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Despite being a priority population for COVID-19 vaccination, limited data are available regarding acceptability of COVID-19 vaccines among people living with HIV (PLWH) in Sub-Saharan Africa. We described COVID-19 vaccine acceptability and factors associated with vaccine acceptability among PLWH in Uganda. This was a cross-sectional study conducted among PLWH, aged ≥18 years, enrolled participants who were seeking HIV care from six purposely selected accredited ART clinics in Kampala. We obtained data on vaccine acceptability defined as willingness to accept any of the available COVID-19 vaccines using interviewer-administered questionnaires. In addition, we assessed vaccination status, complacency regarding COVID-19 disease, vaccine confidence, and vaccine convenience. Factors associated with COVID-19 vaccine acceptability were evaluated using modified Poisson regression with robust standard errors. We enrolled 767 participants of whom 485 (63%) were women. The median age was 33 years [interquartile range (IQR) 28-40] for women and 40 years [IQR], (34-47) for men. Of the respondents 534 (69.6%,95% confidence interval [CI]: 66.3%-72.8%) reported receiving at least one vaccine dose, with women significantly more likely than men to have been vaccinated (73% vs. 63%; p = 0.003). Among the unvaccinated 169 (72.7%, 95% CI: 66.6%-78.0%) were willing to accept vaccination, had greater vaccine confidence (85.9% had strong belief that the vaccines were effective; 81.9% that they were beneficial and 71% safe for PLWH; 90.5% had trust in health care professionals or 77.4% top government officials), and believed that it would be easy to obtain a vaccine if one decided to be vaccinated (83.6%). Vaccine acceptability was positively associated with greater vaccine confidence (adjusted prevalence ratio [aPR] 1.44; 95% CI: 1.08-1.90), and positive perception that it would be easy to obtain a vaccine (aPR 1.57; 95% CI: 1.26-1.96). vaccine acceptance was high among this cohort of PLWH, and was positively associated with greater vaccine confidence, and perceived easiness (convince) to obtained the vaccine. Building vaccine confidence and making vaccines easily accessible should be a priority for vaccination programs targeting PLWH.

BackgroundPsychological distress (PD) is a prevalent concern among undergraduate health science students globally. Despite this, data specific to Uganda is limited.AimThis study assessed the prevalence of PD among undergraduate health sciences students in Uganda.MethodsWe obtained data on the psychological distress burden using self-administered DASS-21 questionnaires. Data were analysed using SPSS version 20.ResultsWe enrolled 398 participants, of whom 217 (54.5%) were males. The median age of the participants was 22 years (interquartile range [IQR], 21 to 24). Of the participants, more than half (57%) had moderate to severe symptoms of anxiety. Nearly half of them (42%) reported moderate to severe symptoms of depression, while 26% of the students had moderate to severe symptoms of stress.Lessons LearntThis study highlights significant psychological distress among health science students at Makerere University, with high levels of anxiety, depression and stress. It emphasises the need for improved mental health support in academic settings, aligning with the African Journal of Primary Health Care & Family Medicine’s focus on contextual healthcare challenges.

Background Despite being a priority population for COVID-19 vaccination, limited data are available regarding acceptability of COVID-19 vaccines among people living with HIV (PLWH) in Sub-Saharan Africa. We described COVID-19 vaccine acceptability and factors associated with vaccine acceptability among PLWH in Uganda. Methods This was a cross-sectional study conducted among PLWH, aged ≥18 years, enrolled participants who were seeking HIV care from six purposely selected accredited ART clinics in Kampala. We obtained data on vaccine acceptability defined as willingness to accept any of the available COVID-19 vaccines using interviewer-administered questionnaires. In addition, we assessed vaccination status, complacency regarding COVID-19 disease, vaccine confidence, and vaccine convenience. Factors associated with COVID-19 vaccine acceptability were evaluated using modified Poisson regression with robust standard errors. Results We enrolled 767 participants of whom 485 (63%) were women. The median age was 33 years [interquartile range (IQR) 28–40] for women and 40 years [IQR], (34–47) for men. Of the respondents 534 (69.6%,95% confidence interval [CI]: 66.3%-72.8%) reported receiving at least one vaccine dose, with women significantly more likely than men to have been vaccinated (73% vs. 63%; p = 0.003). Among the unvaccinated 169 (72.7%, 95% CI: 66.6%-78.0%) were willing to accept vaccination, had greater vaccine confidence (85.9% had strong belief that the vaccines were effective; 81.9% that they were beneficial and 71% safe for PLWH; 90.5% had trust in health care professionals or 77.4% top government officials), and believed that it would be easy to obtain a vaccine if one decided to be vaccinated (83.6%). Vaccine acceptability was positively associated with greater vaccine confidence (adjusted prevalence ratio [aPR] 1.44; 95% CI: 1.08–1.90), and positive perception that it would be easy to obtain a vaccine (aPR 1.57; 95% CI: 1.26–1.96). Conclusion vaccine acceptance was high among this cohort of PLWH, and was positively associated with greater vaccine confidence, and perceived easiness (convince) to obtained the vaccine. Building vaccine confidence and making vaccines easily accessible should be a priority for vaccination programs targeting PLWH.

Sex workers of all genders have a high risk of HIV acquisition and are a priority population for HIV pre-exposure prophylaxis (PrEP). We aimed to assess current oral PrEP use and associated factors among cisgender female sex workers (FSW) in two Ugandan cities. We administered a survey questionnaire to 236 HIV-negative FSW in the cities of Mbale and Mbarara from January to March 2020. The survey was nested in a quasi-experimental study to assess the effect of peer education and text message reminders on the uptake of regular sexually transmitted infection (STI) and HIV testing. Using interviewer-administered questionnaires, we obtained data on current self-reported tenofovir-based oral PrEP use. We used modified Poisson regression with robust standard errors to evaluate the factors associated with current oral PrEP usage. Nearly 70% of FSWs reported taking an HIV test during the past three months. Among the respondents, 33% (33/100) in Mbale and 67% (91/136) in Mbarara reported having ever heard of PrEP. However, only 9.7% (23/236) self-reported currently taking oral-PrEP. In Mbarara, FSWs were twice as likely to be aware of or use oral PrEP than those in Mbale (adjusted prevalence ratio [aPR] 2.33; 95% confidence interval (CI) 1.19-3.97; p = 0.01). Additionally, current use was positively associated with attainment of secondary (aPR 2.50; 95% CI: 1.14-5.45; p = 0.02) or tertiary education (aPR 3.12; 95% CI: 1.09-8.96; p = 0.03). PrEP use in this cohort of FSWs was low and was associated with location and level of education. To increase PrEP uptake among FSWs, targeted educational campaigns and implementation studies are needed, particularly for those with lower levels of education.

Background In a recent observational study, we reported findings on barriers to effective immunization in rural Hoima District, western Uganda, where it emerged that rural contexts may not have same determinants as peri-urban or urban contexts driving underimmunization. In a continuation of that work to incorporate peri-urban and urban barriers to immunization, this study reports a follow up on the recommendations of our earlier publication, through a case study of (peri) urban Wakiso district, and incorporates and compares the findings from both districts to propose unified recommendations to address low immunization coverage (under 90%) in Uganda. The aim was therefore to determine and describe the barriers to the uptake and utilization of immunization services in Hoima and Wakiso districts of Uganda and propose interventions, strategies and approaches that can help address the problem of vaccine hesitancy and underimmunization in Uganda. Methods This was a mixed methods study, that utilized interviews with child caregivers, for the quantitative design and focus group discussions (FGDs) with caregivers of children eligible for vaccination, and single in-person in-depth interviews with health workers, and immunization focal persons (KIs) for the qualitative part in both Wakiso (per-urban) and Hoima (rural) districts of Uganda. Results In this study, majority of the caregivers (369/643) were 21–25 years of age, female, married and protestants, with basic secondary education. The study found that 91% (588/643) of respondents consider vaccines safe, 85% (547/643) consider vaccines effective, 95% (611/643) have complete trust in vaccines and 13% have some misgivings regarding vaccines. Both Districts are under-immunized (Hoima 81% and Wakiso 75.3% DPT3 coverage). Factors independently associated with low DPT3 coverage include: low trust in vaccines, being a single parent caregiver, those who consider vaccines unsafe, relying on social media as source of vaccine information, those who did not receive any education on vaccines during immunization visits, and those who have misgivings about vaccines. Additional drivers of underimmunization include access difficulties, geographical barriers, inadequate funding, cold chain inadequacies, inadequate social mobilization, vaccine stock outs, high training needs for health workers, and adverse events following immunization. Conclusions This study found that both Hoima and Wakiso districts are under-immunized given a DPT3 vaccine coverage less than 90%. The Ministry of Health needs to train Health Workers through improved mentorship, enhance outreach services, social mobilization, and build trust in communities.

Background Evidence shows that negative childbirth experiences may lead to undesirable effects including failure to breastfeed, reduced love for the baby, emotional upsets, post-traumatic disorders and depression among mothers. Understanding childbirth experiences and their meaning could be important in planning individualized care for mothers. The purpose of this study was to explore childbirth experiences and their meaning among postnatal mothers. Methods A phenomenological qualitative study was conducted at Mbale Regional Referral Hospital among 25 postnatal mothers within two months after birth using semi-structured interviews and focus group discussions and data was thematically analyzed. Results The severity, duration and patterns of labour pains were a major concern by almost all women. Women had divergent feelings of yes and no need of biomedical pain relief administration during childbirth. Mothers were socially orientated to regard labour pains as a normal phenomenon regardless of their nature. The health providers’ attitudes, care and support gave positive and negative birth experiences. The Physical and psychosocial support provided comfort, consolation and encouragement to the mothers while inappropriate care, poor communication and compromised privacy contributed to the mothers’ negative childbirth experiences. The type of birth affected the interpretations of the birth experiences. Women who gave birth vaginally, thought they were strong and brave, determined and self-confident; and were respected by members of their communities. On the contrary, the women who gave birth by operation were culturally considered bewitched, weak and failures. Conclusion Childbirth experiences were unique; elicited unique feelings, responses and challenges to individual mothers. The findings may be useful in designing interventions that focus on individualized care to meet individual needs and expectations of mothers during childbirth.

Background Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV). Antiretroviral therapy (ART) initiation lowers the risk of HIV-associated TB. Earlier studies have shown TB incidence to be high in the first year of ART. We undertook a study to (1) assess the incidence of TB and (2) associated factors among persons initiating ART in a rural cohort. Methods We conducted a retrospective cohort analysis study among PLHIV aged ≥ 18 years, initiated on ART from January 1, 2012, to December 31, 2019, and TB disease-free at the time of ART initiation, at Kalisizo ART clinic. TB disease incidence was calculated by dividing the number of new TB cases by the total follow-up time expressed per 100 person-years among persons followed up until the date of incident TB disease, loss to follow-up, transfer out, death or censored at the end of the study; whichever occurred first. Factors associated with TB disease incidence were assessed in the multivariable analysis by Poisson regression analysis at 5% significance level. Results For the period 2012 to 2019, 2,589 PLHIV were initiated on ART; 57% (1,470/2,589) were female. Females were more likely to be aged below 35 years while males were more likely to be aged 25–44 years ( p  < 0.001). Eighty-seven per cent (1,269/1,470) of females compared to 78% (866/1,119) of males were in WHO clinical stage 1 ( p  < 0.001). Sixty-one TB disease events were observed in 7,363 person-years. The overall TB disease incidence was 0.83 (95% CI: 0.63–1.06) per 100 person-years. Males were more likely than females to develop TB disease, adjusted incidence rate ratio (adj IRR) 2.13 (95% CI: 1.27–3.57) per 100 person-years, p  = 0.004. Compared to using ART for 0–5 months, time on ART was associated with a lower TB incidence rate at 6–12 months, 13–24 months, > 24 months (adj IRR 0.20 (95% CI: 0.09–0.46), 0.14 (95% CI: 0.06–0.33), 0.16 (95% CI: 0.08–0.31) p  < 0.001 respectively). Conclusions and recommendations Incidence of TB among PLHIV on ART was low in this rural population. Clinicians offering care to people with HIV in the rural setting should have a heightened index of suspicion for TB disease.

Background Periodic testing of female sex workers (FSW) for sexually transmitted infections (STIs) is a core component of global and national responses to achieve population-level STI elimination. We conducted a qualitative study to explore barriers and facilitators of regular syphilis and HIV testing among FSW in Uganda. Methods Within a quasi-experimental study among 436 FSW to assess the effect of peer education and text message reminders on uptake of regular STI and HIV testing among FSW, we conducted 48 qualitative interviews in four cities in Uganda from August–December 2018. We purposively selected FSW who tested for syphilis and HIV every 3–6 months; 12 FSW were interviewed in each city. Sex worker interviews explored: 1) reasons for periodic syphilis and HIV testing; 2) barriers and facilitators of testing; 3) experiences of testing; and 4) challenges faced while seeking testing services. Data were analyzed using thematic content analysis. Results Thematic analysis revealed individual- and health system-level barriers and facilitators of testing. For syphilis, barriers were a) interpersonal stigma, low perceived severity of syphilis and testing misconceptions (individual); and b) judgmental provider attitudes, paucity of facilities offering syphilis testing, stockouts of test kits and high cost (health system). Facilitators were c) desire to remain healthy, get married and have children, knowing the benefits of early treatment, influence of male partners/clients and normative testing behaviors (individual); and d) sex worker clinics offering dual syphilis/HIV testing (health system). For HIV, barriers included: a) internalized stigma (individual); and b) unfavorable clinic hours, stigma, discrimination, and unfriendly provider (health system). Facilitators were a) motivations to stay healthy and attract clients, habitual testing, self-efficacy, doubts about accuracy of negative test results, and use of post-exposure prophylaxis (individual); and d) availability of testing facilities (health system). Syphilis and HIV had similar testing barriers and facilitators. Conclusions HIV programs are likely to be important entry points for syphilis testing among FSW. Multi-level interventions to address testing barriers should consider focusing on these service delivery points. Extending the dual syphilis and HIV testing approach to FSW may improve testing uptake for both infections at public health facilities and decrease population-level incidence.

Background We assessed the willingness of female students at a Ugandan public university to use long-acting Cabotegravir (CAB-LA) for HIV prevention, given their high prevalence of HIV risk behaviours. Methods Using an online questionnaire, this cross-sectional study surveyed 346 female undergraduate students aged 18–25. Factors influencing their willingness were analysed with modified Poisson regression and robust standard errors. Results More than half, 56.7% (95% CI: 51.4 to 61.8), were willing to use CAB-LA. Willingness was significantly associated with being sexually active in the past 3 months, using alcohol in the past 6 months, or being in the 4th year of study compared to the 1st year. Conclusion Educational initiatives on innovative HIV prevention strategies, such as CAB-LA, should be introduced early in university students’ studies to increase awareness and acceptance.

Background Long-acting injectable cabotegravir (CAB-LA) pre-exposure prophylaxis (PrEP) has superior efficacy compared with daily oral PrEP. However, implementation in sub-Saharan Africa (SSA) is constrained by high costs and limited access. Assessing willingness to pay (WTP) is critical for the sustainable rollout of CAB-LA PrEP. This study evaluated WTP for CAB-LA PrEP among heterosexual male and female sex workers in Uganda. Methods Within a discrete choice experiment (DCE) to evaluate CAB-LA delivery preferences, we surveyed HIV negative heterosexual male and female sex workers (SWs) in two high prevalence cities in Central and Southwestern Uganda (October-December 2024). Willingness to pay (WTP) for injectable CAB-LA, including the maximum amount per injection, was assessed among sex workers (SWs) by trained interviewers. Trained interviewers collected data on WTP for injectable CAB-LA, including the maximum amount in Ugandan shillings (UGX) per injection. Modified Poisson regression was used to identify factors associated with WTP. Results We enrolled 251 sex workers (SWs), including 52 (21%) males. Males had higher education (27% vs. 5%), while females had been in the industry longer (24 months vs. 18 months). Females reported higher median weekly earnings (250,000 Ugandan shillings [UGX] [US $71.43]) than males (145,000 UGX [US $41.42]). Overall, 51% of females and 42% of males expressed WTP for injectable CAB-LA, with a median WTP of 10,000 UGX [$3], compared with the current average cost of 100,000 UGX [$29] in Uganda. WTP was positively associated with residing in Kampala (adjusted prevalence ratio [aPR] 2.41; 95% confidence interval [CI] 1.64–3.55) and with older age, including ages 25–30 years (aPR 1.51; 95% CI 1.03–2.22) and 31–35 years (aPR 1.87; 95% CI: 1.25–2.92), compared with ages 18–24 years. Higher WTP was also observed among respondents with previous PrEP use (aPR 1.52; 95% CI: 1.14–2.03), while no significant differences were observed by sex (aPR 0.96; 95% CI: 0.65–1.43). Conclusions This cohort of sex workers preferred injectable PrEP, but their willingness to pay remained modest. Future studies should assess the feasibility and effectiveness of out-of-pocket payment models for injectable PrEP programs.