"Live streaming comprehensive sexuality education (CSE) to rural schools in China's western region" is an innovative program that was implemented by the United Nations Population Fund (UNFPA), Marie Stopes International of China (MSIC), and the Chinese Family Planning Association (CFPA) between September and December 2020. An 8-week CSE course was delivered to 418 Students, grades 7-9, in five middle schools in Western China. The course curriculum applied internationally approved technical standards and was delivered by trained online tutors. An independent research team undertook a curriculum content analysis to evaluate course effectiveness, administered a pre-post students survey, and conducted interviews with students, teachers, and principals. The findings revealed statistically significant positive changes in students' reproductive and sexual health knowledge (SRH), attitudes, and self-efficacy to make decisions, negotiate, and communicate about sexual matters. Multivariable analysis indicated that the school, gender, and students' living arrangement were important predictors of outcomes. The study concluded that the pairing of live streaming technology with a comprehensive CSE curriculum is an effective teaching strategy to expand access to CSE to students in remote areas of the country.