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Ritah Kiconco,1,2 Robert Kalyesubula,3,* Gertrude N Kiwanuka4,* 1Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda; 2Department of Biochemistry, Soroti University, Soroti, Uganda; 3Departments of Internal Medicine and Physiology, Makerere University, Kampala, Uganda; 4Department of Biochemistry, Mbarara University of Science and Technology, Mbarara, Uganda*These authors contributed equally to this workCorrespondence: Ritah Kiconco, Mbarara University of Science and Technology, P.O. Box 1410, Mbarara, Uganda, Tel +256 783990501, Fax +256-485-20782, Email rkiconco@must.ac.ugPurpose: We aimed at determining the distribution of the ACE insertion/deletion gene polymorphisms among type 2 diabetic patients and their association with the nephropathy biomarkers and the metabolic indicators.Patients and Methods: Data were collected from 237 adult type 2 diabetes mellitus patients receiving healthcare at the diabetic clinic of Mbarara Regional Referral Hospital. Peripheral blood genomic DNA was amplified using a conventional PCR technique and analyzed for the ACE homozygous forms of the insertion (II), deletion (DD) and heterozygous insertion deletion (ID) genotypes as well as their respective allele counts. Biomarkers of nephropathy were analyzed on a Beckman coulter AU480 chemistry analyzer using system compatible reagents.Results: Majority of the participants were older persons (Median = 57, IQR = 49– 64) and female 171 (72.2%). Most of them had the Deletion allele 198 (83.5%) and DD genotype 116 (48.9%). At multivariate logistic regression, the nephropathy biomarkers that is microalbuminuria, serum creatinine, urea, eGFR and electrolytes had no association with the ACE I/D alleles or genotypes (p > 0.05). On the other hand, selected metabolic indicators had a positive relationship. The insertion allele was associated with increasing glycated hemoglobin (OR = 1.082, p = 0.019) and decreasing serum glucose levels (OR = 0.891, p = 0.001). Deletion allele was associated with decreasing glycated hemoglobin (OR = 0.924, p = 0.047) and increasing serum glucose levels (OR = 1.208, p = 0.001). ACE II genotype was associated with decreasing serum glucose levels (OR = 0.873, p = 0.029). ACE DD genotype was associated with decreasing glycated hemoglobin (OR = 0.917, p = 0.010) and increasing serum glucose levels (OR = 1.132, p = 0.001). ACE ID genotype was associated with increasing glycated hemoglobin (OR = 1.077, p = 0.022), triglyceride levels (OR = 1.316, p = 0.031) and decreasing serum glucose levels (OR = 0.933, p = 0.038).Conclusion: The presence or absence of the ACE I/D alleles and genotypes affects the ultimate increase or decrease in the serum glucose, glycated hemoglobin and triglyceride levels. Although there was no significant association between the biomarkers of nephropathy and the ACE I/D alleles or genotypes, the above implicated metabolic indicators should be included in healthcare guidelines used when attending to type 2 diabetic patients.Keywords: angiotensin converting enzyme gene, insertion, deletion, polymorphism, biomarkers, type 2 diabetes mellitus, diabetic nephropathy, Uganda

Rebecca Ingenhoff,1,2 Nicole Robertson,3 Richard Munana,4,5 Benjamin E Bodnar,6 Ivan Weswa,5 Isaac Sekitoleko,7,8 Julia Gaal,1 Bruce J Kirenga,9 Robert Kalyesubula,5,10,11 Felix Knauf,1,11 Trishul Siddharthan12 1Department of Nephrology and Medical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany; 2Charité Center for Global Health, Charité - Universitätsmedizin Berlin, Berlin, Germany; 3University of Kentucky College of Medicine, Lexington, KY, USA; 4School of Public Health, Makerere University College of Health Sciences, Makerere University, Kampala, Uganda; 5African Community Center for Social Sustainability, Nakaseke, Uganda; 6Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA; 7MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda; 8London School of Hygiene and Tropical Medicine, London, UK; 9Makerere University Lung Institute, Kampala, Uganda; 10Department of Physiology, Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda; 11Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA; 12Department of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Coral Gables, FL, USACorrespondence: Rebecca Ingenhoff, Email Rebecca.ingenhoff@charite.deBackground: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death globally. The burden of COPD is expected to increase in low- and middle-income countries (LMICs). COPD screening and diagnostics tools are often inaccessible in rural settings of LMICs. To contribute to the growing body of evidence on the effectiveness of Community Health Worker (CHW) interventions, this study aims to understand the facilitators and barriers of implementing a CHW-led COPD screening and referral program in rural Uganda.Methods: This qualitative study was conducted from September to October 2022 to explore Community Members, CHWs, and Healthcare Providers (HCPs) perceptions on the challenges of CHW-delivered COPD programming in Nakaseke, rural Uganda. In total, we held eight individual in-depth interviews with CHWs, ten in-depth interviews with HCPs and six focus group discussions with 34 Community Members. Research assistants audio-recorded and transcribed interviews verbatim. The implementation outcomes framework guided the thematic analysis.Results: Implementation acceptability was constrained by a lack of COPD awareness, a lack of perceived utility in COPD screening as well as stigma around the diagnostic process. Limited spirometry adoption was also attributed to Community Member accessibility and willingness to participate in the COPD diagnostic referral process. The high patient volume and the complex, time-consuming diagnostic and referral process hindered successful implementation. To enhance program sustainability, all participants suggested increasing CHW support, medication access, decentralizing COPD care and upscaling follow-up of Community Members by CHWs.Conclusion: CHW-led interventions remain a potentially critical tool to alleviate barriers to treatment and self-management in settings where access to care is limited. While community-based interventions can create sustainable infrastructure to improve health outcomes, formative assessments of the potential barriers prior to intervention are required. Evidence-based, localized approaches and sustained funding are imperative to achieve this.Keywords: community health workers, task shifting, screening and referral, chronic obstructive pulmonary disease, Uganda

Ronald Kasoma Mutebi,1– 3 Andrew Weil Semulimi,1,4 John Mukisa,5 Martha Namusobya,1 Joy Christine Namirembe,3 Esther Alice Nalugga,1 Charles Batte,1 David Mukunya,6 Bruce Kirenga,1,7 Robert Kalyesubula,4 Pauline Byakika-Kibwika7 1Lung Institute, Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 2Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 3Department of Medicine, Mengo Hospital, Kampala, Uganda; 4Department of Physiology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda; 5Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Kampala, Uganda; 6Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda; 7Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, UgandaCorrespondence: Ronald Kasoma Mutebi, Department of Medicine, Mengo Hospital, PO BOX 7161, Kampala, Uganda, Email dr.rkmutebi@gmail.comIntroduction: Dolutegravir-based anti-retroviral therapy (ART) regimens were rolled out as first line HIV treatment in Uganda due to their tolerability, efficacy and high resistance barrier to human immunodeficiency virus (HIV). They have however been associated with weight gain, dyslipidemia and hyperglycemia which are cardiometabolic risk factors of hypertension. We assessed the prevalence and factors associated with hypertension among adults on dolutegravir regimens.Methods: We conducted a cross-sectional study on 430 systematically sampled adults on dolutegravir-based ART for ≥ 6 months. Hypertension was defined as systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg or history of use of antihypertensive agents.Results: The prevalence of hypertension was 27.2% (117 of 430 participants) [95% CI: 23.2– 31.6]. Majority were female (70.7%), the median age 42 [34, 50] years, with body mass index (BMI) ≥ 25 kg/m3 (59.6%) and median duration on DTG-based regimens of 28 [15, 33] months. Being male [aPR: 1.496, 95% CI: 1.122– 1.994, P = 0.006], age ≥ 45 years [aPR: 4.23, 95% CI: 2.206– 8.108, P < 0.001] and 35– 44 years [aPR: 2.455, 95% CI: 1.216– 4.947, P < 0.012] as compared with age < 35 years, BMI ≥ 25 kg/m3 [aPR: 1.489, 95% CI: 1.072– 2.067, P = 0.017] as compared with BMI < 25 kg/m3, duration on dolutegravir-based ART [aPR: 1.008, 95% CI: 1.001– 1.015, P = 0.037], family history of hypertension [aPR: 1.457, 95% CI: 1.064– 1.995, P = 0.019] and history of heart disease [aPR: 1.73, 95% CI: 1.205– 2.484, P = 0.003] were associated with hypertension.Conclusion: One in every four people with HIV (PWH) on dolutegravir-based ART has hypertension. We recommend the integration of hypertension management in the HIV treatment package and policies to improve existing supply chains for low cost and high-quality hypertension medications.Keywords: hypertension, dolutegravir, HIV

Trishul Siddharthan,1,2 Adaeze C Wosu,2,3 Suzanne L Pollard,1,2 Shakir Hossen,1,2 Patricia Alupo,4,5 Timothy Shade,1,2 Robert Kalyesubula,4 Shumonta Quaderi,6 Robert A Wise,1 John R Hurst,6 Bruce Kirenga,4,5 William Checkley1,2 On behalf of LiNK Cohort Study Investigators1Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; 2Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University, Baltimore, MD, USA; 3Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; 4School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda; 5Makerere Lung Institute, Makerere University, Kampala, Uganda; 6UCL Respiratory, University College London, London, UKCorrespondence: William CheckleyDivision of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, 1800 Orleans Ave Suite 9121, Baltimore, MD 21287, USATel +1 443-287-4587Email wcheckl1@jhmi.eduBackground: Low- and middle-income countries (LMICs) account for > 90% of deaths and illness episodes related to COPD; however, this condition is commonly underdiagnosed in these settings. Case-finding instruments for COPD may improve diagnosis and identify individuals that need treatment, but few have been validated in resource-limited settings.Methods: We conducted a population-based cross-sectional study in Uganda to assess the diagnostic accuracy of a respiratory symptom, exposure and functional questionnaire in combination with peak expiratory flow for COPD diagnosis using post-bronchodilator FEV1/FVC z-score below the 5th percentile as the gold standard. We included locally relevant exposure questions and statistical learning techniques to identify the most important risk factors for COPD. We used 80% of the data to develop the case-finding instrument and validated it in the remaining 20%. We evaluated for calibration and discrimination using standard approaches. The final score, COLA (COPD in LMICs Assessment), included seven questions, age and pre-bronchodilator peak expiratory flow.Results: We analyzed data from 1,173 participants (average age 47 years, 46.9% male, 4.5% with COPD) with acceptable and reproducible spirometry. The seven questions yielded a cross-validated area-under-the-curve [AUC] of 0.68 (95% CI 0.61– 0.75) with higher scores conferring greater odds of COPD. The inclusion of peak expiratory flow and age improved prediction in a validation sample (AUC=0.83, 95% CI 0.78– 0.88) with a positive predictive value of 50% and a negative predictive value of 96%. The final instrument (COLA) included seven questions, age and pre-bronchodilator peak expiratory flow.Conclusion: COLA predicted COPD in urban and rural settings in Uganda has high calibration and discrimination, and could serve as a simple, low-cost screening tool in resource-limited settings.Keywords: low- and middle-income countries, COPD, COLA, respiratory symptom

Introduction: Young people living with HIV (YPLHIV) are at increased risk of developing chronic kidney disease (CKD) which is associated with high mortality and morbidity. Early diagnosis is important to halt progression. We aimed to estimate the prevalence and factors associated with CKD among YPLHIV in Kampala, Uganda, and to compare serum creatinine and cystatin C for early diagnosis of CKD in this population., Methods: A cross-sectional study with YPLHIV aged 10 to 24 years was conducted in seven HIV clinics. Participants provided a urine and blood sample to measure urinary albumin, proteinuria, serum creatinine and cystatin C levels at baseline and after three months. The estimated glomerular filtration rate (eGFR) was calculated using CKDEPI 2021, Cockroft-Gault and bedside Schwartz equations using creatinine or cystatin C. The albumin creatinine ratio (ACR) and proteinuria were measured. CKD was defined as either eGFR < 60 ml/min/1.73m 2 or < 90 ml/min/1.73m 2 or ACR above 30 mg/g on two separate occasions. Univariable and multivariable logistic regression were used to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) for factors associated with CKD., Results: A total of 500 participants were enrolled. Most were female (56%; n = 280) and aged 10 to 17 years (66.9%; n = 335). CKD prevalence ranged from 0 to 23% depending on the criteria, equation and biomarker used. Cystatin C-based equations estimated higher prevalence of CKD compared to creatinine-based ones. Prevalence of ACR above 30 mg/g was 10.1% and of proteinuria 29%. Factors independently associated with CKD were age (aOR = 1.42; 95% CI:1.30-1.51) and male sex (aOR = 3.02; 95% CI:1.68-5.43)., Conclusion: CKD prevalence among YPLHIV varied substantially depending on definitions used and the current definition would likely lead to missed cases of CKD among YPLHIV. Estimating equations should be validated against measured GFR in YPLHIV and the optimal definition of CKD in this vulnerable population should be revised to optimise detection and opportunities for reducing disease progression., Clinical Trial Number: Not applicable., Competing Interests: Declarations. Human ethics and consent to participate declarations: Ethical approval was received from the Uganda Virus Research Institute (UVRI) Research Ethics Committee (reference number GC/127/946), the Uganda National Council of Science and Technology (HS2578ES) and the London School of Hygiene and Tropical Medicine institutional review board (28797). Information about the study appropriate for adults, semi-literate adults and children was provided in an information booklet that was read to the participants and caregivers. All the participants more than 18 years of age provided written informed consent. Those below 18 years of age provided assent, and their caregivers provided written informed consent. If a child refused to provide assent even after their caregiver had provided consent, that child was not enrolled into the study. All participants had the option to withdraw at any point during the research. All participants with suspected CKD were referred to a nephrologist for management. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Chronic kidney disease (CKD) is often complicated by disorders in multiple body systems, associated with higher mortality and morbidity. Young people living with HIV (YPLHIV) have an increased risk of multisystem chronic comorbidities. However, there are few data describing comorbidities associated with CKD among YPLHIV., Methods: We conducted a case-control study in seven ART clinics in Kampala, Uganda. Cases were YPLHIV (aged 10-24 years) diagnosed with CKD and controls were those without CKD. We collected data on demographic and clinical factors: blood pressure, fasting glucose levels, anaemia, electrolytes, parathyroid hormone, and cognitive impairment. We summarized the demographic and clinical factors and used logistic regression to estimate odds ratios (OR) and 95% confidence intervals for associations between CKD comorbidities, adjusted for age, sex and viral suppression., Results: A total of 292 participants (96 cases and 196 controls) were recruited. Cases were mostly male (59.4% vs 36.5%), and younger (88.5% vs 46.4% aged <17 years) compared to controls. CKD was associated with having a detectable HIV viral load (OR=3.73; 95% CI 1.53-9.12) and proteinuria (aOR=4.19; 95% CI 2.28-7.72). CKD was also associated with low haematocrit, hypochloraemia, hyperphosphatemia, and high mean corpuscular volume. There was no evidence of an association of CKD with hypertension, anaemia, or stunting., Conclusion: The pattern of comorbidities among YPLHIV with CKD is uncertain and difficulties may relate to difficulty determining true kidney function and normal ranges in this population. Further studies are needed to discern the pattern of CKD complications to improve management efforts and clinical outcomes.

Background: Globally, the prevalence of chronic kidney disease (CKD) is increasing among young people living with HIV (YPLHIV), with inconsistent estimates. Aggregated data on the prevalence of CKD are needed in sub-Saharan Africa (SSA) to inform strategies for early diagnosis and management. We conducted a systematic review and meta-analysis to estimate the pooled prevalence of CKD among YPLHIV in SSA., Methods: We searched Medline/PubMed, EMBASE, African Index Medicus, and African Journals Online for articles reporting the prevalence of CKD among YPLHIV in SSA using predefined search strategies up to 15th January 2024. The reference lists of identified articles were checked for additional eligible studies. The eligibility criteria were studies among YPLHIV aged 10-24 years reporting CKD prevalence defined by either glomerular filtration rate (GFR), albumin-to-creatinine ratio (ACR) or proteinuria. We used a narrative synthesis to report differences between the included studies. The DerSimonian-Laird random effects model was used to pool the CKD prevalence, and heterogeneity was assessed using the Cochrane Q-test and I-squared values. We assessed the risk of bias in each article using the Joanna Briggs Institute checklist and publication bias in a funnel plot and Egger's test., Results: Of 802 retrieved articles, 15 fulfilled the eligibility criteria and were included in the meta-analysis. Of these, 12 (80%) were cross-sectional studies that used estimated GFR to diagnose CKD. Only one study followed the standard definition of CKD. The pooled CKD prevalence from 15 studies was 12% (95% CI 6.0-19.5%), ranging from 0.8% to 53.1% according to the definition used, with a high degree of heterogeneity (I2 = 97.7%, p<0.001). The included studies were of moderate quality, with no evidence of publication bias. Sensitivity analysis showed that the findings were robust to the methodological and analytic approach., Conclusion: CKD prevalence among YPLHIV is moderately high and highly heterogeneous across SSA. The standard definition of CKD should be used to enable estimation of CKD prevalence in different studies and settings. HIV programs enrolling YPLHIV should routinely screen for CKD to ensure early diagnosis and management., Trial Registration: PROSPERO registration number: CRD42022347588., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Nasuuna et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose of Review: Discussion of inequalities and inequities in global distribution of and access to home dialysis., Recent Findings: The majority of patients receiving home dialysis receive peritoneal dialysis, but these are concentrated in few countries across the globe. Peritoneal dialysis as the most common form of home dialysis has many advantages in terms of individual freedoms, similar outcomes to haemodialysis, being less costly in some countries, and more scalable than in-centre haemodialysis. Despite this there are many inequities in access at the patient, clinician, health system and geopolitical levels. Poverty, discrimination and lack of support at home are important drivers of inequities at the patient level. At the clinician and health systems level lack of experience in home dialysis, lack of resources and lack of time drive patients towards in-centre dialysis. At the geopolitical level, high costs associated with procurement and distribution of peritoneal dialysis solutions exacerbate inequities in access., Summary: The challenge of reducing global inequities in access to home dialysis in low- and middle-income countries are vast and would require training of the doctors, nurses, families, patients, leaders and community partners. Once this is achieved, dealing with costs and logistics of supplies is crucial to improve and sustain equitable access., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: People living with HIV (PLWH) are at risk of kidney function impairment due to HIV-related inflammation, antiretroviral therapy (ART), diabetes mellitus, and hypertension. Older persons may experience a higher burden of chronic kidney disease (CKD) as kidney function declines with increasing age. There is a paucity of data comparing the prevalence of kidney function impairment in older PLWH to that in people without HIV in sub-Saharan Africa., Methods: We conducted a cross-sectional study among people aged ≥ 60 years living with and without HIV in Kampala, Uganda who were matched 1:1 by community location. We collected data on sociodemographics, comorbidities, and HIV-related clinical characteristics. We defined kidney function impairment as an estimated glomerular filtration rate(eGFR) < 60mls/min/1.73m 2 with or without proteinuria. We constructed multivariable logistic regression models to study associations between participant characteristics and kidney function impairment., Results: We enrolled 278 people (median age 66 years); 50% were PLWH, and 51.8% were female. Among PLWH, 33.1% (95% CI: 25.7-41.4%) had kidney function impairment versus 12.9% (95% CI: 8.3-19.7%) among people without HIV, (p-value < 0.01). The prevalence of proteinuria among PLWH versus people without HIV was 43.9% (95% CI:35.8-52.3%) versus 19.4% (95% CI:13.6-26.9%) p-value < 0.01. Living with HIV (OR = 3.89(95% CI: 2.04-7.41), p-value < 0.01), older age (OR = 1.13, (95% CI:1.07-1.20), p-value < 0.01), female sex (OR = 1.95, (95% CI:1.06-3.62), p-value = 0.03) and a prior diagnosis of hypertension (OR = 2.19(95% CI:1.02-4.67), p-value = 0.04) were significantly associated with kidney function impairment., Conclusions: HIV infection is strongly associated with kidney function impairment among older PLWH. Prioritizing routine measurements of kidney function and proteinuria in older PLWH will enable early detection and institution of measures to reduce the progression of kidney disease., (© 2024. The Author(s).)

Background Kidney dysfunction is a common finding among patients with diabetes mellitus. We sought to determine the prevalence and contributors to kidney dysfunction among type 2 diabetes mellitus (T2D) patients. Methods In this descriptive and analytical cross-sectional study, we received consent and enrolled 148 T2D patients attending the diabetic clinic of Soroti Regional Referral Hospital in eastern Uganda from May 2023 to July 2023. We used questionnaires to obtain participants' socio-demographic and behavioral characteristics. Blood and urine samples were collected and analyzed for kidney dysfunction and other metabolic biomarkers, which included serum glucose, creatinine, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), uric acid, triglycerides, total cholesterol, low and high-density lipoprotein cholesterol, and urinalysis. We performed blood tests using an automated chemistry analyzer. Results Of the 148 participants with T2D, 71 (47.97%) had kidney dysfunction (95% CI: 39.98-56.07). Bivariate and multivariate logistic regression analysis revealed only total proteinuria (OR 1.046; 95% CI: 1.014-1.079; P = 0.004) as a significant factor contributing to the observed kidney dysfunction in T2D patients. Conclusion Kidney dysfunction is a common occurrence among T2D patients in our study setting. The presence of proteins in urine contributes immensely to the observed kidney status in our study population. Total proteinuria should be frequently screened in the routine care of T2D patients in eastern Uganda to curb kidney dysfunction at an early stage. Also, a larger study is recommended to validate these findings and inform screening programs in the study area., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Busitema University Faculty of Health Sciences Research Ethics Committee (BUFHSREC) issued approval BUFHS-2023-73. The head of the diabetes clinic and the administration of Soroti Regional Referral Hospital (SRRH) provided their administrative clearance. Before any research subject was recruited, informed written consent (in both the local and English languages) was obtained from them. We adhered to the moral standards that come with using human subjects in research. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: Funding for this research was provided by the Ugandan government through the Soroti University Research Innovation Fund. Funding reference: SUN-RIF/2022/31. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Kiconco et al.)

Background: Dolutegravir-based (DTG) regimens are rapidly becoming the preferred first-line antiretroviral therapy (ART) for people living with HIV (PLHIV) in low and middle-income countries. However, there are rising concerns over the development of hyperglycemia and, in some cases, diabetes mellitus in patients switched to DTG., Objectives: To determine the prevalence and factors associated with hyperglycemia among PLHIV receiving DTG-based ART at Kiruddu National Referral Hospital (KNRH), Uganda., Design: Cross-sectional study., Methods: The study was conducted in the inpatient wards and the infectious disease outpatient clinic of KNRH from May to July 2022. Participants aged ⩾18 years on a DTG-based ART regimen for at least 3 months were consecutively enrolled and interviewed using a research assistant administered questionnaire for sociodemographic and clinical characteristics. HbA1c was measured using whole blood Architect Ci4100 ® (Abbott, Illinois, USA), with hyperglycemia defined using a cut-off of ⩾5.7% as per the Uganda Diabetes Association guidelines. Factors associated with hyperglycemia were examined through logistic regression, adjusting for pertinent confounders, in STATA 17. A significance level was set at p  < 0.05., Results: A total of 398 PLHIV with a median age of 40.5 years (IQR: 32-49) were enrolled. More than half were females (58.3%, n  = 232) and the majority (90%) had a CD4 count above 200 cells/µL. About 16% had a family history of diabetes, 11.73% ( n  = 46) showed elevated blood pressure levels, and 16.7% ( n  = 64) had obesity. Hyperglycemia was present in 12.8% ( n  = 51), with 10.3% having pre-diabetes ( n  = 41) and 2.5% with diabetes mellitus ( n  = 10). At bivariate analysis, hyperglycemia was significantly associated with age >40 years ( p  < 0.001), herbal medicine use ( p  = 0.03), being widowed ( p  < 0.001), obesity ( p  = 0.042), hypertension ( p  = 0.002) and >3 since diagnosis with HIV ( p  = 0.030). At multivariable regression, only age >40 (AOR 2.55, 95% CI: 1.05-6.23, p  = 0.039) and hypertension (AOR 2.93, 95% CI: 1.07-8.02, p  = 0.036) remained significantly associated with hyperglycemia., Conclusion: More than 1 in 10 patients on DTG-based ART in our study had hyperglycemia. We recommend regular monitoring of plasma glucose, especially for patients >40 years old and those with other comorbidities, before starting/switching to DTG regimens. Longitudinal studies are recommended to determine the underlying mechanisms of hyperglycemia in this population., (© The Author(s), 2024.)

Objectives: The main aim was to determine the diagnostic performance of an albuminuria point-of-care test (POC) for diagnosis of chronic kidney disease among young people living with HIV (YPLHIV) in Uganda., Design: We conducted a cross-sectional study comparing the diagnostic performance of MicroalbuPHAN (Erba Lachema, Czech Republic), an albuminuria POC test against the laboratory-measured albumin and creatinine as the reference standard., Setting: The study was set in seven HIV clinics in Kampala, Uganda that provide antiretroviral therapy to adults and children living with HIV. The study took place from April to August 2023., Participants: 497 YPLHIV aged 10-24 years who were diagnosed with HIV before 10 years of age were randomly selected from the HIV clinics. Pregnant YPLHIV were excluded., Procedures: Participants provided a spot urine sample that was tested for albumin and creatinine using the POC and in the laboratory and proteinuria using urine dipstick. The sensitivity, specificity, negative and positive predictive values (NPV, PPV) of the POC versus the laboratory test were calculated, and factors associated with having a positive POC test were estimated using logistic regression., Outcome Measures: The primary outcome was a diagnosis of albuminuria defined as an albumin creatinine ratio above 30 mg/g., Results: Of the 497 participants enrolled, 278 (55.9%) were female and 331 (66.8%) were aged 10-17 years. The POC test had a sensitivity of 74.5% (95% CI 70.6% to 78.4%) and specificity of 68.1% (95% CI 63.9% to 72.3%). The PPV was 21.5% (95% CI 17.8% to 25.1%) and the NPV was 95.8% (95% CI 94.0% to 97.6%), with an accuracy of 68.8%. There was strong evidence that a positive POC test was associated with having proteinuria (OR 2.82; 95% CI 1.89 to 4.22, p<0.001); body mass index <19.5 (OR 1.69 95% CI 1.17 to 2.45, p=0.005) and being male (OR 1.48; 95% CI 1.02 to 2.14, p=0.04)., Conclusions: The albuminuria POC test had low sensitivity and specificity. However, it can be used to exclude kidney disease given its high NPV. It should be validated against the 24-hour urinary excretion rate to further determine its diagnostic performance., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The presence of hypertension could reduce the health-related quality of life (HRQoL) of people with HIV (PWH). Yet, literature describing the HRQoL of PWH who have hypertension in Uganda is scarce making the design of locally adapted interventions cumbersome. In our study, we compared HRQoL scores of people with HIV with and without hypertension on long term antiretroviral therapy (ART) in Uganda., Methods: We recruited 149 PWH with hypertension and 159 PWH without hypertension in the long-term ART cohort at an urban clinic in Kampala, Uganda. Data on socio-demographics were collected using an interviewer designed questionnaire while data on the World Health Organisation clinical stage viral load and CD4 count as well as ART duration were extracted from clinic electronic database and a generic EuroQol -5D- 5L (EQ-5D- 5L) and Medical Outcome Study (MOS-HIV) questionnaire used to collect HRQoL data. Data were summarized using descriptive statistics while inferential statistics were used to determine associations between key variables and HRQoL. Mann-Whitney U tests were used to compare HRQoL between groups of interest., Results: One hundred ninety (61.7%) participants were female. PWH who had hypertension were older (Mean ± SD: 53.7 ± 8.3 vs 49.9 ± 8.6, p value <0.001) than those without hypertension. Participants with hypertension had lower overall median health utility scores (0.71 (0.33-0.80) vs 0.80 (0.44-0.80), p value = 0.029) and mean physical health score (48.44 ± 10.17 vs 51.44 ± 9.65, p value < 0.001) as opposed to those without hypertension. Hypertension (p value = 0.023), high income status, >70,000 UGX, (p value = 0.044), disclosure of the HIV status of the participants to their partner (p value = 0.026), and current history of smoking (p value = 0.029) were associated with low HRQoL scores., Conclusion: Among people with HIV, those with hypertension had lower HRQoL compared to those without. This calls for inclusion of quality-of-life assessment in the management of PWH who have been diagnosed with hypertension to identify those at risk and plan early interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Batte et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

CKD affects about 850 million people worldwide and is projected to be the fifth leading cause of death by 2040. Individuals from low- and middle-income countries (LMICs) bear the bulk of CKD. They face challenges including lack of awareness among the general population, as well as health care providers, unique risk factors such as genetic predispositions, infectious diseases, and environmental toxins, limited availability and affordability of diagnostic tests and medications, and limited access to KRTs. The inadequate health system infrastructure, human resources, and financing mechanisms to support comprehensive and integrated kidney care worsen the situation. Overcoming these challenges needs concerted efforts toward early detection, intervention, and multidisciplinary follow-up, policy, collaboration, advocacy, and financing. To achieve this, there is need for individual governments to include kidney health among the key health priorities and build capacity toward resilient health care systems. Integrating kidney care using the roadmaps of well-established management systems for other chronic diseases, such as HIV, has the potential to expedite the widespread adoption of kidney health. The aim of this article is to provide an overview of the current state and future prospects of kidney care in LMICs, highlighting the main challenges, ongoing efforts, and opportunities for improvement. We present case studies of exemplary efforts from three continents of the world with the highest densities of LMICs and propose potential strategies for a sustainable solution., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.)

Mycobacterium tuberculosis remains one of the deadliest infectious agents globally. Amidst efforts to control TB, long treatment duration, drug toxicity, and resistance underscore the need for novel therapeutic strategies. Despite advances in understanding the interplay between microbiome and disease in humans, the specific role of the microbiome in predicting disease susceptibility and discriminating infection status in tuberculosis still needs to be fully investigated. We investigated the impact of M.tb infection and M.tb -specific IFNγ immune responses on airway microbiome diversity by performing TB GeneXpert and QuantiFERON-GOLD assays during the follow-up phase of a longitudinal HIV-Lung Microbiome cohort of individuals recruited from two large independent cohorts in rural Uganda. M.tb rather than IFNγ immune response mainly drove a significant reduction in airway microbiome diversity. A microbiome signature comprising Streptococcus, Neisseria, Fusobacterium, Prevotella, Schaalia, Actinomyces, Cutibacterium , Brevibacillus , Microbacterium , and Beijerinckiacea accurately discriminated active TB from Latent TB and M.tb- uninfected individuals., Competing Interests: All Authors declared no conflicts of interest., (© 2024 The Authors.)

Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr S.K. is a scientific consultant for George Clinical. Dr V.C.-S. is a speaker and consultant from Baxter Brazil. Dr S.S. has received an education grant from Amgen Canada. The rest of the authors have no relevant disclosures.