Browsing by Author "Kabami, Jane"

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    Adherence to Viral Load Testing Guidelines, Barriers, and Associated Factors Among Persons Living with HIV on ART in Southwestern Uganda: a Mixed-Methods Study.
    (Kabale University, 2024) Lubega, Polly; Nalugya, Sylivia Juliet; Kimuli, Angella Namyalo; Twinokusiima, Majoreen; Khasalamwa, Mercy; Kyomugisa, Richard; Kabami, Jane; Owaraganise, Asiphas
    Background: Uganda adapted Viral load (VL) testing for monitoring HIV treatment success and virologic failure. However, there is a paucity of data on how the VL testing guidelines are followed in practice in HIV clinics. This study determined the adherence to national guidelines on VL testing, barriers, and associated factors in persons living with HIV (PLHIV) on ART in southwestern Uganda. Methods: We conducted a cross-sectional mixed methods study from April to May 2021 at four HIV clinics in southwestern Uganda. Patient chart review using a checklist that captured age, gender, and level of a healthcare facility, dates of ART initiation, dates VL specimens were drawn, line of ART, and patient adherence to ART was done. Continuous data were summarized using mean and median and Chi-square was used for categorical data. We performed regression analysis to determine factors associated with adherence to viral load testing guidelines at a 95% level of significance. Key informant interviews with managers of the health facility, ART clinic, and laboratory were carried out, and thematic analysis was conducted to explore barriers to adherence to VL testing guidelines. Results: The participants’ mean (SD) age was 39.9(±13.1) years, 39.5% were male, 45.8% received care at a general hospital and the median duration of ART was 5 years (IQR;3–7). Of the 395 patient charts reviewed, 317 had their VL testing (80.3%) per the guidelines (defined as up to one month post-due date). Receiving care at a hospital (aOR=2.20; 95%CI 1.30–3.70; p=0.002) and increasing patient age (aOR=1.02; 95%CI 1.02–1.06; p=0.020) were the factors associated with adhering to VL testing guidelines. Long turnaround times of VL results and insufficient VL testing kits were cited by providers as barriers. Conclusion: We found suboptimal adherence to VL testing guidelines in PLHIV on ART in southwestern Uganda. Increasing patient age and getting care at a higher-level health facility were associated with guideline-based viral VL testing. The long turnaround time of VL test results and inadequate test kits hindered compliance with VL monitoring guidelines. Strategies that target young PLHIV and lower-level health facilities, increase the stock of consumables, and Shorten VL results turnaround time are needed to improve adherence to VL testing guidelines.
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    Enrollment and Retention of Female Sex Workers in HIV Care in Health Facilities in Mbarara City.
    (Kabale University, 2024) Arinaitwe, Bridget; Ariho, Philbert; Naturinda, Christine Hilda; Byoleko, Brian; Base, Anitah; Atwijukiire, Humphrey; Matavu, Hariat; Kabami, Jane; Obua, Celestine; Wakida, Edith K.; Otwine, Anne
    Background: Sex work is a global driver of the HIV epidemic, and the risk of acquiring HIV is 13 times higher for female sex workers (FSWs) compared to the general population. The enrollment and retention of FSWs in HIV care is a challenge and has been a major contributing factor to increased new HIV infections. Methods: We conducted a qualitative study among 30 FSWs and 21 healthcare workers (HCWs) working in antiretroviral therapy (ART) clinics at the selected three primary health facilities in Mbarara City, Southwestern Uganda. The study participants were enrolled by both purposive and snowball sampling techniques. We obtained informed consent from all the participants, and data were collected using in-depth interviews and thematically analyzed. Results: Three themes emerged as facilitators toward enrollment and retention of FSWs into HIV care, namely, (1) good health living, (2) receptive HCWs and availability of health services, and (3) community outreach services and peer support. The barriers are summarized into four major themes: (1) stigma, community discrimination, and beliefs; (2) social obstacles; (3) adverse effects of ART; and (4) inadequate services at the health facilities. Conclusion: FSWs are challenged by unsupportive environments and communities where they live and work, which hinders their enrollment and retention in HIV care. Creating awareness of the utilization of HIV care services and extending such services to hotspot communities could enhance the response of HIV-positive FSWs to ART.
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    Experiences and Perceptions on Community Client-Led ART Delivery (CCLADS) Model of Antiretroviral (ART) Delivery: Patients’ and Providers’ Perspectives in South Western Uganda.
    (Kabale University, 2024) Kasande, Meble; Tusimiirwe, Happiness; Taremwa, Michael; Lamulatu, Kabiite; Amanyire, Mark; Nakidde, Gladys; Kabami, Jane
    Purpose: Community Client-Led ART Delivery groups (CCLADS) were introduced as part of the differentiated service delivery models in 2017 to better serve the growing number of HIV patients and reduce unnecessary burden on the HIV care delivery system. However, there is limited evidence on the exact experiences and perceptions of patients and care providers regarding the CCLADS model of ART delivery. We, therefore, aimed to explore the experiences and perceptions of the CCLADS model from the patient and provider perspectives. Participants and Methods: A descriptive qualitative study was conducted at two ART clinics in Southwestern Uganda. We conducted in-depth interviews (IDI) to get a deeper understanding of the patient and providers’ perspectives regarding the model. Responses from participants were recorded using audio recorders and were translated and transcribed. We used a thematic approach to analyze the data. Results: A total of 20 in-depth interviews were conducted, with providers, CCLAD leaders, and Adults Living with HIV (ALHIV) to assess the experiences and perceptions of participation among People Living with HIV (PLHIV) enrolled in CCLADS and the care providers. Key themes included benefits, limitations, experiences, and perceptions of CCLADS. Benefits to ALHIV included: Longer refills, reduced transport costs, receiving drugs in time, and peer advice; to providers: time-saving, less tiresome, and reduced congestion at the facility. Barriers included: stigma, limited outreaches, and failure to comply. Patients perceived the model positively (cost-effective, improved quality care, no missed appointments), whereas others perceived it negatively (blood samples were not taken like before). Experiences also included enough time, learning some activities, and good adherence. Conclusion: Participation in the CCLADS groups provides several benefits to the patient including reduced transport, longer refills, and good adherence. Stigma remains a challenge to CCLADS participation, which requires innovative and collaborative strategies from the Ministry of Health (MOH) and implementation partners to address to sustain CCLADS participation.
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    Experiences of HIV Positive Serostatus Disclosure to Sexual Partner Among Individuals in Discordant Couples in Mbarara City, Southwestern Uganda.
    (Kabale University, 2024) Atwijukiire, Humphrey; Nakidd, Gladys; Tweheyo, Otwine Anne; Kabami, Jane
    Purpose: Disclosure of HIV status is key in HIV management. Despite many studies on serostatus disclosure, there is a gap in experiences regarding HIV status disclosure among discordant couples. The current study addressed this research gap and explored the lived experiences of serostatus disclosure among discordant couples in Mbarara City, South Western Uganda. Participants and Methods: We conducted 12 in-depth interviews with the help of a translated interview guide, and they were audio recorded. Participants were purposively enrolled in the study, which employed a phenomenological qualitative design. The study was conducted at three public health facilities in Mbarara City. The data was analyzed using thematic content analysis. Approval for this research was obtained from the Mbarara University Research Ethics Committee (MUST-REC) and administrative clearance from the city clerk of Mbarara City. Results: The mean age of the participants was 38 years old, ranging from 20 to 67 years. An equal number of males (six) and females participated in this study. Most of them had at least secondary level education, and only three had primary education. Half of the participants disclosed their serostatus to partners immediately after testing HIV positive. Key emerging themes as experienced benefits of HIV serostatus disclosure included: 1) social support and care; 2) decisions regarding health, fertility, and childbearing; 3) sharing information on HIV prevention and protection measures; 4) positive living; and 5) ease of HIV serostatus disclosure. The challenges associated with serostatus disclosure were summarized as one theme: misunderstandings in the families of the discordant couples. Conclusion: Socially, psychologically, and financially HIV positive individuals have benefited from their negative partners. Healthwise, they have been supported and cared for after disclosing their positive status, but some have faced challenges, such as family misunderstandings. Couple HIV counseling and testing by a trained health worker is beneficial in HIV care and could mitigate the challenges related to HIV serostatus disclosure.
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    Factors Associated with Healthcare-Seeking Behavior among Health Profession Students in Selected Universities in Southwestern Uganda.
    (Kabale University, 2024) Wamaani, Hannington Gamukama; Olum, Ronald; Ajuna, Noble; Atwijukire, Humphrey; Kabami, Jane; Asiimwe, John Baptist
    Introduction: Health professional students (HPS) tend to seek informal health care associated with self-medication (SM). Therefore, this study investigated the factors associated with healthcare-seeking behavior (HSB) among HPS. Methods: The study employed a cross-sectional design. Four hundred (400) HPS from two universities Bishop Stuart University (BSU) and Kampa- la International University Western Campus (KIU)] in southwestern Uganda were selected using a convenience sampling method. Data was collected using a Google form containing structured questions. The link to the questionnaire was sent to prospective participants via WhatsApp platform or email between September and November 2021. Ethical clearance was obtained from the Mbarara University Research Ethics Committee. Data were entered into SPSS software and analyzed using descriptive chi-square statistics, and logistic regression. HSB was considered formal or appropriate if the participant usually sought healthcare from a health worker. Results: A total of 400 HPS were enrolled, 60.3% were males, and the mean age of the participants was 23.06 (SD =2.74) years. Fifty-seven percent (57.5%) of the participants consulted a health worker when ill in the last 12 months (had formal HSB). Most participants’ main reason for seeking health care was to treat the underlying illness (73.3%). About sixty-nine percent (68.6%) of the participants treated themselves during the most recent illness or health problem. Most of the partici- pants searched the internet for health-related information when ill at some point. (Sometimes = 35.8%, Always = 27%, Often = 16%).The academic year of HPS (P < 0.001), access to health facilities (P = 0.018), being too busy (P =0.028), and minor illnesses (P < 0.001) were significantly associated with healthcare-seeking behavior. The lower academic years 1 & 2 (OR = 0.453, P < 0.001, 95% CI = 0.296 - 0.695) and easy access to the health facility (OR = 0.447 P < 0.001, 95% CI = 0.287 - 0.696) were predictors of formal HSB, being too busy (OR = 1.620, P = 0.049, 95% CI = 1.002 - 2.621) and having a minor illness (OR = 2.465, P< 0.001, 95% CI = 1.597 - 3.803) were predictors of informal healthcare seeking behavior. Conclusion: Our study findings indicate that a larger proportion of the participants sought formal health advice upon getting ill although others resorted to self-medication. Accessibility to health facilities and lower academic years predicted formal healthcare-seeking behavior while minor illnesses and being too busy predicted informal HSB among health profession students. Health training institutions should have easily accessible student-friendly healthcare facilities to promote formal healthcare-seeking behavior.
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    “I Desire to Have an HIV‐Free Baby”: Pregnant and Breastfeeding Mothers’ Perceptions of Viral Load Testing and Suppression in HIV Care in Southwestern Uganda.
    (Kabale University, 2024) Kabami, Jane; Akatukwasa, Cecilia; Kabageni, Stella; Nangendo, Joanita; Byamukama, Ambrose; Atwiine, Fredrick; Mftumukiza, Valence; Tamu, Munezero John Bosco; Arinaitwe, Elizabeth; Mutabazi, Andrew; Ssebutinde, Peter; Musoke, Phillipa; Kamya, Moses R.; Katahoire, Anne R.
    Introduction Viral suppression is a critical component for preventing mother-to-child transmission of HIV(MTCT). Mothers’ perceptions of viral load suppression is crucial in the attainment of successful outcomes in preventing mother-to-child transmission of HIV. We therefore aimed to explore the experiences and perceptions of women on viral suppression. Methods This was a qualitative sub-study embedded in a cluster-randomized trial (NCT04122144) designed to improve viral load outcomes among pregnant and breastfeeding mothers living with HIV in four level III/IV health facilities in Southwestern Uganda. Thirty-two in-depth interviews were conducted with pregnant and breastfeeding women with HIV from 1st March 2020 to 30th September 2020 to explore their understanding and interpretation of viral suppression. Interviews were audio-recorded, transcribed, and coded in Dedoose software for analysis. Results A total of 32 Women living with HIV were enrolled in this qualitative study. WLHIV explained viral suppression in the context of attaining good health and having HIV-free babies. Adherence to ART was presented as a key avenue to viral suppression. The level of engagement with providers was presented as a key attribute of attaining viral suppression. The participants narrated their experiences with viral load testing within the routine services. However, they revealed experiencing some proximate barriers to suppression, including anticipated stigma, challenges with nondisclosure of HIV status, pregnancy distress, and distance to the health facility. Conclusion The understanding and interpretation of viral suppression among pregnant and breastfeeding mothers living with HIV provides a basis for adopting behaviors leading to the prevention of vertical transmission of HIV. Health care workers can support women by providing clear and culturally appropriate education about viral suppression, adherence strategies and creating a supportive and non-judgmental environment.
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    Prevalence of and Risk factors associated with hypertension: a community based- cross sectional study in Ndorwa West Health Sub District, Kabale district, southwestern Uganda.
    (Kabale University, 2024) Munezero,Tamu John Bosco; Mfitumukiza, Valence; Okafor, Christiana Nkiru; Mandera, Immaculate; Kabami, Jane; Arineitwe, Edward Bwengye; Namuyibwa, Lydia; Izo, Herbert; Baikaitwoha, Everd M.; Okonkwo, Uchenna Prosper
    Globally, one billion people have hypertension (HT), it kills 9.4 million people annually. Prevalence is higher in developed countries and is rapidly rising in developing countries, and approximately 31.5% of Ugandans have HT. This study aimed to determine the prevalence of and risk factors associated with HT among adults aged 25–65 years in the Ndorwa West HSD, Kabale District. A community-based cross-sectional survey was conducted with 381 adults aged 25–65 years in Ndorwa West HSD, using a modified WHO STEPwise approach to chronic disease risk factor surveillance. Chi-square tests with 95% Confidence Intervals (CI) and p-values less than 0.05, were used to assess the association between hypertension and associated factors. Odds Ratios (OR) with their corresponding 95% confidence intervals (95% CI) estimated the risk. The prevalence of HT and pre-HT in Ndorwa HSD was 28.3% and 45.7%, respectively. 61.8% (n = 243) were females and 36.1% (n = 142) were males with a mean age of 48.18 years and standard deviation of 11.5 years. The mean Body Mass Index (BMI) was 25.92 kg/m2 and the standard deviation was 3.69 kg/m2. Only Age (p = 0.010, OR = 1.81(1.14–2.87) and level of education (p = 0.04) were significantly associated with hypertension. age ≥ 45years increased the likelihood of developing HT by 0.81 times. Behavioral factors associated with HT included awareness of the BP status (p = 0.010, OR = 0.53(CI: 0.32–0.87),use of fats/oil for cooking (p = 0.02, OR = 1.73 (CI: 1.09–2.75)), reduced salt intake (p = 0.001, OR = 0.075(CI:0.01–0.55)), and overweight and obesity (BMI) level ( p = 0.010, OR = 1.77 (CI 1.12–2.80)). BMI ≥ 25kg/m2 increased the likelihood of developing HT by 0.77 times. The prevalence of HT and pre-HT in this rapidly transitioning rural–urban population was high. The risk of CVDs is about 16 folds higher among pre-HT compared to no HT and doubles for every 10-mmHg increase in BP. Hence, the considerable risk and burden of HT and related CVDs that require a dire need to adopt strategies to prevent and control hypertension based on the identified associated risk factors in Ndorwa HSD