IntroductionSustaining evidence-based HIV prevention interventions remains a persistent challenge, particularly in low- and middle-income countries where programs often rely on time-limited funding. This study explored youth-generated strategies for sustaining HIV prevention interventions among adolescents and young adults (AYA) in Nigeria following initial implementation.MethodsWe conducted a national crowdsourcing open call inviting Nigerian AYA (aged 14–24 years) to propose strategies for sustaining HIV prevention services through maintaining intervention activities (A), preserving benefits (B), and strengthening capacity (C). The open call was part of the 4 Youth By Youth (4YBY) initiative. Submissions were received as text, images, or short videos and were de-identified prior to analysis. Two trained qualitative researchers conducted inductive thematic analysis with iterative codebook development. Emergent findings were subsequently interpreted using the PLAN (People, Learning, Adaptation, and Nurturing) framework and the Dynamic Sustainability Framework to examine youth-defined sustainment mechanisms. Demographic data were analyzed descriptively.ResultsOf 105 submissions received, 70 met eligibility criteria and were included in the analysis. Youth proposed actionable strategies across three sustainment domains: maintaining delivery activities, preserving intervention value, and strengthening enabling infrastructure. Strategies included youth leadership development, institutional integration, digital adaptation, stigma reduction, participatory monitoring, and diversified financing. Across domains, youth emphasized relational engagement, adaptive learning, and capacity building as mechanisms for long-term viability.ConclusionNigerian AYA articulated practical, context-responsive strategies for sustaining HIV prevention interventions. Centering youth perspectives highlights relational, structural, and adaptive mechanisms necessary for sustaining evidence-based interventions in resource-limited settings.

Abstract 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 ± 2.7 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.

In the United States, molecular HIV epidemiology (MHE) is a key part of the National HIV/AIDS Strategy, which incorporates the evaluation of HIV genetic sequences for cluster detection and response. Data collection for MHE occurs without any requirement for formal consent from patients, which has sparked ethical concerns among community members, ethicists, and advocates. We conducted a rapid review of the current literature on informed consent and MHE to understand the key concerns and recommendations. We searched 4 academic databases and included articles that examined the issue of informed consent in MHE practices. We screened a total of 119 articles and selected 30 articles for inclusion. From these, we extracted data pertaining to concerns and recommendations related to informed consent in MHE, including MHE in the context of both research and surveillance. Our findings revealed 2 main categories of concerns: (1) challenges in obtaining valid informed consent and (2) concerns related to the current lack of consent such as risks of data misuse, privacy violations, and potential stigma. We identified 3 main categories of recommendations: establishing stronger data governance, developing ethical consent practices, and increasing community engagement. A key theme identified was an unresolved contestation about the ethics of using MHE without consent and whether the potential public health benefits of MHE justify concerns about autonomy, privacy, and potential harm. Future directions include the need for empirical research to evaluate the risks and benefits of MHE and the development of practices for meaningful community engagement to ensure ethical and context-sensitive approaches.

Background Generosity is a critical yet understudied dimension of prosocial behavior in healthcare. Existing research has focused on individual traits or professional values, with limited attention to how generosity is shaped in everyday clinical contexts. This study examines how healthcare professionals in China understand and enact generosity in sexually transmitted infection (STI) services, and how it is shaped by relational and organizational conditions. Methods We conducted semi-structured interviews with 27 healthcare professionals and a focus group with four participants across five hospitals in Guangdong Province, China. Thematic analysis explored clinicians’ understandings and experiences of generosity. Crisp-set Qualitative Comparative Analysis (csQCA) examined configurations of relational and organizational conditions associated with reported generous practices. Data were analyzed using NVivo 12 and csQCA 4.0. Given uniform outcome presence, findings are interpreted as descriptive configurational patterns rather than causal effects. Results Participants described generosity as discretionary practices beyond formal duties, including emotional support, flexible scheduling, and financial accommodations. These practices were associated with patient trust and collegial support, but also with emotional strain and boundary tensions in resource-constrained settings. Generosity was more often described in accounts involving clinicians’ engagement with patients’ broader social circumstances and experiences of supportive team environments. Overall, generosity appeared as a context-dependent practice shaped by interacting relational and organizational conditions. Conclusion Generosity in STI care appears as a relationally embedded practice shaped by interactions among clinicians, patients, and organizational environments. It reflects the coupling of relational dynamics and institutional conditions that simultaneously enable and constrain discretionary care. Sustaining situated generosity therefore depends less on individual motivation than on organizational infrastructures that structure relational work in clinical settings.

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.

Pregnant adolescents are often excluded from biomedical HIV research participation, resulting in less evidence to inform safe and effective treatment and prevention strategies. We explored adolescent views on enrollment in biomedical HIV research during pregnancy via in-depth interviews with ever-pregnant adolescents living with and at-risk of HIV age 15-20 years in Botswana and Malawi. A semi-structured interview guide explored decision-making around study enrollment during pregnancy using vignettes depicting two hypothetical HIV studies: (1) testing pregnancy-specific dosage of an HIV medication, and (2) a randomized control trial comparing an oral regimen to a new injectable. Audio-recorded interviews were transcribed, translated to English, coded in NVivo, and thematically analyzed for emergent themes in participation motivators/barriers. Of the 80 adolescents interviewed (40 living with and 40 at-risk of HIV), 73 (91.3%) were interested in joining vignette study 1 and 65 (81.3%) in vignette 2. Participation motivators included treating/preventing HIV, gaining health knowledge, and helping others. Barriers included study participation requirements, the studies' experimental nature, and randomization. Adolescents' high interest in and reasons for participation during pregnancy suggest their exclusion from biomedical HIV research may be inconsistent with their views, interests, and capacities, providing important considerations for ethical and inclusive study design.

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.

Donation-based prosocial interventions for health, such as monetary donations for diagnostic tests, aim to encourage voluntary actions that benefit others while fostering public participation to promote health. These interventions are increasingly used in public health, but the associated ethical issues have not been comprehensively described. We conducted a scoping review using the Arksey and O’Malley framework to synthesize bioethics and public health literature on the ethical issues encountered with donation-based prosocial interventions for health. We searched PubMed, PsycINFO, SCOPUS, NIH Reporter, and ClinicalTrials.gov for empirical qualitative, quantitative, and mixed-methods studies. Two independent reviewers extracted data and coded data from each study according to a codebook. Categories of similar codes were analyzed to name cross-cutting issues across the included studies. The search identified 2,585 citations; 34 publications were included in our review. The publications described studies involving donations of blood, organs, biospecimens, data, and money. Most studies (32/34) were conducted in high-income countries and used observational designs (31/34). We identified three broad categories of benefits associated with donation-based interventions: health (physical and psychological), social (generosity, kindness, and community cohesion), and economic (improving welfare). We also identified several problematic ethical concerns at different levels (donor, recipient, provider, and system), such as undue pressure, privacy concerns, and inaccurate information. To mitigate these concerns, the literature discussed strengthening informed consent, ensuring confidentiality, building public trust, and ensuring appropriate stewardship of donations. We found that most studies did not empirically measure adverse consequences associated with donation-based prosocial interventions. Donation-based prosocial interventions offer several health, social, and economic benefits. However, it is essential to consider the potential ethical concerns that may arise in their design and dissemination. Further research is needed to evaluate the success of mitigation strategies for addressing these concerns and thereby enhance the overall benefits of prosocial interventions.

Sustaining evidence-based HIV prevention interventions remains a challenge, particularly among at-risk youth in Africa. The 4 Youth by Youth (4YBY) sustainment study is a hybrid type 2 cluster randomized controlled trial that evaluates the sustainability and cost-effectiveness of a crowdsourced approach to sustaining a package of evidence-based HIV prevention services. The study will be conducted across 40 community sites, supported by 18 community-based organizations (CBOs) providing HIV prevention services in Nigeria. Given their longstanding engagement with young people, CBOs serve as key partners in assessing long-term sustainability strategies for the 4YBY intervention, which has proven effective in increasing HIV prevention service uptake among youth. This protocol describes a cluster randomized controlled trial that will be conducted across 40 sites, all randomized into two arms. Half of the sites (20) will be assigned to receive the standard 4YBY intervention (4YBY-S), while the other 20 sites will receive the standard 4YBY intervention plus an enhanced sustainability strategy (4YBY-S + 4YBY-E). While the 4YBY-S group will continue implementing core intervention activities, the 4YBY-E group will receive additional sustainability-focused support. The Enhanced Sustainability Strategy in the 4YBY-E arm consists of four key components. First, “People” involves identifying and training sustainability teams within CBOs to champion intervention longevity. Second, “Learning”, where bi-weekly collaborative sessions will be established to foster knowledge-sharing and problem-solving among stakeholders. Third, “Adaptation Monitoring” will focus on continuously tracking and modifying intervention strategies to better align with local needs. Finally, “Nurturing Coaches” includes dedicated coaches who will provide technical assistance, conduct audits, and offer feedback to strengthen sustainability efforts. Evaluation will be guided by Youth Participatory Action Research (YPAR), the PEN-3 Cultural Model, Proctor’s Implementation Outcomes Framework, and the Consolidated Framework for Implementation Research (CFIR). The study hypothesizes that sites receiving the enhanced sustainability strategy (4YBY-S + 4YBY-E) will exhibit greater sustainability of core intervention components, defined as the continued delivery, adaptation, and integration of the intervention within community-based organizations—compared to sites receiving only the standard 4YBY intervention (4YBY-S). Additionally, the 4YBY-S + 4YBY-E arm is expected to achieve a higher uptake of HIV prevention services at 24 months, reflecting both the intervention’s effectiveness and its long-term viability within community settings. This protocol represents one of the first cluster randomized controlled trials evaluating intervention sustainment strategies for a youth-led, evidence-based HIV prevention program in Africa. Findings will advance implementation science by establishing a threshold for sustainable strategies and identifying the key factors that support the long-term integration and continuation of HIV prevention services for at-risk youth. The results critically impact scaling up community-led interventions and shaping policy frameworks to strengthen the global HIV response. The protocol was registered with clinicaltrials.gov under registration NCT07072481.

Clinical trials often require women and girls of childbearing potential to adhere to contraceptive mandates, typically requiring the use of two forms of contraceptives for the duration of the study. Understanding adolescent perspectives on contraceptive mandates within HIV prevention and treatment trials is critical for evaluating whether and when such requirements are ethically justified and, if so, how they might be appropriately applied in trials involving this group. We conducted semi-structured interviews with adolescents age 15–24 in the U.S. on their perspectives about contraceptive requirements. Interviews were audio-recorded and transcribed verbatim. We used Nvivo qualitative analysis software to code transcripts, and then conducted thematic analysis to identify emergent patterns in adolescents’ perceptions of the advantages and disadvantages of requiring contraception use for adolescent participants of HIV research studies. Forty adolescents were interviewed in total. Overall, most participants expressed support for a contraceptive requirement. Regardless of their stance, perceived advantages and disadvantages of such requirements stood in tension, including the ability to prevent pregnancy and desires to become pregnant, desirable health benefits and concerning side effects, and voluntary participation and violated decisional autonomy. Our findings illustrate that although contraceptive mandates are intended to facilitate and promote inclusion in research, they can simultaneously work to restrict adolescent participation in research and limit access to its potential benefits. In doing so, these requirements risk undermining their ethical justification and obstructing the generation of data needed to advance health outcomes for adolescents.

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:Older adults (people aged >60 years) are often stereotyped as being asexual, reflecting a broader lack of research into the sexual lives of this age group. Few studies have examined sexual well-being among older adults in low- and middle-income countries, especially in Africa. This scoping review aims to identify and synthesize the factors that affect sexual functioning and quality of sexual life among older adults in Africa. METHODS:Following the approach of Arksey and O'Malley, a scoping review was conducted on determinants affecting the quality of sexual life among older adults in Africa. Seven databases were searched: PubMed, Google Scholar, CINAHL, Scopus, Web of Science, ProQuest and AJOL. Full texts were reviewed to determine the final set of papers for inclusion. Included papers were published, with publication dates between January 2010 and January 2025. Data were extracted on the study population, study design, mean age of the study participants, aims of the study and the determinants affecting the quality of sexual life, and summarized using narrative synthesis. RESULTS:A total of 14,398 citations were identified in the database search, and seven studies were included in the review. The age of study participants averaged approximately 70 years. The research consisted of three qualitative and four quantitative articles. Four studies were conducted in Nigeria, and one each from South Africa, Morocco and Tanzania. Our review identified four categories of determinants influencing the quality of sexual life among older adults in Africa: psychological, sociocultural, physiological and health. Psychological determinants, including past trauma, performance anxiety and societal expectations, were identified across five studies. Sociocultural determinants, including sexual attitudes and culturally embedded behaviors, were examined in six studies, and found to shape the sexual functioning and behaviors of older adults. Physiological determinants, such as menopause and erectile dysfunction, were reported in four studies and associated with reduced sexual activity. Health determinants, including chronic conditions and pharmacological factors (medications), were identified in five studies as influencing older adults' sexual function and intimacy. CONCLUSION:Multiple, complex determinants affect the quality of sexual life among older adults in Africa. Our study findings have implications for designing sexual health services among older adults in Africa.

Ethical abuses related to syphilis research have led to significant barriers to implementation of syphilis clinical trials. Insights from an expert meeting included ways to actively involve participants in clinical research, considerations for community engagement, and strategies to enhance clinical syphilis research.

Background Middle-aged and older adults have unmet sexual health needs but often encounter challenges in accessing sexual health services (SHS). Individual, social, and environmental issues discourage middle-aged and older adults from accessing SHS. This study aimed to examine the barriers and facilitators experienced by middle-aged and older adults when accessing SHS in the UK. We included disabled people and sexual minorities with intersectional needs. Methods We organised semi-structured interviews with residents in England aged 45 years and older, including disabled people and sexual minorities. Participants were recruited using social media, primary care clinics, and community-based organisations. Interviews were audio-recorded and transcribed. Levesque et al .'s framework of healthcare access was used as a theoretical guide for analysing and presenting the study findings. After initial coding and theme generation, sub-themes of barriers and facilitators were mapped onto the healthcare access framework. Results The mean age of the 22 participants was 59years with 15 men and 7 women. Participants included people of different ethnicities (White British, Black African, and White mixed), disabilities, and sexualities. These participants highlighted various barriers to accessing SHS. Physical obstacles, such as narrow corridors, were cited as significant hindrances, although accommodations, such as physical assistance, were noted to enhance accessibility. Additionally, participants noted the pervasive stigma surrounding sexual health in older adults, exacerbated by healthcare providers presuming asexuality within this demographic. To address these multi-faceted challenges, greater involvement of disabled older individuals in the design of SHS is advocated. This collaborative approach is believed to expedite the development of age-responsive clinical services, fostering inclusivity and accessibility while simultaneously addressing psychological and social barriers. Conclusions Our data suggest that physical inaccessibility and stigma are persistent barriers to accessing SHS for older disabled people. Increasing training for healthcare providers, further research, and supportive policies are needed to improve delivery and access to SHS for older adults, including those with disabilities in the UK.

Background Crowdsourcing is a process whereby a large group, including experts and non-experts, collaborate to solve a problem and then share the solution with the public. Crowdsourcing can be used to identify strategies to sustain HIV services in low-and-middle-income countries. This study aims to identify innovative adolescent and young adult (AYA) solutions through a crowdsourcing open call to sustain HIV services. Methods Building on HIV prevention services developed by AYA from an initial open call, we organized a crowdsourcing open call to identify innovative, AYA-led strategies to sustain these services through partnerships with the community. The open call question was, 'How might we sustain the 4 Youth by Youth HIV prevention services while nurturing our existing relationships, practices, procedures and services that will last in our communities?'. All submissions were assessed based on prespecified judging criteria. Qualitative data were analyzed using thematic analysis and categorized into strategies for sustaining AYA-friendly HIV prevention services in Nigeria. Results We received 102 eligible submissions from AYA. Twenty-three submissions met the mean score threshold and were qualitatively analyzed. Through this analysis, we identified four strategies for sustaining AYA-friendly HIV prevention services in Nigeria: AYA engagement and leadership in research, digital health solutions, financing and efficiency, and partnerships. Conclusion This open call highlights how strategies developed by AYA may sustain AYA-friendly HIV prevention services. Our findings offer key insights for maintaining HIV prevention services in Nigeria and other similar settings.

Importance:Donation-based prosocial interventions involve someone receiving a free health service and then distributing or donating to support health services for others; examples within the HIV and sexually transmitted infection (STI) literature include secondary distribution of HIV self-tests, secondary syringe exchange, and pay it forward for STI testing. These interventions answer research and policy recommendations to incorporate prosocial behaviors into HIV/STI services. Objective:To describe motivations, facilitators, and barriers of donation-based interventions in HIV and STI research using data from qualitative studies. Evidence Review:In this systematic review, 5 databases (PubMed, CINAHL, Embase, PsycInfo, and Scopus) and references were searched up to January 23, 2024, for qualitative studies of donation-based interventions. Thematic synthesis was used to summarize findings, the Critical Appraisal Skills Programme Qualitative Studies Checklist was used to assess risk of bias among studies, and GRADE-CERQual (Confidence in the Evidence From Reviews of Qualitative Research) was used to assess confidence in review findings. Findings:Of 374 studies screened, 27 were included, which included 1543 participants, assessing secondary distribution of HIV self-tests (15 studies), secondary syringe exchange among people who inject drugs (10 studies), and pay it forward for STI testing (2 studies). Studies were from low-income (5 studies), middle-income (13 studies), and high-income (12 studies) countries. Givers who distributed health services were motivated by a selfless concern to benefit others (20 studies, moderate confidence) and by the cultivation of a prosocial identity (20 studies, moderate confidence). Social proximity between givers and recipients facilitated distribution (22 studies, moderate confidence), allowing for recipient-tailored strategies to introduce the service, strengthen peer relationships, and promote reciprocal giving. However, secondary syringe distribution could subject people who use drugs to legal harms and encourage them to provide unsupervised clinical care (7 studies, low confidence). Conclusions and Relevance:This systematic review identified motivations, facilitators, and barriers of donation-based interventions for HIV/STI services that could enhance implementation. Donation-based interventions may foster prosocial motivation and responsibility among socially marginalized populations to increase access to HIV/STI services.

Amidst resurging syphilis infection rates, increasing efforts are being made towards development of a syphilis vaccine. This study aims to identify barriers and facilitators of syphilis vaccine trial participation among priority groups for early phase studies. We conducted interviews with English-speaking individuals ≥18 years old recruited from an infectious disease clinic, a sexually transmitted infection (STI) testing site, an online research bulletin board, and HIV community advisory boards in North Carolina from April 2021-June 2022. Eligibility criteria included STI diagnosis within 12 months, people living with HIV (PLWH), men who have sex with men, or persons engaged in transactional sex. The interview guide examined views on syphilis vaccines, trial participation, and community engagement. Interviews were transcribed verbatim, coded, and analysed for emergent themes using a social ecological model. Thirty individuals were interviewed, including eight (27%) women, 13 (43%) Black/African American individuals, and 19 (63%) PLWH. While 19 (63%) interviewees were interested in syphilis vaccine trial participation, 10 (33%) noted participation would depend on trial parameters; one person expressed no interest. Trial participation barriers included physical risks, time commitments, and concerns related to mistrust and mistreatment. Facilitators included advancing science, syphilis prevention, and trusting the researchers. Interviewees emphasized the importance of community involvement to inform vaccine trials, particularly amidst the lingering shadow of the Tuskegee Syphilis Study. While priority groups thus expressed interest in syphilis vaccine trial participation, tailored community engagement will be essential prior to clinical trials. Additional mixed methods research is urgently needed.