Browsing by Author "Campbell, Jeffrey I."

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    Electrocardiographic Evidence of Cardiac Disease by Sex and HIV Serostatus in Mbarara, Uganda
    (Global heart, 2019) Kentoffio, Katie; Albano, Alfred; Koplan, Bruce; Feng, Maggie; Muthalaly, Rahul G.; Campbell, Jeffrey I.; Sentongo, Ruth; Tracy, Russell P.; Peck, Robert; Okello, Samson; Tsai, Alexander C.; Siedner, Mark J.
    Numerous studies in the United States and Europe have demonstrated an increased risk for cardiovascular disease (CVD) among persons living with HIV (PLWH).[1] The relationship between HIV and subsequent CVD has not been as well-established in sub-Saharan Africa (SSA). PLWH in SSA have a high burden of untreated risk factors, but results vary regarding surrogate markers of CVD. Data on outcomes, such as stroke or myocardial infarction, are limited. An analysis of data from the SMART trial found that PLWH had a high prevalence of ECG abnormalities at baseline, which predicted CVD risk over the study period.[2] We investigated the prevalence of ECG abnormalities by HIV serostatus in rural Uganda to estimate differences in CVD risk. As secondary aims, we assessed a) ECG evidence of ischemic coronary artery disease by HIV serostatus and b) sex-based differences in ECG findings.
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    Low population prevalence of atrial fibrillation in rural Uganda: A community-based cross-sectional study
    (International journal of cardiology, 2018) Muthalaly, Rahul G.; Koplan, Bruce A.; Albano, Alfred; North, Crystal; Campbell, Jeffrey I.; Kakuhikire, Bernard; Vořechovská, Dagmar; Kraemer, John D.; Tsai, Alexander C.; Siedner, Mark J.
    Atrial fibrillation (AF) is a major risk factor for stroke, which is the leading cause of cardiovascular mortality in sub-Saharan Africa. However, there is limited population-based epidemiological data on AF in sub-Saharan Africa. We sought to estimate the prevalence and correlates of AF in rural Uganda.We conducted a cross-sectional study using community health fairs in 2015 targeting eight villages in rural Uganda. Study participants completed a medical history, a clinical exam, blood collection, and 12‑lead electrocardiographic (ECG) screening. Of 1814 participants enrolled in a parent cohort study that includes 98% of adults residing in the geographic area, 856 attended a health fair and were included in this study. Our primary outcome was AF or atrial flutter. We modelled population prevalence of the outcome with inverse probability of treatment weighting using data collected from the full population.856 (47.2%) adults in the area attended a health fair and were included in the analysis. Health fair attendees were older (42 vs 34 years, P < 0.0001), in worse self-reported health (P < 0.0001) and more likely to be female (62% vs 49%, P < 0. 0001) compared with non-attendees. After applying weights, the estimated population mean age was 37.7 ± 14.9 years. 15% of the population was overweight or obese and 1.9% had left atrial enlargement on ECG. Despite this, the weighted estimate of AF was 0% (95%CI 0–0.54%).AF appears less prevalent in rural Uganda than in developed countries. The explanations for this finding may be genetic, environmental or related to survivorship bias.
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    The importance of how research participants think they are perceived: results from an electronic monitoring study of antiretroviral therapy in Uganda
    (AIDS Care, 2018) Campbell, Jeffrey I.; Musiimenta, Angella; Burns, Bridget; Natukunda, Sylvia; Musinguzi, Nicholas; Haberer, Jessica E.; Eyal, Nir
    Novel monitoring technologies in HIV research, such as electronic adherence monitors (EAMs), have changed the nature of researcher-participant interactions. Yet little is known about how EAMs and the resulting interaction between researchers and participants affect research participation and the data gathered. We interviewed participants and research assistants (RAs) in an observational cohort study involving EAMs for HIV antiretroviral therapy (ART) in Uganda. We qualitatively explored interviewees’ views about ethical issues surrounding EAMs and assessed data with conventional and directed content analysis. Participants valued their relationships with RAs and were preoccupied with RAs’ perceptions of them. Participants were pleased when the EAM revealed regular adherence, and annoyed when it revealed non-adherence that contradicted self-reported pill-taking behavior. For many, the desire to maintain a good impression incentivized adherence. But some sought to creatively conceal non-adherence, or refused to use the EAM to avoid revealing non-adherence to RAs. These findings show that participants’ perceptions of the study staff’s perceptions of them affected the experience of being monitored, study participation, and ultimately the data gathered in the study. Investigators in monitoring-based research should be aware that social interactions between participants and study staff could affect both the practical and ethical conduct of that research.
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    The Technology Acceptance Model for Resource-Limited Settings (TAM-RLS): A Novel Framework for Mobile Health Interventions Targeted to Low-Literacy End-Users in Resource-Limited Settings
    (AIDS and Behavior, 2017) Campbell, Jeffrey I.; Aturinda, Isaac; Mwesigwa, Evans; Burns, Bridget; Santorino, Data; Haberer, Jessica E.; Bangsberg, David R.; Holden, Richard J.; Ware, Norma C.; Siedner, Mark J.
    Although mobile health (mHealth) technologies have shown promise in improving clinical care in resource limited settings (RLS), they are infrequently brought to scale. One limitation to the success of many mHealth interventions is inattention to end-user acceptability, which is an important predictor of technology adoption. We conducted in-depth interviews with 43 people living with HIV in rural Uganda who had participated in a clinical trial of a short messaging system (SMS)-based intervention designed to prompt return to clinic after an abnormal laboratory test. Interviews focused on established features of technology acceptance models, including perceived ease of use and perceived usefulness, and included open-ended questions to gain insight into unexplored issues related to the intervention’s acceptability. We used conventional (inductive) and direct content analysis to derive categories describing use behaviors and acceptability.
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    Ugandan Study Participants Experience Electronic Monitoring of Antiretroviral Therapy Adherence as Welcomed Pressure to Adhere
    (AIDS and Behavior, 2018) Campbell, Jeffrey I.; Eyal, Nir; Musiimenta, · Angella; Burns, Bridget; Natukunda, Sylvia; Musinguzi, Nicholas; Haberer, Jessica E.
    Many new technologies monitor patients’ and study participants’ medical adherence. Some have cautioned that these devices transgress personal autonomy and ethics. But do they? This qualitative study explored how Ugandan study participants perceive the effect of electronic monitoring of their adherence to antiretroviral therapy (ART) on their freedoms to be nonadherent and pursue other activities that monitoring may inadvertently expose. Between August 2014 and June 2015, we interviewed 60 Ugandans living with HIV and enrolled in the Uganda AIDS Rural Treatment Outcomes (UARTO) study, a longitudinal, observational study involving electronic adherence monitors (EAMs) to assess ART adherence. We also interviewed 6 UARTO research assistants. Both direct and indirect content analysis were used to interpret interview transcripts. We found that monitoring created a sense of pressure to adhere to ART, which some participants described as “forcing” them to adhere. However, even participants who felt that monitoring forced them to take medications perceived using the EAM as conducive to their fundamental goal of high ART adherence. Overall, even if monitoring may have limited participants’ effective freedom to be non-adherent, participants welcomed any such effect. No participant rejected the EAM on the grounds that it would limit that effective freedom. Reports that monitoring altered behaviors unrelated to pill-taking were rare. Researchers should continue to be vigilant about the ways in which behavioral health monitoring affects autonomy, but should also recognize that even autonomy-limiting monitoring strategies may enable participants to achieve their own goals.