Browsing by Author "Kinyanda, Eugene"
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Item Association between serotonin transporter gene polymorphisms and increased suicidal risk among HIV positive patients in Uganda(BMC genetics, 2017) Kalungi, Allan; Seedat, Soraya; Hemmings, Sian M. J.; Merwe, Lize van der; Joloba, Moses L.; Nanteza, Ann; Nakassujja, Noeline; Birabwa, Harriet; Serwanga, Jennifer; Kaleebu, Pontiano; Kinyanda, EugenePersons living with HIV/AIDS (PLWHA) are at an increased risk of suicide. Increased suicidal risk is a predictor of future attempted and completed suicides and has been associated with poor quality of life and poor adherence with antiretroviral therapy. Clinical risk factors have low predictive value for suicide, hence the interest in potential neurobiological correlates and specific heritable markers of suicide vulnerability. The serotonin transporter gene has previously been implicated in the aetiology of increased suicidal risk in non-HIV infected study populations and its variations may provide a platform for identifying genetic risk for suicidality among PLWHA. The present cross-sectional study aimed at identifying two common genetic variants of the serotonin transporter gene and their association with increased suicidal risk among human immunodeficiency virus (HIV)-positive adults in Uganda. Results: The prevalence of increased suicidal risk (defined as moderate to high risk suicidality on the suicidality module of the Mini Neuropsychiatric Interview (M.I.N.I) was 3.3% (95% CI, 2.0–5.3). The 5-HTTLPR was found to be associated with increased suicidal risk before Bonferroni correction (p-value = 0.0174). A protective effect on increased suicidal risk was found for the 5-HTTLPR/rs25531 SA allele (p-value = 0.0046)- which directs reduced expression of the serotonin transporter gene (5-HTT). Conclusion: The SA allele at the 5-HTTLPR/rs25531 locus is associated with increased suicidal risk among Ugandan PLWHA. Further studies are needed to validate this finding in Ugandan and other sub-Saharan samples.Item The Cango Lyec Project - Healing the Elephant”: HIV related vulnerabilities of post-conflict affected populations aged 13–49 years living in three Mid-Northern Uganda districts(BMC Infectious Diseases, 2016) Malamba, Samuel S.; Muyinda, Herbert; Spittal, Patricia M.; Ekwaru, John P.; Kiwanuka, Noah; Ogwang, Martin D.; Odong, Patrick; Kitandwe, Paul K.; Katamba, Achilles; Jongbloed, Kate; Sewankambo, Nelson K.; Kinyanda, Eugene; Blair, Alden; Schechter, Martin T.The protracted war between the Government of Uganda and the Lord’s Resistance Army in Northern Uganda (1996–2006) resulted in widespread atrocities, destruction of health infrastructure and services, weakening the social and economic fabric of the affected populations, internal displacement and death. Despite grave concerns that increased spread of HIV/AIDS may be devastating to post conflict Northern Uganda, empirical epidemiological data describing the legacy of the war on HIV infection are scarce. Methods: The ‘Cango Lyec’ Project is an open cohort study involving conflict-affected populations living in three districts of Gulu, Nwoya and Amuru in mid-northern Uganda. Between November 2011 and July 2012, 8 study communities randomly selected out of 32, were mapped and house-to-house census conducted to enumerate the entire community population. Consenting participants aged 13–49 years were enrolled and interviewer-administered data were collected on trauma, depression and socio-demographic-behavioural characteristics, in the local Luo language. Venous blood was taken for HIV and syphilis serology. Multivariable logistic regression was used to determine factors associated with HIV prevalence at baseline. Results: A total of 2954 participants were eligible, of whom 2449 were enrolled. Among 2388 participants with known HIV status, HIV prevalence was 12.2% (95%CI: 10.8-13.8), higher in females (14.6%) than males (8.5%, p < 0.001), higher in Gulu (15.2%) than Nwoya (11.6%, p < 0.001) and Amuru (7.5%, p = 0.006) districts. In this post-conflict period, HIV infection was significantly associated with war trauma experiences (Adj. OR = 2.50; 95%CI: 1.31–4.79), the psychiatric problems of PTSD (Adj. OR = 1.44; 95%CI: 1.06–1.96), Major Depressive Disorder (Adj. OR = 1.89; 95%CI: 1.28–2.80) and suicidal ideation (Adj. OR = 1.87; 95%CI: 1.34–2.61). Other HIV related vulnerabilities included older age, being married, separated, divorced or widowed, residing in an urban district, ulcerative sexually transmitted infections, and staying in a female headed household. There was no evidence in this study to suggest that people with a history of abduction were more likely to be HIV positive. Conclusions: HIV prevalence in this post conflict-affected population is high and is significantly associated with age, trauma, depression, history of ulcerative STIs, and residing in more urban districts. Evidence-based HIV/STI prevention programs and culturally safe, gender and trauma-informed are urgently needed.Item A comparison of the behavioral and emotional disorders of primary school-going orphans and non-orphans in Uganda(African health sciences, 2007) Musisi, Seggane; Kinyanda, Eugene; Nakasujja, Noeline; Nakigudde, JanetThis study investigated the emotional and behavioral problems of orphans in Rakai District, Uganda, and to suggest interventions. Studies, elsewhere, have shown orphans to have high levels of psychological problems. However, in Uganda such studies are limited and no specific interventions have been suggested. Methods: The study employed a cross-sectional unmatched case control design to compare emotional and behavioral problems of 210 randomly selected primary school-going orphans and 210 non-orphans using quantitative and qualitative methods employing standardized questionnaires, Focus Group discussions and selected Key Informant interviews. All children were administered Rutter’s Children’s Teacher Administered Behavior Questionnaire to measure psychological distress and a modified version of Cooper’s Self-Report Measure for Social Adjustment. Standardized psychiatric assessments were done on children scoring > 9 on the Rutter’s Scale, using the WHO-ICD-10 diagnostic checklists. Results: Both orphans and non-orphans had high levels of psychological distress as measured using Rutter’s questionnaire but with no significant statistical difference between the two groups (Rutter score > 9; 45.1% & 36.5% respectively; p= 0.10) and no major psychiatric disorders such as psychotic, major affective or organic mental syndromes. Psychological distress was associated with poor academic performance (p=0.00) in both groups. More orphans, than non-orphans had more common emotional and behavioral problems e.g. more orphans reported finding “life unfair and difficult” (p=0.03); 8.3% orphans compared to 5.1 % of the non-orphans reported having had past suicidal wishes (p=0.30) and more reported past “forced sex / abuse” (p=0.05). Lastly, the orphans’ social functioning in the family rated significantly worse compared to the non-orphans (p= 0.05). Qualitatively, orphans, compared to nonorphans were described as “ needy, sensitive, isolative with low confidence and self-esteem and who often lacked love, protection, identity, security, play, food and shelter.” Most lived in big poor families with few resources, faced stigma and were frequently relocated. Community resources were inadequate. Conclusion: In conclusion, more orphans compared to non-orphans exhibited common emotional and behavioral problems but no major psychiatric disorders. Orphans were more likely to be emotionally needy, insecure, poor, exploited, abused, or neglected. Most lived in poverty with elderly widowed female caretakers. They showed high resilience in coping. To comprehensively address these problems, we recommend setting up a National Policy and Support Services for Orphans and Other Vulnerable Children and their families, a National Child Protection Agency for all Children, Child Guidance Counselors in those schools with many orphans and lastly social skills training for all children.Item Effectiveness and Cost‑Effectiveness Of Integrating the Management of Depression into Routine HIV Care in Uganda (the HIV + D trial): A protocol for a cluster‑randomised trial(International journal of mental health systems, 2021) Kinyanda, Eugene; Kyohangirwe, Leticia; Mpango, Richard S.; Tusiime, Christine; Ssebunnya, Joshua; Katumba, Kenneth; Tenywa, Patrick; Mugisha, James; Sentongo, Hafsa; Akena, Dickens; Muhwezi, Wilson; Kaleebu, Pontiano; Ssembajjwe, Wilber; Patel, VikramAn estimated 8–30 % of people living with HIV (PLWH) have depressive disorders (DD) in sub-Saharan Africa. Of these, the majority are untreated in most of HIV care services. There is evidence from low- and middle- income countries of the effectiveness of both psychological treatments and antidepressant medication for the treatment of DD among PLWH, but no evidence on how these can be integrated into routine HIV care. This protocol describes a cluster-randomised trial to evaluate the effectiveness and cost-effectiveness of the HIV + D model for the integration of a collaborative stepped care intervention for DD into routine HIV care, which we have developed and piloted in Uganda.Forty public health care facilities that provide HIV care in Kalungu, Masaka and Wakiso Districts will be randomly selected to participate in the trial. Each facility will recruit 10–30 eligible PLWH with DD and the total sample size will be 1200. The clusters will be randomised 1:1 to receive Enhanced Usual Care alone (EUC, i.e. HIV clinicians trained in Mental Health Gap Action Programme including guidelines on when and where to refer patients for psychiatric care) or EUC plus HIV + D (psychoeducation, Behavioural Activation, antidepressant medication and referral to a supervising mental health worker, delivered in a collaborative care stepwise approach). Eligibility criteria are PLWH attending the clinic, aged ≥ 18 years who screen positive on a depression screening questionnaire (Patient Health Questionnaire, PHQ-9 ≥ 10). The primary outcome is the mean depressive disorder symptom severity scores (assessed using the PHQ-9) at 3 months’ post-randomisation, with secondary mental health, disability, HIV and economic outcomes measured at 3 and 12 months. The cost-effectiveness of EUC with HIV + D will be assessed from both the health system and the societal perspectives by collecting health system, patient and productivity costs and mean DD severity scores at 3 months, additional to health and non-health related quality of life measures (EQ-5D-5 L and OxCAP-MH).The study findings will inform policy makers and practitioners on the cost-effectiveness of a stepped care approach to integrate depression management in routine care for PLWH in low-resource settings.Item Experiences of HIV-related stigma among HIV-positive older persons in Uganda – a mixed methods analysis(Journal of Social Aspects of HIV/AIDS, 2014) Kuteesaa, Monica O.; Wright, Stuart; Seeley, Janet; Mugisha, Joseph; Kinyanda, Eugene; Kakembo, Frederick; Mwesigwa, Richard; Scholten, FrancisThere is limited data on stigma among older HIV-infected adults in sub-Saharan Africa. We describe the experiences of stigma and disclosure in a cohort of HIV-positive older people in Uganda. Using data from the Wellbeing of Older Peoples’ Study of Kalungu (rural site) and Wakiso district (peri-urban site) residents, we measured self-reported stigma levels for 183 respondents (94 on antiretroviral therapy (ART); 88, not on ART) using a stigma score generated using three questions on stigma perceptions where 0 meant no stigma at all and 100 was maximum stigma. Based on two questions on disclosure, an overall score was computed. High disclosure was assigned to those who often or very often disclosed to the family and were never or seldom afraid to disclose elsewhere. We examined the experiences of HIV stigma of 25 adults (52% females) using semi-structured, open-ended interviews and monthly oral diaries over one year. Mean age of the respondents was 70 years (range 60–80 years) and 80% of all respondents were enrolled in ART. Interview transcripts were analysed using thematic content analysis. Overall, 55% of respondents had a high disclosure score, meaning they disclosed easily, and 47% had a high stigma score. The stigma scores were similar among those with high and low disclosure scores. In multivariate analyses with disclosure and stigma scores as dependent variables none of the respondents’ characteristics had a significant effect at the 5% level. Qualitative data revealed that stigma ranges from: (1) perceptions (relatively passive, but leading to behaviour such as gossip, especially if not intended maliciously); to (2) discriminatory behaviour (active or enacted stigma; from malicious gossip to outright discrimination). Despite the relatively high levels of disclosure, older people suffer from high levels of stigma of various forms apart from HIVrelated stigma. Efforts to assess for different forms of stigma at an individual level deserve greater attention from service providers and researchers, and must be context specific.Item A 'hidden problem': Nature, prevalence and factors associated with sexual dysfunction in persons living with HIV/AIDS in Uganda(Public Library of Science, 2024-03-07) Mutamba, Brian Byamah; Rukundo, Godfrey Zari; Sembajjwe, Wilber; Nakasujja, Noeline; Birabwa-Oketcho, Harriet; Mpango, Richard Stephen; Kinyanda, EugeneWe conducted a clinic-based cross-sectional survey among 710 people living with HIV/AIDS in stable 'sexual' relationships in central and southwestern Uganda. Although sexual function is rarely discussed due to the private nature of sexual life. Yet, sexual problems may predispose to negative health and social outcomes including marital conflict. Among individuals living with HIV/AIDS, sexual function and dysfunction have hardly been studied especially in sub-Saharan Africa. In this study, we aimed to determine the nature, prevalence and factors associated with sexual dysfunction (SD) among people living with HIV/AIDS (PLWHA) in Uganda. We conducted a clinic based cross sectional survey among 710 PLWHA in stable 'sexual' relationships in central region and southwestern Uganda. We collected data on socio-demographic characteristics (age, highest educational attainment, religion, food security, employment, income level, marital status and socio-economic status); psychiatric problems (major depressive disorder, suicidality and HIV-related neurocognitive impairment); psychosocial factors (maladaptive coping styles, negative life events, social support, resilience, HIV stigma); and clinical factors (CD4 counts, body weight, height, HIV clinical stage, treatment adherence). Sexual dysfunction (SD) was more prevalent in women (38.7%) than men (17.6%) and majority (89.3% of men and 66.3% of women) did not seek help for the SD. Among men, being of a religion other than Christianity was significantly associated with SD (OR = 5.30, 95%CI 1.60-17.51, p = 0.006). Among women, older age (> 45 years) (OR = 2.96, 95%CI 1.82-4.79, p<0.01), being widowed (OR = 1.80, 95%CI 1.03-3.12, p = 0.051) or being separated from the spouse (OR = 1.69, 95% CI 1.09-2.59, p = 0.051) were significantly associated with SD. Sexual dysfunction has considerable prevalence among PLWHA in Uganda. It is associated with socio-demographic, psychiatric and clinical illness factors. To further improve the quality of life of PLWHA, they should be screened for sexual dysfunction as part of routine assessment.Item Stakeholders’ perspectives on integrating the management of depression into routine HIV care in Uganda: qualitative findings from a feasibility study(International journal of mental health systems, 2021) Rutakumwa, Rwamahe; Ssebunnya, Joshua; Mugisha, James; Mpango, Richard Steven; Tusiime, Christine; Kyohangirwe, Leticia; Taasi, Geoffrey; Sentongo, Hafsa; Kaleebu, Pontiano; Patel, Vikram; Kinyanda, EugeneHIV/AIDS continues to be a major global public health problem with Eastern and Southern Africa being the regions most affected. With increased access to effective antiretroviral therapy, HIV has become a chronic and manageable disease, bringing to the fore issues of quality of life including mental wellbeing. Despite this, the majority of HIV care providers in sub-Saharan Africa, including Uganda’s Ministry of Health, do not routinely provide mental health care including depression management. The purpose of this paper is to explore stakeholders’ perspectives on the feasibility and acceptability of integrating depression management into routine adult HIV care. The paper addresses a specific objective of the formative phase of the HIV + D study aimed at developing and evaluating a model for integrating depression management into routine HIV care in Uganda. Methods: This was a qualitative study. Data were collected through in-depth interviews with 11 patients at enrollment and follow-up in the pilot phase, and exit interviews with 11 adherent patients (those who completed their psychotherapy sessions) and six non-adherent patients (those missing at least two sessions) at the end of the pilot phase. Key informant interviews were held with four clinicians, five supervisors and one mental health specialist, as were three focus group discussions with lay health workers. These were purposively sampled at four public health facilities in Mpigi District. Data were analysed thematically. Results: Patients highlighted the benefits of treating depression in the context of HIV care, including improved adherence to antiretroviral therapy, overcoming sleeplessness and suicidal ideation, and regaining a sense of selfefficacy. Although clinicians and other stakeholders reported benefits of treating depression, they cited challenges in managing depression with HIV care, which were organisational (increased workload) and patient related (extended waiting time and perceptions of preferential treatment). Stakeholders generally shared perspectives on how best to integrate, including recommendations for organisational level interventions–training, harmonisation in scheduling appointments and structural changes–and patient level interventions to enhance knowledge about depression. Conclusions: Integrating depression management into routine HIV care in Uganda is acceptable among key stakeholders, but the technical and operational feasibility of integration would require changes both at the organisational and patient levels.Item War related sexual violence and it’s medical and psychological consequences as seen in Kitgum, Northern Uganda: A cross-sectional study(BMC International Health and Human Rights 2, 2010) Kinyanda, Eugene; Musisi, Seggane; Biryabarema, Christine; Ezati, Isaac; Oboke, Henry; Ochieng, Ruth Ojiambo-; Oguttu, Juliet Were; Levin, Jonathan; Grosskurth, Heiner; Walugembe, JamesBackground: Despite the recent adoption of the UN resolution 1820 (2008) which calls for the cessation of war related sexual violence against civilians in conflict zones, Africa continues to see some of the worst cases of war related sexual violence including the mass sexual abuse of entire rural communities particularly in the Great Lakes region. In addition to calling for a complete halt to this abuse, there is a need for the systematic study of the reproductive, surgical and psychological effects of war related sexual violence in the African socio-cultural setting. This paper examines the specific long term health consequences of war related sexual violence among rural women living in two internally displaced person’s camps in Kitgum district in war affected Northern Uganda who accessed the services of an Isis-Women’s International Cross Cultural Exchange (Isis-WICCE) medical intervention. Methods: The study employed a purposive cross-sectional study design where 813 respondents were subjected to a structured interview as part of a screening procedure for an emergency medical intervention to identify respondents who required psychological, gynaecological and surgical treatment. Results: Over a quarter (28.6%) of the women (n = 573) reported having suffered at least one form of war related sexual violence. About three quarters of the respondents had ‘at least one gynaecological complaint’ (72.4%) and ‘at least one surgical complaint’ (75.6%), while 69.4% had significant psychological distress scores (scores greater than or equal to 6 on the WHO SRQ-20). The factors that were significantly associated with war related sexual violence were the age group of less than or equal to 44 years, being Catholic, having suffered other war related physical trauma, and having ‘at least one gynaecological complaint’. The specific gynaecological complaints significantly associated with war related sexual violence were infertility, chronic lower abdominal pain, abnormal vaginal bleeding, and sexual dysfunction. In a multivariable analysis the age group of less than or equal to 44 years, being Catholic and having ‘at least one gynaecological complaint’ remained significantly associated with war related sexual violence. Conclusion: The results from this study demonstrate that war related sexual violence is independently associated with the later development of specific gynaecological complaints.