The AIDS Support Organization

Despite Uganda making significant progress in reducing mother-to-child transmission (eMTCT), from 20% in 2000 to 2.8% in 2021, regional differences in MTCT rates exist. The drivers of these differences remain unclear in some nomadic populations of the Karamoja region. This study aimed to determine the maternal and infant predictors of HIV infection among HIV-exposed infants (HEI) under 18 months of age in the Karamoja region, Northeastern Uganda. We conducted a retrospective cross-sectional study across twelve public health facilities in Karamoja, Uganda. Data on mothers and their HEI who had their first HIV nucleic acid amplification test at 4 to 6 weeks of age by either dry blood test or point of care testing were abstracted from the Early Infant Diagnosis (EID) register. The primary outcome was an HEI PCR test result (Positive or Negative). Firth’s penalized likelihood regression was used to determine factors associated with Infant HIV positivity. Data was analyzed using STATA version 15, and a p-value of < 0.05 was considered significant. A total of 223 mother-baby pairs were included in the analysis, with 52.9% (n=118) of the HEI being female, and the maternal median age was 27 (interquartile range 23-30). The Infant HIV positivity was 2.2% (n=5) and was significantly lower among mothers with no advanced HIV disease (stage 1 or 2)[adjusted odds ratio (aOR): 0.008, 95% confidence interval (CI): 0.0002- 0.35 P=0.012], Mothers having a suppressed viral load (<1000 copies/ml) [aOR: 0.019, 95% CI: 0.0011- 0.36, P=0.008] and infants who received Nevirapine [aOR: 0.038, 95% CI: 0.0015 - 0.922, P=0.044]. The results showed that maternal viral suppression, absence of advanced HIV disease, and infant receipt of nevirapine prophylaxis were associated with lower infant HIV positivity. Ensuring mother-baby pairs receive all the eMTCT services can avert new HIV infections among the HEI. Not applicable.

IntroductionHIV incidence remains high among women in Africa, especially adolescent girls and young women (AGYW), despite existing oral pre‐exposure prophylaxis (PrEP) programmes. With expanding biomedical prevention options, understanding PrEP use patterns when women are offered choice can inform HIV prevention programming in Africa.MethodsThe CATALYST study offers informed PrEP choice through an enhanced service delivery package for women in 27 public health sites across Kenya, Lesotho, South Africa, Uganda, and Zimbabwe. Women attending sites who were HIV negative and interested in learning about HIV prevention were eligible. We describe uptake and use among those offered choice between oral PrEP and the monthly dapivirine ring from May 2023 through July 2024, explore factors associated with method choice using logistic regression, describe reasons for choice and assess time until PrEP discontinuation using survival analysis.ResultsOf 3967 participants, 44.9% were AGYW (15−24 years), 25.5% were sex workers, and 12.2% and 8.7% were breastfeeding and/or pregnant, respectively. At enrolment, 66.2% chose oral PrEP, 29.9% chose the dapivirine ring and 3.5% chose no method. Common reasons for choosing oral PrEP were ease of use (58.6%) and efficacy (31.7%); the ring was chosen due to ease of use (56.9%) and not needing to swallow pills (53.0%). In multivariable analysis, participants ≤ 24 years (p = 0.007) and participants who were pregnant (p = 0.002) or breastfeeding (p < 0.001) had lower odds of choosing the ring. Month 1 return was 32.7% for oral PrEP and 55.2% for the ring. Ring users reported higher adherence as compared to oral PrEP users (p < 0.001). Of participants returning for ≥ 1 PrEP refills, 12.1% switched methods at least once. Median time until PrEP discontinuation was 95 days (95% CI: 91, 110) for those choosing oral PrEP at enrolment and 169 days (95% CI: 139, 190) for those choosing the ring. Risk of discontinuation was greater for participants choosing oral PrEP at enrolment (p < 0.001) and those ≤ 24 years (p < 0.001), PrEP naïve at enrolment (p < 0.001) or not currently using contraception (p = 0.03).ConclusionsWe demonstrated that women took advantage of PrEP choice. PrEP use varied by product, with 1 month return and method continuation higher for the ring. AGYW had a greater risk of discontinuing either method, suggesting more support is needed.

Globally, adolescent girls and young women (AGYW) continue to be at an elevated risk of HIV infection. We assessed the impact of layered behavioral, socio-economic and school-based interventions on selected behavioral and biomarker indicators among AGYW in Uganda. We used data from two serial cross-sectional surveys conducted in 14 (eight intervention and six comparison) districts in 2018 (n = 8,236) and 2023 (n = 5,449). Between 2019 and 2023, AGYW in the intervention districts received social and behavioral change communication plus either socio-economic support, vocational skills-based training or educational subsidies, as appropriate. AGYW in the comparison districts were not exposed to these interventions. We collected data on eight behavioral and two biomarker (HIV, syphilis) indicators. Exposure to AGYW interventions was defined as participation in or receipt of at least one intervention and expressed as a percentage. Impact was determined using a difference-in-difference approach with the observed net effect assumed to represent the overall impact of the interventions. We compared the effect of the interventions between exposed and unexposed AGYW and between intervention and non-intervention districts or schools. Data were analyzed using STATA, version 16.0. Half of the AGYW were in school while 50-70% were single/never married. Overall exposure to AGYW interventions was low; ranging from 4.4% to 43% depending on the type of intervention. Exposure to the interventions had a small net effect (0.7% to 14%) on almost all behavioral indicators and HIV prevalence was much higher among exposed than unexposed AGYW (1.56% vs. 0.94%). Syphilis prevalence was much lower among exposed than unexposed AGYW (0.26% vs. 0.82%) with an overall marginal net decline of 1.0% in the intervention versus non-intervention districts or schools. These findings suggest a need for a critical re-appraisal of the design and implementation of interventions targeting AGYW in order to achieve the desired changes in behavioral and biomarker indicators.

Background Transport workers, particularly taxi drivers and commercial motorcyclists, comprise a population at high risk for HIV and account for nearly one-third of new HIV infections in sub-Saharan Africa (SSA). Furthermore, transport workers bridge HIV infections from high-risk populations to the general population. This scoping review aimed to map the available evidence around HIV prevalence, risk factors for HIV infection, use of HIV prevention methods, and HIV interventions among taxi drivers and commercial motorcyclists in SSA. Method This scoping review used the Arksey and O’Malley framework. Published articles were retrieved from MEDLINE (via PubMed), CINAHL, African Index Medicus, Web of Science, Scopus, EMBASE, HINARI, and Google Scholar from inception to August 2024. Two authors screened the titles and abstracts of retrieved studies and examined the references of relevant articles for additional literature. Three authors independently extracted data from the included studies using a standard data extraction form. Data were analyzed using descriptive statistics and content analysis techniques. The themes were collated, and a descriptive summary of the findings was reported. Results This review included 24 studies. The HIV prevalence was 2.02%–9.9% among commercial motorcyclists, and reached 33.4% in samples comprising both motorcyclists and taxi drivers. The high HIV infection rate was attributable to numerous behavioral (e.g., multiple sex partners), psychosocial (e.g., stigma), and sociodemographic (e.g., age, income) risk factors. However, there was suboptimal use of HIV prevention methods such as safe male circumcision (20.7%–64.9%) and condoms (26%–45.7%). The two HIV interventional studies were conducted among commercial motorcyclists. Despite HIV testing being an entry point for chronic care, we found no study reporting the HIV cascade for commercial motorcyclists or taxi drivers who were diagnosed with HIV, including the use of antiretroviral therapy, pre-exposure prophylaxis (PREP), and post-exposure prophylaxis. Conclusions The numerous research gaps highlight the need for longitudinal research on HIV incidence and predictors in this key population, especially the structural determinants of HIV infection. There is also a need for interventional and observational research on new models of HIV testing (e.g., HIV oral testing), antiretroviral-based HIV prevention methods (e.g., PREP), and the role of peer-to-peer educator or group support/counseling models in reducing HIV infection and mitigating risky HIV-related sexual behavior. Such studies may provide evidence to inform better HIV prevention and control policies and programs among taxi drivers and commercial motorcyclists in SSA.

This proof-of-concept study evaluated an optimization strategy for the Community Case Detection Tool (CCDT) aimed at improving community-level mental health detection and help-seeking among children aged 6–18 years. The optimization strategy, CCDT+, combined data-driven supervision with motivational interviewing techniques and behavioural nudges for community gatekeepers using the CCDT. This mixed-methods study was conducted from January to May 2023 in Palorinya refugee settlement in Uganda. We evaluated (1) the added value of the CCDT+ in improving the accuracy of detection and mental health service utilization compared to standard CCDT, and (2) implementation outcomes of the CCDT+. Of the 1026 children detected, 801 (78%) sought help, with 656 needing mental health care (PPV = 0.82; 95% CI: 0.79, 0.84). The CCDT+ significantly increased detection accuracy, with 2.34 times higher odds compared to standard CCDT (95% CI: 1.41, 3.83). Additionally, areas using the CCDT+ had a 2.05-fold increase in mental health service utilization (95% CI: 1.09, 3.83). The CCDT+ shows promise as an embedded quality-optimization process for the detection of mental health problems among children and enhance help-seeking, potentially leading to more efficient use of mental health care resources.

During humanitarian crises, women face both heightened vulnerabilities and a disruption to their social networks. Previous research points to the positive impact of women's collectives in low-income settings, but less is known about the distinct forms, mechanisms, and consequences of the social support that emerges from these collectives, particularly for women affected by conflict. Recognizing the importance of social support in such contexts, this study utilizes the photovoice methodology to examine the dynamics of social support across women's collectives in three distinct settings. This study recruited forcibly displaced women participating in women's collectives in Indonesia (n = 5), Jordan (n = 12), and Uganda (n = 11). Photovoice, a participatory research method that centers the voices of study participants, was implemented across 7-8 sessions in each setting. Participants took photographs in response to four prompts and then discussed their pictures and lived experiences related to social support in facilitated discussion groups. Transcripts were analyzed using thematic analysis and a mixed inductive and deductive approach. Across all study sites, participants highlighted the importance of five types of informal social support: emotional, instrumental, informational, companionship, and esteem support. Emotional support, one of the most prominently mentioned forms, served to buffer against stressors and enhance mental well-being. Instrumental and informational support facilitated meeting basic needs, accessing resources, and, in Uganda, improving members' physical safety. Companionship support fostered a sense of belonging and shared identity, while esteem support validated members' perspectives and aspirations and bolstered self-worth. In the Jordan collective, esteem support proved especially beneficial in countering the marginalization members experienced in their community. Findings underscore the critical role of women's collectives in providing diverse forms of social support to foster empowerment, agency, and resilience among forcibly displaced women. By centering the voices of participants and employing survivor-centered approaches like photovoice, this study amplifies the perspectives of women within these collectives, contributing to more inclusive and responsive humanitarian interventions. Future research should continue prioritizing women's experiences and research questions, ensuring that interventions address their needs effectively.

Tuberculosis (TB) is the leading cause of death among infectious agents globally. An estimated 10 million people are newly diagnosed and 1.5 million die of the disease annually. Uganda is among the 30 high TB-burdenedd countries, with Karamoja having a significant contribution of the disease incidence in the country. Control of the disease in Karamoja is complex because a majority of the at-risk population remain mobile; partly because of the nomadic lifestyle. This study, therefore, aimed at describing the factors associated with drug-susceptible TB treatment success rate (TSR) in the Karamoja region. This was a retrospective study on case notes of all individuals diagnosed with and treated for drug-susceptible TB at St. Kizito Hospital Matany, Napak district, Karamoja from 1st Jan 2020 to 31st December 2021. Data were abstracted using a customised data abstraction tool. Data analyses were done using Stata statistical software, version 15.0. Chi-square test was conducted to compare treatment success rates between years 2020 and 2021, while Modified Poisson regression analysis was performed at multivariable level to determine the factors associated with treatment success. We studied records of 1234 participants whose median age was 31 (IQR: 13-49) years. Children below 15 years of age accounted for 26.2% (n = 323). The overall treatment success rate for the study period was 79.3%(95%CI; 77.0%-81.5%), with a statistically significant variation in 2020 and 2021, 75.4% (422/560) vs 82.4% (557/674) respectively, (P = 0.002). The commonest reported treatment outcome was treatment completion at 52%(n = 647) and death was at 10.4% (n = 129). Older age, undernutrition (Red MUAC), and HIV-positive status were significantly associated with lower treatment success: aPR = 0.87(95%CI; 0.80-0.94), aPR = 0.91 (95%CI; 0.85-0.98) and aPR = 0.88 (95%CI; 0.78-0.98); respectively. Patients who were enrolled in 2021 had a high prevalence of treatment success compared to those enrolled in 2020, aPR = 1.09 (95%CI; 1.03-1.16). TB TSR in Matany Hospital was suboptimal. Older age, poor nutrition, and being HIV-positive were negative predictors of treatment success. We propose integrating nutrition and HIV care into TB programming to improve treatment success.

Reproductive health emergencies, such as postpartum hemorrhage, contribute significantly to maternal and neonatal morbidity and mortality in Uganda due to knowledge and skills gaps. Medical interns, intern midwives, and nurses are crucial as frontline healthcare workers in responding to these emergencies. Our proposed hands-on strategy involves comprehensive simulation-based training (SBT) to equip these healthcare workers with the essential knowledge to manage common reproductive health emergencies and procedures in the country. The study aimed to assess the effectiveness of comprehensive SBT in improving the knowledge of interns and fifth-year medical students on reproductive health emergencies and procedures at Gulu University and its Teaching Hospitals in Uganda. A before-and-after study. A 4-day SBT was conducted for fifth-year medical students and interns (nurses, midwives, and doctors) at Gulu University Teaching Hospitals, focusing on reproductive health emergencies. Pre- and post-tests with 40 multiple-choice questions were used to evaluate knowledge enhancement, the scores were summarized as medians and interquartile ranges. Paired sample t-tests was used to test the difference in pre- and post-test scores. Independent sample t-tests compared median post-test results between interns and students, with a p-value <0.05 considered significant. A total of 153 participants were enrolled, the majority being males (78.4%, n = 120) and medical students (73.9%, n = 113). Among the 40 interns, 55% (n = 22) were doctors, 30% (n = 12) were midwives, and 15% (n = 6) were nurses. The study participants showed an increase in knowledge, with median post-test scores higher than pre-test scores for all participants [63% (interquartile ranges, IQR: 57-71%) versus 49% (42-54%), with a median difference of 14% (8-23%), p < 0.001]. The SBT effectively imparts key knowledge competencies to the interns and fifth-year medical students. We recommend that SBT be included as part of the course units that students should take and for continuous medical education for qualified healthcare workers in resource-limited settings.

BackgroundUganda is one of the 30 countries with a high burden of TB in the world. According to the 2014–2015 National TB prevalence survey, 39% of people with cough for two or more weeks did not seek treatment. Similarly, there was an estimated 1500 people (range 820–2300) with Drug resistant TB (DR TB) in 2018 but only 34% were notified. While Ankole region in South-Western Uganda detected 36 DR TB cases from April 2022 to March 2023, Kazo District, a majorly pastoral community diagnosed 2. Additionally, in 2021/2022, Kazo District had a case detection rate of 46% (Target 90%). There was need to improve TB case finding and therefore pairing Health workers and village health teams (VHT) to screen for TB in community hotspots was initiated. MethodsMicroplanning meetings were held with the District Health Team and USAID LPHS Ankole (TASO). A review of the District TB register was done. Hotspot mapping was done with community participation while prioritising areas with previously high TB notification. Buremba, Kyampangara and Nkungu were selected. In each hotspot, a professional health worker and a VHT were paired to do household health education, TB screening using MOH designed tools and sputum sample collection for 3 days. Samples were tested using Gene-Xpert. All diagnosed clients were started on respective treatment.ResultsA total of 524 households were reached,1526 people were screened for TB. Presumptive TB was identified in 220/1526(14.4%) and 15/220 (6.8%) (8 male and 7 female) confirmed with TB. Of these, 13 (87%) were from Buremba. Out of the 13 clients,7(53.8%) (3 male and 4 female) had Rifampicin resistant TB. ConclusionPairing Village Health Teams with Professional Health workers in community hotspot screening leads to high TB yield. These data provide a paradigm for optimal active TB case finding in hard to reach communities.

Measures to contain the Corona Virus Disease 2019 (COVID-19) pandemic curtailed access to prevention and treatment services for endemic infectious diseases like HIV. We used an uncontrolled before-and-after study design to compare general and HIV positive (HIV+) inpatient outcomes at a tertiary hospital in Uganda, using electronic records of medical inpatients. Data was downloaded, cleaned in Microsoft Excel, and exported to STATA for analysis. We determined the difference in number of admissions and median length of hospital stay using Mann-Whitney U test; and difference in median survival and incidence rates of mortality using Kaplan – Meier statistics, between the pre- and peri-COVID-19 groups. Of 7506 patients admitted to Kiruddu NRH, 50.8% (3812) were female and 18.7% (1,401) were aged 31–40 years, and 18.8% (1,411) were HIV+. Overall, 24.6% (1849) died. Total admissions were lower (2192 vs. 5314 patients), overall mortality rate higher (41.8% vs. 17.6%, p < 0.01), median length of hospital stay longer (6 vs. 4 days, p < 0.01) and median survival shorter (11 vs. 20 days, Chi-square = 252.05, p < 0.01) in the peri- than in pre-COVID-19 period. The adjusted hazard ratio (aHR) of death was 2.08 (95% CI: 1.85–2.23, p < 0.01) in the peri- compared to the pre-COVID-19 period. These differences were more pronounced in HIV + patients. Compared to pre-COVID-19, the peri-COVID-19 period registered lower inpatient admissions but poorer treatment outcomes for general and HIV + inpatients. Emerging epidemic responses should minimize disruption to inpatient care, especially for HIV + individuals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10461-023-04092-2.