Four models of HIV counseling and testing: utilization and test results in South Africa.

BACKGROUND: HIV Counseling and Testing (HCT) is the point-of-entry for pathways of HIV care and prevention. However, HCT is not reaching many who are HIV infected and this may be related to the HCT provision model. We describe HCT utilization and HIV diagnosis using four models of HCT delivery: clinic-based, urban mobile, rural mobile, and stand-alone. METHODS: Using cross-sectional data from routine HCT provided in South Africa, we described client characteristics and HIV test results from information collected during service delivery between January 2009 and June 2012. RESULTS: 118,358 clients received services at clinic-based units, 18,597; stand-alone, 28,937; urban mobile, 38,840; and rural mobile, 31,984. By unit, clients were similar in terms of median age (range 28-31), but differed in sex distribution, employment status, prior testing, and perceived HIV risk. Urban mobile units had the highest proportion of male clients (52%). Rural mobile units reached the highest proportion of clients with no prior HCT (61%) and reporting no perceived HIV risk (64%). Overall, 10,862 clients (9.3%) tested HIV-positive. CONCLUSIONS: Client characteristics varied by HCT model. Importantly, rural and urban mobile units reached more men, first-time testers, and clients who considered themselves to be at low risk for HIV

Contraceptive use among in and out-of school adolescents in rural southwest Uganda.

OBJECTIVE: To compare the level of contraceptive use among in and out-of school rural Ugandan adolescents. DESIGN: Cross sectional survey. SETTING: Mbarara district. SUBJECTS: Five hundred in-school and 220 out-of school adolescents aged 15-19 years. MAIN OUTCOME MEASURE: Contraceptive use. RESULTS: Contraceptive prevalence was 171 (23.8%), with 99 (19.8%) among in-school and 72 (32.7%) in out-of school (OR=0.8, 95% CI=0.5-1.3). Of the 286 who had had sexual intercourse, 171 (59.8%) were current users with 99 (57.9%) in-school and 72 (42.1%) out-of school. The predominant method was the male condom with 80 (56.7%) in-school and 61 (43.3%) out-of-school (p=0.3). Sixty five (67%) of in-school aged 18-19 used contraceptives compared to those less than 18 years (OR=0.4, 95% CI=0.2-0.8). The out-of school who were urban residents 51(75%) were more likely to use contraceptives (OR=0.3, 95% CI=0.1-0.6). Out-of school with secondary education 37(84.1%) were more likely to use contraceptives (OR=0.2, 95% CI=0.1-0.5). Cost was a barrier for contraceptive use among in-school users 37(77.1%) (OR=2.6, 95% CI=1.7-5.4). Stigma surrounding their sexual activity was a barrier to out-of school 25 (58.1%) (OR=0.4, 95% CI=0.2-0.8). CONCLUSION: Contraceptive use among rural sexually active adolescents is low although the prevalence is higher in out-of school. Reorientation of contraceptive services to make them more accessible through strengthening of school health programme and establishment of out-of school adolescent health programme are urgently needed

Oral health status of school children in Mbarara, Uganda

Background: Despite the need for oral health morbidity surveys to aid in reviewing of the oral health services, dental data of Ugandan children is scanty. Objectives: to describe the magnitude and distribution of selected oral health conditions among primary school children in Mbarara, Uganda. Methods: A stratified two-stage cluster sample of 437 children aged 5-6, 8-9 and 11-12 was enrolled. The selected conditions included: dental caries, plaque, calculus, gingivitis, fluorosis and malocclusion (maxillary overjet). These conditions were diagnosed and scored in accordance with World Health Organisation (WHO) criteria. Results: The mean decayed, missing, filled permanent teeth (DMFT) was 1.5(±0.8 SD). Females had higher DMFT (1.6±0.8SD) than males (1.3±0.8SD). Decayed, filled milk teeth (dt) was 2.7(±1.8SD) but more in males 3.1(±2.1SD) than in females 2.4(±1.6SD). Children in private schools were likely to have more caries in both permanent teeth (DMFT: 1.6±0.9SD) and milk teeth (dt: 3.0±1.9SD). Day-scholars were likely to have more caries in permanent teeth (DFMT: 1.50.8SD). Those in boarding were likely to have more caries in milk teeth (dt: 3±2.2SD). Milk teeth caries decreased with age (p<0.0001). Eight (1.8%) had very mild to moderate fluorosis. Nine (2%) lost permanent canines due to practice of "nylon teeth mutilation." Majority 325(75%) had dental plaque, which increased with age (p<0.0001). Males significantly had plaque. Children in private schools were associated with less plaque (OR: 0.6, 95%CI: 0.4-0.9), as were those in boarding schools. Some 113(25.9%) had calculus that increased with age (p<0.0001). Calculus was more prevalent in males, government schools, and among day-scholars. Females were less likely to have maxillary overjet (OR: 0.5, 95% CI: 0.3-0.8). Day-scholars were 2 times more likely to have maxillary overjet (OR: 1.9, 95%CI: 1.1-3.5). None had severe gingivitis. Conclusion: The oral hygiene of school children was poor with high plaque prevalence demonstrating a lack of established oral hygiene practices. A comprehensive community-focused oral health care intervention that includes oral health education in homes and the strengthening of school health programme is needed to improve the oral health status of children in Mbarara

Birth plans and health facility Based delivery in rural Uganda

Objectives: To evaluate whether the completion of birth plans is associated with delivery in a health facility and the perceptual causes of birth plan completion and health facility based delivery were explored according to a well-tested health behaviour theory. Design: A community survey. Setting: Rakai and Luwero districts. Subjects: A total of 415 (202 in Rakai and 213 in Luwero district) respondents were randomly selected and interviewed using a mixed survey questionnaire composed of open and close-ended questions. Main outcome measures: Health facility based delivery. Results: The results demonstrate a statistically significant relationship between the completion of birth plans and delivery in a health facility (OR =1.86, 95% CI =1.1, 3.1). The fear of consequences of delivering at home was found to be an important driving force in promoting the completion of birth plans, thereby indirectly influencing the likelihood of delivery in a health facility. Conclusion: Given the empirical evidence presented here, this study suggests that birth plans are an important tool in improving the rate of health facility based deliveries and thus essential in the fight against maternal mortality in Uganda. It is further recommended that campaigns market the use of birth plans as a way to reduce uncertainty and manage fear and the unknown about pregnancy. East African Medical Journal Vol. 83(3) 2006: 74-8