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Background Health workers play a critical role in providing gender-sensitive HIV care. However, without adequate training, they may inadvertently reinforce negative gender norms that hinder engagement in care. To improve ART services in sub-Saharan Africa, effective implementation strategies, including trainings, are essential. Methods This study evaluated the feasibility and acceptability of a novel 4-session, gender-sensitivity training for HIV health and lay workers in rural and peri-urban Uganda. We conducted a pilot quasi-experimental controlled trial in 2022–23, utilizing data from three sources: process data from 144 providers and 238 clients, qualitative post-intervention focus groups and interviews with 53 training attendees, and stakeholder interviews with 12 community leaders and facilitators. We employed thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR). Results The training was highly rated by attendees via brief post-session surveys, with 99% of sessions deemed satisfactory. Qualitative feedback indicated that the sessions were perceived as appropriate for addressing providers’ gaps in delivering gender-sensitive care and as beneficial for participants. High feasibility was evidenced by 100% of intervention steps delivered (fidelity checklists), 86% attendance (attendance logs), and 98.6% and 94.8% recruitment of eligible providers and clients (study records), respectively. Through qualitative exit focus groups, factors that positively affected acceptability and feasibility included tactics to gain support from supervisors, the use of experienced facilitators and active learning approaches, and the consideration of the health system context in delivery (e.g., cadre mix, location). Suggested improvements encompassed addressing interpersonal and structural barriers to client-centered care, incorporating community sensitization, streamlining content, and enhancing mentorship follow-ups. Stakeholders recognized the training’s alignment with national health priorities and emphasized the need for clarity regarding its integration with existing training curricula and ongoing stakeholder engagement. Conclusions This study underscores the acceptability and feasibility of a gender-sensitivity training program for HIV providers; further evaluation of the program is warranted. Identified factors influencing implementation can inform enhancements to gender-focused training initiatives to improve the quality of HIV services and enhance client engagement and health outcomes. Trial registration Clinicaltrials.gov, NCT05178979, registered: November 15, 2021.

This study evaluated the effectiveness and responsiveness of differentiated Human Immunodeficiency Virus (HIV)/Acquired Immuno-Deficiency Syndrome (AIDS) service delivery models (DSDMs) implemented to enhance antiretroviral therapy (ART) access and outcomes for patients while addressing Tuberculosis (TB)-HIV integration, focusing on four of the five DSDMs currently implemented in Uganda. A descriptive cross-sectional survey was conducted in eight districts of central Uganda using Lot Quality Assurance Sampling approach from 7th to 23rd March 2023. We randomly sampled 2668 patients who have been on ART for at least 1 year in a Facility-Based Individual Management (FBIM) model or in a non-FBIM DSDM for at least one year. Data were collected through patient interviews and review of records in ART and DSDM registers as well as ART cards. We analyzed the data in proportions, comparing the selected ART outcome and responsiveness indicators between Community Client Led ART Distribution (CCLAD), Community Drugs Distribution Point (CDDP) and Fast-Track Drug Refill (FTDR) DSDMs with the standard care (FBIM) model. The ART outcome variables include patients retained in the 1st line of the ART regimen, patients in World Health Organization clinical stage 1 during the last facility visit, patients who had no CD4 request during the past 12 months, viral load suppression, ART adherence, and patients who reported that they did not experience HIV/AIDS-related symptoms in the past 6 months. The variables on TB care include screening for TB using the intensified case finding form and patients tested positive for TB. Responsiveness variables include the perceived; travel time for ART refill, travel distance for ART refill, convenience and flexibility during ART refill, cost of travel for ART refill, fear of being seen at ART refill point, waiting time before service, adequacy of service time, crowding and risk of infections, social support, ability to address ART treatment challenges, HIV status disclosure and barriers to access. Non-overlap in 95% confidence interval in indicator proportion between non-FBIM DSDM and FBIM means a statistically significant difference in proportion, or otherwise non-significant. Higher proportions of ART patients in the CCLAD and CDDP DSDMs adhered to ART, had suppressed viral load, and a lower TB prevalence than those in FBIM model. Additionally, more CCLAD and CDDP clients reported shorter travel time and distance to access ART than their counterparts in the FBIM model. Compared to FBIM model, higher proportions of those in CCLAD and CDDP also reported flexibility in ART refill scheduling, reduced transport costs, fewer privacy concerns, less HIV/AIDS-related stigma, shorter waiting times, more efficient services, decreased congestion at ART pickup sites, enhanced peer support, improved problem-solving assistance, and increased HIV status disclosure. The FTDR model outperformed FBIM in proportions with fewer requests for CD4 testing, viral load suppression, as well as proportions of clients who reported; shorter travel time, lower transportation cost, decreased privacy concerns, shorter waiting time, and efficient service provision. Compared to both CDDP and FTDR, the FBIM had a higher proportion of clients remain on the first-line ART regimen. Community-based DSDMs show responsiveness to clients' needs without compromising the effectiveness of ART care for patients. Although FTDR also demonstrates high effectiveness and responsiveness for clients on ART, there is potential for further improvement. Planners and implementers of ART programs should consider both demand- and supply-side innovations to sustain the continuation of DSDMs.

Introduction: The use of Dolutegravir (DTG) expanded in Uganda since its introduction in 2020. Adverse effects of DTG use related to hyperglycemia are a concern(1). The risk of hyperglycemia and DM has not been fully characterized, especially in cohorts using DTG, nevertheless, there has been an effort to document and characterize events of symptomatic hyperglycemia following transition to DTG in Uganda(2). Aim: To evaluate whether prior exposure to non-DTG based ART backbone regimen influences the occurrence of hyperglycemia among patients receiving DTG-based ART regimens. Methods: A prospective cohort study among clients aged 18 years from July 2021 to September 2022 from urban and rural Mildmay Uganda study sites. Results: Overall, 628 participants currently on tenofovir, lamivudine and dolutegravir fixed dose combination (TLD)were enrolled. The overall incidence of hyperglycemia was 24.5 (95% CI 19.3-31.1) per 100 person-years. Sixty-eight cases (11%) of hyperglycemia were observed in a total of 277.4 years of observation. There was no statistical evidence to detect an association between previous exposure to non DTG based regimen and incidence of hyperglycemia in the population of clients on DTG. The following factors remained independently associated with hyperglycemia: the study site indicator (pvalue\\0.001), the duration on Dolutegravir-based ART regimens (pvalue = 0.02), age of the respondent (p-value\\0.001) and marital status (p-value = 0.06). Overall, 10% (n = 63) reported at least one adverse event at any point during follow-up. The most common adverse events were related to cardiovascular (24.4%), sexual dysfunction (19.5%), Central nervous system (14.6%), and neuropathies (9.8%). Conclusions: Prior exposure to non-DTG based ART regimens was associated with increased occurrence of glycaemia. It was noted that increasing age and duration of exposure to DTG based regimens was associated with an increased risk of hyperglycemia among PLHIV on TLD. The implication of the findings is that screening, care and treatment of hyperglycemia should be integrated into the existing HIV care and treatment services among clients transitioned or initiated on DTG based regimens. More follow up time was recommended to detect a difference in hyperglycemia incidence between new participants initiated on DTG and those initially initiated on other non-DTG ART regimen.

This study assessed tuberculosis (TB)-related knowledge among people of different demographic groups that is essential for effective TB program planning and implementation. We conducted a cross-sectional study using the lot quality assurance sampling (LQAS) methodology in 8 districts, stratifying each district into five supervision areas (SAs). We randomly sampled 19 villages from each SA using probability proportional to size (PPS). We interviewed 2280 respondents, including 760 each of youth 15-24 years, women 15-49 years and men 15+ years. The data were analyzed in proportions and SA-level classifications using the LQAS-based decision rules. The findings underscore variations in TB knowledge across demographic groups. Among youths, knowledge of at least two TB symptoms stood at 48.6%, while among women and men, it was 55.3% and 57.0%, respectively. Awareness of TB curability was 75.6% among youths, 80.2% among women, and 84.6% among men. A notable proportion of youths (83.4%), women (89.5%), and men (91.4%) were aware of the potential coexistence of HIV and TB. Concerning actions to take if a family member is suspected of having TB, 89.4% of youth, 92.4% of women, and 57.5% of men were knowledgeable. Knowledge of the risks of incomplete TB treatment was noted among 30.9% of youth, 33.0% of women, and 35.0% of men. There is variation in the level of knowledge across different TB thematic areas between demographic groups, districts and sub-districts (SAs). Planners and implementers of TB programs should be cognizant of such variations and make deliberate efforts to develop tailored interventions in order to address the information and/or education needs of specific contexts in order to improve TB outcomes. The findings highlight the need to particularly target the youth with education programs on TB.

This study examined citizens' knowledge and compliance with COVID-19 standard operating procedures (SOPs), vaccine acceptance and hesitancy, and factors that could influence these behaviors. The study that utilised the Lot Quality Assurance Sampling (LQAS) approach was conducted in eight districts of Central Uganda; Kiboga, Kyankwanzi, Mubende, Kasanda, Mityana, Luwero, Nakaseke, and Nakasongola districts. Each district was divided into five supervision areas (SAs). Data were collected from 19 respondents per SA, focusing on women aged 15-49 years and men aged 15 years and above. A satisfactory performance for study indicators was determined by the LQAS decision rules. There was high awareness of COVID-19, with 98.2% of women and 99.3% of men having heard of the pandemic. However, knowledge of at least four COVID-19 preventive measures was low, reported by only 45.4% of women and 48.6% of men. Adherence to social distancing measures in the previous 24 hours was modest, with 67.2% of men and 66.5% of women complying. There was a pronounced lack of hand hygiene, with only 24.8% of women and 19.0% of men frequently washing their hands or using hand sanitizer. COVID-19 vaccine uptake was relatively high for the first dose, with 83.5% of women and 83.0% of men receiving at least one dose. However, full vaccination coverage was low, at 37.5% for women and 41.5% for men. A hesitancy to get vaccinated was driven by fear of side effects, misinformation, doubts about vaccine effectiveness, long distances and queues, and beliefs that vaccines cause infertility. While awareness of COVID-19 was high, knowledge of preventative measures was lacking. The low vaccination rates highlight barriers to uptake. A tailored, trust-based messaging approach through community leaders was recommended to address these gaps. Inter-district and inter-SA disparities indicated the need for localized interventions.

Artificial intelligence (AI) in mammography screening has shown promise in retrospective evaluations, but few prospective studies exist. PRAIM is an observational, multicenter, real-world, noninferiority, implementation study comparing the performance of AI-supported double reading to standard double reading (without AI) among women (50–69 years old) undergoing organized mammography screening at 12 sites in Germany. Radiologists in this study voluntarily chose whether to use the AI system. From July 2021 to February 2023, a total of 463,094 women were screened (260,739 with AI support) by 119 radiologists. Radiologists in the AI-supported screening group achieved a breast cancer detection rate of 6.7 per 1,000, which was 17.6% (95% confidence interval: +5.7%, +30.8%) higher than and statistically superior to the rate (5.7 per 1,000) achieved in the control group. The recall rate in the AI group was 37.4 per 1,000, which was lower than and noninferior to that (38.3 per 1,000) in the control group (percentage difference: −2.5% (−6.5%, +1.7%)). The positive predictive value (PPV) of recall was 17.9% in the AI group compared to 14.9% in the control group. The PPV of biopsy was 64.5% in the AI group versus 59.2% in the control group. Compared to standard double reading, AI-supported double reading was associated with a higher breast cancer detection rate without negatively affecting the recall rate, strongly indicating that AI can improve mammography screening metrics. In a large-scale prospective study run across 12 sites in Germany and involving 463,094 women and 119 radiologists, AI-supported screening increased breast cancer detection rates by a significant margin without affecting the recall rate.

Screening and vaccination against Hepatitis B virus (HBV) infection remains the most effective intervention in curbing the disease. However, there is limited evidence on the factors associated with the uptake of these services in Uganda. This study determined the uptake of HBV screening and vaccination status, and associated factors among Healthcare Providers (HCPs) in Wakiso district, Uganda. This cross-sectional study was conducted among 306 HCPs, randomly selected from 55 healthcare facilities. Prevalence ratios (PR) were used to determine the factors associated with HBV screening and vaccination status of HCPs. Of the 306 HCPs, 230 (75.2%) had ever screened for HBV infection while 177 (57.8%) were fully vaccinated. Being male was positively associated with 'ever been screened' for HBV infection (Adjusted PR = 1.27, 95%CI 1.13-1.41). Working in a public healthcare facility (Adjusted PR = 0.78, 95%CI 0.68-0.90) was negatively associated with ever been screened. Male sex (Adjusted PR = 1.21, 95%CI 1.01-1.46), the belief that the HBV vaccine was safe (Adjusted PR = 1.72, 95%CI 1.03-2.89) and ever been screened (Adjusted PR = 2.28, 95%CI 1.56-3.34) were positively associated with being fully vaccinated. However, working in a public healthcare facility (Adjusted PR = 0.79, 95%CI 0.64-0.98), self-perceived risk of HBV infection (Adjusted PR = 0.72, 95% CI:0.62-0.84), and working in a healthcare facility with infection control guidelines (Adjusted PR = 0.79, 95%CI 0.66-0.95) were negatively associated with being fully vaccinated. Three quarters of HCPs had ever been screened for HBV while slightly more than half were fully vaccinated. HBV screening and vaccination interventions need to consider the HCP sex, risk perception, attitude towards safety and efficacy of the hepatitis B vaccine, and healthcare facility characteristics such as ownership and availability of infection control guidelines, in order to be successful.

This paper is based on the deliberations of the Assessment Working Group at EDUsummIT 2015 in Bangkok, Thailand. All of the members of Thematic Working Group 5 (TWG5) have contributed to this synthesis of potentials, concerns and issues with regard to the role of technology in assessment as, for and of learning in the 21^(st) century. The group decided to focus primarily on formative assessment rather than summative assessment and high stakes testing. Formative assessments and feedback provide an important opportunity to support and enhance student learning. Recognizing shifts in education towards blended and online learning with problem-based and inquiry-based approaches led to considerations of technologies that could effectively support formative assessment and informative feedback to 21^(st) century learners. The paper concludes with a summary of conclusions and recommendations of the working group to be taken up in subsequent efforts.

IntroductionIn Uganda, fisherfolk have an HIV prevalence between 15% and 40%, significantly higher than the national average of 5.5%. Pre-exposure prophylaxis (PrEP) is effective in preventing HIV but faces challenges in uptake and continuation among fisherfolk. This study explores factors influencing PrEP continuation and discontinuation among fisherfolk in Uganda using the Consolidated Framework for Implementation Research (CFIR).MethodsParticipants were recruited from two fishing communities near Entebbe, Uganda. One community received enhanced PrEP support (adherence support, educational workshops and check-in calls), while the other received standard healthcare outreach. Forty fisherfolk (20 who continued PrEP and 20 who discontinued PrEP) were interviewed 6 months after initiating PrEP. Data were analysed using directed content analysis, with high inter-rater consistency. Ethical approval and informed consent were obtained.ResultsFindings highlighted several determinants of PrEP continuation and discontinuation across the CFIR domains. Intervention characteristics such as side effects and the pill burden were significant barriers, particularly for women who reported nausea and stomach issues. Individual characteristics revealed that perceived HIV risk influenced PrEP use, with women’s decisions often influenced by their partners' behaviours and mobility. However, insufficient information and education, especially among women, led to misunderstandings and discontinuation. Inner-setting factors like mobility issues and the distance to healthcare clinics posed significant barriers exacerbated by the geographical isolation of fishing communities. In the outer setting, high HIV prevalence motivated PrEP initiation, but stigma, particularly the misconception that PrEP is an antiretroviral drug used by people living with HIV, led to discontinuation.ConclusionFisherfolk in Uganda encounter multiple barriers to PrEP continuation, with women facing more significant challenges. Enhanced support strategies are essential for improving PrEP adherence and informing future HIV prevention interventions in high-risk populations.

Poor solid waste management is among the major challenges facing urban slums in developing countries including Uganda. Understanding community concerns and willingness towards involvement in solid waste management improvement initiatives is critical for informing interventions in slums. Methods. We used a cross-sectional study to collect quantitative data from 435 residents in two urban slums in central Uganda. A semistructured questionnaire was used which assessed waste collection practices, separation and disposal methods, concerns regarding solid wastes, and willingness to participate in waste separation and composting. Data was analysed using STATA 12. Results. Food remains (38%) and plastics (37%) formed the biggest proportion of wastes generated in households. Most households (35.9%) disposed of general wastes by open dumping while 27% disposed of plastics by burning. Only 8.8% of households conducted composting while 55% carried out separation for some decomposable wastes. Separation was carried out for only banana peelings and leftover foods for feeding animals. Respondents expressed high willingness to separate (76.6%) and compost (54.9%) solid wastes. Conclusion. Practices in waste disposal and separation were poor despite high willingness to participate in initiatives to improve waste management, highlighting a need for authorities to engage residents of slums to improve their practices.