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ItemContraceptive utilization among hiv-positive women aged 15-49 years accessing art services at Kotor PHCC in Juba City Council, South Sudan(Makerere University, 2025)Women of reproductive age living with HIV face a dual challenge of unintended pregnancies and the risk of mother-to-child transmission (MTCT). Family planning (FP) is critical for addressing these risks, yet contraceptive use in South Sudan remains among the lowest globally. Understanding utilization and the barriers HIV-positive women face is vital for designing effective interventions. This study assessed contraceptive utilization among HIV-positive women aged 15–49 years accessing ART services at Kotor Primary Health Care Centre (PHCC) in Juba City Council. Specifically, it determined the prevalence of modern contraceptive use, identified associated factors, and explored women’s perceptions and experiences regarding FP. A sequential explanatory mixed-methods design was used. Quantitative data were collected from 439 HIV-positive women through structured questionnaires, whereas qualitative data were obtained from key informant interviews to explore socio-cultural and systemic factors influencing contraceptive decisions. Data were analyzed using multivariable logistic regression and thematic analysis, guided by the Health Belief Model. Of the 439 participants,75.2% (95% CI: 70.9% -78.9%) reported using modern contraceptive methods, with condom being the most commonly used method. The results indicated that the following groups of women were more likely to utilize modern contraceptive methods; women with multiple sexual partners (adj. PR= 1.45, 95%CI: 1.00-2.10, p=0.048), and history of abortion (adj. PR=1.16, 95%CI: 1.01-1.33, p=0.035). Whereas women aged 45 years and above (adj. PR=0.27, 95%CI:0.07-1.00, p=0.050), those who rarely engage in sexual activity (adj. PR= 0.68, 95%CI: 0.51-0.90, p=0.006), with increasing age at menstruation (adj. PR= 0.93, 95%CI: 0.88-0.99, p=0.016) were less likely to utilize modern contraceptive methods. Qualitative findings revealed barriers such as stigma, cultural and religious opposition, stockouts, limited provider training, and myths around infertility and Antiretro Viral Therapy contraceptive interactions. Despite these barriers, provider counseling and partner support emerged as important facilitators of uptake. Contraceptive use among HIV-positive women in Juba is high and is shaped by a complex interplay of individual, socio-economic, cultural, and health system factors. While knowledge and empowerment predict use, stigma, misconceptions, and weak service delivery continue to hinder uptake. Integrating family planning within HIV care, addressing myths and stigma through community engagement, and strengthening provider capacity are essential strategies to improve under utilized contraceptive methods, reduce mother to child transmission, and enhance reproductive health outcomes in South Sudan.
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ItemDeterminants of timeliness in the routine monitoring of HIV-Exposed Infants (HEI) at health facilities in Kampala district.(Makerere university, 2026-01-27)Background: Early Infant Diagnosis (EID) testing is a critical strategy for improving early detection and monitoring of HIV among HIV-Exposed infants (HEIs). Uganda implemented EID services across all HIV points of care in 2018. However, challenges in ensuring timely implementation of EID indicators persist. This study assessed determinants of timeliness in the routine monitoring of HIV-Exposed Infants (HEI) at health facilities in Kampala district. Methods: A mixed-methods study design using an explanatory concurrent approach was employed, integrating both quantitative and qualitative data. Quantitative data were collected using a customized data abstraction tool from EID registers (HMIS ACP: 017), while qualitative data were obtained through open-ended questionnaires administered to healthcare workers. Quantitative data were analyzed using descriptive statistics (frequencies and percentages), and associations were assessed using chi-square tests. A modified Poisson regression model was used to identify factors independently associated with the timeliness of EID indicators, with adjusted Prevalence Ratios (aPRs) reported at a 5% level of significance. Qualitative data were analyzed thematically, and closed-ended responses were summarized using a 5-point Likert scale. Results: A total of 300 HIV-exposed infants were included in the quantitative analysis, of whom 159 (53%) were male. The mean age was 8 months (range: 3–17 months; SD = 2). Overall, 198 (66%) HEIs received EID program indicators in a timely manner. Factors independently associated with poor timeliness included a history of poor maternal ART adherence in the preceding six months, long distance from home to the health facility (>20 km), and younger maternal age (≤24 years). Good maternal ART adherence in the past six months was identified as a protective factor. Qualitative findings from 16 healthcare workers revealed key challenges, including gaps in knowledge of EID indicator definitions, shortages of healthcare personnel, inadequate availability of computers, and limited HMIS tools. Conclusion and recommendations. Timely monitoring of EID program indicators remains suboptimal and is influenced by both individual and health system–related factors. Missed or delayed clinic visits undermine the effectiveness of EID services and increase the risk of mother-to-child HIV transmission. Strengthening maternal appointment adherence, improving availability of essential infrastructure such as computers and HMIS tools, and enhancing healthcare worker capacity through regular training and mentorship are recommended to improve the timeliness of EID program indicators.
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ItemPrevalence of viral load non-suppression and associated factors among adult persons living with HIV on antiretroviral therapy at Kigungu Art Clinic, Entebbe, Wakiso District, Uganda(Makerere University, 2026)The human immunodeficiency virus (HIV) epidemic remains a global public health problem despite the increased rollout of antiretroviral therapy (ART). In Uganda, only 75.4% of persons living with HIV (PLHIV) on ART achieve viral load suppression. This figure falls short of the Joint United Nations Programme on HIV/AIDS (UNAIDS) 95-95-95 target, which requires 95% of PLHIV on ART to be virally suppressed. To determine the prevalence of viral load non-suppression and associated factors among adult PLHIV receiving ART at Kigungu Health Center III ART clinic in Entebbe, Wakiso District, Uganda. This cross-sectional study utilized patient clinic records and structured questionnaire interviews. A systematic random sampling technique was employed to select 234 participants for inclusion in this study between June and September 2025. The primary outcome was viral load non-suppression. Data were collected using a structured questionnaire to assess socio-demographics and psychological factors. Drug and clinical factors data were extracted from records, entered into Epidata, and subsequently exported to Stata version 18 for analysis. Prevalence was reported as a percentage, and modified Poisson regression analysis was used to determine associated factors. The study enrolled 234 participants with a median age (Interquartile range [IQR]) of 36 (29, 44) years; 59.2% were female, 56.9% were fisher folks, 47.6% had primary-level education, and 47.8% were Catholics. The prevalence of viral load non-suppression was 19.7% (95% CI:15.0- 25.3). Duration on current ART regimen (aPR 1.02, 95% CI:1.01- 1.03), having a recent CD4 Count <200 cells/µL (aPR 2.21, 95% CI:1.26 - 3.87), and being a current smoker (aPR 2.42, 95% CI: 1.07-5.47) were significantly associated with viral load non-suppression. One in every five persons living with HIV on ART may have viral load non-suppression, posing a significant challenge to achieving the third 95% UNAIDS target. Duration of the current ART regimen, recent low CD4 count, and smoking were significantly associated with viral load non-suppression. There is a need to strengthen existing interventions and design new strategies to improve viral load suppression. The Ministry of Health should ensure continuous access to CD4 testing at all ART clinics, enhance structured long-term follow-up programs, and promote smoking cessation among PLHIV on ART.
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ItemEnhancing outbreak surveillance through integration of natural language processing in Uganda’s electronic integrated disease surveillance and response system(Makerere University, 2026)Early detection of diseases or infections is essential to prevent infectious diseases from escalating into large outbreaks. In Uganda, the Electronic Integrated Disease Surveillance and Response (eIDSR) system enables community-level reporting of suspected cases via SMS. However, manual processing of these unstructured messages often delays outbreak detection and response, particularly during high-volume reporting periods. The manual processing of incoming SMS messages within the eIDSR system creates a bottleneck that hinders timely outbreak detection and response. This delay has the potential to increase morbidity and mortality, especially in resource-limited settings. This study aimed to integrate Natural Language Processing (NLP) to automate the extraction of key information, such as disease type, location, and symptoms, from SMS alerts submitted to the eIDSR system. It also sought to understand the contextual factors that influenced model accuracy and performance. A retrospective design was employed using historical SMS data submitted to the eIDSR system in 2024. A Bidirectional Encoder Representations from Transformers (BERT)-uncased model was fine-tuned on a manually annotated dataset to support named entity recognition. The model was evaluated using precision, recall, F1-score, and processing speed, and its performance was compared with manual extraction. McNemar’s test was used to assess the statistical significance of differences between the two methods. The model achieved an F1-score of 92.6%, with recall of 94.2% and precision of 91.1%, processing approximately 48 messages per second. It extracted high-value entities such as disease, age, gender, and location, with near-perfect accuracy. Errors were concentrated around symptom span boundaries and ambiguous entries. Interviews confirmed the value of automation for reducing analyst workload and outlined key limitations of the current manual workflow, including handling of ambiguous or duplicate messages. This study demonstrated the feasibility of applying NLP to automate SMS-based disease surveillance within Uganda’s eIDSR system. Although human review remains necessary for edge cases, the model showed strong potential to accelerate processing, eliminate backlog, and support timely response under frameworks like 7-1-7. With targeted improvements especially in symptom handling and multilingual input. The model would be suitable for pilot integration under a human-in-the-loop deployment model.
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ItemPrevalence and determinants of unmet blood needs among patients at Jinja Regional Referral Hospital in Eastern Uganda(Makerere University, 2025)Access to safe blood is critical for healthcare delivery, especially in resourcelimited settings. Uganda requires 450,000 units annually but consistently falls short by over 30%. In the Eastern Region, which has the highest maternal mortality ratio nationally, 34% of maternal deaths are linked to a lack of blood. Despite shortages, inappropriate use and wastage occur, and there is limited data quantifying unmet blood needs and their determinants. The study determined the prevalence of unmet blood needs and their determinants among patients at Jinja Regional Referral Hospital in Eastern Uganda. Methods: A convergent mixed-methods design was employed at Jinja Regional Referral Hospital, Uganda, in July 2025. Quantitative data were obtained via a census of 987 blood transfusion orders from the hospital’s electronic A-LIS system to estimate the prevalence of unmet blood needs. Qualitative data were collected through 25 key informant interviews and 17 in-depth patient interviews, purposively sampled to explore systemic, institutional, and socio-cultural factors influencing unmet blood needs. Quantitative analysis used descriptive statistics while qualitative data underwent hybrid thematic analysis, with findings triangulated across sources to ensure validity. Results: A total of 987 blood transfusion orders at Jinja RRH were analyzed; the majority, 66.7% were for females, while 33.3% were for males, and the mean patient age was 32 years (SD 19). Most orders were for blood group O+ (42.2%). Overall, 68.3% of orders were unmet, highest among females (69.6%), patients aged 20–30 years (39.9%), and those with blood group O- (83%). Qualitative findings revealed institutional factors influencing unmet blood needs, such as high demand, stock-outs, off-site screening for TTIs, inadequate storage capacity, staffing shortages, and community barriers, including low donations, mistrust, and religious beliefs. Conclusion: The high proportion of unmet blood transfusion orders (68.3%) at Jinja RRH, especially for blood group O-, warrants action and solutions to target both institutional and community factors. Inefficiencies in the blood supply chain and low voluntary donation hinder timely access. Targeted blood donation drivers should be considered for high-demand blood groups. Strengthening supply chain management and community mobilization is critical to ensuring adequate and safe blood availability