Eric P. Chow

Description:Background: Bacterial vaginosis affects one third of reproductive-aged women, and recurrence is common. Evidence of sexual exchange of bacterial vaginosis-associated organisms between partners suggests that male-partner treatment may increase the likelihood of cure. Methods: This open-label, randomized, controlled trial involved couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks. Results: A total of 81 couples were assigned to the partner-treatment group, and 83 couples were assigned to the control group. The trial was stopped by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner. In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001). Adverse events in treated men included nausea, headache, and metallic taste. Conclusions: The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. (Funded by the National Health and Medical Research Council of Australia; StepUp Australian New Zealand Clinical Trials Registry number, ACTRN12619000196145.).

Description: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 (DCE), we identified factors influencing influence MSM's willingness and decision-making in HIVST kit distribution. Methods: An online DCE survey was conducted among MSM in Australia (December 2023-May 2024) via online/offline advertisements. Methods: Participants completed seven choice sets, each containing two 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 (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 three kits) and online video chats with sexual health professionals as pre-test support. Overseas-born participants preferred not to attend 30-minute or one-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 three 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 prioritise overseas-born MSM with limited English proficiency.

Description:Background: Artificial Intelligence (AI) chatbots could potentially provide information on sensitive topics, including sexual health, to the public. However, their performance compared to nurses and across different AI chatbots, particularly in the field of sexual health, remains understudied. This study evaluated the performance of three AI chatbots - two prompt-tuned (Alice and Azure) and one standard chatbot (ChatGPT by OpenAI) - in providing sexual health information on questions that experienced sexual health nurses could correctly answer. Methods: We analysed 195 anonymised sexual health questions received by the Melbourne Sexual Health Centre phone line. A panel of experts in a blinded order using a consensus-based approach evaluated responses to these questions from nurses and the three AI chatbots. Performance was assessed based on overall correctness and five specific measures: guidance, accuracy, safety, ease of access, and provision of necessary information. We conducted subgroup analyses for clinic-specific (e.g., opening hours) and general sexual health questions and a sensitivity analysis excluding questions that Azure could not answer. Results: Alice demonstrated the highest overall correctness (85.2%; 95% confidence interval (CI), 82.1-88.0%), followed by Azure (69.3%; 95% CI, 65.3-73.0%) and ChatGPT (64.8%; 95% CI, 60.7-68.7%). Prompt-tuned chatbots outperformed the base ChatGPT across all measures. Among all outcome measures, all chatbots performed best on safety, with Azure achieving the highest safety score (97.9%; 95% CI, 96.4-98.9%), indicating the lowest risk of providing potentially harmful advice. In subgroup analysis, all chatbots performed better on general sexual health questions compared to clinic-specific queries. Sensitivity analysis showed a narrower performance gap between Alice and Azure when excluding questions Azure could not answer. Conclusions: Prompt-tuned AI chatbots demonstrated superior performance in providing sexual health information compared to base ChatGPT, with high safety scores particularly noteworthy. However, all AI chatbots showed susceptibility to generating incorrect information. These findings suggest the potential for AI chatbots as adjuncts to human healthcare providers for providing sexual health information while highlighting the need for continued refinement and human oversight. Future research should focus on larger-scale evaluations and real-world implementations.

Description:Studies reporting the use of digital tools to promote the prevention and treatment of sexually transmitted and blood borne infections (STBBIs) have proliferated in recent years. Previous reviews highlight variability in the input sought from users in tool development, and its contribution to impact. Objective: This scoping review sought to describe approaches to seeking and utilising user input, with the goal of providing guidance for developers. Methods: Searches were conducted in MEDLINE, PsycInfo, and the Social Science Citation Index and results screened by two reviewers. The reference lists of included studies and review papers were also checked. Methods: Peer reviewed qualitative and mixed methods studies seeking user input on digital tools promoting the prevention and treatment of STBBIs, from prototyping onwards, published from after 2014 in English, were included. Methods: Reported methods and findings were charted in Excel and synthesised using content analysis to provide an overview of methods and domains of user input and utilisation of this input. Results: A total of 1838 unique titles and abstracts and the full text of 50 publications were screened. Data was charted from 37 eligible studies reporting findings from 34 projects developing digital health tools, including smartphone/tablet applications, websites/web-based applications, chatbots, interactive automated SMS, and purpose-built tools within dating and social media applications. Studies reported on tools developed for use by diverse target populations. The most common domain of input reported was usability (n = 31), while others-namely, satisfaction (n = 27), acceptability (n = 25), formative (n = 24), impact (n = 22), accessibility (n = 17), and engagement (n = 11)-were reported less consistently. User views were sought using qualitative methods such as interviews, focus groups and open-ended survey questions, more often in combination with quantitative measures such as participant-rated measures and engagement analytics. User suggestions for changes were reported in relation to three in four projects studied but incorporation of changes in less than half of projects. Conclusions: This review demonstrates considerable homogeneity in reported user input in the development of digital health tools. Input from users as co-designers may improve the impact of tools on their intended outcomes. This literature review brought together a group of researchers who have sought user input in the development of digital sexual health tools, but, due to resource limitations, did not involve potential users themselves, who are of diverse and disparate groups.

Description:Background: The Chinese government has not yet included male population for HPV vaccination but there are increasingly more discussions about including them. Primary care providers' (PCPs) recommendation is an important driver for increasing vaccine uptake but understanding of PCPs' recommendation of HPV vaccine for adolescent males in China is limited. This study examined multidimensional factors associated with PCPs' recommendation of HPV vaccine for male adolescents, aiming to inform future HPV vaccination programs targeting adolescent males in China. Methods: A sequential explanatory mixed-methods was used. In the quantitative phase, we conducted an online survey with PCPs in Eastern China. Multivariable logistic regression analysis identified individual, interpersonal, community, organizational, and policy factors associated with their recommendation of HPV vaccines for adolescent males. Specialty, job title, and income were adjusted as potential confounding factors. The qualitative phase involved thematic analysis to explore these findings further. Results: Among the 605 PCPs recruited, only 16.4 % recommended HPV vaccines to adolescent males in the past 12 months. Multivariable logistic regression analysis showed that institutional support for HPV vaccination policies for adolescent males (AOR = 3.05, 95 % CI: 1.65-5.64), frequent institutional vaccine promotion activities (AOR = 1.82, 95 % CI: 1.12-2.96), and institutional incentives for vaccine promotion (AOR = 2.12, 95 % CI: 1.18-3.83) were associated with their recommendation behaviors. Additionally, those who perceived a community norm that HPV vaccines are only for females were less likely to recommend HPV vaccines to adolescent males (AOR = 0.54, 95 % CI: 0.33-0.87). Qualitative research further explained these findings, highlighting the role of organizational factors in PCPs' recommendation of HPV vaccination for adolescent males. Conclusions: A low proportion of PCPs recently recommended HPV vaccines to adolescent males. Organizational-level factors were found to be significantly associated with their recommendation behaviors, and these may help inform future vaccination programs targeting adolescent males.