Browsing by Author "Kiwanuka, George"

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    Health system factors influencing uptake of Human Papilloma Virus (HPV) vaccine among adolescent girls 9-15 years in Mbale District, Uganda
    (BMC Public Health, 2020) Nabirye, Juliet; Okwi, Livex Andrew; Nuwematsiko, Rebecca; Kiwanuka, George; Muneza, Fiston; Kamya, Carol; Babirye, Juliet N.
    Globally, cervical cancer is the fourth most common cancer in women with more than 85% of the burden in developing countries [1]. The majority of cervical cancer mortality occurs in developing countries, where screening and optimal treatment are not adequately available [2]. Cancer of the cervix constituted 22.2% of all cancers among women in Sub-Saharan Africa in 2012 [3]. In Uganda, cervical cancer is the number one cancer killer disease among women, this is followed by breast cancer [4]. With the incidence standing at 52 /100,000 women of reproductive age, it is one of the highest globally. Regrettably, more than half of these women die every year [5, 6]. The Kampala cancer registry shows that Uganda has an age standardized incidence rate of 47.5 per 100,000 against the global estimate of 15.8 per 100,000 [7]. Many of the Cervical cancer cases present with an advanced stage of the disease [8].
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    Overcoming Shortcoming in Monitoring Retention in Option B+
    (SPEED Initiative, 2018) Kiwanuka, George; Ssennyonjo, Aloysius
    The retention in care is a serious pointer of achievement for the Prevention of Mother to Child Transmission(PMTCT) care program. The level of retention of women under PMTCT care program at the different time points of the cascade of the elimination of mother to child transmission (EMTCT) cascade is critical to treatment outcomes. The current methods of measuring retention in care, at health facility level are reported to under-estimate overall retention since several women self-transfer to other facilities without being accounted for. Individual health facility retention is used in care assessment and no attention is paid to transfers. This policy memo provides information on the alternative courses of action that may be taken to mitigate this issue of retention in care, clearly stating the pros and cons of each course of action. It also gives a recommendation for the best course of action that should be taken.
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    Retention of HIV infected pregnant and breastfeeding women on option B+ in Gomba District, Uganda: a retrospective cohort study
    (BMC Infectious Diseases, 2018) Kiwanuka, George; Kiwanuka, Noah; Muneza, Fiston; Nabirye, Juliet; Oporia, Frederick; Odikro, Magdalene A.; Castelnuovo, Barbara; Wanyenze, Rhoda K.
    Lifelong antiretroviral therapy for HIV infected pregnant and lactating women (Option B+) has been rapidly scaled up but there are concerns about poor retention of women initiating treatment. However, facilitybased data could underestimate retention in the absence of measures to account for self-transfers to other facilities. We assessed retention-in-care among women on Option B+ in Uganda, using facility data and follow-up to ascertain transfers to other facilities. Methods: In a 25-month retrospective cohort analysis of routine program data, women who initiated Option B+ between March 2013 and March 2015 were tracked and interviewed quantitatively and qualitatively (in-depth interviews). Kaplan Meier survival analysis was used to estimate time to loss-to-follow-up (LTFU) while multivariable Cox proportional hazards regression was applied to estimate the adjusted predictors of LTFU, based on facility data. Thematic analysis was done for qualitative data, using MAXQDA 12. Quantitative data were analyzed with STATA® 13. Results: A total of 518 records were reviewed. The mean (SD) age was 26.4 (5.5) years, 289 women (55.6%) attended primary school, and 53% (276/518) had not disclosed their HIV status to their partners. At 25 months post-ART initiation, 278 (53.7%) were LTFU based on routine facility data, with mean time to LTFU of 15.6 months. Retention was 60.2 per 1000 months of observation (pmo) (95% CI: 55.9–64.3) at 12, and 46.3/1000pmo (95% CI: 42.0–50.5) at 25 months. Overall, 237 (55%) women were successfully tracked and interviewed and 43/118 (36.4%) of those who were classified as LTFU at facility level had self-transferred to another facility. The true 25 months post-ART initiation retention after tracking was 71.3% (169/237). Women < 25 years, aHR = 1.71 (95% CI: 1.28–2.30); those with no education, aHR = 5.55 (95% CI: 3.11– 9.92), and those who had not disclosed their status to their partners, aHR = 1.59 (95% CI: 1.16–2.19) were more likely to be LTFU. Facilitators for Option B+ retention based on qualitative findings were adequate counselling, disclosure, and the desire to stay alive and raise HIV-free children. Drug side effects, inadequate counselling, stigma, and unsupportive spouses, were barriers to retention in care. Conclusions: Retention under Option B+ is suboptimal and is under-estimated at health facility level. There is need to institute mechanisms for tracking of women across facilities. Retention could be enhanced through strategies to enhance disclosure to partners, targeting the uneducated, and those <25 years.