BMJ Global HealthPub Date : 2026-07-30DOI: 10.1136/bmjgh-2025-020904
Inga Saknite, Patrick Mutombo Lupola, Andrew J McNeil, Sylva Kasereka Sivasingana, Jean Marc Tshilombo Mwindila, Elie Malamba Lohalo, Olga Divine Tshi-Manina, Fiston Lodi Ndjovu, Celestin Tshimanga, Baudouin Matiba Ngalumono, Marcel Alonga Etshindo, Roger Djese Logombe, Glody Diphanga Mbambi, Gael Nzengu Mukanya, Gael-Aubert Mukendi, Francis Amani Songa, Odette Kasangi Kitenge, Michel Ndjekembo Djamba, Josue Mayaka Oyeka, Hyppie Lonza Lotepa, Sandrine Ibemba Alanda, Charles Lukala Ngereza, Michel Okamba Denga, Clementine Ndeke Ndongo, Edwige Margot Makuenda, Jean Oleko Yemba, Dalton Takoy Ndjeka, Jean Luhata Mukindji, Michael Kombozi Basika, Joseph Bitilembo Bitilembo, Aisha Aridja Kayembe, Mara Mara Kisaka, Glodie Chikesa Vangu, Gaby Kayembe Mpinga, Ali Dilu Phanzu, Bruce Nganga Mbutu, Rosine Ali Ekangu, Antoine Oloma Tshomba, Tyra Silaphet, Rachel Weiss, Bohan Jiang, Aimé Zonveni Be Lombe, Edward W Cowen, Ian Crozier, Benoit M Dawant, Lori E Dodd, Richard Davey, H Clifford Lane, Jean-Jacques Muyembe-Tamfum, Jean-Luc Biampata Mutumukole, Veronique Nussenblatt, Olivier Tshiani Mbaya, Placide Mbala Kingebeni, Eric R Tkaczyk
{"title":"Total body photography for standardised documentation of mpox skin lesions in remote study sites in the Democratic Republic of the Congo.","authors":"Inga Saknite, Patrick Mutombo Lupola, Andrew J McNeil, Sylva Kasereka Sivasingana, Jean Marc Tshilombo Mwindila, Elie Malamba Lohalo, Olga Divine Tshi-Manina, Fiston Lodi Ndjovu, Celestin Tshimanga, Baudouin Matiba Ngalumono, Marcel Alonga Etshindo, Roger Djese Logombe, Glody Diphanga Mbambi, Gael Nzengu Mukanya, Gael-Aubert Mukendi, Francis Amani Songa, Odette Kasangi Kitenge, Michel Ndjekembo Djamba, Josue Mayaka Oyeka, Hyppie Lonza Lotepa, Sandrine Ibemba Alanda, Charles Lukala Ngereza, Michel Okamba Denga, Clementine Ndeke Ndongo, Edwige Margot Makuenda, Jean Oleko Yemba, Dalton Takoy Ndjeka, Jean Luhata Mukindji, Michael Kombozi Basika, Joseph Bitilembo Bitilembo, Aisha Aridja Kayembe, Mara Mara Kisaka, Glodie Chikesa Vangu, Gaby Kayembe Mpinga, Ali Dilu Phanzu, Bruce Nganga Mbutu, Rosine Ali Ekangu, Antoine Oloma Tshomba, Tyra Silaphet, Rachel Weiss, Bohan Jiang, Aimé Zonveni Be Lombe, Edward W Cowen, Ian Crozier, Benoit M Dawant, Lori E Dodd, Richard Davey, H Clifford Lane, Jean-Jacques Muyembe-Tamfum, Jean-Luc Biampata Mutumukole, Veronique Nussenblatt, Olivier Tshiani Mbaya, Placide Mbala Kingebeni, Eric R Tkaczyk","doi":"10.1136/bmjgh-2025-020904","DOIUrl":"10.1136/bmjgh-2025-020904","url":null,"abstract":"<p><p>We designed and successfully implemented photography protocols for the PALM007 (<i>Pamoja Tulinde Maisha - Together Save Lives</i> in Swahili) randomised clinical trial evaluating tecovirimat for the treatment of mpox in the Democratic Republic of the Congo (DRC). We addressed the unique challenges and limitations of conducting standardised photography procedures on patients with mpox in high-risk 'red zones' in remote study treatment centre sites. Key considerations included standardised photography protocols, training, quality assurance, participant privacy and comfort, and interpersonal communication. Our developed procedures enabled acquisition of 61 926 standardised, clinical-quality photographs of 597 patients with mpox. These considerations may guide future studies collecting standardised photographs in a low-resource setting.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423061/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Global HealthPub Date : 2026-07-30DOI: 10.1136/bmjgh-2026-023904
Dennis Juma Matanda, Martina Mchenga, Stella Muthuri, Francis Obare, Viola Rutto, Herbert Barasa Wanyonyi, David Kawai, Claire Arnott, Chi-Chi Undie
{"title":"How community dialogues influence norm change around female genital mutilation: a mediation analysis from a high-burden Kenyan setting.","authors":"Dennis Juma Matanda, Martina Mchenga, Stella Muthuri, Francis Obare, Viola Rutto, Herbert Barasa Wanyonyi, David Kawai, Claire Arnott, Chi-Chi Undie","doi":"10.1136/bmjgh-2026-023904","DOIUrl":"10.1136/bmjgh-2026-023904","url":null,"abstract":"<p><strong>Introduction: </strong>Female genital mutilation (FGM) remains highly prevalent in parts of Kenya, including Narok County, where marriageability expectations and social sanctions continue to sustain the practice. Although community-dialogue interventions are central to strategies to end FGM, evidence on their effects and mechanisms of influence remains limited.</p><p><strong>Methods: </strong>We conducted a cross-sectional survey of 2658 respondents (1272 women and 1386 men) aged 15-60 years in Narok County in 2024. The primary exposure was participation in mixed-sex community dialogues with participation in couples-only dialogues as secondary exposure. Outcomes were measured using survey items adapted from established FGM and social norms literature, including a composite index of beliefs favourable to cutting and single-item measures of intention to cut a daughter, perceived marriageability expectations and opposition to FGM. Analyses used generalised estimating equations, predicted probabilities and generalised structural equation models to assess mediation pathways.</p><p><strong>Results: </strong>Participation in community dialogues was associated with more progressive norms, including lower odds of endorsing pro-cutting beliefs (adjusted OR (aOR) 0.61, 95% CI 0.48 to 0.76), intending to cut a daughter (aOR 0.49, 95% CI 0.37 to 0.64) and perceiving uncut girls as unmarriageable (aOR 0.53, 95% CI 0.43 to 0.66), and higher odds of opposing FGM (aOR 2.39, 95% CI 1.84 to 3.11). Couples-only dialogues had smaller and less consistent associations. Predicted probabilities indicated substantial positive associations among participants exposed to community dialogues alone or combined with couples' sessions. Mediation analysis showed that 88% of the effect of community dialogues on opposition to FGM indirectly linked through shifts in pro-cutting beliefs, intentions to cut and marriageability expectations, with intentions representing the strongest linkages.</p><p><strong>Conclusion: </strong>Community dialogues are strongly associated with shifts in the social expectations and intentions that underpin FGM in a high-burden Kenyan context. These findings provide support for dialogue-centred strategies to eliminate FGM. Beliefs, intentions and marriageability norms are key intermediate indicators for monitoring normative change.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Global HealthPub Date : 2026-07-30DOI: 10.1136/bmjgh-2025-021128
Luma Bashmi, Derrick Silove, Carol Brayne, Isla Kuhn, Eolene Boyd
{"title":"A systematic review of MHPSS interventions targeting non-clinical Arabic-speaking refugees and/or displaced populations in the MENA region.","authors":"Luma Bashmi, Derrick Silove, Carol Brayne, Isla Kuhn, Eolene Boyd","doi":"10.1136/bmjgh-2025-021128","DOIUrl":"10.1136/bmjgh-2025-021128","url":null,"abstract":"<p><strong>Background: </strong>Arabic-speaking refugees and displaced populations in the Middle East and North Africa (MENA) face ongoing adversity that negatively impacts their mental health. Despite increasing mental health needs, there is no published systematic review evaluating non-clinical mental health and psychosocial support (MHPSS) interventions in the MENA region for this population, particularly through a culturally grounded framework.</p><p><strong>Methods: </strong>We conducted a systematic review of MHPSS interventions published from 2011 to 2022 targeting non-clinical Arabic-speaking adult refugees and/or displaced persons in MENA countries. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines and PROSPERO registration (CRD42023421057), we searched ten databases and grey literature sources. Objectives were to identify, appraise and synthesise eligible MHPSS interventions and assess their alignment with the Integrative Complexity (IC)-Adaptation and Development After Persecution and Trauma (ADAPT) framework. Studies were appraised using four validated quality assessment tools and a novel tool assessing links to the IC-ADAPT framework, which integrates an eco-psycho-social model (ADAPT) and a cognitive-interactionist model (IC). A subset of ten top-rated interventions was synthesised for IC-ADAPT alignment.</p><p><strong>Results: </strong>Thirty-eight studies met the inclusion criteria. Most interventions were conducted in Lebanon or Jordan, group-based and delivered by non-specialist facilitators in community settings. Parenting, resilience-building and trauma-focused therapies were the most common modalities. Most studies prioritised feasibility and effectiveness over efficacy. While none explicitly applied IC-ADAPT, several implicitly aligned with its eco-psychosocial systems (eg, bonds/networks, safety/security and roles/identities) and IC (eg, increased 'differentiation'), reporting reduced harsh parenting and improved reflective capacity. Culturally adapted interventions that promoted complex thinking, relational healing and community participation were linked with more favourable outcomes.</p><p><strong>Conclusion: </strong>This review highlights the value of culturally sensitive, non-clinical MHPSS interventions in enhancing mental health outcomes for Arabic-speaking refugee populations in MENA. Programmes grounded in eco-psychosocial and cognitive complexity frameworks-such as IC-ADAPT-offer effective, scalable strategies for addressing refugee mental health. Future work should embed these models explicitly to optimise intervention design, relevance and impact.</p><p><strong>Prospero registration number: </strong>CRD42023421057.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13423163/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148629402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Preoperative chlorhexidine mouthwash to prevent postoperative infections in low-risk elective abdominal surgeries: a double-blind RCT from North India among patients with poor oral hygiene.","authors":"Shefali Gautam, Sanjeev Kumar, Vimala Venkatesh, Aparna Shukla, Ravi Prakash, Vinod Kumar Srivastava, Rajesh Raman, Shashank Kumar, Neel Kamal Mishra, Monica Kohli, Titiksha Singh, Vinita Singh, Mohan Tiwari, Deepali Chandra, Geeta Singh","doi":"10.1136/bmjgh-2025-021607","DOIUrl":"10.1136/bmjgh-2025-021607","url":null,"abstract":"<p><strong>Introduction: </strong>Postoperative respiratory complications, particularly in patients with poor oral hygiene, contribute significantly to morbidity and healthcare burden. The oral cavity serves as a reservoir of pathogenic micro-organisms that, when aspirated during or after surgery, can lead to respiratory infections. While chlorhexidine mouthwash has shown promise in high-risk surgeries, its role in short-duration elective abdominal surgeries remains unexplored, especially in low-resource settings.</p><p><strong>Methods: </strong>This double-blind, randomised controlledrial included 228 patients (American Society of Anaesthesiologists I/II, aged 18-65 years, Oral Hygiene Index (OHI) >6) undergoing elective abdominal surgery under general anaesthesia lasting <4 hours. Patients were randomised to receive either 0.2% chlorhexidine (group A) or normal saline (group B) mouthwash two times before surgery. Outcomes measured included postoperative sore throat, fever, pneumonia, surgical site infections (SSI) and length of hospital stay. Microbiological cultures, complete blood count, C-reactive protein (CRP) and chest X-rays were evaluated on postoperative days 1, 3 and 7.</p><p><strong>Results: </strong>Chlorhexidine significantly reduced sore throat (18.42% vs 47.37%, p<0.001), positive bacterial cultures (21.05% vs 62.28%, p<0.001), CRP elevation and SSI (4.39% vs 21.93%, p<0.001). Length of hospital stay was also shorter in the chlorhexidine group (p<0.001). Pneumonia rates were low and comparable.</p><p><strong>Conclusion: </strong>This double-blind randomised controlled trial demonstrates that preoperative use of chlorhexidine mouthwash significantly reduces postoperative sore throat, bacterial colonisation, SSI and length of hospital stay in patients with poor oral hygiene undergoing short-duration elective abdominal surgeries. These findings highlight the utility of a simple, low-cost oral hygiene intervention in improving surgical outcomes, particularly in low-resource settings and support its incorporation into standard perioperative protocols, even for lower risk procedures.</p><p><strong>Trial registration number: </strong>CTRI/2024/06/069511).</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13422918/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Global HealthPub Date : 2026-07-29DOI: 10.1136/bmjgh-2025-021301
Fengqing Chao, Vladimíra Kantorová, Giulia Gonnella, Bruno Schoumaker, David A Sánchez-Páez, Patrick Gerland
{"title":"Levels and trends in fertility rates among adolescents aged 10-14 and 15-19 in 201 countries and areas from 1950 to 2023.","authors":"Fengqing Chao, Vladimíra Kantorová, Giulia Gonnella, Bruno Schoumaker, David A Sánchez-Páez, Patrick Gerland","doi":"10.1136/bmjgh-2025-021301","DOIUrl":"10.1136/bmjgh-2025-021301","url":null,"abstract":"<p><strong>Introduction: </strong>Reducing adolescent childbearing is essential for improving sexual and reproductive health and the social and economic well-being of adolescents. Adolescent birth rate is an indicator to monitor progress towards Sustainable Development Goal (SDG) Target 3.7 by 2030, ensuring universal access to sexual and reproductive healthcare services. However, the availability and reliability of data on adolescent fertility rates are low.</p><p><strong>Methods: </strong>We produce annual estimates of age-specific fertility rates (ASFR) for girls aged 10-14 and 15-19 from 1950 to 2023 for the world, regions and 201 countries and territories. Based on a comprehensive ASFR database, we estimate the under-20 ASFR with a Bayesian hierarchical time series model, using covariates such as total fertility rates and female educational attainment and adjusting for biases and under-reporting. We calculate the number of births to adolescents by applying rates to the female population in the respective age groups.</p><p><strong>Results: </strong>Between 1990 and 2023, global ASFR for girls aged 10-14 decreased by 76%, from 4.5 (95% uncertainty interval (UI) (4.1 to 5.2)) to 1.1 (95% UI 0.9 to 1.4) births per 1000, while ASFR for girls aged 15-19 fell by 48%, from 74.7 (95% UI 72.5 to 77.1) to 39.0 (95% UI 36.8 to 41.4) births per 1000. In 2023, births to mothers aged 10-14 years were estimated at 347 (95% UI 285 to 454) thousand, and for those aged 15-19 years at 12.2 (95% UI 11.5 to 12.9) million. The number of births among adolescents aged 15-19 in sub-Saharan Africa increased during 1990-2023 due to population growth and slower fertility declines.</p><p><strong>Conclusion: </strong>Despite significant global reduction in adolescent childbearing, regional and national disparities persist. Targeted interventions addressing child marriage, educational inequities and lack of access to reproductive health services will be critical for achieving related SDG targets and advancing gender equality and women's empowerment.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13475349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148618392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Global HealthPub Date : 2026-07-27DOI: 10.1136/bmjgh-2025-019661
Michael Kiremeji, Eliudi Eliakimu, Joseph Hokororo, Naoufel Dridi, Florian Mwebesa, Calvin Sindato, Erasto Sylvanus, James Hellar, Theresia Haule, Erick Richard, Lilian Mreta, Alex Sanga, Erick Stephen Kinyenje, Ruth Ngowi, Radenta Bahegwa, George Mrema, Pascal Muhode, Noel Saitoti, Neema Kamara, Juma Mfinanga, Janeth Masuma, Faraja Msemwa, John Masina, Dick Damas Chamla, Michele Di Marco, Janet Diaz, George S Mgomella, Wangeci Gatei, Ernest Kyungu, Ntuli Kapologwe, Eric Nzeyimana, Said Kilindimo, Leonard Katalambula, Hendry Sawe, Stephen Kibusi, Charles Sagoe-Moses, Grace Magembe
{"title":"Transforming health systems in crisis: innovative infrastructure adaptations for Marburg outbreak response in Biharamulo, Kagera, Tanzania.","authors":"Michael Kiremeji, Eliudi Eliakimu, Joseph Hokororo, Naoufel Dridi, Florian Mwebesa, Calvin Sindato, Erasto Sylvanus, James Hellar, Theresia Haule, Erick Richard, Lilian Mreta, Alex Sanga, Erick Stephen Kinyenje, Ruth Ngowi, Radenta Bahegwa, George Mrema, Pascal Muhode, Noel Saitoti, Neema Kamara, Juma Mfinanga, Janeth Masuma, Faraja Msemwa, John Masina, Dick Damas Chamla, Michele Di Marco, Janet Diaz, George S Mgomella, Wangeci Gatei, Ernest Kyungu, Ntuli Kapologwe, Eric Nzeyimana, Said Kilindimo, Leonard Katalambula, Hendry Sawe, Stephen Kibusi, Charles Sagoe-Moses, Grace Magembe","doi":"10.1136/bmjgh-2025-019661","DOIUrl":"10.1136/bmjgh-2025-019661","url":null,"abstract":"<p><strong>Background: </strong>Marburg virus disease (MVD), a highly fatal haemorrhagic fever with a fatality rate that can reach up to 88%. The outbreak in Biharamulo District in Tanzania in 2025 prompted a rapid transformation of the district hospital into a Marburg treatment unit (MTU). We describe approaches to our innovative solutions and highlight best practices for adapting existing infrastructure in resource-limited and emergency settings.</p><p><strong>Methods: </strong>We used a mixed-methods approach, integrating observational assessments, facility design analysis, disease containment and clinical data review into the following '5S' framework, that is, systems, security, structure, staff and supplies.</p><p><strong>Results: </strong>The MTU was systematically organised into green and red treatment zones to prevent cross-contamination. Structural innovations included controlled entry and exit points, a low-risk monitoring area with observation windows and a contactless patient monitoring and medication delivery system. Clinical care strategies focused on implementation of effective systems for triage, early case detection, use of point-of-care (POC) diagnostics, like POC malaria rapid diagnostic test, i-STAT Chem 8, blood gas analysis and bedside ultrasound to guide supportive therapy, including provision of critical care. Deployment of a mobile laboratory to the nearby health facility enabled real-time diagnostics and efficient referral system to improve case management. Staff preparedness and healthcare system's ability to rapidly expand beyond normal services to meet an increased demand for clinical care during emergencies (surge capacity) were strengthened through infection prevention and control training, basic emergency care training, emergency response drills and psychological support.</p><p><strong>Conclusion: </strong>The structured response to the Biharamulo MVD outbreak demonstrated the effectiveness of adaptable healthcare infrastructure, evidence-based clinical management and workforce capacity building. These locally-context innovations have highlighted the importance of flexibility, timely intervention and effective collaboration in addressing public health emergencies, while ensuring optimal protection for patients, health staff and the community.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13409078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599177","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Global HealthPub Date : 2026-07-27DOI: 10.1136/bmjgh-2025-022450
Valentina Carnimeo, Pascale Lissouba, Douglas Mbang Massom, Etienne Guillard, Felix Kouassi, Laura Sannino, Suna Balkan, Elisabeth Poulet, Raphael Kananga, Marie Charlotte Sana, Edouard Kangbi, Gilles Ngaya, Valarie Opollo, Jihane Ben-Farhat
{"title":"Navigating the HIV continuum of care from treatment to retention strategies in Carnot, Central African Republic: a sequential explanatory mixed-methods study.","authors":"Valentina Carnimeo, Pascale Lissouba, Douglas Mbang Massom, Etienne Guillard, Felix Kouassi, Laura Sannino, Suna Balkan, Elisabeth Poulet, Raphael Kananga, Marie Charlotte Sana, Edouard Kangbi, Gilles Ngaya, Valarie Opollo, Jihane Ben-Farhat","doi":"10.1136/bmjgh-2025-022450","DOIUrl":"10.1136/bmjgh-2025-022450","url":null,"abstract":"<p><strong>Background: </strong>HIV remains a major public health challenge globally, including in the Central African Republic (CAR). Despite progress in awareness, prevention and access to antiretroviral therapy (ART), notably with dolutegravir (DTG), significant challenges persist. This study aimed to describe clinical status, virological failure (VF), ART resistance and reasons for disengagement among people living with HIV at Médecins Sans Frontières-supported sites in CAR.</p><p><strong>Methods: </strong>A sequential explanatory mixed-methods study was conducted in Carnot district, comprising: (1) a retrospective cohort analysis (2011-2022); (2) a cross-sectional study estimating VF and resistance profiles in patients on ART ≥6 months; and (3) a qualitative component exploring factors influencing engagement and disengagement in HIV care from patients, healthcare workers and key informants. The cross-sectional component included clinical exams, CD4 counts, viral load (VL) and resistance testing for patients with VL ≥500 copies/mL. VF was defined as VL ≥1000 copies/mL. Qualitative data were collected through semistructured interviews and analysed using content analysis.</p><p><strong>Results: </strong>Since 2011, over 5400 adults living with HIV have been managed in Carnot. By 2022, 46.5% remained in care, 35.5% were lost to follow-up and 11.3% had died; median follow-up was 32.7 months dropping to 16.6 months among those who died. After Test & Treat, over 80% initiated ART at diagnosis, but differentiated service delivery did not improve long-term retention. By 2022, 96% received DTG-based regimens; 88% achieved VL <1000 copies/mL, but only 32% were fully suppressed. Qualitative data identified insecurity, distance, food insecurity, stigma and health system barriers as key drivers of attrition and poor adherence.</p><p><strong>Conclusion: </strong>Sustained ART delivery and high DTG uptake were achievable in this fragile context, yet retention and full viral suppression remain limited. Attrition and suboptimal adherence driven by insecurity and health system barriers underscore the need for context-adapted, patient-centred and community-responsive HIV care models.</p>","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405036/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148599171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Global HealthPub Date : 2026-07-23DOI: 10.1136/bmjgh-2025-020673
Amos M Makelele, Baraka Marthe Kalyoko, Agness Shimilimo, Million Teklay Solomon, Simon Binezero Mambo, Iacane Bampoque, Gbolahan O Obajimi
{"title":"Abortion in Africa: diverging paths of DR Congo and Nigeria under the Maputo Protocol.","authors":"Amos M Makelele, Baraka Marthe Kalyoko, Agness Shimilimo, Million Teklay Solomon, Simon Binezero Mambo, Iacane Bampoque, Gbolahan O Obajimi","doi":"10.1136/bmjgh-2025-020673","DOIUrl":"10.1136/bmjgh-2025-020673","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13405211/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148577135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BMJ Global HealthPub Date : 2026-07-22DOI: 10.1136/bmjgh-2026-024444
Hawkar Ibrahim, Frank Neuner
{"title":"Open access, unequal access: why publication fee waivers still exclude many researchers.","authors":"Hawkar Ibrahim, Frank Neuner","doi":"10.1136/bmjgh-2026-024444","DOIUrl":"10.1136/bmjgh-2026-024444","url":null,"abstract":"","PeriodicalId":9137,"journal":{"name":"BMJ Global Health","volume":"11 7","pages":""},"PeriodicalIF":5.8,"publicationDate":"2026-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13404612/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148560887","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}