Shenglan Tang

Background: Men who have sex with men (MSM) are at high risk of human papillomavirus (HPV) infection, and HPV testing can facilitate early detection and timely intervention. However, evidence on the willingness to undergo different HPV testing modalities among MSM remains limited. The information-motivation-behavioral skills model provides a theoretical framework for understanding factors associated with the willingness to undergo HPV testing. Objective: This study aimed to investigate the current status of HPV testing and screening among MSM in China; assess their willingness to undergo professional-collected HPV testing, self-collected HPV testing, and regular HPV testing; and identify associated factors. Methods: A cross-sectional study was conducted through the Blued application (Danlan Public Welfare) from July 15, 2024, to August 2, 2024. The questionnaire collected information on participants’ sociodemographic characteristics, sexual behaviors, willingness to undergo HPV testing, HPV testing and infection history, HPV knowledge level, motivation, and behavioral skills related to HPV testing. Chi-square tests and 2-tailed t tests were used to compare the distribution of variables between groups. Multivariable logistic regression analyses were used to identify factors associated with willingness to undergo each HPV testing modality among MSM. Results: Among the 1080 participants recruited, 88.3% (n=954) were willing to receive professional-collected HPV testing, 83.6% (n=903) were willing to receive self-collected HPV testing, and 78.7% (n=850) were willing to engage in regular HPV testing. In multivariable analyses, willingness to undergo professional-collected HPV testing was positively associated with higher HPV knowledge (odds ratio [OR] 1.04, 95% CI 1.00‐1.08), greater perceived susceptibility (OR 1.24, 95% CI 1.01‐1.53), and higher self-efficacy (OR 1.69, 95% CI 1.14‐2.50), while it was negatively associated with perceived barriers (OR 0.61, 95% CI 0.47‐0.78). Participants who were retired or unemployed (OR 0.48, 95% CI 0.27‐0.83) and those with prior testing experience (OR 0.49, 95% CI 0.33‐0.73) were less likely to undergo self-collected HPV testing. Moreover, willingness to undergo regular HPV testing was positively associated with perceived susceptibility (OR 1.20, 95% CI 1.02‐1.40), whereas living with a partner (OR 0.54, 95% CI 0.33‐0.88) and living with family members (OR 0.69, 95% CI 0.48‐0.99) were negatively associated. Conclusions: This study suggests that willingness to undergo HPV testing among MSM in China is high, whereas prior HPV testing uptake remains low, indicating a gap between testing intention and behavior. By applying the information-motivation-behavioral skills framework to different HPV testing modalities, this study extends the previous evidence from testing willingness to understanding of testing initiation and sustained HPV screening behavior. These findings suggest that personalized health education initiatives and differentiated, privacy-sensitive, and accessible HPV testing strategies may help improve HPV testing uptake and support sustained HPV testing among MSM in China.

Background: Indonesia launched a nationwide school-based HPV immunization program in August 2023. Despite this, regional disparities in vaccine uptake persist. Therefore, we undertook a study in North Sumatra Province to assess HPV vaccination coverage and analyze the main factors affecting the uptake of HPV vaccination. Methods: This study employed a mixed-methods approach and was carried out in Medan and Deli Serdang of North Sumatra Province. Quantitative data were used to examine HPV coverage rates among school-aged girls in 2024, while qualitative interviews with parents, teachers, and health officers explored administrative, social, and behavioral barriers and facilitators. Results: In 2024, HPV vaccine coverage in Deli Serdang reached 62.09%, while Kota Medan lagged behind at just 27.20%. High-coverage schools in the Galang subdistrict benefited from proactive engagement between Puskesmas (community health clinics) and parents. In contrast, lower-coverage areas experienced logistical and communication challenges. Parents expressed a preference for face-to-face communication over written consent forms and emphasized the importance of clear, empathetic messaging. Conclusions: The stark contrast in coverage—particularly the low uptake in urban Kota Medan—highlights the need for more responsive and localized implementation strategies. Strengthening direct communication, addressing administrative inefficiencies, and fostering trust through tailored community engagement are critical. These findings suggest a need for targeted improvements in urban settings and further research across diverse regions to inform policy development and strategies for improved coverage of HPV vaccinations.

Background: Trust in information sources is essential to enhance an individual’s understanding of the message and boost their willingness to change or act on specific health behavior, including vaccine uptake. This study explores the association between trust in information sources and parents’ knowledge, attitudes, and practices regarding their children’s 13-valent pneumococcal conjugate vaccine (PCV13) uptake across seven cities in the Yangtze River Delta (YRD) region in China. Methods: A cross-sectional web-based survey was conducted from May to June 2023. Adult parents (N = 1304) who had at least one child aged 24 months or less and lived in the YRD region were recruited. The Adjusted Ordinary Least Squares (OLSs) regression model was applied to estimate the association between participants’ level of trust in different information sources and their knowledge, attitudes, and practices of children’s PCV13 vaccination. Results: Information from the Disease Control and Prevention Center (CDC) source received the highest trust score. Age, gender, education, and annual household income were related to varied trust levels in specific sources. Trust in the health service provider source was significantly associated with a better command of PCV13 knowledge, acceptance of PCV13, and a higher likelihood of vaccination. Trust in online community sources was positively associated with vaccine uptake. Conclusions: The study participants highly trusted information from health service provider sources. These sources may be effective channels with potential to enhance parents’ vaccine knowledge and acceptance of PCV13. Public health workers could utilize trusted sources to disseminate the benefits of the PCV13 and encourage the uptake of the vaccine.

Background: The Sustainable Development Goals (SDGs) articulate an ambitious global agenda and set of targets to achieve by 2030. Among the health-related SDGs, many formidable challenges remain in settings like the Association of Southeast Asian Nations (ASEAN) which face wide-ranging social, economic and health inequalities. In advance of the 2030 horizon, charting the trajectory of the health SDGs is critical for informing policy and programmatic course corrections to advance health and well-being among ASEAN’s 10 member countries with its 667 million people. Methods and findings: We used estimates from the Global Burden of Disease (GBD) Study 2021 and surveillance data to identify 27 health-related SDG indicators. The indicators were classified into 7 thematic areas: (i) nutrition, (ii) maternal, child and reproductive health (MCH), (iii) infectious diseases, (iv) non-communicable diseases (NCDs), (v) environmental health, (vi) universal health coverage (UHC), and (vii) road injuries. We developed an attainment index ranging from 0 to 100 for each SDG indicator by referencing the SDG targets and projected their progress to 2030. We find an overall positive progress towards the health-related SDG targets in ASEAN from 1990 to 2030. At the aggregate level by 2030, 2 member countries, Singapore and Brunei, are projected to achieve their targets (attainment score ≥ 90). At a wider regional level, ASEAN is projected to make substantial progress in nutrition, MCH, and UHC, with a majority of countries projected to come close to or achieve their targets. However, progress is projected to be slower in the areas of reducing the incidence of infectious disease (i.e., HIV and AIDs, hepatitis B, TB, and neglected tropical diseases), NCD-related mortality and its risk factors (i.e., harmful alcohol use and smoking), environment-related mortality and its risk factors (i.e., unsafe water and poor hygiene, and air pollution), and road injuries. Substantial disparities are identified in the region, with Singapore, Brunei, Malaysia and Thailand generally performing better than elsewhere. A limitation of our study was its reliance on historical trends which may not fully capture future political, social, or technological changes. Conclusions: As a regional bloc, ASEAN faces persistent challenges in achieving health-related SDG targets by 2030, with unequal progress between countries. Moreover, epidemiological transitions and worsening environmental threats further compound potential gains. At the country level, efforts to enhance health system financing, quality and equity will need to be coupled with wider approaches that address structural drivers of disease. Furthermore, coordinated regional efforts will be essential to effectively respond to emerging threats posed by pollution and environmental risks.

One of the key priorities in strengthening global health capacity for pandemic response is the rapid risk assessment using cross-sectional evidence to inform timely decision-making in local contexts and scenarios [1,2]. However, this remains a significant challenge in many settings, but particularly in low- and middle-income countries (LMICs), where pandemic response decisions have often lacked […]

Ensuring adequate and sustainable financing of national immunisation programmes (NIPs) is one of the important elements to achieve the Immunisation Agenda 2030. Many middle-income countries ineligible for support from the Global Alliance for Vaccines and Immunisation have relatively slow progress in introducing new critical vaccines, due largely to financial constraints. China has not introduced any vaccines into the NIP since 2008. Its funding for the NIP, relying solely on the government budget, has been decreasing as the number of targeted children has declined. This paper presents the current situation of NIP and identifies main challenges in vaccine introduction in China: fluctuating and insufficient financing, restrictions on using health insurance funds for immunisation, high prices for non-NIP vaccines and the complicated and non-transparent decision-making mechanism to adjust NIP. There are also opportunities for introducing vaccines, such as local pilots to provide free or subsidised new vaccines and reducing domestic vaccine prices. Feasible options to optimise NIP financing in China include increasing government funding, diversifying financing channels such as using health insurance funds, improving the vaccine procurement mechanism and optimising the new vaccine introduction decision-making process.