Alternative accountability in the Ugandan community-led HIV/AIDS programme

Internationally, many public sector reform initiatives have been undertaken over the last three decades under the label New Public Management (NPM), with improvements in accountability and management among their main objectives. This thesis draws on social capital theory to examine the potential of a Ugandan community-led HIV/AIDS programme to supplement NPM approaches to public service delivery and accountability. Hermeneutics methodology is used to guide the research design and the interpretation of evidence.The findings of this study suggest that Uganda's community-led HIV/AIDS initiatives operate within a "bottom-up" accountability framework, characterized by the community taking a role in budgeting, program implementation, reporting, project-oversight, and audit activities. In regard to accounting practices, this study reveals that Ugandan community projects use basic and simple accounting procedures. The findings suggest that simple communal accountability mechanisms can compensate for the types of formal control mechanisms typically promoted within NPM-style reforms. The findings also suggest that multiple accountability relationships can operate in the form of both hierarchical and lateral accountability practices and that these multiple accountability relationships lead to tighter control and accurate accountability, even though formal accountability mechanisms may be weak.This study identified some challenges for community-led service delivery initiatives, including the potential for corrupt practices in some community groups and variations in the level of participation of group members in the execution of various tasks. Further, several areas for further research have been identified. These include the measurement of social capital within community groups and the establishment of measures of group capacities.This study has revealed the latent accountability technology of a "bottom-up" communitarian accountability framework and demonstrated its potential as a complement to NPM models of service delivery and accountability. As an accountability innovation, it needs to be keenly watched as further field experiences emerge over time and reveal more of its potential in developing countries, and perhaps beyond

Participatory Evaluation of Common Bean for Drought and Disease Resilience Traits in Uganda

The use of genetic resources to respond to occurring and unpredictable climatic changes is one of the coping mechanisms for small scale farmers in Africa. This paper summarizes findings of a participatory action research (PAR) project evaluating different common bean (Phaseolus vulgaris) varieties with nine farmer groups across nine villages in two CCAFS sites of Rakai and Hoima districts in Uganda. Six and fifteen bean varieties including local landraces, farmer variety (commonly grown by farmers), Uganda officially released varieties and new germplasm bearing different characteristics were evaluated with over 300 farmers in replicated trials in the first season of 2012, and two seasons of 2013, respectively. The study provides evidence that breeders and farmers look out for similar traits, with yield being the major driver, and in most cases end up with the same results with a few discrepancies. Some key lessons emerged from the findings. First, making blanket variety and management recommendations to cover large physical areas is erroneous. Site and context specific recommendations, especially in the view of the variability in climatic conditions and soils are probably the best option. Second, the results highlight the need for plasticity in bean varieties (i.e. ability to change structure and function when exposed to changes in the environments hence suitability to a wide range of environments) in addition to having farmer preferred traits. Lastly, the project also highlighted the ability, capacity and willingness of farmers to adopt and adapt new technologies in the face of varying climate scenarios

Agronomic performance and farmer preferences of selected bean varieties in uganda, hoima and rakai districts

Genetic resources are one of the key strategies with which farmers respond to occurring and unpredicatable weather patterns. This study was aimed at testing the performance of farmer-acceptable improved multiple stress tolerant bean varieties and assessing farmers perceptions through participatory variety selection approach in the districts of Rakai and Hoima in Uganda. The specific objectives of the study were to determine the agronomic pefromance for yield and disease reaction of the bean varieties in multi-environment trials, and to understand variety selection criteria of farmers and compare it with that used by breeders to determine where there is convergence/divergence and its implications for breeding and the selection of varieties for future participatory variety selection studies. The study was conducted with nine selected farmer groups in Hoima and Rakai district. These districts were identified to experience contrasting climatic conditions, degraded soils and declining soil fertility by the Climate Change, Agriculture and Food Security programme (CCAFS) of the Consultative Group for International Agricultural Research (CGIAR). Fifteen bean varieties bred for different traits were tested in six villages to determine their performance for yield and yield components, and reaction to diseases and in nine villages for farmer preference. Each trial was planted in split plot design with two replicates. Finlay and Wilkinson (FW), the Additive Main Effect and Multiplicative Interaction (AMMI) analysis and Genotype + Genotype interaction (GGE) biplot were used to assess G x E effects on performance for key agronomic traits of the fifteen varieties in six locations. Researchers selection index were derived from the traits measured in the trials and compared with the farmers’ preference index using spearman rank correlation. The result indicates that the six environments under evaluation could best be classified in two mega-environments based on the yield output of clean seed. Mega-environment 1 consisted of Gosola village in Rakai, and three villages in Hoima district; Butimba, Butyamba and Kyakamese village while mega-environment 2 consisted of two villages; one in Rakai; Ninzi and another in Hoima, Mpalangasi village. Varieties NABE 2 and NABE 14 performed best in one mega-environment while varieties ROBA 1 and NABE 2 were the best in the second mega-environment. Based on Finlay and Wilkinson and AMMI, varieties Masindi Yellow Long, NABE 17 and CAL 143 were the most stable while varieties ROBA 1, NABE 2 and RWR 719 were high yielding but unstable in clean seed weight. The latter varieties (viz. ROBA 1, NABE 2 and RWR 719) were also highly responsive to environment difference in number of pods and in reaction to the three diseases, namely, ALS, bean rust and CBB disease severity. The number of pods per plant and reaction to disease were the traits less influenced by genotype-by-environment interaction. A significant but negative spearman rank relationship was observed between choices of researcher and that of farmers’ for varieties. Varieties RWR 719, NABE 2, NABE 14 and ROBA 1 were the best based on researcher ranking. While Masindi Yellow Long, Farmers’ seed and NABE 17 were farmer preferred varieties. Some of the introduced varieties were as well liked as the local varieties. The exotic varieties of choice included KAT B1, KATX 69, KATX 69 and KATX 56. Early maturity, seed size and colour (KAT B1) are attributes that could have favoured the varieties selection by farmers. These findings imply that Masindi Yellow Long was the most popular variety and produced stable clean seed yield across locations. The variety however, was found highly susceptible to diseases. Thus, improvement of Masindi Yellow Long by researchers would improve food security situations in the CCAFS selected sites and in the whole of Uganda. Furthermore, strong researcher-farmer collaboration will be required in the futur for selection and development of improved varieties to ensure high likelihoods of adoption of varieties that are resilient to stresses influenced by the changing seasonal weather pattern

High serum estradiol confers no risk for breast cancer: another disparity for sub Saharan Africa women

Introduction: There are breast cancer epidemiological and tumor behaviour disparities between black women in sub Saharan Africa and their counter parts in western high resource countries. In Uganda, the incidence of breast cancer has nearly tripled in over a four decades for uncertain reasons. High serum estradiol is a known risk factor for breast cancer among women in high resourced nations. The objective of this study was to establish whether high serum estradiol is an associated risk for breast cancer amongst a group of black Ugandan women. Methods: A case control study, conducted over eight month period with incident breast cancer as cases and the controls were without breast cancer but at risk and representative of the population from which the cases were chosen. Questionnaires were administered, clinical examination was done, serum estradiol level estimation was done using cobase immunoassay analyzer using Electro chemiluminescence Immuno assay (ECLIA). Data was analyzed using logistic regression model, and a p - value of less than 0.05 was considered significant. IRB approval was secured. Results: A total of 140 women participated, 70 cases and 70 controls. The median estrogen levels was 43.2 pg/ml with IQR of 18.48 to 75.8 pg/ml, the value was higher among premenopausal women than those without cancer but with no statistical significance. No association was found between level of estradiol and breast cancer (p 0.647). The median oestrogen levels were significantly higher than normal levels in Caucasian women. Conclusion: There was no association between level of estradiol and breast cancer. This is yet another disparity between women of African origin and the non Africans in high resourced countries. There is need to explore more to explain this disparity. Pan African Medical Journal 2012; 12:2

Participatory and incremental development in an African local government accounting reform

Despite significant donor funding, government accounting reforms seeking transparent and effective management of public resources often fail or have limited success, especially in Africa, prompting questions about donors? implementation approach and calls for studies of successful reforms. This paper investigates a local government accounting reform in Benin supported by a German development agency ? perceived as successful due to the participatory, pragmatic and incremental approach reinforced by conditionalities in the face of neo-patrimonial leadership

Phenotypic and genotypic analyses to guide selection of reverse transcriptase inhibitors in second-line HIV therapy following extended virological failure in Uganda

Objectives We investigated phenotypic and genotypic resistance after 2 years of first-line therapy with two HIV treatment regimens in the absence of virological monitoring. Methods NORA [Nevirapine OR Abacavir study, a sub-study of the Development of AntiRetroviral Therapy in Africa (DART) trial] randomized 600 symptomatic HIV-infected Ugandan adults (CD4 cell count <200 cells/mm3) to receive zidovudine/lamivudine plus abacavir (cABC arm) or nevirapine (cNVP arm). All virological tests were performed retrospectively, including resistance tests on week 96 plasma samples with HIV RNA levels ≥1000 copies/mL. Phenotypic resistance was expressed as fold-change in IC50 (FC) relative to wild-type virus. Results HIV-1 RNA viral load ≥1000 copies/mL at week 96 was seen in 58/204 (28.4%) cABC participants and 21/159 (13.2%) cNVP participants. Resistance results were available in 35 cABC and 17 cNVP participants; 31 (89%) cABC and 16 (94%) cNVP isolates had a week 96 FC below the biological cut-off for tenofovir (2.2). In the cNVP arm, 16/17 participants had resistance mutations synonymous with high-level resistance to nevirapine and efavirenz; FC values for etravirine were above the biological cut-off in 9 (53%) isolates. In multivariate regression models, K65R, Y115F and the presence of thymidine analogue-associated mutations were associated with increased susceptibility to etravirine in the cABC arm. Conclusions Our data support the use of tenofovir following failure of a first-line zidovudine-containing regimen and shed further light on non-nucleoside reverse transcriptase inhibitor hypersusceptibility

Dominant stakeholders, activity and accountability discharge in the CSO Sector

Civil Society Organisations (CSOs) comprise a diverse range of associations, including NGOs, community groups, political parties and social networks. Nevertheless, despite heterogeneity, regulators, funders and donors often treat CSOs as homogeneous when demanding accountability. This paper highlights differences in to whom CSOs across different categories (or types) perceive themselves to be accountable, what for, and the different practices they undertake to discharge accountability. It calls for stakeholders to acknowledge diversity in accountability across different CSO types. This survey-based research finds CSOs weight upwards and downwards stakeholders equally, and undertake voluminous reporting. They would benefit from negotiating multiple-use mechanisms, especially with dominant stakeholders. In combining stakeholder and accountability theory, the research highlights specific CSO types needing further study

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

Phenotypic and genotypic analyses to guide selection of reverse transcriptase inhibitors in second-line HIV therapy following extended virological failure in Uganda.

OBJECTIVES: We investigated phenotypic and genotypic resistance after 2 years of first-line therapy with two HIV treatment regimens in the absence of virological monitoring. METHODS: NORA [Nevirapine OR Abacavir study, a sub-study of the Development of AntiRetroviral Therapy in Africa (DART) trial] randomized 600 symptomatic HIV-infected Ugandan adults (CD4 cell count <200 cells/mm(3)) to receive zidovudine/lamivudine plus abacavir (cABC arm) or nevirapine (cNVP arm). All virological tests were performed retrospectively, including resistance tests on week 96 plasma samples with HIV RNA levels ≥1000 copies/mL. Phenotypic resistance was expressed as fold-change in IC(50) (FC) relative to wild-type virus. RESULTS: HIV-1 RNA viral load ≥1000 copies/mL at week 96 was seen in 58/204 (28.4%) cABC participants and 21/159 (13.2%) cNVP participants. Resistance results were available in 35 cABC and 17 cNVP participants; 31 (89%) cABC and 16 (94%) cNVP isolates had a week 96 FC below the biological cut-off for tenofovir (2.2). In the cNVP arm, 16/17 participants had resistance mutations synonymous with high-level resistance to nevirapine and efavirenz; FC values for etravirine were above the biological cut-off in 9 (53%) isolates. In multivariate regression models, K65R, Y115F and the presence of thymidine analogue-associated mutations were associated with increased susceptibility to etravirine in the cABC arm. CONCLUSIONS: Our data support the use of tenofovir following failure of a first-line zidovudine-containing regimen and shed further light on non-nucleoside reverse transcriptase inhibitor hypersusceptibility