Health
COVID-19: Handwashing Adherence Drops by 93% in Kampala Hotspots
By Joseph Odoi
As Uganda continues to fight tirelessly to control the spread of COVID-19, results from a field-based survey in Kampala’s informal settlements have indicated that citizens have abandoned hand hygiene, a key pillar in stopping the spread of a virus.
To beat the virus today and ensure better health outcomes beyond the pandemic, hand hygiene, especially through handwashing with soap have been emphasized as a top priority.
But results of a study titled: Adherence, Lived Experiences and Resilient Transformation among “slum dwellers” (ALERTs) in COVID-19: A study of Ki-Mombasa and Kabalagala-Kataba slums in Kampala present an urgent need to intervene in these communities in order to improve public hygiene practices such as handwashing, if the intended objectives are to be achieved.
Dr. Gloria Seruwagi, a behavioural scientist at Makerere University School of Public Health has observed that some of the set Standard Operating Procedures such as physical distancing, regular sanitizing and use of face masks are less likely to be followed and implemented due to congestion in the settlements.
While presenting an overview of results from the study, Dr. Seruwagi said Ugandans had gone back to their old ways and abandoned best hygiene practices such as handwashing, which is critical in the fight against COVID-19.
“Residents say they can’t afford masks and those who have them say masks make breathing uncomfortable. Sanitizing is a luxury to most people in Bwaise and Kataba communities. While the practice of handwashing was feasible and adhered to at the beginning of March, it has drastically dropped by up to 92.6%.
Dr. Seruwagi, who is also the Study Principal Investigator observed that residents of Ki-Mombasa and Kabalagala-Kataba still have a major infodemic challenge of misinformation surrounding COVID-19, also exacerbated by multiple power centres and enforcers who locals say give confusing messages and seemed to have an uncoordinated response strategy.
“The community told us that everyone seems to be a “little king” in enforcing COVID SOPs and guidelines – from the police to Division leaders, food distributors, VHTs and local village leaders. They were not working in harmony and were giving different, sometimes confusing, messages and instructions. This greatly contributed to confusion and partly resulted in community noncompliance” she said.
According to Hilda Namakula, ALERTs study Co-Investigator people living in informal settlements had vast knowledge of COVID-19 signs, symptoms and how it is spread.
For instance, in this study, up to 82% mentioned high fever as a symptom while 80.2% mentioned sore throat as a symptom. Meanwhile 80.8% knew that sneezing and coughing were symptoms and 78% mentioned body pain.
Despite this knowledge, Namakula contends that communities have multiple – and sometimes contradictory – sources of information which affect their adherence to the preventive measures.
“In Kampala, TV takes lead as the main information source at 78%, social media 14%. Other sources include radio, family members and neighbors. In addition to multiple information sources, multiple enforcement authorities in Ki-Mombasa and Kabalagala-Kataba have contributed to confusion on which information to follow.’’ said Ms. Namakula.
In a bid to establish reasons for non-compliance to COVID-19 SOPs such as physical distancing or staying home, researchers also found that livelihoods and the need to make a living were the most common explanatory factors.
“Other reasons for non-compliance include perceptions that COVID-19 is a political ploy, declining enforcement and multiple implementers with confusing messages and warring power centres. Moreover, in their power struggles, the different actors who were enforcing SOPs were themselves not adhering for example by wearing masks” Namakula added.
According to the study, communities reported lot of myths and misconceptions about COVID-19 as key drivers of high risk behaviour. For example; people living in Kampala’s informal settlements believe that taking alcohol reduces the risk of infection (16.8%); that sunbathing protects against COVID-19 (47.9%); and that Africans are immune by virtue of their skin Colour (46.5%).
Following the survey findings, Makerere University researchers underscored the need for sustainable community-led interventions to minimize the pandemic implications. The researchers observe that the current efforts to contain the pandemic cannot yield better results unless there is harmony and consistency in messages shared out.
The project team set out to engage health workers and community leaders of Ki-Mombasa Bwaise and Kabalagala-Kataba slum communities to jointly co-design tailored interventions on Thursday 17th December 2020. The engagement climaxed with a dialogue held at Makerere University Central Teaching Facility (CTF-1) with key stakeholders in attendance, including representatives from Makerere University, Kampala Capital City Authority (KCCA), Division and political leaders, Village Health Teams (VHTs), community, administrative leaders, religious leaders among others.
Following presentation of findings, there was consensus from all participants that it was still possible to reverse the non-adherence and high-risk behaviour.
The stakeholders identified priority areas for interventions underscoring the need for community leaders (Village Chairperson, VHTs) to be at the forefront. The co-design process comprised proposals for re-adaptation of some existing interventions or focusing more on some than others (e.g. emphasising wearing facemasks vs. social distancing); and practical ways for operationalizing the Community Engagement Strategy (CES) amidst increasing community transmission; designing a community behavioural change communication component; as well as undertaking joint rigorous resource mobilisation at the next phase to implement some of the proposed interventions.
Government of Uganda through the Ministry of Health launched the National Community Engagement Strategy (CES) for COVID-19 Response in October 2020. This strategy arose from the need to stem the wide spread community transmission amidst low levels of compliance to the COVID-19 SOPs.
This strategy puts responsibility to community individuals, local leaders, households and communities to take charge and ensure optimal compliance. The CES also spells out the key role of VHTs, other local leaders the roles of the proposed village health Taskforce (VTF) and expected outcomes.
This study is funded by the Government of Uganda, through the Makerere University Research and Innovation Fund (MakRIF). The ALERTs study is dual-pronged and phased in implementation that combines an innovative citizen science approach with a participatory project co-design phase.
Ms. Carol Kamugira, a Mak-RIF representative applauded the research team for being innovative and bringing community members to devise community-led sustainable solutions in the fight against the coronavirus.
“It is the first time I have seen this kind of arrangement, bringing real community members to co-design interventions here at the university. Such interventions will be successful because they came from the people concerned and who will monitor the process. As the RIF we are very proud of Dr Seruwagi and her team and that is why we are here to support such meaningful studies. The government gave us resources, we advertised and received many research proposals. The proposal for this research was among those selected for funding because it was strong and very innovative,” Ms. Kamugira said.
She hailed the Uganda Government for the support rendered towards research and other training needs at Makerere University.
Other Key Findings
• The living arrangements in the informal settlements affect people’s adherence to SOPs like social distancing –emphasis should be on encouraging them to adhere to the other more plausible measures like hand washing or wearing masks.
• The participants reported doing the following often: the washing of hands with water (38.3%); washing hands with water and soap (33%); covering the mouth while sneezing/coughing (28.5%); using a mask while in a public place (32.2%); consumption of fruits (25.8%); regular drinking of water (35.5%).
• A big proportion of the study participants knew that chronic illness increases the risk of death from COVID-19 (81%); and that those infected with the disease should be isolated (93%).
• While children living in informal settlements were aware of COVID-19, they are generally not adhering to the SOPs because it is believed that their age group is not at risk.
• COVID-19 has increased levels of violence, including violence against children and SGBV. It has also significantly contributed to increased cases of defilement, early marriages, teenage pregnancy and pimping children for transactional sex. For example, forced sex among the respondents during lockdown was reported at 2% and slapping 4%.
• The study also revealed that some men are survivors of violence whose condition has been worsened by COVID through not having an income source and depending on their wives who job is commercial sex work (CSW). Other men are clients of CSWs who target them claiming nonpayment; or their husbands who don’t want clients sleeping with their partner.
• Study findings also highlight some adults, including parents, local leaders and law enforcement officers as being more collusive than supportive in cases involving violence against children.
• Local duty bearers and key stakeholders in child protection such as social workers and police officers need more support to effectively undertake their roles in child protection and wellbeing.
• Schools remain both a cognitive and physical safe space for children. The closure of schools presented heightened vulnerability for children as they became more exposed, over prolonged periods of time, to multiple rights violation including lack of food and all forms of violence. Nearly all children in study sites are not benefitting much from the Education Continuity Programme and most caregivers were not in position to support learning during school closure. Children wanted to return to school and worried about an uncertain future.
• There is also evidence of belief of the politicization of COVID-19 for example the impression that the related measures are intended to curtail the activities of the opposition politicians.
• Slum communities reported limited knowledge and access to COVID-19 testing services in their communities or within Kampala as a whole.
Recommendations:
The researchers recommend that, building on from its massively successful awareness campaign on COVID-19, government should now work on addressing the barriers of non-compliance; emphasising personal responsibility and the community’s own contribution in the fight against COVID-19.
Moving forward, the researchers recommend that:
1. Government and all stakeholders should focus on addressing the drivers of non-compliance and enforcement fatigue. These drivers include:
- The feasibility of interventions: Guidelines like physical distancing are not feasible in crowded informal or slum settings and need to be revisited. Emphasis should be placed on feasible ones like hand washing and masking.
- Myths and negative perceptions: Majority of the community has not fully bought into the seriousness ofCOVID-19 and think it is not only a joke but is also a political and monetary ploy advanced by politicians, some scientists and supremacists or population control enthusiasts. These myths need to be addressed.
- Shielding community from the reality of COVID as cases are managed out of the community. More profiling of COVID-19 trends and cases should be undertaken for behavioural change impact. However, stigma and other potentially related dilemmas should be carefully managed.
- Leaders, implementers and enforcers of COVID-19 guidelines should be consistent and “walk the talk”.
2. The issue of livelihoods and food security must be resolved as a key bottleneck to compliance.
3. Innovative multi-sectoral and tailored approaches should be adopted to address COVID-19 effects, including violence against children, men and women.
4. Children and adolescents should be effectively targeted in COVID-19 interventions. They need awareness, products (e.g. fitting face masks), voice and protection from the effects of COVID-19 including being witnesses and victims of different forms of violence.
5. Local and community leader and grassroots organisations should be recognised and engaged more in behavioural change campaigns – for instance to engage their communities identify alternative social norms for greetings, for showing love and kindness etc., without putting their lives at risk.
6. The timeliness and critical role of the recently launched Community Engagement Strategy should be leveraged. Local health system capacity should be strengthened and equipped to effectively take up the implementation and enforcement of SOPs for COVID-19 prevention. Equip community health systems and other enforcement structures with the knowledge, required supplies and supportive infrastructure.
Mak Researchers-Slum Communities Designing interventions
In this dissemination, Makerere University researchers and slum community leaders and journalists engaged in co- designing behavioural change interventions to address COVID-19. The results of these sessions will form the final part of the ALERTs study objectives and will be presented in its final reporting. However, some of the suggested “quick” solutions from the groups include:
- Involvement of women in sensitization drives around COVID-19
- Preventive treatment of suspected cases
- Skilling of Youth at Village Level
- Health Education
- Incorporating church leaders in the fight against COVID-19
- Politicians should incorporate COVID-19 Messages in their campaigns
- There is need for VHT support to counter community Spread
- Cultural leaders should join the sensitization
- Incorporate Youth Leaders in awareness
- Have local leaders and Police enforcing directives
- Incorporate NGOs in the fight against COVID-19
- Employ musicians in COVID-19 since they have a huge following
- There is need to incorporate drama and plays with key messages highlighting COVID-19 dangers and how to fight it.
More about the Study
The ALERTS Study was conducted by researchers from Makerere University and Gulu University with funding by Government of Uganda through the Makerere University Research Innovation Fund (MakRIF).
The total number of study participants was 807 in two slum communities of Kampala i.e. Kataba-Kabalagala-Kataba in Makindye and Ki-Mombasa Bwaise in Kawempe Division.
The Study Team:
1. Dr. Gloria Seruwagi – PI, Makerere University
2. Prof. Stephen Lawoko – Co-Investigator, Gulu University
3. Catherine Nakidde Lubowa – Co-Investigator, CHASE-i
4. Hilda Namakula – Co-Investigator, CHASE-i
5. Dr. Eric Lugada – Co-Investigator, CHASE-i
6. Daniel Magumba – Coordinator, Makerere University
7. Flavia Nakacwa – Administrator, Department of Social Work and Social Administration, Makerere University
Article originally posted on MakSPH
In a decisive step toward ending HIV as a public health threat by 2030, Uganda on Thursday, May 29, 2025, officially launched the third Uganda Population-based HIV Impact Assessment (UPHIA 2025) survey, a nationally representative household study expected to provide updated measurements on the status of the HIV epidemic by the end of the year.
The effort is led by Uganda’s Ministry of Health (MoH), with technical assistance from Makerere University School of Public Health (MakSPH), Uganda Bureau of Statistics (UBOS), Uganda Virus Research Institute (UVRI), and the U.S. Centers for Disease Control and Prevention (U.S. CDC), funded by the U.S. government through PEPFAR.
The Population-based HIV Impact Assessment (PHIA) surveys were first launched in 2014 as a global initiative at the International Center for AIDS Care and Treatment Programs (ICAP), based at Columbia University’s Mailman School of Public Health. Supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through the U.S. CDC, the surveys have been conducted in at least 15 high-burden countries globally, including Uganda.
Led by national Ministries of Health, the PHIA surveys provide robust, population-level data on HIV prevalence, incidence, and viral suppression, offering a clear picture of epidemic trends and the effectiveness of national responses. They are designed to track progress, identify persistent gaps, and inform strategies to reach epidemic control, in line with global targets, including the fast-approaching goal of ending AIDS as a public health threat by 2030.
In Uganda, this survey was first rolled out between August 2016 and March 2017. The second followed in February 2020 but was disrupted by the COVID-19 outbreak, continuing through to March 2021. Both rounds were supported by ICAP at Columbia University, which provided technical assistance to strengthen data collection systems, improve laboratory infrastructure, and build national capacity to design, implement, and analyse the two national HIV surveys.
What sets UPHIA 2025 apart is the shift in technical leadership to Ugandan institutions for this third survey, reflecting local capacity to lead rigorous, high-quality public health research. For UPHIA 2025, Makerere University School of Public Health, in partnership with the Uganda Bureau of Statistics and the Uganda Virus Research Institute, is providing technical leadership to the Ministry of Health, alongside U.S. CDC. Implementation began with initial recruitment and training of over 300 field teams that begun on May 19, 2025, ahead of their nationwide deployment for data collection starting this June.
The first survey (UPHIA 2016) was an important milestone in informing Uganda’s national HIV response. This survey, concluded in 2017, measured, among things, the viral load suppression at the population level and provided household-based HIV testing and counselling, with results returned to participants and those who tested positive referred to care. The survey also assessed HIV incidence, HIV and syphilis prevalence, as well as hepatitis B infection rates. These findings would offer nationally representative data to track Uganda’s progress in controlling the HIV epidemic at both national and regional levels.
The next survey, UPHIA 2020, building on past success, was again executed with technical leadership from Columbia University’s ICAP, working with Uganda’s Ministry of Health alongside UVRI, UBOS, regional referral hospitals, local governments, and the U.S. CDC. It offered useful insights that showed encouraging progress, indicating that up to 88% of people living with HIV in Uganda at the time knew their status, 98% of them were on treatment, and 90% had achieved viral suppression. These results reflected momentum toward the UNAIDS global 95-95-95 targets, ensuring that most people living with HIV are diagnosed, treated, and have the virus under control, and advancing the broader goal of ending the epidemic by 2030.
Since the release of these findings nearly five years ago, which helped shape national HIV programming in Uganda, the country has made notable progress, but challenges remain. The UPHIA 2020 findings reported major gaps in testing coverage, particularly among young people and men. The results were also instrumental in identifying service delivery shortfalls and guiding decisions on resource allocation, program design, and policy. Yet today, Uganda remains one of the most heavily burdened countries in the world, with over 1.5 million people living with HIV and over 50,000 preventable new infections recorded per year.
It is this trend that Uganda’s Ministry of Health is working urgently to reverse. Launching UPHIA 2025 at the Ministry’s headquarters in Kampala on May 29, 2025, amidst great hope and expectation among the participants, Uganda’s Minister of Health, Dr. Jane Ruth Aceng Ocero, noted that the long-anticipated and previously delayed survey had arrived at such a critical moment. She welcomed UPHIA 2025 as both a measure of the country’s resilience and a guide for the final stretch toward ending AIDS by 2030, now just a few years away.
“The UPHIA 2025 survey comes at a strategic time to help us recalibrate and refocus our efforts,” the Health Minister said, underscoring the importance of its outcomes. “This will be Uganda’s final population-based HIV survey before 2030, the target year for ending AIDS as a public health threat. The findings will serve as a baseline for tracking our progress toward this national and global goal. They will also guide the next phase of strategic planning, ensuring that the final push toward 2030 is grounded in robust and reliable data.”
This third round of the survey will be carried out in 6,685 randomly selected households across the country. The exercise will involve interviews with approximately 15,000 individuals aged at least 15 and selected through a national household listing by UBOS. Of those, around 14,980 are expected to provide blood samples for HIV testing and analysis of viral suppression and other health indicators. The survey will also include interviews with 1,300 children and adolescents aged 10 to 14, though no blood draws will be taken from this group. Participation is voluntary, free of charge, and requires consent from the head of each household.
Dr. Aceng explained that beyond providing updated estimates of HIV prevalence, incidence, and viral load suppression, and examining regional and demographic disparities, the survey, which will cover the rest of the year, will include a qualitative post-survey assessment component to gather insights from people living with HIV, particularly those not virally suppressed, to understand their challenges and strengthen support services. Also, for the first time, this survey will assess the burden of non-communicable diseases among people living with HIV and include focused interviews with adolescents aged 10 to 14 in Mid-North and Mid-Eastern Uganda, where viral suppression was reported to be lowest in UPHIA 2020.
These activities are made possible thanks to the development support from the U.S. government, which invested $10 million (about UGX 37 billion) for this survey. Speaking at the UPHIA 2025 launch, U.S. Ambassador to Uganda William W. Popp noted that the United States has partnered with Uganda for over three decades to help people live longer, healthier lives;
“The bulk of our annual support, approximately $500 million this year, is dedicated to health programs, making the U.S. government the largest single provider of health assistance to Uganda,” the Ambassador said. He added, “Through PEPFAR, the United States has played a major role in Uganda’s progress toward ending HIV as a public health threat. Since 2003, when Uganda became one of the first countries to implement the program, we have invested nearly three billion dollars—almost 11 trillion Uganda shillings—in HIV prevention, care, and treatment services, saving millions of lives and making both our countries safer from HIV.”
With the benefit of hindsight, Uganda’s early encounter with HIV in the 1980s marked the beginning of one of the region’s most severe epidemics. But over the decades, a determined national response, driven by political leadership, community mobilisation, collaboration and global support, has delivered measurable progress. In the recent past, adult HIV prevalence fell from 7.2% in 2010 to 5.1% in 2023. Among women, it declined from 8.5% to 6.6%, and among men from 5.8% to 3.6%. AIDS-related deaths dropped from 53,000 to 20,000 over the same period, with female mortality declining by 66% and child deaths by 77%.
All these gains, amidst the challenge, go to show what is possible with sustained commitment. What is more, throughout this long journey of Uganda’s battle with eradicating HIV, Makerere University School of Public Health has played a pivotal role. From the early work of Prof. David Serwadda, whose ground-breaking research during the initial detection of HIV helped shape Uganda’s early response, to last year’s 2024 landmark Purpose 1 study on the twice-yearly injectable Lenacapavir that proved 100% efficacy in preventing HIV infection, MakSPH has remained at the forefront of innovation, evidence generation, and policy influence.
That legacy continues today, with the School providing technical leadership to the Ministry of Health in the implementation of UPHIA 2025. At the launch, MakSPH Dean Prof. Rhoda Wanyenze expressed pride in the School’s role as a trusted partner in Uganda’s fight against HIV and other public health challenges. She noted that for over 70 years, during which the School has existed, MakSPH has helped shape the country’s public health landscape through rigorous research, training, and policy support, anchored by a strong, long-standing partnership with the Ministry of Health and partners.
She also noted that the collaboration between Makerere University and the U.S. CDC has helped build national capacity in surveillance and epidemiology, while also strengthening Uganda’s ability to lead high-quality, large-scale national surveys, asserting that:
“The partnership between Makerere University and CDC has not only helped build national capacity in surveillance and epidemiology, but has also strengthened our ability to lead high-quality, large-scale national surveys. After two decades of joint work, we are proud that UPHIA 2024–2025 is now a fully Ugandan-led effort. This is critical to the sustainability of the skills and knowledge generation to inform our local response.”
The survey builds on MakSPH’s experience conducting similar national studies, including those on tuberculosis, prison health, family planning, schistosomiasis, and non-communicable diseases such as the STEPS survey. It will leverage the School’s strong capacity in research and impact evaluation, both in Uganda and across the African region, with a firm commitment to delivering high-quality data guided by the same rigour and integrity that have defined our work over the years, Prof. Wanyenze affirmed.
Nearly half of Uganda’s prison population has latent tuberculosis (TB), according to the latest Uganda National Prevalence Survey on Tuberculosis, HIV, and COVID-19. The survey, released on May 15, 2025, found that active TB cases in prisons stand at 1,900 per 100,000—eight times higher than in the general population.
The survey was conducted by Makerere University School of Public Health (MakSPH) in conjunction with the Uganda Prisons Services (UPS) and the Ministry of Health—with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and technical support from the U.S. Centers for Disease Control and prevention (CDC)—and purposed to have a more profound understanding of TB to help inform public health programs for this high-risk population.
Dr. Simon Kasasa, a Senior Lecturer at MakSPH and Principal Investigator of this study, stressed that “staying for a longer duration, three years and above, posed a greater risk to TB infection in prison.” He also noted TB infection was much higher among male prisoners (48%) compared to female prisoners (38%) and among those of older age, 65 years and above. Meanwhile, the report noted concerns about excessive numbers in prisons as a key risk factor for TB transmission.
UPS consists of 257 prisons spread over 16 administrative regions with an average prisoner population of 56,400 (95% male), accommodation capacity of 16,612 (340%), and 9,904 staff (29% female).
HIV prevalence among prisoners was also alarmingly high at 11%, twice that of the general population. Notably, female persons in prison (PIP) had the highest HIV rates at 21%, compared to 11% for male PIP and just 2% among prison staff. However, the data also showed a significant drop in overall HIV prevalence within prisons, falling from 15% in 2013 to 11% in 2023, with the most dramatic decline among staff, from 12% to 2%.
Dr. George Tumusinze, a Program Manager and Research Associate, pointed out that although 92% of people with HIV in prisons know their status and 99% are receiving antiretroviral therapy (ART), only 70% have successfully reduced the virus in their bodies, highlighting important issues with how well the treatment is working.
Mr. Samuel Akena, the Deputy Commissioner General of Prisons, echoed these concerns by stating that the survey represents a significant milestone for the Prisons, not only in terms of data collection but also in Uganda’s journey towards achieving equity, justice, and the right to health for all. “This survey is historic. It represents one of the most comprehensive efforts to understand the health status of people in prisons in Uganda.” He emphasized the necessity of a collective and bold response, urging that “the time for piecemeal responses is over.”
Dr. Charles Olaro, Director General of Health Services at the Ministry of Health, emphasized the urgency of the situation, stating, “As we gather today to reflect on the findings of this important survey, we must recognize the urgent need for action in our fight against tuberculosis (TB) in Uganda. Despite our efforts, we are still grappling with the burden of this disease, and our progress toward eliminating it by 2030 has not been as swift as we had hoped.” He pointed out that the survey serves as a critical baseline that will shape future responses and guide resource allocation.
HIV prevalence among prison staff members was the lowest, at just 2%, reflecting a significant achievement in workplace health. Dr. Daniel Byamukama, Head of HIV Prevention at the Uganda AIDS Commission, praised prison authorities for their efforts, noting the remarkable progress over the past decade. In the first survey in 2013, only 34% of HIV-positive staff on treatment had achieved viral load suppression. Today, that figure has reached an impressive 100%, underscoring the impact of sustained prevention and care efforts.
While the prison HIV program has shown effectiveness—evidenced by a drop in prevalence from 15% to 11% among the prisoners over the past decade—Mr. Akena stressed the importance of prioritizing gender-responsive strategies in health interventions.
“Diseases do not recognize bars or borders. They thrive in environments where conditions are poor and resources are scarce. Women in prison face disproportionately higher risks, yet often remain invisible in program planning. This is not acceptable. If we are serious about health equity, we must prioritize gender-responsive strategies — within prison health systems and beyond,” Mr. Akena.
CDC Uganda Director Dr. Adetinuke (Mary) Boyd reinforced the significance of the survey in addressing public health risks. “In Uganda, CDC partners are helping to ensure inmates stay healthy during custody. This work facilitates safe reintegration into their communities, mitigates disease transmission to the general population, and reduces public health risks like untreated TB,” she stated. Dr. Boyd highlighted the role of PEPFAR in tackling critical global health threats, asserting that the survey offers helpful data for enhancing health collaboration within this vulnerable population.
The U.S. CDC has been supporting Uganda Prisons Services to provide comprehensive HIV/AIDS, STI, and TB prevention, care, and treatment services for the last 15 years (2010–2025), totaling over $18,046,263 in investment—including $550,000 to this study alone, through the Makerere University School of Public Health. The program supports capacity building, scale-up, and health system strengthening efforts in HIV/TB testing, care, and support for prisoners and prison staff, plus surrounding communities.
With 80% of prison wards overcrowded and 95% lacking adequate natural ventilation, the conditions in which these individuals live exacerbate the spread of infectious diseases, public health specialists have warned. This survey underlines the urgent need for systemic changes within the prison health system, as well as a commitment to uphold the rights and health of all individuals, regardless of their circumstances.
As Uganda grapples with these alarming statistics, the call to action is clear. Stakeholders must come together to implement effective health interventions, improve screening and treatment protocols, and ensure that the rights of incarcerated individuals are respected. The health of the general population is inextricably linked to the health of those within prison walls, and addressing these challenges is not just a moral imperative but a public health necessity.
Professor Rhoda Wanyenze, one of the investigators and Dean of the School of Public Health, asserts that the Survey findings are a wake-up call for stakeholders to prioritize health equity and justice for society’s most vulnerable members.
Prof. Wanyenze advocated for improved TB screening methods and institutionalization of regular mass TB screening using the WHO-recommended advanced diagnostic tools like digital chest X-rays with Computer-Aided Detection (CAD), as well as molecular diagnostics like GeneXpert and TB LAM, noting that traditional symptom-based screening missed nearly half of TB cases. “The use of molecular diagnostics like GeneXpert significantly improved case detection in our study,” she added, emphasizing the importance of timely diagnosis and treatment.
Uganda Prisons Service, in partnership with the Ministry of Health, has so far installed 14 GeneXpert machines in medium- to high-volume prison health facilities.
While some, including Members of Parliament, have raised concerns about the potential infringement on individual rights through mandatory TB testing in prisons, Dr. James Kisambu, the Commissioner for Prison Health Services, noted that it is now apparent, with these findings, for everyone to appreciate that in such confined settings, the risk of transmission is extraordinarily high. TB testing in these settings is not just a medical practice but also a crucial public health precaution that protects both prisoners and the wider community.
“Prisons are high-risk, high-transmission environments where one undetected case can rapidly escalate into an outbreak. In such settings, the right to refuse testing must be weighed against the right of others to be protected from infection. Mandatory TB screening, when done with dignity and linked to prompt treatment, is not a violation of rights — it is an essential public health measure to protect both people in prison and the communities they return to,” said Dr. James Kisambu.
The researchers from MakSPH were; Dr. Simon Kasasa, Associate Professor Esther Buregyeya, Dr. George Tumusinze, Dr. Simon Walusimbi, Dr. Dick Kasozi, Dr. Ronald Senyonga, John Baptist Bwanika, Prossy Nabaterega and Professor Rhoda Wanyenze.
Additionally, the study team from the Uganda Prisons Service comprised of Dr. Leonard Marungu, Charles Butagasa, Dr. James Kisambu and Dr. Johnson Byabashaiza, the Commissioner General of Prisons.
Finally, Dr. Deus Lukoye, Dr. Julius Ssempiira, Charles Kavuma, Rise Nakityo, Samuel Sendagala, Grace Nantege, Lisa Mills, Dr. Lisa Nelson, Kenneth Mwambi from U.S. CDC Uganda/Atlanta and PEPFAR USG agencies, and George William Kasule, Didas Tugumisirize, Dr. Simon Muchuro, Professor Moses Joloba, Dr. Turyahabwe Stavia from the Uganda Ministry of Health National TB and Leprosy Program (NTLP) completed the team.
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