Okay this one is not as bad as I thought layout wise, or in terms of keeping up with what is going on.
You can use the l and shift l to get to the start of lists, which is a handy way of getting to just below the building kew and the end of the log, from where you can also change the display to show jobs, buildings upgrades etc, there is also the "custom" link which is just above where the actual contents of each tab display.
To get combat options about the world or about the current map, select upgrades, since unless your hoarding books there will be fewer items and you can go down from there.
You can make the layout of certain lists like the equipment list a bit more manageable by turning off "use screen layout when supported" in NvdA, you can also use the three buttons to hide log messages which is a handy way if you want to check whether you got an unlock or a story message (I wish there were more buttons but hay).
Mouseovers are a miner pain, but aren't too bad since once you hit numbpad slash, you always move to the mouseover with the s key for "next separator"
Now, for the bad bits.
if you uncheck the "screen layout" option with NVdA it means that the map no longer displays in rows but in a long list, and I can't determine what is where.
This is fine as far as actually playing through the game and doing combats goes, because you have to play through all cells of a map in order anyway, but I doubt the tower defence game would be easy, it'd be handy to have the number of your cell reported either in the log or in the box showing the next enemy, and also to get a message when you finish a map. It'd be really helpful if there was a indication on the various menus when the next upgrade was purchasable, with job alocations and equipment upgrades you can just click and see if the amount goes up, but with buildings since you have to either mouseover onto the building and check the cost for the next one manually, or click it and dodge up to see if its been added in the cue its fairly lengthy.
There are some completely unlabeled clickable areas in the game, for example the saving boxes for saving map configurations, though as these just involve moving sliders around it isn't too bad anyway, and I've not yet been in a position of getting stuff that quickly.
In terms of speed and over all strategy, if your just running through a map you can set auto combat going and forget about it,this is handy for farming resources or running through same maps extra times to get upgrades, though with most world maps I like to make sure I know whats going on to check the enemies haven't got too tough.
With resource gathering, your usually better farming maps of certain biomes anyway, though I've not yet got enough map fragments to do this efficiently, though since the fire and recruit buttons are relatively close together switching your workers around isn't too bad when your trying to get specific upgrades for specific things.
I do think contacting the developers would be a good idea if at all possible, since are some fairly basic things that could be done in terms of changes in layout to make matters a bit more screen reader friendly.
Edit: Okay I created a congrigate profile and sent the developer of trimps a pm since that seems to be the only contact method I could find.
I added a link to this topic as well as my email address, so hopefully she/he will get back to me about this.
With our dreaming and singing, Ceaseless and sorrowless we! The glory about us clinging Of the glorious futures we see,
Our souls with high music ringing; O men! It must ever be
That we dwell in our dreaming and singing, A little apart from ye. (Arthur O'Shaughnessy 1873.)