Browsing by Author "Akello, Carolyne"

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    The association between depression, Quality of life, and the Health care expenditure of patients with diabetes mellitus in Uganda
    (Journal of Affective Disorders, 2015) Akena, Dickens; Kadama, Philippa; Ashaba, Scholastic; Akello, Carolyne; Kwesiga, Brendan; Rejania, Lalitha; Okello, James; Mwesiga, Emmanuel. K.; Obuku, Ekwaro. A.
    Background—Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa. Methods—We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures. Results—The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87–5.04)], younger [OR=3.98 CI (1.20–13.23)], un-employed [OR=1.99(CI 1.04–3.81)], and having lost a spouse [OR=2.36 (CI 1.29–4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47–0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95–0.99)], psychological [OR=1.05 (CI 1.03–1.07)], and environmental [OR=0.97, (CI 0.95–0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03–2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01–2.28)]. Limitation—The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes. Conclusions—Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.
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    The Association Between Depression,Quality Of Life,And The Health Care Expenditure Of Patients With Diabetes Mellitus In Uganda
    (Journal of Affective Disorders, 2015) Akena, Dickens; Kadama, Philippa; Ashaba, Scholastic; Akello, Carolyne; Kwesiga, Brendan; Rejani, Lalitha; Okello, James; Mwesiga, Emmanuel.K.; Obuku, Ekwaro.A.
    Depression is one of the commonest neuropsychiatric disorders in patients with diabetes mellitus (DM) and is associated with poor glycaemic control, vascular complications, a low quality of life and increased health care expenditure. Co-morbid DM and depression remains poorly identified and inadequately treated in sub-Saharan Africa.We conducted a cross-sectional survey of 437 patients with DM at 3 DM clinics in Uganda. Participants were assessed for depression, blood sugar levels, diabetic neuropathy, quality of life, and health care expenditures.The prevalence of depression was 34.8%. Depressed participants were more likely to be suicidal [OR=3.81, (CI 2.87–5.04)], younger [OR=3.98 CI (1.20–13.23)], un-employed [OR=1.99(CI 1.04–3.81)], and having lost a spouse [OR=2.36 (CI 1.29–4.31)]. Overall quality of life was poor [OR=0.67 (CI 0.47–0.96)], they scored poorer in the physical [OR=0.97, (CI 0.95–0.99)], psychological [OR=1.05 (CI 1.03–1.07)], and environmental [OR=0.97, (CI 0.95–0.99)] domains. They had an increased likelihood of incurring direct out-of-pocket payments for health care services [OR=1.56 (CI 1.03–2.36)], and were more likely to be impoverished [OR=1.52 (CI 1.01–2.28)].The cross sectional nature of this study makes it difficult to examine causation. More studies are required in order to better understand the associations and impact of the factors examined above on patient outcomes.Depression is highly prevalent among patients with DM in Uganda, and is associated with a number of adverse outcomes. A holistic approach that focuses on the depression management among patients with diabetes is recommended.
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    Case Study: Converting Paper-based Case Report Forms to an Electronic Format (e-CRF) with ACASI Self-Report Integration
    (Online journal of public health informatics, 2017) Mierzwa, Stan; Souidi, Samir; Akello, Carolyne; Etima, Juliane; Ssebagala, Richard; Nolan, Monica; Kabwigu, Samuel; Nakablito, Clemensia
    This paper will discuss the integration of electronic Case Report Forms (e-CRFs) into an already existing Android-based Audio Computer-Assisted Self-Interview (ACASI) software solution that was developed for a public health project in Kampala, Uganda, the technical outcome results, and lessons learned that may be useful to other projects requiring or considering such a technology solution. The developed product can function without a connection to the Internet and allows for synchronizing collected data once connectivity is possible. Previously, only paper-based CRFs were utilized at the Uganda project site. A subset or select group of CRFs were targeted for integration with ACASI in order to test feasibility and success. Survey volume, error rate, and acceptance of the system, as well as the operational and technical design of the solution, will be discussed.
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    Ethical considerations for involving adolescents in biomedical HIV prevention research
    (BMC Medical Ethics, 2021) Nakalega, Rita; Akello, Carolyne; Gati, Brenda; Nakabiito, Clemensia; Nolan, Monica; Kamira, Betty; Etima, Juliane; Nakyanzi, Teopista; Kemigisha, Doreen; Nanziri, Sophie C.; Nanyonga, Stella; Nambusi, Maria Janine; Mulumba, Emmie; Biira, Florence; Nabunya, Hadijah Kalule; Akasiima, Simon Afrika; Nansimbe, Joselyne; Maena, Joel; Babirye, Juliet Allen; Ngure, Kenneth; Mujugira, Andrew
    Background: Involvement of adolescent girls in biomedical HIV research is essential to better understand efficacy and safety of new prevention interventions in this key population at high risk of HIV infection. However, there are many ethical issues to consider prior to engaging them in pivotal biomedical research. In Uganda, 16–17-year-old adolescents can access sexual and reproductive health services including for HIV or other sexually transmitted infections, contraception, and antenatal care without parental consent. In contrast, participation in HIV prevention research involving investigational new drugs requires adolescents to have parental or guardian consent. Thus, privacy and confidentiality concerns may deter adolescent participation. We describe community perspectives on ethical considerations for involving adolescent girls in the MTN 034 study in Uganda. Methods: From August 2017 to March 2018, we held five stakeholder engagement meetings in preparation for the MTN 034 study in Kampala, Uganda (NCT03593655): two with 140 community representatives, two with 125 adolescents, and one with 50 adolescents and parents. Discussions were moderated by the study team. Proceedings were documented by notetakers. Summary notes described community perspectives of adolescent participation in HIV research including convergent, divergent or minority views, challenges, and proposed solutions. Results: Most community members perceived parental or guardian consent as a principal barrier to study participation due to concerns about adolescent disclosure of pre-marital sex, which is a cultural taboo. Of 125 adolescent participants, 119 (95%) feared inadvertent disclosure of sexual activity to their parents. Community stakeholders identified the following critical considerations for ethical involvement of adolescents in HIV biomedical research: (1) involving key stakeholders in recruitment, (2) ensuring confidentiality of sensitive information about adolescent sexual activity, (3) informing adolescents about information to be disclosed to parents or guardians, (4) offering youth friendly services by appropriately trained staff, and (5) partnering with community youth organizations to maximize recruitment and retention. Conclusions: Stakeholder engagement with diverse community representatives prior to conducting adolescent HIV prevention research is critical to collectively shaping the research agenda, successfully recruiting and retaining
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    The Influence of Perceived Dapivirine Vaginal Ring Effectiveness on Social Disclosure and Ring Adherence
    (AIDS and Behavior, 2013) Stoner, Marie C. D.; Brown, Elizabeth R.; Palanee‑Phillips, Thesla; Mansoor, Leila E.; Tembo, Tchangani; Nair, Gonasagrie; Akello, Carolyne; Seyama, Linly; Jeenarain, Nitesha; Naidoo, Logashvari; Mgodi, Nyaradzo; Hunidzarira, Portia; Chitukuta, Miria; Straten, Ariane van der
    We analyzed data from 1428 users of the dapivirine vaginal ring, who participated in the MTN-020/ASPIRE phase III trial and subsequent open-label extension MTN-025/HOPE trial, to examine relationships between perceived ring protection, social disclosures, and self-reported ring adherence. In HOPE, 77% perceived the ring to be highly effective, and this view was associated with speaking: (a) to a greater number of people about the study, (b) with other participants, (c) to more people who were in favor of the ring, and (d) to more people whose opinions were valued. Reported adherence was not directly associated with perceived protection but was associated with disclosing to someone who was in favor of the ring. These findings suggest the importance of women’s internalized ideas about the protective benefits of the DVR in sharing information about the ring and the importance of social support on adherence
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    Neurocognitive and Motor Deficits in HIV-Infected Ugandan Children With High CD4 Cell Counts
    (Clinical Infectious Diseases, 2012) Ruel,Theodore D.; Boivin, Michael J.; Boal, Hannah E.; Bangirana, Paul; Charlebois,Edwin; Havlir, Diane V.; Rosenthal, Philip J.; Dorsey,Grant; Achan, Jane; Akello, Carolyne; Kamya, Moses R.; Wong, Joseph K.
    Background. Human immunodeficiency virus (HIV) infection causes neurocognitive or motor function deficits in children with advanced disease, but it is unclear whether children with CD4 cell measures above the World health Organization (WHO) thresholds for antiretroviral therapy (ART) initiation suffer significant impairment