Browsing by Author "Ross, Jennifer M."

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    Frequency of HIV sero different couples within TB-affected households in a setting with a high burden of HIV-associated TB
    (medRxiv, 2022) Anguzu, Godwin; Gupta, Amanda J.; Ochom, Emmanuel; Tseng, Ashley S.; Barnabas, Ruanne V.; Katamba, Achilles; Ross, Jennifer M.
    Strong epidemiological links between HIV and tuberculosis (TB) may make household TB contact investigation an efficient strategy for HIV screening and finding individuals in serodifferent partnerships at risk of HIV and linking them to HIV prevention services. We aimed to compare the proportions of HIV serodifferent couples in TB-affected households and in the general population of Kampala, Uganda.
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    Frequency of HIV serodifferent couples within TB-affected households in a setting with a high burden of HIV-associated TB
    (medRxiv, 2022) Anguzu, Godwin; Gupta, Amanda J.; Ochom, Emmanuel; Tseng, Ashley S.; Zhang, Meixin; Barnabas, Ruanne V.; Flaxman, Abraham D.; Katamba, Achilles; Davis, J. Lucian; Ross, Jennifer M.
    Strong epidemiological links between HIV and tuberculosis (TB) may make household TB contact investigation an efficient strategy for HIV screening and finding individuals in serodifferent partnerships at risk of HIV and linking them to HIV prevention services. We aimed to compare the proportions of HIV serodifferent couples in TB-affected households and in the general population of Kampala, Uganda. Methods: We included data from a cross-sectional trial of HIV counselling and testing (HCT) in the context of home-based TB evaluation in Kampala, Uganda in 2016-2017. After obtaining consent, community health workers visited the homes of participants with TB to screen contacts for TB and offer HCT to household members ≥15 years. We defined index participants and their spouses and parents of the same index participant as couples, and classified couples as serodifferent if confirmed by self-reported HIV status or by HIV testing results. We used a two-sample test of proportions to compare the frequency of HIV serodifference among couples in the study to its prevalence among couples in Kampala in the 2011 Uganda AIDS Indicator Survey (UAIS). Results: We included 323 index TB participants and 507 household contacts aged ≥18. Most index participants (55%) were male, while most (68%) adult contacts were female. There was ≥1 couple in 115/323 (35.6%) households, with most couples (98/115, 85.2%) including the index participant and spouse. The proportion of households with HIV-serodifferent couples was 18/323 (5.6%), giving a number-needed-to-screen of 18 households. The proportion of HIV serodifference among couples identified in the trial was significantly higher than among couples in the UAIS (15.7% vs 8%, p=0.039). The 18 serodifferent couples included 14 (77.8%) where the index participant was living with HIV and the spouse was HIV-negative, and 4 (22.2%) where the index partner was HIV-negative, while the spouse was living with HIV. Conclusions: The frequency of HIV serodifference among couples identified in TB-affected households was higher than in the general population. TB household contact investigation may be an efficient strategy for identifying people with substantial exposure to HIV and linking them to HIV prevention services.
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    Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems
    (The American journal of tropical medicine and hygiene, 2015) Ross, Jennifer M.; Cattamanchi, Adithya; Miller, Cecily R.; Tatem, Andrew J.; Katamba, Achilles; Haguma, Priscilla; Handley, Margaret A.; Davis, J. Lucian
    Reducing geographic barriers to tuberculosis (TB) care is a priority in high-burden countries where patients frequently initiate, but do not complete, the multi-day TB evaluation process. Using routine cross-sectional study from six primary-health clinics in rural Uganda from 2009 to 2012, we explored whether geographic barriers affect completion of TB evaluation among adults with unexplained chronic cough. We measured distance from home parish to health center and calculated individual travel time using a geographic information systems technique incorporating roads, land cover, and slope, and measured its association with completion of TB evaluation. In 264,511 patient encounters, 4,640 adults (1.8%) had sputum smear microscopy ordered; 2,783 (60%) completed TB evaluation. Median travel time was 68 minutes for patients with TB examination ordered compared with 60 minutes without (P < 0.010). Travel time differed between those who did and did not complete TB evaluation at only one of six clinics, whereas distance to care did not differ at any of them. Neither distance nor travel time predicted completion of TB evaluation in rural Uganda, although limited detail in road and village maps restricted full implementation of these mapping techniques. Better data are needed on geographic barriers to access clinics offering TB services to improve TB diagnosis.