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Intimate partner violence, HIV and sexually transmitted infections in fishing, trading and agrarian communities in Rakai, Uganda.
BackgroundIntimate partner violence (IPV), HIV and sexually transmitted infections (STI) can contribute to disparities in population health, depending on the individual, social and environmental factors characterizing a setting. To better understand the place-based determinants and patterns of these key interrelated public health problems in Uganda, we compared risk factors for IPV, HIV and STI in fishing, trading and agrarian communities in Rakai, Uganda by gender.MethodThis study used cross-sectional data collected from 14,464 sexually active men (n = 6531) and women (n = 7933) as part of the Rakai Community Cohort Study, a population-based open cohort study of men and women aged 15-49 years. We used multilevel modified poisson regression models, which incorporated random intercepts for community and households. Factors associated with IPV, HIV and STI were assessed separately for men and women in fishing, trading and agrarian communities.ResultsA larger proportion of participants in the fishing communities than those in trading and agrarian communities were HIV positive, engaged in HIV risk behaviors, had STI symptoms and reported perpetration of or victimization by IPV. Female gender was a shared correlate of IPV, HIV and STI in the fishing communities. Engagement in multiple sexual relationships or partner's engagement in multiple relationships were shared correlates of IPV, and HIV in agrarian communities and IPV and STI in trading communities.ConclusionPrograms should target factors at multiple levels to reduce risk for syndemic conditions of HIV, STI and IPV in Rakai, Uganda particularly among men and women in fishing communities
Survival time and its predictors among preterms in the neonatal period post-discharge in Busoga region-Uganda June – July 2017
Introduction: Globally, out of 15 million babies born preterm each year, one million die. In Uganda, preterm deaths contribute 30% of the neonatal mortality rate. There is a paucity of information on the most critical time to conduct high impact interventions among neonate born preterm especially post-discharge from hospital. We determined the survival time to mortality and its predictors among preterm infants in the neonatal period post-discharge from hospital. Methods: We conducted a prospective cohort study in which 128 preterm infants were recruited from six hospitals including Jinja Regional Referral, St. Francis Buluba, Kamuli mission, Iganga, Kamuli and Bugiri district hospitals were prematurity was confirmed using gestation age and birth weight. Initially, background characteristics of the participants were assessed and then followed prospectively until 28 days. Kaplan-Meier survival analysis was used to estimate survival probabilities while time to preterm mortality was described using the 5thpercentile. Cox proportional hazards regression was used to determine predictors of survival. Results: Overall, 8% (10/128) of the preterm infants died; the 5th percentile survival time was 17 days. There was a 6-fold increase in hazard to mortality among preterm infants who had Kangaroo Mother Care (KMC) compared to those who did not (adjusted HR: 6.4, 95%CI: 1.7 – 24.5), a 5-fold increase in the hazard to preterm mortality among preterm infants born to HIV positive mothers compared to their counterparts who had HIV negative mothers (adjusted HR: 4.9, 95%CI: 1.1 – 22.2); and a 4-fold increase in the hazard to preterm mortality among preterm infants who were not exclusively breastfed compared to those who were exclusively breastfed (adjusted HR: 4.4, 95%CI: 1.1 – 18.3). Conclusion: Among babies who died, death occurred in the first 17 days while factors negatively associated with preterm survival included; not practicing Kangaroo Mother Care, not being breastfed exclusively and being born to an HIV positive mother. We recommend follow-up care for preterm infants following hospital discharge, implementation of prevention of mother to child transmission of HIV and exclusive breastfeeding of preterm babies
Process evaluation of the SHARE intervention for preventing intimate partner violence and HIV infection in Rakai, Uganda.
The Safe Homes And Respect for Everyone (SHARE) intervention introduced an intimate partner violence (IPV) prevention approach into Rakai Health Sciences Program, an established HIV research and service organization in Uganda. A trial found exposure to SHARE was associated with reductions in IPV and HIV incidence. This mixed methods process evaluation was conducted between August 2007 and December 2009, with people living in SHARE intervention clusters, to assess awareness about/participation in SHARE, motivators and barriers to involvement, and perceptions of how SHARE contributed to behavior change. Surveys were conducted with 1407 Rakai Community Cohort Study participants. Qualitative interviews were conducted with 20 key informants. Most (77%) were aware of SHARE, among whom 73% participated in intervention activities. Two-thirds of those who participated in SHARE felt it influenced behavior change related to IPV. While some felt confident to take part in new IPV-focused activities of a well-established program, others were suspicious of SHARE's motivations, implying awareness raising is critical. Many activities appealed to the majority (e.g., community drama) while interest in some activities was limited to men (e.g., film shows), suggesting multiple intervention components is ideal for wide-reaching programming. The SHARE model offers a promising, acceptable approach for integrating IPV prevention into HIV and other established health programs in sub-Saharan Africa
Eff ectiveness of an integrated intimate partner violence and HIV prevention intervention in Rakai, Uganda: analysis of an intervention in an existing cluster randomised cohort
Background Intimate partner violence (IPV) is associated with HIV infection. We aimed to assess whether provision
of a combination of IPV prevention and HIV services would reduce IPV and HIV incidence in individuals enrolled in
the Rakai Community Cohort Study (RCCS), Rakai, Uganda.
Methods We used pre-existing clusters of communities randomised as part of a previous family planning trial in this
cohort. Four intervention group clusters from the previous trial were provided standard of care HIV services plus a
community-level mobilisation intervention to change attitudes, social norms, and behaviours related to IPV, and a
screening and brief intervention to promote safe HIV disclosure and risk reduction in women seeking HIV
counselling and testing services (the Safe Homes and Respect for Everyone [SHARE] Project). Seven control group
clusters (including two intervention groups from the original trial) received only standard of care HIV services.
Investigators for the RCCS did a baseline survey between February, 2005, and June, 2006, and two follow-up surveys
between August, 2006, and April, 2008, and June, 2008, and December, 2009. Our primary endpoints were selfreported
experience and perpetration of past year IPV (emotional, physical, and sexual) and laboratory-based diagnosis
of HIV incidence in the study population. We used Poisson multivariable regression to estimate adjusted prevalence
risk ratios (aPRR) of IPV, and adjusted incidence rate ratios (aIRR) of HIV acquisition. This study was registered with
ClinicalTrials.gov, number NCT02050763.
Findings Between Feb 15, 2005, and June 30, 2006, we enrolled 11 448 individuals aged 15–49 years. 5337 individuals
(in four intervention clusters) were allocated into the SHARE plus HIV services group and 6111 individuals (in seven
control clusters) were allocated into the HIV services only group. Compared with control groups, individuals in the
SHARE intervention groups had fewer self-reports of past-year physical IPV (346 [16%] of 2127 responders in control
groups vs 217 [12%] of 1812 responders in intervention groups; aPRR 0·79, 95% CI 0·67–0·92) and sexual IPV
(261 [13%] of 2038 vs 167 [10%] of 1737; 0·80, 0·67–0·97). Incidence of emotional IPV did not diff er (409 [20%] of
2039 vs 311 [18%] of 1737; 0·91, 0·79–1·04). SHARE had no eff ect on male-reported IPV perpetration. At follow-up 2
(after about 35 months) the intervention was associated with a reduction in HIV incidence (1·15 cases per 100 personyears
in control vs 0·87 cases per 100 person-years in intervention group; aIRR 0·67, 95% CI 0·46–0·97, p=0·0362).
Interpretation SHARE could reduce some forms of IPV towards women and overall HIV incidence, possibly through
a reduction in forced sex and increased disclosure of HIV results. Findings from this study should inform future
work toward HIV prevention, treatment, and care, and SHARE’s ecological approach could be adopted, at least partly,
as a standard of care for other HIV programmes in sub-Saharan Africa.
Funding Bill & Melinda Gates Foundation, US National Institutes of Health, WHO, President’s Emergency Plan for
AIDS Relief, Fogarty International Center
Intimate partner violence as a predictor of marital disruption in rural Rakai, Uganda: a longitudinal study.
ObjectivesWe assessed the association between intimate partner violence (IPV) and union disruption (divorce or separation) in the rural Ugandan setting of Rakai District.MethodsWe analyzed longitudinal data collected from April 1999 to June 2006, from 6834 women (15-49Â years) living in 50 communities in Rakai. Participants were either officially married, traditionally married or in a consensual union during one or more surveys and completed at least one follow-up survey. The primary outcome was union disruption through divorce or separation from the primary sexual partner.ResultsPast year IPV ranged from 6.49Â % (severe physical abuse) to 31.99Â % (emotional abuse). Severe physical IPV was significantly associated with divorce/separation, after adjusting for other covariates (aORÂ =Â 1.80, 95Â % CI 1.01-3.22). Another predictor of union disruption was a woman having two or more sexual partners in the past year (aORÂ =Â 8.42, 95Â % CI 5.97-11.89). Factors protecting against divorce/separation included an increasing number of co-resident biological children and longer duration of union.ConclusionsIPV, particularly severe physical abuse, is an important risk factor for union disruption. Marital counseling, health education and interventions should address the role of IPV on the wellbeing of women and the stability of couples in Uganda
Survival of Infants Born to HIV-Positive Mothers, by Feeding Modality, in Rakai, Uganda
Data comparing survival of formula-fed to breast-fed infants in programmatic settings are limited. We compared mortality and HIV-free of breast and formula-fed infants born to HIV-positive mothers in a program in rural, Rakai District Uganda.One hundred eighty two infants born to HIV-positive mothers were followed at one, six and twelve months postpartum. Mothers were given infant-feeding counseling and allowed to make informed choices as to whether to formula-feed or breast-feed. Eligible mothers and infants received antiretroviral therapy (ART) if indicated. Mothers and their newborns received prophylaxis for prevention of mother-to-child HIV transmission (pMTCT) if they were not receiving ART. Infant HIV infection was detected by PCR (Roche Amplicor 1.5) during the follow-up visits. Kaplan Meier time-to-event methods were used to compare mortality and HIV-free survival. The adjusted hazard ratio (Adjusted HR) of infant HIV-free survival was estimated by Cox regression. Seventy-five infants (41%) were formula-fed while 107 (59%) were breast-fed. Exclusive breast-feeding was practiced by only 25% of breast-feeding women at one month postpartum. The cumulative 12-month probability of infant mortality was 18% (95% CI = 11%–29%) among the formula-fed compared to 3% (95% CI = 1%–9%) among the breast-fed infants (unadjusted hazard ratio (HR)  = 6.1(95% CI = 1.7–21.4, P-value<0.01). There were no statistically significant differentials in HIV-free survival by feeding choice (86% in the formula-fed compared to 96% in breast-fed group (Adjusted RH = 2.8[95%CI = 0.67–11.7, P-value = 0.16]Formula-feeding was associated with a higher risk of infant mortality than breastfeeding in this rural population. Our findings suggest that formula-feeding should be discouraged in similar African settings
0734 Cost-effectiveness analysis of PBO-LLINs compared to Non PBO LLINs in the reduction of malaria among children in Jinja district
abstract appears in Infection Prevention & Control / International Journal of Infectious Diseases 101(S1) (2021) 300–335
the organizers of the 19th International Congress on Infectious Diseases (ICID) made the decision to cancel the Congress scheduled for September 10-13, 2020 in Kuala Lumpur, Malaysi
Use of injectable hormonal contraception and women’s risk of herpes simplex virus type 2 acquisition: a prospective study of couples in Rakai, Uganda
Background The injectable hormonal contraceptive depo-medroxyprogesterone acetate (DMPA) has been associated
with increased risk of HIV acquisition, but fi ndings are inconsistent. Whether DMPA increases the risk of other
sexually transmitted viral infections is unknown. We assessed the association between DMPA use and incident
herpes simplex virus type 2 (HSV2) infection in women.
Methods In this prospective study, we enrolled HIV-negative and HSV2-negative women aged 15–49 years whose
HIV-negative male partners were concurrently enrolled in a randomised trial of male circumcision in Rakai, Uganda.
We excluded women if either they or their male partners HIV seroconverted. The primary outcome was HSV2
seroconversion, assessed annually. The male circumcision trial was registered with ClinicalTrials.gov, number
NCT00425984.
Findings Between Aug 11, 2003, and July 6, 2006, we enrolled 682 women in this study. We noted HSV2
seroconversions in 70 (10%) women. Incidence was 13·5 per 100 person-years in women consistently using DMPA
(nine incident infections per 66·5 person-years), 4·3 per 100 person-years in pregnant women who were not using
hormonal contraception (18 incident infections per 423·5 person-years), and 6·6 per 100 person-years in women
who were neither pregnant nor using hormonal contraception (35 incident infections per 529·5 person-years).
Women consistently using DMPA had an adjusted hazard ratio for HSV2 seroconversion of 2·26 (95% CI
1·09–4·69; p=0·029) compared with women who were neither pregnant nor using hormonal contraception. Of
132 women with HSV2-seropositive partners, seroconversion was 36·4 per 100 person-years in consistent DMPA
users (four incident infections per 11 person-years) and 10·7 per 100 person-years in women who were neither
pregnant nor using hormonal contraception (11 incident infections per 103 person-years; adjusted hazard ratio
6·23, 95% CI 1·49–26·3; p=0·012).
Interpretation Consistent DMPA use might increase risk of HSV2 seroconversion; however, study power was low.
These fi ndings should be assessed in larger populations with more frequent follow-up than in this study, and other
contraceptive methods should also be assessed. Access to a wide range of highly eff ective contraceptive methods is
needed for women, particularly in sub-Saharan Africa
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