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Navigating HIV self-testing: Concerns among adolescents and young people aged 15-24 years in Uganda. An exploratory qualitative study.
Get PDFINTRODUCTION: HIV self-testing (HIVST) has the potential to overcome barriers to conventional clinic-based HIV testing services by offering a convenient, private, and confidential way to test. This study aimed to explore the concerns about HIV self-testing among adolescents and young people (AYP) aged 15-24 years in Uganda, where HIV self-testing is still not widely available. METHODS: This exploratory qualitative study conducted 14 audio-recorded in-depth interviews and six focus group discussions with adolescents and young people in Wakiso district, Uganda, between March 2021 to February 2022. These interviews were transcribed verbatim and analysed thematically using the socio-ecological model. All participants provided written informed consent and assent before participating in the study. RESULTS: AYP viewed HIVST as a potentially helpful and acceptable testing method. However, several concerns emerged and these are presented using five themes. At the individual level, participants expressed fear of suicidal thoughts if one tested HIV positive, lack of adequate information, anticipated increased risky sexual behaviours, neglect of other HIV preventive measures, and misinterpretation of test kit results. Interpersonal concerns were centred on partner violence, parental coercion, and social rejection. At the community level, participants noted the potential for stigma, unintended pregnancies, and discrimination. Institutional concerns focused on the lack of referral services and inadequate counselling following HIV self-testing. At the structural level, limited accessibility for persons with disabilities was a key concern. CONCLUSION: While AYP have established that HIVST is essential, various concerns need to be addressed to improve its acceptability, up-take and utilisation. Providing more explicit information about the testing procedure, clarifying any misinterpretation of results, and providing easy access to counselling services, especially at distribution points, is crucial towards guaranteeing the effective roll-out of HIVST among young people. Special attention must also be given to marginalised populations, including people living with disabilities, to ensure fairness in their access and utilisation of services. Implementation of all this will be crucial towards maximising the potential benefits of HIVST in Uganda's HIV prevention efforts
The gut microbiome and metabolome associate with Schistosoma mansoni infection and cardiovascular disease risk in Uganda.
No full textHelminth infections are consistently associated with reduced cardiovascular disease (CVD) risk, yet the biological mechanisms underlying this relationship remain unclear. The gut microbiome and metabolome are key regulators of cardiometabolic health and may mediate infection-associated effects on host physiology. Here we show that Schistosoma mansoni infection associates with distinct gut microbial and metabolic profiles linked to CVD risk in people living in Uganda. In a cross-sectional study of 209 individuals living in communities with contrasting S. mansoni endemicity, we profile the gut microbiome using 16S rRNA gene sequencing and the faecal metabolome using liquid chromatography-mass spectrometry. S. mansoni infection associates with increased gut microbial diversity and distinct taxonomic signatures, including enrichment of taxa such as Treponema and depletion of Prevotella and Streptococcus. Several infection-associated microbial taxa statistically mediate the relationships between S. mansoni infection and cardiovascular disease risk. Faecal metabolomic profiling identifies infection-associated metabolites, and integrative analyses showed linked microbe-metabolite networks associated with cardiovascular risk.These findings identify gut microbiome and metabolome signatures associated with S. mansoni infection and cardiovascular disease risk in Uganda. Although causality cannot be inferred, this work provides insight into host-parasite-microbiome interactions and highlights microbial and metabolic pathways relevant to cardiometabolic health
Inpatient initiation of tuberculosis preventive therapy with 1 month of isoniazid and rifapentine for adults with advanced HIV disease and cryptococcal meningitis (IMPROVE): a non-inferiority, randomised controlled trial.
Get PDFBACKGROUND: Tuberculosis preventive therapy coverage for people with advanced HIV disease (AHD) is poor. Innovative delivery strategies to increase tuberculosis preventive therapy uptake are needed; we sought to evaluate the safety and feasibility of two strategies for ultra-short course tuberculosis preventive therapy with 1 month of daily rifapentine plus isoniazid (1HP). METHODS: In this phase-3, open-label, non-inferiority, randomised controlled strategy trial (ISRCTN 18437550), we recruited consecutive adults (aged ≥18 years) admitted to hospital with AHD receiving treatment for cryptococcal meningitis who were screened for active tuberculosis during their hospitalisation from three tertiary referral hospitals in Uganda (Mulago National Specialised Hospital, Kiruddu National Referral Hospital in Kampala, and Mbarara Regional Referral Hospital). Adults without evidence of tuberculosis disease and meeting all eligibility criteria were approached for consent and inclusion. Patients were excluded if they had evidence of active hepatitis B infection, abnormal liver function tests, had known chronic liver disease, were jaundiced, were pregnant or breastfeeding, or presented with a clinical syndrome which, in the opinion of the attending clinician, put the patient at significant risk if they were to participate in the trial. After providing informed consent, we randomly assigned participants (1:1) to inpatient initiation of 1HP before hospital discharge or outpatient initiation at 6 weeks after time of cryptococcal meningitis diagnosis. 1HP was standardised across treatment groups, a 28-day course of 600 mg rifapentine plus 300 mg isoniazid daily with adjunctive pyridoxine (25 mg per day). The 1HP regimen was not dose adjusted on the basis of weight. The primary endpoint was tuberculosis disease-free survival and 1HP treatment completion at 18 weeks, powered for a 15% non-inferiority margin; analysis was by intention to treat. FINDINGS: From Jan 24, 2022, to Nov 13, 2024, 419 adults were screened after 210 were found ineligible and four died before random allocation, 205 were randomly allocated (171 in Kampala and 34 in Mbarara, Uganda): 103 to the inpatient group and 102 to the outpatient group. 119 participants (58%) were male and 86 (42%) were female. In the primary adjusted intention-to-treat analysis, 72 participants in the inpatient 1HP group (70%) had tuberculosis disease-free survival and 1HP treatment completion at 18 weeks compared with 63 (62%) in the outpatient 1HP group (adjusted risk difference 7·1%, 90% CI -3·8 to 17·9) confirming non-inferiority. Treatment completion was achieved in 78 (76%) of 103 in the inpatient 1HP group compared to 67 (66%) of 102 in the outpatient 1HP group (site-adjusted risk difference 9·7%, 95% CI -2·4 to 21·8). 170 grade 3 or 4 adverse events occurred in 99 (48%) of 205 participants. Among participants who had taken at least one dose of 1HP the frequency of adverse events across trial groups was similar apart from grade 4 anaemia, which occurred in a higher proportion of participants in the outpatient group (9% vs 2%, p=0·045). INTERPRETATION: 1HP initiation before hospital discharge was non-inferior to outpatient initiation among adults with AHD and cryptococcosis. These data suggest that following exclusion of active tuberculosis disease, inpatient 1HP initiation is feasible and comparably safe compared with outpatient initiation. FUNDING: The Wellcome Trust, UK National Institute for Health and Care Research, US National Institutes of Health
Association between female genital schistosomiasis and high-risk human papillomavirus among women of reproductive age in Zambia: the Schista study.
Get PDFBACKGROUND: Female genital schistosomiasis (FGS), a gynaecological disease caused by Schistosoma haematobium eggs deposition in the female genital tract, is prevalent in sub-Saharan Africa (SSA), the region with the highest cervical cancer burden globally. Persistent high risk (HR-) human papilloma virus (HPV) infection is necessary for cervical cancer development. We determined the association between FGS and HR-HPV genotypes in Zambian women. METHODS: Sexually active women aged 15-50, not menstruating or pregnant, were recruited at home and provided two cervicovaginal self-swabs, urine sample, HIV and Trichomonas vaginalis self-tests, and completed a questionnaire. In clinic, midwives collected cervicovaginal swabs and cervical images with point-of-care colposcopy (EVA System, MobileODTⓇ). Swabs were analysed for 14 HR-HPV types (GeneXpertⓇ) and Schistosoma DNA (ITS-2 qPCR); urine for Schistosoma ova by microscopy and circulating anodic antigen (CAA). Visual FGS was defined as colposcopic identification of specific genital lesions, and molecular FGS as Schistosoma-positive cervicovaginal qPCR. RESULTS: Among 2,532 women (median age 28 [IQR:22-36]) recruited at home; 67% (1,694/2,532) completed clinic follow-up. Prevalence of visual FGS, molecular FGS, and HR-HPV were 35.2% [595/1,691], 6.5% [165/2,532], and 28.7% [690/2,401], respectively. Molecular FGS was weakly associated with all HR-HPV (adjusted Odds Ratio [aOR]=1.3, 95% CI 0.9-1.9). Women with molecular FGS were more likely to test positive for HR-HPV 16/18/45 (aOR=1.7, 95%CI 1.0-2.8). No association was observed between visual FGS and HR-HPV infection (95% CI 0.7-1.1). CONCLUSIONS: This is the first study to jointly screen for FGS and HR-HPV in Zambia, reporting an association between oncogenic HR-HPV types and molecular FGS
simulist: An R package to simulate disease outbreak line list and contacts data
Get PDFEpidemic and pandemic preparedness and response requires robust analysis methods and a deep understanding of outbreak data. We introduce simulist, an open-source R package for simulating realistic infectious disease outbreak data. It is designed to allow users to generate data with specific disease outbreak characteristics by enabling flexible parameterisation of processes and variables, including epidemiological parameters (e.g. delay distributions), contact patterns and demographic information, to simulate two common datasets in outbreak settings: 1) line list data, and 2) contact tracing data. It also offers post-processing of line list data to replicate right-truncation of real-time outbreak data, as well as creating “messy” data with realistically incomplete and inconsistent value
From Pledge to Practice: A Call for FIGO/WHO to Issue Harmonized, Consolidated Abortion Care Guidelines.
Get PDFOctober 5, 2025, saw the launch of first-ever consolidated postpartum hemorrhage (PPH) management guidelines issued by three global health agencies-World Health Organization (WHO), Federation International of Gynecologists and Obstetricians (FIGO), and International Confederation of Midwives (ICM)-at the FIGO congress in Cape Town, South Africa. This landmark XXV FIGO 2025 congress also hosted inauguration of two vital pledge walls-"End PPH" and "Safe abortion saves women. Denial takes them." These pledge walls represent a commitment to initiatives of end two leading causes of maternal mortality at global level, which are PPH and unsafe abortion. We call on WHO and FIGO-in collaboration with Society of Family Planning (SFP) and other guideline-setting bodies-to convene a similar harmonization and process and issue a consolidated, consistent abortion care guidelines to reduce contradictory recommendations and improve uptake of evidence-based recommendations
Prevalence and Determinants of Depression Among Adolescent Girls and Young Women at Risk of HIV in Urban Slums of Kampala.
Get PDFAdolescents and young women (AGYW) represent 15.1% of the global population and face a heightened risk of depression, especially in low and middle-income countries. We investigated the prevalence and determinants of Depression among AGYW at risk of HIV in urban slums of Kampala. A quantitative cross-sectional design was used to assess depression in 394 AGYW (14-24 years) using the Patient Health Questionnaire from January to May 2023. Prevalence was analyzed using proportions and 95% confidence intervals. Statistical tests, including chi-square, Fisher's exact, ANOVA, and Mann-Whitney U, explored associations. Logistic regression models assessed risk, and the Hosmer-Lemeshow test evaluated the model fit. The prevalence of depression was 7.9% (95% CI = 5.6%-11.0%). Marital status (P = .024), having a high number of multiple sexual partners in the last 3 months (P = .029), and having a high number of multiple paying sexual partners in the last 3 months (P = .005) were significantly associated with depression. Thus, advocacy is crucial for improving depression screening and treatment for AGYW
Hepatitis D Virus Seroconversion Rate Among People With Chronic Hepatitis B Virus Infection in France and The Gambia (Inci-D).
Get PDFBackground: Superinfection with the hepatitis D virus (HDV) leads to a more aggressive form of chronic hepatitis B. While around 5% of hepatitis B surface antigen (HBsAg)–positive individuals are estimated to be hepatitis B virus (HBV)–HDV dually infected globally, the time point of superinfection is unknown and repeated HDV testing is not yet supported by international guidelines. Inci-D is a post hoc analysis from 2 prospective cohorts to evaluate the HDV superinfection rate.
Method: The Inci-D cohort consists of 2 HBV cohorts of clinical meta-data and stored plasma samples or dried-blood spots (DBS) from The Gambia (Prolifica) and France.
Results: Overall, samples from 1016 HBsAg-positive individuals were analyzed (625 from The Gambia, 391 from France); the baseline HDV prevalence was 1.1% (7/625) and 2.5% (10/391), respectively. The median age (interquartile range) was 38 (32–50) years, and 63% were male. Patients in the French cohort were older (P < .001), with higher liver enzymes (P < .001), were more often hepatitis B e antigen positive (P < .001) or anti-HCV positive (P < .001), and had more advanced liver disease (P < .001). In the Gambian cohort, after a median follow-up time of 5.98 years, 14 individuals were detected to be newly HDV antibody (Ab) positive (3.85/1000 patient-years). In the French cohort, after a median follow-up time of 2.1 years, 3 individuals were newly detected to be HDV Ab positive (3.70/1000 patient-years).
Conclusions: Hepatitis Delta superinfection increases considerably in HBsAg-positive carriers in The Gambia as well as in France. These findings support consideration of repeated HDV serology testing in HBsAg-positive individuals
Long-term risk of death after tuberculosis diagnosis and treatment
Get PDFTuberculosis (TB) remains a major societal burden, yet data on long-term mortality following TB diagnosis and treatment are limited. We conducted a nationwide Brazilian cohort study using linked data (2004-2018) to quantify long-term mortality (up to 14 years) following TB. We matched: (i) individuals diagnosed with TB or (ii) individuals who had completed TB treatment to TB-free individuals. We used competing risk methods to analyze natural causes (that is, defined as deaths excluding TB, HIV and external causes) and cause-specific mortality. In the diagnosed cohort (185,921 pairs), the risk of 14-year natural cause mortality was significantly higher (risk ratio (RR) = 2.16, 95% confidence interval = 1.96-2.37); RRs were significantly elevated for deaths due to cancer, cardiovascular, endocrine, respiratory and external causes. The treated cohort (111,871 pairs) presented elevated natural cause mortality risk (RR = 1.77,1.55-2.03), with similarly increased RRs across specific causes. We showed that TB survivors, even after treatment, faced a significantly elevated, prolonged risk of death from various causes up to 14 years later. This finding highlights the need for long-term monitoring to reduce the burden of TB
Informing the Development of Tailored Antenatal Care Services for Pregnant Adolescents: A Systematic Review and Stakeholder Survey
Get PDFBackground: Pregnant adolescents are at higher risk of adverse birth outcomes. Tailoring antenatal care (ANC) to adolescents’ unique needs may be a way to reduce adverse maternal and child outcomes within this population. This systematic review aimed to evaluate ANC services for pregnant adolescents and their impact on maternal and infant outcomes. Methods: Two reviewers independently searched five electronic databases (September 2024) to evaluate existing ANC services that are tailored to adolescents and the impact they have on maternal and infant outcomes. Studies were assessed for quality using the NICE quality appraisal tool and a narrative synthesis was carried out to present the findings. In addition, a survey was disseminated through the Global Adolescent Nutrition Network (GANN) to gain further insights into stakeholder views and experiences of tailored ANC for adolescents. Results: 11,236 articles were reviewed, with 14 studies included for analysis. Interventions as part of ANC for pregnant adolescents included micronutrient supplementation, supplementary feeding, community-based delivery, group-delivery, tailored nutrition education, and additional support and counselling. Outcomes such as birthweight, preterm birth, and gestational age were reported, with most studies (11/14) demonstrating positive effects. Of 103 survey responses, 100% agreed that ANC for pregnant adolescents need to be delivered in a youth-friendly manner, and 57% indicated that providing both youth-friendly delivery and additional support are crucial. Inclusive and supportive care, tailored educational support, tailored nutrition care, and mental health support were most commonly mentioned as key components for tailored ANC. Conclusions: The systematic review and survey data concur in identifying key elements of adolescent-tailored ANC. Some of these have already been shown to be effective; however, due to the high heterogeneity of the study designs, a stronger evidence-base is needed. Specific elements of future ANC packages for pregnant adolescents might include group ANC delivery, community-based services, increased confidentiality measures, mental health support and counselling, health education, and nutrition care tailored to adolescents’ physiological and emotional needs