NRU :: Browsing by Author "Asiimwe, Stephen"

Browsing by Author "Asiimwe, Stephen"

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Adherence to HIV antiretroviral therapy among pregnant and postpartum women during the Option B+ era: 12-month cohort study in urban South Africa and rural Uganda
(Journal of the International AIDS Society, 2020) Matthews, Lynn T.; Orrell, Catherine; Mwebesa, Bosco Bwana; Tsai, Alexander C.; Psaros, Christina; Asiimwe, Stephen; Amanyire, Gideon; Musinguzi, Nicholas; Bell, Kathleen; Bangsberg, David R.; Haberer, Jessica E.
We conducted a cohort study to understand patterns of anti-retroviral therapy (ART) adherence during pregnancy, postpartum and non-pregnancy follow-up among women initiating ART in public clinics offering Option B+ in rural Uganda and urban South Africa. We collected survey data, continuously monitored ART adherence (Wisepill), HIV-RNA and pregnancy tests at zero, six and twelve months from women initiating ART in Uganda and South Africa, 2015 to 2017. The primary predictor of interest was follow-up time categorized as pregnant (pregnancy diagnosis to pregnancy end), postpartum (pregnancy end to study exit) or non-pregnancy-related (neither pregnant nor postpartum). Fractional regression models included demographics and socio-behavioural factors informed by the Behavioral Model for Vulnerable Populations. We evaluated HIV-RNA at 12 months by ever- versus never-pregnant status. In Uganda, 247 women contributed 676, 900 and 1274 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median ART adherence was consistently ≥90%: pregnancy, 94% (interquartile range [IQR] 78,98); postpartum, 90% (IQR 70,97) and non-pregnancy, 90% (IQR 80,98). Poorer adherence was associated with younger age (0.98% [95% CI 0.33%, 1.62%] average increase per year of age) and higher CD4 cell count (1.01% [0.08%, 1.94%] average decrease per 50 cells/ mm3). HIV-RNA was suppressed among 91% (N = 135) ever-pregnant and 86% (N = 85) never-pregnant women. In South Africa, 190 women contributed 259, 624 and 1247 months of pregnancy, postpartum and non-pregnancy-related follow-up. Median adherence was low during pregnancy, 74% (IQR 31,96); postpartum, 40% (IQR 4,65) and non-pregnancy, 77% (IQR 47,92). Poorer adherence was associated with postpartum status (22.3% [95%CI 8.6%, 35.4%] average decrease compared to non-pregnancy-related follow-up) and less emotional support (1.4% [0.22%, 2.58%] average increase per unit increase). HIVRNA was suppressed among 57% (N = 47) ever-pregnant and 86% (N = 93) never-pregnant women. Women in rural Uganda maintained high adherence with 91% of ever-pregnant and 86% of never-pregnant women suppressing HIV-RNA at 12 months. Women in urban South Africa struggled with adherence, particularly during postpartum follow-up with median adherence of 40% and 57% of women with HIV-RNA suppression at one year, suggesting a crisis for postpartum women with HIV in South Africa. Findings suggest that effective interventions should promote emotional support.
ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South Africa
(Journal of the International AIDS Society, 2019) Haberer, Jessica E.; Bwana, Bosco M.; Orrell, Catherine; Asiimwe, Stephen; Amanyire, Gideon; Musinguzi, Nicholas; Siedner, Mark J.; Matthews, Lynn T.; Tsai, Alexander C.; Katz, Ingrid T.; Bell, Kathleen; Kembabazi, Annet; Mugisha, Stephen; Kibirige, Victoria; Cross, Anna; Kelly, Nicola; Hedt-Gauthier, Bethany; Bangsberg, David R.
The success of universal antiretroviral therapy (ART) access and aspirations for an AIDS-free generation depend on high adherence in individuals initiating ART during early-stage HIV infection; however, adherence may be difficult in the absence of illness and associated support. From March 2015 to October 2017, we prospectively observed three groups initiating ART in routine care in Uganda and South Africa: men and non-pregnant women with early-stage HIV infection (CD4 > 350 cells/lL), pregnant women with early-stage HIV infection and men and non-pregnant women with late-stage HIV infection (CD4 < 200 cells/lL). Socio-behavioural questionnaires were administered and viral loads were performed at 0, 6 and 12 months. Adherence was monitored electronically. Adherence data were available for 869 participants: 322 (37%) early/non-pregnant, 199 (23%) early/pregnant and 348 (40%) late/non-pregnant participants. In Uganda, median adherence was 89% (interquartile range 74 to 96) and viral suppression was 90% at 12 months; neither differed among groups (p > 0.72). In South Africa, median adherence was higher in early/non-pregnant versus early/pregnant or late/non-pregnant participants (76%, 37%, 52%; p < 0.001), with similar trends in viral suppression (86%, 51%, 79%; p < 0.001). Among early/non-pregnant individuals in Uganda, adherence was higher with increasing age and lower with structural barriers; whereas in South Africa, adherence was higher with regular income, higher perceived stigma and use of other medications, but lower with maladaptive coping and cigarette smoking. ART adherence among non-pregnant individuals with early-stage infection is as high or higher than with late-stage initiation, supporting universal access to ART. Challenges remain for some pregnant women and individuals with late-stage infection in South Africa and highlight the need for differentiated care delivery.
Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples
(Journal of the International AIDS Society, 2019) Nakku-Joloba, Edith; Pisarski, Emily E.; Wyatt, Monique A.; Muwonge, Timothy R.; Asiimwe, Stephen; Celum, Connie L.; Baeten, Jared M.; Katabira, Elly T.; Ware, Norma C.
Pre-exposure prophylaxis (PrEP) to prevent HIV infection is being rolled out in Africa. The uptake of PrEP to date has varied across populations and locations. We seek to understand the drivers of demand for PrEP through analysis of qualitative data collected in conjunction with a PrEP demonstration project involving East African HIV serodiscordant couples. Our goal was to inform demand creation by understanding what PrEP means – beyond HIV prevention – for the lives of users. Methods: The Partners Demonstration Project evaluated an integrated strategy of PrEP and antiretroviral therapy (ART) delivery in which time-limited PrEP served as a “bridge” to long-term ART. Uninfected partners in HIV serodiscordant couples were offered PrEP at baseline and encouraged to discontinue once infected partners had taken ART for six months. We conducted 274 open-ended interviews with 93 couples at two Ugandan research sites. Interviews took place one month after enrolment and at later points in the follow-up period. Topics included are as follows: (1) discovery of serodiscordance; (2) decisions to accept/decline PrEP and/or ART; (3) PrEP and ART initiation; (4) experiences of using PrEP and ART; (5) PrEP discontinuation; (6) impact of PrEP and ART on the partnered relationship. Interviews were audio-recorded and transcribed. We used an inductive, content analytic approach to characterize meanings of PrEP stemming from its effectiveness for HIV prevention. Relevant content was represented as descriptive categories. Results: Discovery of HIV serodiscordance resulted in fear of HIV transmission for couples, which led to loss of sexual intimacy in committed relationships, and to abandonment of plans for children. As a result, partners became alienated from each other. PrEP countered the threat to the relationship by reducing fear and reinstating hopes of having children together. Condom use worked against the re-establishment of intimacy and closeness. By increasing couples’ sense of protection against HIV infection and raising the prospect of a return to “live sex” (sex without condoms), PrEP was perceived by couples as solving the problem of serodiscordance and preserving committed relationships. Conclusions: The most effective demand creation strategies for PrEP may be those that address the everyday life priorities of potential users in addition to HIV prevention.
Effect of Age at Initiation of Antiretroviral Therapy on Treatment Outcomes; A Retrospective Cohort study at a large HIV Clinic in Southwestern Uganda
(Plos one, 2018) Ssebutinde, Peter; Kyamwanga, Imelda T.; Turyakira, Eleanor; Asiimwe, Stephen; Bajunirwe, Francis
The prevalence of HIV infection among older persons is increasing yet older age at initiation of antiretroviral therapy (ART) may be associated with poorer treatment outcomes including mortality. However, majority of these studies have been done in the western world and there is limited data in resource limited settings. Our study used routinely collected health facility data to assess trends in age at initiation of ART, the effect of age at ART initiation on mortality and immunological response at a large urban hospital in south western Uganda.We conducted a retrospective records review of patients attending the HIV clinic at Mbarara Regional Referral Hospital in western Uganda. We retrieved records for 8,533 patients who started ART between January 2006 and December 2012. Their data had been collected and stored as part of the larger International Epidemiological Database for the Evaluation of AIDS (IeDEA). Age was stratified into three categories namely; 18–34 (young adults), 35–49 (mid-age) and 50 years or older (older adults). Survival analysis procedures with Kaplan-Meier’s plots were used to calculate the survival probability with mortality as the endpoint and Poisson regression analysis used to determine the adjusted relative risks (RR) of mortality.The proportion of young adults and patients at WHO stage I initiating ART increased steadily over the 7-year period. Older age at ART initiation (> = 50 years) was associated with a higher risk of mortality with adjusted relative risk (RR) at 1.63, (95% CI 1.26–2.11) compared to younger age. Male gender, WHO stages III and IV, lower CD4 count and lower body mass index were also all independently and significantly associated with higher risk for mortality. Older adults also had a poorer immunological response RR = 1.79 (95% CI 0.89–3.58) but was not statistically significant.Following ART initiation, older adults compared to the young, have a higher risk of mortality. This age group should be targeted first for ‘screen and treat’ approach. Optimization of ART treatment regimens for this age group is also required to reduce mortality and improve immunological response.
Enrollment and Retention in Community Health Insurance: Experiences from ICOCARE scheme in South Western Uganda
(Research Schare, 2019) Turyamureba, Bosco; Ssengooba, Freddie; Ssennyonjo, Aloysius; Asiimwe, Stephen; Baguma, Bildard; Kisakye, Angela; Kirunga, Christine
Globally, developing countries have inadequate capacity to raise tax to finance wellfunctioning health systems. In sub Saharan Africa, over 40% of the total health expenditure comes from households and mostly out of pocket payments. Over 20% of the population spend more than 10% of their total household consumption expenditure on health care. Prepayment schemes are crucial for promoting resource pooling and risk sharing to prevent catastrophic health expenditure, yet in Uganda only 1% of women and less than 2% of men are covered by health insurance schemes. Private insurance companies cover approximately 12% of Ugandans who are formally employed. We analyzed factors associated with enrollment and retention in ICOCARE health insurance scheme and examined ways to increase enrollment and reduce dropouts. Methods: This was a cross sectional study which employed both quantitative and qualitative methods of data collection. We interviewed 194 respondents who included both active and non-scheme members of the ICOCARE community health insurance scheme. We conducted three focus group discussions and two key informant interviews with key stakeholders. Quantitative data was analyzed using Statistical Package for Social Scientists software version 20 and STATA 13 while qualitative data was analyzed using the six steps of thematic analysis developed by Braun and Clarke.
Intimate partner violence and self-reported pre-exposure prophylaxis (PrEP) interruptions among HIV-negative partners in HIV serodiscordant couples in Kenya and Uganda
(Journal of acquired immune deficiency syndromes, 2018) Cabral, Alejandra; Baeten, Jared; Ngure, Kenneth; Velloza, Jennifer; Odoyo, Josephine; Haberer, Jessica; Celum, Connie; Muwonge, Timothy; Asiimwe, Stephen; Heffron, Renee
Oral pre-exposure prophylaxis (PrEP) is effective for HIV prevention and PrEP delivery studies are investigating ways to deliver PrEP with high adherence. However, in many settings with high HIV burden, intimate partner violence (IPV) is reported often and could be a barrier to effective PrEP use. We examined the association between IPV and interruptions in PrEP use. Methods—We analyzed data from 1,013 serodiscordant heterosexual couples enrolled in a large PrEP demonstration project in Kenya and Uganda, the Partners Demonstration Project. At quarterly study visits, HIV-negative participants receiving PrEP were asked about interruptions in their PrEP use and experiences with IPV. The association between IPV and PrEP interruptions was analyzed using multivariable generalized estimating equations. Results—At baseline and follow-up there were 53 visits with reports of abuse by 49 HIV-negative partners, including physical, economic, and verbal IPV. Interruptions in PrEP use were reported at 328 visits (7.1% of all visits) by 249 people. The median length of PrEP interruption was 28 days (interquartile range [IQR]: 7–45). The frequency of PrEP interruptions among those reporting IPV was 23.8% and those without IPV was 6.9%. PrEP interruption was significantly associated with IPV after adjustment for age and frequency of sexual intercourse (adjusted OR=2.6, 95% CI 1.2–6.0). Conclusion—IPV was more likely to be reported at visits when PrEP interruptions were also reported, which may have implications for sustained adherence to PrEP. Within PrEP delivery programs, there may be opportunities to assess individual safety and well-being in order to bolster adherence.
Long-distance truck drivers and the increasing risk of COVID-19 spread in Uganda
(International Journal of Infectious Diseases, 2020) Bajunirwe, Francis; Izudi, Jonathan; Asiimwe, Stephen;
To examine the patterns of COVID-19 transmission in Uganda.We reviewed ten weeks of press releases from the Uganda Ministry of Health from the day when the first case was announced, March 22, through May 29, 2020. We obtained the press releases from the MoH website and the Twitter handle (@MinofHealthUG). Data include the number of persons tested and the categories were classified as international arrivals, community members, and long-distance truck drivers.The first cases were international arrivals from Asia and Europe, and after that, community cases emerged. However, in the middle of April 2020, COVID-19 cases were detected among long-distance truck drivers. By May 29, 2020, 89, 224 persons had been tested; overall, 442 tested positive. Of those that tested positive, the majority, or 317 (71.8%) were truck drivers, 75 (16.9%) were community cases, and 50 (11.3%) were international arrivals. The majority of community cases have been linked to contact with truck drivers.Truck drivers were the most frequently diagnosed category, and have become a core group for COVID-19 in Uganda. They have generated significant local transmission, which now threatens a full-blown epidemic unless strict controls are put in place.
Sexual behavior and perceived HIV risk among HIV-negative members of serodiscordant couples in East Africa
(AIDS and Behavior, 2020) Wanga, Valentine; Baeten, Jared M.; Bukusi, Elizabeth A.; Mugo, Nelly R.; Asiimwe, Stephen; Ngure, Kenneth; Mujugira, Andrew; Muwonge, Timothy; Odoyo, Josephine B.; Haberer, Jessica E.; Celum, Connie; Heffron, Renee
HIV risk perception may influence the use of HIV prevention interventions. Using data from HIV-negative adults enrolled in a study of pre-exposure prophylaxis (PrEP) and antiretroviral therapy for HIV-serodiscordant couples in Kenya and Uganda, we examined associations between: 1) condom use and risk perception and 2) risk perception and PrEP adherence. Two-thirds of HIV-negative partners reported condomless sex with their HIV-positive partner or another partner in the month prior to study enrollment. Compared to those who reported no condomless sex, participants who reported condomless sex during the month prior to study visit had 5-fold higher odds of reporting “high risk” vs “no risk” perception (36.3 versus 10.9%: aOR=4.9, 95% CI: 3.4–6.9). Reporting condomless sex in the most recent sex act was associated with increased odds of perceiving some HIV risk (aOR for high risk=7.3, 95% CI 4.9–10.8; aOR for moderate risk=4.8, 95% CI 3.5–6.7; aOR for low risk=3.5, 95% CI 2.7–4.6). We found no significant association between risk perception and PrEP adherence. Sexual behavior aligned with perceived HIV risk, which can facilitate an HIV-negative individual’s decisions about PrEP use.
Social networks and HIV treatment adherence among people with HIV initiating treatment in rural Uganda and peri-urban South Africa
(Elsevier, 2024-03) Comfort, Alison B; Asiimwe, Stephen; Amaniyre, Gideon; Orrell, Catherine; Moody, James; Musinguzi, Nicholas; Bwana, Mwebesa Bosco; Bangsberg, David R;; Haberer, Jessica E; Tsai, Alexander C
Timely initiation of and adherence to antiretroviral therapy (ART) is critical for improving HIV outcomes and reducing HIV transmissibility. Social networks, or the social relationships individuals have with each other, have been linked with positive health outcomes, but less is known about the extent to which social network composition and structure are associated with improved ART adherence among people living with HIV (PLWH). We conducted an ego-centric network study among 828 previously ART-naïve PLWH presenting for ART initiation at 11 clinics in Mbarara, Uganda (rural population) and Gugulethu, South Africa (peri-urban population). We collected social network data using name generator and name interpreter questions. ART adherence was monitored over 12 months using wireless monitors (Wisepill). Our primary outcome of interest was ART adherence during the 12-month follow-up period. We used generalized linear models to estimate the associations between network measures and ART adherence. PLWH at the Uganda site (compared with the South Africa site) were less isolated, had larger social networks, and had more social ties providing sufficient social support; they were also more likely to bridge different social groups whereby not all social ties were connected to each other. In Uganda, social isolation was associated with a 5.5 percentage point reduction in ART adherence (95% confidence interval [CI] -9.95 to -1.13; p = 0.014), while having more same gender social ties was associated with higher ART adherence (b = 0.13, 95% CI 0.02-0.25, p = 0.025). In South Africa, there was no association between social isolation and ART adherence, and having more friendship ties (vs. family ties) was associated with lower ART adherence (b = -2.20, 95% CI -3.56 to -0.84; p = 0.002). Identifying and supporting PLWH who are isolated may facilitate optimal adherence, but understanding how networks differentially affect ART adherence by country context is important.
Use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, Uganda
(PLoS One, 2015) Nanvubya, Annet; Ssempiira, Julius; Mpendo, Juliet; Ssetaala, Ali; Nalutaaya, Annet; Wambuzi, Mathias; Kitandwe, Paul; Bagaya, Bernard S.; Welsh, Sabrina; Asiimwe, Stephen; Nielsen, Leslie; Makumbi, Fredrick; Kiwanuka, Noah
Fishing communities (FCs) in Uganda have high HIV infection rates but poor access to health services including family planning (FP). Although FP is a cost-effective public health intervention, there is a paucity of data on knowledge and use of modern FP in FCs. This study determined knowledge and use of modern FP methods in FCs of Uganda. Data were accrued from a 12-month follow up of 1,688 HIV-uninfected individuals, 18–49 years from 8 FCs along Lake Victoria, between September 2011 and March 2013. Data on knowledge and use of modern FP were collected through a semi-structured questionnaire. Prevalence Risk Ratios with corresponding 95% CIs were used to determine factors associated with Modern FP knowledge and use. The mean age was 31.4 years, with nearly half (48.8%) being females while more than half (58.6%) had attained up to primary education level. Knowledge of modern FP was high, 87.5% (1477/1688); significantly higher among females [adj. PRR = 4.84 (95% CI; 3.08, 7.61)], among older respondents (25–29 years) [adj. PRR = 1.83 (95% CI; 1.12, 2.99)] compared to younger ones (18–24 years) and among those conducting business [adj. PRR = 2.42(95% CI; 1.02, 5.74)] relative to those primarily in fishing. Just over a third (35.2%, 595/1688) reported use of at least one modern FP method. Use of modern FP methods was significantly higher among females [adj. PRR = 2.04 (95% CI; 1.56, 2.65, and among those reporting multiple sexual partnerships [adj. PRR = 2.12, 95% CI; 1.63, 2.76)]. Nonuse of modern methods was mostly due to desire for more children (30.6%), fear of side effects (12.2%) and partner refusal (5.2%).

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