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Browsing Research Papers and Publications by Author "Alege, John Bosco"

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    Alcohol consumption increases non-adherence to ART among people living with HIV enrolled to the community-based care model in rural northern Uganda
    (Plos One, 2020-11-24) Adrawa, Norbert; Alege, John Bosco; Izudi, Jonathan
    Background Non-adherence to anti-retroviral therapy (ART) is associated with considerable morbidity and mortality among people living with Human Immunodeficiency Virus (PLHIV). Community-based ART delivery model offers a decentralized and patient-centered approach to care for PLHIV, with the advantage of improved adherence to ART hence good treatment outcomes. However, data are limited on the magnitude of non-adherence to ART among PLHIV enrolled to the community-based ART model of care. In this study, we determined the frequency of non-adherence to ART and the associated factors among PLHIV enrolled to the community-based ART delivery model in a large health facility in rural northern Uganda. Methods This analytic cross-sectional study randomly sampled participants from 21 community drug distribution points at the AIDS Support Organization (TASO) in Gulu district, northern Uganda. Data were collected using a standardized and pre-tested questionnaire, entered in Epi-Data and analyzed in Stata at univariate, bivariate, and multivariate analyses levels. Binary logistic regression analysis was used to determine factors independently associated with non-adherence to ART, reported using odds ratio (OR) and 95% confidence level (CI). The level of statistical significance was 5%.. Results Of 381 participants, 25 (6.6%) were non-adherent to ART and this was significantly associated with alcohol consumption (Adjusted (aOR), 3.24; 95% CI, 1.24–8.34). Other factors namely being single/or never married (aOR, 1.97; 95% CI, 0.62–6.25), monthly income exceeding 27 dollars (aOR, 1.36; 95% CI, 0.52–3.55), being on ART for more than 5 years (aOR, 0.60; 95% CI, 0.23–1.59), receipt of health education on ART side effects (aOR, 0.36; 95% CI, 0.12–1.05), and disclosure of HIV status (aOR, 0.37; 95% CI, 0.04–3.20) were not associated with non-adherence in this setting. Conclusion Non-adherence to ART was low among PLHIV enrolled to community-based ART delivery model but increases with alcohol consumption. Accordingly, psychosocial support programs should focus on alcohol consumption.
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    Health Facilities’ Readiness to Manage Hypertension and Diabetes Casesat Primary Health Facilities in Bidibidi Refugee Settlement,Yumbe District, Uganda
    (Hindawi, 2021-01-23) Isadru, Vuchiri Ray; Nanyonga, Rose Clarke; Alege, John Bosco
    Background. NCDs are the greatest global contributors to morbidity and mortality and are a major health challenge in the 21stcentury. .e global burden of NCDs remains unacceptably high. Access to care remains a challenge for the majority of persons living with NCDs in sub-Saharan Africa. In Uganda, 55% of refugee households, including those with chronic illnesses, lack access to health services. Of these, 56% are in the West-Nile region where the Bidibidi settlement is located, with 61% of its refugee households in need of health services especially for NCDs (UNHCR, 2019). Data on NCDs in Bidibidi are scarce. Unpublished health facilities’ (HFs) data indicate that cardiovascular diseases (CVDs) (54.3%) and metabolic disorders (20.6%) were the leading causes of consultation for major NCDs (IRC, 2019). No readiness assessment has ever been conducted to inform strategies for the efficient management of NCDs to avert more morbidity, mortality, and the economic burden associated with NCD managementor complications among refugees. .is study sought to determine the readiness of HFs in managing hypertension (HTN) and diabetes cases at primary health facilities in the Bidibidi refugee settlement, Yumbe district, Uganda. Methods. .e study used facility-based, cross-sectional design and quantitative approach to assess readiness for the management of HTN and diabetes. Allthe 16 HFs at the Health Centre III (HCIII) level in Bidibidi were studied, and a sample size of 148 healthcare workers (HCWs) was determined using Yamane’s formula (1967). Proportionate sample sizes were determined at each HF and the simple randomsampling technique was used. HF data were collected using the Service Availability and Readiness Assessment (SARA) checklist and a structured questionnaire used among HCWs. Data were analyzed using SPSS version 20. Univariate analysis involved descriptive statistics; bivariate analysis used chi-square, Fisher’s exact test, and multivariable regression analysis for readiness of HCWs. Results. 16 HCIIIs were studied in five zones and involved 148 HCWs with a mean age of 28 (std±4) years. .e majority71.6% (106) were aged 20–29 years, 52.7% were females, and 37.8% (56/148) were nurses. Among the 16 HFs, readiness average score was 71.7%. .e highest readiness score was 89.5% while the lowest was 52.6%. .e 16 HFs had 100% diagnostic equipment,96% had diagnostics, and 58.8% had essential drugs (low for nifedipine, 37.5%, and metformin, 31.2%). Availability of guidelines for the management of HTN and diabetes was 94%, but only low scores were observed for job aid (12.5%), trained staff (50%), and supervision visits (19%). Only 6.25% of the HFs had all the clinical readiness parameters. On the other hand, only 24% (36) of theHCWs were found to be ready to manage HTN and diabetes cases. Chi-square tests on sex (p<0.001), education level (p�0.002),and Fisher’s tests on profession (p<0.001) established that HCWs with bachelor’s degree (AOR�3.15, 95% CI: 0.569–17.480) and diploma (AOR�2.93, 95% CI: 1.22–7.032) were more likely to be ready compared to the reference group (certificate holders). Medical officers (AOR�4.85, 95% CI: 0.108–217.142) and clinical officers (AOR�3.79, 95 CI: 0.673–21.336) were more likely to be ready compared to the reference group, and midwives (AOR�0.12, 95% CI: 0.013–1.097) were less likely to be ready compared to the reference group. In addition, female HCWs were significantly less likely to be ready compared to male HCWs (AOR�0.19,95% CI: 0.073–474). Conclusion. HFs readiness was high, but readiness among HCWs was low. HFs had high scores in equipment,diagnostics, and guidelines, but essential drugs, trained staff, and supervision visits as well HCWs had low scores in trainings and supervisions received. Being male, bachelor’s degree holders, diploma holders, medical officers, and clinical officers increased the readiness of the HCWs.
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    Performance of Epidemic Preparedness and ResponseCommittees to Disease Outbreaks in Arua District,West Nile Region
    (NCBI, 2019-02-03) Afayo, Robert; Buga, Muzamil; Alege, John Bosco; Akugizibwe, Pardon; Atuhairwe, Christine; Taremwa, Ivan Mugisha
    The Epidemic Preparedness and Response Committees (EPPRCs) are at the heart of preventing outbreaks from becoming epidemics by controlling the spread. Evidence-based information regarding factors associated with the performance of EPPRCs in preparedness and response to disease outbreaks is needed in order to improve their performance. A cross-sectional study involving 103 EPPRC members was carried out in Arua district, West Nile region, between the months of July and December 2014. Data were collected using a structured questionnaire, and the chi-square test was used to establish associations. Forty-eight percentage of EPPRC members showed a moderate level of preparedness, and only 39.8% of them had a moderate level of response. The performance drivers of preparedness and response were dependent on presence of a budget (χ2 = 10.281, p=0.002), availability of funds (χ2 = 5.508, p=0.019), adequacy of funds, (χ2 = 11.211, p=0.008), support given by health development partners (χ2 = 19.497, p=0.001), and motivation (χ2 = 20.065, p < 0.001). Further, membership duration (χ2 = 13.776, p=0.001) and respondent cadre (χ2 = 12.538, p=0.005) had a significant association. Based on these findings, there is a big gap in the preparedness and response ability, all of which are dependent on the financial gap to the Committees. To this, funding for preparedness and response is a critical aspect to respond and contain an outbreak.
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    Prevalence of tobacco use and associated risk factors among pregnant women in Maracha District, Uganda
    (Academic Journals, 2021-06) Alege, John Bosco; Jurua, Russall Okudra; Drazidio, Judith
    Globally, tobacco use has become the largest public health threat that kills around 7 million people annually, of which about 6 million deaths are due to direct tobacco use, and 890,000 are attributed to passive smoking. This study assessed prevalence and associated risk factors of tobacco use among pregnant women, 15 to 49 years. Health facility-based analytical cross-sectional study was conducted among 199 pregnant women using purposive sampling technique and convenient sampling technique for the respondents. Chi-square test and binary logistic regression were used to compare quantitative data at a 95% CI. Prevalence of tobacco use among respondents was 39.2%. The results gives those who starting to smoke at more than 30 years (p≤0.001), agreeing that smoking makes pregnant women feel they have total control over their health and life (p≤0.008); the likelihood of tobacco use reduced among pregnant women aged 20-29 years (p≤0.032), those disagreeing that tobacco use as a sign of maturity (p≤0.003) and disagreeing that smoking can help calm nerves, control moods, and alleviates stress (p≤0.002). However, cultural factors that reduced the chances of smoking in pregnancy include smoking more than five times a day (p≤0.01) and smoking cigarettes (p≤0.017), were statistically associated with smoking. High prevalence of tobacco use among pregnant women in Kijomoro and Eliofe health center III was recorded. Thus, there is need to sensitize pregnant women about tobacco-related health problems on them and their unborn children.
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    Unsuppressed viral load after intensive adherence counselling in rural eastern Uganda;
    (BMC Health Services Research, 2021-12-18) Ndikabona, Geoffrey; Alege, John Bosco; Kirirabwa, Nicholas Sebuliba; Kimuli, Derrick
    Background:The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV ). Although the viral suppression rate in Kamuli district is higher than that observed in some of the districts in the region, the district has one of the largest populations of people living with HIV (PLHIV ). We sought to examine the factors associated with viral suppression after the provision of intensive adherence counselling (IAC) among PLHIV in the district. Methods: We reviewed records of PLHIV and used them to construct a retrospective cohort of patients that started and completed IAC during January – December 2019 at three high volume HIV treatment facilities in Kamuli district. We also conducted key informant interviews of focal persons at the study sites. We summarized the data descriptively, tested differences in the outcome (viral suppression after IAC) using chi-square and t-tests, and established indepen-dently associated factors using log-binomial regression analysis with robust standard errors at 5% statistical signifi-cance level using STATA version 15. Results: We reviewed 283 records of PLHIV. The mean age of the participants was 35.06 (SD 18.36) years. The major-ity of the participants were female (56.89%, 161/283). The viral suppression rate after IAC was 74.20% (210/283). The most frequent barriers to ART adherence reported were forgetfulness 166 (58.66%) and changes in the daily routine 130 (45.94). At multivariable analysis, participants that had a pre-IAC viral load that was greater than 2000 copies/ml [adjusted Prevalence Risk Ratio (aPRR)= 0.81 (0.70 - 0.93), p=0.002] and those that had a previous history of viral load un-suppression [aPRR= 0.79 (0.66 - 0.94), p=0.007] were less likely to achieve a suppressed viral load after IAC. ART drug shortages were rare, ART clinic working hours were convenient for clients and ART clinic staff received training in IAC. Conclusion: Despite the consistency in drug availability, counselling training, flexible and frequent ART clinic days, the viral suppression rate after IAC did not meet recommended targets. A high viral load before IAC and a viral rebound were independently associated with having an unsuppressed viral load after IAC. IAC alone may not be enough to achieve viral suppression among PLHIV. To improve viral suppression rates after IAC, other complementary services should be paired with IAC