BMJ public health最新文献

{"title":"COVID-19 and sexual assault: trends in US emergency department visits-a cross-sectional analysis.","authors":"Rose McKeon Olson, Bharti Khurana, Randall T Loder","doi":"10.1136/bmjph-2025-002722","DOIUrl":"10.1136/bmjph-2025-002722","url":null,"abstract":"<p><strong>Background: </strong>Sexual assault often increases during crises, yet trends in United States (US) emergency department (ED) visits for sexual assault during COVID-19 remain unclear.</p><p><strong>Objective: </strong>To examine demographic, incident and injury trends in US sexual assault presentations during early and late COVID-19 compared with pre-COVID-19.</p><p><strong>Methods: </strong>This study analysed National Electronic Injury Surveillance System All Injury Programme (2014-2021) retrospective data. ED visits for assault (n=246 499) and sexual assault (n=22 752) were compared across pre-COVID-19 (January 2014-March 2020), early COVID-19 (March 2020-January 2021) and late COVID-19 (February 2021-December 2021). Demographic and injury trends were analysed via t-tests, analysis of variance or χ² tests, with national trends assessed using Joinpoint regression and weighted data in SUDAAN.</p><p><strong>Results: </strong>From 2017 to 2021, while assault-related ED visits declined (-5.05% annually; p=0.003), sexual assault ED visits remained stable (-1.15% annually; p=0.57). During COVID-19, sexual assault cases decreased among 0-19 years (46.1% pre-COVID-19 to 37.3% late COVID-19) but increased among 20-34 years (36.0% to 40.3%) and 35-64 years (17.2% to 21.0%). From early to late COVID-19, cases increased among black (31.7% to 32.8%) and Hispanic (13.8% to 15.6%) populations but declined among white populations (49.5% to 47.7%). Assaults by parents (9.0% to 11.2%) and partners (10.9% to 13.5%) increased, as did poisoning-related (1.4% to 5.5%) and anoxia-related injuries (0.1% to 0.7%).</p><p><strong>Conclusions: </strong>Despite the pandemic, ED visits for sexual assault persisted, with demographic shifts and increased injury severity (eg, drug-facilitated violence, strangulation-related anoxia). These findings highlight the need for targeted interventions during public health crises.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002722"},"PeriodicalIF":0.0,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12443212/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145088676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correlates of unawareness of HIV status and recency of HIV infections among women living with HIV: findings from population-based surveys in 13 African countries.","authors":"Irene Mbabazi, Derrick Bary Abila, Richard Muhindo, Christine Sekaggya, Stella Zawedde-Muyanja","doi":"10.1136/bmjph-2024-002211","DOIUrl":"10.1136/bmjph-2024-002211","url":null,"abstract":"<p><strong>Background: </strong>Despite efforts to increase HIV testing availability, a substantial number of women living with HIV (WLHIV) remain unaware that they have HIV. We explored the demographic, socioeconomic and clinical characteristics associated with being unaware of HIV status among WLHIV.</p><p><strong>Methods: </strong>Secondary analysis of data from 13 population-based HIV impact assessment surveys. We used weighted χ² analysis and log-binomial regression to identify associations between awareness of living with HIV and various factors.</p><p><strong>Results: </strong>Among 27 983 WLHIV, 7459 (26.6%) were unaware that they were living with HIV. Women at the extremes of age; 15-24 years (adjusted prevalence ratio (aPR): 1.84; 95% CI 1.67 to 2.03, p value <0.01), those >60 years; and those living in rural areas (aPR: 1. 09; 95% CI 1.02 to 1.18, p value 0.02) were more likely to be unaware of that they were living with HIV. Of the 7459 women who were unaware that they were living with HIV, 7071 (94.8%) had long-term HIV infection. Factors associated with long-term HIV infection included: older age 35-44 years (aPR: 1.03; 95% CI 1.02 to 1.08, p value <0.01), 45-59 years (aPR: 1.05; 95% CI 1.01 to 1.09, p value 0.02) and having no sexual partner in the past 12 months (aPR: 1.04; 95% CI 1.00 to 1.09, p value 0.04).</p><p><strong>Conclusion: </strong>A high proportion of women who were unaware that they were living with HIV had long-term HIV infections. HIV testing interventions should be targeted towards these women to improve early access to HIV treatment.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002211"},"PeriodicalIF":0.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145077056","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of universal and targeted recommendations for vaccines for sexually transmitted infections in the USA, China and Indonesia: a cross-sectional study.","authors":"Maria Alexandra Santana-Garces, Abram L Wagner, Harapan Harapan, Yihan Lu","doi":"10.1136/bmjph-2024-001897","DOIUrl":"10.1136/bmjph-2024-001897","url":null,"abstract":"<p><strong>Background: </strong>Vaccines for sexually transmitted infections (STIs) are in development and little is known about their future acceptance. The type of recommendations released by National Immunisation Technical Advisory Groups could influence vaccine uptake. This study aims to understand how universal and targeted wording affects theoretical acceptance to vaccines for four common STIs (chlamydia, gonorrhoea, syphilis and genital herpes) in the USA, China and Indonesia. We also aim to understand how universal and targeted wording may influence acceptance among those who engage in high-risk sexual behaviours.</p><p><strong>Methods: </strong>A total of 1941 adults between the ages of 18 and 45 were included in the final sample. For each country, the sample was stratified by sexual behaviours, then the proportion of those who accepted each vaccine under universal or targeted wording was reported. χ² tests were used to assess differences, and the likelihood of vaccine acceptance was represented using prevalence ratios (PRs) from Poisson regression models.</p><p><strong>Results: </strong>Overall, vaccine acceptance for each STI and in every country sampled tended to be lower among those who received targeted wording compared with universal wording. Previous knowledge of STIs significantly affected vaccine acceptance. In the USA, there was significant interaction between recommendation wording type and having heard of the STI; individuals who had previously heard of STIs were more likely to accept an STI vaccine, and that this acceptance varied significantly based on whether they received a universal (PR: 1.30, 95% CI: 1.05 to 1.62) versus targeted recommendation (PR: 2.45, 95% CI: 1.69 to 3.56).</p><p><strong>Conclusions: </strong>Our results are important for future vaccine recommendations as vaccine hesitancy and refusal are on the rise globally. Thus, wording and education surrounding sexual health and STIs are factors that influence decision-making. Our research also highlights the importance of appealing to certain high-risk groups and providing informative language when releasing vaccine recommendations.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e001897"},"PeriodicalIF":0.0,"publicationDate":"2025-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12434757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testing the diagnostic expansion hypothesis with a population-based survey of attitudes to depression in Australia.","authors":"Nicola Reavley, Anthony Jorm, Stephen Carbone, Ellie Tsiamis, Amy Joanna Morgan","doi":"10.1136/bmjph-2025-003040","DOIUrl":"10.1136/bmjph-2025-003040","url":null,"abstract":"<p><strong>Introduction: </strong>There is growing concern about the increasing use of psychiatric terminology to describe behaviours and experiences that do not meet criteria for diagnosis of a mental illness. We aimed to conduct a nationally representative online cross-sectional survey exploring diagnostic labelling of vignettes describing a person with different levels of depression symptoms or risk and whether this was associated with mental health-related intended actions and psychological distress.</p><p><strong>Methods: </strong>Australian respondents (n=6142) were randomly assigned to read one of five vignettes describing a person in the following situations: (1) currently well (family history of depression), (2) currently well (own history of depression), (3) subthreshold depressive symptoms, (4) major depressive disorder (MDD) and (5) MDD with suicidal thoughts. They were asked what, if anything, was wrong with this person. Further questions covered intentions to seek professional help or take self-help actions; psychological distress and personal experience of depression.</p><p><strong>Results: </strong>Labelling non-clinical or subthreshold vignettes with diagnostic labels was relatively common, with a depression label applied by 19.8% [99% CI 16.6, 23.6], 31.3% [99% CI 27.4, 35.6], 47.7% [99% CI 43.4, 52.0], 68.6 [99% CI 64.5, 72.5] and 77.2 [99% CI 73.1, 80.7] of respondents to vignettes 1 to 5 respectively. Younger people were more likely to give a depression label. Across all vignettes, labelling was associated with a greater likelihood of intentions to speak to a health professional or take medication but not with psychological distress or reductions in effective self-help.</p><p><strong>Conclusions: </strong>Findings suggest that public messages should have a more nuanced approach, making it clear that, for some mental health difficulties, non-medical solutions may be more appropriate, while also taking care not to increase the proportion of people with more severe problems who meet diagnostic criteria but do not seek help.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e003040"},"PeriodicalIF":0.0,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421594/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Well-being among people with long and short COVID: a serial cross-sectional study in Victoria, Australia.","authors":"Aimée Altermatt, Anna L Wilkinson, Katherine Heath, Defeng Jin, Thi Nguyen, Alexander J Thomas, Tianhui Ke, Yanqin Zhang, Rebecca E Ryan, Lisa Gibbs, Alisa Pedrana, Dean Lusher, Stephanie Fletcher-Lartey, Mark Stoové, Katherine B Gibney, Margaret Hellard","doi":"10.1136/bmjph-2024-002062","DOIUrl":"10.1136/bmjph-2024-002062","url":null,"abstract":"<p><strong>Background: </strong>It is critical to disseminate all evidence on long COVID's impact on people's lives to inform policy and practice. We aimed to assess five measures of well-being, before and after SARS-CoV-2 infection between people with long COVID (defined as symptoms lasting more than 1 month) and people with short COVID (defined as symptoms resolving within 1 month).</p><p><strong>Methods: </strong>Participants from the Optimise Study, a longitudinal cohort study in Victoria, Australia (September 2020-August 2022), had self-reported history of SARS-CoV-2 infection and self-reported long COVID status. Serial cross-sectional analysis compared participants with long and short COVID on Personal Well-being Index, number of COVID-19-like symptoms experienced, number of days exercised and frequency of experiencing positive and negative emotions.</p><p><strong>Results: </strong>217 participants were included, aged 20-86 years (median age 43, IQR: 31-57), 75% women. Compared with those with short COVID, participants with long COVID had lower well-being before (mean difference (MD)=-8.3, 95% CI (-14.7, -2.0), p-adjusted=0.07), during (MD=-10.3, 95% CI (-16.5, -4.0), p-adjusted=0.03) and after (MD=-9.91, 95% CI (-16.71, -3.11), p-adjusted=0.05) infection and experienced more COVID-19-like symptoms during infection (MD=1.72 (0.72, 2.72), p-adjusted=0.03). In December 2022, 71% (40/56) reported difficulty performing tasks in the past 4 weeks.</p><p><strong>Conclusion: </strong>On average, we observed lower well-being among participants with long COVID, including before SARS-CoV-2 infection, suggesting an underlying difference in well-being between groups. Long COVID continued to impact physical functioning, but ongoing changes were not detected by personal well-being scales.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002062"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Missed opportunities for vaccination among healthcare-seeking children: a cross-sectional study in Bishkek, Kyrgyzstan, 2023.","authors":"Gulzada Dadanova, Roberta Horth, Aisuluu Kubatova, Gulbara Ishenapysova, Dinagul Otorbaeva, Dilyara Nabirova","doi":"10.1136/bmjph-2025-002652","DOIUrl":"10.1136/bmjph-2025-002652","url":null,"abstract":"<p><strong>Background: </strong>High vaccination coverage is critical for preventing disease transmission. In Bishkek (population: 1.15 million), childhood vaccination coverage was <90% in 2022. Understanding missed opportunities for vaccination (MOV) at healthcare visits was needed to increase coverage.</p><p><strong>Methods: </strong>Using the World Health Organization MOV assessment guide, we selected 33 primary care clinics in Bishkek. We conducted sequential exit interviews with caregivers of children aged <30 months who received healthcare for any reason. Caregiver's attitude towards vaccines was measured by asking if it was good, neutral or negative. We extracted vaccine records from the facility's medical records. MOV was calculated as the proportion of children who were not up to date on all their vaccines by the end of the visit, among those eligible for at least one vaccine at the start of the visit. We used multivariable Poisson regression to assess characteristics associated with MOV.</p><p><strong>Results: </strong>Of 650 participating children, 448 (69%) were eligible for vaccination. Among whom, 86% had a MOV after their visit and 6% had never been vaccinated. MOV prevalence was 81% for children aged 0-11 months (n=240) and 92% for those aged 12-30 months (n=208), ranging from 79% to 93% across the four districts. Providers did not check the immunisation status of 53% of children. Among 133 children whose primary visit purpose was vaccination, 53% were still not up to date on all their vaccines by the end of the visit. MOV risk was higher among children whose vaccination status was not checked by the provider compared with those who were checked (adjusted prevalence ratio (aPR) 1.13, 95% CI 1.05 to 1.22) and children whose caregivers had negative (aPR 1.10, 95% CI 1.03 to 1.18) or neutral attitudes (aPR 1.11, 95% CI 1.03 to 1.19) vs positive attitudes.</p><p><strong>Conclusion: </strong>Nearly nine in 10 children missed a vaccination opportunity during their healthcare visit. Strategies for checking immunisation status at each visit and addressing caregiver and healthcare barriers may help increase immunisation coverage.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002652"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is why we drink alcohol important when considering the potential public health benefit of alcohol-free and low-alcohol drinks? A cross-sectional study investigating associations between alcohol drinking motives and alcohol-free and low-alcohol drink consumption among adults in Great Britain.","authors":"Lucy C Burke, Colin Angus, Jamie Brown, Inge Kersbergen","doi":"10.1136/bmjph-2025-002828","DOIUrl":"10.1136/bmjph-2025-002828","url":null,"abstract":"<p><strong>Introduction: </strong>The UK has promoted increased availability of alcohol-free and low-alcohol drinks (no/lo, ≤1.2% alcohol by volume) as a public health strategy. To be effective, no/lo beverages must replace, and not supplement, standard alcoholic drinks. Emerging evidence suggests that the reasons people drink alcohol may be an important determinant of the potential public health impact of these drinks. This study aimed to determine whether alcohol drinking motives were associated with no/lo consumption after accounting for sociodemographic characteristics and alcohol consumption.</p><p><strong>Methods: </strong>A cross-sectional sample of adults residing in Great Britain (aged 16-93) who had drunk alcohol in the past year were recruited via the Alcohol Toolkit Study (N=2555; 49.0% female). The dependent variable was frequency of no/lo consumption (less than vs at least monthly). Five questions captured respondents' alcohol drinking motives (enhancement, social, conformity, coping-anxiety, and coping-depression), derived from the Drinking Motives Questionnaire-Revised. Sociodemographic characteristics, including age, gender, social grade, education, Index of Multiple Deprivation (a UK-wide measure of relative deprivation for small geographic areas), and hazardous alcohol use (Alcohol Use Disorder Identification Test), were also assessed. Descriptive analysis presents the proportion of respondents drinking no/lo at least monthly among low endorsement (ie, drinking for a motive less than half the time) versus high endorsement (ie, drinking for a motive at least half the time) of each drinking motive. Quasibinomial regression modelling explored relationships between alcohol drinking motives and no/lo consumption, accounting for sociodemographic characteristics and hazardous drinking.</p><p><strong>Results: </strong>Drinking alcohol to conform was associated with an increased likelihood of at least monthly no/lo consumption after accounting for sociodemographic characteristics and hazardous drinking (OR 1.10, 95% CI 1.00 to 1.21, p=0.041).</p><p><strong>Conclusions: </strong>No/lo drinks may facilitate reduced alcohol consumption by offering an alternative for individuals wishing to participate in alcogenic environments. However, those who drink alcohol to conform are not typically higher-risk drinkers, which may limit the public health benefit of no/lo drinks. Further research is needed to explicitly explore substitution effects.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002828"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421153/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiological trends and economic burden of genital warts in Dutch primary care.","authors":"Clazinus Veijer, Julia Maria Bes, Christiaan Dolk, Maarten Jacobus Postma, Lisa Aniek de Jong","doi":"10.1136/bmjph-2024-002057","DOIUrl":"10.1136/bmjph-2024-002057","url":null,"abstract":"<p><strong>Background: </strong>This study aims to describe the epidemiological trends and estimate the economic burden of genital warts (GW) in Dutch primary care.</p><p><strong>Methods: </strong>A retrospective, non-interventional, multiyear study (2011-2021) was performed using data from the Nivel Primary Care Database. Changes in incidence by age group, sex and level of urbanisation of individuals with GW and associated healthcare resource use (general practitioner consultations, prescribed medication and referrals) were estimated over the 11-year period. Total annual healthcare costs and cost per incident case were estimated via a bottom-up gross costing approach.</p><p><strong>Results: </strong>Between 2011 and 2021, GW incidence increased, which was especially seen in men (from 2.0 to 3.5 per 1000 inhabitants) and to a lesser extent in women (from 1.9 to 2.1 per 1000 inhabitants). GW incidence was most common in age group 20-29 years (men: 43.6%; women: 50.7%) and highly urbanised areas. Medication was prescribed in 61.4% of GW cases, and 5.4% of patients with GW were referred to secondary care. Total costs in Dutch primary care increased by 108% from €2.3 million in 2011 to €4.9 million in 2021. The cost per incident case also showed an increasing trend from €72 in 2011 to €99 in 2021. Referrals to secondary care resulted in a 14%-30% increase in total costs.</p><p><strong>Conclusions: </strong>This study provides novel insights into recent epidemiological trends of GW and its associated costs in Dutch primary care. The incidence of GW increased particularly among men, and the total annual costs of GW in primary care doubled between 2011 and 2021.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002057"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in mental health care utilisation before and during the COVID-19 pandemic among people living with HIV in the USA: a retrospective cohort study using the All of Us dataset.","authors":"Atena Pasha, Shan Qiao, Jiajia Zhang, Ruilie Cai, Buwei He, Xueying Yang, Chen Liang, Sharon Weissman, Xiaoming Li","doi":"10.1136/bmjph-2024-002173","DOIUrl":"10.1136/bmjph-2024-002173","url":null,"abstract":"<p><strong>Introduction: </strong>Despite the profound impact of the COVID-19 pandemic on people living with HIV (PLWH) mental health, large-scale, real-world data on mental healthcare utilisation and associated factors among PLWH remain limited. This study explores mental healthcare utilisation and associated factors among PLWH during the COVID-19 pandemic.</p><p><strong>Methods: </strong>Using a retrospective cohort design, we identified and included 4575 PLWH through computational phenotyping based on relevant Observational Medical Outcomes Partnership Common Data Model concept sets from the All of Us programme between March 2018 and March 2022. Mental healthcare utilisation was measured using the yearly count of mental healthcare visits and compared between pre-pandemic (2018-2020) and during the pandemic (2020-2022). Incidence rate ratios (IRRs) from the Poisson generalised linear mixed models were used to examine associations between mental healthcare utilisation, history of COVID-19 infection, demographic factors, pre-existing chronic conditions and socioeconomic status.</p><p><strong>Results: </strong>Annual number of mental healthcare visits among PLWH decreased significantly during the pandemic compared with pre-pandemic (IRR=0.89, p<0.001). COVID-19 infection (IRR=1.35, p<0.001), pre-existing comorbidities (one comorbidity: IRR=5.49; two or more: IRR=10.4, p<0.001) and Medicaid health insurance (IRR=1.29, p=0.007) were associated with a higher number of visits. Middle-aged group participants (aged 30-39: IRR=2.35, p=0.002; 40-49: IRR=3.49, p<0.001 and 50-64: IRR=2.07, p=0.004) had higher visit numbers compared with the youngest group (18-29 years). Compared with white participants, black or African American (IRR=0.71, p=0.002) and those with employer-sponsored or union-sponsored insurance (IRR=0.54, p<0.001) had fewer visits.</p><p><strong>Conclusion: </strong>This study reveals a decrease in mental healthcare utilisation and diverse experiences of mental healthcare among PLWH during the COVID-19 pandemic. Addressing these disparities is crucial, particularly during public health emergencies.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002173"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421162/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042815","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health facility and contextual correlates of HIV test positivity: a multilevel model of routine programmatic data from Malawi.","authors":"Miyu Niwa, Dylan Green, Tyler Smith, Brandon Klyn, Yohane Kamgwira, Sara Allinder, Deborah Hoege, Suzike Likumbo, Charles B Holmes, Gift Kawalazira, Linley Chewere","doi":"10.1136/bmjph-2025-002568","DOIUrl":"10.1136/bmjph-2025-002568","url":null,"abstract":"<p><strong>Background: </strong>Innovative and efficient methods are needed to identify remaining people living with HIV unaware of their status. Routine health information system (RHIS) data, widely available in high-burden HIV settings, may help target areas of high risk to deliver timely prevention services. Often underused, RHIS data were leveraged at the facility level to predict changes in HIV test positivity in Malawi.</p><p><strong>Methods: </strong>From District Health Information Software-2 from January 2017 to March 2023, we analysed sexually transmitted infection (STI) cases and HIV tests and test results across 563 health facilities in Malawi. A multilevel model was employed to determine whether changes in STI diagnoses were predictive of changes in HIV test positivity. We considered STI types and their incubation periods, and controlled for facility type, ownership, quarter, season, zonal HIV and STI prevalence (2016 Population-Based HIV Impact Assessment).</p><p><strong>Results: </strong>Among 139 million HIV tests, overall positivity was 2.8%. Blantyre facilities had the highest positivity (6.0%) while those in the central-east zone had the lowest (1.8%). Key variables-changes in syndromic STI counts (lagged and cross-sectional)-showed weak or no associations with HIV positivity (OR: 1.01, CI: 1.01 to 1.01; OR: 1.00, CI: 1.00 to 1.00). However, contextual covariates, including zonal HIV prevalence (OR: 1.04, CI: 1.04 to 1.04), genital ulcers (OR: 1.16, CI: 1.16 to 1.16) and clinical STI diagnoses (OR: 1.29, CI: 1.29 to 1.29), were positively associated with HIV positivity.</p><p><strong>Conclusions: </strong>In settings with high STI screening uptake, RHIS data can be used to monitor changes in STI diagnoses and contextual factors to identify HIV hotspots and guide targeted testing, prevention and treatment services.</p>","PeriodicalId":101362,"journal":{"name":"BMJ public health","volume":"3 2","pages":"e002568"},"PeriodicalIF":0.0,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145042879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}