Browsing by Author "Konde-Lule, Joseph"
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Item Antiretroviral Treatment for HIV in Rural Uganda: Two Year Treatment Outcomes of a Prospective Health Centre/Community-Based and Hospital-Based Cohort(PloS one, 2012) Kipp, Walter; Konde-Lule, Joseph; Saunders, L. Duncan; Alibhai, Arif; Houston, Stan; Rubaale, Tom; Senthilselvan, Ambikaipakan; Okech-Ojony, JoaIn sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda.Item Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda(BMC international health and human rights, 2011) Kipp, Walter; Konde-Lule, Joseph; Rubaale, Tom; Okech-Ojony, Joa; Alibhai, Arif; Saunders, Duncan L.Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs.Item Education attainment as a predictor of HIV risk in rural Uganda: results from a population-based study(International journal of STD & AIDS, 1999) Smith, Jennifer; Nalagoda, Fred; Serwadda, David; Sewankambo, Nelson; Konde-Lule, Joseph; Lutalo, Tom; Li, ChuanjunWe examined the association between education and prevalent HIV-1 infection in the Rakai district, rural Uganda based on a cross-sectional analysis of a population-based cohort. In 1990, 1397 men and 1705 women aged 13 years and older, were enrolled in 31 randomly selected communities. Strata were comprised of main road trading centres, secondary road trading villages and rural villages. Sociodemographic and behavioural data were obtained by interview and serum for HIV serostatus were obtained in the home. The analysis examines the association between sex-specific prevalent HIV infection and educational attainment, categorized as secondary, primary or none. The odds ratios (ORs) and 95% confidence intervals (95% CIs) of HIV infection were estimated, using no education as the referent group. Higher levels of education were associated with a higher HIV seroprevalence in bivariate analyses (OR 2.7 for primary and 4.1 for secondary education, relative to no education). The strength of the association was diminished but remained statistically significant after multivariate adjustment for sociodemographic and behavioural variables (adjusted OR of HIV infection 1.6 (95% CI: 1.2-2.1)) for primary education and 1.5 (95% CI: 1.0-2.2) for secondary education. Stratified multivariate analyses by place of residence indicated that the association between education and HIV prevalence was statistically significant in the rural villages, but not in the main road trading centres and intermediate trading villages. Educational attainment is a significant predictor of HIV risk in rural Uganda, in part because of risk behaviours and other characteristics among better educated individuals. Preventive interventions need to focus on better educated adults and on school-aged populations.Item Effect of changing antiretroviral treatment eligibility criteria on patient load in Kampala, Uganda(AIDS care, 2011) Konde-Lule, Joseph; Makumbi, Fred; Pakker, Nadine; Muyinda, Asad; Mubiru, Mesach; Cobelens, Frank G.J.In many resource-poor countries, CD4 count thresholds of eligibility for antiretroviral treatment (ART) were initially low (<200 cells/mm3) but are now being increased to improve patient survival and to reduce HIV transmission. There are few quantitative data on the effect of such increases on the demand for ART. The objective of this study was to measure HIV prevalence and the proportion of HIV-positives eligible for antiretroviral therapy at different CD4 cut-off levels among users of public health care services in Kampala, Uganda. We recruited 1200 adults from three primary care clinics in Kampala, including equal numbers of family planning (FP) clients, pregnant women, adult patients with any complaint, and persons seeking HIV counseling and testing. All participants were screened for HIV and those positive had a CD4 count done. HIV prevalence in all patients was 16.9% (203/1200). ART eligibility based on CD4 counts significantly increased from 36% at a 200 cells/mm3 cut-off to 44% at 250 cells and to 57% at 350 cells cut-off (p for χ2 trend<0.001). We concluded that changing cut-off levels to higher CD4 counts will significantly increase patient load in Kampala's primary care clinics, but a phased implementation should minimize negative effects on quality of care.Item Effect on weight gain of routinely giving albendazole to preschool children during child health days in Uganda: cluster randomised controlled trial(BMJ, 2006) Alderman, Harold; Konde-Lule, Joseph; Sebuliba, Isaac; Bundy, Donald; Hall, AndrewTo estimate the effectiveness of delivering an anthelmintic through a community child health programme on the weight gain of preschool children in Uganda. Participants 48 parishes participating in a new programme for child health: 24 offered children an additional service of anthelmintic treatment. The outcome is based on measurements from 27 995 children. Treatment of children aged between 1 and 7 years with 400 mg albendazole added to standard services offered during child health days over a three year period. Main outcome measure Weight gain.The provision of periodic anthelmintic treatment as a part of child health services in Uganda resulted in an increase in weight gain of about 10% (166 g per child per year, 95% confidence interval 16 to 316) above expected weight gain when treatments were given twice a year, and an increase of 5% when the treatment was given annually. Deworming of preschool children in Uganda as part of regularly scheduled health services seems practical and associated with increased weight gain.Item Gender-related mortality for HIV-infected patients on highly active antiretroviral therapy (HAART) in rural Uganda(International journal of women's health, 2010) Alibhai, Arif; Kipp, Walter; Senthilselvan, Ambikaipakan; Konde-Lule, Joseph; Okech-Ojony, Joa; Rubaale, TomThe purpose of this study was to examine gender differences in mortality for human immunodeficiency virus (HIV) patients in rural Western Uganda after six months of highly active antiretroviral therapy (HAART). Three hundred eighty five patients were followed up for six months after initiating HAART. Statistical analysis included descriptive, univariate and multivariate methods, using Kaplan–Meier estimates of survival distribution and Cox proportional hazards regression. Mortality in female patients (9.0%) was lower than mortality in males (13.5%), with the difference being almost statistically significant (adjusted hazard ratio for females 0.55; 95% confidence interval [CI]: 0.28–1.07; P = 0.08). At baseline, female patients had a significantly higher CD4+ cell count than male patients (median 147 cells/μL vs 120 cells/μL; P < 0.01). A higher CD4+ cell count and primary level education were strongly associated with better survival. The higher CD4+ cell count in females may indicate that they accessed HAART services at an earlier stage of their disease progression than males. A borderline statistically significant lower mortality rate in females shows that females fare better on treatment in this context than males. The association between lower mortality and higher CD4+ levels suggest that males are not accessing treatment early enough and that more concerted efforts need to be made by HAART programs to reach male HIV patients.Item Hear our voices: A Photovoice project with children who are orphaned and living with HIV in a Ugandan group home(Children and Youth Services Review, 2014) Fournier, Bonnie; Bridge, Andrea; Kennedy, Andrea Pritchard; Alibhai, Arif; Konde-Lule, JosephIn June 2010, we conducted a qualitative participatory research study to explore the experience of orphaned, HIV seropositive children who live in a group home in semi-urban western Uganda. Photovoice was used as a participatory method to enhance storytelling with children between 12 and 18years (n=5 girls; n=8 boys). In previous project work done by the research team in Uganda, children's affirming experiences in their group home suggested an extension to the dominant view that favors extended family placements, and raises the need for further inquiry regarding institutional care. Children in this study revealed how the group home supported key protective factors in their everyday lives that promote well-being, and resilience for coping with challenges such as stigma. Children expressed how their group home fostered a sense of belonging and appreciation for nature, home, resources and community. Children also described their hardships stemming from stigma, including associated psychological, emotional and social challenges. This forces us to re-think the role of institutional care for orphaned children who are HIV seropositive, guided by the unique perspective of children themselves. This research extends our understanding of key protective factors, while also challenging the dominant view to include institutional care as an effective placement option for those that require specialized care and support. Moreover, findings demonstrate that HIV seropositive orphaned children who live in a group home setting experience protective factors supporting their psychological, emotional and social well-being.Item “Living by the hoe” in the age of treatment: perceptions of household well-being after antiretroviral treatment among family members of persons with AIDS(AIDS care, 2010) Kaler, Amy; Alibhai, Arif; Kipp, Walter; Rubaale, Tom; Konde-Lule, JosephThis paper considers the effects of antiretroviral treatment on the households of person with AIDS in western Uganda. Interviews were carried out with 110 co-resident “treatment partners” of people receiving treatment. We discuss these family members' accounts of the impact of sickness, followed by treatment, on their household's livelihood, defined as the activities needed to obtain and process the resources required to sustain the households. The household's ability to muster labour for subsistence agriculture was of paramount concern when family members considered what treatment meant for the households. While they were very happy with the treatment, they said that households have not yet recovered from the shock of AIDS sicknesses.Item Long Delays and Missed Opportunities in Diagnosing Smear-Positive Pulmonary Tuberculosis in Kampala, Uganda: A Cross-Sectional Study(PLOS one, 2010) Sendagire, Ibrahim; Loeff, Maarten Schim Van der; Mubiru, Mesach; Konde-Lule, Joseph; Cobelens, FrankEarly detection and treatment of tuberculosis cases are the hallmark of successful tuberculosis control. We conducted a cross-sectional study at public primary health facilities in Kampala city, Uganda to quantify diagnostic delay among pulmonary tuberculosis (PTB) patients, assess associated factors, and describe trajectories of patients' health care seeking. Semi-structured interviews with new smear-positive PTB patients (≥15 years) registered for treatment. Between April 2007 and April 2008, 253 patients were studied. The median total delay was 8 weeks (IQR 4–12), median patient delay was 4 weeks (inter-quartile range [IQR] 1–8) and median health service delay was 4 weeks (IQR 2–8). Long total delay (>14 weeks) was observed for 61/253 (24.1%) of patients, long health service delay (>6 weeks) for 71/242 (29.3%) and long patient delay (>8 weeks) for 47/242 (19.4%). Patients who knew that TB was curable were less likely to have long total delay (adjusted Odds Ratio [aOR] 0.28; 95%CI 0.11–0.73) and long patient delay (aOR 0.36; 95%CI 0.13–0.97). Being female (aOR 1.98; 95%CI 1.06–3.71), staying for more than 5 years at current residence (aOR 2.24 95%CI 1.18–4.27) and having been tested for HIV before (aOR 3.72; 95%CI 1.42–9.75) was associated with long health service delay. Health service delay contributed 50% of the total delay. Ninety-one percent (231) of patients had visited one or more health care providers before they were diagnosed, for an average (median) of 4 visits (range 1–30). All but four patients had systemic symptoms by the time the diagnosis of TB was made. Diagnostic delay among tuberculosis patients in Kampala is common and long. This reflects patients waiting too long before seeking care and health services waiting until systemic symptoms are present before examining sputum smears; this results in missed opportunities for diagnosis.Item Low HIV testing rates among tuberculosis patients in Kampala, Uganda(BMC Public Health, 2010) Sendagire, Ibrahim; Schreuder, Imke; Mubiru, Mesach; Cobelens, Frank; Konde-Lule, JosephHIV testing among tuberculosis patients is critical in improving morbidity and mortality as those found to be HIV positive will be offered a continuum of care including ART if indicated. We conducted a cross-sectional study in three Kampala City primary care clinics: to assess the level of HIV test uptake among newly diagnosed pulmonary tuberculosis (PTB) patients; to assess patient and health worker factors associated with HIV test uptake; and to determine factors associated with HIV test uptake at the primary care clinicsItem Low Impact of a Community-Wide HIV Testing and Counseling Program on Sexual Behavior in Rural Uganda(AIDS Education and Prevention, 2001) Kipp, Walter; Kabagambe, Geoffrey; Konde-Lule, JosephStudy results on the assessment of a community-wide HIV counseling and testing program are presented The aim of this study was to elucidate whether HIV counseling and testing was effective in reducing high risk sexual behavior of a rural population in Uganda. From a total of 2,267 persons of Kigoyera Parish, western Uganda, who were HIV tested and counseled, 495 persons were selected and interviewed about their sexual behavior. Persons who were HIV tested showed no difference in sexual behavior compared to those who were not tested (condom use 4.3% vs. 5.5%, mean number of sexual partner in the past three months 1.8 vs. 2.0). The conclusion is that only knowing the HIV serostatus is not enough to reduce high risk behavior The study results also showed that there is a demand for HIV counseling services without being HIV tested.Item Male Participation in Family Planning: Results from A Qualitative Study in Mpigi District, Uganda(Journal of biosocial science, 2005) Kaida, Angela; Kipp, Walter; Hessel, Patrick; Konde-Lule, JosephThe aim of this study was to determine men’s perceptions about family planning and how they participate or wish to participate in family planning activities in Mpigi District, central Uganda. Four focus group discussions were conducted with married men and with family planning providers from both the government and private sector. In addition, seven key informants were interviewed using a semi-structured interview guide. The results indicate that men have limited knowledge about family planning, that family planning services do not adequately meet the needs of men, and that spousal communication about family planning issues is generally poor. However, almost all men approved of modern family planning and expressed great interest in participating. The positive change of the beliefs and attitudes of men towards family planning in the past years has not been recognized by family planning programme managers, since available services are not in line with current public attitudes. A more couple-oriented approach to family planning is needed. Measures could include, for example, recruiting males as family planning providers, offering more family planning counselling for couples, and promoting female-oriented methods with men and vice versa.Item Male partner attendance of skilled antenatal care in peri-urban Gulu district, Northern Uganda(BMC pregnancy and childbirth, 2010) Tweheyo, Raymond; Konde-Lule, Joseph; Tumwesigye, Nazarius M.; Sekandi, Juliet N.Male partner attendance of skilled Antenatal Care (ANC) is beneficial to improving maternal outcomes. This study investigated the level, perceived benefits and factors associated with male partner attendance of skilled ANC in a peri-urban community recovering from two decades of civil conflict. This cross-sectional survey used multi-stage sampling in 12 villages of Omoro county to select 331 married male respondents aged 18 years or more, whose female spouses had childbirth within 24 months prior to the survey. A structured questionnaire elicited responses about male partner attendance of ANC during pregnancy at a public health facility as the main outcome variable. Analysis used Generalized Linear Model (GLM) in Stata version 10.0 to obtain Prevalence Risk Ratios (PRR) for association between the binary outcome and independent factors. All factors significant at p < 0.15 and potential confounders were included in the multivariable model. Overall, 65.4% (95%CI; 60.3, 70.5) male partners attended at least one skilled ANC visit. Mean age was 31.9 years [SD 8.2]. Perceived benefits of attending ANC were: HIV screening (74.5%), monitoring foetal growth (34%) and identifying complications during pregnancy (18.9%). Factors independently associated with higher ANC attendance were: knowledge of 3 or more ANC services (adj.PRR 2.77; 95%CI 2.24, 3.42), obtaining health information from facility health workers (adj.PRR 1.14; 95%CI 1.01, 1.29) and if spouse had skilled attendance at last childbirth (adj.PRR 1.31; 95%CI 1.04-1.64). However, factors for low attendance were: male partners intending their spouse to carry another pregnancy (adj.PRR 0.83; 95%CI 0.71, 0.97) and living more than 5 Km from a health facility (adj.PRR 0.83, 95%CI 0.70, 0.98). Men who were knowledgeable of ANC services, obtained health information from a health worker and whose spouses utilised skilled delivery at last pregnancy were more likely to accompany their spouses at ANC, unlike those who wanted to have more children and lived more than 5 km from the health facility. These findings suggest that empowering male partners with knowledge about ANC services may increase their ANC participation and in turn increase skilled delivery. This strategy may improve maternal health care in post conflict and resource-limited settings.Item Nutritional Status of Young Children in Aids-Affected Households and Controls in Uganda(The American journal of tropical medicine and hygiene, 2006) Bridge, Andrea; Kipp, Walter; Jhangri, Gian S.; Laing, Lory; Konde-Lule, JosephThis study conducted in Uganda assessed the nutritional status of young children and their disease history in the 3-month period before the study. Two groups of children were randomly selected: the first group consisted of 105 children living in homes where a family member fell sick of AIDS, whereas the second group consisted of 100 children who were living in homes where nobody was affected by AIDS. Acute malnutrition (wasting) was rare. There was no difference in the severity of stunting in the two groups (Z scores, −2.1 versus −2.2, P 0.70). In those children living in AIDS-affected homes, disease episodes were longer (15.7 versus 11.3 days, P 0.014), but the frequency of disease occurrence was similar in both groups. Fifty-five percent of all children suffered from moderate to severe malnutrition (stunting). The high stunting rate in early childhood suggests a public nutritional intervention program is recommended. mItem Population-based Study of Fertility in Women with HIV-1 Infection in Uganda(The lancet, 1998) Gray, Ronald H.; Serwadda, David; Sewankambo, Nelson; Li, Chuanjun; Wabwire-Mangen, Frederick; Kiwanuka, Noah; Kigozi, Godfrey; Konde-Lule, Joseph; McNairn, DeniseTo assess the effects of HIV-1 and other sexually transmitted infections on pregnancy, we undertook cross-sectional and prospective studies of a rural population in Rakai district, Uganda. 4813 sexually active women aged 15–49 years were surveyed to find out the prevalence of pregnancy by interview and selective urinary human chorionic gonadotropin tests. The incidence of recognised conception and frequency of pregnancy loss were assessed by follow-up. Samples were taken to test for HIV-1 infection, syphilis, and other sexually transmitted diseases. At time of survey, 757 (21·4%) of 3544 women without HIV-1 infection or syphilis were pregnant, compared with 46 (14·6%) of 316 HIV-1-negative women with active syphilis, 117 (14·2%) of 823 HIV-1-positive women with no concurrent syphilis, and 11 (8·5%) of 130 women with both syphilis and HIV-1 infection. The multivariate adjusted odds ratio of pregnancy in HIV-1-infected women was 0·45 (95% Cl 0·35–0·57); the odds of pregnancy were low both in HIV-1-infected women without symptoms (0·49 [0·39–0·62]) and in women with symptoms of HIV-1-associated disease (0·23 [0·11–0·48]). In women with concurrent HIV-1 infection and syphilis the odds ratio was 0·28 (0·14–0·55). The incidence rate of recognised pregnancy during the prospective follow-up study was lower in HIV-1-positive than in HIV-1-negative women (23·5 vs 30·1 per 100 woman-years; adjusted risk ratio 0·73 [0·57–0·93]). Rates of pregnancy loss were higher among HIV-1-infected than uninfected women (18·5 vs 12·2%; odds ratio 1·50 [1·01–2·27]). The prevalence of HIV-1 infection was significantly lower in pregnant than in non-pregnant women (13·9 vs 21·3%). Pregnancy prevalence is greatly reduced in HIV-1-infected women, owing to lower rates of conception and increased rates of pregnancy loss. HIV-1 surveillance confined to pregnant women underestimates the magnitude of the HIV-1 epidemic in the general population.Item The Potential of the Private Sector to Improve Health Outcomes in Uganda(Makerere University Institute of Public Health, 2006) Konde-Lule, Joseph; Okuonzi, Sam; Matsiko, Charles; Mukanga, David; Onama, Virgil; Gitta, Sheba NakacuboIn Uganda, as in many other developing countries, the rural poor shoulder a large share of the disease burden, but the mix and roles of the health providers accessible to local communities has not been fully documented.Item Private and Public Health Care in Rural Areas of Uganda(BMC international health and human rights, 2010) Konde-Lule, Joseph; Gitta, Sheba N; Lindfors, Anne; Okuonzi, Sam; Onama, Virgil ONIn many low and middle income countries, the private sector is increasingly becoming an important source of health care, filling gaps where no or little public health care is available. However, knowledge on the private sector providers is limited The objective of this study was to determine the type and number of different types of health care providers, and the quality, cost and utilization of care delivered by those providers in rural Uganda.Item Public knowledge and attitudes toward HIV/AIDS and antiretroviral therapy in Kabarole district, western Uganda(AIDS care, 2009) Kipp, Walter Eigen; Alibhai, Arif; Saunders, Duncan; Konde-Lule, Joseph; Ruhunda, AlexA study on knowledge about HIV/AIDS and antiretroviral therapy (ART) was conducted in the general population of a rural district in western Uganda. Three hundred seventy-two participants were selected by random cluster sampling and interviewed with an interview-administered questionnaire. Data were analyzed quantitatively with descriptive, univariate and linear multivariate statistical analysis with the knowledge score about ART as the dependent variable. The results indicate that the mean knowledge was 7.7 in a scale from 0 to 13. Predictor for better ART knowledge was a higher educational status of the participants. Older participants over 50 years were less ART knowledgeable. Only 19% of the participants have been tested for HIV. The conclusions are that the ART knowledge in this population is remarkably high which is reaffirming and important for achieving a high adherence to ART. Of concern is the low proportion of persons tested for HIV in this general population. Kabarole district seems to be receptive and capable for intensifying HIV testing which is a precondition for the ART roll-out.Item Quality of Life of HIV Patients in a Rural Area of Western Uganda: Impact of a Community-Based Antiretroviral Treatment Program(Current HIV research, 2010) Alibhai, Arif; Martin, Leah J.; Kipp, Walter; Konde-Lule, Joseph; Rubaale, Tom; Okech-Ojony, JoaCommunity-based antiretroviral treatment (CBART) programs should aim to achieve positive quality of life outcomes. The purpose of this study was to investigate changes in the health related quality of life (HRQOL) outcomes of patients in a CBART program supported by community volunteers in one sub-county in western Uganda located 50 km from the nearest urban centre. We administered a translated version of the MOS-HIV survey and collected clinical data at baseline and after one year from 130 patients. Inclusion criteria included residency in the sub-county, eighteen years of age or, treatmentnaive, eligible for ART based on CD4 cell count <200 cells/mm3 or WHO clinical stage 3 or 4, and willing to accept daily treatment support by family/friends and to be visited by a community volunteer weekly. We assessed changes in physical health (PHS) and mental health (MHS) summary scores and examined associations between patient characteristics and changes in HRQOL. After one year, we observed significant increases in mean PHS (42.7 to 50.1; p<0.01) and MHS (43.5 to 49.5; p<0.01) scores. Lower age (p<0.01) and lower baseline PHS scores (p<0.01) were associated with increases in PHS scores and lower age (p=0.03) and lower baseline MHS scores (p<0.01) were associated with increases in MHS scores. Fifteen patients (12%) had reductions in their HRQOL after one year which were not associated with patient or clinical characteristics, including virological suppression. The observed improvements in HRQOL demonstrate that positive treatment outcomes can be achieved in CBART programs in rural Uganda. However, some patients appear to experience declines in their overall well-being, despite achieving virological suppression. HRQOL surveys can be useful in identifying these patients, who may require additional attention and support to achieve the full benefits of ART.Item Responses to VCT for HIV among young people in Kampala, Uganda(African Journal of AIDS Research, 2007) Råssjö, Eva-Britta; Darj, Elisabeth; Konde-Lule, Joseph; Olsson, PiaAttitudes to voluntary counselling and testing (VCT) for HIV among young men and women in a slum area of Kampala, Uganda, were studied through 22 individual semi-structured interviews and 5 focus group discussions. Attitudes to VCT ranged from having no problem with the procedure to being very reluctant. Despite fear of stigma, the participants perceived 'positive living' after HIV testing as realistic. VCT was regarded as an important step to avoid HIV infection, but informants expressed the need for the service to be more accessible in terms of cost, time and quality of pre- and post-test counselling. We argue that counselling without HIV testing should be available for those who are reluctant to test. Poverty and gender power imbalances appeared to limit youths' possibility of making rational decisions about sexual behaviour and accessing VCT. The importance of considering the context in which such issues are being negotiated and decided is highlighted.