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Sileo KM, Muhumuza C, Wanyenze RK, Kershaw TS, Ellerbe B, Muñoz S, Sekamatte S, Lule H, Kiene SM. Effects of a community-based, multi-level family planning intervention on theoretically grounded intermediate outcomes for couples in rural Uganda: Results from a mixed methods pilot evaluation. Br J Health Psychol 2024. [PMID: 38242837 DOI: 10.1111/bjhp.12713] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 12/18/2023] [Indexed: 01/21/2024]
Abstract
OBJECTIVES This study tested the theoretically grounded conceptual model of a multi-level intervention, Family Health = Family Wealth (FH = FW), by examining FH = FW's effect on intermediate outcomes among couples in rural Uganda. FH = FW is grounded in the social-ecological model and the social psychological theory of transformative communication. DESIGN A pilot quasi-experimental controlled trial. METHODS Two matched clusters (communities) were randomly allocated to receive the FH = FW intervention or an attention/time-matched water, sanitation and hygiene intervention (N = 140, 35 couples per arm). Quantitative outcomes were collected through interviewer-administered questionnaires at baseline, 7-months and 10-months follow-up. Focus group discussions (n = 39) and semi-structured interviews (n = 27) were conducted with subsets of FH = FW participants after data collection. Generalized estimated equations tested intervention effects on quantitative outcomes, and qualitative data were analysed through thematic analysis-these data were mixed and are presented by level of the social-ecological model. RESULTS The findings demonstrated an intervention effect on family planning determinants across social-ecological levels. Improved individual-level family planning knowledge, attitudes and intentions, and reduced inequitable gender attitudes, were observed in intervention versus comparator, corroborated by the qualitative findings. Interpersonal-level changes included improved communication, shared decision-making and equitable relationship dynamics. At the community level, FH = FW increased perceived acceptance of family planning among others (norms), and the qualitative findings highlighted how FH = FW's transformative communication approach reshaped definitions of a successful family to better align with family planning. CONCLUSIONS This mixed methods pilot evaluation supports FH = FW's theoretically grounded conceptual model and ability to affect multi-level drivers of a high unmet need for family planning.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Christine Muhumuza
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavior Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Brooke Ellerbe
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Suyapa Muñoz
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | | | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Susan M Kiene
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University (SDSU) School of Public Health, San Diego, California, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Muhumuza C, Sileo KM, Wanyenze RK, Kershaw TS, Lule H, Sekamatte S, Kiene SM. Development of a multi-level family planning intervention for couples in rural Uganda: key findings & adaptations made from community engaged research methods. BMC Womens Health 2023; 23:545. [PMID: 37865746 PMCID: PMC10590522 DOI: 10.1186/s12905-023-02667-8] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 09/21/2023] [Indexed: 10/23/2023] Open
Abstract
BACKGROUND Uganda has among the highest fertility rates in the world and multi-level barriers contribute to the low contraceptive use. OBJECTIVE The objective of this study was to develop a culturally and socially relevant, community-based intervention to increase contraceptive use among couples in rural Uganda through community-engaged research methods. This study reports on the community-engaged research that informed the intervention's content and structure and the final content of the intervention; the evaluation of the pilot intervention will be reported upon completion. METHODS An intervention steering committee of community stakeholders reviewed the initially proposed intervention content and approach. Four (4) gender-segregated focus groups were conducted with twenty-six (26) men and women who had an unmet need for family planning. Fifteen key-informant interviews were conducted with community leaders and family planning stakeholders. Finally, the 4-session intervention was pilot tested with a cohort of couples (N = 7) similar in demographics to the target sample of the future pilot intervention trial. Qualitative data were analyzed thematically. RESULTS Findings included the identification of community beliefs to reshape in order to increase family planning acceptance, as well as strategies to engage men, acceptable approaches for community leader involvement in the intervention to endorse family planning, and methods for managing gender dynamics and minimizing risk of unintended negative consequences of participation. The findings were used to inform the ideal structure and format of the intervention, including the distribution of contraceptives directly during group sessions, and identified the need to strengthen health worker capacity to provide Long-Acting Reversable Contraceptives (LARCs) as part of the intervention. CONCLUSIONS These findings were used to refine an intervention before a larger scale pilot test of its feasibility, acceptability, and potential efficacy. They can inform other multi-level family planning interventions in similar settings and the methods can be adopted by others to increase the feasibility, acceptability, and cultural relevance of interventions.
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Affiliation(s)
- Christine Muhumuza
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala, Uganda.
| | - Katelyn M Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Haruna Lule
- Gombe Hospital, Butambala Local Government, Kayenje, Uganda
| | | | - Susan M Kiene
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
- School of Public Health, San Diego State University, San Diego, USA
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Almeida A, Ogbonnaya IN, Wanyenze RK, Crockett KS, Ediau M, Naigino R, Lin CD, Kiene SM. A Psychometric Evaluation and a Framework Test of the HIV Stigma Mechanisms Scale Among a Population-Based Sample of Men and Women Living with HIV in Central Uganda. AIDS Behav 2023; 27:3038-3052. [PMID: 36917424 PMCID: PMC10440247 DOI: 10.1007/s10461-023-04026-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/15/2023]
Abstract
HIV stigma is a critical barrier to HIV prevention and care. This study evaluates the psychometric properties of the HIV Stigma Mechanisms Scale (HIV-SMS) among people living with HIV (PLHIV) in central Uganda and tests the underlying framework. Using data from the PATH/Ekkubo study, (n = 804 PLHIV), we assessed the HIV-SMS' reliability and validity (face, content, construct, and convergent). We used multiple regression analyses to test the HIV-SMS' association with health and well-being outcomes. Findings revealed a more specific (5-factor) stigma structure than the original model, splitting anticipated and enacted stigmas into two subconstructs: family and healthcare workers (HW). The 5-factor model had high reliability (α = 0.92-0.98) and supported the convergent validity (r = 0.12-0.42, p < 0.01). The expected relationship between HIV stigma mechanisms and health outcomes was particularly strong for internalized stigma. Anticipated-family and enacted-family stigma mechanisms showed partial agreement with the hypothesized health outcomes. Anticipated-HW and enacted-HW mechanisms showed no significant association with health outcomes. The 5-factor HIV-SMS yielded a proper and nuanced measurement of HIV stigma in central Uganda, reflecting the importance of family-related stigma mechanisms and showing associations with health outcomes similar to and beyond the seminal study.
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Affiliation(s)
- Alexandra Almeida
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, USA
- School of Social Work, College of Health and Human Services, San Diego State University, San Diego, CA, USA
- Programa de Computação Científica, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | - Ijeoma Nwabuzor Ogbonnaya
- School of Social Work, Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Rose Naigino
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Chii-Dean Lin
- Department of Mathematics & Statistics, San Diego State University, La Jolla, CA, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala, Uganda.
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
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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, Wawer M, Wagman JA. In the era of universal test and treat in Uganda, recent intimate partner violence is not associated with subsequent ART use or viral suppression. AIDS Care 2023; 35:1291-1298. [PMID: 37170392 PMCID: PMC10524228 DOI: 10.1080/09540121.2023.2206092] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 04/17/2023] [Indexed: 05/13/2023]
Abstract
Intimate partner violence (IPV) has been associated with delays throughout the HIV care continuum. This study explored prospective associations between experiences of past-year IPV and two HIV care outcomes in the context of current universal test and treat guidelines using two consecutive rounds of an ongoing HIV surveillance study conducted in the Rakai region of Uganda. Longitudinal logistic regression models examined associations between IPV, use of antiretroviral therapy (ART) and viral load suppression (VS), adjusting for outcome variables at baseline. To address differences in ART retention by IPV, propensity scores were used to create inverse-probability-of-treatment-and-censoring-weighted (IPTCW) models. At baseline, of 1923 women with HIV (WWH), 34.6%, 26.5%, 13.5% reported past-year verbal, physical and sexual IPV; a lower proportion of persons who experienced physical IPV (79.4%) were VS than those who did not (84.3%; p = 0.01). The proportion VS at baseline also significantly differed by exposure to verbal IPV (p = 0.03). However, in adjusted longitudinal models, IPV was not associated with lower odds of ART use or VS at follow-up. Among WWH in the Rakai region, IPV does not appear to be a barrier to subsequent ART use or VS. However, given the prevalence of IPV in this population, interventions are needed.
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Affiliation(s)
- Amanda P Miller
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Eileen V Pitpitan
- San Diego State University School of Social Work, San Diego, CA, USA
| | - Susan M Kiene
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Anita Raj
- Department of Medicine, School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Sonia Jain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | | | | | - 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
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Maria Wawer
- Rakai Health Sciences Program, Entebbe, Uganda
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer A Wagman
- Department of Community Health Sciences, University of California, Los Angeles Fielding School of Public Health, Los Angeles, CA, USA
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Sileo KM, Muhumuza C, Wanyenze RK, Kershaw TS, Sekamatte S, Lule H, Kiene SM. A pilot quasi-experimental controlled trial of a community-based, multilevel family planning intervention for couples in rural Uganda: evidence of feasibility, acceptability, and effect on contraceptive uptake among those with an unmet need for family planning. Contraception 2023; 125:110096. [PMID: 37355086 DOI: 10.1016/j.contraception.2023.110096] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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] [Received: 02/28/2023] [Revised: 06/02/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVES Effective interventions to reduce the unmet need for family planning in low-income settings are limited. This study aimed to establish the feasibility, acceptability, and preliminary effects of Family Health=Family Wealth (FH=FW), a multilevel intervention aimed to increase high-efficacy contraceptive uptake among couples wanting to delay pregnancy. STUDY DESIGN A pilot quasi-experimental controlled trial was conducted in rural Uganda, with 70 couples wanting to delay pregnancy but not using contraceptives (n = 140). Two matched clusters (communities) were randomly allocated to receive FH=FW or a comparator intervention via coin toss. FH=FW included health system strengthening elements and four facilitated group sessions. Interviewer-administered questionnaires were conducted at baseline and at ∼7-month and ∼10-month follow-up, and process data gathered feasibility/acceptability outcomes. RESULTS Of 121 households visited in the intervention community, 63 couples were screened, and 35 enrolled. In the comparator, 61 households were visited, 45 couples screened, and 35 enrolled. Intervention attendance was 99%, fidelity was 96%, and 100% of participants reported being satisfied with the intervention. From no use at baseline, there was 31% more high efficacy contraceptive uptake at 7 months and 40% more at 10 months in intervention versus comparator couples (adjusted odds ratio = 1.68, 95% confidence interval = 0.78-3.62, p = 0.19). A decline in fertility desires was observed in intervention versus comparator participants from baseline (Wald χ2 = 9.87, p = 0.007; Cohen's d: 7 months, 0.06; 10 months, 0.49). CONCLUSIONS FH=FW is a feasible and acceptable intervention with strong promise in its effect on contraceptive uptake to be established in a future trial. IMPLICATIONS The FH=FW intervention addresses multilevel family planning barriers through four group dialogs with couples paired with efforts to reduce health system barriers. A quasi-experimental controlled trial provides preliminary support for its feasibility, acceptability, contraceptive uptake and fertility desire effects, and success in engaging both women and men.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, TX, United States.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Mulago Kampala, Uganda.
| | - Trace S Kershaw
- Department of Social and Behavior Science, Yale School of Public Health, New Haven, CT, United States.
| | | | - Haruna Lule
- Global Center of Health Excellency (GloCHE), Kampala, Uganda.
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Mulago Kampala, Uganda; Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, United States.
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Schuster JE, Erickson TR, Goldman JL, Benjamin DK, Brookhart MA, Dewhurst S, Fist A, Foxe J, Godambe M, Gwynn L, Kiene SM, Keener Mast D, McDaniels-Davidson C, Newland JG, Oren E, Selvarangan R, Shinde N, Walsh T, Watterson T, Zand M, Zimmerman KO, Kalu IC. Utilization and Impact of Symptomatic and Exposure SARS-CoV-2 Testing in K-12 Schools. Pediatrics 2023; 152:e2022060352I. [PMID: 37394504 PMCID: PMC10312273 DOI: 10.1542/peds.2022-060352i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES The Centers for Disease Control and Prevention recommend that schools can offer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnostic (on-demand) testing for students and staff with coronavirus disease 2019 symptoms or exposures. Data related to the uptake, implementation, and effect of school-associated on-demand diagnostic testing have not been described. METHODS The Rapid Acceleration of Diagnostics Underserved Populations Return to School program provided resources to researchers to implement on-demand SARS-CoV-2 testing in schools. This study describes the strategies used and uptake among the different testing programs. Risk of positivity was compared for symptomatic and exposure testing during the δ and ο variant periods. We estimated the number of school absence days saved with school-based diagnostic testing. RESULTS Of the 16 eligible programs, 7 provided school-based on-demand testing. The number of persons that participated in these testing programs is 8281, with 4134 (49.9%) receiving >1 test during the school year. Risk of positivity was higher for symptomatic testing compared with exposure testing and higher during the ο variant predominant period compared with the δ variant predominant period. Overall, access to testing saved an estimated 13 806 absent school days. CONCLUSIONS School-based on-demand SARS-CoV-2 testing was used throughout the school year, and nearly half the participants accessed testing on more than 1 occasion. Future studies should work to understand participant preferences around school-based testing and how these strategies can be used both during and outside of pandemics.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Maya Godambe
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Lisa Gwynn
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | | | - Corinne McDaniels-Davidson
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Jason G. Newland
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Eyal Oren
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California
| | - Rangaraj Selvarangan
- Pathology and Laboratory Medicine, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Nidhi Shinde
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Tyler Walsh
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Treymayne Watterson
- Division of Pediatric Infectious Diseases, Washington University in St Louis, St Louis, Missouri
| | - Martin Zand
- Division of Nephrology, School of Medicine and Dentistry, University of Rochester, Rochester, New York
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Uthappa DM, Mann TK, Goldman JL, Schuster JE, Newland JG, Anderson WB, Dozier A, Inkelas M, Foxe JJ, Gwynn L, Gurnett CA, McDaniels-Davidson C, Walsh T, Watterson T, Holden-Wiltse J, Potts JM, D’Agostino EM, Zandi K, Corbett A, Spallina S, DeMuri GP, Wu YP, Pulgaron ER, Kiene SM, Oren E, Allison-Burbank JD, Okihiro M, Lee RE, Johnson SB, Stump TK, Coller RJ, Mast DK, Haroz EE, Kemp S, Benjamin DK, Zimmerman KO. Common Data Element Collection in Underserved School Communities: Challenges and Recommendations. Pediatrics 2023; 152:e2022060352N. [PMID: 37394503 PMCID: PMC10312277 DOI: 10.1542/peds.2022-060352n] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES To provide recommendations for future common data element (CDE) development and collection that increases community partnership, harmonizes data interpretation, and continues to reduce barriers of mistrust between researchers and underserved communities. METHODS We conducted a cross-sectional qualitative and quantitative evaluation of mandatory CDE collection among Rapid Acceleration of Diagnostics-Underserved Populations Return to School project teams with various priority populations and geographic locations in the United States to: (1) compare racial and ethnic representativeness of participants completing CDE questions relative to participants enrolled in project-level testing initiatives and (2) identify the amount of missing CDE data by CDE domain. Additionally, we conducted analyses stratified by aim-level variables characterizing CDE collection strategies. RESULTS There were 15 study aims reported across the 13 participating Return to School projects, of which 7 (47%) were structured so that CDEs were fully uncoupled from the testing initiative, 4 (27%) were fully coupled, and 4 (27%) were partially coupled. In 9 (60%) study aims, participant incentives were provided in the form of monetary compensation. Most project teams modified CDE questions (8/13; 62%) to fit their population. Across all 13 projects, there was minimal variation in the racial and ethnic distribution of CDE survey participants from those who participated in testing; however, fully uncoupling CDE questions from testing increased the proportion of Black and Hispanic individuals participating in both initiatives. CONCLUSIONS Collaboration with underrepresented populations from the early study design process may improve interest and participation in CDE collection efforts.
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Affiliation(s)
- Diya M. Uthappa
- Duke University School of Medicine, Doctor of Medicine Program
| | - Tara K. Mann
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | | | | | | | - Moira Inkelas
- Department of Health Policy and Management, UCLA Fielding School of Public Health UCLA Clinical and Translational Science Institute, Los Angeles, California
| | - John J. Foxe
- The Del Monte Institute for Neuroscience and The Department of Neuroscience, University of Rochester School of Medicine, Rochester, New York
| | - Lisa Gwynn
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida USA
| | - Christina A. Gurnett
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri
| | | | - Tyler Walsh
- Department of Pediatrics, Division of Infectious Diseases
| | | | | | | | | | | | | | | | - Gregory P. DeMuri
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yelena P. Wu
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | | | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, California
| | - Eyal Oren
- School of Public Health, San Diego State University, San Diego, California
| | | | - May Okihiro
- Department of Pediatrics, John A. Burns School of Medicine, University of Hawaii Manoa, Honolulu, Hawaii
| | - Rebecca E. Lee
- Edson College of Nursing & Health Innovation, Center for Health Promotion and Disease Prevention, Senior Global Futures Scientist, Julie Ann Wrigley Global Futures Laboratory, Arizona State University, Phoenix, Arizona
| | - Sara B. Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tammy K. Stump
- Department of Dermatology
- Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Ryan J. Coller
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | | | - Emily E. Haroz
- Department of International Health & Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Steven Kemp
- Duke Clinical Research Institute, Duke University School of Medicine
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
| | - Kanecia O. Zimmerman
- Duke Clinical Research Institute, Duke University School of Medicine
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
- The ABC Science Collaborative, Durham, North Carolina
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9
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Kiene SM, McDaniels-Davidson C, Lin CD, Rodriguez T, Chris N, Bravo R, Moore V, Snyder T, Arechiga-Romero M, Famania-Martinez L, Carbuccia J, Pinuelas-Morineau R, Oren E. At-Home Versus Onsite COVID-19 School-based Testing: A Randomized Noninferiority Trial. Pediatrics 2023; 152:e2022060352F. [PMID: 37394511 PMCID: PMC10312284 DOI: 10.1542/peds.2022-060352f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Equitable access to coronavirus 2019 (COVID-19) screening is important to reduce transmission and maintain in-person learning for middle school communities, particularly in disadvantaged schools. Rapid antigen testing, and at-home testing in particular, could offer substantial advantages over onsite testing from a school district's perspective, but it is unknown if engagement in at-home testing can be initiated and sustained. We hypothesized that an at-home COVID-19 school testing program would be noninferior to an onsite school COVID-19 testing program with regard to school participation rates and adherence to a weekly screening testing schedule. METHODS We enrolled 3 middle schools within a large, predominantly Latinx-serving, independent school district into a noninferiority trial from October 2021 to March 2022. Two schools were randomized to onsite and 1 school to at-home COVID-19 testing programs. All students and staff were eligible to participate. RESULTS Over the 21-week trial, at-home weekly screening testing participation rates were not inferior to onsite testing. Similarly, adherence to the weekly testing schedule was not inferior in the at-home arm. Participants in the at-home testing arm were able to test more consistently during and before returning from school breaks than those in the onsite arm. CONCLUSIONS Results support the noninferiority of at-home testing versus onsite testing both in terms of participation in testing and adherence to weekly testing. Implementation of at-home COVID-19 screening testing should be part of schools' routine COVID-19 prevention efforts nationwide; however, adequate support is essential to ensure participation and persistence in regular at-home testing.
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Affiliation(s)
- Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health
| | | | - Chii-Dean Lin
- Department of Mathematics and Statistics, San Diego State University, San Diego, California
| | - Tasi Rodriguez
- Communities Fighting COVID! Returning Our Kids Back to School Safely, San Diego State University Research Foundation, San Diego, California
| | - Nicole Chris
- Communities Fighting COVID! Returning Our Kids Back to School Safely, San Diego State University Research Foundation, San Diego, California
| | - Rebecca Bravo
- Sweetwater Union High School District, Chula Vista, California
| | - Vernon Moore
- Sweetwater Union High School District, Chula Vista, California
| | | | - Marisela Arechiga-Romero
- Communities Fighting COVID! Returning Our Kids Back to School Safely, San Diego State University Research Foundation, San Diego, California
| | | | | | | | - Eyal Oren
- Division of Epidemiology and Biostatistics, School of Public Health
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10
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Keener Mast D, Gwynn L, Johnson SB, McDaniels-Davidson C, Hoffman R, Pulgaron ER, D’Agostino EM, Ko LK, Goldman JL, Drain PK, Schuster JE, Duran MC, Kiene SM, Oren E, Corneli A. A Multi-Study Synthesis of Facilitators and Barriers to SARS-CoV-2 Testing Enrollment in School Settings. Pediatrics 2023; 152:e2022060352J. [PMID: 37394502 PMCID: PMC10312272 DOI: 10.1542/peds.2022-060352j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2023] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVES Understanding the motivators and barriers to testing enrollment from different stakeholder perspectives is essential to increasing participation in school-based testing programs, particularly among underserved populations. This multistudy analysis aimed to identify facilitators and barriers to enrollment in school-based testing for coronavirus disease 2019 (COVID-19). METHODS Four independent studies collected and analyzed qualitative data from study participants regarding: (1) motivators, benefits, and/or reasons for enrolling and/or participating in COVID-19 testing in schools; and/or (2) concerns, barriers, and/or negative outcomes related to COVID-19 testing in schools. Study authors conducted a retrospective review of findings from the independent studies to identify themes related to testing motivators and concerns that emerged across the studies. RESULTS The analysis identified 10 distinct themes regarding the perceived motivators of COVID-19 testing in schools and 15 distinct themes regarding concerns and barriers to COVID-19 testing in schools. Common motivators across multiple studies included convenience of testing in school and the desire to keep self and others safe from COVID-19. Concerns about the implications of receiving a positive test result was a barrier identified by multiple studies. CONCLUSIONS Themes from 4 independent studies revealed insights about the motivations and barriers to enrolling and participating in COVID-19 testing programs in kindergarten through 12th grade school settings. Study findings can be used to improve enrollment and participation in new and existing school-based testing programs to reduce transmission of COVID-19 and other infectious diseases in schools.
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Affiliation(s)
| | - Lisa Gwynn
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Sara B. Johnson
- Johns Hopkins Schools of Medicine, Dept. of Pediatrics, Division of General Pediatrics, Baltimore, Maryland
| | | | | | - Elizabeth R. Pulgaron
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Linda K. Ko
- Departments of Health Systems and Population Health
| | - Jennifer L. Goldman
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | - Paul K. Drain
- Global Health, Medicine, Epidemiology, University of Washington, Seattle, Washington
| | - Jennifer E. Schuster
- Division of Pediatric Infectious Diseases, Children’s Mercy Kansas City, University of Missouri-Kansas City, Kansas City, Missouri
| | | | - Susan M. Kiene
- San Diego State University School of Public Health, San Diego, California
| | - Eyal Oren
- San Diego State University School of Public Health, San Diego, California
| | - Amy Corneli
- Population Health Sciences
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
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11
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Kane JC, Allen I, Fatch R, Scheffler A, Emenyonu N, Puryear SB, Chirayil P, So-Armah K, Kahler CW, Magidson JF, Conroy AA, Edelman EJ, Woolf-King S, Parry C, Kiene SM, Chamie G, Adong J, Go VF, Cook RL, Muyindike W, Morojele N, Blokhina E, Krupitsky E, Fiellin DA, Hahn JA. Efficacy of alcohol reduction interventions among people with HIV as evaluated by self-report and a phosphatidylethanol (PEth) outcome: protocol for a systematic review and individual participant data meta-analysis. BMJ Open 2023; 13:e070713. [PMID: 37280036 PMCID: PMC10254608 DOI: 10.1136/bmjopen-2022-070713] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/07/2023] [Indexed: 06/08/2023] Open
Abstract
INTRODUCTION Unhealthy alcohol use is associated with a range of adverse outcomes among people with HIV (PWH). Testing the efficacy and promoting the availability of effective interventions to address unhealthy alcohol use among PWH is thus a priority. Alcohol use outcomes in intervention studies are often measured by self-report alone, which can lead to spurious results due to information biases (eg, social desirability). Measuring alcohol outcomes objectively through biomarkers, such as phosphatidylethanol (PEth), in addition to self-report has potential to improve the validity of intervention studies. This protocol outlines the methods for a systematic review and individual participant data meta-analysis that will estimate the efficacy of interventions to reduce alcohol use as measured by a combined categorical self-report/PEth variable among PWH and compare these estimates to those generated when alcohol is measured by self-report or PEth alone. METHODS AND ANALYSIS We will include randomised controlled trials that: (A) tested an alcohol intervention (behavioural and/or pharmacological), (B) enrolled participants 15 years or older with HIV; (C) included both PEth and self-report measurements, (D) completed data collection by 31 August 2023. We will contact principal investigators of eligible studies to inquire about their willingness to contribute data. The primary outcome variable will be a combined self-report/PEth alcohol categorical variable. Secondary outcomes will include PEth alone, self-report alone and HIV viral suppression. We will use a two-step meta-analysis and random effects modelling to estimate pooled treatment effects; I2 will be calculated to evaluate heterogeneity. Secondary and sensitivity analyses will explore treatment effects in adjusted models and within subgroups. Funnel plots will be used to explore publication bias. ETHICS AND DISSEMINATION The study will be conducted with deidentified data from completed randomised controlled trials and will be considered exempt from additional ethical approval. Results will be disseminated through peer-reviewed publications and international scientific meetings. PROSPERO REGISTRATION NUMBER CRD42022373640.
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Affiliation(s)
- Jeremy C Kane
- Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Isabel Allen
- Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Robin Fatch
- Medicine, University of California, San Francisco, California, USA
| | - Aaron Scheffler
- Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Nneka Emenyonu
- Medicine, University of California, San Francisco, California, USA
| | - Sarah B Puryear
- Medicine, University of California, San Francisco, California, USA
| | - Priya Chirayil
- Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Kaku So-Armah
- School of Medicine, Boston University, Boston, Massachusetts, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jessica F Magidson
- Psychology, University of Maryland, College Park, Maryland, USA
- Center for Substance Use, Addiction & Health Research, University of Maryland, College Park, MD, USA
| | - Amy A Conroy
- Medicine, University of California, San Francisco, California, USA
| | | | | | - Charles Parry
- Mental Health, Alcohol, Substance Use & Tobacco Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Susan M Kiene
- Epidemiology and Biostatistics, San Diego State University College of Health and Human Services School of Public Health, San Diego, California, USA
| | - Gabriel Chamie
- Medicine, University of California, San Francisco, California, USA
| | - Julian Adong
- Makerere University School of Public Health, Kampala, Uganda
| | - Vivian F Go
- Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Robert L Cook
- Epidemiology, University of Florida, Gainesville, Florida, USA
| | | | - Neo Morojele
- University of Johannesburg, Auckland Park, South Africa
| | - Elena Blokhina
- Global Health Institute, St. Petersburg, Russian Federation
| | - Evgeny Krupitsky
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neuroology, St. Petersburg, Russian Federation
| | | | - Judith A Hahn
- Epidemiology & Biostatistics, University of California, San Francisco, California, USA
- Medicine, University of California, San Francisco, California, USA
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12
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Dixit A, Johns NE, Ghule M, Battala M, Begum S, Saggurti N, Silverman J, Reed E, Kiene SM, Benmarhnia T, Averbach S, Raj A. Association of traditional marital practices with contraceptive decision-making, couple communication, and method use among couples in rural Maharashtra, India. Cult Health Sex 2023; 25:521-536. [PMID: 35465833 PMCID: PMC9588848 DOI: 10.1080/13691058.2022.2062052] [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: 07/26/2021] [Accepted: 03/31/2022] [Indexed: 10/18/2022]
Abstract
In India, traditional social practices around marriage, such as non-involvement of prospective brides in choice of partner and timing of marriage, child/early marriage, dowry and purdah, compromise women's agency at the time of marriage and may also affect contraceptive practices in marriage. This paper examines the associations between traditional marital practices and contraceptive behaviours, including women's control over contraceptive decision-making, couples' communication about contraception, and ever use of contraceptives, among married women aged 18-29 years (N = 1,200) and their husbands in rural Maharashtra, India. Multivariable logistic regression was used to examine the association between these marginalising social practices and family planning behavioural outcomes, adjusting for demographic and parity confounders. Wives who were the primary decision-makers on who to marry had higher odds of ever having communicated with their husband on pregnancy prevention (AOR 1.76, 95% CI 1.16-2.68), and ever using modern contraceptives (AOR 2.19, 95% CI 1.52-3.16). Wives who were the primary decision-makers on when to marry also had higher odds of ever having used modern contraceptives (AOR 1.86, 95% CI 1.21-2.93). Women's involvement in marital choice may facilitate couples' engagement related to family planning, possibly via the establishment of better communication between partners.
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Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Joint Doctoral Program in Public Health (Global Health track), University of California San Diego/San Diego State University, San Diego, CA, USA
| | - Nicole E. Johns
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Mohan Ghule
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Shahina Begum
- ICMR-National Institute for Research in Reproductive Health, Mumbai, India
| | | | - Jay Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Elizabeth Reed
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Division of Health Promotion and Behavior, San Diego State University, San Diego, CA, USA
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, USA
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
- Scripps Institution of Oceanography, University of California San Diego, San Diego, CA, USA
| | - Sarah Averbach
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences, School of Medicine, University of California San Diego, San Diego, CA, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Education Studies, Division of Social Sciences, University of California San Diego, San Diego, CA. USA
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13
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Sileo KM, Muhumuza C, Helal T, Olfers A, Lule H, Sekamatte S, Kershaw TS, Wanyenze RK, Kiene SM. Exploring the effects of COVID-19 on family planning: results from a qualitative study in rural Uganda following COVID-19 lockdown. Reprod Health 2023; 20:31. [PMID: 36759838 PMCID: PMC9910252 DOI: 10.1186/s12978-023-01566-3] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/06/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has likely affected the already high unmet need for family planning in low- and middle-income countries. This qualitative study used Andersen's Behavioral Model of Health Service Use as a theoretical framework to explore the possible ways in which the COVID-19 pandemic, including the impact of a 3-month government mandated lockdown, might affect family planning outcomes in rural Uganda. A secondary aim was to elicit recommendations to improve family planning service delivery in the context of COVID-19. METHODS Between June and October 2020, we conducted four focus group discussions with men and women separately (N = 26) who had an unmet need for family planning, and 15 key-informant interviews with community leaders and family planning stakeholders. Data were analyzed using thematic analysis. RESULTS We identified a significant disruption to the delivery of family planning services due to COVID-19, with potential negative effects on contraceptive use and risk for unintended pregnancy. COVID-19 had a negative effect on individual enabling factors such as family income, affecting service access, and on community enabling factors, such as transportation barriers and the disruption of community-based family planning delivery through village health teams and mobile clinics. Participants felt COVID-19 lockdown restrictions exacerbated existing contextual predisposing factors related to poverty and gender inequity, such as intimate partner violence and power inequities that diminish women's ability to refuse sex with their husband and their autonomy to use contraceptives. Recommendations to improve family planning service delivery in the context of COVID-19 centered on emergency preparedness, strengthening community health systems, and creating new ways to safely deliver contractive methods directly to communities during future COVID-19 lockdowns. CONCLUSIONS This study highlights the consequences of COVID-19 lockdown on family planning distribution, as well as the exacerbation of gender inequities that limit women's autonomy in pregnancy prevention measures. To improve family planning service uptake in the context of COVID-19, there is a need to strengthen emergency preparedness and response, utilize community structures for contraceptive delivery, and address the underlying gender inequities that affect care seeking and service utilization.
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Affiliation(s)
- Katelyn M. Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | | | - Teddy Helal
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
| | - Allison Olfers
- Department of Public Health, University of Texas at San Antonio, San Antonio, TX USA
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14
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Sileo KM, Muhumuza C, Sekamatte S, Lule H, Wanyenze RK, Kershaw TS, Kiene SM. The "Family Health = Family Wealth" intervention: study protocol for a pilot quasi-experimental controlled trial of a multi-level, community-based family planning intervention for couples in rural Uganda. Pilot Feasibility Stud 2022; 8:265. [PMID: 36564852 PMCID: PMC9789630 DOI: 10.1186/s40814-022-01226-6] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/05/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Uganda has one of the highest fertility rates globally, but only 30% of women report using an effective method of contraception. Community-based, multi-level interventions are needed to help couples in rural Uganda overcome barriers to contraceptive use. METHODS This study will pilot test the Family Health = Family Wealth intervention, a multi-level, community-based intervention employing transformative community dialogues, which use facilitated discussion to reshape community norms that influence family planning acceptance, to alter individual attitudes and the perception of community norms that discourage family planning. Community dialogues are delivered to groups of couples over 4 sessions (two gender-segregated and two gender-mixed). Sessions simultaneously address individual and interpersonal-level determinants of family planning and link couples to family planning services. At the health system level, a refresher training will be conducted with health workers in the intervention community's health center to address gaps in contraceptive knowledge and skills as identified from a needs assessment. The intervention will be evaluated through a pilot quasi-experimental trial paired with a mixed methods process evaluation. Participants include 70 couples (N=140) randomized by community to the Family Health = Family Wealth intervention (n=35 couples) or to an attention-matched water, sanitation, and hygiene (WASH) intervention (n=35 couples). Participants include sexually active, married couples who are age 18 (or an emancipated minor) to 40 for women and age 18 (or an emancipated minor) to 50 for men, not pregnant, at least one person in the couple reports wanting to avoid pregnancy for at least a year, and not currently using a method of contraception or using a low-efficacy or ineffective method of contraception. The primary aims of the study are to (1) assess the feasibility of the intervention trial procedures, (2) the acceptability and feasibility of the intervention content and structure, and (3) explore the intervention's preliminary effectiveness at increasing contraceptive use and affecting related outcomes among couples. DISCUSSION Filling the unmet need for family planning has important public health implications, including reductions in pregnancy-related health risks and deaths, and infant mortality. This pilot intervention trial will gather preliminary evidence on the acceptability, feasibility, and potential effect of a novel, multi-level, community-based intervention to increase contraceptive use among couples with an unmet need for family planning in rural Uganda. We aim to use the findings of this pilot study to refine the trial procedures and intervention content for a future, larger cluster randomized controlled trial to establish the intervention's efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT04262882; registered on February 10, 2020.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, One UTSA Circle, San Antonio, TX, 78249, USA.
| | - Christine Muhumuza
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | | | - Haruna Lule
- Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
- United States Agency for International Development (USAID), Kampala, Uganda
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
| | - Trace S Kershaw
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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15
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Saldana CDR, Beletsky L, Borquez A, Kiene SM, Marquez LK, Strathdee SA, Zúñiga ML, Cepeda J, Martin NK. Modelling the contribution of incarceration and public health oriented drug law reform to HCV transmission and elimination among PWID in Tijuana, Mexico. Int J Drug Policy 2022; 110:103878. [PMID: 36242829 PMCID: PMC9841890 DOI: 10.1016/j.drugpo.2022.103878] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Incarceration is associated with increased risk of hepatitis C virus (HCV) among people who inject drugs (PWID). Mexico's previous attempt in implementing a public health-oriented drug law reform resulted in minimal impact on incarceration among PWID. However, implementation of reforms alongside Mexico's HCV elimination program has the potential to reshape the HCV epidemic among PWID in the next decade. We use data from a cohort of PWID in Tijuana, Mexico, to inform epidemic modeling to assess the contribution of incarceration and fully implemented drug reform on HCV transmission and elimination among PWID. METHODS We developed a dynamic, deterministic model of incarceration, HCV transmission and disease progression among PWID. The model was calibrated to data from Tijuana, Mexico, with 90% HCV seroprevalence among 10,000 PWID. We estimated the 10-year population attributable fraction (PAF) of incarceration to HCV incidence among PWID and simulated, from 2022, the potential impact of the following scenarios: 1) decriminalization (80% reduction in incarceration rates); 2) fully implemented drug law reform (decriminalization and diversion to opiate agonist therapy [OAT]); 3) fully implemented drug law reform with HCV treatment (direct-acting antivirals [DAA]). We also assessed the number DAA needed to reach the 80% incidence reduction target by 2030 under these scenarios. RESULTS Projections suggest a PAF of incarceration to HCV incidence of 5.4% (95% uncertainty interval [UI]:0.6-11.9%) among PWID in Tijuana between 2022-2032. Fully implemented drug reforms could reduce HCV incidence rate by 10.6% (95%UI:3.1-19.2%) across 10 years and reduce the number of DAA required to achieve Mexico's HCV incidence reduction goal by 14.3% (95%UI:5.3-17.1%). CONCLUSIONS Among PWID in Tijuana, Mexico, incarceration remains an important contributor to HCV transmission. Full implementation of public health-oriented drug law reform could play an important role in reducing HCV incidence and improve the feasibility of reaching the HCV incidence elimination target by 2030.
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Affiliation(s)
- Carlos D Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; School of Public Health, San Diego State University, San Diego, CA, 92182, United States.
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Susan M Kiene
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Lara K Marquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, 92182, United States
| | - Javier Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, United States
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States; Population Health Sciences, University of Bristol, Bristol BS8 1QU, United Kingdom
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16
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McDaniels-Davidson C, Arechiga-Romero M, Snyder T, Chris N, Sturgis K, Moore V, Bravo R, Famania-Martinez L, Oren E, Kiene SM. Development of an At-Home COVID-19 Test Results-Reporting System for a School District Primarily Serving Underrepresented Minority Groups, San Diego, CA, 2021-2022. Am J Public Health 2022; 112:S883-S886. [PMID: 36265090 PMCID: PMC9707717 DOI: 10.2105/ajph.2022.307073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/28/2023]
Abstract
School-sponsored at-home COVID-19 testing benefits users, school administrators, and surveillance efforts, although reporting results remains challenging. Users require simple systems with tailored posttest guidance, and administrators need timely positive test information. We built a system to serve these needs and to collect data for our Rapid Acceleration of Diagnostics-Underserved Populations Return to School Program study in San Diego County, California, from October 2021 through January 2022. We describe this system and our participant outreach strategies and outline a replicable model for at-home results reporting. (Am J Public Health. 2022;112(S9):S883-S886. https://doi.org/10.2105/AJPH.2022.307073).
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Affiliation(s)
- Corinne McDaniels-Davidson
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Marisela Arechiga-Romero
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Tom Snyder
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Nicole Chris
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Kanako Sturgis
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Vernon Moore
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Rebecca Bravo
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Lynnette Famania-Martinez
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Eyal Oren
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
| | - Susan M Kiene
- Corinne McDaniels-Davidson, Eyal Oren, and Susan M. Kiene are with the School of Public Health, San Diego State University, San Diego, CA. Marisela Arechiga-Romero, Nicole Chris, and Kanako Sturgis are with the San Diego State University Research Foundation, San Diego. Tom Snyder is with geMatrix, Inc., San Diego. Vernon Moore, Rebecca Bravo, and Lynnette Famania-Martinez are with Sweetwater Union High School District, Chula Vista, CA
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Ogbonnaya IN, Reed E, Wanyenze RK, Wagman JA, Silverman JG, Kiene SM. Perceived Barriers to HIV Care and Viral Suppression Comparing Newly Diagnosed Women Living with HIV in Rural Uganda with and without a History of Intimate Partner Violence. J Interpers Violence 2022; 37:NP17133-NP17156. [PMID: 34176367 PMCID: PMC9814921 DOI: 10.1177/08862605211028284] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Intimate partner violence (IPV) is associated with poor HIV care linkage and retention, medication adherence, and viral suppression. However, limited knowledge exists regarding potential mechanisms linking IPV to these outcomes. We aimed to (a) identify the top barriers to accessing HIV care experienced by women living with HIV (WLHIV) who report a history of IPV and have suppressed viral load (VL) versus unsuppressed VL and (b) understand how these barriers influence VL, comparing WLHIV with a history of IPV to WLHIV without a history of IPV. Study data come from newly diagnosed WLHIV in rural Uganda participating in the standard-of-care control arm of a randomized trial (n = 152). Descriptive results ranking mean scores from highest to lowest showed that, among women with a history of IPV, irrespective of viral suppression status, paying for transportation to come to clinic, having to wait at the clinic for long periods of time, and finding a clinic within reasonable travel distance were the top three barriers to accessing HIV care. WLHIV with a history of IPV were significantly more likely to have unsuppressed VL versus suppressed VL if they reported higher levels of difficulty finding a clinic within reasonable travel distance (RRR = 1.7, 95% CI [1.1-2.7]), getting permission to take time off from work (RRR = 1.5, 95% CI [1.0-2.9]), and finding time to come to the clinic for an appointment (RRR = 1.6, 95% CI [1.0-2.6]). The same relationships were not present among WLHIV without a history of IPV, suggesting these barriers and their effect on VL may be uniquely related to IPV. Interventions should address IPV and HIV care continuum outcomes in tandem, targeting barriers to accessing HIV care likely associated with IPV. Additional research is necessary to better understand how IPV relates to HIV care barriers and VL.
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Affiliation(s)
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | | | - Jennifer A. Wagman
- University of California Los Angeles Jonathan and Karin Fielding School of Public HealthLos Angeles, CA, USA
| | - Jay G. Silverman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, La Jolla, CA, USA
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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Sileo KM, Wanyenze RK, Schmarje Crockett K, Naigino R, Ediau M, Lule H, Kalichman SC, Lin CD, Menzies N, Bateganya MH, Kiene SM. Prevalence and correlates of depressive symptoms, and points of intervention, in rural central Uganda: results from a cross-sectional population-based survey of women and men. BMJ Open 2022; 12:e054936. [PMID: 35641013 PMCID: PMC9157366 DOI: 10.1136/bmjopen-2021-054936] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The present study aimed to identify the prevalence and correlates of depressive symptoms and potential intervention points among women and men from a population-based sample in rural central Uganda. DESIGN A cross-sectional study. SETTING Four districts in rural Uganda. PARTICIPANTS Women and men aged 15-59 residing in four districts in rural Uganda accepting home-based HIV testing who completed a baseline survey at the time of testing. PRIMARY OUTCOME MEASURES Depressive symptoms measured by the 10-item Center for Epidemiological Studies Depression Scale using a cut-off score of 13 for significant depressive symptoms. RESULTS Among a sample of 9609 women and 6059 men, 1415 (14.7%) women and 727 (12.0%) men met criteria for significant depressive symptoms. Having ever received mental health services was associated with lower odds of significant depressive symptoms (women: adjusted OR (adjOR)=0.32, 95% CI=0.22 to 0.47; men: adjOR=0.36, 95% CI=0.18 to 0.62). Having received outpatient (women: adjOR=3.64, 95% CI=3.14 to 4.22; men: adjOR=3.37, 95% CI=2.78 to 4.07) or inpatient (women: adjOR=5.44, 95% CI=4.24 to 6.97; men: adjOR=3.42, 95% CI=2.21 to 5.28) care in the prior 6 months was associated with greater odds of significant depressive symptoms. For women only, known HIV positive status (adjOR=1.37, 95% CI=1.05 to 1.77), and for men only, alcohol misuse (adjOR=1.38, 95% CI=1.12 to 1.70), were associated with increased odds of significant depressive symptoms. CONCLUSION Our findings suggest that depression screening within outpatient and inpatient settings may help to identify people in need of mental health services. Routine screening in outpatient or inpatient clinics along with the implementation of evidence-based interventions could ultimately help close the mental health gap for depression in this and similar settings.
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Affiliation(s)
- Katelyn M Sileo
- Department of Public Health, The University of Texas at San Antonio, San Antonio, Texas, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - Katherine Schmarje Crockett
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Rose Naigino
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Haruna Lule
- Division of Health Systems Strengthening, Global Centre of Excellence in Health (GLoCEH), Kampala, Uganda
| | - Seth C Kalichman
- Institute for Collaboration on Health, Intervention and Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Chii-Dean Lin
- Department of Mathematics and Statistics, San Diego State University, San Diego, California, USA
| | - Nicolas Menzies
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Moses H Bateganya
- Infectious Diseases and Health Systems, FHI 360, Durham, North Carolina, USA
| | - Susan M Kiene
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
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19
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Naigino R, Makumbi F, Mukose A, Buregyeya E, Arinaitwe J, Musinguzi J, Kiene SM, Wanyenze RK. Resumption of Sexual Intercourse Among Postnatal Women Enrolled on Lifelong Antiretroviral Therapy in Uganda. AIDS Behav 2022; 26:1684-1694. [PMID: 34714435 DOI: 10.1007/s10461-021-03520-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2021] [Indexed: 11/26/2022]
Abstract
The postnatal period is critical to the delivery of interventions aimed at improving maternal health outcomes. This study examined the timing to resumption of sexual intercourse and associated factors among postnatal women living with HIV (WLWH) in Uganda. A sample of 385 women was drawn from a larger prospective cohort study conducted between 2013 and 2015. We used survival analysis to estimate the postpartum time periods during which women had a higher risk of sexual intercourse resumption within 6 months after childbirth. Cox proportional hazards regression was used to examine associated factors with sexual intercourse resumption. The cumulative probability of sexual intercourse resumption was lowest (6.2%) in the sub-acute postpartum period (1-45 days since delivery) and highest (88.2%) in the delayed postpartum period (151-183 days since delivery). Having a live-term baby (adjusted HR 0.52, 95% CI 0.31-0.85, p = 0.01) and an advanced education (adjusted HR 0.63, 95% CI 0.40-0.98, p = 0.04) were associated with a lower risk of sexual intercourse resumption. Desire for another child (adjusted HR 1.36, 95% CI 1.08-1.73, p = 0.01), having a sexual partner (adjusted HR 5.97, 95% CI 3.10-11.47, p < 0.001) and contraceptive use (adjusted HR 2.21, 95% CI 1.65-2.95, p < 0.001) were associated with a greater risk of sexual intercourse resumption. However, only 1 in 4 women who resumed sexual intercourse by the 90th day after childbirth, reported currently using contraception. HIV programs should focus on supporting postnatal women to align the timing of sexual intercourse resumption with their return to contraceptive use. Interventions aimed at improving contraceptive uptake among postnatal WLWH should target the delayed postpartum period.
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Affiliation(s)
- Rose Naigino
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda.
| | - Fredrick Makumbi
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Aggrey Mukose
- Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Esther Buregyeya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | | | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, CA, USA
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Bloom BE, Hamilton K, Adeke B, Tuhebwe D, Atuyambe LM, Kiene SM. 'Endure and excuse': a mixed-methods study to understand disclosure of intimate partner violence among women living with HIV in Uganda. Cult Health Sex 2022; 24:499-516. [PMID: 33530887 DOI: 10.1080/13691058.2020.1861328] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 12/03/2020] [Indexed: 06/12/2023]
Abstract
Intimate partner violence and HIV remain significant health challenges among women living with HIV. Intimate partner violence has been linked to negative health outcomes and poorer HIV care engagement. This study examined intimate partner violence among Ugandan women living with HIV, their experiences disclosing such violence and how culturally normative factors affected disclosure-related outcomes. In a mixed-methods study conducted in Uganda in 2018, 168 women participated in interviewer-administered surveys; a sub-set who reported experiencing intimate partner violence participated in in-depth interviews (IDIs). Intimate partner violence was prevalent among women in the sample (68.0%); almost half experienced emotional violence (45.2%), while a smaller proportion had experienced physical (32.1%) and/or sexual violence (19.6%). Most women living with HIV (61.8%) had disclosed their experience of intimate partner violence to someone. Women who experienced intimate partner violence had higher odds of disclosure if they feared their partner and perpetrated violence against their partner. Thematic analysis of IDIs revealed enduring violence and blaming alcohol for men's perpetration of violence. Traditional cultural and gender norms, especially concerning motherhood and partnership, influenced women's experiences of intimate partner violence and disclosure. Multi-sectoral responses to challenge and reform cultural norms that perpetuate violence are needed, including mobilising key stakeholders (e.g. family, community, policy-makers) to serve as catalysts for change and encourage resource- and safety-seeking for women living with HIV to escape violence.
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Affiliation(s)
- Brittnie E Bloom
- School of Public Health, San Diego State University, San Diego, CA, USA
- School of Medicine, University of California San Diego, San Diego, CA, USA
| | | | - Barbra Adeke
- School of Public Health, Makerere University, Kampala, Uganda
| | - Doreen Tuhebwe
- School of Public Health, Makerere University, Kampala, Uganda
| | - Lynn M Atuyambe
- School of Public Health, Makerere University, Kampala, Uganda
| | - Susan M Kiene
- School of Public Health, San Diego State University, San Diego, CA, USA
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21
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Salawu MM, Okedare OO, Reed E, Kiene SM, Fawole OI. Money, Power, and Relationships: Economic Vulnerability in Girls' Lives and Risk for Partner Violence Among Girls in Ibadan, Nigeria. Violence Against Women 2021; 28:2805-2824. [PMID: 34860615 DOI: 10.1177/10778012211058223] [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] [Indexed: 11/16/2022]
Abstract
This study explored the experience of economic vulnerability and its effect on girls' future aspirations, relationships, and financial reliance on male partners, as well as risk for intimate partner violence (IPV) and related health consequences. Thirteen Focus Group Discussions (FGDs) were conducted among 122 female adolescents aged 15-19 years. Participants reported that lack of economic resources limits girls' ability to be economically independent by reducing opportunities to receive education or enter into a trade. Economic vulnerability decreases girls' ability to become economically independent, increasing financial reliance on male partners, and in turn, increasing risk for IPV, sexually transmitted infections, and unintended pregnancy.
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Affiliation(s)
- Mobolaji M Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Omowumi O Okedare
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, 229220School of Public Health, San Diego State University, San Diego, CA, USA.,Center on Gender Equity and Health, University of California San Diego, Division of Infectious Disease and Global Public Health, La Jolla, CA, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, 7117San Diego State University, San Diego, CA, USA
| | - Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, 113092University of Ibadan, Ibadan, Nigeria
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22
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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: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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23
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Rivera Saldana CD, Beletsky L, Borquez A, Kiene SM, Strathdee SA, Zúñiga ML, Martin NK, Cepeda J. Impact of cumulative incarceration and the post-release period on syringe-sharing among people who inject drugs in Tijuana, Mexico: a longitudinal analysis. Addiction 2021; 116:2724-2733. [PMID: 33620749 PMCID: PMC8380753 DOI: 10.1111/add.15445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/14/2020] [Accepted: 02/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Syringe-sharing among people who inject drugs, which can occur during incarceration and post-release, has been linked with increased risk of blood-borne infections. We aimed to investigate the cumulative effect of repeated incarceration and the post-release period on receptive syringe-sharing. DESIGN Ongoing community-based cohort, recruited through targeted sampling between 2011 and 2012 with 6-month follow-ups. SETTING Tijuana, Mexico. PARTICIPANTS Sample of 185 participants (median age 35 years; 67% female) with no history of incarceration at study entry, followed to 2017. MEASUREMENTS Cumulative incarceration and post-release period were constructed from incarceration events reported in the past 6 months for each study visit. Receptive syringe-sharing in the past 6 months was assessed as a binary variable. We used logistic regression with generalized estimating equations to examine the association between cumulative incarceration events and the post-release period with receptive syringe-sharing over time. Missing data were handled through multiple imputation. FINDINGS At baseline, 65% of participants engaged in receptive syringe-sharing in the prior 6 months. At follow-up, 150 (81%) participants experienced a total of 358 incarceration events [median = 2, interquartile range (IQR) = 1-3]. The risk of receptive syringe-sharing increased with the number of repeated incarcerations. Compared with never incarcerated, those with one incarceration had 1.28 [95% confidence interval (CI) = 0.97-1.68] higher adjusted odds of syringe-sharing; two to three incarcerations, 1.42 (95% CI = 1.02-1.99) and more than three incarcerations, 2.10 (95% CI = 1.15-3.85). Participants released within the past 6 months had 1.53 (95% CI = 1.14-2.05) higher odds of sharing syringes compared with those never incarcerated. This post-release risk continued up to 1.5 years post-incarceration (adjusted odds ratio = 1.41, 95% CI = 1.04-1.91), but then waned. CONCLUSIONS A longitudinal community cohort study among people who inject drugs suggested that the effects of incarceration on increased injecting risk, measured through syringe-sharing, are cumulative and persist during the post-release period.
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Affiliation(s)
- Carlos D. Rivera Saldana
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Leo Beletsky
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- School of Law and Bouve College of Health Sciences, Northeastern University, Boston, MA, 02115, United States
| | - Annick Borquez
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - Susan M. Kiene
- School of Public Health, San Diego State University, San Diego, CA, 92182, United States
| | - Steffanie A. Strathdee
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
| | - María Luisa Zúñiga
- School of Social Work, San Diego State University, San Diego, CA, 92182, United States
| | - Natasha K. Martin
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
- Population Health Sciences, University of Bristol, Bristol BS8 1QU, United Kingdom
| | - Javier Cepeda
- Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, La Jolla, CA, 92093, United States
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Marquez LK, Fleiz C, Burgos JL, Cepeda JA, McIntosh C, Garfein RS, Kiene SM, Brodine S, Strathdee SA, Martin NK. Cost-effectiveness of hepatitis C virus (HCV) elimination strategies among people who inject drugs (PWID) in Tijuana, Mexico. Addiction 2021; 116:2734-2745. [PMID: 33620750 PMCID: PMC8380744 DOI: 10.1111/add.15456] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/23/2020] [Accepted: 02/10/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS In Latin America, Mexico was first to launch a hepatitis C virus (HCV) elimination strategy, where people who inject drugs (PWID) are a main risk group for transmission. In Tijuana, HCV seroprevalence among PWID is > 90%, with minimal harm reduction (HR). We evaluated cost-effectiveness of strategies to achieve the incidence elimination target among PWID in Tijuana. METHODS Modeling study using a dynamic, cost-effectiveness model of HCV transmission and progression among active and former PWID in Tijuana, to assess the cost-effectiveness of incidence elimination strategies from a health-care provider perspective. The model incorporated PWID transitions between HR stages (no HR, only opioid agonist therapy, only high coverage needle-syringe programs, both). Four strategies that could achieve the incidence target (80% reduction by 2030) were compared with the status quo (no intervention). The strategies incorporated the number of direct-acting anti-viral (DAA) treatments required with: (1) no HR scale-up, (2) HR scale-up from 2019 to 20% coverage among PWID, (3) HR to 40% coverage and (4) HR to 50% coverage. Costs (2019 US$) and health outcomes [disability-adjusted life years (DALYs)] were discounted 3% per year. Mean incremental cost-effectiveness ratios (ICER, $/DALY averted) were compared with one-time per capita gross domestic product (GDP) ($9698 in 2019) and purchasing power parity-adjusted per capita GDP ($4842-13 557) willingness-to-pay (WTP) thresholds. RESULTS DAAs alone were the least costly elimination strategy [$173 million, 95% confidence interval (CI) = 126-238 million], but accrued fewer health benefits compared with strategies with HR. DAAs + 50% HR coverage among PWID averted the most DALYs but cost $265 million, 95% CI = 210-335 million). The optimal strategy was DAAs + 50% HR (ICER $6743/DALY averted compared to DAAs only) under the one-time per-capita GDP WTP ($9698). CONCLUSIONS A combination of high-coverage harm reduction and hepatitis C virus treatment is the optimal cost-effective strategy to achieve the HCV incidence elimination goal in Mexico.
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Affiliation(s)
- Lara K Marquez
- University of California San Diego, La Jolla, CA, USA
- San Diego State University, San Diego, CA, USA
| | - Clara Fleiz
- National Institute of Psychiatry Ramon de la Fuente Muniz, Colonia, Huipulco, Tlalpan, Ciudad de Mexico, Mexico
| | | | | | | | | | | | | | | | - Natasha K Martin
- University of California San Diego, La Jolla, CA, USA
- University of Bristol, Bristol, UK
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Sileo KM, Wanyenze RK, Mukasa B, Musoke W, Kiene SM. The Intersection of Inequitable Gender Norm Endorsement and HIV Stigma: Implications for HIV Care Engagement for Men in Ugandan Fishing Communities. AIDS Behav 2021; 25:2863-2874. [PMID: 33566214 DOI: 10.1007/s10461-021-03176-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 01/20/2021] [Indexed: 11/24/2022]
Abstract
Men's engagement in the HIV care continuum may be negatively affected by adherence to inequitable gender norms, which may be exacerbated by HIV stigma. This cross-sectional study with 300 male fisherfolk in Uganda examined the independent and interacting effects of inequitable gender norm endorsement and HIV stigma on men's missed HIV care appointments and missed antiretroviral (ARV) doses. Greater gender inequitable norm endorsement was associated with increased odds of missed HIV clinic visits (adjusted odds ratio [AOR)] 1.44, 95% CI 1.16-1.78) and a statistically significant interaction between internalized HIV stigma and inequitable gender norms on missed ARV doses was identified (AOR 5.32, 95% CI 2.60-10.86). Adherence to traditional gender norms reduces men's HIV appointment attendance, and among men with high internalized stigma, increases the likelihood of poor treatment adherence. These findings point to the need for HIV interventions that reconfigure harmful gender norms with a focus on stigma reduction.
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Affiliation(s)
- K M Sileo
- Department of Public Health, University of Texas At San Antonio, One UTSA Circle, MB 3.472, San Antonio, TX, 78249, USA.
- SDSU School of Public Health, San Diego State University, San Diego, CA, USA.
| | - R K Wanyenze
- Makerere School of Public Health, Makerere University, Kampala, Uganda
| | | | | | - S M Kiene
- SDSU School of Public Health, San Diego State University, San Diego, CA, USA
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Wynn A, Nabukalu D, Lutalo T, Wawer M, Chang LW, Kiene SM, Serwadda DM, Sewankambo N, Nalugoda F, Kigozi G, Wagman JA. Alcohol use during pregnancy in Rakai, Uganda. PLoS One 2021; 16:e0256434. [PMID: 34437616 PMCID: PMC8389483 DOI: 10.1371/journal.pone.0256434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/21/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction Antenatal alcohol use is linked to adverse maternal and neonatal outcomes. Uganda has one of the highest rates of alcohol use in sub-Saharan Africa, but the prevalence of antenatal alcohol use has not been reported in the Rakai region. Methods We used cross-sectional data from pregnant women in the Rakai Community Cohort Study between March 2017 and September 2018. Using bivariate and multivariable analyses, we assessed associations between self-reported antenatal alcohol use and sociodemographic characteristics, intimate partner violence (IPV), and HIV status. Results Among 960 pregnant women, the median age was 26 years, 35% experienced IPV in the past 12 months, 13% were living with HIV, and 33% reported alcohol use during their current pregnancy. After adjusting for marital status, education, smoking, and HIV status; Catholic religion (AOR: 3.54; 95% CI: 1.89–6.64; compared to other), bar/restaurant work (AOR: 2.40; 95% CI: 1.17–4.92; compared to agriculture), >one sex partner in past year (AOR: 1.92; 95% CI: 1.17–3.16), a partner that drank before sex in past year (AOR: 2.01; 95% CI: 1.48–2.74), and past year IPV (AOR: 1.55; 95% CI: 1.14–2.11) were associated with antenatal alcohol use. Conclusion We found that alcohol use during pregnancy was common and associated with religion, occupation, higher numbers of past year sex partners, having a partner who drank before sex in the past 12 months, and IPV experience. More research is needed to understand the quantity, frequency, and timing of antenatal alcohol use; and potential impacts on neonates; and to identify services that are acceptable and effective among pregnant women.
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Affiliation(s)
- Adriane Wynn
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, United States of America
- * E-mail:
| | - Dorean Nabukalu
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Tom Lutalo
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Maria Wawer
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| | - Larry W. Chang
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Department of Medicine, John Hopkins School of Medicine, Baltimore, MD, United States of America
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States of America
| | | | | | - Fred Nalugoda
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Godfrey Kigozi
- Rakai Health Sciences Program/Uganda Virus Research Institute, Kalisizo, Uganda
| | - Jennifer A. Wagman
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States of America
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Marquez LK, Chaillon A, Soe KP, Johnson DC, Zosso JM, Incerti A, Loarec A, Nguyen A, Walker JG, Mafirakureva N, Lo Re Iii V, Wynn A, McIntosh C, Kiene SM, Brodine S, Garfein RS, Vickerman P, Martin NK. Cost and cost-effectiveness of a real-world HCV treatment program among HIV-infected individuals in Myanmar. BMJ Glob Health 2021; 6:bmjgh-2020-004181. [PMID: 33627360 PMCID: PMC7908309 DOI: 10.1136/bmjgh-2020-004181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/16/2021] [Accepted: 01/30/2021] [Indexed: 12/16/2022] Open
Abstract
Introduction Over half of those hepatitis C virus (HCV)/HIV coinfected live in low-income and middle-income countries, and many remain undiagnosed or untreated. In 2016, Médecins Sans Frontières (MSF) established a direct-acting antiviral (DAA) treatment programme for people HCV/HIV coinfected in Myanmar. The purpose of our study was to evaluate the real-world cost and cost-effectiveness of this programme, and potential cost-effectiveness if implemented by the Ministry of Health (MoH). Methods Costs (patient-level microcosting) and treatment outcomes were collected from the MSF prospective cohort study in Dawei, Myanmar. A Markov model was used to assess cost-effectiveness of the programme compared with no HCV treatment from a health provider perspective. Estimated lifetime and healthcare costs (in 2017 US$) and health outcomes (in disability-adjusted life-years (DALYs)) were simulated to calculate the incremental cost-effectiveness ratio (ICER), compared with a willingness-to-pay threshold of per capita Gross Domestic Product in Myanmar ($1250). We evaluated cost-effectiveness with updated quality-assured generic DAA prices and potential cost-effectiveness of a proposed simplified treatment protocol with updated DAA prices if implemented by the MoH. Results From November 2016 to October 2017, 122 with HIV/HCV-coinfected patients were treated with DAAs (46% with cirrhosis), 96% (n=117) achieved sustained virological response. Mean treatment costs were $1229 (without cirrhosis) and $1971 (with cirrhosis), with DAA drugs being the largest contributor to cost. Compared with no treatment, the program was cost-effective (ICER $634/DALY averted); more so with updated prices for quality-assured generic DAAs (ICER $488/DALY averted). A simplified treatment protocol delivered by the MoH could be cost-effective if associated with similar outcomes (ICER $316/DALY averted). Conclusions Using MSF programme data, the DAA treatment programme for HCV among HIV-coinfected individuals is cost-effective in Myanmar, and even more so with updated DAA prices. A simplified treatment protocol could enhance cost-effectiveness if further rollout demonstrates it is not associated with worse treatment outcomes.
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Affiliation(s)
- Lara K Marquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA .,School of Public Health, San Diego State University, San Diego, California, USA
| | - Antoine Chaillon
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Kyi Pyar Soe
- Medical Department, Dawei Project, Doctors Without Borders, Dawei, Myanmar
| | - Derek C Johnson
- Medical Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar
| | - Jean-Marc Zosso
- Finance Department, Myanmar Project, Doctors Without Borders, Yangon, Myanmar
| | - Andrea Incerti
- Medical Department, Doctors Without Borders, Geneva Operational Center, Geneva, Switzerland
| | - Anne Loarec
- Epidemiology, Epicentre, Paris, Île-de-France, France
| | - Aude Nguyen
- Medical Department, Doctors Without Borders, Geneva Operational Center, Geneva, Switzerland.,Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Vincent Lo Re Iii
- Division of Infectious Diseases, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Adriane Wynn
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
| | - Craig McIntosh
- School of Global Policy and Strategy, University of California San Diego, La Jolla, California, USA
| | - Susan M Kiene
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Stephanie Brodine
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Richard S Garfein
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, USA
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Dixit A, Bhan N, Benmarhnia T, Reed E, Kiene SM, Silverman J, Raj A. The association between early in marriage fertility pressure from in-laws' and family planning behaviors, among married adolescent girls in Bihar and Uttar Pradesh, India. Reprod Health 2021; 18:60. [PMID: 33750403 PMCID: PMC7941884 DOI: 10.1186/s12978-021-01116-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 11/04/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
Background Married adolescent girls are vulnerable to risky sexual and reproductive health outcomes. We examined the association of fertility pressure from in-laws’ early in marriage with contraceptive use ever, parity, time until first birth, and couple communication about family size, among married adolescent girls. Methods Data were taken from a cross-sectional survey with married girls aged 15–19 years (N = 4893) collected from September 2015 to July 2016 in Bihar and Uttar Pradesh, India. Multivariable regression assessed associations between in-laws’ fertility pressure and each outcome, adjusting for sociodemographic covariates. Results We found that 1 in 5 girls experienced pressure from in-laws’ to have a child immediately after marriage. In-laws’ fertility pressure was associated with lower parity (Adj. β Coef. − 0.10, 95% CI − 0.17, − 0.37) and couple communication about family size (AOR = 1.77, 95% CI 1.39, 2.26), but not contraceptive use or time until birth. Conclusions Our study adds to the literature identifying that in-laws’ pressure on fertility is common, affects couple communication about family size, and may be more likely for those yet to have a child, but may have little effect impeding contraceptive use in a context where such use is not normative. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-021-01116-9.
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Affiliation(s)
- Anvita Dixit
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA. .,Joint Doctoral Program in Public Health, San Diego State University-University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA.
| | - Nandita Bhan
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Tarik Benmarhnia
- Scripps Institution of Oceanography, University of California San Diego, 8622 Kennel Way, La Jolla, CA, 92037, USA.,Department of Family Medicine and Public Health, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Dr, San Diego, CA, 92182, USA
| | - Jay Silverman
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA
| | - Anita Raj
- Center on Gender Equity and Health, Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, USA.,Department of Education Studies, Division of Social Sciences, University of California San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, USA
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29
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Sileo KM, Miller AP, Wagman JA, Kiene SM. Psychosocial interventions for reducing alcohol consumption in sub-Saharan African settings: a systematic review and meta-analysis. Addiction 2021; 116:457-473. [PMID: 33463834 PMCID: PMC8543382 DOI: 10.1111/add.15227] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/04/2020] [Accepted: 08/12/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Harmful alcohol use is a leading cause of morbidity and mortality in sub-Saharan Africa (sSA); however, the effects of non-pharmacological alcohol interventions in this region are unknown. DESIGN A systematic review and meta-analysis of the available literature through 14 March 2019 was undertaken. Two authors extracted and reconciled relevant data and assessed risk of bias. Meta-analyses were conducted. The review protocol is registered on International Prospective Register of Systematic Reviews (PROSPERO) (CRD42019094509). SETTING Studies conducted in sSA were eligible for inclusion. PARTICIPANTS Individuals participating in interventions aimed at reducing alcohol use. INTERVENTIONS Randomized and non-randomized controlled trials testing non-pharmacological interventions (psychosocial and structural) on alcohol consumption in sSA. MEASUREMENTS Eligible outcomes included the Alcohol Use Disorders Identification Test (AUDIT) scores; alcohol abstinence; measures of drinking quantity and frequency; and biomarkers of alcohol consumption. FINDINGS Nineteen intervention trials (18 reports) testing psychosocial interventions (no structural interventions included), judged of moderate quality, were included in meta-analyses. A beneficial effect was identified for psychosocial interventions on alcohol abstinence at 3-6 months [odds ratio (OR) = 2.05, 95% confidence interval (CI) = 1.20-3.48, k = 5, n = 2312, I2 = 79%] and 12-60 months (OR = 1.91, 95% CI = 1.40-2.61, k = 6, n = 2737, I2 = 63%) follow-up. There were no statistically significant effects found for AUDIT score [2-3 months: mean differences (MD) = -1.13, 95% CI = -2.60 to 0.34, k = 6, n = 992, I2 = 85%; 6 months: MD = -0.83, 95% CI = -1.92 to 0.26, k = 6, n = 1081, I2 = 69%; 12 months: MD = -0.15, 95% CI = -1.66 to 1.36, k = 4; n = 677; I2 = 75%], drinks per drinking day (3 months: MD = -0.22, 95% CI = -2.51 to 2.07, k = 2, n = 359, I2 = 82%; 6-36 months: MD = -0.09, 95% CI = -0.49 to 0.30, k = 3, n = 1450, I2 = 60%) or percentage of drinking days (3 months: MD = -4.60, 95% = -21.14 to 11.94; k = 2; n = 361; I2 = 90%; 6-9 months: MD = 1.96, 95% CI = -6.54 to 10.46; k = 2; n = 818; I2 = 88%). CONCLUSION Psychosocial interventions show promise at increasing self-reported alcohol abstinence in sSA, but clinical, methodological and statistical heterogeneity across meta-analytical outcomes suggests that results should be interpreted with caution.
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Affiliation(s)
- Katelyn M. Sileo
- The Department of Public Health, The University of Texas at
San Antonio, One UTSA Circle, San Antonio, TX, USA,Division of Epidemiology and Biostatistics, School of
Public Health, San Diego State University, 5500 Campanile Drive San Diego, CA
92182,The Center for Interdisciplinary Research on AIDS (CIRA),
Yale University, 135 College Street, Suite 200, New Haven, CT 06510-2483
| | - Amanda P. Miller
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, The University of California, San Diego, 9500 Gilman Drive,
La Jolla, CA 92093
| | - Jennifer A. Wagman
- Division of Infectious Diseases and Global Public Health,
Department of Medicine, The University of California, San Diego, 9500 Gilman Drive,
La Jolla, CA 92093,The Department of Community Health Sciences, The University
of California, Los Angeles, 650 Charles E. Young Drive South, 46-071B CHS, Box
951772, Los Angeles, CA, 90095-1772
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, School of
Public Health, San Diego State University, 5500 Campanile Drive San Diego, CA
92182
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Marquez LK, Cepeda JA, Bórquez A, Strathdee SA, Gonzalez-Zúñiga PE, Fleiz C, Rafful C, Garfein RS, Kiene SM, Brodine S, Martin NK. Is hepatitis C virus (HCV) elimination achievable among people who inject drugs in Tijuana, Mexico? A modeling analysis. Int J Drug Policy 2021; 88:102710. [PMID: 32165050 PMCID: PMC8133359 DOI: 10.1016/j.drugpo.2020.102710] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In 2019, Mexico became the first Latin American country committed to hepatitis C virus (HCV) elimination, but the amount of intervention scale-up required is unclear. In Tijuana, HCV among people who inject drugs (PWID) is high; yet there is minimal and intermittent harm reduction, and involuntary exposure to compulsory abstinence programs (CAP) occurs which is associated with increased HCV risk. We determined what combination intervention scale-up can achieve HCV elimination among current and former PWID in Tijuana. METHODS We constructed a dynamic, deterministic model of HCV transmission, disease progression, and harm reduction among current and former PWID parameterized to Tijuana (~10,000 current PWID, 90% HCV seropositive, minimal opiate agonist therapy [OAT] or high coverage needle/syringe programs [HCNSP]). We evaluated the number of direct-acting antiviral (DAA) treatments needed from 2019 to achieve elimination targets (80% incidence reduction, 65% mortality reduction by 2030) with: (a) DAAs alone, (b) DAAs plus scale-up of OAT+HCNSP (up to 50% coverage of OAT and HCNSP separately, producing 25% of PWID receiving both), (c) DAAs plus CAP scale-up to 50%. Scenarios examined the number of DAAs required if prioritized to current PWID or provided regardless of current injection status, and impact of harm reduction interruptions. RESULTS Modeling suggests among ~30,000 current and former PWID in Tijuana, 16,160 (95%CI: 12,770-21,610) have chronic HCV. DAA scale-up can achieve the incidence target, requiring 770 treatments/year (95%CI: 640-970) if prioritized to current PWID. 40% fewer DAAs are required with OAT+HCNSP scale-up to 50% among PWID, whereas more are required with involuntary CAP scale-up. Both targets can only be achieved through treating both current and former PWID (1,710 treatments/year), and impact is reduced with harm reduction interruptions. CONCLUSIONS Elimination targets are achievable in Tijuana through scale-up of harm reduction and DAA therapy, whereas involuntary CAP and harm reduction interruptions hamper elimination.
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Affiliation(s)
- Lara K Marquez
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, United States; School of Public Health, San Diego State University, San Diego, California, United States.
| | - Javier A Cepeda
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Annick Bórquez
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Steffanie A Strathdee
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Patricia E Gonzalez-Zúñiga
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States
| | - Clara Fleiz
- National Institute of Psychiatry Ramon de la Fuente Muniz, Huipulco, Tlalpan, Mexico City, United States
| | - Claudia Rafful
- Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico City, United States; Center on Global Mental Health Research, National Institute of Psychiatry, Mexico City, United States; Centre on Drug Policy Evaluation, St. Michael's Hospital, Toronto, OH, Canada
| | - Richard S Garfein
- Department of Family Medicine & Public Health, University of California San Diego, La Jolla, California, United States
| | - Susan M Kiene
- School of Public Health, San Diego State University, San Diego, California, United States
| | - Stephanie Brodine
- School of Public Health, San Diego State University, San Diego, California, United States
| | - Natasha K Martin
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, California, United States; Population Health Sciences, University of Bristol, Bristol, United Kingdom
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Fawole OI, Okedare OO, Salawu MM, Kiene SM, Reed E. Relationship dynamics with male partners among girls in low-income communities of Ibadan, Nigeria: Risk for violence and health related consequences. J Adolesc 2021; 87:74-85. [PMID: 33508729 DOI: 10.1016/j.adolescence.2021.01.002] [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: 06/10/2020] [Revised: 01/11/2021] [Accepted: 01/14/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION This study explored the motivations for and relationship dynamics that may promote girls' vulnerability for intimate partner violence and sources of support reported in unhealthy relationships among girls residing in low-income communities in Ibadan, Nigeria. METHODS Focus group discussions (n = 14; 122 girls) were conducted among girls aged 15-19 years, who reported having been in a relationship lasting at least 3 months. Girls were recruited from schools and worksites where partner violence has been reported in high proportions. Data were analysed using conceptual content analyses and independently coded by two researchers. RESULTS Adolescent girls reported keeping their relationships secret from their parents. While girls reported that sometimes relationships were out of love, relationships were also often motivated by girls' financial need. The financial and secretive nature of these relationships appeared to place girls at risk for intimate partner violence, with sexual coercion, resulting in multiple adverse social and health outcomes, including sexually transmitted infections and unintended pregnancy. Girls reported that leaving an abusive relationship is especially difficult when girls rely financially, were sexually involved, pregnant, or have had a child with the male partner. Friends/peers, rather than girls' family, were often the source of support for intimate partner violence. CONCLUSION Early identification of unhealthy relationships and supporting girls to be financially independent appear to be critical to reduce vulnerability to violence. Peer-based interventions may be most appropriate, given that girls' friends, rather than parents, were most often the source of support for intimate partner violence and other relationship challenges.
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Affiliation(s)
- Olufunmilayo I Fawole
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Omowumi O Okedare
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Mobolaji M Salawu
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria.
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, USA.
| | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, School of Public Health, San Diego State University, USA; Center on Gender Equity and Health, University of California San Diego, Division of Infectious Disease and Global Public Health, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
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Sileo KM, Miller AP, Huynh TA, Kiene SM. A systematic review of interventions for reducing heavy episodic drinking in sub-Saharan African settings. PLoS One 2020; 15:e0242678. [PMID: 33259549 PMCID: PMC7707537 DOI: 10.1371/journal.pone.0242678] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 01/22/2020] [Accepted: 11/08/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Assess the effect of non-pharmacological alcohol interventions on reducing heavy episodic drinking (HED) outcomes in sub-Saharan Africa. METHODS A systematic review of the available literature through August 19, 2020 was conducted. Randomized and non-randomized controlled trials testing non-pharmacological interventions on alcohol consumption in sub-Saharan Africa were eligible for inclusion. Eligible outcomes included measures of HED/binge drinking, and measures indicative of this pattern of drinking, such as high blood alcohol concentration or frequency of intoxication. Three authors extracted and reconciled relevant data and assessed risk of bias. The review protocol is available on PROSPERO (registration number: CRD42019094509). The Cochrane Handbook recommendations for the review of interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines guided all methodology. RESULTS Thirteen intervention trials were identified that met our inclusion criteria and measured change in HED. Studies were judged of moderate quality. A beneficial effect of non-pharmacological interventions on HED was reported in six studies, three of which were deemed clinically significant by the review authors; no statistically significant effects were identified in the other seven studies. Interventions achieving statistical and/or clinical significance had an intervention dose of two hours or greater, used an array of psychosocial approaches, including Motivational Interviewing integrated in Brief Intervention, cognitive behavioral therapy and integrated risk reduction interventions, and were delivered both individually and in groups. CONCLUSIONS Evidence for the effectiveness of non-pharmacological interventions to reduce HED in sub-Saharan African settings was limited, demonstrating the need for more research. To strengthen the literature, future research should employ more rigorous study designs, improve consistency of HED measurement, test interventions developed specifically to address HED, and explore structural approaches to HED reduction.
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Affiliation(s)
- Katelyn M. Sileo
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, United States of America
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California, United States of America
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, New Haven, Connecticut, United States of America
| | - Amanda P. Miller
- Division of Infectious Disease and Global Public Health, Department of Medicine, The University of California, San Diego, La Jolla, California, United States of America
| | - Tina A. Huynh
- Department of Public Health, University of Texas at San Antonio, San Antonio, Texas, United States of America
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, San Diego, California, United States of America
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Ogbonnaya IN, Wanyenze RK, Reed E, Silverman JG, Kiene SM. Prevalence of and Risk Factors for Intimate Partner Violence in the First 6 Months Following HIV Diagnosis Among a Population-Based Sample in Rural Uganda. AIDS Behav 2020; 24:1252-1265. [PMID: 31538284 DOI: 10.1007/s10461-019-02673-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/26/2022]
Abstract
Research in Uganda examining HIV-positive status disclosure and IPV victimization is scarce, and existing findings may not generalize to community-based samples of men and women newly diagnosed with HIV in Uganda. We investigated the prevalence of lifetime IPV, IPV experienced between HIV diagnosis and 6 months following diagnosis (recent IPV), and IPV specifically related to a partner learning one's HIV-positive status among a sample of men and women newly diagnosed with HIV in a population-based study in rural Uganda. We also examined correlates of recent IPV, including HIV-positive status disclosure. The sample included 337 participants followed for 6 months after HIV diagnosis. Lifetime IPV findings showed that over half of the sample reported experiencing emotional IPV (62.81% of men, 70.37% of women), followed by physical IPV (21.49% of men, 26.39% of women) then sexual IPV (7.44% of men, 17.59% of women). For recent IPV, men and women reported similar rates of physical (4.63% and 8.29%, respectively) and emotional (19.44% and 25.91%, respectively) IPV. Women were more likely than men to report recent sexual IPV (8.29% vs. 1.85%); however, this relationship was no longer significant after controlling for other risk factors associated with sexual IPV (AOR = 3.47, 95% CI [0.65, 18.42]). Participants who disclosed their HIV-positive status to their partner had 59% lower odds of reporting emotional IPV (AOR = 0.41, 95% CI [0.21, 0.81]) than participants who did not disclose their HIV-positive status. Younger age, non-polygamous marriage, lower social support, and greater acceptance for violence against women were also significantly associated with experience of recent IPV. Overall, 12.20% of participants who experienced recent IPV reported that the IPV was related to their partner learning their HIV-positive status. Findings highlight the need for IPV screening and intervention integrated into HIV diagnosis, care, and treatment services.
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Affiliation(s)
- Ijeoma Nwabuzor Ogbonnaya
- San Diego State University School of Social Work, San Diego, CA, USA
- Arizona State University School of Social Work, Phoenix, AZ, USA
| | | | - Elizabeth Reed
- Division of Health Promotion and Behavioral Science, San Diego State University School of Public Health, San Diego, CA, USA
| | - Jay G Silverman
- Division of Infectious Diseases & Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, La Jolla, CA, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
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Miller AP, Kintu M, Kiene SM. Challenges in measuring depression among Ugandan fisherfolk: a psychometric assessment of the Luganda version of the Center for Epidemiologic Studies Depression Scale (CES-D). BMC Psychiatry 2020; 20:45. [PMID: 32024472 PMCID: PMC7003345 DOI: 10.1186/s12888-020-2463-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 01/24/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Depression is a prevalent and serious mood disorder and a major source of disability adjusted life years (DALY) in Uganda. Furthermore, evidence from Uganda and other countries throughout sub-Saharan Africa suggests that nearly a third of persons living with human immunodeficiency virus (HIV) suffer from depression and it adversely affects healthcare seeking behavior. The high burden of disease attributable to depression makes data on the prevalence of depression in Uganda, a country with a generalized HIV epidemic, a public health priority. This paper describes the psychometric properties of the Center for Epidemiologic Studies-Depression (CES-D) measure when administered to men and women residing in three fishing communities along the shore of Lake Victoria. METHODS We applied methods based on item response theory and classical test theory approaches to assess individual item characteristics, conducted exploratory factor analysis and assessed internal reliability, and construct and content validity of the measure. All analyses were performed in R Studio. RESULTS The study sample consisted of 300 residents of fishing communities in Wakiso District, Uganda. Fifty-six percent of the sample was female and 19.7% reported being HIV positive. Seven items of the measure that did not perform well, either because they could not differentiate between levels of the latent trait or because they did not map onto the primary factor, were removed from the scale. A single factor structure best fit our final set of 13-items and we found an overall coefficient alpha of 0.89, indicating high internal consistency in this population. CONCLUSIONS Based on our findings, we recommend that future use of the CES-D in this population utilize our revised scale with the final set of 13-items. The addition of other measures that can improve the rigor of CES-D validation efforts, such as inclusion of a clinical depression measure and administration in both a clinical and a general population sample in this setting are needed.
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Affiliation(s)
- Amanda P. Miller
- Division of Infectious Disease and Global Public Health, University of California, San Diego, La Jolla, CA USA ,0000 0001 0790 1491grid.263081.eDivision of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Drive (MC-4162), San Diego, CA 92182 USA
| | - Michael Kintu
- Wakiso Integrated Rural Development Association, Entebbe, Uganda
| | - Susan M. Kiene
- 0000 0001 0790 1491grid.263081.eDivision of Epidemiology and Biostatistics, San Diego State University School of Public Health, 5500 Campanile Drive (MC-4162), San Diego, CA 92182 USA ,0000 0004 1936 9094grid.40263.33Alcohol Research Center of HIV, Brown University School of Public Health, Providence, RI USA
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Kiene SM, Ediau M, Schmarje KA, Kintu M, Tumwesigye NM. Exploring the Potential of Savings-Led Economic Strengthening HIV Interventions Among High-Risk Economically Vulnerable Fishing Communities in Uganda: Associations Between Use of Commitment Savings, Sexual Risk Behavior, and Problematic Alcohol Use. AIDS Behav 2019; 23:2347-2360. [PMID: 30924063 DOI: 10.1007/s10461-019-02475-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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] [Indexed: 12/18/2022]
Abstract
Fishing communities are a most-at-risk population for HIV in Uganda. Alcohol use and abuse and economic vulnerability fuel risky sexual practices and lead to increased risk of HIV infection in these communities. Economic strengthening is an emerging intervention approach and interventions promoting saving money via mechanisms with a "soft commitment" in the form of restricting or charging small fees for withdrawals, may serve to reduce spending on alcohol and spending that leads to HIV risk behaviors in cash-based economies. However, little research has been conducted to explore the potential for commitment savings-led economic strengthening interventions to address alcohol use and sexual risk behavior among fisherfolk. This cross-sectional study explored the associations between commitment savings, HIV sexual risk behavior, and problematic alcohol among fisherfolk. We also determined whether commitment savings moderated the associations between problematic alcohol use and risky sexual behaviors. 300 (132 male, 168 female) residents of fishing communities on Lake Victoria, Uganda completed a structured interviewer-assisted interview. Over half (55.3%) used commitment savings by saving money in a bank or savings cooperative or via mobile money. Having problematic alcohol use increased the rate of risky unprotected sex with: all partners (adjIRR 6.08, 95% CI 4.30-8.60) and with casual partners and CSWs/clients (adjIRR 4.90, 95% CI 3.09-7.78), and increased the odds of having met a sex partner at an alcohol venue (adjOR 2.84, 95% CI 1.46-5.51) compared to those without problematic alcohol use. Commitment savings was associated with lower odds of: problematic alcohol use (adjOR 0.50, 95% CI 0.26-0.96), meeting a sex partner at an alcohol venue (adjOR 0.43, 95% CI 0.24-0.78), as well as lower rates of risky unprotected sex with all partners (adjIRR 0.68, 95% CI 0.48-0.96), and with causal partners, CSWs/clients (adjIRR 0.38, 95% CI 0.17-0.85). Use of commitment savings moderated the associations between problematic alcohol use and unprotected sex. However, the moderating effects of commitment savings varied by gender. These findings suggest that promoting saving money in savings mechanisms which involve a commitment may be a potentially viable avenue for HIV prevention among fishing communities and may be particularly helpful for those who have problematic alcohol use.
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Affiliation(s)
- Susan M Kiene
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
- Alcohol Research Center on HIV, Brown University School of Public Health, Providence, RI, USA.
| | - Michael Ediau
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
- Makerere University School of Public Health, Kampala, Uganda
| | - Katherine A Schmarje
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
| | - Michael Kintu
- Wakiso Integrated Rural Development Association, Entebbe, Uganda
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Sileo KM, Reed E, Kizito W, Wagman JA, Stockman JK, Wanyenze RK, Chemusto H, Musoke W, Mukasa B, Kiene SM. Masculinity and engagement in HIV care among male fisherfolk on HIV treatment in Uganda. Cult Health Sex 2019; 21:774-788. [PMID: 30422078 PMCID: PMC6513725 DOI: 10.1080/13691058.2018.1516299] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [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: 06/20/2018] [Revised: 08/21/2018] [Accepted: 08/22/2018] [Indexed: 05/31/2023]
Abstract
This study explored the intersection of masculinity and HIV care engagement among fishermen and other male fisherfolk on antiretroviral therapy (ART) in Wakiso District, Uganda. We conducted 30 in-depth interviews with men on ART recruited from HIV treatment sites and used a thematic analysis approach. Since HIV diagnosis and ART initiation, men had adopted masculine identities more conducive to HIV care engagement. The masculine roles of worker and provider, husband and sexual partner and the appearance of physical strength were compromised by HIV, but restored by ART's positive effects on health. Peers also emerged as facilitators to HIV care, with men supporting each other to seek testing and treatment. However, structural and occupational barriers to HIV care associated with the masculine role of worker remained a barrier to care engagement. Findings suggest that emphasising the benefits of ART in bolstering men's ability to fulfil the roles important to them may improve the effectiveness of HIV testing and treatment messaging for men. Differentiated care models that address structural-level barriers to care, and community-level gender-transformative programming to help fishermen engage in HIV care, may be beneficial.
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Affiliation(s)
- Katelyn M. Sileo
- San Diego State University School of Public Health, San Diego, CA, USA
- University of California San Diego, La Jolla, CA, USA
| | - Elizabeth Reed
- San Diego State University School of Public Health, San Diego, CA, USA
| | | | | | | | - Rhoda K. Wanyenze
- Makerere School of Public Health, Makerere University, Kampala, Uganda
| | | | | | | | - Susan M. Kiene
- San Diego State University School of Public Health, San Diego, CA, USA
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Sileo KM, Kizito W, Wanyenze RK, Chemusto H, Reed E, Stockman JK, Musoke W, Mukasa B, Kiene SM. Substance use and its effect on antiretroviral treatment adherence among male fisherfolk living with HIV/AIDS in Uganda. PLoS One 2019; 14:e0216892. [PMID: 31158232 PMCID: PMC6546219 DOI: 10.1371/journal.pone.0216892] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 01/09/2019] [Accepted: 04/30/2019] [Indexed: 02/07/2023] Open
Abstract
Background Fisherfolk are a most-at-risk population for HIV being prioritized for the scale up of HIV treatment in Uganda. Heavy alcohol use and potential drug use may be a major barrier to treatment adherence for men in this setting. Objective This study examines the prevalence of substance use, and its influence on antiretroviral treatment (ART) adherence, among male fisherfolk on ART in Wakiso District, Uganda. Methods This cross-sectional study included structured questionnaires (N = 300) with men attending HIV clinics near Lake Victoria. Using generalized logistic modeling analyses with a binomial distribution and logit link, we conducted multivariate models to test the association between each alcohol variable (quantity and frequency index, hazardous drinking) and missed pills, adjusting for covariates, and tested for interactions between number of pills prescribed and alcohol variables. Results Thirty-one percent of men reported sub-optimal adherence. Half (46.7%) reported drinking, of which 64.8% met criteria for hazardous drinking. Illicit drug use was low (6%). In the multivariate model, men with greater scores on the alcohol frequency and quantity index were more likely to report missed pills compared to those reporting no drinking (AOR: 1.60, 95% CI: 1.29–1.97). Hazardous drinking had a greater effect on missed ARV doses among men taking twice daily regimens compared to once daily (AOR: 4.91, 95% CI: 1.68–14.37). Conclusions Our findings highlight the need for targeted alcohol-reduction interventions for male fisherfolk on ART who drink at high quantities to improve ART adherence and to prevent the known negative health effects of alcohol for HIV-infected individuals.
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Affiliation(s)
- Katelyn M. Sileo
- San Diego State University School of Public Health, San Diego, California, United States of America
- * E-mail:
| | | | - Rhoda K. Wanyenze
- Makerere School of Public Health, Makerere University, Kampala, Uganda
| | | | - Elizabeth Reed
- San Diego State University School of Public Health, San Diego, California, United States of America
| | - Jamila K. Stockman
- Division of Global Public Health in the Department of Medicine, University of California San Diego, La Jolla, California, United States of America
| | | | | | - Susan M. Kiene
- San Diego State University School of Public Health, San Diego, California, United States of America
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Sileo KM, Wanyenze RK, Kizito W, Reed E, Brodine SK, Chemusto H, Musoke W, Mukasa B, Kiene SM. Multi-level Determinants of Clinic Attendance and Antiretroviral Treatment Adherence Among Fishermen Living with HIV/AIDS in Communities on Lake Victoria, Uganda. AIDS Behav 2019; 23:406-417. [PMID: 29959718 PMCID: PMC6492274 DOI: 10.1007/s10461-018-2207-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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] [Indexed: 10/28/2022]
Abstract
This cross-sectional study assessed determinants of HIV clinic appointment attendance and antiretroviral treatment (ART) adherence among 300 male fisherfolk on ART in Wakiso District, Uganda. Multi-level factors associated with missed HIV clinic visits included those at the individual (age, AOR = 0.98, 95% CI 0.97-0.99), interpersonal (being single/separated from partner, AOR: 1.25, 95% CI 1.01-1.54), normative (anticipated HIV stigma, AOR: 1.55, 95% CI 1.05-2.29) and physical/built environment-level (travel time to the HIV clinic, AOR: 1.11, 95% CI 1.02-1.20; structural-barriers to ART adherence, AOR: 1.27, 95% CI 1.04-1.56; accessing care on a landing site vs. an island, AOR: 1.35, 95% CI 1.08-1.67). Factors associated with ART non-adherence included those at the individual (age, β: - 0.01, η2 = 0.03; monthly income, β: - 0.01, η2 = 0.02) and normative levels (anticipated HIV stigma, β: 0.10, η2 = 0.02; enacted HIV stigma, β: 0.11, η2 = 0.02). Differentiated models of HIV care that integrate stigma reduction and social support, and reduce the number of clinic visits needed, should be explored in this setting to reduce multi-level barriers to accessing HIV care and ART adherence.
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Affiliation(s)
- K M Sileo
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
- Center for Interdisciplinary Research on AIDS at Yale University, New Haven, CT, USA.
| | - R K Wanyenze
- Makerere School of Public Health, Makerere University, Kampala, Uganda
| | | | - E Reed
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - S K Brodine
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | | | | | | | - S M Kiene
- Graduate School of Public Health, San Diego State University, San Diego, CA, USA
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Sileo KM, Kizito W, Wanyenze RK, Chemusto H, Musoke W, Mukasa B, Kiene SM. A qualitative study on alcohol consumption and HIV treatment adherence among men living with HIV in Ugandan fishing communities. AIDS Care 2018; 31:35-40. [PMID: 30241440 DOI: 10.1080/09540121.2018.1524564] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Ugandan fishing communities are dually burdened with high rates of HIV and alcohol use. This qualitative study explores context and motivation of alcohol consumption, and alcohol's effect on antiretroviral treatment (ART) adherence, among male fisherfolk living with HIV in Wakiso District, Uganda. We conducted in-depth semi-structured interviews with 30 men in HIV care and on ART, and used a thematic analysis approach for analysis. Alcohol use was identified as a major barrier to ART adherence through cognitive impairment and the intentional skipping of doses when drinking. Men reportedly reduced their drinking since HIV diagnosis - motivated by counseling received from providers and a newfound desire to live a healthy lifestyle. However, social, occupational, and stress-related influences that make alcohol reduction difficult were identified. Our findings suggest alcohol use may pose a challenge to ART adherence for fishermen living with HIV - and has implications for the tailoring of screening and brief intervention for alcohol reduction in HIV care for this population.
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Affiliation(s)
- Katelyn M Sileo
- a Graduate School of Public Health , San Diego State University , San Diego , CA , USA.,b The Center for Interdisciplinary Research on AIDS , Yale University , New Haven , CT
| | | | - Rhoda K Wanyenze
- d Makerere School of Public Health , Makerere University , Kampala , Uganda
| | | | | | | | - Susan M Kiene
- a Graduate School of Public Health , San Diego State University , San Diego , CA , USA
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Nogueira BMF, Rolla VC, Akrami KM, Kiene SM. Correction: Factors associated with tuberculosis treatment delay in patients co-infected with HIV in a high prevalence area in Brazil. PLoS One 2018; 13:e0202292. [PMID: 30089165 PMCID: PMC6082544 DOI: 10.1371/journal.pone.0202292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Kiene SM, Sileo KM, Dove M, Kintu M. Hazardous alcohol consumption and alcohol-related problems are associated with unknown and HIV-positive status in fishing communities in Uganda. AIDS Care 2018; 31:451-459. [PMID: 30022681 DOI: 10.1080/09540121.2018.1497135] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
In Uganda, alcohol consumption is associated with higher HIV prevalence. However, research is needed to better understand how different patterns of alcohol consumption and alcohol-related problems may drive this association. In this cross-sectional study, we examined how hazardous alcohol use and alcohol-related problems such as psychological, physical, and social harms are associated with HIV status in fishing communities in Uganda. 300 (132 male, 168 female) residents of fishing communities in Uganda (75 participants from each of the following occupational groups: fishmongers, alcohol sellers, commercial sex workers (CSW), and fishermen) completed an interviewer-assisted computerized interview. We captured information on sociodemographics and HIV testing history. Prior 12-month hazardous alcohol consumption patterns and alcohol-related problems were assessed with the AUDIT and AUDADIS. 19.7%, 58.0%, and 23.3% of the sample reported being HIV positive, being HIV negative from a test within the prior 12 months, and not knowing their HIV status respectively. 18.7% reported the co-occurrence of hazardous alcohol consumption patterns and alcohol-related problems. 7.7% reported either hazardous alcohol consumption patterns or alcohol-related problems. Compared to non-drinkers, those with co-occurring hazardous consumption and alcohol-related problems had greater odds of being HIV positive (adjOR 2.75, 95% CI 1.17-6.43) and of unknown HIV status (adjOR 3.35, 95% CI 1.52-7.42). Reporting only hazardous consumption levels, only alcohol-related problems, or low-risk drinking, did not increase the odds of being HIV positive or of unknown status. Among those not HIV positive, those with co-occurring hazardous consumption and alcohol-related problems had greater odds of never having had an HIV test (adjOR 3.78, 95% CI 1.63-8.68). The co-occurrence of hazardous alcohol use and alcohol related problems appears to be a prominent risk factor for HIV infection, not knowing one's HIV status, and never testing for HIV in this setting.
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Affiliation(s)
- Susan M Kiene
- a Division of Epidemiology and Biostatistics , School of Public Health, San Diego State University , San Diego , CA , USA.,b Brown University Alcohol Research Center on HIV , Providence , RI , USA
| | - Katelyn M Sileo
- a Division of Epidemiology and Biostatistics , School of Public Health, San Diego State University , San Diego , CA , USA
| | - Meredith Dove
- c Department of Psychology , University of Massachusetts Dartmouth , Dartmouth , MA , USA
| | - Michael Kintu
- d Wakiso Integrated Rural Development Association , Uganda
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Nogueira BMF, Rolla VC, Akrami KM, Kiene SM. Factors associated with tuberculosis treatment delay in patients co-infected with HIV in a high prevalence area in Brazil. PLoS One 2018; 13:e0195409. [PMID: 29624603 PMCID: PMC5889181 DOI: 10.1371/journal.pone.0195409] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 11/19/2017] [Accepted: 03/21/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Worldwide, about 11% of Tuberculosis (TB) cases occur in people living with HIV (PLHIV) and it is the leading cause of death in this population. An important step towards reducing the incidence and mortality of TB in PLHIV is to reduce the time from onset of symptoms to treatment. Factors related to TB treatment delay therefore need to be understood. METHODS Using data from a prospective cohort study of patients diagnosed with TB at the National Institute of Infectious Disease, at the Oswaldo Cruz Foundation, Rio de Janeiro, Brazil we conducted a survival analysis to identify factors associated with patient and health care treatment delay. In our analysis we included patients who were co-infected with TB and HIV (n = 201). Patients were followed during the course of their TB treatment and information regarding duration of symptoms, sociodemographics and clinical characteristics were collected at the baseline visit. RESULTS The median time from onset of initial symptoms to prescription of TB treatment (total delay) was 82 days. From initiation of symptoms to first visit at INI clinic (patient delay), the median was 51 days. From first visit to initiation of treatment (health care delay) the median was 16 days. Illiteracy was associated with greater patient delay [Hazard Ratio (HR) = 2.25, CI 95% 1.29-3.94]. Having had a previous episode of TB (HR = 0.53, CI 95% 0.37-0.74) and being married (HR = 0.71, CI 95% 0.54-0.94) were inversely related to patient delay. Illiteracy was also associated with greater health care delay (HR = 2.83, CI 95% 1.25-5.47) in contrast to high viral load (HR = 0.37, CI 95% 0.24-0.54) and weight loss greater than 10% (HR = 0.54, CI 95% 0.37-0.8), both of which were inversely related to health care delay. CONCLUSIONS This study highlights the existence of factors that lead to greater risk of delayed treatment of TB among patients co-infected with HIV and TB. These include factors that can be assessed through targeted interventions which have implications for improving treatment outcomes and, through reduced duration of infectiousness, reduce the incidence of TB in Brazil.
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Affiliation(s)
- Betânia M. F. Nogueira
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, United States of America
| | - Valéria C. Rolla
- Instituto de Pesquisa Clínica Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Kevan M. Akrami
- Division of Infectious Diseases, University of California San Diego, La Jolla, California, United States of America
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University, San Diego, California, United States of America
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Abstract
Intimate partner violence (IPV) may increase risk for HIV/AIDS among women engaging in transactional sex in Ugandan fishing communities. In this cross-sectional study, 115 women reporting engaging in transactional sex in Lake Victoria fishing communities completed a computerized interview. We tested associations between IPV and other HIV risk factors, with unprotected sex and HIV status, and tested moderators of the IPV-HIV risk relationship. Women reporting recent sexual IPV reported 3.36 times more unprotected sex acts (AdjExp[B] = 3.36, 95% CI = 1.29-8.69, p = 0.07). The effect of sexual IPV on sexual risk was significantly greater among alcohol and fish sellers compared to sex workers (interaction: Exp[B] = 12.29, 95% CI = 5.06-29.85, p < 0.001). Women reporting any sexual IPV were nearly four times more likely to report being HIV positive than women reporting no sexual IPV (AOR = 3.94, 95% CI = 1.22-12.66, p = 0.02). Integrated IPV and HIV interventions are needed in this context, especially among alcohol and fish sellers engaging in transactional sex.
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Affiliation(s)
- Katelyn M. Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Michael Kintu
- Wakiso Integrated Rural Development Association, Entebbe, Uganda
| | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
- Alcohol Research Center on HIV, Brown University School of Public Health, Providence, PI, USA
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Sileo KM, Wanyenze RK, Lule H, Kiene SM. "That would be good but most men are afraid of coming to the clinic": Men and women's perspectives on strategies to increase male involvement in women's reproductive health services in rural Uganda. J Health Psychol 2017; 22:1552-1562. [PMID: 26929173 PMCID: PMC5565706 DOI: 10.1177/1359105316630297] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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] [Indexed: 11/15/2022] Open
Abstract
In Uganda, increasing male involvement in reproductive health services may improve women's access to care. The purpose of this study was to explore factors influencing male support for women's reproductive health services and to elicit suggestions for strategies to increase male involvement. In 2008-2009, focus groups ( N = 76) were conducted with men and women in a rural hospital in Uganda. A content analysis approach was used for data analysis. Our findings point to the need for multi-level approaches that educate and mobilize men, while improving quality of care at the facility level to increase male involvement in reproductive health services.
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Affiliation(s)
- Katelyn M. Sileo
- Division of Epidemiology and Biostatistics, San Diego State University Graduate School of Public Health, San Diego, CA, USA
| | - Rhoda K. Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | | | - Susan M. Kiene
- Division of Epidemiology and Biostatistics, San Diego State University Graduate School of Public Health, San Diego, CA, USA
- Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI USA
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Novotny T, Hendrickson E, Soares ECC, Sereno AB, Kiene SM. HIV/AIDS, tuberculosis, and tobacco in Brazil: a syndemic that calls for integrated interventions. CAD SAUDE PUBLICA 2017; 33Suppl 3:e00124215. [PMID: 28954053 DOI: 10.1590/0102-311x00124215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 02/24/2016] [Indexed: 11/21/2022] Open
Affiliation(s)
- Thomas Novotny
- San Diego State University, San Diego, U.S.A.,University of California, San Diego, U.S.A
| | - Erik Hendrickson
- San Diego State University, San Diego, U.S.A.,University of California, San Diego, U.S.A
| | | | - Andrea B Sereno
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
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Kiene SM, Kalichman SC, Sileo KM, Menzies NA, Naigino R, Lin CD, Bateganya MH, Lule H, Wanyenze RK. Efficacy of an enhanced linkage to HIV care intervention at improving linkage to HIV care and achieving viral suppression following home-based HIV testing in rural Uganda: study protocol for the Ekkubo/PATH cluster randomized controlled trial. BMC Infect Dis 2017; 17:460. [PMID: 28673251 PMCID: PMC5494823 DOI: 10.1186/s12879-017-2537-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/09/2017] [Indexed: 01/05/2023] Open
Abstract
Background Though home-based human immunodeficiency virus (HIV) counseling and testing (HBHCT) is implemented in many sub-Saharan African countries as part of their HIV programs, linkage to HIV care remains a challenge. The purpose of this study is to test an intervention to enhance linkage to HIV care and improve HIV viral suppression among individuals testing HIV positive during HBHCT in rural Uganda. Methods The PATH (Providing Access To HIV Care)/Ekkubo Study is a cluster-randomized controlled trial which compares the efficacy of an enhanced linkage to HIV care intervention vs. standard-of-care (paper-based referrals) at achieving individual and population-level HIV viral suppression, and intermediate outcomes of linkage to care, receipt of opportunistic infection prophylaxis, and antiretroviral therapy initiation following HBHCT. Approximately 600 men and women aged 18-59 who test HIV positive during district-wide HBHCT in rural Uganda will be enrolled in this study. Villages (clusters) are pair matched by population size and then randomly assigned to the intervention or standard-of-care arm. Study teams visit households and participants complete a baseline questionnaire, receive HIV counseling and testing, and have blood drawn for HIV viral load and CD4 testing. At baseline, standard-of-care arm participants receive referrals to HIV care including a paper-based referral and then receive their CD4 results via home visit 2 weeks later. Intervention arm participants receive an intervention counseling session at baseline, up to three follow-up counseling sessions at home, and a booster session at the HIV clinic if they present for care. These sessions each last approximately 30 min and consist of counseling to help clients: identify and reduce barriers to HIV care engagement, disclose their HIV status, identify a treatment supporter, and overcome HIV-related stigma through links to social support resources in the community. Participants in both arms complete interviewer-administered questionnaires at six and 12 months follow-up, HIV viral load and CD4 testing at 12 months follow-up, and allow access to their medical records. Discussion The findings of this study can inform the integration of a potentially cost-effective approach to improving rates of linkage to care and HIV viral suppression in HBHCT. If effective, this intervention can improve treatment outcomes, reduce mortality, and through its effect on individual and population-level HIV viral load, and decrease HIV incidence. Trial registration NCT02545673
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Affiliation(s)
- Susan M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Katelyn M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - Nicolas A Menzies
- Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Rose Naigino
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Chii-Dean Lin
- Department of Mathematics and Statistics, San Diego State University, San Diego, CA, USA
| | - Moses H Bateganya
- Formerly: Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Kiene SM, Lule H, Sileo KM, Silmi KP, Wanyenze RK. Depression, alcohol use, and intimate partner violence among outpatients in rural Uganda: vulnerabilities for HIV, STIs and high risk sexual behavior. BMC Infect Dis 2017; 17:88. [PMID: 28103834 PMCID: PMC5248514 DOI: 10.1186/s12879-016-2162-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 12/22/2016] [Indexed: 12/27/2022] Open
Abstract
Background Intimate partner violence (IPV), alcohol use, and depression are key vulnerabilities for HIV in Uganda, and taken together may have a synergistic effect on risk. Our objective was to investigate the associations between depression, IPV, and alcohol use and HIV-risk indicators among a sample of outpatients in rural Uganda, and the effect of co-occurrence of these factors on HIV-risk indicators. Methods In a structured interview we collected data on high-risk sexual behavior, depression symptoms, emotional and physical IPV, and alcohol use, as well as a blood sample for HIV and syphilis tests and a urine sample for chlamydia and gonorrhea tests from 325 male and female outpatients receiving provider-initiated HIV testing and counseling (PITC) at a public hospital outpatient clinic in rural Uganda. We used logistic regression and generalized linear modeling to test independent associations between depression, IPV, and alcohol use and HIV-risk indicators, as well as the effect of co-occurrence on HIV-risk indicators. Results Twelve percent of men and 15% of women had two or more of the following conditions: depression, IPV, and alcohol use; another 29% of men and 33% of women had 1 condition. Each condition was independently associated with HIV risk behavior for men and women, and for women, depression was associated with testing positive for HIV or a sexually transmitted infection (STI). Men with one condition (AOR 2.32, 95% CI 1.95–2.77) and two or more conditions (AOR 12.77, 95% CI 7.97–20.47) reported more high risk sex acts compared to those with no potential co-occurring conditions. For men, experiencing two or more conditions increased risky sex more than one alone (χ2 24.68, p < 0.001). Women experiencing one condition (AOR 3.33, 95% CI 137–8.08) and two co-occurring conditions (AOR 5.87, 95% CI 1.99–17.35) were more likely to test positive for HIV or an STI and women with two co-occurring conditions were also at increased risk for risky sex (AOR 2.18, 95% CI 1.64–2.91). We also found preliminary evidence suggesting synergistic effects between depression and emotional IPV and between alcohol use and depression. Conclusions This study demonstrates the co-occurrence of depression, IPV, and alcohol use in men and women in an outpatient setting in rural Uganda. The co-occurrence of these factors was associated with greater HIV risk, highlighting the need for a more holistic approach to HIV prevention and care research and programming.
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Affiliation(s)
- Susan M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
| | | | - Katelyn M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
| | - Kazi Priyanka Silmi
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA
| | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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48
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Kiene SM, Bateganya MH, Lule H, Wanyenze RK. The Effect of Motivational Interviewing-Based Counseling During Outpatient Provider Initiated HIV Testing on High-Risk Sexual Behavior in Rural Uganda. AIDS Behav 2016; 20:1928-36. [PMID: 27037546 DOI: 10.1007/s10461-016-1377-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [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] [Indexed: 11/26/2022]
Abstract
Provider-initiated HIV testing and counseling (PITC) has rapidly expanded in many countries including Uganda. However, because it provides HIV prevention information without individualized risk assessment and risk reduction counseling it may create missed opportunities for effective HIV prevention counseling. Our objective was to assess the effect of a brief motivational interviewing-based intervention during outpatient PITC in rural Uganda compared to Uganda's standard-of-care PITC at reducing HIV transmission-relevant sexual risk behavior. We enrolled 333 (160 control, 173 intervention) participants in a historical control trial to test the intervention vs. standard-of-care. Participants received PITC and standard-of-care or the intervention counseling and we assessed sexual risk behavior at baseline and 3 and 6 months follow-up. The intervention condition showed 1.5-2.4 times greater decreases in high risk sexual behavior over time compared to standard-of-care (p = 0.015 and p = 0.004). These data suggest that motivational interviewing based counseling during PITC may be a promising intervention to reduce high-risk sexual behavior and potentially reduce risk of HIV infection.
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Affiliation(s)
- Susan M Kiene
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA.
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA.
| | - Moses H Bateganya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
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Bateganya MH, Sileo KM, Wanyenze RK, Kiene SM. Strategies for delivery of HIV test results in population-based HIV seroprevalence surveys: a review of the evidence. Public Health 2016; 135:3-13. [PMID: 26947313 DOI: 10.1016/j.puhe.2016.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 03/17/2015] [Revised: 01/14/2016] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Many population-based demographic surveys assess local and national HIV prevalence in developing countries through home-based HIV testing and counselling (HBHTC), but results are rarely returned to participants. This review gathered evidence on the feasibility and best practices of providing HIV test results during such surveys by reviewing population-based surveys that provided test results. STUDY DESIGN Literature review. METHODS This review was conducted as part of a broader literature review related to HBHTC. We present results from population-based HIV seroprevalence surveys conducted between January 1984 and June 2013. RESULTS We identified eighteen population-based surveys describing uptake of results when testing or results were offered in the home, four of which compare home uptake to facility-based testing. All were from Sub-Saharan Africa. More people tested and received results in HBHTC compared to facility-based testing. Uptake of test results (72%) and the percentage of the population tested (59%) was highest when testing and the provision of results were provided in the home compared to the provision of results elsewhere (41% uptake; 37% population coverage), as well as mobile/facility-based testing and the provision of results (15% uptake; 13% population coverage). Providing results the same day as testing in HBHTC produces higher uptake (97% uptake; 74% population coverage) than delayed results. CONCLUSIONS Inclusion of home testing and provision of HIV results to participants in national population-based surveys in Sub-Saharan Africa is possible and should be prioritized. The timing and location of testing and the provision of results during HBHTC as part of population-based surveys affects uptake of testing and population coverage.
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Affiliation(s)
- M H Bateganya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - K M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA
| | - R K Wanyenze
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - S M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
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Sileo KM, Kintu M, Chanes-Mora P, Kiene SM. "Such Behaviors Are Not in My Home Village, I Got Them Here": A Qualitative Study of the Influence of Contextual Factors on Alcohol and HIV Risk Behaviors in a Fishing Community on Lake Victoria, Uganda. AIDS Behav 2016; 20:537-47. [PMID: 25921303 PMCID: PMC4626436 DOI: 10.1007/s10461-015-1077-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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] [Indexed: 12/31/2022]
Abstract
In Uganda, elevated HIV prevalence in fishing communities along Lake Victoria have been attributed in part to heavy alcohol use, but qualitative research is needed to understand the contextual factors influencing alcohol and sexual risk. Eight focus group discussions were conducted (n = 50; 23 male, 27 female) in Gerenge, Uganda with five occupational groups: fishermen, fishmongers, alcohol-sellers, commercial sex workers, and restaurant owners. Data was analyzed using content analysis. Alcohol use was prevalent and said to influence risky sex. Sex-related alcohol expectancies and occupational factors influenced individuals to drink during sex and structural factors related to the built environment, economy, and policy were identified as key contributors to both alcohol use and sexual risk in general. The findings highlight alcohol reduction as an important component of HIV/AIDS prevention and suggest structural interventions should be prioritized in this context.
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Affiliation(s)
- Katelyn M Sileo
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA
| | - Michael Kintu
- Wakiso Integrated Rural Development Association, Entebbe, Uganda
| | - Paola Chanes-Mora
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA
| | - Susan M Kiene
- Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
- Department of Community Medicine and Health Care, University of Connecticut Health Center, Farmington, CT, USA.
- Alcohol Research Center on HIV, Brown University School of Public Health, Providence, RI, USA.
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