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Wake E, Rosen JG. Heavy alcohol use and the HIV care continuum in Kenya: a population-based study. AIDS Care 2024; 36:1508-1517. [PMID: 38648525 PMCID: PMC11343670 DOI: 10.1080/09540121.2024.2343587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/29/2024] [Indexed: 04/25/2024]
Abstract
Heavy alcohol use (HAU) can destabilize engagement along the HIV care continuum. Population-based studies assessing associations of HAU with HIV treatment outcomes are lacking, especially in sub-Saharan Africa. We leveraged data from the Kenya Population-based HIV Impact Assessment to identify associations of self-reported HAU, assessed using two items measuring the frequency and quantity of past-year alcohol consumption, with serum biomarkers for HIV serostatus unawareness, antiretroviral therapy (ART) non-use, and HIV viremia (≥1000 RNA copies/mL). Overall and sex-stratified survey-weighted logistic regression with jackknife variance estimation modeled adjusted odds ratios (adjOR) of HIV treatment indicators by HAU. Overall, 1491 persons living with HIV aged 15-64 years (68.4% female) were included. The prevalence of HAU was 8.9% (95% confidence interval [95%CI]: 6.8-11.0%) and was significantly more pronounced in males than females (19.6% vs. 4.0%, p < 0.001). In multivariable analysis, HAU was significantly (p < 0.001) associated with HIV serostatus unawareness (adjOR = 3.65, 95%CI: 2.14-6.23), ART non-use (adjOR = 3.81, 95%CI: 2.25-6.43), and HIV viremia (adjOR = 3.13, 95%CI: 1.85-5.32). Incorporating sex-specific alcohol use screening into HIV testing and treatment services in populations where HAU is prevalent could optimize clinical outcomes along the HIV care continuum.
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Affiliation(s)
- Edom Wake
- Division of Gastroenterology and Hepatology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Joseph G. Rosen
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States
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Guy K, Ritchie A, Tumuhimbise P, Balinda E, Nasim K, Kalanzi M, Wipfli H. Mixed-methods community assessment of drowning and water safety knowledge and behaviours on Lake Victoria. Inj Prev 2024:ip-2023-045106. [PMID: 38604661 DOI: 10.1136/ip-2023-045106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/01/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Drowning is a major cause of death in Uganda, especially among young adults with water-based occupations and livelihoods. Information about drowning and other water-related deaths and injuries is limited. To address this gap in knowledge, study partners assessed knowledge, attitudes and beliefs about drowning and drowning prevention interventions in the Mayuge district of eastern Uganda. METHODS This study consisted of a mixed-methods, cross-sectional community health assessment. Research was conducted in 10 landing sites of 6 subcounties within Mayuge district bordering Lake Victoria and focused on 505 head-of-household interviews, 15 key informant interviews, 10 landing site observations and 3 focus group discussions with 10 young adults each. RESULTS While landing site observations revealed high lake use, households reported limited community drowning prevention knowledge and revealed risky behaviours and attitudes towards water safety. Less than one-third (30.9%) of participants reported that at least one family member can swim. 64.2% of all respondents reported no existing safety measures (eg, signage, fences) around the lake and 95.8% reported no aquatic emergency response system in their community. The majority of households (85.7%) had experienced a drowning incident in their area. Key informants and focus group participants were eager for community-based interventions and offered solutions that reflected international drowning prevention recommendations. CONCLUSIONS The results reveal gaps in services, access and knowledge and highlight a need for water safety services and interventions in lakeside communities in Uganda and throughout the Lake Victoria Basin.
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Affiliation(s)
- Kyra Guy
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | - Ava Ritchie
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | | | - Khoban Nasim
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
| | | | - Heather Wipfli
- Department of Population and Public Health Sciences, University of Southern California, Los Angeles, California, USA
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Miller AP, Appa A, Muyindike W, Fatch R, Kekibiina A, Beesiga B, Adong J, Emenyonu N, Marson K, Getahun M, Kamya M, Chamie G, Camlin CS, Hahn JA. A Qualitative Exploration of Intimate Partner Violence Among HIV/TB Coinfected Persons With Problematic Alcohol Use Participating in an Incentive-Based Alcohol/Medication Adherence Intervention in Uganda During COVID-19. Violence Against Women 2024:10778012231225229. [PMID: 38196278 PMCID: PMC11231058 DOI: 10.1177/10778012231225229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
In Uganda, four in ten women report experiencing intimate partner violence (IPV) in the past year. Salient drivers of IPV in sub-Saharan Africa include stress related to household finances, alcohol use, and partner infidelity. We conducted 42 interviews with participants (n = 32) in the Drinkers' Intervention to Prevent Tuberculosis (DIPT) study which included economic incentives, and their partners (n = 10) to understand how participating in DIPT during COVID-19 lockdown restrictions impacted relationship dynamics in intimate partnerships. Our findings highlight the need to develop policies to address root causes of IPV and to ensure continuity of IPV services in future pandemics. Policy and programming recommendations based on study results are presented.
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Affiliation(s)
- Amanda P Miller
- School of Public Health, San Diego State University, San Diego, CA, USA
| | - Ayesha Appa
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Winnie Muyindike
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robin Fatch
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Allen Kekibiina
- Global Health Collaborative, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Brian Beesiga
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Julian Adong
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Nneka Emenyonu
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Kara Marson
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Moses Kamya
- Infectious Diseases Research Collaboration (IDRC), Kampala, Uganda
| | - Gabriel Chamie
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Carol S Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA
| | - Judith A Hahn
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
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Naigino R, Miller AP, Ediau M, Anecho A, Senoga U, Tumwesigye NM, Wanyenze RK, Mukasa B, Hahn JA, Reed E, Sileo KM, Kiene SM. Stakeholder perspectives on the Kisoboka intervention: A behavioral and structural intervention to reduce hazardous alcohol use and improve HIV care engagement among men living with HIV in Ugandan fishing communities. Drug Alcohol Depend 2023; 253:111011. [PMID: 37952352 PMCID: PMC11016226 DOI: 10.1016/j.drugalcdep.2023.111011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/25/2023] [Accepted: 10/20/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND East Africa's fishing communities experience a high burden of two interrelated and frequently co-occurring health issues: HIV and hazardous alcohol use. Nearly two-thirds of Ugandan fisherfolk men meet the criteria for harmful alcohol use. We developed a multilevel intervention to reduce hazardous alcohol use and improve HIV care engagement among fisherfolk men living with HIV (LWHIV) in Wakiso district, Uganda. METHODS This is a qualitative study of stakeholder perspectives on the appropriateness, acceptability, and feasibility of a multilevel intervention for fisherfolk men LWHIV. The proposed intervention, Kisoboka ("It is possible!"), combines a structural component [changing the mode of work payments from cash to mobile money] with a behavioral component [motivational interviewing-based counseling combined with content using behavioral economic principles to promote behavior change]. We conducted one focus group (n=7) and eight in-depth interviews with fisherfolk men LWHIV and 19 key informant (KI) interviews with health workers, employers, and community leaders. These explored the appropriateness, acceptability, and feasibility of specific key intervention components. RESULTS Overall, stakeholders' perspectives supported high intervention acceptability and perceived appropriateness of the proposed intervention. It was perceived to be feasible with some caveats of recommendations for overcoming potential implementation challenges identified (e.g., having a friend assist with documenting savings and alcohol use if an individual was unable to write themselves) which are discussed. CONCLUSION This work highlights the potential of the Kisoboka intervention and the importance of early engagement of key stakeholders in the intervention development process to ensure appropriateness, acceptability, feasibility, and socio-cultural fit.
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Affiliation(s)
- Rose Naigino
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA; Makerere University School of Public Health, Kampala, Uganda
| | - Amanda P Miller
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA; Makerere University School of Public Health, Kampala, Uganda
| | - Asha Anecho
- Makerere University School of Public Health, Kampala, Uganda
| | - Umar Senoga
- Makerere University School of Public Health, Kampala, Uganda
| | | | | | | | - Judith A Hahn
- Department of Medicine, University of California San Francisco, CA, USA
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University, CA, USA
| | - Katelyn M Sileo
- Department of Public Health, University of Texas at San Antonio, TX, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, CA, USA; Makerere University School of Public Health, Kampala, Uganda.
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Vancampfort D, Mugisha J, Rosenbaum S, Van Damme T. Physical activity counselling in women with HIV/AIDS and suicidal ideation: a secondary analysis of a real-world intervention in Ugandan HIV counselling centres. Pan Afr Med J 2023; 45:70. [PMID: 37637405 PMCID: PMC10460103 DOI: 10.11604/pamj.2023.45.70.40093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 05/10/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction people with HIV/AIDS have higher rates of suicidal ideation than the general population. Consequently, HIV counselling settings should implement suicide risk reduction initiatives. Physical activity (PA) counselling could be a relevant add-on intervention. The aim of this secondary analysis from a single-arm pre- and post-study exploring the efficacy of PA counselling for HIV/AIDS patients with mental health problems was to investigate the efficacy of PA counselling on reducing suicidal ideation. Methods out of 41 participants in an 8-week PA counselling intervention, 15 participants reported suicidal ideation. These 15 (15♀, median age=42 years, interquartile range=24 years) participants completed the Patient Health Questionnaire-9 (PHQ-9), Alcohol Use Disorder Identification Test -10 (AUDIT-10), and the Simple Physical Activity Questionnaire (SIMPAQ) pre- and immediately post-intervention. Results the prevalence of suicidal ideation (PHQ-9 item 9≥1) dropped to 20% post-intervention, i.e. only three patients with HIV still reported suicidal ideation. Also, following the intervention significant (P<0.05) increases in walking and incidental PA (SIMPAQ) levels, and reductions in depressive and alcohol abuse symptoms were observed. Conclusion our data demonstrate that PA counselling might be promising in reducing suicidal ideation in most HIV patients in low-resourced settings. Randomized controlled trials are warranted to confirm these beneficial findings.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
| | - James Mugisha
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Simon Rosenbaum
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Tine Van Damme
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
- University Psychiatric Centre KU Leuven, Leuven-Kortenberg, Belgium
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Miller AP, Ddaaki WG, Bloom BE, Wirtz AL, Nakyanjo N, Kigozi G, Wagman JA. Perspectives of Women Living With HIV on Addressing Violence and Use of Alcohol During HIV Services: Qualitative Findings From Fishing Communities in Uganda. Violence Against Women 2022; 28:1483-1504. [PMID: 34139908 PMCID: PMC8678385 DOI: 10.1177/10778012211019054] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The syndemic relationship between harmful alcohol use, intimate partner violence (IPV), and HIV is well established across international settings. Less is known about how these health issues are perceived by women living with HIV (WLWH), who are disproportionately affected by these intertwined epidemics. A qualitative study was undertaken with 20 WLWH in Rakai, Uganda, to assess their perceptions of how these issues have affected their lives and their communities and to assess the acceptability of integrating a screening and brief intervention for alcohol use and IPV into HIV posttest counseling. Recommendations for intervention programming arising from the results are discussed.
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Affiliation(s)
| | - William G. Ddaaki
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | | | | | - Neema Nakyanjo
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program, Kalisizo, Uganda
- Uganda Virus Research Institute, Entebbe, Uganda
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Perkins JM, Kakuhikire B, Baguma C, Jurinsky J, Rasmussen JD, Satinsky EN, Namara E, Ahereza P, Kyokunda V, Perkins HW, Hahn JA, Bangsberg DR, Tsai AC. Overestimation of alcohol consumption norms as a driver of alcohol consumption: a whole-population network study of men across eight villages in rural, southwestern Uganda. Addiction 2022; 117:68-81. [PMID: 34159646 PMCID: PMC8759576 DOI: 10.1111/add.15615] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/20/2021] [Accepted: 05/09/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Little is known about how perceived norms about alcohol consumption may influence high alcohol consumption rates in Uganda. This study estimated the accuracy of perceived norms about men's alcohol consumption and estimated the association between perceived norms and personal alcohol consumption. DESIGN Cross-sectional, whole-population, sociocentric social network study. SETTING Eight rural villages in Rwampara District, southwestern Uganda in 2016-18. PARTICIPANTS A total of 719 men aged 18 years and older (representing 91% of permanent resident men). MEASUREMENTS Self-reported frequent (≥ 4 days per week) and heavy alcohol consumption (six or more drinks on one occasion, more than three occasions of intoxication, or spending an excessive amount on alcohol). Participants also reported whether they thought most other men in their village engaged in frequent and heavy alcohol consumption (perceived norms). Using the network study design, we calculated alcohol consumption behavior within villages and social networks. Perceived norms were compared with aggregated self-reports. Multivariable Poisson regression models were used to estimate the association between perceived norms and individual behavior. FINDINGS Throughout villages, frequent and heavy alcohol consumption ranged from 7 to 37%. However, 527 (74%) participants perceived, contrary to fact, that most other men in their villages frequently consumed alcohol, and 576 (81%) perceived that most others heavily consumed alcohol. Overestimation of alcohol consumption by others was pervasive among socio-demographic subgroups and was present irrespective of the actual consumption behavior at the village level and within social networks. Men who misperceived these alcohol consumption behaviors as being common were more likely to engage in frequent [adjusted relative risk (aRR) = 3.98; 95% confidence interval (CI) = 1.69-9.34) and heavy (aRR = 4.75; 95% CI = 2.33-9.69) alcohol consumption themselves. CONCLUSIONS Most men in eight rural Ugandan villages incorrectly thought that frequent and heavy alcohol consumption were common among men in their villages. These misperceived norms had a strong positive association with individual drinking behavior.
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Affiliation(s)
- Jessica M. Perkins
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA,Vanderbilt Institute of Global Health, Vanderbilt University Medical Center, Nashville, TN, USA,Corresponding author: Dr. Jessica M. Perkins, , Phone: (615) 875-3289, Fax: 615-343-2661
| | | | - Charles Baguma
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jordan Jurinsky
- Peabody College of Education and Human Development, Vanderbilt University, Nashville, TN, USA
| | | | - Emily N. Satinsky
- Center for Global Health, Massachusetts General Hospital, Boston MA USA
| | | | - Phionah Ahereza
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Viola Kyokunda
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Judith A. Hahn
- University of California at San Francisco, San Francisco, CA, USA
| | - David R. Bangsberg
- Mbarara University of Science and Technology, Mbarara, Uganda,Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Alexander C. Tsai
- Mbarara University of Science and Technology, Mbarara, Uganda,Center for Global Health, Massachusetts General Hospital, Boston MA USA,Harvard Medical School, Boston, MA, USA,Mongan Institute, Massachusetts General Hospital, Boston MA USA
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Leddy AM, Hahn JA, Getahun M, Emenyonu NI, Woolf-King SE, Sanyu N, Katusiime A, Fatch R, Chander G, Hutton HE, Muyindike WR, Camlin CS. Cultural Adaptation of an Intervention to Reduce Hazardous Alcohol Use Among People Living with HIV in Southwestern Uganda. AIDS Behav 2021; 25:237-250. [PMID: 33590322 DOI: 10.1007/s10461-021-03186-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2021] [Indexed: 02/08/2023]
Abstract
Hazardous drinking by persons living with HIV (PLHIV) is a well-established determinant of sub-optimal HIV care and treatment outcomes. Despite this, to date, few interventions have sought to reduce hazardous drinking among PLHIV in sub-Saharan Africa (SSA). We describe an iterative cultural adaptation of an evidence-based multi-session alcohol reduction intervention for PLHIV in southwestern Uganda. The adaptation process included identifying core, theoretically informed, intervention elements, and conducting focus group discussions and cognitive interviews with community members, HIV clinic staff and patients to modify key intervention characteristics for cultural relevance and saliency. Adaptation of evidence-based alcohol reduction interventions can be strengthened by the inclusion of the target population and key stakeholders in shaping the content, while retaining fidelity to core intervention elements.
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Miller AP, Pitpitan EV, Kiene SM, Raj A, Jain S, Zúñiga ML, Nabulaku D, Nalugoda F, Ssekubugu R, Nantume B, Kigozi G, Sewankambo NK, Kagaayi J, Reynolds SJ, Grabowski K, Wawer M, Wagman JA. 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 Alcohol Depend 2021; 228:109005. [PMID: 34600249 PMCID: PMC8628865 DOI: 10.1016/j.drugalcdep.2021.109005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/16/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Abstract
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 = 3823 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.
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Affiliation(s)
- Amanda P Miller
- University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, 92093, United States; San Diego State University School of Public Health, San Diego, CA, United States.
| | - Eileen V Pitpitan
- San Diego State University School of Social Work, San Diego, CA, United States
| | - Susan M Kiene
- San Diego State University School of Public Health, San Diego, CA, United States
| | - Anita Raj
- University of California, San Diego School of Medicine, Division of Infectious Diseases and Global Public Health, La Jolla, CA, 92082, United States
| | - Sonia Jain
- University of California, San Diego, Herbert Wertheim School of Public Health and Human Longevity Science, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- San Diego State University School of Social Work, San Diego, CA, United States
| | | | | | | | | | | | - Nelson K Sewankambo
- Rakai Health Sciences Program, Entebbe, Uganda; Makerere University School of Medicine, Kampala, Uganda
| | | | - Steven J Reynolds
- Rakai Health Sciences Program, Entebbe, Uganda; Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, United States; Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Kate Grabowski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Pathology, Johns Hopkins School of Medicine, Baltimore, United States
| | - Maria Wawer
- Rakai Health Sciences Program, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, United States; Department of Medicine, Johns Hopkins School of Medicine, United States
| | - Jennifer A Wagman
- University of California, Los Angeles Fielding School of Public Health, Department of Community Health Sciences, Los Angeles, CA, United States
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Kwiringira JN, Mugisha J, Akugizibwe M, Ariho P. 'When will the doctor be around so that I come by?!' Geo-socio effects on health care supply, access and utilisation: experiences from Kalangala Islands, Uganda. BMC Health Serv Res 2021; 21:1163. [PMID: 34702272 PMCID: PMC8549200 DOI: 10.1186/s12913-021-07204-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/20/2021] [Indexed: 11/19/2022] Open
Abstract
Background The study set out to give an in-depth intersection of geo, eco-socio exposition of the factors relating to geography, healthcare supply and utilization in an island setting. This analysis is informed by what has emerged to be known as social epidemiology. We provide in-depth explanation of context to health care access, utilization and outcomes. We argue that health care delivery has multiple intersections that are experientially complex, multi-layered and multi-dimensional to the disadvantage of vulnerable population segments of society in the study area. Methods We used a cross-sectional qualitative exploratory design. Qualitative methods facilitated an in-depth exploration and understanding of this island dispersed and peripheral setting. Data sources included a review of relevant literature and an ethnographic exploration of the lived experiences of community members while seeking and accessing health care. Data collection methods included in-depth interviews (IDI) from selected respondents, observation, focus group discussions (FGDs) and key informant interviews (KII). Results We report based on the health care systems model which posits that, health care activities are diverse but interconnected in a complex way. The identified themes are; the role of geography, access (geographical and financial) to health services, demand and utilization, Supplies, staffing and logistical barriers and a permissive and transient society. When and how to travel for care was beyond a matter of having a health need/ being sick and need arising. A motivated workforce is as critical as health facilities themselves in determining healthcare outcomes. Conclusion Geography doesn’t work and affect health outcomes in isolation. Measures that target only individuals will not be adequate to tackle health inequalities because aspects of the collective social group and physical environment may also need to be changed in order to reduce health variations.
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Affiliation(s)
| | - James Mugisha
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Mathias Akugizibwe
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
| | - Paulino Ariho
- Department of Sociology and Social Administration, Kyambogo University, Kampala, Uganda
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HIV epidemic in fishing communities in Uganda: A scoping review. PLoS One 2021; 16:e0249465. [PMID: 33793652 PMCID: PMC8016276 DOI: 10.1371/journal.pone.0249465] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Fishing communities in many Sub-Saharan African countries are a high-risk population group disproportionately affected by the HIV epidemic. In Uganda, literature on HIV in fishing communities has grown extensively since the first country’s documented case of HIV in a fishing community in 1985. The current study describes the status of the HIV burden, prevention, and treatment in Ugandan fishing communities. Method This scoping review was conducted based on the York Framework outlined by Arksey and O’Malley. We searched the PubMed, Embase, and Web of Science databases to identify relevant quantitative and qualitative studies on HIV incidence, HIV prevalence, HIV-related risk factors, HIV testing, antiretroviral therapy coverage and adherence, and interventions to improve treatment outcomes and reduce HIV risk factors. Results & conclusion We identified 52 papers and 2 reports. Thirty-four were quantitative, 17 qualitative, and 3 had a mixed-methods design. Eleven studies reported on the prevalence of HIV and 8 on HIV incidence; 9 studies documented factors associated with HIV incidence or HIV positive status; 10 studies reported on HIV testing coverage and/or associated factors; 7 reported on antiretroviral therapy coverage/adherence/outcomes; and 1 study reported on the impact of combination HIV interventions in fishing communities. This scoping review revealed a significant lack of evidence in terms of what works in HIV prevention and for improving adherence to ART, in contrast to the relatively large amount of evidence from observational quantitative and qualitative studies on HIV prevalence, incidence and related risk factors in Ugandan fishing communities. Intervention studies are urgently needed to fill the current evidence gaps in HIV prevention and ART adherence.
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Wandera SO, Tumwesigye NM, Walakira EJ, Kisaakye P, Wagman J. Alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in fishing communities of Lake Victoria, Uganda. BMC Public Health 2021; 21:544. [PMID: 33740935 PMCID: PMC7978165 DOI: 10.1186/s12889-021-10595-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have investigated the association between alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in fishing communities from eastern and central Uganda. Therefore, we aimed to determine the association between alcohol use, intimate partner violence, and HIV sexual risk behavior among young people in the fishing communities on the shores of Lake Victoria, in Uganda. METHODS We conducted multivariable logistic regression analyses of HIV risk behavior using cross-sectional data from 501 young people from Mukono (Katosi landing site) and Namayingo districts (Lugala landing site). RESULTS Almost all (97%) respondents reported at least one HIV risk behavior; more than half (54%) reported engagement in three or more HIV risk behaviors. Results from the adjusted model indicate that alcohol use, working for cash or kind, being married, and having multiple sexual partners increased the odds of HIV risk behavior. IPV was not associated with HIV risk behavior. CONCLUSION Interventions to promote consistent condom use and fewer sexual partnerships are critical for young people in the fishing communities in Uganda.
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Affiliation(s)
- Stephen Ojiambo Wandera
- Department of Population Studies (DPS), School of Statistics and Planning (SSP), College of Business and Management Sciences (CoBAMS), Makerere University, Kampala, Uganda. .,Postdoctoral Research Fellow, Fogarty International Center of the National Institutes of Health (NIH) and the University of California Global Health Institute (UCGHI), San Francisco, USA.
| | - Nazarius Mbona Tumwesigye
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eddy J Walakira
- Department of Social Work and Social Administration, School of Social Sciences, College of Humanities and Social Sciences, Makerere University, Kampala, Uganda
| | - Peter Kisaakye
- Department of Population Studies (DPS), School of Statistics and Planning (SSP), College of Business and Management Sciences (CoBAMS), Makerere University, Kampala, Uganda
| | - Jennifer Wagman
- School of Public Health, University of California, Los Angeles (UCLA), Los Angeles, California, USA
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Kuteesa MO, Webb EL, Kawuma R, Naluwugge J, Thadeus K, Ndekezi D, Seeley J. 'We shall drink until Lake Victoria dries up': Drivers of heavy drinking and illicit drug use among young Ugandans in fishing communities. Glob Public Health 2021; 17:538-554. [PMID: 33460355 DOI: 10.1080/17441692.2021.1873399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
We investigated patterns and drivers of alcohol misuse and illicit drug use among young fisherfolk. We undertook this study in fishing communities on Koome Island, Lake Victoria, Uganda, from December 2017-July 2018. We conducted six group discussions with men (3) and women (3) and 33 in-depth interviews with: young people [users (n = 10); non-users (n = 2)], local leaders (n = 3), health workers (n = 2), parents (n = 5), alcohol/illicit drugs sellers/distributors (n = 5), law enforcement officers (n = 5). We sampled participants using purposive and snowball strategies. Interview themes included: knowledge, experiences and perceptions of alcohol use/illicit drug use, HIV risk behaviour and harm reduction. We mapped alcohol/illicit drug use outlets using a Geographic Information System to capture density, distribution and proximity to young people's homes. We coded and analysed qualitative data using thematic content analysis. Motivations for heavy drinking and illicit drug use were multifaceted and largely beyond individual control. Key contextual determinants included social norms around consumption (acceptability), price (affordability), and ease of purchase (availability). Prevention and harm reduction interventions to tackle alcohol misuse and illicit drug use should be aimed at the structural rather than individual level and must be conducted in tandem with strategies to control poverty and HIV.
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Affiliation(s)
- Monica O Kuteesa
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Emily L Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Racheal Kawuma
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Josephine Naluwugge
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Kiwanuka Thadeus
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Denis Ndekezi
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Social Aspects of Health Programme, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.,Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
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Prevalence and correlates of men's and women's alcohol use in agrarian, trading and fishing communities in Rakai, Uganda. PLoS One 2020; 15:e0240796. [PMID: 33125397 PMCID: PMC7598464 DOI: 10.1371/journal.pone.0240796] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/03/2020] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION 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).
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