Browsing by Author "Chemusto, Harriet"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Maternal depression treatment in HIV (M-DEPTH) Study protocol for a cluster randomized controlled trial
    (Medicine, 2019) Wagner, Glenn J.; McBain, Ryan K.; Akena, Dickens; Ngo, Victoria; Nakigudde, Janet; Nakku, Juliet; Chemusto, Harriet; Beyeza-Kashesya, Jolly; Gwokyalya, Violet; Faherty, Laura J.; Kyohangirwe, Leticia; Kisaakye Nabitaka, Linda; Lukwata, Hafsa; Linnemayr, Sebastian; Ghosh-Dastidar, Bonnie; Businge, Juliet; Mukasa, Barbara; Wanyenze, Rhoda K.
    Over one-third of human immunodeficiency virus (HIV)-infected pregnant women are clinically depressed, increasing the risk of mother-to-child transmission (MTCT) of HIV, as well as negative birth and child development outcomes. This study will evaluate the efficacy and cost-effectiveness of an evidence-based stepped care treatment model for perinatal depression (maternal depression treatment in HIV [M-DEPTH]) to improve adherence to prevention of MTCT care among HIV+ women in Uganda. Methods: Eight antenatal care (ANC) clinics in Uganda will be randomized to implement either M-DEPTH (n=4) or usual care (n=4) for perinatal depression among 400 pregnant women (n=50 per clinic) between June 2019 and August 2022. At each site, women who screen positive for potential depression will be enrolled and followed for 18 months post-delivery, assessed in 6-month intervals: baseline, within 1 month of child delivery or pregnancy termination, and months 6, 12, and 18 following delivery. Primary outcomes include adherence to the prevention of mother-to-child transmission (PMTCT) care continuum—including maternal antiretroviral therapy and infant antiretrovial prophylaxis, and maternal virologic suppression; while secondary outcomes will include infant HIV status, post-natal maternal and child health outcomes, and depression treatment uptake and response. Repeated-measures multivariable regression analyses will be conducted to compare outcomes between M-DEPTH and usual care, using 2-tailed tests and an alpha cut-off of P <.05. Using a micro-costing approach, the research team will relate costs to outcomes, examining the incremental cost-effectiveness ration (ICER) of M-DEPTH relative to care as usual. Discussion: This cluster randomized controlled trial will be one of the first to compare the effects of an evidence-based depression care model versus usual care on adherence to each step of the PMTCT care continuum. If determined to be efficacious and costeffective, this study will provide a model for integrating depression care into ANC clinics and promoting adherence to PMTCT.
  • Thumbnail Image
    Item
    A qualitative study on alcohol consumption and HIV treatment adherence among men living with HIV in Ugandan fishing communities
    (AIDS care, 2019) Sileo, Katelyn M.; Kizito, Williams; Wanyenze, Rhoda K.; Chemusto, Harriet; Musoke, William; Mukasa, Barbara; Kiene, Susan M.
    Ugandan fishing communities are dually burdened with high rates of HIV and alcohol use. This qualitative study explores context and motivation of alcohol consumption, and alcohol’s effect on antiretroviral treatment (ART) adherence, among male fisherfolk living with HIV in Wakiso District, Uganda. We conducted in-depth semi-structured interviews with 30 men in HIV care and on ART, and used a thematic analysis approach for analysis. Alcohol use was identified as a major barrier to ART adherence through cognitive impairment and the intentional skipping of doses when drinking. Men reportedly reduced their drinking since HIV diagnosis – motivated by counseling received from providers and a newfound desire to live a healthy lifestyle. However, social, occupational, and stress-related influences that make alcohol reduction difficult were identified. Our findings suggest alcohol use may pose a challenge to ART adherence for fishermen living with HIV – and has implications for the tailoring of screening and brief intervention for alcohol reduction in HIV care for this population
  • Thumbnail Image
    Item
    Socio-demographic predictors of gender inequality among heterosexual couples expecting a child in south-central Uganda.
    (African Health Sciences, 2020-09) Vrana-Diaz, Caroline J.; Korte, Jeffrey E.; Gebregziabher, Mulugeta; Richey, Lauren; Selassie, Anbesaw; Sweat, Michael; Chemusto, Harriet; Wanyenze, Rhoda
    Background: Gender inequality is a pervasive problem in sub-Saharan Africa, and has negative effects on health and de- velopment. Objective: Here, we sought to identify socioeconomic predictors of gender inequality (measured by low decision-making power and high acceptance of intimate partner violence) within heterosexual couples expecting a child in south-central Uganda. Method: We used data from a two-arm cluster randomized controlled HIV self-testing intervention trial conducted in three antenatal clinics in south-central Uganda among 1,618 enrolled women and 1,198 male partners. Analysis included Cochran Mantel-Haenzel, proportional odds models, logistic regression, and generalized linear mixed model framework to account for site-level clustering. Results: Overall, we found that 31.1% of men had high acceptance of IPV, and 15.9% of women had low decision-making power. We found religion, education, HIV status, age, and marital status to significantly predict gender equality. Specifically, we observed lower gender equality among Catholics, those with lower education, those who were married, HIV positive women, and older women. Conclusion: By better understanding the prevalence and predictors of gender inequality, this knowledge will allow us to better target interventions (increasing education, reducing HIV prevalence in women, targeting interventions different reli- gions and married couples) to decrease inequalities and improve health care delivery to underserved populations in Uganda.
  • Thumbnail Image
    Item
    Substance use and its effect on antiretroviral treatment adherence among male fisherfolk living with HIV/AIDS in Uganda
    (PloS one, 2019) Sileo, Katelyn M.; Kizito, Williams; Wanyenze, Rhoda K.; Chemusto, Harriet; Reed, Elizabeth; Stockman, Jamila K.; Musoke, William; Mukasa, Barbara; Kiene, Susan M.
    Fisherfolk are a most-at-risk population for HIV being prioritized for the scale up of HIV treatment in Uganda. Heavy alcohol use and potential drug use may be a major barrier to treatment adherence for men in this setting. This study examines the prevalence of substance use, and its influence on antiretroviral treatment (ART) adherence, among male fisherfolk on ART in Wakiso District, Uganda. This cross-sectional study included structured questionnaires (N = 300) with men attending HIV clinics near Lake Victoria. Using generalized logistic modeling analyses with a binomial distribution and logit link, we conducted multivariate models to test the association between each alcohol variable (quantity and frequency index, hazardous drinking) and missed pills, adjusting for covariates, and tested for interactions between number of pills prescribed and alcohol variables.