Browsing by Author "Okoboi, Stephen"

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Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda:
(Wiley Online Library, 2019-04-01) Okoboi, Stephen; Twimukye, Adelline; Oucul, Lazarus; Castelnuovo, Barbara; Agaba, Collins; Muloni, Immaculate; Nanfuka, Mastula; Kambugu, Andrew; King, Rachel
Introduction: HIV self-testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the accept- ability, perceived reliability and challenges associated with distributing HIV self-test (HIVST) to young men who have sex with men (MSM) in Uganda. Methods: Between February and May 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management. Results: MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non-painful; and non-stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop-in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services. Conclusions: Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow-up, linkage to HIV care and prevention services are needed for effective results.
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.
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
Peer distribution of HIV self-test kits to men who have sex with men to identify un-diagnosed HIV infection in Uganda:
(Plos One, 2020-01-23) Okoboi, Stephen; Oucu, Lazarus; Castelnuovo, Barbara; Nanfuka, Mastula; Kambugu, Andrew; Mujugira, Andrew; King, Rachel
Introduction One-in-three men who have sex with men (MSM) in Uganda have never tested for HIV. Peer-driven HIV testing strategies could increase testing coverage among non-testers. We evaluated the yield of peer distributed HIV self-test kits compared with standard-of-care testing approaches in identifying undiagnosed HIV infection. Methods From June to August 2018, we conducted a pilot study of secondary distribution of HIV self-testing (HIVST) through MSM peer networks at The AIDS Support Organization (TASO) centres in Entebbe and Masaka. Peers were trained in HIVST use and basic HIV counselling. Each peer distributed 10 HIVST kits in one wave to MSM who had not tested in the previous six months. Participants who tested positive were linked by peers to HIV care. The primary outcome was the proportion of undiagnosed HIV infections. Data were analysed descriptively. Results A total of 297 participants were included in the analysis, of whom 150 received HIVST (intervention). The median age of HIVST recipients was 25 years (interquartile range [IQR], 22–28) compared to 28 years IQR (25–35) for 147 MSM tested using standard-of-care (SOC) strategies. One hundred forty-three MSM (95%) completed HIVST, of which 32% had never tested for HIV. A total of 12 participants were newly diagnosed with HIV infection: 8 in the peer HIVST group and 4 in the SOC group [5.6% vs 2.7%, respectively; P = 0.02]. All participants newly diagnosed with HIV infection received confirmatory HIV testing and were initiated on antiretroviral therapy. Conclusion Peer distribution of HIVST through MSM networks is feasible and effective and could diagnose more new HIV infections than SOC approaches. Public health programs should consider scaling up peer-delivered HIVST for MSM.
Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda:
(plus one, 2020-01-23) Okoboi, Stephen; Oucul, Lazarus; Castelnuovo, Barbara; Nanfuka, Nanfuka; Kambugu, Andrew; Mujugira, Andrew; King, Rachel
Introduction One-in-three men who have sex with men (MSM) in Uganda have never tested for HIV. Peer-driven HIV testing strategies could increase testing coverage among non-testers. We evaluated the yield of peer distributed HIV self-test kits compared with standard-of-care testing approaches in identifying undiagnosed HIV infection. Methods From June to August 2018, we conducted a pilot study of secondary distribution of HIV self- testing (HIVST) through MSM peer networks at The AIDS Support Organization (TASO) centres in Entebbe and Masaka. Peers were trained in HIVST use and basic HIV counselling. Each peer distributed 10 HIVST kits in one wave to MSM who had not tested in the previous six months. Participants who tested positive were linked by peers to HIV care. The primary outcome was the proportion of undiagnosed HIV infections. Data were analysed descriptively. Results A total of 297 participants were included in the analysis, of whom 150 received HIVST (intervention). The median age of HIVST recipients was 25 years (interquartile range [IQR], 22– 28) compared to 28 years IQR (25–35) for 147 MSM tested using standard-of-care (SOC) strategies. One hundred forty-three MSM (95%) completed HIVST, of which 32% had never tested for HIV. A total of 12 participants were newly diagnosed with HIV infection: 8 in the peer HIVST group and 4 in the SOC group [5.6% vs 2.7%, respectively; P = 0.02]. All participants newly diagnosed with HIV infection received confirmatory HIV testing and were initiated on antiretroviral therapy. Conclusion Peer distribution of HIVST through MSM networks is feasible and effective and could diagnose more new HIV infections than SOC approaches. Public health programs should consider scaling up peer-delivered HIVST for MSM.
Pre-lacteal Feeding Among Infants Within the FirstWeek of Birth in Eastern Uganda:Evidence From aHealth Facility-based Cross-sectional Study
(Research Square, 2021-05-17) Akello, Rachael; Kimuli, Derrick; Okoboi, Stephen; Komuhangi, Alimah; Izudi, Jonathon
Background: Pre-lacteal feeding hinders early initiation of breastfeeding and exclusive breastfeeding butis understudied in Uganda. We examined the prevalence and factors associated with pre-lacteal feedingamong postpartum mothers in Kamuli district in rural eastern Uganda.Methods: We conducted a cross-sectional study at four large healthcare facilities and randomly sampledmother-baby pairs attending postnatal care clinics.