth-led HIVST could substantially benefit Nigerian youth, but the preferred implementation strategy depends on the WTP threshold. At the 1-time per-capita GDP reference threshold, implementation every two years over five years with high coverage was preferred. Funding Eunice Kennedy Shriver National Institute of Child Health and Human Development.

INTRODUCTION:Interventions to eliminate mother-to-child transmission of HIV have led to a low vertical transmission rate and improved reproductive outcomes for women living with HIV. There are genuine concerns about the long-term effect of antiretroviral drugs (ARVs) on the future reproductive function of females, as female rodent models have shown impaired folliculogenesis when treated with contemporary ARVs. There is a need to investigate the effect of contemporary ARVs on the ovarian reserve of patients receiving ARVs. METHODS:This cross-sectional study was conducted on women between the reproductive age of 15 and 45 years, forming three study categories. Group 1 comprised HIV-positive patients already on efavirenz-based antiretroviral therapy. Group 2 comprised HIV-positive patients who were naïve to ARVs at the time of recruitment. Group 3 comprised HIV-negative women within the reproductive age range not on ARVs (controls). We used t-test and ANOVA for statistical analysis. The alpha level was significant if the p-value was <0.05. RESULTS:The average value of follicle-stimulating hormone was significantly higher in the HIV-positive group receiving ARVs, compared to the control group (p = 0.039). The average value of luteinizing hormone was significantly higher in the HIV-positive group receiving ARVs when compared to the HIV-negative group (p = 0.014). The antral follicular count was significantly reduced in the group receiving ARVs, compared to HIV-positive individuals naïve to ARVs and HIV-negative controls (p = 0.009). CONCLUSION:Evidence from this study suggests that efavirenz-based antiretroviral medication disrupts follicular development.

Sustaining evidence-based interventions in resource-limited settings is critical to optimizing gains in health outcomes. In 2015, we published a review of the sustainability of health interventions in African countries, highlighting gaps in the measurement and conceptualization of sustainability in the region. This review updates and expands upon the original review to account for developments in the past decade and recommendations for promoting sustainability. First, we searched five databases (PubMed, SCOPUS, Web of Science, Global Health, and Cumulated Index to Nursing and Allied Health Literature (CINAHL)) for studies published between 2015 and 2022. We repeated the search in 2023 and 2024. The review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. Studies were included if they reported on the sustainability of health interventions implemented in African countries. Study findings were summarized using descriptive statistics and narrative synthesis, and sustainability strategies were categorized based on the Expert Recommendations for Implementing Change (ERIC) strategies. Thirty-four publications with 22 distinct interventions were included in the review. Twelve African countries were represented in this review, with Nigeria (n = 6) having the most representation of available studies examining sustainability. Compared to the 2016 review, a similar proportion of studies clearly defined sustainability (52

While a growing body of scientific literature suggests that evidence-based interventions may improve health outcomes in diverse settings, little is known about the best strategies for large-scale implementation. In Africa, music—an important positive social determinant of health—leverages existing cultural values, which may effectively enhance the reach, uptake, and long-term sustainability of evidence-based interventions in the region. To understand how music interventions work, why they are effective, and with whom they resonate, this systematic review aims to evaluate the quality and empirical application of music as an implementation strategy for adopting evidence-based interventions in Africa using the RE-AIM framework as a guide. A comprehensive librarian-assisted search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five major electronic databases, EBSCOhost, PubMed, Web of Science, Embase, and MEDLINE, were searched for empirical studies focused on using music as an implementation strategy to improve health outcomes in Africa. Two independent investigators extracted components of retrieved papers using the RE-AIM framework as a guide. From 981 citations, eight studies met the inclusion criteria, each reporting a unique music intervention. The interventions were conducted in West Africa (n = 3), South African regions (n = 4), and East Africa (n = 1) and included seven observational studies and one randomized controlled trial (RCT). Using the RE-AIM scoring criteria, we summarize the RE-AIM dimensions reported from selected studies – Adoption (72.5

The COVID-19 pandemic has presented substantial global challenges, necessitating a deep understanding of infection dynamics across diverse populations. Seroepidemiological studies offer valuable insights into these dynamics but depend heavily on obtaining representative samples. This study aimed to assess participant response rates across different age groups and residence settings in Nigeria, focusing on three distinct locations: Lagos, Delta, and Sokoto States. The study utilized a probability sampling procedure, employing a two-stage cluster sampling method to select Enumeration Areas (EAs) and then households with equal probability. Data from the sero-epidemiological survey served as secondary data for analyzing response rates. The American Association for Public Opinion Research (AAPOR) Response Rate 4 (RR4) method was applied. Response rates were calculated, and analyses stratified by age and residence were conducted to examine survey response patterns. In Lagos State, response rates varied significantly across age groups and residence settings. Children aged <2 years had a response rate of 87.9%, but a lower survey response rate of 54.3%. The 2-9 years age group had a high response rate of 97.4% with a survey response rate of 75.5%. Adolescents (10-17 years) showed a response rate of 99.3% and a survey response rate of 83.5%. Adults aged 18-64 years had a response rate of 99.2% and a survey response rate of 86.8%. The 65+ years age group showed a response rate of 96.3% and a survey response rate of 85.9%. Urban areas had a higher response rate (99.1%) compared to rural areas (95.2%), with corresponding survey response rates of 85.5% and 73.1%, respectively. Sokoto State presented lower response rates, particularly among children aged <2 years (4.3%) and the elderly (65+ years) at 19.8%. Urban areas in Sokoto had significant challenges, with an overall response rate of 35.9% and a survey response rate of 4.1%. In contrast, Delta State showed more consistent results, with response rates of 93.2% overall and a survey response rate of 81.8%. The study highlights variations in response and survey response rates across different age groups and residence settings in Lagos, Delta and Sokoto States. These findings underscore the importance of considering demographic and geographic factors when interpreting seroepidemiological data.

Adolescents and young adults (AYAs) participatory approaches for HIV control have increased across LMICs, but there are few trials to evaluate effectiveness. We assessed a crowdsourced HIV self-testing (HIVST) intervention among a cohort of AYA in Nigeria. METHODS:We conducted a pragmatic stepped-wedge cluster randomized control trial recruiting participants (aged 14-24 years) from 32 local government areas across four geo-political zones in Nigeria. Eligible AYA were HIV negative or unknown HIV status, residing in study sites, spoke English, and consented. Areas were randomly assigned to one of four steps and AYA were followed for 24 months. AYA research facilitators implemented a 4YBY crowdsourced HIV prevention bundle. The primary outcome was self-reported HIVST uptake. We compared the probability of HIVST between the control and intervention periods using a generalized linear mixed model. We examined the fixed cost and per capita cost of the intervention. The protocol was registered with Clinical Trials.gov on January 15, 2021, under registration NCT04710784. RESULTS:2652 AYA were screened, and 1500 were enrolled in the study (March 10, 2021- August 31, 2023). 1333/1500 (89 %) were followed up at 24 months. The mean age of AYA was 20 ± 2.65 years old, most were students (1155/1500, 77 %), and unemployed (915/1500, 61 %). The intervention led to a 9.96-fold increase in HIV self-testing uptake compared to the control period (95 % CI: 8.36-11.85, p < 0.0001). The annual fixed cost of the intervention was estimated at US$42,237, with a per capita testing cost of US$14.8. No significant adverse events were reported. CONCLUSION:A crowdsourced HIV prevention intervention increased HIVST uptake among Nigerian AYA. Greater participation of AYA in the design and implementation of clinical trials is needed to achieve UNAIDS targets.

OBJECTIVE:In Nigeria, adolescents and young adults (AYA) who engage in multiple sexual partnerships, transactional sex, and needle-sharing are eligible for preexposure prophylaxis (PrEP) and are prioritized for HIV testing. AYA with PrEP-eligible behaviors should be using facility-based HIV testing services. We examined associations between these behaviors and facility-based HIV testing among AYA aged 14-24 years. DESIGN:A longitudinal analysis of a stepped-wedge trial. METHODS:Using Innovative Tools to Expand Youth-friendly HIV Self-Testing (I-TEST) data, we fit generalized linear models using generalized estimating equations. We used a two-stage weighted approach to generalize I-TEST estimates to all AYA in Nigeria. RESULTS:Of 1429 trial participants, the median age was 20 years (IQR: 18-22), 50.3% were female, and 69.4% reported secondary education as highest level of education completed. Recent facility-based HIV testing uptake was higher among AYA with one [unadjusted risk difference: 11.7%, 95% confidence interval (95% CI): 8.1-15.2], two [11% (5.3, 16.8)], and three or more sexual partners in the past 3 months [17.3% (10.5, 24)], compared to AYA with no recent sexual partners. AYA who engaged in transactional sex had higher facility-based testing uptake [14.7% (9.8, 19.5)] than AYA who never engaged in transactional sex. AYA who shared needles had lower facility-based testing uptake [-3.3% (-6.7, 0.2)] than AYA with no needle-sharing history. The trial and generalized estimates were in the same direction. CONCLUSION:While facility-based testing may reach AYA who engaged in multiple sexual partnerships or transactional sex, AYA who shared needles may require more tailored HIV testing approaches.

BACKGROUND:Adolescents and young adults (AYA, 14-24 years old) have the highest rates of drug use in most low- and middle-income countries. Little is known about the drivers of drug use among AYA in Nigeria and harm reduction services are limited. METHODS:A secondary data analysis was performed of the baseline survey of the 'I-TEST' study involving AYA in Nigeria. The two primary outcomes of interest were lifetime measures of drug use and needle sharing. Logistic regression analyses were performed to obtain odds ratios for the associations between socio-demographic exposures and the two primary outcomes. Odds ratios were subsequently adjusted for age and sex. RESULTS:1500 AYA survey responses were analysed. Respondents were mostly unemployed, students, and living in southern Nigeria. Drug use was reported by 301/1500(20.3 %) AYA. Among these, 213/301(71.5 %) reported needle sharing. Drug use did not vary by age (OR:0.94, 95 %CI:0.73-1.22) or sex (OR:1.00, 95 %CI:0.77-1.28). AYA in the North-Central zone had higher odds of drug use (OR:1.86, 95 %CI:1.28-2.69) and needle sharing (OR:2.51, 95 %CI:1.07-5.91) compared to AYA in the South-West zone of Nigeria. AYA aged 14-19 had higher odds of needle sharing compared to those aged 20-24 (OR:3.49, 95 %CI:1.94-6.26). Female AYA had higher odds of needle sharing compared to males (OR:5.05, 95 %CI:2.85-8.95). CONCLUSIONS:Drug use and needle sharing are common among AYA in Nigeria. There is an urgent need for harm reduction services and research informed by AYA.

Background:Expanding HIV research capacity among the global majority (individuals identifying as Black/African American, American Indian and Alaska Native, Asian, Native Hawaiian and Other Pacific Islander, Multiracial, and Hispanic/Latino) is important. However, achieving national goals to increase the pool of implementation science and HIV early-stage investigators from underrepresented backgrounds remains elusive, largely due to limited investment in training and mentoring these individuals. To address this issue, we launched the Stimulating Training and Access to HIV Research Experiences (STAR) program, a partnership led by Saint Louis University and the University of North Carolina at Chapel Hill in collaboration with Georgia State University and Texas A&M University. The STAR program aims to establish a pathway for Underrepresented minority (UREM) students to engage in HIV and implementation science research. Methods:We launched a crowdsourcing open call from November 30, 2022, to January 22, 2023, to identify potential trainees at the four participating institutions (Prompt: "How might we promote HIV prevention among youth aged 13-24 years in your community?"). The finalists from the crowdsourcing call participated in a 2-day designathon, which included didactic introductory lectures on HIV, dissemination and implementation science. The finalists participated in a 6-week innovation bootcamp, including modules on HIV research, implementation science, research ethics, and fieldwork experience with community partners. We assessed the acceptability of the STAR program through participant self-reported surveys on their experience and evaluation of the lectures. Findings:Twenty-four individuals applied to the STAR program by completing the crowdsourcing open call, 12 were selected for the designathon, and 10 completed the fellowship. The first cohort of STAR trainees (10 students-6 undergraduate and 4 graduate students) successfully completed the STAR innovation bootcamp. The innovation bootcamp culminated in seven proposals that the trainees implemented and evaluated over 12 months, with support from the research team, mentors, and participatory learning community. The implementation strategies proposed by the trainees include the use of peer engagement, storytelling, digital engagement tools, and artificial intelligence to promote awareness of HIV and increase the uptake of HIV testing. All the participants were satisfied with the STAR program (90% very satisfied and 10% satisfied) and indicated enthusiasm for pursuing academic and research careers in HIV and/or implementation science. Conclusion:Building a pathway for UREM investigators is crucial to ending the HIV epidemic. The STAR program may enhance interest, build research capacity, and increase the UREM talent pool retained in this field.

Background: Female sex workers have a 13-fold higher risk of acquiring HIV than women who do not engage in sex work. The willingness and acceptability of a product is crucial for the development of microbicides. This research aimed to evaluate the sexual practices, existing HIV prevention methods, and willingness to use a microbicide for HIV prevention among female sex workers in Nigeria. We also explored factors that might influence their willingness to use a new microbicide product. Methods: A cross-sectional study was conducted among female sex workers recruited from brothels within Lagos-Nigeria, in which participants were selected via purposive sampling over a period of five-months. An interviewer-administered, semi-structured questionnaire was used to obtain information. Descriptive statistics were used to present the results, and a multiple logistic regression model was used to determine the factors associated with willingness to use a microbicide. Results: A total of 461 female participants with a mean-age of 29.63 +/- 8.8 years were included in the analysis of which 34.3% had >4 sexual partners, 91.8% used condoms, 53.6% engaged in anal sex, 69.6% had experienced condom rupture, and 31% would "accept unprotected sex" if the male partner refuses to use a condom. Approximately 43% had received PEP, of which only 15% completed the one-month PEP-regimen. On the other hand, 64.6% had taken PrEP medications, of which 28% admitted skipping doses. Although 41% were concerned about male partner acceptance, a total of 95% will be willing to use a microbicide. The number of sexual partners ([aOR] 1.555; 95% Cl 1.035-2.335), use of condoms ([aOR] 4.701; 95% Cl 1.418-15.584), and condom rupture experience ([aOR] 2.550; 95% Cl 1.817-7.959) were associated with greater odds of willingness to use an HIV microbicide. Conclusion: There is a high level of willingness to use a future microbicide among the female commercial sex workers in this study. In addition, majority of the participants will prefer a microbicide product that is female controlled, affordable, and provided as an overthe-counter medication. This cohort of women engage in high-risk sexual practices and play a significant role in HIV prevention efforts. Therefore, their product preferences and concerns should be considered in microbicide development to enhance the acceptability, adherence, and efficacy of future microbicides.