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01.
arXiv (CS.CV) 2026-06-19

Language-Instructed Vision Embeddings for Controllable and Generalizable Perception

Vision foundation models are typically trained as static feature extractors, placing the burden of task adaptation onto large downstream models. We propose an alternative paradigm: instead of solely feeding visual features into language models, we use language itself to dynamically guide the vision encoder. Our method, Language-Instructed Vision Embeddings (LIVE), leverages language as high-level guidance to produce task-centric embeddings at inference time, removing the need for task-specific retraining. This enables the encoder to focus on contextually relevant aspects of the input, yielding more controllable and generalizable representations. Empirically, LIVE reduces visual hallucinations (+34 points on MMVP), surpasses vision-language models with orders of magnitude more parameters on visual question answering, and generalizes to unseen instructions and tasks – offering a direct path toward adaptive, instruction-driven visual intelligence.

02.
arXiv (CS.LG) 2026-06-15

Generalizing GNNs with Tokenized Mixture of Experts

arXiv:2602.09258v2 Announce Type: replace Abstract: Deployed graph neural networks (GNNs) are frozen at deployment yet must fit clean data, generalize under distribution shifts, and remain stable to perturbations. We show that static inference induces a fundamental tradeoff: improving stability requires reducing reliance on shift-sensitive features, leaving an irreducible worst-case generalization floor. Instance-conditional routing can break this ceiling, but is fragile because shifts can mislead routing and perturbations can make routing fluctuate. We capture these effects via two decompositions separating coverage vs selection, and base sensitivity vs fluctuation amplification. Based on these insights, we propose STEM-GNN, a pretrain-then-finetune framework with a mixture-of-experts encoder for diverse computation paths, a vector-quantized token interface to stabilize encoder-to-head signals, and a Lipschitz-regularized head to bound output amplification. Across nine node, link, and graph benchmarks, STEM-GNN achieves a stronger three-way balance, improving robustness to degree/homophily shifts and to feature/edge corruptions while remaining competitive on clean graphs.

03.
arXiv (CS.AI) 2026-06-11

TAHOE: Text-to-SQL with Automated Hint Optimization from Experience

arXiv:2606.12387v1 Announce Type: cross Abstract: Large Language Models (LLMs) have democratized database access through Text-to-SQL, but moving from prototypes to production remains difficult. Real deployments must handle strict SQL dialects, massive schemas, and evolving user preferences, while supervised fine-tuning is costly and rigid and agentic test-time scaling is expensive. We present Tahoe, a system that treats prompt optimization as a dynamic data management problem. Tahoe uses an error-driven hint learning pipeline across Development and Deployment to consolidate debugging traces into a structured Hint Bank. Compiler feedback is distilled into reusable Syntax Hints for dialect-specific rules, while execution and user feedback are converted into Semantic Hints for schema- and user-specific logic. Tahoe further introduces a Strategy Layer that models conflicting user intents as competing strategies under shared natural-language triggers, with recency signals and post-learning attribution statistics that summarize empirical success, harm, inertness, and support. At inference time, Tahoe retrieves relevant hints and guides the LLM through Logic Planning followed by SQL Synthesis. We implement and evaluate the development-phase workflow, leaving deployment-time human-feedback updates for future work. On Spider 2.0-Snow, Tahoe substantially improves Text-to-SQL without updating model parameters. On 113 supervised Spider 2.0-Snow-0212 examples using GPT-5.5, Tahoe raises pass rate from 61.95 percent to 79.42 percent and pass-at-4 from 72.57 percent to 87.61 percent, achieves 100 percent Snowflake syntax pass rate, and reduces average compiler-feedback critic rounds from 2.79 to 0.12 per sampled candidate. The same Hint Bank also transfers to weaker backbones, including a 19.7 percentage-point pass-rate gain on Doubao-2.0-lite.

04.
arXiv (CS.AI) 2026-06-16

ArtBoost: Synthetic Articulatory Data Augmentation for Acoustic-to-Articulatory Inversion

arXiv:2606.16327v1 Announce Type: cross Abstract: Recent acoustic-to-articulatory inversion (AAI) models rely on electromagnetic articulography (EMA) data, which are costly and limited in scale. To address this limitation, we propose ArtBoost, a novel data augmentation strategy that leverages large-scale speech–mesh datasets originally developed for speech-driven 3D facial animation to improve AAI under limited EMA supervision. ArtBoost extracts pseudo articulatory trajectories from visible facial anchors and uses them for pre-training before fine-tuning on real EMA data. Experiments show consistent improvements in PCC and RMSE. Trajectory analyses confirm that the pseudo articulatory signals reflect physically meaningful visible articulatory dynamics. Additional evaluations across different AAI architectures demonstrate stable performance gains, indicating that ArtBoost can be integrated into diverse AAI models. These results suggest that speech–mesh data provide an effective and scalable source of articulatory supervision for AAI. Project page: https://cau-irislab.github.io/Interspeech26-ArtBoost/

06.
arXiv (CS.AI) 2026-06-16

Entropy-Gated Latent Recursion

arXiv:2606.16620v1 Announce Type: cross Abstract: Inference-time scaling has become the dominant lever for improving language-model reasoning, but existing methods derive rollout diversity from a single source: stochastic token-level sampling. We argue that this single-axis sampling space is fundamentally limiting, and identify a second, fully deterministic and complementary axis: the layer span $L$ at which a frozen model's top decoder layers are recursively re-applied at high-uncertainty tokens. Different choices of $L$ produce distinct rollouts that solve different subsets of problems, with no stochasticity. We instantiate this axis through Entropy-Gated Latent Recursion (EGLR), a training-free decoding procedure that re-applies the top-$L$ layers for at most $K_{\max}$ iterations until the next-token distribution converges. Combined with $T$ temperature samples, EGLR turns a single-axis stochastic rollout pool into an $L\times T$ Cartesian sampling space at almost the same per-rollout cost. We characterize this space across $8$ instruction-tuned models and $6$ math reasoning benchmarks, and show that the $L$-axis is genuinely complementary to temperature: on MATH-500 with Qwen2.5-3B-Instruct, the joint $L\times T$ oracle reaches $91.6\%$, $+8.2$ percentage points beyond the temperature-only oracle ($83.4\%$) and $+10.4$ points beyond the layer-only oracle ($81.2\%$), confirming that the two axes capture genuinely complementary problems. The expanded rollout pool provides richer per-prompt candidates for any downstream procedure that consumes rollouts, including self-consistency, best-of-$N$ with verifiers, and group-relative RL training (GRPO), opening a new direction for inference-time scaling that does not rely on stochastic noise.

07.
arXiv (CS.AI) 2026-06-17

Brep2Shape: Boundary and Shape Representation Alignment via Self-Supervised Transformers

arXiv:2602.07429v2 Announce Type: replace-cross Abstract: Boundary representation (B-rep) is the industry standard for computer-aided design (CAD). While deep learning shows promise in processing B-rep models, existing methods suffer from a representation gap: continuous approaches offer analytical precision but are visually abstract, whereas discrete methods provide intuitive clarity at the expense of geometric precision. To bridge this gap, we introduce Brep2Shape, a novel self-supervised pre-training method designed to align abstract boundary representations with intuitive shape representations. Our method employs a geometry-aware task where the model learns to predict dense spatial points from parametric Bézier control points, enabling the network to better understand physical manifolds derived from abstract coefficients. To enhance this alignment, we propose a Dual Transformer backbone with parallel streams that independently encode surface and curve tokens to capture their distinct geometric properties. Moreover, the topology attention is integrated to model the interdependencies between surfaces and curves, thereby maintaining topological consistency. Experimental results demonstrate that Brep2Shape offers significant scalability, achieving state-of-the-art accuracy and faster convergence across various downstream tasks.Code is available at this repository: https://github.com/thuml/Brep2Shape.

08.
arXiv (CS.AI) 2026-06-16

Do Large Language Models Have Emotions?

arXiv:2606.14742v1 Announce Type: cross Abstract: Do LLMs have emotions? A recent paper from Anthropic reports finding internal representations of emotion concepts in Claude Sonnet 4.5, concluding that the LLM has 'functional emotions.' We evaluate this claim against what is known about how emotions actually function in biological systems. We argue that emotions serve two core functions: the context-sensitive interpretation of situations, and the reorganization of processing across multiple systems in response to those interpretations. The Anthropic findings offer partial support for the first function, though the consistent, discrete emotional representations identified in Claude sit uneasily with affective neuroscience findings that human emotion is characterized by variable rather than uniform neural signatures. On the second function, the evidence is mixed: Claude's representations modulate output without producing the dynamic reorganization of attention, decision speed, and motivational state that defines emotion in biological systems. We close by proposing what it would take for an LLM to have emotions.

09.
arXiv (CS.CL) 2026-06-19

CzechDocs: A Multiway Parallel Dataset of Formatted Documents for Minority Languages in Czechia

We present CzechDocs, a multiway parallel dataset of formatted documents (HTML, DOCX, and PDF) covering Czech and minority languages used in Czechia-primarily Ukrainian and English, with smaller portions of Vietnamese, Russian and other languages. The dataset is designed to support the evaluation of machine translation systems that aim to preserve document formatting during translation. We provide a comparison of the most common approaches to format-preserving machine translation on a validation subset of the dataset. This validation split, together with the evaluation toolkit, is publicly released for further research. A held-out test split will be reserved for a future shared task focused on document-level translation with formatting preservation.

10.
arXiv (CS.AI) 2026-06-17

Distributed General-Purpose Agent Networks: Architecture, Key Mechanisms, and Prototypes

arXiv:2606.17368v1 Announce Type: new Abstract: Large language models have accelerated the transition from passive conversational assistants to autonomous agents that can understand goals, plan actions, invoke tools, and execute multi-step tasks. Yet the capability of a single agent remains constrained by its local data, tool permissions, runtime environment, and governance boundary. This paper studies distributed general-purpose agent networks: open peer-to-peer networks in which heterogeneous agents deployed on personal devices, edge nodes, or autonomous computing environments can discover one another, establish trust, negotiate cooperation rules, and execute open-ended tasks. We argue that such networks cannot be obtained by simply combining existing peer-to-peer overlays with conventional multi-agent systems. Unlike traditional P2P networks, agent networks must propagate semantic declarations about intentions, capabilities, states, and cooperation constraints. We therefore propose a layered architecture centered on a protocol adaptation layer that connects upper-level task semantics with lower-level network operations. Based on this architecture, the paper identifies three core mechanism problems: semantic announcement propagation for collaborator discovery, verifiable identity and multi-topic reputation for cooperation governance, and semantic-gradient mechanism design for open task execution. For each problem, we present a technical route, including bodyless gossip with sequential logs, BAID-based identity binding with MG-EigenTrust reputation, and a Stackelberg-style mechanism-generation loop driven by semantic attribution feedback. We further report prototype overhead results for BAID-style tiered verification and mechanism-level simulations of MG-EigenTrust under cross-topic disguise-collusion attacks. The resulting framework provides a system-level foundation for open, trustworthy, and scalable agent collaboration.

11.
arXiv (CS.LG) 2026-06-19

Unsupervised Causal Abstractions Discovery

arXiv:2606.19594v1 Announce Type: new Abstract: Causal abstractions formalize when a high-level structural causal model (SCM) captures the interventional behavior of a lower-level SCM. Existing applications of this notion largely follow a hypothesis-testing paradigm: an expert proposes a candidate high-level model and then evaluates if the low-level system implements it. We study the complementary problem of learning a high-level model directly from low-level measurements. Our contributions leverage hypotheses from low-rank causal discovery, and can be summarized as follows: (1) we show that observations generated by a low-rank graph induce latents that form a causal abstraction, (2) we provide identifiability results about these latents, and (3) we propose a practical objective to learn this high-level SCM.

12.
arXiv (CS.LG) 2026-06-17

Uncertainty Quantification of Engineering Structures by Polynomial Chaos Expansion and Multivariate Active Learning

arXiv:2606.17233v1 Announce Type: new Abstract: In many engineering applications, a single high-fidelity model produces multiple quantities of interest (QoIs) under the same input parameters, e.g. finite element models of complex physical systems. To alleviate the high computational cost of direct model evaluations, surrogate models are widely used to construct efficient approximations of model responses. Naturally, the accuracy of surrogates strongly depends on the quality of the experimental design (ED). However, a single ED may not provide an adequate representation for all outputs simultaneously, especially when different outputs exhibit varying sensitivities to the input variables. A straightforward solution is to perform separate sampling for each output, but this results in increased sampling complexity and computational cost. From a statistical perspective, such an approach also ignores potential correlations among all outputs and may compromise data consistency. To address this issue, an adaptive sequential sampling method for constructing polynomial chaos expansion surrogate models is generalized for vector valued QoIs. The method sequentially selects new samples from a candidate pool based on their local contribution to the output variance, while balancing distance-based exploration of the input space and exploitation of aggregated variance information across all outputs. Its performance is compared with non-sequential Latin Hypercube Sampling through several numerical examples from engineering problems. Numerical results demonstrate that the proposed strategy improves both surrogate accuracy and stability, and provides a more reliable estimation of second-order statistics.

13.
arXiv (CS.CL) 2026-06-18

UniECG: Understanding and Generating ECG in One Unified Model

Electrocardiogram (ECG) interpretation is a fundamental skill in medical education, yet students often need more than static examples to connect waveform evidence with diagnostic reasoning. This paper presents UniECG as a step toward interactive ECG education. UniECG supports two complementary learning interactions: given an ECG signal or image, it generates an evidence-based explanation; given a textual learning objective, it generates a corresponding ECG signal example for case-based learning. The model follows a two-stage design. First, it learns grounded ECG explanation from ECG signal–image–text data. Second, it introduces special ECG generation tokens and aligns their hidden representations with a pretrained text-conditioned ECG diffusion model, enabling controllable signal-level ECG generation. We evaluate UniECG through grounded ECG explanation and generation-oriented qualitative analysis, examining its potential to support explanation and case-based learning. UniECG is intended as an educational aid and a research step toward interactive AI-assisted ECG learning, rather than a clinically validated diagnostic system.

14.
arXiv (CS.CV) 2026-06-16

SGFormer++: Semantic Graph Transformer for Incremental 3D Scene Graph Generation

In this paper, we propose SGFormer++, a novel Semantic Graph Transformer for 3D scene graph generation (SGG), which aims to parse point cloud scenes into semantic structural graphs, where nodes denote detected object instances and edges encode their pairwise relationships, with the core challenge lying in modeling complex global scene structure. While existing graph convolutional network (GCN)-based methods suffer from over-smoothing and limited receptive fields, SGFormer++ leverages Transformer layers as its backbone to enable global message passing. Specifically, we introduce two key components tailored for 3D SGG: (1) a Graph Embedding Layer++ that efficiently integrates edge-aware global context with linear computational complexity, and (2) a Semantic Injection Layer++ that enriches visual features with linguistic priors from large language models (LLMs) and vision-language models (VLMs), boosting semantic representation without introducing extra trainable parameters. To further address the practical challenge of incremental SGG (I-SGG), where new relationship categories arrive sequentially, we equip SGFormer++ with a novel Spatial-guided Feature Adapter, which calibrates predicate features using subject-object spatial geometry to counter scale variation, and a Cascaded Binary Prediction Head that mitigates catastrophic forgetting via task-incremental classifier expansion and logit distillation. Extensive experiments on the 3DSSG benchmark demonstrate that SGFormer++ achieves state-of-the-art performance in both standard and incremental settings: it yields a significant 4.49% absolute improvement in Predicate A@1 under the incremental setting. Code and data are available at: https://github.com/Andy20178/SGFormer.

15.
medRxiv (Medicine) 2026-06-15

Natural Language Processing Based Solution for Labeling Brain Metastasis Identified in Radiology Reports

Abstract Purpose: Brain metastases (BM) far exceed primary CNS tumours and constitute the majority workload for neuro-oncology care providers. Currently, the cancer registries only capture synchronous BMs, which is only a small proportion of all BMs. We aim to develop and validate a natural language processing (NLP) algorithm that identifies brain metastases in radiology reports, enabling scalable surveillance of asynchronous BMs. Methods: Using population-based cancer registry data in Alberta, Canada, we identified a cancer cohort diagnosed between 2012–2019 with follow-up to 2022. All brain/head radiology reports at and post-cancer diagnosis were identified. Reports were sampled through a multi-phase approach and manually labeled for BM presence. We trained two Bio_ClinicalBERT models on the "Findings" and "Impressions" sections, respectively, and took the maximum predicted probability as the report-level prediction. Internal and external validation used reports from the Canadian provinces of Alberta, Ontario, and British Columbia. Results: The models were trained on 1,879 samples. For internal validation, 1,833 reports from 357 patients were tested. At a probability threshold of 0.4, the model achieved a sensitivity of 0.888 and precision of 0.499. The ensemble substantially outperformed single-section models, which achieved sensitivities of only 67.8% (Findings) and 74.2% (Impressions). On external validation, sensitivity was 0.918 in Ontario and 0.726 in British Columbia, demonstrating robustness across diverse data distributions. Conclusions: An NLP-based pipeline processing both Findings and Impressions sections has been developed and validated in three Canadian provinces. It meets cancer registry operational requirements and to be implemented into the surveillance workflow in Alberta and British Columbia, providing a foundation for population-level BM surveillance.

17.
arXiv (CS.CL) 2026-06-11

Redesign Mixture-of-Experts Routers with Manifold Power Iteration

Router is the cornerstone component to the Mixture-of-Experts models. Serving as expert proxies, the rows of the router matrix compute their similarity to the MoE inputs to determine which subset of experts is activated. Ideally, each router row is designed to encode the expert matrix into this representative vector, such that its dot-product with token can better reflect token-expert affinity. However, there exists no design principles to enforce this condensation. In this paper, we propose to align each router row with the principal singular direction of the associated expert, as this direction provides the most expressive mathematical description of a matrix. Based on this principle, we propose a router redesign with Manifold Power Iteration (MPI). Specifically, it introduces a "Power-then-Retract" paradigm, where a power iteration step is performed on the router weights, followed by a retraction to impose a norm constraint to ensure both efficiency and stability. Theoretically, we show that MPI drives router rows to converge toward the principal singular directions of associated experts. Empirically, we pretrain MoE model across scales from 1B to 11B parameters to confirm that this alignment facilitates more effective MoE models.

18.
arXiv (CS.CL) 2026-06-16

Stop When Further Reasoning Won't Help: Attention-State Adaptive Generation in Reasoning Models

By incorporating test-time compute scaling, large reasoning models (LRMs) can solve complex problems through explicit chain-of-thought (CoT) reasoning processes. However, they often suffer from overthinking, resulting in redundant token outputs and degraded accuracy. Current methods to mitigate this issue remain limited: training-based approaches require substantial computational resources, while training-free methods rely on well-crafted prompts or unreliable confidence signals. In this work, we investigate early stopping from the perspective of attention distributions and propose a simple method, ASAG, which infers the model's reasoning state and adaptively adjusts the generation strategy. The proposed framework is training-free and plug-and-play, enabling seamless integration into existing LRMs. Extensive experiments on nine benchmarks demonstrate consistent improvements across mainstream LRMs with varying parameter scales, including the DeepSeek-R1-Distill and Qwen3 series. Specifically, ASAG improves average accuracy by 3.2% while reducing the number of generated tokens by nearly 40% across all reasoning tasks on Qwen3-8B.

19.
arXiv (CS.AI) 2026-06-11

Inside the Latent Flow: Causal Deciphering of Attention Dynamics in Audio Separation Foundation Models

arXiv:2606.10046v2 Announce Type: replace-cross Abstract: Flow-matching transformers achieve strong audio separation, yet their attention dynamics are opaque. We adapt established causal-intervention principles into a deterministic, inference-time probing protocol for SAM Audio. Orthogonal probing uncovers a dual-pathway text-conditioning mechanism: additive injections control semantic identity, while cross-attention refines acoustic structure. We observe an asynchronous layerwise convergence: stable layers build temporal scaffolds early, whereas fast layers continue resolving artifacts during sampling. The model also attenuates temporal segmentation cues to maintain continuous-flow stability. Using these insights, we propose Layer-Selective Attention Caching (LSAC), a training-free acceleration method that caches attention in stable layers. Across acoustic complexities, LSAC cuts self-attention computation by about ~25% with negligible quality loss and yields up to 6.7x higher quality retention than naive step reduction.

20.
arXiv (CS.LG) 2026-06-12

Majority-of-Three is Optimal

arXiv:2606.13614v1 Announce Type: cross Abstract: We give a short proof that the majority vote of three independent consistent classifiers is an optimal learner in the realizable PAC setting. This proves optimality for the simplest voting scheme, while simplifying both the algorithmic structure and the probabilistic analysis of previous voting learners, including the algorithm of S. Hanneke and the analysis of bagging by K. Green Larsen.

21.
arXiv (CS.AI) 2026-06-16

AI Pluralism and the Worlds It Misses

arXiv:2606.16167v1 Announce Type: new Abstract: AI pluralism is often framed as a problem of representing diverse values, preferences, users, or outputs. This paper argues that this framing is incomplete because AI systems also impose ontologies: they define what counts as an entity, relation, feature, harm, benefit, and valid form of evidence. We define ontological flattening as the conversion of situated, contested, and historically specific meanings into a restricted technical category, proxy, aggregation rule, or benchmark target that is treated as neutral and difficult to contest. The paper develops a bounded conceptual and qualitative synthesis across value pluralism, pluralistic alignment, participatory and democratic AI, procedural justice, science and technology studies, accountability research, aggregate themes from 11 expert interviews, and three urban AI companion cases. The cases illustrate how pluralistic methods can improve or structure model behavior while still compressing categories, proxies, aggregation rules, and revision rights before affected actors have procedural standing. We introduce Pluralistic Lifecycle Governance (PLG) as a preliminary qualitative audit scaffold for documenting ontological openness, epistemic inclusion, procedural authority, evaluation pluralism, and lifecycle accountability. PLG is not presented as a validated scoring instrument; it is a framework for making the evidence and governance conditions of pluralistic AI explicit.

22.
arXiv (quant-ph) 2026-06-11

Lowest order Carleman linearization for low Reynolds long-term behaviour of fluid flow simulations

arXiv:2605.23380v2 Announce Type: replace Abstract: It is shown that the lowest (second) order truncation of the Carleman linearization of the fluid equations (C2) recovers the late stage of the evolution, namely the steady-state solution, although to a decreasing degree of accuracy at increasing Reynolds number. This asymptotic property is first proved analytically for the decaying logistic with external forcing and then shown to hold to a significant degree of accuracy also for the more complex case of two-dimensional Kolmogorov-like fluid flow at low Reynolds numbers, below $Re \sim 10$. This time-asymptotic property may open interesting prospects for the quantum simulation of low-Reynolds steady-state fluid flows.

23.
arXiv (quant-ph) 2026-06-16

Readout-Induced Leakage in Superconducting Circuits with Nonlinear Couplings

arXiv:2606.16055v1 Announce Type: new Abstract: In superconducting circuits, drive-induced unwanted transitions limit the readout power, thereby constraining readout speed and fidelity. When such transitions excite the qubit into leakage states, they produce correlated errors that are particularly harmful for quantum error correction. Native nonlinear qubit-readout resonator coupling is a promising alternative to conventional linear hybridization because it provides intrinsic Purcell protection and stricter selection rules for multiphoton processes. In realistic devices, however, we show that such a coupling alone neither eliminates nor necessarily suppresses drive-induced transitions. Instead, if not appropriately engineered, these couplings often worsen the situation by introducing additional parasitic processes. Moreover, the rates of these unwanted transitions remain sensitive to the choice of readout frequency, regardless of the coupling mechanism. We demonstrate that readout-induced leakage can thus vary by orders of magnitude even when readout frequencies differ by less than ~7%. Our results establish that the benefits of native nonlinear couplings are realized only through informed device design, including the spectral placement of relevant auxiliary modes and elimination of parasitic ones.

24.
arXiv (CS.AI) 2026-06-18

Externalizing Research Synthesis and Validation in AI Scientists through a Research Harness

arXiv:2606.18874v1 Announce Type: new Abstract: AI systems can increasingly automate scientific workflows, but the reasoning that links prior evidence, generated ideas, experiments and final claims often remains implicit inside model inference. Here we introduce Xcientist, a research harness that externalizes research synthesis and experimental validation into inspectable, contract-governed processes. Xcientist organizes literature evidence, idea states, implementation plans, ablation records and repair traces as persistent research artifacts, so that generated mechanisms can be grounded, executed, tested and revised without losing their evidential basis. We identify claim drift as a failure mode of automated research, where runnable artifacts no longer support the mechanism originally claimed. Across training-free memory systems, graph-structured traffic forecasting and multi-scale physics-informed neural networks, Xcientist preserves traceable trajectories from problem formulation to mechanism design, validation and bounded revision. These results suggest that AI scientists should be evaluated not only by their final artifacts, but by whether their synthesis and validation processes remain attributable, inspectable and scientifically accountable.

25.
medRxiv (Medicine) 2026-06-11

Incremental costs of transitioning from four to eight WHO-recommended antenatal care visits in Uganda: A costing analysis from a societal perspective

Background In 2016, the World Health Organization revised its antenatal care (ANC) recommendation from four to eight visits. For low- and middle-income countries like Uganda, where achieving even four visits remains a challenge, this transition has significant cost implications for both the health system and households. This study estimated the incremental costs of adopting the eight-visit model from a societal perspective. Methods The study was conducted in six government health facilities in southwestern Uganda. A micro-costing approach estimated health facility costs (personnel, equipment, consumables, and overhead). Costs incurred at patients end (transport, ultrasound, medical expenses, and time) were collected from 785 women using a questionnaire, with all costs in 2025 USD. Results For an average of 4.3 visits, total cost per woman was $100.1: facility costs $43.7 (43.7%), and patient costs $56.4 (56.3%). Transitioning to eight visits would increase total cost by $57.8 (57.8%), of which $36.4 (63.0%) would fall on households, equivalent to 68.8% of average monthly household income. Total costs would rise by 55.4% ($115.5 to $179.5) at Health Center IVs and 64.3% ($102.3 to $168.1) at Health Center IIIs, with facility costs up 43.4% and 62.9% and patient costs up 61.2% and 65.7%, respectively. Conclusion Transitioning to eight ANC visits would impose a large financial burden on households, with the incremental patient cost equivalent to more than two-thirds of average monthly household income. Equitable implementation requires improving availability of medicines and diagnostics, subsidizing transport, exploring telemedicine or community-based models, and improving efficiency at lower-tier health centers.