Browsing by Author "Nabaggala, Maria Sarah"

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Cost-effectiveness of an interactive voice response system for improving retention in care and adherence to antiretroviral therapy among young adults in Uganda
    (BMC, 2024-09) Naggirinya, Agnes Bwanika; Nuwamanya, Elly; Nabaggala, Maria Sarah; Musinguzi, Francis; Nanungi, Annet; Waiswa, Peter; Rujumba, Joseph; Meya, David B; Parkes-Ratanshi, Rosalind
    Abstract Background New interventions aimed at increasing access to and adherence to antiretroviral therapy among young people living with the human immunodeficiency virus (YPLHIV) are needed. This study assessed the cost-effectiveness of the call-for-life interaction voice response tool compared to that of the standard of care (SOC) for promoting treatment adherence and retention in care among YPLHIV in Western Uganda. This cost-effectiveness study used data from a randomized controlled trial and a decision-analytic Markov model to estimate the long-term outcomes and costs of the Call for Life-Interactive Voice Response (CFL-IVR) tool and the usual care from the Ugandan public payer perspective. The model was parameterized using primary data and the literature and adopted a 1-year Markov cycle. The main outcomes were mean annual costs, disability-adjusted life-years (DALYs), and the incremental cost-effectiveness ratio (ICER) in form of cost per DALY averted. The CLF-IVR was deemed cost-effective if the ICER was between 1% and 51% of Uganda’s gross domestic product. We conducted deterministic and probabilistic sensitivity analyses to assess the effect of adjusting parameter values on cost-effectiveness estimates. All costs were reported in 2021 US dollars, and a discount rate of 3% was applied to both costs and outcomes. Results The base case analysis showed that, from the Ugandan public payer perspective, the CLF-IVR led to more mean annual costs ($359 vs. $280) and averted more mean annual DALYs (15.78 vs. 11.09) than the SOC, leading to an ICER of $17 per DALY averted. The base-case results did not change significantly in the deterministic and probabilistic sensitivity analyses. The cost-effectiveness estimates were more responsive to uncertainties surrounding ART duration, viral load suppression rates, and discount rates. Conclusion The CLF-IVR may be a cost-effective intervention for promoting treatment adherence and retention in care among YPLHIV in Uganda and other low-income settings. Once implemented, similar interventions may lead to greater returns in encouraging adherence to ART and retention in care among YPLHIV and other vulnerable groups, and eventually favorable clinical outcomes. Trial registration NCT04718974 Registry: clinical Trials.gov https://ichgcp.net/nl/clinical-trials-registry/NCT04718974 (20 Jan 2021).
  • Thumbnail Image
    Item
    Differences in Adverse Events Related to Voluntary Male Medical Circumcision Between Civilian and Military Health Facilities in Uganda
    (Research Square, 2021) Ogweng Obangaber, Lucky; Seruwagi, Gloria; Nabaggala, Maria Sarah; Lugada, Eric; Bwayo, Denis; Nyanzi, Abdul; Rwegyema, Twaha; Wamundu, Cassette; Lawoko, Stephen; Kasujja, Vincent; Asiimwe, Evarlyne; Musinguzi, Ambrose; Kikaire, Bernard; Kiragga, Agnes
    Voluntary medical male circumcision (VMMC) significantly reduces the risk of acquiring HIV in men. Despite the percentage of circumcised men (15-49 years) in Uganda increasing over time, some populations are not taking up the surgical procedure. The government of Uganda and implementing partners have responded to this lack of VMMC coverage among key populations by intensifying introducing innovative strategies that increase demand particularly among military personnel using the WHO’s MOVE strategy. As a surgical intervention, it is critical that VMMC services are safe for clients and that adverse events or complications are minimized. This paper describes the prevalence and trends of adverse events reported among military mobile camps in comparison to civilian sites in Uganda. Methods: A prospective study conducted in eighteen (18) public health facilities between March and August 2019. Of these nine (9) were providing care to civilian populations while nine (9) served the military population and catchment areas. Descriptive statistics, Chi-square test and trends analysis were carried out to describe profile of advance events among civilian and military facilities over the study period. Results: The highest proportions of VMMC were done among persons aged 15 to 19 years whereas among military camps the highest proportions of circumcision among males aged 20 to 24 years. Regarding site of circumcision, the highest proportions of VMMC were done at outreaches, with higher levels in military camps compared to civilian camps. For the proportions of adverse events reported, higher proportions were reported in civilian camps compared to military camps (Total – 1.3% vs 0.2%; p- value<0.05). For trends analysis, results indicate that there was no statistically significant trend for both civilian and military number of adverse events reported for the four quarters in 2020 (P-value =0.315 for civilian and P=0.094 for the military). Conclusions: The MOVE model is great for scaling up VMMC 48 in specialized populations such as military. Can also be adapted in other populations if contextual bottlenecks are identified and collectively addressed by key stakeholders – leadership, community engagement and using a largely horizontal approach offer promising possibilities and outcomes.
  • Thumbnail Image
    Item
    An Observational Study in an Urban Ugandan Clinic comparing Virological Outcomes of Patients Switched from first-line Antiretroviral Regimens to Second-line Regimens containing Ritonavir-boosted Atazanavir or Ritonavir-boosted Lopinavir
    (BMC Infectious Diseases, 2019) Laker, Eva Agnes Odongpiny; Nabaggala, Maria Sarah; Kaimal, Arvind; Nalwanga, Damalie; Abdu Musubire, Abdu Musubire; Kiragga, Agnes; Lamorde, Mohammed; Parkes- Ratanshi, Rosalind
    The World Health Organisation approved boosted atazanavir as a preferred second line protease inhibitor in 2010. This is as an alternative to the current boosted lopinavir. Atazanavir has a lower genetic barrier than lopinavir. We compared the virological outcomes of patients during the roll out of routine viral load monitoring, who had switched to boosted second- line regimens of either atazanavir or lopinavir.
  • Thumbnail Image
    Item
    Re‑engagement in HIV care following a missed visit in rural Uganda
    (BMC research notes, 2018) Nabaggala, Maria Sarah; Parkes‑Ratanshi, Rosalind; Kasirye, Ronnie; Kiragga, Agnes; Castlenuovo, Barbara; Ochaka, Ian; Nakakawa, Lilian; Asiimwe Bena, Diana; Mujugira, Andrew
    We conducted a retrospective cohort study to assess the effect of tracking People Living with HIV (PLHIV) after missed clinic visits and factors associated with return to care in rural Uganda. We assessed retention in care among 650 HIV-infected women and men. We used univariable and multivariable generalized linear models to assess demographic and self-reported factors associated with re-engagement in HIV care. Results: Of 381 PLHIV who ever missed a scheduled appointment, 68% were female and most (80%) had initiated ART. Most (70%) of those tracked returned to care. Relative to men, women (adjusted risk ratio [ARR] 1.23; 95% confidence interval (CI) 1.05–1.43; p = 0.009) were more likely to return to care after active tracking. PLHIV who missed scheduled visits for other reasons (forgetting, adequate drug supplies, or long distance to clinic) had reduced odds of return to care (ARR 0.41; 95% CI 0.28–0.59; p < 0.001). These data support close monitoring of patient retention in HIV care and active measures to re-engage those who miss an appointment. Furthermore, they highlight the need for targeted interventions to those more resistant to re-engagement such as men.