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Hladik W, Nasirumbi Muniina P, Familiar I, Kaiser P, Ogwal M, Serwadda D, Sande E, Kiyingi H, Siya Bahinduka C, Dolan C. Sexual and nonsexual violence and mental health among male refugees from the Democratic Republic of Congo residing in Kampala, Uganda: a population-based survey. Med Confl Surviv 2023; 39:389-411. [PMID: 37849278 DOI: 10.1080/13623699.2023.2263730] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/23/2023] [Indexed: 10/19/2023]
Abstract
We conducted a population-based survey in 2013 in Kampala, Uganda, to examine violence and mental health outcomes among self-settled male refugees from the Eastern Democratic Republic of Congo (DRC). Male DRC refugees aged 18+ years were sampled through respondent-driven sampling. Key interview domains included demographics, experiences of sexual and nonsexual violence, social support, PTSD, depression and suicide ideation. Data analysis was weighted to generate population-level estimates. We sampled 718 men (mean age: 33 years), most of whom had lived in North or South Kivu. Nonsexual violence, such as beatings (79.4%) and torture (63.8%), was frequent. A quarter (26.2%) had been raped; 49.9% of rape victims had been raped on multiple occasions, and 75.7% of rape victims had been gang raped. We estimated 52.8% had post-traumatic stress disorder (PTSD); 44.4% reported suicidal ideation. Numerous traumas were significantly (p < 0.05) associated with PTSD such as rape (adjusted odds ratio [aOR] = 1.82), war-related injuries (aOR = 2.90) or having been exposed to >15 traumas (compared to ≤10; aOR = 6.89). Traumata are frequent experiences in this self-settled male refugee population and are often accompanied by adverse mental health outcomes. Screening for trauma and adverse mental health outcomes and providing targeted services are paramount to improve these refugees' lives.
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Affiliation(s)
- Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, USA
| | | | - Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, Michigan
| | - Peter Kaiser
- Center for Victims of Torture and War, Swiss Red Cross, Bern, Switzerland
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Chris Dolan
- Global Sustainable Development Department, Warwick University, Coventry, UK
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Dickson-Gomez J, Krechel S, Katende D, Johnston B, Twaibu W, Glasman L, Ogwal M, Musinguzi G. The Role of Context in Integrating Buprenorphine into a Drop-In Center in Kampala, Uganda, Using the Consolidated Framework for Implementation Research. Int J Environ Res Public Health 2022; 19:10382. [PMID: 36012015 PMCID: PMC9407835 DOI: 10.3390/ijerph191610382] [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] [Received: 06/29/2022] [Revised: 08/02/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although Africa has long borne the brunt of the human immunodeficiency virus (HIV) epidemic, until recently, the continent has been considered largely free of illicit drug use and injection drug use in particular. In Uganda, the number of people who use or inject drugs (PWUD and PWID, respectively) has increased, and PWID are a key population at high risk for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) infection. However, harm reduction practices, including providing clean injection equipment and medication-assisted treatment (MAT), have only recently been piloted in the country. This project aims to integrate buprenorphine into a harm reduction drop-in center (DIC). METHODS The Consolidated Framework for Implementation Research was used to guide our preparations to integrate buprenorphine into existing practices at a harm reduction DIC. We conducted key informant interviews with members of a community advisory board and DIC staff to document this process, its successes, and its failures. RESULTS Results indicate that criminalization of drug use and stigmatization of PWUD challenged efforts to provide buprenorphine treatment in less regulated community settings. CONCLUSIONS DIC staff and their commitment to harm reduction and advocacy facilitated the process of obtaining necessary approvals.
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Affiliation(s)
- Julia Dickson-Gomez
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Sarah Krechel
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Dan Katende
- Uganda Harm Reduction Network, Kampala 31762, Uganda
| | - Bryan Johnston
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Wamala Twaibu
- Uganda Harm Reduction Network, Kampala 31762, Uganda
| | - Laura Glasman
- Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala 7072, Uganda
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Hakim AJ, Ogwal M, Doshi RH, Kiyingi H, Sande E, Serwadda D, Musinguzi G, Standish J, Hladik W. At the intersection of sexual and reproductive health and HIV services: use of moderately effective family planning among female sex workers in Kampala, Uganda. BMC Pregnancy Childbirth 2022; 22:646. [PMID: 35978285 PMCID: PMC9382809 DOI: 10.1186/s12884-022-04977-5] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
Background Female sex workers are vulnerable to HIV, sexually transmitted diseases, and unintended pregnancies; however, the literature on female sex workers (FSW) focuses primarily on HIV and is limited regarding these other health issues.
Methods We conducted a respondent-driven sampling (RDS) survey during April-December 2012 to characterize the reproductive health of and access to contraceptives FSW in Kampala, Uganda. Eligibility criteria included age ≥ 15 years, residence in greater Kampala, and having sold sex to men in ≤ 6 months. Data were analyzed using RDS-Analyst. Survey logistic regression was used in SAS. Results We enrolled 1,497 FSW with a median age of 27 years. Almost all FSW had been pregnant at least once. An estimated 33.8% of FSW were currently not using any form of family planning (FP) to prevent pregnancy; 52.7% used at least moderately effective FP. Among those using FP methods, injectable contraception was the most common form of FP used (55.4%), followed by condoms (19.7%), oral contraception (18.1%), and implants (3.7%). HIV prevalence was 31.4%, syphilis prevalence was 6.2%, and 89.8% had at least one symptom of a sexually transmitted disease in the last six months. Using at least a moderately effective method of FP was associated with accessing sexually transmitted disease treatment in a stigma-free environment in the last six months (aOR: 1.6, 95% CI: 1.1–2.4), giving birth to 2–3 children (aOR: 2.5, 95% CI: 1.4–4.8) or 4–5 children (aOR: 2.9, 95% CI: 1.4–5.9). It is plausible that those living with HIV are also less likely than those without it to be using a moderately effective method of FP (aOR: 0.7, 95% CI: 0.5–1.0). Conclusions The provision of integrated HIV and sexual and reproductive health services in a non-stigmatizing environment has the potential to facilitate increased health service uptake by FSW and decrease missed opportunities for service provision.
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Affiliation(s)
- Avi J Hakim
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA.
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - Reena H Doshi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
| | - Herbert Kiyingi
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Enos Sande
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, Kampala, Uganda
| | - David Serwadda
- School of Public Health, Makerere University, Kampala, Uganda
| | | | - Jonathan Standish
- Department of Counseling and Psychological Services, Georgia State University, Atlanta, USA
| | - Wolfgang Hladik
- Division of Global HIV and Tuberculosis, US Centers for Disease Control and Prevention, 1600 Clifton Rd, NE, US1-2, Atlanta, GA, 30329, USA
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Kim B, Ogwal M, Sande E, Kiyingi H, Serwadda D, Hladik W. Using geographical data and rolling statistics for diagnostics of respondent-driven sampling. Soc Networks 2022; 69:74-83. [PMID: 38616951 PMCID: PMC11009932 DOI: 10.1016/j.socnet.2020.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Respondent-driven sampling (RDS) is commonly used to sample from key populations without a sampling frame since traditional methods are unable to efficiently survey them. Surveying these populations is often desirable to inform service delivery, assess effectiveness of programs, and determine prevalence of diseases. However, there are concerns about how RDS works in practice due to its many assumptions. To assess some of these assumptions, we develop diagnostics using geographical data and demonstrate their utility by identifying lack of convergence and characterizing RDS reach in surveys conducted among female sex workers and men who have sex with men in Kampala, Uganda.
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Affiliation(s)
- Brian Kim
- Joint Program in Survey Methodology, University of Maryland, 1218 LeFrak Hall, 7251 Preinkert Dr., College Park, MD 20742, USA
| | - Moses Ogwal
- Makerere University School of Public Health, Old Mulago Hill Road, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Enos Sande
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
| | - David Serwadda
- Makerere University School of Public Health, Old Mulago Hill Road, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, USA
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Familiar I, Muniina PN, Dolan C, Ogwal M, Serwadda D, Kiyingi H, Bahinduka CS, Sande E, Hladik W. Conflict-related violence and mental health among self-settled Democratic Republic of Congo female refugees in Kampala, Uganda - a respondent driven sampling survey. Confl Health 2021; 15:42. [PMID: 34039400 PMCID: PMC8157662 DOI: 10.1186/s13031-021-00377-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 05/11/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Violence and traumatic events are highly prevalent among refugees, but less is known about the impact of these experiences among self-settled refugees in the country of asylum. We evaluated the association between traumatic experiences and PTSD and depression symptoms among female Democratic Republic of Congo (DRC) refugees living in Kampala, Uganda. METHODS Participants were recruited using respondent driven sampling in one refugee service center in Kampala, Uganda. Eligibility criteria included: Congolese nationality, age 18+ years, self-settled in Kampala for at least 6 months, refugee status or documentation of application for refugee status. Only data from female participants were included in this analysis. Depression symptoms were screened with the Patient Health Questionnaire-2, and symptom criteria for PTSD and traumatic experiences were evaluated with the Harvard Trauma Questionnaire. Logistic regression models were performed to separately assess associations between mental health outcomes (PTSD and depression), rape and non-sexual violence. RESULTS Five hundred eighty women with a mean age of 33 years were interviewed. Among participants, 73% (95% CI:67-78%) met symptom criteria for PTSD, 57% (95% CI: 51-63%) for depression, and 65% reported thoughts of ending one's life. 79% of women reported experience of rape, for over half (54%) it occurred more than once, and 82% were gang raped. Crude and adjusted odds ratios (ORs) show that PTSD was most strongly associated with being raped (OR = 2.43, p < 0.01), lacking shelter (OR = 2.86, p < 0.01), lacking food or water (OR = 2.53, p = 0.02), lacking access to health care (OR = 2.84, p < 0.01), forced labor (OR = 2.6, p < 0.01), extortion and/or robbery (OR = 3.08, p < 0.01), experiencing the disappearance/kidnapping of a family member or friend (OR = 2.72, p < 0.01), and witnessing the killing or murder of other people (OR = 3.28, p < 0.01). Depression was significantly associated with several traumatic experiences including rape (OR = 2.3, p = 0.01), and experiencing the disappearance/kidnapping of a child or spouse (OR = 1.99, p = 0.01). CONCLUSIONS Refugee women self-settled in Kampala reported high lifetime experiences of violence and traumatic events including rape, as well as high rates of PTSD and depression. Future programming addressing self-settled refugees and their settlement in host countries may benefit from including local and national integration strategies.
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Affiliation(s)
- Itziar Familiar
- Department of Psychiatry, Michigan State University, East Lansing, MI USA
| | | | - Chris Dolan
- Refugee Law Project, School of Law, Makerere University, Kampala, Uganda
| | - Moses Ogwal
- School of Public Health, Makerere University, Kampala, Uganda
| | - David Serwadda
- Department of Disease Control, School of Public Health, Makerere University, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Centers for Disease Control and Prevention, MS E-30, 1600 Clifton Rd, Atlanta, GA-30333 USA
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Correction: Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2020; 6:e19893. [PMID: 32396517 PMCID: PMC7351262 DOI: 10.2196/19893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 05/05/2020] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.2196/12118.].
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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King R, Sebyala Z, Ogwal M, Aluzimbi G, Apondi R, Reynolds S, Sullivan P, Hladik W. How men who have sex with men experience HIV health services in Kampala, Uganda. BMJ Glob Health 2020. [PMCID: PMC7245422 DOI: 10.1136/bmjgh-2019-001901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
In sub-Saharan Africa, men who have sex with men (MSM) are socially, largely hidden and face disproportionate risk for HIV infection. Attention to HIV epidemics among MSM in Uganda and elsewhere in sub-Saharan Africa has been obscured by repressive governmental policies, criminalisation, stigma and the lack of basic epidemiological data describing these epidemics. In this paper, we aim to explore healthcare access, experiences with HIV prevention services and structural barriers to using healthcare services in order to inform the acceptability of a combination HIV prevention package of services for men who have sex with men in Uganda. We held focus group discussions (FGDs) with both MSM and healthcare providers in Kampala, Uganda, to explore access to services and to inform prevention and care. Participants were recruited through theoretical sampling with criteria based on ability to answer the research questions. Descriptive thematic coding was used to analyse the FGD data. We described MSM experiences, both negative and positive, as they engaged with health services. Our findings showed that socio-structural factors, mediated by psychological and relational factors impacted MSM engagement in care. The socio-structural factors such as stigma, homophobia and policy issues emerged strongly as did the mediating factors such as relations with specific health staff and a social support structure. A combination intervention addressing structural, social and psychological barriers could have an impact even in the precarious policy environment where this study was conducted.
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Affiliation(s)
- Rachel King
- Global Health Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Zubayiri Sebyala
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ogwal
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Uganda, Kampala, Uganda
| | - Rose Apondi
- Centers for Disease Control and Prevention, Uganda, Kampala, Uganda
| | - Steven Reynolds
- Department of Medicare, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
- National Institute of Allergy and Infectious Diseases Division of Intramural Research, Bethesda, Maryland, USA
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Atlanta, Georgia, USA
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Doshi RH, Apodaca K, Ogwal M, Bain R, Amene E, Kiyingi H, Aluzimbi G, Musinguzi G, Serwadda D, McIntyre AF, Hladik W. Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study. JMIR Public Health Surveill 2019; 5:e12118. [PMID: 31407673 PMCID: PMC6771531 DOI: 10.2196/12118] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 01/09/2019] [Accepted: 05/09/2019] [Indexed: 01/19/2023] Open
Abstract
Background Key populations, including people who inject drugs (PWID), men who have sex with men (MSM), and female sex workers (FSW), are disproportionately affected by the HIV epidemic. Understanding the magnitude of, and informing the public health response to, the HIV epidemic among these populations requires accurate size estimates. However, low social visibility poses challenges to these efforts. Objective The objective of this study was to derive population size estimates of PWID, MSM, and FSW in Kampala using capture-recapture. Methods Between June and October 2017, unique objects were distributed to the PWID, MSM, and FSW populations in Kampala. PWID, MSM, and FSW were each sampled during 3 independent captures; unique objects were offered in captures 1 and 2. PWID, MSM, and FSW sampled during captures 2 and 3 were asked if they had received either or both of the distributed objects. All captures were completed 1 week apart. The numbers of PWID, MSM, and FSW receiving one or both objects were determined. Population size estimates were derived using the Lincoln-Petersen method for 2-source capture-recapture (PWID) and Bayesian nonparametric latent-class model for 3-source capture-recapture (MSM and FSW). Results We sampled 467 PWID in capture 1 and 450 in capture 2; a total of 54 PWID were captured in both. We sampled 542, 574, and 598 MSM in captures 1, 2, and 3, respectively. There were 70 recaptures between captures 1 and 2, 103 recaptures between captures 2 and 3, and 155 recaptures between captures 1 and 3. There were 57 MSM captured in all 3 captures. We sampled 962, 965, and 1417 FSW in captures 1, 2, and 3, respectively. There were 316 recaptures between captures 1 and 2, 214 recaptures between captures 2 and 3, and 235 recaptures between captures 1 and 3. There were 109 FSW captured in all 3 rounds. The estimated number of PWID was 3892 (3090-5126), the estimated number of MSM was 14,019 (95% credible interval (CI) 4995-40,949), and the estimated number of FSW was 8848 (95% CI 6337-17,470). Conclusions Our population size estimates for PWID, MSM, and FSW in Kampala provide critical population denominator data to inform HIV prevention and treatment programs. The 3-source capture-recapture is a feasible method to advance key population size estimation.
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Affiliation(s)
- Reena H Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Kevin Apodaca
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Public Health Institute, Oakland, CA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Rommel Bain
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Ermias Amene
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Entebbe, Uganda
| | | | - David Serwadda
- Makerere University, School of Public Health, Kampala, Uganda
| | - Anne F McIntyre
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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Apodaca K, Doshi RH, Ogwal M, Kiyingi H, Aluzimbi G, Musinguzi G, Lutalo I, Akello E, Hladik W. Capture-Recapture Among Men Who Have Sex With Men and Among Female Sex Workers in 11 Towns in Uganda. JMIR Public Health Surveill 2019; 5:e12316. [PMID: 30942697 PMCID: PMC6468338 DOI: 10.2196/12316] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 12/18/2018] [Accepted: 02/05/2019] [Indexed: 11/13/2022] Open
Abstract
Background Key populations at higher risk for HIV infection, including people who inject drugs, men who have sex with men (MSM), and female sex workers (FSWs), are disproportionately affected by the HIV/AIDS epidemic. Empirical estimates of their population sizes are necessary for HIV program planning and monitoring. Such estimates, however, are lacking for most of Uganda’s urban centers. Objective The aim of this study was to estimate the number of FSWs and MSM in select locations in Uganda. Methods We utilized conventional 2-source capture-recapture (CRC) to estimate the population of FSWs in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, Busia, Tororo, Masaka, and Kabale and the population of MSM in Mbale, Jinja, Wakiso, Mbarara, Gulu, Kabarole, and Mukono from June to August 2017. Hand mirrors and key chains were distributed to FSWs and MSM, respectively, by peers during capture 1. A week later, different FSWs and MSM distributors went to the same towns to collect data for the second capture. Population size estimates and 95% CIs were calculated using the CRC Simple Interactive Statistical Analysis. Results We estimated the population of FSWs and MSM using 2 different recapture definitions: those who could present the object or identify the object from a set of photos. The most credible (closer to global estimates of MSM; 3%-5%) estimates came from those who presented the objects only. The FSW population in Mbale was estimated to be 693 (95% CI 474-912). For Jinja, Mukono, Busia, and Tororo, we estimated the number of FSWs to be 802 (95% CI 534-1069), 322 (95% CI 300-343), 961 (95% CI 592-1330), and 2872 (95% CI 0-6005), respectively. For Masaka, Mbarara, Kabale, and Wakiso, we estimated the FSWs population to be 512 (95% CI 384-639), 1904 (95% CI 1058-2749), 377 (95% CI 247-506), and 828 (95% CI 502-1152), respectively. For Kabarole and Gulu, we estimated the FSWs population to be 397 (95% CI 325-469) and 1425 (95% CI 893-1958), respectively. MSM estimates were 381 (95% CI 299-462) for Mbale, 1100 (95% CI 351-1849) for Jinja, 368 (95% CI 281-455) for Wakiso, 322 (95% CI 253-390) for Mbarara, 180 (95% CI 170-189) for Gulu, 335 (95% CI 258-412) for Kabarole, and 264 (95% CI 228-301) for Mukono. Conclusions The CRC activity was one of the first to be carried out in Uganda to obtain small town–level population sizes for FSWs and MSM. We found that it is feasible to use FSW and MSM peers for this activity, but proper training and standardized data collection tools are essential to minimize bias.
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Affiliation(s)
- Kevin Apodaca
- Public Health Institute, Oakland, CA, United States.,Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
| | - Reena Hemendra Doshi
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States.,Centers for Disease Control and Prevention, Epidemic Intelligence Service, Atlanta, GA, United States
| | - Moses Ogwal
- Makerere University, School of Public Health, Kampala, Uganda
| | - Herbert Kiyingi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Kampala, Uganda
| | - George Aluzimbi
- Centers for Disease Control and Prevention, Division of Global HIV and TB, Kampala, Uganda
| | | | - Ibrahim Lutalo
- Makere University, School of Public Health, Monitoring and Evaluation Techical Support Program, Kampala, Uganda
| | - Evelyn Akello
- Makere University, School of Public Health, Monitoring and Evaluation Techical Support Program, Kampala, Uganda
| | - Wolfgang Hladik
- Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, Atlanta, GA, United States
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Doshi RH, Sande E, Ogwal M, Kiyingi H, McIntyre A, Kusiima J, Musinguzi G, Serwadda D, Hladik W. Progress toward UNAIDS 90-90-90 targets: A respondent-driven survey among female sex workers in Kampala, Uganda. PLoS One 2018; 13:e0201352. [PMID: 30231030 PMCID: PMC6145590 DOI: 10.1371/journal.pone.0201352] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 07/13/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND We investigated progress towards UNAIDS 90-90-90 targets among female sex workers in Kampala, Uganda, who bear a disproportionate burden of HIV. METHODS Between April and December 2012, 1,487 female sex workers, defined as women, 15-49 years, residing in greater Kampala, and selling sex for money in the last 6 months, were recruited using respondent-driven sampling. Venous blood was collected for HIV and viral load testing [viral load suppression (VLS) defined as <1,000 copies/mL]. We collected data using audio computer-assisted self-interviews and calculated weighted population-level estimates. RESULTS The median age was 27 years (interquartile range: 23 to 32). HIV seroprevalence was 31.4% (95% confidence interval [CI]: 29.0, 33.7%). Among all female sex workers who tested HIV-positive in the survey (population-level targets), 45.5% (95% CI: 40.1, 51.0) had knowledge of their serostatus (population-level target: 90%), 37.8% (95% CI: 32.2, 42.8) self-reported to be on ART (population-level target: 81%), and 35.2% (95% CI: 20.7, 30.4) were virally suppressed (population-level target: 73%). CONCLUSIONS HIV prevalence among Kampala female sex workers is high, whereas serostatus knowledge and VLS are far below UNAIDS targets. Kampala female sex workers are in need of intensified and targeted HIV prevention and control efforts.
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Affiliation(s)
- Reena H. Doshi
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
- * E-mail:
| | - Enos Sande
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Moses Ogwal
- Makerere University School of Public Health, Kampala, Uganda
| | - Herbert Kiyingi
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Entebbe, Uganda
| | - Anne McIntyre
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Joy Kusiima
- Makerere University School of Public Health, Kampala, Uganda
| | | | - David Serwadda
- Makerere University School of Public Health, Kampala, Uganda
| | - Wolfgang Hladik
- Division of Global HIV and TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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