Blood culture (BC) processes are critical to the utility of diagnostic testing, bloodstream infection (BSI) management, and antimicrobial resistance (AMR) surveillance. While Uganda has established BC guidelines, often laboratory practice does not meet the desired standards. This compromises pathogen recovery, reliability of antimicrobial susceptibility testing, and diagnostic test utility. This study assessed laboratory BC process outcomes among non-malarial febrile children below five years of age at five AMR surveillance sites in Uganda between 2017 and 2018. Secondary BC testing data was reviewed against established standards. Overall, 959 BC specimens were processed. Of these, 91% were from female patients, neonates, infants, and young children (1–48 months). A total of 37 AMR priority pathogens were identified; Staphylococcus aureus was predominant (54%), followed by Escherichia coli (19%). The diagnostic yield was low (4.9%). Only 6.3% of isolates were identified. AST was performed on 70% (18/26) of identified AMR priority isolates, and only 40% of these tests adhered to recommended standards. Interventions are needed to improve laboratory BC practices for effective patient management through targeted antimicrobial therapy and AMR surveillance in Uganda. Further research on process documentation, diagnostic yield, and a review of patient outcomes for all hospitalized febrile patients is needed.

Background: Outbreaks are occurring at increasing frequency and they require multisectoral and multi-stakeholder involvement for optimal response. The Global Health Security Agenda is a framework that governments and other stakeholders can use to strengthen countries’ capacities to prevent, detect and respond to outbreaks but there are few examples of academic programs using this approach. Methods: This is a narrative review of contributions of Makerere University through the Global Health Security Program at the Infectious Diseases Institute (IDI). Information was sourced from peer-reviewed publications and grey literature highlighting work done between 2017 - 2021. Results: Aligned to GHSA, IDI made contributions to strengthen national and subnational capacities for biosafety and biosecurity, sample collection and transportation, electronic disease surveillance, infection prevention and control, case management prior to COVID-19 that were subsequently used to support response efforts for COVID-19 in Uganda. Conclusion: The IDI Global Health Security program provides a model that can be used by institutions to deliberately developcapacities relevant to outbreak preparedness and response. Keywords: Epidemics; University; Ebola.

Introduction: The novel Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that causes COVID-19 disease is a global challenge. Several countries have adopted testing, isolation, and tracing strategy towards the control of the COVID-19 pandemic, but access to rapid and accurate testing is still a global challenge. The conventional PCR – based assay is the most commonly used test yet it has huge costs, infrastructural, and procurement logistical challenges. The Xpert® Xpress SARS-CoV-2 test is an automated in – vitro diagnostic test for the qualitative detection of nucleic acid from SARS-CoV-2 within a turnaround time of 60 minutes on the widely used GeneXpert Dx Instrument Systems. Here we document the best practices and challenges encountered with the operationalization of Xpert® Xpress SARS-CoV-2 testing in a resource-limited setting.Materials and Methods: The Xpert® Xpress SARS-CoV-2 implementation followed an operational work plan that included; Laboratory COVID-19 policy and planning, situational analysis of the Laboratory network, country Xpert® Xpress SARS-CoV-2 assay verification, and rollout at Mutukula Port Health Laboratory. The Laboratory strategy was based on a set of six objectives; conducting infrastructural modifications, building a strong COVID-19 testing capacity, developing robust Laboratory Quality and Information Management Systems, establishing a Bio-risk management and Bio-banking capacity.Results: The Xpert® Xpress SARS-CoV-2 testing implementation team that was appointed by the Ministry of Health (Uganda) successfully established the Xpert® Xpress SARS-CoV-2 testing Laboratory at Mutukula border in Uganda. As of 9th July 2020, this Laboratory had tested a total of 10,990 samples with a median turnaround time of 75 (IQR: 60 – 75) minutes for samples of persons entering through Mutukula Land Point of Entry as compared to the median TAT 1980 minutes before it was established. The laboratory had only one discordant result out of 20 panels in the inter-laboratory comparison retesting program.Conclusions: Implementation of Xpert® Xpress SARS-CoV-2 testing for rapid diagnosis of COVID-19 is feasible and significantly reduces the long TAT observed with conventional RT-PCR based testing. The operationalization of the Xpert® Xpress SARS-CoV-2 testing is largely dependent on the initial planning, adequacy of resources, and preparedness within the laboratory network. Challenges include; the difference in approaches to COVID-19 response, the attitude of truck-drivers/persons on Infection Prevention and Control measures, language barrier, and waste management issues.

In January 2020, the World Health Organization (WHO) declared the outbreak of a new coronavirus disease, COVID-19. The WHO and the Centers for Disease Control and Prevention (CDC) recommend using an alcohol-based hand rub (ABHR) as one of the measures to combat the spread of COVID-19. Objective To assess the impacts and lessons learned from the local production of WHO-recommended alcohol-based hand rub during the COVID-19 Pandemic in Uganda. Method Space for local production was identified at a health facility in Central Uganda that was air-conditioned and well ventilated. Volunteers were trained on the local production of ABHR. The volunteers were trained theoretically and practically for Four days; and each was able to produce at least a batch of ABHR. Logistical support for supplying the raw materials needed for production was from the Infectious Diseases Institute. There were also already established ABHR production units and trained staff on local production of ABHR in 2019 in the Kabarole and Kasese districts, respectively in Western Uganda. These districts were threatened by several outbreaks, including Ebola virus disease, and were monitored for ABHR production during the COVID-19 Pandemic. Result Two production units were set up during the Ebola outbreak, in awake of COVID-19, a production unit in Kasese, was able to produce 3020 litres, and the Kabarole unit produced 2020 litres respectively. A new production unit was set up at Kasangati HCIV in central Uganda and eight laboratory technologists trained on Local Production of ABHR, and within Eleven days they were able to produce 2300ltrs. Conclusion The initiative to produce WHO-recommended hand rub locally during an outbreak is feasible, especially in a resource-limited country like Uganda. There is a need to rapidly scale-up the production capacity of ABHR and to ensure and maintain quality assurance at each production unit.