Browsing by Author "McGrath, Nuala"

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    Antenatal couples’ counselling in Uganda (ACCU): study protocol for a randomised controlled feasibility trial
    (Pilot and feasibility studies, 2022) Mubangizi, Vincent; McGrath, Nuala; Kahuma Kabakyenga, Jerome; Muller, Ingrid; Stuart, Beth L.; Raftery, James P.; Natukunda, Sylvia; Ngonzi, Joseph; Goodhart, Clare; Willcox, Merlin Luke
    Common avoidable factors leading to maternal, perinatal and neonatal deaths include lack of birth planning (and delivery in an inappropriate place) and unmet need for contraception. Progress has been slow because routine antenatal care has focused only on women. Yet, in Uganda, many women first want the approval of their husbands. The World Health Organization recommends postpartum family planning (PPFP) as a critical component of health care. The aim of this trial is to test the feasibility of recruiting and retaining participants in a trial of a complex community-based intervention to provide counselling to antenatal couples in Uganda. Methods: This is a two-group, non-blinded cluster-randomised controlled feasibility trial of a complex intervention. Primary health centres in Uganda will be randomised to receive the intervention or usual care provided by the Ministry of Health. The intervention consists of training village health teams to provide basic counselling to couples at home, encouraging men to accompany their wives to an antenatal clinic, and secondly of training health workers to provide information and counselling to couples at antenatal clinics, to facilitate shared decision-making on the most appropriate place of delivery, and postpartum contraception. We aim to recruit 2 health centres in each arm, each with 10 village health teams, each of whom will aim to recruit 35 pregnant women (a total of 700 women per arm). The village health teams will follow up and collect data on pregnant women in the community up to 12 months after delivery and will directly enter the data using the COSMOS software on a smartphone. Discussion: This intervention addresses two key avoidable factors in maternal, perinatal and neonatal deaths (lack of family planning and inappropriate place of delivery). Determining the acceptability and feasibility of antenatal couples’ counselling in this study will inform the design of a fully randomised controlled clinical trial. If this trial demonstrates the feasibility of recruitment and delivery, we will seek funding to conduct a fully powered trial of the complex intervention for improving uptake of birth planning and postpartum family planning in Uganda.
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    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, David
    Following 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.
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    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, David
    Despite efforts to promote HIV counseling and testing (HCT) among couples, few couples know their own or their partners’ HIV status. We assessed trends in HCT uptake among married individuals in Rakai district, southwestern Uganda. Methods: We analysed data for 21,798 married individuals aged 15-49 years who were enrolled into the Rakai Community Cohort Study (RCCS) between 2003 and 2009. Married individuals were interviewed separately but were retrospectively linked to their partners at analysis. All participants had serologic samples obtained for HIV testing, and had the option of receiving HCT together (couples’ HCT) or separately (individual HCT). Individuals were categorized as concordant HIV-positive if both partners had HIV; concordant HIV-negative if both did not have HIV; or HIV-discordant if only one of the partners had HIV. We used χ2 tests to assess linear trends in individual and couples’ HCT uptake in the entire sample and conducted multinomial logistic regression on a sub-sample of 10,712 individuals to assess relative risk ratios (RRR) and 95% Confidence Intervals (95% CI) associated with individual and couples’ HCT uptake. Analysis was done using STATA version 11.0. Results: Uptake of couples’ HCT was 27.2% in 2003/04, 25.1% in 2005/06, 28.5% in 2006/08 and 27.8% in 2008/09 (χ2 for trend = 2.38; P = 0.12). Uptake of individual HCT was 57.9% in 2003/04, 60.2% in 2005/06, 54.0% in 2006/08 and 54.4% in 2008/09 (χ2 for trend = 8.72; P = 0.003). The proportion of couples who had never tested increased from 14.9% in 2003/04 to 17.8% in 2008/09 (χ2 for trend = 18.16; P < 0.0001). Uptake of couples’ HCT was significantly associated with prior HCT (Adjusted [Adj.] RRR = 6.80; 95% CI: 5.44, 8.51) and being 25-34 years of age (Adj. RRR = 1.81; 95% CI: 1.32, 2.50). Uptake of individual HCT was significantly associated with prior HCT (Adj. RRR = 6.26; 95% CI: 4.24, 9.24) and the female partner being HIV-positive (Adj. RRR = 2.46; 95% CI: 1.26, 4.80). Conclusion: Uptake of couples’ HCT remained consistently low (below 30%) over the years, while uptake of individual HCT declined over time. These findings call for innovative strategies to increase demand for couples’ HCT, particularly among younger couples and those with no prior HCT.