Browsing by Author "Atuyambe, Lynn"
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Item Acceptability, Usefulness, and Ease of Use of an Enhanced Video Directly Observed Treatment System for Supporting Patients With Tuberculosis in Kampala, Uganda: Explanatory Qualitative Study(JMIR Publications, 2023-11) Sekandi, Juliet Nabbuye; McDonald, Adenike; Nakkonde, Damalie; Zalwango, Sarah; Kasiita, Vicent; Kaggwa, Patrick; Kakaire, Robert; Atuyambe, Lynn; Buregyeya, EstherAbstract BACKGROUNDIn tuberculosis (TB) control, nonadherence to treatment persists as a barrier. The traditional method of ensuring adherence, that is, directly observed therapy, faces significant challenges that hinder its widespread adoption. Digital adherence technologies such as video directly observed therapy (VDOT) are emerging as promising solutions. However, as these novel technologies gain momentum, a critical gap is the lack of comprehensive studies evaluating their efficacy and the unique experiences of patients in Africa.OBJECTIVEThe aim of this study was to assess patients' experiences that affected acceptability, usefulness, and ease of use with an enhanced VDOT system during monitoring of TB treatment.METHODSWe conducted individual open-ended interviews in a cross-sectional exit qualitative study in Kampala, Uganda. Thirty participants aged 18-65 years who had completed the VDOT randomized trial were purposively selected to represent variability in sex, adherence level, and HIV status. We used a hybrid process of deductive and inductive coding to identify content related to the experience of study participation with VDOT. Codes were organized into themes and subthemes, which were used to develop overarching categories guided by constructs adapted from the modified Technology Acceptance Model for Resource-Limited Settings. We explored participants' experiences regarding the ease of use and usefulness of VDOT, thereby identifying the facilitators and barriers to its acceptability. Perceived usefulness refers to the benefits users expect from the technology, while perceived ease of use refers to how easily users navigate its various features. We adapted by shifting from assessing perceived to experienced constructs.RESULTSThe participants' mean age was 35.3 (SD 12) years. Of the 30 participants, 15 (50%) were females, 13 (43%) had low education levels, and 22 (73%) owned cellphones, of which 10 (45%) had smartphones. Nine (28%) were TB/HIV-coinfected, receiving antiretroviral therapy. Emergent subthemes for facilitators of experienced usefulness and ease of VDOT use were SMS text message reminders, technology training support to patients by health care providers, timely patient-provider communication, family social support, and financial incentives. TB/HIV-coinfected patients reported the added benefit of adherence support for their antiretroviral medication. The external barriers to VDOT's usefulness and ease of use were unstable electricity, technological malfunctions in the app, and lack of cellular network coverage in rural areas. Concerns about stigma, disease disclosure, and fear of breach in privacy and confidentiality affected the ease of VDOT use.CONCLUSIONSOverall, participants had positive experiences with the enhanced VDOT. They found the enhanced VDOT system user-friendly, beneficial, and acceptable, particularly due to the supportive features such as SMS text message reminders, incentives, technology training by health care providers, and family support. However, it is crucial to address the barriers related to technological infrastructure as well as the privacy, confidentiality, and stigma concerns related to VDOT. MEDLINE - AcademicItem Adolescent and adult first time mothers' health seeking practices during pregnancy and early motherhood in Wakiso district, central Uganda(Reproductive health, 2008) Atuyambe, Lynn; Mirembe, Florence; M. Tumwesigye, Nazarius; Annika, Johansson; Kirumira, Edward K.; Faxelid, ElisabethMaternal health services have a potentially critical role in the improvement of reproductive health. In order to get a better understanding of adolescent mothers 'needs we compared health seeking practices of first time adolescent and adult mothers during pregnancy and early motherhood in Wakiso district, Uganda. Methods: This was a cross-sectional study conducted between May and August, 2007 in Wakiso district. A total of 762 women (442 adolescents and 320 adult) were interviewed using a structured questionnaire. We calculated odds ratios with their 95% CI for antenatal and postnatal health care seeking, stigmatization and violence experienced from parents comparing adolescents to adult first time mothers. STATA V.8 was used for data analysis.Item Alcohol consumption and risky sexual behavior in the fishing communities: evidence from two fish landing sites on Lake Victoria in Uganda(BMC Public Health, 2012) Tumwesigye, Nazarius M.; Atuyambe, Lynn; Wanyenze, Rhoda K.; Kibira, Simon P.S.; Liz, Qing; Wabwire-Mangen, Fred; Wagner, GlennThe fishing communities are among population groups that are most at risk of HIV infection, with some studies putting the HIV prevalence at 5 to 10 times higher than in the general population. Alcohol consumption has been identified as one of the major drivers of the sexual risk behaviour in the fishing communities. This paper investigates the relationship between alcohol consumption patterns and risky behaviour in two fishing communities on Lake Victoria. Methods: Face-to-face interviews were conducted among 303 men and 172 women at the fish landing sites; categorised into fishermen, traders of fish or fish products and other merchandise, and service providers such as casual labourers and waitresses in bars and hotels, including 12 female sexual workers. Stratified random sampling methodology was used to select study units. Multivariable analysis was conducted to assess independent relationship between alcohol consumption and sexual risky behaviour. Measures of alcohol consumption included the alcohol use disorder test score (AUDIT), having gotten drunk in previous 30 days, drinking at least 2 times a week while measures for risky behaviour included engaging in transactional sex, inconsistent condom use, having sex with non-regular partner and having multiple sexual partners. Results: The level of harmful use of alcohol in the two fishing communities was quite high as 62% of the male and 52% of the female drinkers had got drunk in previous 30 days. The level of risky sexual behaviour was equally high as 63% of the men and 59% of the women had unprotected sex at last sexual event. Of the 3 occupations fishermen had the highest levels of harmful use of alcohol and risky sexual behaviour followed by service providers judging from values of most indicators. The kind of alcohol consumption variables correlated with risky sexual behaviour variables, varied by occupation. Frequent alcohol consumption, higher AUDIT score, having got drunk, longer drinking hours and drinking any day of the week were strongly correlated with engaging in transactional sex among fishermen but fewer of the factors exhibited the same correlation among traders and service providers. Fishermen who drank 2 or more times a week were 7.9 times more likely to have had transactional sex (95% CI: 2.05-30.24) compared to those who never drank alcohol. A similar pattern was observed for traders and service providers at the landing sites. Inconsistent condom use or none use of condoms was not significantly correlated with any of the alcohol consumption indicator variables in multivariate analysis except for day of drinking among men.Item Barriers to male involvement in contraceptive uptake and reproductive health services: a qualitative study of men and women’s perceptions in two rural districts in Uganda(Reproductive health, 2014) Kabagenyi, Allen; Jennings, Larissa; Reid, Alice; Nalwadda, Gorette; Ntozi, James; Atuyambe, LynnSpousal communication can improve family planning use and continuation. Yet, in countries with high fertility rates and unmet need, men have often been regarded as unsupportive of their partner’s use of family planning methods. This study examines men and women’s perceptions regarding obstacles to men’s support and uptake of modern contraceptives. Methods: A qualitative study using 18 focus group discussions (FGDs) with purposively selected men aged 15–54 and women aged 15–49 as well as eight key informant interviews (KIIs) with government and community leaders was conducted in 2012 in Bugiri and Mpigi Districts, Uganda. Open-ended question guides were used to explore men and women’s perceptions regarding barriers to men’s involvement in reproductive health. All FGDs and KIIs were recorded, translated, and transcribed verbatim. Transcripts were coded and analyzed thematically using ATLAS.ti. Results: Five themes were identified as rationale for men’s limited involvement: (i) perceived side effects of female contraceptive methods which disrupt sexual activity, (ii) limited choices of available male contraceptives, including fear and concerns relating to vasectomy, (iii) perceptions that reproductive health was a woman’s domain due to gender norms and traditional family planning communication geared towards women, (iv) preference for large family sizes which are uninhibited by prolonged birth spacing; and (v) concerns that women’s use of contraceptives will lead to extramarital sexual relations. In general, knowledge of effective contraceptive methods was high. However, lack of time and overall limited awareness regarding the specific role of men in reproductive health was also thought to deter men’s meaningful involvement in issues related to fertility regulation. Conclusion: Decision-making on contraceptive use is the shared responsibility of men and women. Effective development and implementation of male-involvement family planning initiatives should address barriers to men’s supportive participation in reproductive health, including addressing men's negative beliefs regarding contraceptive services.Item Building capacity for injury research: A case study from Uganda(Abstracts, 2016) Hyder, Adnan A.; Kobusingye, Olive; Bachani, Abdulgafoor M.; Paichadze, Nino; Bishai, David; Wegener, Stephen; Mbona Tumwesigye, Nazarius; Guwatudde, David; Atuyambe, Lynn; Stevens, Kent A.Despite the high burden of injuries, they have largely been overlooked in global health research. One of the reasons for this is that in many developing countries there is limited supply of trained human resources for addressing injury research. Uganda is one such country where two critical gaps in addressing the lifelong consequences of trauma, injuries and disability are the lack of trained human resources and the lack of data. Objectives Through innovative model of sustainable development, the Johns Hopkins University-Makerere University Chronic Consequences of Trauma, Injuries and Disability in Uganda (JHU-MU Chronic TRIAD) program aims to strengthen research capacity on the long-term health and economic consequences of trauma, injuries and disability across the lifespan in Uganda.Item Child pedestrian crossing behaviour and associated risk factors in school zones: a video-based observational study in Kampala, Uganda(BMJ Publishing Group Ltd, 2024-05) Osuret, Jimmy; Van Niekerk, Ashley; Kobusingye, Olive; Atuyambe, Lynn; Nankabirwa, VictoriaAbstract BackgroundPedestrian crashes, often occurring while road crossing and associated with crossing behaviour, make up 34.8% of road casualties in Uganda. This study determined crossing behaviour and associated factors among child pedestrians around primary schools in Kampala, Uganda.MethodsWe conducted a cross-sectional study in 2022 among 2100 primary school children. Data on their crossing behaviour were collected using video recordings from cameras staged at the crossing points of 21 schools. We estimated prevalence ratios (PR) with their corresponding 95% CIs using a modified Poisson regression model for the association between unsafe behaviour and the predictors.ResultsThe prevalence for each of 5 unsafe child pedestrian behaviour was 206 (25.8%) for crossing outside the crosswalk, 415 (19.8%) for failing to wait at the kerb, 238 (11.3%) for failing to look for vehicles, 361 (17.2%) for running and 235 (13%) for crossing between vehicles. There was a higher likelihood of crossing outside the crosswalk when an obstacle was present (adjusted PR (aPR) 1.8; 95% CI 1.40 to 2.27) and when children crossed alone (aPR 1.5; 95% CI 1.13 to 2.06). Children who crossed without a traffic warden (aPR 2; 95% CI 1.40 to 2.37) had a significantly higher prevalence of failing to wait at a kerb.ConclusionThese findings reveal the interaction between child pedestrians, vehicles and the environment at crossings. Some factors associated with unsafe child pedestrian behaviour were the presence of an obstacle, crossing alone and the absence of a traffic warden. These findings can help researchers and practitioners understand child pedestrian crossing behaviour, highlighting the need to prioritise targeted safety measures.Item Correlates of hepatitis B awareness and disease-specific knowledge among pregnant women in Northern and Central Uganda: a cross-sectional study(Hepatology, medicine and policy, 2018) Nankya-Mutyoba, Joan; Aizire, Jim; Makumbi, Fredrick; Atuyambe, Lynn; Ocama, Ponsiano; Kirk, Gregory D.Countries in sub-Saharan Africa with a high hepatitis B burden also have limited resources to identify underlying drivers of disease among key at-risk populations. To improve prioritization and strengthen prevention of mother to child transmission of HBV, it is imperative to understand disease awareness, knowledge and related factors among pregnant women. Objectives: This study assessed HBV disease awareness, knowledge and related factors among pregnant women in public health facilities in two regions with diverse HBV disease epidemiology. Methods: From October 2016 through December 2017, a random sample of 455 pregnant women attending antenatal clinics were surveyed to assess HBV awareness, knowledge and associated factors. Participants responded to an 18-item questionnaire with themes on HBV awareness, knowledge of disease signs and symptoms, transmission, prevention and misconceptions about the disease. Results were analysed in STATA (version 14.0). Results: Of 455 participants enrolled, about two thirds reported having heard about HBV disease. By region, nearly half (47%) of participants from the central region, compared to only 16% from the north, reported that they had never heard of HBV. Region of residence had a moderating effect on the education- HBV awareness relationship. Only 162/455 (36%) of participants had adequate HBV knowledge. More than half 256/455 (56%) and 242/455 (53%) were not knowledgeable about horizontal and mother to child HBV transmission, respectively. About two thirds 298/455 (66%) and 281/455 (62%) believed HBV was spread via sharing of utensils and mosquito bites respectively. In multiple regression analysis, residing in the north, (PR=1.91(1.53 -2.38), p < 0.001) compared to central region and having a secondary education (PR=1.87(1.37 -2.55), p < 0.001) compared to primary were statistically significantly related to being knowledgeable about HBV. Conclusion: We demonstrated marked regional differences in HBV disease awareness and knowledge in this high HBV prevalence setting. However, most pregnant women displayed unacceptably low HBV knowledge and a significant proportion still hold misconceptions about HBV. Interventions to improve HBV prevention through antenatal education will need to be tailored to existing differences in comprehensive HBV knowledge.Item Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts(Global Health Action, 2017) Ekirapa-Kiracho, Elizabeth; Muhumuza Kananura, Rornald; Tetui, Moses; Namazzi, Gertrude; Mutebi, Aloysius; George, Asha; Paina, Ligia; Waiswa, Peter; Bumba, Ahmed; Mulekwa, Godfrey; Nakiganda-Busiku, Dinah; Lyagoba, Moses; Naiga, Harriet; Putan, Mary; Kulwenza, Agatha; Ajeani, Judith; Kakaire- Kirunda, Ayub; Makumbi, Fred; Atuyambe, Lynn; Okui, Olico; Namusoke Kiwanuka, SuzanneThe MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17– 1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39–3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.Item An exploratory study of HIV-prevention advocacy by persons in HIV care in Uganda(African Journal of AIDS Research, 2012) Tumwine, Christopher; Nannungi, Annet; Ssegujja, Eric; Nekesa, Nicolate; Ssali, Sarah; Atuyambe, Lynn; Ryan, Gery; Wagner, GlennPeople living with HIV (PLHIV) play a crucial role in reducing the spread of HIV as they are the primary vectors of HIV transmission. Recent HIV-prevention programmes have focused on counselling HIV-positive individuals to reduce their own risk behaviour as a way to limit transmission of the virus (Gerbert, Danley, Herzig, Clanon, Ciccarone, Gilbert & Allerton, 2006; Gilbert, Ciccarone, Gansky, Bangsberg, Clanon, McPhee et al., 2008; Samayoa, Anderson, O’Sullivan, Patricia, Pacheco, Matos et al., 2010). Other HIV-prevention programmes have focused on helping HIV-negative persons avoid infection (Abdool Karim, Sibeko & Baxter, 2010).Item Factors associated with family planning use among refugee and host populations in Adjumani district, West Nile, Uganda: a comparative study(BioMed Central Ltd, 2024-03-11) Achola, Roselline; Atuyambe, Lynn; Nabiwemba, Elizabeth; Fredrick, Makumbi; Orach, Christopher GarimoiUganda currently hosts an estimated 1.5 million refugees. The refugees have challenges in accessing family planning (FP) services in the host country. The study aimed to investigate factors associated with FP use among host and refugee populations in Adjumani district, Uganda. A comparative cross-sectional study was conducted in May 2021 in three refugee settlements and their host communities in Adjumani district. A total of 1,310 respondents, (664 refugees and 646 host) were randomly selected using multistage cluster sampling and interviewed. Quantitative data were collected using structured questionnaires and analyzed using STATA V.15. Descriptive and Multivariate analysis performed. We found that modern Contraceptive Prevalence Rate (mCPR) was 30.2% (32.2% for host and 28.2% for refugees). Multivariate analysis showed that women who live singly (AOR = 2.25, 95%, CI: 1.56 -3.84), completed primary education [AOR = 1.65, 95% CI: 1.27-2.16], acquired skills [AOR = 2.28, 95% CI: 2.11-2.47], have the desire for another child [AOR = 3.73, 95% CI: 1.45- 9.60], have stayed in the study area between 3-5 years [AOR = 2.24, 95% CI: 1.46-3.42] were statistically significantly associated with FP use among both refugee and host populations. The key barrier to FP use by host was harassment of women and separation/divorce for not consulting the family members. Whereas amongst the refugees, they do not want to use FP methods. Our findings revealed low FP use amongst both populations in Adjumani district. The main factors associated with FP use amongst refugee populations included marital status, level of education, type of occupation, and duration of stay in the study area whereas amongst the host is the marital status. Main reasons for not using FP methods included fear of side effects by hosts and not wanting to use FP by refugees. There is need to sensitize both communities about the benefits of FP at community level.Item Hepatitis B Prevalence among Pregnant Women in Central and West Nile regions of Uganda: Is there a Need to prioritize Prevention of Mother to Child hepatitis B transmission?(Research Square, 2019) Nankya-Mutyoba, Joan; Aizire, Jim; Makumbi, Fredrick; Atuyambe, Lynn; Kirk, Gregory; Ocama, PonsianoIntroduction Within sub-Saharan Africa (SSA), the burden of chronic hepatitis B (HBV) is unacceptably high in several countries including Uganda. Elimination of HBV in the context of inadequate resources and several competing health issues, faces challenges including limited data on disease burden in important population sub-groups. In order to optimize available resources, reliable data on HBV among pregnant women is useful to guide policies on prevention. This study estimated HBV prevalence and related factors among pregnant women in Central and West Nile regions of Uganda Methods Using a twostage sampling approach, we selected a random sample of 310 pregnant women, 18 years or older from public health facility antenatal clinics in central and west Nile, North-western Uganda. Consenting women were interviewed to obtain data on HBV vaccination status, HIV status, selected sexual and lifestyle factors and socio-demographic information. In addition, they underwent phlebotomy to obtain blood for testing for hepatitis B surface antigen, (HBsAg) antibodies to the surface antigen (anti-HBs), and antibodies to the core (anti-HBc), as indicators of chronic infection, prior exposure, and susceptibility (anti-HBs <10 mIU /mL), respectively. Results Out of 310 women, prevalence of chronic HBV infection was 6.2%. Prevalence in the West Nile region was notably higher than in the Central region (11.0% vs. 1.3%), p<0.001. In both regions, majority of pregnant women (61% West Nile region, 76% Central region) were still susceptible to HBV. Overall, proportion who had been tested for HBV and those who reported having been vaccinated was only 5.8% and 11.3% respectively. Conclusion Our findings reveal the burden of HBV in Ugandan pregnant women is still high, with marked regional differences in disease prevalence, and poor levels of HBV testing and vaccination. These data suggest that HBV prevention programs and policies in resource-limited settings like Uganda may need to consider the differential HBV prevalence, as optimizing HBV prevention services in higher prevalence regions may provide greater impact and thereby align with the WHO recommendation on HBV elimination strategy in SSA.Item Maternal and neonatal implementation for equitable systems. A study design paper(Global Health Action, 2017) Ekirapa-Kiracho, Elizabeth; Tetui, Moses; Bua, John; Muhumuza Kananura, Rornald; Waiswa, Peter; Makumbi, Fred; Atuyambe, Lynn; Ajeani, Judith; George, Asha; Mutebi, Aloysuis; Kakaire, Ayub; Namazzi, Gertrude; Paina, Ligia; Namusoke Kiwanuka, SuzanneEvidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacitybuilding. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.Item The new female condom (FC2) in Uganda: perceptions and experiences of users and their sexual partners(African Journal of AIDS Research, 2011) Wanyenze, Rhoda K.; Atuyambe, Lynn; Kibirige, Vista; Mbabazi, Sarah; Tumwesigye, Nazarius M.; Djurhuus, Kara; Namale, AliceThe new version of the female condom (FC2) was introduced in Uganda in October 2009, following an unsuccessful female condom programme begun in 1998. The failure of the earlier programme was partly attributed to low acceptance of the first type of female condom (FC1). We evaluated the acceptability of FC2 and the experiences of users and their sexual partners. This was a qualitative cross-sectional evaluation. We conducted 16 in-depth interviews with FC2 users (8 women and 8 male partners). We also conducted eight focus group discussions with women who used FC2, and 22 key informant interviews with service providers. All the female users appreciated FC2 as a tool to empower them to avoid sexually transmitted infections (STIs) and unwanted pregnancies. They liked FC2 because it has no smell, is not noisy, and does not rupture easily. The men also liked FC2 because of its soft texture and lubrication. Some women found FC2 insertion cumbersome, while others feared that it would slip in on itself during sex. Concurrent use of male condoms with FC2 and the reuse of FC2 were also mentioned. Providers reported a high demand for FC2; their main challenges were inadequate supplies and distribution mechanisms. This evaluation shows generally high acceptance of FC2. The experiences of users and their partners were largely positive, although some fears and incorrect practices arose. FC2 should be added to the existing HIV/STI-prevention and family-planning options in Uganda and other countries, with sufficient training and support to ensure correct use.Item Prevalence and factors associated with hepatitis b vaccination uptake and completion among communities targeted for mass vaccination in gulu: a cross-sectional study(BioMed Central Ltd, 2024-03) Kimera, Andrew; Atuyambe, Lynn; Mutyaba, Huzaifa; Nantongo, Claire; Namagembe, Agnes; Nalumansi, Anna Maria; Basenero, Andrew; Auma, Prisca; Mukiza, Nelson; Mutyoba, JoanAbstract Hepatitis B virus (HBV) is associated with several acute and long-term complications and vaccination is the cornerstone of prevention. A recent outbreak in Gulu, Uganda, one of the districts covered by a mass vaccination campaign, suggests low uptake of HBV vaccination. This study aims to determine the uptake and completion of HBV vaccination and associated factors among residents of Gulu, Uganda. A mixed methods cross-sectional study was conducted in Gulu, Northern Uganda, among 434 adult residents. A pretested questionnaire was used to collect data on socio-demographics, perceptions, and knowledge of HBV vaccination. Modified Poisson regression analysis was used in STATA 14 software to obtain prevalence ratios for the association between the independent and dependent variables. For qualitative data, 9 key informant interviews were conducted and thematic analysis was done using Quirkos software. Out of the 434 respondents, 41.9% had received at least one dose of the hepatitis B vaccine, 32.5% had received at least 2 doses, and only 20% had completed all 3 doses, with an overall completion rate of 47.8% for participants who had been initiated on the vaccine. Gender, residence, risk perception of Hepatitis B infection, perceived safety of the vaccine, and awareness of mass vaccination were associated with uptake of Hepatitis B vaccination. Residence, knowledge, and perception of being at risk of acquiring Hepatitis B were associated with completion. Qualitative results revealed that the levels of uptake and completion could have been affected by access to vaccination sites; inadequate knowledge about the disease; myths about the vaccine and inadequate community engagement. Low Hepatitis B vaccine uptake and completion rates were observed in Gulu. To enhance vaccination coverage, future initiatives should prioritize awareness, education, and dispelling of vaccination myths. Additionally, increased government investment in training health workers can serve as a valuable strategy to improve information dissemination and awareness among the population.Item Reasons for Disclosure of HIV Status by People Living with HIV/AIDS and in HIV Care in Uganda: An Exploratory Study(AIDS patient care and STDs, 2010) Ssali, Sarah N.; Atuyambe, Lynn; Tumwine, Christopher; Segujja, Eric; Nekesa, Nicolate; Nannungi, Annet; Ryan, Gery; Wagner, Glenn; Tumwine, Christopher; Segujja, Eric; Nekesa, Nicolate; Nannungi, Annet; Ryan, Gery; Wagner, GlennMost studies of HIV disclosure in Africa have focused on disclosure to spouses and sexual partners, and particularly among women. Few have examined disclosure to family, friends, and others. Understanding the reasons for disclosure and nondisclosure and how these reasons differ by disclosure target is needed for effective prevention interventions. Using a case study design and content analysis, this study explored whether the reasons for disclosure decisions differ by the nature of the relationship to the disclosure target. Semi structured interviews were conducted with 40 HIV clients in Kampala, with even stratification by gender and age. Most (95%) respondents reported disclosing to someone; among these, 84% disclosed to family members, 63% to friends, 21% to workplace colleagues, and 18% to others. Of the 24 participants who had a spouse, 13 (54%) reported disclosing to a spouse. The most common reasons for disclosure were to receive support (76%), associated with disclosure to family members; relationship ties (76%), associated with disclosure to all target types; explaining change in behavior or appearance (61%), associated with disclosing to family and friends; and HIV prevention (50%), associated with disclosure to spouse/partner and friends. The most common reasons for nondisclosure were: fear of abandonment, particularly among young women disclosing to spouse/partner; inaccessibility to the disclosure target; and not wanting to worry/upset the disclosure target. This exploratory analysis suggests that reasons for disclosure and nondisclosure differ depending on the targets of disclosure, highlighting the need for tailoring interventions for improving disclosure decisions making and outcomes.Item Research translation to inform national health policies: learning from multiple perspectives in Uganda(BMC International Health and Human Rights, 2011) Ssengooba, Freddie; Atuyambe, Lynn; Kiwanuka, Suzanne N.; Puvanachandra, Prasanthi; Glass, Nancy; Hyder, Adnan A.Research and evidence can have an impact on policy and practice, resulting in positive outcomes. However, research translation is a complex, dynamic and non-linear process. Although universities in Africa play a major role in generating research evidence, their strategic approaches to influence health policies and decision making are weak. This study was conducted with the aim of understanding the process of translating research into policy in order to guide the strategic direction of Makerere University College of Health Sciences (MakCHS) and similar institutions in their quest to influence health outcomes nationally and globally. Methods: A case study approach using 30 in-depth interviews with stakeholders involved in two HIV prevention research project was purposively selected. The study sought to analyze the research-to-policy discourses for the prevention of mother-to-child transmission (PMTCT) and safe male circumcision (SMC). The analysis sought to identify entry points, strengths and challenges for research-to-policy processes by interviewing three major groups of stakeholders in Uganda – researchers (8), policy makers (12) and media practitioners (12). Results: Among the factors that facilitated PMTCT policy uptake and continued implementation were: shared platforms for learning and decision making among stakeholders, implementation pilots to assess feasibility of intervention, the emerging of agencies to undertake operations research and the high visibility of policy benefits to child survival. In contrast, SMC policy processes were stalled for over two years after the findings of the Uganda study was made public. Among other factors, policy makers demanded additional research to assess implementation feasibility of SMC within ordinary health system context. High level leaders also publicly contested the SMC evidence and the underlying values and messages – a situation that reduced the coalition of policy champions. Conclusions: This study shows that effective translation of PMTCT and SMC research results demanded a “360 degree” approach to assembling additional evidence to inform the implementation feasibility for these two HIV prevention interventions. MakCHS and similar institutions should prioritize implementation research to guide the policy processes about the feasibility of implementing new and effective innovations (e.g. PMTCT or SMC) at a large scale in contexts that may be different from the research environments.Item Seeking safety and empathy: Adolescent health seeking behavior during pregnancy and early motherhood in central Uganda(Journal of adolescence, 2009) Atuyambe, Lynn; Mirembe, Florence; Annika, Johansson; Kirumira, Edward K.To explore adolescent health seeking behavior during pregnancy and early motherhood in order to contribute to health policy formulation and improved access to health care. This will in long-term have an impact on the reduction of morbidity and mortality among adolescent mothers and their newborns. This was a qualitative study that employed focus group discussions (FGDs) among adolescent girls (10e19 years) and key informant (KI) interviews with health workers. Age for FGD participants ranged from 16 to 19 years. The FGD participants were recruited while seeking antenatal care for their first pregnancy or immunization service for their first child, not being older than 6 months. Six health facilities were selected. Key informants were purposefully selected on the basis of being in-charge of maternity units. Thirteen FGDs comprising of a total of 92 adolescent girls were conducted. The FGDs were held with homogeneously constituted categories; married pregnant adolescents (5), unmarried pregnant adolescents (3) and married or not married adolescents with children (5). Semi structured interviews were held with sixItem Social networks of PLHAs in Uganda: Implications for mobilizing PLHA as Agents for Prevention(AIDS and Behavior, 2014) Harold, Green Jr.; Atuyambe, Lynn; Ssali, Sarah; Ryan, Gery; Sseguja, Eric; Nekesa, Nicolate; Wagner, GlennThe objective of this study was to describe the social networks of people living with HIV/AIDS (PLHA) and explore the implications social network characteristics might have for mobilizing PLHA as prevention agents. Thirty-nine PLHA attending an HIV clinic in Kampala, Uganda provided information on themselves and on 20 network members. Based on these data, descriptive statistics for social network composition and structure were calculated. Research questions relating these network characteristics to treatment-related variables such as time since diagnosis, ART status, and time on ART were investigated. Analyses reveal that, in general, network members know the PLHA's status, are trusted, provide advice and support, and are well-connected to each other. Network features (e.g., proportion of individuals who know the PLHA's status) are related to the previously mentioned treatment variables. Findings suggest that PLHA surround themselves with a social context that enables PLHA to feel fairly protected and supported if they choose to discuss HIV and prevention. With respect to treatment, those on ART may be better prepared to act as prevention advocates.Item Socio-cultural inhibitors to use of modern contraceptive techniques in rural Uganda: a qualitative study(The Pan African Medical Journal, 2016) Kabagenyi, Allen; Reid, Alice; Ntozi, James; Atuyambe, LynnFamily planning is one of the cost-effective strategies in reducing maternal and child morbidity and mortality rates. Yet in Uganda, the contraceptive prevalence rate is only 30% among married women in conjunction with a persistently high fertility rate of 6.2 children per woman. These demographic indicators have contributed to a high population growth rate of over 3.2% annually. This study examines the role of socio-cultural inhibitions in the use of modern contraceptives in rural Uganda. Methods: This was a qualitative study conducted in 2012 among men aged 15-64 and women aged 15-49 in the districts of Mpigi and Bugiri in rural Uganda. Eighteen selected focus group discussions (FGDs), each internally homogeneous, and eight in-depth interviews (IDIs) were conducted among men and women. Data were collected on sociocultural beliefs and practices, barriers to modern contraceptive use and perceptions of and attitudes to contraceptive use. All interviews were tape recoded, translated and transcribed verbatim. All the transcripts were coded, prearranged into categories and later analyzed using a latent content analysis approach, with support of ATLAS.ti qualitative software. Suitable quotations were used to provide in-depth explanations of the findings. Results: Three themes central in hindering the uptake of modern contraceptives emerged: (i) persistence of socio-cultural beliefs and practices promoting births (such as polygamy, extending family lineage, replacement of the dead, gender-based violence, power relations and twin myths). (ii) Continued reliance on traditional family planning practices and (iii) misconceptions and fears about modern contraception. Conclusion: Sociocultural expectations and values attached to marriage, women and child bearing remain an impediment to using family planning methods. The study suggests a need to eradicate the cultural beliefs and practices that hinder people from using contraceptives, as well as a need to scale-up family planning services and sensitization at the grassroots.Item Uptake of family planning methods and unplanned pregnancies among HIV-infected individuals: a cross-sectional survey among clients at HIV clinics in Uganda(Journal of the International AIDS Society, 2011) Wanyenze, Rhoda K.; Tumwesigye, Nazarius M.; Kindyomunda, Rosemary; Beyeza-Kashesya, Jolly; Atuyambe, Lynn; Kansiime, Apolo; Neema, Stella; Ssali, Francis; Akol, Zainab; Mirembe, FlorencePrevention of unplanned pregnancies among HIV-infected individuals is critical to the prevention of mother to child HIV transmission (PMTCT), but its potential has not been fully utilized by PMTCT programmes. The uptake of family planning methods among women in Uganda is low, with current use of family planning methods estimated at 24%, but available data has not been disaggregated by HIV status. The aim of this study was to assess the utilization of family planning and unintended pregnancies among HIV-infected people in Uganda. Methods: We conducted exit interviews with 1100 HIV-infected individuals, including 441 men and 659 women, from 12 HIV clinics in three districts in Uganda to assess the uptake of family planning services, and unplanned pregnancies, among HIV-infected people. We conducted multivariate analysis for predictors of current use of family planning among women who were married or in consensual union and were not pregnant at the time of the interview.