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High HIV incidence among HIV infected BUT undetected individuals seeking HIV voluntary counselling and testing services in the greater Masaka Region in Uganda.
No full textINTRODUCTION: HIV testing is at the cornerstone for interventions aimed at controlling the number of new HIV infections in Sub-Saharan Africa. The current HIV RDTs in use are not able to identify acute HIV infection. METHODS: We collaborated with 10 health centers in Uganda, offering HIV voluntary counselling and testing services to obtain 'left-over' EDTA blood samples after HIV RDT. We investigated for HIV RNA using the GeneXpert HIV-1 Viral Load assay among individuals who had non-reactive Determine (HIV negative) or an inconclusive test result (Indeterminate). We used a formula from Brookmeyer and Quinn to estimate HIV incidence. The study started on the 17th February 2021 and ended on the 24th December 2021. Study activities were suspended between June and September 2021, due to travel restrictions instituted by government of Uganda aimed at reducing levels of connectivity between and within communities, to curb the rising number of COVID-19 infections. RESULTS: Fourteen of 4,941 'left-over' plasma samples retested were reactive with a mean pVL of 1.5X106 copies per ml. The overall HIV incidence per 100 person years was 7.4 (95% CI: 4.3-12.5): higher for females at 9.4 (95% CI: 5.2-16.9) compared to 4.2 (95% CI: 1.3-12.9) for males. The HIV Incidence per 100 person years was 7.8 (95% CI: 3.7-16.4) before travel restrictions were instituted and 7.0 (95% CI: 3.3-14.7) after they were lifted. CONCLUSION: We demonstrated that incident HIV infection can be determined without assembling a longitudinal cohort. GeneXpert HIV-1 Viral Load assay can detect acute infection. There is no evidence that COVID-19 travel restrictions was associated with increased HIV Incidence rates in our communities
Erythrocyte Membrane Protein 3 (EMAP3) Is Exposed on the Surface of the Plasmodium berghei Infected Red Blood Cell.
Get PDFThe human malaria parasite Plasmodium falciparum invades red blood cells (RBCs) and exports parasite proteins to transform the host cell for its survival. These exported proteins facilitate cytoadherence of the infected RBC (iRBC) to endothelial cells of small blood vessels, protecting iRBCs from splenic clearance. The parasite protein PfEMP1 and the host protein CD36 play a major role in P. falciparum iRBC cytoadherence. The murine parasite Plasmodium berghei is a widely used experimental model that combines high genetic tractability with access to in vivo studies. The P. berghei iRBC also sequesters by CD36-binding via an unknown parasite ligand and few parasite proteins, including EMAP1 and EMAP2, have been localised to the iRBC membrane. We have identified a new protein named EMAP3 and demonstrated its export to the iRBC membrane where it likely interacts with EMAP1, with only EMAP3 exposed on the outer surface of the iRBC. Parasites lacking EMAP3 display no significant reduction in growth or sequestration, indicating that EMAP3 is not a major CD36-binding protein. The outer-surface location of EMAP3 offers a new scaffold for displaying P. falciparum proteins on the surface of the P. berghei iRBC, providing a platform to screen in vivo for putative inhibitors of P. falciparum cytoadherence
Examining the effects of climate and environmental hazards on vector and water‑borne diseases in Eastern Uganda
Get PDFBackground: Environmental hazards like floods, droughts and landslides pose serious public health and wellbeing consequences for populations, especially vulnerable communities in countries with low adaptive capacity. Empirical evidence from peer-reviewed literature and official climate change assessments indicates that, alongside high interannual climate variability, Uganda has experienced observable climate change over the past 50 years. This changing and increasingly variable climate poses challenges to population health in diverse ways, including through the transmission of infectious diseases. This study explored local perceptions of the impact of climate variability and change on the prevalence of infectious diseases like typhoid fever, malaria, and diarrhoeal diseases in three districts: Amudat, Bududa, and Katakwi in Eastern Uganda. Relatively few integrated and empirical studies have been conducted in Uganda to assess the specific climate-related health risks faced by local
communities.
Methods: A cross-sectional survey of 341 respondents was conducted to collect data from households. Data were collected using Kobo software, exported, cleaned and analysed with SPSS 28.0
Results: Populations in the three study districts perceived drought, floods, and landslides as significant hazards, though with varying levels of exposure, frequency, and severity. Strong associations were found between environmental hazards and occurrences of infectious diseases. Floods, significantly increased the reported prevalence of malaria (Chi-Square = 12.901, p 0.242) or typhoid fever (Chi-Square = 4.739, p > 0.192). Landslides were significantly associated with diarrheal diseases (Chi-Square = 7.846, p 0.457) or typhoid fever (Chi-Square = 3.277, p > 0.351). Most respondents experienced the negative interactive effects of multiple environmental hazards on their health status. The increased prevalence of diarrhea was attributable to floods, drought, and landslides; cases of typhoid fever were increased by floods rather than by drought or landslides. Malaria was more influenced by floods.
Conclusion: Environmental hazards affected population health in the three districts by increasing the risk of waterborne diseases, such as diarrhea, during severe droughts and landslides. Floods exacerbated waterborne and vector-borne diseases by creating ideal conditions for mosquito breeding and water contamination. There is an urgent need for multihazard-targeted interventions, including improved access to water, sanitation, and hygiene (e.g., regular handwashing with soap, safe water access and use, boiling water, proper sanitation, community WASH sensitization supported by local public health outreach), as well as disaster preparedness strategies, to reduce the health burdens of environmental hazards and enhance community resilience in these regions
Community-Led Total Sanitation implementation in Malawi: process evaluation of a sanitation and hygiene intervention.
Get PDFCommunity-Led Total Sanitation (CLTS) seeks to eliminate open defecation by empowering households to adopt improved sanitation and hygiene behaviours. While widely integrated into national sanitation strategies of low- and middle-income countries, limited evidence exists on how implementation processes drive behaviour change. This study aimed to evaluate the implementation fidelity, reach, dose, adaptation, and mechanisms of impact of a CLTS intervention in Chiradzulu District, Malawi. We conducted a retrospective mixed methods process evaluation between January 2022 and February 2023, using 1,151 household surveys, 36 in-depth interviews, and 28 focus group discussions with community members and implementers. Outcomes assessed were latrine and handwashing facility (HWF) availability, with logistic regression used to explore associations with intervention exposure. All planned activities were delivered, but fidelity was variable ranging from low fidelity for training delivery to high fidelity for household engagement. Intervention reach was suboptimal, with limited household contact and low recall of hygiene campaigns. Combined exposure to both community and household-based activities significantly increased odds of latrine ownership (OR = 1.63, CI = 1.55-1.72) and HWF presence (OR = 1.39, CI = 1.03-1.86). CLTS programmes should strengthen intervention fidelity, integrate affordable climate resilient facilities, and strengthen household-based engagement to enhance sustainability and impact
Effective cataract surgical coverage in adults aged 50 years and older: empirical estimates from population-based surveys in 68 countries and modelled estimates for 2000-30.
Get PDFBACKGROUND: Cataract is the leading cause of blindness worldwide despite treatment being very cost-effective. To stimulate efforts to address the large unmet need for affordable, good-quality cataract services, member states at the 74th World Health Assembly endorsed a global target of a 30 percentage-point increase in effective cataract surgical coverage (eCSC) by 2030. In this Article, we report on progress towards that target. METHODS: We did a secondary analysis of 233 participant-level population-based survey datasets (Rapid Assessment of Avoidable Blindness [RAAB] surveys and other population-based cross-sectional surveys) from 68 countries (2003-24) to estimate eCSC with a cataract surgical threshold of worse than 6/18 pinhole visual acuity and a threshold of 6/18 or better for postoperative presenting visual acuity (eCSC6/18) for each country. Eligible studies included people aged 50 years and older, without any further age restrictions. eCSC was calculated as the number of people who had received surgery and had a good visual outcome as a proportion of all people who had received or were still to receive surgery. For countries with only one survey estimate available, we reported the survey as the country estimate; for each country with two or more surveys, we used more recent and nationally representative survey to generate estimates. We included 228 of 233 datasets (excluding five datasets from the European region) in a mixed-effects logistic regression to estimate global and WHO regional temporal trends in eCSC6/18 from 2000 to 2030. For global estimates, we used eCSC in the Americas region as a proxy for the European region. We used 120 RAAB surveys that measured visual acuity at the 6/12 threshold to analyse causes of non-good outcomes (postoperative presenting visual acuity worse than 6/12) and estimated potential gains in eCSC (with a cataract surgical threshold of worse than 6/12 pinhole visual acuity and a 6/12 or better threshold for postoperative presenting visual acuity [eCSC6/12]) from correcting residual postoperative refractive errors. Potential gains were estimated by comparing eCSC6/12 calculated using postoperative presenting visual acuity with eCSC6/12 calculated using pinhole visual acuity (a proxy for visual acuity with optical correction of refractive error). FINDINGS: We used 130 studies to report 68 country estimates of eCSC6/18. Country estimates for eCSC6/18 from surveys ranged from 2·1% (95% CI 0·9-3·4) in Burundi (2024) to 77·7% (72·9-82·5) in Qatar (2023). Globally, we predicted eCSC6/18 of 48·2% (39·7-57·2) in 2025, increasing by 8·4 percentage points (8·1-8·6) between 2020 and 2030 (from 43·9% [36·6-51·2] to 52·3% [41·4-62·7]). Uncorrected refractive error accounted for a median 26·4% of non-good outcomes per survey; we estimated that treating this condition could yield a median 3·7 percentage-point gain in eCSC6/12 globally. INTERPRETATION: Global efforts are not on track to meet the target of a 30 percentage-point increase in eCSC between 2020 and 2030-immediate and substantial investment in cataract services is, therefore, required. Survey data indicated which elements of the cataract care pathway could be targeted for quality-improvement initiatives. A suite of cataract surgery quality indicators should be collected to better inform service providers. FUNDING: Indigo Trust, The Fred Hollows Foundation, and Wellcome Trust
Happiness and life satisfaction: understanding the effects of question order on subjective wellbeing measures in India
Get PDFSubjective wellbeing measures arepopular tools for assessing quality of life and progress in societies. There are concerns aboutthe validity of answers to questions about happiness and life satisfaction because thesemeasures might suffer from biases during survey administration. This study used a surveyexperiment to understand if measures of life satisfaction and happiness suffered from contexteffects during the administration of a survey in Uttar Pradesh, India, and test the use of a bufferquestion to mitigate any bias. In addition, we examined the association of life satisfaction andhappiness with key socio-economic variables as a further means of validation. While happinessappears to be robust enough to not be influenced by the context, the question on life satisfactionsuffered from mild context effects. The buffer question proved to be able to mitigate this bias.Mental and physical health are significantly correlated with both happiness and life satisfaction.Education is strongly correlated with life satisfaction. Major negative life shocks are stronglyassociated with happiness but not with life satisfaction. This study makes a significantcontribution to the evolving scholarship on subjective wellbeing measurement in a non-WEIRDsetting, by clarifying two critical issues: the conceptual distinction between different subjectivewellbeing measures (happiness and life satisfaction), and their contextual sensitivity. The resultslead to two recommendations that should be considered when measuring subjective wellbeing:happiness and life satisfaction are different concepts, and should not be used interchangeably.Evaluative measures of subjective wellbeing can be context-sensitive. To avoid context effects, it is critical to put the context-sensitive question early in the questionnaire, or to add a buffer/transition question preceding the context-sensitive one
Community perspectives and policy effectiveness: a study on floodplain wetland management and its socio-economic implications in the Msunduzi River Basin
Get PDFAbstract
Despite the crucial role of floodplain wetlands in sustainable development, existing research reveals a significant gap in community awareness and engagement with relevant policies. This study seeks to elucidate the community’s understanding of wetland management policies and their perceived effectiveness in shaping agricultural practices and socio-economic development. Employing a mixed-methods approach, data were collected through structured surveys with residents of the floodplain and interviews with key stakeholders. The key findings reveal a marked deficiency in community awareness regarding existing floodplain wetland management regulations, accompanied by widespread scepticism about their effectiveness. This lack of awareness is further exacerbated by perceptions of ineffective community participation in policy decision-making, highlighting a substantial disconnect between the intentions of these policies and the lived experiences of local residents. These insights suggest that, without meaningful engagement and transparent dissemination of information, the potential for effective floodplain management remains severely compromised, thereby jeopardising both environmental sustainability and socio-economic development within the region. The results underscore the urgent need for improved communication strategies and inclusive engagement processes to empower local communities in floodplain management. By addressing these identified gaps, policymakers can foster enhanced community participation, increase the efficacy of environmental regulations, and ultimately support sustainable socio-economic development. This study contributes to the broader discourse on urban governance and environmental management in the Global South, advocating for a paradigm shift towards participatory approaches in policy formulation and implementation
Knowledge and acceptability of male HPV vaccination among young people and community stakeholders in northwest Tanzania: social sciences in the Add-Vacc trial.
Get PDFINTRODUCTION: Human papillomavirus (HPV) and related diseases are global health concerns affecting both males and females. Tanzania introduced two-dose HPV vaccination for 14-year old girls in 2018. The Add-Vacc trial in rural northwest Tanzania is evaluating the impact of adding one-time, single-dose HPV vaccination for 14-18-year-old boys to the national programme for girls on HPV population prevalence. As this is the first time HPV vaccination has been offered to adolescent males in Tanzania, acceptability of boys' HPV vaccination among adolescents and community stakeholders was assessed. METHODS: Qualitative data were collected between July 2023-May 2024 through: 1) rapid ethnography; 2) rumours tracking using an electronic tool piloted during the study; 3) in-depth interviews with in- and out-of-school boys who accepted or declined vaccination; 4) key informant interviews with vaccination stakeholders including parents, teachers, health workers, and community leaders; and 5) focus group discussions with stakeholders and vaccination-age boys and girls. Data were coded using Nvivo12 and analysed thematically. RESULTS: Messaging on HPV-related complications beyond cervical cancer motivated parental and adolescent support for vaccinating both boys and girls. Framing male HPV vaccination as a gender equity issue and highlighting the economic burden of illness emerged as important themes. Participants emphasised the need for trusted, locally recognised messengers to convey information. Parents and peers were key influencers for adolescents, while health workers and religious/community leaders influenced parents. Some parents and adolescents who initially declined vaccination reported they later accepted it after having time to reflect and seeing vaccinated boys experienced no adverse effects. CONCLUSIONS: Single-dose HPV vaccination of males was generally acceptable across all study groups. Ongoing, dynamic community engagement and open dialogue about the full spectrum of HPV-related sequalae and HPV vaccination for both genders are essential to building trust and improving understanding and acceptability of HPV vaccination targeting boys and girls in this Tanzanian context
Implementing quality improvement in vascular services: a qualitative study.
Get PDFBackground: The Peripheral Arterial Disease Quality Improvement Programme (PAD QIP) was a quality improvement (QI) collaborative between 11 English vascular surgery centres from May 2020 to May 2022, aiming to expedite treatment for PAD. This qualitative study explored beliefs about the PAD QIP and barriers and facilitators to implementation of changes in vascular surgery.
Methods: Sixteen semi-structured interviews were conducted with clinicians from the vascular centres that participated in the PAD QIP and were analysed using framework analysis, based on the five broad domains within the Consolidated Framework for Implementation Research.
Results: Five themes captured the main factors that affected the implementation of changes in the pathway of patients with chronic limb-threatening ischaemia: the programme, the benefit for patients, the role of the team, the resources and organisational processes, and the polarising effect of COVID-19. Regarding the programme, participants stated that the concrete timeframes, external performance monitoring, peer comparison and the programme's national reach helped them obtain resources to implement changes. Learning from and sharing experiences with others was also useful. Accurate performance data were considered essential for leveraging resources, but data entry was onerous and required dedicated staff. The view that the programme was beneficial for patients, the support of a team of healthcare professionals and organisational support in the form of resources were important requirements for implementation, while the COVID-19 pandemic also played a crucial role as a contextual factor beyond the control of the participants. The main factors that differed between high-implementation and low-implementation centres were team beliefs, team structure, team compatibility, networks/communication, resources, implementation climate, relative priority and evidence strength.
Conclusions: This QI collaborative facilitated the implementation of changes according to participants, while team and organisational support was crucial
A two-step actin-mediated strategy enables Campylobacter jejuni to promote mitochondrial aggregation and iron homeostasis, for intracellular survival and persistence.
Get PDFCampylobacter jejuni, a major cause of bacterial gastroenteritis, is capable of surviving in diverse hosts, including free-living amoebae such as Acanthamoeba. However, the molecular mechanisms that facilitate its intracellular persistence and subsequent transfer remain poorly defined. Here, we hypothesize that C. jejuni employs a biphasic actin-remodelling strategy, mediated by the effector proteins CiaI and CiaD, to reposition and remodel host mitochondria, promoting mitochondrial aggregation and iron homoeostasis. Using dual proteomics, microscopy, biochemical assays, and defined genetic mutants, we show that actin polymerization and CiaI are critical for mitochondrial interaction. We found that CiaI binds nucleotides with cooperative kinetics, acting as a molecular switch, and is crucial for C. jejuni localization near mitochondria, while CiaD promotes actin polymerization and acanthopodia formation to facilitate uptake. We propose a two-phase model: early actin polymerization repositions mitochondria, followed by localized actin depolymerization and mitochondrial remodelling. Iron chelation promotes bacterial survival, suggesting that oxidative stress functions as a host defence. These findings highlight a sophisticated mechanism of intracellular adaptation by C. jejuni that may be relevant to pathogenesis and identify new potential targets for disrupting its environmental and clinical persistence