Uganda implements interventions for injection drug use, but significant barriers hinder efforts to effectively reach and support persons who inject drugs (PWID). We describe characteristics of PWID, and associated risk behaviour, to inform the designing of programmes that are tailored to clients' needs and preferences. A cross-sectional survey (August 23rd to December 5th, 2023) in Kampala interviewed 354 PWID (≥18-years) at selected venues(bars,lodges, street corners and ghetto). Peer eductors and counsellors administered a structured questionnaire covering socio-demographics, drug use, sexual risk, and medical history. HIV serostatus was determined by self-report or testing for consenting participants without history of recent testing Binary logistic regression was used to establish the relationship between HIV infection and risky drug- and sexual behaviour of PWID. Participants were predominantly Ugandan (95.2%), male (73.2%), unmarried (55.9%), unemployed (81.8%), with higher levels of education and varying ages. Mental disorders were prevalent, with 48.7% reporting at least one underlying condition, including depression (30.8%) and anxiety (9.6%). Physical health issues included fever (32.9%), cough (32.5%), malaria (22%), and sexually transmitted infections (15%). Over 82.6% were introduced to drugs by close acquaintances. HIV prevalence among participants was 3.7%, higher in females (8.4%) and non-Ugandans (16.7%). Being female and experiencing difficulty accessing sterile injection materials were associated with HIV-positive status. Our study provides valuable insight into the socio-demographic, mental, physical health, and HIV risk behaviour of PWID in Kampala, Uganda. The findings indicate significant vulnerabilities to injecting drug use, mental disorders, and high-risk behaviors that predispose this population to HIV infection. Despite a low HIV prevalence in this population compared to previous estimates, the interplay between drug use, risky injecting practices, and sexual behaviour suggests an urgent need for targeted interventions to address these intertwined challenges.

BACKGROUND: Other than Kaposi sarcoma (KS)-associated herpesvirus and CD4 T-cell lymphopenia, the mechanisms responsible for KS in the context of HIV are poorly understood. One recently explored pathway of HIV pathogenesis involves induction of the enzyme indoleamine 2,3-dioxygenase-1 (IDO), which catabolizes tryptophan into kynurenine and several other immunologically active metabolites that suppress T-cell proliferation. We investigated the role of IDO in the development of KS in HIV disease. METHODS: In a case-control study among untreated HIV-infected Ugandans, cases were adults with KS and controls were without KS. IDO activity was assessed by the ratio of plasma kynurenine to tryptophan levels (KT ratio), measured by liquid chromatography-tandem mass spectrometry. RESULTS: We studied 631 HIV-infected subjects: 222 KS cases and 409 controls. Non-KS controls had a higher median plasma KT ratio (130, interquartile range: 90 to 190 nM/muM) than KS cases (110, interquartile range: 90 to 150 nM/muM) (P = 0.004). After adjustment for age, sex, CD4 count, and plasma HIV RNA level, subjects with the highest (fourth quartile) plasma KT ratios had a 59% reduction (95% confidence interval: 27% to 77%) in the odds of KS compared with those with the lowest (first quartile) levels. KS was also independently associated with lower CD4 count, higher plasma HIV RNA, and men. CONCLUSIONS: Among HIV-infected individuals, greater activity of the kynurenine pathway of tryptophan catabolism, as evidenced by higher levels of plasma KT ratio, was associated with lower occurrence of KS. Some consequences of immune activation in HIV infection might actually suppress certain cancers.

Public health response relies upon rapid and reliable confirmation of disease by diagnostic assays. Here we detail design and validation of two variola virus-specific real-time PCR assays, since previous assays cross-reacted with newly identified cowpox viruses. Assay specificity must continually be reassessed as other closely related viruses are identified.