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mHealth interventions to increase HIV non-occupational post-exposure prophylaxis uptake, adherence and linkage to pre-exposure prophylaxis services in Sub-Saharan Africa: a scoping review protocol

Por: Segomotso · N. L. P. · Mokgatle · M. M. · Oladimeji · O. · Swanepoel · J.
Introduction

Non-occupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP) are effective HIV prevention methods, but their use is low in Sub-Saharan Africa (SSA). Mobile applications (apps) could increase uptake and adherence to these interventions, yet research on their use in communities is limited. Furthermore, there is limited information on the design and development of these apps, impacting their implementation. This scoping review aims to identify, analyse and evaluate mobile apps designed to improve nPEP uptake, adherence and linkage to PrEP services focusing on key features, barriers and facilitators. It also seeks to address gaps in studies assessing the feasibility, usability and acceptability of these apps, with the goal of informing future research, healthcare policies and public health strategies to reduce the HIV burden in Sub-Saharan Africa.

Methods and analysis

This review will follow the Arksey and O'Malley framework and search databases such as PubMed, Scopus and Web of Science for relevant studies. Two independent reviewers will screen and assess full-text studies. Primarily, the review will include studies on digital interventions for nPEP and PrEP, excluding opinion papers, narrative reviews and sub-studies. Grey literature from sources like Google Scholar will also be considered. Data will be captured using a charting form, and results will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews framework. Completion is expected in December 2025.

Ethics and dissemination

No ethical approval is required as publicly available materials will be used. Results will be shared through peer-reviewed journals, conferences and with policymakers to inform HIV prevention strategies.

Orchestrating Human Connection in Digital NICUs: Leadership Strategies for Technology‐Enhanced Family‐Centred Care

ABSTRACT

Aim(s)

To explore how neonatal nurse leaders sustain human-centred care while implementing digital technologies in neonatal intensive care units (NICUs).

Design

Qualitative descriptive multi-site study across four NICUs in the Eastern Region of Saudi Arabia (November 2024–May 2025), reported in accordance with COREQ.

Methods

Purposive maximum-variation sampling recruited 24 neonatal nurse leaders across leadership levels, hospital types and digital maturity stages. Semi-structured interviews were conducted in Arabic or English, transcribed, translated as needed and thematically analysed in NVivo 14 using a hybrid inductive–deductive approach. Directed content analysis of key organisational documents enabled triangulation. Trustworthiness was supported through member checking, peer debriefing, audit trail, external review and double coding of a subset of transcripts.

Results

Four interrelated strategies were identified: (1) embedding a values-based human-centred vision; (2) selecting and customising digital tools to strengthen, not replace, nurse–family connection; (3) redesigning workflows (e.g., device-free openings, protected presence time, family-inclusive portals) to preserve presence and partnership; and (4) fostering team capability and psychological safety for digital–human integration.

Conclusion

Human-centred care in digital NICUs is intentionally led and structurally engineered. The study offers a practice-ready framework that translates values into reproducible routines within complex sociotechnical systems.

Implications for the Profession and/or Patient Care

The framework supports nurse leaders in aligning digital transformation with family-centred care, protecting nurse–family presence, and enhancing safety, trust and partnership for high-risk neonates.

Impact

Addresses risks of relational erosion in digital and AI-enabled NICUs and provides transferable nurse-led strategies to sustain ethical, family-centred practice.

Reporting Method

COREQ-compliant qualitative study.

Patient or Public Contribution

No Patient or Public Contribution.

Feasibility, efficacy and effectiveness of community health worker-facilitated hearing aid provision: a systematic review

Por: Frisby · C. · Manchaiah · V. · Swanepoel · D. W.
Objectives

The WHO recommends task-sharing with community health workers (CHWs) to help overcome the limited access to hearing healthcare and hearing aids in low-income and middle-income settings (LMIs). This systematic review examined the feasibility, efficacy and effectiveness of CHW-facilitated hearing aid provision.

Design

Systematic review guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines.

Data sources

PubMed, Scopus and Web of Science were searched through 4 June 2025.

Eligibility criteria

Studies in which CHWs facilitated hearing aid provision in any context.

Data extraction and synthesis

Data on study characteristics, CHW training and roles, hearing-aid outcomes and implementation factors were extracted. Study quality was determined using the National Institute of Health quality assessment tool, and level of evidence was determined using the Centre for Evidence-Based Medicine. A narrative synthesis was conducted.

Results

Six studies published between 2013 and 2025 were included. Two were conducted in high-income countries but implemented in LMI communities. Four studies were conducted in LMI countries. All provided CHW training, though content and duration varied; only one used WHO-endorsed materials. Sustained device use was high as reported at follow-ups, though only one included 12-month outcomes. All studies included validated outcome measures, including the International Outcome Inventory for Hearing Aids, Hearing Handicap Inventory for the Elderly–Screening version, Abbreviated Profile of Hearing Aid Benefit and Self-Efficacy for Situational Communication Management Questionnaire. Implementation facilitators included use of local CHWs, delivery in participants’ home languages, comprehensive CHW training and employing mHealth tools. Barriers included CHW scope constraints and unfamiliarity with outcome subscales in rural contexts. Only two studies used formal feasibility frameworks.

Conclusions

CHW-facilitated hearing aid provision is feasible and effective. However, variation in training and implementation highlights the need for standardised training materials, supervision models and culturally adapted outcome measures. Further research should examine long-term outcomes, cost-effectiveness and scalability using formal implementation frameworks.

Intensive weight loss intervention versus usual care in adults with obesity: a protocol for the LightCARE randomised clinical trial

Por: Larsen · S. C. · Heitmann · B. L. · Wane · S. · Wielsoe · S. · Lindschou · J. · Jakobsen · J. C. · Engstrom · J. · Specht · I. O. · Christiansen · A.-K. L. · Jensen · A. K. G. · Nyvold Bojsen-Moller · K. · Bandholm · T. · Overbeck · G. · Kousgaard · M. B. · Albury · C. · Reventlow · S
Introduction

Total diet replacements (TDRs) and weight loss medications (WLMs) have proven effective in producing substantial weight loss for individuals with obesity. Evidence is lacking on whether combining these treatments is effective and cost-effective in primary care for adults with obesity class I (body mass index (BMI) 30–34.9) or uncomplicated obesity class II or higher (BMI≥35 without obesity-related disease).

Methods and analysis

LightCARE is a 2-year 1:1 randomised, parallel-group, clinical superiority trial with blinded outcome assessment evaluating the benefits and harms of an intensive weight loss (IWL) intervention compared with usual care for adults with obesity in Denmark and the UK. The trial will include 400 participants aged 18–60 years with obesity class I or uncomplicated obesity class II or higher. The IWL programme aims to achieve and maintain a weight loss of ≥20% through a flexible and individualised combination of TDR, behavioural support, including physical activity and sleep guidance, and WLM if needed and will continue for 2 years. The control group will receive usual care offered in each country, typically consisting of brief behavioural support for weight loss. The primary outcome is body weight 2 years after randomisation. Secondary outcomes will include the proportion of participants achieving ≥20% weight loss, Short-Form-36 Mental Component Score, 4-m gait speed and Metabolic Syndrome Severity-Z score. Serious adverse events, the incidence of eating disorders and bone mineral density will be evaluated as safety outcomes. We will also examine the cost-effectiveness of the intervention, within the trial and in the longer term through modelling. We will conduct a process evaluation to inform any future implementation.

Ethics and dissemination

Ethical approval was granted in Denmark (December 2023, H-23051332) and the UK (August 2024, 24/SC/0210). Findings from the trial will be disseminated through peer-reviewed journals and scientific conferences.

Trial registration number

NCT06321432.

Cervical precancer thermal ablation versus LLETZ excision comparative efficacy study in WLWH (TALL Study): protocol for a randomised clinical trial in South Africa

Por: Adams · R. A. · Kelly · H. · Van der Merwe · F. H. · Butt · J. L. · Zwanepoel · J. E. · Botha · M. H.
Background

Cervical cancer remains a significant global health concern and is the fourth most prevalent cancer among women. In South Africa, it is the leading cause of cancer-related deaths in women aged 15–44 years. The disease is typically preceded by persistent high-risk HPV infection, leading to cervical intraepithelial neoplasia and eventually cancer. Currently, in South Africa, management primarily involves excision, particularly through large loop excision of the transformation zone, which has associated risks and limitations. Thermal ablation is an alternative cost-effective treatment method, providing a straightforward approach to treatment, particularly advantageous in environments characterised by limited resources. The study aims to assess the efficacy, safety and patient experience of thermal ablation, providing valuable data for potential integration into South Africa’s cervical cancer prevention policies.

Methods

Randomised controlled trial in which 420 women living with HIV aged 30–60 years will be recruited from the Colposcopy Clinic at Tygerberg Hospital and will be followed up for a period of two years. The primary study endpoint is a test of cure that will be assessed by HPV genotyping, cervical cytology and histology at six month intervals. Other endpoints include the occurrence of adverse events.

Ethics and dissemination

The study protocol has been approved by the Health Research Ethics Committee of Stellenbosch University (Ethics Reference No: M20/11/035) and by the Western Cape Department of Health and Wellness via the National Health Research Database (WC_202109_016). All study procedures comply with the Declaration of Helsinki, South African Good Clinical Practice Guidelines and the Medical Research Council’s ethical guidelines. Trial results will be disseminated through peer-reviewed journals, national and international conference presentations and professional associations. A lay summary will be shared with the Community Advisory Board to guide community-level dissemination.

Trial registration number

Pan African Clinical Trial Registry: PACTR202504820339039.

Perceived quality of life and associated factors in long COVID syndrome among older Brazilians: A cross‐sectional study

Abstract

Aims and objectives

This paper aims to: (a) determine the personal, sociodemographic, clinical, behavioural, and social characteristics of older Brazilians with clinical evidence of long COVID; (b) evaluate perceived quality of life and determine its association with personal, sociodemographic, behavioural, clinical and social variables; and (c) assess significant predictors of high perceived QoL.

Background

Given the inherent vulnerabilities of the ageing process, the older people are an at-risk group for both contagion of SARS-CoV-2 and the perpetuation of residual symptoms after infection, the so-called long COVID or post-COVID syndrome.

Design

A cross-sectional survey design using the STROBE checklist.

Methods

Brazilian older people with long COVID syndrome (n = 403) completed a phone survey measuring personal, sociodemographic, behavioural, clinical, and social characteristics, and perceived Quality of Life (QoL). Data were collected from June 2021–March 2022. A multiple linear regression model was performed to identify salient variables associated with high perceived QoL.

Results

The mean age of participants was 67.7 ± 6.6 years old. The results of the multivariate regression model showed that race, home ownership, daily screen time, musculoskeletal and anxiety symptoms, and work situation were the significant predictors of QoL among COVID-19 survivors.

Conclusions

Knowledge about the persistence of physical, emotional, and social symptoms of COVID-19 can help nurses and other healthcare providers to improve the management of survivors, bringing benefits to the whole society.

Relevance to clinical practice

Given the novelty of long-COVID and its heterogeneous trajectory, interventions focusing on the repercussions and requirements unique to more vulnerable older persons should be developed and these aspects should be included in public health recommendations and policymakers' concerns.

Patient or Public Contribution

No patient or public contribution was required to design, to outcome measures or undertake this research. Patients/members of the public contributed only to the data collection.

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