Browsing by Author "Bufumbo, Leonard"
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Item Adolescents Discussing Sexual Behaviors With Key Influencing Audiences(Global Journal of Health Science, 2018) Nalukwago, Judith; Crutzen, Rik; Bart, van den Borne; Bukuluki, Paul M.; Bufumbo, Leonard; Batamwita, Richard; Zikusooka, Amos; Thompson, Gretchen; Alaii, JaneThere is an increasing concern on early initiation of sexual activity among adolescents, increasing sexually transmitted infections, and teenage pregnancy in Uganda. Adolescents perceptions of these sexual behaviors might be the result of discussing sexual and reproductive health issues with key influencing audiences. This study qualitatively explored the effect of sexuality discussions with key influencing audiences by means of in-depth interviews and focus group discussions with adolescents (N=83). Findings indicate that adolescence stage comes with changes of intense sexual desires, often presumed difficult to control thus leading adolescents to engage in sexual activities. Adolescents indicated that they were aware of the sexual behaviors such as condom use, contraception use, and multiple concurrent partnerships, but intertwined with persistent myths and misconceptions. Although discussing sexuality issues with someone was found to be instrumental, adolescent highlighted challenges that hinder discussion with key influencers. Challenges include, parents lack of time to talk to their children; some religious affiliations perceived to discourage use of contraception; limited skills of community health workers to address adolescent information needs; meetings held in groups not followed up with age-focused or one-on-one discussions; negative health workers’ attitudes and use of technical language; and peer pressure. These findings suggest the need to provide adequate and updated information to clear any misconceptions and strengthening of key influencers’ communication skills to gain confidence in addressing adolescent sexual and reproductive health needs.Item Barriers to starting ART and how they can be overcome: individual and operational factors associated with early and late start of treatment(Tropical medicine & international health, 2010) Parkes-Ratanshi, Rosalind; Bufumbo, Leonard; Nyanzi-Wakholi, Barbara; Levin, Jonathan; Grosskurth, Heiner; Lalloo, David G.; Kamali, AnatoliDespite expanding access to antiretroviral therapy (ART) in Sub-Saharan Africa, there are few data on patients’ perceptions about starting ART to explore issues affecting decisions to start ART in eligible individuals during the ART roll out. Methods We studied patterns of ART uptake for 957 participants in a trial of cryptococcal disease prevention and performed a qualitative cross-sectional study about issues affecting decisions to start ART in this cohort. In-depth interviews (IDIs) were conducted with 48 participants who started ART after variable time on the trial. results Time to starting ART from trial enrolment decreased during the ART roll out (Median 83 days to 68 days). Multiple factors causing delay to ART were reported; awaiting home visit by service provider (P = 0.025), domestic issues (P = 0.028), moving from area (P £ 0.001) and fear of side effects (P = 0.013) were statistically significant. In the IDIs, fear of side effects was the strongest factor for delay and observation of health improvement in others on ART was the strongest inducement to start. Information from patients already taking ART was the most valued source of information. Conclusions This study provided novel information about factors encouraging people to start ART early; positive beliefs about ART were the most important. Whilst side effects of ART must not be downplayed, programmes should provide information in a balanced way to prevent unnecessary fear of starting ART. Those already receiving ART were found to be good advocates and should be utilised by ART programmes to educate others.Item Evaluation of the Obulamu? integrated health communication campaign in Uganda: results from a repeated cross-sectional household survey(Journal of Communication in Healthcare, 2021) Burke, Holly M.; Okumu, Eunice; Zikusooka, Amos; Batamwita, Richard; Nalukwago, Judith; Field, Samuel; Bernholc, Alissa; Martinez, Andres; Bufumbo, Leonard; Kimbowa, Musa; Coutinho, Sheila M.; Mack, Natasha; Alaii, JaneUganda’s Obulamu? campaign delivered messages relevant to life stage to address evolving health needs of audiences at times they were likely to change behaviors. We estimated Obulamu?’s effects on HIV/AIDS, family planning, maternal and child health, tuberculosis, malaria, and nutrition behavioral outcomes. Methods: We conducted repeated cross-sectional household surveys with women, men, and children’s caregivers in 2015 and 2017 in 16 districts using multi-stage probability sampling weighted by population. Eleven pre-specified outcomes were evaluated in multivariable weighted regression models. Results: Survey 1 included 2,377 households with 4,012 individuals and survey 2 included 2,398 households with 3,563 individuals. After controlling for time and potentially confounding factors, we observed notable increases among people exposed to topicspecific messages in condom use with at least one non-marital, non-cohabiting partner in the last six months; recent male circumcision; seeking tuberculosis screening/testing for self; seeking tuberculosis screening/testing for child; delivery of baby in a facility; and caregiver seeking advice or treatment for child under five years with fever. Exposure did not appear to influence knowledge of antiretroviral therapy, delay sexual debut, breastfeeding infants and all of the household’s pregnant women/children less than five years sleeping under a net the night before the survey. Conclusion: Exposure to topic-specific messages was associated with improvements in six of the eleven outcomes. Across the health priority areas, we observed improvements in select HIV/AIDS, tuberculosis, and maternal and child health outcomes. We did not observe effects of exposure on select outcomes in the areas of family planning, malaria, or nutrition.Item Gender norms associated with adolescent sexual behaviors in Uganda(International Social Science Journal, 2019) Nalukwago, Judith; Crutzen, Rik; Borne, Bart van den; Mukisa Bukuluki, Paul; Bufumbo, Leonard; Burke, Holly McClain; Field, Samuel; Zikusooka, Amos; Fiedler, Anne Akia; Alaii, JaneGender norm attitudes and practices remain deeply entrenched in many African societies (Gibson et al. 2014; Wight et al. 2006). Countries driven by gender inequalities that constrain Judith Nalukwago, the lead author of this article, has a PhD in Public Health from the Faculty of Health, Medicine and Life Sciences of Maastricht University, The Netherlands. She is a health promotion scholar, practitioner and a behavioural scientist with grounded skills in both theoretical and practical implementation of social and behaviour change interventions. She has a background in monitoring, evaluation, research, learning/ knowledge management, and adolescent health programming from an academic and programme implementation perspective. Email: j.nalukwago@maastrichtuniversity.nl individual behaviour in sexual interactions often have the highest rates of HIV and teenage pregnancies (Hardee et al. 2014; Richards et al. 2013; Van den Berg et al. 2013). Women and girls face more gendered risks than their male counterparts, which affects their social, economic and political opportunities (Mbonye et al. 2012; UNAIDS 2016; UNICEF 2015)Item Keeping community health workers in Uganda motivated: key challenges, facilitators, and preferred program inputs(Global Health: Science and Practice, 2014) Brunie, Aure´lie; Wamala-Mucheri, Patricia; Otterness, Conrad; Akol, Angela; Chen, Mario; Bufumbo, Leonard; Weaver, MarkIn the face of global health worker shortages, community health workers (CHWs) are an important health care delivery strategy for underserved populations. In Uganda, community-based programs often use volunteer CHWs to extend services, including family planning, in rural areas. This study examined factors related to CHW motivation and level of activity in 3 family planning programs in Uganda. Methods: Data were collected between July and August 2011, and sources comprised 183 surveys with active CHWs, in-depth interviews (IDIs) with 43 active CHWs and 5 former CHWs, and service statistics records. Surveys included a discrete choice experiment (DCE) to elicit CHW preferences for selected program inputs.Item Observational study of the acceptability of Sayana® Press among intramuscular DMPA users in Uganda and Senegal(Contraception, 2014) Burkea, Holly M.; Mueller, Monique P.; Perry, Brian; Packer, Catherine; Bufumbo, Leonard; Mbengue, Daouda; Mall, Ibrahima; Mamadou Daff, Bocar; Mbonye, Anthony K.Sayana® Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) in Uniject™, has potential to be a valuable innovation in family planning (FP) because it may overcome logistic and safety challenges in delivering intramuscular DMPA (DMPA IM). However, SP's acceptability is unknown. We measured acceptability of SP among DMPA IM users. Study design: This open-label observational study was conducted in clinics in three districts in Senegal and community-based distribution services in two districts in Uganda. Experienced DMPA IM users were offered SP by community health workers (CHWs) or clinic-based providers. SP decliners were asked to discuss their reasons. Those who received SP were interviewed pre- and post injection and 3 months later, when they were asked if they would select SP over DMPA IM if it were available.Item On the road again: concurrency and condom use among Uganda truck drivers(African Journal of AIDS Research, 2015) Costenbader, Elizabeth C.; Lancaster, Kathryn; Bufumbo, Leonard; Akol, Angela; Guest, GregLong-distance truck drivers have been shown to be a critical population in the spread of HIV in Africa. In 2009, surveys with 385 Ugandan long-distance truck drivers measured concurrency point prevalence with two methods; it ranged from 37.4% (calendar-method) to 50.1% (direct question). The majority (84%) of relationships reported were long-term resulting in a long duration of overlap (average of 58 months) across concurrent partnerships. Only 7% of these men reported using any condoms with their spouses during the past month. Among all non-spousal relationships, duration of relationship was the factor most strongly associated with engaging in unprotected sex in the past month in a multivariable analyses controlling for partner and relationship characteristics. Innovative intervention programs for these men and their partners are needed that address the realities of truck drivers’ lifestyles.Item Pregnancy in HIV Clinical Trials in Sub Saharan Africa: Failure of Consent or Contraception?(PLoS ONE, 2013) Ssali, Agnes; Namukwaya, Stella; Bufumbo, Leonard; Seeley, Janet; Lalloo, David G.; Parkes-Ratanshi, Rosalind; Kamali, AnatoliHigher than expected pregnancy rates have been observed in HIV related clinical trials in Sub-Saharan Africa. We designed a qualitative study to explore the factors contributing to high pregnancy rates among participants in two HIV clinical trials in Sub-Saharan Africa. Methods: Female and male participants enrolled in one of two clinical HIV trials in south-west Uganda were approached. The trials were a phase III microbicide efficacy trial among HIV negative women using vaginal gel (MDP); and a trial of primary prevention prophylaxis for invasive cryptococcal disease using fluconazole among HIV infected men and women in Uganda (CRYPTOPRO). 14 focus group discussions and 8 in-depth interviews were conducted with HIV positive and negative women and their male partners over a six month period. Areas explored were their experiences about why and when one should get pregnant, factors affecting use of contraceptives, HIV status disclosure and trial product use. Results: All respondents acknowledged being advised of the importance of avoiding pregnancy during the trial. Factors reported to contribute to pregnancy included; trust that the investigational product (oral capsules/vaginal gel) would not harm the baby, need for children, side effects that led to inconsistent contraceptive use, low acceptance of condom use among male partners. Attitudes towards getting pregnant are fluid within couples over time and the trials often last for more than a year. Researchers need to account for high pregnancy rates in their sample size calculations, and consider lesser used female initiated contraceptive options e.g. diaphragm or female condoms. In long clinical trials where there is a high fetal or maternal risk due to investigational product, researchers and ethics committees should consider a review of participants contraceptive needs/pregnancy desire review after a fixed period, as need for children, partners and health status of participants may alter over time.Item Provider acceptability of Sayana® Press: results from community health workers and clinic-based providers in Uganda and Senegal(Contraception, 2014) Burke, Holly M.; Mueller, Monique P.; Packer, Catherine; Perry, Brian; Bufumbo, Leonard; Mbengue, Daouda; Mamadou Daff, Bocar; Mbonye, AnthonySayana® Press (SP), a subcutaneous formulation of depot medroxyprogesterone acetate (DMPA) in Uniject™, has potential to be a valuable innovation in family planning (FP) because it may overcome logistic and safety challenges in delivering intramuscular DMPA (DMPA IM). However, SP's acceptability is unknown. We measured acceptability of SP among clinic-based providers (Senegal only) and community health workers. Study design: This open-label observational study was conducted in clinics in three districts in Senegal and community-based services in two districts in Uganda. Providers administered SP to clients seeking reinjection of DMPA IM. We conducted in-depth interviews with 86 providers (52 in Senegal, 34 in Uganda) to assess their experiences providing SP to clients.Item Socio-Cognitive Factors Associated With Condom Use, Multiple Sexual Partnerships, and Contraception Use Among Sexually-Active Adolescent Girls in Uganda(Global Journal of Health Science, 2018) Nalukwago, Judith; Crutzen, Rik; Borne, Bart van den; Bukuluki, Paul M.; Bufumbo, Leonard; Burke, Holly M.; Field, Samuel; Zikusooka, Amos; Fiedler, Anne A.; Alaii, JaneMany adolescent girls start sexual activity early which exposes them to health risks of HIV and unplanned pregnancies. However, adolescent girls are less likely than boys to initiate discussion or demand use of condoms. Multiple sexual partnerships among girls are reported to be on the rise with eminent transactional sex and pre-marital relationships. The unmet need for contraception among adolescent girls is also high. A cross-sectional survey covering 16 districts in Uganda assessed the socio-cognitive factors associated with condom use, multiple sexual partnerships and contraception use among sexually active adolescent girls (N=255). There were strong associations between feeling confident to discuss contraceptive methods with a partner (OR = 9.41, 95 % CI = 3.54, 25.06), being comfortable to use contraception (OR = 30.61, 95% CI = 4.10, 228.64), discussing contraception use with someone (OR = 10.53, 95% CI = 5.61, 19.78), and contraception use. Whereas knowledge was found to have no significant relationship with service uptake, information services remain important in clearing any misconceptions and addressing any health concerns. It is imperative to explore communication factors including skills development and providing adequate health information to guide dialogue among adolescents and their key influencers.Item Traditional Male Circumcision in Uganda: A Qualitative Focus Group Discussion Analysis(PLoS ONE, 2012) Sarvestani, Amir Sabet; Bufumbo, Leonard; Geiger, James D.; Sienko, Kathleen H.The growing body of evidence attesting to the effectiveness of clinical male circumcision in the prevention of HIV/AIDS transmission is prompting the majority of sub-Saharan African governments to move towards the adoption of voluntary medical male circumcision (VMMC). Even though it is recommended to consider collaboration with traditional male circumcision (TMC) providers when planning for VMMC, there is limited knowledge available about the TMC landscape and traditional beliefs. Methodology and Main Findings: During 2010–11 over 25 focus group discussions (FGDs) were held with clan leaders, traditional cutters, and their assistants to understand the practice of TMC in four ethnic groups in Uganda. Cultural significance and cost were among the primary reasons cited for preferring TMC over VMMC. Ethnic groups in western Uganda circumcised boys at younger ages and encountered lower rates of TMC related adverse events compared to ethnic groups in eastern Uganda. Cutting styles and post-cut care also differed among the four groups. The use of a single razor blade per candidate instead of the traditional knife was identified as an important and recent change. Participants in the focus groups expressed interest in learning about methods to reduce adverse events.Item What Does your Partner Want? Using a Gender Equality Lens to Assess Partner Support and Involvement in Family Planning in Uganda(Research Square, 2022) Olapeju, Bolanle; Odeke, Paul; Nalukwago, Judith; Mugabe, Pallen; Bufumbo, Leonard; Kimbowa, Musa; Kayongo, Emmanuel; Naibere, Mabel; Nanyonga, Nanah; Mugahi, Richard; Bakyaita, Tabley; Kabanda, RichardWhile partner involvement in health-related decision-making is linked with positive health behaviors, a key gap in the literature exists on how this construct should be measured and the specific ways men and women in Uganda perceive partner support in the context of family planning. The USAID-funded Social and Behavior Change Activity (SBCA) in Uganda explored the differences in male versus female priorities in the decision-making considerations and preferred measures of partner support related to family planning in order to design contextually relevant solutions.Item Willingness to participate in preventive HIV vaccine trials in a community-based cohort in South Western Uganda(Tropical medicine & international health, 2009) Ruzagira, Eugene; Wandiembe, Symon; Bufumbo, Leonard; Levin, Jonathan; Price, Matthew A.; Grosskurth, Heiner; Kamali, AnatoliTo assess willingness to participate in HIV vaccine trials and possible barriers to participation. methods Questionnaire survey of participants completing a 2-year community-based HIV Vaccine Preparedness Study, followed by cross sectional analysis of data. results 95% of participants were willing to participate in a trial with similar attributes to the Vaccine Preparedness Study. Certain hypothetical trial attributes significantly reduced willingness to participate: The requirement to delay pregnancy (for females) had the largest effect, reducing willingness to participate from 97% to 23% (P < 0.0001). Larger blood draws had the second largest effect: 95–55% (P < 0.0001). The possibility of receiving either candidate vaccine or placebo had the third largest effect: 95–73% (P < 0.0001). Monthly study visits had the fourth largest effect: 95–92% (P < 0.0001). Trial duration longer than 2 years had the least effect: 95–93% (P = 0.0025). Combined attributes reduced willingness to participate from 95% to 43% (McNemar’s v2 = 521.00; P < 0.0001) overall and 97–11% (McNemar’s v2 = 531.00; P < 0.0001) for female participants. Physical harm concerns (adjusted OR = 34.9; 95% CI, 10.4–118) and a low risk behaviour index (adjusted OR = 0.09; 95% CI, 0.01–0.73) were associated with unwillingness to participate. conclusions We found a high level of willingness to participate in HIV vaccine trials in this population. However, certain HIV vaccine trial requirements were associated with reduced willingness to participate. Community as well as individual concerns will have to be carefully addressed in planned HIV vaccine trials.Item Women who fall by the roadside: gender, sexual risk and alcohol in rural Uganda(Addiction, 2006) Wolff, Brent; Busza, Joanna; Bufumbo, Leonard; Whitworth, JimmyTo investigate community perceptions about the different relationship between alcohol consumption and sexual risk-taking for men and women in a high HIV prevalence African setting Design and setting Participatory learning and action (PLA) activities were conducted in five rural villages in south-western Uganda in 2002. For each village, discussions and visualization activities over the course of 5 days explored local concepts of fun, drinking alcohol and HIV-related behavioural risks. Twelve focus group discussions (FGDs) investigated emerging themes. Analysis is based on visual outputs, observation notes and focus group transcripts. Participants Attendance at sex-segregated PLA sessions was open to all village residents. FGDs were purposively sampled from drinkers and general population groups. Findings For men, drinking is conducted invariably outside the home, usually at night in bars, emphasizing independence, masculinity and freedom from domestic responsibilities. For women, drinking outside male supervision challenges feminine ideals of domesticity and signifies potential sexual vulnerability. Accepting drinks from men was viewed as signifying assent to sex and refusal could justify men resorting to sexual coercion. Even though drinking is seen to promote sexual risk, HIV prevention campaigns were considered unwelcome in bars. Communities preferred seminars involving drinkers and non-drinkers alike. Conclusions Public drinking in this community serves as a marker for men willing to exercise privileges of independence (sexual and otherwise) and women willing to defy gender norms (and risk the sexual consequences). The social and symbolic context of drinking suggests why effective HIV prevention around alcohol should not be limited to drinking environments alone.