PLOS global public health最新文献

{"title":"Prevalence and incidence of non-communicable diseases among older adults living with HIV on antiretroviral therapy in Northern Haiti: A retrospective cohort study.","authors":"Ronald Thiersaint, Romaine Nephtalie Mésidor, Valérie Pelletier, Chesnel Parny Norcéide, Jean Géto Dubé, Harold Prévil, Kesner François, Jean Baptiste T Koama, Michael A Melchior, Macarthur Charles","doi":"10.1371/journal.pgph.0007175","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007175","url":null,"abstract":"<p><p>The growing burden of non-communicable diseases (NCDs) among aging people living with HIV (PLHIV) represents a major public health challenge, yet data to guide integrated care in Haiti remain limited. To address this gap, we conducted a retrospective cohort study of PLHIV aged 40 years and older receiving care at two hospitals in northern Haiti. Using electronic medical record data from routine HIV clinical visits between July 1 and September 30, 2015, we compared NCD prevalence at ART initiation and after ≥12 months of follow-up. We also identified baseline risk factors associated with incident NCDs, with a secondary analysis focused specifically on predictors of incident renal insufficiency. Among 318 participants, 65.7% had one or more NCD at ART initiation, increasing to 70.8% after ≥12 months. The prevalence of hypertension rose from 37.1% to 47.2% and diabetes from 7.9% to 12.6%, while overweight/obesity remained stable (14.5% to 15.7%). In contrast, renal insufficiency prevalence decreased from 31.1% to 22.6%. In the adjusted analysis, female sex was the sole independent predictor for developing at least one incident NCD (AOR: 3.29; 95% CI: 1.40-7.72). In the secondary analysis for incident renal insufficiency, female sex (AOR: 5.88; 95% CI: 1.78-19.50) and elevated systolic blood pressure (AOR: 1.052; 95% CI: 1.005-1.101) were the only significant predictors. A high proportion of older PLHIV in northern Haiti are affected by NCDs. These findings underscore the need for integrated care models, particularly for older women living with HIV, who appear to be at the highest risk for developing new NCDs.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007175"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-occurrence of anaemia and malaria among children under five in Uganda: A joint modeling analysis.","authors":"Grace Kakaire, Robert Too, Gregory Kerich, Mathew Kosgei","doi":"10.1371/journal.pgph.0007387","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007387","url":null,"abstract":"<p><p>Childhood illnesses such as anaemia and malaria continue to pose significant health risks for children under five in sub-Saharan Africa. These conditions often co-occur, reflecting complex interdependencies driven by shared biological and environmental factors. Traditional analytical approaches typically assume independence between health outcomes, potentially overlooking meaningful associations. This study aims to identify the dependence structure among anaemia and malaria in children under five using a joint modeling approach. Data were drawn from the most recent Malaria Indicator Survey (MIS), comprising 5,755 children. A bivariate probit model was estimated using a Gaussian copula framework with probit margins for each outcome. This approach allowed for the simultaneous modeling of the marginal probability of each illness and the latent correlations among them. The model incorporated a range of child-, household-, and maternal-level covariates. Average Marginal Effects (AMEs) were calculated to facilitate interpretation. The copula correlation (ρ) between anaemia and malaria from the copula structure was estimated to quantify the dependence between the two illnesses. Descriptive analyses revealed substantial co-occurrence: 13.8% of children experienced both illnesses simultaneously. The joint copula model detected significant positive copula correlations (ρ ≈ 0.19) between anaemia and malaria. Several covariates displayed differential effects in the joint versus separate models. For instance, the association between maternal anaemia and child malaria risk reversed direction once interdependence was accounted for. Joint modeling yielded more stable and plausible estimates across outcomes. This study highlights the critical importance of accounting for outcome dependence in the analysis of child morbidity. The significant correlations among malaria and anaemia suggest that these illnesses are influenced by common or interacting risk factors. Joint modeling using a Gaussian copula framework enhances both the precision of marginal effect estimates and the understanding of comorbidity patterns. These findings support the design of integrated health interventions that address the interconnected nature of childhood illnesses in high-burden settings.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007387"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119913","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rapid diagnosis of pulmonary tuberculosis on induced sputum in children in a high burden setting for HIV and malnutrition.","authors":"Juaneta Luiz, Lesley J Workman, Cynthia B Baard, Yekiwe Hlombe, Margaretha Prins, Nomlindo Makubalo, Devan Jaganath, Adithya Cattamanchi, Mark P Nicol, Heather J Zar","doi":"10.1371/journal.pgph.0007271","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007271","url":null,"abstract":"<p><p>Microbiological diagnosis of childhood pulmonary tuberculosis can be challenging. We investigated the accuracy of Xpert MTB/RIF Ultra on the induced sputum, focused on high-risk groups (infants, malnourished children, and those living with HIV), where data is limited. Children (under 15 years) investigated for pulmonary tuberculosis at Dora Nginza Hospital, South Africa, were prospectively enrolled between January 2018 and January 2024, and followed up for 12 months. Induced sputa were tested with liquid culture and Xpert MTB/RIF Ultra (Ultra). Children were categorized with confirmed, unconfirmed, or unlikely tuberculosis, according to NIH consensus definitions. Ultra diagnostic accuracy was calculated against culture, with analysis by high-risk subgroups. Of 636 children (median age, 27.4 (IQR 11.8-61.6) months), 173 (27.2%) were classified with confirmed TB, 384 (60.4%) with unconfirmed TB, and 79 (12.4%) with unlikely TB. There were 223 (37.8%) children underweight-for-age, 168 (26.5%) living with HIV, and 163 (25.6%) infants. Of 557 children with TB, 145 (26.0%) were confirmed on induced sputa; with 137/557 (24.6%) confirmed on Ultra (46.0%; 63/137, of which were \"trace positive\"), and 88/557 (15.8%), on culture. Of those confirmed, 57/145 (39.3%) were Ultra positive, culture negative - contributing 10.2% to the overall yield. Ultra performed better in children over 5 years and with weight-for-height Z-scores < -3. Overall, Ultra sensitivity was 90.9% (95%CI 82.9-96.0) and specificity, 89.6% (95%CI 86.7-92.0), with high accuracy across high-risk groups. Mortality amongst children treated for PTB was 4.9% (27/557) with aRR highest for stunted children (7.3; 95% CI, 2.2-24.2), followed by children with HIV (3.5; 95% CI, 1.6-7.5), and infants (3.3; 95% CI, 1.6-6.7). Ultra on induced sputum was feasible, with high yield and diagnostic accuracy for high-risk children.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007271"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does the messenger make the difference? Perceived reliability of health information sources during the COVID-19 pandemic in multi-ethnic Malaysia.","authors":"Nicholas Yee Liang Hing, Yew Kong Lee, Hyung Joon Kim, Nurhyikmah M Lothfi, Elizabeth Wong, Joan Costa-Font","doi":"10.1371/journal.pgph.0007397","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007397","url":null,"abstract":"<p><p>The COVID-19 infodemic highlighted the need to identify the extent to which health information messengers were perceived as reliable by the public in supporting effective public health communication. A question that remains is whether there are differences across ethnic groups in information processing. This study examines the perceived reliability of three formal sources (healthcare workers, scientists, and non-governmental organisations [NGOs]) and four informal sources (religious leaders, community leaders, interpersonal sources, and influencers) among Malaysia's multi-ethnic population through a cross-sectional online survey conducted between April and June 2021. Logistic regression was used to identify the perceived reliability of different information sources in steering vaccination intentions. We further examine the extent to which there were ethnic differences in the perceived reliability of these sources across education levels and age groups. Adjusted predicted probabilities were estimated to illustrate these differences. Among 5,784 participants, formal sources were consistently perceived as the most reliable across all ethnic groups and, together with community leaders, were identified as the main information sources influencing vaccination intention. We find large predicted probabilities of perceiving healthcare workers and scientists as reliable across most groups (≥ 80%), except among Indigenous groups who exhibit lower education attainment and are older (≤ 78%). Across education levels and age groups, Indians and Chinese exhibit higher predicted probabilities of perceiving NGOs as reliable, averaging approximately 80% and 75%, respectively, compared with approximately 65-70% among Malays and Indigenous groups. In contrast, predicted probabilities of perceiving community leaders as reliable were moderate across all ethnicities at the lowest education level and youngest age group (45 - 55%). This pattern remained relatively stable across higher education levels and age groups among Malays and Indigenous groups, but generally decreased among Chinese and Indian respondents. These results suggest that healthcare workers and scientists ought to remain central to health communication strategies, while NGOs and community leaders may play complementary roles. Multi-messenger approaches may enhance the effectiveness of public health responses during health crises.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007397"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge of HIV status in a rural Ugandan population with a sustained, generalised HIV epidemic.","authors":"Keith Tomlin, Ronald Makanga, Janet Seeley, Emma Slaymaker, Robert Newton, Joseph Mugisha","doi":"10.1371/journal.pgph.0007354","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007354","url":null,"abstract":"<p><p>For people living with HIV, knowledge of their status is essential to access antiretroviral therapies (ART). This knowledge can be measured by population surveys that record self-reported HIV status before offering HIV testing. We conducted a survey among residents of 25 villages in the rural sub-county of Kyamulibwa in Southwest Uganda where there has been a sustained, generalised HIV epidemic. Through the survey we determined the proportions of those living with HIV who knew their status (with reference to UNAIDS targets), exposures associated with knowledge of HIV status, and the proportions of those who knew their HIV status who reported taking ART. Data were collected from June 2019 to July 2021. Among survey participants, 39.7% of men and 28.7% of women had never tested for HIV. This was associated with older age, male sex, lower education and never having been married. All participants consented to HIV testing and 99.9% had a result. 83.6% of men and 88.0% of women living with HIV already knew their status. Of these, 99% of men and women reported taking ART. Of those never previously tested, 2.5% of men and 2.7% of women received a positive diagnosis. HIV prevalence was 8.1% among men and 10.5% among women. While significant proportions of survey participants did not know their HIV status they did not represent a large source of undiagnosed HIV infection. The proportions of men and women living with HIV who already knew their status were below current UNAIDS targets to end AIDS by 2030, and the study highlighted groups for whom participation in testing needs to increase. Among those with HIV who knew their status almost all reported taking ART, suggesting high acceptance and good availability of treatment. The overall prevalence of HIV among survey participants means that reliable access to sufficient ART is essential.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007354"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630239/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARS-CoV-2 neutralising antibody profiles reveal variant specific antibody dynamics and regional differences in infection histories in Malawi.","authors":"Mhairi J McCormack, Louis Banda, Stephen Kasenda, Ellen C Hughes, Amelia Crampin, Abena S Amoah, Jonathan M Read, Antonia Ho, Brian J Willett, James A Hay","doi":"10.1371/journal.pgph.0007133","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007133","url":null,"abstract":"<p><p>Serological data provide important insights into SARS-CoV-2 transmission and immunity, particularly in regions with limited routine surveillance such as sub-Saharan Africa. However, antibody waning and boosting following reinfection or vaccination remain poorly characterised, complicating interpretation of serological measurements. Improved understanding of these dynamics is critical for accurate epidemiological inference. Modelling longitudinal serological data provides a means to quantify antibody kinetics and reconstruct infection histories. We analysed 15,679 neutralising antibody (nAb) titres from 1,675 unvaccinated, HIV-uninfected participants in urban (Lilongwe) and rural (Karonga) Malawi (February 2021-April 2022). NAb titres against ancestral B.1, Beta, Delta, and Omicron (BA.1/BA.2) viruses were measured using an HIV-based SARS-CoV-2 pseudotyped virus neutralisation assay. A multi-level Bayesian model was used to reconstruct infection histories and antibody kinetics. The model identified 429 infections (95% credible interval 417-441), including 39 (9.1%) that had not been identified by traditional seroconversion-based thresholds. Antibody levels waned rapidly, with 48% (0.403-0.560) of the acute boost remaining after three months and only 5% (0.027-0.098) after one year. Pre-Omicron infections generated stronger antibody boosts than Omicron infections. Responses varied, with individuals clustering into low and high responders. Cross-reactive responses extended across substantial antigenic distances - Omicron infections induced broader immunity. Seroincidence was higher in Lilongwe than in Karonga (0.41 vs. 0.27 infections per person per three months), driven by the early 2022 Omicron wave. Reinfections were common, particularly among adults and urban residents. SARS-CoV-2 nAb responses following infection were heterogeneous and declined rapidly. This rapid waning underscores the importance of vaccination for sustained protection, while cross-reactivity suggests only partial immunity from prior variants. Identifying reinfections is essential for understanding transmission and finding populations at higher repeat infection risk, particularly where routine surveillance is limited.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007133"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630256/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening men in the Toledo district of southern Belize for elevated blood pressure and blood sugar.","authors":"John Rovers, Matthew Nicasio","doi":"10.1371/journal.pgph.0007380","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007380","url":null,"abstract":"<p><p>Belize is a small country in Central America that has largely completed its epidemiological transition. Consequently, the Belizean burden of disease is increasingly composed of chronic illness, especially diabetes and hypertension. Recently, Belizean progress towards Sustainable Development Goal 3 (Good Health and Wellbeing) has slowed. Belizean men have 275 cardiac and 60 diabetes related deaths per 100,000 per year which are the third and fifth highest incidence in the Americas. Prevalence of raised fasting glucose is 8.5% in men (third highest in the Americas). Overall, 24% of Belizeans have an elevated blood pressure. In men, 20.3% have an elevated blood pressure. (12th highest in the Americas). The objective of this study was to screen men in the Toledo district for both conditions. During visits to two local villages and at four health fairs held in the Punta Gorda town square, men were invited to have their blood pressure and blood sugar checked. Data was collected from 103 men. Systolic blood pressure ≥ 140mm/Hg was seen in 32 (31.1%) of men while diastolic blood pressure ≥ 90m mm/Hg was seen in 26 (25.2%) of men screened. Eight subjects (7.8%) had a random blood glucose ≥ 200mg/dl meriting further evaluation to rule out diabetes. Blood pressure and blood sugar were both statistically higher in men taking antihypertensive or antiglycemic medication. Hypertension and diabetes are common in men in the Toledo District and neither condition is well controlled in most men. Facilitators and barriers to control are largely related to social determinants of health. Men's opinions about health and healthcare are often gender specific. Interventions to improve care in this setting should increase their focus on the social determinants of health and the gender specific beliefs and preferences men may have.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 10","pages":"e0007380"},"PeriodicalIF":2.8,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630257/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119714","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How (not) to write about health equity.","authors":"Aaron Koay, Lisa Bowleg, Po-Han Lee, Rochelle A Burgess","doi":"10.1371/journal.pgph.0007292","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007292","url":null,"abstract":"","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007292"},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High transmission risk of Human Immunodeficiency Virus in blood transfusions: A critical evaluation of blood bank serological tests in Mozambique.","authors":"Nédio Mabunda, Odete Matola, Júlia Sambo, Imelda Chelene, Abras Munguambe, Nuro Abílio, Adolfo Vubil, Osvaldo Loquiha, Ilesh Jani","doi":"10.1371/journal.pgph.0007398","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007398","url":null,"abstract":"<p><p>Many settings in sub-Saharan Africa use rapid antibody assays to detect human immunodeficiency virus (HIV) infection among blood donor candidates. This study aimed to evaluate the analytical performance of HIV serological tests used to screen blood donor candidates in Mozambique. Determine HIV 1/2 + Uni-Gold HIV (the routine HIV testing at blood banks in Mozambique), and two newer rapid tests (Determine HIV Early Detect and Meriscreen HIV1-2 Western Blot) were compared with an Enzyme-Linked Immunosorbent Assays (Merilisa HIV Gen 4 test + Uni-Gold HIV). Additionally, all serological tests were compared with the molecular cobas MPX test. The sensitivity and specificity of Determine HIV 1/2 + Uni-Gold HIV; Determine HIV Early Detect, and Meriscreen HIV1-2 Western Blot compared to the Merilisa HIV Gen 4 test + Uni-Gold were 85.5% and 99.6%; 88.7% and 99.5%; 90.0% and 99.6% respectively. The sensitivity and specificity of Determine HIV 1/2 + Uni-Gold HIV; Determine HIV Early Detect, Meriscreen HIV1-2 Western Blot, and Merilisa HIV Gen 4 test + Uni-Gold compared to the cobas MPX test were 64.0% and 99.1%; 68.6% and 99.1%; 70.8% and 99.0%; 66.0% and 99.4%, respectively. The probability of undetected positive results in the rapid tests and Merilisa HIV Gen 4 test ranged from 5.6 to 6.7 per 1,000 blood donors. The results of this study point to the need for the introduction of molecular testing for HIV in blood banks in developing countries to improve transfusion safety and contribute to controlling HIV as a public health problem.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007398"},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626358/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Co-creation in research, policy engagement and advocacy: Lessons and limits from two decades of practice at the African Population and Health Research Center.","authors":"Emmanuel Oloche Otukpa, Abdhalah K Ziraba, Luchuo Engelbert Bain","doi":"10.1371/journal.pgph.0007405","DOIUrl":"https://doi.org/10.1371/journal.pgph.0007405","url":null,"abstract":"<p><p>Co-creation is widely advocated in global health research and inconsistently practiced. This paper offers a reflective, practice-based synthesis of two decades of co-created research, policy engagement and advocacy at the African Population and Health Research Center (APHRC).We define co-creation through four dimensions; shared agenda setting, joint knowledge production, power sharing, and community leadership and ownership. We distinguish it from consultation, stakeholder engagement and partnership, and assess each dimension on a graded scale. To this we add a second axis: the reach of co-creation across the research-to-policy-to-advocacy interface, and the condition of the transitions between its segments. Six cases spanning evidence generation, policy processes, capacity strengthening and rights-based advocacy are assessed against both axes. Three findings emerge. Co-creation in this institution's practice is substantive where knowledge is produced and weak where authority is held. Agendas were substantively shared in four of six cases and financial resources in none. It fails at the transitions between research, policy engagement and advocacy rather than within them, at moments that were neither designed nor evaluated nor recorded. And the domains of co-creation differ systematically in the dimensions they can realize, with community leadership substantive only in rights-based advocacy. We draw practice guidance on governance, funding, community roles, transitions and assessment, and state what a single-institution insider synthesis cannot establish.</p>","PeriodicalId":74466,"journal":{"name":"PLOS global public health","volume":"6 9","pages":"e0007405"},"PeriodicalIF":2.8,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626369/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}