JMIR Publications

ABSTRACT

Background:

Malaria remains one of the most significant global health threats, and its control depends on timely, accurate entomological surveillance. In Uganda, routine vector surveillance relies heavily on microscope-based mosquito identification by a limited number of trained entomologists, which can delay reporting. VectorCam is an artificial intelligence (AI) enabled digital tool to support real-time mosquito identification and can be operated by community health workers, supporting rapid data reporting. After co-designing the implementation package using a human-centered design approach with Uganda’s Ministry of Health, we are implementing a surveillance strategy that incorporates VectorCam into routine work.

Objective:

This study aims to evaluate acceptability, fidelity, feasibility, cost, and preliminary effectiveness of VectorCam, the intervention, along with supporting implementation strategies as it is integrated into Uganda’s national malaria control program.

Methods:

This mixed-methods hybrid type III implementation-effectiveness study uses district-level restricted randomization to assign 12 districts to four sequential rollout waves following a two-district pilot phase. The implementation package will be introduced over a one-year period across malaria-endemic districts in Northern and Eastern Uganda. Implementation outcomes, including acceptability, feasibility, fidelity, and cost, will be assessed using qualitative interviews, system usage logs, field observations, and program documentation. Effectiveness outcomes include technical performance of mosquito species identification, time efficiency, and operational use of surveillance data for decision-making. Accuracy will be evaluated through comparison with molecular identification methods, alongside additional classification performance metrics. Data will be analyzed using a mixed-methods approach, with triangulation of qualitative and quantitative data and longitudinal analyses across districts and rollout waves. An adaptive learning approach will guide iterative refinement of the implementation package.

Results:

Fourteen districts were selected by the Ministry of Health in September 2025 for VectorCam introduction. A pilot phase conducted between December 2025 and January 2026 in two districts was used to refine implementation strategies and research tools through stakeholder workshops. Ethical approval was obtained from Johns Hopkins in January 2026 and Ugandan ethics committees in September 2025. Implementation began in February 2026 and will continue through March 2027 with concurrent data collection and analysis throughout the implementation timeline.

Conclusions:

This study will evaluate a task-shifting approach to entomological surveillance by integrating an AI–enabled tool into routine workflows of community health workers through a co-designed implementation package. By examining how the VectorCam intervention and supporting implementation strategies function together within real-world health system contexts, this study will generate evidence on the sustainability of digitally enabled surveillance. Findings will provide insight into how task shifting and digital tools can expand surveillance capacity, improve timeliness of data reporting, and strengthen the use of entomological data for decision-making. These results will inform national scale-up efforts in Uganda and offer a model for other malaria-endemic settings seeking to modernize vector surveillance.