BACKGROUND:Hepatitis C virus (HCV) disproportionately affects incarcerated individuals, and effective interventions are needed to improve HCV care within prisons to achieve global elimination targets. This review aimed to identify and synthesise evidence on interventions to improve HCV testing, linkage to care, and direct-acting antiviral (DAA) treatment initiation among people in prison and post-release. METHODS:We systematically searched MEDLINE (PubMed), Scopus, Web of Science, Cochrane CENTRAL, and PsycINFO for studies assessing non-pharmaceutical interventions with a comparator or control group. Outcomes were HCV antibody testing, HCV RNA testing, linkage to HCV care, and treatment initiation. Randomised controlled trials (RCTs) and controlled non-randomised studies were included; data were extracted and risk of bias assessed in duplicate using standard tools (RoB 2 and ROBINS-I). This analysis was restricted to studies of interventions evaluated in prison settings or among people recently released from prison. Searches had no date restriction and were updated November 2024. This review is registered in PROSPERO (CRD42020178035). FINDINGS:Of 20,643 unique records, 22 studies were included (19 non-randomised; three RCTs). Simplified testing modalities had the most evidence of impact on testing and treatment outcomes: dried blood spot (DBS) testing improved antibody testing uptake in three studies (two RCTs and one non-randomised study; OR 2.90, 95 % CI 1.43-5.86) and point-of-care RNA testing improved treatment initiation in three non-randomised studies (OR 9.60, 95 % CI 3.38-27.32). Simplified opt-out screening strategies also increased antibody testing uptake in three studies (OR 20.41, 95 % CI 1.88-221.19). Other interventions simplifying testing (e.g., reflex RNA testing, broadened testing criteria) were effective in individual studies, but pooled analyses for broadened testing criteria were not statistically significant due to high heterogeneity. Single studies also showed improvements in treatment initiation using DBS testing, nurse-led care, and no-cost coverage of HCV medications. INTERPRETATION:Several interventions, particularly those to enhance testing, may be successful in increasing HCV testing and treatment in prisons. However, the heterogeneity of interventions, methodological limitations of included studies, and limited number of studies underscore the need for further robust research, particularly RCTs, to optimise care in this setting.

Sexual health has always been a social matter. While the science of disease transmission remains a focus for public health stakeholders, for social scientists, the sociality of infections, both enduring and emerging, remains central. That is, friendships and relationships are core to health, risk and illness. Yet, there has been virtually no work on how friendships and their varying contours are interplaying with (increasingly) antibiotic resistant STIs. Drawing on 49 interviews with sexuality and/or gender diverse people in Australia, we argue that the sociality of sexual health is central to the development of antibiotic resistance. Our analysis highlights the importance of friends to this, including de(stigmatising) STIs, deployment of humour to regularise important meanings, striking a balance between autonomy and mutuality, and role of friends as sexual health educators. These hitherto under-recognised relational dimensions of sexual health are critical to working with communities in addressing the rise of resistant STIs.

Background and aims Prison needle exchange programs (PNEPs) are evidence-based, cost-effective interventions that prevent transmission of blood-borne viruses. PNEPs were introduced in a minority of Canadian federal prisons in 2018; however, participation is contingent on a mandatory approval process known as a "Threat Risk Assessment" (TRA). Although the TRA seeks to protect institutional safety and staff well-being, it has delayed access and restricted program participation. We aimed to explore prison administrators' perceptions of the TRA, including its goals and potential alternatives, within the broader PNEP policy objective of facilitating access to clean needles/syringes for people who inject drugs in prison. Design and setting Qualitative analysis using semi-structured interviews across nine Canadian federal prisons with PNEPs. Participants Twenty-seven institutional heads, including Wardens, Assistant Wardens of Operations and Chiefs of Health Services. Measurements Matland's Ambiguity-Conflict model informed this analysis. Findings Institutional heads largely described the TRA as a security tool, a clear goal consistent with low ambiguity, but whose aims often conflicted with PNEP goals of low-threshold access, placing implementation in a high conflict-low ambiguity political implementation paradigm. In this paradigm, top-down decision making, underpinned by carceral logic and moral hazard framing, prioritizes institutional security over public health. Many also perceived the TRA's function as symbolic, primarily to appease labour partners and demonstrate due diligence to external bodies, an interpretation that increases ambiguity around the TRA's true purpose consistent with high conflict-high ambiguity implementation. Participants proposed two pragmatic alternatives to reduce conflict: re-assigning the TRA to Health through a more bottom-up decision making approach, characteristic of low conflict-high ambiguity experimentation implementation; and streamlining the current TRA process within Operations, consistent with a low conflict-low ambiguity administrative implementation paradigm. A minority advocated to eliminate the TRA and grant automatic PNEP enrolment, aligning with community norms and international practice. Conclusion Within Canadian federal prisons, the "Threat Risk Assessment" (TRA) appears to be a structural process obstacle within the prison needle exchange program (PNEP) policy that fails to provide low threshold access to PNEPs due to the prioritization of institutional safety at the cost of public health. Alternative options to the current TRA process clarify actionable levels for policy refinement that preserve safety, improve access and better align with evidence and public health goals.

Background:Prison needle exchange programs (PNEPs) are evidence-based harm reduction interventions that decrease bloodborne virus transmission by reducing the sharing of injection equipment. Canada introduced PNEPs in nine of its 43 federal prisons in 2018-2019; however, uptake is low. This implementation gap undermines program effectiveness, jeopardising individual- and population-level benefits of the program. This stepped-wedge cluster non-randomised type 1 hybrid implementation trial will evaluate whether the Network for the Improvement of Addiction Treatment (NIATx) bundle of implementation strategies and tools increases PNEP uptake. Methods:All nine prisons were allocated non-randomly to three sequences; each sequence is activated at six-month intervals. Over 24 months, each prison will use NIATx tools to address site-specific barriers to PNEP determined during preliminary work. Stepped implementation will be evaluated using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework of the Practical Robust Implementation and Sustainability Model (PRISM). The primary effectiveness outcome is PNEP uptake (i.e., number of participants enrolled on the program). Secondary effectiveness outcomes include number of kits distributed (evidencing active participation) and individuals tested and diagnosed with bloodborne virus infections, including HIV and hepatitis B and C virus (to assess harm reduction impact). Staff surveys and focus groups during and post-implementation, respectively, will explore individual- and organisational-level factors influencing implementation and maintenance. Discussion:We anticipate that NIATx tools will improve uptake of PNEPs among people who inject drugs in Canadian federal prisons. Findings are expected to inform scale-up across remaining Canadian prisons, support long-term sustainability, and inform global advocacy for prison needle and syringe programs.

BACKGROUND:Prison needle exchange programs (PNEPs) reduce bloodborne virus transmission among people who inject drugs, yet global implementation remains limited. Canada introduced PNEPs in 2018, but uptake is low, and barriers to implementation persist. While perspectives of correctional officers, healthcare workers, and incarcerated individuals have been examined, little is known about how prison leadership shapes program delivery. Drawing on interviews informed by the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework, we sought to identify the organisational, system, and structural/policy-level barriers to PNEP implementation from the perspectives of prison administrators. METHODS:Between January and March 2025, 27 prison leaders from custodial and medical services from nine Canadian federal prisons with operational PNEPs participated in semi-structured interviews. Data were thematically analysed using the EPIS framework. RESULTS:Implementation was shaped by structural tensions between harm reduction goals and "zero tolerance" custodial mandates. Outer context factors, especially union resistance, lack of policy clarity, and federal directives, created misalignment and ambiguity in program ownership. Prison climate, staff turnover, and leadership engagement influenced shifts in attitudes toward PNEPs over time. Healthcare personnel, though central to delivery, were often tasked with communicating custodial decisions, undermining trust. Intervention fit was shaped by security classification and perceived drug use patterns, with PNEPs viewed as ill-suited for minimum-security settings. Sites that streamlined approval processes and designated leadership roles were better positioned to support program uptake. Time, experiential exposure, and tailored education were key facilitators of cultural change and implementation readiness. CONCLUSION:Addressing outer context barriers and clarifying responsibilities between health and corrections are critical to PNEP sustainability. Leadership engagement is essential to enabling system-wide adoption.

Often, research takes place once a health issue is already at 'crisis' point. However, health professionals and populations can have different understandings of 'urgency'. At present, health authorities, scientists and other medical professionals are increasingly concerned about escalating antimicrobial resistance (AMR) in the context of STIs. Clinicians worry about Neisseria gonorrhoeae becoming progressively resistant to last-line treatment, as well as the very limited treatment options for resistant Mycoplasma genitalium. This paper explores how states of 'urgency' and 'crisis' are socially produced within people's everyday contexts. Drawing on semi-structured interviews with 49 gay and bisexual cisgender men and trans and gender diverse people, we explore contemporary GBTQ+ (gay, bisexual, trans and queer+) understandings of antibiotic-resistant STIs and people's perceptions of urgency. Findings reveal that urgency is shaped by pre-existing understandings of resistance, spatial-temporal dimensions, histories and experiences of pleasure. We conceptualise this as a relation of mediated urgency, which centres the multidimensional production and reception of crisis rather than making a priori assumptions that 'crisis' has already arrived. This theoretically and empirically recentres the everyday, relational and contextualised manifestations of how people relate to 'crisis', critical to working with communities to address it/them.

Infrastructures fundamentally shape sexual health, but their gaps and failings often only come into view during moments of crisis. Antimicrobial resistance (AMR) is a looming microbiological and global societal crisis, and one that is posing increasing challenges and risks for medical practice and public health alike. In sexual health, concerns have been raised about growing resistance in Neisseria gonorrhoeae and the less well-known Mycoplasma genitalium. In this article, we examine contemporary sexual health infrastructures and their adequacy in the context of rising antibiotic-resistant STIs. To do this, we draw on 49 semi-structured interviews with cisgender gay and bisexual men, and trans and gender diverse people (GBTQ+) in Australia. Findings reveal that growing costs, a lack of access to sexual healthcare services, complexities in navigating these services and lengthy wait times all present challenges to optimal care, and that growing resistance may further strain these socio-material-temporal arrangements. We argue that greater investment in sexual health infrastructures will increase capacity to accommodate complex lives, multiple subjectivities and ensure easier access to services. In the context of resistance, this frames sexual health infrastructures beyond ideas of simply 'coping with crisis' to being able to care well for people within a shifting environment.

Background Given sub-optimal harm reduction access, people in prison who inject drugs are at great risk of hepatitis C virus (HCV) infection, including reinfection following successful treatment. In New South Wales, Australia, prison-based opioid agonist treatment (OAT) is available, but there is no needle syringe programme. This study evaluated post-treatment HCV reinfection incidence among people in New South Wales prisons who inject drugs. Methods SHARP-P was a cohort study of people with recent injecting drug use (previous six months) receiving direct-acting antiviral (DAA) treatment in New South Wales prisons (2019-21). Participants were recruited before commencing therapy and assessed every 3-6 months post-treatment for recurrent viremia. HCV genome sequencing and clinical follow-up data were used to classify recurrent viremia as: definite reinfection, possible reinfection, virological failure, and undefined. Person-time of observation was used to calculate reinfection incidence, overall and in sub-populations. Results Of 201 participants, 154 (77%) with post-treatment follow-up were included in the analyses (median age 32 years, 20% women, 16% receiving OAT, 62% reported injecting drugs in the month before enrolment, of whom 95% shared injecting equipment in prison). Twenty-six episodes of recurrent viremia were detected, including 16 definite reinfections, three possible reinfections, one virological failure, and six undefined. During 103 person-years of follow-up, incidence of definite HCV reinfection was 15.5/100 person-years (95%CI, 9.525.3) overall, 19.4/100 person-years (95%CI, 11.2-33.4) among those injecting during follow-up, and 57.9/100 person-years (95%CI, 32.9-101.9) among those sharing injecting equipment. Conclusions The high HCV reinfection incidence in prisons emphasises the need to enhance prison-based harm reduction measures including access to sterile injecting equipment, currently prohibited in Australian prisons. The finding that reinfection accounts for most recurrent viremia could assist retreatment clinical decision-making in prison.

OBJECTIVES:Community attitudes contribute to social exclusion of people with incarceration and injecting drug use histories. Interventions that positively impact community attitudes can strengthen efforts to reduce recidivism and support positive outcomes. This study aimed to investigate the impact of such interventions on public perceptions towards people who inject drugs newly released from prison. STUDY DESIGN:Randomised controlled trial. METHOD:A narrative script on the theme of "exhaustion" was produced from an interview study of post-release experiences. Members of the public participated in a three-armed randomised controlled trial: (1) control; (2) neutral intervention (plain English description); (3) narrative intervention (scripted performance). Surveys administered at baseline, post-intervention, and three-month follow-up measured perceptions of the target group through four key dimensions of stigma. Qualitative interviews were conducted with 24 participants to further investigate responses to the narrative intervention. RESULTS:1071 participants completed all phases of the trial. Post-intervention scores indicated more positive perceptions among participants in the neutral and narrative intervention arms than the control arm. Effects were mostly more positive for the narrative intervention arm. At follow-up, scores for the neutral intervention arm indicated more positive perceptions than the control arm on the Opinions scale, while the narrative intervention arm recorded more positive perceptions than the control arm on both Opinions and Attitudes scales. Interviews indicated that participants who were not influenced by the narrative intervention believed that people who inject drugs should be held accountable for not controlling their drug use. CONCLUSION:Research-informed, co-designed, arts-based interventions can positively impact public perceptions of a highly stigmatised group. Effects of the interventions attenuated over time, suggesting a need for further interventions focusing on perceptions of controllability of drug use.

In 2018–2019, Canada introduced a Prison Needle Exchange Program (PNEP) across nine federal facilities to mitigate the harms associated with drug injection among incarcerated people. However, program uptake has been limited. We explored the barriers and facilitators to improving PNEP services among key stakeholders in prison. Stakeholders in nine federal prisons with active PNEP participated in focus groups using nominal group technique to achieve rapid consensus. Responses were generated, rank-ordered, and prioritized by each stakeholder group (correctional officers, healthcare workers, and people in prison). We identified the highest-ranking responses to questions about barriers and solutions to PNEP uptake and described them using the five levels of the Socioecological Model: individual, interpersonal, organizational, system, and structural/policy. Between September 2023 and February 2024, 34 focus groups were conducted with 215 participants (n = 51 correctional officers (24

To evaluate the acceptability of MyCheck for asymptomatic sexually transmissible infections (STIs) testing. Regular testing for STIs in at-risk populations is recommended by Australian guidelines as many STIs are asymptomatic. Consequently, MyCheck was developed to enhance access by combining a telehealth consultation with direct referral to pathology, avoiding the need for in-person clinic visits. MyCheck was piloted at Sydney Sexual Health Centre (SSHC)—the largest publicly funded urban sexual health clinic in New South Wales—between June 2021 and February 2022. MyCheck integrated telehealth assessment with electronic referrals to over 500 pathology centres and automated result entry into the clinic’s patient management system. Staff initiated MyCheck testing offers to asymptomatic clients without complex care needs. Evaluation was based on clinic data and client surveys. Staff offered MyCheck to 9.8

BACKGROUND:Globally, hepatitis C virus (HCV) elimination is a priority for marginalised communities, including Aboriginal and Torres Strait Islander peoples in Australia. Innovative and equity focused models of care are required to achieve elimination. The aim of this analysis was to evaluate prevalence of, and factors associated with, HCV infection among Aboriginal peoples engaged during implementation of a point-of-care testing and treatment intervention at Aboriginal primary health care services. METHODS:The SCALE-C prospective cohort study implemented a decentralised, on-site community-based "test and treat" intervention through four regional Aboriginal Community Controlled Health Organisations (primary care services) in New South Wales and South Australia between May 2019 and July 2022. Following a screening questionnaire (history of HCV infection, injecting drug use, incarceration, opioid agonist therapy use), participants underwent fingerstick point-of-care HCV testing (antibody [no risk] and/or RNA [history of HCV, ever at risk]); those at risk or with current HCV infection were also offered point-of-care HIV and HBV testing, education, and longitudinal follow-up. Participants with current HCV infection were offered DAA treatment. The primary endpoint was current HCV infection, with secondary endpoints including DAA uptake and outcome. Factors associated with current HCV infection were assessed using logistic regression analysis. RESULTS:Of 536 individuals enrolled (median age 39 years, 49% women, 37% injecting drug use ever, 32% incarceration ever), 79% identified as Aboriginal and/or Torres Strait Islander. The proportion with current HCV infection was 9%, ranging from 0.5% among people reporting no lifetime risk to 20% among those reporting risk within the past 12 months. Current HCV infection was associated with recent injecting drug use (adjusted OR: 10.43; 95% CI: 1.34-81.01). Among participants with HCV infection, 62% (28/45) received DAA treatment (median time from enrolment to treatment initiation, nine days [range 2, 22]) and 57% (16/28) of those treated had confirmed sustained virological response (SVR); SVR was 100% (16/16) among those retained in follow up. CONCLUSION:A community-based decentralised on-site "test and treat" intervention integrated within existing Aboriginal community-controlled health organisations was feasible and effective in HCV case detection. While it holds potential for future elimination efforts, health system enhancement will be required (including dedicated staffing and infrastructure) to support broader implementation and improve linkage to care and treatment. CLINICAL TRIAL:This study was registered with clinicaltrials.gov (NCT03776760) on December 12, 2018.

BACKGROUND:Injecting drug use following treatment for hepatitis C virus (HCV) may result in reinfection, potentially reversing individual, and population benefits of HCV treatment. The aim of this study was to evaluate the incidence of HCV reinfection following successful direct acting antiviral (DAA) therapy among people with recent injecting drug use. METHODS:This analysis used data from an observational cohort study of people with recent injecting drug use (previous six months) following successful DAA treatment in Australia, Canada, and New Zealand. Participants were either recruited prior to commencing DAA therapy or after a documented sustained virological response (SVR). Participants were assessed three-monthly for HCV reinfection. Reinfection was defined as recurrence of virus distinct from the initial infecting strain or recurrence after confirmed cure at or after 12 weeks post-treatment. Person-time of observation and Cox proportional hazard models were used to calculate reinfection incidence and associated factors. RESULTS:Among 112 participants who contributed follow-up time at risk of reinfection (113 person-years of follow-up time), the median age was 43 years, 34 % were female, and 86 % reported injecting drug use in the month prior to enrolment. Eleven cases of reinfection were observed for an incidence of 9.7/100 person-years (95 % confidence interval [CI], 5.4-17.4) overall, 11.1/100 person-years (95 % CI, 6.1-20.0) among people who reported injecting drugs during follow-up, and 24.3/100 person-years (95 % CI, 7.8-75.3) among those who reported sharing needles/syringes during follow-up. All cases of HCV reinfection occurred among people reporting injecting drug use during the study. CONCLUSIONS:The relatively high incidence of reinfection seen in this study underscores the importance of targeted harm reduction measures and monitoring for HCV reinfections within the first year following successful treatment among people who inject drugs. Additional research into integrated models of care incorporating harm reduction and supporting reducing risk of reinfection and HCV treatment are needed.

BACKGROUND:Hepatitis C virus (HCV) is prevalent among people who are incarcerated. Provision of opioid agonist treatment (OAT) has been shown to reduce risk of HCV transmission in the community. Little is known about the navigation of HCV (re-)exposure in prisons, and people's experiences and utilisation of OAT as a risk reduction strategy while incarcerated. METHODS:Semi-structured interviews were completed with n=25 men incarcerated in an urban reception (intake) and remand (awaiting sentencing) prison in New South Wales, Australia. De-identified transcripts were coded deductively and analysed thematically, informed by a fragile treatment environment lens focused on OAT treatment as a risk mitigation strategy for HCV (re-)exposure. RESULTS:Overall, 25 men were included (all had previously been diagnosed with HCV, 13 were receiving long-acting injectable buprenorphine). Participants viewed risk of HCV (re-)exposure as part of injecting drug use in prison. Participants who were prescribed long-acting injectable buprenorphine described the treatment as supporting reduced injection drug use while incarcerated. However, OAT dosage was not always experienced as 'adequate', with some participants reporting supplementing with 'the yard program' (injecting drug use in the yard/cells) as the prescribed OAT dose lacked effectiveness to sustain until the next dose. Continuity of care was tenuous as people cycled from prison to community to prison, with people being removed from their OAT program after missing a scheduled dose in the community often due to a participant being 'on the run'. CONCLUSION:Continuity of OAT and HCV care remains a fragile experience for people who cycle in and out of incarceration. People who miss their OAT appointment in the community might wait several months upon re-incarceration to re-enter the OAT program. This leaves people vulnerable to injection sharing in custody and, subsequently, increased risk of HCV (re-)exposure while waiting to recommence OAT or to return to the optimal dosing level.

BACKGROUND:The decentralisation of hepatitis C virus (HCV) point-of-care testing is a core part of Australia's strategy to meet WHO elimination targets. However, little is known about the experiences of providers implementing these interventions and thus what is needed to improve integration. The study aim was to understand operator experiences, including the challenges and enablers, of implementing point-of-care testing as part of a National Point-of-Care Testing Program. METHODS:Providers who were enrolled in the National Program and qualified to perform point-of-care testing were invited to participate in semi-structured qualitative interviews between April and August 2023. Data were analysed according to iterative categorisation and themes were organised according to Service delivery, Resources, and Governance-elements of the Health Systems Dynamics Framework. RESULTS:Of the 31 participants, most were from New South Wales (n = 17), were practicing clinicians (n = 18), worked in outpatient or community health clinics (n = 21), and had no previous experience using a molecular point-of-care testing device (n = 24). Many participants struggled to deliver HCV testing and treatment according to national HCV management guidelines. Some participants avoided using the point-of-care testing device altogether. Others found it challenging to manage the administrative load of delivering the National Program, including planning outreach and following-up clients. These challenges were exacerbated by workforce shortages, difficult-to-navigate IT systems, and a lack of specific implementation advice from Program leadership. CONCLUSIONS:This study illustrates several challenges to and enablers of adopting a decentralised HCV point-of-care testing program, highlighting the need to further explore what providers require to effectively implement these interventions.

Few studies have explored community experiences of our increasingly resistant bacterial landscape, and, in the sphere of sexually transmissible infections (STIs) and antimicrobial resistance, there is even greater absence of community-centred research. This is despite a growth in STI transmission worldwide, which, alongside accelerated resistance, will disproportionately affect GBTQ+ (gay, bisexual, trans, queer+) populations. In this article, drawing on semi-structured interviews conducted in 2024 with 49 cisgender and trans gay and bisexual men, trans women and gender diverse people, we explore contemporary GBTQ+ safe sex practices as they relate to the growing threat of antibiotic resistant STIs in Australia. Key themes identified were the pharmaceutical turn in safe sex practices, the tensions this produced, the complexities of condom use, and the influence of biographies on safe sex practices. We illustrate how the turn toward pharmaceutical solutions has reconfigured and continues to reconfigure safe sex, giving rise to pleasures that were hitherto 'off-limits' to many. However, escalating antibiotic resistance threatens to again alter community practices and relationships to STI prevention measures. Drawing on Barad, we develop these themes to theoretically conceptualise safe sex as not fixed, but as an entanglement that is relationally and iteratively (re)configured through the connections between objects, subjectivities, practices, temporalities, and the human-microbial dynamics entailed therein. Findings suggest public health and clinical communication about resistance should speak to population concerns about gut health, resistance vis-à-vis Doxy-PEP, changing definitions of safe sex, and the importance of pleasure.

Background Untreated sexually transmissible infections (STIs) such as Chlamydia trachomatis and Neisseria gonorrhoeae can lead to serious health issues, including pelvic inflammatory disease, infertility in women, increased HIV risk, and emotional distress. Timely testing and treatment are crucial for reducing transmission. Australia's STI Management Guidelines recommend regular STI testing every 6-12months for sexually active individuals aged 15-35 years in high-prevalence, remote areas. However, testing uptake remains low among young Aboriginal and Torres Strait Islander peoples. This analysis explores how healthcare providers engage Aboriginal and Torres Strait Islander peoples in STI testing using point-of-care (POC) diagnostics. Methods Semi-structured interviews were conducted with trained STI POC testing operators within the Test Treat ANd GO (TTANGO2) project. Seven clinics involved in TTANGO2 were selected for their 'high' and 'low' implementation of STI POC testing. Purposive sampling was used to recruit similar personnel from each of the selected clinics. Coding was informed by a patient communication protocol lens. Results Twenty healthcare personnel, including Aboriginal Health Workers/Practitioners (n =8), Registered Nurses (n =7), Coordinators (n =2), and Clinical/Practice Managers (n =3) participated. Key themes related to implementing STI POC testing focused on different stages of identified patient communication protocols, such as offering tests, providing follow-up results, and contact tracing. Concerns about shame and confidentiality were significant factors affecting patient communication protocols throughout the process. Conclusions Normalising sexual health discussions in healthcare settings helps reduce feelings of shame and stigma, further encouraging patient participation in sexual health services. Ensuring patient safety and offering culturally appropriate explanations of STI POC testing are essential to reduce barriers, such as shame and stigma. Culturally safe practices can increase patient engagement and provide opportunities for health education. Integrating STI POC testing into routine health care can help normalise testing and boost uptake. However, same-day results may still require patient follow-up to maintain confidentiality. Addressing external factors, such as accessibility, confidentiality, stigma reduction, and community engagement, is crucial for improving STI testing services.

Significant health disparities exist between gay and bisexual men (GBM) and the general population in Japan and internationally. Social capital is recognized as a key factor for positive health and well-being outcomes, including HIV prevention behaviors, among GBM. However, limited research examines how the sexual orientation of alters (i.e., possessors of resources within social capital networks) impacts access to these resources. In this study, a cross-sectional online survey of 1564 gay and bisexual men in Tokyo was conducted to investigate how social capital access varies by GBM and heterosexual alters, independent of socioeconomic factors. Multivariable logistic regression indicated that access to heterosexual social capital was positively correlated with younger age, higher education, full-time employment, good self-rated health, and bisexual behavior. In contrast, gay social capital access was positively associated with being out to close friends, identifying as gay, and attending gay venues, and negatively associated with student status, living outside central Tokyo, bisexual behavior, and using gay mobile apps predominantly for sex. These findings highlight differences in the distribution and determinants of gay versus heterosexual social capital among GBM in Greater Tokyo. To close health disparities for Tokyo GBM, policy interventions should consider groups deprived of gay social capital, such as those who avoid gay venues, live outside central Tokyo, or engage in bisexual behaviors, as these individuals may benefit most from targeted support.

BACKGROUND:Hepatitis C (HCV) testing innovations such as dried blood spot (DBS) and point-of-care testing should have fewer client-related barriers than traditional diagnostic pathways, yet there is limited evidence on their acceptability among people who inject drugs. To address this gap, this study sought to evaluate the acceptability of DBS and point-of-care testing among people at risk of HCV infection and understand the circumstances in which such testing is most preferred. METHODS:Participants were recruited from community sites involved in the Australian HCV Point-of-Care Testing Program. Inclusion criteria were aged ≥18 years, sufficient proficiency in the English language, history of HCV testing at least once, and informed consent. Between June and August 2023, in-depth, semi-structured interviews were conducted via telephone with clients on their perceptions and experiences of HCV DBS and point-of-care testing. Data were coded and analysed thematically with Sekhon's theoretical framework of acceptability. RESULTS:Forty participants were interviewed: 18 had previously received HCV DBS testing, 8 had received HCV point-of-care testing, 8 had experience with both, and 6 had no prior experience with either test. Most participants preferred point-of-care compared to DBS and venepuncture due to the shorter time to result and some identified that this reduced anxiety while waiting for results (burden). Among participants in this study, many felt that the provision of non-judgemental care was more important than whether testing was performed by peers (ethicality). Many participants indicated a preference for assisted collection when compared to self-collected or mail testing service (self-efficacy). CONCLUSION:Applying Sekhon's acceptability framework highlighted remaining service gaps to bridge client HCV testing experiences, including enhanced education on testing modalities and their results, an increased need for non-judgemental care, and the use of peer support in community settings.

Point-of-care testing for hepatitis C virus (HCV) offers multiple benefits to key populations and healthcare providers, but it has not achieved widespread implementation. This analysis investigates the impact of the health system on the sustainability of point-of-care HCV testing in Australia. Between September 2023 and January 2024, in-depth, semi-structured interviews were conducted with people involved in HCV policymaking in Australia. Data were coded using WHO's Health System Building Blocks framework (i.e., Health Workforce, Health System Financing, Medical Technologies, Leadership and Governance). Thematic analysis examined how the health system supports and hinders the long-term sustainability of HCV point-of-care testing. There were 29 participants working in seven Australian jurisdictions or nationally: 13 from departments of health, six from community-led organisations, five from local health services, and five from pathology. The analysis demonstrates the interrelations between Building Blocks, but governance was consistently foregrounded across each theme. For Health Workforce, the community approach to models of care in Australia bolstered support for HCV testing outside of traditional healthcare settings. For Health System Financing, sustainability was threatened by a lack of long-term funding mechanisms for point-of-care testing. For Leadership and Governance, state and national HCV elimination targets were seen as important to drive point-of-care testing at the local level, especially when they were reflected in services' key performance indicators. Integration into existing health system structures, sustainable funding mechanisms, and strengthened governance frameworks are needed to sustain HCV point-of-care testing in Australia. Study findings are critical to inform a long-term testing strategy in Australia and internationally.