Browsing by Author "Lule, Haruna"

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    Barriers to and acceptability of provider-initiated HIV testing and counselling and adopting HIV prevention behaviours in rural Uganda: A qualitative study
    (Journal of health psychology, 2015) Kiene, Susan M.; Sileo, Katelyn; Wanyenze, Rhoda K.; Lule, Haruna; Bateganya, Moses H.; Jasperse, Joseph; Nantaba, Harriet
    In Uganda, a nation-wide scale-up of provider initiated HIV testing and counseling (PITC) presents an opportunity to deliver HIV prevention services to large numbers of people. In a rural Ugandan hospital, focus group discussions and key informant interviews were conducted with outpatients receiving PITC and staff to explore the HIV prevention information, motivation, and behavioral skills strengths and weaknesses, and community and structural-level barriers to PITC acceptability and HIV prevention among this population. Strengths and weakness occurred at all levels, and results suggest brief client-centered interventions during PITC may be an effective approach to increase prevention behaviours in outpatient settings.
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    “The burden is upon your shoulders to feed and take care of your children, not religion or culture”: qualitative evaluation of participatory community dialogues to promote family planning’s holistic benefits and reshape community norms on family success in rural Uganda
    (BioMed Central, 2024-05) Sileo, Katelyn M.; Muhumuza, Christine; Tuhebwe, Doreen; Muñoz, Suyapa; Wanyenze, Rhoda K.; Kershaw, Trace S; Sekamatte, Samuel; Lule, Haruna; Kiene, Susan M.
    Background Family planning has significant health and social benefits, but in settings like Uganda, is underutilized due to prevalent community and religious norms promoting large family size and gender inequity. Family Health = Family Wealth (FH = FW) is a multi-level, community-based intervention that used community dialogues grounded in Campbell and Cornish’s social psychological theory of transformative communication to reshape individual endorsement of community norms that negatively affect gender equitable reproductive decision-making among couples in rural Uganda. Methods This study aimed to qualitatively evaluate the effect of FH = FW’s community dialogue approach on participants’ personal endorsement of community norms counter to family planning acceptance and gender equity. A pilot quasi-experimental controlled trial was implemented in 2021. This paper uses qualitative, post-intervention data collected from intervention arm participants (N = 70) at two time points: 3 weeks post-intervention (in-depth interviews, n = 64) and after 10-months follow-up (focus group discussions [n = 39] or semi-structured interviews [n = 27]). Data were analyzed through thematic analysis. Results The community dialogue approach helped couples to reassess community beliefs that reinforce gender inequity and disapproval of family planning. FH = FW’s inclusion of economic and relationship content served as key entry points for couples to discuss family planning. Results are presented in five central themes: (1) Community family size expectations were reconsidered through discussions on economic factors; (2) Showcasing how relationship health and gender equity are central to economic health influenced men’s acceptance of gender equity; (3) Linking relationship health and family planning helped increase positive attitudes towards family planning and the perceived importance of shared household decision-making to family wellness; (4) Program elements to strengthen relationship skills helped to translate gender equitable attitudes into changes in relationship dynamics and to facilitate equitable family planning communication; (5) FH = FW participation increased couples’ collective family planning (and overall health) decision-making and uptake of contraceptive methods. Conclusion Community dialogues may be an effective intervention approach to change individual endorsement of widespread community norms that reduce family planning acceptance. Future work should continue to explore innovative ways to use this approach to increase gender equitable reproductive decision-making among couples in settings where gender, religious, and community norms limit reproductive autonomy. Future evaluations of this work should aim to examine change in norms at the community-level.
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    Concordance Between Laboratory Diagnosed Sexually Transmitted Infections and Self-Reported Measures of Risky Sex by Partner Type Among Rural Ugandan Outpatients
    (AIDS and Behavior, 2017) Kiene, Susan M.; Lule, Haruna; Hughes, Peter; Wanyenze, Rhoda K.
    Numerous HIV risk reduction interventions which show effects on sexual risk behaviors fail to find effects on STIs. We examined the concordance between laboratory diagnosed STIs and sexual risk behavior among Ugandan outpatients (n = 328). We screened for STIs and assessed sexual behavior at baseline and 6 month followup. Less risk was associated with an STI at baseline. At follow-up more unprotected sex with casual partners was associated with incident Syphilis, more unprotected sex with primary and secondary regular partners was associated with incident Chlamydia or Gonorrhea. Our results suggest ways to improve concordance between behavioral measures and STIs.
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    Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior
    (BMC infectious diseases, 2017) Kiene, Susan M.; Lule, Haruna; Sileo, Katelyn M.; Silmi, Kazi Priyanka; Wanyenze, Rhoda K.
    Intimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators. Methods: In a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators.
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    Determinants of family planning service uptake and use of contraceptives among postpartum women in rural Uganda
    (International journal of public health, 2016) Sileo, Katelyn M.; Wanyenze, Rhoda K.; Lule, Haruna; Kiene, Susan M.
    Uganda has one of the highest unmet needs for family planning globally, which is associated with negative health outcomes for women and population-level public health implications. The present cross-sectional study identified factors influencing family planning service uptake and contraceptive use among postpartum women in rural Uganda. Methods—Participants were 258 women who attended antenatal care at a rural Ugandan hospital. We used logistic regression models in SPSS to identify determinants of family planning service uptake and contraceptive use postpartum. Results—Statistically significant predictors of uptake of family planning services included: education (AOR = 3.03, 95 % CI 1.57–5.83), prior use of contraceptives (AOR = 7.15, 95 % CI 1.58–32.37), partner communication about contraceptives (AOR = 1.80, 95 % CI 1.36–2.37), and perceived need of contraceptives (AOR = 2.57, 95 % CI 1.09–6.08). Statistically significant predictors of contraceptive use since delivery included: education (AOR = 2.04, 95 % CI 1.05–3.95), prior use of contraceptives (AOR = 10.79, 95 % CI 1.40–83.06), and partner communication about contraceptives (AOR = 1.81, 95 % CI 1.34–2.44). Conclusions—Education, partner communication, and perceived need of family planning are key determinants of postpartum family planning service uptake and contraceptive use, and should be considered in antenatal and postnatal family planning counseling.
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    The Effect of Motivational Interviewing-Based Counseling During Outpatient Provider Initiated HIV Testing on High-Risk Sexual Behavior in Rural Uganda
    (AIDS and Behavior, 2016) Kiene, Susan M.; Bateganya, Moses H.; Lule, Haruna; Wanyenze, Rhoda K.
    Provider-initiated HIV testing and counseling (PITC) has rapidly expanded in many countries including Uganda. However, because it provides HIV prevention information without individualized risk assessment and risk reduction counseling it may create missed opportunities for effective HIV prevention counseling. Our objective was to assess the effect of a brief motivational interviewing-based intervention during outpatient PITC in rural Uganda compared to Uganda’s standard-of-care PITC at reducing HIV transmission-relevant sexual risk behavior. We enrolled 333 (160 control, 173 intervention) participants in a historical control trial to test the intervention vs. standard-of-care. Participants received PITC and standard-of-care or the intervention counseling and we assessed sexual risk behavior at baseline and 3 and 6 months follow-up. The intervention condition showed 1.5–2.4 times greater decreases in high risk sexual behavior over time compared to standard-of-care (p = 0.015 and p = 0.004). These data suggest that motivational interviewing based counseling during PITC may be a promising intervention to reduce high-risk sexual behavior and potentially reduce risk of HIV infection.
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    Initial Outcomes of Provider-Initiated Routine HIV Testing and Counseling During Outpatient Care at a Rural Ugandan Hospital: Risky Sexual Behavior, Partner HIV Testing, Disclosure, and HIV Care Seeking
    (AIDS patient Care and STDs, 2010) Kiene, Susan M.; Bateganya, Moses; Wanyenze, Rhoda K.; Lule, Haruna; Nantaba, Harriet; Stein, Michael D.
    Provider-initiated routine HIV testing is being scaled up throughout the world, however, little is known about the outcomes of routine HIV testing on subsequent behavior. This study examined the initial outcomes of provider-initiated routine HIV testing at a rural Ugandan hospital regarding partner HIV testing, sexual risk behavior, disclosure, and HIV care seeking. In a prospective cohort study, 245 outpatients receiving routine HIV testing completed baseline and 3-month follow-up interviews. After receiving routine HIV testing the percentage of participants engaging in risky sex decreased from 70.1% to 50.3% among HIV-negative and from 75.0% to 53.5% among HIV-positive participants, the percentage knowing their partner(s)’ HIV status increased from 18.7% to 34.3% of HIV-negative and from 14.3% to 35.7% of HIV-positive participants. Among those reporting risky sex at baseline, HIV-positive participants were more likely to eliminate risky sex in general and specifically to become abstinent at follow-up than were HIV-negative participants. Similarly, unmarried participants who were risky at baseline were more likely to become safe in general, become abstinent, and start 100% condom use than were married=cohabitating participants. Rates of disclosure were high. Over 85% of those who tested HIV positive enrolled in care. Routine HIV testing in this setting may promote earlier HIV diagnosis and access to care but leads to only modest reductions in risky sexual behavior. To fully realize the potential HIV prevention benefits of routine HIV testing an emphasis on tailored risk-reduction counseling may be necessary.
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    Provider-initiated HIV testing in health care settings: Should it include client-centered counselling?
    (Journal of Social Aspects of HIV/AIDS, 2009) Kiene, Susan M.; Stein, Michael; Bateganya, Moses; Wanyenze, Rhoda K.; Mayer, Kenneth; Lule, Haruna
    To increase access to HIV testing, the WHO and CDC have recommended implementing provider-initiated HIV testing (PITC). To address the resource limitations of the PITC setting, WHO and CDC suggest that patient-provider interactions during PITC may need to focus on providing information and referrals, instead of engaging patients in client-centered counselling, as is recommended during client-initiated HIV testing. Providing HIV prevention information has been shown to be less effective than client-centered counselling in reducing HIV-risk behaviour and STI incidence. Therefore, concerns exist about the efficacy of PITC as an HIV prevention approach. However, reductions in HIV incidence may be greater if more people know their HIV status through expanded availability of PITC, even if PITC is a less effective prevention intervention than is client-initiated HIV testing for individual patients. In the absence of an answer to this public health question, adaptation of effective brief client-centered counselling approaches to PITC should be explored along with research assessing the efficacy of PITC.
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    “That would be good but most men are afraid of coming to the clinic”: Men and women's perspectives on strategies to increase male involvement in women's reproductive health services in rural Uganda
    (Journal of health psychology, 2017) Sileo, Katelyn M.; Wanyenze, Rhoda K.; Lule, Haruna; Kiene, Susan M.
    In Uganda, increasing male involvement in reproductive health services may improve women's access to care. The purpose of this study was to explore factors influencing male support for women's reproductive health services, and to elicit suggestions for strategies to increase male involvement. In 2008-2009, focus groups (N=76) were conducted with men and women in a rural hospital in Uganda. A content analysis approach was used for data analysis. Our findings point to the need for multilevel approaches that educate and mobilize men, while improving quality of care at the facility-level to increase male involvement in reproductive health services.