Access To Health Services Research Articles

Rural pharmacist and consumer perspectives of expanded pharmacy services to address inequity in accessing health services

Abstract Objectives Australians living in rural and remote communities have inadequate access to health services, contributing to poorer health outcomes compared to their metropolitan counterparts. This study investigated consumers’ and pharmacists’ perspectives of expanded pharmacy services in rural and remote communities in Australia. It aims to identify the role of the pharmacist in addressing the inequity of access to healthcare through the provision of expanded services in rural and remote practice. Methods A concurrent parallel mixed-methods study was undertaken in rural Western Queensland, Australia to include a survey of 167 consumers and in-depth interviews with 10 pharmacists. Quantitative data analysis employed descriptive statistics and chi-square tests, while qualitative data were analysed thematically against the constructs of the Diffusion of Innovations Theory. Key findings Consumers indicated that they would like to access weight management services (53%), whereas pharmacists thought it was important to offer respiratory clinics and services. Both pharmacists and consumers would like to see diabetes checks (30% and 56%, respectively) and vision, hearing, and ear checks (40% and 53%, respectively) implemented as services in community pharmacies. Most consumers (97%) believe pharmacists have the skills and knowledge to deliver expanded services and in doing so, they would improve the overall health of the community. Pharmacists reported staffing availability, workload and time constraints, cost, and jeopardizing inter-professional relationships as barriers to implementing expanded services. Conclusions Consumers were supportive of pharmacists working to their full scope of practice to provide expanded services, whereas pharmacists, while open to the idea, highlighted that there were barriers to overcome.

The modern role of paraprofessionals in delivering brief psychological interventions

AbstractThe increasing global demand for mental health services, compounded by the COVID‐19 pandemic, has spurred innovative approaches. Among these, the utilisation of paraprofessionals for delivering brief psychological interventions (BPIs) is gaining significant traction across diverse settings and populations. Paraprofessionals (individuals equipped with specialised mental health training but lacking formal qualifications) have emerged as a valuable resource. They have the potential to offer cost‐effective, culturally sensitive and readily accessible support. The integration of paraprofessionals into various healthcare settings, such as inpatient psychiatric units and primary care clinics, underscores their potential to enhance holistic well‐being and early intervention. This integration not only lightens the load on licensed therapists but also broadens access to services while reducing treatment costs. At a global scale, paraprofessionals, armed with local knowledge and community connections, play a pivotal role in improving mental health outcomes among underserved populations. Furthermore, the rise of telemental health, an increasingly crucial aspect of mental healthcare, presents new avenues for paraprofessionals to deliver psychological care. Despite their potential, paraprofessionals encounter challenges related to work‐life balance, boundary‐setting and the stigma attached to their roles. Their integration into healthcare systems requires clear roles and responsibilities, along with continuous support to ensure effective intervention and the well‐being of both providers and recipients. Further research and development are necessary to harness their full potential and meet the increasing demand for accessible mental health services.

Validation and Reliability Study of The Turkish Version of The Health Services Access Scale

Background/aim: The aim of this study is to establish the Turkish validity and reliability of the Healthcare Access Scale and to determine whether perceptions of healthcare access vary according to demographic variables. Materials and methods: Data for the research were collected through surveys of 468 participants across Turkey. Exploratory factor analysis and confirmatory factor analysis were conducted in the process of adapting the Healthcare Access Scale. In addition, t-tests and ANOVA tests were used to determine variations in access to healthcare according to demographic variables. The factors obtained from the exploratory factor analysis were confirmed by confirmatory factor analysis. The fit index values of the five-dimension health care access scale were found to be in the good fit range. Results: As a result of the difference analyses carried out, no significant differences were found in the perceptions of access to healthcare according to gender, age and educational level. However, various differences were observed between the groups in terms of the type of hospital services received, income level and frequency of hospital visits in the past year. In conclusion, this study makes a significant contribution to the literature by testing the appropriateness, validity and reliability of the Healthcare Access Scale. Conclusion: This study makes a significant contribution to the literature by testing the appropriateness, validity and reliability of the Healthcare Access Scale. Key words: Health Services, Health System, Validity and Reliability, Access to Health Services, Turkish Validity, Health

Access and use of sexual and reproductive health services among asylum-seeking and refugee women in high-income countries: A scoping review

Access and use of sexual and reproductive health services among asylum-seeking and refugee women in high-income countries: A scoping review

THE IMPACT OF TELEMEDICINE ON ACCESS TO PRIMARY CARE

The COVID-19 pandemic has driven the implementation of telemedicine as a solution for maintaining access to healthcare, transforming the primary care landscape in many parts of the world. In Brazil, telemedicine has established itself as an essential tool for overcoming geographical and social barriers, facilitating access to basic care for populations that traditionally faced difficulties in accessing health services. This study seeks to investigate the impact of telemedicine on access to primary care, analyzing its main challenges and opportunities in the context of post-pandemic primary care. This study seeks to analyze the impact of telemedicine on access to primary care, exploring the main challenges and opportunities that arise with this modality of care. It also aims to identify practices and policies that can strengthen the implementation of telemedicine in Primary Care, ensuring that remote care is effective, safe and inclusive. This is a literature review, based on a qualitative approach, using the Scielo, Google Scholar and PubMed databases. To refine the research, the health descriptors “telemedicine”, “primary care”, “COVID-19”, and “equity in access to health” were selected, with a time frame between 2021 and 2023. Through a literature review, the study explores recent data on telemedicine in primary care, focusing on the main opportunities it offers, such as improved access and efficiency of services, as well as the challenges, including limited technological infrastructure in poor regions, privacy and confidentiality issues, and the need for adequate training for health professionals. Telemedicine enables more agile care and coverage of a larger population, but still faces obstacles related to digital accessibility and maintaining quality and continuity of care, especially for vulnerable groups. Telemedicine has therefore proved to be a strategic tool for expanding access to primary care, offering a viable alternative for reducing gaps in primary care. However, in order to maximize its impact, it is essential to overcome the technological challenges, guarantee information security and train health professionals in this new type of care. The continued use of telemedicine in the post-pandemic context presents an opportunity to strengthen the Unified Health System (SUS) in Brazil, expanding the reach of primary care and promoting greater equity in access to health.

Integrating large language models in mental health practice: a qualitative descriptive study based on expert interviews

BackgroundProgress in developing artificial intelligence (AI) products represented by large language models (LLMs) such as OpenAI’s ChatGPT has sparked enthusiasm for their potential use in mental health practice. However, the perspectives on the integration of LLMs within mental health practice remain an underreported topic. Therefore, this study aimed to explore how mental health and AI experts conceptualize LLMs and perceive the use of integrating LLMs into mental health practice.MethodIn February–April 2024, online semi-structured interviews were conducted with 21 experts (12 psychiatrists, 7 mental health nurses, 2 researchers in medical artificial intelligence) from four provinces in China, using snowballing and purposive selection sampling. Respondents’ discussions about their perspectives and expectations of integrating LLMs in mental health were analyzed with conventional content analysis.ResultsFour themes and eleven sub-themes emerged from this study. Firstly, participants discussed the (1) practice and application reform brought by LLMs into mental health (fair access to mental health services, enhancement of patient participation, improvement in work efficiency and quality), and then analyzed the (2) technological-mental health gap (misleading information, lack of professional nuance and depth, user risk). Based on these points, they provided a range of (3) prerequisites for the integration of LLMs in mental health (training and competence, guidelines for use and management, patient engagement and transparency) and expressed their (4) expectations for future developments (reasonable allocation of workload, upgrades and revamps of LLMs).ConclusionThese findings provide valuable insights into integrating LLMs within mental health practice, offering critical guidance for institutions to effectively implement, manage, and optimize these tools, thereby enhancing the quality and accessibility of mental health services.

The Impact and Future of Teletherapy in Mental Health Support

Teletherapy, a digital form of mental health support, has become an essential aspect of psychological care, driven by technological advancements and evolving societal needs. This paper examines the evolution, benefits, and challenges of teletherapy, emphasizing its accessibility, especially for underserved populations. It highlights innovations such as artificial intelligence (AI) and secure messaging and discusses ethical considerations like confidentiality and informed consent. Despite limitations, such as technical barriers and reduced non-verbal communication, teletherapy is poised to grow, offering flexible, accessible mental health services. The future of teletherapy will likely see further integration with emerging technologies, potentially reshaping the landscape of mental health care. Keywords: Teletherapy, mental health support, digital therapy, online therapy, telehealth, accessibility.

Barriers to and enablers of the early diagnosis of breast cancer among women from ethnic minority backgrounds in the UK: protocol for a qualitative evidence synthesis

IntroductionBreast cancer is the most commonly diagnosed cancer in women of all ethnic groups in the UK. The largest single ethnic groups in the UK are white, Indian, Pakistani, black...

Protocol for an ambidirectional cohort study on long COVID and the healthcare needs, use and barriers to access health services in a large city in Southeast Brazil

IntroductionPost-COVID-19 condition, or syndrome, also known as long COVID, is an infection-associated chronic condition that can develop after a SARS-CoV-2 infection and last at least 3 months to years. Despite...

Unmasking population undercounts, health inequities, and health service access barriers across Indigenous populations in urban Ontario.

Our Health Counts (OHC) methods are designed to address gaps in urban-based Indigenous health information. In partnership with local Indigenous health service providers, we have successfully implemented OHC in six Ontario cities. The aim of this study is to summarize findings regarding Indigenous population undercount, health inequities, and health service access barriers across study sites. We estimated Indigenous population size using OHC census participation survey responses and a multiplier approach. Health inequities between Indigenous populations and overall populations in each city were examined using respondent-driven sampling (RDS), adjusted OHC survey results, and existing public data. Measures included health status outcomes; determinants of health; barriers to health service access, including discrimination by health service providers; and unmet health needs. Indigenous social networks were strong and extensive, and the urban populations demonstrate resilience and cultural continuity across multiple measures. Self-reported rates of census participation for Indigenous populations were markedly lower than those for the general population in each city, and OHC Indigenous population size estimates were consistently 2‒4 times higher than reported in the census. Indigenous to general population health inequities cut across measures of chronic disease, determinants of health, and unmet health needs. Indigenous populations experienced multiple barriers to health services access, including racial discrimination by health service providers. The Canadian census appears to markedly underestimate Indigenous population size in urban areas. Indigenous health inequities and service access barriers are striking and cross-cutting. Timely adaptation of health policies, services, and funding allocations in response to these findings is recommended.

Analysis of the Impact of Mileage, Service Costs, and Availability of Medical Personnel on Patient Satisfaction in Accessing Health Services in Disadvantaged Areas in Indonesia

This study examines the impact of distance travelled, cost of service, and availability of medical staff on patient satisfaction in accessing healthcare services in disadvantaged areas of Indonesia. Using a quantitative approach, data were collected from 50 respondents through a structured questionnaire, employing a Likert scale of 1-5. Multiple regression analysis was performed using SPSS version 26 to determine the relationships between the independent variables (distance travelled, cost of service, and availability of medical staff) and the dependent variable (patient satisfaction). The results indicate that distance travelled and cost of service have significant negative impacts on patient satisfaction, while the availability of medical staff positively influences satisfaction. These findings provide valuable insights for policymakers and healthcare providers in addressing the barriers to healthcare access in underserved regions of Indonesia and improving patient satisfaction.

Health literacy and COVID-19 pandemic impacts among adults in rural northern Arizona.

Limited health literacy - the ability to access, process, and use health information and services - contributes to persistent health inequities. Yet little is known about associations of limited health literacy with impacts from the COVID-19 pandemic, particularly for US adults in rural areas. This study sought to determine associations of limited health literacy with impacts from the COVID-19 pandemic among a diverse sample of adults in rural Northern Arizona. A cross-sectional, interviewer-administered survey was conducted with 119 adults from June 2020 to August 2021. Participants were recruited from two federally qualified health centers and by word of mouth. The Newest Vital Sign was used to measure health literacy, and the Epidemic-Pandemic Impacts Inventory was used to measure the effects of the COVID-19 pandemic on various aspects of personal and family life (eg spent more time on screens and devices, had family celebrations canceled or restricted). Descriptive, bivariate, and multivariable linear regression statistics were computed. Nineteen percent of participants had limited health literacy, and participants had an average of 22 individual impacts and 2 household impacts of the 92 COVID-19 impacts assessed. Multivariable regression model results showed that being male versus female or having public only versus any private insurance was significantly associated with fewer individual COVID-19 impacts on average. Being black, Indigenous, people of color versus White or being Hispanic, Latino, or Spanish versus not were each associated with significantly more individual COVID-19 impacts on average. Limited versus adequate health literacy was significantly associated with more household COVID-19 impacts on average. Sensitivity analysis results further showed that limited versus adequate health literacy was associated with significantly higher adjusted rates of household social, emotional, and infection COVID-19 impacts. This study's findings highlight the importance of assessing and accounting for health literacy in clinical practice and health services research addressing the impacts of the COVID-19 pandemic and future emergency events.

Gendered socio-economic and mental health effects of the COVID-19 pandemic among adults living in selected informal settlements in Kenya: an intersectional analysis

BackgroundCOVID-19 pandemic had devastating socio-economic and health effects, including mental health. This study examines the intersectionality between gender and mental health outcomes among Kenyan adults in informal settlements of Nairobi, Kisumu, and Kilifi Counties during the COVID-19 crisis. This is necessary to inform mental health response in case of another pandemic.MethodsWe analyzed data collected in a longitudinal survey between July 2020 (fourth round) and February 2021 (fifth round). The data covered COVID-19-related effects on job loss, food insecurity, access to health services, and mental health. Participants were randomly sampled from existing cohorts at the Population Council. The outcomes of interest were depressive and anxiety disorders, combined into a binary composite outcome variable. Descriptive statistics included means for continuous variables and frequencies and proportions for categorical variables. Chi-square tests were used to examine the differences between groups. The relationship between the gendered COVID-19 socio-economic effects and participants’ mental health was examined using modified Poisson regression.ResultsA total of 4,050 participants were interviewed, 66% female and median age 38 [interquartile range (IQR): 29–46]. Complete income loss was strongly associated with negative mental health outcomes in multiple intersections with varied magnitudes. The association was larger among older females (≥50 years) (PR = 1.33, 95% CI = 1.17–1.51, p < 0.001) than older males (PR = 1.22, 95% CI = 1.17–1.27, p < 0.001). Partial loss of income was protective against negative mental health outcomes among young males (18–29 years) (PR = 0.81, 95% CI = 0.76–0.87, p < 0.001) but linked to negative outcomes among middle-aged males (30–49 years old) (PR = 1.14, 95% CI = 1.12–1.16, p < 0.001). Skipping meals was associated with negative mental health outcomes for both genders particularly the married (married male: PR = 1.49, 95% CI = 1.22–1.83, p < 0.001; married female: PR = 1.42, 95% CI = 1.26–1.60, p < 0.001).ConclusionWe observed significant gender differences in the prevalence of depressive symptoms and anxiety disorders during the COVID-19 pandemic, underscoring the importance of socio-economic factors and health services access in shaping mental health outcomes. Interventions targeting pandemic-related mental health issues should be gender-sensitive and address economic vulnerabilities such as job losses and food insecurity. Policies to mitigate these effects, especially for at-risk groups are crucial for reducing mental health burden in future crises.

Protocol for a qualiquantitative study of accessibility of sexual and reproductive health services among women with motor disabilities in Morocco

Introduction Approximately 1.3 billion people worldwide live with a disability, underlining the need for equitable health care for this group is important. Inclusive health systems are consistent with global health priorities, respond to United Nations sustainable development goals and economically viable. Despite advancements in Morocco’s health system and legal framework, significant disparities remains inaccessing sexual and reproductive health (SRH) services for women with disabilities. This study explores barriers and facilitators affecting access to SRH services for these women, aiming to provide recommendations for more inclusive services and improved health outcomes. Methods Using a mixed approach, this study assessSRH access for women with motor disabilities in two cities in Morocco, selected for their socio-demographic, cultural and and healthcare diversity. Quantitative data will be generated through questionnaires administrered to 400 participants, while qualitative information will come from 20 to 30 interviews. Recruitment involves working with health professionals, NGOs and social media campaigns to ensure a diverse sample. Data analysis includes NVivo for qualitative data and descriptive/inferential statistics for quantitative data. Conclusion The study aims to explore the perspectives of women with disabilities and health professionals regarding SRH services. It will provide recommendations for making SRH services more equitable and inclusive, ultimately improving health out comes and uphold health rights for women with disabilities.

Documenting the availability and accessibility of reproductive health services for youth in Albania

Abstract Youth in Albania are initiating sexual activity at an earlier age. However, use of all forms of contraception has declined in the last decade and uptake now stands at 4%. The self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms has risen dramatically, as has reliance on abortion as a predominant method of family planning. In 2020-2022, we conducted a multi-method qualitative study in Albania to document the availability and accessibility of sexual and reproductive health (SRH) services and examine challenges that youth face when seeking SRH care. This study comprised a document review, a curriculum review, a community-based survey with 273 youth, semi-structured interviews with 15 youth, semi-structured interviews with 15 key informants, and a service mapping exercise in Tirana. Lack of adequate infrastructure and bureaucratic hurdles make it difficult for youth to navigate and access SRH services in Albania. A third of survey participants (n = 90, 33%) expressed discomfort inquiring about SRH matters, while nearly two-thirds rarely or never sought SRH services from a doctor or clinic. Furthermore, Albania’s school-based sexuality education curriculum lacks in topics, content, and responsiveness, resulting in inconsistent learning experiences and limited knowledge of SRH. Sexuality education is primarily focused on the anatomy and physiology of reproduction, leading to significant knowledge gaps in other aspects of SRH. Only half of survey participants (n = 150, 55%) had received any education on birth control, contraception, or family planning; and only few had knowledge about gender identity (n = 103, 38%), or consent (n = 77; 28%). Widespread lack of awareness and fear of judgment contribute to the underutilization of SRH services among youth in Albania. Improving knowledge and awareness, alongside investing in infrastructure and capacities, are essential to enhancing accessibility and quality of SRH services for Albanian youth. Key messages • Lack of knowledge and awareness prevent youth from accessing SRH services. • Establishing youth-friendly services and training health providers and educators are crucial to delivering confidential and non-judgmental youth-friendly SRH care.

Digital health divide in Indonesia: evidence from national-level data

Abstract Indonesia is a country in south-east Asia with a diverse population and context underlined by its geographical condition as an archipelagic country. Due to closer proximity to the capital, the Western regions (e.g., provinces in Sumatra and Java islands) are relatively more developed than the central and eastern parts of Indonesia (e.g., Nusa Tenggara, Sulawesi, and Papua). In the last few years, the country started to embrace digital transformation for public services including the health sector. Accelerated by the COVID-19 pandemic, a proliferation of digital health services through for example the use of telehealth and health apps is now considered important to improve access and availability of health services, especially among marginalized and hard-to-reach populations. Nonetheless, the difference in access to information and technology infrastructure and services as well as in the level of digital literacy across different regions in Indonesia may perpetuate the existing inequity in access to health services. In 2022, data from the Indonesian Central Bureau of Statistics showed that the level of internet access in Indonesia’s capital Jakarta has reached 85%, while the level in the eastern part of Indonesia (i.e., Papua) is only 26%. Similarly, the level of internet access in the Western provinces tend to be higher than their Eastern counterparts. Additionally, a survey performed by the Ministry of Communication and Informatics to assess the level of digital literacy in Indonesia shows that 85% out of 10,000 respondents accessed the internet through smartphones. However, almost all respondents encounter problems when accessing the internet, especially regarding network quality which causes unstable and frequent connections disconnected. In addition, the level of digital literacy varies across different regions, with the Western region performing better than other regions (e.g., digital literacy index of 3.64 in Yogyakarta vs 3.55 in Papua in 2022).

How can healthcare providers reduce the adverse effects of endometriosis on women’s life course?

Abstract Background Endometriosis is a chronic gynecological disease that affects about 10% of women of reproductive age. Its symptoms vary in severity and manifestation. Diagnosis is often delayed by an average of 10 years, which may significantly affect women’s lives. This study explores how endometriosis morbidity affects women’s relationships, intimacy, and employment over their lifetime. Methods An online survey was conducted in February 2024 among Jewish Israeli women aged 18 to 50. Out of the 573 women, 270 were diagnosed with endometriosis. The survey collected information on the women’s diagnostic status, pain severity, social support, negative interactions, life-course impact, and distance from the doctor’s clinic. Results Women with endometriosis experience a negative impact on their life course compared to women without the disease, particularly in relationships and intimacy (39.41 vs. 18.44, p<.001) and employment (19.39 vs. 19.11, p<.001). A multivariate regression model was used to predict the effect of endometriosis on the women’s life course and revealed that a negative impact on relationships and intimacy (R2=.385, n = 505) might be predicted by longer travel distance to the doctor’s clinic, higher reported pain level, less reported social support level, and higher reported negative interactions. Furthermore, a negative effect on employment (R2 = .270, n = 513) was predicted by a longer distance to the clinic, a higher reported pain level, less reported social support level, and higher reported negative interactions. Conclusions Enencing supportive environments and increasing accessibility to health services is vital to improving the negative impact of endometriosis on women’s lives. Key messages • Endometriosis treatment requires a multi-faceted approach, including supportive frameworks, reducing negative interactions, and addressing gaps in health service accessibility. • Awareness must be raised among employers regarding endometriosis, creating a supportive environment and making necessary adjustments for employees to openly communicate their needs and struggles.

11.P. Scientific session: Behavioural Science of Emergency Preparedness across Europe

Abstract The COVID-19 pandemic highlighted the critical role of human behaviour in times of crisis. However, it also revealed that the behavioural sciences were not optimally prepared to provide actionable insights to policy makers to support preventive and coping behaviours in a crisis context. To ensure that the behavioural sciences can provide timely and effective advice to policy makers during future emergencies, it is key to act before a crisis occurs. The current workshop chaired by the Behavioural and Cultural Insights Unit of the WHO, will offer five perspectives to explore how behavioural science as a discipline is being applied to our understanding of pandemic and emergency preparedness and what concrete actions can and are already being taken now. Following five short presentations, a discussion with the panel and the audience will take place. The Dutch National Institute of Public Health and the Environment (RIVM) will start by presenting their approach toward embedding behavioural science of pandemic preparedness: the organisation of a national stakeholder network, the development of a conceptual framework, and3) development of a quantitative survey monitor for individual level behaviour. monitoring pandemic preparedness. f The Spanish Carlos III Health Institute and Slovenian Public Health institute will present insights about operationalising this monitor in their given context. They will present results of the first two rounds of this monitor on behalf of the four European member states, focusing on comparative insights on perceptions and states of preparedness, vaccination, citizen wellbeing and resilience with respect to their context. Next, the Competence Centre on Behavioural Insights of the European Commission will present an experimental approach toward preparedness. They will present results based on a scenario study, focused on understanding behaviours in the broader context of pandemic and disaster preparedness. The last two presentations will reflect on qualitative approaches. The Behavioural and Cultural Insights Unit of the WHO will present their qualitative study on health-service access, needs and behaviours of Ukrainian refugees in neighbouring countries, and reflect on operating under emergency constraints. In the final presentation the RIVM will present their findings of qualitative methods to study perceived emergency readiness. In particular, their study focuses on what citizens understand by pandemic preparedness, and to what extent they perceive their government as prepared for a future pandemic. Overall, the workshop aims to equip participants with a comprehensive understanding of the importance of behavioural science in pandemic and disaster preparedness and inspire collaborative action towards building resilient and effective strategies for future crises. Key messages • The workshop underlines the importance of behavioural science in preventing and responding to infectious disease outbreaks. • Participants learn how behavioural sciences can already be applied now to prepare citizens and organisations for future pandemics and crises.

Healthcare accessibility of individuals at increased risk of STIs: a cross-sectional survey in Italy

Abstract Access to STI prevention and sexual health services in Italy, especially among vulnerable and marginalized groups, is inadequately documented. With the support of community organizations, a cross-sectional survey was conducted between September 2023 and March 2024 to assess health services accessibility among individuals at increased risk of STIs. A total of 1456 responses were analyzed. The respondents comprised 1327 (91.14%) cisgender men, 58 (3.98%) cisgender women, 11 (0.76%) transgender men, 10 (0.69%) transgender women, and 47 (3.23%) non-binary individuals. Overall, 93.8% were men who have sex with men, and 2.8% were women who have sex with women. Mean age was 38 (SD 12). Among respondents, 1284 (88.2%) had undergone HIV testing at least once [102 (7%) living with HIV; 45.1% diagnosed during prior year]. Overall, 563 (38.7%) had been diagnosed with at least one STI in the prior year. Chemsex was reported by 106 (7.3%), with 4.7%, 75.5%, and 35.5% using injective, inhaled or oral substances. Despite a high risk for STIs, 728 (50%) and 410 (28.2%) individuals, respectively, did not visit a specialist in infectious diseases or their primary care provider in the prior year. PrEP awareness was high: 1286 (88.2%) respondents were knowledgeable about it, but only 342 (23.5%) attended PrEP centers and 297 (20.4%) used it. Among PrEP users, 27 (7.9%) encountered difficulties obtaining the drug and 174 (50.9%) considered the cost prohibitive (before it became free). Additionally, 27 (7.9%) of those attending PrEP centers felt judged or disrespected. Overall, 1179 (80.9%) had heard of Mpox, and 1012 (69.5%) were aware of the vaccine, with 301 (20.6%) being vaccinated. Among those vaccinated, 18 (5.2%) felt judged or disrespected. Out of 55 (3.8%) individuals tested for Mpox, 13 (23.6%) tested positive, among which one reported feeling disrespected. The survey highlights critical gaps in healthcare access and awareness among individuals at increased risk of STIs in Italy. Key messages • In a final open-ended question, responders commented on various issues including high costs of services, insufficient provider training and the necessity for improved inclusion of LGBTQ+ individuals. • The robust response from typically hard-to-reach groups underscores the pivotal role of community involvement in enhancing awareness and accessibility of sexual health services, fostering inclusivity.

‘We do not include tests and treatment for those [STI] conditions’: the trouble in navigating access and care for STIs among gay, bisexual men and transgender and other MSM in Kenya and Rwanda

Abstract Background Lesbian, gay, bisexual men, and transgender persons (LGBT) in Kenya and Rwanda have a hard time accessing healthcare, in particular sexual health screening. We used a social norms and values framework to examine determinants of access to healthcare, with specific attention to sexual healthcare. Methods We draw on cross-sectional mixed methods research in Kenya and Rwanda that examined the lived experiences of sexual and gender minorities in access to health services. A cross-sectional quantitative survey in Rwanda (n = 499) and Kenya (n = 1,550) was conducted with LGBT people. We conducted key informant interviews (n = 81), in-depth interviews (n = 48), digital storytelling (n = 3), and focus group discussions (n = 30). We used a mixed-methods thematic and content analysis to integrate quantitative and qualitative findings. Findings Accessibility and quality of care were the main barriers to healthcare services. The results indicate widespread discrimination and stigma toward LGBT people in service provision. Approximately half of the survey participants, 47%, reported challenges accessing health services, and 25% indicated they experienced discrimination in healthcare. Qualitative results link low quality of care to stigma and discrimination. “Mostly at the hospitals, there are times people take too much time discussing who we are instead of giving us the treatment we seek, and send us to mental health to first deal with our sexuality issues since they think it is a ‘sickness.’” (Focus group, Muhanga, Rwanda). Our study highlights challenges in navigating sexual healthcare in government, faith-based, and donor-funded health facilities. Conclusions Access to healthcare services, particularly sexual health screening and prevention, is a growing issue for LGBT people in Kenya and Rwanda. Stigma acts as a significant barrier to high-quality healthcare. Sensitivity training and educational opportunities for healthcare professionals are urgently needed to address stigma.