Browsing by Author "Mugyenyi, Peter N."

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    Hematological Reference Ranges among Healthy Ugandans
    (Clinical Diagnostic Laboratory Immunology, 1995) Tugume, Sitefano B.; Piwowar, Estelle M.; Lutalo, Tom; Mugyenyi, Peter N.; Grant, Robert M.; Mangeni, Fred W.; Pattishall, Katherine; Katongole-Mbidde, Edward
    An estimated 8 million individuals living in sub-Saharan Africa (including Uganda) are infected with the human immunodeficiency virus (HIV) (2). Infection with HIV results in progressive generalized immune suppression due predominantly to cytopathic effects of HIV type 1 (HIV-1) on CD41 T-helper–T-inducer lymphocytes (6). HIV also suppresses normal hematopoiesis and is associated with a broad spectrum of hematologic abnormalities. Measurements of the peripheral blood absolute CD4 cell count (ACD4), CD4 percentage (%CD4), and CD4/CD8 ratio have been found to be useful surrogates for determining the risk of progression of HIV infection and are extensively used in observational studies and AIDS clinical trials (7). Many AIDS-related research studies are being conducted in Uganda and other African nations with a high prevalence of HIV infection. Because of the lack of normal reference ranges for hematological parameters in healthy subjects, many investigators interpret their data using normal values derived from populations in Europe and the United States. There is a need to establish appropriate normal reference values for hematologic parameters in African populations. In this report, we describe hematologic reference ranges obtained by studying 183 symptom-free HIV-seronegative Ugandans. (Results of this investigation were presented at the Eighth International Conference on AIDS in Africa, Marrakesh, Morocco, December 1993.)
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    Identification of gaps for implementation science in the HIV prevention, care and treatment cascade; a qualitative study in 19 districts in Uganda
    (BMC research notes, 2016) Bajunirwe, Francis; Tumwebaze, Flora; Abongomera, George; Akakimpa, Denis; Kityo, Cissy; Mugyenyi, Peter N.
    Over the last 20 years, countries in sub Saharan Africa have made significant strides in the implementation of programs for HIV prevention, care and treatment. Despite, the significant progress made, many targets set by the United Nations have not been met. There remains a large gap between the ideal and what has been achieved. There are several operational issues that may be responsible for this gap, and these need to be addressed in order to achieve the targets. Therefore, the aim of this study was to identify gaps in the HIV prevention, care and treatment cascade, in a large district based HIV implementation program. We aimed to identify gaps that are amenable for evaluation using implementation science, in order to improve the delivery of HIV programs in rural Uganda.We conducted key informant (KI) interviews with 60 district health officers and managers of HIV/AIDS clinics and organizations and 32 focus group discussions with exit clients seeking care and treatment for HIV in the 19 districts. The data analysis process was guided using a framework approach. The recordings were transcribed verbatim. Transcripts were read back and forth and codes generated based on the framework.Nine emerging themes that comprise the gaps were identified and these were referral mechanisms indicating several loop holes, low levels of integration of HIV/TB services, low uptake of services for PMTCT services by pregnant women, low coverage of services for most at risk populations (MARPs), poor HIV coordination structures in the districts, poor continuity in the delivery of pediatric HIV/AIDS services, limited community support for orphans and vulnerable (OVC’s), inadequate home based care services and HIV services and support for discordant couples. The themes indicate there are plenty of gaps that need to be covered and have been ignored by current programs.Our study has identified several gaps and suggested several interventions that should be tested before large scale implementation. The implementation of these programs should be adequately evaluated in order to provide field evidence of effectiveness and replicability in similar areas.
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    Persistence of traditional and emergence of new structural drivers and factors for the HIV epidemic in rural Uganda; A qualitative study
    (Plos one, 2019) Bajunirwe, Francis; Akakimpa, Denis; Tumwebaze, Flora P.; Abongomera, George; Mugyenyi, Peter N.; Kityo, Cissy M.
    In Uganda, the HIV epidemic is now mature and generalized. Recently, there have been reports of resurgence in the incidence of HIV after several years of successful control. The causes for this resurgence are not clear but suspected to be driven by structural factors that influence large groups of people rather than individuals. The aim of this study was to describe the structural drivers of the HIV epidemic in high prevalence regions and inform the next generation of interventions.We conducted a total of 35 focus group discussions in 11 districts in Uganda. Due to their high HIV prevalence, the districts had been selected to implement a donor supported program to scale up HIV prevention, care and treatment. Focus groups consisted of men and women including opinion leaders, civil servants including teachers, police officers, religious, political leaders, shop keepers, local residents and other ordinary persons from all walks of life. The qualitative data were transcribed and analyzed manually. Texts were coded using a coding scheme which was prepared ahead of time but emerging themes and codes were also allowed.Our data indicated there is persistence of several structural drivers and factors for HIV in rural Uganda. The structural drivers of HIV were divided into three categories: Gender issues, socio-cultural, and economic drivers. The specific drivers included several gender issues, stigma surrounding illness, traditional medical practices, urbanization, alcohol and substance abuse and poverty. New drivers arising from urbanization, easy access to mobile phone, internet and technological advancement have emerged. These drivers are intertwined within an existing culture, lifestyle and the mixture is influenced by modernization. The traditional structural drivers of HIV have persisted since the emergence of the HIV epidemic in Uganda and new ones have emerged. All these drivers may require combined structural interventions that are culturally and locally adapted in order to tackle the resurgence in incidence of HIV in Uganda.