Improving HIV prevention among heterosexual men seeking sexually transmitted infection services in Malawi: Protocol for a Type I effectiveness-implementation hybrid randomized controlled trial of systems navigator–delivered integrated prevention package (HPTN 112-NJIRA Study)

Background: Preexposure prophylaxis (PrEP) remains one of the most efficacious interventions for preventing HIV, but its effectiveness is often limited by poor persistence. Although regional efforts have primarily focused on young women and men who have sex with men, heterosexual men in East and Southern Africa represent a crucial group to engage and retain in PrEP care—both to improve health outcomes for men and to interrupt HIV transmission chains. Men seeking sexually transmitted infection (STI) services are particularly vulnerable to HIV acquisition, yet only a few interventions have tested strategies for engaging and retaining these men in PrEP services. Systems navigation, which addresses barriers to health care access and enhances comfort in clinical settings, may offer a promising approach to improving persistent PrEP use among heterosexual men. Objective: This study will assess the effect of a peer-delivered systems navigator–facilitated HIV prevention package on PrEP persistence at 26 weeks among heterosexual men seeking STI clinical services in Lilongwe, Malawi. It will also evaluate the acceptability of the intervention and barriers to implementation among key stakeholders. Insights will inform the feasibility of a future randomized controlled trial. Methods: In this single-site pilot type I effectiveness-implementation hybrid randomized controlled trial, 200 heterosexual men seeking STI services and initiated on PrEP in Lilongwe, Malawi, will be randomized (1:2) to standard-of-care PrEP services or systems navigator–assisted PrEP care (intervention). Participants will be followed every 13 weeks for at least 26 and up to 52 weeks. PrEP use and engagement in care will be assessed through medical record review and intraerythrocytic tenofovir diphosphate measurement, using objective biomedical analyses via dried blood spot. Primary effectiveness and implementation outcomes include 26-week PrEP persistence (adapted to accommodate daily oral, event-driven oral, or injectable PrEP) and acceptability, respectively. Additional implementation outcomes include feasibility and cost. Exploratory objectives characterize preferences for PrEP modalities, perceived and experienced stigma, and the influence of gender norms on PrEP persistence. All clinical services, including the provision of PrEP and PrEP safety monitoring, are being conducted by the Malawi Ministry of Health. Results: HPTN (HIV Prevention Trials Network) 112 was funded in November 2023. Study recruitment began in April 2024 and closed in November 2024. As of February 3, 2025, the study has enrolled 199 participants, with follow-up expected through June 2025. No interim analyses were planned; data analysis for primary end points is expected in the summer of 2025. Conclusions: Improving PrEP use outcomes among heterosexual men in East and Southern Africa is critical to interrupting HIV transmission. This study offers unique insights into a low-resource, potentially scalable intervention, focusing on a group of men at particularly high risk of HIV acquisition—those with recent STIs. The hybrid RCT design addresses clinically relevant effectiveness questions and explores key determinants that will inform future multisite implementation trials

Optimized intranasal delivery of segesterone acetate progestin to the brain using nanoemulsions and microemulsions

Segesterone acetate (SA) is a selective and potent progesterone receptor agonist with potential application in the treatment of neurological diseases, such as multiple sclerosis and stroke. In this study, a microemulsion (ME) and three nanoemulsions (NEs) with a target SA concentration of 0.48 mg/g were developed for intranasal administration and extensively characterized regarding their physicochemical properties, stability, antimicrobial activity, and safety (in primary cortical cells, Hen’s Egg Test, MucilAir™ model and in rats). Plasma and brain SA levels were measured 30 and 60 min after intranasal administration in male rats. The ME and the different NEs exhibited a droplet mean diameter of approximately 20 nm and 100 nm, respectively, with a low polydispersity index (≤ 0.1). Depending on their composition, they had neutral, positive, or negative zeta potentials and varying viscosities. The NEs exhibited good chemical and physical stability for 150–180 days at 4 °C, while the ME required a reduction in initial SA concentration to avoid drug precipitation. The NEs also demonstrated antimicrobial activity, although not ensuring effective antimicrobial preservation. The ME was the least cytotoxic of the formulations in vitro. No significant impairment of olfactory function or histopathological evidence of toxicity was observed in rats following single or repeated administrations of the ME and neutral NE at doses up to 40 µg/kg of SA. After a single intranasal administration of 40 µg/kg, SA brain concentrations exceeded 4 ng/g at 30 min, with no significant differences observed among the different formulation strategies. Notably, the ME led to a higher brain-to-plasma ratio (~ 7) at 30 min and thereby is a promising strategy to increase brain targeting

What about well-being? Measuring what we really care about in sexual and reproductive health

The well-being of individuals and communities is increasingly recognized as a core objective of economic and global development policies and programs. However, existing measures of well-being neglect sexual and reproductive experiences, which are core dimensions of people\u27s lives. While there has been increasing attention to the concept of sexual well-being, measures of sexual and reproductive health are predominantly deficit-based and ignore whether people are having positive experiences. To consider the development of a measure of sexual and reproductive well-being, a multidisciplinary and geographically diverse group of experts was convened. Outcomes of this meeting included endorsement of a draft definition of sexual and reproductive well-being, demonstrated enthusiasm and commitment to the development of a measure capturing this construct, and delineation of core considerations in the measure development process. These included considering the diversity of normative and political contexts around sexuality and reproduction, and the critical nature of meaningful community engagement when developing this measure. A pathway for measuring development was defined, with the goal of creating a concise measure assessing people\u27s holistic experiences of sexuality and reproduction that can draw attention to and monitor the extent to which people are having the sexual and reproductive lives they wish to have

Communities started the end of the HIV epidemic: Experiences with and recommendations for conducting community-engaged HIV implementation research

Communities of people living with or impacted by HIV have been at the forefront of HIV research, from identifying the health priorities to advocating for the development and implementation of interventions that benefit affected populations and individuals. Community engagement is considered fundamental for successful implementation of science projects. However, researchers have acknowledged the limited guidance on community engagement for implementation science research. Some recommendations have been made for community engagement in implementation sciences, but conducting HIV implementation research must consider the unique challenges of addressing the stigma and disenfranchisement of the populations affected. Despite the specific difficulties for community-engaged implementation science research, there are successful experiences and lessons learned that could support future fruitful experiences. This publication aims to share recommendations for community-engaged HIV implementation research based on the expertise of community–academic partnerships. These recommendations include the perspectives of academic and community partners. Community engagement in HIV implementation research will be needed beyond ending the epidemic. The future of community engagement in research may lay in embracing the constant change and securing the mechanisms to respond to it

Building a rights-based approach to nutrition for women and children: Harnessing the potential of women’s groups and rights-based organizations in South Asia

Women face numerous gender-based barriers that hinder their access to resources, nutritious foods, nutrition services, and maternity entitlements. Evidence shows that certain types of women’s groups can improve women’s access to resources and social capital and in some approaches also improve health and nutrition outcomes. Women’s rights-based organizations in South Asia have a longstanding tradition of collective action toward gender equality. Women’s rights-based organizations work in areas such as microfinance, livelihoods, women’s rights, health, and combating violence against women. In this perspective article, we explore how women’s groups and rights-based organizations can leverage their collective strength to advance nutrition outcomes for women and children. We identify seven pathways implemented through women’s groups toward improving nutrition outcomes. These pathways include (i) income generation, (ii) agriculture, (iii) health and nutrition behavior change communication and participatory learning and action, (iv) advocating for rights to better health and social services, (v) food access, (vi) cash transfers, and (vii) strengthening service delivery and fostering convergence with health systems. We also note that women’s groups have the potential to implement integrated interventions through combined food-systems-rights pathways. Investing in this area can support transforming nutrition policy from a service delivery model to a rights-based approach

Developing and validating measures of unintended pregnancy and reasons for contraceptive non-use

This was a prospective cohort study involving follow-up with women to monitor their reproductive outcomes and adoption and continuation of contraceptive use over 18 months in Homa Bay County, Kenya

Reproductive health education in Ghana: Perspectives of School Health Education Programme (SHEP) Coordinators

Schools in Ghana have integrated reproductive health education (RHE) topics into their curricula and School Health Education Programme (SHEP) Coordinators recognize the importance of RHE. However, for RHE to reach its full potential, it needs to be established as a stand-alone subject. This study highlights the challenges and opportunities in delivering in-school RHE, underscoring the interplay between policy frameworks, implementation strategies, and locally accepted approaches

Trends in the utilisation of maternal and child healthcare services from the public and private health sectors in India, 2005–2021: An analysis of cross-sectional survey data

Objectives: To estimate the levels and trends of maternal and child healthcare (MCH) service utilisation in India across subsidised and unsubsidised health sectors and to explore total market approach to identify geographies where the private sector has potential to improve MCH services in India. Design and setting: This study used three recent rounds of the National Family Health Survey (NFHS), a cross-sectional survey in India, conducted in 2005–2006, 2015–2016 and 2019–2021. Bivariate analysis and multinomial logistic regression were used to estimate the utilisation of key MCH indicators from subsidised and unsubsidised health sectors. Market sustainability of key MCH indicators was assessed by level of MCH services and subsidisation. Participants: 36 850, 190 898 and 176 843 ever-married women aged 15–49 years, 4440, 22 500 and 15 334 children under 5 years of age with diarrhoea before the survey, and 2552, 6960 and 6117 children with symptoms of acute respiratory infections (ARI) in NFHS 2005–2006, 2015–2016 and 2019–2021, respectively. Outcome measures: The study used three maternal healthcare indicators: women had four or more antenatal care (ANC) visits, had institutional delivery, and received postnatal care (PNC); and two child healthcare indicators: care seeking for ARI and diarrhoea. Results: In India, utilisation of maternal healthcare services increased over the last 15 years: four or more ANC visits increased from 37% to 58% and PNC of mothers increased from 33% to 78% between 2005–2006 and 2019–2021. The results of the multivariate analysis showed that utilisation of ANC (67% from public vs 18% from private health facilities), institutional delivery (64% from public vs 25% from private health facilities) and PNC (73% from public vs 27% from private health facilities) was significantly higher (pConclusions: A targeted approach is needed to enhance the competitiveness of private sectors, especially in maternity care markets, to ensure the sustainability of healthcare services in India. Strengthening both the private and public sectors is crucial, with a focus on improving care quality and addressing regional disparities in access to maternal and child health services

Sexual and Reproductive Health and Rights (SRHR) in climate policies and frameworks

The integration of SRHR—a cornerstone of women and girls’ empowerment—and human rights, has been recognised by the Intergovernmental Panel on Climate Change (IPCC), among others, as a fundamental pathway to climate resilient development and as an important multi-sectoral approach to climate adaptation and resilience building for individuals and communities. This document compiles several country experiences of integrating SRHR into climate policies and frameworks, thus responding to the urgent need to understand the experiences of countries that have made progress, ensure scaling up and accountability regarding these important commitments to improve the lives of women and girls in the face of climate change

Pathways to prosperity for adolescent girls in Kenya

The World Bank, in partnership with the Population Council, and the Center for Global Development (CGD), launched the Pathways to Prosperity for Adolescent Girls in Africa report in October 2024. The joint report brings urgently needed focus to the challenges faced by adolescent girls across the region and presents targeted policy solutions to address their diverse experiences and needs. The report findings were discussed in Nairobi, Kenya during a policy and evidence workshop held on March 3, 2025. The workshop shone a spotlight on the status and wellbeing of adolescent girls in Kenya and enabled stakeholders to share insights and priority actions that will set adolescent girls on the path to prosperity, positioning them as key drivers of Kenya and Africa\u27s future. The workshop brought together over 100 participants, including representatives of government ministries and county departments serving adolescents, multi-lateral agencies, youth representatives, and international, national and grassroots organizations focused on adolescents. Key indicators on adolescent girls in Kenya are included in this country brief and the related presentation