Prevalence and predictors of unknown HIV status among women delivering in Mulago National Referral Hospital, Kampala, Uganda.

Introduction: Knowledge of a person’s HIV status during pregnancy is critical for prevention of mother to child transmission of HIV.Objectives: To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital.Methods: This was a cross-sectional study of women that had just delivered. The women’s demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher’s exact test, Wilcoxon rank sum test and logistic regression were used to test associations.Results: The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 – 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 - 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/ government accredited health facilities “opted out” of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one “opted out”.Conclusion: Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC.Keywords: Unknown HIV status, women delivering, Mulago National Referral Hospital, Kampala, Ugand

Prevalence and predictors of unknown HIV status among women delivering in Mulago National Referral Hospital, Kampala, Uganda.

Introduction: Knowledge of a person\u2019s HIV status during pregnancy is critical for prevention of mother to child transmission of HIV. Objectives: To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital. Methods: This was a cross-sectional study of women that had just delivered. The women\u2019s demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher\u2019s exact test, Wilcoxon rank sum test and logistic regression were used to test associations. Results: The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 \u2013 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 - 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/ government accredited health facilities \u201copted out\u201d of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one \u201copted out\u201d. Conclusion: Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC

Adherence as a Predictor of Sexual Behaviors in People Living with HIV/AIDS during the First Year of Antiretroviral Therapy in Rural Cameroon: Data from Stratall ANRS 12110/ESTHER Trial

Objective: This study aims to investigate the time pattern of inconsistence condom use (ICU) during the first year of antiretroviral therapy (ART) and its relationship with treatment adherence in naive HIV-infected adult patients. ' Methods: Data collection was nested within a longitudinal trial on HIV treatment. ICU was defined as reporting to have "never", "sometimes" or "nearly always" used condoms with one's main or casual partner(s) - either HIV-negative or of unknown HIV status in the three previous months. Adherence was defined as taking 100% of their ART prescribed doses in the 4 days before the visit and "not having interrupted treatment", even once, for more than two consecutive days during the 4 previous weeks. Mixed logistic regression was used to study the relationship between adherence and ICU. Results: Among the 459 patients enrolled, 212 (46%) during 334 visits reported to have had sexual intercourse at least once with their partner(s) - either HIV-negative or of unknown HIV status-during the first 12 months of ART. The proportion of ICU was 76%, 50% and 59% at month 0 (M0), month 6 (M6) and month 12 (M12), while 60% and 66% of patients were ART-adherent at M6 and M12, respectively. After adjustment for the frequency of sexual activity, type of sexual partner(s), perceived social class and desire for a child, patients adherent to ART were less likely to report ICU when compared with baseline (AOR [95% CI]: 0.38 [0.19-0.76]; P = 0.006). Conclusions: Adherence to ART is associated with a lower risk of ICU but this result needs to be interpreted carefully. As adherence behaviors are not only determined by problems with the healthcare systems but also by social barriers encountered by patients in their daily life, counseling should not only be ART adherence-centered but also patient-centered, including sexual risk minimization and psychosocial support

Finding meaning: HIV self-management and wellbeing among people taking antiretroviral therapy in Uganda

© 2016 Russell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in anymedium, provided the original author and source are credited. The health of people living with HIV (PLWH) and the sustained success of antiretroviral therapy (ART) programmes depends on PLWH's motivation and ability to self-manage the condition over the long term, including adherence to drugs on a daily basis. PLWH's selfmanagement of HIV and their wellbeing are likely to be interrelated. Successful self-management sustains wellbeing, and wellbeing is likely to motivate continued self-management. Detailed research is lacking on PLWH's self-management processes on ART in resourcelimited settings. This paper presents findings from a study of PLWH's self-management and wellbeing in Wakiso District, Uganda. Thirty-eight PLWH (20 women, 18 men) were purposefully selected at ART facilities run by the government and by The AIDS Support Organisation in and around Entebbe. Two in-depth interviews were completed with each participant over three or four visits. Many were struggling economically, however the recovery of health and hope on ART had enhanced wellbeing and motivated self-management. The majority were managing their condition well across three broad domains of self-management. First, they had mobilised resources, notably through good relationships with health workers. Advice and counselling had helped them to reconceptualise their condition and situation more positively and see hope for the future, motivating their work to self-manage. Many had also developed a new network of support through contacts they had developed at the ART clinic. Second, they had acquired knowledge and skills to manage their health, a useful framework to manage their condition and to live their life. Third, participants were psychologically adjusting to their condition and their new 'self': They saw HIV as a normal disease, were coping with stigma and had regained self-esteem, and were finding meaning in life. Our study demonstrates the centrality of social relationships and other nonmedical aspects of wellbeing for self-management which ART programmes might explore further and encourage

A palliative care link nurse programme in Mulago Hospital, Uganda: an evaluation using mixed methods

BACKGROUND: Integrating palliative care (PC) and empowering the health care workforce is essential to achieve universal access to PC services. In 2010, 46 % of patients in Mulago Hospital, Uganda had a life limiting illness, of whom 96 % had PC needs. The university/hospital specialist PC unit (Makerere/Mulago Palliative Care Unit –MPCU) implemented a link-nurse model to empower hospital nurses to provide generalist PC. Over two years, 27 link nurses were trained and mentored and 11 clinical protocols developed. The aim of the study was to evaluate the impact of the palliative care link nurse programme at Mulago Hospital METHODS: An evaluation approach utilising mixed methods was used integrating qualitative and quantitative data including: pre and post course assessment confidence ratings; course evaluation forms; audit of clinical guidelines availability; review of link-nurse activity sheets/action plans; review of MPCU patient documentation; Most Significant Change (MSC); individual and focus group interviews. RESULTS: A significant difference was seen in nurses’ confidence after the training (p < 0.001). From July 2012 to December 2013, link nurses identified 2447 patients needing PC, of whom they cared for 2113 (86 %) and referred 334 (14 %) to MPCU. Clinical guidelines/protocols were utilised in 50 % of wards. Main themes identified include: change in attitude; developing new skills and knowledge; change in relationships; improved outcomes of care, along with the challenges that they experienced in integrating PC. Since the start of the programme there has been an increase in PC patients seen at the hospital (611 in 2011 to 1788 in 2013). CONCLUSION: The link-nurse programme is a practical model for integrating PC into generalist services. Recommendations have been made for ongoing development and expansion of the programme as an effective health systems strengthening approach in similar healthcare contexts, as well as the improvement in medical and nursing education

Multidimensional needs of patients living and dying with heart failure in Kenya: a serial interview study

Abstract Background Heart failure is an emerging challenge for Sub Saharan Africa. However, research on patients’ needs and experiences of care is scarce with little evidence available to support and develop services. We aimed to explore the experiences of patients living and dying with heart failure in Kenya. Methods We purposively recruited 18 patients admitted with advanced heart failure at a rural district hospital in Kenya. We conducted serial in depth interviews with patients at 0, 3 and 6 months after recruitment, and conducted bereavement interviews with carers. Interviews were recorded, transcribed into English and analyzed using a thematic approach, assisted by Nvivo software package. Results Forty-four interviews were conducted. Patients experienced physical, psychosocial, spiritual and financial distress. They also had unmet needs for information about their illness, how it would affect them and how they could get better. Patients experience of and their interpretation of symptoms influenced health care seeking. Patients with acute symptoms sought care earlier than those with more gradual symptoms which tended to be normalised as part of daily life or assumed to be linked to common treatable conditions. Nearly all patients expected to be cured and were frustrated by a progressive illness poorly responsive to treatment. Accumulating costs was a barrier to continuity of care and caused tensions in social relationships. Patients valued information on the nature of their illness, prognosis, self-care, lifestyle changes and prevention strategies, but this was rarely available. Conclusions This is the first in-depth study to explore the experiences of people living with advanced heart failure in Kenya. This study suggests that patients would benefit from holistic care, such as a palliative approach that is aimed at providing multidimensional symptom management. A palliative approach to services should be provided alongside chronic disease management aimed at primary prevention of risk factors, and early identification and initiation of disease modifying therapy. Further research is needed to determine best practice for integrating palliative care for people living and dying with heart failure

Public preferences and priorities for end-of-life care in Kenya:a population-based street survey

BACKGROUND: End-of-life care needs are great in Africa due to the burden of disease. This study aimed to explore public preferences and priorities for end-of-life care in Nairobi, Kenya. METHODS: Population-based street survey of Kenyans aged ≥18; researchers approached every 10th person, alternating men and women. Structured interviews investigated quality vs. quantity of life, care priorities, preferences for information, decision-making, place of death (most and least favourite) and focus of care in a hypothetical scenario of serious illness with <1 year to live. Descriptive analysis examined variations. RESULTS: 201 individuals were interviewed (100 women) representing 17 tribes (n = 90 44.8%, Kikuyu). 56.7% (n = 114) said they would always like to be told if they had limited time left. The majority (n = 121, 61.4%) preferred quality of life over quantity i.e. extending life (n = 47, 23.9%). Keeping a positive attitude and ensuring relatives/friends were not worried were prioritised above having pain/discomfort relieved. The three most concerning problems were pain (45.8%), family burden (34.8%) and personal psychological distress (29.8%). Home was both the most (51.1% n = 98) and least (23.7% n = 44) preferred place of death. CONCLUSION: This first population-based survey on preferences and priorities for end-of-life care in Africa revealed that psycho-social domains were of greatest importance to the public, but also identified variations that require further exploration. If citizens’ preferences and priorities are to be met, the development of end-of-life care services to deliver preferences in Kenya should ensure an holistic model of palliative care responsive to individual preferences across care settings including at home

SPARC 2021 - Against all odds : Salford postgraduate annual research conference book of abstracts

Welcome to the Book of Abstracts for the 2021 SPARC conference. Our conference is called “Against All Odds” as we celebrate the achievements of our PGRs and their supervisors, who have continued to excel despite the most challenging circumstances. For this reason, we showcase the work of our PGRs alongside the outstanding supervision that they receive, with our Doctoral School Best Supervisor awards. We also focus on developing resilience and maintaining good mental health in the research environment, supported by exceptional keynote speakers, including our very own Dr Michelle Howarth and Ruby Wax OBE, which makes this year’s conference extra special

Improved callogenesis and plant regeneration from immature male flowers of East African highland banana cv. “Nakitembe” (AAA-EA)

Application of biotechnological tools in breeding, germplasm conservation and propagation of the East African bananas (Musa sp.) is limited by the crop’s recalcitrance to somatic embryogenesis. This study was undertaken to establish an efficient callus induction and plant regeneration protocol from immature male flowers in the most commercial and farmer preferred banana cultivar “Nakitembe”. Embryogenic callusing was improved from 2.9% on conventional MA1 culture medium to 4.2% with 500 mg L-1 L-Glutamine, 500 mg L-1 L-Proline and 300 mg L-1 casein hydrolysate supplements. A combination of the three amino acids with Chui N6 salts yielded the highest callusing of 10.2%. Cell suspensions were developed and maintained on conventional MS based MA2 medium. Subsequently, the highest efficiency of embryos germination (up to 80%) was achieved on MA4 medium, supplemented with 2.25 mg L-1 BAP and 0.2 mg L-1 IAA. The developed protocol has been successfully applied in Agrobacterium mediated genetic transformations of this variety

Improved callogenesis and plant regeneration from immature male flowers of East African highland banana cv. \u201cNakitembe\u201d (AAA-EA)

Application of biotechnological tools in breeding, germplasm conservation and propagation of the East African bananas ( Musa sp.) is limited by the crop\u2019s recalcitrance to somatic embryogenesis. This study was undertaken to establish an efficient callus induction and plant regeneration protocol from immature male flowers in the most commercial and farmer preferred banana cultivar \u201cNakitembe\u201d. Embryogenic callusing was improved from 2.9% on conventional MA1 culture medium to 4.2% with 500 mg L-1 L-Glutamine, 500 mg L-1 L-Proline and 300 mg L-1 casein hydrolysate supplements. A combination of the three amino acids with Chui N6 salts yielded the highest callusing of 10.2%. Cell suspensions were developed and maintained on conventional MS based MA2 medium. Subsequently, the highest efficiency of embryos germination (up to 80%) was achieved on MA4 medium, supplemented with 2.25 mg L-1 BAP and 0.2 mg L-1 IAA. The developed protocol has been successfully applied in Agrobacterium mediated genetic transformations of this variety.L\u2019application des outils biotechnologiques dans la s\ue9lection, la conservation du mat\ue9riel g\ue9n\ue9tique et la propagation des bananiers d\u2019Afrique de l\u2019Est ( Musa sp.) est limit\ue9e par la r\ue9ticence de la culture \ue0 l\u2019embryogen\ue8se somatique. Cette \ue9tude a \ue9t\ue9 entreprise pour \ue9tablir un protocole efficace d\u2019induction des cals embryog\ue8nes et de r\ue9g\ue9n\ue9ration des plantes \ue0 partir de fleurs m\ue2les immatures dans le cultivar de bananier le plus commercial et pr\ue9f\ue9r\ue9 des agriculteurs \uab Nakitembe \ubb. Les callosit\ue9s embryog\ue8nes ont \ue9t\ue9 am\ue9lior\ue9es de 2,9% sur le milieu de la culture MA1 conventionnel \ue0 4,2% avec des suppl\ue9ments de 500 mg L-1 L-Glutamine, 500 mg L-1 L-Proline et 300 mg L-1 d\u2019hydrolysat de cas\ue9ine. Une combinaison des trois acides amin\ue9s avec des sels de Chui N6 a donn\ue9 le cal embryog\ue8ne le plus \ue9lev\ue9 de 10,2 %. Des suspensions cellulaires ont \ue9t\ue9 d\ue9velopp\ue9es et maintenues sur un milieu MA2 \ue0 base de MS conventionnel. Par la suite, l\u2019efficacit\ue9 la plus \ue9lev\ue9e de la germination des embryons (jusqu\u2019\ue0 80 %) a \ue9t\ue9 obtenue sur le milieu MA4 compl\ue9t\ue9 par 2,25 mg L-1 de BAP et 0,2 mg L-1 d\u2019IAA. Le protocole d\ue9velopp\ue9 a \ue9t\ue9 appliqu\ue9 avec succ\ue8s dans les transformations g\ue9n\ue9tiques induites par Agrobacterium de cette vari\ue9t\ue9