Ying Zhang

Background: Human papillomavirus (HPV) vaccine hesitancy is a major barrier to achieving optimal vaccination coverage worldwide, and Mainland China and Hong Kong are particularly affected by this challenge. An understanding of the multilevel determinants shaping vaccine hesitancy and willingness in these settings is needed. Methods: We conducted a scoping review, searching four databases for studies published in English or Chinese on HPV vaccine hesitancy and willingness up to November 2025. Through a hybrid inductive–deductive thematic approach, we used the Socio-ecological Model (SEM) to organise determinants across individual, interpersonal, organisational, community, and policy levels. Findings: We included 96 studies. Individual-level determinants were identified in nearly all studies (97·9%), with determinants also found at the policy (60·4%), community (54·2%), interpersonal (44·8%), and organisational (43·8%) levels. Hesitancy was shaped not only by individual knowledge and perception, but also by social networks, healthcare providers, service delivery, social norms, and vaccination policy. Information emerged as a cross-level determinant, with both insufficient and excessive or conflicting information contributing to hesitancy. Together, these determinants operated across levels and collectively shaped vaccine hesitancy and willingness. Interpretation: HPV vaccine hesitancy in Mainland China and Hong Kong is a socially and structurally shaped phenomenon. Multilevel, coordinated strategies are needed, alongside further research on under-represented regions, to achieve equitable HPV vaccine uptake.

Background: Gonococcal antimicrobial resistance (AMR) surveillance depends on phenotypic susceptibility testing of viable Neisseria gonorrhoeae isolates. However, diagnosis increasingly relies on nucleic acid amplification tests (NAATs), which detect gonococcal nucleic acid but do not yield viable isolates. We quantified culture recovery among NAAT-positive N gonorrhoeae infections and identified clinical and laboratory factors associated with recovery.Methods: We searched PubMed, Embase, Scopus, and Dimensions for studies and conference abstracts published between Jan 1, 2000, and May 7, 2026. Eligible studies reported data to calculate culture recovery among NAAT-positive N gonorrhoeae infections. Pooled recovery was estimated using random-effects meta-analysis and associated factors were assessed using random-effects meta-regression.Findings: We included 99 studies, contributing 251 study estimates. Overall pooled recovery was 54% (95% CI 50–59), ranging from 81% (76–85) for male urethral to 27% (23–30) for pharyngeal specimens. Recovery was 60% (47–72) among symptomatic infections and 40% (31–50) among asymptomatic infections. In multivariable meta-regression, compared with cervical specimens, recovery was lower for anorectal (β -0·10, 95% CI -0·17 to -0·02; p=0·014), pharyngeal (-0·36, -0·43 to -0·28; p<0·001), and vaginal specimens (-0·21, -0·34 to -0·08; p=0·001), and higher for male urethral specimens (0·17, 0·10 to 0·25; p6 h after specimen collection) was independently associated with lower recovery than immediate or ≤6 h plating (β -0·12, -0·23 to -0·01; p=0·038).Interpretation: Only about half of NAAT-positive infections yielded isolates, and recovery was strongly associated with anatomical site and the culture-specimen pathway. These findings show that culture recovery is not simply a laboratory outcome, but a selective infection-to-isolate pathway that determines which diagnosed infections become available for phenotypic antimicrobial resistance surveillance, which can limit the representativeness and bias the surveillance. Surveillance systems should optimise culture pathways, report transparent diagnostic-to-susceptibility denominators, and integrate molecular tools that complement culture. Funding : Australian National Health and Medical Research Council and the Australian Research Council Industrial Transformation Research Hub.

Background: HIV self-testing (HIVST) can help overcome barriers to clinic-based testing among men who have sex with men (MSM). Peer-led distribution through existing social networks may further extend reach and acceptability. Objective: Guided by the Consolidated Framework for Implementation Research (CFIR), this study evaluated a social network-based HIVST intervention in Australia, in which “test promoters” distributed HIVST kits to friends and sexual partners, to identify facilitators and barriers to implementation. Methods: Online semi-structured interviews were conducted with 22 MSM, including both test promoters and recipients involved in social network-based HIVST distribution trial. Interviews explored perceptions of acceptability, feasibility, and contextual appropriateness. Data were thematically analysed using the CFIR framework to identify multilevel implementation determinants. Results: Participants’ mean age was 33.3 years (SD = 8.2). Three interconnected enablers shaped successful implementation: (1) HIVST as an empowering, low-barrier testing option, enhancing privacy, convenience, and autonomy while mitigating stigma; (2) trust and peer credibility, which normalised test sharing and created culturally resonant pathways; and (3) collective responsibility for health, which sustained engagement and diffusion within MSM networks. HIVST’s privacy, convenience, and autonomy enhanced motivation, while peer reassurance reduced procedural anxiety, particularly around finger-prick sampling among first-time or infrequent testers. However, participants also identified persistent barriers, including culturally rooted discomfort discussing HIV, fear of judgment, and the risk of excluding socially isolated or newly arrived individuals. Social network distribution reframed testing as an act of care and solidarity, mitigating stigma and fostering collective ownership. Participants recommended culturally tailored materials, non-invasive test options, and expanded digital platforms to strengthen inclusion and reach. Conclusion: Social network-based HIVST represents a feasible, acceptable, and culturally responsive strategy to expand testing among MSM in high-income settings. By leveraging relational trust and community solidarity rather than financial incentives, this model offers a scalable and equitable pathway to advance progress toward national and global HIV prevention targets.

Bacterial vaginosis (BV) is a common vaginal condition with high recurrence after standard treatment. Male partners may serve as reservoirs for BV-associated bacteria. Randomised controlled trial (RCT) data show that adding male-partner treatment to standard female care reduces recurrence compared with female-only treatment. We assessed the economic viability of this approach. A cost-effectiveness analysis was conducted using decision-analytic models informed by RCT data. Country-specific models for Australia and South Africa represented high- and middle-income healthcare settings. Simulated cohorts of 10,000 women with symptomatic BV were followed over 12 months. Models incorporated recurrence, downstream complications (STIs, pelvic inflammatory disease, adverse pregnancy outcomes), healthcare costs, and quality-adjusted life-years (QALYs). Threshold analyses showed male-partner treatment became cost-saving at uptake ≥ 28.0% in Australia and ≥ 2.0% in South Africa. At base-case uptake (73%, based on observed partner participation in the trial extension), concurrent treatment reduced pregnancy complications (4,454 to 3,910), increased QALYs (0.89 to 0.92), and yielded substantial cost-savings (ICERs: -USD 24.6 M/QALY in Australia; -USD 43.0 M/QALY in South Africa). Cost-effectiveness improved with higher uptake. Main cost drivers were consultation, medication, and recurrent BV treatment in Australia, and preterm birth, low birthweight, and syndromic STI care in South Africa. Concurrent male-partner treatment reduces BV recurrence and is cost-saving, supporting updates to clinical guidelines and more efficient resource allocation.

Objective: Social network distribution of HIV self-test (HIVST) kits uses social networks to increase HIV testing among marginalized populations, such as men who have sex with men (MSM). Using a discrete choice experiment, we identified factors influencing MSM's willingness and decision making in HIVST kit distribution. Design: An online discrete choice experiment survey was conducted among MSM in Australia (December 2023−May 2024) through online/offline advertisements. Methods: Participants completed 7 choice sets, each containing 2 hypothetical scenarios for HIVST kits distribution described by attributes such as cost, location, training, support system, and self-reporting methods. Mixed logit models and latent class analysis explored preference heterogeneity across language (English vs. non-English first language) and nativity (Australian-born vs. overseas-born) groups. Results: There were 251 participants, including 140 overseas-born MSM, with a mean age of 36.5 years (SD = 11.9). Participants who did not speak English as their first language (29/251, 12%) showed a lower preference for paid HIVST kits ($30 or $60 for 3 kits) and online video chats with sexual health professionals as pretest support. Overseas-born participants preferred not to attend 30-minute or 1-hour training sessions on distributing HIVST kits. They did not like accessing HIVST kits from hospitals. Class 1 (‘Cost-conscious and minimal support seekers’; 61.7%) were willing to pay up to $30 for 3 kits, while Class 2 (‘Subsidy-dependent and structured support seekers’; 38.3%) disliked costs and self-reporting results by phone. Conclusions: Increasing participation in social network distribution of HIVST kits will require free or subsidized kits. Tailored support systems should prioritize overseas-born MSM with limited English proficiency.

Introduction: The World Health Organization (WHO) recommends the use of antiretroviral drugs as post‐exposure prophylaxis (PEP) for preventing HIV acquisition for occupational and non‐occupational exposures. To inform the development of global WHO recommendations on PEP, we reviewed national guidelines of PEP for their recommendations.Methods: Policies addressing PEP from 38 WHO HIV priority countries were obtained by searching governmental and non‐governmental websites and consulting country and regional experts; these countries were selected based on HIV burden, new HIV acquisitions and the number of HIV‐associated deaths. We reviewed national guidelines to collate data on where PEP can be offered, who can prescribe PEP, PEP eligibility, recommended drug regime, linkage to other interventions, recommended investigations prescribed with PEP, HIV self‐test recommendation related to PEP and stopping rules for PEP.Results: In total, 46 guidelines from January 2010 to May 2023 across 36 countries were included, with 70% of documents published during or after 2020. There was significant variation across national guidelines regarding where PEP can be accessed and who can provide or prescribe PEP. Six countries (17%) described being able to access PEP from a primary care facility, four countries (11%) from hospitals and two (6%) from community‐based services. Only three countries (8%) specifically considered dispensing PEP by professionals other than doctors (e.g. nurses). None mentioned pharmacists as prescribers. We found a lack of consistency across countries regarding who is eligible for PEP, regimens used, interventions integrated into PEP provision and recommended investigations for PEP users. No country guidance provided considerations on using HIV self‐tests for starting or stopping PEP.Discussion: Despite PEP being recommended for more than three decades, many national policies were lacking in terms of PEP guidance. There are opportunities for countries to update and optimize guidance to consider ways to improve the accessibility of PEP. Greater efforts are needed to support the development of global consensus on how best to implement and integrate PEP, as well as how to include decentralization and task‐sharing to achieve sufficient scale for impact.Conclusions: Improving timely access to PEP and promoting PEP adherence could help contribute to reducing the incidence of HIV globally.