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Background: ART initiation in the 3rd trimester of pregnancy is associated with failure to achieve viral suppression (VS) by delivery and increased transmission of HIV. We randomised 60 treatment naïve pregnant women at 28-36w gestation in Uganda and South Africa 1:1 to receive EFV or DTG+2NRTIs. The primary endpoint was pharmacokinetics (PK) of DTG in women and breastfed infants; secondary endpoints included VS. Methods: To comply with national guidelines, EFV+2NRTI was initiated on referral, with subjects randomized to DTG switched within 7 days. Viral load (VL) was collected at every visit; intensive maternal PK sampling (0-24h) was performed at 14 days on DTG, and 2 weeks post-partum, with paired sampling between maternal plasma and cord blood, breastmilk and infant plasma. All infants were exclusively breastfed. Results: There was no significant pre-ART differences between DTG (n=29) and EFV (n=31) arms in maternal age, gestation at treatment initiation (30.8w), weight, obstetric history, VL (log 4 copies) and CD4 count (394 cells/mm3). Third trimester DTG exposures were low with Ctrough at or below target (MEC 324ng/mL) in 9/28 (32%) mothers. DTG transfer across the placenta (122%) and in breast milk (3%) coupled with delayed elimination resulted in significant infant exposures potentially persisting during breast-feeding. Both regimens were well-tolerated. A total of 10 SAEs were reported in 5 mothers and 3 infants, with no significant differences between arms. Superior VS was observed with DTG (Table 1) at the 2w post-partum visit (P=0.005). However, VL>1000 copies/mL near delivery was still observed with both DTG (3.7%) and EFV (7.4%). No HIV transmissions were observed Conclusions: HIV RNA suppression < 50 copies/mL was more rapid with DTG (despite low DTG exposures when started in the third trimester) which may translate to improved PMTCT for ART initiation in late pregnancy. The impact of significant infant DTG exposures related to intrauterine transfer, continued breastfeeding and delayed elimination is being evaluated in the DolPHIN-2 study.

Uganda has registered profound levels of primary and secondary school attendance since the introduction of Universal Primary Education in 1997 and Universal Secondary Education in 2007. Introducing Universal Secondary Education made Uganda the first country in sub-Saharan Africa to introduce the compulsory secondary level education. While this policy has improved access, there has not been a corresponding increase in quality, and large numbers of children are still missing out on secondary education. This master thesis is analyzing inclusive education at the heart of the reformed lower secondary school curriculum. To reach this goal, the lower secondary school curriculum framework document and two interviews from people familiar with the reform process serves as the data for the analysis. The research is a qualitative study and the data was analyzed using content analysis approach. The theoretical framework consists of theories of inclusive education and aims of Education for All global movement (EFA) as well as Sustainable Development Goal 4. The Uganda lower secondary school framework document is analyzed visa-vis the aims of EFA and SDG 4. The main categories that emerged from the data concerning inclusive education were: Participation as a requirement addressing diversity; inclusive, alternative ways of learning for all; inclusive and safe learning environment; teaching material addressing diversity without stereotypes; and assessment addressing all learners and their achievement. There were also topics that were missing from the data, such as, specific discussions about people or groups that might be in danger of exclusion or concrete methods or pedagogy of including everyone.