In response to coronavirus disease-2019 pandemic (COVID-19), the government of Uganda instituted movement restrictions to curb disease spread. However, this affected accessibility to medical services in a setting where the healthcare system is not equipped to handle most healthcare needs of the populace outside hospital premises. This gap led to the prominence and unprecedented rise in the use of digital health technologies to deliver health information and services at a distance (telehealth) during the COVID-19 outbreak. The use of telehealth modalities including tele-consultation, tele-psychiatry, call centers and mobile phone health information dissemination increased. The COVID-19 pandemic augmented the rising role of digital health technologies as a much needed aspect of medical service delivery in our times. However, the efficacy and impact on clinical outcomes across various healthcare thematic areas need to be explored further and more evidence generated.

23 Introduction: Artificial intelligence (AI) in healthcare has gained momentum with advances in 24 affordable technology that has potential to help in diagnostics, predictive healthcare and 25 personalized medicine. In pursuit of applying universal non-biased AI in healthcare, it is 26 essential that data from different settings (gender, age and ethnicity) is represented. We present 27 findings from beta-testing an AI-powered dermatological algorithm called Skin Image Search, by 28 online dermatology company First Derm on Fitzpatrick 6 skin type (dark skin) dermatological 29 conditions. Methods: 123 dermatological images selected from a total of 173 images 30 retrospectively extracted from the electronic database of a Ugandan telehealth company, The 31 Medical Concierge Group (TMCG) after getting their consent. Details of age, gender and 32 dermatological clinical diagnosis were analyzed using R on R studio software to assess the 33 diagnostic accuracy of the AI app along disease diagnosis and body part. Predictability levels of 34 the AI app was graded on a scale of 0 to 5, where 0-no prediction made and 1-5 demonstrating 35 reducing correct prediction. Results: 76 (62%) of the dermatological images were from females 36 and 47 (38%) from males. The 5 most reported body parts were; genitals (20%), trunk (20%), 37 lower limb (14.6%), face (12%) and upper limb (12%) with the AI app predicting a diagnosis in 38 62% of image body parts uploaded. Overall diagnostic accuracy of the AI app was low at 17% 39 (21 out of 123 predictable images) with varying predictability levels correctness i.e. 1-8.9%, 2-40 2.4%, 3-2.4%, 4-1.6%, 5-1.6% with performance along individual diagnosis highest with 41 dermatitis (80%). Conclusion: There is a need for diversity in the image datasets used when 42 training dermatology algorithms for AI applications in clinical decision support as a means to 43 increase accuracy and thus offer correct treatment across skin types and geographies. 44

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The ubiquity of mobile phones offers an opportunity for a paradigm change in health-care delivery, which may offer solutions to some of the challenges faced by the health sector in Uganda. The Medical Concierge Group (TMCG) is a digital health company, headquartered in Uganda, which leverages on mobile phone-based platforms – such as short messaging service (SMS), voice calling – and social media to deliver health services. Just over two-thirds (68%) of users of TMCG’s services are males between 18 and 30 years of age. SMS reminders have improved the honouring of health facility appointments among HIV-positive clients, from 60% to 90%; retention rates at supported health facilities have improved from 45% to 89%. Furthermore, information dissemination has been achieved via mobile SMS, wherein subscribers can access health content on diverse topics – such as HIV/AIDS prevention and family planning – by sending messages to a pre-defined short code to a phone line. Over 900 beneficiaries have accessed health content via SMS subscriptions. Social media platforms, including Facebook and Twitter, are used for health information dissemination and have enabled a wider reach to over 13 million beneficiaries accessing health information on TMCG’s Facebook page alone. Tailoring mobile phone-based health content to meet the target beneficiaries’ needs is critical for TMCG’s impact and uptake. With rising rates of phone ownership and Internet connectivity in Uganda, mobile phones offer an affordable and proven adoptable avenue to overcome the chronic challenges faced by the health sector.

In sub-Saharan Africa (SSA), men are generally difficult to engage in healthcare programs. However, sports gambling centers in SSA can be used as avenues for male engagement in health programs. We offered point-of-care HIV and syphilis testing for men located at five gambling centers in Uganda and assessed HIV risky sexual behavior. Among 507 men, 0.8% were HIV-positive and 3.8% had syphilis. Risky sexual behavior included condomless sex with partner(s) of unknown HIV status (64.9%), having multiple sexual partners (47.8%), engaging in transactional sex (15.5%), and using illicit drugs (9.3%). The majority at 64.5% were nonalcohol consumers, 22.9% were moderate users, and 12.6% had hazardous consumption patterns. In 12 months of follow-up, the incidence rate of syphilis was 0.95 (95% CI: 0.82-1.06) among 178 men. Thus, men in SSA have a high prevalence of syphilis and risky sexual behavior which should be more effectively addressed to reduce the risk of HIV acquisition.