Biomedical Research and Training Institute

Electronic monitoring devices (EMDs) may provide an objective method for assessing medication adherence. However, evidence on their validity compared to other adherence measures, their functional feasibility, and their acceptability, especially among adolescents, remains limited. Adolescents face multifaceted adherence challenges, yet there is a lack of evidence to inform the use of digital tools for adherence monitoring and support in this age group, particularly in low-income settings. We assessed feasibility, acceptability, and validity of an EMD among adolescents enrolled in the multi-country clinical trial VITALITY. An explanatory sequential mixed methods study was embedded within the Zimbabwean site of the VITALITY trial, a randomised controlled trial evaluating weekly vitamin D supplementation on bone health in adolescents living with HIV. A random sample of 97 participants (aged 11-19years) was provided an EMD for 24weeks to monitor adherence to vitamin D or placebo. Validity was assessed by correlating EMD-measured adherence with serum vitamin D levels. Feasibility of the EMD was investigated through records of battery duration, network connectivity, and EMD malfunction. Seventeen participants were purposively selected for qualitative exit interviews to explore acceptability and reasons for discordance between adherence measured through the EMD and pill count. Ninety-seven participants, median age 16.7 (interquartile range13.5, 18.7) years, 50 (51.5%) female were provided with the EMD for a median of 24 (range 22-25) weeks. There was a strong positive correlation between EMD-measured adherence and week-48 vitamin D levels (β = 0.63, 95% CI: 0.42-0.85; R2 = 0.42; p < 0.001), supporting the validity of EMD data as a proxy for medication intake. The EMD functioned reliably despite intermittent network coverage, and no major malfunctions were reported. Adolescents found the EMDs highly acceptable due to their ease of use, discretion, and perceived motivational benefits. This study demonstrates that EMDs are valid, feasible, and acceptable tools for monitoring adherence among adolescents in low-income settings. These findings support the potential for broader use of EMDs to promote and monitor adherence to long-term treatments in adolescents beyond research settings. Pan African Clinical Trials Registry (PACTR), PACTR202009897660297 .

Routine adolescent health check-ups can support healthy development and well-being, but evidence on the feasibility, acceptability and effectiveness of contextually relevant comprehensive check-ups in low- and middle-income settings is limited. We conducted a hybrid implementation-effectiveness study incorporating a mixed-methods pre-post design of Y-Check, a comprehensive health check-up intervention in Zimbabwe, as part of a multicountry study developed and coordinated by the World Health Organization. Eligible participants were 10-19-year-old adolescents attending school or community venues. We used self-administered digital questionnaires, provider-led clinical tests and nurse reviews to screen for 25 conditions/behaviors. We provided health promotion, on-site care and referral to relevant providers. From October 2022 to September 2023, 2,097 adolescents were enrolled, of whom 1,843 (87.9%) were seen at 6 months. The primary outcome of appropriate care and/or referral(s) for all identified issues was achieved for 70.8% (95% confidence interval: 68.7-72.9%) of 1,865 participants with at least one issue. At follow-up, there were improvements in nutrition, health-related quality of life, self-esteem, behaviors and educational outcomes. The intervention was feasible and largely acceptable. Uptake of referral services varied by issue. Y-Check cost US$47 per participant. Through Y-Check, we identified untreated conditions and risk behaviors and successfully treated and linked adolescents to services. Here we provide evidence on the potential of the intervention to positively impact health and well-being.

Tuberculosis (TB) rarely occurs in isolation; most people with TB experience multiple coexisting conditions, including HIV, diabetes, undernutrition, depression, and substance use disorders, which worsen disease severity and compromise treatment outcomes. Although the World Health Organization has issued disease-specific guidance for managing key comorbidities, TB care remains largely siloed and poorly equipped to address the growing burden of multimorbidity, particularly in African health systems. In this perspective article, we propose a phased framework for multimorbidity-centered TB care. The first phase emphasizes systematic screening for common comorbidities and establishment of basic referral pathways. The second phase focuses on strengthening coordination between TB programs and existing health and social services, including task sharing and longitudinal follow-up. The third phase advances toward fully integrated, co-located, multidisciplinary models of care that embed TB services within broader multimorbidity platforms. Together, this framework offers a pragmatic roadmap for TB programs to deliver more person-centered, equitable, and efficient care, strengthen primary care systems, and accelerate progress toward ending TB as a public health threat in Africa.

BackgroundPeople living with HIV (PLWH) experience up to twofold increased risk of cardiovascular disease compared to the general population. The coronary artery calcium (CAC) score offers a non-invasive and quantifiable assessment of subclinical coronary artery disease (CAD), making it a valuable tool for early detection and risk stratification in this high-risk population.MethodsA systematic review and meta-analysis were conducted to quantify the percentage of detectable CAC among PLWH. Detectable CAC was defined as a CAC >0 based on the Agatston method. CAC scores were further categorized into mild (1–100), moderate (101–399), and high ( >400). Pooled percentages with corresponding 95% confidence intervals (95%CI) were calculated. Subgroup analyses were performed by continent to assess geographic variations in the prevalence of detectable CAC among PLWH.ResultsA total of 56 studies were included, with a pooled percentage of detectable CAC among PLWH of 45.7% (95%CI 36.5-48.2). The pooled percentage with mild CAC was 27.7% (95%CI 22.7-32.9%, N=17), moderate CAC was 9.8% (95%CI 7.7-12.0, N=16) and high CAC 4.4% (.8-6.3%, N=10). Significant regional variations were found in the percentage of PLWH with detectable CAC (p< 0.01): with the highest percentage reported in North America (49.3%, 43.6-55.1, N=35) followed by Asia (42.3%, 95%CI 37.7-48.2, N=5), Europe (42.3%, 95%CI 36.5-48.2, N=12) and Africa (13.4%, 95%CI 9.6-17.6, N=3). A single study from South America reported a pooled percentage of PLWH with detectable CAC of 67.4% (95%CI 50.9-81.4).ConclusionAlmost half of PLWH had detectable CAC, indicating a substantial burden of subclinical coronary artery disease in this population. The higher prevalence observed in North America highlights the importance of targeted preventive strategies, including lifestyle interventions and pharmacologic therapies. The scarcity of data from South America, Oceania and Africa highlights a critical need for further research in these underrepresented regions.DisclosuresAniruddha Hazra, MD, Gilead Sciences: Advisor/Consultant|Gilead Sciences: Grant/Research Support|ViiV Healthcare: Advisor/Consultant

Sepsis is a leading cause of neonatal mortality in sub-Saharan Africa (SSA), where microbiological diagnostic capacity and antibiotic access are limited. High antimicrobial resistance (AMR) rates limit the effectiveness of current treatment guidelines, with concern that available antibiotics are rarely adequate treatment for neonatal sepsis in the region. A cross-sectional online survey was electronically distributed in English, French and Portuguese to neonatal clinicians across SSA between April and June 2025. Questions focused on the management of neonatal sepsis including diagnostic, antibiotic and guideline use. Responses were analysed descriptively and presented as percentages of the total number of responses. Of 169 responses (40/48 countries; 83.3%) from SSA, 71.6% were senior doctors, 88.8% managed neonatal sepsis at least weekly and 58.0% worked in central healthcare facilities.14.9% (95% CI 10.3% to 21.0%) of respondents never and 28.6% (CI 22.3% to 35.8%) less than half of the time received blood culture results in time to impact patient care. Guidelines were almost universally used (97.6% (CI 94.0% to 99.1%)). The most common guideline for early-onset neonatal sepsis advised amoxicillin/ampicillin plus aminoglycosides (46.4% of responses (CI 39.1% to 54.0%)). 50.3% (CI 42.8% to 57.7%) of respondents had difficulties accessing antibiotics, with carbapenems and piperacillin-tazobactam least accessible. 45.4% (CI 38.0% to 53.1%) had attempted to author local guidelines with insufficient local AMR data (45.6% (CI 35.7% to 55.8%)) the most common barrier to guideline development. This large survey highlighted widespread challenges in diagnostic and antibiotic access for neonatal sepsis in SSA. We find that clinicians rely on guidelines to guide starting antibiotics and to guide agent choice. Their practices reflect advice in global guidelines. Attempts to author locally applicable guidelines are hindered by insufficient AMR data. These findings strengthen calls to improve microbiological diagnostic access and support data sharing to generate evidence-based, locally appropriate guidelines.

ObjectiveTo describe well-care visit attendance among children of adolescent mothers living with HIV and HIV-negative adolescent mothers and identify factors associated with optimal retention in the well-care visit schedule up to 18 months.Design, setting, participantsCross-sectional data were used from a community-based observational cohort study of adolescent mothers (10–19 years; n=481) and their children (≥19 months old; n=502) in the Eastern Cape, South Africa.OutcomeOptimal well-care visit retention up to 18 months was defined as attending visits within 4 weeks of the recommended child age, attending the 18-month visit and missing no more than one scheduled visit.ResultsAttendance was highest at the 6-week visit (88.4%; 95% confidence interval (CI) 85.6% to 91.3%) and lowest at the 18-month visit (58.0%, 95% CI 53.6% to 62.3%). About one-third (36.1%; 95% CI 31.8% to 40.3%) of children were retained to 18 months. Retention was highest among children living in rural vs urban areas (adjusted odds ratio (aOR)=2.01, 95% CI 1.32 to 3.06), those born to mothers whose highest education at pregnancy was secondary versus primary school (aOR=2.73, 95% CI 1.60 to 4.65), born via caesarean section vs vaginal birth (aOR=1.65, 95% CI 1.05 to 2.60) and living closer to the clinic (aOR=0.52, 95% CI 0.28 to 0.96 for long vs short distance). There was weak evidence that retention was lower among children of mothers living with HIV (aOR=0.64, 95% CI 0.40 to 1.02) and higher among food-secure children (aOR=2.18, 95% CI 0.96 to 4.96) and those receiving the child support grant (aOR=1.71, 95% CI 0.92 to 3.16).ConclusionsUniversal interventions are needed for retention beyond the neonatal period for children of adolescent mothers living with HIV and HIV-negative adolescent mothers. Interventions must address structural barriers, especially for adolescent mothers with primary education and in urban areas. Future research should examine the underlying mechanisms linking mode of delivery with well-care retention.

The Coronavirus Disease 2019 (COVID-19) posed significant health policy challenges, particularly for low-income countries, where policymakers faced both direct threats from the virus and social and economic harm owing to lockdown measures. We present a holistic contextualized case study of the direct and indirect impacts on women and children, highlighting disparities across socioeconomic, age, and gender groups. We utilized multiple data sources, including primary and secondary data from 28 in-depth interviews, six focus group discussions, and 40 household interviews, as well as data from government reports, District Health Information Software version 2 (DHIS2), and published research. A conceptual framework was devised to hypothesize causal pathways and guide the analysis of results. The findings indicate that the pandemic not only had direct effects, on morbidity and mortality, but also more severe indirect impacts, including job losses and limited access to healthcare, including maternal and child healthcare services, due to measures put in place to control it, which were exacerbated by well-known but inadequately considered preexisting political and economic challenges. The most severe indirect effects on healthcare services availability and wider livelihoods fell on the poorest segments of society, further widening the age and gender inequalities. Policymakers faced significant challenges in managing the direct and indirect harm of COVID-19, including short- and long-term effects and their unequal distribution across society. We conclude that the indirect effects of COVID-19 were at least as harmful, if not more so, than the direct impacts, especially for women and children. In the future, it is highly recommended to establish specific protocols and guidance for maternal and child health service access, including strategies that reduce barriers to social support.

This review synthesises current evidence on the cardiovascular disease (CVD) burden among young people living with HIV. It explores myocardial and vascular pathology, evaluates the role of advanced imaging, and highlights critical gaps in understanding the mechanisms driving HIV-associated CVD in this population. Emerging data suggest that HIV-associated CVD in youth may be predominantly driven by non-atherosclerotic mechanisms, including direct myocardial injury, fibrosis, and remodelling, rather than traditional coronary atherosclerosis. Imaging studies have revealed subclinical myocardial changes such as increased left ventricular mass and reduced strain. Vascular studies show inconsistent findings. However, longitudinal data and multimodal imaging approaches remain scarce, particularly in high-burden regions like Africa. Young adults with HIV face a significant burden of cardiovascular pathology, often subclinical and poorly understood. The prevailing paradigm focused on atherosclerosis may not fully apply to this group, especially in African settings. There is an urgent need for longitudinal, mechanistic research to inform tailored clinical strategies and policy interventions aimed at reducing long-term cardiovascular morbidity in young people with HIV.