Jean Bisimwa Nachega

The 2026 Bundibugyo virus disease (BVD) outbreak in the DRC and Uganda raises urgent questions about the efficacy of existing Ebola virus (EBOV) monoclonal antibodies (mAbs) against Bundibugyo virus (BDBV). Here, we perform genomic and structural analyses of 44 BDBV sequences, including 12 from the 2026 outbreak, to assess mAb binding to the viral glycoprotein (GP). While the MBP134 cocktail epitopes remain conserved, mAb114 (Ebanga) binding is compromised by E112D and P116A mutations, causing off-target binding and reduced affinity. Structural modeling of Inmazeb shows that while Odesivimab maintains epitope binding, Atoltivimab and Maftivimab fail to bind their designated sites individually, though the complete trimeric cocktail demonstrates BDBV synergistic binding. These findings suggest that mAb114 could have reduced efficacy against BDBV due to epitope mutations affecting binding affinity, whereas MBP134 retains conserved targeting and holds promise as a broadly protective therapeutic. The complex binding behavior of Inmazeb components points to the importance of antibody combinatorial effects for treatment efficacy and warrants urgent experimental validation through neutralization assays.

Dolutegravir-based antiretroviral therapy (ART), a key component of HIV treatment in low- and middle-income countries, has been associated with weight gain and increased adiposity in people living with HIV (PLWH). This weight gain, along with fat redistribution, can elevate the risk of diabetes, hypertension, and cardiovascular disease. The South African Diabetes Prevention Program (SA-DPP) is a culturally tailored lifestyle intervention addressing nutrition, physical activity, and other risky behaviors, developed for resource-limited communities. We sought to evaluate the clinical experiences of PLWH and the acceptability and suitability of the SA-DPP intervention for this population. A qualitative study was conducted with PLWH and health staff from three primary health clinics in Cape Town (n = 35), selected through purposive sampling. The research included five focus groups and two individual interviews with PLWH, as well as five interviews (with healthcare staff (doctors, nurses (paired interview), and lay counselors; n = 6,). The discussions explored experiences regarding HIV treatment, lifestyle challenges, education, and support from clinics, and collected perspectives on the SA-DPP materials. All sessions were transcribed and thematically analyzed for insights into feasibility and acceptability. The SA-DPP curriculum was well received by both PLWH and healthcare staff, who found the content and structure comprehensive and relevant to nutrition and exercise needs. Participants valued the practicality of the booklets, with experts noting that the information and suggested activities were accessible in terms of cost and availability. Both groups indicated the material supported healthy behavior changes, though some experts suggested further adaptation to address unique challenges faced by PLWH, such as stigma and cultural perceptions of body image. The SA-DPP intervention was considered acceptable and relevant for addressing key lifestyle issues among PLWH. It has potential as a resource for managing various lifestyle-related diseases in this population, though further adaptation may be needed to enhance its relevance and address specific barriers in the context of HIV care. The online version contains supplementary material available at 10.1186/s12889-026-26991-4.

Background: On 14 August 2024, the WHO redesignated Monkeypox (mpox) as a Public Health Emergency of International Concern. Ocular disease is under-recognised and can cause irreversible vision loss. Clarifying its burden, clade-specific patterns and HIV-related risks is essential for clinical care and public health. Methods: We conducted an umbrella review and meta-analysis, systematically searching PubMed, Embase, Scopus, Web of Science and the Cochrane Library from inception to September 2025. Eligible studies were systematic reviews reporting ophthalmic manifestations in laboratory-confirmed mpox cases, stratified by viral clades I, II and IIb. Pooled proportions were estimated using random-effects meta-analysis, with clade-stratified subgroup analyses. The protocol was registered in PROSPERO (CRD420251137180). Results: Five systematic reviews (36 primary studies; 28 139 patients) were included. The pooled proportion of conjunctivitis was 8.9% (95% CI 4.8 to 13.9), highest in clade I (21.9%) and lowest in clade IIb (2.7%). Keratitis (1.5%), eyelid lesions (3.3%), conjunctival lesions (8.4%) and corneal ulceration (3.3%) varied by clade. Visual impairment occurred in 4.5% overall; unilateral (0.9%) and bilateral (0.4%) blindness were reported only with clade I. Across reviews, people living with advanced HIV experienced disproportionately higher rates of severe and persistent ocular complications than HIV-negative individuals. Conclusions: Mpox-related ophthalmic disease can cause substantial—and potentially preventable—visual disability. Clade I infection is associated with a greater burden of ocular complications than clade II—particularly IIb. Improved access to eye health services, early recognition and integration of HIV and mpox care are critical to reducing vision loss, especially in resource-limited settings.

Background:Depression is a critical public health issue among youth in Uganda, with limited access to mental health services. This pilot randomized controlled trial (RCT) evaluated the mechanisms and cost-effectiveness of mobile phone-based Tele-Support Psychotherapy (TSP) delivered by lay counselors for youth with depression in Kampala. Methods: We randomized 300 youth aged 15–30 with mild to moderate depression to TSP combined with Standard Mental Health Services (SMHS) or SMHS alone. Assessments at baseline, 6, and 12 months measured depression (Mini International Neuropsychiatric Interview), stigma, and income generation. Generalized structural equation modeling (GSEM) explored mediation pathways, and a provider-perspective cost-effectiveness analysis calculated the incremental cost-effectiveness ratio (ICER) using disability-adjusted life years (DALYs). Results: TSP significantly reduced depression through stigma reduction and increased income generation (total effect β = -3.736, p<0.001, 95% CI [-4.273, -3.198]). The ICER was US$2,293 per DALY averted, cost-effective compared to Uganda’s GDP per capita (US$1,002). Conclusions: TSP is an effective and cost-effective intervention for youth depression in low-resource settings, with potential for integration into national mental health strategies. Trial Registration: PACTR202201684613316.

Africa's participation in vaccine trials has historically been limited, but the COVID-19 pandemic highlighted the need for greater involvement. This study explores vaccine clinical development in Africa, emphasizing its importance for global health security. Using a scoping review and bibliometric analysis, we examined 662 vaccine trials conducted before, during, and after the pandemic. The analysis revealed a significant increase in vaccine trials after 2018 and particularly following the end of the COVID-19 pandemic in May 2023. Most trials focused on viral infections and were single-country studies. Pharmaceutical company sponsors funded most of the earlier trials, with increased government and academic involvement post-2020. Despite progress, challenges remain in the geographic distribution of trials, the number of government-supported studies, and the diversity of conditions studied. Addressing these gaps is crucial to bolstering Africa's role in global vaccine development.

In response to the rise in mental health problems among youth during the COVID-19 pandemic, we conducted a qualitative study in March 2022, using a user-centered design approach guided by ecological theories, to adapt group support psychotherapy into tele-support psychotherapy (TSP) via mobile phones. The development of a call platform, informed by the unified theory of acceptance and use of technology, was integrated into the Medical Concierge Group’s (TMCG) telehealth services under Rocket Health Africa. This platform included a dedicated toll-free line for psychotherapy, connecting users with lay counselors. An open-label randomized controlled trial (PACTR202201684613316) was conducted to assess the feasibility, acceptability, and effectiveness of TSP in combination with standard mental health services (n = 154) compared with standard mental health services alone (n = 146) among youth with mild to moderate major depression in Kampala. Participants commonly equated mental health with mental illness and reported significant challenges, including financial stress, substance abuse, and family dysfunction. Although digital interventions were largely accepted, some participants preferred in-person services. The adapted TSP maintained gender sensitivity and used folk tales, stories, riddles, and creative visualizations to facilitate emotional expression, acquisition of coping strategies, and income-generating skills, addressing both emotional and socio-economic needs.