Browsing by Author "Izudi, Jonathan"

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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.
Breastfeeding cessation in the era of Elimination of Mother to Child Transmission of HIV in Uganda:
(Research Square, 2020-06-08) Okoboi, Stephen; Izudi, Jonathan; Ngbapai, Jackslina Gaaniri
Background: Among human immunodeficiency (HIV) infected mothers, the World Health Organization (WHO) recommends cessation of breastfeeding at one year to prevent HIV transmission but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at one year among HIV infected postpartum mothers at Ndejje Health Center IV, a large Peri-urban health facility in Uganda. Methods: This retrospective cohort study involved all HIV infected postpartum mothers enrolled in HIV care for at least 12 months between June 2014 and June 2018. We abstracted data from registers, held focused group discussions with HIV infected postpartum mothers, and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of HIV infected postpartum mothers who had stopped breastfeeding at one year. We summarized quantitative data descriptively, tested differences in outcome with the Chi-square and t-tests, and established independently associated factors using the modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results. Results: Of 235 HIV infected postpartum mothers, 150 (63.8%) ceased breastfeeding at one year and this was independently associated with the HIV exposed infant (HEI) being female than male (Adjusted risk ratio (aRR): 1.25, 95% confidence interval (CI), 1.04, 1.50), the mother being multiparous than primparous (aRR, 1.26; 95% CI, 1.04-1.53), and breastfeeding initiation on same-day as birth (aRR, 0.06; 95% CI, 0.01- 0.41). Qualitative results showed that partner reminders about breastfeeding adequacy of BF knowledge and maternal literacy facilitated continued breastfeeding until one year. Inadequate breastfeeding knowledge, casual and formal work demands, in addition to increased breastfeeding demand among boys led to cessation of breastfeeding before one year. Conclusion. Cessation of breastfeeding at one year among HIV infected postpartum mothers was sub optimal and this might increase risk of mother to child transmissions of HIV. Cessation of breastfeeding was more likely among female HEIs and multifarious mothers, and less likely when breastfeeding is initiated on same-day as birth. Interventions to enhance cessation of breastfeeding at one year should target groups of women with lower rates.
Discontinuation of tuberculosis treatment among children in the Kampala Capital City Authority health facilities: a mixed-methods study
(BMC, 2021) Kibirige, Leonard; Izudi, Jonathan; Okoboi, Stephen
Introduction: Discontinuation of tuberculosis treatment (DTT) among children in sub-Saharan Africa is a major obstacle to effective tuberculosis (TB) control and has the potential to worsen the emergence of multi-drug resistant TB and death. DTT in children is understudied in Uganda. We examined the level and factors associated with DTT among children at four large health facilities in Kampala Capital City Authority and documented the reasons for DTT from treatment supporters and healthcare provider perspectives. Methods: We conducted a retrospective analysis of records for children < 15 years diagnosed and treated for TB between January 2018 and December 2019. We held focus group discussions with treatment supporters and key informant interviews with healthcare providers. We defined DTT as the stoppage of TB treatment for 30 or more consecutive days. We used a stepwise generalized linear model to assess factors independently associated with DTT and content analysis for the qualitative data reported using sub-themes. Results: Of 312 participants enrolled, 35 (11.2%) had discontinued TB treatment. The reasons for DTT included lack of privacy at healthcare facilities for children with TB and their treatment supporters, the disappearance of TB symptoms following treatment initiation, poor implementation of the community-based directly observed therapy short-course (CB-DOTS) strategy, insufficient funding to the TB program, and frequent stock-outs of TB drugs. DTT was more likely during the continuation phase of TB treatment compared to the intensive phase (Adjusted odds ratio (aOR), 5.22; 95% Confidence Interval (CI), 1.76–17.52) and when the treatment supporter was employed compared to when the treatment supporter was unemployed (aOR, 3.60; 95% CI, 1.34–11.38). Conclusion: Many children with TB discontinue TB treatment and this might exacerbate TB morbidity and mortality. To mitigate DTT, healthcare providers should ensure children with TB and their treatment supporters are accorded privacy during service provision and provide more information about TB symptom resolution and treatment duration versus the need to complete treatment. The district and national TB control programs should address gaps in funding to TB care, the supply of TB drugs, and the implementation of the CB-DOTS strategy.
Effect of disclosure of HIV status on patient representation and adherence to clinic visits in eastern Uganda:
(Plos One, 2021-10-19) Izudi, Jonathan; Okoboi, Stephen; Lwevola, Paul; Kadengye, Damazo; Bajunirwe, Francis
Background: Disclosure of human immunodeficiency virus (HIV) status improves adherence to antiretroviral therapy (ART) and increases the chance of virological suppression and retention in care. However, information on the effect of disclosure of HIV status on adherence to clinic visits and patient representation is limited. We evaluated the effects of disclosure of HIV status on adherence to clinic visits and patient representation among people living with HIV in eastern Uganda. Methods: In this quasi-randomized study, we performed a propensity-score-matched analysis on observational data collected between October 2018 and September 2019 from a large ART clinic in eastern Uganda. We matched participants with disclosed HIV status to those with undisclosed HIV status based on similar propensity scores in a 1:1 ratio using the nearest neighbor caliper matching technique. The primary outcomes were patient representation (the tendency for patients to have other people pick-up their medications) and adherence to clinic visits. We fitted a logistic regression to estimate the effects of disclosure of HIV status, reported using the odds ratio (OR) and 95% confidence interval (CI). Results: Of 957 participants, 500 were matched. In propensity-score matched analysis, disclosure of HIV status significantly impacts adherence to clinic visits (OR = 1.63; 95% CI, 1.13–2.36) and reduced patient representation (OR = O.49; 95% CI, 0.32–0.76). Sensitivity analysis showed robustness to unmeasured confounders (Gamma value = 2.2, p = 0.04). Conclusions: Disclosure of HIV status is associated with increased adherence to clinic visits and lower representation to collect medicines at the clinic. Disclosure of HIV status should be encouraged to enhance continuity of care among people living with HIV.
HIV infection modifies the relationship between distance to a health facility and treatment success rate for tuberculosis in rural eastern Uganda
(Elsevier, 2021-03-04) Izudi, Jonathan; olupot, Ben
Rationale: Distance from residence to a health facility especially in rural areas presents a physical barrier and may influence tuberculosis (TB) treatment outcomes. Objectives: We examined the association between distance from residence to a health facility and TB treatment outcomes namely treatment success rate (TSR) and mortality, and whether HIV influences this relationship among people with TB in Kumi district in rural eastern Uganda. Methods: In this cross-sectional design, we abstracted data from TB unit registers across four large health facil-ities. Travel of ≥5 km to a health facility was considered a long distance. The primary outcome was TSR and the secondary was mortality. We performed a generalized linear model with Poisson distribution with a log-link and robust standard errors to determine the association between distance and the study outcomes adjusting for potential confounders. We report the adjusted risk ratio (aRR) and 95% confidence interval (CI). Measurement and results: Of 611 participants studied, 484 (79.2%) were successfully treated, 18 (2.9%) died, and 359 (58.7%) travelled a long distance to access TB treatment. Long-distance was significantly associated with lower TSR (aRR, 0.93; 95% CI, 0.89–0.96). Further analysis showed that longer distance was associated with lower TSR among HIV positive persons with TB (aRR, 0.83; 95% CI, 0.72–0.96), but not among HIV negative persons with TB (aRR, 0.94; 95% CI, 0.85–1.03). Although it was not significant, longer distance showed a tendency towards worse mortality among HIV positive people with TB (aRR, 2.78; 95% CI, 0.80–9.66), but not among HIV negative people with HIV (aRR, 0.21; 0.03–1.74). Conclusions: A majority of people with TB travel long distances to access treatment. Long distances are associated with lower TSR and higher mortality and affect people with TB who are HIV positive but not HIV negative. Interventions should focus on improving access to treatment for people with TB who travel long distances.
Low level of tuberculosis preventive therapy incompletion among people living with Human Immunodeficiency Virus in eastern Uganda: A retrospective data review
(Elsevier, 2021-08-28) Lwevola, Paul; Izudi, Jonathan; Kimuli, Derrick; Komuhangi, Alimah; Okoboi, Stephen
ntroduction: In most developing countries, tuberculosis (TB) is the leading cause of mortality among people living with the Human Immunodeficiency Virus (PLHIV). Uganda implements TB preventive therapy (TPT) using Isoniazid but data are limited about TPT incompletion. We, therefore, assessed the magnitude of TPT incom- pletion and the associated factors among PLHIV in a large rural referral health facility in rural eastern Uganda. Methods and materials: We conducted a retrospective data review for PLHIV initiated on TPT between October 2018 and September 2019. The outcome variable was TPT incompletion defined as the failure to finish 6 consecutive months of Isoniazid or failure to finish 9 months of Isoniazid without stopping for more than 2 months at a time. We descriptively summarized numerical data using frequencies and percentages and compared differences in the outcome with independent variables using the Chi-square or fisher’s exact, and the Student’s t- tests. We used a generalized linear model to assess factors independently associated with TPT incompletion, reported using adjusted odds ratio (aOR) and 95% confidence interval (CI). Results: We enrolled 959 participants with a mean age of 41.1 ± 13.8 years, 561 (58.5%) were females, 663 (69.1%) married, 538 (56.1) travelled 5–10 km from their place of residence to the ART clinic, 293 (30.6%) had disclosed HIV status, 362 (37.7%) had been on ART for 5–9 years, and 923 (96.2%) were on first-line ART regimen. We found 26 (2.7%) participants had incomplete TPT. Non-adherence to ART clinic visits (aOR, 2.81; 95% CI, 1.09–7.73), history of switch in ART regimen (aOR, 9.33; 95% CI, 1.19–52.39), patient representation (aOR, 4.70; 95% CI, 1.35–13.99), and one unit increase in ongoing counselling session (aOR, 0.67; 95% CI, 0.46–0.91) were associated with TPT incompletion. Conclusion: We found low rates of TPT incompletion among PLHIV in rural eastern Uganda. Non-adherence to ART clinic visits, patient representation, and history of switch in ART regimen is associated with a higher likelihood of TPT incompletion while ongoing counselling is associated with a reduction in TPT incompletion. The health system should address non-adherence to ART clinic visits and patient representation, through ongoing psychosocial support
Retention of HIV exposed infants in care at Arua regional referral hospital, Uganda:
(BMC Public Health, 2019-04-25) Apangu, Pontius; Izudi, Jonathan; Bajunirwe, Francis; Mulogo, Edgar; Batwala, Vincent
Background: Retention of HIV Exposed Infants (HEIs) in care ensures adequate care. Data on retention of HEIs at large referral hospitals in Uganda is limited. We investigated the retention level of HEIs and associated factors. Methods: We conducted a retrospective cohort study on 352 HEIs in care (January 2014 and April 2015) at Arua Regional Referral Hospital, North-western Uganda. Electronic medical data were retrieved and analyzed with Stata. Chi-square, Fisher’s exact, and Students t-tests were used for bivariate analysis. Logistic regression was performed to determine factors independently associated with retention. Results: 236 (67.0%) HEIs were delivered in a health facility and 306 (86.9%) received Nevirapine prophylaxis from birth until 6-weeks. Of mothers, 270 (76.7%) were 25–46 years, 202 (57.4%) attended antenatal care (ANC) at recent pregnancy, and 328 (93.2%) were on life-long anti-retroviral therapy. At 18-months, 277 (78.7%) HEIs were retained in care. Maternal age (25–46 years) (Adjusted Odds Ratio (AOR), 2.32; 95% CI, 1.32–4.06), ANC attendance during recent pregnancy (AOR, 2.01; 95% CI, 1.19–4.3.41) and Nevirapine prophylaxis initiation from birth until 6-weeks (AOR, 3.07; 95% CI, 1.50–6.26) were associated with retention. Conclusion: Retention was suboptimal. Older maternal age, ANC visits at last pregnancy, and timely NVP initiation increased retention.
Retention of HIV-Positive Adolescents in Care:
(Hindawi, 2018-05-06) Izudi, Jonathan; Mugenyi, John; Mugabekazi, Mary; Muwanika, Benjamin; Tumukunde, Victor Spector; Katawera, Andrew; Kekitiinwa, Adeodata
Background. Low retention of HIV-positive adolescents in care is a major problem across HIV programs. Approximately 70% of adolescents were non-retained in care at Katooke Health Center, Mid-Western Uganda. Consequently, a quality improvement (QI) project was started to increase retention from 29.3% in May 2016 to 90% in May 2017. Methods. In May 2016, we analyzed data for retention, prioritized gaps with theme-matrix selection, analyzed root causes with fishbone diagram, developed site-specific improvement changes and prioritized with countermeasures matrix, and implemented improvement changes with Plan-Do-Study-Act (PDSA). Identified root causes were missing follow-up strategy, stigma and discrimination, difficult health facility access, and missing scheduled appointments. Interventions tested included generating a list of adolescents who missed scheduled appointments, use of mobile phone technology, and linkage of adolescents to nearest health facilities (PDSA 1), Adolescent Only Clinic (PDSA 2), and monthly meetings to address care and treatment challenges (PDSA 3). Results. Retention increased from 17 (29.3%) in May 2016 to 60 (96.7%) in August 2016 and was maintained above 90% until May 2017 (with exception of February and May 2017 recording 100% retention levels). Conclusion. Context-specific, integrated, adolescent-centred interventions implemented using QI significantly improved retention in Mid-Western Uganda.