Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 14 appraisals
JMIR human factors
Japanese Health Information Technology Usability Evaluation Scale for Sexually Transmitted Infection-Related Chatbots: Development and Psychometric Validation Study
BACKGROUND: The rapid expansion of mobile technology has accelerated the integration of health applications and conversational AI into clinical and public health practices. To ensure these tools are effective and sustainable, usability evaluations and early user engagement during development are essential. The Health Information Technology Usability Evaluation Scale (Health-ITUES) is a validated and flexible usability assessment instrument that is available in multiple languages and applicable across diverse contexts. However, a Japanese version of this scale has not yet been developed. OBJECTIVE: This study aimed to translate and validate a Japanese version of the Health-ITUES, customized for a sexually transmitted infection (STI)-related chatbot, and to support the usability assessment of emerging mobile health tools in Japan. METHODS: We developed a Japanese version of the Health-ITUES using a chatbot under development as a consultation tool for young women regarding STIs. First, the original scale was customized to reflect the chatbot's specific purpose and intended usage context. Following established translation guidelines, we conducted forward translation from English to Japanese, back translation, expert review, and reconciliation. We then evaluated the reliability and validity of the Japanese version in a sample of 301 young women. RESULTS: The Japanese version of the Health-ITUES demonstrated high internal consistency (Cronbach α=0.85-0.98). Confirmatory factor analysis supported acceptable construct validity (root mean square error of approximation is 0.10, comparative fit index>0.90). Additionally, the Health-ITUES scores showed strong correlations with satisfaction and usage intention for the tool (r=0.779 and 0.797, respectively). CONCLUSIONS: The Japanese version of the Health-ITUES provides initial evidence of reliability and validity in an STI-related scenario among young women and may facilitate more rigorous usability evaluations of mHealth and conversational AI tools in Japan.
24 July 2026
Read appraisal →The Journal of dermatological treatment
Intralesional human papillomavirus vaccination for cutaneous verrucae: a systematic review and meta-analysis of therapeutic efficacy
OBJECTIVES: To evaluate the efficacy of intralesional human papillomavirus (HPV) vaccination in the management of cutaneous warts. METHODS: A comprehensive search of PubMed, MEDLINE, Embase, Scopus, and ClinicalTrials.gov was conducted in accordance with a registered PROSPERO protocol (CRD420251170324). Chronic or persistent warts were defined as lesions lasting more than six months or showing inadequate response to conventional therapies. The primary outcome was complete wart clearance, and pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: Six studies were included. Intralesional HPV vaccination was associated with a significantly higher rate of complete clearance compared with intralesional normal saline (RR 18.54; 95% CI 6.59-52.18). Subgroup analyses demonstrated comparable efficacy between bivalent and quadrivalent vaccines. Reported adverse events were mild and localized. CONCLUSION: Intralesional HPV vaccination demonstrated significant therapeutic efficacy in the treatment of cutaneous warts and represents a promising immunotherapeutic option for patients with persistent or treatment-refractory disease.
30 June 2026
Read appraisal →The New Zealand medical journal
Cancer risk and screening in transgender and gender-diverse individuals on gender-affirming hormone therapy: a review article for the Australasian context
AIM: We aimed to synthesise current evidence on the association between gender-affirming hormone therapy (GAHT) and cancer risk in transgender and gender-diverse (TGD) individuals and to provide evidence-based cancer screening recommendations for Australasian general practitioners. METHODS: A systematic review of epidemiological studies, case reports and clinical guidelines was conducted in accordance with PRISMA 2020 guidelines. Searches were performed across PubMed/MEDLINE, Embase, Scopus and the Cochrane Library for literature published up to December 2025. Key evidence sources were narratively synthesised to develop practical recommendations tailored to the Australasian context. RESULTS: The available evidence, although limited by short follow-up durations and small cohort sizes, does not demonstrate a consistent, statistically significant increase in common cancers among TGD individuals receiving GAHT. However, emerging case reports highlight novel clinical concerns, including malignancies in surgically constructed tissues (neophallus and neovagina). Breast cancer risk in trans women appears to increase with the duration of oestrogen therapy, though it remains lower than in cisgender women. Prostate cancer may present at a higher grade in trans women receiving oestrogen. Screening participation is consistently lower in TGD populations, often resulting in later-stage diagnoses. CONCLUSION: Cancer screening for TGD individuals should be guided by an organ-inventory approach, based on the organs a person has rather than their gender identity. Clinicians should maintain a low threshold for investigating suspicious lesions, particularly in surgically altered tissues. The development of culturally safe and inclusive primary care environments is paramount to improving screening uptake and ensuring equitable health outcomes for TGD communities in Australia and New Zealand.
31 May 2026
Read appraisal →Human vaccines & immunotherapeutics
Strategies implemented to increase HPV vaccine uptake and confidence among men who have sex with men and transgender people: A systematic review
Men who have sex with men (MSM) and transgender persons are disproportionately affected by HPV-related disease. The HPV vaccine effectively prevents infection, but vaccine uptake remains suboptimal in this group. Thus, this systematic review aimed to synthesize the literature on interventions and strategies implemented to increase HPV vaccine confidence and uptake among MSM and transgender persons. Six databases were searched in May 2025. We assessed risk of bias and extracted and descriptively summarized key data through narrative synthesis and content analysis. Sixteen articles reporting on eight interventions were identified, all implemented in high-income settings. The interventions can be broadly categorized into two types: strategies to integrate HPV vaccination into existing health services and digital interventions aimed at generating vaccine demand. Overall, evidence remains limited on interventions to increase HPV vaccine uptake in these groups, particularly studies focusing on the needs of transgender persons.
31 May 2026
Read appraisal →Antiviral therapy
Factors associated with immunological non-response in HIV patients receiving antiretroviral therapy in Southeast Asia: A systematic review
ObjectiveThis systematic review summarizes factors associated with immunological non-response (INR) among people with HIV on antiretroviral therapy (ART) in Southeast Asia.MethodsWe conducted a systematic search of PubMed, ScienceDirect, DOAJ, and Lens.org for studies published between 2010 and 2025. Observational studies examining immunological outcomes following ART initiation and related factors were included. Study quality was assessed using the Newcastle-Ottawa Scale, and results were synthesized using a harvest plot.ResultTen eligible studies were included in the synthesis, comprising a total of 6,988 participants with substantial heterogeneity observed across studies. Factors associated with INR included age, sex, baseline CD4 cell count, HIV RNA levels, and co-infections. Among these factors, baseline CD4 cell count at the initiation of ART emerged as the most consistently associated determinant; lower baseline CD4 levels were linked to a higher risk of INR even with virological suppression.ConclusionThis review highlights baseline immunological status at ART initiation as a key predictor of immunological non-response in Southeast Asia. These findings underscore the critical importance of early HIV diagnosis and timely initiation of ART to prevent advanced immune damage and optimize immunological recovery.
12 May 2026
Read appraisal →Journal of medical Internet research
Facility-Level Associations Between Use of a Digital Health Platform for Voluntary Counseling and Testing and HIV Testing Outcomes in the Urban Primary Health Care Centers of Guangzhou, China: Cross-Sectional Study
BACKGROUND: WellTest, a digital health platform designed to facilitate HIV voluntary counseling and testing (VCT) services, has been widely implemented in Guangzhou, China. However, the extent of its use by primary health care centers (PHCs) and the facility-level associations between WellTest use and HIV testing outcomes remain unclear. OBJECTIVE: This study aimed to assess the use of WellTest at the facility level across PHCs in urban Guangzhou, China, and to explore the associations between WellTest use and HIV testing outcomes. METHODS: We obtained data on VCT services visits from the National HIV/AIDS Prevention and Control Information System and the WellTest platform between January 1 and December 31, 2022. Two facility-level HIV testing outcomes, the HIV testing volume and HIV positivity rate, were calculated for each PHC. A structured questionnaire collected data on the PHCs' characteristics. Multilevel negative binomial regression and zero-inflated gamma models were used to examine associations between WellTest use and 2 HIV testing outcomes at the facility level. RESULTS: A total of 81 PHCs across 5 urban districts in Guangzhou were included. WellTest was used for 7997 active consultations and 7969 HIV tests that resulted in 157 newly diagnosed HIV cases, for an overall positivity rate of 2.0%, during 2022. The median share of clients booking via WellTest was 71% (IQR 34%-98%), and 81% (66/81) of PHCs offered online slots on all service days without mandates. PHCs that actively confirmed appointments had significantly lower HIV testing volumes compared with those that took no actions after clients scheduled appointments (incidence rate ratio 0.75, 95% CI 0.58-0.97; P=.03) but exhibited higher HIV positivity rates (β=.39, 95% CI 0.02-0.76; P=.04). Additionally, PHCs where ≥50% of clients used WellTest to schedule appointments showed higher HIV positivity rates than those with lower uptake (β=1.11; 95% CI 0.82-1.40; P<.001). CONCLUSIONS: WellTest showed substantial use among VCT clients and providers in urban Guangzhou PHCs, with greater use of digital appointments and counselor follow-up linked to increased HIV positivity rates. Strategies to optimize institutional adoption may help address stigma-related barriers, strengthen engagement in HIV testing, and support HIV case finding in primary health care settings.
20 Apr 2026
Read appraisal →JMIR formative research
A Survey of Primary Care Clinician Experiences With Electronic Health Record-Based Clinical Decision Support to Improve HIV Pre-Exposure Prophylaxis Prescribing
A survey of primary care clinicians suggests that a clinical decision support tool to support sexual risk assessment and prescribing of HIV pre-exposure prophylaxis was appropriate and useful for identifying at-risk patients, but uptake was hindered by workflow and usability barriers, which underscores the importance of postimplementation clinician feedback to improve the use of clinical decision support tools.
17 Apr 2026
Read appraisal →Journal of medical Internet research
Digital Monitoring of Pre-Exposure Prophylaxis Users Through Electronic Patient-Reported Outcome Measures and Electronic Patient-Reported Experience Measures: Multicenter Prospective Study on Feasibility, Safety, and Predictive Modeling of Digital Engagement
BACKGROUND: Digital health tools integrating electronic patient-reported outcome and experience measures (ePROMs/ePREMs) enable longitudinal monitoring of health-related quality of life (HRQoL), psychological well-being, and treatment satisfaction in pre-exposure prophylaxis (PrEP) users. However, determinants of sustained engagement with digital follow-up platforms remain insufficiently characterized. OBJECTIVE: To describe the feasibility of the Naveta-Phemium digital platform for longitudinal monitoring of safety, HRQoL, and treatment satisfaction among PrEP users, and to develop and internally validate a machine learning framework to characterize and predict engagement with digital follow-up. METHODS: A prospective observational study was conducted using the Naveta digital follow-up platform. HIV-negative adults at high risk of HIV infection received tenofovir disoproxil fumarate (245 mg) plus emtricitabine (200 mg). Clinical safety, HRQoL, and satisfaction were assessed using laboratory parameters and validated ePROMs/ePREMs (Hospital Anxiety and Depression Scale, Patient-Reported Outcome Measurement Information System Profile-29, Treatment Satisfaction Questionnaire for Medication, and Person-Centered Coordinated Care Experience Questionnaire). Engagement was defined at the questionnaire level and analyzed using the ALGOPROMIA-Classification framework with repeated stratified cross-validation. Model explainability was assessed using permutation-based Shapley Additive Explanations. RESULTS: A total of 81 participants contributed repeated questionnaire-level observations (mean PrEP duration 689 d). PrEP was well tolerated, with no moderate or severe adverse events; mild transient symptoms were mainly gastrointestinal (31/45, 68.9%) and neurological (26/45, 57.8%). Renal function remained stable (creatinine: 0.86 [SD 0.13] mg/dL; estimated glomerular filtration rate: P=.498). Psychological well-being and HRQoL remained stable (Hospital Anxiety and Depression Scale<7; Patient-Reported Outcome Measurement Information System Profile-29 near population norms). Treatment satisfaction was consistently high (Treatment Satisfaction Questionnaire for Medication≈85-87), and satisfaction with the NAVETA telemedicine model remained stable (8/10). Engagement showed clear sociodemographic and behavioral gradients. Ensemble-based machine learning models achieved good discrimination in predicting engagement (area under the curve≈0.82) across ≈12,300 questionnaire-level observations. Random forest was retained for robustness and consistency. Shapley Additive Explanations analysis highlighted lifestyle-related variables as the most influential predictors, with heterogeneous individual-level effects. CONCLUSIONS: Naveta enabled feasible telemedicine-based PrEP follow-up with preserved HRQoL, high satisfaction, and stable safety. Combining longitudinal ePROMs/ePREMs with explainable machine learning allowed detailed characterization of digital engagement, supporting digitally supported PrEP care optimization and informing future comparative and cost-effectiveness studies.
15 Apr 2026
Read appraisal →PloS one
Inconsistent condom use and its associated factors among female sex workers in African countries: Systematic review and meta-analysis
BACKGROUND: Inconsistent condom use represents the most proximal behavioral risk factor for acquisition and transmission of sexually transmitted infections, including human immunodeficiency virus. However, certain situations hinder female sex workers from practicing consistent condom use. This study aimed to assess the pooled estimate of inconsistent condom use among female sex workers and identify factors associated with it. METHODS: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, 2020 reporting checklist. Electronic databases (PubMed, Cochrane Library, Epistemonikos, Hinari, and Science Direct), Google Scholar, and other university repositories were searched until March 20, 2024, based on the eligibility criteria. Three independent reviewers screened the titles, abstracts, and full texts. Two independent reviewers extracted the data. The Joanna Briggs Institute quality appraisal checklist was used. The Higgin's I² test was used to quantify heterogeneity. Pooled analysis was conducted using a random-effects model. Sensitivity and subgroup analyses were done. Publication bias was assessed using Egger's regression test and funnel plot. The pooled prevalence and statistical association were declared at a p-value < 0.05 with the 95% CI. RESULTS: A total of 24 studies involving 23,496 female sex workers with a median age of 27.3 years were included. The overall pooled prevalence of inconsistent condom use among FSW in Africa was estimated at 46.73% (95% CI: 37.60, 55.86), I² = 99.59%, and p = 0.00. Condom availability (AOR = 0.68; 95% CI: 0.50, 0.92), depression (AOR = 1.51; 95% CI: 1.00, 2.30), no education (AOR = 1.87; 95% CI: 1.19, 2.93), two or more nonpaying clients (AOR = 2.90; 95% CI: 1.51, 5.54), having >9 current client number (AOR = 0.46; 95% CI: 0.29, 0.74), violence (AOR = 1.74; 95% CI: 1.33, 2.27), and police harassment (AOR = 2.28; 95% CI: 1.03, 5.05) were significant factors. CONCLUSION AND RECOMMENDATION: Inconsistent condom use was high in Africa. Factors including availability of condoms, depression, and education, having two or more nonpaying clients, client numbers, violence, and police harassment were significant factors. Strategies like improving peer education, providing mental health support, empowering women, and improving female sex workers educational status, ensuring condom availability, and strengthening supply for easily accessible condoms can decrease inconsistent condom use and protect FSWs from STI including HIV.
11 Apr 2026
Read appraisal →Sexual health
Co-creation and evaluation of people-centered mobile health messages to promote PrEP adherence among GBMSM in China: a feasibility study
BACKGROUND: Co-creation has the potential to generate people-centered mobile health (mHealth) interventions to improve PrEP adherence. This study generated people-centered mHealth messages with Chinese gay, bisexual and other men who have sex with men (GBMSM) via a structured co-creation approach, and evaluated the messages quality, and assessed the feasibility of the co-creation approach. METHODS: A three-step co-creation framework was implemented with 19 GBMSM PrEP users and six HIV researchers between 2021 and 2023. Messages were assessed via 10-point scales, and the degree of usefulness by co-creators and 783 participants from a PrEP demonstration trial. Thematic analysis identified PrEP adherence barriers and participants' reflections from meeting notes and materials, with descriptive statistics summarizing evaluation results. RESULTS: Four levels of PrEP adherence barriers were identified (insufficient education, efficacy concerns, inadequate behavioral skills, PrEP stigma). Based on these barriers, 25 mHealth messages (19 posters, three videos, three text messages) were co-created, covering nine themes (e.g. missed dose coping, side-effect management). Seventeen high-quality messages were selected, with mean scores of 8.25 (relevance), 7.86 (appropriateness) and 7.25 (elaboration). Among GBMSM PrEP users who received the messages, 90.4% (708/783) valued the co-created messages as helpful. Reflections from the co-creators highlighted the value of the participatory process, confirming that co-creation effectively engages GBMSM PrEP users. CONCLUSIONS: Co-creation groups are feasible for Chinese GBMSM to identify context-specific PrEP adherence barriers and develop people-centered mHealth messages, supporting the value of co-creation for PrEP adherence intervention development in this population.
9 Apr 2026
Read appraisal →Sexual health
E-screening for sexually transmissible infections and blood-borne viruses in New South Wales, Australia: a cost analysis.
BACKGROUND: MyCheck is an e-testing pathway, first implemented at Sydney Sexual Health Centre, which enhances access to STI/HIV testing via telehealth and off-site sample collection; thus, reducing clinic visits. This study evaluates MyCheck's direct and indirect costs versus standard in-person screening (Xpress). METHODS: A 12-month bottom-up cost analysis from a societal perspective compared MyCheck and Xpress. Direct medical (health system), direct non-medical (patient travel) and indirect non-medical (productivity) costs were calculated using retrospective Sydney Sexual Health Centre data. Costs included pathology, staff time, overheads, consumables, patient travel and forgone productivity. Statewide scale-up costs were estimated, with sensitivity analyses adjusting for inflation, minimum wage and an increase in the proportion of MyCheck users with productivity loss. RESULTS: From January to July 2023, Sydney Sexual Health Centre conducted 2548 screening episodes (45% MyCheck, 55% Xpress), with MyCheck attracting more men who have sex with men/transgender and gender diverse patients. MyCheck's shorter appointments (median 5 min vs Xpress's 15 min) led to lower staff costs (A$5 vs A$16). MyCheck had higher overall health system cost (A$127/patient) compared with Xpress (A$91/patient), mostly due to pathology costs. However, considering patient travel cost and productivity loss for Xpress, MyCheck's societal cost (A$137) was lower than Xpress (A$146), yielding A$104,260 annual savings. Statewide scale-up provides significant societal savings (A$419,077/year). CONCLUSION: This analysis of MyCheck's direct and indirect costs compared with traditional in-person screening demonstrates significant societal savings, despite higher direct pathology costs. It underscores the importance of a broader societal perspective in cost analyses. Lowering private pathology costs could further enhance MyCheck's cost-effectiveness. MyCheck, an innovative e-screening pathway, reduces barriers for STI/blood-borne virus screening by improving patient convenience and reduced opportunity costs. Despite higher direct pathology costs, its societal cost savings support statewide scale-up for improved screening accessibility.
9 Apr 2026
Read appraisal →Journal of medical Internet research
Social Media Intervention Based on the Information-Motivation-Behavioral Skills Model Promotes HIV Testing and Reduces High-Risk Behaviors Among Men Who Have Sex With Men in Resource-Limited Settings in China: Randomized Controlled Trial
BACKGROUND: Social media intervention may enhance HIV prevention among men who have sex with men, but the effect of this intervention in resource-limited settings remains unclear. OBJECTIVE: This randomized controlled trial evaluated whether a social media intervention grounded in the information-motivation-behavioral skills (IMB) model could be beneficial for HIV prevention among men who have sex with men in resource-limited settings. METHODS: Participants were recruited in Nanning, China, between April 2023 and April 2024. Eligible participants were randomly assigned to either the social media intervention group or the routine HIV prevention services control group. Participants in the intervention group received a 3-month social media intervention, which included completing video-based tasks. Baseline surveys were conducted, followed by follow-up surveys every 3 months, for a total of 2 follow-ups. Outcomes included HIV testing uptake, high-risk behavior, AIDS-related knowledge, safe sex self-efficacy, and attitude. RESULTS: A total of 180 eligible men who have sex with men were enrolled (90 per group). Follow-up rates were 97.8% (88/90) and 95.5% (86/90) for the intervention and control groups, respectively. At the follow-ups, the intervention group demonstrated significantly higher uptake of HIV testing, a lower proportion of participants reporting high-risk sexual behaviors, and higher condom use self-efficacy compared to the control group (all P<.05). After controlling for sociodemographic variables, generalized estimating equations analysis revealed that the intervention group had significantly higher odds of HIV testing (risk ratio [RR] 1.739, 95% CI 1.110-2.730), HIV self-testing (RR 2.306, 95% CI 1.593-3.340), and consistent condom use (RR 2.457, 95% CI 1.636-3.690) than the control group. Cochran-Armitage trend tests within the intervention group revealed that with increasing intervention duration, both HIV testing and HIV self-testing significantly increased, while high-risk sexual behaviors significantly decreased (all P<.05). CONCLUSIONS: The social media intervention guided by the IMB model demonstrated a positive effect on expanding HIV testing coverage, reducing high-risk behavior, enhancing AIDS-related knowledge, and improving safer sex self-efficacy among men who have sex with men in resource-limited settings. These findings provide valuable guidance for future HIV prevention and control efforts targeting this population.
8 Apr 2026
Read appraisal →Clin Dermatol
Gonorrhea.
Neisseria gonorrhoeae, a Gram-negative intracellular pathogen, causes gonorrhea. Although usually sexually transmissible, it can be acquired by direct inoculation. Untreated gonococcal infections have deleterious impacts, including adverse pregnancy outcomes, ectopic pregnancy, infertility, and even blindness. Extended-spectrum cephalosporins remain the mainstay of therapy, and gonococcal culture is essential to determine susceptibility to these agents. Antimicrobial resistance is a global public health concern, and a few new agents are in the pipeline. Gonorrhea control programs rely on health education, access to diagnostic testing (where possible), effective therapy, and partner notification. Introducing inexpensive, sensitive, and specific point-of-care tests will aid antimicrobial stewardship efforts in countries using the syndromic management approach. Targeted vaccination of higher-risk populations with cross-protective outer membrane vesicle-based meningococcal B vaccines might reduce N. gonorrhoeae transmission in the future. Doxycycline postexposure prophylaxis may further reduce gonococcal incidence in the short term; however, its long-term impact on the human resistome/microbiome remains unknown.
1 Jan 2026
Read appraisal →Clin Dermatol
Chancroid.
Chancroid, caused by Haemophilus ducreyi, is a sexually transmitted genital ulcerative condition associated with inguinal bubo formation. The relative prevalence of chancroid has dramatically declined based on surveillance findings in those few endemic settings where the appropriate diagnostic tools exist; however, laboratory-based diagnostics are lacking to assist clinical management and support etiological surveillance in most parts of the world. Recent yaws surveys within the Western Pacific region indicate that H ducreyi has re-emerged as a frequent cause of chronic skin ulceration. Although there have been no antimicrobial susceptibility studies for three decades, it is assumed that a cure remains possible with extended-spectrum cephalosporins, macrolides, or fluoroquinolones. HIV-1-infected patients require careful followups due to reports of treatment failure with single-dose regimens. Buboes may need additional treatment with either aspiration or excision and drainage.
1 Jan 2026
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