NRU :: Browsing by Author "Wagman, Jennifer A."

Browsing by Author "Wagman, Jennifer A."

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Alcohol use and alcohol-related consequences are associated with not being virally suppressed among persons living with HIV in the Rakai region of Uganda
(Drug and Alcohol Dependence, 2021) Miller, Amanda P.; Pitpitan, Eileen V.; Kiene, Susan M.; Raj, Anita; Jain, Sonia; Luisa Zuniga, Marıa; Nabulaku, Dorean; Nalugoda, Fred; Ssekubugu, Robert; Nantume, Betty; Kigozi, Godfrey; Sewankambo, Nelson K.; Kagaayi, Joseph; Reynolds, Steven J.; Grabowski, Kate; Wawer, Maria; Wagman, Jennifer A.
Background: Alcohol use is common among persons living with HIV (PWH) in Uganda and associated with poor HIV care outcomes; findings regarding the relationship between alcohol use and viral suppression (VS) have been inconclusive. Methods: Data from two rounds (2017-2020) of the Rakai Community Cohort Study, an open population-based cohort study in the Rakai region, Uganda, were analyzed. Two alcohol exposures were explored: past year alcohol use and alcohol-related consequences. Multivariable models (GEE) were used to estimate associations between alcohol exposures and VS for the overall sample and stratified by sex, adjusting for repeated measurement. Causal mediation by ART use was explored. Results: Over half (55%) of participants (n=3,823 PWH) reported alcohol use at baseline; 37.8% of those reporting alcohol use reported alcohol-related consequences. ART use and VS at baseline significantly differed by alcohol use with person reporting alcohol use being less likely to be on ART or VS. Alcohol use was significantly associated with decreased odds of VS among women but not men (adj. OR 0.72 95% CI 0.58-0.89, p=0.0031). However, among males who use alcohol, experiencing alcohol-related consequences was significantly associated with decreased odds of VS (adj. OR 0.69 95% CI 0.54-0.88, p=0.0034). The relationships between both alcohol exposures and VS were not significant in models restricted to persons on ART. Conclusions: We provide sex-stratified estimates of associations between two alcohol measures and VS in the context of current HIV treatment guidelines. This study confirms that alcohol use is adversely associated with VS but ART use mediates this pathway, suggesting that initiation and retention on ART are critical steps to addressing alcohol-related disparities in VS.
Alcohol use during pregnancy in Rakai, Uganda
(Plos one, 2021) Wynn, Adriane; Nabukalu, Dorean; Lutalo, Tom; Wawer, Maria; Chang, Larry W.; Kiene, Susan M.; Serwadda, David M.; Sewankambo, Nelson; Nalugoda, Fred; Kigozi, Godfrey; Wagman, Jennifer A.
Antenatal alcohol use is linked to adverse maternal and neonatal outcomes. Uganda has one of the highest rates of alcohol use in sub-Saharan Africa, but the prevalence of antenatal alcohol use has not been reported in the Rakai region. Methods We used cross-sectional data from pregnant women in the Rakai Community Cohort Study between March 2017 and September 2018. Using bivariate and multivariable analyses, we assessed associations between self-reported antenatal alcohol use and sociodemographic characteristics, intimate partner violence (IPV), and HIV status. Results Among 960 pregnant women, the median age was 26 years, 35% experienced IPV in the past 12 months, 13% were living with HIV, and 33% reported alcohol use during their current pregnancy. After adjusting for marital status, education, smoking, and HIV status; Catholic religion (AOR: 3.54; 95% CI: 1.89–6.64; compared to other), bar/restaurant work (AOR: 2.40; 95% CI: 1.17–4.92; compared to agriculture), >one sex partner in past year (AOR: 1.92; 95% CI: 1.17–3.16), a partner that drank before sex in past year (AOR: 2.01; 95% CI: 1.48–2.74), and past year IPV (AOR: 1.55; 95% CI: 1.14–2.11) were associated with antenatal alcohol use. Conclusion We found that alcohol use during pregnancy was common and associated with religion, occupation, higher numbers of past year sex partners, having a partner who drank before sex in the past 12 months, and IPV experience. More research is needed to understand the quantity, frequency, and timing of antenatal alcohol use; and potential impacts on neonates; and to identify services that are acceptable and effective among pregnant women.
Construct validity and internal consistency of the Patient Health Questionnaire-9 (PHQ-9) depression screening measure translated into two Ugandan languages
(Psychiatry Research Communications, 2021) Miller, Amanda P.; Silva, Cristina Espinosa da; Ziegel, Leo; Stephen, Mugamba; Kyasanku, Emma; Bulamba, Robert M.; Wagman, Jennifer A.; Ekstromc, Anna Mia; Nalugoda, Fred; Kigozi, Grace; Nakigozi, Gertrude; Kagaayi, Joseph; Watya, Stephen; Kigozi, Godfrey
In Uganda, depression is a major public health issue. Psychometric assessment of translated depression measures is critical to public health planning to ensure proper screening, surveillance, and treatment of depression and related outcomes. We examined aspects of the validity and reliability of the Patient Health Questionnaire-9 (PHQ- 9) translated into Luganda and Runyoro among Ugandan adolescents and adults. Data from the ongoing AMBSO Population Health Surveillance study were analyzed from the Wakiso and Hoima districts in Uganda. Descriptive statistics were calculated for the overall sample and stratified by translated language. Construct validity was assessed for each translated scale using confirmatory factor analysis for ordinal data. The internal consistency of each translated scale was assessed using Cronbach's alpha, McDonald's omega total and omega hierarchical. Both the Luganda- and Runyoro-translated PHQ-9 had similar sample means (3.46 [SD ¼ 3.26] and 3.58 [SD ¼ 3.00], respectively), supported a single-factor structure, and demonstrated satisfactory internal consistency (Cronbach's alpha of 0.73 and 0.72, respectively). Our preliminary findings indicate that the Luganda and Runyoro translations of the PHQ-9 had satisfactory construct validity and internal consistency in our sample. Future studies should expand on this promising work by assessing additional psychometric characteristics of these translated measures in other communities in Uganda.
Intimate partner violence as a predictor of marital disruption in rural Rakai, Uganda: a longitudinal study
(International journal of public health, 2016) Wagman, Jennifer A.; Charvat, Blake; Thoma, Marie E.; Ndyanabo, Anthony; Nalugoda, Fred; Ssekasanvu, Joseph; Kigozi, Grace; Serwadda, David; Kagaayi, Joseph; Wawer, Maria J.; Gray, Ronald H.
We assessed the association between intimate partner violence (IPV) and union disruption (divorce or separation) in the rural Ugandan setting of Rakai District. We analyzed longitudinal data collected from April 1999 to June 2006, from 6834 women (15–49 years) living in 50 communities in Rakai. Participants were either married, traditionally married or in a consensual union during one or more surveys and completed at least one follow-up survey. The primary outcome was union disruption through divorce or separation from the primary sexual partner.
Not Enough Money and Too Many Thoughts: Exploring Perceptions of Mental Health in Two Ugandan Districts Through the Mental Health Literacy Framework
(Qualitative Health Research, 2021) Miller, Amanda P.; Ziegel, Leo; Mugamba, Stephen; Kyasanku, Emmanuel; Wagman, Jennifer A.; Nkwanzi-Lubega, Violet; Nakigozi, Gertrude; Kigozi, Godfrey; Nalugoda, Fred; Kigozi, Grace; Nkale, James; Watya, Stephen; Ddaaki, William
Mental health disorders account for a heavy disease burden in Uganda. In order to provide culturally appropriate mental health prevention and treatment approaches, it is necessary to understand how mental health is conceptualized in the population. Three focus group discussions (FGDs) and 31 in-depth interviews (IDIs) were conducted with men and women aged 14 to 62 years residing in rural, urban, and semi-urban low-income communities in central and western Uganda to explore perceptions and knowledge of mental health. Interpretive thematic analysis was undertaken; results were organized through the lens of the mental health literacy framework. Environmental and societal stressors were identified as primary underlying causes of poor mental health. While participants recognized symptoms of poor mental health, gaps in mental health literacy also emerged. Mental health resources are needed in this setting and additional qualitative work assessing knowledge and attitudes toward mental health care seeking behavior can inform the development of acceptable integrated services.
Perceptions of Adolescent Pregnancy Among Teenage Girls in Rakai, Uganda
(Global qualitative nursing research, 2017) Maly, Christina; McClendon, Katherine A.; Baumgartner, Joy Noel; Nakyanjo, Neema; Ddaaki, William George; Serwadda, David; Nalugoda, Fred Kakaire; Wawer, Maria J.; Bonnevie, Erika; Wagman, Jennifer A.
The leading causes of death and disability among Ugandan female adolescents aged 15 to 19 years are pregnancy complications, unsafe abortions, and childbirth. Despite these statistics, our understanding of how girls perceive adolescent pregnancy is limited. This qualitative study explored the social and contextual factors shaping the perceptions of adolescent pregnancy and childbirth among a sample of 12 currently pregnant and 14 never pregnant girls living in the rural Rakai District of Uganda. Interviews were conducted to elicit perceived risk factors for pregnancy, associated community attitudes, and personal opinions on adolescent pregnancy. Findings indicate that notions of adolescent pregnancy are primarily influenced by perceptions of control over getting pregnant and readiness for childbearing. Premarital pregnancy was perceived as negative whereas postmarital pregnancy was regarded as positive. Greater understanding of the individual and contextual factors influencing perceptions can aid in development of salient, culturally appropriate policies and programs to mitigate unintended adolescent pregnancies.
Prevalence and correlates of men’s and women’s alcohol use in agrarian, trading and fishing communities in Rakai, Uganda
(PLoS ONE, 2020) Wagman, Jennifer A.; Nabukalu, Dorean; Miller, Amanda P.; Wawer, Maria J.; Ssekubugu, Robert; Nakowooya, Hadijja; Nantume, Betty; Park, Eunhee; Hahn, Judith A.; Serwadda, David M.; Sewankambo, Nelson K.; Nalugoda, Fred; Kigozi, Godfrey
Uganda has one of the highest rates of alcohol use in sub-Saharan Africa but prevalence and correlates of drinking are undocumented in the Rakai region, one of the earliest epicenters of the HIV/AIDS epidemic in East Africa. Methods We analyzed cross-sectional data from 18,700 persons (8,690 men, 10,010 women) aged 15–49 years, living in agrarian, trading and fishing communities and participating in the Rakai Community Cohort Study (RCCS) between March 2015 and September 2016. Logistic regression models assessed associations between past year alcohol use and sociodemographic characteristics, other drug use and HIV status, controlling for age, religion, education, occupation, marital status, and household socioeconomic status. Results Past year alcohol prevalence was 45%. Odds of drinking were significantly higher in men (versus women) and fishing communities (versus agrarian areas). Odds of drinking increased with age, previous (versus current) marriage and past year drug use. By occupation, highest odds of drinking were among fishermen and (in women) bar/restaurant workers. Alcohol-related consequences were more commonly reported by male (vs. females) drinkers, among whom up to 35% reported alcohol dependence symptoms (e.g., unsteady gait). HIV status was strongly associated with alcohol use in unadjusted but not adjusted models. Conclusions Alcohol use differed by gender, community type and occupation. Being male, living in a fishing community and working as a fisherman or restaurant/bar worker (among women) were associated with higher odds of drinking. Alcohol reduction programs should be implemented in Uganda’s fishing communities and among people working in high risk occupations (e.g., fishermen and restaurant/bar workers).
Process evaluation of the SHARE intervention for preventing intimate partner violence and HIV infection in Rakai, Uganda
(Evaluation and program planning, 2018) Wagman, Jennifer A.; Gray, Ronald H.; Nakyanjo, Neema; McClendond, Katherine A.; Bonneviea, Erika; Namatovu, Fredinah; Kigozi, Grace; Kagaayi, Joseph; Wawer, Maria J.; Nalugoda, Fred
The Safe Homes And Respect for Everyone (SHARE) intervention introduced an intimate partner violence (IPV) prevention approach into Rakai Health Sciences Program, an established HIV research and service organization in Uganda. A trial found exposure to SHARE was associated with reductions in IPV and HIV incidence. This mixed methods process evaluation was conducted between August 2007 and December 2009, with people living in SHARE intervention clusters, to assess awareness about/participation in SHARE, motivators and barriers to involvement, and perceptions of how SHARE contributed to behavior change. Surveys were conducted with 1407 Rakai Community Cohort Study participants. Qualitative interviews were conducted with 20 key informants. Most (77%) were aware of SHARE, among whom 73% participated in intervention activities. Two-thirds of those who participated in SHARE felt it influenced behavior change related to IPV. While some felt confident to take part in new IPV-focused activities of a well-established program, others were suspicious of SHARE’s motivations, implying awareness raising is critical. Many activities appealed to the majority (e.g., community drama) while interest in some activities was limited to men (e.g., film shows), suggesting multiple intervention components is ideal for wide-reaching programming. The SHARE model offers a promising, acceptable approach for integrating IPV prevention into HIV and other established health programs in sub-Saharan Africa.
A Public Health Approach to Intimate Partner Violence Prevention in Uganda: The SHARE Project
(Violence against women, 2012) Wagman, Jennifer A.; Namatovu, Fredinah; Nalugoda, Fred; Kiwanuka, Deus; Nakigozi, Gertrude; Gray, Ron; Wawer, Maria J.; Serwadda, David
Research from Rakai, Uganda, suggests intimate partner violence (IPV) is common and attitudes condoning it are widespread. We used a public health approach to develop and implement an evidence-based IPV prevention intervention named the Safe Homes and Respect for Everyone (SHARE) Project. SHARE was designed on the Transtheoretical Model of behavior change and adapted IPV prevention strategies from Raising Voices and Stepping Stones. SHARE was implemented in four regions of Rakai. This article describes the design and implementation of SHARE, provides details on strategies and activities used, discusses challenges and lessons learned, and provides recommendations for other violence prevention programmers.
Transactional Sex, Alcohol Use and Intimate Partner Violence Against Women in the Rakai Region of Uganda
(AIDS and Behavior, 2021) Miller, Amanda P.; Pitpitan, Eileen V.; Nabukalu, Dorean; Nalugoda, Fred; Nakigozi, Gertrude; Kigozi, Godfrey; Grabowski, Mary K.; Kennedy, Caitlin E.; Wagman, Jennifer A.
Transactional sex (TS) is prevalent in sub-Saharan Africa. Women’s engagement in TS is linked with HIV infection; little is known about the relationship between TS, intimate partner violence (IPV) and alcohol use—established HIV risk behaviors. Using modified Poisson regression, we assessed associations between TS and physical, verbal and sexual IPV among 8248 women (15–49 years) who participated in the Rakai Community Cohort Study across forty communities in Uganda. An interaction term assessed moderation between alcohol use and TS and no significant interaction effects were found. In adjusted analysis, alcohol use and TS were significantly associated with all forms of IPV. In stratified analysis, TS was only associated with IPV in agrarian communities; alcohol use was not associated with physical IPV in trade communities or sexual IPV in trade and fishing communities. Identifying differences in IPV risk factors by community type is critical for the development of tailored interventions.
Women's access to family planning and experiences of reproductive coercion during the COVID-19 lockdown in two districts of Uganda
(Elsevier Ltd, 2024-05) Qureshi, Mira J.; Miller, Amanda P.; Mugamba, Stephen; Kyasanku, Emmanuel; Nalugoda, Fred; Bulamba, Robert Malyabe; Kigozi, Godfrey; Nakigozi, Gertrude; Nkale, James; Kato, Phillip; Nalwoga, Grace Kigozi; Watya, Stephen; Wagman, Jennifer A.
In March 2020, Uganda enforced country-wide restrictions to control the spread of SARS-CoV-2, categorizing some health services, including family planning (FP), as non-essential. Globally, similar COVID-19 restrictions have been associated with increased vulnerability to reproductive coercion (RC) among women, due to changes in FP service availability and restricted access by partners. This study aims to investigate these dynamics in Uganda, specifically examining the impact of the COVID-19 lockdown on women's access to FP, their experiences of RC, and the relationship between RC and intimate partner violence (IPV). We conducted a cross-sectional analysis of data from 960 women participating in the AMBSO Population Health Surveillance Study (APHS) between August 2020 and March 2021 across Wakiso (N = 164) and Hoima (N = 796) districts in Uganda. Our analysis focused on women who were sexually active in the past month, using bivariate analyses to explore the associations between RC and recent experiences of sexual, physical, and verbal IPV. The most commonly reported FP methods were injectables (36.8 %) and implants (16 %). Despite the COVID-19 lockdown, less than one percent of participants reported an inability to access their preferred FP method. Notably, 3 % of the women experienced RC in the past 12 months. There was a significant association between RC and sexual IPV (p < 0.0001), as well as physical IPV (p < 0.0001). Instances of verbal IPV were observed to have tripled during the lockdown period. An increase in verbal IPV was found among women during the COVID-19 lockdown. Additionally, a notable association emerged between other forms of IPV and an increased risk of RC. Despite the lockdown, access to FP remained high, which could be attributed to the prevalent use of long-acting FP methods.

Browsing by Author "Wagman, Jennifer A."

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