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BackgroundThe advent of direct-acting antivirals (DAAs) and point-of-care (POC) testing platforms for hepatitis C allow for the decentralization of care to primary care settings. In many countries, access to DAAs is generally limited to tertiary hospitals, with limited published research documenting decentralized models of care in low-and middle-income settings. ObjectiveThis study aims to assess the feasibility, acceptability, effectiveness, and cost-effectiveness of decentralized community-based POC testing and DAA therapy for hepatitis C among people who inject drugs and the general population in Yangon, Myanmar. MethodsRapid diagnostic tests for anti-hepatitis C antibodies were carried out on-site and, if reactive, were followed by POC GeneXpert hepatitis C RNA polymerase chain reaction tests. External laboratory blood tests to exclude other major health issues were undertaken. Results were given to participants at their next appointment, with the participants commencing DAA therapy that day if a specialist review was not required. Standard clinical data were collected, and the participants completed behavioral questionnaires. The primary outcome measures are the proportion of participants receiving GeneXpert hepatitis C RNA test, the proportion of participants commencing DAA therapy, the proportion of participants completing DAA therapy, and the proportion of participants achieving sustained virological response 12 weeks after completing DAA therapy. ResultsRecruitment was completed on September 30, 2019. Monitoring visits and treatment outcome visits are scheduled to continue until June 2020. ConclusionsThis feasibility study in Myanmar contributes to the evidence gap for community-based hepatitis C care in low- and middle-income settings. Evidence from this study will inform the scale-up of hepatitis C treatment programs in Myanmar and globally.

BackgroundA growing number of health promotion interventions are taking advantage of the popularity and interactivity of new social media platforms to foster and engage communities for health promotion. However, few health promotion interventions using social networking sites (SNS) have been rigorously evaluated. "Queer as F**k"(QAF) began as pilot project in 2010 to deliver sexual health promotion via short "webisodes" on SNS to gay men. Now in its fifth season, QAF is among the few published examples internationally to demonstrate the sexual health promotion potential of SNS. ObjectiveThe objective of this evaluation is to assess reach, interactivity, and engagement generated by QAF to inform future health interventions and evaluations using SNS. MethodsWe undertook a mixed method process evaluation using an uncontrolled longitudinal study design that compared multiple measurements over time to assess changes in reach and engagement. We adapted evaluation methods from the health promotion, information systems, and creative spheres. We incorporated online usage statistics, interviews informed by user diary-scrapbooks, and user focus groups to assess intervention reach and engagement. ResultsDuring Series 1-3 (April 2010 to April 2011), 32 webisodes were posted on the QAF Facebook and YouTube pages. These webisodes attracted over 30,000 views; ranging from 124-3092 views per individual episode. By April 2011, the QAF Facebook page had 2929 predominantly male fans. Interview and focus group participants supported the balance of education and entertainment. They endorsed the narrative "soap opera" format as an effective way to deliver sexual health messages in an engaging, informative, and accessible manner that encouraged online peer discussion of sexual health and promoted community engagement. ConclusionsQAF offers a successful example of exploiting the reach, interactivity, and engagement potential of SNS; findings from this process evaluation provide a model to inform the delivery and evaluation of future health promotion interventions on SNS.

Online social networking sites offer a novel setting for the delivery of health promotion interventions due to their potential to reach a large population and the possibility for two-way engagement. However, few have attempted to host interventions on these sites, or to use the range of interactive functions available to enhance the delivery of health-related messages. This paper presents lessons learnt from “The FaceSpace Project”, a sexual health promotion intervention using social networking sites targeting two key at-risk groups. Based on our experience, we make recommendations for developing and implementing health promotion interventions on these sites. Elements crucial for developing interventions include establishing a multidisciplinary team, allowing adequate time for obtaining approvals, securing sufficient resources for building and maintaining an online presence, and developing an integrated process and impact evaluation framework. With two-way interaction an important and novel feature of health promotion interventions in this medium, we also present strategies trialled to generate interest and engagement in our intervention. Social networking sites are now an established part of the online environment; our experience in developing and implementing a health promotion intervention using this medium are of direct relevance and utility for all health organizations creating a presence in this new environment.

Objective To describe a systematic process of transforming paper registers into a digital system optimized to enhance service provision and fulfil reporting requirements. Methods We designed a formative study around primary health workers providing reproductive, maternal, newborn and child health services in three countries in Bangladesh, Indonesia and Pakistan. The study ran from November 2014 to June 2018. We developed a prototype digital application after conducting a needs assessment of health workers' responsibilities, workflows, routine data requirements and service delivery needs. Methods included desk reviews, focus group discussions, in-depth interviews; data mapping of paper registers; observations of health workers; co-design workshops with health workers; and usability testing. Finally, we conducted an observational feasibility assessment to monitor uptake of the application. Findings Researchers reviewed a total of 17 paper registers across the sites, which we transformed into seven modules within a digital application running on mobile devices. Modules corresponded to the services provided, including household enumeration, antenatal care, family planning, immunization, nutrition and child health. A total of 65 health workers used the modules during the feasibility assessment, and average weekly form submissions ranged from 8 to 234, depending on the health worker and their responsibilities. We also observed variability in the use of modules, requiring consistent monitoring support for health workers. Conclusion Lessons learnt from this study shaped key global initiatives and resulted in a software global good. The deployment of digital systems requires well-designed applications, change management and strengthening human resources to realize and sustain health system gains. Objectif Decrire un processus methodique de transformation des registres papier en systeme numerique optimise, en vue d'ameliorer la fourniture de services et de remplir les exigences relatives a l'etablissement de rapports. Methodes Nous avons concu une etude formative consacree aux professionnels des soins primaires proposant des services de sante reproductive et maternelle, de sante des nouveau-nes et de sante infantile dans trois pays: le Bangladesh, l'Indonesie et le Pakistan. Cette etude a ete menee entre novembre 2014 et juin 2018. Nous avons mis au point un prototype d'application numerique apres avoir evalue les besoins des soignants, leurs responsabilites, leur charge de travail, les donnees necessaires a leurs activites quotidiennes et les imperatifs lies a leurs prestations de service. Parmi les methodes employees figuraient des examens documentaires, des discussions de groupes, des entretiens approfondis; une cartographie des donnees fondee sur les registres papier; une observation des professionnels de la sante; des ateliers de cocreation avec les soignants; et enfin, des tests d'utilisabilite. Pour terminer, nous avons effectue une analyse de faisabilite observationnelle afin de mesurer le taux d'adhesion a l'application. Resultats Les chercheurs ont passe au crible un total de 17 registres papier sur l'ensemble des sites, que nous avons transformes en sept modules repris dans une application numerique compatible avec les appareils mobiles. Ces modules correspondaient aux services proposes, dont le recensement des menages, les soins prenatals, la planification familiale, la vaccination, la nutrition et la sante infantile. Au total, 65 soignants ont utilise les modules au cours de l'analyse de faisabilite et le nombre moyen de formulaires soumis chaque semaine etait compris entre 8 et 234, en fonction du soignant et de ses responsabilites. Nous avons egalement observe des variations dans l'utilisation des modules, ce qui montre la necessite d'assurer un suivi permanent aupres des professionnels de la sante. Conclusion Les lecons tirees de cette etude ont permis de faconner des initiatives internationales majeures et d'elaborer un logiciel d'interet mondial. Le deploiement de dispositifs numeriques requiert des applications bien pensees, une bonne gestion du changement et un renforcement des ressources humaines afin d'obtenir et de preserver les avantages pour le systeme de sante. Objetivo Describir un proceso sistematico que permita transformar los registros en papel en un sistema digital optimizado para mejorar la prestacion de servicios y cumplir con los requisitos de informacion. Metodos Se diseno un estudio formativo en torno a los profesionales de la salud primaria que prestan servicios de salud reproductiva, materna, neonatal e infantil en tres paises: de Bangladesh, Indonesia y Pakistan. El estudio se realizodesarrollo entre noviembre de 2014 y junio de 2018. Se desarrollo un prototipo de aplicacion digital despues de realizar una evaluacion sobre las necesidades de las responsabilidades de los profesionales sanitarios, los flujos de trabajo, los requisitos de datos rutinarios y las necesidades de prestacion de servicios. Los metodos incluyeron revisiones de documentos, grupos de discusion, entrevistas en profundidad; mapeo de datos de los registros en papel; observaciones de los profesionales sanitarios; talleres de codiseno con los profesionales sanitarios; y pruebas de usabilidad. Por ultimo, se llevo a cabo una evaluacion de viabilidad observacional para supervisar la aceptacion de la aplicacion. Resultados Los investigadores revisaron un total de 17 registros en papel en todos los sitios, que se adaptaron a siete modulos dentro de una aplicacion digital que funcionaba en dispositivos moviles. Los modulos correspondian a los servicios prestados, como la enumeracion de los hogares, la atencion prenatal, la planificacion familiar, la inmunizacion, la nutricion y la salud infantil. Un total de 65 profesionales sanitarios utilizaron los modulos durante la evaluacion de viabilidad, y la media de envios de formularios semanales oscilo entre 8 y 234, dependiendo del profesional sanitario y de sus responsabilidades. Tambien se observo una variabilidad en el uso de los modulos, lo que requirio un apoyo de seguimiento constante por parte de los profesionales sanitarios. Conclusion Las lecciones aprendidas de este estudio dieron forma a iniciativas globales clave y permitieron crear un programa informatico de interes mundial. El despliegue de los sistemas digitales requiere aplicaciones bien disenadas, la gestion del cambio y el fortalecimiento de los recursos humanos para realizar y mantener los beneficios del sistema sanitario., Introduction Global agencies advocate for the use of information and communication technologies to accelerate progress on priorities, such as the sustainable development goals, the Roadmap for Measurement and Accountability, and [...]

Background: Understanding the effectiveness of novel models of care in community-based settings is critical to achieving hepatitis C elimination. We conducted an evaluation of a hepatitis C model of care with financial incentives that aimed to improve engagement across the hepatitis C cascade of care at a sexual health service in Cairns, Australia. Methods: Between March 2020 and May 2021, financial incentives were embedded into an established person-centred hepatitis C model of care at Cairns Sexual Health Service. Clients of the Service who self-reported experiences of injecting drugs were offered an AUD 20 cash incentive for hepatitis C testing, treatment initiation, treatment completion, and test for cure. Descriptive statistics were used to describe retention in hepatitis C care in the incentivised model. They were compared to the standard of care offered in the 11 months prior to intervention. Results: A total of 121 clients received financial incentives for hepatitis C testing (antibody or RNA). Twenty-eight clients were hepatitis C RNA positive, of whom 92% (24/28) commenced treatment, 75% (21/28) completed treatment, and 68% (19/28) achieved a sustained virological response (SVR). There were improvements in the proportion of clients diagnosed with hepatitis C who commenced treatment (86% vs. 75%), completed treatment (75% vs. 40%), and achieved SVR (68% vs. 17%) compared to the pre-intervention comparison period. Conclusions: In this study, financial incentives improved engagement and retention in hepatitis C care for people who inject drugs in a model of care that incorporated a person-centred and flexible approach. [ABSTRACT FROM AUTHOR]

: Introduction: Sexualized drug use (SDU), the use of psychoactive drugs in the context of sexual intercourse, has been identified as a risk factor for HIV among men who have sex with men (MSM) in Asia. Given the distinct social and cultural context of same‐sex relationships and drug‐using practice in Asia, we aimed to describe the prevalence of SDU in East and South Asian countries and its associations with condomless anal sex (CAI) and HIV status. Synthesizing SDU research in this region, including SDU definitions, prevalence and outcomes, provides insights to inform future research and improved programme planning, resourcing and advocacy. Methods: We systematically searched OVID Medline, OVID EMBASE, OVID Global Health, CINAHL, PsycINFO and SCOPUS publication databases for scientific articles published from 1990 to 2022 measuring SDU among MSM in East and South Asian countries. A narrative synthesis was utilized to describe key study attributes and findings, and meta‐analyses using random pooled effect models were used to estimate SDU prevalence and its associations with CAI and HIV status. Subgroup meta‐analyses, sensitivity analysis and assessment of publication bias examined potential sources of heterogeneity for the pooled SDU prevalence estimates. Results and discussion: Of the 1788 publications screened, 49 publications met the selection criteria and 18 were suitable for meta‐analyses. Findings highlight SDU definitions distinct from other regions but inconsistencies in the definition of SDU between studies that have been highlighted in research elsewhere. The pooled prevalence of recent SDU (past 12 months) was 13% (95% CI = 10–16%; I[sup.2] = 97.6) but higher when studies utilized self‐administered surveys (15%; 95% CI = 12–19%; p Conclusions: SDU is common among MSM in East and South Asian countries, but varying SDU definitions limit between‐study comparisons. Responses to SDU‐related harms should consider local contexts, including specific drug types used and their relative risks., INTRODUCTION The United Nations Office on Drugs and Crimes has recently emphasized the urgency of addressing intersecting drug use and sexual practices by recommending targeted interventions for HIV prevention, particularly [...]

Introduction: In Myanmar, men who have sex with men (MSM) and transgender women (TW) are disproportionately affected by HIV, despite national HIV program scale-up. However, limited HIV surveillance capacity prevents monitoring of epidemic trends and program impact. This study aimed to estimate HIV prevalence and incidence and explore associated sexual risk behaviours among MSM and TW clients attending HIV testing clinics in Myanmar. Methods: An electronic data management system was implemented in two community-based, MSM and TW -tailored HIV testing clinics in Myanmar in August 2016. Unique client identifiers enabled prospective monitoring of service engagement, testing frequency and outcomes. We estimated HIV incidence and rate of HIV diagnosis at baseline testing visit among clients over a 15 month period. Correlates of HIV diagnoses were identified using multivariable logistic regression. Results: 2794 MSM and TW were tested for HIV. At their baseline test, 38% of clients reported any previous testing and 93% reported being sexually active over the previous three months, with 74% reporting sex with casual male partners and 28% reporting consistent condom use with casual partners. 291 clients tested positive for HIV for the first time at baseline (10.4%; 95% CI: 9.3 to 11.6). Twelve incident cases were detected among 279 clients receiving [greater than or equal to]2 tests (incidence = 10.1 per 100 person-years; 95% CI: 5.73 to 17.8). HIV diagnosis at baseline was significantly associated with being a transgender woman or a non-openly disclosing man who has sex with men, age 26 to 39 years, and reporting no testing history. Conclusions: High HIV incidence and new diagnoses being associated with reporting no testing history points to undiagnosed HIV driving transmissions in Myanmar. Repeat testing was uncommon. HIV programs in Myanmar must focus on promoting frequent HIV testing alongside adequate coverage of education and primary prevention interventions among MSM and TW. Keywords: HIV prevention; men who have sex with men; transgender women; Myanmar; HIV epidemiology; HIV testing, (1) | INTRODUCTION Evidence of emergent HIV epidemics and prevalence estimates greater than 10% point to a disproportionate burden of HIV among men who have sex with men (MSM) and [...]

Introduction: Gay and bisexual men (GBM) are at increased risk of hepatitis C/HIV co-infection. In Australia, the availability of subsidized direct-acting antiviral treatment for hepatitis C has rendered eliminating co-infection possible. High reinfection rates in subgroups with continued exposure may compromise elimination efforts. To inform the development of hepatitis C risk reduction support in GBM, we explored reinfection risk perceptions and attitudes among GBM living with HIV recently cured from hepatitis C Methods: Between April and August 2017, 15 GBM living with diagnosed HIV were recruited from high caseload HIV primary care services in Melbourne following successfull hepatitis C treatment. In-depth interviews were conducted exploring understandings of hepatitis C risks, experiences of co-infection and attitudes towards reinfection. Constructivist grounded theory guided data aggregation. Results: Participants' understandings of their hepatitis C infection and reinfection trajectories were captured in three categories. Hepatitis C and HIV disease dichotomies: Hepatitis C diagnosis was a shock to most participants and contrasted with feelings of inevitability associated with HIV seroconversion. While HIV was normalized, hepatitis C was experienced as highly stigmatizing. Despite injecting drug use, interviewees did not identify with populations typically at risk of hepatitis C Risk environments and avoiding reinfection: Interviewees identified their social and sexual networks as risk-perpetuating environments where drug use was ubiquitous and higher risk sex was common. Avoiding these risk environments to avoid reinfection resulted in community disengagement, leaving many feeling socially isolated. Hepatitis C care as a catalyst for change: Engagement in hepatitis C care contributed to a better understanding of hepatitis C risks. Interviewees were committed to applying their improved competencies around transmission risk reduction to avoid reinfection. Interviewees also considered hepatitis C care as a catalyst to reduce their drug use. Conclusions: Hepatitis C/HIV co-infection among GBM cannot be understood in isolation from co-occurring drug use and sex, nor as separate from their HIV infection. Hepatitis C prevention must address subcultural heterogeneity and the intersectionality between multiple stigmatized social identities. Hepatitis C care presents an opportunity to provide support beyond cure. Peer support networks could mitigate social capital loss following a commitment to behaviour change and reduce hepatitis C reinfection risks. Keywords: hepatitis C; HIV; gay and bisexual men; direct-acting antivirals; reinfection; risk behaviours; attitudes, 1 | INTRODUCTION Hepatitis C virus (HCV) infection is a significant public health threat; in 2015, an estimated 71 million people worldwide had chronic HCV infection [1]. Due to shared [...]

Introduction: There is currently no published data on the effectiveness of DAA treatment for elimination of HCV infection in HIV-infected populations at a population level. However, a number of relevant studies and initiatives are emerging. This research aims to report cascade of care data for emerging HCV elimination initiatives and studies that are currently being evaluated in HIV/HCV co-infected populations in the context of implementation science theory. Methods: HCV elimination initiatives and studies in HIV co-infected populations that are currently underway were identified. Context, intervention characteristics and cascade of care data were synthesized in the context of implementation science frameworks. Results: Seven HCV elimination initiatives and studies were identified in HIV co-infected populations, mainly operating in high-income countries. Four were focused mainly on HCV elimination in HIV-infected gay and bisexual men (GBM), and three included a combination of people who inject drugs (PWID), GBM and other HIV-infected populations. None were evaluating treatment delivery in incarcerated populations. Overall, HCV RNA was detected in 4894 HIV-infected participants (range within studies: 297 to 994): 48% of these initiated HCV treatment (range: 21% to 85%; within studies from a period where DAAs were broadly available the total is 57%, range: 36% to 74%). Among studies with treatment completion data, 96% of 1109 initiating treatment completed treatment (range: 94% to 99%). Among those who could be assessed for sustained virological response at 12 weeks (SVR12), 1631 of 1757 attained SVR12 (93%, range: 86% to 98%). Conclusions: Early results from emerging research on HCV elimination in HIV-infected populations suggest that HCV treatment uptake is higher than reported levels prior to DAA treatment availability, but approximately half of patients remain untreated. These results are among diagnosed populations and additional effort is required to increase diagnosis rates. Among those who have initiated treatment, completion and SVR rates are promising. More data are required in order to evaluate the effectiveness of these elimination programmes in the long term, assess which intervention components are effective, and whether they need to be tailored to particular population groups. Keywords: hepatitis C virus; disease elimination; MSM; IDU; implementation science; barriers; cascade of care, 1 | INTRODUCTION Over two million people are estimated to be HIV/HCV coinfected globally [1]. Chronic viral hepatitis accounts for approximately 10% of mortality among people living with HIV [2]. [...]

Gay and bisexual men (GBM) report higher rates of sexualised and injecting drug use (IDU) than heterosexual men. Injecting-related stigma is linked to negative health outcomes among people who inject drugs (PWID). This paper describes the ways in which stigmatisation manifests in the narratives of GBM who inject drugs. We conducted in-depth interviews with Australian GBM with IDU histories, exploring drug use, pleasure, risk, and relationality. Data were analysed using discourse analytical approaches. Interviewees (n = 19), aged 24–60 years, narrated their experiences of IDU practice over 2–32 years. Most (n = 18) injected methamphetamine, and used other (non-injected) drugs, in sexual contexts. From participants' narratives, we developed two themes related to stigmatisation of PWID that illustrate the limitations of conventional drug discourses to narrate GBM's experiences. The first theme captures participants' attempts to pre-empt stigmatisation, outlining the layering of stigma faced by GBM who inject drugs. Linguistically, participants transformed injecting stigma by distinguishing their personal practice from that of more discreditable drug users. Practically, they mitigated stigmatisation by keeping discrediting information from others. The second theme illustrates how by complicating the stereotypes of IDU, participants took up prominent discursive practices linking IDU with trauma and pathology. Participants exerted agency by broadening available interpretive repertoires for understanding IDU among GBM, thus creating a counter-discourse. We argue that mainstream discursive practices reverberate through gay communities, perpetuating stigmatisation of PWID and inhibiting care-seeking. More narration of unconventional experiences, beyond insular social groups and critical scholarship, is needed in public discourse to effect destigmatisation. [ABSTRACT FROM AUTHOR]