Background:In resource-rich regions, such as the U.S. and Europe, the incidence of Kaposi sarcoma (KS) amongst persons living with HIV (PWH) has dramatically declined with the advent of combination antiretroviral therapy (ART). In contrast, in low- and middle-income countries (LMICs), much less is known, particularly since the World Health Organization's recommendation in late 2015 to use ART in all PWH. We take advantage of the coincident electronic clinical data capture at HIV care facilities to estimate the incidence of KS among PWH in care with ready access to ART, piloting a data validation approach to address errors in these routine clinic data. Methods:We evaluated PWH enrolled from January 2010 to December 2019 in 13 HIV care clinics in 8 countries participating in the East Africa (EA-IeDEA) and Caribbean, Central and South America (CCASAnet) regions of the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium. Selected measurements were validated via chart review on a subset of PWH, and we estimated KS incidence in both unvalidated and validated data via generalized raking techniques. Results:A total of 235,474 PWH from EA-IeDEA and 19,683 from CCASAnet gave rise to 719 and 103 incident cases of KS, respectively. A total of 824 eligible records were validated. ART use was substantially lower in EA-IeDEA than CCASAnet in 2010 but equalized by 2019. From 2010 to 2019, KS incidence decreased on average 21% per year (incidence rate ratio [IRR] 0.79; 95% CI 0.75-0.82) in EA-IeDEA but only 6% (IRR=0.94; 95% CI 0.83-1.06) in CCASAnet. Conclusions:Among PWH attending HIV care facilities in East Africa, we observed a trend suggesting a reduction in KS incidence that paralleled increased Treat All era ART use in these clinics. In the Caribbean, Central and South America, there was hardly a change in the incidence, despite high-frequency ART use in the region as well.

BACKGROUND:Data on the population-scale impact of dolutegravir (DTG)-based HIV regimens in sub-Saharan Africa are extremely limited. We used data from a surveillance cohort in southern Uganda to assess viral suppression and antiretroviral (ART) resistance over 10-years alongside DTG scale-up. METHODS:Consenting participants in the population-based Rakai Community Cohort Study between August 2011 and March 2023 aged 15-49 completed questionnaires and provided samples for HIV testing, viral load quantification, and viral deep-sequencing. We collected data on DTG utilization at HIV care clinics. We estimated the prevalence of HIV suppression and ART resistance using robust Poisson regression. Bayesian logistic regression quantified associations between resistance and individual-level suppression across surveys. RESULTS:Among 8781 people with HIV (PWH), suppression increased from 57.1% (2014, 95% confidence interval [CI], 55.4%-58.8%) to 90.3% (2022, 95% CI, 89.2%-91.4%). By 2020 84.4% (95% CI, 83.7%-85.2%) and 64.6% (95% CI, 63.9%-65.3%) of men and women on ART were on DTG. Among treatment-experienced viremic PWH, any intermediate/high resistance decreased from 51.1% (95% CI, 40.7%-64.2%, 2014) to 27.9% (95% CI, 21.3%-36.5%, 2022). Two of 258 (0.8%) 2022 participants harbored intermediate/high-level DTG resistance (inQ148R, inE138K, and inG140A). inS153Y (2-fold INSTI resistance) was observed in 23/306 (7.5%) of viremic individuals, with evidence of transmission. By 2022, NNRTI/NRTI resistance was not associated with a reduction in individual-level suppression (risk ratios: 1.15, 95% HPD: 0.93-1.39; 1.14, 0.86-1.42). CONCLUSIONS:Viral suppression increased during the DTG transition with minimal emerging intermediate/high-level resistance. Falling resistance among treatment-experienced PWH underscores the role of ART adherence in reducing viremia. The emergence of inS153Y justifies continued surveillance.

Cognitive complications remain common among people with HIV (PWH) globally, yet social cognition, critical for daily functioning, has received little attention, particularly in sub-Saharan Africa. We examined facial emotion perception (FEP), a core social cognitive process, among 235 PWH and 224 people without HIV (PWoH) from the Rakai Neurology Cohort Study. FEP was assessed using the FEP task and associations with cognitive and psychosocial factors were examined. While overall accuracy did not differ between groups, PWH demonstrated greater fear bias (Cohen’s d = 0.20, 95

INTRODUCTION:Prior studies showed that some female bar workers (FBWs) may engage in sex work in Africa. However, population-level data on HIV burden among FBWs in African settings are rare. METHODS:We used five survey rounds of data (2011-2020) from the Rakai Community Cohort Study, a population-based HIV surveillance cohort in 36 inland agrarian/trading communities (HIV prevalence∼12%) and four Lake Victoria fishing communities(∼40%) in southern Uganda. Women reporting bar work as a primary or secondary occupation were identified and compared to non-FBWs. Primary outcomes included HIV seropositivity, incident infection, viral suppression (<200copies/ml) among women with HIV, and population prevalence of viremia. Prevalence ratios (PRs) and incidence rate ratios (IRRs) were estimated using Poisson regression with 95% confidence intervals (CIs). RESULTS:Among 23,556 female participants contributing 52,708 person-visits, 1,205(5.1%) self-identified as FBWs, who had significantly higher baseline HIV seroprevalence than non-FBWs (51.9%vs.18.5%;PR=2.81,95%CI=2.64-2.95). There were 356 incident infections over 39,228 person-years. HIV incidence among FBWs was 2.49/100 person-years compared to 0.87 among non-FBWs (age-adjusted IRR=3.64,95%CI=2.33-5.42). While HIV viral suppression was similar among participants living with HIV regardless of FBW status, the population prevalence of HIV viremia was 1.69 times higher among FBWs (95%CI=1.38-2.08). Among 179 HIV-seronegative FBWs surveyed in 2018-2020, 79.9%(143/179) were aware of PrEP, while only 13.4%(24/179) had ever used it, with just 2.8%(5/179) current users. CONCLUSIONS:FBWs in Uganda experience substantially higher HIV burden and acquisition risk compared to the general population. Prevention strategies tailored to the occupational context of bar work, including prioritization of HIV service delivery and access to oral and long-acting injectable PrEP, may substantially reduce HIV incidence among FBWs and their sexual partners.

Early and ongoing stakeholder engagement is critical to the development and implementation of scalable behavioral health interventions. Our overarching goal in this implementation research study was to understand and document the process of planning and rolling out Common Elements Treatment Approach (CETA), a transdiagnostic mental health intervention, in Uganda. Guided by the Consolidated Framework for Implementation Research (CFIR) 2.0, we conducted in-depth interviews with multilevel stakeholders (healthcare providers, MOH members, clinic managers, implementing partners, n = 20) to understand and document the process of planning and rolling out CETA in Western Uganda. All interviews were audio recorded, transcribed, and analyzed thematically in Dedoose using a codebook based on CFIR 2.0 domains and constructs. Multilevel stakeholder engagement supported strategic decision making at each stage. Early endorsement of CETA by Uganda's MOH was instrumental in facilitating program integration. Ministry of Health leadership guided facility selection, while clinic leaders identified trainees positioned to implement CETA. Training incorporated both didactic and participatory methods, including real-time adaptation of intervention content for contextual relevance and identification of "champion" trainees to serve as supervisors as part of the ongoing support supervision infrastructure. During rollout, an incremental implementation strategy facilitated integration into clinic workflows. Ongoing multilevel stakeholder supervision and technical assistance helped CETA deliverers troubleshoot challenges, maintain fidelity, and gain confidence. Together, these processes enabled expansion beyond the initial pilot sites, providing early evidence of stakeholder-perceived feasibility and identifying foundational conditions for scalability. Continued engagement with policymakers, those delivering CETA, and community stakeholders will be essential to refine CETA implementation and support integration into national mental health strategies. By reframing stakeholder engagement as an implementation strategy that builds enduring, locally led infrastructures, this study offers a replicable model for preparing behavioral health interventions for scale-up in low resource settings and advances implementation research in global mental health.

BackgroundHIV incidence among adolescent girls and young women (AGYW) in eastern and southern Africa has declined substantially over the past two decades. These declines are often attributed to biomedical HIV prevention strategies, though concurrent changes in sexual behavior may also contribute. We evaluated the contributions of biomedical and behavioral drivers to historical incidence decline in AGYW and projected their impact on incidence trajectories over the next 30 years.Methods and findingsWe conducted a mathematical modeling study using data from the Rakai Community Cohort Study (RCCS), an open, population-based cohort of adults aged 15-49 years in 30 communities in Rakai, Uganda. We used an agent-based HIV-1 transmission model calibrated to cohort data to estimate HIV incidence trends among AGYW, aged 15-24, and to quantify the independent and combined effects of antiretroviral therapy (ART), voluntary medical male circumcision (VMMC), and changes in age at first sex (AFS). HIV incidence among women aged 15-24 declined by 71% between 2000 and 2019, from 1.57 to 0.45 per 100 person-years, representing the largest decline across female age groups in the cohort. Increasing AFS over the study period (by approximately 3 years in women and 2 years in men) was the largest contributor to incidence declines among adolescent women aged 15-19, averting 17% of cumulative infections between 2000 and 2020 and 37% between 2000 and 2050. Among women aged 20-24, ART scale-up had the greatest impact, averting 13% of infections by 2020 and 43% by 2050. VMMC contributed modestly to historical declines but had larger projected effects over longer time horizons. ART, VMMC, and delays in AFS acted additively to reduce HIV incidence among AGYW. Study limitations include reliance on self-reported sexual behavior and the use of a mathematical model that cannot capture all real-world sexual network dynamics.ConclusionsBoth biomedical HIV interventions and broader behavioral changes contributed to declines in HIV incidence among AGYW. Sustaining continued incidence declines in young women will require maintaining both the protective changes in sexual behaviors and effective biomedical interventions.

Brain health disorders (BHDs) remain a concern for people with HIV (PWH) despite antiretroviral therapy access and viral suppression. The contribution of HIV to brain health is often obscured by comorbidities in high-income settings which are less prevalent in sub-Saharan Africa. Neurofilament light chain (NfL), a biomarker of axonal injury, may offer insight into underlying mechanisms. 338 virally-suppressed PWH and 250 people without HIV (PWoH) completed a Research Domain Criteria-informed battery assessing cognitive, sensorimotor, and social processing systems. Demographically-adjusted norms were derived from PWoH. Serostatus differences in impairment (≥ 1SD below the mean) were examined using multivariable logistic regression. Additional models examined associations between NfL (plasma, cerebrospinal fluid [CSF]) and task performance. PWH were similar to PWoH in age (43.9 vs. 43.5yrs), sex (female, 54 vs. 46

Background:Novel HIV prevention interventions such as long-acting pre-exposure prophylaxis (PrEP) could substantially reduce HIV transmission in Africa. However, efficient implementation in high-prevalence settings where incidence has declined requires an understanding of the contemporary dynamics driving new infections. Methods:We identified incident HIV cases from a longitudinal, population-based cohort in Uganda. We individually matched cases to HIV-negative controls; traced and enrolled reported sexual partners; and enrolled female sex workers (FSWs) from reported venues. Conditional logistic regression, transmission modeling, and phylogenetics were used to characterize transmission networks. Findings:From 2021-2024, 38,899 HIV tests among 22,255 people identified 187 people with incident infections (47.6% male); 164 (88%) were enrolled and matched to 164 HIV-negative controls. Overall, 593 non-sex-worker partners (371 enrolled,62.6%), 146 FSW partners (21 enrolled,14.4%), and 28 venues (208 FSWs enrolled) were reported. Incident infection was most strongly predicted by partnership with a FSW (odds ratio:15.5; 95%CI:3.7-64.8), identified in 43.0% of male cases versus 6.3% of controls. Men with FSW partners had larger sexual networks than men without (median:6 vs 2 partners), and 91.2% of men with FSW partners also had non-sex-worker partners. Transmission modeling attributed 34.4% (95%CI:31.5-36.8%) of all male infections and 80.0% (95%CI:73.2-84.4%) of infections among male clients to sex with FSWs. Oral PrEP use among HIV-negative partners of incident cases was low (8.9% in women; 2.1% in men). Interpretation:Men with FSW partners accounted for a substantial share of incident HIV infections and had markedly higher odds of infection than men without such partnerships. Together with the high potential for onward transmission within male client networks, these findings suggest that inclusion of male clients in long-acting HIV prevention strategies could be highly efficient and impactful. Funding:National Institutes of Health, United States; Gates Foundation; National Health and Medical Research Council, Australia.

We analyzed perinatal transmission in a pre-antiretroviral therapy Ugandan cohort by maternal human immunodeficiency virus type 1 subtype and infant sex in 131 mother-child pairs. Among all children, if the mother was infected with subtype A there was a nearly 3-fold increased risk of perinatal transmission compared with subtype D (risk ratio [RR], 2.96 [95% confidence interval (CI), 1.46-6.01]; P = .008). When stratifying infants by both sex and maternal subtype, significantly more female (56.3% [9 of 16]) than male (9.1% [1 of 11]) infants born to mothers with subtype A were infected (RR, 6.19 [95% CI, .91-42.12]; P = .02). In contrast, among infants born to mothers with subtype D, transmission rates were comparable across sex (RR, 1.59 [95% CI, .57-4.41]; P = .39).

BACKGROUND:Africa accounts for 56% of maternal syphilis and 62% of congenital syphilis cases globally. The high prevalence of syphilis in this region is particularly concerning in the context of a generalized HIV epidemic, as syphilis infection increases potential for sexual transmission of HIV. The present study qualitatively explores perceptions of syphilis risk, transmission, testing and treatment, and experiences accessing antenatal care from the perspectives of currently pregnant people residing in communities across two Ugandan districts: Wakiso and Hoima. METHODS:We conducted focus group discussions (k = 10) with pregnant women (n = 82) across six communities. FGDs were audio recorded. Data analysis involved transcription and translation, coding (by two qualitative researchers), and thematic analysis. We promoted trustworthiness through various methodological strategies (e.g. purposive sampling, reflexivity). RESULTS:Many women described barriers to care seeking at government ANC clinics that centered around poor treatment by providers, long wait times for appointments, high out of pocket costs (due to travel and fees) and the expectation that male partners should accompany them to appointments. This led many to seek their antenatal care from traditional birth attendants instead. From these themes we identified several salient barriers to both syphilis testing and treatment, leading us to identify four critical and modifiable targets: [1] structural barriers to care seeking that reflect facility and provider policies that are not necessarily in line with governmental policies; [2] untapped opportunities to leverage alternative care providers (such as traditional birth attendants) to bolster ANC attendance and syphilis treatment uptake [3] improve health literacy around syphilis through education campaigns within the community to increase demand of timely syphilis screening and treatment and [4] sub-optimal patient-provider interactions in government run healthcare facilities. CONCLUSION:The study provides practical suggestions for enhancing syphilis awareness, engagement in care, and women's experiences in ANC within a resource-limited, high-burden context. Future efforts should concentrate on extending syphilis education beyond clinics, utilizing Village Health Teams (VHTs) as trusted sources, and identifying barriers to improving healthcare quality for women, informing quality improvement programming.

BACKGROUND:Accurate interpretation of survey questions about sensitive matters such as sexual practices is crucial for obtaining reliable data to inform effective public health interventions. Describing sexual practices involves reflecting on acts and contextually attributing meanings. However, participants in sexual behaviour studies may struggle to understand questions, affecting the validity of the data. AIM:We investigated factors that shape the understanding of survey questions on sexual practices in South Central Uganda using a survey instrument and a semi-structured cognitive interview guide. METHODOLOGY:Participants (n = 24), stratified by age, sex, and community type, and including persons with disabilities, were recruited. Interviews were conducted in person, and data were analysed using thematic analysis and an analytic matrix. RESULTS:A complex interaction between awareness or knowledge of the practice, memory retrieval, denial, sexual involvement, and cultural beliefs influenced participants' understanding of survey questions on sexual activities. Specifically, awareness and knowledge of the practice facilitated spontaneous and accurate responses, while a lack of familiarity led to hesitation and confusion. Memory retrieval was easier for recent experiences, and denial slowed down the process. CONCLUSION:This study highlights the importance of considering individual, interpersonal, and community-level factors to improve the accuracy and reliability of survey research on sexual practices for effective public health interventions.

Background:As HIV incidence declines in African settings with high treatment coverage, it remains unclear how transmission is structured within populations and whether new infections arise from external introductions or local transmission. We characterized the molecular epidemiology of ongoing transmission in a mature multi-subtype epidemic in Uganda. Methods:We analyzed HIV genome sequences and survey data from the Rakai Community Cohort Study collected between 1994 and 2019. We identified phylogenetic clusters at 5·3% and 2·5% genetic distance thresholds and inferred long-horizon transmission chains with phylogeographic models. Newly diagnosed infections identified between 2016 and 2019 were mapped onto subtype- specific phylogenies to assess their origins and transmission context. A Bayesian negative binomial branching process model estimated undersampled chain sizes and case reproduction numbers. Findings:Among 4215 participants living with HIV between December 2016 and May 2019, 474 were newly diagnosed, of whom 269 had at least one pure-subtype sequence available. We identified 649 phylogenetic clusters at 5·3% genetic distance and 673 phylogeographic chains including ≥2 individuals. Most clusters and chains were small (median sizes 2 [IQR 2-3] and 3 [2-4], respectively), with new diagnoses rarely clustered together. Only 46/269 (17·1%) new diagnoses had phylogeographic external origins, while the remaining 82·9% were partially or fully linked to local chains. Mixed-subtypes/recombinant chains were larger and had higher case reproduction numbers (A1/D: 0.84 [95% CrI: 0.79-0.93]; mixed: 0.84 [0.73-0.97]) than single- subtype chains (A1: 0.56 [0.51-0.60]; D: 0.63 [0.59-0.66]; C: 0.55 [0.41-0.71]), yet all estimates were less than one. Interpretation:HIV transmission was fragmented across numerous, slowly propagating lineages, maintained by local clusters with occasional introduction. Continued transmission across many chains suggests that further reductions in HIV incidence will require maintaining high levels of population-wide treatment and prevention coverage. Funding:The National Institute of Allergy and Infectious Diseases, the Gates Foundation, and the HIV Prevention Trials Network Laboratory Center.

The health and social consequences of untreated mental health disorders and heavy alcohol use are substantial, particularly in settings with high HIV-prevalence. Transdiagnostic approaches may offer a more efficient public health response, particularly where behavioral health services are limited. The present study explored the implementation of Common Elements Treatment Approach (CETA), a transdiagnostic intervention, in Western Uganda, from the perspectives of multilevel stakeholders. One-on-one in-depth interviews with multilevel stakeholders involved in the rollout of CETA in Uganda were conducted (n = 20) including Ministry of Health officials (n = 2), CETA trainers (n = 2), clinic managers (n = 5), and frontline providers (n = 11) involved in the rollout of CETA. Data were thematically analyzed and organized using the Consolidated Framework for Implementation Research (CFIR 2.0). Key themes that emerged, organized by CFIR 2.0 domain and construct, included the acceptability and perceived need for CETA (and its perceived advantages over existing behavioral health services), the importance of expanding CETA beyond healthcare facilities into communities (through a task-shifting approach that leverages community health workers) to reduce provider fatigue and eliminate transportation related barriers to patient retention, and the necessity of building in-country capacity to support long-term sustainability and the train-the-trainer apprenticeship model. This qualitative implementation assessment provides suggestions for optimization of CETA delivery for this context in future implementation. Rigorous testing of CETA is needed to examine both implementation and effectiveness outcomes in Uganda.

BACKGROUND:Globally, human trafficking disproportionately affects women and girls, exposing them to severe exploitation and long-term psychological, social, and economic harm. While global efforts to prevent trafficking have intensified, the risk of re-trafficking remains a critical yet understudied issue in low-resource settings, particularly in Uganda. Uganda's limited data on the effects of adverse childhood and re-trafficking vulnerabilities on the long-term mental health outcomes of survivors of trafficking limits the design of evidence-based interventions to improve survivors' health. Our study examined the link between Adverse Childhood Experiences (ACE), re-trafficking vulnerability, and lasting mental health consequences among female survivors of human trafficking in Uganda. METHODS:A cross-sectional study was conducted among 350 female survivors of human trafficking in Kampala, Central Uganda, in January 2025. Trained female research assistants conducted one-on-one interviews in English or Luganda, a local language. Data on participants' socio-demographic characteristics, adverse childhood experiences (ACE-IQ), human trafficking vulnerability (AHTST), anxiety (GAD-7), depression (PHQ-9), and PTSD were collected. Bivariate and multivariable modified regression models with robust standard errors were performed using Stata version 17.0 for analysis. RESULTS:Of the 350 female survivors of trafficking interviewed in Central Uganda, more than half (63.7%) reported experience of ACEs, 63.4% screened positive for human trafficking vulnerability, 57.1%, 56%, and 40.9% identified with anxiety, depression, and PTSD symptoms, respectively. Experience of ACEs strongly correlated with a 5%, 4%, and 6% increased risk of experiencing anxiety (aRR = 1.05, 95% CI: 1.02-1.08), depression (aRR = 1.04, 95% CI: 1.01-1.06), and PTSD (aRR =1.06, 95% CI: 1.03-1.09) symptoms, respectively. Additionally, age and education were strongly linked to a heightened risk of experiencing mental health (MH) symptoms among this population. Furthermore, trafficking vulnerabilities were paradoxically associated with lower symptom severity of all three MH conditions in this population. CONCLUSION:This study highlights the strong link between adverse childhood experiences (ACEs), re-trafficking vulnerability, and MH risks among trafficking survivors in Uganda. High ACE exposure significantly increases anxiety, depression, and PTSD risk. The results reveal the immediate need for trauma-informed interventions addressing ACEs and mental health to reduce re-trafficking risks and promote survivor resilience. Unexpectedly, greater trafficking vulnerability correlated with lower symptom severity, warranting further investigation.

Hemoglobin estimation (Hb) is the most requested hematology test, especially among pregnant/postnatal women and people living with HIV (PLHIV). In Uganda, several point-of-care (POC) Hb testing devices are currently used and performance may be affected by multiple factors. This study evaluated the diagnostic and analytic performance of four Hb POC devices. During October 2021–April 2022, four POC Hb devices (HemoCue Hb 301, DiaSpect Tm, Hemo Control, and VERI-Q Red) were evaluated against the Beckman Coulter as gold standard at four sites: Rakai Health Sciences Program clinic/Kalisizo General Hospital, Mbarara Municipal Council Health Center IV, Mpigi Health Center IV, and Atutur Hospital. Adult, consented participants aged ≥ 18 years, provided 4 mL of venous blood for concurrent Hb testing across the POC Hb devices. Anemia classification followed World Health Organization guidelines: <11.0 g/dl for pregnant women, < 12.0 g/dl for non-pregnant adult women, and < 13.0 g/dl for adult men. The Bland–Altman method was used to assess the agreement of Hb results (mean difference, standard deviation of differences, and limits of agreement). Diagnostic accuracy parameters (sensitivity, specificity, positive predictive value, negative predictive value, and accuracy) were calculated to evaluate the performance of each device compared to the reference machine. A total of 768 participants (192 from each site), comprising equal numbers of PLHIV and pregnant/postnatal women were recruited. Participants’ mean (SD) Hb values were 12.1 (± 2.2) g/dl. There were strong positive correlations (all r ≥ 0.9) between each POC Hb device and the Beckman Coulter. The mean difference between POC Hb devices and Coulter readings across sites was 0.06 for the HemoCue Hb 301, 0.16 for VERI-Q Red, 0.35 for Hemo Control, and 0.57 for Diaspect Tm, with the Diaspect Tm showing the broadest limits of agreement (−0.76,1.91). The DiaSpect Tm, Hemo Control, HemoCue Hb 301 and VERI-Q Red were at least 94

INTRODUCTION:The antiretroviral therapy (ART) initiation policy in Uganda recommends that ART is initiated on the same day of HIV diagnosis to those who do not have contraindications. We assessed determinants of retention in ART care at the first follow-up (FFU) after same-day ART initiation and retention in long-term care beyond the FFU visit. METHODS:We conducted a retrospective longitudinal analysis among persons living with HIV aged ≥18 years who initiated ART during April 2016-February 2021 after the inception of Uganda's Test-and-Treat ART policy, which states that 'all individuals diagnosed with HIV should initiate ART regardless of clinical stage CD4 count'. Missing the FFU after ART initiation (missing FFU) was defined as not returning for FFU within 1 month of ART initiation; loss to follow-up long-term (LTFU-LT) was defined as delaying more than 3 months to return for a scheduled ART drug refill after the FFU appointment. LTFU-LT time was defined as the time from the FFU visit date to the last follow-up visit date during the study period. We used log-binomial distributions to estimate unadjusted and adjusted relative risks (adjRRs) of missing FFU, and we used Cox proportional hazard models to estimate unadjusted and adjusted hazard ratios (adjHRs) for LTFU-LT. RESULTS:Overall, 8332 clients initiated ART on the same day of HIV diagnosis. Most were female (55%), aged 25-34 years (44%), resided in the semi-urban or rural district (41% and 41%, respectively) and had a median age of 25 years (IQR = 24-35). Overall, missing FFU was 15.1%. Increased likelihood/risk of missing FFU was seen in clients who initiated ART at outreach health service centres versus health facilities (adjRRs = 1.79, 95% CI = 1.6-2.0), in younger clients aged 18-24 years and 25-34 years versus ≥45 years [(adjRRs = 1.65, 95% CI = 1.3-2.0) and (adjRRs = 1.31, 95% CI = 1.1-1.6), respectively], and clients residing in agrarian districts versus fishing districts (adjRRs = 1.24, 95% CI = 1.1-1.4). Overall, the LTFU-LT rate was 25 clients/100 pys (95% CI = 23.9-25.9) and was associated with younger age (18-34 years versus ≥45 years, adjHRs = 1.77, 95% CI = 1.5-2.1), residence in semi-urban (adjHRs = 1.33, 95% CI = 1.2-1.5) or agrarian district (adjHRs = 1.30, 95% CI = 1.2-1.5) versus fishing-community district. CONCLUSION:Retention-strengthening strategies in tandem with same-day ART initiation efforts for younger clients and clients initiated on ART from mobile and outreach health service settings might improve HIV treatment retention. Best practices for retaining fishing-community clients might improve health outcomes if applied to agrarian and semi-urban communities.

BackgroundUganda has the highest prevalence and incidence of cervical cancer in the East African region, with 80% of women diagnosed at advanced stage when survival is minimal. Literature on uptake of cervical cancer screening is limited in Uganda and thus womens' knowledge and uptake of cervical cancer screening in the general population remains unknown. This study examined this gap of knowledge among women aged 25-65 years, across rural, urban and semi urban communities in a Ugandan district to inform design of targeted future cervical cancer screening programs in the country.MethodsThis descriptive cross-sectional study was conducted in Wakiso district, Uganda in May 2024 among 783 eligible women. Face-to-face interviews were conducted. Uptake of cervical cancer screening (outcome of interest) was dichotomously (yes/no) assessed. Knowledge of cervical cancer disease was assessed using the AWACAN validated tool, knowledge of cervical cancer screening was assessed using a set of ten (10) questions adapted from previous studies elsewhere, and all were measured on a Likert scale. Univariate, bivariate, and multivariable Poisson regression models with robust variance were performed using Stata software version 17.ResultsRespondents' median age was 31 years (IQR 27-39 years). Majority (89.5%, 701/783) had heard of cervical cancer, and 90.6% (635/701) were aware of screening. Median knowledge score on signs and symptoms, risk factors and cervical cancer screening was 8.0 (IQR = 5-10), 8.0 (IQR = 5-11) and 7.0 (IQR = 4-10) respectively, and 54.3% had high knowledge about cervical cancer screening. Uptake of cervical cancer screening was 33.4%. Living in urban areas (aPR = 1.41, 95% CI: 1.05-1.88), being the ages 40-49 years (aPR = 1.76, 95% CI: 1.36-2.27), 50 years and above (APR = 2.16, 95% CI: 1.53-3.04), smoking (aPR = 1.39, 95% CI: 1.05-1.86), partner involvement (aPR = 2.61, 95% CI: 2.12-3.21), high knowledge about cervical cancer screening (aPR = 3.29, 95% CI: 2.35-4.60), and living with HIV (aPR = 1.66, 95% CI: 1.66-2.13) were significantly associated with higher uptake of cervical cancer screening among women in this setting.ConclusionKnowledge of cervical cancer screening was high, but the uptake of cervical cancer screening was lower than the recommended population coverage by WHO and Uganda national guidelines. There is need to improve accessibility to cervical cancer screening, increase nationwide cervical cancer awareness campaigns focusing on high-risk age groups and design targeted, tailored, culturally and socially sensitive interventions for young women aged 25-39 years to improve cervical cancer screening in Uganda.

Adolescents living with HIV (ALHIV) in sub-Saharan Africa (SSA) face significant challenges in maintaining adherence to antiretroviral therapy (ART). We aimed to identify ART adherence latent profiles among ALHIV in Uganda, and explore the factors associated with profile membership. We analyzed baseline data from 702 ALHIV aged 10–16 years enrolled in the Suubi + Adherence Study, a cluster-randomized controlled trial in Southern Uganda. ART adherence was assessed using six self-reported items, which were linearized and analyzed using latent profile analysis (LPA) to identify adherence profiles. The relationship between factors including age, gender, HIV knowledge, pill burden, depressive symptoms, and duration of living with HIV, and profile membership was examined using multinomial logistic regression—with high adherence group being the reference profile. Model fit was evaluated using Akaike Information Criterion (AIC), Bayesian Information Criterion (BIC), and entropy. Three adherence profiles emerged including High (comprising 13.8

People living with HIV can acquire secondary infections through a process called superinfection, giving rise to simultaneous infection with genetically distinct variants (multiple infection). Multiple infection provides the necessary conditions for the generation of novel recombinant forms of HIV and may worsen clinical outcomes and increase the rate of transmission to HIV seronegative sexual partners. To date, studies of HIV multiple infection have relied on insensitive bulk-sequencing, labor intensive single genome amplification protocols, or deep-sequencing of short genome regions. Here, we identified multiple infections in whole-genome or near whole-genome HIV RNA deep-sequence data generated from plasma samples of 2,029 people living with viremic HIV who participated in the population-based Rakai Community Cohort Study (RCCS). We estimated individual- and population-level probabilities of being multiply infected and assessed epidemiological risk factors using the novel Bayesian deep-phylogenetic multiple infection model (deep - phyloMI) which accounts for bias due to partial sequencing success and false-negative and false-positive detection rates. We estimated that between 2010 and 2020, 4.09% (95% highest posterior density interval (HPD) 2.95%-5.45%) of RCCS participants with viremic HIV multiple infection at time of sampling. Participants living in high-HIV prevalence communities along Lake Victoria were 2.33-fold (95% HPD 1.3-3.7) more likely to harbor a multiple infection compared to individuals in lower prevalence neighboring communities. This work introduces a high-throughput surveillance framework for identifying people with multiple HIV infections and quantifying population-level prevalence and risk factors of multiple infection for clinical and epidemiological investigations.