Browsing by Author "Watya, Stephen"
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Item 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, GodfreyIn 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.Item Designing and Usage of a Low-cost Penile Model for Male Medical Circumcision Skills Training in Rakai, Uganda(Urology, 2011) Kigozi, Godfrey; Nkale, James; Wawer, Maria; Anyokorit, Margaret; Watya, Stephen; Nalugoda, Fred; Kagaayi, Joseph; Kiwanuka, Noah; Mwinike, Joshua; Kighoma, Nehemiah; Nalwoga, Grace K.; Nakigozi, Gertrude F.; Katwalo, Henry; Serwadda, David; Gray, Ronald H.To describe the designing and usage of a locally made low-cost penile model used for male medical circumcision (MMC) skills training. The Rakai MMC training team has experienced a number of challenges during conduct of MMC skills training, one of which was the lack of a model to use for MMC skills training. To address this challenge, the Rakai MMC skills training team has designed and developed a low-cost penile model for use in MMC skills training. The model has been successfully used to demonstrate external penile anatomy, to describe the biological mechanisms through which male circumcision (MC) prevents HIV acquisition, and for demonstration and practice of the MMC procedures. With an initial cost of only $10 and a recurrent cost of $5, this is a cost-efficient and useful penile model that provides a simulation of normal penile anatomy for use in MC training in resource limited settings. It has also been used as a visual aid in preoperative education of patients before receiving male circumcision. The model can be improved and scaled up to develop cheaper commercial penile models.Item The effects of male circumcision on female partners’ genital tract symptoms and vaginal infections in a randomized trial in Rakai, Uganda(American journal of obstetrics and gynecology, 2009) Gray, Ronald H.; Kigozi, Godfrey; Serwadda, David; Makumbi, Fredrick; Nalugoda, Fred; Watya, Stephen; Moulton, Laurence; Cheng, Michael Z.; Sewankambo, Nelson K.; Kiwanuka, Noah; Sempijja, Victor; Lutalo, Tom; Kagayii, Joseph; Wabwire-Mangen, Fred; Ridzon, Renée; Bacon, Melanie; Wawer, Maria J.The objective of the study was to assess effects of male circumcision on female genital symptoms and vaginal infections. STUDY DESIGN: Human immunodeficiency virus (HIV)-negative men enrolled in a trial were randomized to immediate or delayed circumcision (control arm). Genital symptoms, bacterial vaginosis (BV), and trichomonas were assessed in HIV-negative wives of married participants. Adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CIs) were assessed by multivariable log-binomial regression, intent-to-treat analyses. RESULTS: A total of 783 wives of control and 825 wives of intervention arm men were comparable at enrollment. BV at enrollment was higher in control (38.3%) than intervention arm spouses (30.5%, P .001). At 1 year follow-up, intervention arm wives reported lower rates of genital ulceration (adjPRR, 0.78; 95% CI, 0.63-0.97), but there were no differences in vaginal discharge or dysuria. The risk of trichomonas was reduced in intervention arm wives (adjPRR, 0.52; 95% CI, 0.05- 0.98), as were the risks of any BV (adjPRR, 0.60; 95% CI, 0.38-0.94) and severe BV (prevalence risk ratios, 0.39; 95% CI, 0.24-0.64). CONCLUSION: Male circumcision reduces the risk of ulceration, trichomonas, and BV in female partners.Item Effects of Medical Male Circumcision (MC) on Plasma HIV Viral Load in HIV+ HAART Nai¨ve Men; Rakai, Uganda(PLoS ONE, 2014) Kigozi, Godfrey; Musoke, Richard; Kighoma, Nehemiah; Watya, Stephen; Serwadda, David; Nalugoda, Fred; Kiwanuka, Noah; Wabwire-Mangen, Fred; Tobian, Aaron; Makumbi, Fredrick; Galiwango, Ronald Moses; Sewankambo, Nelson; Nkale, James; Kigozi Nalwoga, Grace; Anyokorit, Margaret; Lutalo, Tom; Henry Gray, Ronald; Wawer, Maria JoanMedical male circumcision (MC) of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. We assessed the effect of MC on plasma HIV viral load in HIV-infected men in Rakai, Uganda. 195 consenting HIV-positive, HAART naı¨ve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Data were also collected on baseline social demographic characteristics and CD4 counts. Change in log10 plasma viral load between baseline and follow-up visits was estimated using paired t tests and multivariate generalized estimating equation (GEE).Item Evaluation of the Safety and Efficiency of the Dorsal Slit and Sleeve Methods of Male Circumcision Provided by Physicians and Clinical Officers in Rakai, Uganda(BJU international, 2012) Buwembo, Dennis; Musoke, Richard; Kigozi, Godfrey; Sempijja, Victor; Serwadda, David; Makumbi, Frederick; Watya, Stephen; Namuguzi, Dan; Nalugoda, Fred; Kiwanuka, Noah; Sewankambo, Nelson K.; Mangen, Fred Wabwire; Lutalo, Tom; Kiggundu, Valerian; Anyokorit, Margaret; Nkale, James; Kighoma, Nehemia; Wawer, Maria J.; Gray, Ronald H.To assess safety and efficiency of the dorsal slit and sleeve male circumcision (MC) procedures performed by physicians and clinical officers.We evaluated the time required for surgery and moderate / severe adverse events (AEs), among circumcisions by trained physicians and clinical officers using sleeve and dorsal slit methods. Univariate and multivariate regression with robust variance was used to assess factors associated with time for surgery (linear regression) and adverse events (logistic regression). Six physicians and 8 clinical officers conducted 1934 and 3218 MCs, respectively. There were 2471 dorsal slit and 2681 sleeve procedures. The mean duration of surgery was 33 minutes for newly trained providers and decreased to ~20 minutes after ~100 circumcisions. The adjusted mean duration of surgery for dorsal slit was significantly shorter than that for sleeve method (Δ −2.8 minutes, p- <0.001). The duration of surgery was longer for clinical officers than physicians performing the sleeve procedure, but not the dorsal slit procedure. Crude AEs rates were 0.6% for dorsal slit and 1.4% with the sleeve method (p=0.006). However, there were no significant differences after multivariate adjustment. Use of cautery significantly reduced time needed for surgery (Δ − 4.0 minutes, p =0.008), but was associated with higher rates of AEs (adjusted odds ratio 2.13, 95%CI 1.26–3.61, p=0.005).The dorsal slit resection method of male circumcision is faster and safer than sleeve resection, and can be safely performed by non-physicians. However, use of cautery may be inadvisable in this setting.Item Genetic Risk of Prostate Cancer in Ugandan Men(The Prostate, 2018) Du, Zhaohui; Lubmawa, Alexander; Gundell, Susan; Wan, Peggy; Nalukenge, Cissy; Muwanga, Proscovia; Lutalo, Moses; Nansereko, Deborah; Ndaruhutse, Olivia; Katuku, Molly; Nassanga, Rosemary; African Ancestry Prostate Cancer Consortium; Asiimwe, Frank; Masaba, Benon; Kaggwa, Sam; Namuguzi, Dan; Kiddu, Vicky; Mutema, George; Conti, David V.; Luke, Asiimwe; Job, Kuteesa; Henry, Dabanja M.; Haiman, Christopher A.; Watya, StephenMen of African-ancestry have elevated prostate cancer (PCa) incidence and mortality compared to men of other racial groups. There is support for a genetic contribution to this disparity, with evidence of genetic heterogeneity in the underlying risk alleles between populations. Studies of PCa among African men may inform the contribution of genetic risk factors to the elevated disease burden in this population.We conducted an association study of >100 previously reported PCa risk alleles among 571 incidence cases and 485 controls among Uganda men. Unconditional logistic regression was used to test genetic associations and a polygenic risk score (PRS) was derived to assess the cumulative effect of the known risk alleles in association with PCa risk. In an exploratory analysis, we also tested associations of 17 125 421 genotyped and imputed markers genome-wide in association with PCa risk.Of the 111 known risk loci with a frequency >1%, 75 (68%) had effects that were directionally consistent with the initial discovery population,14 (13%) of which were nominally significantly associated with PCa risk at P < 0.05. Compared to men with average risk (25th−75th percentile in PRS distribution), Ugandan men in the top 10% of the PRS, constructed of alleles outside of 8q24, had a 2.9-fold (95%CI: 1.75, 4.97) risk of developing PCa; risk for the top 10% increased to 4.86 (95%CI: 2.70, 8.76) with the inclusion of risk alleles at 8q24. In genome-wide association testing, the strongest associations were noted with known risk alleles located in the 8q24 region, including rs72725854 (OR = 3.37, P = 2.14 × 10−11) that is limited to populations of African ancestry (6% frequency).The ~100 known PCa risk variants were shown to effectively stratify PCa risk in Ugandan men, with 10% of men having a >4-fold increase in risk. The 8q24 risk region was also found to be a major contributor to PCa risk in Ugandan men, with the African ancestry-specific risk variant rs72725854 estimated to account for 12% of PCa in this population.Item Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda(BMJ Open, 2021) Awungafac, George; Mugamba, Stephen; Nalugoda, Fred; Sjöland, Carl Fredrik; Kigozi, Godfrey; Rautiainen, Susanne; Bulamba Malyabe, Robert; Ziegel, Leo; Nakigozi, Gertrude; Kigozi Nalwoga, Grace; Kyasanku, Emmanuel; Nkale, James; Watya, Stephen; Ekström, Anna Mia; Kågesten, AnnaThis study aimed to determine the lifetime prevalence of male-perpetrated intimate partner violence (IPV), and to assess the association with food insecurity, sociodemographic factors and health risk behaviors in Uganda in the year preceding COVID-19- associated lockdowns. Population-based, cross-sectional household survey. Urban, semi urban and rural communities of the Wakiso and Hoima districts in Uganda. Participants A total of N=2014 males aged 13–80 years participated in the survey. The current study included males who reported having ever been in a sexual union and responded to the IPV questions (N=1314).Item 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, WilliamMental 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.Item Pathogenic Variants in Cancer Predisposition Genes and Prostate Cancer Risk in Men of African Ancestry(JCO Precision Oncology, 2020) Matejcic, Marco; Lubmawa, Alexander; Kiddu, Vicky; Masaba, Benon; Namuguzi, Dan; Mutema, George; Kuteesa, Job; Dabanja, Henry M.; Watya, StephenIn studies of men of European ancestry, rare pathogenic variants in DNA repair pathway genes have been shown to be associated with risk of aggressive prostate cancer. The contribution of rare coding variation to prostate cancer risk in men of African ancestry has not been established. We sequenced a panel of 19 DNA repair and cancer predisposition genes in 2,453 African American and 1,151 Ugandan cases and controls with prostate cancer. Rare variants were classified as pathogenic or putatively functionally disruptive and examined in association with prostate cancer risk and disease aggressiveness in gene and pathway-level association analyses. Pathogenic variants were found in 75 of 2,098 cases (3.6%) and 31 of 1,481 controls (2.1%; odds ratio [OR], 1.82; 95% CI, 1.19 to 2.79; P = .0044), with the association being stronger for more aggressive disease phenotypes (OR, 3.10; 95% CI, 1.54 to 6.23; P = .0022). The highest risks for aggressive disease were observed with pathogenic variants in the ATM, BRCA2, PALB2, and NBN genes, with ORs ranging from approximately 4 to 15 in the combined study sample of African American and Ugandan men. Rare, nonpathogenic, nonsynonymous variants did not have a major impact on risk of overall prostate cancer or disease aggressiveness.Rare pathogenic variants in DNA repair genes have appreciable effects on risk of aggressive prostate cancer in men of African ancestry. These findings have potential implications for panel testing and risk stratification in this high-risk population.Item Postcoital penile washing and the risk of HIV acquisition in uncircumcised men(AIDS, 2016) Makumbi, Fredrick E.; Ssempijja, Victor; Sekasanvu, Joseph; Ssekubugu, Robert; Kigozi, Godfrey; Watya, Stephen; Nakigozi, Gertrude; Serwadda, David; Wawer, Maria; Gray, Ronald H.Postcoital genital washing by uncircumcised men may affect the risk of male HIV acquisition. Method: We assessed the association between self-reported washing after sex in 2976 initially HIV-negative, uncircumcised men enrolled in a prospective cohort study in Rakai, Uganda. Results: Data from the 2976 participants who reported sexual intercourse in the past 12 months contributed 4290 visits, with 7316.6 person-years of observation during the 2-year follow-up. The overall HIV-incidence was 1.28/100 person-years 95%CI (1.04–1.57). About 91.0% of men reported washing their penis after sex, and their HIV incidence was 1.34/100 person-years (95%CI 1.08–1.66), compared with an incidence of 0.62/100 person-years (95%CI 0.17–1.60) in men who did not wash their penis after intercourse. Using Poisson multivariable regression, the adjusted incidence rate ratio of HIV acquisition associated with postcoital washing was 1.94 (95%CI 0.71–5.29). Conclusion: Postcoital penile washing, as practiced in this rural African population does not afford protection from HIV acquisition among uncircumcised men, and may increase risk.Item Prevalence Of Protective Tetanus Antibodies And Immunological Response Following Tetanus Toxoid Vaccination Among Men Seeking Medical Circumcision Services In Uganda(PloS one, 2018) Makumbi, Fredrick; Byabagambi, John; Muwanika, Richard; Kigozi, Godfrey; Gray, Ronald; Galukande, Moses; Bagaya, Bernard; Ssebagala, Darix; Karamagi, Esther; Rahimzai, Mirwais; Kaggwa, Mugagga; Watya, Stephen; Mbonye, Anthony K.; Aceng, Jane Ruth; Musinguzi, Joshua; Kiggundu, Valerian; Njeuhmeli, Emmanuel; Nanteza, BarbaraTetanus infection associated with men who had male circumcision has been reported in East Africa, suggesting a need for tetanus toxoid-containing vaccines (TTCV).To determine the prevalence of tetanus toxoid antibodies following vaccination among men seeking circumcision. We enrolled 620 consenting men who completed a questionnaire and received TTCV at enrollment (day 0) prior to circumcision on day 28. Blood samples were obtained at day 0 from all enrollees and on days 14, 28 and 42 from a random sample of 237 participants. Tetanus toxoid (TT) IgG antibody levels were assayed using EUROIMMUN. Analyses included prevalence of TT antibodies at enrollment and used a mixed effects model to determine the immunological response.Mean age was 21.4 years, 65.2% had knowledge of tetanus, 56.6% knew how tetanus was contracted, 22.8% reported ever receipt of TTCV, and 16.8% had current/recently healed wounds. Insufficient tetanus immunity was 57.1% at enrollment, 7.2% at day 14, 3.8% at day 28, and 0% at day 42. Antibody concentration was 0.44IU/ml (CI 0.35–0.53) on day 0, 3.86IU/ml (CI 3.60–4.11) on day 14, 4.05IU/ml (CI 3.81–4.29) on day 28, and 4.48IU/ml (CI 4.28–4.68) on day 42. TT antibodies increased by 0.24IU/ml (CI 0.23, 0.26) between days 0 and 14 and by 0.023IU/ml (CI 0.015, 0.031) between days 14 and 42 days. Immunological response was poorer in HIV-infected clients and men aged 35+ years.Insufficient immunity was common prior to TTCV, and a protective immunological response was achieved by day 14. Circumcision may safely be provided 14 days after vaccination in HIV-uninfected men aged less than 35 years.Item Randomised trial of early infant circumcision performed by clinical officers and registered nurse midwives using the Mogen clamp in Rakai, Uganda(BJU international, 2017) Kankaka, Edward N.; Murungi, Teddy; Kigozi, Godfrey; Makumbi, Frederick; Nabukalu, Dorean; Watya, Stephen; Kighoma, Nehemiah; Nampijja, Resty; Kayiwa, Daniel; Nalugoda, Fred; Serwadda, David; Wawer, Maria; Gray, Ronald H.To assess the safety and acceptability of early infant circumcision (EIC) provided by trained clinical officers (COs) and registered nurse midwives (RNMWs) in rural Uganda. Subjects and Methods We conducted a randomised trial of EIC using the Mogen clamp provided by newly trained COs and RNMWs in four health centres in rural Rakai, Uganda. The trial was registered with clinicaltrials.gov # NCT02596282. In all, 501 healthy neonates aged 1–28 days with normal birth weight and gestational age were randomised to COs (n = 256) and RNMWs (n = 245) for EIC, and were followed-up at 1, 7 and 28 days. Results In all, 701 mothers were directly invited to participate in the trial, 525 consented to circumcision (74.9%) and 23 were found ineligible on screening (4.4%). The procedure took an average of 10.5 min. Adherence to follow-up was >90% at all scheduled visits. The rates of moderate/severe adverse events were 2.4% for COs and 1.6% for RNMWs (P = 0.9). All wounds were healed by 28 days after circumcision. Maternal satisfaction with the procedure was 99.6% for infants circumcised by COs and 100% among infants circumcised by RNMWs. Conclusions EIC was acceptable in this rural Ugandan population and can be safely performed by RNMWs who have direct contact with the mothers during pregnancy and delivery. EIC services should be made available to parents who are interested in the service.Item The Safety and Acceptance of the PrePex Device for Non- Surgical Adult Male Circumcision in Rakai, Uganda. A Non-Randomized Observational Study(PloS one, 2014) Kigozi, Godfrey; Musoke, Richard; Watya, Stephen; Kighoma, Nehemia; Nkale, James; Nakafeero, Mary; Namuguzi, Dan; Serwada, David; Nalugoda, Fred; Sewankambo, Nelson; Wawer, Maria Joan; Gray, Ronald HenryTo assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda.In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and dorsal slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing.The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the dorsal slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with dorsal slit (p<0.0001).The PrePex device was well accepted, but healing was slower than with dorsal slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden.Item Sexual satisfaction of women partners of circumcised men in a randomized trial of male circumcision in Rakai, Uganda(AIDS (London, England), 2016) Kigozi, Godfrey; Lukabwe, Ivan; Kagaayi, Joseph; Wawer, Maria J.; Nantume, Betty; Kigozi, Grace; Nalugoda, Fred; Kiwanuka, Noah; Wabwire-Mangen, Fred; Serwadda, David; Ridzon, Renee; Buwembo, Dennis; Nabukenya, Dorothy; Watya, Stephen; Lutalo, Tom; Nkale, James; Gray, Ronald H.To investigate the effect of adult medical male circumcision on female sexual satisfaction. We investigated self-reported sexual satisfaction among 455 women partners of men circumcised in a randomized trial of male circumcision for the prevention of human immunodeficiency virus in Rakai, Uganda. Women aged 15–49 years were interviewed about their sexual satisfaction before and after their partners were circumcised. We analyzed female-reported changes in sexual satisfaction using chi-square or Fisher’s exact tests.Item The Safety and Acceptance of the PrePex Device for Non- Surgical Adult Male Circumcision in Rakai, Uganda. A Non-Randomized Observational Study(PloS one, 2014-08-21) Kigozi, Godfrey; Musoke, Richard; Watya, Stephen; Kighoma, Nehemia; Nalugoda, Fred; Wawer, Maria Joan; Gray, Ronald HenryTo assess the safety and acceptance of the PrePex device for medical male circumcision (MMC) in rural Uganda. In an observational study, HIV-uninfected, uncircumcised men aged 18 and older who requested elective MMC were informed about the PrePex and dorsal slit methods and offered a free choice of their preferred procedure. 100 men received PrePex to assess preliminary safety (aim 1). An additional 329 men, 250 chose PrePex and 79 chose Dorsal slit, were enrolled following approval by the Safety Monitoring Committee (aim 2). Men were followed up at 7 days to assess adverse events (AEs) and to remove the PrePex device. Wound healing was assessed at 4 weeks, with subsequent weekly follow up until completed healing. The PrePex device was contraindicated in 5.7% of men due to a tight prepuce or phimosis/adhesions. Among 429 enrolled men 350 (82.0%) got the PrePex device and 79 (18.0%) the dorsal slit procedure. 250 of 329 men (76.0%) who were invited to choose between the 2 procedures chose Prepex. There were 9 AEs (2.6%) with the PrePex, of which 5 (1.4%) were severe complications, 4 due to patient self-removal of the device leading to edema and urinary obstruction requiring emergency surgical circumcision, and one due to wound dehiscence following device removal. 71.8% of men reported an unpleasant odor prior to PrePex removal. Cumulative rates of completed wound healing with the PrePex were 56.7% at week 4, 84.8% week 5, 97.6% week 6 and 98.6% week 7, compared to 98.7% at week 4 with dorsal slit (p<0.0001). The PrePex device was well accepted, but healing was slower than with dorsal slit surgery. Severe complications, primarily following PrePex self-removal, required rapid access to emergency surgical facilities. The need to return for removal and delayed healing may increase Program cost and client burden.Item Use of a mixture of lignocaine and bupivacaine vs lignocaine alone for male circumcision under local anaesthesia in Rakai, Uganda(BJU international, 2012) Kigozi, Godfrey; Musoke, Richard; Anyokorit, Margaret; Nkale, James; Kighoma, Nehemiah; Ssebanenya, William; Mwinike, Joshua; Watya, Stephen; Nalugoda, Fred; Kagaayi, Joseph; Nalwoga, Grace; Nakigozi, Gertrude; Kiwanuka, Noah; Makumbi, Frederick; Lutalo, Tom; Serwadda, David; Wawer, Maria; Gray, RonaldMale circumcision (MC) has been shown to reduce the risk of HIV acquisition by 50 – 60% [ 1 – 3 ] and the WHO now recommends it as one of the proven methods for HIV prevention [ 4 ] . Several programmes in sub-Saharan Africa have initiated MC implementation. For MC to be effective at a community level there is need to achieve high MC coverage, and modelling suggests that the higher the prevalence of MC the greater the impact on HIV incidence [ 5 ] . One reason consistently cited by men for not accepting MC is fear of pain during surgery [ 6 – 10 ] . Our experience in Rakai is that when men are offered MC, only a few men initially come for surgery, and the majority, fearing pain, wait to hear the experiences of men who have had surgery.Item 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.