Kiran Paudel

Background: New HIV cases among Malaysian men who have sex with men continue to rise, with young men who have sex with men (YMSM) accounting for 44% of new infections and experiencing high rates of comorbidities. Mobile health (mHealth) apps offer a promising approach to addressing these challenges by providing discreet access to health information, screening tools, and linkage to services. Given the near-universal smartphone ownership among Malaysian YMSM and high levels of mobile gaming engagement, gamified mHealth apps may be particularly effective in sustaining engagement and promoting HIV prevention behaviors and comorbidity management. However, realizing their full potential requires identifying the features and design principles that are most important to Malaysian YMSM and that can support sustained engagement and improve health outcomes in this vulnerable population. Objective: This study used an interdisciplinary expert panel approach to identify the key features, design principles, and gamification elements to be incorporated into MY-Hero, a gamified mHealth app designed to support HIV prevention, comorbidity management, and overall well-being among Malaysian YMSM. Methods: Guided by the integrated behavioral model (IBM), we conducted an interdisciplinary expert panel comprising experts in health, technology, and design sciences, as well as health care professionals with expertise in the Malaysian YMSM population, along with local lesbian, gay, bisexual, transgender, queer, and others (LGBTQ+) community leaders. Through a structured series of discussions and thematic analysis, we identified culturally appropriate design principles and key features for MY-Hero that align with the health needs and sociocultural context of Malaysian YMSM. Results: Three expert panel sessions were conducted with 9 experts. Several key themes emerged: (1) the importance of establishing clinical affiliation and facilitating linkage to HIV testing, pre-exposure prophylaxis (PrEP), and related services, including harm reduction services; (2) the need to enhance user interface (UI) and user experience (UX) by optimizing usability, interactivity, and engagement to maintain user interest; (3) the incorporation of customizable health content to tailor interventions based on individual characteristics and preferences; (4) the use of gamification mechanisms, such as reward systems and progression tracking to promote adoption and sustained engagement with health services; and (5) the importance of privacy and data security as critical design considerations for ensuring user safety, confidentiality, and trust. Conclusions: The findings highlight the importance of user-centered design, contextualized health content, and gamification mechanisms in mHealth tools for Malaysian YMSM. These insights provide practical guidance for developing culturally appropriate gamified mHealth interventions for vulnerable populations by informing strategies to enhance user engagement, reduce HIV prevention fatigue, and support the well-being of YMSM in stigmatized contexts.

In Nepal, chronic obstructive pulmonary disease (COPD) is a growing concern, particularly among traffic police who are exposed to high levels of air pollution. Traffic police in Kathmandu are continuously exposed to air pollution and are at increased health risk. Therefore, we aimed to study COPD literacy among traffic police of Kathmandu Valley, Nepal. A descriptive cross-sectional study was conducted among 250 traffic police officers working at 11 sites in the Kathmandu Valley from July to August 2023. A 20- to 25-minute interview was conducted with randomly selected participants at the respective study location. Multivariable logistic regression was used to assess the factors associated with COPD literacy. The mean age of the participants was 30.5 (±6.6) years, and more than 3-quarters of the respondents had more than 5 years of experience. The study revealed that nearly half of the participants (48.8%) had limited knowledge of COPD. Traffic police who studied COPD in school (adjusted odds ratio [AOR] = 2.7, 95% confidence interval [CI] = 1.5–4.7), who heard about chronic respiratory diseases (AOR = 3.4, 95% CI = 1.7–6.6), and who never smoked (AOR = 1.9, 95% CI = 1.0–3.5) had higher odds of having a good level of knowledge of COPD. Unmarried participants had lower odds of having a good level of knowledge of COPD than the married participants (AOR = 0.4, 95% CI = 0.2–0.7). This study highlights inadequate COPD literacy among Kathmandu’s traffic police and emphasizes the need for targeted educational interventions. Integrating COPD education into school curricula, traffic police training programs, and public health initiatives is crucial, particularly for high-risk occupational groups such as traffic police. These findings underscore the role of health literacy in promoting preventive behaviors and reducing the burden of COPD among at-risk populations.

Introduction: People who use opioids (PWUO) experience a disproportionately high burden of suicidal risk. Syringe services programs (SSPs) are a critical point of contact for this population, providing low-threshold, harm-reduction services. However, gaps persist in understanding suicidal risk among individuals attending SSPs and the extent to which such risk is associated with mental health service utilization in this setting. This study aimed to assess the prevalence and specific risk factors for suicidal ideation (SI) in PWUO, as well as their use of and barriers to accessing mental health services. Methods: We conducted a cross-sectional survey between April and June 2024 among PWUO (N = 199) who were utilizing services in the SSP in New Haven, Connecticut. We used the ninth item from the Patient Health Questionnaire (PHQ-9) scale, which assesses passive thoughts of death and self-harm in the past two weeks, as a proxy measure for the SI. Additionally, participants reported their use of and barriers to accessing mental health services in the past six months. Bivariate and multivariable logistic regression were conducted to examine factors associated with SI. Results: Approximately 84% of participants met the criteria for opioid dependence, and more than two-thirds (71.9%) were currently receiving medication for opioid use disorder. Over one-third of the sample reported SI in the past two weeks (34.7%). Additionally, over one-third of participants (36.2%) reported unmet mental health needs, and 84.4% reported experiencing at least one barrier to accessing mental health services. Individuals with depressive symptoms (aOR: 5.4; 95% CI: 2.5–11.7) were more likely to report SI, while those who were aware of naloxone (aOR: 0.2; 95% CI: 0.1–0.6) were less likely to report SI in the past two weeks. Conclusion: Our study showed a high prevalence of SI among SSP clients who use opioids and a low use of mental health services due to access barriers. These findings support incorporating a brief suicide risk screening and referral options within SSPs and other settings serving PWUO and addressing key access issues like cost and transportation that can prevent timely linkage to mental health services.

Background: Opioids account for 76% of drug overdose deaths in the United States, with nearly 80,000 opioid overdose deaths annually. The risk of overdose is dynamic and influenced by rapidly changing behaviors and contexts that are not well captured by retrospective or infrequent assessments. Ecological momentary assessment (EMA) allows repeated near real-time reporting of behaviors and experiences in natural settings. Objective: This study evaluated the feasibility and acceptability of smartphone-based EMA among people who use opioids to monitor opioid use, overdose experiences, and naloxone access. Methods: Participants were recruited through the New Haven Syringe Services Program in New Haven, Connecticut, and completed fixed-time, twice-daily EMA prompts for 30 days using a smartphone app. EMA measures assessed behaviors and experiences occurring within the previous 12 hours, including opioid craving, plans to use drugs, opioid use, overdose experiences, and naloxone access. Feasibility was assessed through recruitment, retention, and EMA completion rates, as well as the reporting of drug use-related behaviors. Acceptability was evaluated using exit surveys assessing ease of use, burden, and privacy, as well as qualitative interviews. Results: Of the 13 screened individuals, 10 were enrolled and completed the baseline assessment. A total of 9 (90%) participants completed EMA and responded to 411 prompts, with an overall compliance rate of a mean of 85.0% (SD 8.7%). Compliance was similar across morning (84.2%, SD 13.1%) and evening (85.8%, SD 11.2%) prompts. Participants reported opioid cravings (274 reports), plans to use illicit drugs (252 reports), and opioid use (411 reports) during the study period. Two participants reported overdose events (5 reports) and were carrying naloxone during each overdose event. Acceptability ratings were high: all participants reported that EMA prompts were easy to understand and private, and most did not find them burdensome. Qualitative feedback further highlighted the ease of use, integration into daily routines, and increased self-awareness, although some participants reported emotional discomfort when reflecting on their substance use. Conclusions: Smartphone-based EMA was feasible and acceptable among people who use opioids recruited through a syringe service program. EMA may support the monitoring of opioid use, overdose experiences, and naloxone access, and it may inform future digital health interventions aimed at reducing harm, including overdose risk, among people who use opioids.

Men who have sex with men (MSM) have an elevated risk of adverse outcomes associated with cannabis use. Many studies have been conducted globally; however, there is a lack of research regarding the existing status and factors associated with cannabis use among MSM in Nepal. Therefore, this study aimed to examine the characteristics and factors associated with cannabis use among MSM in Nepal. A cross-sectional respondent driven survey was conducted among MSM in Kathmandu Valley, Nepal between October and December 2022. Overall proportions were weighted in respondent driven sampling analyst software, and 95% confidence intervals (CIs) were calculated. Bivariate and multivariable logistic regression analyses were used to evaluate independent correlates of cannabis use in the last 6 months. Among 250 participants, 27.3% of them used cannabis at least once in their lifetime, and 15.6% had used it within the last 6 months. Older MSM were less likely to have used cannabis (adjusted odds ratio [aOR]: 0.8, 95% CI: 0.7–0.9). Participants who were single (aOR: 21.5; 95% CI: 2.6–175.6), detained at least once by the police (aOR: 11.4; 95% CI: 2.2–58.4), and smoked tobacco daily (aOR: 4.6; 95% CI: 1.2–17.9) had higher odds of cannabis use. Participants who had seen a doctor in the last 6 months (aOR: 0.2; 95% CI: 0.1–0.6) and had trusted healthcare provider (aOR: 0.1; 95% CI: 0.01–0.2) were less likely to use cannabis. Given the known negative health effects of cannabis use such as increased risk of HIV transmission, polydrug use, and heightened sexual health risks, special attention should be directed toward MSM who are young, single, and daily smokers. Participants who had seen a doctor in the last 6 months and had trusted healthcare provider were less likely to use cannabis. This highlights the importance of connecting individuals to regular healthcare services and building trust with providers.

Pre-exposure prophylaxis (PrEP) is effective for HIV prevention, yet uptake remains suboptimal among people who inject drugs. A pilot randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of a nurse practitioner–led, same-day PrEP model (iRaPID) within a syringe services program. Forty-four people who inject drugs who were HIV-seronegative were randomized 1:1 to iRaPID or treatment-as-usual. In iRaPID, 12 of 22 participants filled a PrEP prescription at baseline, including nine on the same day. Only three participants refilled prescriptions at both the 30- and 90-day follow-ups. Acceptability was high (scale 1–5), with mean ratings of 3.9 at 30 days and 4.2 at 90 days. PrEP uptake at 30 days was significantly higher in iRaPID (odds ratio: 5.40; 95% confidence interval, 1.37–21.26; p = .016) but not sustained at 90 days (odds ratio: 0.19; 95% confidence interval, 0.02–1.67; p = .133). Findings support the feasibility and acceptability of nurse practitioner–led, same-day PrEP delivery through a syringe services program while highlighting challenges to sustaining uptake.

Introduction: Micronutrients, which include essential vitamins and minerals required in trace amounts, play crucial roles in various physiological processes, such as immune function, cognitive development and overall health. Several previous studies in Nepal have addressed general nutrition and malnutrition trends, few have specifically explored micronutrient-related knowledge and dietary behaviours, particularly among adolescents with attention given to micronutrients in particular. Therefore, this study aims to assess the level of awareness, perceptions and dietary practices related to micronutrients among adolescents. Methods: A school-based cross-sectional study was conducted between October and December 2022 among 755 adolescents in Madhyabindu Municipality, Nepal. The study employed multistage random sampling with a validated self-administered questionnaire distributed to participants. Statistical analyses, including χ ² tests and logistic regression, were performed with significance set at p values <0.05 and <0.001 via the SPSS V.16.0. Results: Adequate knowledge of micronutrient-rich foods was observed in 51.52% of the participants, whereas 47.94% had positive attitudes and 42.38% demonstrated good consumption practices. Higher knowledge levels were linked to higher grades (adjusted OR (AOR)=1.47, 95% CI 0.90 to 2.37), belonging to the advantageous ethnic group (AOR=2.40, 95% CI 1.14 to 3.65), maternal education (primary: AOR=1.91, 95% CI 1.06 to 3.47; secondary: AOR=3.02, 95% CI 1.44 to 6.32) and curriculum nutrition content (AOR=1.92, 95% CI 1.30 to 2.81). Good dietary practices were associated with ethnicity (AOR=3.59, 95% CI 1.89 to 6.79), family income (AOR=2.14, 95% CI 1.18 to 3.86), maternal occupation (AOR=1.73, 95% CI 1.05 to 2.86) and paternal occupation (AOR=1.71, 95% CI 1.01 to 2.90). Conclusion: This study highlights a significant gap between adolescents’ knowledge and their actual consumption or the dietary practices related to micronutrients. There is a pressing need for targeted educational interventions, particularly those involving parents. Enhancing school curricula to include comprehensive and detailed education on micronutrients—especially folate, zinc and vitamins C and D—is crucial for improving adolescent health outcomes.

Introduction: Tobacco consumption is a significant public health problem in Nepal, accounting for 39200 deaths each year, accounting for 23.7% of all deaths. While Nepal has taken several policy measures to strengthen tobacco control, the persistent burden of tobacco and the associated health...

Tobacco consumption is a significant public health problem in Nepal, accounting for 39200 deaths each year, accounting for 23.7% of all deaths. While Nepal has taken several policy measures to strengthen tobacco control, the persistent burden of tobacco and the associated health risks highlight the need for continuous monitoring and evaluation. Therefore, this study assessed the trend in age-specific and sex-specific mortality and disability attributable to different forms of tobacco use (smoking, chewing tobacco) in Nepal from 1990 to 2021. This observational study used publicly available data from Nepal's Global Burden of Disease (GBD) 2021 estimations. The age-standardized and age-specific summary exposure value (SEV), mortality, and disability-adjusted life years (DALYs) were extracted to measure the burden and trend of tobacco use. The data are presented as percentages or rates per 100000 population. From 1991 to 2021, the age-standardized SEV of tobacco consumption for both sexes at all ages decreased from 44.1% to 28.2%. The age-standardized deaths attributable to tobacco use, including all forms of tobacco products, decreased by (46.7%) from 262.9 (95% UI: 193.5–344.3) per 100000 in 1990 to 140.2 (95% UI: 101.1–181.9) per 100000 in 2021. Despite declines in SEV, and DALYs from 1990 to 2021, tobacco use remains a major public health concern. Strengthening smoking cessation programs, enforcing stricter tobacco control policies, raising taxes on tobacco products, and expanding public awareness campaigns are essential to reducing its burden.

BACKGROUND Opioids account for 76% of drug overdose deaths in the US, with nearly 80,000 opioid overdose deaths annually. Overdose risk is dynamic and influenced by rapidly changing behaviors and contexts that are not well captured by retrospective or infrequent assessments. Ecological momentary assessment (EMA) allows for repeated, near real-time reporting of behaviors and experiences in natural settings. OBJECTIVE This study evaluated the feasibility and acceptability of smartphone-based EMA for monitoring opioid use, overdose experiences, and naloxone access among people who use opioids (PWUO). METHODS Participants were recruited through the New Haven Syringe Services Program (NHSSP) in New Haven, Connecticut, and completed twice-daily EMA prompts for 30 days using a smartphone application. EMA measures included opioid craving, plans to use drugs, opioid use, overdose experiences, and naloxone access. Feasibility was assessed through recruitment, retention, and EMA completion rates, as well as reporting of drug use-related behaviors. Acceptability was evaluated using exit surveys assessing ease of use, burden, and privacy, along with qualitative interviews. RESULTS Of 13 individuals screened, 10 were enrolled and completed baseline assessment. Nine participants (90%) completed EMA assessments and responded to 411 prompts with an overall compliance rate of 85.0% (SD 8.7%). Compliance was similar across morning (84.2%) and evening (85.8%) surveys. Participants reported opioid cravings (257 reports), plans to use any illicit drugs (235 reports), and opioid use (385 reports) during the study period. Two participants reported overdose events (5 reports) and were carrying naloxone during each overdose report. Acceptability ratings were high: all participants reported that surveys were easy to understand and private, and most did not find them burdensome. Qualitative feedback further highlighted the ease of use, integration into daily routines, and increased self-awareness, while some participants reported emotional discomfort when reflecting on substance use. CONCLUSIONS Smartphone-based EMA was feasible and acceptable among PWUO recruited through a syringe service program. EMA may support real-time monitoring of opioid use, overdose experiences, and naloxone use and may inform future digital health interventions aimed at reducing overdose risk among PWUO.