Jonathan Hallett

Background: Peer‐based health promotion (PBHP) is recognised for its ability to engage populations who are often excluded or underserved by traditional healthcare. Despite documented strengths, gaps exist in the evidence base regarding PBHP approaches and implementation. Accordingly, this scoping review aimed to explore the frameworks, models, and tools used for the planning, implementation, and evaluation of peer‐based health promotion programs. Methods: This scoping review followed methodological guidance for scoping articles provided by Arksey and O'Malley and Levac et al., and the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐ScR) guidelines. We searched PubMed, Web of Science, ProQuest and Google Scholar using keywords. Included articles were published in English between January 2014 and October 2024 and described PBHP programs or interventions that provided guidance on at least one aspect of program planning, implementation, or evaluation. Consultation with stakeholders ( n = 10) was undertaken to contextualise and validate the review findings. Results: A total of 64 articles were included in the final review. Six articles reported on the development of a conceptual model or framework, whilst 15 reported on the use of named frameworks. Most studies incorporated behavioural theory to inform program design and evaluation, with limited use of systematic planning and implementation elements. Eighteen articles reported systematic evaluation methods. Stakeholder consultation reinforced findings from the literature and provided additional practice‐based insights into funding constraints, evaluation challenges, the need for flexible frameworks, authentic co‐design, reciprocal benefits for peer workers, and workforce sustainability. Conclusion: This review found diverse and often inconsistent application of intervention elements, including theories and models, as well as planning and evaluation frameworks. In addition, findings suggested that while health promotion principles are deeply embedded in peer‐based practice, they are not always explicitly recognised as such. Results point to three actionable priorities: institutional advocacy to strengthen the infrastructure required for comprehensive PBHP program reporting; research to test strategies to address identified gaps in terminology and evaluation; and funding and commissioning organisations to invest in co‐designed, peer‐specific evaluation tools that capture the full scope of PBHP impact.

Knowledge translation (KT) involves the co-creation, exchange and dissemination of knowledge to increase evidence-informed public health. Increasingly, there is a demand to strengthen evidence-informed public health, and with this, a need to understand how to support KT efforts within public health systems. Whilst a variety of KT frameworks have been developed, frameworks and studies that provide insight into KT initiatives that operate across the individual, organisational and system levels are lacking. This paper presents the development of a KT framework used by a government-funded sexual health and blood-borne virus capacity-building partnership for research and evaluation in an Australian jurisdiction. The approaches taken and practical insights into operationalising a collaborative approach to KT are described. The process of developing the framework included inputs from the literature, a needs assessment survey, and stakeholder consultation. The final framework is composed of a conceptual model and a suite of KT strategies that reflect the dynamic and complex nature of KT in public health. The framework illustrates the broader influences of KT, key strategies, and guiding principles. Findings have relevance for service providers, researchers and policymakers (including funders) seeking ways to engage in KT at the individual, organisational and system levels.

Introduction: Globally, men who have sex with men (MSM) have a higher HIV risk, with transmission rising in many Asian countries. Limited information on MSM in Bhutan hampers HIV prevention efforts. This study estimates the size of the MSM population and examines risk behaviours at the district and national levels. Methods: A cross-sectional community-based survey and population size estimation exercises were conducted in Bhutan from November 2019 to December 2020. MSM in 9 of 20 districts in Bhutan were recruited using a hybrid sampling approach, combining peer-referral snowballing, venue-based outreach and online recruitment through MSM-oriented platforms. A standardised face-to-face questionnaire collected demographic and HIV-related data, while population size estimation methods, including the service multiplier, unique object multiplier and wisdom of the crowds, complemented the survey. The study was approved by the Research Ethics Board of Health of Bhutan, and verbal informed consent was obtained. Results: Among 273 MSM surveyed, 85.7% had their first sex before age 15; 17.4% sold sex and 22.1% exchanged sex for goods. Only 40.9% had tested for HIV in the past year, 25.0% attended HIV education, 18.5% faced discrimination at health services and 22.0% experienced violence for being MSM. Bayesian synthesis estimated 1463 MSM (95% CI 1006 to 2030) in the study area, with a national extrapolation of 1726 MSM. Conclusions: Our study estimated that MSM comprise approximately 1.58% of urban men in Bhutan who originate from diverse geographic areas and sociodemographic backgrounds. Findings inform HIV and sexually transmitted infection (STI) services for MSM through target setting and effective resource allocation, emphasising the need for targeted HIV prevention addressing low testing rates and high-risk behaviours. Overcoming healthcare discrimination requires tailored interventions and stronger collaboration between health authorities and MSM communities.

Background: HIV self-testing (HIVST) enhances case diagnosis, but information on its integration for index testing to partner notification is limited. Assessing the acceptability and feasibility of index HIVST and partner testing among people living with HIV (PLHIV) and undiagnosed key populations is critical to ending the AIDS epidemic. Methods: A mixed-methods systematic review using a convergent segregated approach was conducted using the Joanna Briggs Institute’s methodology. Four databases were used to conduct a literature review from October 2023 to March 2024, which included studies published between 2016 and 2023. Rayyan software was used for full-text screening. Meta-analysis was deemed infeasible; however, a qualitative meta-aggregation approach was conducted. Results: A total of 4076 studies were retrieved, and 76 studies met the inclusion criteria after a full review. Most of these studies were from the African region, with only one from South Asia and a few from East Asia. Index HIVST and partner testing were found acceptable and feasible among PLHIV and key populations. Despite low partner elicitation ratios through assisted partner notification, a higher positivity rate was noted among notified individuals. Preferences for index HIVST and partner testing varied, with more inclination for assisted and passive partner referrals to overcome the risk of HIV status disclosure. Assisted partner notification (aPN) showed a low cost per infection averted, indicating it’s a cost-effective intervention. Available evidence was skewed towards married couples, with less evidence on unmarried and undiagnosed key populations. Conclusion: The index HIVST was found to be acceptable and feasible in reaching index partners, including untested and undiagnosed partners of key populations, when various testing approaches are used. Understanding the index HIVST among unmarried HIV index cases, and partner testing of undiagnosed key populations is important, particularly in the Southeast Asian region, to bridge the current HIV case detection gaps. Although no specific cost-effectiveness studies were found for the index HIVST, the aPN was found to be cost-effective. Study registration: PROSPERO Number: CRD42023475417 dated 2023. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023475417 .

Hepatitis C is a significant public health challenge in Australia, particularly in diagnosis, treatment access, and ongoing care among people who inject drugs. Despite the availability of highly effective direct-acting antivirals and government subsidisation, treatment uptake has declined among this population in recent years, beyond what would be expected from the initial treatment of easier-to-reach patients. This rapid scoping review aimed to identify barriers and enablers affecting primary care providers in prescribing direct-acting antivirals for hepatitis C treatment. Studies were included if they: were published after 2014, focused on DAA treatment, included primary care provider perspectives, contained primary data, identified barriers/enablers to treatment, and were conducted in high-income countries. Two databases (Web of Science and Google Scholar) were searched for peer-reviewed articles. Primary care stakeholders were consulted through an online survey (n = 10) and telephone interviews (n = 7) to contextualise and validate findings. Data were charted using a standardised form capturing author, year, location, aim, participants, study details, and main findings. Analysis used a deductive approach to identify key themes. Twenty-three articles, mostly quantitative studies, were included in the review. The analysis identified four key domains influencing direct-acting antiviral prescription: provider characteristics, healthcare systems and service delivery, models of care, and societal and structural issues. This review provides insights into contemporary challenges in hepatitis C care delivery models and highlights critical structural, sociocultural, and interpersonal factors affecting testing and treatment, particularly for people who inject drugs. These findings have implications for improving direct-acting antiviral prescription rates in primary care settings.

Issue Addressed: The gambling industry utilises a range of strategies to attract and retain customers and limit meaningful gambling reform. Industry marketing strategies have demonstrated appeal to young people; however, little is known regarding how young people perceive and engage with gambling and industry marketing strategies in a Western Australian context. Young people's perspectives are vital to effectively respond to the harmful impacts of such commercial determinants on health and social outcomes.Methods: Constructivist Grounded Theory guided data collection and analysis of online group interviews with 25 young people aged 12 to 17 years old residing in Western Australia. Eligible participants received parent or caregiver consent, had lived in WA for at least 5 years, had access to technology, and able to communicate in English.Results: Five key themes were constructed regarding young people's perspectives towards gambling and industry marketing strategies in Western Australia: exposure to gambling marketing is pervasive and inescapable in multiple environments; industry appeal to young people through culturally valued identities; gambling is normalised and embedded in the everyday; corporate power and government reciprocity protects commercial gambling interests; personalising responsibility for preventing gambling harms.Conclusion: This research provides further evidence about young people's everyday exposure to gambling and the need for comprehensive approaches to protect them from industry marketing.So What?: Findings reinforce the ubiquity of young people's exposure to gambling and the highly engaging and sophisticated tactics used by industry to engage young people in their harmful products. Researchers, advocates, practitioners and policymakers can use these findings to further advocate for increased restrictions on children's exposure to gambling marketing.

This review examines the epidemiology, prevention, and management of blood-borne viruses (BBVs) experienced by Aboriginal and Torres Strait Islander peoples in Australia with a focus on hepatitis B, hepatitis C, and HIV. The review highlights the disproportionate burden of BBVs among Aboriginal and Torres Strait Islander peoples in Australia, influenced by historical, social, and cultural factors stemming from colonisation. Key findings include higher prevalence rates of hepatitis B and C compared to non-Indigenous Australians, with some progress in reducing new infections through vaccination and treatment programs. However, significant gaps remain in screening, linkage to care, and treatment uptake. The review discusses successful culturally appropriate interventions which have improved engagement with health services. Barriers to care include stigma, lack of culturally safe services, and competing health priorities. The review emphasises the need for community-led initiatives, integration of BBV care into primary health services, and addressing social determinants of health to improve outcomes. Future directions include expanding access to culturally safe healthcare, scaling up peer-based interventions, and enhancing data collection to inform targeted strategies. This review provides insights to guide public health responses and policy development aimed at reducing the impact of BBVs among Aboriginal and Torres Strait Islander peoples. This review is part of a suite of knowledge exchange products that includes a summary, a video and a fact sheet.