Browsing by Author "Kamali, Anatoli"
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Item Acceptability and Predictors of Uptake of Anti-Retroviral Pre-Exposure Prophylaxis (Prep) among Fishing Communities in Uganda: A Cross-Sectional Discrete Choice Experiment Survey(AIDS and behavior, 2019) Kuteesa, Monica O.; Quaife, Mathew; Biraro, Sam; Katumba, Kenneth R.; Seeley, Janet; Kamali, Anatoli; Nakanjako, DamalieWe used a discrete choice experiment to assess the acceptability and potential uptake of HIV pre-exposure prophylaxis (PrEP) among 713 HIV-negative members of fishing communities in Uganda. Participants were asked to choose between oral pill, injection, implant, condoms, vaginal ring (women), and men circumcision. Product attributes were HIV prevention effectiveness, sexually transmitted infection (STI) prevention, contraception, waiting time, and secrecy of use. Data were analysed using mixed multinomial logit and latent class models. HIV prevention effectiveness was viewed as the most important attribute. Both genders preferred oral PrEP. Women least preferred the vaginal ring and men the implant. Condom use was predicted to decrease by one third among men, and not to change amongst women. Oral PrEP and other new prevention technologies are acceptable among fishing communities and may have substantial demand. Future work should explore utility of multiple product technologies that combine contraception with HIV and other STI prevention.Item Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda(PLoS ONE, 2016) Mayanja, Yunia; Mukose, Aggrey David; Nakubulwa, Susan; Omosa-Manyonyi, Gloria; Kamali, Anatoli; Guwatudde, DavidThe prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance. Methods We enrolled 241 FSWs in a cross sectional study; they were aged 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. MantelHaenszel tests for interaction were performed. Results Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education. Conclusion Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment.Item Adverse Pregnancy Outcomes in Rural Uganda (1996–2013): Trends and Associated Factors from Serial Cross Sectional Surveys(BMC pregnancy and childbirth, 2015) Asiki, Gershim; Baisley, Kathy; Newton, Rob; Marion, Lena; Seeley, Janet; Kamali, Anatoli; Smedman, LarsCommunity based evidence on pregnancy outcomes in rural Africa is lacking yet it is needed to guide maternal and child health interventions. We estimated and compared adverse pregnancy outcomes and associated factors in rural south-western Uganda using two survey methods.Within a general population cohort, between 1996 and 2013, women aged 15–49 years were interviewed on their pregnancy outcome in the past 12 months (method 1). During 2012–13, women in the same cohort were interviewed on their lifetime experience of pregnancy outcomes (method 2). Adverse pregnancy outcome was defined as abortions or stillbirths. We used random effects logistic regression for method 1 and negative binomial regression with robust clustered standard errors for method 2 to explore factors associated with adverse outcome.One third of women reported an adverse pregnancy outcome; 10.8 % (abortion = 8.4 %, stillbirth = 2.4 %) by method 1 and 8.5 % (abortion = 7.2 %, stillbirth = 1.3 %) by method 2. Abortion rates were similar (10.8 vs 10.5) per 1000 women and stillbirth rates differed (26.2 vs 13.8) per 1000 births by methods 1 and 2 respectively. Abortion risk increased with age of mother, non-attendance of antenatal care and proximity to the road. Lifetime stillbirth risk increased with age. Abortion and stillbirth risk reduced with increasing parity.Both methods had a high level of agreement in estimating abortion rate but were markedly below national estimates. Stillbirth rate estimated by method 1 was double that estimated by method 2 but method 1 estimate was more consistent with the national estimates.Strategies to improve prospective community level data collection to reduce reporting biases are needed to guide maternal health interventions.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 The General Population Cohort in Rural South Western Uganda: A Platform for Communicable and Non-Communicable Disease Studies(International journal of epidemiology, 2013) Asiki, Gershim; Murphy, Georgina; Miiro, Jessica Nakiyingi; Seeley, Janet; Nsubuga, Rebecca N.; Karabarinde, Alex; Waswa, Laban; Biraro, Sam; Kasamba, Ivan; Pomilla, Cristina; Maher, Dermot; Young, Elizabeth H; Kamali, Anatoli; Sandhu, Manjinder SThe General Population Cohort (GPC) was set up in 1989 to examine trends in HIV prevalence and incidence, and their determinants in rural south-western Uganda. Recently, the research questions have included the epidemiology and genetics of communicable and non-communicable diseases (NCDs) to address the limited data on the burden and risk factors for NCDs in sub-Saharan Africa. The cohort comprises all residents (52% aged ≥13years, men and women in equal proportions) within one-half of a rural sub-county, residing in scattered houses, and largely farmers of three major ethnic groups. Data collected through annual surveys include; mapping for spatial analysis and participant location; census for individual socio-demographic and household socioeconomic status assessment; and a medical survey for health, lifestyle and biophysical and blood measurements to ascertain disease outcomes and risk factors for selected participants. This cohort offers a rich platform to investigate the interplay between communicable diseases and NCDs. There is robust infrastructure for data management, sample processing and storage, and diverse expertise in epidemiology, social and basic sciences. For any data access enquiries you may contact the director, MRC/UVRI, Uganda Research Unit on AIDS by email to mrc@mrcuganda.org or the corresponding author.Item High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study(International journal of environmental research and public health, 2016) Weiss, Helen A.; Vandepitte, Judith; Bukenya, Justine N.; Mayanja, Yunia; Nakubulwa, Susan; Kamali, Anatoli; Seeley, Janet; Grosskurth, HeinerThe aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.Item Infection with HIV-1 subtype D among Acutely Infected Ugandans is Associated with Higher Median Concentration of Cytokines Compared to Subtype(IJID Regions, 2022) Kapaata, Anne; Balinda, Sheila N.; Kikaire, Bernard; Egesa, Moses; Lubyayi, Lawrence; Macharia, Gladys N.; Kamali, Anatoli; Gilmour, Jill; Bagaya, Bernard; Salazar-Gonzalez, Jesus F.; Kaleebu, PontianoThe observation that HIV-1 subtype D progresses faster to disease than subtype A prompted us to examine cytokine levels early after infection within the predominant viral subtypes that circulate in Uganda and address the following research questions: (1) Do cytokine levels vary between subtypes A1 and D? (2) Do cytokine profiles correlate with disease outcomes? To address these questions, HIV-1 subtypes were determined by population sequencing of the HIV-1 pol gene and 37 plasma cytokine concentrations were evaluated using V-Plex kits on Meso Scale Discovery platform in 65 recent sero-converters. HIV-1 subtype D (pol) infections exhibited significantly higher median plasma concentrations of IL-5, IL-16, IL-1α, IL-7, IL-17A, CCL11 (Eotaxin-1), CXCL10 (IP-10), CCL13 (MCP-4) and VEGF-D compared to subtype A1 (pol) infections. We also found that IL-12/23p40 and IL-1α were associated with faster CD4+T cell count decline, while bFGF was associated with maintenance of CD4+ counts above 350 cells/microliter. Our results suggest that increased production of cytokines in early HIV infection may trigger a disruption of the immune environment and contribute to pathogenic mechanisms underlying the accelerated disease progression seen in individuals infected with HIV-1 subtype D in Uganda.Item Participation in Clinical Research Could Modify Background Risk for Trial Outcome Measures(AIDS Research and Human Retroviruses, 2014) Abaasa, Andrew M.; Asiki, Gershim; Levin, Jonathan; Bahemuka, Ubaldo; Ruzagira, Eugene; Kibengo, Freddie M.; Mulondo, Jerry; Ndibazza, Juliet; Price, Matthew A.; Fast, Pat; Kamali, AnatoliData on HIV incidence and retention are needed to inform study design of efficacy trials. However, the selection criteria and interventions during an actual clinical trial could reduce HIV incidence and thus affect the statistical power. We investigated the effect of inclusion and participation in a simulated vaccine efficacy trial (SiVET) on HIV and pregnancy incidence in a fisherfolk cohort in SW Uganda.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 Trends of Reported HIV Sexual Risk Behaviour and HIV Incidence among Fisherfolk in Uganda Receiving Clinic-based Routine HIV Counseling and Testing(AIDS Research and Human Retroviruses, 2014) Mushabe Bahemuka, Ubaldo; Abaasa, Andrew; Ruzagira, Eugene; Mukasa Kibengo, Freddie; Ndibazza, Juliet; Asiki, Gershim; Mulondo, Jerry; Andrew Price, Matthew; Fast, Patricia; Kamali, AnatoliHIV counseling and testing (HCT) has been shown to reduce HIV risk behavior and is central to HIV prevention programs. We investigated risk behavior and HIV incidence trends in a fisherfolk cohort on Lake Victoria, Uganda. HIV negative volunteers aged 18–49 years, at high risk of HIV infection and willing to undergo HCT were enrolled. At every quarterly visit, they received HCT. Condoms and STI treatment were also provided. Risk behavior data on alcohol consumption before sex, multiple or new sex partners, condom use and exchange of gifts for sex in the past 3 months were collected at baseline and every 6 months for 2 years. We fitted multilevel logistic regression models to investigate the trends.Item Visual inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study highlighting one-year experiences in early detection of precancerous and cancerous cervical lesions in Kampala, Uganda(Infectious Agents and Cancer, 2021) Namale, Gertrude; Mayanja, Yunia; Kamacooko, Onesmus; Bagiire, Daniel; Ssali, Agnes; Seeley, Janet; Newton, Robert; Kamali, AnatoliAlthough cervical cancer is preventable, most women in sub-Saharan Africa (SSA) do not receive routine screening and few treatment options exist. Female Sex Workers (FSWs) are among the Ugandan female population at highest risk of acquiring sexually transmitted infections (STIs) including HIV and human papilloma viruses (HPV), the cause of cervical cancer. We report one-year experiences of visual inspection with acetic acid (VIA) positivity among FSWs in the early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Methods: Between June 2014 and July 2015, we enrolled FSWs into a cross-sectional study at a research clinic. The women were screened using the VIA method (application of 3–5 % acetic acid to the cervix). All VIA positive women were referred to a tertiary hospital for colposcopy, biopsy, and immediate treatment (if indicated) at the same visit according to national guidelines. Data on socio-demographic, sexual behaviour, sexual reproductive health and clinical characteristics were collected. We used logistic regression to identify factors associated with VIA positivity. Results: Of 842 women assessed for eligibility, 719 (85 %) of median age 30 (IQR 26, 35) were screened, and 40 (6 %) women were VIA positive. Of the 24 histology specimens analysed, 6 showed inflammation, only 1 showed cervical intraepithelial neoplasia (CIN) 1, 13 women showed CIN2/3, while 4 women already had invasive cervical cancer. The overall prevalence of HIV was 43 %, of whom only 35 % were receiving ART. In the age-adjusted analysis, VIA positivity was more likely among women who reported having > 100 life-time partners (aOR = 3.34, 95 %CI: 1.38–8.12), and HIV positive women (aOR = 4.55; 95 %CI: 2.12–9.84).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.