In Uganda, where malaria transmission is high, insecticide treated nets (ITNs) have been distributed nationwide every 3 years since 2013. In West Nile, northern Uganda, indoor residual spraying (IRS) was first implemented with clothianidin-deltamethrin (Fludora Fusion®) in 2022, followed by pirimiphos-methyl (Actellic® 300CS) in 2023. We utilised a quasi-experimental study to assess the impact of IRS + ITNs on malaria incidence in West Nile. Data were collected from three malaria reference centres (MRCs) in West Nile (IRS + ITNs, intervention) and five MRCs in neighbouring Acholi (ITNs only, control) over 4 years: (1) Baseline (December 2020–November 2022), prior to IRS; (2) IRS-1 (December 2022–December 2023) following IRS with clothianidin-deltamethrin; (3) IRS-2 (January 2024–December 2024) following IRS with pirimiphos-methyl. The primary outcome was monthly malaria incidence from each MRC target area per 1000 person-years. Data were analysed using negative binomial regression models with a difference-in-difference approach, comparing pre-post trends in malaria incidence between arms. Adjusted models accounted for 2-month lagged rainfall and seasonality. During IRS-1, mean observed malaria incidence fell from baseline in both arms (intervention: 720.9 to 547.9; and control: 523.4 to 455.2 per 1000 person-years). We detected a 15
Adolescents and young adults account for a large proportion of new HIV cases, and this age subgroup has worse outcomes across the HIV care continuum than adults. The lack of harmonization of data elements from implementation science trials is an important barrier that limits the learning across settings and the ability to accelerate adoption of effective implementation strategies. We aim to close this gap by assessing the ability to harmonize data elements across seven studies in the Prevention and Treatment through a Comprehensive Care Continuum for HIV-affected Adolescents in Resource Constrained Settings (PATC3H) consortium. The PATC3H team initiated a collaborative process to prospectively develop harmonized measures and then retrospectively implement additional harmonization based on data collected. We harmonized items on socio-demographic characteristics (12 items), economic stress (8 items), social support (12 items), sexual behaviors (20 items), mental health (24 items), substance use (33 items), HIV care continuum (11 items), and implementation science (126 items) for two or more of the studies. We present analysis of selected harmonized measures that revealed similarities and differences across studies which will be important to consider in future comparative assessments. Key lessons learned are that flexibility is required to collect measures across multiple settings, specifying minimum sample sizes will support meaningful analysis and identifying core measures can help prioritize data elements that can be consistently collected. The PATC3H consortium collaboration has shown that it is feasible to collect harmonized data across implementation science trials and future studies can build on these harmonization efforts.
RATIONALE:Air pollution and pneumonia are both associated with respiratory morbidity and disproportionately impact resource-limited settings. However, the impact of air pollution on lung health in these settings is incompletely understood. We characterized the relationship between personal PM2.5 exposure and lung function among adults who have recovered from pneumonia in Kampala, Uganda. METHODS:Adults 18 to 60 years old who had recovered from pneumonia completed spirometry and diffusing capacity for carbon monoxide (DLco) testing following 48 hours of personal PM2.5 exposure measurement, between June 2021 and April 2023. We fit linear and logistic regression models to characterize the relationship between personal PM2.5 exposure and lung function. Models were adjusted for age, sex, smoking status, HIV, and socioeconomic status and were assessed for effect modification using interaction terms and stratified models. RESULTS:Among 96 participants, the median age was 32.5 years, 48% were women, 53% were people with HIV, and 9% were diagnosed with chronic obstructive pulmonary disease (COPD). Median personal PM2.5 exposure was 67 µg/m3, although 67% of participants reported their home air quality as excellent or good. Personal PM2.5 exposure did not differ by sex, HIV serostatus, or type of pneumonia. In adjusted models, a 1-µg/m3 increase in PM2.5 was associated with decreased forced expiratory volume in 1 second (β = -3.16; 95% CI, -5.59 to -0.74), forced vital capacity (β = -3.09; 95% CI, -5.51 to -0.66), and DLco (β = -0.04; 95% CI, -0.06 to -0.02) and with increased odds of COPD (adjusted odds ratio, 1.01; 95% CI, 1.00 to 1.02). There was no evidence of effect modification by sex, HIV, tuberculosis pneumonia, or socioeconomic status. CONCLUSION:Among adults who had recovered from pneumonia in Kampala, PM2.5 was associated with reduced lung function, highlighting the importance of air pollution exposure mitigation in improving chronic lung health among vulnerable populations in resource-limited settings. Future work must differentiate PM2.5 sources in these settings to inform regionally appropriate mitigation efforts.
Compared with older adults, adolescents and young adults (AYA) face greater HIV incidence and poorer outcomes across the HIV prevention and care continuum. Despite the high HIV burden, youth in sub-Saharan Africa have suboptimal uptake rates of oral preexposure prophylaxis (PrEP) and viral suppression. Although effective interventions are available, AYA exhibit low uptake and persistence due to stigma, pill burden, and accessibility challenges. The HIV Prevention and Care Interventions for Youth in Uganda (HIP-CY) study aims to explore the adoption and effectiveness of cabotegravir (CAB LA), a new long-acting injectable antiretroviral and highly efficacious PrEP choice that can mitigate barriers to the use of daily oral PrEP among AYA at heightened risk of HIV acquisition, and the SEARCH-YOUTH intervention, an efficacious multilevel strategy for improving virologic suppression in AYA aged 15–24 years living with HIV in East Africa. The HIP-CY study uses a type II hybrid (effectiveness-implementation) design to evaluate the feasibility, acceptability, fidelity, and cost-effectiveness of two evidence-based HIV prevention and care interventions (CAB LA and SEARCH-YOUTH) across five geographically distinct urban, semiurban, and rural sites in Uganda. We use the CFIR and RE-AIM frameworks to guide data collection and analysis. Our findings will provide insights into differentiated service delivery models for CAB LA and support policies that integrate CAB LA and contextualized multilevel HIV care interventions (SEARCH-YOUTH) for AYA in real-world health service delivery to reduce the incidence of HIV in Ugandan youth. Stakeholder engagement will inform scalable, policy-aligned solutions for sustainable HIV prevention and care and contribute to broader HIV control efforts across SSA. NCT06474364 Registered 13 June 20 244, https://clinicaltrials.ucsf.edu/trial/NCT06474364. Protocol version 6, dated 16 April 2025. Amendments from versions 1 to 4 incorporated REC recommendations and updated the Investigators Roster. Protocol versions 4 to 6 were updated to align with the Ministry of Health directive on integrating HIV care into chronic medical conditions.
ABSTRACT The emergence and spread of drug resistance threaten malaria control in Uganda. This study reports new data on key polymorphisms associated with antimalarial drug sensitivity at 32 malaria reference centers in Uganda in 2023 and 2024. Ten thousand thirty samples were collected from patients aged >6 months presenting with uncomplicated falciparum malaria and sequenced using the MAD 4 HatTeR panel and Illumina platforms; of these, 8,518 passed quality control and were analyzed. Multiple validated or candidate K13 mutations associated with artemisinin partial resistance were detected at ≥20% prevalence at one or more sites across multiple timepoints. The K13 mutations A675V and C469Y predominated in northern Uganda, P441L was most common in western Uganda, and R561H and C469F were confined to southwestern Uganda. After rapid increases in earlier years, prevalences of K13 mutations plateaued at most sites, with A675V, C469Y, and P441L reaching maximum site prevalences of 40%, 58%, and 46%, respectively. Prevalence of the chloroquine resistance marker CRT K76T was generally low but increased substantially at three sites in northwestern Uganda, rising to 38% at the last timepoint, with CRT H97L, newly reported in Africa, following a similar trend. The antifolate resistance quintuple mutant haplotype remained highly prevalent nationwide. In addition, DHPS A581G and DHFR I164L, markers of higher-level antifolate resistance, were most common in southwestern Uganda with prevalences up to 64% and 76%, respectively; DHFR I164L also expanded into central and eastern regions. These results highlight continued geographic heterogeneity and underscore the need for continued, nationwide molecular surveillance to guide treatment and chemoprevention policies.
