Infectious Diseases of Poverty

Background Dengue is a major public health challenge, and predictive models are crucial for early warning systems. However, many current modeling practices rely exclusively on climatic factors or employ complex algorithms that lack the interpretability needed for informed public health decision-making. To address these shortcomings, we developed and validated a multidimensional, interpretable statistical model to predict monthly dengue incidence. Methodology/Principal Findings We used a Generalized Linear Mixed Model (GLMM) with a Negative Binomial distribution to analyze 14 years (2010-2023) of spatiotemporal data from 37 municipalities in Huila, Colombia, an endemic region. The model integrates non-linear and lagged effects of climatic, demographic, and socioeconomic factors. The final model underwent rigorous external validation on an independent test set (2021-2023). Our model demonstrated high predictive discrimination (R2 = 0.743, Spearman's {rho} = 0.657), accurately capturing the timing of epidemic outbreaks. Key findings include the identification of an optimal thermal window for transmission at 27-28{degrees}C, a threshold effect for precipitation above 800 mm, and a saturation dynamic in outbreak autocorrelation. Conclusions/Significance This mechanistically-informed statistical approach provides a robust and transparent tool for epidemiological surveillance, successfully balancing high predictive performance with the explanatory power needed for effective, data-driven public health interventions.

Background: Snakebite envenoming is a major cause of preventable death and disability in the Brazilian Amazon, where long distances, sparse roads, and dependence on river transport delay access to antivenom. We developed location-allocation models to identify community health centers that could strategically expand access to antivenom in Amazonas State, Brazil. Methodology/Principal Findings: We conducted an ecological geospatial study using a 2025 WorldPop population surface, locations of existing and candidate health facilities, and a multimodal road-and-river transportation network derived from OpenStreetMap and HydroSHEDS. Population demand was represented by 7,065 populated centroids, including 1,586 within Indigenous territories. We applied a maximize-coverage algorithm with a six-hour travel-time threshold. Two models were developed: one for Amazonas excluding Manaus and one for populations living in Indigenous territories. Both models began with 77 facilities already providing antivenom and progressively added candidate community health centers until coverage gains plateaued. The plateau occurred at 110 facilities, corresponding to 33 additional centers. In the model excluding Manaus, this configuration covered 1,118,831 people, or 75.11% of the target population; 87.61% of those covered could reach care within three hours. In Indigenous territories, coverage increased from 50.55% to 69.50%, reaching 50,434 people, of whom 81.39% were within three hours of care. Validation used 3,595 snakebite notifications from the 30 highest-burden municipalities in the Brazilian Notifiable Diseases Information System during 2023-2025. The median proportion reaching care within six hours was 40.81% in observed data and 72.17% in model estimates. Conclusions/Significance: Strategically equipping 33 additional existing community health centers could substantially expand timely access to antivenom, particularly in rural and Indigenous areas. Location-allocation modeling that incorporates river transportation can support evidence-based decentralization of time-sensitive health services in geographically complex settings.

Background: The biological mechanism linking rainfall with leptospirosis transmission is well established, but rigorous quantitative evidence for the insular Caribbean remains scarce, limited mostly to descriptive reports of post-hurricane outbreaks. We aimed to quantify the association between rainfall and leptospirosis incidence in the Dominican Republic, where leptospirosis is endemic, between 2012 and 2026 using a distributed-lag approach. Methods: We conducted an ecological time-series study complemented by a province panel with fixed effects. Case data (5,412 valid cases) were obtained from the national surveillance system (SIP-0276FA51); rainfall data were obtained from 15 INDOMET rain gauge stations across 13 provinces (2000 to 2026). We calculated the cross-correlation function between lagged monthly rainfall (0 to 6 months) and case counts, fitted a negative binomial distributed-lag regression model (lags 0 to 3 months) adjusted for seasonality and trend, triangulated findings with a 13-province fixed-effects panel, compared four rainfall exposure metrics, assessed extreme-rainfall threshold sensitivity, and estimated the population attributable fraction (PAF) with a parametric bootstrap. Results: The rainfall-case association peaked at a 1-month lag (r = 0.551; 95 % CI 0.437-0.647; p < 0.001) and remained significant through 3 months. In the distributed-lag model, all four lags were independently significant, with the 1-month lag showing the strongest effect (incidence rate ratio [IRR] = 1.156 per additional 50mm; 95 % CI 1.090-1.226; p < 0.001). The province panel yielded an almost identical 1-month lag effect (IRR = 1.147; 95 % CI 1.127-1.167). Rainfall above the historical 90th percentile increased case risk the following month (rate ratio = 1.95), with effect magnitude increasing monotonically with threshold stringency. An estimated 28.2 % (95 % CI 19.0-36.6 %) of cases were attributable to rainfall above the recorded historical minimum. Conclusions: Rainfall is a robust, consistent predictor of leptospirosis incidence in the Dominican Republic, with the strongest association observed at a 1-month lag and a lag pattern broadly consistent with findings from distributed-lag studies in Thailand and the Philippines. These findings, which to our knowledge constitute the first formal quantification of this association for the insular Caribbean, provide an evidence base for rainfall-linked early-warning systems, with the strongest signal at approximately one month and elevated risk extending through three months after rainfall.

Mosquito-borne diseases pose a growing public health challenge as climate change reshapes vector population dynamics. West Nile virus (WNV), transmitted between birds and Culex mosquitoes, disproportionately affects Maricopa County, Arizona, one of the nation's highest-burden counties, yet whether models that include weather and avian dynamics improve forecast accuracy remains unclear. Using a 15-year weekly time series of mosquito abundance, mosquito infection prevalence, and human cases, we developed four mechanistic model configurations of varying complexity, from mosquito-human dynamics alone to full models incorporating avian dynamics and weather forcing. We fitted each model to the weekly-observed data, generated probabilistic 1- and 2-week-ahead forecast horizons, and evaluated forecasts against a historical baseline. All configurations fit the data equally regardless of weather or avian dynamics. However, models incorporating both birds and weather created more accurate forecasts of mosquito abundance and mosquito infection prevalence, and all configurations outperformed the baseline for forecasting human cases. Forecast accuracy was highest in summer and fall, and ensemble aggregation sometimes outperformed every individual model, stabilizing predictions across the 15-year record. These findings indicate that avian and weather dynamics are most critical for predicting mosquito-specific data, positioning this framework as a scalable tool for public health planning for WNV surveillance under climate change.

The 17th Ebola outbreak in the Democratic Republic of the Congo, announced on 15 May 2026, was attributed to Bundibugyo ebolavirus (BDBV). Although case isolation is the main control strategy, its effectiveness is compromised when patients escape isolation facilities before recovery. Between 14 May and 17 June 2026, 175 individuals reportedly left isolation facilities without formal discharge across Ituri Province. We assessed how this "isolation leakage" affects community transmission. We refined the SEIHFR framework to distinguish undetected community infections, detected but not-yet-isolated cases, isolated individuals, leakage, funeral-associated transmission, and removals. Using Bayesian inference, we fitted the model to daily Ituri surveillance data, escapee counts, and isolation census records. We estimated the leakage rate, reporting and detection probabilities, and the transmission rate, while fixing other parameters based on the BDBV literature. The model reproduced confirmed cases, deaths, discharges, and escapees. We estimated R_0=3.67 (95% HDI: 2.0-5.7), a leakage rate of {rho} {approx} 0.034 day^-1 (0.022-0.051), and high contact-tracing-driven detection (p_d {approx} 0.91-0.99). Leakage increased the detection-dependent reproduction number [R](p_d) from approximately 3.2 to above 5. Eliminating leakage reduced cumulative infections by about one-third, from 1,120 to 764, while the minimum detection level required for control increased from p_d [&ge;] 0.73 without leakage to p_d [&ge;] 0.87 at the fitted leakage rate. Shortening time to isolation prevented the most infections (73.4%; 59-84), followed by reducing leakage (29.7%; 14-52) and re-isolating escapees (12.6%; 6-24). Delaying leakage reduction until week 4 reduced its benefit from about 27% to below 2%. Isolation leakage represents a major transmission pathway that has until now gone largely unmeasured. While rapid initiation of isolation is highly beneficial, it cannot compensate for permeable isolation; therefore, early, community-driven efforts to control leakage, embedded within a multilayered response, are critical.

Background: HBV coinfection is more common among people with HIV than in the general population. Nucleotide reverse transcriptase inhibitors (NRTIs) in antiretroviral therapy (ART) are also active against HBV. Growing use of NRTI-sparing regimens raises concern about HBV reactivation. Objectives: To determine the rate, cumulative incidence, and factors associated with HBsAg clearance in HIV/HBV-coinfected patients, and to characterize the genetic/structural basis of occult HBV infection (OBI) in the same cohort. Study design: We retrospectively reviewed 256 people with HIV at Kumamoto University Hospital in Japan (1986-2025), stratified by HBsAg clearance status; clinical factors were compared and cumulative incidence estimated by Kaplan-Meier analysis. OBI cases underwent HBsAg-region sequencing. Results: Fifteen patients were analyzed (12 HBsAg-positive, 3 OBI). HBsAg clearance occurred in 7/12 (58%). The Kaplan-Meier estimated cumulative incidence reached 25% by 2 years and 64.3% at approximately 4.4 years, after which no additional clearance events were observed during follow-up. Clearance was associated with higher CD4 ([&ge;]200 cells/L: 71% vs 0%) and lower HIV-RNA (<105 copies/mL: 86% vs 20%); HBV-DNA was significantly higher in the clearance group than OBI (adjusted p=0.007). All OBI sequences matched genotype C2; one also carried a rare genotype A2 'a' determinant substitution, N131K (0.23% of genotype A sequences in HBVdb). Conclusions: HBsAg clearance was frequent, concentrated within 3-4 years of ART, and associated with preserved immune status and HBV replicative activity. A rare 'a' determinant substitution may cause false-negative HBsAg in OBI, informing NRTI-sparing ART selection.

Background: Community case management has been scaled up nationally in Zambia over the last decade. However, there is limited evidence on how this nationwide implementation has affected febrile patients' access to malaria diagnosis and treatment in Zambia. Methodology: This study analyzed four rounds of Malaria Indicator Survey (MIS) data (2012-2021) to evaluate: 1) proportion of all-ages individuals with fever who sought treatment from a formal provider, 2) proportion of individuals going to CHWs over time, among those who sought treatment at a formal provider, 3) time duration between fever onset and treatment seeking at a formal provider, and 4) proportion of children <5 with malaria that received Artemether-Lumefantrine (AL) treatment. Mixed-effect logit models were employed to examine determinants of treatment-seeking behavior and factors affecting AL receipt among children <5 with malaria cases. Results: The proportion of febrile patients seeking treatment remained below 60% throughout 2012-2021, and AL receipt among children with malaria cases consistently stayed below 50%. The mean interval between fever onset and initial treatment-seeking encounter decreased from 2.42 days in 2012 to 1.71 days in 2021. Among formal care seekers, CHW utilization increased from 1.5% in 2012 to 10.0% in 2018 before declining to 3.2% in 2021. Longer walking time to the nearest health facility was associated with lower odds of treatment seeking, whereas CHW density was not associated with treatment seeking or AL receipt. Children who did not went to formal providers had lower odds of AL receipt than those who sought treatment from CHWs. Conclusion: Despite nationwide CCM scale-up over the last decade, significant barriers persist in malaria patients' access to diagnosis and treatment in Zambia. Our results indicate that while CCM coverage should be maintained and further expanded, additional complementary interventions are also needed to overcome remaining access barriers.

Background: In 2019, WHO recommended three consecutive reactive serological test results for HIV diagnosis to reduce false-positive diagnoses. Malawi changed from a two-test to a three-test strategy in 2022 as HIV test positivity declined. We assessed diagnostic performance, implementation fidelity, and costs. Methods: We analysed national HIV testing data from Nov 1, 2022, to Oct 31, 2025. Using observed three-test classifications as the reference standard, we reconstructed classifications under the two-test strategy. We estimated positive predictive value (PPV), implementation fidelity, potential false-positive diagnoses prevented, incremental costs, and time to offset testing costs through avoided antiretroviral therapy expenditure. Results: Among 9,885,599 encounters eligible for implementation-fidelity analysis, 99.98% followed a valid three-test pathway. The diagnostic-performance analysis included 9,862,908 encounters, of which 171,351 (1.7%) were classified HIV-positive and 9,138 (0.09%) were inconclusive. Under the two-test strategy, 1,209 inconclusive encounters with a T1+/T2+/T3- sequence would have been classified as HIV-positive. Retesting and reference-laboratory data indicated that 82.5% of these would subsequently be classified as HIV-negative, corresponding to 997 false-positive diagnoses prevented (10.3 per 100 000 three-test non-positive encounters; 95% CI 9.7-10.9). Retesting within 1-2 weeks was associated with the highest odds of potential false-positive classification (adjusted OR 39.37, 95% CrI 30.63-50.61). The incremental cost was US$471 per false-positive diagnosis averted and was offset within 7.30 years. Conclusions: Malawi's transition to a three-test HIV testing strategy prevented false-positive diagnoses and unnecessary antiretroviral therapy at modest cost, supporting broader adoption of WHO guidance in similar settings. Funding: Gates Foundation.

Background: Case fatality reflects the quality and timeliness of clinical care for leptospirosis, yet no study has examined it at a national level in the Dominican Republic (DR), where leptospirosis is endemic. We describe the case fatality rate (CFR) of leptospirosis in the DR between 2012 and 2026 and identify associations with mortality. Methods: We conducted an analytical cross-sectional study, using national surveillance records merged with a discharge-condition extract via a composite key. We calculated CFR with Wilson 95% confidence intervals among 5,412 valid cases (suspected, probable, or confirmed) reported from January 2012 through June 2026. We compared proportions with Pearson's chi-square test, assessed annual trend with ordinary least squares linear regression, and fitted multivariable logistic regression models to account for confounding. Results: Overall CFR was 8.5% (460/5,412), with no significant annual trend (p=0.372). CFR was higher in men than women (p < 0.001) and increased significantly with age (p < 0.001). Male gender (OR: 1.79; 95%CI: 1.18-2.73) and pre-existing comorbidity (OR: 1.76; 95% CI: 1.21- 2.57) were independent predictors of death. Clinical complications were the strongest predictor in the adjusted model (OR: 3.16; 95%CI: 2.17-4.61), attenuating the gender effect. CFR varied widely by province (2.43-22.22%) and correlated negatively with incidence at the province level (p = 0.066). Conclusions: Leptospirosis case fatality is concentrated among men, people with comorbidity, and those who develop clinical complications. These national, long-term findings can help prioritize clinical and surveillance resources as extreme weather events are expected to intensify across the Caribbean.

Introduction Miltefosine is the only approved oral antileishmanial agent, but its use in women of childbearing potential (WOCBP) is restricted due to preclinical teratogenicity. Current labeling recommends contraception during treatment and for at least five months thereafter, based solely on its long terminal elimination half-life. This study re-evaluated the required contraceptive duration using an exposure margin-based approach. Methods Virtual populations were generated from anthropometric data of 382 Indian, 4,462 Eastern African, and 4,019 Brazilian WOCBP with leishmaniasis. Published population pharmacokinetic models were used to simulate miltefosine exposure following 14-42-day regimens for visceral leishmaniasis (VL), post-kala-azar dermal leishmaniasis (PKDL), and cutaneous leishmaniasis (CL). A developmental safety exposure threshold was derived from the rat no-observed-adverse-effect level (0.6 mg/kg/day for 10 days) and adjusted using a 10-fold safety margin. Contraceptive durations resulting in median residual post-contraception exposure (AUCEOC-{infty}) below this threshold were considered supportive of contraceptive discontinuation. Results The developmental safety exposure threshold was estimated at 2.5 mg{middle dot}day/L. Despite pharmacokinetic differences across geographical regions and disease manifestations, required minimum contraceptive durations were consistent: three months from treatment initiation for the 14-day regimen, four months for 21- and 28-day regimens, and five months for the 42-day regimen. For the 14-day regimen, a single dose of a long-acting injectable contraceptive administered at treatment initiation would provide sufficient coverage. Conclusion An exposure margin-based approach supports shorter contraceptive durations than current recommendations. For the 14-day VL regimen, three months of contraception may provide a practical alternative to current labeling.

Eastern and southern Africa are highly affected by drought, and projections indicate that droughts will become more common in the coming decades. Whilst there has been research on the impact of drought on HIV, attributable to its effect on food insecurity and increased risky sexual behaviour, the link between drought and other sexually transmitted infections (STIs), particularly syphilis, remains largely unexplored. This study therefore assesses the association between drought and active syphilis, history of syphilis, and recovery from syphilis in Zambia, Uganda, and Tanzania, while examining disparities between urban and rural settings. It uses data on 75,225 people from Population-based HIV Impact Assessment surveys (2016-17), which include biomarker information, combined with rainfall data from the Climate Hazards Group InfraRed Precipitation with Station (CHIRPS) dataset to define drought in the two years prior to the survey. Multivariate logistic regression models with country-level fixed effects show that in urban areas, drought was associated with a significant increase in the probability of having active syphilis (average marginal effects (AME) = 0.5%, 95% confidence interval (CI): 0.2%-1.0%) and of having ever had syphilis (AME = 2%, 95% CI: 0.8%-4%). No significant association was found in rural areas. Exposure to drought was not associated with recovery from syphilis in either setting, though confidence intervals were wide. Our results underscore the importance of strengthening healthcare systems to make them more resilient to drought shocks in urban areas, and the need to reinforce syphilis prevention and treatment programmes in those areas when such shocks occur.

Leptospirosis is a widespread zoonotic infection and a growing public health concern in tropical, resource-limited settings, yet remains underrecognized and underreported where diagnostic and surveillance infrastructure is limited. We conducted an analytical cross-sectional study of national surveillance data from the Dominican Republic (2012-June 2026), integrating geospatial meteorological data to characterize disease burden, trends, seasonality, and clinical risk factors. Of 8,425 records, 5,412 met case-definition criteria (3,441 suspected, 1,448 probable, 523 confirmed), yielding a cumulative incidence of 3.55 per 100,000 person-years (2012-2025). Laboratory confirmation rose markedly, from 9.7% overall to half of 2025 cases and over half in 2026. Overall incidence remained stable across all years (p = 0.15), though with three distinct periods: declining infection pre-COVID, low infection during COVID, and increasing infection post-COVID. Cases clustered in the rainy/hurricane season (61.1%, May-November; p< 0.001), with a marginal rainfall correlation (r= 0.553, p= 0.062). Rural provinces bore disproportionate risk, led by Hermanas Mirabal (16.43/100,000 person-years), while large urban and coastal provinces had rates 80% lower. Men had 2.73-fold higher incidence than women (95% CI 2.56-2.90), peaking at younger ages 10-29. Comorbidity was the strongest predictor of complications (OR 2.84, 95% CI 2.01-4.02, p< 0.001). Limited diagnostic confirmation remains the central obstacle to characterizing leptospirosis burden in the Dominican Republic, with confirmation rates exceeding 40% only from 2023 onward. This first multi-decade national analysis identifies high-risk provinces, demographic groups, and seasonal windows for targeted surveillance, highlighting expanded diagnostic capacity as a priority for burden estimation and case management.

Background: Tuberculosis (TB) remains a major public health challenge globally, with Pakistan ranking among the highest TB burden countries worldwide. Although several novel TB vaccine candidates for adolescents and adults are advancing through late-stage clinical trials, little is known about how these vaccines may be introduced in high-burden settings such as Pakistan. Understanding stakeholder perspectives is crucial for informing early implementation planning and policy development. Methods: We conducted an exploratory qualitative study using semi-structured in-depth interviews with key stakeholders involved in TB control, immunization, clinical care, and health policy in Pakistan. Participants were purposively selected from national and provincial TB programs, Expanded Programme on Immunization (EPI), clinical settings, and academia. Interviews were conducted in English or Urdu, audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following the Braun and Clarke framework. A hybrid deductive-inductive coding approach was used. Results: Ten stakeholders participated including one whose interview also served as a pilot test of the interview guide. Participants expressed strong support for the introduction of a new TB vaccine, driven largely by Pakistan's high TB burden and the limitations of current prevention strategies. However, support was based on the availability of strong evidence regarding vaccine safety, effectiveness, and feasibility. Key barriers to vaccine acceptability included low perceived risk of TB, misinformation, stigma, sociocultural influences, and limited public awareness. Stakeholders emphasized community engagement, trusted healthcare providers, and effective communication as critical enablers. Health system challenges included workforce shortages, cold chain limitations, and financing constraints. Household contacts of TB patients were consistently identified as the priority group followed by adolescents and people living with HIV. A phased implementation strategy was broadly preferred followed by gradual integration into existing health services. Conclusion: Stakeholders in Pakistan broadly support new TB vaccines for adolescents and adults. Successful implementation will require addressing sociocultural barriers, strengthening health system capacity, and developing context-specific delivery and prioritization strategies. Early stakeholder engagement and implementation planning are essential for meaningful public health impact in Pakistan.

Between 2017 and 2024, routine diagnostics surveillance in Guinea detected several confirmed viral hemorrhagic fever (VHF) cases among febrile patients. To assess exposure to Lassa virus and other viral pathogens, we conducted a retrospective cross-sectional seroprevalence study in Forest Guinea (Gueckedou and N'Zerekore). Lassa virus seroprevalence was 56.0% in the Gueckedou study group and 29.8% in the N'Zerekore study group. Seropositivity increased with age in both study groups, suggesting cumulative exposure. Samples from Gueckedou laboratory were also tested for other pathogens, and antibodies against Marburg virus (5.8%), Zika virus (5.4%) and Crimean-Congo haemorrhagic fever virus (1.2%) were detected.

Background: Ebola virus disease is a life-threatening illness caused by the Ebolavirus, with symptoms manifesting two to twenty-one days after infection. Although Uganda has faced multiple Ebola outbreaks, many patients survive only to encounter persistent challenges. Therefore, this study explored the post-discharge experiences of survivors following the 2022 Ebola Virus Disease outbreak in Uganda. Methods: An exploratory qualitative study comprising of in-depth participant interviews was conducted at Mubende Regional Referral Hospital in central Uganda. Interviews were face-to-face and data were analyzed manually by inductive content analysis. Ten male and female participants were Ebola Virus Disease survivors in Mubende district who had lived in the community for at least six months post-discharge from the Ebola Treatment Unit. Results: Four themes emerged: (i) Psychosocial Burdens and Social Exclusion, (ii) Economic Hardship and Loss of Financial Stability, (iii) Chronic Physical and Health Burdens Post-Recovery and (iv) Rebuilding Lives: Psychological, Social, and Medical Pathways to Recovery. Survivors faced significant emotional burdens such as survivor guilt, grief, trauma from loss, and anxiety about transmission risks. They experienced social isolation, stigma, and discrimination, which often led to their exclusion from community activities. Financially, they struggled with debt and the loss of livelihoods, compounded by ongoing health issues. Additionally, survivors endured chronic physical complications, including pain and fatigue, which hindered their recovery. Despite these challenges, survivors sought psychological, social, and medical pathways to recovery, including confirmation of their recovery, support from family and organizations, and health maintenance practices. Supportive medical care and community assistance were crucial in their physical and emotional rehabilitation. Conclusion: Ebola Virus Disease survivors in Uganda face significant psychosocial, health, social, and economic challenges post-discharge. The findings highlight the critical need for comprehensive medical and community-based support systems to aid survivors' recovery and well-being. Further research on long-term neurological effects and community reintegration programmes is needed to inform targeted interventions that support Ebola survivors and reduce stigma and discrimination.

To evaluate the cost-utility and 5-year budget impact of first-line olaparib plus abiraterone versus abiraterone alone for metastatic castration-resistant prostate cancer (mCRPC) in China after the eleventh round of volume-based procurement (VBP). The intention-to-treat (ITT) population was assigned primary decision-analytic weight; the prespecified BRCA1/2-mutated (BRCAm) subgroup was a supporting analysis.

In primary healthcare centers lacking advanced imaging, community-based active tuberculosis (TB) case finding often relies on basic symptom screening. This approach often misses cases and leads to the inefficient allocation of rapid molecular testing (RMT). We aimed to develop and internally validate a simple clinical triage scorecard to improve TB detection and guide RMT use in resource-constrained settings. We conducted a retrospective cross-sectional study of 15,137 adults ([&ge;]18 years) evaluated within the Zero TB Yogyakarta program (2020-2025). Participants with complete clinical assessments and confirmatory GeneXpert results were included. Using multivariable logistic regression, we identified independent clinical predictors, which were subsequently transformed into an integer-based point scorecard. Model performance was evaluated via discrimination and calibration, utilizing bootstrap resampling (1,000 iterations) for internal validation. Among the 15,137 participants, 251 (1.7%) were GeneXpert-positive. The final multivariable model identified eight independent predictors: age, male sex, body mass index, prolonged cough, hemoptysis, unexplained weight loss, TB contact history, and diabetes mellitus. The model demonstrated strong predictive accuracy, with an optimism-adjusted AUROC of 0.836 and good calibration. When translated to the integer scorecard and compared directly to standard national symptom screening, the scorecard performed (AUROC 0.81 vs. 0.73; p<0.001). At a high sensitivity cut off score of [&ge;] 0, the tool achieved 93.63% sensitivity and 41.33% specificity. This point-of-care clinical scorecard provides higher diagnostic accuracy than standard symptom screening algorithms. By offering flexible operational thresholds, it empowers local health programs to dynamically balance the urgency of case detection with available diagnostic capacity, optimizing GeneXpert allocation where advanced radiological imaging is unavailable.

Background Floods are among the most devastating natural disasters worldwide and are increasingly associated with adverse mental health outcomes, particularly Post-Traumatic Stress Disorder (PTSD). In December 2023, Hanang District in northern Tanzania experienced catastrophic mud floods that resulted in extensive loss of life, destruction of property, displacement of households, and disruption of livelihoods. While emergency humanitarian responses focused primarily on physical needs, limited evidence exists regarding the long-term psychological consequences among survivors. Therefore, this study aimed to determine the patterns of PTSD manifestations and assess cognitive factors associated with PTSD symptoms among flood victims in Hanang District, Tanzania. Methods A community-based cross-sectional study was conducted among 360 flood victims one year after the disaster. PTSD symptoms were assessed using the PTSD Checklist for DSM-5 (PCL-5). Descriptive statistics summarized PTSD severity, while chi-square tests and regression analyses examined associations between socio-demographic characteristics and PTSD manifestations. Cognitive factors were assessed based on participants' exposure to traumatic experiences and perceptions of traumatic events. Results The mean PCL-5 score was 39.2 (SD = 20.6), indicating a high burden of psychological distress. Approximately 45% of respondents had severe PTSD symptoms (PCL-5 [&ge;]45), while another substantial proportion demonstrated moderate symptom severity. PTSD manifestations varied significantly by geographical location (p < 0.001), household income (p = 0.011), and marital status (p = 0.002). Age positively predicted PTSD severity ({beta} = 0.019, p = 0.001), whereas household income negatively predicted symptom severity ({beta} = -0.297, p = 0.001). Exposure to natural disasters constituted the predominant cognitive factor, with 45% directly experiencing the flood and 38.3% witnessing the event. Exposure to secondary traumatic experiences through witnessing or learning about violent events was also common. Cognitive trauma exposure demonstrated a significant association with PTSD symptoms ({chi}2, p < 0.001). Conclusion PTSD remains highly prevalent among flood survivors in Hanang district. Both direct and indirect trauma exposure significantly contributed to PTSD manifestations. Comprehensive disaster recovery programmes should integrate trauma-focused psychological services, cognitive behavioural interventions, routine PTSD screening, and community-based psychosocial support alongside socioeconomic recovery initiatives.

All primary healthcare centers owned by the Ugandan government in the Western Region of Uganda were submitted to a questionnaire concerning current availability of POCT from the Essential diagnostic List 2 part 1a and 1b, and the African laboratory inventory done by African Society of Laboratory Medicine and AfricaCDC. The data from the questionnaire was then linked to open source geodata provided by TomTom, and population data to calculate and visualize the accessibility of captured POCT. Findings: Availability of POCT Malaria is almost 100%, HIV 68-90%, and >30% for a majority of the POCT in the EDL-2 panel. 90% of the population in Western Region live within 1 hour by car from most of the essential POCT. Figures in the complementary web-based application visualize the accessibility of POCT for Western Uganda. Diagnostic deserts are visualized. Interpretation: Access to POCT at primary health care facilities in western Uganda has expanded substantially over the past decades. The geo-mapping tool presented here could inform policy decisions on strengthening diagnostic capacity at the national, regional, and provincial level. Funding: Swedish Research Council and Infravis All supplementary materials and a preprint of this submission are available on our OSF repository https://osf.io/j7puk/.

Background: In Tanzania, over 10,000 women aged 15-44 are diagnosed with cervical cancer annually, and more than 6525 die. The majority are diagnosed at an advanced stage, which contributes to delays in treatment enrollment and illness complications. Multiple factors can affect womens willingness and ability to access cervical pre-cancer screening. Purpose: To explore the barriers and facilitators to attending cervical pre-cancer screening among women living in a resource-constrained area of Southern Tanzania Methods: A qualitative study of 17 focus group discussions and 12 in-depth interviews was conducted from December 2023 to July 2024. Data collection took place in the community and health centers of a town and the surrounding rural areas in Kilombero district. The study used purposive sampling to recruit 112 women and 23 men aged 18- 50+ years. Results: Fear of death emerged as a central theme in the data, acting as both a barrier to and a facilitator of womens screening behavior. Women linked death with the screening procedure, receiving results and undergoing treatment. Participants mistrusted the speculum itself and linked it to pain, vaginal infection, and infertility. Conversely, fear of physical and social death motivated other women to attend the screening to learn about their health and prevent the consequences of a positive diagnosis. Public trust in the healthcare system and the role of health information sources were also identified as influencing women's decisions to undergo or not undergo screening. Conclusion: Our findings showed that cervical cancer screening uptake is influenced by fear of death and other co-factors. To improve early cervical cancer screening, programs and policy interventions are needed to raise awareness of the disease while also addressing womens specific concerns. Also, strengthening structural dimensions such as the availability of the healthcare workforce, healthcare facilities, and ensuring equitable service availability are essential to reducing cervical cancer complications and avoidable mortality.