Browsing by Author "Mayanja, Yunia"
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Item Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda(PLoS ONE, 2016) Mayanja, Yunia; Mukose, Aggrey David; Nakubulwa, Susan; Omosa-Manyonyi, Gloria; Kamali, Anatoli; Guwatudde, DavidThe prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance. Methods We enrolled 241 FSWs in a cross sectional study; they were aged 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. MantelHaenszel tests for interaction were performed. Results Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education. Conclusion Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment.Item Alcohol use, Mycoplasma genitalium and other STIs associated with HIV incidence among women at high risk in Kampala, Uganda(Journal of acquired immune deficiency syndromes, 2013) Vandepitte, Judith; Weiss, Helen A.; Bukenya, Justine; Nakubulwa, Susan; Mayanja, Yunia; Matovu, Godfrey; Kyakuwa, Nassim; Hughes, Peter; Hayes, Richard; Grosskurth, HeinerIn 2008, the first clinic for women involved in high risk sexual behaviour was established in Kampala, offering targeted HIV prevention. This paper describes rates, determinants and trends of HIV incidence over 3 years. Methods—1027 women at high risk were enrolled into a closed cohort. At 3-monthly visits, data were collected on socio-demographic variables and risk behaviour; biological samples were tested for HIV and other STIs. Hazard ratios (HR) for HIV incidence were estimated using Cox proportional hazards regression, among the 646 women HIV negative at enrolment. Results—HIV incidence was 3.66/100pyr and declined from 6.80/100pyr in the first calendar year to 2.24/100pyr and 2.53/100pyr in the following years (P-trend=0.003). Socio-demographic and behavioural factors independently associated with HIV incidence were younger age, younger age at first sex, alcohol use (including frequency of use and binge drinking), number of paying clients in the past month, inconsistent condom use with clients, and not being pregnant. HIV incidence was also independently associated with M. genitalium infection at enrolment (aHR=2.28, 95%CI: 1.15-4.52), and with N. gonorrhoeae (aHR=5.91, 95%CI: 3.04-11.49) and T. vaginalis infections at the most recent visit (aHR=2.72, 95%CI: 1.27-5.84). The PAF of HIV incidence for alcohol use was 63.5% (95%CI 6.5%-85.8%), and for treatable STI/RTI was 70.0% (95%CI 18.8%-87.5%). Conclusions—Alcohol use and STIs remain important risk factors for HIV acquisition, which call for more intensive control measures in women at high risk. Further longitudinal studies are needed to confirm the association between Mycoplasma genitalium and HIV acquisition.Item Bacterial vaginosis among women at high risk for HIV in Uganda: high rate of recurrent diagnosis despite treatment(Sexually transmitted infections, 2016) Francis, Suzanna C.; Looker, Clare; Vandepitte, Judith; Bukenya, Justine; Mayanja, Yunia; Nakubulwa, Susan; Hughes, Peter; Hayes, Richard J.; Weiss, Helen A.; Grosskurth, HeinerBacterial vaginosis (BV) is associated with increased risk for sexually transmitted infections (STIs) and HIV acquisition. This study describes the epidemiology of BV in a cohort of women at high risk for STI/HIV in Uganda over 2 years of follow-up between 2008–2011. Methods 1027 sex workers or bar workers were enrolled and asked to attend 3-monthly follow-up visits. Factors associated with prevalent BV were analysed using multivariate random-effects logistic regression. The effect of treatment on subsequent episodes of BV was evaluated with survival analysis. Results Prevalences of BV and HIV at enrolment were 56% (573/1027) and 37% (382/1027), respectively. Overall, 905 (88%) women tested positive for BV at least once in the study, over a median of four visits. Younger age, a higher number of previous sexual partners and current alcohol use were independently associated with prevalent BV. BV was associated with STIs, including HIV. Hormonal contraception and condom use were protective against BV. Among 853 treated BV cases, 72% tested positive again within 3 months. There was no difference in time to subsequent BV diagnosis between treated and untreated women. Conclusions BV was highly prevalent and persistent in this cohort despite treatment. More effective treatment strategies are urgently needed.Item High Levels of Persistent Problem Drinking in Women at High Risk for HIV in Kampala, Uganda: A Prospective Cohort Study(International journal of environmental research and public health, 2016) Weiss, Helen A.; Vandepitte, Judith; Bukenya, Justine N.; Mayanja, Yunia; Nakubulwa, Susan; Kamali, Anatoli; Seeley, Janet; Grosskurth, HeinerThe aim of this study was to describe the epidemiology of problem drinking in a cohort of women at high-risk of HIV in Kampala, Uganda. Overall, 1027 women at high risk of HIV infection were followed from 2008 to 2013. The CAGE and AUDIT questionnaires were used to identify problem drinkers in the cohort. Interviewer-administered questionnaires were used to ascertain socio-demographic and behavioural factors. Blood and genital samples were tested for HIV and other sexually transmitted infections. At enrollment, most women (71%) reported using alcohol at least weekly and about a third reported having drunk alcohol daily for at least 2 weeks during the past 3 months. Over half (56%) were problem drinkers by CAGE at enrollment, and this was independently associated with vulnerability (being divorced/separated/widowed, less education, recruiting clients at bars/clubs, and forced sex at first sexual experience). Factors associated with problem drinking during follow-up included younger age, meeting clients in bars/clubs, number of clients, using drugs and HSV-2 infection. HIV prevalence was associated with drinking at enrollment, but not during follow-up. This longitudinal study found high levels of persistent problem drinking. Further research is needed to adapt and implement alcohol-focused interventions in vulnerable key populations in sub-Saharan Africa.Item Oral pre-exposure prophylaxis preference, uptake, adherence and continuation among adolescent girls and young women in Kampala, Uganda: a prospective cohort study(Journal of the International AIDS Society, 2022) Mayanja, Yunia; Kamacooko, Onesmus; Lunkuse, Jane Frances; Muturi-Kioi, Vincent; Buzibye, Allan; Omali, Denis; Chinyenze, Kundai; Kuteesa, Monica; Kaleebu, Pontiano; Price, Matt A.Oral pre-exposure prophylaxis (PrEP) has been scaled up; however, data from real-world settings are limited. We studied oral PrEP preference, uptake, adherence and continuation among adolescent girls and young women (AGYW) vulnerable to HIV in sub-Saharan Africa. Methods: We conducted a prospective cohort study among 14- to 24-year-old AGYW without HIV who were followed for 12 months in Kampala, Uganda. Within at least 14 days of enrolment, they received two education sessions, including demonstrations on five biomedical interventions that are; available (oral PrEP), will be available soon (long-acting injectable PrEP and anti-retroviral vaginal ring) and in development (PrEP implant and HIV vaccine). Information included mode and frequency of delivery, potential side effects and method availability. Volunteers ranked interventions, 1 = most preferred to 5 = least preferred. Oral PrEP was “preferred” if ranked among the top two choices. All were offered oral PrEP, and determinants of uptake assessed using Poisson regression with robust error variance. Adherence was assessed using plasma tenofovir levels and self-reports. Results: Between January and October 2019, 532 volunteers were screened; 285 enrolled of whom 265 received two education sessions. Mean age was 20 years (SD±2.2), 92.8% reported paid sex, 20.4% reported ≥10 sexual partners in the past 3 months, 38.5% used hormonal contraceptives, 26.9% had chlamydia, gonorrhoea and/or active syphilis. Of 265 volunteers, 47.6% preferred oral PrEP. Willingness to take PrEP was 90.2%; however, uptake was 30.6% (n = 81). Following enrolment, 51.9% started PrEP on day 14 (same day PrEP offered), 20.9% within 30 days and 27.2% after 30 days. PrEP uptake was associated with more sexual partners in the past 3 months: 2–9 partners (aRR = 2.36, 95% CI: 1.20–4.63) and ≥10 partners (aRR 4.70, 95% CI 2.41–9.17); oral PrEP preference (aRR 1.53, 95% CI 1.08–2.19) and being separated (aRR 1.55, 95% CI 1.04–2.33). Of 100 samples from 49 volunteers during follow up, 19 had quantifiable tenofovir levels (>10 μg/L) of which only three were protective (>40 μg/L). Conclusions: Half of AGYW preferred oral PrEP, uptake and adherence were low, uptake was associated with sexual behavioural risk and oral PrEP preference. Development of alternative biomedical products should be expedited to meet enduser preferences and, community delivery promoted during restricted movement.Item Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross sectional study(Sexually transmitted infections, 2019) Namale, Gertrude; Kamacooko, Onesmus; Bagiire, Daniel; Mayanja, Yunia; Abaasa, Andrew; Kilembe, William; Price, Matt; Ssemwanga, Deogratius; Lunkuse, Sandra; Nanyonjo, Maria; Ssenyonga, William; Mayaud, Philippe; Newton, Rob; Kaleebu, Pontiano; Seeley, JanetWe assessed the prevalence and risk factors associated with virological failure among female sex workers living with HIV on antiretroviral therapy (ART ) in Kampala, Uganda. Methods We conducted a cross-sectional study between January 2015 and December 2016 using routinely collected data at a research clinic providing services to women at high risk of STIs including HIV. Plasma samples were tested for viral load from HIVseropositive women aged ≥18 years who had been on ART for at least 6 months and had received adherence counselling. Samples from women with virological failure (≥1000 copies/mL) were tested for HIV drug resistance by population-based sequencing. We used logistic regression to identify factors associated with virological failure. Results Of 584 women, 432 (74%) with a mean age of 32 (SD 6.5) were assessed, and 38 (9%) were found to have virological failure. HIV resistance testing was available for 78% (28/38), of whom 82.1% (23/28) had at least one major drug resistance mutation (DRM), most frequently M184V (70%, 16/23) and K103N (65%, 15/23). In multivariable analysis, virological failure was associated with participant age 18–24 (adjusted OR (aOR)=5.3, 95% CI 1.6 to 17.9), self-reported ART nonadherence (aOR=2.6, 95% CI 1.2 to 5.8) and baseline CD4+ T-cell count ≤350 cells/mm3 (aOR=3.1, 95% CI 1.4 to 7.0). Conclusions A relatively low prevalence of virological failure but high rate of DRM was found in this population at high risk of transmission. Younger age, self-reported ART non-adherence and low CD4+ T-cell count on ART initiation were associated with increased risk of virological failure.Item Understanding menstrual factors associated with poor mental health among female secondary school students in Uganda: a cross-sectional analysis(BioMed Central Ltd, 2024-10) Ssesanga, Titus; Thomas, Katherine A; Nelson, Kate Andrews; Oenen, Evaline; Kansiime, Catherine; Lagony, Stephen; Enomut, Jonathan R; Mayanja, Yunia; Weiss, Helen AThere is growing global concern about poor mental health among adolescents in sub-Saharan Africa. In particular, adolescent girls face multiple challenges in managing menstruation which can impact both their health and wellbeing. In this study we address an evidence gap on the association of a broad range of menstrual-related factors with mental health problems amongst secondary school female adolescents in Uganda. We used baseline data from a cluster-randomised menstrual health intervention trial conducted in 60 secondary schools in two districts in Uganda. Baseline data were collected between March and July 2022, including socio-demographic characteristics, menstrual knowledge and attitudes, menstrual practices and self-efficacy, and mental health problems measured using the Strengths and Difficulties Questionnaire Total Difficulties score (SDQ-25). We used random-effects linear regression to estimate the adjusted mean difference (aMD) for the association between mental health problems (SDQ Total Difficulties Score) and menstrual-related factors, including the Menstrual Practice Needs Scale (MPNS) and the Self-Efficacy in Addressing Menstrual Needs scale (SAMNS)), accounting for school-level clustering and adjusting for prior confounders. Among the 3841 female participants, there was strong and consistent evidence of associations between mental health problems and menstrual-related factors. Mental health problems were associated with poor knowledge about menstruation (aMD = 1.17, 95%CI 0.50, 1.84 <0.001), using disposable and reusable menstrual products compared to using just disposable products (aMD = 1.42, 95%CI 0.92, 1.92, p <0.001), and experiencing menstrual pain even when using an effective management method at last menstrual period (LMP) compared to those experiencing no pain (aMD = 1.60, 95%CI 1.19, 2.01, p <0.001). Mental health problems were also associated with greater unmet menstrual needs according to the MPNS (aMD = 4.40 95%CI 3.96, 4.84, p <0.001), and with lower menstrual self-efficacy measured by the SAMNS (aMD = 0.94 95% CI 0.51, 1.37, p <0.001). This study shows strong evidence that mental health problems reported by adolescent girls in Uganda are associated with poor menstrual health. The association between menstrual health and mental health provides evidence as to why menstrual health should be a public health priority. Trial registration: ISRCTN 45461276. Registered on 16 September 2021.Item Visual inspection with acetic acid (VIA) positivity among female sex workers: a cross-sectional study highlighting one-year experiences in early detection of precancerous and cancerous cervical lesions in Kampala, Uganda(Infectious Agents and Cancer, 2021) Namale, Gertrude; Mayanja, Yunia; Kamacooko, Onesmus; Bagiire, Daniel; Ssali, Agnes; Seeley, Janet; Newton, Robert; Kamali, AnatoliAlthough cervical cancer is preventable, most women in sub-Saharan Africa (SSA) do not receive routine screening and few treatment options exist. Female Sex Workers (FSWs) are among the Ugandan female population at highest risk of acquiring sexually transmitted infections (STIs) including HIV and human papilloma viruses (HPV), the cause of cervical cancer. We report one-year experiences of visual inspection with acetic acid (VIA) positivity among FSWs in the early detection of pre-cancerous and cancerous cervical lesions in Kampala, Uganda. Methods: Between June 2014 and July 2015, we enrolled FSWs into a cross-sectional study at a research clinic. The women were screened using the VIA method (application of 3–5 % acetic acid to the cervix). All VIA positive women were referred to a tertiary hospital for colposcopy, biopsy, and immediate treatment (if indicated) at the same visit according to national guidelines. Data on socio-demographic, sexual behaviour, sexual reproductive health and clinical characteristics were collected. We used logistic regression to identify factors associated with VIA positivity. Results: Of 842 women assessed for eligibility, 719 (85 %) of median age 30 (IQR 26, 35) were screened, and 40 (6 %) women were VIA positive. Of the 24 histology specimens analysed, 6 showed inflammation, only 1 showed cervical intraepithelial neoplasia (CIN) 1, 13 women showed CIN2/3, while 4 women already had invasive cervical cancer. The overall prevalence of HIV was 43 %, of whom only 35 % were receiving ART. In the age-adjusted analysis, VIA positivity was more likely among women who reported having > 100 life-time partners (aOR = 3.34, 95 %CI: 1.38–8.12), and HIV positive women (aOR = 4.55; 95 %CI: 2.12–9.84).