Alanna J. Bergman

Background: Amid declining vaccination rates in the United States, school immunization requirements for K–12 students are a critical public health strategy to slow the spread of communicable diseases. School nurses are frontline student‐health advocates; yet their role in school vaccine policies is unclear. Methods: We conducted 6 semi‐structured focus groups with 25 Virginia school nurses between December 2024 and March 2025. Reflexive thematic analysis was used to identify latent concepts and develop themes. Results: We developed four themes that demonstrate the social and institutional complexities of school vaccine requirements: (1) vaccine challenges are present across school settings, (2) tensions between nurse self‐identity and administrators' perceptions of nursing are consequential, (3) unaddressed tensions constrain nursing practice and give rise to moral distress, (4) school administrator support enables concordance between nursing scope and role in vaccine activities. Implications for School Health: Misalignment between administrators' and nurses' views of nurses' role in school vaccine policy implementation limits nurse effectiveness; however, when these perspectives are aligned, nurses can participate in vaccination efforts and provide education. Conclusions: To effectively implement vaccine requirements and advocate for student health, nurses must have a role in school vaccine mandates consistent with their clinical knowledge and code of ethics.

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Cervical cancer (CC) is a leading cause of death, with women with HIV at an increased risk. Geographic disparities in CC and HIV reflect inequities in care access. The purpose of this systematic review was to evaluate integrated models for HIV and CC screening. This review was conducted following PRISMA guidelines. Full-text screening and data extraction were conducted independently. Eligible studies described integrated HIV and CC services. Of 4,280 records, 24 met inclusion criteria. Most studies ( n = 21) were conducted in sub-Saharan Africa; the remaining studies were conducted in high-income settings. Most studies integrated CC screening into HIV care ( n = 19); however, three integrated HIV screening into CC screening/treatment. Two studies implemented fully integrated HIV and CC screening in community settings. Integrated services were considered highly acceptable and feasible. Models introducing CC screening into HIV care will advance global CC elimination goals, but equitable access and HIV metrics will require creative integrative solutions.

For people with HIV and tuberculosis (TB), stigma may change over time. Identifying time points when individuals are most likely to experience HIV or TB related stigma, or when stigma begins to abate, may be useful in tailoring stigma-reduction interventions in resource-limited settings. This study used longitudinal qualitative data to explore if and how HIV and TB stigma change over the course of treatment. People living with HIV and rifampicin-resistant TB were purposively recruited at a district TB hospital in KwaZulu-Natal, South Africa. Participants consented to in-depth interviews throughout TB treatment. The team used reflexive thematic analysis to develop latent themes within the transcripts. This study was designed to identify longitudinal changes stigma over time from the perspective of someone living with HIV and TB. However, participants were more expansive in their conceptualization of evolving stigma. 30 individuals discussed changes in stigma from three distinct perspectives. First was a perspective of lived experience, where participants described changes in experienced, internalized, and anticipated stigma over time beginning with diagnosis. The second was from a shifted perspective, as participants described their diagnosis and movement from status neutral to status positive transitioning from a potential enactor of stigma to someone at risk for experiencing stigma. Finally, participants described changes in stigma from the community perspective whose attitudes towards HIV and TB disease were shaped by time. To strengthen care engagement, we must effectively intervene on disease-related stigma. Appropriate interventions must consider time and shifting social expectations that impact stigma.

Pre-exposure prophylaxis (PrEP) is the administration of antiretroviral medications before HIV exposure to prevent HIV infection. PrEP or biomedical prevention is an essential part of the ending the HIV epidemic strategy. Currently, there are 4 guideline-approved dosing approaches to PrEP, which include 2 oral formulations and 1 long-acting injectable. Unfortunately, most individuals who would benefit from PrEP do not receive a prescription, and even fewer initiate and continue PrEP. Barriers to PrEP uptake and persistence are complex and extend along a socio-ecologic framework from individual through structural. In this article, we highlight the barriers to PrEP care among priority populations, discuss evidence-based solutions, and offer multilevel considerations for clinicians, researchers, and community members to increase access, uptake, and persistence in PrEP care for all.

Coinfection with human papillomavirus (HPV) and HIV compounds the risks of developing cervical, anal, and HPV-associated oral neoplasia. Safe prophylactic vaccines are available to prevent HPV infections in people with HIV(PWH). Yet, vaccine efficacy and duration of protection remain questionable. Historically, the efficacy of vaccines has been suboptimal in PWH compared to people without HIV (PWoH).A systematic review of HPV vaccine trials in PWH was conducted using PRISMA guidelines. Outcomes of interest were vaccine efficacy, immunogenicity, and predictors of HPV vaccine efficacy. A secondary outcome was to assess age and sex differences. Efficacy was reviewed as cervical/anal/oral lesions or neoplasia, and incident or persistent HPV infection following vaccination. A random effects meta-analysis was performed comparing geometric mean titer (GMT) in PWH to PWoH. Twenty-eight studies out of 988 were eligible for inclusion in our study, and qualitatively synthesized. Eight of these studies were meta-analyzed. GMT results of HPV16 and HPV18 genotypes were significantly lower in PWH; Hedges’s g -0.434 (95% CI: -0.823, -0.046) and Hedges’s g -0.57 (95% CI: -0.72, -0.43), respectively. The mean difference in GMT for HPV18 between PWH and PWoH was -536.23 (95% CI: -830.66, -241.81); approximately 22 times higher than HPV18 seropositivity cut-offs, assuming milli-Merck Units per milliliter. Risk factors for incident or persistent infections in PWH included: failure to seroconvert after vaccination, baseline CD4+ T-cell count <500 cells/mm3, early age of sexual debut, HIV viral load ≥ 400 copies/mL. There was a trend towards decreased HPV vaccine efficacy in studies that included enrollees with a history of AIDS or AIDS-defining illness.Applying existing evidence of HPV vaccine efficacy on meaningful clinical outcomes in PWH is questionable. This could be influenced by the diversity of eligibility criteria across clinical trials of HPV vaccine efficacy. Precision medicine may offer novel alternatives for evaluating HPV vaccine efficacy in PWH.

Background: The Patient and Community Perspectives Towards Tuberculosis are the most common measure of tuberculosis (TB) stigma in sub-Saharan Africa. The instrument and its sub-scales (patient and community) have been quantitatively validated but have not undergone qualitative exploration in South Africa. Methods: We explored whether the Patient Perspectives Towards Tuberculosis adequately represents stigma as experienced by people with TB in South Africa. We used mixed methods to explore differences between the lived experience of TB and the quantitative stigma score. Participants with rifampicin-resistant TB and HIV co-infection completed the quantitative scale. Among those, 30 also completed qualitative interviews about their experiences and perceptions of TB stigma. We used cognitive interviewing techniques to interrogate congruence between the two data sources. Results: The scale demonstrated adequate factor structure with approximately normal distribution. Participants qualitatively described experiences and perceptions of stigma that contradicted their quantitative responses. The scale could not discriminate between participants who reported distressing experiences of TB stigma, and those who did not. Item wording caused confusion, and many elements of TB stigma most discussed by participants are not reflected in the scale. Conclusions: The Patient Perspectives Towards Tuberculosis lacks theoretical and experiential domains that are central to TB stigma in South Africa. Studies validating stigma scales in new populations should integrate a mixed-methods approach to ensure content validity.

ChatGPT, an artificial intelligence (AI) system released by OpenAI on November 30th, 2022, has upended scientific and educational paradigms, reshaping the way that we think about teaching, writing, and now research. Since that time, qualitative data analytic software programs such as ATLAS.ti have quickly incorporated AI into their programs to assist with or even replace human coding. Qualitative research is key to understanding the complexity and nuance of HIV-related behaviors, through descriptive and historical textual research, as well as the lived experiences of people with HIV. This commentary weighs the pros and cons of the use of AI coding in HIV-related qualitative research. We pose guiding questions that may help researchers evaluate the application and scope of AI in qualitative research as determined by the research question, underlying epistemology, and goal(s). Qualitative data encompasses a variety of media, methodologies, and styles that exist on a spectrum underpinned by epistemology. The research question and the data sources are informed by the researcher's epistemological viewpoint. Given the heterogeneous applications of qualitative research in nursing, medicine, and public health there are circumstances where qualitative AI coding is appropriate, but this should be congruent with the aims and underlying epistemology of the research.