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Introduction: Successful population‐level antiretroviral therapy (ART) adherence will be necessary to realize both the clinical and prevention benefits of antiretroviral scale‐up and, ultimately, the end of AIDS. Although many people living with HIV are adhering well, others struggle and most are likely to experience challenges in adherence that may threaten virologic suppression at some point during lifelong therapy. Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource‐limited settings. Methods: In July 2015, the Bill and Melinda Gates Foundation convened a meeting to discuss the most promising ART adherence interventions for use at scale in resource‐limited settings. This article summarizes that discussion with recent updates. It is not a systematic review, but rather provides practical considerations for programme implementation based on evidence from individual studies, systematic reviews, meta‐analyses, and the World Health Organization Consolidated Guidelines for HIV, which include evidence from randomized controlled trials in low‐ and middle‐income countries. Interventions are categorized broadly as education and counselling; information and communication technology‐enhanced solutions; healthcare delivery restructuring; and economic incentives and social protection interventions. Each category is discussed, including descriptions of interventions, current evidence for effectiveness, and what appears promising for the near future. Approaches to intervention implementation and impact assessment are then described. Results and discussion: The evidence base is promising for currently available, effective, and scalable ART adherence interventions for resource‐limited settings. Numerous interventions build on existing health care infrastructure and leverage available resources. Those most widely studied and implemented to date involve peer counselling, adherence clubs, and short message service (SMS). Many additional interventions could have an important impact on ART adherence with further development, including standardized counselling through multi‐media technology, electronic dose monitoring, decentralized and differentiated models of care, and livelihood interventions. Optimal targeting and tailoring of interventions will require improved adherence measurement. Conclusions: The opportunity exists today to address and resolve many of the challenges to effective ART adherence, so that they do not limit the potential of ART to help bring about the end of AIDS.

Introduction. Antiretroviral therapy (ART) in resource-limited settings has expanded in the last decade, reaching >8 million individuals and reducing AIDS mortality and morbidity. Continued success of ART programs will require understanding the emergence of HIV drug resistance patterns among individuals in whom treatment has failed and managing ART from both an individual and public health perspective. We review data on the emergence of HIV drug resistance among individuals in whom first-line therapy has failed and clinical and resistance outcomes of those receiving second-line therapy in resource-limited settings. Results. Resistance surveys among patients initiating first-line nonnucleoside reverse-transcriptase inhibitor (NNRTI)—based therapy suggest that 76%—90% of living patients achieve HIV RNA suppression by 12 months after ART initiation. Among patients with detectable HIV RNA at 12 months, HIV drug resistance, primarily due to M184V and NNRTI mutations, has been identified in 60%—72%, although the antiretroviral activity of proposed second-line regimens has been preserved. Complex mutation patterns, including thymidine-analog mutations, K65R, and multinucleoside mutations, are prevalent among cases of treatment failure identified by clinical or immunologic methods. Approximately 22% of patients receiving second-line therapy do not achieve HIV RNA suppression by 6 months, with poor adherence, rather than HIV drug resistance, driving most failures. Major protease inhibitor resistance at the time of second-line failure ranges from 0% to 50%, but studies are limited. Conclusions. Resistance of HIV to first-line therapy is predictable at 12 months when evaluated by means of HIV RNA monitoring and, when detected, largely preserves second-line therapy options. Optimizing adherence, performing resistance surveillance, and improving treatment monitoring are critical for long-term prevention of drug resistance.

The broad availability of smartphones has provided new opportunities to develop less expensive, portable, and integrated point-of-care (POC) platforms. Here, a platform that consists of three main components is introduced: a portable housing, a centrifugal microfluidic disc, and a mobile phone. The mobile phone supplies the electrical power and serves as an analysing system. The low-cost housing made from cardboard serves as a platform to conduct tests. The electrical energy stored in mobile phones was demonstrated to be adequate for spinning a centrifugal disc up to 3000 revolutions per minute (RPM), a rotation speed suitable for majority of centrifugal microfluidics-based assays. For controlling the rotational speed, a combination of magnetic and acoustic tachometry using embedded sensors of the mobile phone was used. Experimentally, the smartphone-based tachometry was proven to be comparable with a standard laser-based tachometer. As a proof of concept, two applications were demonstrated using the portable platform: a colorimetric sandwich immunoassay to detect interleukin-2 (IL-2) having a limit of detection (LOD) of 65.17 ng/mL and a fully automated measurement of hematocrit level integrating blood-plasma separation, imaging, and image analysis that takes less than 5 mins to complete. The low-cost platform weighing less than 150 g and operated by a mobile phone has the potential to meet the REASSURED criteria for advanced diagnostics in resource limited settings.

Background The survival rates for children and adolescents with osteosarcoma in low-income countries are poor. Insufficient data regarding the challenges of managing osteosarcoma in resource-limited settings has been published. We evaluated the treatment of osteosarcoma in children and adolescents with the aim of improving the health system and management outcomes. Methods We sourced data on children under 18 years treated for osteosarcoma at the Uganda Cancer Institute between January 2016 and December 2020. Descriptive statistics and Kaplan-Meier survival analysis were used. Results Seventy-four osteosarcoma cases were identified, with a median age of 13 years (IQR 9.8–15). Referrals were made after a median of 28 days (range 1-147). Before appropriate referral, more than a quarter (26%) had undergone invasive procedures that could compromise tumour integrity and outcome. Half (50%) of the patients had metastatic disease at diagnosis, primarily to the lungs ( n  = 43; 92%). Only 14 (33%) patients received neoadjuvant chemotherapy. Forty-three (58.1%) patients underwent limb amputation surgery, including 25 localized tumours and 18 patients with distant metastatic disease. No metastatectomies were performed. Adjuvant chemotherapy was delayed for longer than 21 days in 26 (61%) patients. No pathology reports described the status of resection margins or the degree of chemotherapy-induced necrosis. Twenty-six (35%) patients abandoned treatment, mainly due to pending radical surgery ( n  = 18/26; 69%). Only 18% ( n  = 13) were still alive; 46% ( n  = 34) had died; and 37% ( n  = 27) had an unknown status. The median overall survival was 1.1 years, and was significantly negatively affected by disease metastasis, timing of adjuvant therapy, and treatment abandonment. Conclusions Osteosarcoma outcomes for children and adolescents at the Uganda Cancer Institute are extremely poor. The quality of care can be improved by addressing delayed referrals, high rates of prior manipulative therapy, metastatic disease, treatment abandonment, surgical challenges, and delayed resumption of adjuvant chemotherapy.

Background When WHO declared the SARS-CoV- 2 respiratory virus pandemic in 2020, Uganda was unprepared to prevent and control its spread or manage the COVID- 19 and non-COVID patients. A community trial to assess the efficacy of an intensive community engagement and risk communication (CERC) was contemplated. However, a baseline assessment of the existing CERC status and the challenges of conducting community research in the early months of the pandemic was necessary. Methods A community baseline qualitative research (in-depth interviews, key informant interviews, focus group discussions, and household conversations) was implemented in 15 parishes (6 and 9 in Kawempe and Nakawa divisions respectively) of Kampala Capital City Authority, Uganda. Qualitative in-depth interviews with 20 household heads ( n  = 10 in each division), 50 household conversations ( n  = 25 in each division), and focus group discussions ( n  = 10, five in each division) were conducted during the pandemic from October 2020 to February 2021. Results Many potential challenges to research involving CERC were identified and were categorized into three main interrelated domains: (a) implementation challenges (b) social, cultural, and political context of the research, and (c) budgetary and funding constraints. Conclusions The three interrelated challenges identified in this study should be considered in future plans for epidemic and pandemic preparedness. The practical application of conventional concepts like CE, risk communication, qualitative research methods must be re-examined prior to epidemics and pandemics to improve their applicability and responsiveness during complex, dynamic epidemics and pandemics.

The aim of this study was to address the problems associated with polypharmacy in elderly cancer patients and to highlight the role of pharmacists in such cases in resource‐limited settings. A narrative review of existing literature was performed to summarize the evidence regarding the impact of polypharmacy in elderly cancer patients and the pharmaceutical strategies to manage it. This review emphasizes the significance of polypharmacy, which is often ignored in real clinical practice. Polypharmacy in the elderly cancer population is mainly due to: chemotherapy with one or more neoplastic agents for cancer treatment, treatment for adverse drug reactions due to neoplastic agents, the patient's comorbid conditions, or drug interactions. The role of the clinical pharmacist in specialized oncology hospitals or oncology departments of tertiary care hospitals is well established; however, this is not the case in many developing countries. A clinical pharmacist can contribute to solving the problems associated with polypharmacy by identifying the risks associated with polypharmacy and its management in resource‐limited settings. As in many developed countries, the involvement of a clinical pharmacist in cancer care for elderly patients may play a vital role in the recognition and management of polypharmacy‐related problems. Further research can be conducted to support this role.

Background and Aim Mathematical modelling plays an important role in public health by enabling the prediction of disease outbreaks, assessment of transmission dynamics and evaluation of intervention strategies. Although widely applied in high‐resource settings, its use in underserved contexts remains underexplored. This review aimed to examine and synthesize current evidence on the application of mathematical modelling for predicting and controlling infectious diseases in underserved settings. Methods A comprehensive and reproducible search was conducted using Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) and population, intervention, comparison and outcome (PICO) frameworks across databases, including PubMed, Scopus, Medline, ScienceDirect and EBSCOhost. Keywords and Medical Subject Headings (MeSH) terms related to mathematical modelling and infectious disease control were applied. Two reviewers independently screened titles, s and full texts, with a third resolving discrepancies. Thematic analysis and meta‐analysis were used for synthesis. Results Out of 838 studies screened, 27 (3.2%) met inclusion criteria. Deterministic models were most used, followed by stochastic and agent‐based models. Diseases modelled included COVID‐19, malaria, tuberculosis (TB), Ebola, Zika, chikungunya, dengue, diphtheria, respiratory infections, visceral leishmaniasis (VL) and Mpox. Modelling predicted the impact of interventions on transmission, with pooled effect size (Ro) of 1.32 (θ = 1.3, p < 0.0001). However, challenges, such as data underreporting, gaps and inconsistencies, were common, potentially affecting model accuracy and real‐world applicability. Conclusion Mathematical modelling has demonstrated value in supporting infectious disease control in underserved settings. However, the predominance of deterministic models limits adaptability across diverse contexts. Poor data quality further constrains reliability. Future work should focus on expanding modelling approaches, strengthening data infrastructure and addressing a broader range of diseases. These findings can guide public health policy by supporting data‐driven decision‐making, improving resource allocation and integrating modelling into outbreak preparedness and response strategies in underserved settings.

Rapid identification of bacterial species from patient samples is crucial for clinical decision‐making. In severe infections, such as bloodstream infections, the early start of an effective treatment is directly associated with reduced mortality rates. Current rapid species identification methods, such as matrix‐assisted laser desorption ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS) or multiplex PCR, require specialized hardware and extensive technical support that prevents application in resource‐limited settings. Here, we present a staining and imaging procedure for bacterial smears using fluorescent dyes directed against intracellular structures and cell wall components. Data on relevant features were extracted from segmented images and used to train a machine learning (ML) model for species classification. The method was tested on clinical isolates from 126 patients. For the seven most common bacteria, the classification performance, indicated by area under the receiver operating characteristic (ROC) curve, ranged from 0.8 (Klebsiella pneumoniae) to 1 (Pseudomonas aeruginosa). Species that were not part of the training dataset, were reliably classified as unknown species. These results hold promise for the identification of further species, particularly Enterobacterales, and clinical application. Impact statement This study introduces a cost‐effective method for bacterial species identification using fluorescent dyes and machine learning, reducing reliance on expensive equipment and specialized expertise. Tested on clinical samples from 126 patients, the technique achieved high accuracy for common bacteria like Pseudomonas aeruginosa and reliably flagged unknown species. Its simplicity and adaptability make it ideal for resource‐limited settings, offering faster diagnostic results to inform life‐saving treatments, especially for severe infections like bloodstream infections. This innovation has the potential to improve global healthcare by expanding access to advanced microbiological diagnostics and combating antibiotic resistance.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive hematological malignancy with limited treatment options and poor prognosis. This case report presents the clinical course and management of a 62-year-old man with BPDCN in a resource-limited setting. The patient presented with constitutional symptoms and abnormal complete blood count findings. Initial treatment was performed with an acute lymphoblastic leukemia–based chemotherapy regimen, and the patient achieved complete remission, but the disease recurred 7 months after the initial diagnosis was confirmed in April 2022. The subsequent therapy was not effective, and the patient died during treatment. This case highlights the challenges in managing BPDCN and the need for further research to improve outcomes.

Introduction Informing children of their own HIV status is an important aspect of long‐term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource‐limited settings and its impact. Methods MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*). We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource‐limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers. Results Thirty‐two articles met the inclusion criteria, with 16 reporting prevalence of disclosure. Of these 16 studies, proportions of disclosed children ranged from 0 to 69.2%. Important factors influencing disclosure included the child's age and perceived ability to understand the meaning of HIV infection and factors related to caregivers, such as education level, openness about their own HIV status and beliefs about children's capacities. Common barriers to disclosure were fear that the child would disclose HIV status to others, fear of stigma and concerns for children's emotional or physical health. Disclosure was mostly led by caregivers and conceptualized as a one‐time event, while others described it as a gradual process. Few studies measured the impact of disclosure on children. Findings suggested adherence to antiretroviral therapy (ART) improved post‐disclosure but the emotional and psychological effects of disclosure were variable. Conclusions Most studies show that a minority of HIV‐infected children in resource‐limited settings know his/her HIV status. While caregivers identify many factors that influence disclosure, studies suggest both positive and negative effects for children. More research is needed to implement age‐ and culture‐appropriate disclosure in resource‐limited settings.