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1.
Am J Trop Med Hyg ; 99(5): 1211-1218, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-30226148

RESUMEN

Nodding syndrome (NS) is an encephalopathy characterized by the core symptom of epileptic head nodding seizures, affecting children at the age between 3 and 18 years in distinct areas of tropical Africa. A consistent correlation with onchocerciasis was found, but so far, the causation of NS has not been fully clarified. With a systematic analysis of features of a cohort of epilepsy patients examined in the Itwara onchocerciasis focus of western Uganda in 1994, we provide evidence that NS actually occurred in this area at this time, and we demonstrate a correlation between prevalence of NS and that of onchocerciasis in different villages. Following the elimination of onchocerciasis by community-directed treatment with ivermectin and ground larviciding, our data provide a baseline to examine the question whether NS will disappear once its putative cause has been removed.


Asunto(s)
Síndrome del Cabeceo/parasitología , Oncocercosis/complicaciones , Adolescente , Antiparasitarios/uso terapéutico , Niño , Preescolar , Estudios de Cohortes , Erradicación de la Enfermedad , Femenino , Humanos , Ivermectina/uso terapéutico , Masculino , Prevalencia , Proyectos de Investigación , Uganda
2.
Glob Public Health ; 12(9): 1092-1103, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-27080727

RESUMEN

Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13-0.65, p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20-17.09, p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients.


Asunto(s)
Antirretrovirales/uso terapéutico , Servicios de Salud Comunitaria , Agentes Comunitarios de Salud , Voluntarios , Adulto , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Población Rural , Resultado del Tratamiento , Uganda
3.
Am J Trop Med Hyg ; 93(1): 198-202, 2015 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-25918208

RESUMEN

Nodding syndrome (NS) is a poorly understood condition, which was delineated in 2008 as a new epilepsy syndrome. So far, confirmed cases of NS have been observed in three circumscribed African areas: southern Tanzania, southern Sudan, and northern Uganda. Case-control studies have provided evidence of an association between NS and infection with Onchocerca volvulus, but the causation of NS is still not fully clarified. We report a case of a 15-year old boy with head nodding seizures and other characteristic features of NS from an onchocerciasis endemic area in western Uganda, with no contiguity to the hitherto known areas. We suggest that the existence of NS should be systematically investigated in other areas.


Asunto(s)
Síndrome del Cabeceo/diagnóstico , Adolescente , Humanos , Masculino , Uganda
4.
AIDS Care ; 26(8): 940-6, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24521055

RESUMEN

The threat of tuberculosis (TB) in Uganda cannot be considered in isolation from the HIV/AIDS epidemic. Stigma contributes to delays in seeking treatment and poor adherence for both TB and HIV patients. This study aims to assess and describe stigma and predictors of stigma related to TB and HIV in the population of western Uganda. This was a cross-sectional mixed methods study. A survey was administered to 360 individuals, randomly selected from one district in western Uganda. Participants were classified as low/high stigma based on weighted scores built from survey questions. Logistic regression was used to determine significant predictors for high stigma. Six focus groups were conducted to inform survey findings; themes were developed using content analysis. Twenty-six per cent of respondents were found to have stigmatising attitudes towards HIV and 47% towards TB. Multivariate logistic regression models included age, sex, marital status, education, residence and having a friend with HIV/TB. Those who had an HIV-positive friend were less likely to have high HIV stigma (OR: 0.41, 95% CI: 0.23-0.72). Those with secondary education or more were half as likely to have high TB stigma (OR: 0.50, 95% CI: 0.27-0.91). Focus group participants felt that "normalisation" of HIV has contributed to reduced HIV stigma, but there is still a fear of being recognised at the HIV clinic. TB stigma causes patients to remain silent instead of seeking care. Fear of TB is driven by the assumption that "TB means HIV". Declining HIV stigma is encouraging but more effort needs to be made to improve confidentiality. TB stigma is high and is likely affecting care seeking behaviour; TB awareness campaigns should be a priority and emphasise the treatability and curability of TB, regardless of HIV status.


Asunto(s)
Infecciones por VIH/psicología , Estigma Social , Tuberculosis/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Estudios de Evaluación como Asunto , Femenino , Grupos Focales , Infecciones por VIH/complicaciones , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Aceptación de la Atención de Salud , Análisis de Regresión , Uganda/epidemiología , Adulto Joven
5.
AIDS Care ; 26(1): 75-8, 2014 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-23656328

RESUMEN

The purpose of this qualitative study was to explore the psychosocial changes revealed by persons living with HIV/AIDS (PLWHA) in western Uganda as a result of the introduction of highly active antiretroviral therapy (HAART). Fourteen participants were interviewed on two occasions. Two focus groups discussions were also conducted. Patients experienced important personal benefits as a result of HAART and the resulting clinical improvement. These benefits included a restoration of hope, self-esteem and personal agency. Patients were also relieved of the great fear which they had about the conditions of their death. The financial and social struggles introduced by AIDS illness continued after the introduction of HAART. The conclusion is that the HAART programs should provide more holistic care to patients to address the persistent family issues identified in this study.


Asunto(s)
Terapia Antirretroviral Altamente Activa/métodos , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Satisfacción Personal , Calidad de Vida , Actividades Cotidianas , Adulto , Costo de Enfermedad , Femenino , Grupos Focales , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Población Rural , Autoimagen , Resultado del Tratamiento , Uganda
6.
BMC Int Health Hum Rights ; 12: 36, 2012 Dec 20.
Artículo en Inglés | MEDLINE | ID: mdl-23254144

RESUMEN

BACKGROUND: In Uganda, despite a significant public health burden of tuberculosis (TB) in the context of high human immunodeficiency virus (HIV) prevalence, little is known about community knowledge of TB. The purpose of this study was to assess and compare knowledge about TB and HIV in the general population of western Uganda and to examine common knowledge gaps and misconceptions. METHODS: We implemented a multi-stage survey design to randomly survey 360 participants from one district in western Uganda. Weighted summary knowledge scores for TB and HIV were calculated and multiple linear regression (with knowledge score as the dependant variable) was used to determine significant predictors. Six focus group discussions were conducted to supplement survey findings. RESULTS: Mean (SD) HIV knowledge score was 58 (12) and TB knowledge score was 33 (15), both scores out of 100. The TB knowledge score was statistically significantly (p < 0.001) lower. Multivariate regression models included age, sex, marital status, education, residence, and having a friend with HIV/TB as independent variables. TB knowledge was predicted by rural residence (coefficient = -6.27, 95% CI: -11.7 to -0.8), and age ≥45 years (coefficient = 7.45, 95% CI: 0.3-14.6). HIV knowledge was only predicted by higher education (coefficient = 0.94, 95%CI: 0.3-1.6). Focus group participants mentioned various beliefs in the aetiology of TB including sharing cups, alcohol consumption, smoking, air pollution, and HIV. Some respondents believed that TB was not curable. CONCLUSION: TB knowledge is low and many misconceptions about TB exist: these should be targeted through health education programs. Both TB and HIV-infection knowledge gaps could be better addressed through an integrated health education program on both infections, whereby TB program managers include HIV information and vice versa.

7.
Afr J Reprod Health ; 16(1): 133-44, 2012 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-22783677

RESUMEN

In this paper, we use survey (n = 87) and interview (n = 30) data to investigate orientations towards future childbearing among people receiving antiretroviral treatment and their family members in western Uganda. We investigate how reproductive options are perceived, by those receiving treatment and those closest to them, and consider what these perceptions suggest about the existence of an "unmet need" for birth control for women with HIV. While most people say they do not wish to have more children while on treatment, this intention coexists with contradictory desires for the benefits and happiness that more children might bring. We argue that the factors influencing birth desires and outcomes are so complex and contradictory that it is virtually impossible to predict demand or uptake of birth control as more and more people with AIDS in Africa gain the ability to access antiretroviral treatment.


Asunto(s)
Infecciones por VIH/psicología , Conducta Reproductiva/psicología , Adulto , Antirretrovirales/uso terapéutico , Actitud , Anticoncepción/estadística & datos numéricos , Conducta Anticonceptiva , Composición Familiar , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Uganda
8.
PLoS One ; 7(7): e40902, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22815862

RESUMEN

BACKGROUND: In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda. METHODS: The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatment-naïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL) after two years of treatment. Adherence was determined through weekly pill counts. RESULTS: Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospital-based cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p = 0.12), and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560). In multivariate analysis patients in the HC/community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04). CONCLUSION: Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a hospital-based ART program run primarily by doctors.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , Centros Comunitarios de Salud , Infecciones por VIH/tratamiento farmacológico , Hospitales , Población Rural , Adulto , Intervalos de Confianza , Demografía , Femenino , Estudios de Seguimiento , Infecciones por VIH/virología , Humanos , Estimación de Kaplan-Meier , Masculino , Oportunidad Relativa , Cooperación del Paciente , Estudios Prospectivos , Tamaño de la Muestra , Factores de Tiempo , Resultado del Tratamiento , Uganda , Carga Viral
9.
Int J Womens Health ; 4: 227-33, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22675268

RESUMEN

BACKGROUND: The aim of this study was to describe the perceptions of married men about barriers to accessing and accepting highly active antiretroviral therapy (HAART) by pregnant/postnatal women positive for human immunodeficiency virus (HIV) and registered in Kabarole District's Program for the Prevention of HIV from Mother to Child (PMTCT-Plus). MATERIALS AND METHODS: Our study was a qualitative descriptive exploratory study using thematic analysis. Four focus group discussions were held with a convenience sample of 40 married men. RESULTS: Lack of disclosure of a positive HIV diagnosis to the partner and stigmatization of persons with HIV were two major obstacles for women in accessing HAART. In addition, men felt that their low knowledge of HAART and their low HIV testing rate also constituted important barriers to these women taking treatment. Men complained that they were not sufficiently involved in the reproductive care of women and that couples' counseling could be a step towards addressing this problem. CONCLUSION: Barriers to HAART experienced by pregnant/postnatal women need to be addressed in order to improve their uptake of treatment, increase their low treatment coverage, improve their survival, and at the same time dramatically reduce HIV transmission from mother to child.

10.
World Health Popul ; 13(3): 5-17, 2012.
Artículo en Inglés | MEDLINE | ID: mdl-22555116

RESUMEN

The rationale of this qualitative study was to determine how a positive HIV diagnosis influenced fertility desires and reproductive decisions for women and men living in western Uganda and what the reasons were behind these fertility desires. The qualitative study was undertaken as part of a larger study on the same topic in order to better understand the quantitative findings. Five focus groups with a total of 35 participants, 20 women and 15 men were conducted. Eighteen participants were HIV positive. Almost all HIV-positive participants reported that they did not wish to have more children. The most important reasons given were the devastating impact of HIV on the health of the mother and the high risk of HIV transmission to the child. Most participants were not aware of the benefits of highly active antiretroviral therapy on reducing the risk of mother-to-child transmission of HIV. Some HIV-negative participants viewed ongoing childbearing by HIV-positive individuals as the result of a lack of education regarding the risks of childbearing while HIV-positive and also as contrary to the current expectations of lifestyle practice. They also emphasized that the community's perceptions of having children when mothers are HIV-infected was unfavorable and that fertility norms for all persons in the study area have now changed due to economic concerns and desire to educate all children in the family. The study findings have to be incorporated in the counselling curriculum for programs directed at HIV prevention and care and family planning. Specific recommendations are provided to improve the districts' primary healthcare programs for HIV care/prevention and family planning.


Asunto(s)
Infecciones por VIH/psicología , Conducta Reproductiva/psicología , Población Rural , Adulto , Terapia Antirretroviral Altamente Activa , Estudios Transversales , Servicios de Planificación Familiar , Femenino , Grupos Focales , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Masculino , Investigación Cualitativa , Factores Sexuales , Medio Social , Encuestas y Cuestionarios , Uganda/epidemiología , Adulto Joven
11.
J Fam Plann Reprod Health Care ; 38(1): 23-9, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-21795262

RESUMEN

BACKGROUND AND METHODOLOGY: This study determined the unmet need for family planning among HIV-positive and HIV-negative individuals living in western Uganda. Semi-structured interviews were conducted with individuals who were randomly selected from HIV testing lists. Of those individuals, further analysis was conducted on a subset of 206 participants who did not desire more children and were not using a highly effective method of contraception. Descriptive, bivariate and multivariate methods were performed to assess the relationship between HIV status and unmet need for effective family planning. RESULTS: The unmet need for effective family planning was much greater in HIV-infected individuals compared to HIV-negative individuals [75.0% vs 33.8%, adjusted odds ratio (OR) 3.97, 95% confidence interval (CI) 1.97-8.03, p<0.001]. Females were more likely to report an unmet need compared to males (69.0% vs 49.5%; adjusted OR 1.94, 95% CI 0.94-4.00, p=0.071). Other predictors of unmet need for effective family planning were older age (adjusted OR 1.08 for each year of age, 95% CI 1.00-1.16, p=0.018) and single/cohabiting vs being married (OR 2.36, 95% CI 1.16-4.80, p=0.036). Being on antiretroviral therapy was not a predictor of having a lower unmet need for effective family planning methods. DISCUSSION AND CONCLUSIONS: There is high unmet need for effective family planning in HIV-positive study participants in a region of western Uganda, which should be of concern. This suggests that HIV-infected individuals do not want to use family planning or encounter barriers to accessing and utilising family planning services. Family planning programmes and HIV care and prevention services have to work together more effectively to create services conducive to clients from both programmes.


Asunto(s)
Servicios de Planificación Familiar/estadística & datos numéricos , Infecciones por VIH/psicología , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Antirretrovirales/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Seropositividad para VIH/psicología , Conocimientos, Actitudes y Práctica en Salud , Humanos , Entrevistas como Asunto , Masculino , Población Rural/estadística & datos numéricos , Factores Sexuales , Factores Socioeconómicos , Uganda/epidemiología , Adulto Joven
12.
BMC Int Health Hum Rights ; 11 Suppl 2: S12, 2011 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-22166168

RESUMEN

BACKGROUND: Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs. THE RESEARCH: This intervention study aimed to; 1) assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi) of Uganda; and 2) compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda. RESULTS AND OUTCOMES: Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda's Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated. CHALLENGES AND SUCCESSES: Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole's health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the long-term feasibility and sustainability of a community-based ARV program in Uganda still remain. THE PARTNERSHIP: This project is a continuation of previous successful collaborations between the School of Public Health of Makerere University, the School of Public Health of University of Alberta, the Kabarole District Administration and the Kabarole Research and Resource Center.

13.
Reprod Health ; 8: 27, 2011 Oct 06.
Artículo en Inglés | MEDLINE | ID: mdl-21975089

RESUMEN

BACKGROUND: Little is known about the fertility desires of HIV infected individuals on highly active antiretroviral therapy (HAART). In order to contribute more knowledge to this topic we conducted a study to determine if HIV-infected persons on HAART have different fertility desires compared to persons not on HAART, and if the knowledge about HIV transmission from mother-to-child is different in the two groups. METHODS: The study was a cross-sectional survey comparing two groups of HIV-positive participants: those who were on HAART and those who were not. Semi-structured interviews were conducted with 199 HIV patients living in a rural area of western Uganda. The desire for future children was measured by the question in the questionnaire "Do you want more children in future." The respondents' HAART status was derived from the interviews and verified using health records. Descriptive, bivariate and multivariate methods were used to analyze the relationship between HAART treatment status and the desire for future children. RESULTS: Results from the multivariate logistic regression model indicated an adjusted odds ratio (OR) of 1.08 (95% CI 0.40-2.90) for those on HAART wanting more children (crude OR 1.86, 95% CI 0.82-4.21). Statistically significant predictors for desiring more children were younger age, having a higher number of living children and male sex. Knowledge of the risks for mother-to-child-transmission of HIV was similar in both groups. CONCLUSIONS: The conclusions from this study are that the HAART treatment status of HIV patients did not influence the desire for children. The non-significant association between the desire for more children and the HAART treatment status could be caused by a lack of knowledge in HIV-infected persons/couples about the positive impact of HAART in reducing HIV transmission from mother-to-child. We recommend that the health care system ensures proper training of staff and appropriate communication to those living with HIV as well as to the general community.


Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Conocimientos, Actitudes y Práctica en Salud , Conducta Reproductiva/psicología , Adolescente , Adulto , Estudios Transversales , Composición Familiar , Femenino , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Humanos , Transmisión Vertical de Enfermedad Infecciosa , Intención , Masculino , Salud Rural/estadística & datos numéricos , Factores Socioeconómicos , Uganda , Adulto Joven
14.
Am J Trop Med Hyg ; 85(2): 225-8, 2011 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-21813839

RESUMEN

In 38 pairs of epilepsy patients and controls matched for time and intensity of exposure to transmission of onchocerciasis, the presence of microfilariae in the skin of epilepsy patients was found insignificantly elevated compared with controls (odds ratio = 1.68; 95% confidence interval [CI] = 0.60-4.57; P = 0.31). This difference was more pronounced when detection of subcutaneous nodules was used as indication of infection with Onchocerca volvulus (odds ratio = 2.77; 95% CI = 0.92-8.33; P = 0.065). These findings from a patient group of limited size suggest that intensity of infection may play a substantial role in the development of onchocerciasis-associated epilepsy. Our results are in contrast to the results of two other independent studies from the identical endemic area; one case concluded a significant positive correlation between onchocerciasis and epilepsy, and the other case concluded a clearly negative correlation. Studies with a greater sample size are needed to confirm this possible relationship.


Asunto(s)
Epilepsia/complicaciones , Oncocercosis/complicaciones , Oncocercosis/epidemiología , Adolescente , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Oportunidad Relativa , Factores de Riesgo , Factores de Tiempo , Uganda/epidemiología , Adulto Joven
15.
J Trop Pediatr ; 57(1): 24-33, 2011 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-20554516

RESUMEN

OBJECTIVES: This representative, cross-sectional study conducted in Kabarole District, Western Uganda, determined the nutritional status of children 6-59 months of age and established a trend in the childhood stunting rates. METHODS: A multi-stage random cluster sampling was performed to select 322 children and their principal caregivers. Anthropometric measurements were taken from the children and compared with a reference population and the children's principle caregivers were interviewed. RESULTS: Childhood stunting was high with 43.0% of all children having a z-score of less than or equal to -2. Predictive factors for stunting were a low economic status of the household, poor health of the child's caregiver, residence located at a long distance from a health unit and use of a contaminated water source. The comparison of our study results with an earlier nutritional study in Kabarole District revealed that there is an increasing trend of childhood stunting over the years of 28.0% [95% confidence interval (CI) 22.1-33.1%] in 1989 vs 43% (95% CI 37.6-48.8%) in 2006 and that stunting rates in Kabarole District were much higher compared to national data. CONCLUSION: The high stunting rates in children and the increasing trend in stunting needs further investigations. It should also be determined why stunting rates in children in Kabarole District are much higher than the national average. There is a need for better nutritional interventions as part of the district's public health programs.


Asunto(s)
Antropometría , Ingestión de Energía , Trastornos del Crecimiento/epidemiología , Desnutrición/complicaciones , Estado Nutricional , Distribución por Edad , Preescolar , Análisis por Conglomerados , Estudios Transversales , Composición Familiar , Femenino , Estudios de Seguimiento , Trastornos del Crecimiento/etiología , Humanos , Lactante , Masculino , Desnutrición/epidemiología , Análisis Multivariante , Prevalencia , Factores de Riesgo , Factores Socioeconómicos , Uganda/epidemiología
16.
Int J Womens Health ; 2: 45-52, 2010 Aug 09.
Artículo en Inglés | MEDLINE | ID: mdl-21072296

RESUMEN

The purpose of this study was to examine gender differences in mortality for human immunodeficiency virus (HIV) patients in rural Western Uganda after six months of highly active antiretroviral therapy (HAART). Three hundred eighty five patients were followed up for six months after initiating HAART. Statistical analysis included descriptive, univariate and multivariate methods, using Kaplan-Meier estimates of survival distribution and Cox proportional hazards regression. Mortality in female patients (9.0%) was lower than mortality in males (13.5%), with the difference being almost statistically significant (adjusted hazard ratio for females 0.55; 95% confidence interval [CI]: 0.28-1.07; P = 0.08). At baseline, female patients had a significantly higher CD4+ cell count than male patients (median 147 cells/µL vs 120 cells/µL; P < 0.01). A higher CD4+ cell count and primary level education were strongly associated with better survival. The higher CD4+ cell count in females may indicate that they accessed HAART services at an earlier stage of their disease progression than males. A borderline statistically significant lower mortality rate in females shows that females fare better on treatment in this context than males. The association between lower mortality and higher CD4+ levels suggest that males are not accessing treatment early enough and that more concerted efforts need to be made by HAART programs to reach male HIV patients.

17.
J Int AIDS Soc ; 13: 37, 2010 Sep 23.
Artículo en Inglés | MEDLINE | ID: mdl-20863399

RESUMEN

BACKGROUND: The aim of this study was to describe barriers to accessing and accepting highly active antiretroviral therapy (HAART) by HIV-positive mothers in the Ugandan Kabarole District's Programme for the Prevention of Mother to Child Transmission-Plus (PMTCT-Plus). METHODS: Our study was a qualitative descriptive exploratory study using thematic analysis. Individual in-depth interviews (n = 45) were conducted with randomly selected HIV-positive mothers who attended this programme, and who: (a) never enrolled in HAART (n = 17); (b) enrolled but did not come back to receive HAART (n = 2); (c) defaulted/interrupted HAART (n = 14); and (d) are currently adhering to HAART (n = 12). A focus group was also conducted to verify the results from the interviews. RESULTS: Results indicated that economic concerns, particularly transport costs from residences to the clinics, represented the greatest barrier to accessing treatment. In addition, HIV-related stigma and non-disclosure of HIV status to clients' sexual partners, long waiting times at the clinic and suboptimal provider-patient interactions at the hospital emerged as significant barriers. CONCLUSIONS: These barriers to antiretroviral treatment of pregnant and post-natal women need to be addressed in order to improve HAART uptake and adherence for this group of the population. This would improve their survival and, at the same time, drastically reduce HIV transmission from mother to child.


Asunto(s)
Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Accesibilidad a los Servicios de Salud , Cooperación del Paciente , Mujeres/psicología , Adulto , Estudios de Evaluación como Asunto , Femenino , Infecciones por VIH/economía , Infecciones por VIH/prevención & control , Seropositividad para VIH , Accesibilidad a los Servicios de Salud/economía , Hospitales , Humanos , Transmisión Vertical de Enfermedad Infecciosa/economía , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Entrevista Psicológica , Embarazo , Uganda , Mujeres/educación , Adulto Joven
18.
AIDS Care ; 22(3): 271-8, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20390506

RESUMEN

Gender differences in treatment outcomes of 305 persons living with HIV receiving antiretroviral treatment (ART) in Kabarole district, western Uganda, were evaluated. The primary treatment outcome was virological suppression defined as HIV-1 RNA viral load (VL) <400 copies/ml and the secondary outcome measure was the increase in the CD4 cell count after six months on ART. Statistical analysis included descriptive, univariate, and multivariate methods. Proportionally, more females chose to seek treatment compared to males. After six months of treatment, females were more likely to have viral suppression (VL > 400 copies/ml) as compared to males (odds ratio 2.14, 95% confidence interval 0.99-4.63, p=0.05). While females had a significantly higher baseline CD4 cell count at initiation of treatment compared to males, the increase in CD4 cell count after six months on ART was similar in males and females. The reasons for better ART outcomes for females should be further investigated. Ideally, ART programs should work toward equitable treatment outcomes for men and women, if the cause of the gender differential lies in patient behavior and the way ART services are delivered.


Asunto(s)
Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa , Infecciones por VIH/tratamiento farmacológico , VIH-1 , Factores Sexuales , Adulto , Recuento de Linfocito CD4 , Estudios de Cohortes , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , Humanos , Modelos Logísticos , Masculino , Aceptación de la Atención de Salud , Salud Rural , Servicios de Salud Rural/estadística & datos numéricos , Población Rural , Factores Socioeconómicos , Resultado del Tratamiento , Uganda/epidemiología , Carga Viral/efectos de los fármacos
19.
Curr HIV Res ; 8(5): 370-8, 2010 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-20353388

RESUMEN

OBJECTIVE: Community-based antiretroviral treatment (CBART) programs should aim to achieve positive quality of life outcomes. The purpose of this study was to investigate changes in the health related quality of life (HRQOL) outcomes of patients in a CBART program supported by community volunteers in one sub-county in western Uganda located 50 km from the nearest urban centre. METHODS: We administered a translated version of the MOS-HIV survey and collected clinical data at baseline and after one year from 130 patients. Inclusion criteria included residency in the sub-county, eighteen years of age or, treatment-naïve, eligible for ART based on CD4 cell count <200 cells/mm3 or WHO clinical stage 3 or 4, and willing to accept daily treatment support by family/friends and to be visited by a community volunteer weekly. We assessed changes in physical health (PHS) and mental health (MHS) summary scores and examined associations between patient characteristics and changes in HRQOL. RESULTS: After one year, we observed significant increases in mean PHS (42.7 to 50.1; p<0.01) and MHS (43.5 to 49.5; p<0.01) scores. Lower age (p<0.01) and lower baseline PHS scores (p<0.01) were associated with increases in PHS scores and lower age (p=0.03) and lower baseline MHS scores (p<0.01) were associated with increases in MHS scores. Fifteen patients (12%) had reductions in their HRQOL after one year which were not associated with patient or clinical characteristics, including virological suppression. CONCLUSIONS: The observed improvements in HRQOL demonstrate that positive treatment outcomes can be achieved in CBART programs in rural Uganda. However, some patients appear to experience declines in their overall well-being, despite achieving virological suppression. HRQOL surveys can be useful in identifying these patients, who may require additional attention and support to achieve the full benefits of ART.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Calidad de Vida/psicología , Adulto , Factores de Edad , Femenino , Infecciones por VIH/patología , Humanos , Estudios Longitudinales , Masculino , Población Rural , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Resultado del Tratamiento , Uganda
20.
Curr HIV Res ; 8(2): 179-85, 2010 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-20163349

RESUMEN

OBJECTIVE: To compare the treatment outcomes and mortality in a rural community-based ART (CBART) program with a hospital-based ART program in the same district. METHODS: The study design was a non-randomized cohort study consisting of 185 persons living with HIV (PLWHIV) in the CBART cohort and 200 PLWHIV in the hospital cohort. Eligibility for both cohorts was: being HIV-infected and eligible for ART, being treatment naïve, age 18 years or older, and being a resident of Rwimi sub-county. The intervention consisted of a community-based program which included weekly home visits to patients by trained volunteers who delivered antiretroviral drugs (ARVs), monitored and supported adherence to treatment, and identified and reported adverse reactions and other clinical symptoms. Outcome variables were compared to patients in a hospital-based cohort who received the standard care delivered to all other HIV patients in the hospital. The main outcome measures were HIV-1 RNA viral load (VL), CD4 cell count and mortality after six months of treatment. RESULTS: Successful ART treatment outcome as measured by virological suppression (VL<400 copies/ml) in the CBART cohort were similar to those in the hospital-based cohort (90.1% vs 89.3%, p=0.47). The median CD4 cell count increased significantly in both cohorts (community-based cohort 159 cells/microl vs 145 cells/microl in the hospital-based cohort). Mortality was not significantly different in both cohorts (community-based cohort 11.9%, hospital-based cohort 9.0%). CONCLUSION: The findings show that outcomes of a CBART intervention in a rural area compare favorably to outcomes of hospital-based care. If the study results are sustainable over a longer time period, this model could be considered for ART roll-out to impoverished rural/remote populations in Uganda and elsewhere.


Asunto(s)
Antirretrovirales/uso terapéutico , Servicios de Salud Comunitaria/normas , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , VIH-1 , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hospitales , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Cooperación del Paciente , Resultado del Tratamiento , Uganda , Adulto Joven
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