Most people around the world do not have access to facility-based diagnostic testing and the gap in availability of diagnostic tests is a major public health challenge. Testing outside conventional clinical settings are transforming infectious disease diagnostic testing especially in low- and middle-income countries (LMICs). We conducted a systematic review and meta-analysis, searching six databases and including original research manuscripts comparing testing outside clinics with conventional testing. Main outcomes were test uptake and linkage to care, delivery models and adverse outcomes. We identified 76 studies which were included. Data from 18 studies were pooled in meta-analyses. Studies focused on HIV (48), chlamydia (8), and multiple diseases (20). HIV self-testing increased test uptake compared with facility-based testing (nine studies, pooled OR 2.59, 95%CI = 1·06–6·29, moderate quality). STI self-sampling increased test uptake compared with facility-based testing (seven studies, pooled OR 1.74 95% CI=0.97 – 3.12, moderate quality). Innovative and other digital test delivery services improved test uptake compared with facility-based testing services. We defined digital as emails, websites, instant messaging, or related internet approaches. Our work shows testing outside of clinics increased test uptake without significant adverse outcomes. These testing approaches provide an opportunity to expand access and empower patients through innovative delivery models. From the policy viewpoint, this work demonstrates that the use of digital technology in testing outside clinics is a useful strategy for improving infectious diseases screening and linkage to care, and policies that aim to promote the use of these strategies are needed. These models may be especially useful for diseases associated with stigmatization such as HIV and other STIs in LMICs. However, inherent challenges include ensuring linkage to care continuum, quality assured testing and getting the right tests to the right people. Further implementation research and scale-up of effective decentralized models in LMIC settings is needed.

Background: HIV counselling is increasingly available in public health facilities in Uganda.Counselling is an entry point into care, treatment and support services of many HIV/AIDS prevention programs.Quality of HCT services have significant role on prognosis of HIV patients.This study assessed the quality of HIV counselling services offered in public health facilities in Kampala by reviewing adherence to the HIV Counselling and Testing (HCT) policy guidelines, content of counselling information offered to clients and health facility amenities.Methods: This was a cross-sectional study conducted in 2016 utilizing quantitative methods of data collection.Quality of HIV counseling was defined in accordance with adherence to the HCT guidelines, offering 'good' content of counselling information and health facilities having adequate amenities.We used principal component analysis to obtain and reveal current composite scores of the variables.Data were summarized into frequencies and proportions using STATA, version 13.0.Scores below 70% were considered as 'poor' quality.Results: In this study, 74 health workers offering HIV counselling services at five public health facilities were interviewed.The study revealed that quality of HIV counselling at the five public health facilities was 'poor' as 74% of the health workers offered 'poor' quality HIV counselling and only one out of five health facilities was found to have adequate amenities.Majority (74.3%) of the health workers were found not to adhere to HCT guidelines.In addition, 67.6% of the health workers offered 'poor' content of counseling information. Conclusion:Overall quality of HIV counselling was found to be poor.Improvements should be focused on mentorship programs for all health workers involved in HIV counselling.Provision of modest space for counselling is also required so as to ensure privacy during counselling sessions.

This paper examines the status and evaluates the progress made towards the establishment of a management information system (MIS) for public administration in Uganda as well as considering the information needs of public administration in the country. The study focuses on the information systems of two central government ministries, the Ministry of Health (MoH) and the Ministry of Finance, Planning and Economic Development (MFPED), and the local administration of five districts. In addition to a literature review, questionnaires were administered to 530 respondents. Data collected was analysed using both quantitative and qualitative techniques. The Study reveals that although public administration in Uganda is based on New Public Management (NPM), an approach which exploits IT-based MIS, the information system that is in place is still dependant on printed data. Computer supplies are dismally inadequate, favour central as opposed to local government, and use of basic applications such as word-processing, constitutes the bulk Of Computer competency. Thus, the application of a management information system within a networked-computer environment barely exists. The study recommends developing ICT policy, strengthening MIS training, developing MIS infrastructure and providing and developing sectoral information analysis centres with relevant rights and obligations.

SETTING: Mulago Hospital, Kampala, Uganda.OBJECTIVE: To evaluate the diagnostic performance of fluorescence microscopy (FM) for diagnosing pulmonary tuberculosis (TB) in a high human immunodeficiency virus (HIV) prevalence setting.DESIGN: Consecutive in-patients with cough for >2 weeks submitted two sputum specimens for smear microscopy. Smears were examined by conventional light microscopy (CM) and FM. The performance of the two methods was compared using mycobacterial culture as a reference standard.RESULTS: A total of 426 patients (82% HIV infected) were evaluated. FM identified 11% more smear-positive patients than CM (49% vs. 38%, P < 0.001). However, positive FM results were less likely than positive CM results to be confirmed by culture when smears were read as either 'scanty' (54% vs. 90%, P < 0.001) or 1+ (82% vs. 91%, P = 0.02). Compared to CM, the sensitivity of FM was higher (72% vs. 64%, P = 0.005), and the specificity lower (81% vs. 96%, P < 0.001). In receiver operating characteristic analysis, maximum area under the curve for FM was obtained at a threshold of >4 acid-fast bacilli/100 fields (sensitivity 68%, specificity 90%).CONCLUSION: Although FM increases the sensitivity of sputum smear microscopy, additional data on FM specificity and on the clinical consequences associated with false-positive FM results are needed to guide implementation of this technology in high HIV prevalence settings.