Browsing by Author "Kyaddondo, David"

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    Client-provider interactions in provider-initiated and voluntary HIV counseling and testing services in Uganda
    (BMC Health Services Research, 2013) Wanyenze, Rhoda K.; Kyaddondo, David; Kinsman, John; Makumbi, Fredrick; Colebunders, Robert; Hardon, Anita
    Provider-initiated HIV testing and counselling (PITC) is based on information-giving while voluntary counselling and testing (VCT) includes individualised client-centered counseling. It is not known if the providerclient experiences, perceptions and client satisfaction with the information provided differs in the two approaches. Methods: In 2008, we conducted structured interviews with 627 individuals in Uganda; 301 tested through PITC and 326 through voluntary counselling and testing (VCT). We compared client experiences and perceptions based on the essential elements of consent, confidentiality, counseling, and referral for follow-up care. We conducted multivariate analysis for predictors of reporting information or counselling as sufficient. Results: In VCT, 96.6% (282) said they were asked for consent compared to 91.3% (198) in PITC (P = 0.01). About the information provided, 92.0% (286) in VCT found it sufficient compared to 78.7% (221) in PITC (P = <0.01). In VCT 79.9% (246) thought their results were kept confidential compared to 71.7% (200) in PITC (P = 0.02). Eighty percent (64) of HIV infected VCT clients said they were referred for follow-up care versus 87.3% (48) in PITC (p = 0.2). Predictors of perceived adequacy of information in PITC included an opportunity to ask questions (adj.RR 1.76, CI 1.41, 2.18) and expecting the test results received (adj.RR 1.18, CI 1.06, 1.33). For VCT significant factors included being given an opportunity to ask questions (adj.RR 1.62, CI 1.00, 2.60) and 3+ prior times tested, (adj.RR 1.05, CI 1.00, 1.09).
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    Disclosure of HIV status between parents and children in Uganda in the context of greater access to treatment
    (Journal of Social Aspects of HIV/AIDS, 2013) Kyaddondo, David; Wanyenze, Rhoda K.; Kinsman, John; Hardon, Anita
    While disclosure of HIV sero-status is encouraged in the management of the HIV and AIDS epidemic, it remains a challenge, especially among family members. This article examines the moral dilemmas and pragmatic incentives surrounding disclosure of HIV status in contemporary Uganda. Our findings are based on 12 in-depth interviews, 2 focus-group discussions, 6 key informant interviews with AIDS activists, and open-ended responses derived from 148 HIV-positive persons in a quantitative survey. The study was conducted in 2008–2009 in Kampala, Mpigi, and Soroti districts in Uganda. We found both parents and adult children facing dilemmas in disclosure, whether it was parents revealing their own HIV status to their children or the status of their perinatally infected children, or young people infected through sexual intercourse telling their parents. For both groups, there is fear of blame, stigma, discrimination, and shame and guilt related to unsafe sex, while young people also fear loss of privileges. On the other hand, there are practical imperatives for disclosure in terms of gaining access to care, treatment, and material resources. Faced with these dilemmas, HIV-positive people and their families require professional counselling to help them work through the emotional challenges encountered and identify mechanisms of support and coping.
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    Home-based HIV counseling and testing: Client experiences and perceptions in Eastern Uganda
    (BMC Public Health, 2012) Kyaddondo, David; Wanyenze, Rhoda K; Kinsman, John; Hardon, Anita
    Though prevention and treatment depend on individuals knowing their HIV status, the uptake of testing remains low in Sub-Saharan Africa. One initiative to encourage HIV testing involves delivering services at home. However, doubts have been cast about the ability of Home-Based HIV Counseling and Testing (HBHCT) to adhere to ethical practices including consent, confidentiality, and access to HIV care post-test. This study explored client experiences in relation these ethical issues. Methods: We conducted 395 individual interviews in Kumi district, Uganda, where teams providing HBHCT had visited 6–12 months prior to the interviews. Semi-structured questionnaires elicited information on clients’ experiences, from initial community mobilization up to receipt of results and access to HIV services post-test. Results: We found that 95% of our respondents had ever tested (average for Uganda was 38%). Among those who were approached by HBHCT providers, 98% were informed of their right to decline HIV testing. Most respondents were counseled individually, but 69% of the married/cohabiting were counseled as couples. The majority of respondents (94%) were satisfied with the information given to them and the interaction with the HBHCT providers. Most respondents considered their own homes as more private than health facilities. Twelve respondents reported that they tested positive, 11 were referred for follow-up care, seven actually went for care, and only 5 knew their CD4 counts. All HIV infected individuals who were married or cohabiting had disclosed their status to their partners. Conclusion: These findings show a very high uptake of HIV testing and satisfaction with HBHCT, a large proportion of married respondents tested as couples, and high disclosure rates. HBHCT can play a major role in expanding access to testing and overcoming disclosure challenges. However, access to HIV services post-test may require attention.
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    Paying to Normalize Life: Monetary and Psychosocial Costs of Realizing a Normal Life in the Context of Free Antiretroviral Therapy Services in Uganda
    (Journal of the International Association of Providers of AIDS Care (JIAPAC), 2019) Kalule Nanfuka, Esther; Kyaddondo, David; Ssali, Sarah N.; Asingwire, Narathius
    Antiretroviral therapy (ART) is considered the treatment that enables people living with HIV (PLHIV) to lead a “normal life”. In spite of the availability of free treatment, patients in resource-poor settings may continue to incur additional costs to realize a normal and full life. This article describes the monetary expenses and psychosocial distress people on free ART bear to live normally. We conducted in-depth interviews with 50 PLHIV on ART. We found that the demands of treatment, poverty, stigma, and health-system constraints interplay to necessitate that PLHIV bear continuous monetary and psychosocial costs to realize local values that define normal life. In the context, access to free medicines is not sufficient to enable PLHIV in resource-poor settings to normalize life. Policy makers and providers should consider proactively complementing free ART with mechanisms that empower PLHIV economically, enhance their problem-solving capacities, and provide an enabling environment if the objective of normalizing life is to be achieved.
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    Social capital and resilience among people living on antiretroviral therapy in resource poor Uganda
    (PLoS ONE, 2018) Kalule Nanfuka, Esther; Kyaddondo, David; Ssali, Sarah N.; Asingwire, Narathius
    Despite the national roll-out of free HIV medicines in Uganda and other sub-Saharan African countries, many HIV positive patients on antiretroviral therapy (ART) are at risk of no adherence due to poverty and other structural and health system related constraints. However, several patients exhibit resilience by attaining and sustaining high levels of adherence amid adversity. Social capital, defined as resources embedded within social networks, is key in facilitating resilience but the mechanism through which it operates remains understudied. This article provides insights into mechanisms through which social capital enables patients on ART in a resource-poor setting to overcome risk and sustain adherence to treatment.
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    Sustaining social support for lifelong HIV treatment: Practices of patients on antiretroviral therapy in Uganda
    (International Scholars Journals, 2019) Nanfuka, Esther K.; Kyaddondo, David; Ssali, Sarah N.; Asingwire, Narathius
    Social support is recognized as a critical resource in promoting adherence to antiretroviral therapy (ART) in resource-poor settings. However, supporter burn-out and stigma may constrain access to social support in the long-term. Little is written about how ART clients overcome these barriers to continue accessing support for lifelong treatment. Therefore, this article examines practices that enable HIV patients in a resource-poor setting to overcome the constraints of stigma and burn-out to continue accessing treatment support. The article is based on data from an ethnographic study of 50 patients enrolled on ART at two treatment sites. Fifteen of these patients were followed-up for six months. The main methods of data collection included in-depth interviews and participant observation. Dependent patients overcame the constraints of stigma and burn-out through three main practices: regulating the frequency of requests for assistance, using secrecy and lies, and continuously reconstituting the treatment support group. The study concludes that stigma and burn-out are serious threats to sustaining social support and concomitant adherence to lifelong ART. Integration of mechanisms for empowering patients to manage burn-out and stigma in HIV service delivery may improve prospects for sustained ART adherence in resource-poor settings.
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    Women’s views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries
    (BMC Public Health, 2012) Hardon, Anita; Vernooij, Eva; Bongololo-Mbera, Grace; Cherutich, Peter; Desclaux, Alice; Kyaddondo, David; Ky-Zerbo, Odette; Neuman, Melissa; Wanyenze, Rhoda; Obermeyer, Carla
    Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods: Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study’s main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher’s exact tests. Results: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband. Conclusion: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.