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Peer-group support intervention improves the psychosocial well-being of AIDS orphans: Cluster randomized trial
(Elsevier, 2009) Kumakech, Edwward; Cantor-Graae, Elizabeth; Maling, Samuel; Bajunirwe, Francis
Accumulating evidence suggests that AIDS orphanhood status is accompanied by increased levels of psychological distress such as anxiety, depression, intense guilt, shame, and anger. However, few studies have examined the possible reduction of psychological distress in AIDS orphans through the help of interventions that promote well-being. The objective of the study was to evaluate the effects of a schoolbased peer-group support intervention combined with periodic somatic health assessments and treatment on the psychosocial well-being of AIDS orphans in the Mbarara District of southwestern Uganda. In a cluster randomized controlled design, 326 AIDS orphans aged 10–15 years were assigned to either peer-group support intervention combined with monthly somatic healthcare (n¼ 159) or control group (n¼ 167) for follow-up assessment. Baseline and 10 week follow-up psychological assessments were conducted in both groups using self-administered Beck Youth Inventories. Complete data were available for 298 orphans. After adjusting for baseline scores, follow-up scores for the intervention group in comparison with controls showed significant improvement in depression, anger, and anxiety but not for self-concept. This study demonstrated that peer-group support intervention decreased psychological distress, particularly symptoms of depression, anxiety and anger. Thus, the use of peer-group support interventions should be incorporated into existing school health programs
Occupational exposure to HIV: a conflict situation for health workersinr
(International Nursing Review, 2011) Kumakech, Edward; Achora, S.; Berggren, V.; Bajunirwe, F.
Aim: To determine the frequency of occupational exposure to human immunodeficiency virus (HIV), the circumstances and predisposing factors, the high-risk groups, the extent to which exposures are reported and the post-exposure prophylaxis (PEP) utilized by health-care workers (HCWs) and students in a Ugandan hospital. Background: Occupational exposure to HIV is a low but potential risk of HIV infection to health workers. Method: Self-administered questionnaire was given to 224 participants (including 98 HCWs and 126 students) in Mbarara Hospital, Uganda. Data were analysed with descriptive statistics using the Statistical Package for the Social Sciences version 15.0 (SPSS Inc, Chicago, IL, USA). Findings: Of the 224 participants surveyed, 19.2% reported having sustained injection needle stick injuries in the previous year, of which 4.46% occurred with HIV-infected blood. Other reported injuries were cannula needle stick injury (0.89%), suture needle stick injuries (3.13%), scalpel cut injuries (0.45%) and muco-cutaneous contamination (10.27%). The most affected groups were nurses–midwives for scalpel injuries and students for stick injuries. The predisposing factors reported included lack of protective devices and recapping of needles. Exposures were under-reported. Uptake of PEP was also low. Conclusion: Occupational exposure to HIV presents a conflict situation for HCWs. It remains a frequent occurrence particularly among student nurses–midwives, despite being avoidable. Its prophylactic treatment is hampered by poor reporting and investigation of exposures, and poor access to PEP. Strict adherence to universal precaution and proper handling of occupational exposure to HIV should be encouraged.
Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries
(Bull World Health Organ, 2011) LaMontagne, D Scott; Barge, Sandhya; Le, Nga Thi; Mugisha, Emmanuel; Penny, Mary E; Gandhi, Sanjay; Janmohamed, Amynah; Kumakech, Edward; Mosqueira, N Rocio; Nguyen, Nghi Quy; Paul, Proma; Tang, Yuxiao; Minh, Tran Hung; Uttekar, Bella Patel; Jumaan, Aisha O
Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Methods Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Findings Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3–85.6) in Peru, 88.9% (95% CI: 84.7–92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0–97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4–81.6) to 87.8% (95% CI: 84.3–91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4–73.4) to 83.3% (95% CI: 79.3–87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. Conclusion High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.
WHO technical specifications Cryosurgical equipment for the treatment of precancerous cervical lesions and prevention of cervical cancer
(WHO, 2012) Chidanyika, Agnes; de Vuyst, Hugo; Blumenthal, Paul; Lu Jhpiego, Ricky; Santos, Carlos; Jeronimo, Jose; Hedman, Lisa; Nordin, Ingegerd; Adnew, Shumet; Zaw, Min; Boxshall, Matts; Kumakech, Edward; Baravilala, Wame
Cervical cancer is a serious and growing global health issue. In 2008, there were approximately 274 000 deaths from the disease, about 88% of which occurred in developing countries. Although it affects women worldwide, cervical cancer mortality is highest in low-resource settings. Cryotherapy, also known as cryosurgery, has been widely accepted as a practical and effective method of treating precancerous cervical lesions. It is appropriate for use in lowresource settings because it is effective, has limited side-effects, does not require electricity, is inexpensive compared to other treatment options, and is technically simple to implement. This document seeks to assist programme managers, purchasing managers, and other interested parties with the procurement, management and effective use of cryosurgical equipment to treat precancerous cervical lesions as part of a comprehensive cervical cancer prevention programme. It provides an overview of the procurement and performance issues associated with some cryosurgical devices, gas supplies and gas cylinders, and necessary connectors. The document offers technical specifications for purchasers, including the design and performance recommendations necessary to ensure the safety and efficacy of cryosurgical equipment, issues related to the gases used by the equipment, and guidance on how to procure both the equipment and the gases. Annexes provide additional useful information.
Using Formative Research to Design a Behavior Change Strategy to Increase the Use of Improved Cookstoves in Peri-Urban Kampala, Uganda
(International journal of environmental research and public health, 2013) Martin, Stephanie L.; Arney, Jennifer K.; Mueller, Lisa M.; Kumakech, Edward; Walugembe, Fiona; Mugisha, Emmanuel
Household air pollution from cooking with biomass fuels negatively impacts maternal and child health and the environment, and contributes to the global burden of disease. In Uganda, nearly 20,000 young children die of household air pollution-related pneumonia every year. Qualitative research was used to identify behavioral determinants related to the acquisition and use of improved cookstoves in peri-urban Uganda. Results were used to design a behavior change strategy for the introduction of a locally-fabricated top-lit updraft gasifier (TLUD) stove in Wakiso district. A theoretical framework—opportunity, ability, and motivation—was used to guide the research and behavior change strategy development. Participants consistently cited financial considerations as the most influential factor related to improved cookstove acquisition and use. In contrast, participants did not prioritize the potential health benefits of improved cookstoves. The theoretical framework, research methodology, and behavior change strategy design process can be useful for program planners and 6921 researchers interested in identifying behavioral determinants and designing and evaluating improved cookstove interventions.
Screen-and-Treat Approach to Cervical Cancer Prevention Using Visual Inspection With Acetic Acid and Cryotherapy: Experiences, Perceptions, and Beliefs From Demonstration Projects in Peru, Uganda, and Vietnam
(The oncologist, 2013) Proma, Paul; Winkler, Jennifer L.; Bartolini, Rosario M.; Penny, Mary E.; Huong, Trinh Thu; Nga, Le Thi; Kumakech, Edward; Mugisha, Emmanuel; Jeronimo, Jose
Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA andcryotherapyintoroutineservices.Resultsshowedthatuseof VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women’s schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Althoughsomechallengeswerefoundacrossallsites, othersvaried fromcountryto country, suggesting that carefulassessmentsbefore beginning new secondary prevention programs will optimize the probability of success. The Oncologist 2013;18: 1278–1284
Consumer Perspectives on a Pericoital Contraceptive Pill in India and Ugand
(2013) Cover, Jane K.; Drake, Jennifer Kidwett; Kyamwanga, Imelda T.; Turyakira, Eleanor; Dargan, Tanya; Kumakech, Edward; Harner-Jay, Claudia
CONTEXT: Studies suggest that women in some countries have adopted emergency contraceptive pills as a routine method of family planning. This practice indicates there may be latent demand for a pericoital contraceptive pill taken only when a woman has sexual intercourse, and labeled and marketed for use as a regular contraceptive method. METHODS: To understand the appeal and potential market for a pericoital contraceptive pill, 39 focus groups and 23 in-depth interviews were conducted with women and men in Lucknow, Uttar Pradesh, India, and Kampala, Uganda. A total of 281 individuals participated in this qualitative study. RESULTS: In general, women embraced the idea of a female-controlled method that would be easier than taking a daily oral contraceptive pill and that could be taken either before or after sexual intercourse; in Uganda, especially, women approved of the fact that the method could be taken without a partner's knowledge. Although we do not yet know the extent of side effects for this method, women expressed some concerns about the level and nature of potential side effects. CONCLUSIONS: The results suggest that a pericoital contraceptive pill would be well-received by consumers in both country settings. If its efficacy and side effects are acceptable, a pericoital contraceptive pill could fill a gap for female-controlled, discreet, coitus-related contraception, particularly among women who do not have sex very frequently.
Immunogenicity of bivalent HPV vaccine among partially vaccinatedyoung adolescent girls in Uganda
(Elsevier Ltd., 2014) LaMontagne, D. Scott; Mugisha, Emmanuel; Pan, Yuanji; Kumakech, Edward; Ssemaganda, Aloysius; Kemp, Troy J.; Cover, Jane; Pinto, Ligia A.; Safaeian, Mahboobeh
Background: Investigations of vaccine efficacy and immunogenicity for adult females receiving fewerthan three doses of human papillomavirus (HPV) vaccine have suggested protection against infection andprecancerous lesions. We investigated the immunogenicity of bivalent HPV vaccines among adolescentgirls from Uganda who received one, two, or three vaccine doses.Methods: Young girls vaccinated through a government program in Uganda were invited to participate.HPV16- and HPV18-specific antibodies were measured at ≥24 months after the last vaccine dose usingan enzyme linked immunoassay in girls who received one (n = 36), two (n = 145), or three (n = 195) doses.Results: Nearly all subjects (99%) were HPV16 and HPV18 seropositive at the time of blood-draw.Geometric mean antibody levels (GMTs) were: HPV161-dose= 230 EU/mL, HPV162-dose= 808 EU/mL,and HPV163-dose= 1607 EU/mL; HPV181-dose= 87 EU/mL, HPV182-dose= 270 EU/mL, andHPV183-dose= 296 EU/mL. The GMT ratio for 2:3 doses was 0.50 (HPV16) and 0.68 (HPV18) anddid not meet the non-inferiority criteria (i.e., lower bound of 97.5% confidence interval of the GMT ratiogreater than 0.50). The GMT ratio for 1:3 doses for HPV16 and HPV18 was inferior, but absolute GMTs forone dose were higher than adult women who received one dose (HPV16 = 124 EU/mL, HPV18 = 69 EU/mL)where efficacy has been demonstrated.Conclusions: Even though immunogenicity with less than three doses did not meet a priori non-inferioritythresholds, antibody levels measured ≥24 months after last dose were similar to those of adult womenwho have been followed for more than eight years for efficacy.
Integration of HIV and cervical cancer screening perceptions of healthcare providers and policy makers in Uganda
(BMC Public Health, 2014) Kumakech, Edward; Andersson, Sören; Wabinga, Henry; Berggren, Vanja
Background: HIV-positive women have an increased risk of developing cervical cancer (CC) compared to the HIV-negative women. Despite this, HIV and CC screening programs in many developing countries have remained disintegrated. Therefore, the objective of the study was to explore perceptions of healthcare providers (HCP) and policy makers (PM) about integration of HIV and CC screening services in Uganda. Methods: This was a qualitative study conducted among 16 participants comprising of 12 healthcare providers and 4 policy makers in Uganda. Data were collected through individual interviews. Participants were purposively selected from different level of health facilities with clinics for HIV and CC screening services. Content analysis method was used to analyze the data. Results: Three themes emerged from the data, namely appreciating benefits of integration, worrying about the limited health system capacity and potential consequences of integration and feeling optimistic about integration under improved health system conditions. The benefits embraced the women – particularly the HIV-positive women- but also men, healthcare providers and the health system or the government. There were worries that HIV stigma and shortage of healthcare workers would affect the effective delivery of the integrated program. Conclusion: Integration of HIV and CC screening can offer manifold benefits to all stakeholders in the health system, more so to the women. However, its feasibility in developing countries such as Uganda will most likely be hampered by weak and inefficient health systems. Therefore, when considering HIV and CC screening integration, it is important not to only recognize the benefits but also take into account resources requirements for addressing the existing weaknesses and inefficiencies in the health systems such as limited infrastructure, insufficient drugs and supplies, inadequate and poorly motivated healthcare workers.
Human Immunodeficiency Virus (HIV), Human Papillomavirus (HPV) and Cervical Cancer Prevention in Uganda
(Örebro university, 2015) Kumakech, Edward
Background: HIV-positive women have an increased risk of developing cervical cancer (CC) compared to the HIV-negative women. Despite this, HIV and CC screening programs in many developing countries have remained disintegrated. Therefore, the objective of the study was to explore perceptions of healthcare providers (HCP) and policy makers (PM) about integration of HIV and CC screening services in Uganda. Methods: This was a qualitative study conducted among 16 participants comprising of 12 healthcare providers and 4 policy makers in Uganda. Data were collected through individual interviews. Participants were purposively selected from different level of health facilities with clinics for HIV and CC screening services. Content analysis method was used to analyze the data. Results: Three themes emerged from the data, namely appreciating benefits of integration, worrying about the limited health system capacity and potential consequences of integration and feeling optimistic about integration under improved health system conditions. The benefits embraced the women – particularly the HIV-positive women- but also men, healthcare providers and the health system or the government. There were worries that HIV stigma and shortage of healthcare workers would affect the effective delivery of the integrated program. Conclusion: Integration of HIV and CC screening can offer manifold benefits to all stakeholders in the health system, more so to the women. However, its feasibility in developing countries such as Uganda will most likely be hampered by weak and inefficient health systems. Therefore, when considering HIV and CC screening integration, it is important not to only recognize the benefits but also take into account resources requirements for addressing the existing weaknesses and inefficiencies in the health systems such as limited infrastructure, insufficient drugs and supplies, inadequate and poorly motivated healthcare workers.
Feasibility of delivering HPV vaccine to girls aged 10 to 15 years in Uganda
(African health sciences, 2015) Mugisha, Emmanuel; LaMontagne, Scott; Katahoire, Anne R; Murokora, Daniel; Kumakech, Edward; Seruyange, Rachel; Tsu, Vivien Davis
Background: Cervical cancer is a leading cause of mortality among women in Uganda. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. The Government of Uganda conducted a demonstration project exploring the feasibility of two delivery strategies. Objective: To explore the feasibility of two HPV vaccine delivery strategies: 1) a stand-alone school-based strategy that selected girls based on their enrolment in grade 5 (known as the “grade-based” strategy; and 2) an age-based strategy that delivered the HPV vaccine based on the girls’ age (10-year-olds). This strategy combined the delivery of the vaccine with the distribution of deworming medication and vitamin A through an existing Child Days Plus program. Methods: A qualitative study that explored the feasibility of the two delivery strategies from the perspective of health workers, district leaders, and staff of the Uganda National Expanded Programme on Immunization, utilizing in-depth interviews and focus group discussions. Results: Coverage data showed that more girls (88%) were vaccinated using the grade-based strategy and completed all three doses compared to those (73%) vaccinated using the age-based strategy. Health workers and teachers indicated that determining vaccination eligibility was easier by grade than by age and there were minor disruptions to health services and school programs during vaccinations, as reported by health workers and teachers using the grade-based strategy. Conclusion: HPV vaccine delivery at schools using grade eligibility was more feasible than selecting girls by age. Lessons learned in Uganda could be relevant for countries considering implementing HPV vaccinations.
Prevalence, genotypes and risk factors for vaccine and non-vaccine types of Human Papillomavirus (HPV) infections among Bivalent HPV-16/18 vaccinated and non-vaccinated young women in Ibanda district Uganda: 5 year follow up study
(2015) Kumakech, Edward; Berggren, Vanja; Lillsunde-Larsson, Gabriella; Helenius, Gisela; Kaliff, Malin; Karlsson, Mats; Musubika, Carol; Kirimunda, Samuel; Wabinga, Henry; Andersson, Sören
Performance of Cervical Cancer Screening Techniques in HIV-Infected Women in Uganda
(Journal of Lower Genital Tract Disease, 2015) Bansil, Pooja; Lim, Jeanette; Kumakech, Edward; Nakisige, Carol; Jeronimo, Jose A
Women infected with human immunodeficiency virus (HIV) have a higher risk of HPV infections and developing cervical cancer, thus screening them is imperative. This study was aimed to evaluate and compare the performance of 3 cervical cancer screening options among HIV-infected women in Uganda. Materials and Methods Data from 2,337 Ugandan women who reported their HIV status were obtained from a population-based cervical cancer screening study. Women were offered 3 screening tests: vaginal and cervical careHPV and visual inspection with acetic acid (VIA), and the results were evaluated by HIV status. Results The prevalence of HIV infection was 16.5%. Women infected with HIV had a higher prevalence of cervical intraepithelial neoplasia grade 2+ (CIN2+) than uninfected women (12.9% vs 1.7%; p < .001). The sensitivity for cervical careHPV among the HIV-infected women was 94.3% compared to 81.3% among the uninfected women. Whereas the sensitivity for vaginal careHPV was also higher among the HIV-infected women, the sensitivity of VIA was higher among the uninfected women. The mean vaginal and cervical careHPV signal strength was higher in the HIV-infected women than in the uninfected women (p < .001). Conclusions CareHPV is very sensitive for detecting CIN2+ in HIV-infected women, even using a vaginal sample. The sensitivity of careHPV in HIV-infected women is higher than in HIV-uninfected women. However, additional research is needed to determine the best option for screening and triage of HPV-positive women that can be implemented in low-resource settings, especially among HIV- and HPV-positive women. CareHPV, a new human papillomavirus DNA screening test, is a very sensitive cervical screening method for detecting cervical intraepithelial neoplasia grade 2+ in human immunodeficiency virus–infected women.
Open Access Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda
(BMC women's health, 2015) Kumakech, Edward; Andersson, Sören; Wabinga, Henry; Berggren, Vanja
Background: Despite the fact that HIV-positive women carry an increased risk of developing cervical cancer (CC) in comparison with HIV-negative women, HIV and CC screening programs in many developing countries have remained unintegrated. The objective of this study is to explore perceptions and preferences of community members in Uganda, including women, men, and village health teams, regarding the integration of HIV and CC screening services in a single-visit approach. Methods: This qualitative study was conducted in three districts in Uganda. Data were collected through focus group discussions with women and village health teams, and individual interviews with men. Respondents were purposely selected from among those linked to three CC clinics in the three districts. The content analysis method was used to analyze the data. Results: Three themes emerged from the data, namely appreciating the benefits of integration, worrying about the challenges of integration, and preferences for integration. The women endorsed the benefits. However, there were worries that integration would prolong the waiting time at the health facility and induce tiredness in both the healthcare providers and the women. There were also fears of being found positive for both HIV and CC and the consequences such as stress, self-isolation, and social conflicts. Participants, particularly the women, considered the challenges of screening integration to be manageable by, for example, taking a day off work to visit the hospital, delegating house chores to other family members, or taking a packed lunch on visiting the hospital. Conclusions: The community members in Uganda perceive the benefits of HIV and CC screening integration to outweigh the challenges, and expect that the challenges can be minimized or managed by the women. Therefore, when considering HIV and CC screening integration, it is important to not only recognize the benefits but also take into consideration the perceived challenges and preferences of community members.
Significantly Reduced Genoprevalence of Vaccine-Type HPV-16/18 Infections among Vaccinated Compared to Non-Vaccinated Young Women 5.5 Years after a Bivalent HPV-16/18 Vaccine (Cervarix1) Pilot Project in Uganda
(2016) Kumakech, Edward; Berggren, Vanja; Wabinga, Henry; Lillsunde- Larsson, Gabriella; Helenius, Gisela; Kaliff, Malin; Karlsson, Mats; Kirimunda, Samuel; Musubika, Caroline
The objective of this study was to determine the prevalence and some predictors for vaccine and non-vaccine types of HPV infections among bivalent HPV vaccinated and non-vaccinated young women in Uganda. This was a comparative cross sectional study 5.5 years after a bivalent HPV 16/18 vaccination (Cervarix1, GlaxoSmithKline, Belgium) pilot project in western Uganda. Cervical swabs were collected between July 2014-August 2014 and analyzed with a HPV genotyping test, CLART1 HPV2 assay (Genomica, Madrid Spain) which is based on PCR followed by microarray for determination of genotype. Blood samples were also tested for HIV and syphilis infections as well as CD4 and CD8 lymphocyte levels. The age range of the participants was 15–24 years and mean age was 18.6(SD 1.4). Vaccine-type HPV-16/18 strains were significantly less prevalent among vaccinated women compared to non-vaccinated women (0.5% vs 5.6%, p 0.006, OR 95% CI 0.08 (0.01–0.64). At type-specific level, significant difference was observed for HPV16 only. Other STIs (HIV/syphilis) were important risk factors for HPV infections including both vaccine types and non-vaccine types. In addition, for non-vaccine HPV types, living in an urban area, having a low BMI, low CD4 count and having had a high number of life time sexual partners were also significant risk factors. Our data concurs with the existing literature from other parts of the world regarding the effectiveness of bivalent HPV-16/18 vaccine in reducing the prevalence of HPV infections particularly vaccine HPV- 16/18 strains among vaccinated women. This study reinforces the recommendation to vaccinate young girls before
Beliefs, perceptions and health-seeking behaviours in relation to cervical cancer: a qualitative study among women in Uganda following completion of an HPV vaccination campaign
(Global Health Action, 2016) Hasahya, Olivia Topister; Berggren, Vanja; Sematimba, Douglas; Nabirye, Rose Chalo; Kumakech, Edward
Background: Cervical cancer remains a leading cause of morbidity and mortality in Uganda. Despite earlier information campaigns to introduce human papilloma virus (HPV) vaccination, which also targeted cervical cancer, misinterpretation and misunderstanding of the subject remain high. Women in Uganda present with cervical cancer at an advanced stage due to poor health-seeking behaviours, with an associated high mortality rate. This project explored beliefs, attitudes, perceptions, and health-seeking behaviours in relation to cervical cancer among women in Uganda after an HPV vaccination project had been rolled out. Design: A qualitative study design was used, with six focus group discussions (FGDs) that included 36 women, aged 25 49 years, with no previous history of cervical cancer symptoms or diagnosis. The women were interviewed in February and March 2013. The transcribed data was analysed using content analysis. Results: Three themes emerged: feeling unprotected and unsafe, misbelief and wondering about cervical cancer, and fear of the testing procedure. Participating women had heard of cervical cancer but preferred to wait to access cervical cancer screening until symptom debut. Conclusions: There are still barriers to cervical cancer screening among women in Uganda, where there is a need for culture-specific, sensitive information and interventions to address the issues of improving the cervical cancer screening uptake among these women. Societal context needs to be taken into account when implementing community-based health education.
Assessing the impact of cervical cancer integration into reproductive health networks: operations research from Uganda
(International Population Conference, 2017) Nuccio, Olivia; Chowdhury, Raveena; Penfold-Taylor, Suzanne; Mesele, Tesfaye; Church, Kathryn; Meglioli, Alejandra; White, Heather; Kumakech, Edward
The Cervical Cancer Screening and Preventive Therapy (CCS&PT) via Reproductive Health Networks initiative started in 2012, with the aim of improving health outcomes through the provision of services targeted at women at highest risk of cervical cancer (those aged 30-49). The project integrates CCS&PT into existing sexual and reproductive health service networks in four sub-Saharan African countries (Nigeria, Kenya, Tanzania, and Uganda). Operations research was conducted in Uganda to assess how well screening services were being provided within the existing networks and to describe the modes and effectiveness of referral methods for further treatment when required. A mixed-methods observational study design included analysis of routine data, quantitative cross-sectional surveys, in-depth interviews, and a referral assessment survey. Data were collected between October and November 2015. Public health impacts were demonstrated, with high proportions of clients reached who had never been screened before, and were in the target age group of 30-49. Opportunities to expand access to treatment were highlighted, with a need to overcome cost and other barriers. Providers reported both benefits and drawbacks of CCS introduction. Encouragingly, integrating CCS&PT provision into SRH care appeared to increase demand for other, complementary services, specifically family planning.
Cervical cancer risk perceptions, sexual risk behaviors and sexually transmitted infections among Bivalent Human Papillomavirus vaccinated and nonvaccinated young women in Uganda - 5 year follow up study
(BMC women's health, 2017) Kumakech, Edward; Andersson, Sören; Wabinga, Henry; Musubika, Caroline; Kirimunda, Samuel; Berggren, Vanja
Background: Previous studies were conflicting regarding the associations between HPV vaccination, cervical cancer risk perceptions, high-risk sexual behaviors and STIs. This study compared the HPV-vaccinated and non-vaccinated young women in Uganda regarding cervical cancer risk perceptions, high-risk sexual behaviors, syphilis and HIV infections 5 years after vaccine implementation. Methods: This was a population-based comparative cross-sectional survey conducted in Uganda. The 438 participants were sexually active young women aged 15–24 years and mean age was 18.6 (SD 1.4). The majority (53.0%) were HPV-vaccinated in 2008 without assessment of sexual activity prior to HPV vaccination. Upon verbal assessment of sexual activity at the time of follow-up, data were collected using a questionnaire and laboratory testing of blood samples for syphilis and HIV infections. Results: There were no significant differences between the HPV-vaccinated and non-vaccinated groups regarding the prevalence of high-risk sexual behaviors, syphilis and HIV infections. Cervical cancer risk perceptions and age at sexual debut were nonetheless significantly lower among the vaccinated group compared to their non-vaccinated counterparts. However, HPV vaccination was not significantly associated to cervical cancer risk perceptions and early age at sexual debut in multivariate logistic regression analysis. Conclusions: We found no associations between HPV vaccination, cervical cancer risk perceptions, high-risk sexual behaviors, syphilis and HIV infections among young women in Uganda 5 years after vaccine implementation. Young girls in the study population were found to be sexually active at a young age, affirming the importance of targeting girls of younger age for HPV vaccination.
Evaluation of a data-informed community engagement strategy to increase immunisation coverage in northern Uganda: a cluster-randomised controlled trial with an embedded process evaluation
(The Lancet Global Health, 2018) Bruce, Jane; Chantler, Tracey; Kumakech, Edward; Mawanda, Ashiraf; Olorunsaiye, Comfort; Schmucker, Laura; Kiapi, Lilian; Landegger, Justine; Webster, Jayne
Background The 2016 Ugandan Demographic and Health Survey indicated that only 86% of children (aged 12–23 months) in northern Uganda had received the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) and only 65% were fully immunised. To help close this gap, the International Rescue Committee developed a data-informed community engagement intervention, the Fifth Child Project, informed by a theory of change and including: (1) an mhealth tool used by health-facility-based staff and defaulter tracing forms used by community health workers aimed at improving data accuracy, (2) training of health workers in interpersonal skills, and (3) involvement of community leaders in planning vaccine outreaches. To test the impact of this intervention and examine its underlying hypothesis that a data-informed community engagement strategy will increase immunisation coverage, we conducted a clusterrandomised controlled trial with an embedded process evaluation. Methods At baseline, a household two-stage cluster survey was conducted in 32 clusters (16 intervention and 16 control health facility catchment areas) from mid-June to mid-July, 2016. The survey collected information on vaccinations, caregivers’ interactions with community-based and facility-based health workers, and reasons for non-vaccination of eligible children. The primary outcome was DPT3 and measles coverage in children aged 9–23 months. Process evaluation activities included: quarterly monitoring reports, interviews, focus group discussions, and observations conducted in four intervention and two control clusters (March–April, 2017). The endline survey was conducted from Sept 19, 2017, to Oct 2, 2017. Findings The sample included 916 households (935 children aged 9–23 months) in the intervention clusters and 881 households (897 children aged 9–23 months) in control clusters. Baseline estimates of immunisation coverage were similar for intervention and control arms. Both arms combined baseline coverage of DTP3 and measles vaccines using information from child immunisation cards, and caregiver recall was 78·3% (95% CI 76·0–81·5) and 64·6% (95% CI 60·9–67·3%), respectively. About 19% of children who received DTP1 had not received the measles vaccine in the intervention arm, compared with 21% of children in the control arm at baseline. The major barriers to complete immunisation included caregivers’ lack of awareness of immunisation schedule and vaccine stock-outs. Interpretation Endline and process evaluation findings will be available in March 2018 and will provide a more complete assessment of the impact of the Fifth Child Project.
Impacts of IRC’s Fifth Child community engagement strategy to increase immunisation in northern Uganda
(2019) Webster, Jayne; Landegger, Justine; Bruce, Jane; Malunda, Dickson; Chantler, Tracey; Kumakech, Edward; Schmucker, Laura; Kiapi, Lilian; Kozuki, Naoko; Olorunsaiye, Comfort; Byrne, Erin
The 2011 Uganda Demographic and Health Survey (UDHS) reported that the national coverage of the third dose of the combined diphtheria, pertussis, tetanus vaccine (DPT3) among children 12-23 months of age was 73%, and only 52% were fully immunized. Intervention overview In search of innovative ways to increase immunization coverage, the IRC, in coordination with the Uganda Ministry of Health, piloted from August 2015-April 2016 an mReach application (mReach) and community engagement strategy (the ‘Fifth Child’ intervention), working with Village Health Teams (VHTs) to identify immunization defaulters and re-enter them into the vaccination schedule. Based on positive results of this pilot, the IRC received funding from 3ie to scale and evaluate the impact of this intervention. The goal of the ‘Fifth Child’ intervention was to increase immunization coverage through defaulter tracing and targeted service delivery, facilitated by the mReach data platform and community engagement strategies. The intervention was implemented from mid-September 2016 to mid-September 2017. The underlying hypothesis of the intervention is that data-driven, targeted community engagement would facilitate more effective defaulter tracing and contribute to increased immunization coverage in hard-to-reach communities. The project has two main components. The first is supporting activities aimed at strengthening the health system (support for outreaches, transport of vaccines and supplies, financial support for VHTs to attend community engagement meetings with health care workers and community leaders, etc.). The second component, mReach with community engagement, included continuous newborn registration, quality VHT home visits for immunization due and defaulter tracking, and community leader involvement and co-management of outreaches based on defaulter data.

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