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Bogart LM, Musoke W, Mayatsa J, Marsh T, Naigino R, Banegura A, Mukama CS, Allupo S, Odiit M, Kadama H, Mukasa B, Wanyenze RK. Recommendations for Improving Oral Pre-exposure Prophylaxis Implementation and Social Marketing in Ugandan Fisherfolk Communities: A Qualitative Exploration. Community Health Equity Res Policy 2024; 44:189-199. [PMID: 36194425 PMCID: PMC10070557 DOI: 10.1177/0272684x221113608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
Background: HIV is hyperendemic among fisherfolk in Sub-Saharan Africa, especially around Lake Victoria, Uganda. Purpose/Research Design: We conducted cross-sectional semi-structured interviews about oral pre-exposure prophylaxis (PrEP) implementation with 35 Ugandan fisherfolk (15 women, 20 men) and 10 key stakeholders (healthcare providers, policymakers, community leaders). We used a directed content analysis approach based on implementation science and social marketing frameworks. Results: Participants showed high acceptability for PrEP. Anticipated barriers among fisherfolk included stigma (due to similar medications/packaging as HIV treatment); misconceptions; mobility, competing needs, poverty, and partner conflict. Anticipated provider barriers included insufficient staffing and travel support. Recommendations included: change PrEP packaging; integrate PrEP with other services; decrease PrEP refill frequency; give transportation resources to providers; train more healthcare workers to provide PrEP to fisherfolk; and use positively framed messages to promote PrEP. Conclusions: Results can inform policymakers and healthcare organizations on how to overcome barriers to PrEP scale-up in most at-risk populations with poor healthcare access.
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Affiliation(s)
| | | | - Jimmy Mayatsa
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Terry Marsh
- RAND Corporation, Santa Monica, California, United States
| | - Rose Naigino
- Ministry of Health, Republic of Uganda, Kampala, Uganda
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Wagner GJ, Gwokyalya V, Akena D, Nakigudde J, McBain R, Faherty L, Ngo V, Nakku J, Kyohangirwe L, Banegura A, Beyeza-Kashesya J, Wanyenze RK. Stressors and Maladaptive Coping Mechanisms Associated with Elevated Perinatal Depressive Symptoms and Suicidality Among Women Living with HIV in Uganda. Int J Behav Med 2023; 30:743-752. [PMID: 36127627 PMCID: PMC10084842 DOI: 10.1007/s12529-022-10124-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Perinatal depression is highly prevalent among women living with HIV and contributes to nonadherence to the PMTCT (prevention of mother-to-child transmission) care continuum. We examined correlates of elevated depressive symptoms and suicidality in this population. METHOD Baseline data from 391 Ugandan women enrolled in a cluster randomized controlled trial of a depression care intervention were analyzed. Adult women with confirmed sero-positive HIV status were eligible if their gestation period was ≤ 32 weeks, and they had a Patient Health Questionnaire (PHQ-9) score ≥ 5. Correlates of elevated depressive symptoms (PHQ-9 > 9) and moderate-to-severe suicidal ideation (more than half of the days in the prior 2 weeks) were assessed using bivariate and multivariate logistic regression models, controlling for clustering within study sites by using a random effects specification (with study site as the random effect), as well as age and education. RESULTS The mean PHQ-9 score was 12.7 (SD = 5.1); 267 (68.3%) participants had elevated depressive symptoms, and 51 (13.0%) reported moderate-to-severe suicidality. In multiple logistic regression analysis, perceived provider stigma of childbearing [OR (95% CI) = 1.81 (1.16, 2.84)], greater use of negative problem-solving [OR (95% CI) = 1.09 (1.04, 1.15)], and lower general social support [OR (95% CI) = 0.50 (0.30, 0.82)] were correlated with elevated depression symptoms, while moderate-to-severe suicidal ideation was correlated with greater experience of physical interpersonal violence (IPV) and greater use of negative problem-solving. CONCLUSIONS Programs aimed at improving provider support for the childbearing needs of persons living with HIV, supporting women who are experiencing IPV, and helping women to develop effective problem-solving skills and social supports may reduce symptoms of perinatal depression and help optimize PMTCT care outcomes. TRIAL REGISTRATION Clinicaltrials.gov NCT03892915 (registered March 21, 2019).
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Affiliation(s)
| | | | | | | | | | - Laura Faherty
- RAND Corporation, Santa Monica, CA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Victoria Ngo
- RAND Corporation, Santa Monica, CA, USA
- City University of New York Graduate School of Public Health and Health Policy, New York City, NY, USA
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Karim QA, Banegura A, Cahn P, Christie CDC, Dintruff R, Distel M, Hankins C, Hellmann N, Katabira E, Lehrman S, Montaner J, Purdon S, Rooney JF, Wood R, Heidari S. Asking the right questions: developing evidence-based strategies for treating HIV in women and children. BMC Public Health 2011; 11:388. [PMID: 21612633 PMCID: PMC3118247 DOI: 10.1186/1471-2458-11-388] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 05/25/2011] [Indexed: 11/10/2022] Open
Abstract
In July 2010, the World Health Organization (WHO) issued formal revisions of its guidelines on the use of highly active antiretroviral therapy for HIV. The new guidelines greatly expand eligibility for treatment of adults and children, as well as for pregnant women seeking prophylaxis for vertical HIV transmission. WHO's new recommendations bring the guidelines closer to practices in developed countries, and its shift to earlier treatment alone will increase the number of treatment-eligible people by 50% or more.Scaling up access to HIV treatment is revealing important gaps in our understanding of how best to provide for all those in need. This knowledge gap is especially significant in developing countries, where women and children comprise a majority of those living with HIV infection. Given the magnitude and significance of these populations, the International AIDS Society, through its Industry Liaison Forum, prioritized HIV treatment and prophylaxis of women and children. In March 2010, the International AIDS Society and 15 partners launched a Consensus Statement outlining priority areas in which a relative lack of knowledge impedes delivery of optimal prevention of mother to child transmission (PMTCT) and treatment to women and children.The Consensus Statement, "Asking the Right Questions: Advancing an HIV Research Agenda for Women and Children", makes a special appeal for a more gender-sensitive approach to HIV research at all stages, from conception to design and implementation. It particularly emphasizes research to enhance the understanding of sex-based differences and paediatric needs in treatment uptake and response. In addition to clinical issues, the statement focuses on programmatic research that facilitates access and adherence to antiretroviral regimens. Better coordination of HIV management with sexual and reproductive healthcare delivery is one such approach.We discuss here our knowledge gaps concerning effective, safe PMTCT and treatment for women and children in light of the expansion envisioned by WHO's revised guidelines. The guideline's new goals present an opportunity for advancing the women and children's agenda outlined in the Consensus Statement.
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Affiliation(s)
- Quarraisha Abdool Karim
- Department of Epidemiology, Columbia University, New York, USA
- Prevention and Epidemiology, Centre for the AIDS Programme of Research in South Africa, Durban, South Africa
| | | | - Pedro Cahn
- Direccion Cientifica, Fundacion Huesped, Buenos Aires, Argentina
| | - Celia DC Christie
- Department of Pediatrics, University of the West Indies, Kingston, Jamaica
| | | | - Manuel Distel
- Medical Affairs, Boehringer Ingelheim GmbH, Ingelheim, Germany
| | - Catherine Hankins
- Office of the Deputy Executive Director, UNAIDS, Geneva, Switzerland
| | - Nicholas Hellmann
- Medical and Scientific Affairs, Elizabeth Glaser Pediatric AIDS Foundation, Washington, DC, USA
| | - Elly Katabira
- Department of Research, Makerere Medical School, Kampala, Uganda
| | - Sandra Lehrman
- Scientific Affairs - Infectious Diseases, Office of the Chief Medical Officer, Merck & Co, Upper Gwynedd, Pennsylvania, USA
| | - Julio Montaner
- AIDS Research and Head of Division of AIDS, University of British Columbia, Vancouver, Canada
| | - Scott Purdon
- Access and Government Affairs, ViiV Healthcare, Middlesex, UK
| | - James F Rooney
- Medical Affairs, Gilead Sciences, Foster City, California, USA
| | - Robin Wood
- Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Centre, University of Cape Town, South Africa
| | - Shirin Heidari
- Research Promotion, International AIDS Society, Geneva, Switzerland
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