Household poverty, malnutrition, overcrowding, and HIV infection place orphans and vulnerable children (OVC) at increased risk of tuberculosis (TB) disease and other adverse health outcomes. We integrated TB and OVC services in Uganda, comparing TB screening, diagnostic, and treatment outcomes before (October 2021-September 2022) and after (October 2022-September 2023) integration. At baseline, TB services included passive TB screening for OVC program beneficiaries living with HIV. During implementation, community-based staff conducted in-home TB screening and specimen collection, accompanied by beneficiaries to health facilities, followed up diagnostic results, and provided adherence counselling. We compare screening, diagnosis, and treatment for TB before and after program integration using chi-square and Fisher's exact tests to assess strength of associations. Following integration, household members were three times more likely to be screened for TB [RR: 3.13, 95% CI: 3.06-3.2, P < 0.0001] and 10 times more likely to be diagnosed with TB (RR: 10.00, 95% CI: 3.61-27.68, P < 0.0001). Among 46 beneficiaries screening positive prior to integration, only four (9%) received TB diagnostic evaluation compared with 198/198 (100%) following integration (P < 0.0001). At baseline, all beneficiaries evaluated (4/4, 100%) were diagnosed with TB, compared to 25% (49/198) following integration. All beneficiaries initiating treatment completed it during both time periods. Integrating TB services into OVC programming increased TB screening, diagnostic investigation, and case-finding among beneficiaries. These gains highlight the impact of harnessing OVC resources to address gaps in TB care, especially among populations that may face barriers to seeking care at a health facility.

ABSTRACT Background Women with disabilities face heightened vulnerability to domestic violence and often encounter multiple barriers to seeking help. However, empirical evidence on help-seeking behaviour among this group in low-resource settings remains limited. Objective The study assessed factors associated with help-seeking among women with disabilities following exposure to domestic violence in Uganda using nationally representative data. Methods We analysed data from 2006, 2011, and 2016 Uganda Demographic and Health Surveys. Disability status was determined using Washington Group Short Set of Questions on functional difficulties. The sample comprised women with disabilities aged 15–49 who reported experiencing domestic violence. Descriptive statistics and logistic regression models estimated associations between socio-demographic characteristics and help-seeking, accounting for sampling weights, clustering, and stratification. Results Help-seeking among women with disabilities remained low over time. In 2016, only about two in five women (43%) who experienced domestic violence reported seeking help. Employment and age were strongly associated with help-seeking. Employed women with disabilities were six times more likely to seek help than their unemployed peers (AOR = 6.68; 95% CI: 1.53–29.23). Younger women were less likely to seek help than older women. No significant associations were observed for education, wealth, or place of residence. Conclusions Employment and older age emerged as important enablers of help-seeking among women with disabilities who are experiencing domestic violence. Strengthening and implementing age-appropriate and inclusive labour policies that promote economic participation and awareness of support services for women with disabilities may enhance their access to domestic violence services in Uganda and similar low-resource settings.

PURPOSEThis study sought to evaluate the accuracy of artificial intelligence (AI)–based interpretation of digital surface images of skin lesions to diagnose Kaposi sarcoma (KS) among dark-skinned patients in Uganda.METHODSPatients were evaluated at skin biopsy services in Uganda because of clinical suspicion of KS. In a cross-sectional design, 482 consecutive participants were enrolled. Lesions were photographed using a digital camera, and punch biopsies were obtained. Histopathologic interpretation was considered the gold standard. Using training (approximately 70% of images) and validation (approximately 10% of images) sets, we developed a prediction model using a rule-based combination of You Only Look Once version 5 and 8 object detection classifiers. We determined sensitivity, specificity, and positive and negative predictive values of the AI-based prediction model in a test set (approximately 20% of images) and compared these with the accuracy of a dermatologist's visual interpretation of images.RESULTSFour hundred seventy-two participants (1,385 images) were evaluable. Of these, 36% was female; the median age was 34 years; and 94% had HIV, 332 had KS, and 140 had no KS by histopathology. In the test set, the AI-derived prediction model achieved 89% sensitivity (85%-94%) and 51% specificity (40%-61%) for diagnosing KS; the positive predictive value was 81% (75%-86%), and the negative predictive value was 67% (55%-78%). The area under the receiver operating characteristic curve was 0.72. A dermatologist evaluating the same images, with emphasis on sensitivity, achieved a sensitivity of 93% (89%-96%) and a specificity of 19% (11%-28%).CONCLUSIONAmong dark-skinned patients in Uganda with lesions suspicious for KS, evaluation of digital surface images by an AI-based prediction model produced moderate accuracy for diagnosing KS. While currently inadequate for clinical use, this inaugural assessment is sufficiently promising to justify future evaluation of larger data sets and evolving technologies.

Palliative care (PC) is crucial for children with cancer to alleviate suffering and enhance quality of life. However, continuity of pediatric palliative care (PPC) can be disrupted by factors such as lack of knowledge, stigma, bureaucratic hurdles, inadequate referral systems, and staffing shortages. There is limited data on the prevalence and factors associated with non-continuity of PPC in Uganda. This study explores the prevalence and factors contributing to non-continuity of PC among children with cancer in Uganda with Busoga Region in Eastern Uganda as a case study.This cross-sectional mixed-methods study was conducted at three facilities; two specialized tertiary facilities managing pediatric cancer and one Hospice Centre. Data were extracted from online databases for 307 children treated from 2019 to 2023, of whom 80 were alive during the study. A semi structured questionnaire was administered to caregivers of 77 children while nine key informant interviews were done with health workers from the three study sites. Descriptive statistics summarized data as proportions or percentages, and bivariate analysis used crude odds ratios to identify significant associations. Key informant interviews were transcribed and analysed thematically using the socio-ecological model. The prevalence of non-continuity of PC was 96.1% (95% CI: 88.4-98.0). All children who did not continue with PPC had received no referral to their nearest PPC provider. Barriers identified included: individual-level gaps in caregiver knowledge; relationship-level issues such as inappropriate cultural beliefs; health system-level challenges like limited human resources, inadequate training and funding, poor coordination and referral pathways, and service access issues; and policy-level concerns, including the lack of a national palliative care policy. The high prevalence of non-continuity of PC for children with cancer in Busoga highlights significant deficiencies in integrating palliative care into pediatric oncology services in Uganda. Addressing these challenges requires urgent government action to enhance palliative care funding and resources.

Background/Objectives: Inclusive nutrition services and data on children with disabilities living in low- and middle-income countries remain limited. We estimated the prevalence of undernutrition and described feeding practices and difficulties among children with disabilities ages birth to 10 years at a rehabilitation hospital in Uganda and identified barriers and opportunities for inclusive nutrition. Methods: This cross-sectional study enrolled 428 children. Data included demographics, weight, height, mid–upper arm circumference (MUAC), hemoglobin levels, risk for feeding difficulties, caregiver-reported feeding practices, and functional difficulties complemented by 32 caregiver and stakeholder interviews. Undernutrition was defined using WHO z-scores, MUAC, and anemia cutoffs. Associations were examined using Pearson’s chi-squared tests and adjusted odds ratios from logistic regression. Results: Over half of participants were boys (56.1%) and 65.9% were <24 months old. Common conditions included cleft lip/palate (55.4%) and cerebral palsy (38.6%). Undernutrition was prevalent: 45.2% were underweight, 38.3% stunted, 16.1% wasted (by MUAC), and 39.5% anemic. Being at risk for feeding difficulties (67.2% of children) increased the odds of underweight [AOR = 2.28 (1.23–4.24)], stunting [2.46 (1.26–4.79)], and wasting [2.43 (1.10–5.35)] after adjusting for covariates. Bottle-feeding increased the odds of stunting [3.09 (1.24–7.70)] in infants with cleft lip/palate < 12 months old. Poor access to services, food insecurity, and feeding challenges were key barriers to optimal nutrition. Most caregivers reported using practices that support responsive feeding. Conclusions: Reported barriers to services and high levels of undernutrition, strongly linked to feeding difficulties, underscore the need for targeted feeding interventions and better access to inclusive nutrition services in Uganda.

Purpose – The study considered enhancing client satisfaction with banking services in Uganda. The significance, utilisation and challenges of Digitalised services. Besides, study considered banking services as a predictive variable for client satisfaction in Uganda. The study was guided by the following specific objectives: i) Provide empirical perspectives and Uganda’s context-specific evidence on the effectiveness of the digitalised banking services to customer satisfaction; ii) Analyse customer experiences with digitalised banking services to identify the extent of access, utilisation and satisfaction as well as the associated challenges. Design/methodology/approach – The study was a cross-sectional in nature applying a quantitative approach. This is in line with the objective of the study to analyze the significance of digitalized banking system to customer satisfaction and draw deeper insights into the experience of clients regarding access, utilization of the digitalized banking system as well as establish the associated challenges.Findings – Using data from 159 respondents from Centenary Development Bank, this study tested and confirmed the contribution of digitalized (online) banking services on customer satisfaction in the context of Uganda.

Introduction: The COVID-19 pandemic severely disrupted maternal, neonatal, and child health (MNCH) services in Uganda. In response, digital health tools were rapidly adopted as one of the strategies to restore service delivery. However, the experiences of MNCH professionals implementing these adaptations remain underexplored. This study aimed to explore how MNCH professionals in Uganda experienced the digital tools adaptations made to restore MNCH services during the pandemic. Methods: This qualitative study involved seven in-depth interviews with MNCH professionals in Kampala, Uganda. Participants were purposively sampled based on their direct involvement in digital health adaptations during the pandemic. Data were analysed using qualitative content analysis to explore both manifest and latent meanings in participants’ experiences. Results: One overarching theme emerged: Experiencing digitalisation as a paradox between promise and practice. This was supported by two sub-themes: realising multi-dimensional gains of digitalisation and recognising digitalisation as only ‘part of the puzzle’, and six categories. The results explored how digital tools improved work-life balance, collaboration, and service continuity, they also exposed infrastructural and socioeconomic barriers, particularly in rural and low-income settings. Conclusions: Digital health innovations offer valuable support for MNCH service delivery during public health emergencies. However, their effectiveness is limited by structural inequities and digital exclusion. This underscores the need for context-sensitive strategies that balance technological innovation with persistent structural and clinical realities.

BackgroundIn Uganda, 22% of all women of reproductive age have an unmet need for family planning services. Access to contraceptive services, especially long-term reversible contraceptives such as implants, remains a challenge. The number of trained health providers is also not sufficient to address the needs for contraception. The Uganda Ministry of Health implemented a community-based implant provision pilot project where community health extension workers (CHEWs) were trained and accredited to insert implants at community level.ObjectiveThis study aims to evaluate the implementation and acceptability of stakeholders toward task shifting the provision of family planning implants to CHEWs in Uganda.MethodsThe evaluation will use a cross-sectional design using both quantitative and qualitative methods. The quantitative component will use a noninferiority design, whereas the qualitative component will use a descriptive approach. The noninferiority design involves a comparison of the competence of the currently authorized cadre to offer the service to the proposed cadre (CHEWs). Compared with a randomized controlled trial, the noninferiority design is more appropriate for this evaluation because the CHEWs and the authorized cadre are not comparable in terms of level of training and competencies. The authorized cadre has gone through formal training, which is not comparable with the training the CHEWs have received, and so the comparison is such that the competencies of the CHEWs are noninferior or at most equal to the competencies of the authorized cadre. Quantitative data will be collected among 92 CHEWs and 92 qualified health workers using performance assessment checklists and practice-based questionnaires that were developed based on the training manuals. Competency will be measured on a continuous scale and summarized as mean (SD) scores. Qualitative data will be collected through key informant interviews (n=23), in-depth interviews (n=24), and focus group discussions (n=18). Qualitative data will be analyzed using thematic analysis following the framework method for the analysis of qualitative data using ATLAS.ti (version 9).ResultsPreliminary findings indicate improved confidence and capacity of community health workers to provide implants despite challenges such as poor waste disposal, record keeping, and data management. By August 2025, training of research assistants had been concluded, and data collection had started. We anticipate that the data collection will be completed by the end of October 2025, the data analysis will be completed by November 2025, and the final results will be published by December 2026.ConclusionsThis pilot will generate contextual information that can be used to improve access to family planning services at the community level.

Despite significant advancements over the past two decades, mothers and newborns continue to experience preventable deaths, even when they give birth at healthcare facilities both globally and in Uganda. Evidence indicates that the quality of facility-based care may be a major factor contributing to this issue. This review aimed to identify, map, and synthesize all published studies on the quality of maternal and newborn care in Uganda . Following the Arksey and O’Malley five-stage framework for scoping reviews, a search strategy was employed to retrieve articles published over 20 years, from 2004 to 2024, in PubMed, EMBASE, and Web of Science. Two independent reviewers screened the extracted articles, first by title and abstract, and subsequently by full text, utilizing Covidence. Data were mapped according to the World Health Organization (WHO) Quality of Maternal and Newborn Care (QMNC) framework. Of the 2,482 studies identified, 36 were included in this review. The majority of the studies focused on human resources and infrastructure, with few addressing the experience of care. Overall, the standards of care were inadequate across the studies, with particularly poor conditions noted in lower-tier government health facilities. Despite the critical importance of quality care in reducing maternal and newborn mortality, levels have remained persistently low in Uganda over the past 20 years, especially in public facilities. There is an urgent need to rethink the health system approach and deliberately enhance the quality of care if Uganda is to meet the 2030 global targets. This protocol has been registered in the Open Science Framework (OSF); https://osf.io/yvm23 • Uganda has had a persistently low quality of maternal and newborn care in the past 20 years • The quality of care is poorer in lower-tier government health facilities • There is a need for increased attention to the quality of both the provision and experience of care.

Sexual Reproductive Health (SRH) self-care offers a pathway for low income countries to advance towards Universal Health Coverage by empowering individuals, families, and communities to prioritize their SRH needs independently of healthcare providers. Facilitating access to SRH products is crucial for embracing self-care and digital health technologies hold promise for enhancing accessibility. This study explored the role played by rocket health digital platforms in enhancing accessibility to SRH self-care products among youth in Uganda. Employing a cross-sectional design with a mixed-method approach, the study involved key informant interviews with youth who had purchased SRH self-care products from Rocket Health in 2022, as well as key staff at Rocket Health. Quantitative data were extracted from Rocket Health’s Electronic Medical Records covering the period from January 2022 to December 2022.More males (57%) utilized digital platforms for SRH compared to females (43%). The highest utilization was via the E-commerce platform (49%) while the least was via the voice call platforms (4%). A notable portion of youth (30%) still relied on visiting the pharmacy. Contraception products were predominantly consumed through digital platforms (44%), whereas self-testing were less frequently utilized (14%). The study also identified key resources such as the digital infrastructure that maximize the potential of digital health platforms in enhancing SRH self-care. By gaining insights into the digital infrastructure, preferences, barriers, and financial considerations associated with accessing SRH self-care services through digital platforms, targeted interventions such as access to contraceptives, awareness programs, prevention and treatment of Sexual Transmitted Infections can be developed to promote positive SRH outcomes among youth.

IntroductionGlobal health initiatives (GHIs) have played a significant role in expanding access to healthcare worldwide, particularly in maternal health. For instance, many regions in sub-Saharan Africa have seen a notable rise in the availability of skilled birth attendants. However, despite these gains in access, maternal mortality rates in low-income and middle-income countries within the African Region remain alarmingly high. Although GHIs have invested heavily in maternal health, there is limited evidence regarding their effects on the quality of maternal healthcare, an essential factor influencing maternal outcomes. The WHO has developed quality standards for maternal and newborn care to guide all stakeholders in delivery of care for mothers. These include evidence-based practices for managing childbirth complications, efficient health information systems, appropriate referral mechanisms, respectful and dignified treatment of patients, emotional support, well-trained and motivated healthcare providers and a conducive physical environment. These standards serve as a framework for improving and assessing the quality of maternal and newborn services. Despite significant funding and technical guidance aimed at enhancing care quality, there remains a lack of robust data on how GHIs have influenced the quality of maternal health services. To address this evidence gap, we conducted a scoping review to gather and analyse existing evidence on the effects of GHIs on maternal care quality in Sub-Saharan Africa. This report presents the findings from that review.MethodsThis study followed the enhanced six-stage framework for scoping reviews developed by Arksey and O’Malley. We included both peer-reviewed and grey literature such as reports and policy documents that addressed the impact of GHIs on maternal health services in sub-Saharan Africa between 2010 and 2024. Sources in all languages were considered. A defined set of inclusion and exclusion criteria guided the screening process. The selected studies underwent qualitative synthesis and descriptive analysis and were visually represented where appropriate. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Key findingsThe search yielded only five quantitative studies, depicting the limited evidence on this critical subject. The studies showed that GHIs had varied effects on quality of care for mothers. These effects included improved readiness of facilities to provide care, improved prenatal-postnatal processes, increased provider knowledge, active management of labour and a decrease in mortality rates in some instances such as Uganda and Zambia. However, there was limited or no improvement in clinical practices, patient experiences and satisfaction with care. Additionally, the studies did not focus on the multidimensional aspects of quality of care as guided by WHO’s comprehensive standards for quality of maternal health services, highlighting a major gap identified throughout this review.ConclusionsWhile the limited studies available showed some improvements in specific care quality indicators, there remain significant gaps in the knowledge around how GHIs affect care quality comprehensively. Additionally, the identified studies highlighted significant challenges as a key gap to achieving the intended outcomes and sustaining the gains made during programme implementation. To have a more in-depth understanding of GHIs and their impact on quality of care, it is important to align programme implementation and assessments with comprehensive frameworks such as WHO’s multidimensional quality model. Further, there is a need to adopt iterative, context-sensitive interventions that provide a comprehensive approach to quality of care. The information gathered will be used to inform subsequent studies on the effects of GHIs on quality of care of maternal health services in Uganda and contribute to the development of maternal healthcare policies.

This article evaluates the outcomes and insights from a collaborative initiative between Moorfields Eye Hospital volunteers, Eye Health Africa and the Ubora Foundation Africa focused on strengthening ophthalmic services in Uganda, particularly at Hoima Regional Referral Hospital. Drawing on comparative insights from National Health Service facilities in the West Midlands (UK), the article reflects on infrastructure limitations; workforce constraints; the collaborative, system-level interventions that must be introduced; and some initial initiatives made possible through the exchange. Emphasis is placed on sustainability, local capacity building and bilateral learning, with implications for replicable models of ophthalmic care development in low-resource settings. Lessons learned reveal the importance of cultural humility, context-specific innovation and long-term investment in human resources for health in the global fight against avoidable blindness and improving patient outcomes while offering a framework for future global eye health partnerships.

Sexual Reproductive Health (SRH) self-care offers a pathway for low income countries to advance towards Universal Health Coverage by empowering individuals, families, and communities to prioritize their SRH needs independently of healthcare providers. Facilitating access to SRH products is crucial for embracing self-care and digital health technologies hold promise for enhancing accessibility. This study explored the role played by rocket health digital platforms in enhancing accessibility to SRH self-care products among youth in Uganda. Employing a cross-sectional design with a mixed-method approach, the study involved key informant interviews with youth who had purchased SRH self-care products from Rocket Health in 2022, as well as key staff at Rocket Health. Quantitative data were extracted from Rocket Health's Electronic Medical Records covering the period from January 2022 to December 2022.More males (57%) utilized digital platforms for SRH compared to females (43%). The highest utilization was via the E-commerce platform (49%) while the least was via the voice call platforms (4%). A notable portion of youth (30%) still relied on visiting the pharmacy. Contraception products were predominantly consumed through digital platforms (44%), whereas self-testing were less frequently utilized (14%). The study also identified key resources such as the digital infrastructure that maximize the potential of digital health platforms in enhancing SRH self-care. By gaining insights into the digital infrastructure, preferences, barriers, and financial considerations associated with accessing SRH self-care services through digital platforms, targeted interventions such as access to contraceptives, awareness programs, prevention and treatment of Sexual Transmitted Infections can be developed to promote positive SRH outcomes among youth.

ABSTRACT This study reviews the status of access to water supply, sanitation, and solid waste management (SWM) services in Uganda, examining the influence of national government policies, institutional frameworks, and financing mechanisms. It employs a mixed‐methods approach, combining qualitative analysis of primary data from key informant interviews with secondary data from systematically reviewed literature, including performance reports, project data from ministries, development partner websites, and peer‐reviewed journal articles. The findings reveal persistent challenges related to intersectoral coordination, overlapping roles, policy inconsistencies, stakeholder conflicts, and funding inefficiencies. Water services receive a disproportionately high percentage of funding (over 80%), whereas sanitation and SWM receive significantly less (approximately 5% and 10%, respectively). Regulations advocate for sustainability, but their implementation in small towns remains weak. Policy analysis at the local level suggests a misalignment that prioritizes SWM over individual water and sanitation services. Decentralization empowers local authorities, but successful service delivery depends on robust enforcement of available policies. The analysis of funding and service delivery gaps underscores the need for equitable resource allocation and integrated approaches. The study concludes by emphasizing the need for active engagement by governments, development partners, local communities, and the private sector to achieve equitable access to basic services.

University libraries are essential in supporting teaching, learning, and research; however, several universities failed to achieve the minimum requirements as envisaged by the National Council for Higher Education (NCHE) and international bodies like IFLA because they face many systemic and institutional problems. Therefore, the study investigated the barriers affecting compliance with library standards by Ugandan universities, as discussed in this study, with a view to enlightenment on institutional, technological, and regulatory hindrances to effective library service delivery. Data collection was carried out through a mixed-methods research design under a pragmatic paradigm in 12 universities through questionnaires (n = 433), interviews, participant observations, and document reviews. Findings revealed that limited funding, outdated and inadequate information resources, poor ICT infrastructure, unstable power supply, inadequate reading space, understaffing, and low staff capacity greatly impacted the compliance levels. High enrolment of students vis-a-vis the gradual expansion of library services, poor enforcement of policy, and negative attitudes towards the library from stakeholders further aggravate the non-compliance issue. The study, therefore, concludes that most of the universities did not attain the minimum levels of NCHE standards owing to systemic and operational problems. Hence, it is recommended that regulatory oversight be strengthened, institutional investment increased, staff trained continuously, content developed within the country, and engagement of users promoted toward filling in these gaps. These findings therefore provide a basis for further advocacy on policy formulation and institutional reforms toward improving library services in Uganda's higher education institutions.

This study assessed the effectiveness of student support services within Uganda's public student loan scheme, focusing on academic advising, career development, and financial literacy. Despite increased financial access to higher education, inadequate support systems may hinder student retention, performance, and employability. Data were gathered through surveys of 430 students and 12 interviews across four public universities (2024–2025). Findings revealed that career development services were the most effective, with 85.2% of students agreeing they enhanced workforce readiness (M = 3.175). However, satisfaction with academic advising (M = 2.753) and financial literacy (M = 2.765) was moderate, with over 30% of students dissatisfied. Hierarchical regression showed academic advising frequency significantly predicted GPA (β = .32, p &lt; .001). Qualitative data highlighted barriers such as under-resourcing, high student-to-advisor ratios, and weak ICT infrastructure. Potential improvements include policy reforms, peer mentoring, and technological innovation. The research underscores the importance of integrating structured and inclusive support services into Uganda's loan program to promote academic success and sustainable loan repayment

Women with disabilities are at disproportionate risk for adverse pregnancy outcomes partly because of the limited information on their pregnancy histories. However, deaf women are faced with communication challenges, sexuality, menstrual health as well as pregnancy and its care, which remain a contemporary phenomenon. Still, little is known about the lived experiences of deaf women and girls. The aim of this study was to examine the maternal health experiences of deaf women and girls, identify the challenges that influence their antenatal, childbirth and postnatal outcomes and improve access. The study used qualitative research of an intrinsic case study design utilising semi-structured interviews and focus group discussions with 50 deaf women and girls who are deaf or hard of hearing in Mbale district and 13 key informants from state and non-state entities. Documentary analysis was also utilised to examine government documents on this topic. Findings revealed that 100% of deaf women and girls lack antenatal services tailored to their linguistic needs and communication barriers, which provide no opportunities for better medical provider-patient communication. Despite Uganda's legal frameworks on maternal health rights (MHRs), deaf women and girls' linguistic needs are yet to be incorporated into the Ugandan health sector. Current healthcare provisions do not always meet their needs during maternal services. Therefore, visible and constructive policies are necessary to steer deaf MHRs and services. Deaf epistemology should be integrated into policy, research spaces and practice for effective and evidence-based policies needed to guide Sexual and Reproductive Health services among deaf women and girls.

In Uganda, the uptake of pre-exposure prophylaxis (PrEP) as a preventive measure against HIV infection is notably low, despite its proven effectiveness, particularly among high-risk populations (UPHIA, 2020). Although PrEP has historically been available at no cost in government facilities, the recent decrease in HIV medication costs and the shift towards private-sector involvement necessitate a reliable assessment of individuals’ ability to pay for PrEP. The growing volume of HIV-related data presents a unique opportunity to leverage artificial intelligence (AI) and machine learning (ML) techniques to identify high-risk sub-populations that are both eligible for and willing to pay for PrEP services. This retrospective study, analyzed three diverse datasets, including, the Uganda Demographic Health Survey, the Uganda Population HIV/AIDS Impact Assessment survey, and a private dataset from the Rocket Health Telemedicine Clinic. The study population included individuals aged 18 years and above that have accessed a private health facility for sexual reproductive health services or products. Statistical methods, including the Chi-square test and Spearman’s correlation test, were employed to identify features with a statistical significance to the ability to pay for PrEP. The datasets were aggregated, cleaned and then split into 70% for training and 30% for testing and validation. An ensemble of machine learning classification models was trained using Python and the PyCaret library. The AdaBoost classifier demonstrated superior predictive power, with a recall of 99% and an AUC of 100%, indicating robust prediction capabilities on this dataset. The model achieved a high training score of 99%, suggesting an excellent fit to the training data. Further analysis revealed that factors such as age, gender, employment status, and socioeconomic status were the most influential predictors of the ability to pay for PrEP services. A web application interface was developed using the Streamlit library, allowing individuals and programs to upload data and make predictions about the likelihood of individuals paying for PrEP. The developed tool leverages publicly available data to identify populations capable of paying for PrEP services, fostering a collaborative effort towards achieving better health outcomes and ensuring the sustainability of HIV prevention services.

COVID-19 vaccines significantly reduced COVID-19 related morbidity and mortality. Although purposeful response measures like movement restrictions affected delivery of other health services, few studies have investigated the association between COVID-19 vaccination as a response strategy and continuity of other immunization services. We aimed to assess the association between the COVID-19 vaccine rollout and continuity of routine immunization services and describe the interventions instituted to maintain delivery in Uganda. This was a cross-sectional study conducted in Wakiso District, Central Uganda. We applied an explanatory, sequential mixed-methods design. We analyzed routine childhood immunization data by computing the percentage change in vaccine doses given for Bacille Calmette-Guerin (BCG), Diptheria, Tetanus Toxoid Pertussis (DPT3), Polio 0, Polio 1, Polio 2 and Polio 3 between March 2021 and April 2021. This was followed by 19 interviews with health workers and 3 focus group discussions with altogether 33 mothers using the World Health Organization Health System Building Blocks as a guiding framework. We found that the COVID-19 vaccine rollout was associated with changes in the trends of routine vaccine uptake. The number of DPT3 vaccine doses reduced by 4.3% between March 2021 and April 2021 after the COVID-19 vaccine rollout while that for Polio 1 vaccine doses reduced by 5.5%, Polio 2 vaccine doses reduced by 5.8% and Polio 3 doses reduced by 5.6%. The challenges to continuity included increased workload, competition for cold chain and storage capacity and impact on perceptions about vaccination. Interventions to sustain demand included engaging community health workers, community mobilization, health education, and prioritizing routine immunization services. Interventions to maintain delivery included integration of services, increasing health workforce and separating resources for routine vs COVID-19 vaccination. In conclusion, the COVID-19 vaccine rollout was associated with infrastructural and logistical challenges which affected delivery of routine immunization services. Introduction of the COVID-19 vaccines was also associated with negative perceptions about routine childhood vaccines. Deployment of new medical countermeasures should integrate interventions to predict and mitigate effects on existing supply systems like the human resources and infrastructure. Medical countermeasures deployment should also involve education and sensitization that addresses misconceptions and sustains demand for existing health services.

BackgroundNovel retention strategies have the potential to reduce vertical transmission of HIV and improve patient outcomes for women living with HIV (WLHIV) and their infants. We estimated the budget impact of the enhanced retention strategy (ERS) compared with the Ministry of Health strategy/standard of care (SOC) approach for preventing vertical transmission of HIV among women initiating antiretroviral therapy (ART) in late pregnancy in Uganda.MethodsA budget impact analysis (BIA) was conducted from the payer (Uganda’s Ministry of Health) perspective with a 5-year time horizon. A Microsoft Excel-based BIA model was populated with HIV epidemiological data and expenditures from the literature and the clinical trial of dolutegravir in pregnant HIV mothers and their neonates. These cost projections accounted for various programmatic inputs, disease progression, differences in mortality based on treatment status, and subsequent pregnancies. The eligible population included all HIV-positive pregnant women currently receiving prevention of vertical transmission services in Uganda. The primary outcomes of the analysis were incremental budget costs, and infections averted over 5 years.ResultsAdopting the ERS would lead to a net cost increase of US$63.8 million over the next 5 years, or a net cost increase of US$12.7 million per year compared with the SOC. Newly enrolled WLHIV accounts for US$39.5 million of these marginal costs, while in-system patients account for US$24.2 million. Direct programmatic costs of the ERS only account for 13% of this additional cost, with 87% of the marginal increase coming from the cost of providing ART for WLHIV who would otherwise be lost to follow-up. The ERS would avert an additional 6933 infant infections compared with the SOC.ConclusionImplementing the ERS would significantly increase the Ugandan Ministry of Health's budget, but most additional costs would be accrued from the resulting expansion of ART client volume. The ERS is a relatively low-cost intervention to reduce loss to follow-up rates among marginalized and hard-to-reach populations.