Barriers and facilitators to the use of diagnostic tests in antimicrobial prescribing among medical interns in public hospitals in Uganda.

Antimicrobial resistance is a growing public health threat globally with a disproportionate burden in low and middle-income countries, including Uganda. Inappropriate antimicrobial prescribing, particularly empirical treatment without confirmatory diagnostic testing, contributes significantly to resistance. Medical interns constitute a substantial proportion of frontline prescribers in public hospitals, yet evidence regarding factors influencing their use of diagnostic tests remains scarce. This study synthesized evidence on barriers and facilitators to the use of diagnostic tests in antimicrobial prescribing among medical interns in public hospitals in Uganda. A systematic review was conducted using PubMed to identify relevant studies published between 2016 and 2026. Eligibility was determined using the PEO (Population, Exposure, Outcome) framework. Studies examining barriers and/or facilitators to diagnostic test utilization in antimicrobial prescribing among health professionals in public hospitals in Uganda and comparable low and middle-income countries were included. Qualitative, quantitative and mixed methods studies were considered. Data were extracted using a standardized excel form, and methodological quality was appraised with the Mixed Methods Appraisal Tool (MMAT). Findings were synthesized narratively and thematically, of 430 records identified, 15 primary empirical studies were included. None focused exclusively on medical interns. Barriers were categorized as individual, institutional and health system level. Facilitators included structured training and supervision, awareness of AMR, improved availability of RDTs, integrated fever management programs, adherence monitoring and strengthened TB and HIV diagnostic programs. Diagnostic test use remains suboptimal, with barriers at multiple levels. Strengthening diagnostic stewardship within internship programs may enhance rational antimicrobial use and mitigate AMR in Uganda.