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Human Papilloma Virus (HPV) vaccination can prevent more than 90% of cancers caused by HPV. Although this vaccination is recommended and provided at no cost to all adolescent girls aged 9 to19 years in Uganda, its uptake remains low. We sought to determine the uptake of, and factors associated with HPV vaccination among adolescent girls living with HIV in Uganda. We conducted an explanatory sequential mixed methods study, among adolescent girls living with HIV, attending HIV care at the Mulago ISS HIV clinic in Kampala, Uganda. We administered a structured questionnaire to elicit data on HPV vaccination and its covariates to a systematic random sample of 264 adolescent girls with HIV. A participant who had received all the three recommended HPV vaccine doses was classified as fully vaccinated. We then conducted four focus group discussions among adolescent girls living with HIV (n = 32), eight in-depth interviews among their parents and five Key informant interviews among their healthcare providers. We conducted descriptive statistics and logistic regression analyses for the quantitative data before thematic analysis for the qualitative data. Of 264 adolescent girls, 31% (83/264) had at least one HPV vaccine dose; 22% (59/264) two doses, while 8.0% (21/264) were fully vaccinated (received three doses). While most participants received their first and second doses (48% (40/83)) and 57.6% (34/59), respectively) from school, the largest number of participants (47.1% (12/21)) received their third dose at community outreaches. Participants who received counseling from community members were three times more likely to get fully vaccinated compared to those who did not receive counseling (aOR 3.28, Cl:1.07-10.08, P = 0.038). From the qualitative follow-up, three major themes were identified: (1): Limited information about HPV vaccination, which gave room for misconceptions and doubts about the vaccine; (2) Parental influence on adolescent decisions was strong despite parents having limited knowledge about HPV vaccination and (3) Inadequacy of HPV vaccination services at the hospital and in the schools. Full HPV vaccination was low among adolescent girls living with HIV. Counseling of the adolescents by community members, alongside HPV vaccination community outreaches, provided a platform for vaccination. There should be strategies to provide adequate information about HPV vaccine to health workers, parents, and the adolescents. In addition to schools, community-based initiatives, including outreaches and lay-health workers can be utilized to improve HPV vaccine uptake among girls with HIV.

Tuberculosis (TB) remains a leading cause of mortality worldwide, with childhood TB posing unique diagnostic challenges due to its pauci bacillary nature. The World Health Organization emphasizes that these diagnostic difficulties hinder early detection, contributing to delays in treatment initiation, disease progression, and increased morbidity and mortality. Addressing these challenges is critical to achieving the global goal of ending TB as a public health threat by 2030. This study aimed to determine the median time to TB treatment initiation and explore the factors influencing early treatment among children under 15 years at Kisenyi Health Center IV. We conducted a retrospective cohort mixed-methods study. Quantitative data were obtained through a retrospective review of medical records for 152 children under 15 years treated for TB at Kisenyi Health Center IV between February 1, 2021, and February 28, 2023. The median time to treatment initiation was estimated using Kaplan-Meier survival analysis, while Cox proportional hazards regression identified determinants of treatment initiation. Qualitative data were collected through key informant interviews with healthcare workers involved in childhood TB care. Thematic analysis, guided by the Capability, Opportunity, and Motivation Behavior (COM-B) model, was used to identify barriers to early TB treatment. A total of 152 children were included in the study. The median time to TB treatment initiation was 39.5 days (IQR: 30,80.9). Pulmonary bacteriologically confirmed TB was the only significant determinant of early treatment initiation (HR: 0.54, 95% CI: 0.31-0.88). Key barriers to timely TB treatment included caregivers' poor knowledge of childhood TB, referral of children under five to the national referral hospital, inadequate diagnostic equipment and supplies, loss of community follow-up contacts, and high patient volumes. Children with TB experience significant treatment delays, underscoring the urgent need for more accessible and rapid diagnostic tools to increase the proportion of bacteriologically confirmed cases and reduce treatment initiation time. Strengthening decentralized TB diagnostic capacity and enhancing caregiver awareness could improve early detection and treatment outcomes.

In the last decade, survival of people living with HIV (PLHIV) has dramatically increased due wide availability of effective antiretroviral therapy. However, PLHIV remain at a comparatively higher risk of non-communicable comorbidities. We sought to determine the burden of COPD and its associations in an urban tertiary HIV clinic in Uganda. HIV-infected adults attending the Makerere University Joint AIDS program; aged ≥30 years without acute ailments were screened for COPD using study questionnaires and spirometry (post-bronchodilator FEV1/FVC<0.7). We determined its prevalence and association with demographic characteristics, body mass index (BMI) and known risk factors. Of 288 participants enrolled, 177 (61%) were female; 253 (88%) were from urban residences, median age was 45 years (IQR: 39-51), 71(25%) were 'ever' smokers, 284(99%) reported biomass fuel use and 72(25%) had a history of tuberculosis. All except 1 participant were on antiretroviral therapy, median current CD4 (cells/mm3) was 558 (IQR 402-753) and 275(96%) were virologically suppressed. Nearly half (130/288, 45%) had recurrent respiratory symptoms. The prevalence of COPD was 3.1% (9/288) [95% CI: 1.63-5.92]. COPD was associated with: previous tuberculosis, (adjusted odds ratio (AOR): 6.36, [95% CI 1.64-35.84], P = 0.036), self-reported chronic shortness of breath (AOR: 9.06, [95% CI 1.34-61.10], P = 0.024) and a BMI <21 Kg/m2 (AOR: 10.42 [95% CI: 1.61-100.00], P = 0.013). In this HIV population, COPD prevalence was low and was associated with previous tuberculosis, self-reported chronic shortness of breath and BMI <21 Kg/m2.

Introduction The World Health Organization recommends Community-based blood pressure monitoring (BPM) for diagnosis and management of hypertension. However, there is limited data on the uptake and factors associated with community BPM among people living with HIV (PLHIV) and hypertension in many low-income settings including Uganda. This study aimed to determine the uptake of, and factors associated with community BPM among PLHIV and hypertension receiving care at selected HIV clinics. Methods A cross-sectional study was conducted between May and July 2024 at three HIV clinics participating in an implementation trial [(NCT05609513), registration date, November 8, 2022) in the Kampala and Wakiso districts. Participants were proportionally distributed across the clinics, were randomly selected and surveyed using a pretested questionnaire. Descriptive statistics were performed, reporting means or medians with standard deviations (SD)/interquartile ranges (IQR) and frequencies with proportions for numerical and categorical variables, respectively. Factors associated with community BPM uptake were assessed using bi-variable and multivariable modified Poisson regression. Data analysis was performed using STATA 14.1. Results Of the 408 participants, 67.7% were female, mean age of 50.1 years (SD = 10.7). Community BPM uptake was 27%. Among those monitoring their BP in the community, 68.6% did so at private clinics, 70% at pharmacies, 15.2% at public health facilities, and 5.4% self-monitored their BP. Multivariable analysis indicated that the uptake of community BPM was associated with receiving three antihypertensive medications, receiving advice from healthcare providers, receiving feedback on BP monitoring and owning a BP device. Conclusion Community BPM uptake among PLHIV and hypertension was low. However, individuals receiving healthcare provider recommendations and feedback, owning BP devices, or on three antihypertensive medications were more likely to engage in community BPM. To improve uptake of community BP monitoring, and ensure continuity of care, targeted interventions such as healthcare provider counseling, feedback mechanisms, and facilitating access to BP devices are recommended.

Background Intimate partner violence (IPV) remains a pervasive public health concern, disproportionately affecting women worldwide and posing significant risks to their physical and psychological well-being. Women living with HIV (WLHIV) are particularly vulnerable to IPV though both its extent or nature and impact on mental wellbeing of WLHIV in Uganda have not been extensively examined. The aim of this sequential explanatory mixed-methods study was to examine the association between intimate partner violence, social support, and depression in WLHIV in central Uganda. Methods We sampled 215 for the quantitative strand. The Abusive Behaviour Inventory (ABI), Beck Depression Inventory (BDI) and Multi-Dimensional Scale of Perceived Social Support measured IPV, depression and social support respectively. These were followed by individual face-to-face semi structured interviews with a subsample of 10 women. Descriptive frequencies, Pearson correlations and process macro were analyzed in SPSS software while interviews were analyzed thematically. Results Overall, 15.1% experienced IPV, 24.9% were depressed respectively, and 68.4% had moderate to high perceived social support as well as significant negative correlations between IPV and depression. Social support significantly mediated the relationship between IPV and depression. Qualitative results explained the earlier quantitative results under three main themes: (1) Multiple forms of Violence/Abuse (2) Managing and Coping with Violence/abuse.3) Impact of Violence/abuse. Conclusion Addressing IPV, promoting social support and financial independence can enhance efforts aimed at ART adherence and improving mental health outcomes among vulnerable WLHIV.

Depression is rarely screened for among People Living with Human Immunodeficiency Virus (PLHIV) although it is 2 to 3 times more prevalent among PLHIV than in the general population. In instances where depression is screened for using screening tools, it usually follows noticing depression risk factors. This practice of selectively screening for depression could be leaving some cases of depression unattended to. On the other hand, subjecting every client to screening tools (non-selective screening) offers every patient an opportunity to be managed for depression. However, this could require additional resources as compared to selective screening. We present and discuss results on whether non-selective and selective screening strategies differ in depression case detection, and in addition, we also present perceptions of the stake holders on the two screening strategies. The study was conducted in Princess Diana Memorial Health Centre IV HIV clinic using a randomized controlled trial with a qualitative component. To determine whether there was a difference in depression case detection, consecutively sampled participants were randomly allocated to either non-selective or selective screening strategy. Participants allocated to selective screening were screened for depression using the patient health questionnaire (s) (PHQs) if they were at \"crisis points\". While those allocated to non-selective screening were screened regardless of whether the \"crisis points\" were noticed or not. The PHQ-2 and PHQ-9 were used in sequence. 326 PLHIV participated in the study. Outcomes of the MINI evaluation were analyzed for those with PHQ-9 scores of 10 or more to confirm major depressive disorder (MDD). Data was analyzed using the two sample Z-test for proportions with Stata 2013 software. To explore the perceptions of the stake holders, key informant interviews were performed with six stakeholders that experienced the study. Cases of depression (PHQ-9 score ≥ 5) were more likely to be detected by the non-selective screening strategy 30.2% (49/162) compared to the selective screening strategy 19.5% (32/164) (difference in proportions 0.107, 95% confidence interval 0.014-0.200, Cohen's h = 0.25, P = 0.03). The stake holders thought it was important to screen for depression among PLHIV with preference to non-selective screening strategy. Evidence from this data suggests that more cases of depression (PHQ-9 score ≥ 5) are likely to be detected with non-selective screening as opposed to selective screening. PACTR201802003141213 (name: comparison of routine versus selective screening for depression strategies among PLHIV attending Princess Diana Memorial Health Centre iv Soroti).

Uganda adopted the HIV Test and Treat in 2016. There is paucity of data about its implementation among hospitalized patients. We aimed to determine the proportion of patients initiating anti-retroviral therapy (ART) during hospitalization, barriers and mortality outcome. In this mixed methods cohort study, we enrolled hospitalized patients with a recent HIV diagnosis from three public hospitals in Uganda. We collected data on clinical characteristics, ART initiation and reasons for failure to initiate ART, as well as 30 day outcomes. Healthcare workers in-depth interviews were also conducted and data analyzed by sub-themes. We enrolled 234 patients; females 140/234 (59.8%), median age 34.5 years (IQR 29-42), 195/234 (83.7%) had WHO HIV stage 3 or 4, and 74/116 (63.8%) had CD4 [less than or equal to] 200 cell/[mu]L. The proportion who initiated ART during hospitalization was 123/234 (52.6%) (95% CI 46.0-59.1), of these 35/123 (28.5%) initiated ART on the same day of hospitalization, while 99/123 (80.5%) within a week of hospitalization. By 30 days 34/234 (14.5%) (95% CI 10.3-19.7) died. Patients residing [greater than or equal to] 35 kilometers from the hospital were more likely not to initiate ART during hospitalization, [aRR = 1.39, (95% CI 1.22-1.59). Inadequate patient preparation for ART initiation and advanced HIV disease were highlighted as barriers of ART initiation during hospitalization. In this high HIV prevalence setting, only half of newly diagnosed HIV patients are initiated on ART during hospitalization. Inadequate pre-ART patient preparation and advanced HIV are barriers to rapid ART initiation among hospitalized patients in public hospitals.

A 12-dose weekly regimen of rifapentine plus isoniazid (3HP) is recommended for the prevention of active tuberculosis (TB); however, it is unclear whether 3HP should be provided by directly observed therapy (DOT) or self-administered therapy (SAT). In addition, the introduction of patient informed choice between delivery modalities may have a positive impact on factors leading to treatment completion. The authors randomized 252 participants with HIV to a hypothetical scenario of providing preventive therapy by either DOT or an informed choice between DOT and SAT. Out of 104 participants who were randomized to a choice between DOT and SAT, 103 chose therapy by SAT. Participants rated their level of confidence and intention to complete therapy. Compared to those assigned to the DOT scenario, patients assigned to the choice scenario expressed greater confidence and intention to complete preventive therapy. Convenience and travel required to complete 3HP therapy were important factors in deciding between delivery modalities. Those assigned to DOT identified more barriers to completing therapy than those given a choice. Empowering patients to make informed decisions about how they receive TB preventive therapy may improve completion rates.

The uptake of cervical cancer screening services among rural Women Living with HIV (WLHIV) attending several rural public facilities in Eastern Uganda is low at less than 50% of the target. This gap is largely influenced by low screening literacy among these women, difficulties in accessing, understanding and applying cervical cancer screening information due to multiple barriers, including limited education, low socioeconomic status, misconceptions, and fear. Therefore, context-specific and culturally appropriate strategies are needed to overcome these barriers. This study engaged rural WLHIV in Eastern Uganda to co-design three strategies to improve their cervical cancer screening literacy. This participatory research combined the User-Centered Design (UCD) approach with co-design workshops to design the three strategies. Participants included 16 rural WLHIV from four rural public health facilities in Mayuge and Namayingo districts who had participated in prior studies that identified and selected these strategies. This process involved the ideation and implementation phases of the UCD approach. It was led by a medical illustrator and a Sexual and a Behavioral Change Communication specialist, supported by two healthcare providers. Two IEC charts, one on the importance of cervical cancer screening and the other addressing key misconceptions regarding cervical cancer screening. Both IEC charts had colorful pictures, and few texts in local language, Luganda, explaining the pictures. Two peer educators were trained to provide cervical cancer screening education, address misconceptions about cervical cancer screening, and encourage women to undergo cervical cancer screening. A ten-minute cervical cancer screening education video was designed, comprising a midwife providing cervical cancer screening education and a trained peer educator interacting with a client. Integrating co-design and UCD approaches facilitated the design of context-specific strategies that incorporated preferences for rural WLHIV and targeted barriers to cervical cancer-screening literacy among these women.

Despite overall increase in HIV testing, more men than women remain untested. In 2018, 92% of Ugandan women but only 67% of men had tested for HIV. Understanding men's needs and concerns for testing could guide delivery of HIV testing services (HTS) to them. We assessed the prevalence of testing, associated factors and men's perspectives on HIV testing in urban and peri-urban communities in Central Uganda. We conducted a parallel-convergent mixed-methods study among men in Kampala and Mpigi districts from August to September 2018. Using two-stage sampling, we selected 1340 men from Mpigi. We administered a structured questionnaire to collect data on HIV testing history, socio-demographics, self-reported HIV risk-related behaviors, barriers and facilitators to HIV testing. We also conducted 10 focus-groups with men from both districts to learn their perspectives on HIV testing. We used modified Poisson regression to assess factors associated with HIV testing and inductive thematic analysis to identify barriers and facilitators. Though 84.0% of men reported having tested for HIV, only 65.7% had tested in the past 12-months despite nearly all (96.7%) engaging in at least one HIV risk-related behavior. Men were more likely to have tested if aged 25-49 years, Catholic, with secondary or higher education and circumcised. Being married was associated with ever-testing while being widowed or divorced was associated with testing in past 12-months. Men who engaged in HIV risk-related behavior were less likely to have tested in the past 12-months. Qualitative findings showed that men varied in their perspectives about the need for testing, access to HTS and were uncertain of HIV testing and its outcomes. Recent HIV testing among men remains low. Modifying testing strategies to attract men in all age groups could improve testing uptake, reduce gender disparity and initiate risk reduction interventions.