Background Adolescent girls and young women (AGYW) account for 29% of new HIV infections in Uganda despite representing just 10% of the population. Peer support improves AGYW linkage to HIV care and medication adherence. We evaluated the feasibility and acceptability of peer delivered HIV self-tests (HIVST) and oral pre-exposure prophylaxis (PrEP) to young women in Uganda. Methods Between March and September 2021, we conducted a pilot study of 30 randomly selected young women, aged 18–24 years, who had received oral PrEP for at least three months, but had suboptimal adherence as measured by urine tenofovir testing (< 1500 ng/ml). Participants were offered daily oral PrEP and attended clinic visits three and six months after enrollment. Between clinic visits, participants were visited monthly by trained peers who delivered HIVST and PrEP. Feasibility and acceptability of peer-delivered PrEP and HIVST (intervention) were measured by comparing actual versus planned intervention delivery and product use. We conducted two focus groups with young women, and five in-depth interviews with peers and health workers to explore their experiences with intervention delivery. Qualitative data were analyzed using thematic analysis. Results At baseline, all 30 enrolled young women (median age 20 years) accepted peer-delivered PrEP and HIVST. Peer delivery visit completion was 97% (29/30) and 93% (28/30) at three and six months, respectively. The proportion of participants with detectable tenofovir in urine was 93% (27/29) and 57% (16/28) at months three and six, respectively. Four broad themes emerged from the qualitative data: (1) Positive experiences of peer delivered HIVST and PrEP; (2) The motivating effect of peer support; (3) Perceptions of female controlled HIVST and PrEP; and (4) Multi-level barriers to HIVST and PrEP use. Overall, peer delivery motivated young women to use HIVST and PrEP and encouraged persistence on PrEP by providing non-judgmental client-friendly services and adherence support. Conclusion Peer delivery of HIVST and oral PrEP was feasible and acceptable to this sample of young women with suboptimal PrEP adherence in Uganda. Future larger controlled studies should evaluate its effectiveness among African AGWY.

Background: Cryptococcal Meningitis (CM), is the second leading cause of HIV-related mortality in Uganda after TB. A CD4 cell count triggered CRAG screening algorithm and pre-emptive therapy is the mainstay of prevention of CM. The recent absolution of routine CD4 monitoring for stable patients on Highly Active Antiretroviral Therapy (HAART) has shifted this trigger to suspected virological failure.Objective: To assess the performance of Viral Load (VL) as a marker for CRAG screening among patients on HAART at an HIV clinic in Mulago National Referral HospitalMethods: This was a cross sectional diagnostic study conducted at the Baylor Uganda Centre of Excellence HIV clinic in Mulago National Referral hospital. Records of 798 HIV positive patients aged 10 years and above, on HAART for at least 6month, with at least one viral load and a corresponding serum CRAG done between January 2017 and December 2018 were extracted from the Electronic Medical Records. The test under evaluation was a VL cut-off of greater or equal to 1000cp/ml (suspected treatment failure) and the Gold standard was Serum CRAG Lateral Flow Assay (LFA). Sensitivity, specificity, positive predictive value, negative predictive value, Likelihood ratio positive, likelihood ratio negative and the Area under the Receiver Operating Characteristic (ROC) curve were then determined using 2x2 contingency tables and ROC curve analysis. Results: Prevalence of CRAG using the gold standard was 0.6% (95%CI: 0.2-1.5). The sensitivity and specificity of VL≥1000cp/ml as a marker for CRAG were 20% (95%CI: 2.1-74.4) and 99.4% (95%CI: 98.4-99.8) respectively. The Area under the ROC curve was 0.56 (95%CI: 0.29-0.82). The likelihood ratio positive and negative were 1.0. The optimal VL cut-off was VL≥49cp/ml with a sensitivity of 60% and specificity of 53%. Conclusion: In populations with low CRAG prevalence, treatment failure (VL≥1000cp/ml) is not a good marker for CRAG screening. A more conservative cut-off of 49cp/ml may be considered were resources allow.