Browsing by Author "Theuring, Stefanie"

Now showing 1 - 8 of 8
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    Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT
    (PLoS One, 2017-05-31) Machnowska, Patrycja; Busingye, Priscilla; Rubaihayo, John; Theuring, Stefanie
    Since 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm).
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    Enhancing the implementation and integration of mHealth interventions in resource-limited settings: a scoping review
    (BioMed Central Ltd, 2024-10) Tumuhimbise, Wilson; Theuring, Stefanie; Kaggwa, Fred; Atukunda, Esther C; Rubaihayo, John; Atwine, Daniel; Sekandi, Juliet N; Musiimenta, Angella
    Although mobile health (mHealth) interventions have shown promise in improving health outcomes, most of them rarely translate to scale. Prevailing mHealth studies are largely small-sized, short-term and donor-funded pilot studies with limited evidence on their effectiveness. To facilitate scale-up, several frameworks have been proposed to enhance the generic implementation of health interventions. However, there is a lack of a specific focus on the implementation and integration of mHealth interventions in routine care in low-resource settings. Our scoping review aimed to synthesize and develop a framework that could guide the implementation and integration of mHealth interventions. We searched the PubMed, Google Scholar, and ScienceDirect databases for published theories, models, and frameworks related to the implementation and integration of clinical interventions from 1st January 2000 to 31st December 2023. The data processing was guided by a scoping review methodology proposed by Arksey and O'Malley. Studies were included if they were i) peer-reviewed and published between 2000 and 2023, ii) explicitly described a framework for clinical intervention implementation and integration, or iii) available in full text and published in English. We integrated different domains and constructs from the reviewed frameworks to develop a new framework for implementing and integrating mHealth interventions. We identified eight eligible papers with eight frameworks composed of 102 implementation domains. None of the identified frameworks were specific to the integration of mHealth interventions in low-resource settings. Two constructs (skill impartation and intervention awareness) related to the training domain, four constructs (technical and logistical support, identifying committed staff, supervision, and redesigning) from the restructuring domain, two constructs (monetary incentives and nonmonetary incentives) from the incentivize domain, two constructs (organizational mandates and government mandates) from the mandate domain and two constructs (collaboration and routine workflows) from the integrate domain. Therefore, a new framework that outlines five main domains-train, restructure, incentivize, mandate, and integrate (TRIMI)-in relation to the integration and implementation of mHealth interventions in low-resource settings emerged. The TRIMI framework presents a realistic and realizable solution for the implementation and integration deficits of mHealth interventions in low-resource settings. MEDLINE
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    The incidence of HIV and associated risk factors among pregnant women in Kabarole District, Uganda
    (PLoS ONE, 2020) Schumann, Hannah; Rubagumya, Kenyonyozi; Rubaihayo, John; Harms, Gundel; Wanyenze, Rhoda K.; Theuring, Stefanie
    The study attempted to determine the incidence of HIV among pregnant women in Kabarole District, Uganda, and to identify socio-demographic and behavioral risk factors for seroconversion during pregnancy. Methods We carried out a retrospective cohort study among women for whom a documented HIV negative test result from the first pregnancy trimester could be confirmed using available records, and who were HIV-retested in the third trimester or during delivery. In total, 1610 pregnant women from three different healthcare settings took part in the study. We captured the results of repeated HIV tests and conducted semi-structured interviews to explore participants’ socio-demographic characteristics and sexual risk behavior. For HIV incidence rates, we calculated the number of seroconversions per 100 person-years. We used Fisher’s exact test to test for potential associations. Penalized maximum likelihood logistic regression and Poisson regression were applied to adjust for potential confounders. Results The overall HIV incidence rate among participants was 2.9/100 women-years. Among socio-demographic characteristics, the multivariable analysis showed a significant association of marital status with HIV incidence in pregnancy (IRR 8.78, 95%CI [1.13–68.33]). Risky sexual behaviors including higher number of sexual partners in pregnancy (IRR 2.78 [1.30–5.94]), unprotected sex with unknown persons (IRR 14.25 [4.52–44.93]), alcohol abuse (IRR 12.08 [4.18–34.90]) and sex under the influence of drugs or alcohol (IRR 6.33 [1.36–29.49]) were significantly associated with seroconversion in pregnancy (similar results in logistic regression).
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    Prevention of Mother-to-Child Transmission of HIV in Option B+ Era: Uptake and Adherence During Pregnancy in Western Uganda
    (AIDS patient care and STDs, 2016-03-14) Schnack, Alexandra; Rubaihayo, John; Busingye, Priscilla; Tumwesigye,Nazarius Mbona; Theuring, Stefanie
    Since 2012, lifelong antiretroviral therapy for all HIV-positive pregnant women (“Option B+”) is recommended by WHO for the prevention of mother-to-child transmission of HIV (PMTCT). Many sub-Saharan African countries have since introduced this regimen, but to date, longer-term outcome evaluations are scarce. We conducted an observational study in Fort Portal Municipality, Uganda, to describe uptake and adherence of Option B+ during pregnancy. HIV-positive women approaching antenatal care (ANC) services in two hospitals were enrolled and followed-up at monthly routine ANC visits until delivery. At each visit, next to sociodemographic and clinical data, we assessed drug adherence through pill counts. In total, 124 HIV-positive pregnant women were enrolled in our study; from these, 80.8% had not been aware of their positive serostatus before. Forty-five PMTCT clients (36.3%) never returned to ANC after their first visit. Protective factors (p < 0.05) for immediate loss to care included previous HIV status knowledge, status disclosure before or at first ANC visit, and tertiary education. Among those clients starting Option B+, the median adherence during pregnancy was 95.7% pill intake. Rather low adherence (<80%) was observed in 21.1% of clients, while more than half achieved an adherence level of ≥95%, with 40.8% of all clients being 100% adherent. The cohort's median adherence remained stable throughout the course of pregnancy. Healthcare providers should place high emphasis on individual PMTCT counseling at first ANC encounter, and pay special attention to those women previously unaware of their HIV status. However, after initial uptake, high adherence seems to be feasible for Option B+.
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    Prevention of mother-to-child transmission of HIV: Postpartum adherence to Option B+ until 18 months in Western Uganda
    (PloS one, 2017-06-29) Decker, Sarah; Rubaihayo, John; Busingye,Priscilla; Tumwesigye, Nazarius Mbona; Theuring, Stefanie
    Since 2012, the WHO recommends Option B+ for the prevention of mother-to-child transmission of HIV. This approach entails the initiation of lifelong antiretroviral therapy in all HIV-positive pregnant women, also implying protection during breastfeeding for 12 months or longer. Research on long-term adherence to Option B+ throughout breastfeeding is scarce to date. Therefore, we conducted a prospective observational cohort study in Fort Portal, Western Uganda, to assess adherence to Option B+ until 18 months postpartum. In 2013, we recruited 67 HIV-positive, Option B+ enrolled women six weeks after giving birth and scheduled them for follow-up study visits after six, twelve and 18 months. Two adherence measures, self-reported drug intake and amount of drug refill visits, were combined to define adherence, and were assessed together with feeding information at all study visits. At six months postpartum, 51% of the enrolled women were considered to be adherent. Until twelve and 18 months postpartum, adherence for the respective follow-up interval decreased to 19% and 20.5% respectively. No woman was completely adherent until 18 months. At the same time, 76.5% of the women breastfed for ≥12 months. Drug adherence was associated with younger age (p<0.01), lower travel costs (p = 0.02), and lower number of previous deliveries (p = 0.04). Long-term adherence to Option B+ seems to be challenging. Considering that in our cohort, prolonged breastfeeding until ≥12 months was widely applied while postpartum adherence until the end of breastfeeding was poor, a potential risk of postpartum vertical transmission needs to be taken seriously into account for Option B+ implementation.
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    Repercussions of the COVID-19 Response in Pregnant Women in Western Uganda: Knowledge, Behavior, and Emotional State after the First Lockdown in 2020
    (International journal of environmental research and public health, 2021-07-23) Theuring, Stefanie; Kengonzi, Agnes; Kabwama, Steven Ndugwa; Rubaihayo, John
    Limited research exists on pregnant women’s knowledge, attitudes, and behavior concerning COVID-19 in sub-Saharan Africa. We performed a cross-sectional study among 648 pregnant women in Fort Portal, Uganda, after the first lockdown starting in June 2020. Structured interviews were conducted at three different facilities during routine antenatal care, assessing sociodemographic background, knowledge of COVID-19, prevention behavior adherence, and psycho-emotional stress levels. We performed descriptive analyses and examined associated factors using multivariable logistic regression. In Fort Portal Region, 32.8% of pregnant women had a higher knowledge regarding the COVID-19 pandemic, while all women at least heard of COVID-19. 88.6% of the women showed low self-reported prevention behavior adherence. More than one third of the pregnant women experienced high psycho-emotional stress related to the pandemic (39.8%). The odds for psycho-emotional stress were increased among the age group 21–30 years (AOR 1.97; 95% CI 1.18–3.35) compared to women under the age of 21, and decreased in single or divorced women compared to women in partnerships (AOR 0.42; 0.22–0.77) and in women having less COVID-19-related knowledge (AOR 0.40; 0.27–0.58). In conclusion, prevention behavior adherence seemed challenging, and psycho-emotional stress was ubiquitous among our cohort. To avoid adverse consequences in maternal and neonatal health, campaigns for hygiene but also women’s emotional state should be a major focus of community healthcare in exceptional times such as the SARS-CoV-2 pandemic.
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    Sexual Risk Behavior in HIV‑Uninfected Pregnant Women in Western Uganda
    (Archives of Sexual Behavior, 2021) Theuring, Stefanie; Rubagumya, Kenyonyozi; Schumann, Hannah; Harms, Gundel; Rubaihayo, John; Wanyenze, Rhoda K.
    Our aim was to identify sexual risk behavior among HIV-negative pregnant women in Kabarole District, Uganda, by conducting a cross-sectional study among 1610 women within three healthcare settings. One in six women engaged in HIV-specific risk behaviors including multiple sexual partners or alcohol abuse; 80% of the pregnant women reported to generally abstain from using condoms. In multivariate analysis, predictors of sexual risk behavior included being a client of the public health facilities as compared to the private facility (AOR 3.6 and 4.8, p < 0.001), being single, widowed or divorced or not cohabiting with the partner (AOR 4.7 and 2.3, p < 0.001), as well as higher household wealth (AOR 1.8, p < 0.001) and lack of partner status knowledge (AOR 1.6, p = 0.008). Self-estimated risk perception was linked with engagement in HIV-related risk behaviors except for alcohol abuse. Our findings indicate that reducing risky behaviors in pregnancy in order to prevent HIV should be a high-priority public health concern.
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    Sexual Risk Behavior in HIV‑Uninfected Pregnant Women in Western Uganda
    (Archives of Sexual Behavior, 2021-10-13) Theuring, Stefanie; Kenyonyozi, Rubagumya; Rubaihayo, John; Wanyenze, Rhoda
    Our aim was to identify sexual risk behavior among HIV-negative pregnant women in Kabarole District, Uganda, by conducting a cross-sectional study among 1610 women within three healthcare settings. One in six women engaged in HIV-specific risk behaviors including multiple sexual partners or alcohol abuse; 80% of the pregnant women reported to generally abstain from using condoms. In multivariate analysis, predictors of sexual risk behavior included being a client of the public health facilities as compared to the private facility (AOR 3.6 and 4.8, p < 0.001), being single, widowed or divorced or not cohabiting with the partner (AOR 4.7 and 2.3, p < 0.001), as well as higher household wealth (AOR 1.8, p < 0.001) and lack of partner status knowledge (AOR 1.6, p = 0.008). Self-estimated risk perception was linked with engagement in HIV-related risk behaviors except for alcohol abuse. Our findings indicate that reducing risky behaviors in pregnancy in order to prevent HIV should be a high-priority public health concern.