Publications

Epidemiology of HPV genotypes in Uganda and the role of current preventive vaccines: A systematic review. BMC Infectious Agents and Cancer; 2011, 6(1): 11

Banura C, Mirembe F, Katahoire, A, Namujju P, Mbonye A, Wabwire F.

HPV vaccination strategies targeting hard-to-reach populations: Out-of-school girls in LMICs

Highlights
• High HPV vaccination coverage is critical for preventing cervical cancer worldwide.
• School-based programs effectively deliver vaccines to adolescents attending school.
• We propose ways to ensure out-of-school girls have equitable access to HPV vaccines.
• Important to quantify out-of-school girls and research barriers to HPV vaccination.
• To increase uptake, consider targeted communication, outreach, and integrated programs.

Keywords
HPV; Human papillomavirus vaccine; Cervical cancer; Implementation; Vaccine uptake; Vaccination programs; Adolescents; School-based programs; LMICs; Africa

Kimberly Bonnera, Cecily Banurab, Nicole E. Bastaa

Schistosoma mansoni-Associated Morbidity among Preschool-Aged Children along the Shores of Lake Victoria in Uganda

Abstract: Schistosoma mansoni causes morbidity in human beings, with the highest prevalence in rural sub-Saharan Africa. Prolonged S. mansoni infection with egg deposition in intestinal blood vessels leads to liver and spleen enlargement, and thus chronic morbidity.

The objective of this study was to assess whether preschool-aged children develop severe S. mansoni-related morbidity. Parasitological, clinical, and ultrasonographic examinations were carried out in 916 preschool-aged children in five schistosomiasis-endemic districts (Bugiri, Buikwe, Jinja, Mayuge, and Namayingo) along the Lake Victoria shoreline in east-central Uganda.

Anaemia and anthropometry measurements were also taken. Using the Kato-Katz technique on one stool sample collected on three consecutive days, 74.9% (686/916) were found infected with S. mansoni; the majority were lightly infected (57.9%), while 22.7% and 19.4% were moderately and heavily infected, respectively. The overall geometric mean intensity (GMI) of infected children was 294.2 eggs per gram faeces. Mayuge and Jinja districts had the highest (51.2%) and lowest (2.2%) number of infected children, respectively. Hookworm infection was found in 7.8% (71/916) of the children. Both liver and spleen were significantly more enlarged in the infected children than in the uninfected children (p < 0.0005), as measured by ultrasonography.

Physical palpation of the spleen was more often detected in the uninfected children. A significantly (p < 0.0005) higher proportion of S. mansoni-positive children were anaemic (359/686; 52.3%) compared to the children who had no eggs in their stool samples (81/230; 35.2%). Schistosoma mansoni infection did not have any severe effect on the nutrition status of preschool-aged children. Neither infected nor uninfected children were found to be underweight or stunted. Liver fibrosis with distinct Symmer’s ‘pipe stems’ was found in a few heavily-infected children (0.3%). In a linear multivariable regression analysis, age of the child, anaemia, liver fibrosis, and size of the left liver lobe were associated with S. mansoni intensity of infection (adjusted R2 = 0.11; p < 0.0005). Our results demonstrate that S. mansoni-related morbidity does develop in children less than six years of age, and that older children (37–60 months) are at higher risk (regression coefficient 0.33; p <0.0005) compared to younger ones (12–36 months).

We recommend that preschool-aged children be included in the target population for schistosomiasis mass treatment so as to prevent the childhood chronic form of schistosomiasis. Keywords: Schistosoma mansoni; morbidity; preschool-aged children; Lake Victoria shoreline; Uganda

Allen Nalugwa 1,*, Fred Nuwaha 2 , Edridah Muheki Tukahebwa 3 and Annette Olsen 4

Investigating unlicensed retail drug vendors’ preparedness and knowledge about malaria: An exploratory study in rural Uganda

Background: Despite major efforts to increase the uptake of preventive measures and timely use of the first lineantimalarial treatment artemisinin-based combination therapies (ACT), Uganda continues to fall short of meeting its national malaria control targets. One of the challenges has been scaling up effective measures in rural and remote areas where the unlicensed private retail sector remains the first point of contact and a common source of treatment. The current paper discusses unlicensed vendors’ (1) training related to malaria case management
for children aged five and under, and (2) knowledge related to the cause of malaria, preventive measures, common signs, and symptoms, diagnostic procedures, and best treatment options.
Methods: A qualitative study using semi-structured interviews was conducted in the rural district of Butaleja, Uganda in 2011. All 88 unlicensed drug outlets enumerated in the study area were visited by six locally recruited research assistants, with one vendor from each outlet invited to participate. The transcripts were analyzed using acceptable qualitative research protocols. Results: About half of the 75 vendors interviewed had received some sort of formal training on malaria at a postsecondary institution, although only 6.7% had qualifications which met licensure requirements. The study found widespread misconceptions relating to the cause, as well as prevention and treatment of malaria. A large majority of the vendors relied primarily on non-specific symptoms and limited physical exams for diagnoses, with less than one-tenth of the vendors recognizing that rapid or microscopic blood testing was necessary to confirm a
clinical diagnosis of malaria. While most recognized mosquitoes as the primary vector for malaria, over two- fifths of the vendors held misconceptions about the factors that could increase the risk of malaria, and nearly a third believed that malaria could not be prevented. With respect to acute case management, three-quarters viewed as the best option a medicine other than the government’s first-line antimalarial, artemisinin-based combination therapies (ACT). Almost three-fifths specified quinine as their preferred option, with about one-fifth recommending quinine injection.Conclusion: Findings from this study confirm significant gaps in unlicensed vendors’ knowledge related to malaria. With increased utilization of unlicensed drug outlets in rural and remote settings such as Butaleja, findings from this study strongly supports the need to implement strategies to improve the quality of care delivered at these outlet.

Eric Liowa , Rosemin Kassama,⁎ , Richard Sekiwungab

Disclosure of HIV test results by women to their partners following antenatal HIV testing: a population-based cross-sectional survey among slum dwellers in Kampala Uganda.

Batte A, Katahoire A, Chimoyi A, Ajambo S, Tibingana B, Banura C.. BMC Public Health 2015, Jan 31;15(1):63

Tensions in Communication between Children on Antiretroviral Therapy and Their Caregivers: A Qualitative Study in Jinja District, Uganda

Phoebe Kajubi , Susan Reynolds Whyte , David Kyaddondo , Anne Ruhweza Katahoire

Communication between HIV-infected children and their caregivers about HIV medicines: a cross-sectional study in Jinja district, Uganda

Abstract
Introduction

Knowledge of antiretroviral therapy (ART) among children with HIV depends on open communication with them about their health and medicines. Guidelines assign responsibility for communication to children's home caregivers. Other research suggests that communication is poor and knowledge about ART is low among children on treatment in low-income countries. This study sought to describe communication about medicine for HIV in quantitative terms from the perspectives of both children and caregivers. Thereafter, it established the factors associated with this communication and with children's knowledge about their HIV medicines.

Methods

We undertook a cross-sectional survey of a random sample of 394 children with HIV on treatment and their caregivers at nine health facilities in Jinja District, Uganda. We assessed reported frequency and content of communication regarding their medicines as well as knowledge of what the medicines were for. Logistic regression analysis was used to determine the factors associated with communication patterns and children's knowledge of HIV medicines.

Results

Although 79.6% of the caregivers reported that they explained to the children about the medicines, only half (50.8%) of the children said they knew that they were taking medicines for HIV. Older children aged 15–17 years were less likely to communicate with a caregiver about the HIV medicines in the preceding month (OR 0.5, 95% CI 0.3–0.7, p=0.002). Children aged 11–14 years (OR 6.1, 95% CI 2.8–13.7, p<0.001) and 15–17 years (OR 12.6, 95% CI 4.6–34.3, p<0.001) were more likely to know they were taking medicines for HIV compared to the younger ones. The least common reported topic of discussion between children and caregivers was “what the medicines are for” while “the time to take medicines” was by far the most mentioned by children.

Conclusions

Communication about, and knowledge of, HIV medicines among children with HIV is low. Young age (less than 15 years) was associated with more frequent communication. Caregivers should be supported to communicate diagnosis and treatment to children with HIV. Age-sensitive guidelines about the nature and content of communication should be developed.

Keywords: children with HIV, antiretroviral therapy, HIV disclosure, therapeutic communication, Uganda

Phoebe Kajubi,§,1 Susan Whyte,*,2 Simon Muhumuza,*,1 David Kyaddondo,*,1 and Anne R Katahoire*,1

Young people with HIV attending a transition clinic in Kampala, Uganda: An exploratory study of social context, illness trajectories, and pathways to HIV testing and treatment

Abstract 

Despite global improvements in antiretroviral treatment (ART) access, little is known about how young people with HIV initially enter treatment.

This article explores young people's trajectories towards HIV treatment: how, when, and with whom testing and treatment decisions are made and the role of adolescents themselves in this process. In 2009, we conducted 20 in-depth interviews with male and female adolescents attending the HIV/AIDS Transition Clinic at the Infectious Diseases Institute in Mulago Hospital, Kampala, Uganda. Interviews were audio recorded and transcribed. The authors read the transcripts, developed codes and synthesized themes.

Though many respondents were likely infected with HIV at birth, most tested and learned their serostatus as teenagers after repeated illnesses or perceived risky sexual behaviour. Young people encountered both obstacles and opportunities in their HIV treatment-seeking efforts. Caregivers' decisions and actions or an absence of spe- cialist HIV services and skills caused delays in ART enrolment. Health workers played an important role in referral and connecting young people to care.

The agency of young people themselves, once they realised that their illness could be HIV, was also crucial in ensuring prompt HIV testing and treatment-seeking. Young people who believed they were infected through mother-to-child transmission saw themselves as innocent victims and appeared mo- tivated to combat HIV, while those suspecting sexual transmission found disclosure to parents difficult and de- scribed feelings of guilt, regret, and self-blame. Understanding pathways to HIV testing and treatment can inform care and support services for young people in Uganda. In particular, earlier disclosure may facilitate pos- itive coping strategies and engagement in care. © 2016 Elsevier Ltd. All rights reserved.

Godfrey E. Siu, Caitlin E. Kennedy , Sabrina Bakeera-Kitaka