Background: The Philippines is facing a rapidly rising HIV epidemic among young men who have sex with men (MSM). Testing rates among young populations is poor. HIV self-testing (HIVST) is a promising strategy to address this testing gap. The study's purpose was to explore the perceived acceptability, feasibility and programmatic challenges of HIVST among key informants and target users. Method: A qualitative study involving semi-structured interviews and focus group discussions (FGD). We interviewed 15 key informants involved with HIV testing programs or policies and 42 target users in six FGD in Metro Manila. We held separate discussions with high socioeconomic MSM (n = 12), urban poor MSM (n = 15) and transgender women (TGW) (n = 15). Results were analysed using a thematic framework approach. Results: MSM and TGW welcomed the convenience and privacy HIVST could provide. They preferred an inexpensive accurate blood-based kit attained from reputable sites. Key informants at national and local level equally welcomed HIVST but identified a number of policy and regulatory issues. Both groups articulated the challenge of enrolling those who test reactive using HIVST to further testing and treatment in an environment characterised by acute stigma around HIV. Conclusions: HIVST was found to be highly acceptable to target users and was welcomed as an additional testing approach at national level. Strategic alliances are now needed between stakeholders to proactively deliver a patientcentred HIVST program that could provide an effective, safe means of increasing testing coverage in this escalating context.

BackgroundThe United Nations has called for countries to improve access to mobility devices when needed. The World Health Organization has published guidelines on the provision of manual wheelchairs in less-resourced settings. Yet little is known about the extent to which appropriate wheelchairs are available and provided according to international guidelines. This study’s purpose was to describe wheelchair users’ experiences receiving services and acquiring wheelchair skills in urban and peri-urban areas of Kenya and the Philippines.MethodsLocal researchers in Nairobi and Manila interviewed 48 adult basic wheelchair users, with even distribution of those who had and had not received wheelchair services along with their wheelchair. Recordings were transcribed in the local language and translated into English. The study team coded transcripts for predetermined and emergent themes, using Atlas-ti software. A qualitative content analysis approach was taken with the WHO service delivery process as an organizing framework.ResultsWheelchair users frequently described past experiences with ill-fitting wheelchairs and little formal training to use wheelchairs effectively. Through exposure to multiple wheelchairs and self-advocacy, they learned to select wheelchairs suitable for their needs. Maintenance and repair services were often in short supply. Participants attributed shorter duration of wheelchair use to lack of repair. Peer support networks emerged as an important source of knowledge, resources and emotional support. Most participants acknowledged that they received wheelchairs that would have been difficult or impossible for them to pay for, and despite challenges, they were grateful to have some means of mobility. Four themes emerged as critical for understanding the implementation of wheelchair services: barriers in the physical environment, the need for having multiple chairs to improve access, perceived social stigma, and the importance of peer support.ConclusionsInterventions are needed to provide wheelchairs services efficiently, at scale, in an environment facilitating physical access and peer support, and reduced social stigma.Trial registrationNot applicable since this was a descriptive study.Electronic supplementary materialThe online version of this article (doi:10.1186/s12914-017-0130-6) contains supplementary material, which is available to authorized users.

Background The Philippines has a high burden of TB and HIV, yet the WHO estimates that only 13% of Filipino TB patients know their HIV status. This is partly attributable to the lack of trained HIV counselors and medical technologists (or laboratory technicians) at the primary healthcare level. In Africa where resources and manpower are also scarce, TB/HIV care is already delegated to community health workers. Evidence is scant however about the acceptability and feasibility of engaging community health workers to provide HIV counseling and testing (HCT) among TB patients in the Philippines. The objective of this paper is to describe and assess the acceptability and feasibility of delegating HCT among TB patients to barangay (community) health workers (BHWs) in the Philippines. Methods Mixed methods study that utilized surveys with patients ( n = 89), BHWs ( n = 81), and ten focus group discussions with key stakeholders ( n = 49) in San Jose del Monte, a city with high HIV prevalence. A facility assessment ( n = 17) was done using a modified version of WHO-Service Availability and Readiness Assessment questionnaire to assess feasibility (scale of 1 to 4) while acceptability from the perspective of patients and BHWs was determined using surveys. Results Only 47% of TB patients agreed to receive HIV counseling from BHWs, while 30% agreed to receive HIV testing. Doctors were preferred by patients as HIV counselors, while medical technologists were preferred as HIV test providers. Two out of three BHWs also disagreed to provide HCT but the same number felt that they could provide HCT if additional trainings were given to them. In the group discussions, BHWs preferred to only provide HIV counseling. Stakeholders said that only select BHWs who meet certain criteria should provide HIV counseling. Program managers and stakeholders rated delegation of HCT to BHWs as moderately feasible. Conclusions Delegation of both HIV counseling and testing among TB patients to BHWs is feasible, but only delegation of HIV counseling is acceptable. Further studies are needed to guide revision of Philippine HCT policies to accommodate lay HIV counselors, and strengthen the mechanisms for delivering integrated TB and HIV services especially at the primary healthcare level. Electronic supplementary material The online version of this article (10.1186/s12889-019-6497-7) contains supplementary material, which is available to authorized users.

Background Opportunities in digital distribution place mobile games as a promising platform for games for health. However, designing a game that can compete in the saturated mobile games market and deliver persuasive health messages can feel like an insurmountable challenge. Although user-centered design is widely advocated, factors such as the user’s subject domain expertise, budget constraints, and poor data collection methods can restrict the benefits of user involvement. Objective This study aimed to develop a playable and acceptable game for health, targeted at young key populations in the Philippines. Methods Authors identified a range of user-centered design methods to be used in tandem from published literature. The resulting design process involved a phased approach, with 40 primary and secondary users engaged during the initial ideation and prototype testing stages. Selected methods included participatory design workshops, playtests, playability heuristics, and focus group discussions. Subject domain experts were allocated roles in the development team. Data were analyzed using a framework approach. Conceptual frameworks in health intervention acceptability and game design guided the analysis. In-game events were captured through the Unity Analytics service to monitor uptake and game use over a 12-month period. Results Early user involvement revealed a strong desire for online multiplayer gameplay, yet most reported that access to this type of game was restricted because of technical and economic constraints. A role-playing game (RPG) with combat elements was identified as a very appealing gameplay style. Findings guided us to a game that could be played offline and that blended RPG elements, such as narrative and turn-based combat, with match-3 puzzles. Although the game received a positive response during playtests, gameplay was at times perceived as repetitive and predicted to only appeal to casual gamers. Knowledge transfer was predominantly achieved through interpretation of the game’s narrative, highlighting this as an important design element. Uptake of the game was positive; between December 1, 2017, and December 1, 2018, 3325 unique device installs were reported globally. Game metrics provided evidence of adoption by young key populations in the Philippines. Game uptake and use were substantially higher in regions where direct engagement with target users took place. Conclusions User-centered design activities supported the identification of important contextual requirements. Multiple data collection methods enabled triangulation of findings to mediate the inherent biases of the different techniques. Game acceptance is dependent on the ability of the development team to implement design solutions that address the needs and desires of target users. If target users are expected to develop design solutions, they must have adequate expertise and a significant role within the development team. Facilitating meaningful partnerships between health professionals, the games industry, and end users will support the games for health industry as it matures.

Rationale for review. Migrants to the WHO European Region are disproportionately affected by infections including tuberculosis, HIV and hepatitis B and C (HBV/HCV), compared with the host population. There are inequities in the accessibility and quality of health services available to refugees and migrants in the Region. This has consequences for health outcomes and will ultimately impact the ability to meet Regional infection elimination targets. We reviewed academic and grey literature to identify national policies and guidelines for tuberculosis/HIV/HBV/HCV specific to migrants in Member States of the WHO European Region, and identify: a) evidence informing policy and b) barriers and facilitators to policy implementation. Key findings Relatively few primary national policy/guideline documents were identified that related to migrants and tuberculosis (14 of 53 Member States (26%), HIV (n = 15, 28%) and HBV/HCV (n = 3, 6%), which often did not align with WHO recommendations and for some countries, violated migrants’ human rights. We found extreme heterogeneity in the implementation of WHO- and European Centre for Disease Prevention and Control-advocated policies and recommendations on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection in migrants across Member States of the WHO European Region. There is great heterogeneity in implementation of WHO- and European Centre for Disease Prevention and Control-advocated policies on the prevention, diagnosis, treatment and care of TB/HIV/HBV/HCV infection in migrants across Member States in the Region. Conclusions/recommendations More transparent and accessible reporting of national policies and guidelines are required, together with the evidence base upon which these policy decisions are based. Political engagement is essential to drive changes in national legislation to ensure equitable and universal access to diagnosis and care for infectious diseases.