Malawi has one of the highest maternal mortality ratios in the world. Unsafe abortions are an important contributor to Malawi's maternal mortality and morbidity, where abortion is illegal except to save the woman's life. Postabortion care (PAC) aims to reduce adverse consequences of unsafe abortions, in part by treating incomplete abortions. Although global and national PAC policies recommend manual vacuum aspiration (MVA) for treatment of incomplete abortion, usage in Malawi is low and appears to be decreasing, with sharp curettage being used in preference. There is limited evidence regarding what influences rejection of recommended PAC innovations. Hence, drawing on Greenhalgh et al.'s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) diffusion of healthcare innovation framework, this qualitative study aimed to investigate factors contributing to the limited and declining use of MVA in Malawi. Semi-structured interviews with 17 PAC providers in a central hospital and a district hospital indicate that a range of factors coalesce and influence PAC and MVA use in Malawi. Factors pertain to four main domains: the system (shortages of material and human resources ; lack of training, supervision and feedback), relationships (power dynamics; expected job roles), the health workers (attitudes towards abortion and PAC; prioritization of PAC) and the innovation (perceived risks and benefits of MVA use). Effective and sustainable PAC policy must adopt a broader people-centred health systems approach which considers all these factors, their interactions and the wider socio-cultural, legal and political context of abortion and PAC. The study showed the value of using Greenhalgh et al.'s (2004. Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Quarterly 82: 581-629.) framework to consider the complex interaction of factors surrounding innovation use (or lack of), but provided more insights into rejections of innovations and, particularly, a low-and middle-income country perspective.

Objective:This review sought to identify the experiences of persons living with genital herpes and what interventions improve the health-related quality of life of young people and adults with primary or recurrent genital herpes.Introduction:Genital herpes is commonly associated with psychosocial challenges. However, a growing body of evidence suggests that its impact can be ameliorated through pharmacological and psychosocial interventions.Inclusion criteria:This review considered English- and German-language studies of community-dwelling males and females, of any ethnicity and geographical location, aged 15 years and older, who had primary or recurrent genital herpes. The quantitative component of the review included studies that reported on the virus’ impact on patients’ health-related quality of life and/or the efficacy of interventions in improving their health-related quality of life. Studies compared antiviral suppression therapies and psychological interventions with usual care or placebo, or against one another. The qualitative component of the review included studies that investigated the perceptions and experiences of young people and adults with genital herpes.Methods:Eleven databases were searched from January 1980 to March 2020. The JBI approach to mixed methods systematic reviews was followed at each stage of the review, and a convergent segregated approach to synthesis and integration was adopted.Results:A total of 31 publications covering 30 studies were deemed suitable for inclusion. Studies encompassed quantitative (n = 27, across 28 publications), qualitative (n = 1), and mixed methods (n = 2) designs. Critical appraisal scores were variable, particularly among the randomized controlled trials and the analytical cross-sectional studies. All studies were included regardless of methodological quality. The quantitative components identified that depression, illness concern, stress, anxiety, isolation, stigma, and a lowering of self-esteem, self-concept, self-confidence, and health-related quality of life may be experienced by both those newly diagnosed with genital herpes and those with recurrences. It was also identified that genital herpes can have an adverse effect on work or school, sexual relationships, and relationships with friends and family. Depression was found to significantly decrease after self-hypnosis and certain psychosocial interventions. Anxiety significantly decreased following pharmacological treatment, psychosocial interventions, and hypnosis. Psychosocial interventions significantly improved mood, and a self-help module with counseling significantly improved participants’ satisfaction with intimate relationships and their self-esteem. Pharmacological treatment significantly improved health-related quality of life; however, there were no significant differences between different active treatment regimens. The qualitative component of the review led to the identification of two synthesized findings: “Disclosure of a diagnosis of genital herpes poses a dilemma for people...

Many STIs are known to disproportionately affect men who have sex with men (MSM) in the UK; therefore, regular asymptomatic screening that is easy to access is vital among this group. Asymptomatic screening pathways can reduce long clinic waits, which may encourage more people to attend for screening. We therefore developed and trialled an asymptomatic pathway for MSM within our service. This extended our previous pathway, which allowed asymptomatic service users to fill in a questionnaire and see a healthcare support worker, to include MSM, as it previously had not. The service has been implemented and rolled out successfully. We believe that this model for asymptomatic screening among MSM can reduce clinic visit duration. This should increase accessibility and also allow trained staff to manage more complex patients, while allowing for risk identification and health promotion among those MSM who may be at higher risk.

No abstract

The study showed that young women from different backgrounds have strong opinions about sex education, and are an important resource for policy makers.

Background/introductionLGBT people have different care needs to other sexual health clinic attendees. Many STIs are known to disproportionately affect men who have sex with men (MSM). We wished to ascertain how to optimise LGBT, and in particular MSM, service provision by our urban sexual health clinic.Methods100 questionnaires were completed by attendees to the local Pride event.Results61 respondents self-defined as female, 34 male, 4 transman and 1 demifem. 27 (20 women, 4 men) stated their sexual partners were both male and female, 38 (12 women, 25 men) had same-sex partners, and 34 (28 women, 5 men) had opposite-sex partners only.81 had not attended the local clinic. Reasons for this included previously living elsewhere (22), not feeling they required the service (15) or not knowing it existed (9). 67 reported they would like a specific LGBT sexual health clinic, with 63 requesting evening clinics. 9 did not want specific clinics, with 2 respondents citing concerns about discrimination. 61 felt more LGBT sexual health services outside the city centre are needed. Features they would like included web-based bookings (64), home-testing kits (49), pre-exposure prophylaxis (79) and HPV vaccination (69).Discussion/conclusionThe questionnaire was successful in capturing opinions of those who hadn’t previously attended our service. However it is not possible to ascertain whether views expressed were representative of the local LGBT population as a whole and less than a third were MSM. We will consider developing a specific LGBT service in response to the survey’s findings.

No abstract