Background Adolescent girls and young women (AGYW) at institutions of higher learning are at high risk of HIV, and conventional HIV testing services may not reach them sufficiently. HIV self-testing (HIVST) scalability can be informed by identifying AGYW who have used or are interested in using HIVST. We aimed to determine factors associated with use and willingness to use HIVST among female university students. Methods An online cross-sectional survey was conducted among 483 female students at Makerere University, Uganda. Proportions of students who have used or are willing to use HIVST and their associated factors were determined. Modified Poisson regression models were used to estimate prevalence ratios (PR) and their 95% confidence intervals (CI). Results The median age of the participants was 22 (Interquartile range [IQR] 21–23) years, and 21% had never tested for HIV. Over 93% were willing to utilize HIVST, and 19% had ever used HIV self-test kits. Increasing age (adjusted prevalence ratio [aPR] 1.23 per year, 95% CI 1.07–1.43) was significantly associated with HIVST use. Predictors of willingness to self-test for HIV were college type (arts vs. science-based, aPR 0.92, 95% CI 0.88–0.97), number of sexual partners (one, aPR 1.07, 95% CI 1.03–1.12 or ≥ 2, aPR 1.08, 95% CI 1.04–1.19, vs. none), alcohol (aPR 1.04, 95% CI: 1.00–1.09) or injection drug (aPR 1.04, 95% CI 1.00–1.09) use, a history of sexually transmitted infections in past 12 months (aPR 1.05, 95% CI 1.01–1.09), and HIV testing experience (tested in past 12 months, aPR 1.12, 95% CI 1.02–1.22 or over 12 months, aPR 1.13, 95% CI 1.03–1.24, vs. never tested). Conclusion HIVST was highly acceptable despite its limited use. This study demonstrates female student characteristics that can be leveraged to scale up HIVST programs in higher institutions of learning.

IntroductionWith the rising resistance to artemisinin-based combination treatments, there is a need to hasten the discovery and development of newer antimalarial agents. Herbal medicines are key for the development of novel drugs. Currently, herbal medicine usage in communities for treatment of malaria symptoms is common as an alternative to conventional (modern) antimalarial agents. However, the efficacy and safety of most of the herbal medicines has not yet been established. Therefore, this systematic review and evidence gap map (EGM) is intended to collate and map the available evidence, identify the gaps and synthesise the efficacy of herbal antimalarial medicines used in malaria affected regions globally.Methods and analysisThe systematic review and EGM will be done following PRISMA and Campbell Collaboration guidelines respectively. This protocol has been registered in PROSPERO. Data sources will include PubMed, MEDLINE Ovid, EMBASE, Web of Science, Google Scholar and grey literature search. Data extraction will be done in duplicate using a data extraction tool tailored in Microsoft Office excel for herbal antimalarials discovery research questions following the PICOST framework. The Risk of Bias and overall quality of evidence will be assessed using Cochrane risk of bias tool (clinical trials), QUIN tool (in vitro studies), Newcastle-Ottawa tool (observational studies) and SYRCLE’s risk of bias tool for animal studies (in vivo studies). Data analysis will be done using both structured narrative and quantitative synthesis. The primary review outcomes will be clinically important efficacy and adverse drug reactions. Laboratory parameters will include Inhibitory Concentration killing 50% of parasites, IC50;Ring Stage Assay, RSA0–3 hou;Trophozoite Survival Assay, TSA50.Ethics and disseminationThe review protocol was approved by the School of Biomedical Science Research Ethics Committee, Makerere University College of Health Sciences (SBS-2022-213).PROSPERO registration numberCRD42022367073.

Background Accurate and affordable laboratory testing is key for timely diagnosis and appropriate management of COVID-19 patients. As such, robust evidence regarding diagnostic accuracy and costs of available tests would inform policy and practice especially in resource-limited settings. We aimed to determine the diagnostic test accuracy, costs and utility of laboratory test strategies for COVID-19 in LMICs. Methods This was a multi-staged protocol-driven systematic review conducted in line with PRISMA guidelines for diagnostic test accuracy studies (PRISMA-DTA). We searched for relevant literature in six databases including: PubMed, Google Scholar, MEDLINE, SCOPUS, Web of Science, and the WHO Global Index Medicus. Studies were screened and coded in pairs. We conducted a structured narrative and quantitative synthesis of the results guided by Fryback and Thornbury framework. The primary outcome was COVID-19 diagnostic test accuracy. The results were reported following the PRISMA-DTA. Results Thirteen articles were from studies in China and one from Turkey. All studies included used the Real-time polymerase chain reaction test (RT-PCR) as their reference test. 21.4% (n = 3) of articles were determining the diagnostic accuracy of the PCR test. The remaining studies (n = 11) used other COVID-19 tests as the index tests. It is generally observed that the tests were more specific than sensitive pooled sensitivity and specificity was 87.6%, (95% CI: 82.2% − 93%), 98.1% (95% CI: 96.4%-100%) respectively. The Reverse-transcription loop-mediated isothermal amplification (RT-LAMP) tests had the highest sensitivity as compared to RT-PCR, serological and chemiluminescent immunoassays (CLIA). The specificity and sensitivity of the tests were highest when bronchial lavage samples were used and lowest with the use of serum specimens/sample. No study documented cost of the diagnostic test used. Conclusion The evidence on COVID-19 testing in LMICs is summarized in this systematic review. The RT-PCR was used as the reference test in all studies. The diagnostic assays' combined sensitivity and specificity were 87.55% and 98.10%, respectively. In the reviewed literature, no study reported on the cost and cost effectiveness of diagnostic tests. Finally, no studies were carried out on the African continent. Registration: This review was registered in PROSPERO No. CRD42020209528. And the protocol published here https://bmjopen.bmj.com/content/11/10/e050296

Background Uganda adopted and implemented the Universal Test and Treat (UTT) guidelines in 2017, which require HIV-infected persons to be initiated on antiretroviral therapy (ART) at any CD4 + cell count, and to be routinely monitored for viral load to assess response to ART. However, there is paucity of data on viral load suppression (VLS) among people living with HIV (PLHIV) with mental disorders. We conducted a parallel convergent mixed methods study to determine HIV VLS among people with a mental disorder and explored the socio-cultural determinants of VLS at Butabika hospital and Mulago (ISS) HIV Clinics in Uganda. Methods We conducted a retrospective medical records review; seven key informant interviews (KII) among purposively selected healthcare providers and 12 in-depth interviews (IDI) among clinically stable PLHIV with a mental disorder. Data was collected on demographics, mental disorder, ART, viral load status, social support, stigma, and disclosure of HIV status. Quantitative data was analysed using descriptive statistics and modified Poisson regression, while Inductive thematic analysis was used for the qualitative data. Results Of the 240 PLHIV with a mental disorder who were enrolled, 161 (67.1%) were female with mean age 38.9 (± 11.2) years. Overall, 88.8% (95% Cl: 84.0% – 92.2%) achieved VLS. Age (aPR = 1.01, 95%Cl = 1.00-1.01), male gender (aPR = 0.95, 95%Cl = 0.95–0.95), divorced (aPR = 0.89, 95%Cl = 0.87–0.91), widowed (aPR = 0.84, 95%Cl = 0.79–0.90), baseline CD4 count < 200 (aPR = 0.89, 95%Cl = 0.82–0.95), and fair (85–94%) ART adherence level (aPR = 0.68, (95%Cl = 0.54–0.87) were associated with HIV VLS. Social support from family members, knowledge of impact of negative thoughts on VLS, fear of breaking up with partners and compassionate healthcare providers positively influenced VLS. Stigma and discrimination from the community, self-perceived stigma hindering social relations, socio-economic challenges and psychiatric drug stock-outs negatively affected VLS. Conclusion and recommendations HIV VLS among PLHIV with mental disorders at institutions that provide integrated HIV and mental health care is still below the UNAIDS 95% target. Health promotion messaging focusing on benefits of VLS and countering stigma to create a safe environment; and active involvement of family members in care could improve HIV treatment outcomes for PLHIV with mental disorders.