Serodifferent relationships, in which one partner lives with HIV and the other does not, represent a critical frontier in HIV prevention. The HIV-negative partner in such a couple faces ongoing exposure risk, and oral PrEP has emerged as one of the most effective biomedical tools for reducing that risk when taken consistently. The study, led by Aromorach Vivian Calo of Makerere University’s Department of Clinical Epidemiology and Biostatistics, together with colleagues from Makerere and the Infectious Diseases Institute in Kampala, set out to quantify how well HIV-negative partners in Gulu District actually adhere to their PrEP regimens and to identify the factors that shape adherence behavior.

The research team recruited participants consecutively from Gulu Regional Referral Hospital, the TASO Gulu Clinic, Awach Health Centre IV, and Layibi Techo Health Centre III between July 1 and August 31, 2024, with proportional allocation across the four sites. Data were collected using a modified AIDS Clinical Trials Group adherence questionnaire, a validated instrument widely used in antiretroviral research. Because the observed prevalence of good adherence was high, the investigators applied modified Poisson regression with robust standard errors, a statistical approach designed for common outcomes that conventional logistic regression can distort, reporting adjusted prevalence ratios with 95 percent confidence intervals.

The headline figure of 92.2 percent good adherence, with a 95 percent confidence interval of 89.4 to 94.3, is notable in a field where self-reported adherence to daily oral PrEP often falls well below optimal levels. Oral TDF/FTC requires consistent daily intake to achieve the protective drug concentrations in mucosal tissues that block HIV acquisition, and real-world adherence has been a persistent challenge across many settings. The Gulu findings suggest that, at least among this population of serodifferent couples attending regular HIV care facilities, oral PrEP is being taken reliably by the vast majority of users.

Three factors emerged as significantly associated with good adherence. The strongest was high perceived risk of HIV acquisition, which increased the prevalence of good adherence by 54 percent (adjusted prevalence ratio 1.54; 95 percent CI 1.23 to 1.95; p less than 0.001). Participants who believed they were at substantial risk of contracting HIV from their partner were markedly more likely to take their pills as directed. Tertiary education was also linked to better adherence (aPR 1.04; 95 percent CI 1.00 to 1.05; p equals 0.03), and the absence of fear of side effects raised adherence prevalence by 19 percent (aPR 1.19; 95 percent CI 1.02 to 1.39; p equals 0.025).

Two factors worked in the opposite direction. The absence of family support was associated with a 9 percent lower prevalence of good adherence (aPR 0.91; 95 percent CI 0.85 to 0.97; p equals 0.012), while forgetfulness reduced adherence prevalence by 5 percent (aPR 0.95; 95 percent CI 0.92 to 0.99; p equals 0.018). These findings point to the social and cognitive architecture underlying pill-taking behavior: people who have supportive family environments and who can remember their daily dose are more likely to maintain the regimen over time.

The emphasis on perceived risk is particularly instructive from a public health standpoint. PrEP works only if people who need it take it, and people take it only if they believe they need it. In serodifferent relationships, the HIV-negative partner’s risk perception can fade over time, especially when the HIV-positive partner is on effective antiretroviral therapy and has a suppressed viral load. The study’s authors suggest that enhanced counseling to sustain risk perception is a key intervention target, alongside strategies to manage side effects and adherence support tools such as reminders.

The finding on family support adds a social dimension to adherence science that is often overlooked in biomedical framing. In Ugandan communities, where extended family networks play a central role in daily life, the presence or absence of supportive family members can influence whether an individual maintains a daily medication routine. The authors call for greater family involvement in PrEP adherence support, an approach that could involve educating family members about PrEP and encouraging them to help remind and motivate the HIV-negative partner.

Forgetfulness, the other negative factor, is a well-documented barrier to daily oral PrEP adherence globally. The study’s recommendation of adherence support tools such as reminders aligns with a growing body of evidence that digital and behavioral reminder systems can improve medication adherence across many chronic disease contexts. Simple interventions, from mobile phone text messages to pill organizers, could help address this cognitive barrier in resource-limited settings.

The study arrives at a moment of rapid expansion in the HIV prevention landscape. While oral TDF/FTC remains an important PrEP option, the field now includes the dapivirine vaginal ring and long-acting injectable cabotegravir, and in 2025 the World Health Organization recommended twice-yearly injectable lenacapavir as an additional PrEP option. The authors note that strengthening adherence monitoring systems and preparing for the integration of these long-acting options will be critical for sustaining HIV prevention efforts in Uganda. For now, the Gulu findings offer a measure of reassurance that oral PrEP, when embedded in supportive clinical and family environments, can achieve high adherence among the people who need it most.

Subject of Research: HIV Prevention

Article Title: Prevalence and factors associated with pre-exposure prophylaxis adherence among HIV-negative partners in serodifferent relationships attending selected health facilities in Gulu District, Uganda

Article References: Calo, A. V., Ngabirano, T., Mujugira, A., Kalyango, J., & Okwero, M. (2026). Prevalence and factors associated with pre-exposure prophylaxis adherence among HIV-negative partners in serodifferent relationships attending selected health facilities in Gulu District, Uganda. BMC Public Health. https://doi.org/10.1186/s12889-026-29931-4

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29931-4

Keywords: PrEP adherence, serodifferent couples, HIV prevention, Uganda, oral TDF/FTC, prevalence, modified Poisson regression, family support, perceived HIV risk, side effects, Gulu District, antiretroviral prophylaxis

The triglyceride-glucose index, usually abbreviated TyG, is computed as the natural logarithm of fasting triglycerides in milligrams per deciliter multiplied by fasting glucose, divided by two. Because both ingredients come from standard lipid and glucose panels, the index costs essentially nothing to calculate and has become a popular surrogate for insulin resistance in large epidemiological studies, where direct clamp-based measurements of insulin sensitivity are impractical. Prior cross-sectional work had already linked higher TyG values to higher urate levels, but those snapshots could not disentangle whether a person’s trajectory, rather than their standing, carried the risk signal.

That distinction matters because longitudinal studies of repeated measurements face a subtle statistical trap. If you measure an exposure, such as the TyG index, at the same visit at which you also confirm the outcome, such as hyperuricemia, the two overlap in time and the analysis can become circular. The research team, led by LingYi Feng and Ke Li of the Department of Clinical Laboratory at The Third People’s Hospital of Chengdu, addressed this with a landmark cohort design, a technique borrowed from survival analysis in which participants must remain free of the outcome up to a fixed landmark time before their subsequent risk is assessed.

Concretely, the investigators drew on de-identified health-examination records from 2023 through 2025 at their tertiary hospital. Only adults who remained normouricemic through the 2024 landmark were eligible, ensuring that the exposure window, the change in TyG between the 2023 and 2024 examinations, strictly preceded the outcome window, the development of hyperuricemia in 2025. The prespecified primary analysis then modeled that one-year TyG change jointly with baseline TyG, age, and sex, while also adjusting for the most recent pre-outcome values of serum urate and estimated glomerular filtration rate, the standard measure of kidney function, both taken from 2024. Because the kidneys excrete the bulk of uric acid, renal function is a critical confounder in any urate study, and using the 2024 values meant the model controlled for kidney status as close to the outcome as the data allowed.

The statistical machinery was modified Poisson regression with robust variance, an approach that estimates risk ratios directly rather than odds ratios, which can overstate effects in common outcomes like hyperuricemia. Among the 21,188 participants who met the eligibility criteria, 1,171, or 5.5 percent, developed hyperuricemia during 2025. In the primary model, each one-standard-deviation greater increase in the TyG index over the 2023-to-2024 year was associated with a 12 percent higher risk of subsequent hyperuricemia, with a risk ratio of 1.120 and a 95 percent confidence interval of 1.061 to 1.181. The confidence interval sits comfortably above 1.0, indicating a statistically robust association.

To test whether the result depended on the choice of adjustment variables, the team ran a complementary model that instead used 2023 serum urate and eGFR, the baseline-covariate version. The estimate barely moved, coming in at a risk ratio of 1.139 with a confidence interval of 1.080 to 1.201. This kind of sensitivity check is important in observational epidemiology, where results can hinge on modeling decisions. The consistency across both specifications suggests the association between rising insulin resistance and incident hyperuricemia is not an artifact of how kidney function or urate levels were anchored in the models.

Yet the study is equally notable for what it did not find. When the researchers asked whether adding one-year TyG change improved the model’s ability to discriminate who would and would not develop hyperuricemia, the gain was almost negligible: the C-statistic, a measure of predictive accuracy where 0.5 represents coin-flip performance and 1.0 represents perfection, rose only from 0.801 to 0.803. In plain terms, the most recent serum urate measurement and kidney function already carried nearly all the predictive information, and knowing how much a person’s TyG index had climbed added almost nothing to individual-level forecasting. The authors are explicit on this point, cautioning that the findings should be interpreted as observational associations rather than evidence of clinical predictive utility or causality.

That honesty is refreshing in a field where novel biomarker studies often overstate their practical implications. The biology linking insulin resistance to urate elevation is plausible and increasingly well mapped. Insulin resistance drives compensatory hyperinsulinemia, which stimulates renal sodium reabsorption and, through shared transporters in the proximal tubule, reduces urinary uric acid excretion. Elevated triglycerides and free fatty acids can also accelerate purine synthesis in the liver, increasing urate production from both ends of the balance. Transporter proteins such as URAT1 and ABCG2, which the study’s abbreviation list flags, sit at the molecular crossroads of this pathway, shuttling urate across renal and intestinal epithelia in ways that are sensitive to the metabolic milieu.

The study’s strengths lie in its scale, its clean temporal separation of exposure and outcome, and its reproducibility posture. The authors released Python analysis scripts, a data dictionary, locked machine-readable expected results, and figure-reproduction files as supplementary material, an unusually transparent package for a clinical epidemiology paper. The analysis followed STROBE reporting guidelines for observational studies, and the protocol, including the prespecified primary model, was defined before the analysis. Ethics approval came from the hospital’s medical ethics committee, with the consent requirement waived because only de-identified routine examination data were used.

Limitations remain, as they always do in single-center retrospective work. All participants came from one tertiary hospital in Chengdu, so the findings may not generalize to other populations or health systems. Health-examination cohorts also tend to skew toward people engaged enough with health care to show up annually, which can underrepresent the most metabolically vulnerable. Hyperuricemia was defined by serum urate thresholds rather than by clinical gout diagnoses, and the one-year measurement interval cannot capture shorter-term fluctuations in diet, weight, or medication use that might influence both TyG and urate. Residual confounding by unmeasured factors, from alcohol intake to diuretic prescriptions, cannot be excluded.

For readers wondering what to take away, the practical message is modest but meaningful. A rising TyG index over a year, visible in ordinary bloodwork, tracks with a modestly elevated chance of crossing the hyperuricemia threshold the following year, even after accounting for where you started and how your kidneys are doing. It is a signal worth watching in population health and in clinical conversations about metabolic trajectory, but it is not yet a tool that will refine anyone’s personal risk prediction. The authors’ own framing sets the right expectation: this is an observational association, a well-executed one, that adds a longitudinal brick to the growing wall of evidence connecting insulin resistance and uric acid metabolism, while leaving the questions of causation and clinical utility for future interventional and multi-center studies to answer.

Subject of Research: Association between one-year change in the triglyceride-glucose index and incident hyperuricemia in adults

Article Title: One-year change in the triglyceride-glucose index and subsequent incident hyperuricemia: a retrospective landmark cohort study

Article References: Feng, L., Xia, Y., Xie, Q., Wang, Y., & Li, K. (2026). One-year change in the triglyceride-glucose index and subsequent incident hyperuricemia: a retrospective landmark cohort study. BMC Endocrine Disorders. https://doi.org/10.1186/s12902-026-02663-7

Image Credits: AI Generated

DOI: 10.1186/s12902-026-02663-7

Keywords: triglyceride-glucose index, hyperuricemia, insulin resistance, serum urate, cohort study, landmark analysis, gout, kidney function, epidemiology, metabolic health, modified Poisson regression, BMC Endocrine Disorders

The study team, led by Chukwuma J. Okafor of the State University of Zanzibar together with colleagues Islam H. Mwita, Rodolfo Isidro Bosch Bayard, and Aziza Japhary, designed their investigation as a cross-sectional survey, a snapshot approach that captures patient attitudes at a single point in time. They adapted the Patient Satisfaction Questionnaire, a widely used instrument in health services research, into a structured 28-item tool spanning nine distinct domains: the physical environment, courtesy and interpersonal manner, communication, accessibility, time spent with the doctor, convenience, technical quality, expenses, and general satisfaction. This multidimensional framing matters because patient satisfaction is not a single feeling but a composite judgment, assembled from everything from the cleanliness of the waiting area to whether a clinician explained a diagnosis in words the patient could understand.

The granularity of the questionnaire allowed the researchers to see precisely where the service was succeeding and where it was collapsing. Administrative interactions fared comparatively well: 83.2 percent of respondents expressed satisfaction with registration staff, suggesting that the clerical backbone of the outpatient department functions acceptably. But the picture deteriorated sharply when the researchers turned to the human and environmental dimensions of care. Communication and patient-centred care items registered very low satisfaction, and a striking 92.9 percent of respondents reported dissatisfaction with cleanliness. Long waiting times emerged as another prominent source of frustration, compounding the sense that patients were spending hours in an unhygienic environment only to receive hurried, impersonal consultations.

Methodologically, the study makes several choices that reflect a growing sophistication in how health services researchers handle common outcomes and imperfect data. Because dissatisfaction affected well over 10 percent of the sample, the authors used modified Poisson regression with robust variance rather than ordinary logistic regression. The technical rationale is important: when an outcome is common, odds ratios derived from logistic models systematically overstate the underlying prevalence ratios, inflating the apparent strength of associations. Poisson regression with robust standard errors directly estimates prevalence ratios, giving a more honest picture of how much more likely one group is to be dissatisfied than another. Reporting adjusted prevalence ratios with 95 percent confidence intervals, the team identified lower satisfaction linked to perceived affordability, accessibility, and perceived socioeconomic barriers.

Equally notable is what the authors chose to disclose about the limits of their own statistics. Two adjusted prevalence ratios — one for perceived socioeconomic influence and one for female sex — came out with magnitudes exceeding 20, values so extreme that no prevalence ratio can plausibly represent them as true effects. Rather than presenting these numbers as headline findings, the researchers flagged them as almost certainly reflecting instability in the underlying data, reporting them for completeness but explicitly declining to interpret them as precise or generalisable effect sizes. They also reported that a logistic-regression specification of the same model failed to converge, a phenomenon known as quasi-complete separation, and chose to state this openly rather than dress up unstable odds-ratio estimates as reliable results. In a field where inflated effect estimates are too often laundered into policy claims, this kind of transparency is rare and welcome.

The reliability of the survey instrument itself received similarly candid treatment. The overall 28-item scale achieved a Cronbach’s alpha of 0.685, a figure the authors describe as acceptable-to-borderline, sitting just below the conventional 0.70 threshold that many researchers treat as the floor for internal consistency. Domain-level reliability varied widely, ranging from 0.42 to 0.82 for domains containing three or more items, and several domains did not reach conventional reliability thresholds at all. Instead of burying this variation behind a single summary statistic, the team reported it domain by domain, acknowledging that some subscales of the adapted questionnaire measured their intended constructs less consistently than others. For readers, this means the domain-level satisfaction percentages should be read as descriptive indicators of where problems lie rather than as precision instruments.

The authors are equally careful about the study’s sampling design. The 309 participants were recruited through a non-probability approach that combined purposive selection of the study hospital with convenience sampling of outpatients during the data-collection period. Convenience sampling, while practical in a busy clinical setting, cannot guarantee that the surveyed patients represent the full population of outpatients, and the researchers accordingly frame their multivariable associations as hypothesis-generating for this particular facility rather than as confirmed, generalisable predictors of patient satisfaction. This is a methodologically honest posture, and it does not diminish the study’s practical value; it simply locates its conclusions at the level of Jitimai District Hospital, where they are most actionable.

Ethical oversight for the research was provided by the Zanzibar Health Research Ethics Committee, which granted approval under number ZAHRE/02/ST/FEB/2025/51, with additional administrative permission from the State University of Zanzibar and the hospital administration. The study was conducted in accordance with the Declaration of Helsinki, and every participant provided written informed consent after being told the study’s purpose, their right to decline or withdraw at any stage without any effect on their care, and the confidentiality protections in place. Only adults aged 18 and above were eligible, so no parental or guardian consent procedures were required. The authors received no external funding for the work and declare no competing interests, and the article is published open access under a Creative Commons licence.

What elevates the study beyond a single hospital’s report card is its identification of modifiable targets. The domains that performed worst — communication, interpersonal care, cleanliness, and waiting time — are precisely the ones that facility-level quality improvement programmes can address without waiting for new buildings, new equipment, or new budgets of the magnitude required for tertiary care upgrades. Training clinicians in patient-centred communication, reforming provider attitudes, tightening cleaning protocols, and reorganising patient flow to cut waiting times are all interventions with documented track records in low- and middle-income country settings. The authors conclude that interventions targeting patient-centred communication, provider attitudes, and financial and access barriers are essential to improve outpatient service quality, and their data give hospital managers a concrete priority list.

The broader significance lies in what the findings suggest about health systems across similar settings. Outpatient departments in low-resource contexts are the primary interface between patients and healthcare systems, and service quality at that interface critically shapes whether people seek care early, adhere to treatment, or trust public medicine at all. Evidence from Zanzibar has historically been limited, making this study a useful data point for regional health planners. If nearly 59 percent dissatisfaction can be documented at one district hospital with transparent methods and honest uncertainty, the question becomes how many neighbouring facilities would produce similar numbers under the same scrutiny — and whether the modest, well-defined fixes this study points toward, from cleaner corridors to kinder consultations, might be among the highest-yield investments available to health systems operating on thin margins.

Subject of Research: Patient satisfaction and its associated factors among outpatients at a district hospital in Zanzibar

Article Title: Patient satisfaction and associated factors among outpatients at a district hospital in Zanzibar: a facility-based cross-sectional study

Article References: Okafor, C. J., Mwita, I. H., Bosch Bayard, R. I., & Japhary, A. (2026). Patient satisfaction and associated factors among outpatients at a district hospital in Zanzibar: a facility-based cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15685-7

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15685-7

Keywords: patient satisfaction, outpatient care, Zanzibar, district hospital, health services research, PSQ-18, modified Poisson regression, low- and middle-income countries, healthcare quality, communication, waiting times, cleanliness