Browsing by Author "Berry, Isha"

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    Mobile Health–Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other
    (JMIR research protocols, 2021) Logie, Carmen; Okumu, Moses; Hakiza, Robert; Kibuuka Musoke, Daniel; Berry, Isha; Mwima, Simon; Kyambadde, Peter; Mimy Kiera, Uwase; Loutet, Miranda; Neema, Stella; Newby, Katie; McNamee, Clara; Baral, Stefan D.; Lester, Richard; Musinguzi, Joshua; Mbuagbaw, Lawrence
    HIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. Objective: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. Results: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. Conclusions: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations.
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    The prevalence and correlates of depression before and after the COVID-19 pandemic declaration among urban refugee adolescents and youth in informal settlements in Kampala, Uganda: A longitudinal cohort study
    (Annals of epidemiology, 2022) Logie, Carmen H.; Berry, Isha; Okumu, Moses; Miranda, Loutet; McNamee, Clara; Hakiza, Robert; Musoke, Daniel Kibuuka; Mwima, Simon; Kyambadde, Peter; Mbuagbaw, Lawrence
    There is scant research examining urban refugee youth mental health outcomes, including potential impacts of the COVID-19 pandemic. We examine prevalence and ecosocial risk factors of depression in the periods before and after the COVID-19 pandemic declaration among urban refugee youth in Kampala, Uganda. Data from a cohort of refugee youth (n = 367) aged 16–24 years were collected in periods before (February 2020) and after (December 2020) the WHO COVID-19 pandemic declaration. We developed crude and adjusted generalized estimating equation logistic regression models to examine demographic and ecosocial factors (food insecurity, social support, intimate partner violence) associated with depression, and include time-ecosocial interactions to examine if associations differed before and after the pandemic declaration. The prevalence of depression was high, but there was no significant difference before (27.5%), and after (28.9%) the pandemic declaration (P = .583). In adjusted models, food insecurity (aOR: 2.54; 95% CI: 1.21–5.33) and experiencing violence (aOR: 2.53; 95% CI: 1.07–5.96) were associated with increased depression, and social support was associated with decreased depression (aOR: 0.85; 95% CI: 0.81–0.89). These findings highlight the urgent need for interventions to address chronic depression, food insecurity, and ongoing effects of violence exposure among urban refugee youth in Kampala.
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    Sexual violence stigma experiences among refugee adolescents and youth in Bidi Bidi refugee settlement, Uganda: Qualitative insights informed by the stigma power process framework
    (Elsevier Ltd, 2023-12) Logie, Carmen H; Okumu, Moses; Coelho, Madelaine; Loutet, Miranda G; Berry, Isha; Lukone, Simon Odong; Kisubi, Nelson; Musoke, Daniel Kibuuka; Kyambadde, Peter
    Abstract There are over 100 million forcibly displaced persons who experience elevated risks for sexual violence. Sexual violence stigma can have immediate and long-lasting effects on social and health outcomes among survivors. There is a dearth of information on the experiences of sexual violence stigma among refugee adolescents and youth, particularly in low and middle-income contexts where most forcibly displaced persons are hosted. Our study focuses on understanding the lived experiences of sexual violence stigma among refugee adolescents and youth in Bidi Bidi Refugee Settlement, Uganda. This qualitative study involved twelve individual in-depth interviews and six focus groups in Bidi Bidi with refugee youth aged 16–24, refugee elder interviews (n = 8), and service provider interviews (n = 10). We explored experiences and impacts of sexual violence stigma, including accessing supportive resources. We conducted thematic analysis informed by the Stigma Power Process framework. This framework examines how social processes of stigma serve to keep people ‘in’, ‘down’, and ‘away’. Participant narratives highlighted negative cultural conceptions of sexual violence survivors and of women and girls, as well as daily indignities targeting survivors that reinforced their lower status. Shaming sexual violence survivors as ‘immoral’ operated to keep people ‘in’ the social order where it was expected that ‘moral’ persons would not experience sexual violence. Fear of such judgment, and wanting to stay ‘in’, produced barriers for survivors to access healthcare and legal support. Participants reported community-level blame and punishment kept them ‘down’, and community isolation and rejection kept them ‘away’. At the individual level, survivors were kept ‘down’ through internalizing shame, low self-esteem, self-isolation, and hiding. Findings signal the need to address the far-ranging impacts of sexual violence stigma on refugee youth health, wellbeing, and rights. Meaningfully engaging refugee youth and communities in reducing sexual violence stigma must concomitantly transform inequitable gender norms and power relations.
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    Social contextual factors associated with lifetime HIV testing among the Tushirikiane urban refugee youth cohort in Kampala, Uganda: Cross-sectional findings
    (International journal of STD & AIDS, 2022) Logie, Carmen H.; Okumu, Moses; Berry, Isha; Hakiza, Robert; Musoke, Daniel Kibuuka; Mwima, Simon; Kyambadde, Peter
    Urban refugee youth may live in social contexts characterized by structural drivers of HIV such as poverty and violence. Knowledge gaps remain regarding HIV testing practices among urban refugee youth, despite the increasing trend toward refugee settlement in urban contexts. This study examined social contextual factors associated with lifetime HIV testing among urban refugee youth in Kampala, Uganda. We conducted a community-based study with a peer-recruited cohort of urban refugee youth aged 16–24 years living in Kampala’s informal settlements, and present baseline cross-sectional findings. We conducted descriptive statistics and logistic regression to examine socio-demographic (e.g., gender and age), material (e.g., income insecurity and education), relational (e.g., social support), and symbolic contexts (e.g., HIV-related stigma and intimate partner violence (IPV]) associated with lifetime HIV testing. Participants (n = 450) had a mean age of 20.4 years (standard deviation: 2.4 years), most lived in Uganda for 1–5 years (53.2%), and less than half reported lifetime HIV testing (43.4%). In multivariable analyses, odds of lifetime HIV testing were higher among youth with secondary school education or higher (adjusted odds ratio (aOR]: 2.30, 95% confidence interval (CI]: 1.27–4.17), currently employed (aOR: 1.79, 95% CI: 1.03–3.10), and reporting IPV (aOR: 3.61, 95% CI: 1.43–9.10). Having children was marginally associated with HIV testing (aOR: 2.17, 95% CI: 0.98–4.81, p = 0.052). Findings demonstrate suboptimal HIV testing and the importance of tailored strategies to reach urban refugee youth who are unemployed and have limited formal education. There is a need to meaningfully engage urban refugee youth to create enabling environments for sexual health.