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‘Mummy told me that I have HIV, that is the only thing she told me’: Experiences of HIV status disclosure to children in Masaka Region, Uganda
(Public Library of Science, 2023-05-24) Kairania, Robert;; Onyango-Ouma, Washington;; Ondicho, Tom G. ;; Kagaayi, Joseph;; Kigozi, Godfrey
In sub-Saharan Africa (SSA), disclosure of HIV status to children remains low. Few studies have examined how children navigate and come to terms with their HIV status. The aim of this study was to explore experiences of children about disclosure of their HIV status.BACKGROUNDIn sub-Saharan Africa (SSA), disclosure of HIV status to children remains low. Few studies have examined how children navigate and come to terms with their HIV status. The aim of this study was to explore experiences of children about disclosure of their HIV status.Between October 2020 and July 2021, 18 purposively selected children aged between 12-17 whose HIV status had been disclosed to them by their caregivers or healthcare providers (HCPs) were recruited for this study. We conducted 18 in-depth interviews (IDIs) to collect data for this study. Data were analyzed using the semantic thematic analysis approach.METHODSBetween October 2020 and July 2021, 18 purposively selected children aged between 12-17 whose HIV status had been disclosed to them by their caregivers or healthcare providers (HCPs) were recruited for this study. We conducted 18 in-depth interviews (IDIs) to collect data for this study. Data were analyzed using the semantic thematic analysis approach.Primary data obtained through IDIs revealed that disclosure of HIV status to children occurred as a one-time event without pre-disclosure preparatory planning or focused post disclosure follow-up counseling irrespective of the discloser. Post disclosure psycho-social experiences elicited mixed responses. Some children experienced insults and belittlement and stigma and discrimination in the family and community for out-of-school children and at school for school-going children. Positive disclosure experiences involved receiving support to improve ART adherence through constantly being reminded to take their medications timely at the workplace, by supervisors, for working children and by teachers, at school for school-going children.RESULTSPrimary data obtained through IDIs revealed that disclosure of HIV status to children occurred as a one-time event without pre-disclosure preparatory planning or focused post disclosure follow-up counseling irrespective of the discloser. Post disclosure psycho-social experiences elicited mixed responses. Some children experienced insults and belittlement and stigma and discrimination in the family and community for out-of-school children and at school for school-going children. Positive disclosure experiences involved receiving support to improve ART adherence through constantly being reminded to take their medications timely at the workplace, by supervisors, for working children and by teachers, at school for school-going children.This research contributes to knowledge about children' s experiences of being HIV infected and can specifically be used to improve disclosure strategies.CONCLUSIONSThis research contributes to knowledge about children' s experiences of being HIV infected and can specifically be used to improve disclosure strategies. MEDLINE - Academic
Suubi + Adherence4Youth: a study protocol to optimize the Suubi Intervention for Adherence to HIV treatment for youth living with HIV in Uganda
(BioMed Central Ltd, 2023-04-20) Ssewamala, Fred M.;; Sauceda, John A.;; Brathwaite, Rachel ;; Neilands, Torsten B.;; Nabunya, Proscovia;; Brown, Derek;; Sensoy Bahar, Ozge;; Namuwonge, Flavia;; Nakasujja, Noeline;; Mugarura, Allan;; Mwebembezi, Abel;; Nartey, Portia;; Mukasa, Barbara;; Gwadz, Marya
Background Suubi is an evidenced based multi-component intervention that targets psychosocial and economic hardships to improve ART adherence, viral suppression, mental health, family financial stability, and family cohesion for adolescents living with HIV (ALHIV) in Uganda. Suubi was originally tested as a combined package of four components: 1) Financial Literacy Training; 2) incentivized matched Youth Savings Accounts with income-generating activities; 3) a manualized and visual-based intervention for ART adherence and stigma reduction; and 4) engagement with HIV treatment-experienced role models. However, it is unknown if each component in Suubi had a positive effect, how the components interacted, or if fewer components could have produced equivalent effects. Hence, the overall goal of this new study is to identify the most impactful and sustainable economic and psychosocial components across 48 health clinics in Uganda. Methods A total of 576 ALHIV (aged 11-17 years at enrollment) will be recruited from 48 clinics and each clinic will be randomized to one of 16 study conditions. Each condition represents every possible combination of the 4 components noted above. Assessments will be conducted at baseline, 12, 24, 36 and 48- months post-intervention initiation. Using the multi-phase optimization strategy (MOST), we will identify the optimal combination of components and associated costs for viral suppression, as well as test key mediators and moderators of the component-viral suppression relationship. Discussion The study is a shift in the paradigm of research to use new thinking to build/un-pack highly efficacious interventions that lead to new scientific knowledge in terms of understanding what drives an intervention's success and how to iterate on them in ways that are more efficient, affordable and scalable. The study advances intervention science for HIV care outcomes globally. Trial Registration This project was registered at clinicaltrials.gov (NCT05600621) on October, 31, 2022. Keywords: Optimization, Suubi + adherence, Youth, Economic empowerment, Viral suppression, Adherence, Intervention components, Multiphase Optimization Strategy, Adolescents living with HIV
Appendico-ileal Knot: A Rare form of small Bowel Obstruction: A case report
(International Journal of Surgery Case Reports, 2024-10-15) Kabuye, Umaru; Damulira, John; Okuku, Maxwel Dancan
Small bowel obstruction (SBO) is a common surgical emergency with various causes. However, SBO resulting from appendicitis is uncommon and often overlooked. Appendico-ileal knotting, a rare and dangerous form of SBO, occurs when the appendix becomes twisted around the small intestine, leading to strangulation. Despite being reported since 1901, there have been very few documented cases of this condition. Diagnosing appendico-ileal knotting preoperatively is challenging, and even imaging techniques like computed tomography scans may not provide definitive diagnostic findings. Our current case report is a valuable addition to the limited literature and enhances understanding of this infrequent cause of SBO from a resource limited setting. We present the case of a 28-year-old female who presented with symptoms of dynamic SBO, including abdominal pain, vomiting, and constipation. Preoperative evaluation couldn't determine the exact cause. Diagnosis of a strangulated ileum was discovered, with the appendix identified as the source intraoperatively, leading to an open retrograde appendectomy. Postoperatively, the patient received IV ceftriaxone (1 g daily), metronidazole (500 mg tds), paracetamol (1 g tds), and IV crystalloids. Oral intake resumed gradually, and discharge occurred on day 4. Follow-up on 10th day was uneventful. Appendico ileal knotting is a rare cause of mechanical SBO. Knowledge of its pathophysiology, diagnosis, and management is very crucial to reduce its associated morbidity and mortality.
Effects of COVID-19 Pandemic on Voluntary Medical Male Circumcision Services for HIV Prevention, Sub-Saharan Africa, 2020
(Emerging Infectious Diseases, 2022-12-28) Peck, Megan E.; Ong, Katherine S.; Kiggundu, Valerian; Bamwesigye, Jackson; Semakula, Muhammed; Kabuye, Geoffrey; Kyobutungi, Sheila; Makumbi, Fredrick E.; Toledo, Carlos
Beginning in March 2020, to reduce COVID-19 transmission, the US President’s Emergency Plan for AIDS Relief supporting voluntary medical male circumcision (VMMC) services was delayed in 15 sub-Saharan African countries. We reviewed performance indicators to compare the number of VMMCs performed in 2020 with those performed in previous years. In all countries, the annual number of VMMCs performed decreased 32.5% (from 3,898,960 in 2019 to 2,631,951 in 2020). That reduction is largely attributed to national and local COVID-19 mitigation measures instituted by ministries of health. Overall, 66.7% of the VMMC global annual target was met in 2020, compared with 102.0% in 2019. Countries were not uniformly affected; South Africa achieved only 30.7% of its annual target in 2020, but Rwanda achieved 123.0%. Continued disruption to the VMMC program may lead to reduced circumcision coverage and potentially increased HIV-susceptible populations. Strategies for modifying VMMC services provide lessons for adapting healthcare systems during a global pandemic.
Prevalence and Risk Factors Associated with Tuberculosis Occurrence among Patients Attending Muhima District Hospital, Nyarugenge District, Rwanda
(European Journal of Social Sciences Studies, 2023-09-15) Elysee, Hitayezu; Kabuye, Fred; Niyigaba, Honore; Ngirinshuti, Vedaste
Tuberculosis (TB) is one the serious public health problems globally and locally and killed at least eight million in 2018 (WHO, 2019). TB is a curable disease if well treated and followed. One of the most key considerations for tracking and evaluating TB prevention and control programs is the prevalence and related risk factors. The study adopted a quantitative approach and a cross-sectional retrospective design to collect data from the respondents. A systematic sampling technique was used and secondary data recorded in the laboratory were collected. Specific objectives were: to determine the prevalence of tuberculosis among patients attending Muhima District Hospital in Nyarugenge District, and to identify behavioral factors associated with TB occurrence among patients attending Muhima District Hospital in Nyarugenge District. Descriptive and analytical statistics were used to analyze the data. The total number of respondents was 2161 patients. The majority, were male 1524(70.5%) and female were 637(29.5%). For the age, those less than 9 years were 19(.9%), between 10-17 years 76(3.5%), between 18-35 years 1185(54.8%), between 36-59 years 843(39.0%), and above 60 years 38(1.8%). Those who were married were 1014(47%), singles were 977(45.2%), and widower were 57(2.6%). For employment, 883(40.9%) were unemployed, 845(39.1%) were employed, 206(9.5%) were students, and 227(10.4%) were prisoners. Based on location, 1181(54.7%) were from urban areas, and 980(45.3%) were from rural areas. The prevalence of TB was 7.2%, out of which the females were 53(34.0%) and males were 103(66.0%). The prevalence of TB among HIV patients was 32.6%. For behavior practices, drinking alcohol was found among 908(42.0%) and smokers were 186(8.6%). For all the predictors of TB occurrence, none of them was statistically associated with TB occurrence. These include demographic characteristics, behavioral factors including use of alcohol, smoking and use of tobacco products, and serology. The prevalence of TB among patients attending Muhima District was higher than the National TB prevalence estimates reported by the World Health Organization (WHO, 2019), respectively 7.2% versus 5.2%. All predictors of TB occurrence including demographic characteristics and behavioral factors none of them was associated with TB occurrence. It is worth recommending a further study to understand in-depth risk factors for TB occurrence in the era of epidemiological transition.
Preventing HIV among Adolescent Boys and Young Men through Pepfar-Supported Voluntary Medical Male Circumcision In 15 Sub-Saharan African Countries, 2018–2021
(AIDS Education and Prevention, 2023-07-14) Peck, Megan E.; Wandira, Ronald; Kazaura, Kokuhumbya J.; Kabuye, Geoffrey; Toledo, Carlos
Voluntary medical male circumcision (VMMC) is an HIV prevention intervention that has predominantly targeted adolescent and young men, aged 10–24 years. In 2020, the age eligibility for VMMC shifted from 10 to 15 years of age. This report describes the VMMC client age distribution from 2018 to 2021, at the site, national, and regional levels, among 15 countries in southern and eastern Africa. Overall, in 2018 and 2019, the highest proportion of VMMCs were performed among 10–14-year-olds (45.6% and 41.2%, respectively). In 2020 and 2021, the 15–19-year age group accounted for the highest proportion (37.2% and 50.4%, respectively) of VMMCs performed across all age groups. Similarly, in 2021 at the site level, 68.1% of VMMC sites conducted the majority of circumcisions among men aged 15–24 years. This analysis highlights that adolescent boys and young men are the primary recipients of VMMC receiving an important lifetime reduction in HIV risk.
Building capacity in conducting clinical research in a virtual setting: experiences from the east african consortium for clinical research (EACCR2).
(BMJ, 2019-04-24) Nyanzi-Kabuye, Emily; Kaleebu, Pontiano; Kikaire, Benard; Peshu, Norbert; Mukhtar,Maowia
EACCR2 is an EDCTP-funded, Eastern African-led network established in May 2009, with 23 regional partners from Ehtiopia, Kenya, Sudan, Tanzania, and Uganda, and 8 northern partners from Germany, Netherlands, Norway, Sweden and United Kingdom. The objective is to strengthen capacity to conduct health research to international standards with specific focus on clinical trials on poverty-relevant diseases such as HIV, TB, malaria and neglected infectious diseases. EACCR2 optimises the use of shared research infrastructures and other regional capacity building resources and opportunities. The activities of the network are implemented in five work packages cutting across ‘nodes’ in different countries. Capacity building programmes and studies funded by EDCTP are implemented by coordinators at the disease nodes. The Uganda Virus Research Institute (UVRI) hosts the secretariat of the consortium of five nodes located in the following institutions: Malaria Node in Kilifi-Kenya Medical Research Institute Wellcome Trust, Tanzania; Training Node in Kilimanjaro Clinical Research Institute, Tanzania; Tuberculosis Node at the National Institute of Medical Research- Muhimbili, Tanzania; the Neglected and Re-Emerging Tropical Diseases Node at the University of Khartoum, Sudan; and the HIV Node at UVRI, Uganda. Coordinators form the project implementation committee which meets via skype or teleconference every quarter to assess progress, share best practice and challenges of the network. Scientific and annual meetings are arranged every year in one of the implementing institutions. During such meetings, students, the nodes and steering committee also meet to minimise travel costs while helping teams to network. EACCR2 learns from the experiences, best practice and challenges of EACCR1 while implementing its current activities. Careful planning and consensus building from all partners has been the driving force to build and implement activities of this virtual network. EACCR2 also works closely with other EDCTP Networks of Excellence.
Yaws Circulating in Nonhuman Primates, Uganda and Rwanda
(U.S. National Center for Infectious Diseases, 2025-03-25) Goldberg, Tony L.;; Owens, Leah A.;; Nziza, Julius ;; Muvunyi, Richard;; Rothman, Jessica M.;; Omeja, Patrick;; Chapman, Colin A.
The bacterium Treponema pallidum pertenue causes yaws in humans and nonhuman primates. We describe 33% T. pallidum pertenue seropositivity in 9 species of nonhuman primates in Uganda and Rwanda, seroconversion during a lethal outbreak and a novel bacterial genomic lineage. Yaws may threaten both public health and conservation in the region. MEDLINE
Rickettsioses as Underrecognized Cause of Hospitalization for Febrile Illness, Uganda
(Centers for Disease Control and Prevention, 2025-08-22) Blair, Paul W.;; Alharthi, Sultanah;; Londoño, Andrés F. ;; Wailagala, Abdullah;; Manabe, Yukari C.;; Dumler, J. Stephen
The complexity of rickettsial serodiagnostics during acute illness has limited clinical characterization in Africa. We used archived samples from sepsis (n = 259) and acute febrile illness (n = 70) cohorts in Uganda to identify spotted fever and typhus group rickettsiae by using immunofluorescence assay and clinically validated rRNA reverse transcription PCR (RT-PCR). Among 329 participants, 10.0% had rickettsial infections (n = 33; n = 20 identified with immunofluorescence assay and n = 13 by RT-PCR). Serum rRNA RT-PCR was 75.0% (95% CI 42.8–94.5%) sensitive and 91.2% (95% CI 85.8–95.1%) specific. Thrombocytopenia was more common among patients with rickettsial infections than with other nonmalarial infections (adjusted odds ratio 3.7; p = 0.003). No participants were on a tetracycline antimicrobial drug at admission. rRNA RT-PCR is a promising diagnostic strategy for identifying acute rickettsial infections. Doxycycline should be included in empiric antimicrobial drug regimens for nonmalarial febrile illness in this region.
Tuberculosis Preventive Therapy among Persons Living with HIV, Uganda, 2016–2022
(U.S. National Center for Infectious Diseases, 2023-02-15) Lukoye, Deus;; Gustavson, Gail;; Namuwenge, Proscovia M. ;; Muchuro, Simon;; Birabwa, Estella;; Dejene, Seyoum;; Ssempiira, Julius;; Kalamya, Julius N.;; Baveewo, Steven;; Ferroussier-Davis, Odile;; Mills, Lisa A.;; Dirlikov, Emilio;; Nelson, Lisa J.;; Turyahabwe, Stavia
During October 2016-March 2022, Uganda increased tuberculosis (TB) preventive therapy coverage among persons living with HIV from 0.6% to 88.8%. TB notification rates increased from 881.1 to 972.5 per 100,000 persons living with HIV. Timely TB screening, diagnosis, and earlier treatment should remain high priorities for TB/HIV prevention programming. MEDLINE
Genetic subgroups inform on pathobiology in adult and pediatric Burkitt lymphoma
(Blood, 2023-02-23) Nicole, Thomas; Namirembe, Constance; Ogwang, Martin D.; Omoding, Abraham
Burkitt lymphoma (BL) accounts for most pediatric non-Hodgkin lymphomas, being less common but significantly more lethal when diagnosed in adults. Much of the knowledge of the genetics of BL thus far has originated from the study of pediatric BL (pBL), leaving its relationship to adult BL (aBL) and other adult lymphomas not fully explored. We sought to more thoroughly identify the somatic changes that underlie lymphomagenesis in aBL and any molecular features that associate with clinical disparities within and between pBL and aBL. Through comprehensive whole-genome sequencing of 230 BL and 295 diffuse large B-cell lymphoma (DLBCL) tumors, we identified additional significantly mutated genes, including more genetic features that associate with tumor Epstein-Barr virus status, and unraveled new distinct subgroupings within BL and DLBCL with 3 predominantly comprising BLs: DGG-BL (DDX3X, GNA13, and GNAI2), IC-BL (ID3 and CCND3), and Q53-BL (quiet TP53). Each BL subgroup is characterized by combinations of common driver and noncoding mutations caused by aberrant somatic hypermutation. The largest subgroups of BL cases, IC-BL and DGG-BL, are further characterized by distinct biological and gene expression differences. IC-BL and DGG-BL and their prototypical genetic features (ID3 and TP53) had significant associations with patient outcomes that were different among aBL and pBL cohorts. These findings highlight shared pathogenesis between aBL and pBL, and establish genetic subtypes within BL that serve to delineate tumors with distinct molecular features, providing a new framework for epidemiologic, diagnostic, and therapeutic strategies.
Implementing and Evaluating a Mobile Phone–Supported and Family-Centered Rehabilitation Program for People With Stroke in Uganda (F@ce 2.0):Protocol for a Randomized Controlled Trial
(JMIR Publications, 2024-09-25) Eriksson, Gunilla;; Kamwesiga, Julius Tunga;; Fors, Uno ;; Oyana, Tonny;; von Koch, Lena;; Ytterberg, Charlotte;; Guidetti, Susanne
Stroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke.BACKGROUNDStroke is a global societal challenge. Annually, 13 million people experience stroke, and the prevalence of stroke is increasing in low-income countries; hence, accessible rehabilitation needs to be developed. Information and communication technology can help by providing access to rehabilitation support through information, self-evaluation, and self-management of rehabilitation. The F@ce 2.0 rehabilitation program provides support in goal-setting and problem-solving strategies through phone calls from the interventionist twice a week and daily SMS text message reminders over 8 weeks to improve performance in valued activities in everyday life. Our hypothesis is that F@ce 2.0 will increase functioning in daily activities and participation in everyday life as well as improve performance and satisfaction in valued daily activities and self-efficacy (ie, confidence in own ability to perform activities) among people living with the consequences of stroke.This study aims to implement F@ce 2.0, a mobile phone-supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0.OBJECTIVEThis study aims to implement F@ce 2.0, a mobile phone-supported and family-centered rehabilitation program, and evaluate its effects on performance in daily activities and participation in everyday life in comparison to ordinary rehabilitation among persons with stroke and their family members in Uganda. An additional aim is to explore experiences of participating in F@ce 2.0 and plausible mechanisms of impact that might explain the potential effects of F@ce 2.0.A randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process.METHODSA randomized controlled trial will be conducted to compare the outcomes of the F@ce 2.0 group and a control group receiving ordinary rehabilitation. Health care professionals will recruit 90 clients from both urban and rural areas. The primary outcomes for persons with stroke are perceived performance in daily activities assessed using the Canadian Occupational Performance Measure and self-efficacy assessed using the Self-Efficacy Scale; for family members, the primary outcome is caregiver burden evaluated using the Caregiver Burden Scale. Descriptive statistics will be used to present characteristics and outcomes at 3 and 6 months. All statistical analyses comparing the outcomes at the different time points between the F@ce 2.0 and control groups will be performed using intention-to-treat analysis. Qualitative interviews will be used to explore the experiences of persons with stroke and their family members participating in F@ce 2.0, using a grounded theory approach to data collection and analysis. A process evaluation will be conducted using a single-case study design with mixed methods to explore the implementation process.Recruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025.RESULTSRecruitment and data collection in the randomized controlled trial were initiated in January 2022 and have been completed. The intervention has been provided to 51 participants in the intervention group. Interviews of persons with stroke, family members, and health care professionals have been conducted. Data analysis will be performed during autumn 2024 and spring 2025.This study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries.CONCLUSIONSThis study will provide evidence of the plausible effects of F@ce 2.0 and the process of implementing the program in low-income countries.DERR1-10.2196/60955.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)DERR1-10.2196/60955. MEDLINE - Academic
Implementation of post-discharge malaria chemoprevention (PDMC) in Benin, Kenya, Malawi, and Uganda: stakeholder engagement meeting report
(BioMed Central, 2024-03-27) Hill, Jenny
A Stakeholder engagement meeting on the implementation of post-discharge malaria chemoprevention (PDMC) in Benin, Kenya, Malawi, and Uganda was held in Nairobi, Kenya, on 27 September 2023. Representatives from the respective National Malaria Control Programmes, the World Health Organization (WHO) Geneva, Africa Regional and Kenya offices, research partners, non-governmental organizations, and the Medicines for Malaria Venture participated. PDMC was recommended by the WHO in June 2022 and involves provision of a full anti-malarial treatment course at regular intervals during the post-discharge period in children hospitalized with severe anaemia in areas of moderate-to-high malaria transmission. The WHO recommendation followed evidence from a meta-analysis of three clinical trials and from acceptability, delivery, cost-effectiveness, and modelling studies. The trials were conducted in The Gambia using monthly sulfadoxine-pyrimethamine during the transmission season, in Malawi using monthly artemether-lumefantrine, and in Kenya and Uganda using monthly dihydroartemisinin-piperaquine, showing a significant reduction in all-cause mortality by 77% (95% CI 30–98) and a 55% (95% CI 44–64) reduction in all-cause hospital readmissions 6 months post-discharge. The recommendation has not yet been implemented in sub-Saharan Africa. There is no established platform for PDMC delivery. The objectives of the meeting were for the participating countries to share country contexts, plans and experiences regarding the adoption and implementation of PDMC and to explore potential delivery platforms in each setting. The meeting served as the beginning of stakeholder engagement within the PDMC Saves Lives project and will be followed by formative and implementation research to evaluate alternative delivery strategies in selected countries. Meeting highlights included country consensus on use of dihydroartemisinin-piperaquine for PDMC and expansion of the target group to "severe anaemia or severe malaria", in addition to identifying country-specific options for PDMC delivery for evaluation in implementation research. Further exploration is needed on whether the age group should be extended to school-age children. Publicly Available Content Database
Medical students’ knowledge, attitudes, and motivation towards antimicrobial resistance efforts in Eastern Uganda
(Public Library of Science, 2025-02-06) Babuya, Jonathan;; Waruingi, Daniel;; Mungujakisa, Douglas ;; Ahimbisibwe, Osmas;; Kako, Victoria Ruth;; Aporu, Faith;; Mugume, Emmanuel;; Nyamupachitu, Julian;; Kiyimba, Kenedy
Learning beyond the classroom is important for holistic engagement in antimicrobial resistance(AMR) mitigation. Extracurricular interventions can catalyze multidisciplinary engagement and inspire innovative solutions. This study aimed to determine the knowledge, attitudes, and motivations influencing medical students' engagement in AMR Club initiatives at Busitema University, Uganda. This was a descriptive cross-sectional study conducted at Busitema University among undergraduate students pursuing Bachelors of Medicine and Surgery, Bachelor of Science in Nursing, and Bachelor of Science in Anesthesia and Critical care. Data collection was performed using a semi-structured, pre-tested questionnaire and administered to the participants The Bloom's cut-off method was used to analyse the knowledge of the participants, while bivariate analysis was conducted using the chi square test. Multivariable logistic regression analysis was used to identify factors independently associated with students' engagement in AMR club activities. Of the 193 study participants, 71.5%(n) demonstrated sufficient knowledge about antimicrobial resistance (AMR), as determined using Bloom's cutoff categories ([greater than or equal to]60% classified as sufficient, <60% as insufficient), with an average knowledge score of 68.18% (SD ±16.12). Additionally, 90% of participants acknowledged the significance of incorporating AMR topics into their curriculum, while 87.5% emphasized the need for AMR training using a One Health approach. The major motivations for students to engage in extracurricular activities addressing AMR were peer influence (n = 42), university support (n = 35), and inspiration drawn from peer mentors' work (n = 35). The students demonstrated a high level of knowledge and positive attitudes towards AMR but highlighted the need for further in-depth training. Participation in extra-curricular activities such as involvement in an AMR Club, was found to significantly influence students' engagement in AMR related interventions.
Delayed culture conversion predicts poor outcomes for isoniazid mono-resistant TB in Uganda: a retrospective cross-sectional study from 2017– 2022
(BioMed Central Ltd, 2025-07-01) Kabugo, Joel;; Sande, Obondo James;; Kabahita, Jupiter Marina ;; Namutebi, Joanita;; Mujuni, Dennis;; Oundo, Hellen Rosette;; Kisakye, Daniel;; Batte, Dorothy Nassozi;; Joloba, Moses;; Mboowa, Gerald
BackgroundIsoniazid-resistant, Rifampicin-susceptible Tuberculosis (TB) is estimated to occur in 13% of new cases and 17% of previously treated cases. Current WHO guidelines recommend treatment with Rifampicin (RFP), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (LFX, Q) for 6 months in patients with isoniazid mono-resistant TB (Hr-TB) but the effectiveness and use of other regimens in managing Hr-TB has not been established. There is a need to pay increased attention to the timely identification of Hr-TB patients to improve treatment success along with the reduction of the risk for further drug resistance development. This study was performed to determine the treatment outcomes and their associated factors among isoniazid mono-resistant TB patients in Uganda.MethodsThis was a cross-sectional study performed among newly diagnosed and retreatment TB patients whose sputum samples were referred to the National TB Reference Laboratory (NTRL)-Uganda from March 2017 to March 2022. Patient samples exhibiting Isoniazid mono-resistance as determined by phenotypic drug resistance testing (DST) were included in this study. Samples with data incompleteness and those whose treatment centers could not be traced were excluded from the study. Selected samples were tested for mutations associated with Isoniazid resistance using line probe. Patient demographic data was obtained from the National TB Reference Laboratory (NTRL) electronic data system and request forms with additional data, such as treatment regimen, adverse effects, and treatment start dates obtained from treatment registers. The independent variables available (age, sex, regimen used, M. tuberculosis mutation genes for isoniazid, specifically InhA and KatG, history of TB, HIV status, and reporting year) were assessed as possible factors in the relationship between Hr-TB and treatment success.ResultsA total of 85 isoniazid monoresistant isolates from different patients were analyzed in this study. In this study, most of the participants belonged to the category of newly diagnosed 35/85 (41.2%). Most of the participants 36/85, 42.3%) turned culture negative at month one upon initiation of treatment. The findings from this study show that the most dominant Mycobacterium tuberculosis mutation occurred in the KatG MUT1 region with a nucleotide change of S315T1. There was no significant treatment outcome difference among the different age groups in this study when compared (unsuccessful Vs successful treatment, median age 35.4 years and 35.86 years, p = 0.078). However, the study found that most deaths were among people aged above 36 years 71.4%, (5/7 participants).ConclusionThis study revealed Isoniazid mono-resistant TB as a significant factor associated with delayed culture conversion of beyond two (2) months. This emphasizes the need for prompt detection using routine point-of-care testing molecular diagnostic platforms to test for Isoniazid and Rifampicin resistance to improve TB treatment outcomes and reduce failures.Clinical trial numberNot applicable. Publicly Available Content Database
Strategies Utilized During Sudan Virus Disease Outbreak Response in Kampala City, Uganda, 2022 − 2023
(Springer Nature B.V, 2025-07-04) Mackline, Ninsiima;; Migisha, Richard;; Ndyabakira Alex ;; Katana, Elizabeth;; Aanyu Dorothy;; Kabami Zainah;; Zalwango, Jane Frances;; Naiga Hellen Nelly; Kiggundu, Thomas; Agaba Brian; Zavuga, Robert; Kizito, Saudah Namubiru; Goretti, Zalwango Marie; King, Patrick; Wanyana, Mercy Wendy; Simbwa, Brenda Nakafeero;; Naiga Hellen Nelly;; Kiggundu, Thomas;; Agaba Brian;; Zavuga, Robert;; Kizito, Saudah Namubiru;; Goretti, Zalwango Marie;; King, Patrick;; Wanyana, Mercy Wendy;; Simbwa, Brenda Nakafeero;; Et.al
Abstract Background On October 8, 2022, Kampala, the capital city of Uganda, recorded its first Sudan virus disease (SVD) case. We described strategies utilized by Kampala Capital City Authority (KCCA) during SVD outbreak response in Kampala City from October 2022 − January 2023. Methods We reviewed daily situation reports submitted by KCCA incident management team to document strategies implemented throughout the SVD response. During SVD After Action Review (AAR), we convened consensus meetings with the Directorate of Public Health and Environment, incident management team, rapid response teams, and representatives from implementing partners. The AAR served as a structured platform for reflection and consensus-building through semi-structured group discussions among stakeholders. Findings were thematically synthesized to identify effective strategies and operational challenges encountered during SVD response in Kampala City. Results KCCA established an incident management system to coordinate the SVD response. Daily coordination meetings were held with rapid response teams and implementing partners to address emerging challenges. A centralized call and dispatch center served as the coordination hub for rapid response teams, facilitating timely verification of alerts and response to suspected SVD cases. Case investigation teams established epidemiological linkages among confirmed SVD cases and identified contacts for daily follow up. Designated ambulances were utilized to transport high-risk patients to isolation units, while confirmed cases were referred to Entebbe Ebola Treatment Unit. Infection prevention and control teams provided essential decontamination services and distributed IEC materials to affected health facilities and communities. KCCA also leveraged innovative strategies such as drones to disseminate public health messages, distributed placards with SVD symptoms and preventive measures, and actively engaged business communities, media outlets, and local leaders to enhance public awareness and risk communication. Conclusion KCCA’s response to the 2022 Sudan virus disease outbreak demonstrated effectiveness of leveraging existing coordination structures, adapting surveillance tools, and engaging communities in a complex city setting. The integration of emergency preparedness efforts and contextualized approaches such as mobile phone tracking, closed-circuit television (CCTV) footage, school-based interventions, and drone utilization contributed to timely containment. These strategies demonstrate valuable best practices for strengthening emergency preparedness and response capacities in high-risk urban settings.
Experiences of Research Coproduction in Uganda; Comment on “Research Coproduction: An Underused Pathway to Impact”
(Kerman University of Medical Sciences, 2024-11-20) Musoke, David;; Nakalawa, Suzan;; Brown, Michael Obeng ;; Lubega, Grace Biyinzika;; Gibson, Linda
This commentary reflects on the principles of research coproduction discussed by Rycroft-Malone et al through our experiences in Uganda, particularly within the partnership between Nottingham Trent University (UK) and Makerere University (Uganda). The commentary highlights the coproduction process we have employed in community health projects in Wakiso district, Uganda, by examining both the opportunities and challenges inherent in this collaborative approach. We further highlight the importance of continuous stakeholder engagement, contextspecific communication, and power-sharing, demonstrating how research coproduction can decolonize research methodologies and enhance the relevance and impact of health interventions. By recognising the inequities between North-South partnerships, this commentary contributes to the discourse on how research coproduction can practically be implemented to drive meaningful, community-centred change while addressing the complexities involved. The lessons drawn from our experiences offer a pathway for other global partnerships aiming to integrate the principles of research coproduction into their work. CrossRef
Implementation strategies to integrate HIV and hypertension care in Kampala and Wakiso districts, Uganda: study protocol for a stepped wedge cluster randomized trial (PULESA-Uganda)
(BioMed Central Ltd, 2025-08-11) Longenecker, Chris T.;; Kiggundu, John Baptist;; Ayebare, Florence ;; Muddu, Martin;; Kayima, James;; Mutungi, Gerald;; Ssinabulya, Isaac;; Schwartz, Jeremy I.;; Spiegelman, Donna;; Tong, Guangyu;; Nugent, Rachel;; Aifah, Angela;; Kagoya, Faith;; Cameron, Drew B.;; Hutchinson, Brian;; Kamya, Moses R.;; Katahoire, Anne R.;; Semitala, Fred C
Hypertension (HTN) is the leading cause of cardiovascular morbidity and mortality among people living with HIV (PLWH) in Africa, yet integration of hypertension treatment in HIV clinics is sub-optimal. Cost-effective strategies to implement evidence-based hypertension care for this population are urgently needed to preserve the life-expectancy gains of antiretroviral therapy. Building on insights gained from a comprehensive mixed-methods formative assessment, we used a human-centered design approach to develop a multi-component HIV-HTN integration (HTN-PLUS) strategy. In a stepped-wedge cluster randomized trial, we are assessing the effectiveness, costs, and implementation of HTN-PLUS as well as a less resource intensive strategy of providing HTN medication and blood pressure cuffs (HTN-BASIC) free of charge to clinics. The trial is being conducted in 16 public and private not-for-profit HIV clinics in Kampala and Wakiso districts in Uganda. The co-primary effectiveness outcomes are population BP control (screened and documented BP < 140/90 mmHg) and HTN patient BP control [BP < 140/90 mmHg among PLWH with HTN]. The trial is designed to have > 80% power to detect a 12%-point increase in both outcomes compared to the pre-implementation control period across a range of scenarios of baseline hypertension prevalence and temporal improvements in the control period. At two pre-specified time points, we are conducting a Learn-As-You-Go optimization analysis and will adapt the HTN-PLUS strategy accordingly. To assess implementation outcomes, we have enrolled a prospective longitudinal mixed-methods cohort study of clinic health workers and PLWH with HTN. An extensive economic evaluation will include time and motion studies, facility-based costing, and out-of-pocket cost surveys to determine costs and cost-effectiveness from a societal perspective. Innovative implementation strategies to integrate evidence-based hypertension care for PLWH in Africa must be informed by the health workers and PLWH who are cared for across diverse HIV clinics. These clinics currently provide high quality HIV care as evidenced by high rates of HIV viral suppression but often lack the knowledge, skills and resources to provide HTN care. Funders and policymakers critically need to know both the effectiveness and costs to scale these strategies and potentially expand them to include other non-AIDS comorbidities.
Predictors of survival among children and adolescents with rhabdomyosarcoma treated in a single resource-limited centre —Uganda
(BioMed Central Ltd, 2025-08-11) Nyeko, Richard;; Geriga, Fadhil;; Angom, Racheal ;; Kambugu, Joyce Balagadde;; van Heerden, Jaques
The treatment outcomes for children and adolescents with rhabdomyosarcoma (RMS) in low-income countries are poor. However, there is a paucity of literature on RMS and its management outcomes in low-resource settings. We evaluated the treatment of RMS with the aim of identifying prognostic factors during management to improve outcomes. We sourced data on children under 18 years treated for rhabdomyosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Kaplan-Meier survival analysis and Cox's proportional hazards model were used for five-year survival analysis. One hundred twenty-eight RMS cases were identified, with a median age of 6.0 years (IQR 3.6-10.0). The most common primary tumour site was the head and neck region, comprising non-parameingeal sites, 37 (28.9%); parameingeal sites, 32 (25.0%); and orbital tumours, 17 (13.3%). Overall, 68 (53.1%) of the primary tumour sites were unfavourable sites. Seventeen (13.3%) patients had metastatic disease at diagnosis, primarily to the lungs, 11 (64.8%). Embryonal and alveolar RMS accounted for 50.0% and 20.3% of the cases, respectively. Only 31 (24.2%) of the patients underwent surgery, and 36 (28.1%) were irradiated. The treatment completion rate was 33.6%, while 46.1% abandoned treatment. Only 25 (19.5%) patients were alive at the time of the study, 65 (50.8%) had died, and 38 (29.7%) had an unknown status. The five-year overall and event-free survival rates were 35% and 30%, respectively. Orbital primary tumour site (HR = 2.86; 95% CI 1.12-7.31; p = 0.028), metastatic disease (HR = 4.09; 95% CI 2.01-8.31; p < 0.001), elevated serum lactate dehydrogenase at diagnosis above 400 U/L (HR = 2.80; 95% CI 1.46-5.33; p = 0.002), and lack of local control (HR = 3.33; 95% CI 1.34-8.29; p = 0.010) were significant factors for poor survival. Rhabdomyosarcoma outcomes in Ugandan children are largely poor, with high treatment abandonment and mortality. Concerted, multidisciplinary efforts are needed to improve outcomes in this setting.
Coinfection of COVID-19 and Tuberculosis in Uganda
(Institute of Tropical Medicine, 2023-06) Nuwagira, Edwin;; Mpagama, Stellah G.;; Katusiime, Asumpta ;; Natamba, Bobson;; Baluku, Joseph Baruch;; Lai, Peggy S.
The clinical features and outcomes of tuberculosis (TB) and COVID-19 coinfection are not well established. This short report describes 11 people with TB/COVID-19 coinfection in Uganda. The mean age was 46.9 ± 14.5 years; eight (72.7%) were male and two (18.2%) were coinfected with HIV. All patients presented with cough whose median duration was 71.1 (interquartile range, 33.1, 109) days. Eight (72.7%) had mild COVID-19 whereas two (18.2%) died, including one with advanced HIV disease. All patients were treated with first-line anti-TB drugs and adjunct therapy for COVID-19 using national treatment guidelines. This report presents the possibility of the coexistence of the two diseases and calls for more vigilance, screening, and collective prevention measures for both COVID-19 and TB. CrossRef

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