Browsing by Author "Bukenya, Justine"
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Item Alcohol use, Mycoplasma genitalium and other STIs associated with HIV incidence among women at high risk in Kampala, Uganda(Journal of acquired immune deficiency syndromes, 2013) Vandepitte, Judith; Weiss, Helen A.; Bukenya, Justine; Nakubulwa, Susan; Mayanja, Yunia; Matovu, Godfrey; Kyakuwa, Nassim; Hughes, Peter; Hayes, Richard; Grosskurth, HeinerIn 2008, the first clinic for women involved in high risk sexual behaviour was established in Kampala, offering targeted HIV prevention. This paper describes rates, determinants and trends of HIV incidence over 3 years. Methods—1027 women at high risk were enrolled into a closed cohort. At 3-monthly visits, data were collected on socio-demographic variables and risk behaviour; biological samples were tested for HIV and other STIs. Hazard ratios (HR) for HIV incidence were estimated using Cox proportional hazards regression, among the 646 women HIV negative at enrolment. Results—HIV incidence was 3.66/100pyr and declined from 6.80/100pyr in the first calendar year to 2.24/100pyr and 2.53/100pyr in the following years (P-trend=0.003). Socio-demographic and behavioural factors independently associated with HIV incidence were younger age, younger age at first sex, alcohol use (including frequency of use and binge drinking), number of paying clients in the past month, inconsistent condom use with clients, and not being pregnant. HIV incidence was also independently associated with M. genitalium infection at enrolment (aHR=2.28, 95%CI: 1.15-4.52), and with N. gonorrhoeae (aHR=5.91, 95%CI: 3.04-11.49) and T. vaginalis infections at the most recent visit (aHR=2.72, 95%CI: 1.27-5.84). The PAF of HIV incidence for alcohol use was 63.5% (95%CI 6.5%-85.8%), and for treatable STI/RTI was 70.0% (95%CI 18.8%-87.5%). Conclusions—Alcohol use and STIs remain important risk factors for HIV acquisition, which call for more intensive control measures in women at high risk. Further longitudinal studies are needed to confirm the association between Mycoplasma genitalium and HIV acquisition.Item Bacterial vaginosis among women at high risk for HIV in Uganda: high rate of recurrent diagnosis despite treatment(Sexually transmitted infections, 2016) Francis, Suzanna C.; Looker, Clare; Vandepitte, Judith; Bukenya, Justine; Mayanja, Yunia; Nakubulwa, Susan; Hughes, Peter; Hayes, Richard J.; Weiss, Helen A.; Grosskurth, HeinerBacterial vaginosis (BV) is associated with increased risk for sexually transmitted infections (STIs) and HIV acquisition. This study describes the epidemiology of BV in a cohort of women at high risk for STI/HIV in Uganda over 2 years of follow-up between 2008–2011. Methods 1027 sex workers or bar workers were enrolled and asked to attend 3-monthly follow-up visits. Factors associated with prevalent BV were analysed using multivariate random-effects logistic regression. The effect of treatment on subsequent episodes of BV was evaluated with survival analysis. Results Prevalences of BV and HIV at enrolment were 56% (573/1027) and 37% (382/1027), respectively. Overall, 905 (88%) women tested positive for BV at least once in the study, over a median of four visits. Younger age, a higher number of previous sexual partners and current alcohol use were independently associated with prevalent BV. BV was associated with STIs, including HIV. Hormonal contraception and condom use were protective against BV. Among 853 treated BV cases, 72% tested positive again within 3 months. There was no difference in time to subsequent BV diagnosis between treated and untreated women. Conclusions BV was highly prevalent and persistent in this cohort despite treatment. More effective treatment strategies are urgently needed.Item Co-occurrence of and factors associated with health risk behaviors among adolescents: a multi-center study in sub-Saharan Africa, China, and India(Elsevier Ltd, 2024-04) Li, Xuan; Dessie, Yadeta; Mwanyika-Sando, Mary; Assefa, Nega; Millogo, Ourohiré; Manu, Adom; Chukwu, Angela; Bukenya, Justine; Patil, Rutuja; Zou, Siyu; Zhang, Hanxiyue; Nurhussien, Lina; Tinkasimile, Amani; Bärnighausen, Till; Shinde, Sachin; Fawzi, Wafaie W; Tang, KunAbstract Despite lifelong and detrimental effects, the co-occurrence of health risk behaviors (HRBs) during adolescence remains understudied in low- and middle-income countries. This study examines the co-occurrence of HRBs and its correlates among adolescents in sub-Saharan Africa, China, and India. A multi-country cross-sectional study was conducted in 2021-2022, involving 9697 adolescents (aged 10-19 years) from eight countries, namely Burkina Faso, China, Ethiopia, India, Ghana, Nigeria, Tanzania, and Uganda. A standardized questionnaire was administered to examine five types of HRBs - physical inactivity, poor dietary habits, smoking, alcohol consumption, and risky sexual behavior. Latent class analysis was employed to identify clustering patterns among the behaviors, and logistic regression was used to identify the correlates of these patterns. Three clusters of HRBs were identified, with Cluster 1 (27.73%) characterized by the absence of any specific risky behavior, Cluster 2 (68.16%) characterized by co-occurrence of physical inactivity and poor dietary habits, and Cluster 3 (4.11%) characterized by engagement in smoking, alcohol consumption, and risky sexual behavior. Relative to Cluster 1, being in Cluster 2 was associated with being female (aOR 1.20, 95% CI 1.09-1.32), not enrolled in education (aOR 0.84, 95% CI 0.71-0.99), and not engaged in paid work (aOR 1.23, 95% CI 1.08-1.41). Compared with those Cluster 1, adolescents in Cluster 3 were less likely to be female (aOR 0.41, 95% CI 0.32-0.54), be engaged in paid work (aOR 0.54, 95% CI 0.41-0.71), more likely to be older (aOR 7.56, 95% CI 5.18-11.03), not be enrolled in educational institution (aOR 1.74, 95% CI 1.27-2.38), and more likely to live with guardians other than parents (aOR 1.56, 95% CI 1.19-2.05). The significant clustering patterns of HRBs among adolescents in sub-Saharan Africa, China, and India highlights the urgent need for convergent approaches to improve adolescent health behaviors. Early life and school-based programs aimed at promoting healthy behaviors and preventing risky and unhealthy behaviors should be prioritized to equip adolescents with the tools and skills for lifelong well-being. Fondation Botnar (Grant #INV-037672) and Harvard T.H. Chan School of Public Health, partially funded this study. PubMedItem Examining the roles of significant others of women in the uptake of health facility delivery in Northern Uganda: perspectives from the health belief model.(Research Square, 2019) Nyachwo, Evelyne B.; Naigino, Rose; Apolo, Rebecca R.; Wanyenze, Rhoda K.; Kiguli, Juliet; Bukenya, JustineHealth facility delivery improves maternal and child health outcomes but has not been fully achieved in countries with the poorest maternal health indicators. We identified and examined the roles of key influencers (significant others) of mother’s perceptions towards health facility delivery in Northern Uganda. Methods: This was an exploratory study conducted using in-depth interviews with eleven significant others in a mother’s life; who were purposively selected from four sub-counties of; Ogur, Agweng, Amach and Agali, as part of a larger study in Lira district, Northern Uganda. We also conducted seven key informant interviews with health workers involved in maternal and child health care. Data analysis using Atlas ti version.7.0 was conducted deductively following a thematic framework approach to analyse themes adapted from the health belief model. Results: The study identified husbands, biological mothers, mothers-in-law, fathers-in-law, brothers and co-wives as influencers of mother’s perceptions on uptake of health facility delivery. Other significant others included traditional birth attendants who were believed to have the ability to determine when the condition of a mother required the intervention of a medical expert. Community members such as local village leaders, village health extension workers and neighbours were also cited . Whereas husbands were regarded as ke y significant others of women, health workers emphasized that, husbands were not always available to support the mothers during pregnancy and child birth. The roles of significant others of women included: planning for birth, providing financial support, making decisions on where a mother will deliver from, continued counselling and psychosocial support.Item Factors associated with utilization of maternal health services by female sex workers in Uganda: a Health facility based survey(Research Square, 2019) Bukenya, Justine; Barrett, Geraldine; Kaharuza, Frank; Guwatudde, David; Wanyenze, Rhoda K.Introduction Female sex workers (FSWs) are marginalized due to social rejection and stigma, especially in countries where the practice is illegal. Many FSWs are mothers but little is known about their utilization of maternal services. This study investigated the determinants of utilization of maternal services by FSWs in Uganda. Methods FSWs were recruited from the “Most at-Risk Initiative” clinics in Uganda. We analyzed data for 318 FSWs who had given birth within two years of the study to estimate the proportion of FSWs who used all the components of maternal services (antenatal, facility-based delivery and postnatal). The outcome variable (utilization of maternal services) was categorized as “recommended package” if the women received all the three services, “moderate” if they received any two and “limited/none” if they received only one or none of the services. Multinomial logistic regression analysis was used to quantify the impact of pregnancy planning and other factors on the utilization of maternal services. Results Overall, 25.2% (80) utilized all the three services in the recommended package of maternal services, 47.5% (151) had moderate utilization, while 27.3% (87) utilized limited or no services. Factors that influenced utilization of the recommended package compared to “limited/none” use were having a planned pregnancy (adjusted RRR (aRR) = 3.87; 95% CI = 1.40-10.67), knowing four as the minimum number of ANC visits (aRR = 2.43; 95% CI = 1.22-4.87), never having been criminalized for sex work (aRR = 2.48; 95% CI = 1.30-4.74) and not believing that health providers deny services to FSWs believing (aRR = 2.63; 95% CI = 1.37-5.07). Conclusion These findings confirm the relevance of pregnancy planning in the utilization of maternal services among FSWs. However, maternal health service utilization was generally low and interventions to reduce barriers including inadequate knowledge of ANC visits, internal stigma and criminalization of sex work are required. These are necessary steps in the move towards universal health coverage.Item Intimate partner violence among HIV positive women in care - results from a national survey, Uganda 2016(BMC women's health, 2019) Ndugwa Kabwama, Steven; Bukenya, Justine; Matovu, Joseph K. B.; Gwokyalya, Violet; Makumbi, Fredrick; Beyeza-Kashesya, Jolly; Mugerwa, Shaban; Baptist Bwanika, John; Wanyenze, Rhoda K.Women remain disproportionally affected by the HIV/ AIDS epidemic because of sociocultural factors including violence perpetrated by intimate partners. Among HIVpositive (HIV+) women, intimate partner violence (IPV) affects engagement in care and reproductive health outcomes. We analyzed data from a national survey to estimate the prevalence of IPV among HIV+ women in care and associated factors. Methods: The study was conducted among 5198 HIV+ women in care. Data were collected on socio-demographic characteristics, self-reported couple HIV status, mutual HIV status disclosure and IPV. IPV was assessed by asking participants whether their current husband or partner ever hit, slapped, kicked or did anything to hurt them physically, and whether their current husband or partner ever physically forced them to have intercourse or perform any sexual acts against their will. Women who responded “yes” were classified as having ever experienced IPV. Modified Poisson regression was used to identify factors associated with experiencing IPV. Results: Of 5198 HIV+ women, 1664 (32.1%) had ever experienced physical violence, 1466 (28.3%) had ever experienced sexual violence and 2290 (44.2%) had ever experienced any IPV. Compared with women in relationships where the woman and their male partner were of the same age, women in relationships where the partner was ≥1 year younger were more likely to ever experience IPV (Prevalence risk ratio [PRR] = 1.43, 95% Confidence Interval [95%CI]: 1.10–1.71), as were women in relationships where the partner was < 10 years older (PRR = 1.20, 95%CI: 1.00–1.43) or ≥ 10 years older (PRR = 1.31, 95%CI: 1.05–1.64). Compared with women who did not have biological children, women with 3–4 biological children were more likely to have ever experienced IPV (PRR = 1.27 95%CI: 1.00–1.59) as were those with ≥5 biological children (PRR = 1.34, 95%CI: 1.06–1.71). Compared with women in sero-concordant relationships, women in sero-discordant relationships were less likely to ever experience IPV (PRR = 0.87 95%CI: 0.78–0.98).Item Knowledge and correlates of use of safer conception methods among HIV-infected women attending HIV care in Uganda(Reproductive health, 2019) Gwokyalya, Violet; Beyeza-Kashesya, Jolly; Bwanika, John B.; Matovu, Joseph K. B.; Mugerwa, Shaban; Arinaitwe, Jim; Kasozi, Dickson; Bukenya, Justine; Kindyomunda, Rosemary; Wagner, Glenn J.; Makumbi, Fredrick E.; Wanyenze, Rhoda K.Many people living with HIV would like to have children but family planning (FP) services often focus on only contraception. Availability of safer conception services is still very low in most low income countries. In this study we assessed the knowledge and use of safer conception methods (SCM) among HIV infected women in HIV care in Uganda to inform integration of safer conception in existing FP services. Methods: Data were accrued from a nationally representative cross-sectional survey of 5198 HIV+ women aged 15– 49 years from 245 HIV clinics in Uganda. Knowledge and use of safer conception methods and associated factors were determined. The measure of association was prevalence ratio (PR) with corresponding 95% confidence intervals, obtained using a modified Poisson regression via generalized linear models. All the analyses were conducted using STATA version 12.0. Results: Overall knowledge of any safer conception method was 74.1% (3852/5198). However only 13.2% knew 3 to 4 methods, 18.9% knew only 2 methods and 42% knew only one method. Knowledge of specific SCM was highest for timed unprotected intercourse (TUI) at 39% (n = 2027) followed by manual self-insemination (MSI) at 34.8% (n = 1809), and pre-exposure prophylaxis (PrEP) at 24.8% (n = 1289). Knowledge of SCM was higher in the Eastern region (84.8%, P < 0.001), among women in HIV-discordant relationships (76.7%, p < 0.017), and those on ART (74.5%, p < 0.034). Overall, 1796 (34.6%) women were pregnant or reported a birth in the past 2 years—overall use of SCM in this group was 11.6% (209/1796). The odds of use of SCM were significantly lower in Kampala [adj. PR = 0.489(0.314, 0.764)] or Eastern region [adj.PR = 0.244; (0.147, 0.405)] compared to Northern region. Higher odds of SCM use were associated with HIV status disclosure to partner [adj.PR = 2.613(1.308, 5.221)] and sero-discordant compared to HIV+ concordant relationship [adj.PR = 1.637(1.236, 2.168)]. Pre-existing knowledge of any one SCM did not influence SCM use.Item Prevalence and Correlates of Mycoplasma genitalium Infection Among Female Sex Workers in Kampala, Uganda(Journal of Infectious Diseases, 2012) Vandepitte, Judith; Muller, Etienne; Bukenya, Justine; Nakubulwa, Susan; Kyakuwa, Nassim; Buve, Anne; Weiss, Helen; Hayes, Richard; Grosskurth, HeinerThe importance of Mycoplasma genitalium in human immunodeficiency virus (HIV)–burdened sub–Saharan Africa is relatively unknown. We assessed the prevalence and explored determinants of this emerging sexually transmitted infection (STI) in high-risk women in Uganda. Methods. Endocervical swabs from 1025 female sex workers in Kampala were tested for Mycoplasma genitalium using a commercial Real-TM polymerase chain reaction assay. Factors associated with prevalent Mycoplasma genitalium, including sociodemographics, reproductive history, risk behavior, and HIV and other STIs, were examined using multivariable logistic regression. Results. The prevalence of Mycoplasma genitalium was 14% and higher in HIV-positive women than in HIVnegative women (adjusted odds ratio [OR], 1.64; 95% confidence interval [CI], 1.12–2.41). Mycoplasma genitalium infection was less prevalent in older women (adjusted OR, 0.61; 95% CI, .41–.90 for women ages 25–34 years vs ,25 years; adjusted OR, 0.32; 95% CI, .15–.71 for women $35 years vs those ,25 years) and in those who had been pregnant but never had a live birth (adjusted OR, 2.25; 95% CI, 1.04–4.88). Mycoplasma genitalium was associated with Neisseria gonorrhoeae (adjusted OR, 1.84; 95% CI, 1.13–2.98) and with Candida infection (adjusted OR, 0.41; 95% CI, .18–.91), and there was some evidence of association with Trichomonas vaginalis (adjusted OR, 1.56; 95% CI, 1.00–2.44). Conclusions. The relatively high prevalence of Mycoplasma genitalium and its association with prevalent HIV urgently calls for further research to explore the potential role this emerging STI plays in the acquisition and transmission of HIV infection.Item The rates of HIV-1 superinfection and primary HIV-1 infection are similar in female sex workers in Uganda(Theoretical Medicine and Bioethics, 2008) Redd, Andrew D.; Ssemwanga, Deogratius; Vandepitte, Judith; Wendel, Sarah K.; Ndembi, Nicaise; Bukenya, Justine; Nakubulwa, Susan; Grosskurth, Heiner; Parry, Chris M.; Martens, Craig; Bruno, Daniel; Porcella, Stephen F.; Quinn, Thomas C.; Kaleebu, PontianoTo determine and compare the rates of HIV superinfection and primary HIV infection in high-risk female sex workers in Kampala, Uganda. Design—A retrospective analysis of individuals who participated in a clinical cohort study among high-risk female sex workers in Kampala, Uganda. Methods—Plasma samples from HIV-infected female sex workers (FSW) in Kampala, Uganda were examined with next-generation sequencing of the p24 and gp41HIV genomic regions for the occurrence of superinfection. Primary HIV incidence was determined from initially HIV-uninfected FSW from the same cohort, and incidence rate ratios were compared. Results—The rate of superinfection in these women (7/85; 3.4/100py) was not significantly different from the rate of primary infection in the same population (3.7/100py; IRR=0.91, p=0.42). Seven women also entered the study dual infected (16.5% either dual or superinfected). The women with any presence of dual infection were more likely to report sex work as their only source of income (p=0.05), and trended to be older and more likely to be widowed (p=0.07). Conclusions—In this cohort of female sex workers, HIV superinfection occurred at a high rate and was similar to that of primary HIV infection. These results differ from a similar study of high-risk female bar-workers in Kenya that found the rate of superinfection to be significantly lower than the rate of primary HIV infection.Item Understanding sexual and reproductive health needs of adolescents: evidence from a formative evaluation in Wakiso district, Uganda(Reproductive health, 2015) Atuyambe, Lynn M.; Kibira, Simon P S; Bukenya, JustineAdolescents are frequently reluctant to seek sexual and reproductive health services (SRH). In Uganda, adolescent health and development is constrained by translation of the relevant policies to practice. Recent studies done in central Uganda have shown that there is need for a critical assessment of adolescent friendly services (AFS) to gain insights on current practice and inform future interventions. This study aimed to assess the sexual reproductive health needs of the adolescents and explored their attitudes towards current services available.