Browsing by Author "Rubaale, Tom"

Now showing 1 - 8 of 8
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    Antiretroviral Treatment for HIV in Rural Uganda: Two Year Treatment Outcomes of a Prospective Health Centre/Community-Based and Hospital-Based Cohort
    (PloS one, 2012) Kipp, Walter; Konde-Lule, Joseph; Saunders, L. Duncan; Alibhai, Arif; Houston, Stan; Rubaale, Tom; Senthilselvan, Ambikaipakan; Okech-Ojony, Joa
    In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda.
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    Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda
    (BMC international health and human rights, 2011) Kipp, Walter; Konde-Lule, Joseph; Rubaale, Tom; Okech-Ojony, Joa; Alibhai, Arif; Saunders, Duncan L.
    Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs.
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    Family Caregivers in Rural Uganda: The Hidden Reality
    (Health Care for Women International, 2007) Kipp, Walter; Tindyebwa, Denis; Rubaale, Tom; Karamagi, Ednah; Bajenja, Ellen
    Kabarole, Kyenyoyo, and Kamwenge districts have a home-based care program that consists of formal and informal parts. The formal part is made up of professional, government-paid nurses who are based at the nearest health center and who visit the homes of patients who have been admitted to the program. The informal part of the program is composed of family members who are the principle caregivers for the AIDS patients at home. Home care nurses deal only with the care for the AIDS patients and not with personal issues of the family caregiver. In the past few years, home visits of professional nurses have declined due to funding shortages of the Kabarole Health Department. Before funding cuts were introduced, the home-based care program coverage reached only an estimated 35% of homes requiring care. The HIV prevalence in the sexually active population is high and estimated to be around 14% in the districts. An estimated 4,200 AIDS patients require clinical care in the Kabarole district alone. The districts are typical for sub-Saharan Africa, with a high burden of infectious diseases, including malaria, tuberculosis, and parasitic infections. All homes visited during this study had no running water and no electricity, and were built poorly, with thatched roofs, mud walls, and earthen floors. Generally, home-based care programs are very much limited in Uganda and, to the best of our knowledge, there was no information on any formal programs targeting family caregiver support.
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    Family Caregiving to AIDS Patients: The Role of Gender in Caregiver Burden in Uganda
    (Journal of International Women's studies, 2006) Kipp, Walter; Tindyebwa, Denis; Karamagi, Ednah; Rubaale, Tom
    The objectives of the study were: 1) What is the burden of care for male and female family caregivers of AIDS patients? and 2) Which factors influence the family care burden for AIDS patients at home? A questionnaire was completed by 29 male and 91 female family caregivers of AIDS patients living in four rural areas in western Uganda. Participating caregivers were selected from a patient list of the home-based care program for AIDS patients and then interviewed. The responses from the questionnaire were used to calculate care burden scores for caregivers of both genders and the scores in each group were compared. In addition, other factors relevant to the burden of family care were extracted and tested in bivariate and multivariate analysis to test whether they were predictors of the care burden. Results show that the care burden scores were high in all domains, except those regarding relationship within the families and substance abuse. Both male and female caregivers reported a similar care burden. Caregivers for spouses had higher care burden scores compared to those who cared for other relatives. The intensity of care was also a significant predictor of the care burden, while other factors
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    Gender-related mortality for HIV-infected patients on highly active antiretroviral therapy (HAART) in rural Uganda
    (International journal of women's health, 2010) Alibhai, Arif; Kipp, Walter; Senthilselvan, Ambikaipakan; Konde-Lule, Joseph; Okech-Ojony, Joa; Rubaale, Tom
    The purpose of this study was to examine gender differences in mortality for human immunodeficiency virus (HIV) patients in rural Western Uganda after six months of highly active antiretroviral therapy (HAART). Three hundred eighty five patients were followed up for six months after initiating HAART. Statistical analysis included descriptive, univariate and multivariate methods, using Kaplan–Meier estimates of survival distribution and Cox proportional hazards regression. Mortality in female patients (9.0%) was lower than mortality in males (13.5%), with the difference being almost statistically significant (adjusted hazard ratio for females 0.55; 95% confidence interval [CI]: 0.28–1.07; P = 0.08). At baseline, female patients had a significantly higher CD4+ cell count than male patients (median 147 cells/μL vs 120 cells/μL; P < 0.01). A higher CD4+ cell count and primary level education were strongly associated with better survival. The higher CD4+ cell count in females may indicate that they accessed HAART services at an earlier stage of their disease progression than males. A borderline statistically significant lower mortality rate in females shows that females fare better on treatment in this context than males. The association between lower mortality and higher CD4+ levels suggest that males are not accessing treatment early enough and that more concerted efforts need to be made by HAART programs to reach male HIV patients.
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    How Much Should We Expect? Family Caregiving of AIDS Patients in Rural Uganda
    (Journal of Transcultural Nursing, 2007) Kipp, Walter; Tindyebwa, Denis; Karamagi, Edna; Rubaale, Tom
    The aim of this study was to measure the burden of care for family caregivers of AIDS patients. A cross-sectional exploratory design was used to describe the care experiences of family caregivers of AIDS care recipients. A questionnaire was used to interview 120 family caregivers of AIDS patients from four rural areas in western Uganda. The questions asked were related to 12 domains of family caregiving. Care burden scores of caregivers were calculated. It was found that care burden scores were high in all domains except those regarding relationships within the families and substance abuse. Serious work overload and low health status were reported. The high burden of caregiving puts family caregivers at risk for decreased health status and increased social isolation and depression.
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    “Living by the hoe” in the age of treatment: perceptions of household well-being after antiretroviral treatment among family members of persons with AIDS
    (AIDS care, 2010) Kaler, Amy; Alibhai, Arif; Kipp, Walter; Rubaale, Tom; Konde-Lule, Joseph
    This paper considers the effects of antiretroviral treatment on the households of person with AIDS in western Uganda. Interviews were carried out with 110 co-resident “treatment partners” of people receiving treatment. We discuss these family members' accounts of the impact of sickness, followed by treatment, on their household's livelihood, defined as the activities needed to obtain and process the resources required to sustain the households. The household's ability to muster labour for subsistence agriculture was of paramount concern when family members considered what treatment meant for the households. While they were very happy with the treatment, they said that households have not yet recovered from the shock of AIDS sicknesses.
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    Quality of Life of HIV Patients in a Rural Area of Western Uganda: Impact of a Community-Based Antiretroviral Treatment Program
    (Current HIV research, 2010) Alibhai, Arif; Martin, Leah J.; Kipp, Walter; Konde-Lule, Joseph; Rubaale, Tom; Okech-Ojony, Joa
    Community-based antiretroviral treatment (CBART) programs should aim to achieve positive quality of life outcomes. The purpose of this study was to investigate changes in the health related quality of life (HRQOL) outcomes of patients in a CBART program supported by community volunteers in one sub-county in western Uganda located 50 km from the nearest urban centre. We administered a translated version of the MOS-HIV survey and collected clinical data at baseline and after one year from 130 patients. Inclusion criteria included residency in the sub-county, eighteen years of age or, treatmentnaive, eligible for ART based on CD4 cell count <200 cells/mm3 or WHO clinical stage 3 or 4, and willing to accept daily treatment support by family/friends and to be visited by a community volunteer weekly. We assessed changes in physical health (PHS) and mental health (MHS) summary scores and examined associations between patient characteristics and changes in HRQOL. After one year, we observed significant increases in mean PHS (42.7 to 50.1; p<0.01) and MHS (43.5 to 49.5; p<0.01) scores. Lower age (p<0.01) and lower baseline PHS scores (p<0.01) were associated with increases in PHS scores and lower age (p=0.03) and lower baseline MHS scores (p<0.01) were associated with increases in MHS scores. Fifteen patients (12%) had reductions in their HRQOL after one year which were not associated with patient or clinical characteristics, including virological suppression. The observed improvements in HRQOL demonstrate that positive treatment outcomes can be achieved in CBART programs in rural Uganda. However, some patients appear to experience declines in their overall well-being, despite achieving virological suppression. HRQOL surveys can be useful in identifying these patients, who may require additional attention and support to achieve the full benefits of ART.