Makerere University Walter Reed Project

ABSTRACT Microfinance, especially microcredit, has increasingly become a popular poverty reduction strategy in many developing nations. Microfinance aims to enhance people’s economic situation through increasing access to credit, with women forming the largest group. The key question is to what extent does microfinance address women’s needs and concerns to enhance their economic empowerment? The article draws on findings from a mixed-methods action-research study with members of community banking schemes, using in-depth interviews, key informant interviews, and focus group discussions. The article examines the extent to which community banking, in the form of a group-based guaranteed microcredit scheme, is gender sensitive to women’s needs and challenges. The study shows that gender-blind design, structure, and delivery of microcredit programs for people from low-resource settings have significant implications for women’s ability to access and benefit from microcredit products. While community banking can contribute to financial inclusion, women continue to face challenges that greatly limit their opportunities for economic empowerment through participation in the scheme. The study underscores the importance of being sensitive to women’s economic, social, and cultural needs to promote their economic empowerment.

Abstract Background : Despite the scale-up of Dolutegravir (DTG)-based regimens in sub-Saharan Africa, limited data exist on the real-world impact of antiretroviral therapy (ART) optimization on viral load suppression (VLS) and safety among children and adolescents. We evaluated regimen transitions, viral load trends, and safety outcomes among children and adolescents in HIV care at Mildmay Uganda Hospital (MUgH). Methods : We conducted a descriptive retrospective cohort study of children and adolescents aged ≤19 years receiving HIV care at MUgH between January 2018 and December 2023. Sociodemographic, clinical, and viral load data were abstracted from registers, patient files, and electronic medical records. Regimen transitions were classified into 11 groups, including Abacavir (ABC)/Zidovudine (AZT) to DTG, DTG to DTG, Efavirenz (EFV) or Nevirapine (NVP) to DTG, EFV or NVP to Protease Inhibitor(PI), EFV or NVP to PI/DTG, and PI to DTG, PI, or PI/DTG. Viral load was classified as suppressed (≤200 copies/mL), low-level viremia (201–999), or high-level viremia (≥1000). Descriptive statistics summarized baseline characteristics and regimen transitions. VLS before (2019) and after optimization (2022) was compared using chi-square tests. Adverse events were classified by Medical Dictionary for Regulatory Activities system organ class. Results : A total of 1,036 participants were included, with mean age 14.4 (±4.1) years; 58.0% were ≥15 years and 52.7% female. Most (94.4%) resided in the Kampala Metropolitan Area and 95.2% initiated ART at MUgH. Following optimization, viral suppression improved across multiple transitions: EFV→DTG (81.3% to 88.0%), PI→DTG (52.3% to 86.1%), ABC/AZT→DTG (65.6% to 90.6%), and NVP→DTG (80.6% to 88.8%). EFV→PI maintained 80.0% suppression, whereas NVP→PI consistently showed 100% high-level viremia. Overall suppression increased from 67.9% to 81.7% (p<0.001). Adverse events were predominantly Respiratory, thoracic and mediastinal disorders (49.2%), asymptomatic presentations (16.5%), and skin disorders (12.2%), with other events occurring at ≤2%. Conclusion: ART optimization at MUgH enhanced viral suppression, particularly with dolutegravir-based regimens, while protease inhibitor transitions showed slower improvement. Persistent viremia and frequent respiratory events highlight the need for vigilant monitoring, adherence evaluation and support, and timely interventions to sustain long-term treatment success among children and adolescents living with HIV.

Objective:This study evaluated factors associated with adverse infant outcomes (preterm delivery, infant mortality) and described access of antiretroviral therapy (ART) by pregnant women living with HIV (WLWH) and their infants.Design:The African Cohort Study (AFRICOS) enrolls individuals aged ≥ 15 years across 12 clinical sites in Kenya, Uganda, Tanzania, and Nigeria. These analyses included WLWH enrolled from 2013 to 2023. Data on sociodemographics, HIV-related factors, and pregnancy outcomes were collected by self-report and medical records.Methods:Multivariable logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for associations between maternal characteristics and infant outcomes, with clustered standard errors to account for multiple pregnancies by the same woman.Results:Among 593 WLWH with 922 pregnancies, 753 (81.7%) resulted in singleton live births. Of these, 12.1% (91/753) were to WLWH who indicated they did not receive ART. In total, 5.2% (39/753) of live born infants were preterm; 5.6% (42/753) of infants died before 12 months of age. Odds of preterm birth were higher among WLWH under 20 years of age (aOR 3.39, 95% CI 1.12–10.31, versus 20–34 years). Increased odds of mortality were observed among infants born preterm (aOR 7.92, 95% CI 3.28–19.13, versus full term) and infants without ARV prophylaxis prescription (aOR 5.13, 95% CI 2.23–11.83, versus infants prescribed ARV prophylaxis).Conclusion:Gaps in prevention of vertical transmission care persist. Expanding ART access to WLWH and adherence to WHO HIV treatment guidelines are critical to end vertical transmission of HIV and reduce infant mortality.

Background: Human immunodeficiency virus (HIV) affects more than 39 million people worldwide, with Uganda ranked 10th among countries with the highest number of cases. As new preventative HIV injectables emerge, it is vital to think about how best to tailor strategies to promote these injectable drugs, like PrEP and vaccines, when available, to the different populations most in need. Discrete choice experiments (DCEs) are economics-derived methods used to determine factors that influence engagement in a certain behavior. Objective: This study used a DCE to determine the preferences for a preventative HIV injectable drugs/vaccines among people at risk of HIV acquisition in urban and peri-urban areas of Uganda. Methods: In June 2024, we implemented a cross-sectional DCE survey in three urban sites in Uganda in English and Luganda. The survey collected information on demographics, HIV risk, vaccine confidence and responses to the 13 injection product choice tasks presented to determine preferences. We used community-based, respondent-driven sampling methods to recruit participants from three key populations: (1) female sex workers; (2) people who identify as lesbian, gay, bisexual or transgender; and (3) young women (18–24 years). We collected the data on tablets using the Sawtooth Lighthouse Studio software (v. 19.15.6), taking into consideration privacy and confidentiality, given the sensitivity of the information and recent governmental policies in Uganda. Data were analyzed using a split-sample mixed logit regression analysis. The study was approved by local ethical regulatory bodies. Results: From the total of 406 participants screened for this study, 376 participants met the eligibility criteria and were included in the final analysis (85 young women, 159 female sex workers, and 132 who identified as lesbian, gay, bisexual or transgender). The average age was 23.7 (SD: 5.7). The majority of participants had received some secondary school or vocational school (202, 53.7%) The attributes that explained the preferences were primarily severe compared to mild side effects (β: −0.69, 95% CI: −0.78, −0.60), a 30% increase in vaccine/drug effectiveness (β: 0.39, 95% CI: 0.34, 0.44), and a 50,000 UGX (or USD ~13.64) increase in cost (β: −0.22, 95% CI: −0.27, −0.17). There were no significant differences between the preferences for different injectable types. The sensitivity analyses suggested potential differences in preferences by the amount of help participants received from research assistants when completing the survey, although not by income level. Conclusions: Side effects had the greatest impact on participants’ preferences for injectable HIV prevention methods, followed closely by effectiveness and cost. It is therefore essential to develop affordable or free prevention options with minimal side effects. Policymakers should focus on reducing the financial barriers to access and emphasize transparent communication about the effectiveness and safety of these injectables in health promotion campaigns to maximize adoption and improve public health outcomes.

Despite significant advances in HIV antiretroviral treatment, and proven efficacy of HIV prevention options, an effective and affordable HIV vaccine is still necessary for the elimination of HIV, particularly in Africa. Furthermore, viral and host factors unique to the African continent provide a strong scientific rationale for local vaccine discovery efforts. Several key challenges hamper Africa's vaccine research and production capabilities. These include inadequate funding for African-led research, equipment and infrastructure challenges, lack of preclinical evaluation capacity, limited manufacturing facilities for clinical-grade vaccines, and a shortage of scientists with specialized laboratory, bioinformatics and biostatistics training. A recently established African-led consortium seeks to strengthen African HIV vaccine contributions by providing support, training and funding to address these gaps by strengthening discovery research and conducting early phase clinical trials of existing and novel Africa-derived vaccine candidates while strengthening African manufacturing infrastructure and capacity. Constant and robust community and stakeholder engagement will be key to ensuring the success of the consortiums' efforts in providing sustainable vaccine development, manufacturing and clinical testing in Africa. Given the magnitude of the HIV burden in Africa, with largely undescribed viral and host diversity, it is vital that HIV vaccine discovery evolves to include the underutilized scientific expertise and capacity on the African continent. Recent interruptions in the funding of consortia in Africa threaten this type of progress and can derail progress in vaccine discovery.

ABSTRACT Background: Fleas transmit a variety of zoonotic agents whose epidemiology and public health risk remains poorly understood in sub-Saharan Africa, including Uganda particularly outside plague-endemic areas. Common flea-borne zoonotic agents include Rickettsia felis and Yersinia pestis.. Objectives: The study aimed at detecting and characterising flea-borne pathogens in peridomestic environments in Uganda. Methods: We collected fleas from domestic animals, chickens, rodents, and homestead environments; pooled them by species, collection time, and host species. A total of 172 pools were analyzed for Y. pestis Pla gene. Further, 62 pools were tested for Rickettsia species gltA, ompA, and htrA genes by PCR and Sanger sequencing. Results: Five flea species were identified: C. canis, C. felis, Echidnophaga gallinacea, Pulex irritans, and X. cheopis. Genus, Ctenocephalides, accounted for 84.8% of fleas collected, mostly found on dogs and goats. The flea species were found across all districts, year-round, with higher numbers collected in dry seasons than rainy seasons. Rattus rattus constituted 74% of rodents captured from human dwellings and was the only rodent species with fleas, where X. cheopis was the predominant species. All 172 pools were negative for Y. pestis. Rickettsia spp. was detected in 29/62 (46.8%) pools by the target genes. Of 25 htrA amplicons sequenced, 4% were identified as R. felis from C. canis, 92% were R. asembonensis from multiple flea species, and 4% were identified as Candidatus Rickettsia senegalensis. Conclusion:The survey identified high pool detection rate of Rickettsia spp. in fleas,suggestingrisk of human exposure and infection. This was the first report of Rickettsia spp. in E. gallinacea and detection of Candidatus R. senegalensis in Uganda.

The bacterium Acinetobacter haemolyticus, with a genome size of 3.4 Mb, was isolated from a pus swab of a wound on the left lower limb above the ankle joint of a female patient. This strain carries the antimicrobial resistance genes cephalosporinase blaADC-25, oxallinase blaOXA-264, floR, and sul2 and other resistance and virulence genes.

ObjectivesThe aim of this study was to evaluate body composition variability assessed by bioimpedance in relation to nutritional status assessed by anthropometry in children and adolescents living in countries characterized by contrasting nutritional conditions. MethodsThe sample was comprised of 8614 children (4245 males; 4369 females), aged 3 to 19 years, from Nepal (477 children), Uganda (488 children and adolescents), UK (297 children and adolescents) and US (7352 children and adolescents). Height-for-age (HAZ) and body mass index-for-age (BAZ) z-scores were calculated according to WHO growth references. Specific bioelectrical impedance vector analysis (BIVA) was used to evaluate body composition variability. In each population sample, the relationship of HAZ and BAZ with bioelectrical outcomes was analysed by confidence ellipses and cubic spline regression, controlling for sex and age. ResultsThe participants from Uganda and Nepal were more affected by undernutrition, and those from the US and UK by obesity. In all groups, phase angle and specific vector length were weakly associated with HAZ, with null or opposite relationships in the different samples, whereas they were positively associated with BAZ. The stronger association was between vector length, indicative of the relative content of fat mass, and BAZ in the UK and US samples. Confidence ellipses showed that the relationships are more strongly related to phase angle in Nepalese and Ugandan samples. ConclusionsBioelectrical values were more strongly associated with BAZ than HAZ values in all population samples. Variability was more related to markers of muscle mass in Ugandan and Nepalese samples and to indicators of fat mass in UK and US samples. Specific BIVA can give information on the variability of body composition in malnourished individuals.

Shorter prophylactic vaccine schedules may offer more rapid protection against Ebola in resource-limited settings. This randomized, observer-blind, placebo-controlled, phase 2 trial conducted in 5 sub-Saharan African countries included people without human immunodeficiency virus (HIV) (PWOH, n = 249) and people with HIV (PWH, n = 250). Adult participants received 1 of 2 accelerated Ebola vaccine regimens (MVA-BN-Filo, Ad26.ZEBOV administered 14 days apart [n = 79] or Ad26.ZEBOV, MVA-BN-Filo administered 28 days apart [n = 322]) or saline/placebo (n = 98). The primary endpoints were safety (adverse events [AEs]) and immunogenicity (Ebola virus [EBOV] glycoprotein-specific binding antibody responses). Binding antibody responders were defined as participants with a >2.5-fold increase from baseline or the lower limit of quantification if negative at baseline. The mean age was 33.4 years, 52% of participants were female, and among PWH, the median CD4+ cell count was 560.0 (interquartile range, 418.0-752.0) cells/μL. AEs were generally mild/moderate with no vaccine-related serious AEs or remarkable safety profile differences by HIV status. At 21 days post-dose 2, EBOV glycoprotein-specific binding antibody response rates in vaccine recipients were 99% for the 14-day regimen (geometric mean concentrations [GMCs]: 5168 enzyme-linked immunosorbent assay units [EU]/mL in PWOH; 2509 EU/mL in PWH) and 98% for the 28-day regimen (GMCs: 6037 EU/mL in PWOH; 2939 EU/mL in PWH). At 12 months post-dose 2, GMCs in PWOH and PWH were 635 and 514 EU/mL, respectively, for the 14-day regimen and 331 and 360 EU/mL, respectively, for the 28-day regimen. Accelerated 14- and 28-day Ebola vaccine regimens were safe and immunogenic in PWOH and PWH in Africa. Clinical Trials Registration. NCT02598388.

Staphylococcus urealyticus bacteria are pathogenic among immune-compromised individuals. A strain (MUWRP0921) of Staphylococcus urealyticus with a genome of 2,708,354 bp was isolated from Uganda and carries genes that are associated with antibiotic resistance, including resistance to macrolides (erm(C) and mph(C')), aminoglycosides (aac(6")-aph(2")), tetracyclines (tet(K)), and trimethoprim (dfrG).