Analysing and Applying Stakeholder Perceptions to Improve Protected Area Governance in Ugandan Conservation Landscapes

Given the diversity of active institutions and stakeholders in a landscape, and the difficulties in ensuring inclusive decision-making, evaluating landscape governance can help surface and address underlying issues. In the context of two protected area landscapes in Uganda, where landscape approaches are being implemented through a wider project on landscape governance, we analyse stakeholder perceptions of inclusive decision-making and then use this evaluation to stimulate dialogue amongst stakeholder groups in each landscape. We ask, how can capturing, analysing, and collaboratively applying people’s perceptions address inclusive decision-making in landscape governance? We collected and analysed perceptions using SenseMaker®, a software package that enables analysis of micronarratives (stories) from the field based on how respondents classify their own stories, using triads, dyads, stones, and multiple-choice questions. This self-categorisation by the respondent reduces bias in the analysis and allows the micronarrative to be cross-examined in a variety of ways when analysed using Sensemaker. This analysis created an integrated view of the stakeholder’s perceptions about inclusive decision-making in landscape governance. The results show large portions of the respondents feel their voices are neglected, and management of the landscape is poor in Mount Elgon, while in Agoro-Agu, it is the opposite trend. During a community feedback process, reasons for these trends were discussed and solutions proposed. Some of the underlying factors include historical relationships with park authorities and displacement during park creation. To more precisely answer our research question, one could have extended stays in the communities studied in these landscapes, using ethnographic methods including interviews and participant observation; nonetheless, our method, including the feedback process, was an innovative and important way to confront our findings with the informants directly and foster collaborative action. We conclude that understanding people’s perceptions, including through participatory feedback, can significantly inform and improve management decisions, help resolve conflicts, and facilitate dialogue between different stakeholders in the landscape

Why does HIV infection not lead to disseminated strongyloidiasis?

We investigated the hypothesis that host immunosuppression due to advancing human immunodeficiency virus (HIV) disease favors the direct development of infective larvae of Strongyloides stercoralis, which may facilitate hyperinfection and, hence, disseminated strongyloidiasis. To do this, we sought correlations between the immune status of the subjects and the development of S. stercoralis infections. Among 35 adults, there were significant negative rank correlations between CD4+ cell counts and the proportions of free-living male and female worms. Thus, in individuals with preserved immune function, direct development of S. stercoralis is favored, whereas, in individuals with lesser immune function, indirect development is relatively more common. These results may explain the notable absence of disseminated strongyloidiasis in advanced HIV disease. Because disseminated infection requires the direct development of infective larvae in the gut, the observed favoring of indirect development in individuals immunosuppressed by advancing HIV disease is not consistent with the promotion of disseminated infection

Effect of a brief alcohol counselling intervention on HIV viral suppression and alcohol use among persons with HIV and unhealthy alcohol use in Uganda and Kenya: a randomized controlled trial

IntroductionUnhealthy alcohol use significantly contributes to viral non-suppression among persons with HIV (PWH). It is unknown whether brief behavioural interventions to reduce alcohol use can improve viral suppression among PWH with unhealthy alcohol use in sub-Saharan Africa (SSA).MethodsAs part of the SEARCH study (NCT04810650), we conducted an individually randomized trial in Kenya and Uganda of a brief, skills-based alcohol intervention among PWH with self-reported unhealthy alcohol use (Alcohol Use Disorders Identification Test-Consumption [AUDIT-C], prior 3 months, ≥3/female; ≥4/male) and at risk of viral non-suppression, defined as either recent HIV viral non-suppression (≥400 copies/ml), missed visits, out of care or new diagnosis. The intervention included baseline and 3-month in-person counselling sessions with interim booster phone calls every 3 weeks. The primary outcome was HIV viral suppression (<400 copies/ml) at 24 weeks, and the secondary outcome was unhealthy alcohol use, defined by AUDIT-C or phosphatidylethanol (PEth), an alcohol biomarker, ≥50 ng/ml at 24 weeks.ResultsBetween April and September 2021, 401 persons (198 intervention, 203 control) were enrolled from HIV clinics in Uganda (58%) and Kenya (27%) and alcohol-serving venues in Kenya (15%). At baseline, 60% were virally suppressed. Viral suppression did not differ between arms at 24 weeks: suppression was 83% in intervention and 82% in control arms (RR: 1.01, 95% CI: 0.93-1.1). Among PWH with baseline viral non-suppression, 24-week suppression was 73% in intervention and 64% in control arms (RR 1.15, 95% CI: 0.93-1.43). Unhealthy alcohol use declined from 98% at baseline to 73% in intervention and 84% in control arms at 24 weeks (RR: 0.86, 95% CI: 0.79-0.94). Effects on unhealthy alcohol use were stronger among women (RR 0.70, 95% CI: 0.56-0.88) than men (RR 0.93, 95% CI: 0.85-1.01) and among participants with a baseline PEth⩽200 ng/ml (RR 0.68, 95% CI: 0.53-0.87) versus >200 ng/ml (RR 0.97, 95% CI: 0.92-1.02).ConclusionsIn a randomized trial of 401 PWH with unhealthy alcohol use and risk for viral non-suppression, a brief alcohol intervention reduced unhealthy alcohol use but did not affect viral suppression at 24 weeks. Brief alcohol interventions have the potential to improve the health of PWH in SSA by reducing alcohol use, a significant driver of HIV-associated co-morbidities