Staff papers

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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.
Socio-Ecological model factors influencing fruit and vegetable consumption among adolescents in Nakawa division, Kampala Capital City Authority, Uganda
(open access text, 2018-01-02) Nagawa, Margaret; Kirabira, Peter; Atuhairwe, Christine; Taremwa, Ivan Mugisha
There is ample evidence to assert the benefits of fruits and vegetable (F&V ) consumption towards health promotion and chronic disease prevention. Despite this, most of the population does not meet the recommendations of consumption. This study assessed the factors that influence fruits and vegetable consumption using a socio ecological model among adolescents in Nakawa division, Kampala Capital City Authority in Uganda. A cross-sectional study was conducted on 301 adolescents, using an interviewer-administered questionnaire. Data was analyzed using SPSS and presented as tables. Statistical significance was considered for variables with p values less than 0.05. While 282 (93.7%) of the respondents regarded it vital to eat fruits and vegetables, only 47.2% ate them weekly, 23.6% bi-weekly and 24.6% after every fortnight; with bananas as the most (52.5%). Consumption of fruits and vegetables was significantly associated with variables of type of school attended, attitude, discussion of community gatherings and lack of religious taboos. Interventions ought to be multi-sectorial to promote fruits and vegetable intake such as health education. Also, increased fruit and vegetable production is desired to augment their uptake as a daily meal serving.
Virologic failure in HIV-positive adolescents with perfect adherence in Uganda:
(BMC Palliative care, 2019-01-17) Natukunda, Julian; Kirabira, Peter; Ong, Ken Ing Cherng; Shibanuma, Akira; Jimba, Masamine
Background: Adolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adolescents in sub-Saharan Africa where the biggest burden of deaths is experienced. This study aimed to identify the factors associated with viral load suppression among HIV-positive adolescents (10–19 years) receiving antiretroviral therapy (ART) in Uganda. Methods: We conducted a cross-sectional study among school-going, HIV-positive adolescents on ART from August to September 2016. We recruited 238 adolescents who underwent ART at a public health facility and had at least one viral load result recorded in their medical records since 2015. We collected the data of patients’ demographics and treatment- and clinic-related factors using existing medical records and questionnaire-guided face-to-face interviews. For outcome variables, we defined viral suppression as < 1000 copies/mL. We used multivariate logistic regression to determine factors associated with viral suppression. Results: We analyzed the data of 200 adolescents meeting the inclusion criteria. Viral suppression was high among adolescents with good adherence > 95% (adjusted odds ratio [AOR] 2.73, 95% confidence interval [95% CI, 1.09 to 6.82). However, 71% of all adolescents who did not achieve viral suppression were also sufficiently adherent (adherence > 95%). Regardless of adherence status, other risk factors for viral suppression at the multivariate level included having a history of treatment failure (AOR 0.26, 95% CI, 0.09 to 0.77), religion (being Anglican [AOR 0.19, 95% CI, 0.06 to 0.62] or Muslim [AOR 0.17, 95% CI, 0.05 to 0.55]), and having been prayed for (AOR 0.38, 95% CI, 0.15 to 0.96). Conclusion: More than 70% of adolescents who experienced virologic failure were sufficiently adherent (adherence > 95). Adolescents who had unsuppressed viral loads in their initial viral load were more likely to experience virologic failure upon a repeat viral load regardless of their adherence level or change of regimen. The study also shows that strong religious beliefs exist among adolescents. Healthcare provider training in psychological counseling, regular and strict monitoring of adolescent outcomes should be prioritized to facilitate early identification and management of drug resistance through timely switching of treatment regimens to more robust combinations.

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Browsing Staff papers by Subject "Adolescents"