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Geographic mobility may disrupt continuity of care and contribute to poor clinical outcomes among people receiving treatment for tuberculosis (TB). This may occur especially where health services are not well coordinated across international borders, particularly in lower and middle income country settings. In this work, we describe mobility and the relationship between mobility and unfavorable TB treatment outcomes (i.e., death, loss to follow-up, or treatment failure) among a cohort of adults who initiated TB treatment at one of 12 health facilities near Lake Victoria. We abstracted data from health facility records for all 776 adults initiating TB treatment during a 6-month period at the selected facilities in Kenya, Tanzania, and Uganda. We interviewed 301 cohort members to assess overnight travel outside one’s residential district/sub-county. In our analyses, we estimated the proportion of cohort members traveling in 2 and 6 months following initiation of TB treatment, explored correlates of mobility, and examined the association between mobility and an unfavorable TB treatment outcome. We estimated that 40.7% (95% CI: 33.3%, 49.6%) of people on treatment for TB traveled overnight at least once in the 6 months following treatment initiation. Mobility was more common among people who worked in the fishing industry and among those with extra-pulmonary TB. Mobility was not strongly associated with other characteristics examined, however, suggesting that efforts to improve TB care for mobile populations should be broad ranging. We found that in this cohort, people who were mobile were not at increased risk of an unfavorable TB treatment outcome. Findings from this study can help inform development and implementation of mobility-competent health services for people with TB in East Africa.

Supplemental material, sj-docx-1-whe-10.1177_17455057221103993 for Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers by Ali Ssetaala, Julius Ssempiira, Mathias Wambuzi, Gertrude Nanyonjo, Brenda Okech, Kundai Chinyenze, Bernard Bagaya, Matt A Price, Noah Kiwanuka and Olivier Degomme in Women’s Health

Supplemental material, sj-docx-3-whe-10.1177_17455057221103993 for Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers by Ali Ssetaala, Julius Ssempiira, Mathias Wambuzi, Gertrude Nanyonjo, Brenda Okech, Kundai Chinyenze, Bernard Bagaya, Matt A Price, Noah Kiwanuka and Olivier Degomme in Women’s Health

Supplemental material, sj-docx-2-whe-10.1177_17455057221103993 for Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers by Ali Ssetaala, Julius Ssempiira, Mathias Wambuzi, Gertrude Nanyonjo, Brenda Okech, Kundai Chinyenze, Bernard Bagaya, Matt A Price, Noah Kiwanuka and Olivier Degomme in Women’s Health

Supplemental material, sj-docx-4-whe-10.1177_17455057221103993 for Improving access to maternal health services among rural hard-to-reach fishing communities in Uganda, the role of community health workers by Ali Ssetaala, Julius Ssempiira, Mathias Wambuzi, Gertrude Nanyonjo, Brenda Okech, Kundai Chinyenze, Bernard Bagaya, Matt A Price, Noah Kiwanuka and Olivier Degomme in Women’s Health

The impact of endemic infections on protective immunity is critical to inform vaccination strategies. In this study, we assessed the influence of Schistosoma mansoni infection on host responses in a Ugandan fishing cohort given a Hepatitis B (HepB) vaccine. Concentrations of schistosome-specific circulating anodic antigen (CAA) pre-vaccination showed a significant bimodal distribution associated with HepB titers, which were lower in individuals with high CAA. We established that participants with high CAA had significantly lower frequencies of circulating T follicular helper (cTfh) subpopulations pre- and post-vaccination and higher regulatory T cells (Tregs) post-vaccination. Polarization towards higher frequencies of Tregs: cTfh cells can be mediated by changes in the cytokine environment favoring Treg differentiation. In fact, we observed higher levels of CCL17 and soluble IL-2R pre-vaccination (important for Treg recruitment and development), in individuals with high CAA that negatively associated with HepB titers. Additionally, alterations in pre-vaccination monocyte function correlated with HepB titers, and changes in innate-related cytokines/chemokine production were associated with increasing CAA concentration. We report, that by influencing the immune landscape, schistosomiasis has the potential to modulate immune responses to HepB vaccination. These findings highlight multiple Schistosoma -related immune associations that could explain abrogated vaccine responses in communities with endemic infections., Author Summary: Schistosomiasis drives host immune responses for optimal pathogen survival, potentially altering host responses to vaccine-related antigen. Chronic schistosomiasis and co-infection with hepatotropic viruses are common in countries where schistosomiasis is endemic. We explored the impact of Schistosoma mansoni ( S. mansoni ) infection on Hepatitis B (HepB) vaccination of individuals from a fishing community in Uganda. We demonstrate that high schistosome-specific antigen (circulating anodic antigen, CAA) concentration pre-vaccination, is associated with lower HepB antibody titers post-vaccination. We show higher pre-vaccination levels of cellular and soluble factors in instances of high CAA that are negatively associated with HepB antibody titers post-vaccination, which coincided with lower frequencies of circulating T follicular helper cell populations (cTfh), proliferating antibody secreting cells (ASCs), and higher frequencies of regulatory T cells (Tregs). We also show that monocyte function is important in HepB vaccine responses, and that high CAA is associated with alterations in the early innate cytokine/chemokine microenvironment. Our findings suggest that in individuals with high CAA and likely high worm burden, schistosomiasis creates and sustains an environment that is polarized against optimal host immune responses to the vaccine, which puts many endemic communities at risk for infection against HepB and other diseases that are preventable by vaccines.