BACKGROUND:The HIV incidence among Chinese men who have sex with men (MSM) has still been high over the past decade. Despite HIV pre-exposure prophylaxis (PrEP) being an effective prevention strategy, few studies have examined PrEP uptake and adherence in China. This study examined PrEP initiation and adherence among Chinese MSM enrolled in a multi-site PrEP demonstration trial. METHODS:Three-month data for this study were drawn from a PrEP demonstration project in Guangzhou and Wuhan, China. The project aimed to increase the engagement of MSM in China for HIV/STI screening, HIV risk reduction, and PrEP initiation and adherence through the use of a mobile phone app and community engagement with crowdsourcing of messages and study images. Part of the intervention was the provision of tenofovir/emtricitabine as PrEP through two types of modalities: (1) once-daily oral dose (Daily-PrEP), or (2) event-driven dose (i.e. the 2 + 1 + 1 approach, Event-Driven PrEP). The outcome of interest was PrEP adherence, defined as missing fewer than five pills in the past 30 days for Daily PrEP, and no missed doses for the Event-Driven PrEP regimen. Univariate and multivariate logistic regressions were conducted for data analyses. RESULTS:A total of 927 individuals started PrEP, with follow-up data available for 650 people (70%) after 3 months. There were 593 men with a median age of 30 years (range 21-61 years) in this study. Of those people, 341 reported taking Daily-PrEP, and 93% (317/341) reported missing fewer than five pills in the past 30 days. Among 252 participants who reported taking the Event-Driven PrEP regimen, 61.5% (155/252) reported full adherence. Daily-PrEP users were more likely to report good adherence than Event-Driven PrEP users (OR 7.28, P < 0.0001, 95% CI: 4.28-12.39). CONCLUSION:We observed a higher adherence to daily PrEP compared with Event-Driven PrEP among a sample of MSM in China. Further research is needed to examine long-term PrEP adherence among MSM in China.

Pre-exposure prophylaxis (PrEP) has been demonstrated as an effective strategy for preventing HIV infection. However, multiple barriers contribute to its suboptimal uptake in China, with drug safety being a shared concern for both clinicians and patients. This study aimed to assess the safety and tolerability of oral tenofovir disoproxil fumarate (TDF)/emtricitabine (FTC) for PrEP in a real-world setting in China. An open-label, prospective cohort study was conducted between September 2021 and September 2024 in Wuhan and Guangzhou, China. PrEP-eligible men who have sex with men (MSM) were enrolled, participants were prescribed TDF/FTC as PrEP and followed up for 12 months. Adverse events (AEs) were self-reported, and participants underwent regular monitoring for HIV, syphilis, liver and kidney function during follow-up. A total of 1,138 participants enrolled and initiated PrEP, with 1,045 completing at least one follow-up visit. Seven participants were diagnosed with HIV infection, yielding an HIV incidence rate of 0.8 per 100 person-years (95

BACKGROUND:Co-creation has the potential to generate people-centered mobile health (mHealth) interventions to improve PrEP adherence. This study generated people-centered mHealth messages with Chinese gay, bisexual and other men who have sex with men (GBMSM) via a structured co-creation approach, and evaluated the messages quality, and assessed the feasibility of the co-creation approach. METHODS:A three-step co-creation framework was implemented with 19 GBMSM PrEP users and six HIV researchers between 2021 and 2023. Messages were assessed via 10-point scales, and the degree of usefulness by co-creators and 783 participants from a PrEP demonstration trial. Thematic analysis identified PrEP adherence barriers and participants' reflections from meeting notes and materials, with descriptive statistics summarizing evaluation results. RESULTS:Four levels of PrEP adherence barriers were identified (insufficient education, efficacy concerns, inadequate behavioral skills, PrEP stigma). Based on these barriers, 25 mHealth messages (19 posters, three videos, three text messages) were co-created, covering nine themes (e.g. missed dose coping, side-effect management). Seventeen high-quality messages were selected, with mean scores of 8.25 (relevance), 7.86 (appropriateness) and 7.25 (elaboration). Among GBMSM PrEP users who received the messages, 90.4% (708/783) valued the co-created messages as helpful. Reflections from the co-creators highlighted the value of the participatory process, confirming that co-creation effectively engages GBMSM PrEP users. CONCLUSIONS:Co-creation groups are feasible for Chinese GBMSM to identify context-specific PrEP adherence barriers and develop people-centered mHealth messages, supporting the value of co-creation for PrEP adherence intervention development in this population.

International faculty development programs aim to strengthen teaching capacity, yet their impact depends on whether participants can apply new skills in their own institutions. In China, few studies have examined outcomes from multi-institutional programs and the process by which institutional partnerships support application of learning. This study evaluates the International Medical Educators Program (IMEP), a longitudinal faculty development program in China focused on curriculum development, teaching skills, and educational leadership, and examines its medium- to long-term outcomes. A cross-sectional survey was administered in 2025 to all IMEP participants from 2019–2024 (n = 86), representing 1–5 years post-training. The survey assessed Kirkpatrick level 3 and 4 outcomes, including project implementation, dissemination, educational impact, and professional advancement. Outcomes were compared across institutional groups using chi-square tests and multivariable logistic regression. Sixty alumni completed the survey (69.8

Background: Adherence to HIV pre-exposure prophylaxis (PrEP) remains a challenge among gay, bisexual, and other men who have sex with men (GBMSM). Digital interventions co-created with users may enhance engagement and adherence. This study evaluated a co-created WeChat-based messaging intervention to support PrEP adherence among Chinese GBMSM using a stepped-wedge randomized trial. Methods: This trial was nested in a PrEP demonstration trial in Guangzhou and Wuhan, China. Participants were provided TDF/FTC for 12 months and followed up quarterly. Eligible PrEP users were randomly allocated to four sequential groups via block randomization, receiving biweekly co-created digital messages in a staggered quarterly order. Generalized linear mixed-effects models were used to assess primary outcomes, including self-reported PrEP adherence in the past 30 days, PrEP discontinuation and reinitiation, and PrEP self-efficacy. Findings: From July 2021 to September 2024, 1,115 GBMSM (median age=27·0, IQR=24·0-31·4) enrolled in the study. About half of the participants reported using an event-driven regimen (2-1-1) at follow-up timepoints. Overall, 389 participants (35%) were lost to follow-up, and 727 (65%) discontinued PrEP, 46·9% of whom reinitiated. Less than 13% reported weekly intervention app use; 42·1% rarely used the app in the last three months. Adherence remained high (75·4–77·7%) but declined over time. The intervention did not improve adherence or self-efficacy; however, participants starting the intervention in quarter 3 were more likely to reinitiate PrEP (aRR=1·25, 95% CI 1·01–1·54). Higher app engagement was associated with greater PrEP self-efficacy (coefficient=0·21, SE=0·07, p=0·001). Event-driven users had lower adherence (aOR=0·08, 95% CI 0·05–0·11) and self-efficacy (coefficient=-0·13, SE=0·04, p=0·002). Interpretation: Co-created digital messaging interventions are feasible to implement in PrEP programs. While the intervention did not improve adherence, higher app engagement was consistently linked to greater PrEP self-efficacy. Lower adherence and self-efficacy with event-driven PrEP suggest the need for interventions tailored to alternate PrEP dosing strategies.

Background Data on persistent use of HIV pre-exposure prophylaxis (PrEP) is limited among Chinese men who have sex with men (MSM). This study aimed to explore factors associated with the re-initiation of PrEP among Chinese MSM from a longitudinal PrEP demonstration trial. Methods A multi-center cohort study was conducted in Guangzhou and Wuhan, China (September 2021-2024), providing 1134 MSM participants with a 12-month dosage of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as oral PrEP. Following the trial, a subgroup of participants were invited to complete a 3-month post-trial follow-up survey. These participants were categorized on the basis of self-reported PrEP use patterns into (1) continued PrEP use, (2) discontinued without re-initiation, and (3) re-initiated after discontinuation. Log-binomial regression models were used to assess factors associated with PrEP re-initiation. Results Out of 408 participants who completed the 3-month post-trial follow-up survey, 70.1% (n =286/408) reported discontinuing PrEP, and 50.7% (n =145/286) of those who discontinued subsequently re-initiated PrEP. Participants who had concurrent sexual partnerships (adjusted risk ratio [aRR]=1.47, 95% CI: 1.11-1.96), used drugs during sex (aRR=1.34, 95% CI: 1.09-1.65), or lived alone (aRR=1.29, 95% CI: 1.03-1.61) were more likely to re-initiate PrEP. The Likert scale analysis indicated that perceived partner influence, specifically the expectation of condomless sex, played a significant role in re-initiation decisions (P =0.03). Conclusion Individuals engaging in higher-risk behaviors are more likely to re-initiate PrEP, highlighting the dynamic nature of risk perception. Future interventions should focus on promoting both re-initiation and consistent condom use, emphasizing partner-related dynamics and substance use as key factors in PrEP decisions among MSM.

Limited training equipment and instructors at training centers cannot fulfill the simultaneous training required of numerous trainees. Optimizing the training organization can improve the training efficiency and trainee performance to enhance the overall training effectiveness. This study aims to evaluate the effectiveness and feasibility of group competition mechanism under peer evaluation during robot training. A randomized controlled trial was conducted with 60 robotic-naive medical students, divided into two groups: independent training and team-based learning with a competitive element. Both groups performed Pick-and-Place (PP), Match-Board-2 (MB), and Thread-the-Rings-1 (TR) tasks on a dV-Trainer robot simulator. Training scores were automatically recorded to construct learning curves and calculate scoring efficiencies, which were compared between the two groups. Compared with the conventional training group, the group utilizing the group competition training format demonstrated significantly higher average operational scores, scoring efficiency, and learning curves (P < 0.05). In addition, the group competition mode demonstrates a higher performance in cultivating the trainees’ satisfactory operational habits (P < 0.001). Based on task-reporting strategies guided by peer evaluation, the group competition mechanism is a novel and effective model for improving robot simulator training. This method holds promise as an effective tool for the surgical education of practicing surgeons and clinical medical students.

Peer referral leverages social networks to connect individuals with health services, potentially enhancing pre-exposure prophylaxis (PrEP) use. This study aims to investigate the impact of peer referral on PrEP adherence and persistence among men who have sex with men (MSM) in China. This study is nested in a 12-month PrEP (FTC/TDF) demonstration trial in China from September 2021 to December 2023. Peer referral was defined as participants being referred by peers already enrolled in the trial. PrEP adherence was measured as taking four or more pills per week for daily users or following the 2 + 1 + 1 event-driven regimen at least 75

BACKGROUND:Mobile health (mHealth) is a promising intervention mode for HIV prevention, but little is known about its feasibility and effects in promoting pre-exposure prophylaxis (PrEP) uptake among Chinese gay, bisexual and other men who have sex with men (GBMSM).METHODS:We evaluated an instant messaging application using a WeChat-based mini-app to promote PrEP uptake among GBMSM via a mixed-methods design that includes a 12-week, two-arm randomized controlled pilot trial and in-depth progress interviews in Guangzhou, China. Primary outcomes include the number of PrEP initiations, individual-level psychosocial variables related to PrEP initiation, and usability of the PrEP mini-app.RESULTS:Between November 2020 and April 2021, 70 GBMSM were successfully enrolled and randomized into two arms at 2:1 ratio (46 to the intervention arm, 24 to the control arm). By the end of 12-week follow-up, 22 (31.4%) participants completed the initial consultation and lab tests for PrEP, and 13 (18.6%) filled their initial PrEP prescription. We observed modest but non-significant improvements in participants' intention to use PrEP, actual PrEP initiation, PrEP-related self-efficacy, stigma, and attitudes over 12 weeks when comparing the mini-app and the control arms. Qualitative interviews revealed the key barriers to PrEP uptake include anticipated stigma and discrimination in clinical settings, burden of PrEP care, and limited operating hours of the PrEP clinic. In-person clinic navigation support was highly valued.CONCLUSIONS:This pilot trial of a mobile phone-based PrEP mini-app demonstrated feasibility and identified limitations in facilitating PrEP uptake among Chinese GBMSM. Future improvements may include diversifying the content presentation in engaging media formats, adding user engagement features, and providing off-line in-clinic navigation support during initial PrEP visit. More efforts are needed to understand optimal strategies to identify and implement alternative PrEP provision models especially in highly stigmatized settings with diverse needs.TRIAL REGISTRATION:Trial registration: The study was prospectively registered on clinicaltrials.gov (NCT04426656) on 11 June, 2020.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic forced international faculty development programs in medical education to forgo in-person activities and transition to online learning. We sought to examine changes in Chinese medical educators’ evaluations of our faculty development program as it transitioned from in-person intensive to online longitudinal due to the pandemic. Methods: A 30-item program evaluation and self-assessment of curriculum development and teaching skills was sent to our 2020 cohort. Results were compared to our 2019 cohort. We analyzed data using t-tests to compare means and chi-square test for categorical variables. Results: We found that trainees in both cohorts rated the program highly with regard to overall program quality and self-assessed learning outcomes. Comparison of cohorts also showed similar growth in pre- and post-training assessment. However, the 2020 cohort rated their relationships with instructors and peers less strongly than the 2019 cohort. Conclusions: Despite the rapid transition to online learning due to social distancing measures, trainees were as confident in the skills they learned as the prior in-person participants. Time zone differences placed additional restrictions on the implementation of the training program, which affected the amount of face-to-face interaction time available.

During the early months of the COVID-19 pandemic, when health systems were overwhelmed with surging hospitalizations and a novel virus, many ambulatory patients diagnosed with COVID-19 lacked guidance and support as they convalesced at home. This case report offers insight into the implementation of a telehealth service utilizing third- and fourth-year medical students to provide follow-up to ambulatory patients diagnosed with COVID-19. The service was evaluated using medical student surveys and retrospective chart review to assess the clinical and social needs of patients during the spring of 2020. Students assessed symptoms for 416 patients with COVID-19 from April 8 to May 20 and provided clinical information and resources. Eighteen percent of these patients sought higher levels of medical care, in part from student referrals. Three key implementation lessons from this experience that may be relevant for others include: 1) Vulnerable patient populations face unique stressors exacerbated by the pandemic and may benefit from intensive follow-up after COVID-19 diagnosis to address both medical and social needs; 2) Medical students can play value-added roles in providing patient education to prevent the spread of COVID-19, assisting patients with escalating care or resource connection, and providing emotional support to those who have lost loved ones; 3) Continuous re-assessment of the intervention was important to address evolving patient needs during the COVID-19 outbreak. Future work should focus on identifying high-risk patient populations and tailoring follow-up interventions to meet the unique needs of these patient populations.

This article introduces the concept of "teacher immediacy," defined as the teacher's communication behaviors that reduce the psychological distance between teacher and students. Though well investigated and recognized in the area of instructional communication, this concept is still new to the field of medical education. The authors first describe the origin, definition, and indicators of teacher immediacy, and then present empirical research findings on teacher immediacy's positive associations with effective teaching. The authors also introduce findings of teacher immediacy research related to the online learning environment. They recommend medical educators adopt the term "teacher immediacy" and explore it in practice.

Adherent pre-exposure prophylaxis (PrEP) uptake can prevent HIV infections. Despite the high HIV incidence, Chinese key populations have low PrEP uptake and adherence. New interventions are needed to increase PrEP adherence among key populations in China. Co-creation methods are helpful to solicit ideas from the community to solve public health problems. The study protocol aims to describe the design of a stepped-wedge trial and to evaluate the efficacy of co-created interventions to facilitate PrEP adherence among key populations in China. The study will develop intervention packages to facilitate PrEP adherence among Chinese key populations using co-creation methods. The study will then evaluate the efficacy of the co-created intervention packages using a stepped-wedge randomized controlled trial. This four-phased closed cohort stepped-wedge design will have four clusters. Each cluster will start intervention at three-month intervals. Seven hundred participants who initiated PrEP will be recruited. Participants will be randomized to the clusters using block randomization. The intervention condition includes receiving co-created interventions in addition to standard of care. The control condition is the standard of care that includes routine clinical assessment every 3 months. All participants will also receive an online follow-up survey every 3 months to record medication adherence and will be encouraged to use a WeChat mini-app for sexual and mental health education throughout the study. The primary outcomes are PrEP adherence and retention in PrEP care throughout the study period. We will examine a hypothesis that a co-created intervention can facilitate PrEP adherence. Generalized linear mixed models will be used for the primary outcome analysis. Developing PrEP adherence interventions in China faces barriers including suboptimal PrEP uptake among key populations, the lack of effective PrEP service delivery models, and insufficient community engagement in PrEP initiatives. Our study design addresses these obstacles by using co-creation to generate social media-based intervention materials and embedding the study design in the local healthcare system. The study outcomes may have implications for policy and intervention practices among CBOs and the medical system to facilitate PrEP adherence among key populations. The study is registered in Clinical Trial databases in China (ChiCTR2100048981, July 19, 2021) and the US (NCT04754139, February 11, 2021).

Introduction The large number of key populations in China who would benefit from HIV pre-exposure prophylaxis (PrEP) in the context of limited health system capacity and public awareness will pose challenges for timely PrEP scale-up, suggesting an urgent need for innovative and accessible interventions. This study aims to develop and pilot test a theory-informed, tailored mobile phone intervention that was codeveloped by young gay men, HIV clinicians and public health researchers to increase engagement in PrEP education and initiation among Chinese gay, bisexual and other men who have sex with men (GBMSM), who bear a disproportionate burden of HIV infections and remain underserved in the healthcare system. Methods and analysis This two-phase study includes a formative assessment using in-depth interviews (N=30) and a 12-week experimental pilot study using a two-arm randomised controlled trial design (N=70). The primary intervention is delivered through a WeChat-based mini-app (a program built into a Chinese multipurpose social media application) developed by young GBMSM from a 2019 crowdsourcing hackathon. Using mixed methods, we will further investigate the specific needs and concerns among GBMSM in terms of using PrEP as an HIV prevention strategy, how their concerns and PrEP use behaviours may change with exposure to the mini-app intervention during the study period and how we can further refine this intervention tool to better meet GBMSM’s needs for broader implementation. Ethics and dissemination This study and its protocols have been reviewed and approved by the Institutional Review Boards of the University of North Carolina at Chapel Hill, USA (19-3481), the Guangdong Provincial Dermatology Hospital, China (2020031) and the Guangzhou Eighth People’s Hospital, China (202022155). Study staff will work with local GBMSM community-based organisations to disseminate the study results to participants and the community via social media, workshops and journal publications. Trial registration number The study was prospectively registered on clinicaltrials.gov (NCT04426656) on 11 June 2020.

To the Editor: In medical education literature, recommendations on teaching skills include a set of behaviors that concern mannerisms, speech patterns, and interactions with students. Using humor, being enthusiastic, and encouraging student participation are examples of such behaviors. Though widely recognized as desirable teacher qualities, they are referred to by various terms in medical education literature. In the field of instructional communication, they are called “teacher immediacy” behaviors, defined as the teacher’s verbal and nonverbal behaviors that decrease the perceived psychological distance between teacher and students. 1 We propose that medical teachers and medical education researchers adopt the established term “teacher immediacy” as a crisp narrative/phrase for these behaviors. Detailed descriptions and measuring tools of teacher immediacy behaviors are found in the literature. In the works of Andersen 2 and Gorham, 3 examples of verbal teacher immediacy behaviors include addressing individual students by name, asking students questions, giving feedback and praise, encouraging students to talk, and basing discussion on something a student brings up. Examples of nonverbal immediacy behaviors include smiling, gesturing, vocal expressiveness, movement about the classroom, and looking at the class while talking. Decades of empirical studies have established that teacher immediacy behaviors are positively associated with student motivation, participation, learning outcomes, and satisfaction with the instructor, instruction, and course content. 4–8 A recent systematic review 7 of studies examining the association of teacher immediacy with learner motivation found that the studies were conducted in courses of various fields, mostly science, engineering, communication, business, and general education. Thus, teacher immediacy is an important contributor to effective teaching. Adopting the established term “teacher immediacy” in medical education will give the field a common language to talk about the same set of teacher characteristics, so the phenomenon will be more likely propagated and studied for its impact. Teachers can learn and use immediacy behaviors to increase their instructional effectiveness, and researchers can investigate the construct of teacher immediacy to understand its roles in various learning contexts.