Christine Atuhairwe

The Quality of Life (QoL) Composite Index provides a multidimensional, person-centred measure integrating functioning, symptom burden, general health perce

Introduction: Dietary intake and physical activity influence antiretroviral therapy (ART) adherence and health outcomes in people living with HIV. This study assessed their association with viral load suppression (VLS) among adults living with HIV in Uganda. Methods: A cross-sectional study was conducted from February to August 2024 at 11 The AIDS Support Organization (TASO) Centres of Excellence across Uganda. Data, including viral load results, were collected via questionnaires and medical record abstraction. Descriptive statistics, bivariate, and multivariate from the modified Poisson regression analyses were performed using STATA v18. Results: Among 440 participants, 64% achieved VLS. Modified Poisson regression revealed that female sex (aPR=1.26, 95%CI: 1.14-1.40, p60 years (aPR=1.17, 95%CI: 1.06-1.31, p=0.003), being divorced/separated (aPR=1.14, 95%CI: 1.01-1.28, p=0.030), and widowed (aPR=1.13, 95%CI: 1.02-1.24, p=0.011), were associated with a higher prevalence of VLS. Being employed or active workforce (aPR=0.88, 95% CI: 0.78-0.99, p=0.037), and riding a bicycle (aPR=0.86, 95% CI: 0.75-0.99, p=0.041) were associated with a lower prevalence of VLS in adults. Conclusion: Viral load suppression among older Ugandan adults on ART was suboptimal. Female sex, older age (56 years and above), and being divorced/separated or widowed were associated with a higher prevalence of viral suppression, whereas being employed/actively working and using a bicycle as a means of transport were associated with a lower prevalence of viral suppression. Targeted interventions are needed to improve treatment outcomes among older adults, particularly among men and those engaged in active employment.

Perceived quality of life (QoL) is a critical element for older persons living with HIV-positive diagnosis. The intersection of aging, chronic illness, and the complexities of managing HIV significantly influences their quality of life. This study investigated the relationship between perceived QoL and lifestyle factors among older adults living with HIV in Uganda. This cross-sectional survey was conducted with older adults (above 50 years) living with HIV attending The AIDS Support Organization centres across the major regions in Uganda. Data were cleaned and analyzed using STATA 15, with modified Poisson regression assessing factors associated with perceived quality of life. A total of 440 participants were interviewed. While 52% reported poor perceived quality of life before initiating antiretroviral therapy (ART), this decreased to 35% after ART initiation. This suggests a substantial improvement in the health of older adults living with HIV. Before ART initiation, poor quality of life was significantly associated with being aged 60 years or older (adjusted risk ratio [aRR] 1.17, 95% CI 0.94-1.46), adhering to the Seventh-day Adventist (SDA) faith (aRR 1.89, 95% CI 1.12-3.21), being a casual labourer (aRR 0.62, 95% CI 0.41-0.94), being married (aRR 0.65, 95% CI 0.42-1.01), having one sexual partner (aRR 1.50, 95% CI 1.16-1.93), alcohol consumption (aRR 0.71, 95% CI 0.15-0.85), infrequent fruit consumption (aRR 1.75, 95% CI 0.99-3.09), consuming white meat 1-3 times per week (aRR 1.61, 95% CI 1.23-2.10), engaging in sports 4-7 days per week (aRR 0.25, 95% CI 0.08-0.75), walking 4-7 days per week (aRR 0.79, 95% CI 0.62-1.00), and having diabetes (aRR 1.57, 95% CI 1.13-2.19). After ART initiation, poor quality of life remained significantly associated with being 60 years or older (aRR 1.34, 95% CI 0.98-1.83) and being a salaried employee (aRR 0.38, 95% CI 0.21-0.81). Additionally, frequent white meat consumption (4-7 days per week) (aRR 2.01, 95% CI 1.18-3.42) and moderate sports engagement (1-3 days per week) (aRR 1.94, 95% CI 1.47-2.55) were significantly associated with poorer quality of life after ART initiation. No significant associations were observed with other variables. Perceived quality of life in older persons living with HIV was poorer among those aged over 60 years. The risk of poor QoL was lower among those who eat white meat and participate in sports weekly. Increasing physical activity through regular exercise routines in older adults can help reduce the risk of age-related diseases, improve energy levels, reduce stress, enhance appetite and sleep quality, boost cardiovascular and pulmonary endurance, and enhance overall quality of life.

Introduction: Despite advancements in Anti-retroviral Therapy (ART), older persons living with HIV (OPLWHIV) continue to face significant challenges, including poor health outcomes and lower quality of life. This study aimed to explore the correlates of health-related quality of life (HRQoL) for older persons on HIV ART attending the Aids Support Organization (TASO) in Uganda. Methods: We conducted a cross-sectional survey among OPLHIV enrolled in care at 11 stand-alone TASO centres between February to August 2024. Data was analyzed using STATA 15, employing an Ordinal Logistic Regression model to identify HRQoL correlates for individuals over 50 years old living with HIV. Results: Ordinal Logistic Regression results revealed that various demographic, social, and clinical indicators significantly correlated with different HRQoL domains. General health perception was associated with multiple sexual partners (p=0.038), advanced HIV disease (p=0.011), and a viral load >200 copies/ml (p=0.003). Physical functioning correlated with tertiary education (p=0.049), being separated (p=0.004), 11-15 years on ART (p=0.027), and WHO clinical stage II (p=0.050). Factors for role functioning included age 60+ (p=0.002), secondary education (p=0.021), unemployment (p=0.001), WHO clinical stage II (p=0.002), and TB history (p=0.037). Social functioning linked to secondary education (p=0.004), being widowed (p200 copies/ml (p=0.008), and WHO clinical stage II (p=0.011). Pain was associated with age 60+ (p=0.014), tertiary education (p=0.004), and unemployment (p=0.005). Energy correlated with secondary education (p=0.062), being separated (p=0.021), viral load >200 copies/ml (p=0.003), and WHO clinical stage II (p=0.028). Health distress was tied to secondary education (p<0.001), tertiary education (p<0.001), unemployment (p=0.033), and WHO stage II (p<0.001). Finally, mental health was associated with secondary education (p=0.017), being widowed (p=0.043), multiple sexual partners (p=0.015), and WHO stage II (p=0.001). Overall HRQoL specifically correlated with age 60+ (p<0.001), secondary education (p200 copies/ml, ART duration), and WHO clinical stage II. Having multiple sexual partners and a history of TB also factored into certain domains. Given these findings, TASO Uganda, with its extensive regional presence, is exceptionally well-positioned to implement multifaceted interventions. These should prioritize comprehensive support for older adults, promote health education and social support, enhance comprehensive HIV care, and provide integrated geriatric HIV health services to improve the HRQoL of OPLWHIV in Uganda.

The growing number of older adults living with HIV, facilitated by wider access to antiretroviral therapy (ART), presents unique challenges. This study aims to identify predictors of survival among older persons living with HIV receiving ART in Uganda’s AIDS Support Organization Centers of Excellence (1987–2023). Understanding these predictors can inform effective clinical interventions to improve outcomes for this population. This study conducted a retrospective analysis of medical records from 11 TASO centers of excellence in Uganda (1987–2023). Using Cox proportional hazards regression, we identified factors associated with survival among older adults living with HIV. TASO centers of excellence in Entebbe, Gulu, Jinja, Masaka, Masindi, Mbale, Mbarara, Mulago, Rukungiri, Soroti, and Tororo. Cox proportional hazards regression analysis identified factors influencing survival among older persons living with HIV (OPLHIV). Of the 30,758 OPLHIV medical records analyzed (1987–2023), 72.5% were active on ART, 5.9% had died, 15.2% were lost to follow-up, and 5.6% transferred to other facilities. Survival was significantly associated with: gender (female, HR = 1.19, p < 0.001), marital status (married, HR = 0.99, p < 0.001; separated/divorced, HR = 0.85, p < 0.001), WHO clinical stage (II, HR = 1.66, p < 0.001), viral load (> 200 copies/ml, HR = 1.49, p < 0.001), and ART adherence (fair, HR = 0.94, p = 0.157). Key predictors of survival among Older Adults Living with HIV (OPLHIV) include: female gender, age 50–59, weight 51–70 kg, married status, viral load > 200 copies/ml, WHO HIV clinical stage II, paid employment, and ART adherence. To improve survival outcomes, consistent clinical screenings of WHO clinical stages, viral load, and ART adherence are essential. These measures can guide healthcare providers in making informed treatment decisions to enhance survival and quality of life for OPLHIV in Uganda. Strengthen routine monitoring of viral load, ART adherence, and WHO clinical staging. Provide targeted support to married and separated/divorced adults to improve their survival chances. Address gender disparities in care to enhance outcomes for females. Focus on maintaining ART adherence and viral suppression to reduce mortality risks.

Introduction: The Corona virus disease (COVID-19) is a respiratory illness that is caused by SARS-CoV-2 virus. This virus was first reported in China in December 2019. It then spread to all countries and from March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic. In Uganda, the disease was first reported in March 2020 and COVID-19 vaccines became available by January 2021. Although COVID-19 vaccines were available in Uganda, uptake remained low. The aim of this study was to establish COVID-19 vaccine uptake awareness in a peri-urban setting in Entebbe City, Uganda. Methods: This was a cross-sectional study conducted among 127 men and 263 women who reside in Entebbe City, Uganda. Data was collected on socio-behavioral characteristics, knowledge, attitude, and practice (KAP) about COVID-19 vaccine using interviewer administered questionnaires. Uptake of COVID-19 vaccine was defined as the proportion of participants who had received at least one dose of the COVID-19 vaccine. We used descriptive statistics to estimate awareness of COVID-19 vaccines. The ‘chi-square test’ and ‘modified Poisson regression’ were used to assess variations in uptake of COVID-19 vaccines among respondents and their socio-demographics as well as other characteristics. Results: Ninety-nine percent (388 out of 390) of the study population were aware of at least one brand of COVID-19 vaccines in the country. Thirty-five percent (138 out of 390) knew that the vaccine immunity was achieved 14 days after the 2^nd dose and 98.7% (385 out of 390) admitted that observing the standard operating procedure for COVID-19 infection prevention was necessary after vaccination. There was a gap in knowledge on vaccine safety reported by 74.6% (291 out of 390) participants. Some participants 37.2% (145 out of 390) had concerns about the vaccine. Of these, 57.9% (84 out of 145) believed that the vaccines were not helpful; and 30.3% (44 out of 145) feared serious side effects. Sixty-six percent (257 out of 390) believed that vaccines were not working and 79.0% (308 out of 390) admitted that vaccines were promoted for financial gain. At the time of performing the study, 36.2% and 22.3% had received the 1^st and 2^nd dose respectively. The main sources of information on COVID-19 vaccine were television (TV) and social media (p-value 0.001). In a multivariate model, COVID-19 vaccine acceptability was associated with salaried and self-employment (p-value 0.046). The other predicative factors were awareness of the COVID-19 vaccine (p-value <0.001) and having vaccine concerns (p-value 0.013). Conclusion: Uptake of COVID-19 vaccination in Entebbe community was low, partly attributed to knowledge gaps and concerns about vaccine safety and effectiveness. This highlights the need to enhance dissemination of information about COVID-19 vaccine. The lessons learnt in this study would be relevant for other emerging infections by informing vaccination implementation programs in similar settings.

Background Vaccination is one of the most successful public health interventions for preventing infectious diseases. A successful vaccination program depends on high coverage, and health care workers (HCWs) play a pivotal role in ensuring high uptake of vaccines in the population. COVID-19 vaccines have been proven to be efficacious, and vaccination campaigns have been ongoing, however there is a perceived high vaccine hesitancy even among health care workers in Uganda. This study aimed at describing the facilitators, barriers to and level of uptake of COVID 19 vaccines among healthcare workers in primary healthcare facilities in an urban setting in Uganda. Methods We conducted an online cross-sectional survey among healthcare workers in private and public healthcare facilities in Entebbe municipality between July 2021 and August 2021. Data was collected using an online questionnaire. Uptake of the vaccines among healthcare workers was analysed as proportions, and logistic regression was used to analyse barriers and facilitators to uptake of COVID 19 vaccines. Results The study enrolled 360 participants, with 61.7% (n=222) females. A total of 236 (65.6%) healthcare workers had received at least one dose of COVID 19 vaccine with higher uptake among females 64%(n=151). Age above 40 years (OR 4.29), participating in COVID 19 vaccine related activities (OR 4.18) and having had a negative SARS-COV-2 test result (OR 1.79) increased the odds of having been vaccinated. Working in either a private for profit (OR 0.23) or a private not for profit (OR 0.19) reduced the odds of having been vaccinated. History of having cared for a COVID 19 patient and having a positive SARS-COV-2 test result did not influence the uptake of the vaccines in the study population. Conclusion Vaccine uptake among healthcare workers was close to the World Health Organisation (WHO) recommended uptake of 70% by mid-2022.

Aim: To assess the utilization of PDAs in addressing the avoidable causes of perinatal mortality in the eastern region of Uganda. Methodology: A cross-section design using a mixed method was conducted between 2014-2015 at Iganga, Bugiri, and Kamuli general hospitals in the East-Central region of Uganda. The interviews involved 115 health workers who included Doctors, Nurses/Midwives, Clinical officers, and Laboratory and Theatre staff. These were drawn from four departments including the Maternity ward, Outpatient department, Theatre, and pediatric ward. Hospital top and departmental managers formed the key informants for this study. Annual reports for the period 2009/10-2012/13 were reviewed. In addition, monthly reports for the calendar year 2013 together with patients’ clinical case notes and patients’ registers were also reviewed to determine the magnitude and causes of perinatal mortality. Factors contributing to perinatal death were assessed and categorized into fetal, maternal, and health facility factors. Results: Results revealed a high and rising perinatal mortality rate of 70/1,000 live births and a decreasing maternal mortality ratio of 363/100,000 live births. Most perinatal deaths were fresh stillbirths 48/88 which occurred during the intrapartum period and the majority of early neonatal death was due to birth asphyxia. None of the health facilities was conducting perinatal death audits and the quality of data used for perinatal death audits was inadequate and was scored poorly. Challenges hindering utilization of perinatal death audits included lack of staff sensitization and training, work overload, lack of motivation, fear of blame and litigation, political interference, and lack of support from the community. Conclusion: There was a high prevalence of perinatal deaths in east-central Uganda yet none of the hospitals was conducting perinatal death reviews. Recommendations: Health workers should be trained on perinatal death audit tools and guidelines. Records departments to revitalize with tools and personnel for effective data management.

Background. Obstetric fistula (OF) remains a silent neglected maternal challenge associated with devastating life consequences. Living with OF presents far-reaching physical, social, psychosocial, and emotional concerns, which negatively impact a woman’s quality of life. This study evaluated the quality of life among obstetric fistula patients in Masaka district, Uganda. Method. A cross-sectional study was conducted among 63 women diagnosed with OF at Kitovu Mission Hospital. Data were collected using a questionnaire, observation, in-depth interviews, and focus group discussions. Data were analyzed at univariate, bivariate, and multivariate levels, where the ordinal logistic regression model was applied. The qualitative data was transcribed and analyzed using qualitative content analysis. Results. Majority (87%) of the women diagnosed with OF reportedly had a poor quality of life. Bivariate analysis indicated that level of education ( ), employment status ( ), energy for everyday life ( ), capacity to work ( ), satisfaction with personal relationships ( ), feelings of loneliness ( ), negative feelings ( ), and self-confidence ( ) were significantly associated with good QoL. Multivariate analysis showed increased odds of good QoL increased among women with self-confidence (OR = 32.320; CI = 2.019–517.467), formal education (OR = 9.9497; CI = 1.075–92.048), women who did not experience difficulties in mobility (OR = 19.144; CI = 0.149–2456.770), and women who were satisfied with their personal relationships (OR = 5.785; CI = 0.447–74.824). Conclusion. A holistic fistula treatment approach is required that takes into consideration all aspects of life to address the consequences of obstetric fistula to realize improved quality of life among patients.

Background: Medical-incident reporting (MIR) ensures patient safety and delivery of quality of care by minimizing unintentional harm among health care providers. We explored medical-incident reporting practices, perceived barriers and motivating factors among health care providers at Mbarara Regional Referral Hospital (MRRH).Methods: We conducted a cross-sectional descriptive study on 158 health provider at Mbarara Regional Referral Hospital (MRRH), Western Uganda. Data was gathered using a structured questionnaire and analyzed with SPSS. The chi-square was used to determine factors associated with MIR at MRRH.Results: The results showed that there was no formal incident reporting structure. However the medical-incidences identified were: medication errors (89.9%), diagnostic errors (71.5%), surgical errors (52.5%) and preventive error (47.7%). The motivating factors of MIR were: establishment of a good communication system, instituting corrective action on the reported incidents and reinforcing health workers knowledge on MIR (p-value 0.004); presence of effective organizational systems like: written guidelines, practices of open door policy, no blame approach, and team work were significantly associated with MIR (p-value 0.000). On the other hand, perceived barriers to MIR were: lack of knowledge on incidents and their reporting, non-existence of an incident reporting team and fear of being punished (p- value 0.669).Conclusion: Medical Incident Reporting at MRRH was sub-optimal. Therefore setting up an incident management team and conducting routine training MIR among health care workers will increase patient safety.