Browsing by Author "Nanfuka, Mastula"

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    Capacity of community advisory boards for effective engagement in clinical research: a mixed methods study
    (BMC medical ethics, 2021) Mugenyi, Levicatus; Mijumbi, Andrew; Nanfuka, Mastula; Agaba, Collins; Kaliba, Fedress; Seryazi Semakula, Irene; Badanga Nazziwa, Winfred; Ochieng, Joseph
    Community engagement is a key component in health research. One of the ways health researchers ensure community engagement is through Community Advisory Boards (CABs). The capacity of CABs to properly perform their role in clinical research has not been well described in many resource limited settings. In this study, we assessed the capacity of CABs for effective community engagement in Uganda. Methods: We conducted a cross sectional study with mixed methods. We used structured questionnaires and key informant interviews (KII) to collect data from CAB members, trial investigators, and community liaison officers. For quantitative data, we used descriptive statistics while for qualitative data we used content analysis. Results: Seventy three CAB members were interviewed using structured questionnaires; 58.9% males, median age 49 years (IQR 24–70), 71.2% had attained tertiary education, 42.5% never attended any research ethics training, only 26% had a training in human subject protection, 30.1% had training in health research, 50.7% never attended any training about the role of CABs, and 72.6% had no guidelines for their operation. On the qualitative aspect, 24 KIIs cited CAB members to have some skills and ability to understand and review study documents, offer guidance on community norms and expectations and give valuable feedback to the investigators. However, challenges like limited resources, lack of independence and guidelines, and knowledge gaps about research ethics were cited as hindrances of CABs capacity. Conclusion: Though CABs have some capacity to perform their role in the Ugandan setting, their functionality is limited by lack of resources to facilitate their work, lack of independence, lack of guidelines for their operations and limited knowledge regarding issues of research ethics and protection of the rights of trial participants.
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    Durability Of Non-Nucleotide Reverse Transcriptase Inhibitor-Based First-Line ART Regimens After 7 Years Of Treatment In Rural Uganda
    (Medicine, 2021) Nanfuka, Mastula; Forrest, Jamie I.; Zhang, Wendy; Okoboi, Stephen; Birungi, Josephine; Kaleebu, Pontiano; Zhu, Julia; Tibenganas, Samuel; Moore, David M.
    Most antiretroviral therapy (ART) programs in resource-limited settings have historically used non-nucleotide reverse transcriptase inhibitor (NNRTI)-based regimens with limited access to routine viral load (VL) testing. We examined the long-term success of these regimens in rural Uganda among participants with 1 measured suppressed VL. We conducted a prospective cohort study of participants who had been on NNRTI-based first-line regimens for ≥4years and had a VL <1000copies/mL at enrollment in Jinja, Uganda. We collected clinical and behavioral data every 6 months and measured VL again after 3 years. We quantified factors associated with virologic failure (VF) (VL≥1000copies/mL) using Wilcoxon Rank Sum, chisquare, and Fisher’s Exact Tests. We enrolled 503 participants; 75.9% were female, the median age was 45years, and the median duration of time on ART was 6.8 years (IQR=6.0–7.6 years). Sixty-nine percent of participants were receiving nevirapine, lamivudine, and zidovudine regimens; 22.5% were receiving efavirenz, lamivudine, and zidovudine; and 8.6% were receiving other regimens. Of the 479 with complete follow-up data, 12 (2.5%) had VL≥1000copies/mL. VF was inversely associated with reporting never missing pills (41.7% of VFs vs 72.8% non-VFs, P=.034). There were differences in distribution of the previous ART regimens (P=.005), but no clear associations with specific regimens. There was no association between having a VL of 50 to 999copies/mL at enrollment and later VF (P=.160). Incidence of VF among individuals receiving ART for nearly 7 years was very low in the subsequent 3 years. NNRTI-based regimens appear to be very durable among those with good initial adherence.
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    Our Choice” improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches
    (Implementation Science, 2021) Wagner, Glenn J.; Wanyenze, Rhoda K.; Beyeza-Kashesya, Jolly; Gwokyalya, Violet; Hurley, Emily; Mindry, Deborah; Finocchario-Kessler, Sarah; Nanfuka, Mastula; Tebeka, Mahlet G.; Saya, Uzaib; Booth, Marika; Ghosh-Dastidar, Bonnie; Linnemayr, Sebastian; Staggs, Vincent S.; Goggin, Kathy
    Safer conception counseling (SCC) to promote the use of safer conception methods (SCM) is not yet part of routine family planning or HIV care. Guidelines for the use of SCM have been published, but to date there are no published controlled evaluations of SCC. Furthermore, it is unknown whether standard methods commonly used in resource constrained settings to integrate new services would be sufficient, or if enhanced training and supervision would result in a more efficacious approach to implementing SCC. Methods: In a hybrid, cluster randomized controlled trial, six HIV clinics were randomly assigned to implement the SCC intervention Our Choice using either a high (SCC1) or low intensity (SCC2) approach (differentiated by amount of training and supervision), or existing family planning services (usual care). Three hundred eighty-nine HIV clients considering childbearing with an HIV-negative partner enrolled. The primary outcome was self-reported use of appropriate reproductive method (SCM if trying to conceive; modern contraceptives if not) over 12 months or until pregnancy. Results: The combined intervention groups used appropriate reproductive methods more than usual care [20.8% vs. 6.9%; adjusted OR (95% CI)=10.63 (2.79, 40.49)], and SCC1 reported a higher rate than SCC2 [27.1% vs. 14.6%; OR (95% CI)=4.50 (1.44, 14.01)]. Among those trying to conceive, the intervention arms reported greater accurate use of SCM compared to usual care [24.1% vs. 0%; OR (95% CI)=91.84 (4.94, 1709.0)], and SCC1 performed better than SCC2 [34.6% vs. 11.5%; OR (95% CI)=6.43 (1.90, 21.73)]. The arms did not vary on modern contraception use among those not trying to conceive. A cost of $631 per person was estimated to obtain accurate use of SCM in SCC1, compared to $1014 in SCC2