Julian Adong

Introduction: Cytomegalovirus (CMV) is the most common congenital infection globally, and the leading cause of non-genetic hearing loss and neurodevelopmental disability. The burden is highest in low- and middle-income countries where HIV is also highly prevalent. Women living with HIV have a higher prevalence of CMV and are more likely to transmit CMV to their infants. Despite this, congenital CMV (cCMV) and newborn hearing screening are not routinely available in sub-Saharan Africa (sSA) resulting in missed diagnoses and delayed treatment. Additionally, data comparing cCMV prevalence in HIV-exposed and non-exposed infants is limited. We aimed to determine cCMV prevalence among HIV-exposed and -unexposed neonates in Uganda, describe associated clinical characteristics, and assess infant hearing outcomes. Methods: This study was nested within a prospective cohort of pregnant women with and without HIV, followed with their infants through early childhood. Eligible participants were 18 years or older, pregnant, and planned to deliver at one of two clinics. We tested newborn saliva for CMV using a real-time PCR. Hearing screening was performed using a pre-approved screening algorithm. Maternal and neonatal medical characteristics and diagnoses were abstracted from clinical records. Results: A total of 793 women and their newborns were enrolled. Mean maternal age was 28 (standard deviation [SD] 6) years, and parity was 3 (SD, 2.0). The mean birth weight was 3.0 (SD, 0.5) kilograms and gestational age was 37 (SD, 2.0) weeks. Overall, 677 out of 793 (84.7%) neonatal saliva samples were tested for cCMV, 23 out of 677 (3.4%) were positive with no difference by maternal HIV status. cCMV was not associated with failed hearing screen. However, lower one-minute Apgar and jaundice were associated with cCMV. Conclusion: cCMV prevalence was high in this Ugandan cohort and did not differ by HIV exposure. Hearing outcomes were similar by cCMV status. Future studies should include a comprehensive clinical and audiological assessment for both HIV-exposed and -unexposed neonates, and longitudinal follow-up to detect hearing loss and other cCMV-associated sequelae.

Objective: HIV care interruptions contribute to adverse outcomes among adolescents and young adults with HIV (AYWH) and may occur due to structural barriers as well as comorbidities (e.g., mental health issues). This study characterizes a cohort of AYWH, examines the frequency of care interruptions, and assesses mental health issues during and after the COVID-19 pandemic while exploring mobile health (mHealth) potential. Methods: Using a retrospective and prospective cohort study design, we enrolled AYWH at Mbarara Regional Referral Hospital and assessed missed visits using the timeline follow-back method (24 months). Mental health was evaluated using the Centers for Epidemiological Disease Scale-Depression (CES-D; >15 considered significant) and a locally validated anxiety/psychosocial distress scale (score 0–100) at enrolment, three and six months. Access to mobile phones, smartphones and internet was also assessed. Results: Of 86 participants (mean age 18.6 years, 51.2% male), 89.5% had a viral load of <400 copies/ml. At enrolment, 53% had depression, with mean anxiety/psychosocial distress of 36.7. AYWH missed 19.0% of clinic visits, 3.2% of ART pickup visits, and 5.1% of laboratory visits, with no clear variation by pandemic phase. Depression and anxiety decreased significantly over 6-months (β=– 0.46; 95% CI – 0.73, – 0.19; p<0.001) and (β=– 1.25; 95% CI – 1.65, – 0.86; p=0.001) respectively. Most AYWH (59%) had mobile phone access, with 67% of those owning a smartphone and 71% having daily internet access. Discussion/conclusion: AYWH frequently missed clinic appointments, regardless of pandemic phase. Mental health symptoms were initially high, but decreased over time. Most AYWH had access to phones and the internet. Conclusion: To ensure continuity of HIV care and mental health support even during such disruptions, mHealth interventions may offer a viable solution and warrant further research.

Background: Human Immunodeficiency Virus (HIV) and alcohol use are widespread in sub-Saharan Africa (sSA), negatively impacting the continuum of HIV care, from prevention and testing to treatment outcomes. Reducing alcohol consumption among people with HIV (PWH) is therefore a public health priority. Most alcohol reduction strategies require in-person interactions and can be challenging during pandemics and social unrest, which are common in sSA. Mobile Health (mHealth) interventions may offer a more accessible reduction counselling, an accessible alternative to, or may augment, in-person interventions. However, the usability of these mHealth interventions in the target population should be assessed before implementation. This analysis evaluates usability of an mHealth intervention (automated booster sessions) to augment in-person alcohol use reduction counselling and examines its association with booster intervention uptake among PWH who self-reported unhealthy alcohol use. Methods: We analyzed data from PWH who participated in an alcohol reduction counselling intervention. Participants were PWH who self-reported unhealthy alcohol use in the prior 3 months by the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C positive; ≥3 women, ≥4 men). We analyzed data from one of the intervention arms, called the technology booster study arm. In this arm, participants received an in-person counselling intervention that was augmented by technology-based boosters delivered over 3 months. These boosters were delivered via interactive voice response (IVR) or short message service (SMS) text messages, based on participant preference. Usability of the IVR and SMS sessions was assessed at 6 months using the Systems Usability Scale (SUS). Booster intervention uptake, the outcome variable for this analysis, was defined as the percentage of booster sessions during the intervention period in which the participant successfully entered a personal identification number (PIN) needed to start the session. Multivariable linear regression (adjusting for sex, age, being literate, social desirability, and baseline high-risk alcohol use) was conducted to examine the relationship between usability and booster intervention uptake. Results: Of the 86 participants randomized to the technology arm, 35% were female, with a median age of 40 years [interquartile range (IQR): 32–47]. Fifty-six (65%) chose to receive IVR calls, while 30 (35%) chose SMS; the median booster intervention uptake was 73% (IQR: 53–83). The median SUS score (out of 100) was 90 (IQR: 85–90). SUS score and being literate were associated with booster intervention uptake [adjusted β =0.65, 95% confidence interval (CI): 0.02–1.29, P=0.04, and β =21.33, 95% CI: 7.65–35.01, reduction counselling, an 0.01, respectively]. Conclusions: In this analysis of usability and booster intervention uptake among PWH using an mHealth-augmented alcohol reduction intervention, usability was associated with increased booster intervention uptake, as was literacy. Understanding the usability aspects of an mHealth intervention and the level of literacy in each unique population may be predictive of intervention uptake rates.

Introduction. The global prevalence of maternal anemia is about 42%, and in sub-Saharan Africa, the prevalence of newborn anemia ranges from 25% to 30%. Anemia in newborn babies may cause complications such as delayed brain maturation and arrested growth. However, there is limited data on the prevalence of newborn anemia and its risk factors in people living in resource-limited settings. Objectives. We determined the prevalence and risk factors for newborn anemia and its correlation with maternal anemia in southwestern Uganda. Methods. This was a cross sectional study of 352 pregnant women presenting to the Mbarara Regional Referral Hospital for delivery. We collected maternal blood in labor and umbilical cord blood from the placental vein. We measured hemoglobin using a point-of-care Hemocue machine. We used summary statistics to characterize the study participants and compared demographic characteristics and outcomes using chi-square, t-test, and Wilcoxon rank sum analyses. We defined newborn anemia as umbilical cord hemoglobin Results. The prevalence of newborn anemia was 17%. Maternal parity was significantly higher for anemic than nonanemic newborns (3 versus 2, ). The mean age in years (SD) was significantly lower for participants with umbilical cord hemoglobin ). In multivariable linear regression analysis, a 1-point decrease in maternal hemoglobin was associated with a 0.14-point decrease in umbilical cord hemoglobin ( ). Each one-unit increase in parity was associated with a 0.25-point decrease in umbilical cord hemoglobin ( ). Cesarean delivery was associated with a 0.46-point lower umbilical cord hemoglobin level compared with vaginal delivery ( ). Conclusions. We found a significant association between maternal and newborn hemoglobin, underscoring the importance of preventing and correcting maternal anemia in pregnancy. Furthermore, maternal anemia should be considered a risk factor for neonatal anemia.

Alcohol use and HIV infection are prevalent in sub-Saharan Africa (sSA), and both are associated with low birth weight. Yet, few studies have evaluated the combined effects of maternal HIV infection and alcohol use on birth outcomes. We analyzed data from a prospective cohort study of HIV-related placental changes in Ugandan women. We defined alcohol use as self-reported alcohol use within the last year, using the AUDIT questionnaire and used linear and logistic regression to measure associations between maternal alcohol use, HIV serostatus, and birth weight. In a subsample, we measured alcohol exposure using phosphatidylethanol (PEth) in neonatal heelstick dried blood spots to confirm maternal alcohol use. Of 352 participants, 176 (50%) were women with HIV (WHIV). Three of 176 (2%) HIVuninfected women and 17/176 (10%) of WHIV self-reported alcohol use (P = 0.002). Maternal HIV infection was associated with lower birth weight (β = −0.12, 95% CI [−0.20, −0.02], P = 0.02), but self-reported alcohol use was not (β = 0.06, 95% CI [−0.15, 0.26], P = 0.54), and the interaction between HIV serostatus and alcohol use was not significant (P = 0.13). Among the PEth subsample, neither HIV status nor PEthconfirmed alcohol use were associated with low birth weight. Maternal HIV infection was associated with lower birth weight, but alcohol use was not, and there was no significant interaction between maternal HIV infection and alcohol use. Alcohol use was more prevalent in WHIV and under-reporting was common. A larger study of the effects of laboratory-confirmed alcohol and HIV exposure on birth outcomes is warranted.

Many adolescents and young adults with HIV (AYWH) struggle with antiretroviral therapy (ART) adherence and experience poorer outcomes than adults. Relevant factors include forgetfulness and poor self-efficacy related to their evolving neurobiology. We qualitatively explored experiences of AYWH–caregivers dyads using real-time ART adherence monitors and associated reminder functions in the home setting. As part of an implementation science-oriented study, AYWH used the Wisepill adherence monitor for 3 months. AYWH could also opt for short message service (SMS) self-reminders, a self-selected social supporter for delayed or missed doses, or an alarm reminder. We conducted in-depth interviews with randomly selected AYWH–caregiver dyads regarding their experience using the monitor. Qualitative data were analyzed using inductive content analysis. We completed 15 AYWH–caregiver dyad interviews. Of the AYWH, 67% were female, mean age was 16 years, 56% lived with their biological mother, and 86% were virologically suppressed. AYWH and their caregivers generally found the adherence monitors acceptable, though some had privacy concerns. AYWH felt the monitors helped them take charge of their medication, largely through the real-time alarm and SMS reminders; this took the burden of adherence reminders away from the caregivers, improving strained AYWH–caregiver relationships. Two adolescents reported rebound poor adherence after monitor withdrawal. ART adherence monitors and associated tools were largely acceptable to AYWH and their caregivers in home settings. The intervention helped improve AYWH self-efficacy and alleviated burden from some AYWH–caregiver relationships. Rebound poor adherence suggests the need for on-going support and/or other means to achieve intrinsic mechanisms for sustained adherence. Clinical Trial Registration number: NCT03825952.

Introduction: The global prevalence of anemia in pregnancy is about 42%, and in sub-Saharan Africa, the prevalence of newborn anemia ranges from 25–30%. Anemia in newborn babies may cause complications such as delayed brain maturation and arrested growth. However, there is limited data on prevalence of newborn anemia and its risk factors in people living in resource-limited settings. Objectives We determined the prevalence and risk factors for newborn anemia and its correlation with maternal anemia in southwestern Uganda. Methods This was a prospective cohort study of 352 pregnant women presenting to Mbarara Regional Referral Hospital for delivery. We collected maternal blood in labor and umbilical cord blood from the placental vein, as a proxy for newborn hemoglobin. We estimated hemoglobin using a point-of-care Hemocue machine. We used summary statistics to characterize the cohort, and compared demographic characteristics and outcomes using Chi-square, t-test, and Wilcoxon Ranksum analyses. We defined newborn anemia as umbilical cord hemoglobin < 13g/dl and estimated the relationship between maternal and umbilical cord hemoglobin using linear regression analysis, adjusting for potential confounders. Results The prevalence of newborn anemia was 17%. The average maternal parity was significantly higher for anemic and non-anemic newborns (3.5 versus 2.8, P = 0.01). Mean age [SD] was significantly lower for participants with umbilical cord hemoglobin < 13g/dl than those > = 13 g/dl, (26 [5.6] versus 28 [6.3], P = 0.01). In multivariable linear regression analysis, a 1-point decrease in maternal hemoglobin was associated with a 0.14-point decrease in umbilical cord hemoglobin (P = 0.02). Each one-unit increase in maternal parity was associated with a 0.25-point decrease in umbilical cord hemoglobin (P = 0.01). Cesarean delivery was associated with a 0.46-point lower umbilical cord hemoglobin level compared to vaginal delivery (P = 0.03). Conclusions We found a significant correlation between maternal and newborn hemoglobin levels, underscoring the importance of preventing and correcting maternal anemia in pregnancy. Furthermore, maternal anemia should be considered a risk factor neonatal anemia.

Background: HIV/AIDS is now a manageable chronic illness owing to effective antiretroviral therapy (ART), which involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mobile health (mHealth), which includes cell phone–delivered services for medical and public health practice. Objective: Here we describe cell phone use and its relationship with alcohol use in a cohort of persons living with HIV and latent tuberculosis (TB). Methods: We performed a cross-sectional analysis of baseline data from a cohort of persons living with HIV and latent TB in HIV care in southwestern Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use—a common modifiable behavior among persons living with HIV. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months or a phosphatidylethanol (an alcohol biomarker) level of ≥8 ng/mL. Results: A total of 300 participants (median age 40 years; n=146, 48.7% male) were included in the analysis. Most (n=267, 89.0%) participants had access to a phone and of them, 26 (9.7%) shared the phone with someone else. In total, 262/300 (87.3%) of participants owned a cell phone that is turned on at least half of the time; the majority (n=269, 89.7%) rarely or never sent text messages, and over two-thirds (n=200, 66.9%) rarely or never received text messages. Most (n=214, 71.3%) had any alcohol use in the prior 3 months. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted odds ratio [aOR] 0.48, 95% CI 0.18-1.25; P=.13) or sending (aOR 0.82, 95% CI 0.28-2.37; P=.71) or receiving (aOR 1.31, 95% CI 0.70-2.47; P=.40) text messages. Conclusions: There is hope that mHealth interventions in this population can be carried out using cell phones owing to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only.

BACKGROUND HIV/AIDS is now a chronic illness due to effective antiretroviral therapy (ART) and involves routine follow-up care, including regular physical visits to the clinic. In the recent past, and in wake of the COVID-19 pandemic, there has been increased need for virtual care and intervention delivery, a modality known as mHealth, which includes cell phone-delivered services OBJECTIVE Here we describe cell phone use and its relationship with alcohol use in a cohort of persons with HIV (PWH) and latent tuberculosis (TB). METHODS We performed a cross-sectional analysis of baseline data from a cohort of PWH and latent TB in HIV care in south-western Uganda. We estimated proportions of cell phone and text message use and evaluated their associations with alcohol use, a common modifiable behaviour among PWH. Cell phone use (primary outcome) was defined as owning a cell phone that is turned on at least half of the day. Any alcohol use was defined as any self-reported alcohol use in the prior 3 months, and/or phosphatidylethanol (an alcohol biomarker) ≥8 ng/ml. RESULTS A total of 300 participants were included in the analysis, with a median age of 40 years; 48.7% were male. Majority (89.0%) of participants had access to a phone and of these 9.7% shared the phone with someone else. Eighty-seven percent owned a cell phone that is turned on at least half of the time; the majority (89.7%) rarely or never sent text messages, and over two-thirds (66.9%) rarely or never received text messages. 71.3% had any alcohol use. In adjusted analyses, any alcohol use was not significantly associated with cell phone use (adjusted OR [aOR]: 0.48, 95% confidence interval [CI]: 0.18-1.25, p-value=.13), or sending (aOR: 0.82, 95% CI: 0.28-2.37, p-value=.71) or receiving (aOR: 1.31, 95% CI: 0.70-2.47, p-value= .40) of text messages. CONCLUSIONS There is hope that mHealth interventions in this population can be carried out using cell phones due to their popularity; however, the interventions may need to employ methods that do not rely on the sending and receiving of text messages only. CLINICALTRIAL NCT 03302299