Browsing by Author "Makumbi, Fredrick"
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Item AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV(AIDS Care, 2011) Nakigozi, Gertrude; Makumbi, Fredrick; Reynolds, Steven; Galiwango, Ronald; Kagaayi, Joseph; Nalugoda, Fred; Ssettuba, Absalom; Sekasanvu, Joseph; Musuuza, Jackson; Serwada, David; Gray, Ron; Wawer, MariaImproved understanding of HIV-related health-seeking behavior at a population level is important in informing the design of more effective HIV prevention and care strategies. We assessed the frequency and determinants of failure to seek free HIV care in Rakai, Uganda. HIV-positive participants in a community cohort who accepted VCT were referred for free HIV care (cotrimoxazole prophylaxis, CD4 monitoring, treatment of opportunistic infections, and, when indicated, antiretroviral therapy). We estimated proportion and adjusted Prevalence Risk Ratios (adj. PRR) of non-enrollment into care six months after receipt of VCT using log-binomial regression. About 1145 HIV-positive participants in the Rakai Community Cohort Study accepted VCT and were referred for care. However, 31.5% (361/1145) did not enroll into HIV care six months after referral. Non-enrollment was significantly higher among men (38%) compared to women (29%, p 0.005). Other factors associated with nonenrollment included: younger age (15 24 years, adj. PRR 2.22; 95% CI: 1.64, 3.00), living alone (adj. PRR 2.22; 95% CI: 1.57, 3.15); or in households with 1 2 co-residents (adj. PRR 1.63; 95% CI: 1.31, 2.03) compared to three or more co-residents, or a CD4 count 250 cells/ul (adj. PRR 1.81; 95% CI: 1.38, 2.46). Median (IQR) CD4 count was lower among enrolled 388 cells/ul (IQR: 211,589) compared to those not enrolled 509 cells/ul (IQR: 321,754).About one-third of HIV-positive persons failed to utilize community-based free services. Non-use of services was greatest among men, the young, persons with higher CD4 counts and the more socially isolated, suggesting a need for targeted strategies to enhance service uptakeItem An investigation of the impact of the Global Gag Rule on women’s sexual and reproductive health outcomes in Uganda: a difference-in-differences analysis(Informa UK Limited, 2022-10-19) Giorgio, Margaret; Makumbi, Fredrick; Kibira, Simon P. S.; Bell, Suzanne O.; Chiu, Doris W.; Firestein, Lauren; Sully, ElizabethIn 2017, the Trump administration reinstated the Global Gag Rule (GGR), making non-U.S. non-governmental organisations ineligible for US government global health assistance if they provide access to or information about abortion. Little is known about the impact of the Trump administration’s GGR on women’s outcomes. Data for this analysis come from a panel of women surveyed in 2018 and 2019 in Uganda (n = 2755). We also used data from meetings with key stakeholders to create a detailed measure of exposure to the GGR within Uganda, classifying districts as more or less exposed to the GGR. Multivariable regression models were used to assess changes in contraceptive use, all births, unplanned births, and abortion from before to during implementation of the GGR. Difference-in-differences (DID) estimates were determined by calculating predicted probabilities from interaction terms for exposure/survey round. Descriptive analyses showed long-acting reversible contraceptive use increased more rapidly among women in less exposed districts after GGR implementation. DID estimates for contraceptive use were small. We observed a DID estimate of 3.5 (95% CI −0.9, 7.9) for all births and 2.9 (95% CI −0.2, 6.0) for unplanned births for women in more exposed districts during the period the policy was in effect. Our results suggest that the GGR may have attenuated Uganda’s recent progress in improving SRHR outcomes, with women in less exposed districts continuing to benefit from this progress, while previously increasing trends for women in more exposed districts levelled off. Although the GGR was rescinded in January 2021, the impact of these disruptions may be felt for years to come.Item The Burden of Tetanus in Uganda(Springerplus, 2016) Nanteza, Barbara; Galukande, Moses; Aceng, Jane; Musinguzi, Joshua; Opio, Alex; Mbonye, Anthony K.; Mukooyo, Eddie; Behumize, Prosper; Makumbi, FredrickThe successful scale-up of safe male circumcision (SMC) in Uganda has been hinged on client’s safety and quality of services. However, after the recent three tetanus deaths after circumcision a review of all tetanus cases in one of the hospitals where the cases occurred was initiated. This was to ascertain the potential for an association between tetanus infection and circumcision. Routinely collected national data were also reviewed to determine the burden of tetanus in Uganda and contextualize these incidents.Item 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, AnitaProvider-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).Item Contraceptive use, prevalence and predictors of pregnancy planning among female sex workers in Uganda: a cross sectional study(BMC pregnancy and childbirth, 2019) Nnakate Bukenya, Justine; Wanyenze, Rhoda K.; Barrett, Geraldine; Hall, Jennifer; Makumbi, Fredrick; Guwatudde, DavidUnintended pregnancies are associated with negative consequences to both mother and baby. Female Sex Workers (FSWs) are at high risk of unintended/unplanned pregnancies. However, prevalence of pregnancy planning and its predictors among FSWs has not been comprehensively investigated. This study was designed to determine contraceptive use, the prevalence, and predictors of pregnancy planning among FSWs in Uganda. Methods: In this cross-sectional study, 819 FSWs attending most at risk populations initiative (MARPI) clinics were recruited using systematic sampling and interviewed with a pretested questionnaire that included collection of data on pregnancy intention using the London Measure of Unplanned Pregnancy (LMUP). Data were analysed using STATA version 14.0. Multinomial logistic regression model was used to identify predictors of pregnancy planning, Results: Of the 819 study participants, only 90 (11.0%) had planned pregnancies. Overall, 462 (56.4%) were hazardous alcohol users and 335 (40.9%) abused drugs; 172 (21.0%) had been raped in the last 2 years and 70 (40.7%) of these accessed emergency contraception post-rape. Dual contraception use (condom and other modern method) was 58.0%. Having a non-emotional partner as a man who impregnated the FSW compared to emotional partner was significantly associated with less planned relative to unplanned pregnancy, (aRR = 0.15 95%Cl =0.08, 0.30), so was lack of reported social support compared to support from friends, (aRR = 0.44; 95% CI = 0.22–0.87), keeping all factors constant in the model. Being raped (aRR = 0.51; 95% CI = 0.31–0.84) or abuse of substances (aRR = 0.65; 95% CI = 0.45–0.93) were significantly associated with lower ambivalence relative to unplanned pregnancy but not with planned relative to unplanned pregnancy. Conclusion: Compared to women in the general population, pregnancy planning was low among FSWs amidst modest use of dual contraceptive. There is an urgent need to promote dual contraception among FSWs to prevent unplanned pregnancies especially with non-emotional partners, drug users, and post-rape.Item Correlates of hepatitis B awareness and disease-specific knowledge among pregnant women in Northern and Central Uganda: a cross-sectional study(Hepatology, medicine and policy, 2018) Nankya-Mutyoba, Joan; Aizire, Jim; Makumbi, Fredrick; Atuyambe, Lynn; Ocama, Ponsiano; Kirk, Gregory D.Countries in sub-Saharan Africa with a high hepatitis B burden also have limited resources to identify underlying drivers of disease among key at-risk populations. To improve prioritization and strengthen prevention of mother to child transmission of HBV, it is imperative to understand disease awareness, knowledge and related factors among pregnant women. Objectives: This study assessed HBV disease awareness, knowledge and related factors among pregnant women in public health facilities in two regions with diverse HBV disease epidemiology. Methods: From October 2016 through December 2017, a random sample of 455 pregnant women attending antenatal clinics were surveyed to assess HBV awareness, knowledge and associated factors. Participants responded to an 18-item questionnaire with themes on HBV awareness, knowledge of disease signs and symptoms, transmission, prevention and misconceptions about the disease. Results were analysed in STATA (version 14.0). Results: Of 455 participants enrolled, about two thirds reported having heard about HBV disease. By region, nearly half (47%) of participants from the central region, compared to only 16% from the north, reported that they had never heard of HBV. Region of residence had a moderating effect on the education- HBV awareness relationship. Only 162/455 (36%) of participants had adequate HBV knowledge. More than half 256/455 (56%) and 242/455 (53%) were not knowledgeable about horizontal and mother to child HBV transmission, respectively. About two thirds 298/455 (66%) and 281/455 (62%) believed HBV was spread via sharing of utensils and mosquito bites respectively. In multiple regression analysis, residing in the north, (PR=1.91(1.53 -2.38), p < 0.001) compared to central region and having a secondary education (PR=1.87(1.37 -2.55), p < 0.001) compared to primary were statistically significantly related to being knowledgeable about HBV. Conclusion: We demonstrated marked regional differences in HBV disease awareness and knowledge in this high HBV prevalence setting. However, most pregnant women displayed unacceptably low HBV knowledge and a significant proportion still hold misconceptions about HBV. Interventions to improve HBV prevention through antenatal education will need to be tailored to existing differences in comprehensive HBV knowledge.Item Corrigendum to “Hepatitis B birth dose vaccination for newborns in Uganda: A qualitative inquiry on pregnant women’s perceptions, barriers and preferences”(Journal of Virus Eradication, 2021) Nankya Mutyoba, Joan; Surkan, Pamela J.; Makumbi, Fredrick; Aizire, Jim; Kirk, Gregory D.; Ocama, Ponsiano; Atuyambe, Lynn M.The full acknowledgment for the article is restated herein: This research (or [initials]) was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand and funded by the Carnegie Corporation of New York (Grant No—G-19-57145), Sida (Grant No:54100113), Uppsala Monitoring Center and the DELTAS Africa Initiative (Grant No: 107768/Z/ 15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS)’s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa’s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the Fellow.Item Desire for female sterilization among women wishing to limit births in rural Rakai, Uganda(Contraception, 2015) Lutalo, Tom; Gray, Ron; Sanyukta, Mathur,; Wawer, Maria; Guwatudde, David; Santelli, John; Nalugoda, Fred; Makumbi, Fredrick: Uganda has an unmet need for family planning of 34% and a total fertility rate of 6.2. We assessed the desire for female sterilization among sexually active women who wanted to stop childbearing in rural Rakai district, Uganda. Study design: 7,192 sexually active women enrolled in a community cohort between 2002 and 2008 were asked about fertility intentions. Those stating that they did not want another child (limiters) were asked whether they would be willing to accept female sterilization, if available. Trends in desire for sterilization were determined by Chi-square test for trend, and Modified Poisson regression was used to estimate prevalence rate ratios (PRR) and 95% confidence intervals of the associations between desire for sterilization and socio-demographic characteristics and HIV status. Results: From 2002 to 2008, the proportion of limiters dropped (47.2% to 43.7%; p<0.01). Use of pills and injectables among limiters significantly increased, 38.9% to 50.3% (p<0.0001), while use of IUDs and implants declined from 3.3% to 1.7% (p<0.001). The desire for sterilization significantly increased from 54.2% to 63.1% (p<0.0001), and this was consistently higher among the HIV-positive (63.6% to 70.9%, p<0.01) than HIV-negative women (53.3% to 61.2%, p<0.0001). Factors significantly associated with the desire for sterilization included higher number of living children (>=3), being HIV-infected and having received HIV counseling and testing. Conclusion: There is latent and growing desire for sterilization in this population. Our findings suggest a need to increase permanent contraception services for women who want to limit childbearing in this setting.Item Determinants of fertility desire among married or cohabiting individuals in Rakai, Uganda: a cross-sectional study(Reproductive health, 2017) Matovu, Joseph K.B.; Makumbi, Fredrick; Wanyenze, Rhoda K.; Serwadda, DavidRecent trends in fertility rates indicate declines in total fertility rate (TFR) in some sub-Saharan African countries. However, countries such as Uganda continue to have a persistently high TFR partly attributed to strong preferences for large family sizes. We explored the factors that influence fertility desire among married or cohabiting individuals in Rakai, a rural district in southwestern Uganda. Methods: This cross-sectional study of fertility desire (desire to have another child) was nested in a clusterrandomized demand-creation intervention trial for the promotion of couples’ HIV counseling and testing uptake among married or cohabiting individuals that was conducted in Rakai district between March 1 and April 30, 2015. A total of 1490 married or cohabiting individuals, resident in three study regions with differing background HIV prevalence, were enrolled into the study. Data were collected on socio-demographic, behavioral and fertilityrelated characteristics. We used a modified Poisson regression model to generate prevalence ratio (PR) as a measure of association for factors that were independently associated with fertility desire. We adjusted for clustering at community level and used STATA version 14.0 for all analyses. Results: Overall, fertility desire was high (63.1%, n = 940); higher in men (69.9%, n = 489) than women (57.1%, n = 451). More than three-quarters (78.8%, n = 1174) had 3+ biological children while slightly more than twothirds (68.5%, n = 1020) reported an ideal family size of 5+ children. Only 30% (n = 452) reported that they had attained their desired family size. After adjusting for potential and suspected confounders, the factors that were negatively associated with fertility desire were: age 30–39 (adjusted prevalence ratio [aPR] = 0.82, 95% CI: 0.78, 0.86) and 40+ years (aPR = 0.65, 95% CI: 0.60, 0.71); having six or more biological children (aPR = 0.88, 95% CI: 0.80, 0.97); being HIV-positive (aPR = 0.86, 95% CI: 0.78, 0.95) and ever use of any family planning methods (aPR = 0.93, 95% CI: 0.87, 0.99). Being male (aPR = 1.19, 95% CI: 1.07, 1.33); having primary education (aPR = 1.21, 95% CI: 1.01, 1.44) and having not yet attained the desired family size (aPR = 4.34, 95% CI: 3.50, 5.38) were positively associated with fertility desireItem Determinants of fertility desire among married or cohabiting individuals in Rakai, Uganda: a cross-sectional study(Reproductive health, 2017) Matovu, Joseph K. B.; Makumbi, Fredrick; Wanyenze, Rhoda K.; Serwadda, DavidRecent trends in fertility rates indicate declines in total fertility rate (TFR) in some sub-Saharan African countries. However, countries such as Uganda continue to have a persistently high TFR partly attributed to strong preferences for large family sizes. We explored the factors that influence fertility desire among married or cohabiting individuals in Rakai, a rural district in southwestern Uganda. Methods This cross-sectional study of fertility desire (desire to have another child) was nested in a cluster-randomized demand-creation intervention trial for the promotion of couples’ HIV counseling and testing uptake among married or cohabiting individuals that was conducted in Rakai district between March 1 and April 30, 2015. A total of 1490 married or cohabiting individuals, resident in three study regions with differing background HIV prevalence, were enrolled into the study. Data were collected on socio-demographic, behavioral and fertility-related characteristics. We used a modified Poisson regression model to generate prevalence ratio (PR) as a measure of association for factors that were independently associated with fertility desire. We adjusted for clustering at community level and used STATA version 14.0 for all analyses. Results Overall, fertility desire was high (63.1%, n = 940); higher in men (69.9%, n = 489) than women (57.1%, n = 451). More than three-quarters (78.8%, n = 1174) had 3+ biological children while slightly more than two-thirds (68.5%, n = 1020) reported an ideal family size of 5+ children. Only 30% (n = 452) reported that they had attained their desired family size. After adjusting for potential and suspected confounders, the factors that were negatively associated with fertility desire were: age 30–39 (adjusted prevalence ratio [aPR] = 0.82, 95% CI: 0.78, 0.86) and 40+ years (aPR = 0.65, 95% CI: 0.60, 0.71); having six or more biological children (aPR = 0.88, 95% CI: 0.80, 0.97); being HIV-positive (aPR = 0.86, 95% CI: 0.78, 0.95) and ever use of any family planning methods (aPR = 0.93, 95% CI: 0.87, 0.99). Being male (aPR = 1.19, 95% CI: 1.07, 1.33); having primary education (aPR = 1.21, 95% CI: 1.01, 1.44) and having not yet attained the desired family size (aPR = 4.34, 95% CI: 3.50, 5.38) were positively associated with fertility desire. Conclusion Having not yet attained one’s desired family size, being male and having primary education were positively associated with fertility desire in this population. Targeting individuals who have not yet attained their desired family size, men and less educated individuals with fertility regulation interventions may help to reduce fertility desire in this population.Item Diabetes and Pre-Diabetes among Persons Aged 35 to 60 Years in Eastern Uganda: Prevalence and Associated Factors(PLoS ONE, 2013) Mayega, Roy William; Guwatudde, David; Makumbi, Fredrick; Nakwagala, Frederick Nelson; Peterson, Stefan; Tomson, Goran; Ostenson, Claes-GoranOur aim was to estimate the prevalence of abnormal glucose regulation (AGR) (i.e. diabetes and prediabetes) and its associated factors among people aged 35-60 years so as to clarify the relevance of targeted screening in rural Africa. Methods: A population-based survey of 1,497 people (786 women and 711 men) aged 35-60 years was conducted in a predominantly rural Demographic Surveillance Site in eastern Uganda. Participants responded to a lifestyle questionnaire, following which their Body Mass Index (BMI) and Blood Pressure (BP) were measured. Fasting plasma glucose (FPG) was measured from capillary blood using On-Call® Plus (Acon) rapid glucose meters, following overnight fasting. AGR was defined as FPG ≥6.1mmol L-1 (World Health Organization (WHO) criteria or ≥5.6mmol L-1 (American Diabetes Association (ADA) criteria. Diabetes was defined as FPG >6.9mmol L-1, or being on diabetes treatment. Results: The mean age of participants was 45 years for men and 44 for women. Prevalence of diabetes was 7.4% (95%CI 6.1-8.8), while prevalence of pre-diabetes was 8.6% (95%CI 7.3-10.2) using WHO criteria and 20.2% (95%CI 17.5-22.9) with ADA criteria. Using WHO cut-offs, the prevalence of AGR was 2 times higher among obese persons compared with normal BMI persons (Adjusted Prevalence Rate Ratio (APRR) 1.9, 95%CI 1.3-2.8). Occupation as a mechanic, achieving the WHO recommended physical activity threshold, and higher dietary diversity were associated with lower likelihood of AGR (APRR 0.6, 95%CI 0.4-0.9; APRR 0.6, 95%CI 0.4-0.8; APRR 0.5, 95%CI 0.3-0.9 respectively). The direct medical cost of detecting one person with AGR was two US dollars with ADA and three point seven dollars with WHO cut-offs. Conclusions: There is a high prevalence of AGR among people aged 35-60 years in this setting. Screening for high risk persons and targeted health education to address obesity, insufficient physical activity and non-diverse diets are necessary.Item The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda(American journal of obstetrics and gynecology, 2009) Gray, Ronald H.; Kigozi, Godfrey; Serwadda, David; Makumbi, Fredrick; Nalugoda, Fred; Watya, Stephen; Moulton, Laurence; Cheng, Michael Z.; Sewankambo, Nelson K.; Kiwanuka, Noah; Sempijja, Victor; Lutalo, Tom; Kagayii, Joseph; Wabwire-Mangen, Fred; Ridzon, Renée; Bacon, Melanie; Wawer, Maria J.The objective of the study was to assess effects of male circumcision on female genital symptoms and vaginal infections. STUDY DESIGN: Human immunodeficiency virus (HIV)-negative men enrolled in a trial were randomized to immediate or delayed circumcision (control arm). Genital symptoms, bacterial vaginosis (BV), and trichomonas were assessed in HIV-negative wives of married participants. Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CIs) were assessed by multivariable log-binomial regression, intent-to-treat analyses. RESULTS: A total of 783 wives of control and 825 wives of intervention arm men were comparable at enrollment. BV at enrollment was higher in control (38.3%) than intervention arm spouses (30.5%, P .001). At 1 year follow-up, intervention arm wives reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI, 0.63-0.97), but there were no differences in vaginal discharge or dysuria. The risk of trichomonas was reduced in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05- 0.98), as were the risks of any BV (adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV (prevalence risk ratios, 0.39; 95% CI, 0.24-0.64). CONCLUSION: Male circumcision reduces the risk of ulceration, trichomonas, and BV in female partners.Item Effects of Medical Male Circumcision (MC) on Plasma HIV Viral Load in HIV+ HAART Nai¨ve Men; Rakai, Uganda(PLoS ONE, 2014) Kigozi, Godfrey; Musoke, Richard; Kighoma, Nehemiah; Watya, Stephen; Serwadda, David; Nalugoda, Fred; Kiwanuka, Noah; Wabwire-Mangen, Fred; Tobian, Aaron; Makumbi, Fredrick; Galiwango, Ronald Moses; Sewankambo, Nelson; Nkale, James; Kigozi Nalwoga, Grace; Anyokorit, Margaret; Lutalo, Tom; Henry Gray, Ronald; Wawer, Maria JoanMedical male circumcision (MC) of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. We assessed the effect of MC on plasma HIV viral load in HIV-infected men in Rakai, Uganda. 195 consenting HIV-positive, HAART naı¨ve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Data were also collected on baseline social demographic characteristics and CD4 counts. Change in log10 plasma viral load between baseline and follow-up visits was estimated using paired t tests and multivariate generalized estimating equation (GEE).Item Erratum to: Trends in HIV counseling and testing uptake among married individuals in Rakai, Uganda(BMC public health, 2013) Matovu, Joseph K.B.; Denison, Julie; Wanyenze, Rhoda K.; Ssekasanvu, Joseph; Makumbi, Fredrick; Ovuga, Emilio; McGrath, Nuala; Serwadda, DavidFollowing publication of this article [1], it has come to our attention that the total number of observations (21,798) has been mistakenly cited as the number of respondents in some paragraphs within the paper. This number appears within the abstract, in the analysis sub-section, within the opening paragraph of the results section, and in the section on HIV prevalence. The number that should have been cited is 11,268 - the total number of respondents in the dataset. 21,798 refers to the total number of observations over the study period. The percentages estimated out of 21,798 have been recalculated. Of the 11,268 individuals enrolled in this study, 81.2% (9,220) were in monogamous marital unions while 18.2% (2,048) were in polygamous marital unions. Of those in polygamous marital unions (n = 2,048), 52.8% were females while 47.2% were males. Thirty eight per cent of the participants (4,236) reported that they had ever received HCT (i.e. individual or couples’ HCT). Overall HIV prevalence was 11.9% (1,337 of 11,268). However, it is important to note that since serial cross-sectional analyses of each of the 4 study visits were used under consideration, the findings shown in Tables 1 and 2 as well as Fig. 2 (A,B,C) are not affected by this error.Item Estimation of cause-specific mortality in Rakai, Uganda, using verbal autopsy 1999-2019(Avestia Publishing, 2023-08) Nabukalu, Doreen; Calazans, Julia; Marston, Milly; Makumbi, Fredrick; Lutalo, Tom; Todd, JimBackground There are scant data on the causes of adult deaths in sub-Saharan Africa. We estimated the level and trends in adult mortality, overall and by different causes, in rural Rakai, Uganda, by age, sex, and HIV status. Objectives To estimate and analyse adult cause-specific mortality trends in Rakai, Uganda. Methodology Mortality information by cause, age, sex, and HIV status was recorded in the Rakai Community Cohort study using verbal autopsy interviews, HIV serosurveys, and residency data. We estimated the average number of years lived in adulthood. Using demographic decomposition methods, we estimated the contribution of each cause of death to adult mortality based on the average number of years lived in adulthood. Results Between 1999 and 2019, 63082 adults (15–60 years) were censused, with 1670 deaths registered. Of these, 1656 (99.2%) had completed cause of death data from verbal autopsy. The crude adult death rate was 5.60 (95% confidence interval (CI): 5.33–5.87) per 1000 person-years of observation (pyo). The crude death rate decreased from 11.41 (95% CI: 10.61–12.28) to 3.27 (95% CI: 2.89–3.68) per 1000 pyo between 1999–2004 and 2015–2019. The average number of years lived in adulthood increased in people living with HIV and decreased in HIV-negative individuals between 2000 and 2019. Communicable diseases, primarily HIV and Malaria, had the biggest decreases, which improved the average number of years lived by approximately extra 12 years of life in females and 6 years in males. There were increases in deaths due to non-communicable diseases and external causes, which reduced the average number of years lived in adulthood by 2.0 years and 1.5 years in females and males, respectively. Conclusion There has been a significant decline in overall mortality from 1999 to 2019, with the greatest decline seen in people living with HIV since the availability of antiretroviral therapy in 2004. By 2020, the predominant causes of death among females were non-communicable diseases, with external causes of death dominating in males.Item Forecast analysis of any opportunistic infection among HIV positive individuals on antiretroviral therapy in Uganda(BMC Public Health, 2016-08-11) Rubaihayo, John; Tumwesigye, Nazarius M.; Konde-Lule, Joseph; Makumbi, FredrickPredicting future prevalence of any opportunistic infection (OI) among persons infected with the human immunodeficiency virus (HIV) on highly active antiretroviral therapy (HAART) in resource poor settings is important for proper planning, advocacy and resource allocation. We conducted a study to forecast 5-years prevalence of any OI among HIV-infected individuals on HAART in Uganda. Monthly observational data collected over a 10-years period (2004–2013) by the AIDS support organization (TASO) in Uganda were used to forecast 5-years annual prevalence of any OI covering the period 2014–2018. The OIs considered include 14 AIDS-defining OIs, two non-AIDS defining OIs (malaria & geohelminths) and HIV-associated Kaposi’s sarcoma. Box-Jenkins autoregressive integrated moving average (ARIMA) forecasting methodology was used. Between 2004 and 2013, a total of 36,133 HIV patients were enrolled on HAART of which two thirds (66 %) were female. Mean annual prevalence for any OI in 2004 was 57.6 % and in 2013 was 27.5 % (X2trend = 122, b = −0.0283, p <0.0001). ARIMA (1, 1, 1) model was the most parsimonious and best fit for the data. The forecasted mean annual prevalence of any OI was 26.1 % (95 % CI 21.1–31.0 %) in 2014 and 15.3 % (95 % CI 10.4–20.3 %) in 2018. While the prevalence of any OI among HIV positive individuals on HAART in Uganda is expected to decrease overall, it’s unlikely that OIs will be completely eliminated in the foreseeable future. There is therefore need for continued efforts in prevention and control of opportunistic infections in all HIV/AIDS care programmes in these settings.Item Frequency and distribution patterns of opportunistic infections associated with HIV/AIDS in Uganda(BMC research notes, 2016) Rubaihayo, John; Tumwesigye, Nazarius M.; Konde‑Lule, Joseph; Wamani, Henry; Nakku‑Joloba, Edith; Makumbi, FredrickWe conducted a study to assess the frequency and distribution patterns of selected opportunistic infections (OIs) and opportunistic cancers (OCs) in different geographical areas before and after HAART in Uganda. This was a cross-sectional serial review of observation data for adult HIV positive patients (≥15 years) enrolled with the AIDS support organization (TASO) in Uganda covering the period from January 2001 to December 2013. Both AIDS defining OIs/OCs and non-AIDS defining OIs were analyzed. The study period was structured into three time periods: “pre- HAART” (2001–2003), “early-HAART” (2004–2008) and “late-HAART” (2009–2013). Descriptive statistics were used to summarize the data by time period, age, gender and geographical location. Chi squared test used to test the significance of the differences in proportions. A total of 108,619 HIV positive patients were included in the analysis. 64% (64,240) were female with median age of 33 years (IQR 27–40). The most frequent OIs before HAART were oral candida (34.6%) diarrhoeal infection (<1 month) (30.6%), geohelminths (26.5%), Mycobacterium tuberculosis (TB) (17.7%), malaria (15.1%) and bacterial pneumonia (11.2%). In early HAART (2004–2008), the most frequent OIs were geohelminths (32.4%), diarrhoeal infection (25.6%), TB (18.2%) and oral candida (18.1%). In late HAART (2009–2013), the most frequent OIs were geohelminths (23.5%) and diarrhoeal infection (14.3%). By gender, prevalence was consistently higher in women (p < 0.05) before and after HAART for geohelminths, candidiasis, diarrhoeal infection, bacterial pneumonia and genital ulcer disease but consistently higher in men for TB and Kaposi’s sarcoma (p < 0.05). By age, prevalence was consistently higher in older age groups (>30 years) before and after HAART for oral candida and TB (p < 0.05) and higher in young age groups (<30 years) for malaria and genital ulcers (p < 0.05). By geographical location, prevalence was consistently higher in Eastern and Northern Uganda before and after HAART for diarrheal infection and geohelminths (p < 0.0001). The frequency and pattern of OIs before and after HAART differs by gender, age and geographical location. Prevalence of geohelminths and diarrhea infection(<1 month) remains high especially in Northern and Eastern Uganda even after HAART and should therefore be given special attention in HIV/AIDS care programmes in these settings.Item Health-related quality of life in epilepsy patients receiving anti-epileptic drugs at National Referral Hospitals in Uganda: a cross-sectional study(Health and Quality of Life Outcomes, 2014) Nabukenya, Anne M.; Matovu, Joseph K. B.; Wabwire-Mangen, Fred; Wanyenze, Rhoda K.; Makumbi, FredrickEpilepsy is a devastating disorder that impacts on patients’ quality of life, irrespective of use of anti epileptic drugs (AEDs). This study estimates the health-related quality of life (HRQOL) and its associated predictors among epilepsy patients receiving AEDs. Methods: A total of 175 epilepsy patients already receiving AED for at least 3 months were randomly selected and interviewed from mental clinics at Mulago and Butabika national referral hospitals in Uganda between May - July 2011. A HRQOL index, the primary outcome, was constructed using items from Quality Of Life in Epilepsy Inventory (QOLIE-31) and the Hospital Anxiety and Depression Scale (HADS) questionnaires. The internal consistency and adequacy of these items was also computed using Cronbach's alpha and Kaiser-Meyer-Olkin tests. Partial correlations were used to evaluate the contribution of the health dimensions (mental, psychological, social, physical functioning and emotional well being) and, multiple linear regressions to determine factors independently associated with HRQOL. Results: Just about half of the respondents (54%) were males, and nearly two thirds (62%) had received AEDs for at least 12 months. The average age was 26.6 years (SD = 11.1). The overall HRQOL mean score was 58 (SD = 13) on a scale of 0–100. The average scores of different dimensions or subscales ranged from 41 (physical) to 65 (psychological). At least three quarters (75%) of all subscales had good internal consistency and adequacy. The largest variations in the overall HRQOL were explained by social and mental functioning; each accounting for about 30% of the difference in the HRQOL but seizure control features explained a little (6%) variation. Factors negatively associated with HRQOL were poly-therapy (−1.16, p = 0.01) and frequency of seizures (−2.29, p = 0.00). Other factors associated with overall HRQOL included drug side effects, sex, marital status and education. Duration on AEDs was not a significant predictor of HRQOL. Conclusion: The HRQOL for epilepsy patients on AEDs is very low. The predictors of low HRQOL were socio factors (marital status, education) and drug side effects, frequency of seizure, and type of therapy.Item Health-related quality of life in epilepsy patients receiving anti-epileptic drugs at National Referral Hospitals in Uganda: a cross-sectional study(Health and quality of life outcomes, 2014) Nabukenya, Anne M.; Matovu, Joseph K. B.; Wabwire-Mangen, Fred; Wanyenze, Rhoda K.; Makumbi, FredrickEpilepsy is a devastating disorder that impacts on patients’ quality of life, irrespective of use of anti epileptic drugs (AEDs). This study estimates the health-related quality of life (HRQOL) and its associated predictors among epilepsy patients receiving AEDs. Methods A total of 175 epilepsy patients already receiving AED for at least 3 months were randomly selected and interviewed from mental clinics at Mulago and Butabika national referral hospitals in Uganda between May - July 2011. A HRQOL index, the primary outcome, was constructed using items from Quality Of Life in Epilepsy Inventory (QOLIE-31) and the Hospital Anxiety and Depression Scale (HADS) questionnaires. The internal consistency and adequacy of these items was also computed using Cronbach's alpha and Kaiser-Meyer-Olkin tests. Partial correlations were used to evaluate the contribution of the health dimensions (mental, psychological, social, physical functioning and emotional well being) and, multiple linear regressions to determine factors independently associated with HRQOL. Results Just about half of the respondents (54%) were males, and nearly two thirds (62%) had received AEDs for at least 12 months. The average age was 26.6 years (SD = 11.1). The overall HRQOL mean score was 58 (SD = 13) on a scale of 0–100. The average scores of different dimensions or subscales ranged from 41 (physical) to 65 (psychological). At least three quarters (75%) of all subscales had good internal consistency and adequacy. The largest variations in the overall HRQOL were explained by social and mental functioning; each accounting for about 30% of the difference in the HRQOL but seizure control features explained a little (6%) variation. Factors negatively associated with HRQOL were poly-therapy (-1.16, p = 0.01) and frequency of seizures (-2.29, p = 0.00). Other factors associated with overall HRQOL included drug side effects, sex, marital status and education. Duration on AEDs was not a significant predictor of HRQOL. Conclusion The HRQOL for epilepsy patients on AEDs is very low. The predictors of low HRQOL were socio factors (marital status, education) and drug side effects, frequency of seizure, and type of therapy.Item Hepatitis B Prevalence among Pregnant Women in Central and West Nile regions of Uganda: Is there a Need to prioritize Prevention of Mother to Child hepatitis B transmission?(Research Square, 2019) Nankya-Mutyoba, Joan; Aizire, Jim; Makumbi, Fredrick; Atuyambe, Lynn; Kirk, Gregory; Ocama, PonsianoIntroduction Within sub-Saharan Africa (SSA), the burden of chronic hepatitis B (HBV) is unacceptably high in several countries including Uganda. Elimination of HBV in the context of inadequate resources and several competing health issues, faces challenges including limited data on disease burden in important population sub-groups. In order to optimize available resources, reliable data on HBV among pregnant women is useful to guide policies on prevention. This study estimated HBV prevalence and related factors among pregnant women in Central and West Nile regions of Uganda Methods Using a twostage sampling approach, we selected a random sample of 310 pregnant women, 18 years or older from public health facility antenatal clinics in central and west Nile, North-western Uganda. Consenting women were interviewed to obtain data on HBV vaccination status, HIV status, selected sexual and lifestyle factors and socio-demographic information. In addition, they underwent phlebotomy to obtain blood for testing for hepatitis B surface antigen, (HBsAg) antibodies to the surface antigen (anti-HBs), and antibodies to the core (anti-HBc), as indicators of chronic infection, prior exposure, and susceptibility (anti-HBs <10 mIU /mL), respectively. Results Out of 310 women, prevalence of chronic HBV infection was 6.2%. Prevalence in the West Nile region was notably higher than in the Central region (11.0% vs. 1.3%), p<0.001. In both regions, majority of pregnant women (61% West Nile region, 76% Central region) were still susceptible to HBV. Overall, proportion who had been tested for HBV and those who reported having been vaccinated was only 5.8% and 11.3% respectively. Conclusion Our findings reveal the burden of HBV in Ugandan pregnant women is still high, with marked regional differences in disease prevalence, and poor levels of HBV testing and vaccination. These data suggest that HBV prevention programs and policies in resource-limited settings like Uganda may need to consider the differential HBV prevalence, as optimizing HBV prevention services in higher prevalence regions may provide greater impact and thereby align with the WHO recommendation on HBV elimination strategy in SSA.