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Meya DB, Kiragga AN, Nalintya E, Banturaki G, Akullo J, Kalyesubula P, Sessazi P, Bitakalamire H, Kabanda J, Kalamya JN, Namale A, Bateganya M, Kagaayi J, Gutreuter S, Adler MR, Mitruka K. Impact of an intensive facility-community case management intervention on 6-month HIV outcomes among select key and priority populations in Uganda. AIDS Res Ther 2022; 19:62. [PMID: 36471321 PMCID: PMC9724352 DOI: 10.1186/s12981-022-00486-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Key and priority populations (with risk behaviours and health inequities) are disproportionately affected by HIV in Uganda. We evaluated the impact of an intensive case management intervention on HIV treatment outcomes in Kalangala District, predominantly inhabited by fisher folk and female sex workers. METHODS This quasi-experimental pre-post intervention evaluation included antiretroviral therapy naïve adults aged ≥ 18 years from six health facilities in the pre-intervention (Jan 1, 2017-December 31, 2017) and intervention phase (June 13, 2018-June 30, 2019). The primary outcomes were 6-month retention and viral suppression (VS) before and after implementation of the intervention involving facility and community case managers who supported participants through at least the first three months of ART. We used descriptive statistics to compared the characteristics, overall outcomes (i.e., retention, lost to follow up, died), and VS of participants by phase, and used mixed-effects logistic regression models to determine factors associated with 6-month retention in care. Marginal (averaging over facilities) probabilities of retention were computed from the final multivariable model. RESULTS We enrolled 606 and 405 participants in the pre-intervention and intervention phases respectively. Approximately 75% of participants were aged 25-44 years, with similar age and gender distributions among phases. Approximately 46% of participants in the intervention were fisher folk and 9% were female sex workers. The adjusted probability of 6-month retention was higher in the intervention phase, 0.83 (95% CI: 0.77-0.90) versus pre-intervention phase, 0.73 (95% CI: 0.69-0.77, p = 0.03). The retention probability increased from 0.59 (0.49-0.68) to 0.73 (0.59-0.86), p = 0.03 among participants aged 18-24 years, and from 0.75 (0.71-0.78) to 0.85 (0.78-0.91), p = 0.03 among participants aged ≥ 25 years. VS (< 1,000 copies/mL) was approximately 87% in both phases. CONCLUSIONS After implementation of the case management intervention, we observed significant improvement in 6-month retention in all age groups of a highly mobile population of predominantly fisher folk.
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Affiliation(s)
- David B. Meya
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418 Kampala, Uganda ,grid.17635.360000000419368657Department of Medicine and International Health, University of Minnesota, Minneapolis, MN USA ,grid.11194.3c0000 0004 0620 0548School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Agnes N. Kiragga
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418 Kampala, Uganda
| | - Elizabeth Nalintya
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418 Kampala, Uganda
| | - Grace Banturaki
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418 Kampala, Uganda
| | - Joan Akullo
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418 Kampala, Uganda
| | - Phillip Kalyesubula
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418 Kampala, Uganda
| | - Patrick Sessazi
- grid.11194.3c0000 0004 0620 0548Infectious Diseases Institute, College of Health Sciences, Makerere University, Mulago Hill Road, 22418 Kampala, Uganda
| | | | - Joseph Kabanda
- grid.512457.0U.S Centers for Disease Control and Prevention, Kampala, Uganda
| | - Julius N. Kalamya
- grid.512457.0U.S Centers for Disease Control and Prevention, Kampala, Uganda
| | - Alice Namale
- grid.512457.0U.S Centers for Disease Control and Prevention, Kampala, Uganda
| | - Moses Bateganya
- grid.416738.f0000 0001 2163 0069U.S Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Joseph Kagaayi
- grid.452655.50000 0004 8340 6224Rakai Health Sciences, Program, Rakai Uganda ,grid.11194.3c0000 0004 0620 0548Makerere School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Steve Gutreuter
- grid.416738.f0000 0001 2163 0069U.S Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Michelle R. Adler
- grid.512457.0U.S Centers for Disease Control and Prevention, Kampala, Uganda
| | - Kiren Mitruka
- grid.416738.f0000 0001 2163 0069U.S Centers for Disease Control and Prevention, Atlanta, GA USA
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Tamale A, Ejobi F, Muyanja C, Naigaga I, Nakavuma J, Drago CK, Amulen DR. Sociocultural factors associated with fish consumption in Lake Albert fishing community: Guidelines for lead and mercury. COGENT ENVIRONMENTAL SCIENCE 2017; 3:1304604. [PMID: 30854410 PMCID: PMC6390268 DOI: 10.1080/23311843.2017.1304604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 03/06/2017] [Indexed: 06/09/2023]
Abstract
Fish consumption in subsistence fishing community is a life style associated with lead and mercury uptake for humans. Fish consumption is influenced by sociocultural factors, exposure and health risks. Unfortunately, no sociocultural study in the Lake Albert fishing community in light of lead and mercury exists. A cross-sectional sociocultural study was carried out between March and June 2015. A total of 270 household heads in four landing sites in Hoima district completed structured questionnaires and data analyzed using SPSS version 20. The majority of the households (74.8%) had primary education or below, 51.1% drank unboiled water, and 30% perceived lake water safe for drinking. Children under five ate soup (15%) and middle piece of the fish (29%). The Poisson general linear model predicting weekly fish consumption amounts against sociocultural factors showed that household size (p = 0.047), male child presence (p = 0.007), methods of preparation i.e. salting (p < 0.0001), fish parts consumed by adults (p < 0.0001), fish preference (p < 0.0001), awareness about the beach management unit (p < 0.0001), and income from charcoal selling (p < 0.0001) were positive predictors. The negative predictors of weekly fish consumption amounts were awareness about fish consumption benefits (p < 0.0001), eating young fish (p = 0.002), donor agency presence (p < 0.0001), and frying as the method of fish preparation (p = 0.002). In conclusion, knowledge of the sociocultural factors associated with fish consumption determines the amounts and frequency of the predominant fish eaten. Therefore, to establish and adopt fish consumption guidelines for lead and mercury in the Lake Albert, the sociocultural factors should be integrated in the message disseminated.
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Affiliation(s)
- Andrew Tamale
- College of Veterinary Medicine, Animal Resources, and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Francis Ejobi
- College of Veterinary Medicine, Animal Resources, and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Charles Muyanja
- Department of Food Technology and Nutrition, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Irene Naigaga
- College of Veterinary Medicine, Animal Resources, and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Jessica Nakavuma
- College of Veterinary Medicine, Animal Resources, and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
| | - Charles Kato Drago
- College of Veterinary Medicine, Animal Resources, and Biosecurity, Makerere University, P.O. Box 7062, Kampala, Uganda
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Andrew T, Francis E, Charles M, Naigaga I, Jesca N, Micheal O, Anne K, Deborah A. Perceptions about mercury and lead in fish consumed in Lake Albert fishing communities Uganda. COGENT FOOD & AGRICULTURE 2016; 2:1220344. [PMID: 27722182 PMCID: PMC5036227 DOI: 10.1080/23311932.2016.1220344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/01/2016] [Indexed: 05/31/2023]
Abstract
Fish consumption is a lifestyle in fishing communities influenced by individual and communal perceptions. However, information about individual perceptions about fish consumption in the vulnerable fishing community in a developing country is lacking. Without this study, the benefits of fish consumption in a vulnerable community may not be realized. Data collection was executed using key informant interviews and survey structured questionnaires. The key informants include fisheries, community development, veterinary, community and environmental officers. The household heads were the respondents. The Qualitative data was organized and queried using QSR Nvivo 10 and quantitative data analyzed with SPSS version 22. The perceived benefits of eating fish are health, income, nutrition and manhood. The perceived risks are Stigma and ill health. The factors increasing fish consumption are heedless of fish consumption benefits (p = 0.041) and household size i.e. number of adults more than seven (p = 0.020). Those decreasing are methods of preparation of fish i.e. boiling and frying (p = 0.019 and p = 0.010) and oblivious about organizations dealing with fishing activities (p = 0.029). An awareness campaign is needed to demystify the health benefits and fallacies of fish consumption. The knowledge on individual perceptions associated with fish consumption will increase fish consumption but with fewer risks.
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Affiliation(s)
- Tamale Andrew
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box. 7062, Kampala, Uganda
| | - Ejobi Francis
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box. 7062, Kampala, Uganda
| | - Muyanja Charles
- Department of Food Technology and Nutrition, MakerereUniversity, P.O Box 7062, Kampala, Uganda
| | - Irene Naigaga
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box. 7062, Kampala, Uganda
| | - Nakavuma Jesca
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box. 7062, Kampala, Uganda
| | - Ocaido Micheal
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, P.O. Box. 7062, Kampala, Uganda
| | - Katuhoire Anne
- College of Health Sciences, Makerere University, P.O. Box. 7062, Kampala, Uganda
| | - Amulen Deborah
- Department of Crop protection, Ghent University, Ghent, Belgium
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Sileo KM, Kintu M, Chanes-Mora P, Kiene SM. "Such Behaviors Are Not in My Home Village, I Got Them Here": A Qualitative Study of the Influence of Contextual Factors on Alcohol and HIV Risk Behaviors in a Fishing Community on Lake Victoria, Uganda. AIDS Behav 2016; 20:537-47. [PMID: 25921303 PMCID: PMC4626436 DOI: 10.1007/s10461-015-1077-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
In Uganda, elevated HIV prevalence in fishing communities along Lake Victoria have been attributed in part to heavy alcohol use, but qualitative research is needed to understand the contextual factors influencing alcohol and sexual risk. Eight focus group discussions were conducted (n = 50; 23 male, 27 female) in Gerenge, Uganda with five occupational groups: fishermen, fishmongers, alcohol-sellers, commercial sex workers, and restaurant owners. Data was analyzed using content analysis. Alcohol use was prevalent and said to influence risky sex. Sex-related alcohol expectancies and occupational factors influenced individuals to drink during sex and structural factors related to the built environment, economy, and policy were identified as key contributors to both alcohol use and sexual risk in general. The findings highlight alcohol reduction as an important component of HIV/AIDS prevention and suggest structural interventions should be prioritized in this context.
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Affiliation(s)
- Katelyn M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Michael Kintu
- Wakiso Integrated Rural Development Association, Entebbe, Uganda
| | - Paola Chanes-Mora
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA.
- Alcohol Research Center on HIV, Brown University School of Public Health, Providence, RI, USA.
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