Barriers to use of Antiretroviral Drugs in Rakai District of Uganda

Background: About 75of people living with HIV/AIDS (PHAs) who need antiretroviral therapy have no access to these drugs in low-income countries. Objective: To investigate the barriers to use of ART in Rakai district of Uganda Methods: We interviewed 38 key informants and 384 PHAs. Data was collected on: education/mobilization for ART; sources of information for ART; beliefs regarding ART; social support; use of alternative medicine; stigma/discrimination towards PHAs; distance to ART centres; transport costs to ART centres; waiting time; and on suggestions as how to improve the use of ART. Results: The major barriers mentioned regarding use of ART included: inadequate mobilization; long waiting time at ART treatment centres; high cost of transport to reach ART centres; stigma/discrimination towards PHAs and inadequate number of health workers to attend to PHAs. Conclusions: Access to antiretroviral therapy could be ameliorated by: improving community education using innovative approaches such as through music; dance and videos; increasing the number of providers who are able to provide ART as through engagement of non health professionals in ART care; bringing ART nearer to where people live and instituting measures aimed at reducing stigma/discrimination such as through involvement of PHAs in demystisfying HIV/AIDS

Factors Influencing Disclosure of HIV Positive Status in Mityana District of Uganda

Background: Disclosure of HIV positive sero-status to sexual partners; friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of persons living with HIV/AIDS (PHA) never disclose. Objective: To identify factors associated with disclosure among PHAs in Mityana district of Uganda. Methods: Using a case control design; we compared 139 PHAs who had disclosed to 139 PHA who had not disclosed regarding socio demographic characteristics; sexual behaviour; individual experiences and perceptions about disclosure; as well as on health facility/community correlates of disclosure. Results: The independent factors that favour disclosure are not fearing negative outcomes of disclosure adjusted odds ratio (AOR) 7.00; 95confidence interval (95CI) 3.03-16.95; having communication skills to disclose (AOR 12.08; 95CI 4.94-29.51); having initiated anti-retroviral therapy (AOR 7.51; 95CI 3.42-16.49); not having tested for HIV during ante-natal clinic (AOR 5.07; 95CI 1.95-13.10); receiving ongoing counselling (AOR 4.33; 95CI 1.50-12.51) and having ever seen a PHA publicly disclose his/her HIV status AOR 2.73; 95CI 1.24-6.02). Conclusions: PHAs that have not initiated anti-retroviral therapy (ART); test for HIV in ante-natal clinic and fear negative outcomes need more help in disclosure. Measures that empower PHA to disclose such as those that lead to improved Counselingskills should be reinforced during ongoing counselling

"False Teeth ""Ebiino"" and Millet Disease ""Oburo"" in Bushenyi District of Uganda"

"Background:""False teeth"" (Ebiino) and ""Millet disease"" (Oburo; Tea-tea) have been reported in Uganda and other countries in Sub-Saharan Africa. These two perceived diseases are commonly reported in children under-five years of age. Anecdotal and published evidence suggests that these conditions are associated with moderate to severe childhood diseases such as malaria; pneumonia and diarrhoea and that most health seeking behaviour for the conditions is from traditional healers. Objectives:To estimate how common the 2 perceived diseases (false teeth and millet disease) are and describe health seeking behaviour for the two diseases. Methods: We did a cross-sectional survey using an interviewer administered questionnaire with closed and open questions in Bushenyi district; Uganda. The participants included 215 heads of households or their spouses obtained by cluster random sampling of 30 villages. Participants answered questions regarding occurrence of false teeth and millet disease disease in the household; treatment sought for false teeth and millet disease; perceived causes of false teeth and millet disease and about social economic situation of the household. Results: More than one in two of the households had a child less than five years who suffered from false teeth or millet disease in the last five years. More than 80of the respondents used traditional medicine alone or in combination with modern medicine to treat false teeth and or millet disease. Occurrence of false teeth and millet disease disease were favoured by low education status and not living in a house with cemented floor or having a brick wall. Use of traditional medicine was not associated with social economic conditions. Conclusions: The frequency of the perceived diseases false teeth and millet disease disease is high and may be attributed to low access to preventive and curative health services"

Risk factors for recurrent sexually transmitted infections in Uganda

To identify predictors of recurrent sexually transmitted infections (STIs). Design: A cross-sectional interview survey. Setting: STD Clinic; Old Mulago; Kampala. Methods: Eligible patients answered questions about their socio-demographic situation; STI symptoms; sexual behaviour; sexual partner referral; health seeking behaviour and whether they had a recurrent infection or not. Bivariate and multivariate stepwise logistic regression models were used to identify independent predictors of recurrent STIs. Results: Fifty two (38) out of 138 patients had recurrent STIs. On bivariate analysis the predictors of recurrent STIs were: being male; age -25 years; inability to read in eng; presenting with genital itching; attributing source of symptoms to sexual partner; not being asked to refer sexual partners at previous treatment site; having more than five lifetime partners; knowing how to use a condom; ever using a condom; and using a condom at least once in the previous three months. On multivariate analysis; idnependent risk factors for recurrent infection were: age -25 years (Adjusted Odds Ratio [AOR] = 2.70; 95CI 1.20; 5.88); inability to read eng AOR = 3.09; (95CI 1.38; 6.92); and having more than five; lifetime partners AOR = 2.56 (95CI 1.11; 5.88). Conclusion: Reducing the number of sexual partners and targeting people who do not speak eng with health education messages in the local language may reduce the frequency of recurrent STIs

Factors influencing choice of delivery sites in Rakai District of Uganda

In order to understand factors influencing choice of delivery sites in Rakai district of south-western Uganda; eight focus group discussions based on the Attitudes-Social Influence-Self efficacy model were held with 211 women from 21 random cluster samples who had a delivery in the previous 12 months (from 2 June 1997). Forty four percent of the sample delivered at home; 17at traditional birth attendants's (TBA) place; 32at public health units; and 7at private clinics. Among the factors influencing choice of delivery site were: access to maternity services; social influence from the spouse; other relatives; TBAs and health workers; self-efficacy; habit (previous experience) and the concept of normal versus abnormal pregnancy. Attitudinal beliefs towards various delivery sites were well understood and articulated. Attendance of ante-natal care may discourage delivery in health units if the mothers are told that the pregnancy is normal. In order to make delivery safer; there is need to improve access to maternity services; train TBAs and equip them with delivery kits; change mother's self-efficacy beliefs; and involve spouses in education about safe delivery

Factors influencing choice of delivery sites in Rakai district of Uganda

In order to understand factors influencing choice of delivery sites in Rakai district of south-western Uganda; eight focus group discussions based on the Attitudes-social influence-Self efficacy model were held with 32 women and 32 men. Semi-structured interviews were also held with 211 women from 21 random cluster samples who had a delivery in the previous 12 months (from 2 June 1997). forty four percent of the sample delivered at home; 17at traditional birth attendant's (TBA) place; 32at public health units; and 7at private clinics. among the factors influencing choice of delivery site were: access to maternity services; social influence from the spouse; other relatives; TBAs and health workers; self-efficacy; habit (previous experience) and the concept of normal versus abnormal pregnancy. Attitudinal beliefs towards various delivery sites were well understood and articulated. Attendance of ante-natal care may discourage delivery in health units if the mothers are told that the pregnancy is normal. In order to make delivery safer; there is need to improve access to maternity services; train TBAs and equip them with delivery kits; change mother's self-efficacy beliefs; and involve spouses in education about safe delivery

Predictors of condom use among patients with sexually transmitted disease in Uganda

Background and objective: Patients with sexually transmitted diseases (STDs) are at an increased risk of HIV infection and they must be targeted for increased condom use. goal : to identify predictors of condom use among patients with STDs. Study Design : in a cross-sectional survey; an interview-ad-ministered questionnaire was administered to 138 patients at the STD clinic; Mulago; and the outpatients department; Mbarara Hospital; in Uganda. Data were collected on socio-demographic situations; STD symptoms; type of sexual partners; and use of condoms. Multivariate logistic regression models were used to identify independent predictors of condomuse. Results: of the 138 patients; 87(66) knew how to use condoms; 81(59) every used a condom; 34(25) used a condom at least once in the previous 3 months; 20(15) used a condom at least once in the previous 3 months; 20(15) used a condom during the last sexual intercourse; and 80 (58) accepted a free supply of condoms. Reasons for not using condoms among the 57 who had never were: having a regular partner or spouse (28; 49) accepted a free supply of condoms. Reasons for not using condoms among the 57 who had never were: having a regular partner or spouse (28; 49);partner does not approve (17;30); reduced sexual pleasure (5;9); and no answer (7;12). The independent predictors of condom use were: being a man; not having a regular partner; having had sex with a casual partner; being able to read eng; having at least secondary education; and using electricity for lighting. Conclusion: Providing health promotion measures in local languages may improve condom use in this population. There is a need for complementary HIV prevention strategies for women and for regular sexual partnerships

Psycho-social determinants for sexual partner referral in Uganda : quantitative Results

The purpose of this study was to investigate the factors influencing sexual partner referral using the attitude-social influence - self efficacy model as a guiding theoretical. The data was collected in an interview survey with 236 women and 190 men attending a sexually transmitted disease clinic in Kampala; Uganda. Intention; attitude; subjective norm; self-efficacy; and past behaviour predicted partner referral for women whereas intention; self efficacy; and previous behaviour predicted partner referral for men. For the women the strongest predictors for intention were self-efficacy followed by partner type and self efficacy. Social influence was a better predictor of intention for women than for men. An analysis of underlying cognitive beliefs discriminating those who referred and those who did not refer the sexual partner showed that attitudinal beliefs were the most important for men whereas self-efficacy beliefs were the most important for women. The targeting of the gender based descriminatory beleifs in intervention may improve compliance with sexual partner referral

Efficacy of patient-delivered partner medication in the treatment of sexual partners in Uganda

Background: patient-based partner referral (PBPR); which is the main method for treating sexual partners of patients with sexually transmitted diseases (STDs); has limited effictiveness. Goal: The authors compared the efficacy of PBPR with patient-delivered partner medication (PDPM) among patients attending the Mulago STD clinic in Kampala; Uganda. Study design: A total of 383 patients (187 women; 196 men) with STDs were randomised to the PBPR or PDPM group. The proportion of sexual partners treated in either group was compared using the chosquare statistic by intention to treat for partners whose follow-up status was unknown. Results: The two groups has similar background characteristics. Of the 237 partners elicited; 176(74) were reported treated in the PDPM group. In the PBPR group; in which 234 partners were elicited; 79(34) were referred to the treatment clinic.This difference was statistically significant (risk ratio (RR); 2.44; 95CI; 1.95-3.07; P0.001). Furthermore; PDPM was more effective than PBPR for women and for casual partners for whom PBPR is considered difficult. For women; 86 of 103 partners in the PDPM group ; compared with only three of 45 partners (7) who were referred in the PBPR group (RR; 1.43; 95 CI; 1.40-2.65; p0.01). Conclusion : Patient-delivered partner medication is more effective than patient-based partner referral in the treatment of sexual partners