Mildmay Uganda

Kampala, Uganda

Mildmay Uganda

Kampala, Uganda
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Odiit M.C.A.,Mildmay Uganda | Mayoka G.K.,Makerere University | Ochara N.M.,University of Pretoria | Rwashana A.S.,Makerere University
ACM International Conference Proceeding Series | Year: 2014

Alignment of Information Systems with organizational objectives and strategy is a key factor for the success of information systems. However, most health facilities have not aligned their Health Information Systems to organizational-wide strategic goals and objectives. This has led to challenges such us poor planning, lack of resources and above all the lack of direction by top management in implementing and using Health Information Systems. This research involved an assessment of the requirements for strategic alignment of health information systems in health facilities, development and validation of a strategic alignment model using selected health facilities. A multi-method research approach involving the use of quantitative and qualitative methods was used. The quantitative approach provided quantitative data that was used to generate requirements for the development of the model, as well as validating and testing of the system dynamics model. A sample of 408 respondents was taken from 39 health facilities in Uganda to participate in the study. Data was analyzed using descriptive statistics and presented in tables and graphs. The requirements for strategic alignment of Health Information Systems were identified as proper planning, establishment of policies, frameworks and standards, resource mobilization, establishment of work processes, training and sensitization of staff members about Health Information Systems work processes. Further, there is need to minimize time lag between HIS and other integrated organization information systems, improve on useful features and functions of HIS and also ensure the system covers all functions of the health facility. The study proposes a model, which when well used can help to improve the strategic alignment of Health Information Systems in health facilities.

Luyirika E.,Mildmay Uganda | Towle M.S.,Independent Health Consultant | Achan J.,Mildmay Uganda | Muhangi J.,Mildmay Uganda | And 3 more authors.
PLoS ONE | Year: 2013

Family-centred HIV care models have emerged as an approach to better target children and their caregivers for HIV testing and care, and further provide integrated health services for the family unit's range of care needs. While there is significant international interest in family-centred approaches, there is a dearth of research on operational experiences in implementation and scale-up. Our retrospective case study examined best practices and enabling factors during scale-up of family-centred care in ten health facilities and ten community clinics supported by a non-governmental organization, Mildmay, in Central Uganda. Methods included key informant interviews with programme management and families, and a desk review of hospital management information systems (HMIS) uptake data. In the 84 months following the scale-up of the family-centred approach in HIV care, Mildmay experienced a 50-fold increase of family units registered in HIV care, a 40-fold increase of children enrolled in HIV care, and nearly universal coverage of paediatric cotrimoxazole prophylaxis. The Mildmay experience emphasizes the importance of streamlining care to maximize paediatric capture. This includes integrated service provision, incentivizing care-seeking as a family, creating child-friendly service environments, and minimizing missed paediatric testing opportunities by institutionalizing early infant diagnosis and provider-initiated testing and counselling. Task-shifting towards nurse-led clinics with community outreach support enabled rapid scale-up, as did an active management structure that allowed for real-time review and corrective action. The Mildmay experience suggests that family-centred approaches are operationally feasible, produce strong coverage outcomes, and can be well-managed during rapid scale-up. © 2013 Luyirika et al.

Mateen F.J.,Johns Hopkins University | Kanters S.,University of Ottawa | Kanters S.,University of British Columbia | Kalyesubula R.,Makerere University | And 4 more authors.
Journal of Hypertension | Year: 2013

Background: To report the prevalence of hypertension and projected 10-year absolute risk of acute cardiovascular disease in a large prospectively followed cohort of HIVpositive youth and adults beginning antiretroviral therapy in sub-Saharan Africa. Methods: HIV-positive individuals seeking HIV treatment, ages 13 years and older, were assessed for repeated blood pressure measurements over the first year following initiation of antiretroviral therapy, including serum total cholesterol, high-density lipoprotein, CD4 cell count and related clinical and laboratory measurements. Outcomes include hypertension, defined according to the 7th Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure categories, and Framingham Risk Score based 10-year cardiovascular disease risk estimates. Results: Five thousand, five hundred and sixty-three patients had at least two blood pressure measurements on at least two separate occasions during the first year of antiretroviral therapy [median age of therapy initiation 34, first and third quartile (Q1-Q3) 28-40 years, 1841 (33.1%) men, baseline CD4 cell count 161 cells/ml (Q1-Q3 72-231 cells/ml]. Hypertension was diagnosed in 1551 patients [27.9%, 95% confidence interval (CI) 26.7-29.1] including 786 (14.1%, 95% CI 13.2-15.1) who met criteria for stage 2 hypertension. The age-standardized prevalence for Ugandans aged 13 or more was 24.8% (95% CI 23.8-26.1). Among those with complete laboratory studies (n=1102), nearly all women were in the 10% or less 10-year Framingham Risk Score category, but 20% of men were at at least 10% or more long-term risk of acute cardiovascular disease. Conclusion: Efforts to combine HIV treatment with vascular disease risk factor prevention and management are urgently needed to address noncommunicable disease multimorbidity in HIV-positive persons in sub-Saharan Africa, particularly in men. © Lippincott Williams and Wilkins.

Odit M.C.A.,Mildmay Uganda | Rwashana A.S.,Makerere University | Kituyi G.M.,Makerere University
Electronic Journal of Information Systems in Developing Countries | Year: 2014

Health Information Systems (HIS) in Uganda always fail to achieve the organizational objectives and yet little research has been conducted to study the strategic alignment of HIS in the country. This study therefore set out to examine the antecedents and dynamics that influence strategic alignment of HIS in Uganda with the aim of adequately addressing the complex IS design issues. A total of 296 respondents were purposively selected from 39 health facilities across the country to participate in the survey. Data was analyzed using descriptive statistics. Findings from the study revealed that HIS are used to locate substitute sources for medical commodities, reduce costs of handling orders as well as minimize uncertainty in ordering lead time. In addition, HIS provide information to clients, add value to existing health services and are used to target health service needs with accuracy as well as identify groups of clients whose needs are not being met. HIS are used to minimize the cost of designing services, adding features to existing services and population grouping services at the health unit level. In the area of internal health facility efficiency, HIS help in ensuring efficiency and enable informed decision making, provide efficiency in internal meetings and discussions, co-ordination among facility departments, and provide good evaluation on annual budget. Further, HIS are used by health workers to provide evaluation on capital, maximize organizational performance, population coverage and strategic planning efficiency. Despite the above, the study revealed that health units do not have standards, frameworks and policies for the strategic alignment of HIS and the funding to support them. For better alignment of HIS, there should be proper planning and training of health workers on the importance of strategic alignment of HIS. Further, health facilities should be encouraged to adopt electronic information systems to improve their efficiency and effectiveness. There should also be policies, frameworks and or standards for guiding strategic alignment of Health Information Systems in health facilities.

Mills E.J.,University of Ottawa | Mills E.J.,Stanford University | Funk A.,University of Ottawa | Kanters S.,University of Ottawa | And 10 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2013

BACKGROUND: Retaining patients in clinical care is necessary to ensure successful antiretroviral treatment (ART) outcomes. Among patients who discontinue care, some reenter care at a later stage, whereas others are or will be lost from follow-up. We examined risk factors for health care interruptions and loss to follow-up within a cohort receiving ART in Uganda. METHODS: Using a large hospital cohort providing free universal ART and HIV clinical care, we assessed characteristics and risk factors for treatment interruptions, defined as a 12-month absence from care at Mildmay, and loss to follow-up, defined as absence from care greater than 12 months without reengagement in care at Mildmay. We included patients aged 14 years and above. We assessed these outcomes over time using Kaplan-Meier analysis and multivariable regression. RESULTS: Of 6970 eligible patients, 784 (11.2%) had a health care interruption of at least 12 months and 217 (3.1%) were lost to follow-up. Patients experiencing health care interruptions had higher baseline CD4 T-cell counts at ART initiation, defined as ≥250 cells per cubic millimeter [odds ratio (OR): 1.29, 95% confidence intervals (CI): 1.11 to 1.50], and lower levels of education (OR: 1.32, 95% CI: 1.09 to 1.61). Adolescents were much more likely to be lost to follow-up (OR: 3.11, 95% CI: 2.23 to 4.34). In contrast, having a partner (OR: 0.22, 95% CI: 0.16 to 0.31) or being sexually active at baseline (OR: 0.40, 95% CI: 0.28 to 0.55) was protective of loss to follow-up. CONCLUSIONS: Within this cohort, long periods of unsupervised health care interruptions were common. Copyright © 2013 by Lippincott Williams & Wilkins.

PubMed | Mildmay Uganda and Makerere University
Type: | Journal: BMC women's health | Year: 2015

Cervical cancer is the second commonest cancer in women worldwide and the commonest cancer among women in Uganda. Annual cervical screening is recommended for women living with HIV for early detection of abnormal cervical changes, however uptake remains grossly limited. This study assessed factors associated with cervical screening uptake among HIV infected women at Mildmay Uganda where cervical screening using Visual inspection with acetic acid and iodine (VIA and VILI) was integrated into HIV care since July 2009.Eighteen (18) in-depth interviews with HIV infected women and 6 key informant interviews with health care providers were conducted in April 2013 to assess client, health care provider and facility-related factors that affect cervical screening uptake. In-depth interview respondents included six HIV infected women in each of the following categories; women who had never screened, those who had screened once and missed follow-up annual screening, and those who had fully adhered to the annual screening schedule. Data was analyzed using content analysis method.Motivations for cervical cancer screening included the need for comprehensive assessment, diagnosis, and management of all ailments to ensure good health, fear of consequences of cervical cancer, suspicion of being at risk and the desire to maintain a good relationship with health care workers. The following factors negatively impacted on uptake of cervical screening: Myths and misconceptions such as the belief that a womans ovaries and uterus could be removed during screening, fear of pain associated with cervical screening, fear of undressing and the need for women to preserve their privacy, low perceived cervical cancer risk, shortage of health workers to routinely provide cervical cancer education and screening, and competing priorities for both provider and patient time. Major barriers to repeat screening included limited knowledge and appreciation of the need for repeat screening, and lack of reminders.These findings highlight the need for client-centered counseling and support to overcome fears and misconceptions, and to innovatively address the human resource barriers to uptake of cervical cancer screening among HIV infected women.

PubMed | University of Witwatersrand, Monash University, Queen's University, New York University and 16 more.
Type: | Journal: Implementation science : IS | Year: 2015

The Global Alliance for Chronic Diseases comprises the majority of the worlds public research funding agencies. It is focussed on implementation research to tackle the burden of chronic diseases in low- and middle-income countries and amongst vulnerable populations in high-income countries. In its inaugural research call, 15 projects were funded, focussing on lowering blood pressure-related disease burden. In this study, we describe a reflexive mapping exercise to identify the behaviour change strategies undertaken in each of these projects.Using the Behaviour Change Wheel framework, each team rated the capability, opportunity and motivation of the various actors who were integral to each project (e.g. community members, non-physician health workers and doctors in projects focussed on service delivery). Teams then mapped the interventions they were implementing and determined the principal policy categories in which those interventions were operating. Guidance was provided on the use of Behaviour Change Wheel to support consistency in responses across teams. Ratings were iteratively discussed and refined at several group meetings.There was marked variation in the perceived capabilities, opportunities and motivation of the various actors who were being targeted for behaviour change strategies. Despite this variation, there was a high degree of synergy in interventions functions with most teams utilising complex interventions involving education, training, enablement, environmental restructuring and persuasion oriented strategies. Similar policy categories were also targeted across teams particularly in the areas of guidelines, communication/marketing and service provision with few teams focussing on fiscal measures, regulation and legislation.The large variation in preparedness to change behaviour amongst the principal actors across these projects suggests that the interventions themselves will be variably taken up, despite the similarity in approaches taken. The findings highlight the importance of contextual factors in driving success and failure of research programmes. Forthcoming outcome and process evaluations from each project will build on this exploratory work and provide a greater understanding of factors that might influence scale-up of intervention strategies.

PubMed | Mildmay Uganda, RAND Corporation and Makerere University
Type: | Journal: AIDS and behavior | Year: 2016

With depression known to impede HIV care adherence and retention, we examined whether depression alleviation improves these disease management behaviors. A sample of 1028 depressed HIV clients in Uganda enrolled in a cluster randomized controlled trial of two depression care models, and were surveyed over 12months. Serial regression analyses examined whether depression alleviation was associated with self-reported antiretroviral therapy (ART) adherence and clinic attendance at month 12, and whether these relationships were mediated by self-efficacy and motivation. Among those with major depression, depression alleviation was associated with better ART adherence and clinic attendance at month 12; these relationships were fully mediated by self-efficacy at month 12, while adherence motivation partially mediated the relationship between depression alleviation and ART adherence. When both mediators were entered simultaneously, only self-efficacy was a significant predictor and still fully mediated the relationship between depression alleviation and adherence. These findings suggest that depression alleviation benefits both ART adherence and clinic attendance, in large part through improved confidence and motivation to engage in these disease management behaviors.

PubMed | Infectious Diseases Institute, RAND Corporation, Massachusetts General Hospital, University of North Carolina at Chapel Hill and Mildmay Uganda
Type: Journal Article | Journal: PloS one | Year: 2015

This paper presents one of the first qualitative studies to discuss programmatic barriers to SMS-based interventions for HIV-positive youth and discusses pathways through which youth perceive them to work. We conducted six focus groups with 20 male and 19 female HIV-positive youths in two clinics in Kampala, Uganda. We find that youth commonly use SMS as over 90% of this studys youths knew how to read, write and send messages and almost three-fourths of them had phones. Youth strongly felt that the success of this intervention hinged on ensuring confidentiality about their HIV-positive status. Key programmatic challenges discussed where restrictions on phone use and phone sharing that could exclude some youth. Participants felt that the intervention would improve their adherence by providing them with needed reminders and social support. Youths suggestions about intervention logistics related to content, frequency, timing and two-way messages will be helpful to practitioners in the field.

PubMed | Baylor College of Medicine, Mildmay Uganda, Boston Childrens Hospital, Makerere University and 2 more.
Type: | Journal: AIDS and behavior | Year: 2016

We compared two community-based HIV testing models among fisherfolk in Lake Victoria, Uganda. From May to July 2015, 1364 fisherfolk residents of one island were offered (and 822 received) home-based testing, and 344 fisherfolk on another island were offered testing during eight community mobilization events (outreach event-based testing). Of 207 home-based testing clients identified as HIV-positive (15% of residents), 82 were newly diagnosed, of whom 31 (38%) linked to care within 3months. Of 41 who screened positive during event-based testing (12% of those tested), 33 were newly diagnosed, of whom 24 (75%) linked to care within 3months. Testing costs per capita were similar for home-based ($45.09) and event-based testing ($46.99). Compared to event-based testing, home-based testing uncovered a higher number of new HIV cases but was associated with lower linkage to care. Novel community-based test-and-treat programs are needed to ensure timely linkage to care for newly diagnosed fisherfolk.

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