Medical and Health Sciences

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    One dollar incentive improves tuberculosis treatment outcomes in programmatic settings in rural Uganda
    (Scientific Reports, 2021) Baluku, Joseph Baruch; Nakazibwe, Bridget; Twinomugisha, Bright; Najjuuko, Rebecca; Nyirazihawe, Isabella; Nassozi, Sylvia; Namiiro, Sharon; Katagira, Winceslaus; Byonanebye, Dathan Mirembe; Sekaggya-Wiltshire, Christine; Muchiri, Joseph; Ndungu, Elizabeth; Anguzu, Godwin; Mayanja-Kizza, Harriet; Andia-Biraro, Irene
    The study aim was to determine the association of a one United States dollar (USD) dollar incentive and tuberculosis (TB) treatment outcomes among people with TB receiving treatment at a rural hospital in Uganda under programmatic settings. We conducted a quasi-experiment in which people with TB were randomised (1:1 ratio) to receive either a one USD incentive at months 0, 2, 5 and 6 (Dollar arm) or routine care (Routine arm). A second control group (Retrospective controls) consisted of participants who had a treatment outcome in the preceding 6 months. Treatment outcomes were compared between the intervention and control groups using Pearson’s chi-square and Fisher’s exact tests. The association between the incentive and treatment outcomes was determined using Poisson regression analysis with robust variances. Between November 2018 and October 2019, we enrolled 180 participants (60 in the Dollar arm and 120 in the Control group). TB cure (33.3% vs. 20.8%, p = 0.068) and treatment success (70.0% vs. 59.2% p = 0.156) were higher in the Dollar arm than the Control group, while loss-to-follow-up was lower in the Dollar arm (10.0% vs. 20.8% p = 0.070). Participants in the Dollar arm were more likely to be cured (adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.04–2.44, p = 0.032) and less likely to be lost to follow-up (aIRR: 0.44, 95% CI 0.20–0.96, p = 0.040). A one-dollar incentive was associated with higher TB cure and lower loss-to-follow-up among people with TB in rural Uganda.
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    High Rate of HIV Resuppression After Viral Failure on First-line Antiretroviral Therapy in the Absence of Switch to Second-line Therapy
    (Clinical infectious diseases, 2014) Gupta, Ravindra K.; Goodall, Ruth L.; Kityo, Cissy; Munderi, Paula; Lyagoba, Fred; Mugarura, Lincoln; Kaleebu, Pontiano; Pillay, Deenan
    In a randomized comparison of nevirapine or abacavir with zidovudine plus lamivudine, routine viral load monitoring was not performed, yet 27% of individuals with viral failure at week 48 experienced resuppression by week 96 without switching. This supports World Health Organization recommendations that suspected viral failure should trigger adherence counseling and repeat measurement before a treatment switch is considered.
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    Glucose Addiction and Glycemic Control in Type 2 Diabetes Mellitus: A Case Report
    (Endocrinol Metab Synd, 2014) Mpora, Odongkara Beatrice; Edonga, Oliver,; Adong, Barbara,; Odokonyero, Francis,; Wokorach, Wilfred; Nyeko, Christopher
    According to Goodman, addiction is defined as a process whereby an individual behaves in such that the activity he or she indulges in produces both pleasure and provides escape from internal discomfort. It is employed in a pattern characterized by recurrent failure to control the behavior (powerlessness) and continuation of the behavior despite significant negative consequences (unmanageability) [1]. Dependence is defined as an adaptive state that develops in response to repeated drug administration, and is unmasked during withdrawal, which occurs when drug taking stops [2]. Many people are addiction to different things including psychoactive substances like heroine, morphine; internet; pornography and smoking, among others. Glucose addiction among diabetic patients has not been described in literature. We report a case of glucose addiction in a 59 year old man who had been to several doctors and hospitals with poorly controlled Type 2 diabetes.
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    Understanding early implementation of pre-exposure prophylaxis for HIV prevention in public health facilities in Uganda using the Consolidated Framework for Implementation Research
    (Clinics, 2019) Ortblad, Katrina; Brown, Charles; Muwonge, Timothy R.; Scoville, Caitlin; Izizinga, Diego; Namanda, Sylvia; Nambi, Florence; Nakabugo, Lylianne; Mujugira, Andrew; Heffron, Renee
    In sub-Saharan Africa, a number of countries are starting to deliver oral preexposure prophylaxis (PrEP) for HIV prevention in public health facilities. • We are conducting a stepped-wedge cluster-randomized trial in 12 health facilities in Kampala & Wakiso, Uganda to launch delivery of a PrEP program within HIV clinics targeting HIV-negative members of HIV serodiscordant couples and determine the impact of the PrEP program on HIV viral suppression in partners living with HIV (
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    Short Report: Comparison of Routine Health Management Information System Versus Enhanced Inpatient Malaria Surveillance for Estimating the Burden of Malaria Among Children Admitted to Four Hospitals in Uganda
    (The American journal of tropical medicine and hygiene, 2015) Mpimbaza, Arthur; Miles, Melody; Sserwanga, Asadu; Kigozi, Ruth; Wanzira, Humphrey; Rubahika, Denis; Nasr, Sussann; Kapella, Bryan K.; Yoon, Steven S.; Chang, Michelle; Yeka, Adoke; Staedke, Sarah G.; Kamya, Moses R.; Dorsey, Grant
    The primary source of malaria surveillance data in Uganda is the Health Management Information System (HMIS), which does not require laboratory confirmation of reported malaria cases. To improve data quality, an enhanced inpatient malaria surveillance system (EIMSS) was implemented with emphasis on malaria testing of all children admitted in select hospitals. Data were compared between the HMIS and the EIMSS at four hospitals over a period of 12 months. After the implementation of the EIMSS, over 96% of admitted children under 5 years of age underwent laboratory testing for malaria. The HMIS significantly overreported the proportion of children under 5 years of age admitted with malaria (average absolute difference = 19%, range = 8–27% across the four hospitals) compared with the EIMSS. To improve the quality of the HMIS data for malaria surveillance, the National Malaria Control Program should, in addition to increasing malaria testing rates, focus on linking laboratory test results to reported malaria cases.
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    An Assessment of Home-Based Care Programs in Uganda: Their Strengths and Weaknesses
    (Ministry of Health Uganda, 2002) Ebun, Walker Mary; Esther, Aceng; Denis, Tindyebwa; Juliet, Nabyonga; Peter, Ogwang; Paul, Kiiza
    Currently, lessons are being learnt from successful HIV/AID programs for policy decisions and program strengthening and implementation. This study assessed the Home-Based Care Programs in Uganda, highlighting their strengths and weaknesses, and relating these to their strategies. Using qualitative and quantitative methods, the following elements of care were assessed in seven Home-Based Care Programs: aims and objectives, provision and continuum of care, staffing, supplies and equipment, education, financing, costs of care, monitoring and evaluation, and impact. The findings were evaluated with the Best Practice criteria of relevance, sustainability, ethical soundness, effectiveness and efficiency. Comprehensiveness and delivery of AIDS care, integration with prevention and types of drugs were relevant to the family, community and national needs. Ethical principles of confidentiality and equity of access guided their approaches. Sustainability measures like networking, active community participation, including volunteer service were employed. Their periods of operation, 10-17 years, reflected medium term sustainability. Effectiveness was reflected in reported satisfaction with care and improvement in quality of life among high proportions of beneficiaries. Identified weaknesses include: weak management and financial controls; deficient records management; lack of defined outcome measures; heavy dependence on foreign funding; weak and informal health facilities linkage; a gap between the programs and the local political and administrative leaders; lack of national policy on AIDS home-based care. The facility outreach programs utilizing nursing personnel and large numbers of community volunteers for medical and enlarged psychosocial support appeared more efficient, from the large patient turnover and number of visits, low ratios of staff/patients and staff/visits conducted and lower average costs of care. There is a need for a national policy on home-based care, for standards and guidelines and internal funding. The home-based care programs require strengthening for enhanced efficiency and effectiveness with regards to management, and resource utilization.
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    Abortion and Postabortion Care In Uganda: A Report from Health Care Professionals and Health Facilities
    (Occasional Report, 2005) Prada, Elena; Mirembe, Florence; Ahmed, Fatima H.; Nalwadda, Rose; Kiggundu, Charles
    Women in Uganda today give birth to almost seven children, on average—two more children than they would prefer. In fact, nearly 40% of all births in 2000 were unwanted or mistimed, up from 29% of births only five years earlier. Only 23% of married women were using contraceptives in 2000, although this proportion was about five times that in 1988. Given such facts about the gap between their desired family size and their actual fertility, as well as their low likelihood of using contraceptives, it is not surprising that many women turn to abortion. Abortion is illegal in Uganda unless a woman’s pregnancy endangers her life. As a result, the procedure is performed in secrecy and often under dangerous conditions. There are no official statistics even on abortion complications, but what data are available indicate that unsafe abortion in Uganda is a leading cause of maternal morbidity and mortality.
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    Retention of adolescents living with HIV in care, treatment, and support programs in Uganda
    (USAID, 2014) Ssali, Livingstone; Kalibala, Sam; Birungi, Josephine; Egessa, Aggrey; Wangisi, Jonathan
    In many countries in sub-Saharan Africa, HIV programs are organized around pediatric or adult care, with adolescents who are living with HIV being treated through pediatric care facilities. This has important implications for retention of adolescents in HIV care programs especially as they transition from pediatric to adult care. Although Uganda is considered a success story in HIV/AIDS programming, the extent to which adolescents living with HIV have been retained in care is not well understood. Retention in care is important for positive clinical outcomes such as viral load suppression and survival. The AIDS Support Organization (TASO) and the Population Council undertook a study to generate evidence on the level of and the factors associated with retention of adolescents aged 10–19 years in HIV and AIDS programs in Uganda. The study was conducted under the U.S. Agency for International Development’s (USAID) HIVCore project led by the Population Council. The study specifically examined: (1) the contextual factors that might facilitate or influence retention of adolescents in HIV care, treatment, and support services in Uganda; (2) the cascade of HIV care, treatment, and support services among adolescents aged 10–19 years in Uganda and how these patterns compare with those of adults aged 20 years and above; (3) the level of and trends in retention in care, treatment, and support programs among adolescents aged 10–19 years in the country in the context of current HIV and AIDS programs at 6, 12, 24, 36, and 48 months following initiation of antiretroviral therapy (ART); and (4) the sociodemographic characteristics that are associated with retention in HIV care, treatment, and support programs among adolescents in Uganda at three different follow-up periods (12, 24, and 36 months). The study reviewed existing national policy and program documents on HIV testing, counseling, treatment, and support as well as retrospective secondary cohort clinical data from clinics operated by TASO in Uganda. TASO implements several HIV-related activities including prevention, counseling, testing, treatment, care, and support services as well as capacity development, research, and advocacy. The study population for the clinical component comprised: (1) 22,089 adolescents aged 10–19 years and 33,139 adults aged 20 years and above who received HIV services under the home-based HIV testing and counseling (HBHTC) program from 2005 (when TASO initiated the program) to 2011; and (2) clinical records of 617 adolescent clients aged 10–19 years (at the time of enrollment) who received HIV care, treatment, and support services from TASO clinics between 2006 and 2011. The review of policy and program documents as well as the extraction and merging of clinical datasets took place from 4–15 November 2013. The HBHTC and ART datasets were obtained from 11 TASO centers. The ART datasets were extracted from the following records: Pre-ART Registry, Case Evaluation, ART Commencement, Deaths, Monitoring Refills, and Laboratory. We identified a patient cohort within the TASO Management Information System who initiated ART since 2006. Analysis involved both descriptive statistics and multivariate Cox regression analysis. Descriptive analysis entailed reviewing the cascade of HIV care, treatment, and support services under the HBHTC program as well as estimating the level of retention in TASO ART programs at 6, 12, 24, 36, and 48 months. Multivariate Cox regression analysis was conducted to determine the sociodemographic and clinical factors associated with program attrition at 12, 24, and 36 months.
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    HIV Modes of Transmission and Prevention Response Analysis
    (Uganda National AIDS Commission, 2009) Mangen, Fred Wabwire; Odiit, Martin; Kirungi, Wilford; Kisitu, David Kaweesa; Wanyama, James Okara
    This study is the outcome of close collaborative by a team in Uganda, with technical and financial support from the UNAIDS Regional Support Team for Eastern and Southern Africa, and UNAIDS Geneva. The UNAIDS Modes of Transmission model was customized for Uganda, and applied, to better understand pattern of new infections. The model results, together with existing epidemiological data and the conclusions of recently completed studies on the factors driving Uganda’s HIV epidemic, are compared with data on HIV funding allocations, to derive recommendations for strengthening Uganda’s HIV prevention response. This was part of a set of studies also done in Kenya, Lesotho, Mozambique, Swaziland and Zambia. The other countries focused more on synthesizing existing data and collecting new data to better know each country's HIV epidemic, comparing the epidemic with the national HIV response and funding allocation, also with the aim of improving HIV prevention based on evidence on what works to prevent new infections.
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    Orbital Compression Syndrome In A Ugandan Child With Sickle Cell Disease: A Case Report
    (Clinical Case Reports, 2021) Olum, Ronald; Nabaggala, Catherine; Mwebe, Victoria Katasi; Namazzi, Ruth; Munube, Deogratias; Kitaka, Sabrina Bakeera
    Orbital compression syndrome is a rare acute complication of sickle cell disease that may impair vision. Assessment by a multidisciplinary team incorporates detailed history and physical examination, fundoscopy, and appropriate imaging to exclude infections or neoplasms. Supportive treatment is adequate unless there is evidence of life-threatening space-occupying lesion warranting surgery.