Lara Tavoschi

People living in prison are disproportionately affected by hepatitis B and C, yet access to prevention, testing, and treatment services remains inconsistent across Europe. Addressing this gap is critical to achieving viral hepatitis elimination targets by 2030. EuroHePP is a European toolkit developed to support national responses to viral hepatitis in prison settings. It was created through a structured, multi‐stage process involving evidence review, stakeholder consultations, and expert validation. The toolkit provides practical guidance across the full continuum of care, including prevention, testing, treatment, and monitoring, and promotes micro‐elimination approaches tailored to prison populations. It emphasises evidence‐based interventions such as opt‐out testing, decentralised and simplified models of care, harm reduction strategies, and continuity of care after release. By offering adaptable tools and frameworks for policymakers and practitioners, EuroHePP aims to strengthen prison health systems, reduce health inequalities, and accelerate progress towards hepatitis elimination at national and regional levels.

Introduction Annual seasonal vaccinations for influenza and COVID-19 are considered to have high public health and economic benefits. Healthcare professionals (HCPs) have a crucial role in individuals’ vaccination decision. However, encouraging HCPs to actively promote vaccination remains challenging. The Capabilities, Opportunities, Motivation-Behaviour (COM-B) model of behaviour offers a framework for identifying individual and contextual factors influencing HCPs’ readiness to promote vaccination. To our knowledge, there are currently no quantitative tools measuring HCPs’ readiness to promote vaccination based on the COM-B Model. Objectives To develop a questionnaire informed by the COM-B model on the readiness of HCPs to promote COVID-19 and influenza vaccination, to assess the cross-national adaptation of the questionnaire across the co-OPERATOR consortium countries (Cyprus, Greece, Italy, Portugal), and to evaluate the validity, reliability, and acceptability of the different language versions. Protocol The questionnaire will be developed in three phases: Item development, questionnaire development, and questionnaire evaluation. Items were developed using deductive methods applied through literature review and assessment of existing scales and items tapping on COM-B domains. Content validity was tested using an Expert Consensus Study. Forward-backward translations will be employed to translate the tool from English into the target languages, and local experts will provide feedback on the suitability of the translated equivalent versions. Cognitive interviews with end-users will take place to assess the understandability and usability of the questionnaire, and appropriateness of response options. The questionnaire will subsequently be distributed to HCPs in the different countries to evaluate its metric properties (e.g., construct validity, reliability) and users’ acceptability. A sub-sample of participants will complete the questionnaire twice, with a 2-week interval. Conclusion A valid and reliable theory-based questionnaire can be used in various clinical settings in different countries to provide measurable, comparable outcomes and performance metrics to support policymaking decisions and vaccination promotion strategies.

Background: People experiencing homelessness (PEH) face complex social and economic challenges that increase their risk of poor health. This study aimed to identify and synthesize key barriers to and facilitators of healthcare access from the perspective of PEH to inform more equitable and sustainable health strategies. Methods: A systematic scoping review was conducted in accordance with the guidelines of the Cochrane Collaboration and the Joanna Briggs Institute and was reported following the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR). A PubMed, Embase and Web of Science search was conducted in January 2025 using terms related to homelessness, healthcare, and interventional and observational studies. A manual search of the reference lists of the included studies was also performed via conventional search engines. Two reviewers independently classified the relevance of the extracted studies according to predefined eligibility criteria. Any discrepancies were solved by a third reviewer. The final list of studies enabled extraction of barriers to and facilitators of access to healthcare, subsequently classified according to the socioecological model. Results: A total of 79 studies ( n = 51,110 PEH) published between 1989 and 2024, mostly from the United States of America (USA) ( n = 48; 63.3%), were included. Interventions most frequently addressed general healthcare ( n = 25; 31.6%), treatment of specific conditions ( n = 23; 29.1%) and sexual and reproductive healthcare ( n = 7; 8.9%). Common individual-level barriers included health related-beliefs and concerns ( n = 43), cognitive and behavioral health challenges ( n = 28), and substance use ( n = 18), whereas increased health awareness ( n = 13) facilitated healthcare utilization. At the interpersonal level, social stigma ( n = 51) and negative provider attitudes ( n = 31) were prominent barriers, whereas strong social networks ( n = 34) supported engagement. Institutional-level barriers included bureaucracy ( n = 21) and lack of service integration ( n = 20); conversely, continuity of care ( n = 8) and process simplification ( n = 7) acted as facilitators. Community-level barriers involved limited-service availability ( n = 22), direct ( n = 34) and indirect costs ( n = 19); facilitators were centered on structure of the health service ( n = 16). At the policy level, limited resources and service offer ( n = 7), as well as undocumented situations by PEH ( n = 4) were key barriers; strategically located services ( n = 7) facilitated healthcare utilization. Conclusion: Improving healthcare for PEH requires multilevel, person-centered strategies that address structural, interpersonal, and individual barriers while streamlining access through inclusive public policy. Review registration: International Prospective Register of Systematic Reviews (PROSPERO): CRD42025635835.

Introduction Annual seasonal vaccinations for influenza and COVID-19 are considered to have high public health and economic benefits. Healthcare professionals (HCPs) have a crucial role in individuals’ vaccination decision. However, encouraging HCPs to actively promote vaccination remains challenging. The Capabilities, Opportunities, Motivation-Behaviour (COM-B) model of behaviour offers a framework for identifying individual and contextual factors influencing HCPs’ readiness to promote vaccination. To our knowledge, there are currently no quantitative tools measuring HCPs’ readiness to promote vaccination based on the COM-B Model. Objectives To develop a questionnaire informed by the COM-B model on the readiness of HCPs to promote COVID-19 and influenza vaccination, to assess the cross-national adaptation of the questionnaire across the co-OPERATOR consortium countries (Cyprus, Greece, Italy, Portugal), and to evaluate the validity, reliability, and acceptability of the different language versions. Protocol The questionnaire will be developed in three phases: Item development, questionnaire development, and questionnaire evaluation. Items were developed using deductive methods applied through literature review and assessment of existing scales and items tapping on COM-B domains. Content validity was tested using an Expert Consensus Study. Forward-backward translations will be employed to translate the tool from English into the target languages, and local experts will provide feedback on the suitability of the translated equivalent versions. Cognitive interviews with end-users will take place to assess the understandability and usability of the questionnaire, and appropriateness of response options. The questionnaire will subsequently be distributed to HCPs in the different countries to evaluate its metric properties (e.g., construct validity, reliability) and users’ acceptability. A sub-sample of participants will complete the questionnaire twice, with a 2-week interval. Conclusion A valid and reliable theory-based questionnaire can be used in various clinical settings in different countries to provide measurable, comparable outcomes and performance metrics to support policymaking decisions and vaccination promotion strategies.

Introduction Cervical cancer is the first cancer potentially eliminable through widespread HPV vaccination. In Italy, despite free access, vaccine coverage among adolescents remains low. Psychological factors and cognitive biases can influence vaccine decisions and contribute to vaccine hesitancy (VH). While social media offer new avenues for health communication, their effectiveness in reducing VH is uncertain. This study investigates the impact of Instagram-based communication strategies on adolescents’ HPV knowledge and VH.Methods A three-arm randomized controlled trial was conducted in 22 high school classes in Tuscany, Italy, involving 526 students. Classes were assigned to one of three Instagram accounts: a neutral control, an information-based, or a bias-aware information. After three weeks (T2), students completed a follow-up survey, followed by an in-class lesson. Surveys were administered at baseline (T1), post-intervention (T2), and three-month follow-up (T3).Results The final analysis included 301 students (mean age 15.2, 74% female). At T1, VH and knowledge scores were low (mean VH = 40%; knowledge score = 27%), and 47.9% reported likely seeking information from sexual and reproductive services. No significant changes in VH or knowledge were found at T2 overall. However, in students with low information avoidance (IA), the info-based page reduced VH significantly compared to the control (-6.9%, p = 0.009). In contrast, among high-IA students, the same intervention increased VH (estimate: +8.9%, p = 0.002). Willingness to seek information increased in the info group among low-IA students (+1.639 vs. control, p = 0.034). At T3, we measured the impact of an in-person lecture on students’ HPV and HPV vaccination literacy. A significant increase of knowledge compared to T1 is observed despite the smaller sample collected.Conclusion Social media campaigns alone may not effectively reduce VH in adolescents and can even backfire among high-IA individuals. Future strategies should incorporate personalized, bias-aware messaging and interactive tools to address VH and improve HPV vaccine uptake more effectively.

Introduction Annual seasonal vaccinations for influenza and COVID-19 are considered to have high public health and economic benefits. Healthcare professionals (HCPs) have a crucial role in individuals’ vaccination decision. However, encouraging HCPs to actively promote vaccination remains challenging. The Capabilities, Opportunities, Motivation-Behaviour (COM-B) model of behaviour offers a framework for identifying individual and contextual factors influencing HCPs’ readiness to promote vaccination. To our knowledge, there are currently no quantitative tools measuring HCPs’ readiness to promote vaccination based on the COM-B Model. Objectives To develop a questionnaire informed by the COM-B model on the readiness of HCPs to promote COVID-19 and influenza vaccination, to assess the cross-national adaptation of the questionnaire across the co-OPERATOR consortium countries (Cyprus, Greece, Italy, Portugal), and to evaluate the validity, reliability, and acceptability of the different language versions. Protocol The questionnaire will be developed in three phases: Item development, questionnaire development, and questionnaire evaluation. Items were developed using deductive methods applied through literature review and assessment of existing scales and items tapping on COM-B domains. Content validity was tested using an Expert Consensus Study. Forward-backward translations will be employed to translate the tool from English into the target languages, and local experts will provide feedback on the suitability of the translated equivalent versions. Cognitive interviews with end-users will take place to assess the understandability and usability of the questionnaire, and appropriateness of response options. The questionnaire will subsequently be distributed to HCPs in the different countries to evaluate its metric properties (e.g., construct validity, reliability) and users’ acceptability. A sub-sample of participants will complete the questionnaire twice, with a 2-week interval. Conclusion A valid and reliable theory-based questionnaire can be used in various clinical settings in different countries to provide measurable, comparable outcomes and performance metrics to support policymaking decisions and vaccination promotion strategies.

Worldwide, an estimated 57.8 million people are chronically infected with the Hepatitis C virus (HCV). The advent of direct-acting antivirals (DAAs) has made possible the definition of elimination targets by 2030. This study aimed to evaluate the effectiveness of a population-level health intervention to expand access to HCV treatment in the Tuscany Region, Italy. We used individual-level administrative data from the Tuscany region, collected between January 2015 and December 2022. Data include monthly observations on i) the number of serological tests to detect HCV, ii) the number of PCR tests to detect HCV and, iii) the number of prescriptions of direct-acting antivirals against HCV. We implemented an Interrupted Time Series (ITS) model, where the primary outcome was the number of monthly prescriptions of direct-acting antivirals, while the number of tests to detect HCV were included as control variables. The analysis was implemented i) in the general population, ii) in specific sub-population groups. Results show that the health intervention promoted by the Tuscany Regional Health Authority was highly effective in increasing DAAs treatment coverage in the general population, while no significant effects were observed among sub-population groups. Findings of this study provide evidence to support policies at national and subnational levels to booster HCV screening and simplify access to DAA prescriptions.

HIV testing is crucial towards the control of the Acquired Immune Deficiency Syndrome (AIDS) epidemic. Monitoring trends of human immunodeficiency virus (HIV) testing over time may help interpret the incidence of new HIV diagnoses and effectiveness of HIV testing strategies. We started a research project aimed at assessing testing rates for HIV infection among Italian outpatients in 2018–2023. Numeric data for screening, confirmatory, and monitoring tests obtained by a national register were compared with the numbers of adult residents, newly diagnosed HIV infections, and patients undergoing treatment. The number of screening tests declined from 1,133,377 in 2018 to 889,972 in 2020 and increased to 1,096,822 in 2023. HIV-RNA tests showed a similar pattern, whereas confirmatory immunoblots did not vary significantly over time. The ratio of screening tests to adult residents was higher in North-West (2.87%) and North-East (2.31%) Italy compared to South Italy and the islands (1.47%), indicating that screening should be enhanced in the latter area. We observed differences between the ratio of screening tests and the incidence of newly diagnosed HIV infections by geographic area. Discrepancies in the number of screening and confirmatory tests needed for each new diagnosis suggest repeated testing on people already diagnosed and possible data reporting issues. The monitoring of HIV screening tests at the national and regional levels can provide essential data to interpret trends in HIV epidemiology and plan relevant testing strategies over time.

Background: The World Health Organization (WHO) recently advocated an urgent need for implementing national surveillance systems for the timely detection and reporting of emerging antimicrobial resistance (AMR). However, public information on the existing national early warning systems (EWSs) is often incomplete, and a comprehensive overview on this topic is currently lacking. Objective: This review aimed to map the availability of EWSs for emerging AMR in high-income countries and describe their main characteristics. Methods: A systematic review was performed on bibliographic databases, and a targeted search was conducted on national websites. Any article, report, or web page describing national EWSs in high-income countries was eligible for inclusion. EWSs were identified considering the emerging AMR-reporting WHO framework. Results: We identified 7 national EWSs from 72 high-income countries: 2 in the East Asia and Pacific Region (Australia and Japan), 3 in Europe and Central Asia (France, Sweden, and the United Kingdom), and 2 in North America (the United States and Canada). The systems were established quite recently; in most cases, they covered both community and hospital settings, but their main characteristics varied widely across countries in terms of the organization and microorganisms under surveillance, with also different definitions of emerging AMR and alert functioning. A formal system assessment was available only in Australia. Conclusions: A broader implementation and investment of national surveillance systems for the early detection of emerging AMR are still needed to establish EWSs in countries and regions lacking such capabilities. More standardized data collection and reporting are also advisable to improve cooperation on a global scale. Further research is required to provide an in-depth analysis of EWSs, as this study is limited to publicly available data in high-income countries.

The RISE-Vac project consortium applied evidence-based public health methods to collate, assess, and analyze all the evidence generated through project activities, including literature review and prospective data collection on quantitative and qualitative aspects of vaccine services implementation in prison settings. A multi-sectorial and inter-disciplinary group of experts was set-up including health professionals, statisticians, social scientists and people with lived experience from civil society organisations, health services, prison administrations, academia and international agencies. A set of recommendations, advice, and policy options on how to increase vaccine uptake, targeted to people in prison and using a citizen-centred approach, were developed and tailored to specific needs profiles of different prison population subgroups. Vaccinations to be considered in prison settings were grouped according to target population and/or public health objective into: Seasonal vaccinations and vaccination during outbreak; Childhood life-course vaccinations (booster doses); Vaccinations for cancer prevention; Vaccination for older population groups and people with chronic conditions. In consideration of the diversity of the countries participating in the project, their epidemiological context and available resources and infrastructures, a multi-tiered approach for the development and implementation of models for vaccination services implementation in prison settings was devised, encompassing core vaccinations, such as HBV, Flu, COVID-19 and tetanus, as well as expanded vaccination offer to respond to enhanced health needs and to promote equity of health outcomes, including e.g. HPV vaccination.