Prevalence and predictors of cervical cancer screening among HIV-positive women in rural western Uganda: insights from the health-belief model.

BACKGROUND: Women living with HIV are at increased risk of developing cervical cancer (CC). Screening for cancer is an important preventive strategy for the early detection of precancerous lesions and its management. There has been inadequate evidence on cervical cancer screening (CCS) practices among HIV-positive women in rural western Uganda. This study aimed to assess the prevalence and predictors of CCS among HIV-positive women, as well as knowledge and practices regarding cervical cancer screening. METHODS: A cross-sectional, analytical study was conducted among HIV-positive women attending HIV care facilities located in rural settings of western Uganda. A validated and interview-based data collection form was used to capture statistics regarding demographics, HIV care, obstetric profile, health belief constructs, and knowledge and history of CCS from the participants. Bivariate and multivariate logistic regression analyses were used to correlate women's characteristics and health beliefs toward CCS practices. RESULTS: The prevalence of CCS among HIV-positive women was found to be 39.1% (95%CI: 14.0-71.7). A multivariate logistic regression analysis showed that post-secondary education attainment (AOR = 3.21; 95%CI = 2.12-7.28), four years or more lapsing after being diagnosed as HIV-positive (AOR = 2.87; 95%CI = 1.34-6.13), having more than one child (AOR = 1.87; 95%CI = 1.04-3.35), antenatal care attendance (AOR = 1.74; 95%CI = 1.02-3.43), post-natal care attendance (AOR = 3.75; 95%CI = 1.68-5.89), and having good knowledge regarding CC (AOR = 1.26; 95%CI = 1.98-3.02) were positively associated with adherence to CCS among HIV-positive women in western Uganda. Health Belief Model (HBM) constructs like the perceived risk of developing CC (AOR = 1.82; 95%CI = 1.16-2.01), worries about developing CC (AOR = 5.01; 95%CI = 4.26-8.32), believing that CC leads to death (AOR = 2.56; 95%CI = 1.64-3.56), that screening assists in early identification (AOR = 2.12; 95%CI = 1.84-3.74) and treatment (AOR = 4.63; 95%CI = 2.78-6.43) of precancerous lesions, reducing the risk of mortality (AOR = 1.84; 95%CI = 1.12-2.75), and the reassurance provided by negative test results (AOR = 2.08; 95%CI = 1.33-4.22) were positively associated with adhering to CCS. A female doctor performing the screening (AOR = 2.02; 95%CI = 1.57-3.98) as well as offering a free screening service (AOR = 3.23; 95%CI = 1.99-4.38) were significantly associated with CCS. Meanwhile, screening being painful (AOR = 0.28; 95%CI = 0.12-0.45), expensive (AOR = 0.36; 95%CI = 0.24-0.53), time-consuming (AOR = 0.30; 95%CI = 0.19-0.41), embarrassing (AOR = 0.02; 95%CI = 0.01-0.06), and the fear of positive results (AOR = 0.04; 95%CI = 0.02-0.10) were found to have a significant negative association with adhering to CCS. CONCLUSIONS: Only one-third of HIV-positive women had undergone CCS. Variables including secondary education attainment, four years or more lapsing after being diagnosed as HIV-positive, having more than one child, antenatal care attendance, post-natal care attendance, and knowledge about CC were positively associated with CCS adherence. Educational programs should be geared towards the risk of CC, severity of cases, benefits of screening, and reducing barriers associated with screening, which can significantly improve cervical CCS among HIV-positive women. The study proposes the incorporation of free screening services and the inclusion of trained female staff in CC prevention policies to improve CCS.

Evaluation of Rational Drug Use Based on WHO/INRUD Core Drug Use Indicators in a Secondary Care Hospital: A Cross-Sectional Study in Western Uganda.

Purpose: Rational drug use (RDU) promotes safe, efficient, and cost-effective utilization of medicines in hospital settings. The aim of this study was to assess rational drug use based on the World Health Organization (WHO) and the International Network for Rational Use of Drugs (INRUD) core drug use indicators. Patients and Methods: This prospective, descriptive, hospital-based cross-sectional study was conducted among patients attending the Outpatient Department of a secondary care hospital located in the Sheema District of Western Uganda. A total of 450 prescriptions were prospectively collected from eligible patients and subjected to evaluation by using the WHO/INRUD core drug use indicators (prescribing, patient care, and health-facility indicators). Results: The average number of drugs prescribed per encounter was found to be 3.2 (optimal value=1.6-1.8). The percentages of drugs prescribed by their generic name (90.48%) and from the Essential Medicine List (96.23%) were close to the WHO reference (100%). The percentage of antibiotics (66.22%) and injections (25.22%) per encounter exceeded the WHO standards (antibiotics=20.0-26.8; injections=13.4-24.1). Among the patient-care indicators, the average consultation time (5.41 minutes), average dispensing time (131.03 seconds), percentage of medicines dispensed (76.11%), percentage of medicines adequately labeled (59.74%), and percentage of patients with dosage knowledge (49.50%) did not meet the WHO reference. Facility indicators such as the percentage of key medicines available in the stock (66.67%) did not conform to the WHO optimal value. The hospital made the EML hundred percent available to all practitioners. Conclusion: The study concludes that the prescribing, patient care, and health facility indicators at Sheema District Secondary Care Hospital deviate from the optimal values recommended by the WHO. Therefore, this study indicates a need for improvement on these indicators and a requirement for the ongoing educational initiatives focused on rational drug prescribing, dispensing, and patient use in order to comply with the standards set by the WHO.

Study of adverse drug reactions to antiretroviral therapy in a tertiary care hospital, Tirupati.

PURPOSE: Human immunodeficiency virus-infected patients do not adhere to their antiretroviral therapy (ART) due to adverse effects of drugs. The continuous monitoring of adverse drug reactions (ADRs) may ensure the safe use of drugs in patients. Hence, a retrospective analysis was carried out to assess the ADRs pattern, causality, and severity associated with various antiretroviral drug regimens in patients receiving ART. MATERIALS AND METHODS: A retrospective, analytical study was carried out at ART nodal center in Sri Venkateswara Ramnarain Ruia Government General Hospital, Tirupati. Data were collected by spontaneous reporting of health-care professionals from ART centers using Suspected ADR Reporting Forms of Indian Pharmacopoeia Commission to record the ADRs occurred in the patients who underwent treatment from December 2015 to November 2016. A total of 299 ADR reports were collected during the study period. The causality and severity of the reported ADRs were assessed using suitable scales. RESULTS: From a total of 299 ADR reports, females (63.81%) experienced higher ADRs than males (36.12%). The highest number of ADRs was reported to zidovudine/lamivudine/nevirapine (ZLN) regimen (76.92%) than tenofovir/lamivudine/efavirenz (TLE) regimen (23.07%). Cutaneous reactions were higher (34.34%) among patients receiving ZLN therapy, and drowsiness (53.62%) was the most common ADR in patients receiving TLE regimen. According to the World Health Organization causality assessment scale, most of the ADRs were possible (75.92%). On the assessment of Modified Hartwig and Siegel Severity Scale, 55.09% of ADRs were moderate. CONCLUSION: The study showed an increased incidence of ADRs to ART which calls for efficient pharmacovigilance systems to improve patient care and drug safety.