Muhamadi L.,District Health Office |
Muhamadi L.,Makerere University |
Muhamadi L.,Karolinska Institutet |
Muhamadi L.,Busoga University |
And 9 more authors.
Trials | Year: 2011
Background: Many newly screened people living with HIV (PLHIV) in Sub-Saharan Africa do not understand the importance of regular pre-antiretroviral (ARV) care because most of them have been counseled by staff who lack basic counseling skills. This results in low uptake of pre-ARV care and late treatment initiation in resource-poor settings. The effect of providing post-test counseling by staff equipped with basic counseling skills, combined with home visits by community support agents on uptake of pre-ARV care for newly diagnosed PLHIV was evaluated through a randomized intervention trial in Uganda.Methods: An intervention trial was performed consisting of post-test counseling by trained counselors, combined with monthly home visits by community support agents for continued counseling to newly screened PLHIV in Iganga district, Uganda between July 2009 and June 2010, Participants (N = 400) from three public recruitment centres were randomized to receive either the intervention, or the standard care (the existing post-test counseling by ARV clinic staff who lack basic training in counseling skills), the control arm. The outcome measure was the proportion of newly screened and counseled PLHIV in either arm who had been to their nearest health center for clinical check-up in the subsequent three months +2 months. Treatment was randomly assigned using computer-generated random numbers. The statistical significance of differences between the two study arms was assessed using chi-square and t-tests for categorical and quantitative data respectively. Risk ratios and 95% confidence intervals were used to assess the effect of the intervention.Results: Participants in the intervention arm were 80% more likely to accept (take up) pre-ARV care compared to those in the control arm (RR 1.8, 95% CI 1.4-2.1). No adverse events were reported.Conclusions: Provision of post-test counseling by staff trained in basic counseling skills, combined with home visits by community support agents had a significant effect on uptake of pre-ARV care and appears to be a cost-effective way to increase the prerequisites for timely ARV initiation.Trial registration: The trial was registered by Current Controlled Trials Ltd C/OBioMed Central Ltd as ISRCTN94133652 and received financial support from Sida and logistical support from the European Commission. © 2011 Muhamadi et al; licensee BioMed Central Ltd.
Inadequate pre-antiretroviral care, stock-out of antiretroviral drugs and stigma: Policy challenges/bottlenecks to the new WHO recommendations for earlier initiation of antiretroviral therapy (CD<350 cells/μL) in eastern Uganda
Muhamadi L.,District Health Office |
Nsabagasani X.,Northern Uganda Transition Initiative |
Tumwesigye M.N.,Makerere University |
Ekstrom A.-M.,Makerere University |
And 2 more authors.
Health Policy | Year: 2010
Objective: This study explores reasons for late ART initiation among known HIV positive persons in care from a client/caretaker perspective in eastern Ugandan where ART awareness is presumably high yet AIDS related mortality is a common function of late initiation of ARVs. Methods: In Iganga, Uganda we conducted in-depth interviews with clients who started ART at 50-200 CD4 cells/μL and those initiated very late at CD4<50 cells/μL. Focus-group discussions were also conducted with caretakers of clients on ART. Content analysis was performed to identify recurrent themes. Results: ARV stock-outs, inadequate pre-antiretroviral care and lack of staff confidentiality were system barriers to timely ART initiation. Weak social support and prevailing stigma and misconceptions about ARVs as drugs designed to kill, cause cancer, infertility or impotence were other important factors. Conclusion: If the new WHO recommendations (start ART at CD4 350 cells/μL) should be feasible, PLHIV/communities need sensitization about the importance of regular pre-ARV care through the local media and authorities. The ARV supply chain and staff attitudes towards client confidentiality must also be improved in order to encourage timely ART initiation. PLHIV/communities should be sensitization about drug package labeling and the use and importance of ARVs. Stronger social support structures must be created through public messages that fight stigma, enhance acceptance of PLHIV and encourage timely ART initiation. © 2010 Elsevier Ireland Ltd.
Nancy Mungai W.,Egerton University |
Njue A.M.,Egerton University |
Abaya S.G.,Community Livelihood Development Forum |
Said A.H.V.,The University of Dodoma |
Ibembe J.D.,Busoga University
African Journal of Agricultural Research | Year: 2011
Frequent periodic flooding and land use changes taking place in the Lake Victoria basin (LVB) in east Africa may cause soil deterioration and further exacerbating food insecurity. Surface (0 to 20 cm) soil samples were collected at three locations along Sondu Miriu (Kenya) and Simiyu-Duma (Tanzania) rivers. Samples were collected from fields that were periodically flooded (1-28 d) and those that never flood, either under grass or crops. Samples were analysed for soil texture, organic carbon (OC), total nitrogen (TN), pH, extractable phosphorus (P), exchangeable potassium (K) and β-glucosidase activities. β-glucosidase activities, clay and P contents were higher in some of the soils that flood, while OC, exchangeable K and sand contents were lower at P< 0.05 in flooded soils. Observed differences account for 11% of comparisons in the two river basins. Soils under grass had higher β-glucosidase activities and silt content but lower sand content than cultivated soils in 6% of samples in the two basins. However, conversion of natural ecosystems to grassland or cropped lands resulted in a 17 to 113% reduction in OC, TN, and exchangeable K in Sondu, and a 129% decline in TN in Simiyu. Soil properties exhibited clear but different patterns from upstream to downstream in the two basins. OC, TN, clay and β-glucosidase activities were higher in Sondu upstream, while OC, TN, extractable P and exchangeable K were lower in Simiyu upstream. Observed difference across each basin underscore the importance of inherent soil characteristics in influencing soil properties compared to short-term flooding or short duration changes in land use. © 2011 Academic Journals.
Lubega M.,District Health Office |
Lubega M.,Makerere University |
Lubega M.,Busoga University |
Lubega M.,National Institute of Allergy and Infectious Diseases |
And 11 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2015
Background: Over 50% of people living with HIV (PLHIV) in sub-Saharan Africa are lost to follow-up between diagnosis and initiation of antiretroviral treatment during pre-antiretroviral (pre- ARV) care. The effect of providing home counseling visits by community support agents on 2-year retention in pre-ARV care was evaluated through a randomized controlled trial in eastern Uganda. Methods: Four hundred newly screened HIV-positive patients were randomly assigned to receive posttest counseling alone (routine arm) or posttest counseling and monthly home counseling visits by community support agents to encourage them go back for routine pre-ARV care (intervention arm). The outcome measure was the proportion of new PLHIV in either arm who attended their scheduled pre-ARV care visits for at least 6 of the anticipated 8 visits in the first 24 months after HIV diagnosis. The difference between the 2 study arms was assessed using the x2 and T tests. Mantel-Haenszel Risk Ratios and multivariate logistic models were used to assess the adjusted effect of the intervention on the outcome. Results: In all models generated, participants receiving monthly home counseling visits were 2.5 times more likely to be retained in pre-ARV compared with those in standard care over a period of 24 months (adjusted risk ratio, 2.5; 95% confidence interval: 2.0 to 3.0). Conclusion: Monthly follow-up home visits by community workers more than doubled the retention of PLHIV in pre-ARV care in rural Uganda and can be applicable in similar resourcepoor settings. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
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News & Updates Admission for January/April 2015 Intake is in progress Admission for January/April 2015 Intake is in progress The office of the Academic Registrar, Busoga University, invites applicants for the following regular,weekend, holiday and evening programmes for the January 2015 intake. The intake commences on January 5th, 2015 ...