Tropical Medicine and Infectious Disease

Background/aims The World Health Organization (WHO) aims to eliminate schistosomiasis as a public health problem (EPHP) across 78 endemic countries by 2030. However, for low-prevalence settings that reach EPHP, guidance on managing transmission to maintain EPHP or move towards Interruption of Transmission (IoT) is limited, partly due to insufficient evidence on drivers of resurgence. In Uganda, some communities inland from Lake Victoria have achieved EPHP for Schistosoma mansoni but not progressed to IoT. This study explored whether routine, short-range travel to the highly endemic lake could sustain transmission in these settings. Methods We conducted a cross-sectional study in five Ugandan villages ~5 km from Lake Victoria. Parasitological data were collected using Kato-Katz and Point-of-Care Circulating Cathodic Antigen tests, alongside questionnaires on lake travel from 585 individuals aged 1-91 years. A structural causal model estimated the total and direct effects of travel frequency, activity type, water contact duration, and drug treatment history on infection. Bayesian regression models and counterfactual simulations predicted infection under hypothetical interventions. Results Reaching IoT in low-risk villages may be undermined by habitual, short-range travel to high-risk sites, driven by the nature and duration of lake contact. Daily lake travel caused a 1.7-fold increase in odds of infection, while occupational activities caused a 3.4-fold increase compared with no lake activity. Counterfactual analysis showed that removing lake contact duration most reduced infection risk among moderate-frequency travellers, while daily travellers showed smaller changes, and some transmission persisted among individuals with little or no lake contact. Simulations demonstrated that modifying lake contact behaviours could reduce individual infection risk but had limited population-level impact. Conclusion These findings indicate that targeting only high-risk villages or individual behaviours is unlikely to achieve sustained, wide-spread IoT, underscoring the need for integrated control strategies that account for mobility, behaviour, and local transmission ecology.

Background: Since September 2024, France has implemented a national reform allowing prescription-free access (PFA) to sexually transmitted infection (STI) screening in medical biological laboratories (MBLs). This study aims to characterize the populations undergoing STI testing according to their access modality and evaluate the probability of test positivity in relation to testing pathway, sex, and age groups. Methods: We conducted a cross-sectional analysis of all individuals screened for Chlamydia trachomatis, Gonorrhoea, human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis by treponemal-specific immunoassay (TSI) in Cerballiance MBLs between Mars 2025 and February 2026. Multivariable logistic regression models stratified by sex and adjusted for age and region assessed associations between screening modality and STI positivity. Results: Among 1,008,737 individuals included, 27.8% were under PFA and 72.2 under prescription-based access (PBA). PFA users were more frequently male (47.4% vs. 36.3%, p<0.001) and aged 20-39 years (34.0%, p<0.001). Overall positivity rates differed by modality: PFA was associated with higher detection of Chlamydia (4.6% vs. 3.6%). PBA group showed more positive cases of syphilis (3.4% vs. 1.2%), HBV (1.3% vs. 0.4%), and HIV infections (0.3% vs. 0.2%, all p<0.001). Co-infection and gonorrhoea proportions did not significantly differ between modalities. Conclusions: PFA substantially increased STI screening uptake, particularly among young adults and men, and enhanced detection of bacterial STIs. PBA remains essential for diagnosing viral and chronic infections. These findings highlight the complementary roles of both access strategies and support PFA screening as an effective public health intervention to broaden STI detection and reduce transmission.

BackgroundAnimal bites represent a significant public health concern due to the risk of injuries and transmission of zoonotic diseases such as Rabies, particularly in low and lower- middle-income countries (LMICs). Understanding the epidemiological characteristics of animal bite incidents is essential for improving the prevention and control strategies. This study aimed to characterize the epidemiological patterns and characteristics of animal bite cases in Sylhet, Bangladesh. Methodology/Principal findingsWe conducted a retrospective analysis of 6,565 animal bite cases reported between January 1 and December 31, 2024, in Sylhet, Bangladesh. Data on demographic characteristics, type of biting animal, site of bite, and exposure category were collected and analyzed to determine associations using correlation analyses and chi-square tests. Among the victims, 3,917 (60%) were male and 2,648 (40%) were female and young adults aged 20-39 years comprised the largest group (39% of cases). The majority of cases (88.1%) originated from urban areas within Sylhet City Corporation. Cats were the leading cause of bites (56.6%), followed by dogs (35.0%) and monkeys (7.5%), suggesting a shift from the traditional dog-dominated pattern. The most frequently affected anatomical sites were the legs (50.3%) and hands (40.9%). Most exposures were classified as World Health Organization (WHO) Category II (98.2%). Bite incidents showed moderate seasonal variation, with peaks in spring and early autumn. A significant declining temporal trend was observed for monkey bites (R = -0.59, p = 0.044), whereas cat and dog bite patterns remained relatively stable throughout the year. Significant associations were identified between bite site and age group, as well as between biting animal and demographic characteristics (p < 0.05). Conclusion/SignificanceThese findings highlight the epidemiological patterns of animal bites in Sylhet and emphasize the need for strengthened public awareness, surveillance, and preventive strategies to reduce animal bite incidents and associated zoonotic disease risks. SynnopsisO_LIA large-scale retrospective analysis of 6,565 animal bite cases revealed a cat-dominant bite pattern (56.6%), contrasting with the traditional dog-dominant paradigm in South Asia. C_LIO_LIYoung adults (20-39 years) and males (60%) were disproportionately affected, reflecting occupational and behavioral exposure risks. C_LIO_LIUrban residents (88.1%) accounted for the majority of cases, highlighting the growing public health burden of animal bites in rapidly urbanizing settings. C_LIO_LIThe most frequently affected anatomical sites were the legs (50.3%) and hands (40.9%). Bite incidents showed moderate seasonal variation, with peaks in spring and early autumn. C_LIO_LICategory II exposures (98.2%) predominated, indicating a high burden of seemingly minor injuries that may be underestimated in rabies prevention strategies. C_LI

Background Urogenital schistosomiasis (UGS), caused by Schistosoma haematobium (S. haematobium), disproportionately affects women in sub-Saharan Africa and can lead to haematuria, anaemia, and urinary tract morbidity. Data on the prevalence in women of reproductive age remains limited in contrast to infection among school-aged children in Kenya. This study assessed the prevalence of UGS and its socioeconomic determinants among women in Kilifi County, Kenya. Methods: Urine samples (20-50 mL) were collected from each participant over three consecutive days. Day-one samples were tested for haematuria, proteinuria, nitrites, leukocytes, and pregnancy using dipsticks. On the other hand, 10 mL of urine was examined for S. haematobium eggs via urine filtration on all three days. Results: A total of 599 women aged 15-50 years were enrolled, with complete data available for 336. The mean age was 33 years; 57.7% were <35 years. Most participants were from rural Magarini Sub-county (63%) and engaged in crop farming (62.5%). Primary education was the highest level attained by 59.8% of participants. Frequent contact with stagnant water was reported by 92%. The overall prevalence of S. haematobium infection was 13.7% (95% CI: 10.2-17.8), higher in Magarini (14.9%) than in Rabai (12.0%), though not statistically significant. Younger age, primary education, and frequent water contact were associated with higher infection rates; however, after adjustment for covariates, haematuria showed the strongest independent association with infection. Women with haematuria were 25.2 times more likely to be infected (OR: 25.24, 95% CI: 7.07-82.63, p < 0.001); multivariate analysis confirmed haematuria as the sole significant predictor (OR: 20.83, 95% CI: 5.45-79.57, p < 0.001). Conclusion: UGS prevalence among women in Kilifi County is substantial, with variation between sub-counties. Haematuria demonstrated the strongest independent association with infection and may serve as a simple, non-invasive diagnostic marker. These findings underscore the pressing need for the integration of UGS screening into the reproductive health services and targeted interventions. Authors Summary UGS, caused by the parasitic worm Schistosoma haematobium, is a neglected tropical disease and remains a major public health problem in sub-Saharan Africa. Although control programmes in Kenya primarily target school-aged children, women of reproductive age are frequently exposed through daily water contact and may develop chronic urinary and reproductive health complications. However, data on the infection burden among adult women are limited. In this study, we assessed the prevalence of urogenital schistosomiasis and associated risk factors among women aged 15-50 years in Kilifi County, Kenya. Urine samples were collected over three consecutive days and examined for parasite eggs and indicators of urinary tract disease. We found that urogenital schistosomiasis affected more than one in ten women in the rural sub-counties where the study was conducted. Haematuria was strongly associated with infection and remained the most reliable predictor after accounting for other social and behavioural factors. These findings demonstrate that UGS is an under-recognised health issue among women and highlight the potential value of simple urine-based screening tools. Integrating UGS screening into existing reproductive health services could improve early detection and contribute to more inclusive disease control strategies.

Objectives: In Latin America, up-to-date information to monitor UNAIDS 95-95-95 HIV targets in key populations, such as men who have sex with men, is limited. Elsewhere, structural homophobia restricts access to ART. Conceptual frameworks suggest that intersecting forms of violence and discrimination may negatively influence HIV care outcomes through psychosocial and structural pathways, although empirical evidence remains limited. The study aimed to assess whether sexual orientation outness and recent homophobic violence are associated with not being on ART among Latin American MSM living with HIV. Methods: This cross-sectional study is a secondary analysis of data from LAMIS-2018, including 7,609 MSM aged 18+ with an HIV diagnosis [&ge;]1 year prior from 18 Latin American countries. Participants self-reported ART status, sociodemographic characteristics, homophobic violence, and sexual orientation outness. Bivariate and multivariate logistic regressions identified those factors associated with not being on ART. Results: Nine percent of MSM with HIV were not on ART, 18% reported low sexual orientation outness, and 27% experienced homophobic violence, especially in Andean and Central American countries. Not being on ART was associated with recent homophobic violence (aPR=1.25), low outness (aPR=1.22), unemployment (aPR=1.27), and residence in the Andean subregion (aPR=1.87), Mexico (aPR=1.28), or the Southern Cone (aPR=1.45) versus Brazil. Protective factors included being older (25-39: aPR=0.72; >39: aPR=0.49), living in large cities (aPR=0.72), having a stable partner (aPR=0.78), and university education (aPR=0.74). Conclusions: Recent homophobic violence and low sexual orientation outness were associated with not being on ART among MSM in Latin America. While access varies across countries, structural factors such as stigma and violence may limit engagement in care. Addressing these barriers alongside strengthening health systems may be key to improving ART uptake and advancing progress toward the 95-95-95 targets.

Syphilis is a sexually transmitted and bloodborne infection caused by Treponema pallidum spp. pallidum. Given the paucity of data on syphilis in Kenyan sex workers and gay, bisexual, and other men who have sex with men (GBMSM), we conducted a retrospective study of syphilis seropositivity in female sex workers (FSW) and GBMSM in Nairobi, Kenya. Seropositivity testing of cryopreserved plasma samples showed that 11.1% (72/647) were positive. Syphilis seropositivity was associated with HIV status, and FSWs were disproportionately represented in the seropositive group (66/72, 92%). Here, we report a higher seropositive rate than in previous studies in Kenya, and ongoing community and surveillance supports are important for addressing the ongoing public health impacts of syphilis.

Triatomine bugs are blood feeding insects that transmit the parasite Trypanosoma cruzi, causative agent of Chagas disease. The bugs are found primarily in the Americas with a few species in Asia and Africa. Here we report the first case of a live triatomine bug in Europe, found in a Lisbon hotel room. In August, 2025, the hotel room occupants discovered a triatomine bug perched on the headboard of their bed. Upon capture, bright red blood emerged from the bug; the occupants suspected that it had bitten them during the night. The bug was identified morphologically as triatomine species Hospesneotomae protracta, which was confirmed molecularly. Hospesneotomae protracta is native to the southwestern United States where it is a competent T. cruzi vector. Trypanosoma cruzi was not detected in this specimen. Although this case likely represents an accidental importation, it illustrates the ease with which disease vectors can be unknowingly transported globally. Ergo it is crucial to document and share these findings to prevent introductions of non-native arthropods of medical importance.

Background: HIV/AIDS remains a major public health challenge in Tanzania, where viral load suppression among adults on ART stands at 78% and HVL testing uptake among eligible patients is approximately 22%. Since the introduction of the National HVL Testing Guideline in 2015, little has been done to systematically evaluate its implementation. Objective: To evaluate adherence to the National HVL Testing Guideline across CTC clinics in Dar es Salaam Region, covering ART monitoring, documentation, turnaround time, and factors affecting implementation. Methods: A cross-sectional study was conducted in 2021 across 15 public health facilities with CTC clinics in all five Dar es Salaam districts. A total of 330 PLHIV on ART for more than six months were selected through systematic random sampling with proportional to size allocation, and 45 healthcare providers through convenient sampling. Data were collected via abstraction forms and self-administered questionnaires, and analysed using SPSS Version 23 with descriptive statistics, bivariate analysis, and binary logistic regression. Results: Only 25.1% of patients had their first HVL sample taken at six months as per guideline, with 68.8% delayed beyond six months. Second and third samples were similarly delayed. MoHCDGEC sample tracking forms were absent in 96.7% of facilities and incomplete in 99.1%, and no facility captured specimen acceptance or rejection as site feedback. Turnaround time exceeded the 14-day guideline threshold in 64.5%, 66.7%, and 69.4% of first, second, and third results respectively. Patient negligence (AOR=9.84; 95% CI: 1.83-52.77) and storage (AOR=5.72; 95% CI: 0.94-35.0) were independently associated with guideline adherence. Conclusion: Adherence to the National HVL Testing Guideline in Dar es Salaam is suboptimal across testing timelines, documentation, and turnaround time, with patient negligence and storage capacity as significant determinants. Targeted interventions are needed to strengthen patient education, improve storage infrastructure, enhance documentation systems, and support providers in adhering to guideline-specified timelines.

Trichomonas gallinae is a protozoan parasite of major concern in avian medicine, particularly in domestic pigeons (Columba livia). This study investigated the risk factors associated with the frequency of nitroimidazole resistance and T. gallinae prevalence in domesticated pigeons from Eastern Spain, kept for different competitions. A total of 220 pigeons from 11 lofts were sampled and examined by microscopy and culture, revealing a 63.6% infection prevalence. Genotyping identified genotype C as predominant, with occasional detection of genotype A, mixed A/C infections, and one isolate of Lineage III. In vitro susceptibility testing of 42 isolates showed a high prevalence (81%) of metronidazole resistance (MIC values [&ge;] 20 {micro}g/ml), with minimum inhibitory concentrations (MICs) ranging from 5 to >100 {micro}g/mL in 9/11 pigeon lofts examined. Resistance was significantly associated with the use of metronidazole and was more frequent in young and non-reproductive birds. Biannual treatments and the combination of ronidazole and dimetridazole at higher doses were associated with lower infection rates than monotherapies or annual treatments. No significant associations were found between resistance and environmental or loft management parameters, although poor hygiene and high bird density were common in lofts with resistant strains. These findings highlight the urgent need for regulated treatment protocols, improved biosecurity, and the development of alternative trichomonacidal agents to combat the emergence of drug-resistant T. gallinae in pigeon populations.

Introduction: The need to collaborate with community partners has long been considered essential for achieving sustainable HIV prevention and treatment. While the level of youth engagement in research varies by project, it is important that youth collaboration and partnership is meaningful and measurable. We previously conducted a survey that aimed to assess the acceptability of providing SRH/HIV services for young women at hair salons in Lesotho. The survey relied on participatory research with several community partners who were fundamental to its implementation. This study reports on the lessons learned from these participatory processes. Methods: The Hair SALON survey was conducted in Lesotho between December 2023 and August 2024. For the present study, we used the Report of Engagement in Community Research (REACH) tool to systematically define the various depths of engagement of stakeholders at different stages of the research. In addition, we conducted semi-structured individual interviews with the four young community partners who were involved as the Hair Salon Expert Group (HSEG) throughout the project, and a subset of six stylists who helped enroll clients to fill in the questionnaires. The audio-recorded interviews were transcribed, translated, and coded using thematic analysis. Results: Challenges to engagement with the research project included the lack of full understanding of the project team's expectations (for the HSEG), and difficulty engaging potential participants due to mistrust and the sensitive content of the project (for the stylists). As possible mitigation strategies, interviewees suggested developing better community dissemination efforts prior to the project start, and providing more training to the community partners. Facilitators for engagement included multiple altruistic, professional development, and material incentives. Conclusions: Our findings highlight that a participatory approach across all research phases is feasible and that various facilitators - beyond material incentives - motivate youth community partners to be part of such a project. However, some barriers remain. It is important to increase efforts to clarify community partners' roles and responsibilities beyond written agreements, which in turn improves their perceived ownership of the research.

BackgroundLymphatic filariasis remains a public health concern in many endemic regions, where chronic disease persists despite substantial reductions in transmission. In Ghana, more than two decades of mass drug administration have significantly reduced disease prevalence and transmission; however, chronic manifestations and gaps in community understanding continue to be reported in parts of the north. This study assessed infection status, chronic morbidity burden, and community knowledge in a rural setting in northern Ghana approaching elimination. Methodology/Principal FindingsA community-based cross-sectional study was conducted in Birifor, northern Ghana, from October 2024 to January 2025. A total of 261 residents aged ten years and above were selected using random sampling. Data collection included structured questionnaires, clinical examination for chronic disease, and night blood microscopy for the detection of infection. No microfilariae were detected (0/261; 0%). However, chronic lymphoedema was identified in five individuals (1.9%), all aged over 40 years. Awareness of the disease was high (95.8%), yet only 39.5% of participants demonstrated good community knowledge and perceptions and self-reported preventive practices. Misconceptions regarding transmission, particularly beliefs that the disease is hereditary or caused by spiritual factors, were common. Participation in mass drug administration was high (93.1%). Despite this, chronic disease imposed a notable socioeconomic burden: all affected individuals reported loss of income, and 60% reported additional household income loss due to caregiving. Conclusions/SignificanceThese findings suggest that transmission in the study area is likely very low, although residual infection cannot be excluded; however, chronic disease and gaps in community knowledge persist. Strengthening morbidity management, improving community education, and providing support for affected households are essential. Sustained surveillance and integrated approaches will be critical to prevent resurgence and support long-term elimination efforts. Author SummaryLymphatic filariasis, also known as elephantiasis, is a mosquito-borne disease that can cause long-term swelling of the legs, arms, or genitals. Global efforts have greatly reduced its occurrence, especially through repeated mass drug administration to afflicted communities. However, many people continue to live with chronic swelling caused by past infections, which can affect their ability to work and participate fully in daily life. In this study, we examined the current situation of lymphatic filariasis in a rural community in northern Ghana that has received many years of treatment. We tested people for active infection, assessed signs of chronic disease, and explored what community members know and believe about the disease. We found no evidence of active infection, suggesting that transmission is now very low. However, some individuals were still living with chronic swelling and reported loss of income, while households also experienced financial strain due to caregiving. Although most people had heard of the disease, many did not fully understand how it is transmitted. Our findings show that reducing transmission alone is not enough. Continued education, community support, and access to care are needed to address the long-term impact of the disease and support ongoing elimination efforts.

People who inject drugs (PWID) experience a high burden of HIV and hepatitis C virus (HCV) infection due to unsafe injection practices and limited access to harm-reduction services. In Mozambique, data on PWID remain limited. This study analyzed two rounds of biobehavioral surveys conducted in 2014 and 2023 in Maputo and Nampula to assess trends in HIV and HCV prevalence and to identify associated behavioral and structural factors. We compared unweighted prevalence estimates using descriptive analysis and applied multivariable logistic regression to examine independent associations with each infection and interaction effects with survey year. HIV prevalence declined across most demographic and behavioral groups. Among PWID aged [&ge;]25 years, prevalence decreased from 55.7% to 26.3%, and among men from 45.7% to 16.7% (both p < 0.001). Reductions were also observed among daily injectors (58.0% to 21.3%) and individuals reporting syringe sharing (75.0% to 21.8%). In Maputo, HIV prevalence declined from 56.6% to 28.0%, while the decrease in Nampula was not statistically significant. Age and female sex were strong predictors of HIV infection in the earlier survey, although the association with age weakened in 2023. HCV prevalence showed divergent trends. In Maputo, prevalence decreased from 49.3% to 18.7% (p < 0.001), whereas in Nampula it increased from 11.7% to 48.1% (p < 0.001). PWID aged 16-24 years experienced a fivefold increase in HCV prevalence. Interaction analysis demonstrated a significant rise in Nampula in 2023 (AOR 14.6; p < 0.001). Lower injection frequency and not sharing needles were protective factors for both HIV and HCV. These findings indicate a substantial reduction in HIV prevalence among PWID in Mozambique over the past decade, alongside an increase in HCV prevalence in specific geographic and age groups. The contrasting trends highlight the need for differentiated harm-reduction strategies, expansion of HCV prevention and treatment services, and tailored interventions for subgroups at elevated risk.

BackgroundRabies remains a cause of mortality in many low- and middle-income countries, with the majority of human infections resulting from dog-to-human transmission. The Integrated Bite Case Management (IBCM) model is a One Health approach that aims to strengthen rabies surveillance and response by linking the management of human bite cases with investigation of the implicated animals. This study aimed to evaluate the effectiveness of implementing IBCM in Quang Nam Province under existing resource conditions. Methodology/Principal FindingsA pre-post intervention study without a control group was conducted across the entire province. During the intervention period, 11,673 animal-bite cases were recorded; IBCM identified 75 animals suspected of having rabies, of which 40 tested positive for rabies virus by RT-PCR. Most of these animals were unvaccinated, free-roaming dogs. In communes where outbreaks were detected, the average number of registered dogs increased from 507 to 543 per commune, and vaccination coverage increased from 44.1% to 72.6% within 21 days. The average number of Post-exposure prophylaxis (PEP) courses administered per month increased from 349 to 971, the proportion of high-risk exposures increased from 9.3% to 11.9%, and the proportion of delayed PEP ([&ge;]10 days after exposure) rose slightly from 5.9% to 6.6%. At the same time, the proportion of staff with good knowledge of rabies diagnosis in animals increased substantially, from 9.1% to 55.6%. The main limitations included the pre-post design and loss to follow-up of some animals, which prevented laboratory testing. ConclusionThe implementation of IBCM within the existing health and veterinary systems substantially strengthened rabies surveillance and response in accordance with the One Health approach. IBCM was demonstrated to be feasible, resource-appropriate, and scalable, thereby contributing to progress toward the global goal of eliminating human deaths from dog-mediated rabies by 2030. Author summaryRabies is a preventable disease, yet it continues to cause deaths in many countries where dogs remain the primary reservoir and source of infection. In Vietnam, rabies surveillance remains largely separated between the human and animal health sectors. The IBCM model uses human bite cases as the "trigger point" for coordinated investigation of the implicated animals, risk assessment, and information sharing between the two sectors, thereby supporting both clinical decision-making and outbreak response. We implemented the IBCM model in Quang Nam Province and observed an increase in the number of rabid animals detected, a marked rise in dog vaccination coverage in outbreak-affected areas, and substantial improvement in the knowledge and capacity of both health and veterinary staff. Simply by strengthening collaboration and information sharing between the two sectors, the rabies surveillance system became more sensitive and effective. This represents a practical example of One Health approach in action.

Background Nepal has set a goal to eliminate lymphatic filariasis (LF) by 2030. As of 2024, Nepal has stopped the mass drug administration (MDA) in 56 of the 64 endemic districts and completed two rounds of MDA in six districts with persistent LF ([&ge;]2% antigen prevalence) using the three-drug regimen of Ivermectin, Diethylcarbamazine, and Albendazole (IDA), exceeding 65% coverage. We subsequently conducted an Epidemiological Monitoring Survey (EMS) to assess the impact of the MDA in reduction of LF infection prevalence below the transmission threshold and examine the factors associated with it. Methods We conducted a cross-sectional EMS nine months after MDA in 12 evaluation units (EUs) across six districts, with two sites per EU. We recruited a total of 7,343 individuals aged [&ge;]20 years, sampled using multi-stage sampling, ensuring at least 300 blood samples collected per site. We collected data on demographics and MDA participation. We performed the LF antigen testing for all participants, followed by night blood microfilariae testing in antigen-positive individuals. Statistical analyses included non-parametric tests, Chi-square and Fishers Exact tests, and multivariable logistic regression to assess outcomes after adjusting for potential confounders. Results Nine of 12 evaluation units (EUs) recorded <1% microfilaremia, meeting the WHO threshold for passing EMS, while three EUs failed with [&ge;]1% prevalence in at least one site. Antigen and MF prevalence were 4.47% and 0.34%, respectively (ratio 13:1). Both Antigen and MF prevalences were significantly associated with female sex (AOR= 0.564, 95% CI: 0.441-0.721 and AOR = 0.326, 95% CI: 0.129-0.826 respectively) and participation in the most recent MDA round (AOR = 0.477; 95% CI: 0.385-0.591 and AOR = 0.089; 95% CI: 0.017-0.464 respectively). MDA uptake was influenced by age (<40 years, AOR = 0.72; 95% CI: 0.653-0.793), sex (female, AOR = 1.438; 95% CI: 1.29-1.603), cross-border residence (AOR = 0.616; 95% CI: 0.558-0.681), and occupation (agriculture and housewife, AOR = 1.144; 95% CI: 1.008-1.298). MF prevalence was also associated with younger age (<40 years, AOR = 0.211; 95% CI: 0.071-0.626). Conclusion The survey indicates progress toward LF elimination, with nine of twelve EUs achieving WHOs <1% microfilaremia threshold after two rounds of IDA-MDA. However, transmission persists in three sites, likely linked to poor MDA participation among specific subgroups--particularly males, younger adults, and cross-border populations. Strengthening MDA coverage and compliance across all demographic and occupational groups, with special focus on border areas, is essential to achieve LF elimination in Nepal.

Background: In sub-Saharan Africa where both tuberculosis (TB) and HIV are prevalent, empiric TB treatment in people living with HIV (PLHIV) persists due to limited sensitivity of sputum-based TB tests. We evaluated mortality among molecular test-negative presumptive TB adult PLHIV in a population where the majority are or have been on antiretroviral therapy (ART), comparing mortality between those who received empiric TB treatment and those who did not. Materials and Methods: From November 2017 to December 2020, Xpert-negative presumptive TB adult PLHIV were recruited at Mulago Referral Hospital and Kisenyi Health Centre-IV in Kampala, Uganda. Clinical data including TB symptoms, chest X-ray, and empiric TB treatment decision were collected. Laboratory investigations included CD4 cell count, serum cryptococcal antigen (CrAg), urine TB-lipoarabinomannan (TB-LAM), microbiological blood cultures, and sputum mycobacterial growth indicator tube (MGIT) cultures. Participants were followed monthly for 12 months to ascertain vital status. Results: Overall, 300 participants were enrolled; 61.3% inpatients, 55.7% female, median age 37 (IQR 29-45) years, 82.3% on ART, median CD4 206 cells/mm3 (IQR 36-507). Of the 300 participants, 68 (22.7%) received empiric TB treatment, of which 53 (77.9%) were inpatients. 12-month mortality was 31.0% (93/300); 91.4% among inpatients, 72% within three months post-enrolment. Mortality was higher among those who received empiric TB treatment (51.5 vs. 30.2 per 1,000 person-months; p=0.013) compared to those who did not. TB cultures were positive in 5.0% (15/300), of whom seven (46.7%) were also TB-LAM positive. CrAg was positive in 12.3% and 3.7% had positive blood culture. Conclusion: We found high mortality among Xpert-negative PLHIV, particularly those who received empiric TB treatment, despite high ART coverage. Cryptococcal antigenemia and bacteremia were not uncommon. In presence of negative Xpert results in PLHIV, clinicians should perform extensive laboratory evaluations to identify possible comorbidities or alternative non-TB diagnosis.

BackgroundUrogenital schistosomiasis is a major cause of preventable morbidity, primarily in rural, resource-limited regions. After decades of mass drug administration, changing epidemiologic landscapes, and ongoing resource limitations, test-and-treat models may be necessary to meet elimination goals. However, diagnostic capacity remains centralized and laboratory-dependent, and community-led, contextually adapted implementation strategies remain poorly defined. This study describes the accuracy and feasibility of a low-cost diagnostic toolkit and explores community-integrated implementation models. Methodology/Principal FindingsThis mixed-methods study enrolled 418 participants from five endemic sites near Oyan River Dam, Ogun State, Nigeria in July 2025. Urine samples underwent parallel analysis by community health extension workers utilizing the toolkit and by laboratory technicians using standard microscopy. The toolkit consisted of a reusable urine filtration device paired with a under-$2 paper microscope. Semi-structured interviews with community health extension workers and key informants were analyzed using the Consolidated Framework for Implementation Research. Prevalence was 27.5% (115/418). Community health extension workers demonstrated progressive improvement in diagnostic accuracy across five sequential communities (n=237), rising from 52.5% (95% CI 37.5-67.1) to 92.1% (79.2-97.3) over eight study days (Cochran-Armitage Z=3.08, p=0.002). Specificity improved from 53.6% to 96.3% (Z=3.00, p=0.003), final sensitivity reached 81.8% (52.3-94.9), and final Cohens kappa reached 0.803. In the hands of laboratory scientists, Foldscope microscopy achieved 91.0% sensitivity and 99.3% specificity. Conclusions/SignificanceCommunity-led diagnostic task-shifting for urogenital schistosomiasis control is accurate, feasible, and implementation-ready. Consolidated Framework for Implementation Research-guided analysis demonstrated strong end-user acceptability, with local ownership, collaboration, and trust-building as key implementation facilitators. This approach addresses diagnostic gaps in resource-limited endemic settings with relevance to other community health worker-led strategies. Author SummarySchistosomiasis is a parasitic infection that spreads through contact with freshwater and often goes undetected and untreated for years. Most common in sub-Saharan Africa, the disease damages the bladder and genitourinary tract, increasing risk of infertility, bladder cancer, and HIV transmission. It is most prevalent in rural communities where the snail intermediate host thrives in local water sources used daily for fishing, farming, and bathing. One such area is the Oyan River in Nigeria. Here, we found that barriers to diagnosis and treatment of the illness include distance and transportation. In this study, community health workers diagnosed their neighbors and community members using a low-cost toolkit: a <$2 / 2700 microscope, called the Foldscope paired with a small steel filter card we designed, called the SchistoFilter.. We enrolled 418 people across five villages along the Oyan River in Nigeria and trained eight community health workers to use this toolkit at the point of care. By the fifth community visite, they reached 92.1% accuracy. The study team interviewed community health workers and government officials to contextualize this approach, and they were enthusiastic: The tools can be used with confidence, the training is feasible, and what is most needed is a reliable supply chain and supportive oversight.

PurposeUnderstanding patient perspectives is essential to improving quality and satisfaction of care in dermatology clinics. In Saudi Arabia, limited national data exist on patients educational needs and communication barriers. This study aimed to assess patient satisfaction, identify educational gaps, and explore communication challenges in dermatology clinics across Saudi Arabia. Patients and methodsA national cross-sectional survey was conducted among 976 dermatology patients. A structured questionnaire evaluated demographics, perceived knowledge, satisfaction with information provided, communication barriers, and preferred educational methods. Descriptive statistics and chi-square tests were used for analysis. ResultsAmong participants who had attended dermatology clinics (n = 795), 61.6% reported frequent or occasional confusion about their condition, and only 45.4% demonstrated high self-reported knowledge. Overall satisfaction was moderate, with 58.3% satisfied or very satisfied, while 9.9% reported dissatisfaction. The most reported communication barriers were limited consultation time (25.2%) and patient anxiety about asking questions (15.3%). Patients felt least informed about treatment options (22.6%), diagnosis (20.3%), and potential side effects (19.3%). Most participants (70.6%) preferred language communication to be in Arabic, and 78% favored the physical method of face-to-face education consultation. Patient knowledge, barriers and preferences significantly differed with age, gender, and condition complexity (p < 0.05). ConclusionDermatology patients in Saudi Arabia report moderate satisfaction with substantial educational needs and communication barriers. Addressing consultation time constraints, fostering supportive communication environments, and providing patient-centered, language-appropriate education; particularly through direct face-to-face interactions will aid to enhance understanding, satisfaction, and engagement in for an overall better provider-patient dermatologic care.

BackgroundEvidence emerging from Sub-Saharan Africa indicates that people living with HIV (PLHIV) on long-term antiretroviral therapy (ART) especially when the viral load is undetectable, may falsely test negative for HIV on rapid diagnostic tests. This study assessed the prevalence and factors associated with false negative rapid diagnostic HIV tests among Patients on antiretroviral therapy, with undetectable viral load levels at Kisenyi Health Center IV, Kampala, Uganda. MethodsBetween October 2023 and February 2024, a cross-sectional study was conducted among 1,248 PLHIV on ART with undetectable viral loads at Kisenyi Health Center IV. Participants were recruited consecutively, and HIV re-testing was conducted in accordance with the national serial rapid testing algorithm. The algorithm includes a screening test (Determine HIV-1/2), a confirmatory test (Stat-Pak(R)), and a tie-breaker test (SD Bioline(R)). Enzyme-linked immunosorbent assay (ELISA) was used as the final confirmatory method. Data on socio-demographics and clinical characteristics was collected using an electronic data abstraction tool. Logistic regression analysis was done to assess for factors associated with false negative results, using STATA version 14.0. ResultsThe median age of the participants was 34.0 (interquartile range 29.0-42.5 years). The prevalence of false-negative rapid test results was 3.2% (40/1248; CI:2.20-4.2). CD4 (aOR 1.001, CI:1.001-1.003) and duration on ART (aOR 0.884, CI:0.801-0.978) were significantly associated with false-negative HIV results. ConclusionFalse-negative results were observed in approximately 3 in every 100 PLHIV on ART with an undetectable viral load. Serial rapid testing alone may be suboptimal for detecting HIV infection in this population. Further confirmatory testing in individuals who test negative on rapid testing is recommended.

Introduction: Despite global progress in tuberculosis (TB) control, treatment outcomes remain suboptimal, particularly in high-burden settings and among people with HIV or drug-resistant TB. Identifying predictors of unsuccessful treatment is essential to improve TB care and policy. Methods: We evaluated TB treatment outcomes and patient characteristics associated with unsuccessful outcomes in five cohorts of the International epidemiology database to evaluate AIDS (IeDEA); Center for Infectious Disease Research, Zambia; Chiure health center, Mozambique; Martin Preuss Center, Lighthouse clinic, Malawi; Masvingo health center Zimbabwe; and Themba Lethu clinic, Hellen Joseph hospital, South Africa. We included all patients with TB aged 15 years starting TB treatment and assessed their treatment outcomes in association with sociodemographic and clinical characteristics using multivariable mixed-effects models. Unsuccessful outcomes were defined as death, loss to follow-up and treatment failure. Results: Among 1438 people with TB, median age was 39 years, 67% males, 40% with HIV, and 4% with MDR-TB; 1151 (80%) treatment outcomes were successful (606 cured and 545 completed treatment), 221 (15%) unsuccessful (89 deaths, 129 loss to follow-up and 3 treatment failures), and 66 (5%) other (49 unknown and 17 transfer-outs). Unsuccessful outcomes were more probable among people with multidrug-resistant TB (MDR-TB) and among participants without formal education. Risk of death was lower for people with bacteriologically confirmed TB (adjusted odds ratio (aOR) 0.5, 95%-credible interval [CI] 0.25-0.80), those with a secondary or higher education (aOR 0.3, 95%-CI 0.13-0.69) and BMI 318 kg/m{superscript 2} (aOR 0.6, 95%-CI 0.36-0.99). MDR-TB was associated with an increase (aOR 2.4 95%-CI 1.17-4.97) and primary and secondary or higher education with a decrease in loss to follow-up (aOR 0.3, 95%-CI 0.14-0.89 and aOR 0.3, 95%-CI 0.11-0.67, respectively). Conclusions: TB treatment outcomes fell short of the targets set by the World Health Organization of <10% unsuccessful outcomes, indicating a critical need for enhanced management strategies. Tackling loss to follow-up is crucial, especially among MDR-TB patients, including stronger retention activities and improved diagnostic capacities.

BackgroundOnly 54% of people with TB had an initial molecular diagnostic test in 2024, due to barriers including high test costs. Pooled testing is implemented in Cameroon as a strategy to increase testing efficiency on the Xpert MTB/RIF Ultra (Ultra) assay and extend molecular testing to more people when test reagents are limited, as recently recommended by the World Health Organization. At GeneXpert sites, laboratory personnel decide whether to test individually or in pools and pool size based on locally available information, including smear microscopy results, lab positivity rates, daily testing volume, availability of Ultra cartridges and GeneXpert modules, and patient characteristics. MethodsWe conducted a retrospective evaluation of Ultra testing at GeneXpert laboratories that implemented both individual and pooled testing in pools of 2 to 8. Ultra test results and duration were extracted from GeneXpert instruments. Testing efficiency, instrument time to result, and assay cost were analyzed overall and by pool size. ResultsFrom October 2023 to March 2025, 71,328 sputum specimens were tested at 16 GeneXpert laboratories. For 59,164 specimens tested in pools, including 1,999 (3.4%) with TB detected, 20,838 Ultra cartridges were used, or 0.35 cartridges per result, enabling an additional 38,326 people to have molecular test results compared to if specimens were tested individually. The average time to result varied from 45 minutes to 10 minutes for specimens tested in pools of 2 or 8, respectively, as compared to 66 minutes for individual testing. The calculated assay cost per result was $2.81 for specimens tested in pools (from $5.29 to $1.19 for specimens in pools of 2 or 8, respectively) as compared to $7.97 for individual testing. DiscussionImplementation of pooled testing enabled many more people to have a molecular test result for TB, with significant time and cost savings compared to individual testing. What is already known on this topicPooled testing is a strategy used to increase testing efficiency by combining specimens from multiple individuals prior to testing; if the pool tests negative, a negative result is reported for each specimen with no further testing, and if the pool tests positive, then each specimen from the pool is re-tested individually and the individual result is reported. The World Health Organization has recently recommended the use of pooled testing to increase access to molecular diagnostic testing for tuberculosis when resources are constrained. What this study addsThis is the first report of large-scale programmatic implementation of pooled testing for the detection of TB. Pooled testing was performed by laboratory personnel who decided whether to test individually or in pools of size 2 to 8, based on the information available to them. Implementation of pooled testing enabled many more people to be tested with existing resources, with significant reductions in time to result and assay cost per specimen tested. How this study may affect research, practice or policyThis demonstration of the successful scale up of pooled testing for TB should contribute to uptake of pooled testing by national TB programs and laboratories to increase access to molecular testing for TB when resources are constrained.