Comparing static and outreach immunization strategies and associated factors in Uganda, Nov-Dec 2016

Introduction: the government of Uganda aims at reducing childhood morbidity through provision of immunization services. We compared the proportion of children 12-33 months reached using either static or outreach immunization strategies and factors affecting utilization of routine vaccination services in order to inform policy updates.Methods: we adopted the 2015 vaccination coverage cluster survey technique. The sample selection was based on a stratified three-stage sample design. Using the Fleiss formula, a sample of 50 enumeration areas was sufficient to generate immunization coverages at each region. A total of 200 enumeration areas were selected for the survey. Thirty households were selected per enumeration area. Epi-Info software was used to calculate weighted coverage estimates.Results: among the 2231 vaccinated children aged 12-23 months who participated in the survey, 68.1% received immunization services from a health unit and 10.6% from outreaches. The factors that affected utilization of routine vaccination services were; accessibility, where 78.2% resided within 5km from a health facility. 29.7% missed vaccination due to lack of vaccines at the health facility. Other reasons were lack of supplies at 39.2% and because the caretaker had other things to do, 26.4%. The survey showed 1.8% (40/2271) respondents had not vaccinated their children. Among these, 70% said they had not vaccinated their child because they were busy doing other things and 27.5% had not done so because of lack of motivation.Conclusion: almost 7 in 10 children aged 12-23 months access vaccination at health facilities. There is evidence of parental apathy as well as misconceptions about vaccination

Visiting health centers as a risk factor for measles transmission: Kamwenge District, Uganda, April ­ July 2015

Introduction: Uganda has been implementing a one-dose measles vaccination at age 9 months in its national EPI schedule. On 27 April 2015, a measles outbreak, which was confirmed by serum positivity in several patients, occurred in Kamwenge District. Since then, the number of reported measles patients has increased despite the implementation of measures to control the outbreak by the local government. We investigated this outbreak to identify the risk factors for measles transmission, estimate vaccination coverage, determine vaccine effectiveness, and recommend control measures.Methods: we defined a probable case as onset in a Kamwenge District resident of fever and generalized rash from 16 April 2015 onward with ≥ 1 of the following: coryza, conjunctivitis, or cough. A confirmed case was a probable case with positive measles-specific IgM in patient serum. For case-finding we reviewed medical records and found patients in the community with the help of the village health team. We determined vaccination histories by vaccination cards or interviews. In a case-control study, we compared the exposure histories of 50 probable case-persons with 200 asymptomatic control-persons during case-persons' exposure period (i.e., between minimum and maximum incubation). We matched case- and control-persons by age and residence village. We estimated vaccination coverage for children aged ≤ 2 years based on the percent of control-children vaccinated. Results: we identified 213 probable/ confirmed cases from 3 affected sub-counties (attack rate = 5.1/10,000). The epidemic curve showed sustained community transmission. The case-control study showed that 42% (21/50) of case-persons and 12% (23/200) of control-persons visited health centers during case-persons' exposure period (AORM-H = 6.1; 95% CI = 2.7-14). Vaccination coverage among children aged ≤ 2 years was 58% (95% CI = 47-68%). The vaccine effectiveness was 80% (95% CI = 35-94%). We found that all health centers were crowded, with no triaging system to separate suspect measles patients from patients with other illnesses.Conclusion: exposures to measles patients at crowded health centers, low vaccination coverage, and suboptimal vaccine effectiveness facilitated measles transmission in this outbreak. We recommended an emergency immunization campaign targeting young children, triaging and isolating suspect measles patients at health centers, and introducing a second dose of measles vaccine in the immunization schedule

Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015

Introduction: virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression. Methods: a descriptive cross-sectional study was conducted using routinely collected data from viral load testing samples from 100,678 HIV+ patients enrolled in HIV care across the country between August 2014 and July 2015. Viral load testing was conducted at the Central Public Health Laboratories in Kampala, Uganda. We extracted data on socio-demographic, clinical and viral load testing results. We defined virological non-suppression as having ≥ 1000 copies of viral RNA/ml of blood for plasma or ≥ 5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results: majority of the patients (68%) were females. The overall non-suppression rate was 11%. Second-time testers had a higher non-suppression rate than first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5 years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR = 4.1, 95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age groups. Non-suppression rates were also higher among suspected treatment failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence levels < 85% (35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR = 2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%, OR = 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91) had lower non-suppression rates than non-breastfeeding and non-pregnant women (10%). Conclusion: virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics