Background: In Uganda, the main stay for provision of human immunodeficiency virus (HIV) voluntary counseling and testing (VCT) has been at health facilities. Home based VCT on the other hand, was initiated in the country to improve service coverage. Objective: To evaluate the cost effectiveness of facility-and home-based HIV VCT strategies in rural southwestern Uganda. Methods: Data on costs and effectiveness of facility-and home-based HIV VCT intervention strategies was collected in two sub-Counties in rural southwestern Uganda. Costing was performed using the ingredients approach. Effectiveness was measured as the number of HIV sero-positive clients identified. Incremental Cost-Effectiveness Ratios (ICERs) were calculated from the provider perspective. Results: The cost per client tested were US$6.4 for facility based VCT and US$5.0 for home based VCT. The corresponding costs per positive case identified were US$86.5 and US$54.7 respectively. The incremental cost to providers per additional positive case identified by facility based VCT was US$3.5. Conclusion: Home based VCT was the least costly strategy per client tested and was also cost effective in identifying HIV sero-positive clients in rural areas. This strategy should therefore be promoted to improve service coverage and thereby facilitate early and extensive detection of clients eligible for treatment.

There is a paucity of information on the state of water, sanitation, and hygiene (WASH) at health care facilities in Uganda. A survey on WASH service availability was conducted at 50 health care facilities across 4 districts of rural southwestern Uganda between September and November 2015. The main water points at the majority (94%) of the health care facilities were improved sources, while improved toilets were available at 96% of the health care facilities visited. Hospitals had the poorest toilet to patient ratio (1 : 63). Only 38% of the health care facilities had hand washing facilities at the toilets. The lack of hand washing facilities was most prominent at the level IV health centre toilets (71%). Hand washing facilities were available at other points within most (76%) of the health care facilities. However, both water and soap were present at only 24% of these health care facilities. The poor toilet to patient/caregiver ratios particularly in the high volume health care facilities calls for the provision of cheaper options for improved sanitation in these settings. Priority should also be given to the sustainable provision of hygiene amenities such as soap for hand washing particularly the high patient volume health care facilities, in this case the level IV health centres and hospitals.

Background. Under Option B plus, the transmission of Human Immunodeficiency Virus (HIV) along the Early Infant Diagnosis (EID) of HIV cascade remains unknown. We described HIV transmission along the EID cascade and determined associated factors at Arua Regional Referral Hospital, Northwestern Uganda. Methods. Data on 295 mother-baby pairs in EID care (January 2014 and April 2015) was extracted, cleaned, and analysed in STATA. Univariate, bivariate, and multivariate analyses were performed. Independently associated factors were stated in adjusted odds ratio (AOR), 95% confidence interval (CI), and p-values. Results. 233 (89.0%) mothers were above 30 years, 251 (85.1%) were in World Health Organization (WHO) clinical stages I/II at enrolment, 170 (57.6%) attended antenatal care (ANC) visits during recent pregnancy, and 204 (69.1%) delivered in a health facility. Meanwhile, 257 (87.1%) HIV Exposed Infants (HEIs) received Nevirapine prophylaxis from birth up to 6 weeks and 245 (83.0%) were exclusively breastfed during the first 6 months. Of 295 mother-baby pairs, 25 (8.5%) HEIs turned HIV-positive along the EID cascade. Baseline maternal CD4 count of more than 500 cells/ul compared to less than 500 cells/ul (adjusted odds ratio (AOR) = 0.29; 95% Confidence Interval (CI): 0.10–0.85; p = 0.024) and exclusive breastfeeding (EBF) in the first 6 months of delivery in contrast to not EBF in the first 6 months (AOR = 0.17; 95% CI: 0.52–0.55; p = 0.003) reduced HIV transmission. Meanwhile, ANC visits, place of delivery, time of Nevirapine initiation, and maternal antiretroviral therapy use were not significantly associated with infant HIV transmission. Conclusion. HIV transmission was high. High baseline CD4 count and exclusive breastfeeding reduced HIV transmission.

Globally, respiratory illness is one of the most common reasons that children seek care. It is often treated inappropriately with antibiotics, which can drive the development of antibiotic resistance.

One-sentence summary: Novel malaria SHERLOCK assays enabled robust detection, 16 speciation, and genotyping of Plasmodium spp. in diverse samples collected in Africa Abstract word count: 228 20 Manuscript word count: 5291 21 # Corresponding author information: Jonathan B. Parr, MD, MPH; 130 Mason Farm 22Rd., Chapel HillABSTRACT 24 25 CRISPR-based diagnostics are a new class of highly sensitive and specific assays with 26 multiple applications in infectious disease diagnosis. SHERLOCK, Sensitivity Enzymatic Reporter UnLOCKing, is one such CRISPR-based diagnostic that 28 combines recombinase polymerase pre-amplification, CRISPR-RNA base-pairing, and 29LwCas13a activity for nucleic acid detection. We developed SHERLOCK assays for 30 malaria capable of detecting all Plasmodium species known to cause malaria in humans 31 and species-specific detection of P. vivax and P. falciparum, the species responsible for 32 the majority of malaria cases worldwide. We validated these assays against parasite 33 genomic DNA and achieved analytical sensitivities ranging from 2.5-18.8 parasites per 34 reaction. We further tested these assays using a diverse panel of 123 clinical samples 35 from the Democratic Republic of the Congo, Uganda, and Thailand and pools of 36 Anopheles mosquitoes from Thailand. When compared to real-time PCR, the P. 37 falciparum assay achieved 94% sensitivity and 94% specificity in clinical samples. In 38 addition, we developed a SHERLOCK assay capable of detecting the dihydropteroate 39 synthetase (dhps) single nucleotide variant A581G associated with P. falciparum 40 sulfadoxine-pyrimethamine resistance. Compared to amplicon-based deep sequencing, 41 the dhps SHERLOCK assay achieved 73% sensitivity and 100% specificity when 42 applied to a panel of 43 clinical samples, with false-negative calls only at lower parasite 43 densities. These novel SHERLOCK assays have potential to spawn a new generation of 44 molecular diagnostics for malaria and demonstrate the versatility of CRISPR-based 45 diagnostic approaches. 46 47 48 Newly developed technologies that utilize Clustered, Regularly-Interspaced Palindromic 49 Repeat (CRISPR) systems have the potential to revolutionize infectious disease 50 diagnostic testing.(1) SHERLOCK, or Specific High-Sensitivity Enzymatic Reporter 51UnLOCKing, is a CRISPR-based diagnostic assay that has now been used to detect 52 dengue and Zika viruses with excellent sensitivity and specificity.(2) Its simple workflow 53 and robust performance characteristics have enabled multiplexed detection and 54 genotyping of Zika and dengue viruses, with increasingly streamlined protocols that 55 facilitate use at the point-of-care.(3, 4) SHERLOCK's potential is perhaps greatest in 56 low-resource settings where improved, reliable diagnostics are urgently needed for 57 multiple pathogens and for malaria, in particular. 58 59 Timely and accurate diagnosis is an important component of malaria control and 60 elimination efforts. The current generation of rapid diagnostic tests (RDTs) that detect 61 ...