Community-Based Surveillance in Uganda's Border Districts during the 2024 Mpox Outbreak: Enablers, Constraints, and Adaptive Responses

Abstract Background Uganda's Integrated Disease Surveillance and Response framework designates community-based surveillance (CBS) as a core pillar of outbreak detection, yet how this pillar functions during a live, stigmatised, cross-border outbreak remains poorly understood. This study qualitatively examined CBS during the 2024 Mpox Clade Ib outbreak in Uganda's Kasese and Amuru border districts, focusing on the enablers, constraints, and adaptive responses shaping surveillance performance. Methods A qualitative descriptive design was employed, with data collected between June and August 2025 through 19 key informant interviews and 8 focus group discussions, engaging 100 participants across the two districts. Participants included Health-sector personnel, implementing partner staff, Community Health Workers (CHWs), and community members. Data were analysed thematically. Results Three interrelated themes emerged. Institutional memory and pre-existing infrastructure from prior outbreaks (Ebola, COVID-19, and the 2022 Mpox outbreak) strengthened clinical suspicion, reactivated standing response structures, and sustained community trust and partner support. Structural and social barriers, including delayed disbursement of funds, fragile specimen transport, limited staff, fragmented coordination, and stigma linked to both the sexualised transmission narrative and the confusion of Mpox with locally recognised skin conditions, drove concealment and care seeking outside the formal system. Communities responded with improvised adaptive mechanisms, including informal self-diagnosis, peer-based referral networks among key populations, informal cross-border resource-sharing and integration of Mpox screening into existing platforms such as antenatal and HIV/ART clinics. Conclusions Strengthening CBS in Uganda's border districts requires reliable financing, sustainable specimen transport, adequate staffing, locally appropriate risk communication, and formalised cross-border collaboration as a deliberate component of preparedness in high-mobility border settings.