Adolescents living with HIV (ALHIV) face barriers to accessing sexual and reproductive health (SRH) services, negatively affecting their health and quality of life. These challenges are particularly pronounced in sub-Saharan Africa (SSA), where HIV prevalence, unintended pregnancies and child marriage remain high. This review aimed to map interventions designed to improve SRH access for ALHIV in SSA, applying Levesque’s framework to identify facilitators and barriers from supply-side and demand-side perspectives.

Review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR).

PubMed, EMBASE and Web of Science were searched, alongside institutional grey literature, for English and French language studies published between 2010 and 2024.

Studies were included if they focused on ALHIV aged 10–19 years in SSA, regardless of HIV acquisition mode and used experimental, quasi-experimental, qualitative or observational designs.

Two independent reviewers screened studies in Covidence, extracted data on study design, population, intervention components and delivery settings and mapped barriers and facilitators using Levesque’s framework. Findings were synthesised narratively.

of 6835 records screened, 14 studies met inclusion criteria. Interventions ranged from comprehensive strategies addressing financial, infrastructural and psychological barriers to targeted approaches like education and stigma reduction, implemented across schools, clinics, communities and digital platforms. Most studies emphasised service acceptability, with 13 of 14 highlighting cultural relevance, while approachability, physical accessibility and affordability received less attention. Key barriers included fear of HIV disclosure and stigma, whereas facilitators, including peer support, community outreach and digital platforms, enhanced engagement, trust and comfort with SRH services.

Improving access to SRH services for ALHIV in SSA requires adolescent-friendly, integrated, context-specific interventions that combine stigma reduction, peer and community engagement, digital innovations and financial support to overcome barriers and improve SRH outcomes.

Open Science Framework (https://doi.org/10.17605/OSF.IO/7PBEW).

Pharmaceutical manufacturers routinely launch high-cost, specialty medicines, including biologics and biosimilars, with an accompanying patient support program (PSP). PSPs offer patients financial support, case management and clinical services to facilitate access to the promoted medicine. Because these programs are proprietary, there is little publicly available information, thus, this study aimed to generate in-depth understandings of the patient, health system and policy-level implications of relying on manufacturer PSPs for affordable access to high-cost medicines.

Qualitative, critical ethnographic study conducted from November 2023 to April 2025. We conducted an interpretive, thematic analysis, triangulating fieldnotes (40 hours observations at public events), semistructured in-depth interview transcripts (n=48 interviews with 52 participants) and documents (ie, policies, media, reports).

This study examined direct experiences with manufacturer PSPs across Canada. PSPs have proliferated in Canada as the universal public health insurance scheme does not cover outpatient prescription drugs or infusion services.

A purposive sample of 52 participants with direct experience of pharmaceutical industry PSPs, including patients prescribed specialty medicines, clinicians, pharmaceutical industry and PSP provider employees, payers and policymakers.

Manufacturer PSPs are the default pathway for people to afford and access high-cost specialty and biologic prescription medicines in Canada. Though they are the only care pathway available, participants experienced support as variably helpful, stressful and superfluous; variable over time and across patients’ experiences; and available at the discretion of the PSP. Across participants, four core themes were identified: (1) patients are required to engage with PSPs in exchange for access; (2) outsourcing supports for access to medicines gives rise to a parallel, private health system, generating additional health system complexity; (3) programs are inherently designed for physicians, thus adoption is prioritised over access; and (4) this results in calculated policy trade-offs and health system and patient risks when depending on manufacturer PSPs for affordable access to medicines.

Patients and health systems are precariously dependent on manufacturers to afford and access high-cost, specialty medicines. As a parallel, private care system, there remains little transparency nor patient accountability, with access at the discretion of manufacturers through physician intermediaries. Thus, reliance on pharmaceutical industry resources for affordable access to medicines may incur greater costs for patients and health systems in the longer term. Policymakers need to consider how to design patient-centred, equitable, accountable systems that ensure affordable access to important medicines.

In kidney transplantation, immunosuppressive therapy is essential to control alloimmune reactions, prevent graft rejection and improve patient survival rates. However, commonly used drugs like tacrolimus (TAC) and mycophenolate mofetil (MMF) have a narrow therapeutic window and exhibit significant inter- and intra-individual variability in pharmacokinetics (PK) and dose-response relationships. Recent pilot studies suggest that the gut microbiome may influence this variability.

ElucidatiNg Immunosuppressant pharmacokinetic variabilities by investigating Gut Microbiome modulations After kidney transplantation (ENIGMA) is a prospective, low-interventional, naturalistic longitudinal trial designed to identify biomarkers of TAC and MMF PK variability by examining gut microbiome changes and modulations after kidney transplantation and their link with TAC and MMF PK. Biological samples from 50 patients will be collected at nine specific timepoints pre- and post-transplantation using a rich PK and biological sampling strategy. This approach will enable the derivation of PK parameters for the investigated drugs and the creation of a biobank for future hypothesis testing.

The ENIGMA trial has received ethical approval from the European Medicines Agency (EMA). The reference number of our project is R&D/1325226 and is registered on the Clinical Trial Information System (CTIS) platform with European Union Clinical Trial number 2023–5 08 335-31-00. Results of the trial will be published in scientific journals and presented at different (inter)national conferences.

2023–5 08 335-31-00 EMA.

Polygenic risk scores are increasingly available to consumers to provide an estimate of the genetic contribution to health conditions. However, healthcare providers report limited knowledge and confidence using polygenic risk scores. Clinical implementation necessitates educational programmes to support clinicians to integrate this new test into practice. This study aimed to identify healthcare providers’ learning needs and preferences for polygenic risk education to inform the design of tailored education initiatives.

This pragmatic qualitative study used focus groups to capture healthcare providers’ perspectives. To ensure informed responses, genetic healthcare providers with prior experience using polygenic risk scores, and/or who had completed polygenic risk education were recruited to participate in focus groups or interviews (n=30). There were no exclusions based on country of practice. Recordings were transcribed and content analysis conducted to identify learning needs. Themes related to education engagement were mapped to the capability, opportunity and motivation model for behaviour change.

Among this cohort of experienced providers, residual gaps existed in polygenic risk-related knowledge, skills and local guidelines to inform practice. Learning needs encompassed: (i) polygenic risk-specific knowledge, and (ii) communication skills needed to discuss results and facilitate risk management. Themes related to engaging with polygenic risk education mapped to capability included awareness of, and access to educational resources and initiatives, including practice resources and position statements from professional bodies. Time-poorness was a primary barrier to accessing education. Opportunities comprised of building on existing workplace training and activities such as multidisciplinary team meetings and journal clubs. All participants noted that motivation for completing polygenic risk training was primarily driven by a desire to improve patient-centred care and clinical outcomes.

This study highlights priority learning areas to inform the development of tailored polygenic risk education initiatives, and resources and delivery strategies that meet the identified needs. Participants’ expert insights reveal potential barriers as well as solutions to engaging healthcare providers with polygenic risk score education to ultimately facilitate implementation into clinical practice.