Factors Determining the Retention of Academic Staff in Universities

This paper examines the critical factors that determine the retention of academic staff at Makerere and Kyambogo universities in Uganda. The study was prompted by reportedly persistent low levels of academic staff retention in the two public universities in the recent past. The investigation followed the positivist research paradigm. The study employed the descriptive cross-sectional survey design where data were collected using an adapted self-administered questionnaire from 298 academic staff proportionately drawn from the two universities studied. The staff respondents were sampled through stratified random sampling technique. The data were analysed with the use of descriptive statistics such as frequencies, percentages, means and standard deviations as well as inferential statistics like student t-test, Analysis of Variance (ANOVA), and regression analyses. Study findings revealed that respondent’s marital status (F = 0.288; p = 0.750 > 0.05), age (F = 0.748; p = 0.560 > 0.05), experience (F= 0.270; p = 0.841 > 0.05), education level (F = 0.528; p = 0.663 > 0.05), and interpersonal relationships (B = 0.003; p = 0.957 > 0.05) had statistically no significant effect on the retention of academic staff in the two universities. However, respondent’s gender (t = 2.556; p= 0.006 < 0.05), terms of work (B = 0.163; p = 0.005< 0.05) and work-life balance (B = 0.318; p= 0.000 < 0.05) were found to have statistically significant effects on the retention of academic staff. Thus, it was concluded that certain factors were more critical than others in determining the retention of academic staff, other factors notwithstanding. The researchers therefore recommended that the management of the two universities should design engendered policies that would improve on the terms of work, favourably treat men and women, and allow for optimal work-life balance amongst their academic staff. Keywords: Academic staff, Retention, Factors, Demographic characteristics, Interpersonal relationships, Terms of work, Work-life balance DOI: 10.7176/JEP/10-8-07 Publication date:March 31st 201

HIV-associated anemia after 96 weeks on therapy: determinants across age ranges in Uganda and Zimbabwe.

Given the detrimental effects of HIV-associated anemia on morbidity, we determined factors associated with anemia after 96 weeks of antiretroviral therapy (ART) across age groups. An HIV-positive cohort (n=3,580) of children age 5-14, reproductive age adults 18-49, and older adults ≥50 from two randomized trials in Uganda and Zimbabwe were evaluated from initiation of therapy through 96 weeks. We conducted logistic and multinomial regression to evaluate common and differential determinants for anemia at 96 weeks on therapy. Prior to initiation of ART, the prevalence of anemia (age 5-11 <10.5 g/dl, 12-14 <11 g/dl, adult females <11 g/dl, adult males <12 g/dl) was 43%, which decreased to 13% at week 96 (p<0.001). Older adults had a significantly higher likelihood of anemia compared to reproductive age adults (OR 2.60, 95% CI 1.44-4.70, p=0.002). Reproductive age females had a significantly higher odds of anemia compared to men at week 96 (OR 2.56, 95% CI 1.92-3.40, p<0.001), and particularly a greater odds for microcytic anemia compared to males in the same age group (p=0.001). Other common factors associated with anemia included low body mass index (BMI) and microcytosis; greater increases in CD4 count to week 96 were protective. Thus, while ART significantly reduced the prevalence of anemia at 96 weeks, 13% of the population continued to be anemic. Specific groups, such as reproductive age females and older adults, have a greater odds of anemia and may guide clinicians to pursue further evaluation and management

CD4 T cell activation as a predictor for treatment failure in Ugandans with Plasmodium falciparum malaria.

Host immunity plays an important role in response to antimalarial therapy but is poorly understood. To test whether T cell activation is a risk factor for antimalarial treatment failure, we studied CD4(+) and CD8(+) T cell activation in 31 human immunodeficiency virus-negative Ugandan patients 5-37 years of age who were treated for uncomplicated Plasmodium falciparum malaria. Increased CD4(+) T cell activation, as indicated by co-expression of HLA-DR and CD38, was an independent risk factor for treatment failure (hazard ratio = 2.45, 95% confidence interval = 1.02-5.89, P = 0.05) in multivariate analysis controlling for age, baseline temperature, and pre-treatment parasite density. The results provide insight into the role of cellular immunity in response to antimalarial therapy and underscore the need to investigate the mechanisms behind immune activation

Retention of adolescents living with HIV in care, treatment, and support programs in Uganda

Understanding the extent to which adolescents aged 10–19 years who are living with HIV are retained in HIV care, treatment, and support is important for informing the design of effective services for this population to better meet their needs across three main areas of HIV and AIDS programming: treatment; care and support; and prevention. Retention in HIV programs is, in turn, important for positive clinical outcomes including viral suppression and survival. In 2013–2014, The AIDS Support Organization and the Population Council undertook a study to generate evidence on factors associated with retention of adolescents in HIV and AIDS programs in Uganda. The study was conducted under the USAID HIVCore project led by the Council, and responded to WHO and UNFPA guidelines on care, treatment, and support for women living with HIV and AIDS and their children in resource-constrained settings that emphasize ensuring availability of age-appropriate information and counseling on SRH and safer sexual practices, and offering adolescent-friendly family planning counseling and services. The goal was to generate evidence on the level of, and factors associated with, retention of HIV-positive adolescents in HIV and AIDS programs in Uganda

The effect of AIDS defining conditions on immunological recovery among patients initiating antiretroviral therapy at Joint Clinical Research Centre, Uganda

<p>Abstract</p> <p>Background</p> <p>Many HIV-infected patients only access health care once they have developed advanced symptomatic disease resulting from AIDS Defining Conditions (ADCs). We carried out a study to establish the effect of ADCs on immunological recovery among patients initiated on antiretroviral therapy (ART).</p> <p>Methods</p> <p>A retrospective cohort of 427 HIV-1 patients who were initiated on ART between January 2002 and December 2006 was studied. Data on ADCs was retrieved from Joint Clinical Research Centre (JCRC) data base and backed up by chart reviews. We employed Kaplan-Meier survival curves to estimate median time to 50 CD4 cells/μl from the baseline value to indicate a good immunological recovery process. Cox proportional hazard models were used at multivariate analysis.</p> <p>Results</p> <p>The median time to gaining 50 CD4 cells/μl from the baseline value after ART initiation was longer in the ADC (9.3 months) compared to the non-ADC group (6.9 months) (log rank test, p = 0.027). At multivariate analysis after adjusting for age, sex, baseline CD4 count, baseline HIV viral load, total lymphocyte count and adherence level, factors that shortened the median time to immunological recovery after ART initiation were belonging to the non-ADC group (HR = 1.31; 95% CI: 1.03–1.28, p = 0.028), adherence to ART of ≥ 95% (HR = 2.22; 95% CI: 1.57–3.15, p = 0.001) and a total lymphocyte count ≥ 1200 cells/mm³(HR = 1.84; 95% CI: 1.22–2.78, p = 0.003). A low baseline CD4 count of ≤ 200 cells/μl (HR = 0.52; 95% CI: 0.37–0.77, p = 0.001) was associated with a longer time to immunological recovery. There was no interaction between low CD4 counts and ADC group.</p> <p>Conclusion</p> <p>Patients with ADCs take longer to regain their CD4 counts due to the defect in the immune system. This may prolong their risk of morbidity and mortality.</p

Cost effectiveness analysis of clinically driven versus routine laboratory monitoring of antiretroviral therapy in Uganda and Zimbabwe.

BACKGROUND: Despite funding constraints for treatment programmes in Africa, the costs and economic consequences of routine laboratory monitoring for efficacy and toxicity of antiretroviral therapy (ART) have rarely been evaluated. METHODS: Cost-effectiveness analysis was conducted in the DART trial (ISRCTN13968779). Adults in Uganda/Zimbabwe starting ART were randomised to clinically-driven monitoring (CDM) or laboratory and clinical monitoring (LCM); individual patient data on healthcare resource utilisation and outcomes were valued with primary economic costs and utilities. Total costs of first/second-line ART, routine 12-weekly CD4 and biochemistry/haematology tests, additional diagnostic investigations, clinic visits, concomitant medications and hospitalisations were considered from the public healthcare sector perspective. A Markov model was used to extrapolate costs and benefits 20 years beyond the trial. RESULTS: 3316 (1660LCM;1656CDM) symptomatic, immunosuppressed ART-naive adults (median (IQR) age 37 (32,42); CD4 86 (31,139) cells/mm(3)) were followed for median 4.9 years. LCM had a mean 0.112 year (41 days) survival benefit at an additional mean cost of $765 [95$7386 [3277,dominated] per life-year gained and $7793 [4442,39179] per quality-adjusted life year gained. Routine toxicity tests were prominent cost-drivers and had no benefit. With 12-weekly CD4 monitoring from year 2 on ART, low-cost second-line ART, but without toxicity monitoring, CD4 test costs need to fall below$3.78 to become cost-effective (<3xper-capita GDP, following WHO benchmarks). CD4 monitoring at current costs as undertaken in DART was not cost-effective in the long-term. CONCLUSIONS: There is no rationale for routine toxicity monitoring, which did not affect outcomes and was costly. Even though beneficial, there is little justification for routine 12-weekly CD4 monitoring of ART at current test costs in low-income African countries. CD4 monitoring, restricted to the second year on ART onwards, could be cost-effective with lower cost second-line therapy and development of a cheaper, ideally point-of-care, CD4 test

Scaling up antiretroviral therapy: experience of the Joint Clinical Research Centre (JCRC) access programme

Despite Uganda’s success in lowering the rate of HIV infection, numbers of people already infected and progressing to AIDS continue to rise. The JCRC pioneered the use of antiretroviral drugs in Africa since 1992, and developed a successful model that incorporates drugs logistics, adherence and sustainability strategies, as well as regional referral centres of excellence and laboratories. JCRC rapidly established 35 satellite centres in the various districts, currently providing antiretroviral drugs to over 35 000 out of 70 000 patients on therapy. Increased access to treatment proceeds   contemporaneously with improving infrastructure, while addressing critical human resource needs by ongoing training. This model provides data that inform a way forward for a robust, high-quality and sustainable ART programme, and aims to integrate into an improved national continuum of health care delivery