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Item Innovation platforms and value chain role expansion among Ugandan coffee farmers: Evidence on peer learning, group option, and legitimacy(EScience Press, 2026-02-25) Ochago, RobertInnovation platforms can help Ugandan coffee smallholders expand their roles in the value chain, beyond production, when they create repeated peer learning, support group action, and build legitimacy for new roles. However, most research emphasises platform design and average outcomes and says little about the daily social costs of upgrading attempts, such as recognition, trust, moral pressure, and jealousy. This study examines how smallholders in eastern Uganda identify value chain constraints, what they learn through platform participation, and how local legitimacy shapes who persists as trader, mobiliser, or processor. Qualitative methods were used, including focus group discussions and interviews of 91 innovation platform participants from Kapchorwa, Manafwa, and Namisindwa districts. The study applied a reflective thematic analysis. The study found that the expansion of the roles beyond primary production, including marketing, buying, coordination, and service, is achieved through practical learning, peer learning, training and interactions. The dynamics of recognition by others enhance farmers' trust, enabling them to sustain these expanded roles. On the other hand, recognition also creates new obligations and moral pressure, with expectations for support, training others, and exemplary behaviour, which sometimes contribute to conflict and to withdrawal from leadership or facilitation roles. As much as collective action spaces created opportunities for bargaining and visibility, they also generated tensions over governance and the sharing of benefits. This study contributes to extension research by illustrating how platforms contribute to value chain upgrading through socially verified learning and legitimacy, and by creating social costs for the longevity of new farmer roles. The policy implications point to the need to design innovation platforms that consider governance, equitable recognition and opportunities, and support for farmer intermediaries.Item Viral load suppression after intensive adherence counselling among previously non-suppressed adolescents and young people with HIV in East-Central Uganda(Taylor & Francis, 2026-03-03) Ejalu, David Livingstone; Okello, Peter Simon; Puleh, Sean Steven; Nangendo, Joanita; Izudi, Jonathan; Bakeera-Kitaka, Sabrina; Katamba, Achilles; Katahoire, Anne R; Kalyango, Joan N; Cattamanchi, Adithya; Semitala, Fred C; Kamya, Moses RBackground: Viral load suppression remains suboptimal among adolescents and young people living with HIV in Uganda (AYPLHIV). Although Intensive Adherence Counselling is recommended for individuals who remain virally non-suppressed while on antiretroviral therapy, its contribution to suppression among AYPLHIV is not well understood. This study aimed to determine the level of viral load suppression achieved following intensive adherence counselling among previously non-suppressed AYPLHIV in east central Uganda. Methods: We conducted a sequential explanatory mixed methods study among 580 participants aged 10– 24 years receiving care at 32 health facilities. Quantitative data were abstracted covering a five-year period from 2019– 2024. Suppression levels and subgroup differences were assessed using chi-square tests. A qualitative study was conducted with 12 purposively selected participants and thematic analysis were guided by the Capability, Opportunity, Motivation and Behavior framework. Results: Participants had a median age of 16.4 years and a median ART duration of 4 years. Overall, out of the 580 participants, 313 (53.9%) achieved viral load suppression after counselling. Participants living more than 5 km compared to less than 5km from a health facility (p=0.003) and those counselled by counsellors rather than nurses (p< 0.001) had significantly higher suppression level. Lower suppression level was observed among participants who had not disclosed their HIV status versus those who disclosed (p=0.011) and those reporting fear or stigma compared to those not reporting (p=0.010). Qualitative findings indicated that understanding the purpose and benefits of intensive adherence counselling (Capability), financial barriers and provider interactions (Opportunity), and non-disclosure (Motivation) influenced suppression outcomes among AYPLHIV. Conclusion: IAC resulted in modest improvements in VL suppression among AYPLHIV. Low retention and contextual barriers, including distance, stigma and non-disclosure, limited its effectiveness. Tailored IAC strategies addressing subgroup-specific barriers are needed to improve VL suppression.Item Effectiveness of ART optimization on viral load suppression in children and adolescents with HIV in Uganda: A quasi-experimental study(Wolters Kluwer Health, 2026-02-27) Nasuuna, Esther M; Babirye, Lillian; Kigozi, Joanita; Muganzi, Alex; Izudi, JonathanUganda implemented the antiretroviral therapy (ART) optimization program in July 2019, based on an eligibility rule. ART optimization targeted individuals with prior viral load (VL) < 1000 copies/mL, while those with VL ≥ 1000 copies/mL continued with non-optimized regimens. We assessed the effectiveness of ART optimization on VL suppression among children and adolescents with HIV (CAWH) in Uganda. We also assessed the compliance of human immunodeficiency virus (HIV) clinics with the eligibility rule and its effect on ART optimization. Therefore, we designed a quasi-experimental study using data from 21 urban and rural HIV clinics. The exposure was ART optimization, defined as the initiation or transition of CAWH on dolutegravir or a protease inhibitor (boosted lopinavir). Children and adolescents with HIV on an optimized ART regimen formed the exposed group, while those on a non-optimized ART regimen comprised the nonexposed group. The primary outcome was VL suppression, defined by VL < 1000 copies/mL after ≥6 months of ART optimization. We assessed the effectiveness of ART optimization on VL suppression using 2-stage least squares instrumental variable regression due to imperfect compliance with the eligibility rule across the clinics. We also established the effectiveness of the eligibility rule on ART optimization for individuals just below and just above the cutoff. Sensitivity analysis was performed using a noncausal approach. We analyzed data from 2999 CAWH aged ≤19 years and found an overall VL suppression of 76.1% (2282/2999). We found that ART optimization showed a trend toward improved VL suppression (risk ratio [RR] 1.81, 95% CI: 0.79–4.14). However, compliance with the rule was only for 2.6% of the participants, and the rule did not improve ART optimization (RR 0.96, 95% CI: 0.88–1.05). Overall, ART optimization, guided by an eligibility rule, did not achieve the target of ≥95% VL suppression among CAWH across the 21 public HIV clinics in Uganda, partly due to low compliance with the rule, although it showed a trend toward improvement. Addressing context-specific biological, behavioral, social, and structural barriers is needed to optimize VL outcomes.Item Magnitude and correlates of overweight or obesity among adults with diabetes mellitus duration of five or more years in rural Uganda: A cross-sectional study(Elsevier, 2026-02-26) Lumori, Boniface Amanee Elias; Lodiong, Lodiong Jackson Dumo; Ucama, Ufoymungu Patrick; Izudi, JonathanBackground Overweight and obesity are major risk factors for micro and macrovascular diseases, with diabetes mellitus exacerbating these burdens. We determined the prevalence of overweight or obesity and its associated factors among adults with diabetes mellitus with a duration of ≥5 years at Mbarara Regional Referral Hospital in Southwestern Uganda. Methods This analytic cross-sectional study was conducted over 5 months, from November 2017 to March 2018. We collected demographic and clinical data and measured body mass index (BMI). The outcome was overweight or obesity, measured as the proportion of individuals with a BMI of 25 kg/m2 or more. We used binary logistic regression to estimate associations of a priori selected variables with the outcome. Results Of 189 participants, 138 (73%) were female, the mean age was 61.5 ± 11.1 years, and the median duration of diabetes mellitus since diagnosis was 10 years (interquartile range, 7–15). Overall, 122 (64.5%) participants were overweight or obese. In the multivariable logistic regression analysis, former cigarette smoking (adjusted odds ratio (AOR) 0.2, 95% confidence interval (CI) 0.1–0.6), every 1-year increase in the duration of diabetes mellitus (AOR 1.1, 95% CI 1.0–1.1), and hypertension (AOR 2.8, 95% CI 1.2–6.5) were independently associated with overweight or obesity. Conclusion Overweight/obesity is prevalent among adults with diabetes mellitus duration of 5 years and over, in a rural Ugandan population. Former cigarette smokers have a decreased likelihood of being overweight or obese, while hypertension and every 1-year increase in the duration of diabetes mellitus are associated with a higher likelihood of being overweight or obese.Item Participation of livestock farmers and community animal health workers in one health intervention to control zoonotic diseases in Rwanda: a qualitative study(Springer Nature, 2026-01-27) Hugor, Shema; Izudi, Jonathan; Shyaka, AnselmeBackground In zoonotic disease hotspots, engaging local communities in zoonotic disease monitoring and reporting is essential for effective prevention and early outbreak detection. In Rwanda, the Eastern Province has experienced nearly 90% of all zoonotic disease outbreaks. This qualitative study explored the participation of livestock farmers and community animal health workers (CAHWs) in One Health interventions aimed at controlling zoonotic disease outbreaks in Nyagatare district, Eastern Province, Rwanda. Method Among livestock farmers and CAHWs, we collected qualitative data through in-depth interviews and focused group discussions. We held key informant interviews with district-level officials, namely district veterinary, district health, and district environmental health officers, to validate the data from livestock farmers and CAHWs. The data were transcribed verbatim and verified by replaying the audio recordings. Content analysis was performed. Results Five major themes emerged as areas of participation: (i) capacity building focused on livestock management and livestock disease identification and prevention; (ii) community-level health education encompassing zoonotic disease risk communication and awareness raising; (iii) interruption of zoonotic disease transmission that comprised infection prevention and control, separation of sick and healthy livestock, quarantine, and zero grazing, adherence to guidelines, and the testing, treatment, spraying, and vaccination of livestock; (iv) collaboration with multiple sectors via training on zoonotic diseases, including its treatment, investigation, and prevention; and 5) zoonotic disease surveillance that included livestock monitoring and inspection for zoonotic diseases and the notification and reporting of zoonotic diseases to relevant authorities. The collaboration between the environmental health sector and the animal and human sectors was weak, while vaccination targeted mainly cattle but not small ruminants. Conclusions Livestock farmers and CAHWs participate in several One Health interventions aimed at controlling zoonotic diseases, particularly in vaccination campaigns for cattle, community sensitization, and basic animal husbandry practices. However, collaboration between the environmental health sector and the animal and human sectors was weak, vaccination efforts largely excluded small ruminants, and some farmers relied on local herbs for treatment due to limited access to professional veterinary services. Efforts to sustain the major areas of participation are needed, while weaker areas need strengthening.Item Determinants of underweight and overweight/ obesity among people with tuberculosis in Kampala, Uganda: A cross-sectional study(PLOS, 2026-02-13) Kyazze, Simon; Appeli, Saidi; Baluku, Joseph Baruch; Izudi, JonathanBackground Malnutrition significantly contributes to mortality among people with tuberculosis (TB). However, evidence on factors associated with the specific forms of malnutrition, specifically underweight and overweight/obesity, beyond clinical determinants, remains limited in many settings. We investigated the prevalence and determinants of underweight and overweight/obesity among people with pulmonary TB across five health facilities in Kampala, Uganda. Methods This analytic cross-sectional study involved people with pulmonary TB, either clinically diagnosed or bacteriologically confirmed, aged ≥18 years sampled across five health facilities in Kampala, Uganda. Nutritional status was assessed using body mass index (BMI, kg/m²) and categorized as underweight (<18.5), normal weight (18.5–24.9), and overweight/obese (≥25.0). To identify factors independently associated with nutritional status, normal weight was considered as the reference category in a multinomial logistic regression analysis, adjusting for multiple covariates and clustering at the health facility level. The measure of association was the adjusted relative risk ratios (aRRR) and the corresponding 95% confidence intervals (CI). Results Of the 818 participants studied, 417 (51.0%) had normal weight, 302 (36.9%) were underweight, and 99 (12.1%) were overweight or obese. Adjusted analysis showed that being underweight was associated with household food insecurity (aRRR 2.04, 95% CI: 1.48–2.80) while being overweight or obese was associated with self-employment (aRRR 2.26, 95% CI: 1.35–3.79) and being newly diagnosed with TB (aRRR 2.10, 95% CI: 1.30–3.41). Conclusion This study, conducted among people with pulmonary TB in an urban setting in Uganda, showed that underweight and overweight/obesity are prevalent. Furthermore, the study showed that food insecurity is associated with being underweight, while being overweight or obese is associated with being self-employed or newly diagnosed with TB. Therefore, TB control programs need to regularly assess the nutritional status of people with TB to mitigate the effect of being underweight or overweight on treatment outcomes.Item Timeliness of vaccine administration among children in urban informal settlements in Nairobi, Kenya(PLOS, 2026-02-11) Ng’oda, Maurine; Izudi, Jonathan; Omenda, Collins; Njeri, Anne; Mbaya, Nelson; Ziraba, AbdhalahTimeliness of vaccination among children in urban informal settlements is understudied in sub-Saharan Africa. We determined the proportion of children below 5 years who received vaccines on time and the associated factors in two large urban informal settlements in Nairobi, Kenya. We conducted an analytic cross-sectional study in Viwandani and Korogocho, randomly selected households with a child below 5 years, and administered questionnaires to mothers/caregivers. Timely vaccination was defined according to the Kenya Expanded Programme on Immunization schedule. Vaccination was considered timely if administered within 28 days of birth for Bacille Calmette-Guérin (BCG), between 14 and 18 weeks for Diphtheria-Tetanus-Pertussis-Haemophilus influenzae type b-Hepatitis B dose 3 (DTP-Hib-HepB-3), and between 9 and 10 months for Measles-Containing Vaccine dose 1 (MCV1). Multivariable modified Poisson regression identified the factors associated with timely vaccination. Of 412 children, 216 (52%) with verifiable immunization booklets were analyzed for timeliness. Timely vaccination rates were 90.4% for BCG (189/209), 90.2% for DTP-HIB-Hep-3 (184/204), and 84.2% for MCV1 (160/190). Factors associated with timely vaccination included caregiver uncertainty about access to health services, which reduced the likelihood of timely BCG (adjusted prevalence risk ratio [aPR] 0.87, 95% confidence interval [CI] 0.78-0.96), DTP-Hib-HepB-3 (aPR 0.88, 95% CI 0.79-0.98), and MCV1 (aPR 0.81, 95% CI 0.70-0.94). Compared with Korogocho, children in Viwandani were more likely to receive timely MCV1 (aPR 1.18, 95% CI 1.03-1.35), whereas children of Christian caregivers were less likely than those of non-religious caregivers (aPR 0.83, 95% CI 0.70-0.99). Overall, vaccination timeliness varied by antigen, with a slight decline over time for later-schedule vaccines such as MCV1. Residence, religion, and access to routine health services were key determinants of timely vaccination. Strengthening outreach, faith-based engagement, and reminder systems in informal settlements like Korogocho could enhance vaccine timeliness, particularly for vaccines administered later in infancy.Item Intention to disclose medical errors by healthcare providers to patients and associated factors in Ugandan health facilities: A cross-sectional study(PLOS, 2026-02-09) Alupo, Catherine; Izudi, Jonathan; Ddamulira, ChristopherThis study assessed the prevalence and factors associated with intention to disclose medical errors by healthcare providers to patients in public health facilities in Mukono District, Uganda. We conducted an analytic cross-sectional study among healthcare providers across four public health facilities in Mukono District, Uganda. The outcome, Intention to disclose medical errors to patients, was defined as self-reported likelihood of informing a patient or their caregiver about a medical error if it had occurred, including the circumstances of error occurrence and any corrective actions taken. Data were collected using a self-administered structured questionnaire capturing factors at the individual and institutional levels. Logistic regression analysis was used to identify factors independently associated with intention to disclose medical errors, with adjusted odds ratios (aOR) and 95% confidence intervals (CI) reported. We studied 166 healthcare providers, of whom 90 (54.2%) were aged ≥35 years and 95 (57.2%) were female. Overall, 74 (44.6%) participants reported an intention to disclose medical errors. After adjusting for potential confounders, nurses (aOR 0.09, 95% CI 0.02-0.37) and other cadres (aOR 0.09, 95% CI 0.02-0.47) had significantly lower odds of intention to disclose medical errors compared with medical doctors/physicians. In contrast, healthcare providers working in health facilities with supportive supervision had higher odds of intention to disclose medical errors than those without supportive supervision (aOR 3.32, 95% CI 1.37-8.06). Fewer than half of healthcare providers have the intention to disclose medical errors to patients, indicating a substantial gap from the ethical expectation of full transparency. Supportive supervision was associated with an increased likelihood of intention to disclose medical errors, while non-physician cadres were less likely to report intention to disclose medical errors compared to medical doctors. Interventions that strengthen supervision and empower all cadres through training and institutional support may enhance openness and accountability in healthcare practice.Item Effect of facility- versus community-based HIV testing services on the diagnosis of advanced HIV disease in Uganda: a quasi-experimental study(Springer Nature, 2025-12-30) Izudi, Jonathan; Ssentongo, Saadick Mugerwa; Appeli, Saidi; Bajunirwe, FrancisBackground Advanced HIV disease (AHD) at first diagnosis remains a significant barrier to HIV epidemic control. We evaluated whether health facility-based or community-based HIV testing services (HTS) better impact the yield of AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. Methods We designed a quasi-experimental study and applied instrumental variable analysis, a causal inference methodology, to compare the effect of facility-based HTS versus community-based HTS on the yield of AHD at diagnosis among newly diagnosed PWH. The exposure was HTS comparing community-based versus facility-based, and the outcome was AHD at diagnosis, defined as CD4 < 200 cells/µL or WHO clinical stage 3 or 4 disease at baseline. The instrumental variable was the HTS access radius that reflects the HTS geographical coverage for each health facility. The instrumental variable ensured the categorization of health facilities as offering HTS within a 5 km radius only or both within and beyond 5 km. The relevance of the instrumental variable was assessed using the F-statistic and independence from measured covariates. We used a two-stage residual inclusion approach to estimate the effect of HTS on AHD at diagnosis. Causal effect was reported as an odds ratio (OR) and 95% confidence interval (CI). Results Of 1,233 participants included in the analysis, AHD prevalence was 1.9% (24/1,233). The instrumental variable was strongly correlated with HTS (First-stage F-statistic = 28.05, p < 0.0001) and uncorrelated with AHD and all measured covariates. Facility-based HTS has no significant effect on AHD at diagnosis compared to community-based HTS (OR 1.20, 95% CI 0.49–2.90). Conclusions Persons with AHD at diagnosis are a minority. Facility- and community-based HTS do not differ in identifying AHD among newly diagnosed PWH, but moderate effects cannot be excluded. These findings support efforts to implement both strategies for HIV testing to reach and test persons with advanced HIV.Item Effect of food insecurity on hazardous alcohol consumption and psychological well-being among people with tuberculosis in Kampala, Uganda(Elsevier, 2025-11-27) Izudi, Jonathan; Appeli, Saidi; Bajunirwe, FrancisRationale Food insecurity (FI), hazardous alcohol consumption (HAC), and poor mental health are common among people with tuberculosis (TB), yet empirical evidence on their interrelationships remains limited. Objective We evaluated the effect of FI on HAC and psychological well-being among people with pulmonary TB in Kampala, Uganda. Methods We collected data across five TB clinics and constructed a quasi-experimental design. FI was the exposure, measured using the FI Experience Scale (FIES). FIES scores range between 0 and 8, and individuals were classified as food insecure if they scored ≥ 4. The primary outcome was HAC, assessed using the Alcohol Use Disorders Identification Test (AUDIT) tool. Participants with AUDIT scores ≥ 16, indicating high-risk drinking or possible alcohol dependence, were categorized as having HAC. The secondary outcome was psychological well-being measured using the World Health Organization’s Five Well-Being Index, with a total score of <15 indicating poor psychological well-being. We used doubly robust estimation to report causal risk ratios (RR) and 95 % confidence intervals (CI). Results Of 818 participants, 475 (58.1 %) were from food-insecure households, 153 (18.7 %) had HAC, and 316 (38.6 %) had poor psychological well-being. FI was independently associated with HAC (RR 1.43, 95 % CI: 1.21–1.69), but not poor psychological well-being (RR 1.06, 95 % CI: 0.81–1.37). Conclusion FI is associated with a higher likelihood of HAC but not psychological well-being among people with TB in Kampala, Uganda. Given their high prevalence, there is a need to address food insecurity, HAC, and poor psychological well-being within TB control programs.Item Tree-based intervention typologies and improvements in refugee displacement regions(AccScience Publishing, 2025-11-10) Juster, Sarah H.; Munsell, John F.; Njenga, Mary; Okia, Clement A.Concern about deforestation in contexts of refugee displacement is substantial. Tree-based interventions (TBIs) are efforts to plant trees, conserve trees, and/or facilitate tree regrowth. TBIs are implemented by non-governmental organizations in refugee displacement contexts to address landscape-level deforestation, soil erosion, and biodiversity loss while providing livelihood opportunities to participants. Although humanitarian stakeholders recommend TBIs in refugee-hosting regions, the diversity of TBI models and associated strengths and weaknesses are not well understood. This research focuses on five TBIs implemented in a northwest Uganda refugee settlement that include large-acre woodlot planting, household-level planting of trees yielding short-term products, and conservation site establishment to protect indigenous tree species. Interviews and focus-group discussions with TBI staff revealed that each intervention makes trade-offs in navigating five key challenges associated with TBI implementation in a refugee context: Obtaining access to land, providing short-term livelihood benefits to participants, gaining equitable involvement by gender, achieving environmental conservation goals, and successfully engaging community members. Significant differences were found between the strategies of TBIs implemented at home sites when compared to TBIs implemented at community sites. While TBIs implemented at home sites are intended to provide participants long-term access to tree products with clear user rights and enable women to grow trees alongside ongoing domestic activities, TBIs implemented at community sites can achieve large-scale environmental goals and provide cash-based employment opportunities to participants. An applied integrated landscape approach is recommended to maximize inter-program collaboration and collective benefits across programs, while realizing sustainable TBI impacts within complex socioecological refugee displacement contexts.Item Regenerating the food system: A proposed vision and guiding principles for regenerative, inclusive food systems (RIFS)(Springer Nature, 2025-12-29) O’Keeffe, Sine´ad; Amede, Tewodros Tefera; Bockline, Bebe Omedo; Kajobe, Robert; Reemer, Thies; Haggard, Ben; Froebrich, Jochen; Siegmund-Shultze, MariannaThe aim of this perspective is to further the discussion on regenerating our food system, by describing our future food system (FS) vision to be a regenerative, inclusive food system (RIFS) and providing guiding principles that work within an interactive dynamic framework to achieve this vision. The five RIFS principles outlined in this paper are intended to support and guide place-based processes for regenerating our FS. These are: (1) sense of place and purpose; (2) socio-ecological design for innovation; (3) building connections; (4) fair, just and inclusive transitions; and (5) design for renewal (it is a living process). The use of the five principles are at the heart of RIFS, supporting transformative, experiential learning and guiding the actions and responsibility of all actors involved in FS transformation towards RIFS. We argue that when all these principles occur in a transformation process, this provides the fertile ground for achieving a RIFS’s vision.Item Effect of food insecurity on hazardous alcohol consumption and psychological well-being among people with tuberculosis in Kampala, Uganda(Elsevier, 2025-11-27) Izudi, Jonathan; Appeli, Saidi; Bajunirwe, FrancisRationale: Food insecurity (FI), hazardous alcohol consumption (HAC), and poor mental health are common among people with tuberculosis (TB), yet empirical evidence on their interrelationships remains limited. Objective: We evaluated the effect of FI on HAC and psychological well-being among people with pulmonary TB in Kampala, Uganda. Methods: We collected data across five TB clinics and constructed a quasi-experimental design. FI was the exposure, measured using the FI Experience Scale (FIES). FIES scores range between 0 and 8, and individuals were classified as food insecure if they scored ≥ 4. The primary outcome was HAC, assessed using the Alcohol Use Disorders Identification Test (AUDIT) tool. Participants with AUDIT scores ≥ 16, indicating high-risk drinking or possible alcohol dependence, were categorized as having HAC. The secondary outcome was psychological well-being measured using the World Health Organization’s Five Well-Being Index, with a total score of <15 indicating poor psychological well-being. We used doubly robust estimation to report causal risk ratios (RR) and 95 % confidence intervals (CI). Results: Of 818 participants, 475 (58.1 %) were from food-insecure households, 153 (18.7 %) had HAC, and 316 (38.6 %) had poor psychological well-being. FI was independently associated with HAC (RR 1.43, 95 % CI: 1.21–1.69), but not poor psychological well-being (RR 1.06, 95 % CI: 0.81–1.37). Conclusion: FI is associated with a higher likelihood of HAC but not psychological well-being among people with TB in Kampala, Uganda. Given their high prevalence, there is a need to address food insecurity, HAC, and poor psychological well-being within TB control programs.Item Barriers and facilitators to integrating tuberculosis treatment into community pharmacies for people with TB/HIV in Kampala, Uganda: A qualitative study(PLOS, 2025-11-21) Izudi, Jonathan; Cattamanchi, Adithya; Sekaggya-Wiltshire, Christine; Kiwanuka, Noah; Sammann, Amanda; King, RachelCommunity pharmacies (private retail drug shops or pharmacies) have proven successful for delivering anti-retroviral therapy to people living with human immunodeficiency virus (HIV). Leveraging this model for tuberculosis (TB) treatment integration could improve access to both TB and HIV treatment among people with TB/HIV. We identified the barriers and facilitators to integrating TB treatment into community pharmacies for people with TB/HIV in Kampala, Uganda, using a qualitative study across six public health facilities. Participants included people with TB/HIV; healthcare providers (HCPs) from the six facilities and their affiliated community pharmacies; and experts from the Ministry of Health. Data were collected through interviews guided by the Consolidated Framework for Implementation Research (CFIR). We performed framework analysis and mapped the emergent sub-themes to the relevant CFIR domains. We enrolled 47 participants: six TB focal persons, six HIV focal persons, nine pharmacy HCPs, three Ministry of Health staff, and 23 people with TB/HIV. Major facilitators included the convenience of accessing both TB and HIV treatment at a single location; enhanced privacy and reduced stigma; improved accessibility through extended hours, shorter wait times, and proximity; readiness of community pharmacy HCPs to deliver TB treatment; willingness of people with TB/HIV to engage in self-managed care; and training of pharmacy HCPs in TB care. Key barriers included unclear eligibility criteria for enrolling people with TB/HIV, absence of TB counseling services at pharmacies, inadequate infrastructure for TB drug storage, limited confidence among pharmacy HCPs in delivering TB care, and unclear logistics and operational procedures for implementation. Therefore, context-specific interventions that are developed in collaboration with key stakeholders, address barriers like eligibility criteria refinement, enhanced pharmacy HCP training, and financial incentives, and leverage facilitators like policy support and stakeholder readiness, are needed for the successful integration of TB treatment into community pharmacies for people with TB/HIV in Uganda.Item Tree-based intervention typologies and improvements in refugee displacement regions(AccScience Publishing, 2025-11-10) Juster, Sarah H.; Munsell, John F.; Njenga, Mary; Okia, Clement A.Concern about deforestation in contexts of refugee displacement is substantial. Tree-based interventions (TBIs) are efforts to plant trees, conserve trees, and/or facilitate tree regrowth. TBIs are implemented by non-governmental organizations in refugee displacement contexts to address landscape-level deforestation, soil erosion, and biodiversity loss while providing livelihood opportunities to participants. Although humanitarian stakeholders recommend TBIs in refugee-hosting regions, the diversity of TBI models and associated strengths and weaknesses are not well understood. This research focuses on five TBIs implemented in a northwest Uganda refugee settlement that include large-acre woodlot planting, household-level planting of trees yielding short-term products, and conservation site establishment to protect indigenous tree species. Interviews and focus-group discussions with TBI staff revealed that each intervention makes trade-offs in navigating five key challenges associated with TBI implementation in a refugee context: Obtaining access to land, providing short-term livelihood benefits to participants, gaining equitable involvement by gender, achieving environmental conservation goals, and successfully engaging community members. Significant differences were found between the strategies of TBIs implemented at home sites when compared to TBIs implemented at community sites. While TBIs implemented at home sites are intended to provide participants long-term access to tree products with clear user rights and enable women to grow trees alongside ongoing domestic activities, TBIs implemented at community sites can achieve large-scale environmental goals and provide cash-based employment opportunities to participants. An applied integrated landscape approach is recommended to maximize inter-program collaboration and collective benefits across programs, while realizing sustainable TBI impacts within complex socioecological refugee displacement contextItem Missed opportunities in engaging community pharmacies for integrated tuberculosis care in Sub-Saharan Africa: A Call to Action.(American Society of Tropical Medicine and Hygiene (ASTMH), 2025-11-06) Izudi, Jonathan; Sekaggya-Wiltshire, Christine; Adithya, CattamanchTuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. Community pharmacies, which are often the first point of contact for people with TB, are underutilized in expanding TB care. Engaging community pharmacies in TB care could facilitate personalized adherence counseling, the timely detection and reporting of medication side effects, and the integration of TB and HIV services for individuals with both TB and HIV. Pharmacies can reduce stigma and address social and psychological barriers by offering person-centered care in convenient, accessible settings, including for working people and hard-to-reach communities. Integrating community pharmacies into national TB programs could strengthen adherence, reduce loss to follow-up, improve case detection, and help achieve End TB Strategy goals. The authors of the present study advocate for deliberate policy, training, and data linkages to realize this scalable opportunity, including implementation research.Item Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study(Elsevier, 2025-10-22) Ssentongo, Saadick Mugerwa; Appeli, Saidi; Izudi, JonathanObjectives Advanced HIV disease (AHD) at diagnosis substantially contributes to HIV-related morbidity and mortality but has been understudied. We determined the prevalence and factors associated with AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. Methods We conducted a retrospective cohort study of newly diagnosed PWH between May 2020 and July 2023 across 23 public health facilities in 14 districts in rural eastern Uganda. AHD at diagnosis was defined by a cluster of differentiation 4 count <200 cells/µL or World Health Organization clinical stage 3-4 disease. A generalized linear mixed model was used to identify factors associated with AHD at diagnosis. Results Among 1233 participants, we found that 24/1233 (1.9%) had AHD at diagnosis. In adjusted analysis, AHD at diagnosis was independently associated with being male rather than female (adjusted odds ratio, 3.84; 95% confidence interval, 1.53-9.61). Conclusions The low prevalence of AHD at diagnosis among newly diagnosed PWH suggests progress toward earlier diagnosis in rural eastern Uganda. Men tended to present with AHD at diagnosis more than women, although the finding is imprecise. Our findings highlight the need for targeted, gender-sensitive interventions to promote early diagnosis and care linkage.Item Effect of healthcare worker vs. non-health worker delivered health education on modern contraceptive uptake among women in Malawi: a quasi-experimental study(Springer Nature, 2025-10-29) Salamba, Thom; Izudi, Jonathan; Masegese, Tumaini; Mwila, Gabriel; Gueye, Ibrahima; Kyule, Grace; Khakayi, Sadie; Karan, Annaline; Vellemu, Ruth; Mwanga, Daniel; Gerbaba, Mulusew J.Background Most women receive health education from healthcare workers. However, the same information can be delivered by non-health workers such as religious and traditional leaders, and peers, among others. The effectiveness of non-health worker-delivered health education on the uptake of hormonal contraceptives, however, remains uncertain. We compared the effectiveness of health worker and non-health worker-delivered health education on the uptake of modern contraceptives among women of reproductive age in two large districts in Malawi. Methods We designed a quasi-experimental study in two Malawian districts (Mangochi and Chikwawa). The intervention was health education delivered by either a health worker, such as a nurse (intervention group), while the comparator was health education delivered by a non-health worker, like a religious or traditional leader, peer, or the media, among others (comparison group). The main outcome was the uptake of modern contraceptives. To remove systematic differences between the two groups and achieve comparability on observed covariates, we used inverse probability of treatment weighting to emulate a randomized trial. After achieving covariate comparability, we performed a binary logistic regression to estimate the effect of health worker-delivered health education on contraceptive uptake, adjusting for the inverse probability of treatment weights. We reported the odds ratios (OR) and 95% confidence intervals (CI). Results We studied 414 participants aged 15–49 years (median age 29 years, interquartile range 23–36). There were 316 participants in the intervention group, and 143 (45.3%) of them used modern contraceptives. The comparison group had 98 participants, and 41 (41.8%) of them used modern contraceptives (p = 0.552). Participants in the intervention group tended to have an increased modern contraceptive uptake compared to those in the comparison group, although the difference was statistically insignificant (OR 1.45, 95% CI 0.74–2.89). Conclusions Modern contraceptive uptake did not differ between health worker and non-health worker-delivered health education approaches in the two Malawian districts. Non-health worker-delivered health education could be an additional tool for reaching several women of reproductive age with modern contraceptive information. This would contribute to increasing the contraceptive prevalence rate and reducing maternal and neonatal morbidity and mortality in these districts and similar settings.Item Effect of safe water delivery plus water and sanitation hygiene behavior change communication on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya: a quasi-experimental study(Springer Nature, 2025-10-28) Izudi, Jonathan; Muchiri, Evans; Musyoka, Dennis; Simiyu, Sheillah; Tumwebaze, Innocent K.; Mbaya, Nelson; Sidze, Estelle; Musau, Kelvin; Abajobir, AmanuelBackground Diarrheal diseases are prevalent among children under five years of age in slum areas. We evaluated the effect of safe water delivery plus water, sanitation, and hygiene (WASH)-Behavior Change Communication (WASH-BCC on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya. Methods We designed a quasi-experimental study, with the intervention as safe water delivery plus WASH-BCC. The intervention arm consisted of 2 slum villages that received safe water plus WASH-BCC, while the comparison arm comprised 2 slum villages that did not receive the intervention. The primary outcome was diarrheal disease in a child under five years of age in the past 2 weeks in both study arms, defined as the passage of ≥ 3 watery stools in the past 24 h. Data were collected at the baseline and endline from a random sample of eligible households in the villages. Propensity score weighting was used to achieve similarity in measured covariates between both arms. Binary logistic regression analysis, adjusting for propensity-score weights, was utilized to estimate the causal effect of the intervention, reported as odds ratio (OR) and 95% confidence interval (CI). Results We analyzed data from 1,876 participants in a 1:1 ratio and found 382 (20.4%) children under five years of age had diarrheal disease at the endline. Diarrheal disease prevalence declined in the intervention villages (33.3% baseline vs. 23.5% endline) but increased in the comparison villages (15.7% baseline vs. 17.5% endline). We found a 31% decline in diarrheal disease in the intervention villages relative to the comparison villages (OR 0.69, 95% CI 0.55–0.86). In a difference-in-differences analysis, the decline was 11.4%. The findings remained robust in a sensitivity analysis. Conclusion The intervention significantly reduced diarrheal disease prevalence in children under five years of age in the slum setting. Therefore, there is a need to expand the intervention to the remaining areas to reduce diarrheal disease morbidity and mortality.Item Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study(Elsevier, 2025-10-04) Ssentongo, Saadick Mugerwa; Appeli, Saidi; Izudi, JonathanObjectives Advanced HIV disease (AHD) at diagnosis substantially contributes to HIV-related morbidity and mortality but has been understudied. We determined the prevalence and factors associated with AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. Methods We conducted a retrospective cohort study of newly diagnosed PWH between May 2020 and July 2023 across 23 public health facilities in 14 districts in rural eastern Uganda. AHD at diagnosis was defined by a cluster of differentiation 4 count <200 cells/µL or World Health Organization clinical stage 3-4 disease. A generalized linear mixed model was used to identify factors associated with AHD at diagnosis. Results Among 1233 participants, we found that 24/1233 (1.9%) had AHD at diagnosis. In adjusted analysis, AHD at diagnosis was independently associated with being male rather than female (adjusted odds ratio, 3.84; 95% confidence interval, 1.53-9.61). Conclusions The low prevalence of AHD at diagnosis among newly diagnosed PWH suggests progress toward earlier diagnosis in rural eastern Uganda. Men tended to present with AHD at diagnosis more than women, although the finding is imprecise. Our findings highlight the need for targeted, gender-sensitive interventions to promote early diagnosis and care linkage.