Research Articles

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Adherence to Tuberculosis Treatment and Its Associated Factors among Drug-susceptible Tuberculosis Patients in Lira District, Northern Uganda
(International Journal of Academic Research in Business and Social Sciences, 2023) Nabaziwa, Jannat; Kigongo, Eustes; Kabunga, Amir; Acup, Walter; Puleh, Sean Steven
Uganda has a high incidence of tuberculosis infection at 200 cases per 100,000 people. With effective therapy and adherence to medications is essential for reducing the spread of tuberculosis in the community. However, many of the initiated patients do not get to finish the entire course of treatment. The purpose of this study was to investigate the level of and factors associated with tuberculosis treatment adherence among drug-susceptible tuberculosis patients in the Lira district. A facility-based cross-sectional survey was conducted among 234 randomly selected tuberculosis patients between October and December 2022. The Morisky medication adherence scale was used to measure adherence. Using a structured questionnaire to collect data on socio-demographic characteristics, community factors, and health service delivery factors associated with adherence. Binary logistic regression analysis was used to determine the correlates of adherence to tuberculosis drugs at a p value of 0.05. Most of the respondents (135, 57.7%) were males, (93, 39.7%) aged above 45 years, and (135, 57.7%) in a marital relationship. The prevalence of adherence to tuberculosis drugs was 84.6% (198/234) and was associated with marital status (AOR: 0.307; 95% CI: 0.13-0.0724, p=0.007) and the experience of stigma (AOR: 4.39; 95% CI: 1.612-11.958, p=0.004). The study reported that 2 in 10 drug-susceptible tuberculosis patients are non-adherent, which is lower than the targeted 90%. Marital status and stigma experience are predictors of non-adherence. Interventions by the ministry of health should target how to improve tuberculosis treatment and reduce stigma.
Determinants of primary healthcare providers’ readiness for integration of ART services at departmental levels: A case study of Lira City and District, Uganda
(PLoS ONE, 2023) Ikwara, Emmanuel Asher; Nakero, Lakeri; Anyolitho, Maxson Kenneth; Isabirye, Rogers; Namutebi, Syliviah; Mwesiga, Godfrey; Puleh, Sean Steven
Background Decreasing or flattening funding for vertical HIV services means that new and innovative ways of providing care are necessary. This study aimed to assess the determinants of readi- ness for integration of Antiretroviral Therapy (ART) services at the departmental level among primary health care providers (PHCP) at selected health facilities in Lira District. Methods A cross-sectional survey employing mixed methods approaches was conducted between January and February 2022 among 340 primary healthcare practitioners (PHCP) at selected health facilities in Lira district. An interviewer-administered questionnaire was used to collect quantitative data. Quantitative data was analyzed using Stata version 15. and presented as proportions, means, percentages, frequencies, and odds ratios. Logistic regression was used to determine associations of the factors with readiness for ART integration at a 95% level of significance. Thematic analysis was used to analyze qualitative data. Results The majority 75.2% (95% CI; 0.703–0.795) of the respondents reported being ready for the integration of ART services. PHCPs who were aware of the integration of services and those who had worked in the same facility for at least 6 years had higher odds of readiness for integration of ART, compared with their counterparts [aOR = 7.36; 95% CI = 3.857– 14.028, p-value <0.001] for knowledge and duration at the current facility [aOR = 2.92; 95% CI = 1.293–6.599, p-value < 0.05] respectively. From the qualitative data, the dominant view was that integration is a good thing that should be implemented immediately. However, several challenges were noted, key among which include limited staffing and drug supplies at the facilities, coupled with limited space. Conclusions The study reveals a high level of readiness for the integration of ART services at departmen- tal levels among Primary Healthcare Providers. Notably, PHCPs knowledgeable about inte- gration and those who spent at least six years at the current health facility of work, were strong determinants for the integration of ART services in resource limited settings. In light of these findings, we recommend that policymakers prioritize the implementation of training programs aimed at upskilling healthcare workers. Furthermore, we advocate that a cluster randomized controlled trial be conducted, to evaluate the long-term effects of this integration on overall health outcomes.
Factors Associated with Linkage to Care following Community-Level Identification of HIV-Positive Clients in Lira District
(Hindawi Advances in Public Health, 2022) Adwar, Claire; Puleh, Steven Sean; Ochaba, Isaac; Ogweng, Isaac; Benyumiza, Deo; Amusu, Kosta; Achola, Brenda; Ocen, Francis; Abolo, Lydia; Kumakech, Edward; Obua, Celestino
Background. Community HIV testing helps to increase access to high-risk groups who are less likely to visit a clinic for a test. A large proportion of people identified with HIV following community-based testing are not easily linked to care compared to facility-based identified cases. (ere is a paucity of literature on linkage to HIV care and its predictors particularly following community-based testing in a rural setting. We assessed the level of linkage to the care of HIV-positive individuals and associated factors following community-level identification in Lira district. Method. A cross-sectional survey was conducted in Lira district employing mixed methods among HIV-positive adults identified in the communities. Quantitative data were collected from 329 randomly selected study participants using interviewer-administered questionnaires. Key informant interview guide was used to collect qualitative data. (e data were double entered, cleaned, and analyzed using SPSS version 23. Odds ratios and confidence intervals were used to assess the association between predictors of linkage with HIV care. Qualitative data were analyzed using thematic content analysis. Results. (e respondents were aged between 18 and 85 years with a mean age of 42.9 (SD � 11.6). (e level of linkage to HIV care following community-level identification of HIV testing in Lira district was 98% (95% CI 96.07–99.33). Clients who self-initiated the HIV testing were more likely to link to HIV care than their counterparts (AOR � 9.03; 95% CI 1.271–64.218, p � 0.028). Key informants identified factors influencing linkage to care as health education, counseling, follow-up, and family support. Fear of stigma, disclosure, denial, and distance to facility were reported as barriers to linkage. Conclusion/ Recommendation. (e level of linkage to HIV care following community identification was found to be excellent (98%). Predictors to linkage to care included self-initiated testing, positive perception of distance, and waiting time at health facilities. We recommend health education, counseling, follow-up, and family support as interventions to strengthen successfully linking to careLin
Factors Influencing ART Adherence Among Persons Living with HIV Enrolled in Community Client-Led Art Delivery Groups in Lira District, Uganda: A Qualitative Study
(Dovepress, 2023) Rogers, Isabirye; Didan, Jacob Opii; Sharon, Opio Ekit; Alice, Kawomera; Luke, Lokiru; Robert, Isoke; Joachim, Ssenkaali; Sean Steven, Puleh
Background: Community client-led ART delivery groups (CCLADs) were introduced as one of the strategies to better serve individual needs and reduce unnecessary burdens on the health system. However, limited data adequately explained the factors influencing ART adherence among HIV/AIDS patients in CCLAD’s model of care. The study aimed to assess the factors influencing ART adherence among HIV-positive patients attending CCLADs in Lira District, Uganda. Materials and Methods: We employed a qualitative method of data collection recruiting 25 study participants (expert clients) between July and August 2020. The study purposefully chose 25 participants to participate in with HIV/AIDS patients enrolled in community-based HIV care models. The interviews were recorded on audiotape, transcribed, and translated verbatim. We used a thematic approach to analyze the data. Results: Our study shows that social support among group members, patient self-motivation, counselling, and guidance were the major facilitators of adherence. From the analysis of results, our study found the following themes: Lack of food, stigma, forgetfulness, stress, unfair staff at the hospital, and socio-cultural beliefs were among the major barriers identified in this study. Conclusion: The study emphasizes that CCLADs improve ART adherence for HIV-positive clients by providing a supportive environment and medication access. Peer influence on alternative medicine usage hinders adherence. We recommend that continued support, funding, and education are necessary to address misconceptions and sustain CCLADs’ effectiveness.
Knowledge and perceptions of primary healthcare providers towards integration of antiretroviral therapy (ART) services at departmental levels at selected health facilities Lira district, Uganda
(BMC Health Services Research, 2023) Puleh, Sean Steven; Ikwara, Emmanuel Asher; Namutebi, Syliviah; Nakero, Lakeri; Mwesiga, Godfrey; Isabirye, Rogers; Acen, Joy; Anyolitho, Maxson Kenneth
Background Investigations conducted among healthcare providers to assess their knowledge and perceptions towards the integration of anti-retroviral therapy (ART) related services in Sub-Saharan Africa are limited. This study explored the knowledge and perceptions of primary healthcare providers towards the integration of ART management services at departmental levels in health facilities in Lira district. Methods We conducted a descriptive cross-sectional survey that employed qualitative methods of data collection in four selected health facilities in Lira district between January and February 2022. The study involved in-depth interviews with key informants and focus group discussions. The study population consisted exclusively of primary healthcare providers; however, those who were not full-time employees of the participating health facilities were excluded. We used thematic content analysis. Results A significant proportion of staff (especially those who are not directly involved in ART) still lack full knowledge of ART services integration. There was generally a positive perception, with some suggesting ART integration can minimize stigma and discrimination. The potential barriers to integration included limited knowledge and skills for providing comprehensive ART services, insufficient staffing and space, funding gaps, and inadequate drug supplies, coupled with increased workload due to enlarged clientele. Conclusion Whereas healthcare workers are generally knowledgeable about ART integration, but their knowledge was limited to partial integration. The participants had a basic understanding of ART services being provided by different health facilities. Furthermore, participants viewed integration as critical, but it should be implemented in conjunction with ART management training. Given that respondents reported a lack of infrastructure, increased workload, and understaffing, additional investments in staff recruitment, motivation through training and incentives, and other means are needed if ART integration is to be implemented
Knowledge and perceptions of religious leaders towards HIV prevention among young people in Lira district, Northern Uganda: a qualitative study
(Discover Health Systems, 2024) Murungi, Tom; Kunihira, Irene; Oyella, Pamela; Mugerwa, Moses; Gift, Peruth; Aceng, Mercy Jane; Puleh, Sean Steven
Background Currently, 410,000 new HIV infections among youth occur worldwide, which is a significant public health issue. Members of the clergy can be trustworthy allies in the reduction of HIV infections among the youth. However, little is known regarding their knowledge as well as the perceptions they hold towards HIV prevention among young people. Thus, we explored the knowledge and perceptions of religious leaders regarding HIV prevention among young people (15–24 years) in Lira district. Methods This was a cross-sectional qualitative study conducted among 20 religious’ leaders in March 2021 in Lira district. Religious leaders were sampled purposively and recruited from modern religions (beliefs influenced by Christianity or Islam) in Lira district. Guides for key informant interviews were utilized to gather information. Each interview was audio recorded, transcribed, and entered into NVivo version 12 software, and the data was then ready for analysis. The main themes were determined using thematic analysis. Results Although a few individuals had some misconceptions, the majority of participants had good knowledge about the transmission and prevention of HIV. Participants knew awareness creation, abstinence, and faithfulness in marriage as HIV prevention strategies and held positive perceptions. Perceived barriers to HIV prevention involvement were lack of knowledge and training and inadequate resources, whereas motivating factors were being respected and trusted and having easy access to young people. Conclusion In conclusion, religious leaders show limited HIV prevention knowledge due to religious beliefs, but understand the importance of measures like abstinence. Despite the challenges, their involvement is crucial. Addressing knowledge gaps and providing support is vital. Future efforts should emphasize both behavioral measures and interventions like condom use, post-exposure prophylaxis, and pre-exposure prophylaxis.
Parents’ Readiness to Vaccinate Their Children Aged 5 to 17 Years Against Covid-19 and Its Associated Factors in Lira District, Uganda
(Pediatric Health, Medicine and Therapeutics Dovepress, 2023) Puleh, Sean Steven; Kigongo, Eustes; Opio, Innocent Ojok; Akech, Stella Immaculate; Opollo, Marc Sam; Achan, Everlyne; Acen, Joy; Anyolitho, Maxson Kenneth; Acup, Walter; Kabunga, Amir
Background: Data on parents’ readiness to vaccinate their children aged 5 to 17 years against COVID-19 is still scarce. This study assessed parents’ readiness to vaccinate their children aged 5 to 17 years against COVID-19 and factors associated in Lira district, Uganda. Methods and Materials: A cross-sectional survey employing quantitative methods was conducted between October and November 2022 among 578 parents of children aged 5–17 years in 3 sub-counties in Lira district. An interviewer-administered questionnaire was used to collect data. Data was analyzed using descriptive statistics including means, percentages, frequencies, and odds ratios. Logistic regression was used to determine associations between the factors and the readiness of parents at a 95% level of significance. Results: Out of 634 participants, 578 responded to the questionnaire, giving a response rate of 91.2%. The majority of the parents (327, 56.8%) were female, had children aged between 12 and 15 years (266, 46.4%), and had completed primary education (351, 60.9%). Most of the parents were Christian (565, 98.4%), married (499, 86.6%), and had been vaccinated against COVID-19 (535, 92.6%). Results also indicated that 75.6% (ranging from 71.9% to 78.9%) of the parents were unwilling to vaccinate their children for the COVID-19 virus. The predictors of readiness were the age of the child (AOR: 2.02; 95% CI: 0.97–4.20; p=0.05) and lack of trust in the vaccine (AOR: 3.33; 95% CI: 1.95–5.71; p0.001). Conclusion: Our study shows that parents’ readiness to vaccinate their children aged 5 to 17 years was only 24.6%, which is suboptimal. The predictors of hesitancy were the age of the child and a lack of trust in the vaccine. Based on our results, the Ugandan authorities should provide health education interventions targeting parents to combat mistrust with respect to COVID-19 and the COVID-19 vaccine and highlight the benefits of the vaccines.
Risk Factors For Maternal Anemia Among Women Attending Antenatal Care In Moroto Regional Referral Hospital: A Case Control Study
(Research journal's Journal of Public Health, 2024) Emina, Godfrey; Omech, Bernard; Puleh, Sean Steven
Background: Maternal anemia continues to be a serious public health issue because of its link to poor maternal and fetal outcomes. The study’s objective was to assess the association between risk factors and maternal anemia among women attending antenatal care in Moroto Regional Referral Hospital. Methods: A case-control study involving 100 pregnant women -50 cases and 50 controls- was conducted between November 2021 to March 2022. Pregnant women who had hemoglobin levels below 11 g/dl at their first antenatal appointment were considered cases, while pregnant women with hemoglobin levels of 11 g/dl and higher were considered controls. A semi-structured interviewer-administered questionnaire was used to gather the data, and Stata version 15.0 was used for analysis. The risk factors for anemia in pregnant women were determined using a bivariate and multivariate logistic regression model. To find the significant link, adjusted odds ratios (AOR) with a 95% confidence interval (CI) and p-value were utilized. Results: The independent risk/protective factors were; residential area, wealth category, an education level (AOR=0.16, 95% CI: 0.03 -0.89), Dietary diversity score (DDS) (AOR=0.51, 95% CI: 0.14 -1.82) and gestational age (AOR=3.78, 95%CI: 1.36,10.55). Conclusion: In this study, the protective factors were; being an urban residential area, high education level, high wealth category, and high dietary diversity. Increasing gestational age was a risk factor. Prevention strategies should include improving livelihood and household income for women of reproductive age, advocating for and encouraging girl child education, community-based health education and counseling on nutrition, and improving household dietary diversity. Keywords: Maternal anemia, Anemia Risk factors, Pregnancy, Antenatal care
The role of religious leaders on the use of HIV/ AIDS prevention strategies among young people (15–24) in Lira district, Uganda
(PLOS ONE, 2022) Murungi, Tom; Kunihira, Irene; Oyella, Pamela; Mugerwa, Moses; Gift, Peruth; Aceng, Mercy Jane; Abolo, Lydia; Puleh, Sean Steven
Background Young people (15–24 years) bear the highest burden of new infections and are particularly vulnerable because of their highly risky behavior such as early sexual activity. There is paucity of information on the role of religious leaders in the multi-sectoral fight against HIV/ AIDS. We examined the role of religious leaders in the use of HIV prevention strategies among young people. Methods A cross sectional study was conducted between March and April 2021 among 422 randomly selected young people in Lira district, Uganda. An interviewer administered a questionnaire to the young people in order to collect quantitative data. A total 20 key informants were purposively sampled and interviews were conducted with religious leaders using a key informant’s interview guide. Data was collected on social demographics, HIV prevention messages, and awareness about HIV prevention strategies. Data was analyzed using Stata version 15 using proportions, means, percentages, frequencies, and logistic regression analysis at a 95% level of significance. Qualitative data was analyzed using thematic content analysis and the major themes were generated from the participants’ responses. Results About 57.1% (241/422) of the respondents were females. The prevalence of use of HIV prevention strategies among young people was 69.4%. Factors significantly associated with the use of HIV prevention included completing the primary level (aOR 4.95, p< 0.05), completing at least A level (aOR 8.85, p < <0.05), Awareness of HIV prevention strategies advocated for by religious leaders (aOR 0.02, p<0.001), religious leaders provided targeted HIV prevention messages (aOR 2.53, p<0.01), Advocacy for abstinence outside marriage and fidelity in marriage (aOR 35.6, p<0.01), Religious leaders preaching about HIV prevention (aOR 4.88, p<0.001). Qualitative data indicated that a section of religious leaders recommended abstinence/faithfulness. Condom use was the most discouraged HIV prevention strategy. However, most religious leaders agree with the fact that they have a role to play in HIV prevention, which includes sensitization, teaching and organizing sermons about HIV prevention. Conclusion The use of HIV prevention strategies advocated for by religious leaders among young people was nearly 70%. This finding indicates that religious leaders have a role to play in HIV/ AIDS prevention among young people in the Lira district. This calls for the involvement of religious leaders in HIV prevention programs tailored to prevent new infections of HIV among young people.

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