Rebecca J. Guy

Background: Human Papillomavirus (HPV) vaccination is a key strategy to reduce HPV-related cancers such as cervical cancer. Rural, low socioeconomic status, ethnic minority, Indigenous and migrant populations often experience inequity when accessing HPV vaccination. Methods: This scoping review searched six databases for intervention studies which measured the uptake of HPV vaccination of rural, low SES, ethnic minority, Indigenous or migrant adolescent-young adult population. Strategies were categorised according to their setting: clinical, school-based, community, or a combination of one or more of these settings. Results: Effective strategies from 46 studies which increased equity in HPV vaccination uptake included: (1) Information disseminated through handouts, multilingual material, and health care conversations using presumptive language; (2) 'Prompting' using a practice-wide coordination to flag patient records, remind patients, and alert them of their appointment for HPV vaccination; (3) Health Care Professional (HCP) training to communicate information effectively about HPV vaccination, and include HCP champions as HPV vaccination advocates; (4) School-based programs, using strategies such as on-site vaccination, student-engagement fetes and partnership with clinics to increase HPV vaccination 'catch-up'; (5) Family-centred care to motivate HPV vaccination for cancer prevention. Conclusions: Although interventions demand preparation and coordination to initiate, they can positively influence the uptake of HPV vaccination. There are a wide range of effective strategies to increase equity in HPV vaccination in the rural, low SES, ethnic minority, Indigenous and migrant adolescent-young adult populations. Future evaluation of effective strategies could explore their sustainability and long-term implementation in interventions.

Internationally, vaccination rates among adolescents with intellectual and developmental disability (IDD) are lower than those of the general population. Little research has addressed this issue. This study investigates the experiences of vaccinating adolescents with IDD in special education settings in Australia, with a focus on student engagement. Semistructured interviews and focus groups were undertaken with 50 stakeholders involved in the school vaccination program. Data was analyzed thematically using a framework approach. We identified five themes: lack of student engagement, practices discouraging engagement, practices fostering engagement, lack of vaccination protocol adjustments, and lack of disability-specific nurse training. Nurses' limited knowledge and skills in engaging students with IDD can result in unethical practices, students feeling excluded from vaccination decisions, and students being traumatized by negative treatment experiences. Clinical protocols lack guidance and reasonable adjustments to provide inclusive vaccination services. Supported decision making could provide more inclusive school vaccinations, more positive vaccination experiences, and higher vaccination rates among adolescents with IDD.

Decentralized molecular testing for infectious disease diagnosis at the point-of-care (POC) is critical to address inequities in access to timely, informed health care. The COVID-19 pandemic accelerated the demand, development and adoption of POC tests for infectious diseases globally. This has provided opportunities to maximize the individual benefits and public health impact of POC testing, particularly in remote and resource-limited primary care settings. Despite this, there remains a lack of harmonized, regulatory compliance and quality management frameworks for the delivery of molecular POC testing networks outside the laboratory setting. This Perspective describes real-world lessons and experiences of delivering a fit-for-purpose, quality framework for one of the world's largest decentralized molecular POC testing programs for infectious disease across rural and remote Australian communities. Here we detail unique, key considerations to ensure the quality of POC testing in primary health settings with global application. There is an ethical and public health imperative to provide sustained access to decentralized POC testing for infectious disease in primary care. Genuine partnerships across stakeholders and disciplines are essential to deliver well governed, fit-for-purpose quality management POC testing frameworks and increase equitable access to timely, high-quality person-centered care.

Background: Adolescents with intellectual and developmental disability (IDD) are reported to have lower uptake of routine vaccines than their peers. Little research has explored stakeholders' perceptions and support of school-based vaccinations for this population in NSW, Australia. Methods: Focus groups and interviews were conducted with four stakeholder groups involved in the vaccination program in special education schools in New South Wales, Australia: students with IDD, parents, education staff, and health professionals. Results: Stakeholders mostly supported vaccinating adolescents with IDD in school settings. Students valued the familiar environment and emotional support from teachers. Parents appreciated the convenience and accessibility of the program. Education staff regarded vaccinations as vital for student health and mostly supported school-based delivery but faced practical and ethical challenges, such as insufficient resourcing, confusion around holding students for safety and emotional support, and concerns about losing students' trust in the school as a safe environment if vaccination was experienced as traumatic. Health staff identified a need for better prevaccination communication with families and schools to improve vaccine uptake and student preparation. Conclusions: Findings highlight a need for increased support for special schools that act as key program facilitators between those who deliver and those who receive this vital health service.

Few studies have explored community experiences of our increasingly resistant bacterial landscape, and, in the sphere of sexually transmissible infections (STIs) and antimicrobial resistance, there is even greater absence of community-centred research. This is despite a growth in STI transmission worldwide, which, alongside accelerated resistance, will disproportionately affect GBTQ+ (gay, bisexual, trans, queer+) populations. In this article, drawing on semi-structured interviews conducted in 2024 with 49 cisgender and trans gay and bisexual men, trans women and gender diverse people, we explore contemporary GBTQ+ safe sex practices as they relate to the growing threat of antibiotic resistant STIs in Australia. Key themes identified were the pharmaceutical turn in safe sex practices, the tensions this produced, the complexities of condom use, and the influence of biographies on safe sex practices. We illustrate how the turn toward pharmaceutical solutions has reconfigured and continues to reconfigure safe sex, giving rise to pleasures that were hitherto 'off-limits' to many. However, escalating antibiotic resistance threatens to again alter community practices and relationships to STI prevention measures. Drawing on Barad, we develop these themes to theoretically conceptualise safe sex as not fixed, but as an entanglement that is relationally and iteratively (re)configured through the connections between objects, subjectivities, practices, temporalities, and the human-microbial dynamics entailed therein. Findings suggest public health and clinical communication about resistance should speak to population concerns about gut health, resistance vis-à-vis Doxy-PEP, changing definitions of safe sex, and the importance of pleasure.