Self-sampling strategies (with/without digital innovations) in populations at risk of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analyses.

BACKGROUND: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) resulted in over 200 million new sexually transmitted infections last year. Self-sampling strategies alone or combined with digital innovations (ie, online, mobile or computing technologies supporting self-sampling) could improve screening methods. Evidence on all outcomes has not yet been synthesised, so we conducted a systematic review and meta-analysis to address this limitation. METHODS: We searched three databases (period: 1 January 2000-6 January 2023) for reports on self-sampling for CT/GC testing. Outcomes considered for inclusion were: accuracy, feasibility, patient-centred and impact (ie, changes in linkage to care, first-time testers, uptake, turnaround time or referrals attributable to self-sampling).We used bivariate regression models to meta-analyse accuracy measures from self-sampled CT/GC tests and obtain pooled sensitivity/specificity estimates. We assessed quality with Cochrane Risk of Bias Tool-2, Newcastle-Ottawa Scale and Quality Assessment of Diagnostic Accuracy Studies-2 tool. RESULTS: We summarised results from 45 studies reporting self-sampling alone (73.3%; 33 of 45) or combined with digital innovations (26.7%; 12 of 45) conducted in 10 high-income (HICs; n=34) and 8 low/middle-income countries (LMICs; n=11). 95.6% (43 of 45) were observational, while 4.4% (2 of 45) were randomised clinical trials.We noted that pooled sensitivity (n=13) for CT/GC was higher in extragenital self-sampling (>91.6% (86.0%-95.1%)) than in vaginal self-sampling (79.6% (62.1%-90.3%)), while pooled specificity remained high (>99.0% (98.2%-99.5%)).Participants found self-sampling highly acceptable (80.0%-100.0%; n=24), but preference varied (23.1%-83.0%; n=16).Self-sampling reached 51.0%-70.0% (n=3) of first-time testers and resulted in 89.0%-100.0% (n=3) linkages to care. Digital innovations led to 65.0%-92% engagement and 43.8%-57.1% kit return rates (n=3).Quality of studies varied. DISCUSSION: Self-sampling had mixed sensitivity, reached first-time testers and was accepted with high linkages to care. We recommend self-sampling for CT/GC in HICs but additional evaluations in LMICs. Digital innovations impacted engagement and may reduce disease burden in hard-to-reach populations. PROSPERO REGISTRATION NUMBER: CRD42021262950.

Factors associated with intention to receive vaccines for bacterial sexually transmitted infections among young HPV-vaccinated Canadian women.

OBJECTIVE: The aim of this study was to explore the acceptability of bacterial STI vaccines among young HPV-vaccinated Canadian women to inform future vaccine program implementation. METHODS: A 20-item cross-sectional questionnaire was administered from June 2019 to June 2020 to HPV-vaccinated participants of the pan-Canadian QUEST cohort. Multivariable logistic regression models assessed interest in chlamydia, syphilis, and gonorrhea vaccines using a priori variables and factors significant in bivariate analysis. RESULTS: Of the 1092 respondents analyzed, 82% indicated interest in receiving one or more future STI vaccines. Respondents had a median age of 19.6 years (range 16.9-23.4), and 75% of respondents identified as white/European descent. In adjusted analyses, intent to engage in positive health behaviours was associated with vaccine interest for syphilis (OR = 5.76, 95% CI 4.03-8.27), chlamydia (OR = 5.27, 95% CI 3.66-7.63), and gonorrhea (OR = 5.96, 95% CI 4.15-8.60). Willingness to pay for an STI vaccine was also associated with vaccine interest for syphilis (OR = 2.02, 95% CI 1.29-3.19), chlamydia (OR = 2.41, 95% CI 1.50-3.90), and gonorrhea (OR = 2.29, 95% CI 1.44-3.63). Ever having sexual intercourse and identifying as LGBTQ were significantly associated with vaccine interest for all infections, while age and ever being immunosuppressed were not significant in any adjusted models. CONCLUSION: Findings indicate over 80% of participants in a cohort of young HPV-vaccinated Canadian women are interested in receiving future bacterial STI vaccines. Further exploration of STI vaccine acceptability among diverse populations is required to inform future bacterial STI vaccine program implementation.

RéSUMé: OBJECTIF: Cette étude visait à explorer l'acceptabilité des vaccins contre les ITS bactériennes chez les jeunes Canadiennes vaccinées contre le VPH pour éclairer la mise en œuvre de futurs programmes de vaccination. MéTHODE: Un questionnaire transversal de 20 questions a été administré entre juin 2019 et juin 2020 aux participantes de la cohorte QUEST pancanadienne ayant été vaccinées contre le VPH. Des modèles de régression logistique multivariée ont permis d'analyser l'intérêt pour les vaccins contre la chlamydia, la syphilis et la gonorrhée à l'aide de variables a priori et des facteurs significatifs dans l'analyse bivariée. RéSULTATS: Sur les 1 092 répondantes analysées, 82 % ont manifesté l'intérêt de recevoir un ou plusieurs futurs vaccins contre les ITS. L'âge médian des répondantes était de 19,6 ans (intervalle 16,9­23,4), et 75 % s'identifiaient comme étant blanches/d'ascendance européenne. Dans les analyses ajustées, l'intention de s'adonner à des comportements de santé positifs était associée à l'intérêt pour les vaccins contre la syphilis (RC = 5,76, IC de 95 % 4,03­8,27), la chlamydia (RC = 5,27, IC de 95 % 3,66­7,63) et la gonorrhée (RC = 5,96, IC de 95 % 4,15­8,60). La volonté de payer pour un vaccin contre les ITS était aussi associée à l'intérêt pour les vaccins contre la syphilis (RC = 2,02, IC de 95 % 1,29­3,19), la chlamydia (RC = 2,41, IC de 95 % 1,50­3,90) et la gonorrhée (RC = 2,29, IC de 95 % 1,44­3,63). Le fait d'avoir déjà eu des rapports sexuels et le fait de s'identifier comme une personne LGBTQ présentaient une corrélation significative avec l'intérêt pour les vaccins contre toutes les infections, mais l'âge et le fait d'avoir déjà subi un traitement immunodépresseur n'étaient des facteurs significatifs dans aucun des modèles ajustés. CONCLUSION: Selon nos constatations, plus de 80 % des participantes d'une cohorte de jeunes Canadiennes vaccinées contre les VPH sont intéressées à recevoir de futurs vaccins contre les ITS bactériennes. Une exploration plus poussée de l'acceptabilité des vaccins contre les ITS dans des populations à forte mixité est nécessaire pour éclairer la mise en œuvre de futurs programmes de vaccination contre les ITS bactériennes.

The Community Health and Social Medicine Incubator: a service-learning framework for medical student-led projects.

The Community Health and Social Medicine (CHASM) Incubator is a social impact venture that gives medical and other health care students the opportunity to develop initiatives that sustainably promote health equity for, and in partnership with, community partners and historically marginalized communities. Students learn how to develop projects with project management curricula, are paired with community health mentors, and are given seed micro-financing. As the first community health incubator driven by medical students, CHASM provides a framework for students interested in implementing sustainable solutions to local health disparities which extends the service-learning opportunities offered in existing curricula.

L'incubateur CHASM (Community Health and Social Medicine) est une initiative visant à créer un impact social en donnant aux étudiants en médecine et des autres sciences de la santé la possibilité de développer des initiatives durables en collaboration avec des partenaires communautaires et des communautés historiquement marginalisées. CHASM met en valeur l'équité en matière de santé. Les étudiants apprennent à élaborer des projets via un cursus de gestion de projet, sont jumelés à des mentors en santé communautaire et bénéficient de micro-financement de départ. Ce premier incubateur de santé communautaire mené par des étudiants en médecine fournit un cadre aux étudiants qui souhaitent mettre en œuvre des solutions durables aux inégalités en matière de santé. Il élargit également les possibilités d'apprentissage par le service offertes dans les cursus existants.

Impact of a personalised, digital, HIV self-testing app-based program on linkages and new infections in the township populations of South Africa.

INTRODUCTION: Implementation data for digital unsupervised HIV self-testing (HIVST) are sparse. We evaluated the impact of an app-based, personalised, oral HIVST program offered by healthcare workers in Western Cape, South Africa. METHODS: In a quasirandomised study (n=3095), we recruited consenting adults with undiagnosed HIV infection from township clinics. To the HIVST arm participants (n=1535), we offered a choice of an offsite (home, office or kiosk based), unsupervised digital HIVST program (n=962), or an onsite, clinic-based, supervised digital HIVST program (n=573) with 24/7 linkages services.With propensity score analyses, we compared outcomes (ie, linkages, new HIV infections and test referrals) with conventional HIV testing (ConvHT) arm participants (n=1560), recruited randomly from geographically separated clinics. RESULTS: In both arms, participants were young (HIVST vs ConvHT) (mean age: 28.2 years vs 29.2 years), female (65.0% vs 76.0%) and had monthly income <3000 rand (80.8% vs 75%).Participants chose unsupervised HIVST (62.7%) versus supervised HIVST and reported multiple sex partners (10.88% vs 8.7%), exposure to sex workers (1.4% vs 0.2%) and fewer comorbidities (0.9% vs 1.9%). Almost all HIVST participants were linked (unsupervised HIVST (99.7%), supervised HIVST (99.8%) vs ConvHT (98.5%)) (adj RR 1.012; 95% CI 1.005 to 1.018) with new HIV infections: overall HIVST (9%); supervised HIVST (10.9%) and unsupervised HIVST (7.6%) versus ConvHT (6.79%) (adj RR 1.305; 95% CI 1.023 to 1.665); test referrals: 16.7% HIVST versus 3.1% ConvHT (adj RR 5.435; 95% CI 4.024 to 7.340). CONCLUSIONS: Our flexible, personalised, app-based HIVST program, offered by healthcare workers, successfully linked almost all HIV self-testers, detected new infections and increased referrals to self-test. Data are relevant for digital HIVST initiatives worldwide.

HIV self-testing with digital supports as the new paradigm: A systematic review of global evidence (2010-2021).

BACKGROUND: HIV self-testing (HIVST) is recommended by the WHO as an innovative strategy to reach UNAIDS targets to end HIV by 2030. HIVST with digital supports is defined as the use of digital interventions (e.g., website-based, social media, mobile HIVST applications (apps), text messaging (SMS), digital vending machines (digital VMs)) to improve the efficiency and impact of HIVST. HIVST deployment and integration in health services is an emerging priority. We conducted a systematic review aiming to close the gap in evidence that summarizes the impact of digitally supported HIVST and to inform policy recommendations. METHODS: We searched PubMed and Embase for articles and abstracts on HIVST with digital supports published during the period February 1st, 2010 to June 15th, 2021, following Cochrane guidelines and PRISMA methodology. We assessed feasibility, acceptability, preference, and impact outcomes across all populations and study designs. Metrics reported were willingness to use HIVST, preferences for HIVST delivery, proportion of first-time testers, HIVST uptake, HIVST kit return rate, and linkage to care. Heterogeneity of the interventions and reported metrics precluded us from conducting a meta-analysis. FINDINGS: 46 studies were narratively synthesized, of which 72% were observational and 28% were RCTs. Half of all studies (54%, 25/46) assessed web-based innovations (e.g., study websites, videos, chatbots), followed by social media (26%, 12/46), HIVST-specific apps (7%, 3/46), SMS (9%, 4/46), and digital VMs (4%, 2/46). Web-based innovations were found to be acceptable (77-97%), preferred over in-person and hybrid options by more first-time testers (47-48%), highly feasible (93-95%), and were overall effective in supporting linkage to care (53-100%). Social media and app-based innovations also had high acceptability (87-95%) and linkage to care proportions (80-100%). SMS innovations increased kit return rates (54-94%) and HIVST uptake among hard-to-reach groups. Finally, digital VMs were highly acceptable (54-93%), and HIVST uptake was six times greater when using digital VMs compared to distribution by community workers. INTERPRETATION: HIVST with digital supports was deemed feasible, acceptable, preferable, and was shown to increase uptake, engage first-time testers and hard-to-reach populations, and successfully link participants to treatment. Findings pave the way for greater use of HIVST interventions with digital supports globally.