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Study background This study will employ a mixed-methods design. The study area will be Lira district and Lira city located in northern Uganda. The setting for recruitment of participants will be the public health facility-based anti-retroviral therapy (ART) clinics. These ART clinics serves a total of about 1,771 YWLHIV. A sample of 425 YWLHIV will be selected by stratified random sampling from the ART clinic registers. The three strata of interest will be the YWLHIV attending the ART clinic at referral hospitals, health centers level IV (primary healthcare centers), and health centers level III (dispensaries). The primary outcome will be the use of the female-controlled dual protection methods. The outcome will be measured by asking the YWLHIV 'what methods under their control as YWLHIV do they use to protect against both unintended pregnancy and HIV during sexual intercourse with their male partners.' The questionnaire also has measures for the unintended pregnancy, HIV status, and the potential predictors. Qualitative component of the study will be in-depth interviews of the participants about their experiences and perceptions regarding the female-controlled dual protection methods. Data collection was still ongoing at the time of first submission of this study protocol to the journal (14th March 2023). The Statistical Package for Social Sciences (SPSS) version 23.0 will be used for the statistical analyses. Descriptive statistics, bivariate and multivariate regression analyses will be used to establish the prevalence, associated factors and the predictors of the outcome respectively. The statistical significance level of 5% and 95% confidence interval will be considered. In-depth interviews will be manually analyzed using a thematic analysis approach for codes, themes, and categories.

Although many studies were conducted on COVID-19 knowledge, attitude, and practice (KAP) among the general population in many countries, very little is known about refugees, particularly Rohingya refugees in Cox's Bazar. A vast array of risk communication and community engagement (RCCE) interventions were implemented in Cox's Bazar with the intent of reducing disease transmission by empowering the community to adopt public health measures. The study aimed to assess the level of knowledge, attitude and practice (KAP) of COVID-19 preventive measures among the Rohingya refugees in Cox's Bazar, and to identify their socio-demographic determinants. A cross-sectional study was conducted with 500 Rohingya individuals. Participants in the study were Rohingya refugees residing in five randomly selected camps where International Organization for Migration (IOM) Health was operating. Using a structured questionnaire, skilled community health workers surveyed the Rohingya population. In addition to the survey on knowledge, attitude, and practice, the study gathered information on the perspectives and relevance of sociodemographic factors that influence KAP. The study findings indicate that the mean scores for knowledge, attitude, and practice were 9.93, 7.55, and 2.71 respectively. Association was found between knowledge and practice level and age group-the elderly age group (>/ = 61 years) had less level of knowledge (AOR 0.42, P value = 0.058) and the late mid-age group (46-60 years) had better practice level (AOR 2.67, P value <0.001). Our study found that the Rohingya refugee community in Cox's Bazar has improved knowledge and attitude toward COVID-19 preventive measures. However, the practice level of these measures remains low compared to the knowledge and positive attitude. The reason behind the poor practice of preventive measures needs to be identified and addressed engaging the community in similar future outbreaks.

Adolescent girls and young women living with HIV (AGYWLHIV) in Uganda face dual risks of HIV transmission to male partners and unintended pregnancies. Male condoms require male partner cooperation. Female-controlled dual protection methods (FCDPM) offer a potential solution by enabling AGYWLHIV to independently manage their sexual and reproductive health. This study assessed the prevalence of dual protection methods (DPMs), identified factors influencing their use, and explored reasons for non-use among AGYWLHIV in northern Uganda. A parallel convergent mixed-methods study was conducted among the AGYWLHIV attending antiretroviral therapy services at six public health facilities in Lira City and Lira District between November 2022 and April 2023. Participants were asked about the methods they were using to simultaneously prevent unintended pregnancy and HIV transmission. If not using any dual protection method, why not? Quantitative data on DPM prevalence and associated factors were analysed using descriptive statistics and chi-square tests, while qualitative data on non-use reasons were thematically analysed. Among the 423 participants (median age 22 years), no one reported using the FCDPM, while only 1.2% used any form of DPM. Male condoms alone were used by 29.3% of the participants. The few who used the DPM combined the use of the male condoms with oral contraceptive pills, emergency contraceptive pills, IUD or implants. Factors positively influencing the DPM use included marital status, prior condom use, and knowledge of safer conception methods. Barriers included personal or partner disapproval of the modern contraceptives, lack of contraceptive knowledge or misconceptions, fear of contraceptive side effects or stigma, desire to conceive, and sole reliance on the male condoms. The findings highlight a critical gap in FCDPM uptake and the low prevalence of DPM use among AGYWLHIV. Strengthening health education on modern contraception, addressing misconceptions, and reducing fears about contraceptive side effects or stigma could improve DPM acceptance and uptake in this population.

Introduction Over 60% of unplanned pregnancies end up in abortion and an estimated 45% of these abortions are unsafe, contributing for 13% of all maternal death globally. This study aimed to determine the prevalence and factors associated with unsafe abortion among married women admitted to the gynecological ward at Lira Regional Referral Hospital, a public facility in Lira City, Northern Uganda. Methodology We conducted a cross-sectional study among married women admitted with abortion to the gynecological ward at Lira Regional Referral Hospital, Lira City, Northern Uganda from December 2022 to April 2023. We used a consecutive sampling technique to recruit 368 participants. We collected quantitative data using an interviewer-administered questionnaire, and we analyzed descriptive statistics using Statistical Package for Social Sciences version 29.0. We obtained ethical approval from the Gulu University Research Ethics Committee and Lira Regional Referral Hospital’s administration. We gained informed consent from the study participants. Results 203 (55.2%) of the respondents were aged 15–24 years, 160 (43.5%) were from a rural setting, 158 (42.9%) were Protestants by religion, 338 (91.8%) were Lango by tribe, 111 (30.2%) were peasants, and 229 (62.2%) had primary level of education. 176 (47.8%) respondents had unsafe abortions, while 192 (52.2%) had safe abortions. Respondents who were aged 15–24 years were less likely to have unsafe abortion (AOR: 0.685, 95% CI: 0.454–0.725, P  = 0.020) compared to respondents aged > 34 years. Respondents who were from rural settings were more likely to have unsafe abortion AOR: 2.559, 95% CI: 1.453–4.505, P  = 0.001) compared to those who were urban settings. Respondents who had monthly income of < 100,000 shillings (AOR: 2.677, 95% CI: 1.426–5.023, P  = 0.002), 100,000–250,000 shillings (AOR: 2.854, 95% CI: 1.463–5.567, P  = 0.002), and 250,000–500,000 shillings (AOR: 2.306, 95% CI: 1.031–5.158, P  = 0.042) were more likely to have unsafe abortions compared to those who had total monthly income of > 500,000 shillings. Conclusions There was a high prevalence of unsafe abortion in this study. Older age, coming from rural settings, and low monthly income were significantly associated with unsafe abortion practices. The Ministry of Health should launch a national campaign to educate the public about the risks of unsafe abortion and the availability of sexual and reproductive health services, such as family planning services, to prevent unsafe abortion from unplanned pregnancies.

Women of reproductive age constitute a significant proportion of the global HIV burden, with millions becoming pregnant while on lifelong antiretroviral therapy (ART). Although ART has dramatically improved maternal and child health outcomes, concerns persist regarding its safety in pregnancy. This study compares obstetric and neonatal outcomes between women with and without HIV infection at Anaka General Hospital, a rural hospital in northern Uganda. A hospital-based retrospective cross-sectional study at Anaka General Hospital in northern Uganda was conducted from July 2020 to June 2023. A total of 914 delivery records were included, sampled using systematic random sampling from the hospital maternity register. Data were extracted from maternity and neonatal records using a structured tool. Associations between HIV status and obstetric or neonatal outcomes were assessed using Chi-square or Fisher's exact tests for categorical variables and independent sample t-tests for continuous variables. Multivariable logistic regression was used to adjust for potential confounders and a p < 0.05 was considered statistically significant. Of the 914 participants included in the study 38 (4.2%) were HIV-positive. The odds of congenital anomalies were significantly higher among infants born to HIV-positive women compared with HIV-negative women (adjusted odds ratio = 9.76, 95% confidence interval: 1.72-55.48, p < 0.01). No significant differences were observed in maternal or neonatal outcomes between the two groups. HIV infection was significantly associated with an increased risk of congenital anomalies, while other obstetric and neonatal outcomes were similar between HIV-positive and HIV-negative women. We recommend enhanced prenatal monitoring and early fetal screening among HIV-positive pregnant women on dolutegravir-based ART. Additionally, prospective studies are needed to better understand the contribution of dolutegravir and maternal factors to congenital anomalies in HIV-exposed pregnancies.

Background Caregivers of patients with chronic illnesses are often uncompensated for work that is physically demanding, time consuming and emotionally and economically draining. This is particularly true for caregivers of children with nodding syndrome, an emergent neurological disorder of unknown etiology in resource poor settings in Africa. We aimed to explore perceptions of caregivers regarding challenges that a typical caregiver faces when caring for a child with nodding syndrome. Methods We used a qualitative exploratory study design with focus group discussions and in-depth interviews to collect data. We analyzed data using the qualitative analysis software package of NVivo and thematic query building. Results Emergent themes centered on burden of care with emotional agony as the most prominent. Subthemes reflecting the burden of care giving included child and caregiver safety concerns, burnout, social isolation and rejection, and homicidal ideation. Caregivers also complained of physical and financial constraints associated with the care of children with nodding syndrome. Conclusions The findings point to a high burden of care for caregivers of children with nodding syndrome and suggests the need to incorporate community-based psychosocial and mental health care services for the caregivers of affected children into the national health system response.

Introduction Abortion is a critical reproductive health issue among young women living with HIV (YWLHIV). Despite the widespread use of the antiretroviral therapy (ART) for women of reproductive age, its impact on abortion prevalence remains unclear. We set out to determine the prevalence of abortion among the YWLHIV receiving TLD-based ART regimen in northern Uganda and its association with the ART regimen and duration alongside other key socio-demographic, reproductive health, lifestyle and facility access– related factors. Methods A cross-sectional study of YWLHIV who reported at least one pregnancy in northern Uganda. Using an interviewer-administered questionnaire, participants were asked about their abortion history, ART regimen and duration, contraceptive use, parity, male partner’s HIV status, and access to community-based family planning resources. Descriptive statistics for abortion prevalence, Chi-square test, Fisher’s Exact test, bivariate and multivariate Poisson regression analyses for the associations between these variables and the occurrence of abortion were used. The 5% significance level and 95% confidence intervals were considered. Results We analyzed data of 268 YWLHIV who reported conceiving at least one pregnancy. The abortion prevalence was 20.9% (95% Confidence Interval (CI) of 16.2% − 26.1%). No significant association was found between the abortion experience and ART regimens nor duration. The significant predictors for abortion included awareness of public health facilities that provide family planning services, parity, sero-concordant HIV-positive partnerships, and modern contraceptive use. Conclusion This study found a substantial abortion prevalence of 20.9% among the YWLHIV in northern Uganda. There was no significant association between the occurrence of abortion and ART regimens nor duration. Key predictors of abortion included awareness of public health facilities that provide family planning services, parity, use of contraceptive methods and the male partner’s HIV positive status. To reduce abortion, creation of awareness of public health facilities that provide family planning services, contraceptive use, and couple-focused HIV testing and status disclosure are recommended.

The association between attachment and mental health symptoms in adolescents in a post-conflict low resource setting has not been documented. We investigated the relationship between parent and peer attachment and posttraumatic stress, depression and anxiety symptoms in a sample of 551 adolescents aged 13-21 years old. Attachment quality was assessed using the Inventory of Parent and Peer Attachment (IPPA). Post-traumatic stress, depression and anxiety symptoms were assessed using the Impact of Events Scale Revised (IESR) and Hopkins Symptom Checklist for Adolescents (HSCL-37A) respectively. Gender differences in attachment relationships were determined using independent t-tests. Multivariate logistic regression was used to assess whether attachment relationships were independently associated with posttraumatic stress, depression and anxiety symptoms. Hierarchical linear regression analyses were conducted to explore the moderating role of war-related trauma. Our analyses revealed gender differences in attachment to parents, with males reporting stronger attachment than females. Parental attachment was protective against depression and anxiety symptoms but not posttraumatic stress symptoms after adjusting for potential confounders. Alienation by parents was independently associated with an increase in these mental health symptoms while peer attachment was not associated with any of these symptoms. However, in situations of severe trauma, our analyses showed that peer attachment was significantly protective against post-traumatic stress symptoms. Secure parental attachment is associated with better psychosocial adjustment in adolescents affected by war. Further, adolescents with secure peer attachment relationships in situations of severe war trauma may be less likely to develop posttraumatic stress symptoms. Interventions to enhance peer support in this post conflict setting would benefit this vulnerable population.

Background The burden of HIV remains disproportionally high among the adolescent girls and young women. This is often coupled with nondisclosure of HIV status partly due to delayed knowledge of HIV status which affects entry into HIV prevention interventions. HIV self-testing which provides instant knowledge of HIV status is being promoted to enable early disclosure. However, previous studies about the association between HIV self-testing (HIVST) and HIV disclosure are scarce. We, therefore, set out to determine the prevalence of HIVST, nondisclosure of HIV status to male partners, and the predictors among adolescent girls and young women living with HIV (AGYWLHIV) in Uganda. Methods In a cross-sectional study design, a stratified random sample of AGYWLHIV were recruited from ART clinics in semi-rural northern Uganda between November 2022 and April 2023. The participants received an interviewer-administered questionnaire. HIV self-testing was defined as the use of the HIVST method by the AGYWLHIV to discover their HIV status. Similarly, HIV nondisclosure was defined as the AGYWLHIV’s failure to disclose her initial HIV status to her current male sexual partner before their first sexual intercourse regardless of the use of condoms. Results A total of 423 participants with a mean age of 21.6 ± 2.5 years participated in the study. The study found that only 3.8% of the AGYWLHIV discovered their HIV status through HIVST. Furthermore, 26.7% of the AGYWLHIV did not disclose their status to their current male partners, 35.5% experienced non-disclosure from their current male partners, and 16.5% experienced bidirectional non-disclosure. The predictors for non-disclosure of initial HIV status were found to include the AGYWLHIV’s knowledge of their initial negative HIV status [APR 0.3 (0.2–0.5), p 0.001], the AGYWLHIV’s knowledge of their initial positive HIV status [APR 0.5 (0.3–0.7), p 0.002], the AGYWLHIV’s prior knowledge of the positive initial HIV status of the male partner [APR 0.4 (0.2–0.8), p 0.010] and the male partner’s nondisclosure of their initial HIV status to the AGYWLHIV [APR 2.0 (1.2–3.5), p 0.008]. Conclusions The prevalence of HIVST and HIV nondisclosure to male sexual partners among the AGYWLHIV in semi-rural Uganda stood at 38 in 1000 and 267 in 1000 respectively. The HIVST wasn’t associated with HIV nondisclosure but the women’s initial negative or positive HIV status, the male partner’s initial positive HIV status and the male partners’ nondisclosure of their initial HIV status to the AGYWLHIV were found to be independent predictors. These findings point to the need for health workers to target the distribution of HIVST kits at the AGYWLHIV attending ART clinics to give them to men in their sexual and social networks to expand access to HIV testing, improve chances of two-way HIV disclosure and entry into the HIV prevention, treatment, and care services.

Background: In 2020 in sub-Saharan Africa, 25% of new human immunodeficiency virus (HIV) infections occurred among young women (15–24 years). In Uganda, the HIV prevalence is three times higher among young women at 2.9% compared to 0.8% among their male counterparts. HIV status disclosure is a gateway to preventive services. Objectives: We set out to estimate the prevalence of HIV status disclosure to current male partners, and the predictors among the adolescent girls and young women living with HIV (AGYWLHIV) in a semi-rural northern Uganda. Design: In a cross-sectional study design, a consecutive sample of the AGYWLHIV was recruited from six antiretroviral therapy clinics between November 2022 and April 2023. Methods: Participants were administered an interviewer-guided questionnaire. They were asked whether they have ever disclosed their HIV status to their current male partners. They were also asked about their socio-demographics, sexual and reproductive health profiles, knowledge and perceptions of dual protection, and safer conception methods for AGYWLHIV. Percentages to estimate prevalence, Chi-square tests to assess associations, simple and multivariate modified Poisson regression to identify predictors at p < 0.05 and 95% confidence intervals (CI) were considered. Results: Overall, 423 participants with a median age of 22 (IQR 4) years participated in the study. The prevalence of HIV status disclosure to the current male partners was found at 73.3% (95% CI 69.0–77.5). The predictors for HIV status disclosure were found to include the women’s knowledge of their HIV status (APR 1.1 (95% CI 1.0–1.2), p 0.032), knowledge of their male partner’s HIV status (APR 0.8 (95% CI 0.7–0.9), p 0.003), and the male partners’ disclosure of their HIV status to the women (APR 0.7 (95% CI 0.5–0.9), p <0.016). Conclusion: About three-fourths of the AGYWLHIV in semi-rural northern Uganda disclosed their HIV status to their male partners. The predictors of disclosure included the women’s knowledge of their HIV status, knowledge of their male partner’s HIV status, and the male partner’s reciprocal disclosure of their HIV status. To enhance disclosure rates, post-test, and disclosure counseling for both individuals and couples is recommended as part of the routine HIV testing, treatment, and care programs. Plain language summary HIV status disclosure to male sexual partners and the predictors. The world is still experiencing many new HIV infections among young women including adolescent girls. Adolescent girls and young women are more affected than boys and men. Women and girls can get to know of their HIV status because of the HIV counseling and testing during preconception, antenatal, and postnatal care aimed at preventing the transmission of the infection to their babies. Beside that, it is important that women who know their status disclose their HIV status to their male sexual partners so that both partners can seek medical treatments for prevention of the transmission if one partner remained uninfected or for treatment of both partners if both of them are infected. This research estimated the proportion of adolescent girls and young women living with HIV who have disclosed their HIV status to their current male sexual partners and the factors that influence disclosure. To answer the above objectives, we asked 423 adolescent girls and young women living with HIV in rural Uganda whether they disclosed their HIV status to their current male sexual partners. We also collected information about the women’s sociodemographic characteristics, sexual and reproduction related perceptions and behaviors. The research findings reveal that 73.3% of the adolescent girls and young women disclosed their HIV status to their current male sexual partners. The factors that were found to have influenced disclosure were the women’s knowledge of their HIV status, the male partners disclosing their HIV status to the women, the women’s age at initiation of sexual activity and the women’s years of experience in sex. In conclusion, this research conducted in rural Uganda found that not all sexually active young women living with HIV disclose their HIV status to their male sexual partners. Disclose is influenced by the woman’s knowledge of her HIV status, reciprocal disclosure by the male sexual partner, the woman’s age at inititiation of sexual activity and her years of experience in sexual matters. The research calls for couple testing and disclosure counseling.