Browsing by Author "Nabukenya, Anne M."

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Correlates of HIV Status Awareness Among Older Adults in Uganda: Results From a Nationally Representative Survey
(BMC Public Health, 2018-09) Nabukenya, Anne M.; Matovu, Joseph K. B.
Background Recent evidence suggests that HIV prevalence is generally higher among older than younger persons. However, few studies have explored issues regarding HIV testing and awareness of HIV status among older persons. We explored the correlates of HIV status awareness among older adults (aged 45+ years) in Uganda. Methods This paper is based on secondary analysis of existing data on persons aged between 45 and 59 years from a nationally representative Uganda AIDS Indicator Survey which was conducted between February and September 2011. Records on the socio-demographics and HIV/AIDS-specific indicators for 2472 persons were extracted for analysis. Individuals were considered to be aware of their HIV status if they reported that they had tested and received their HIV test results within the past 12 months. Data analyses were done using the sample survey procedures to take into account the sampling structure of the data. Odds ratios were used to quantify the associations between receipt of HIV test results and potential factors. Results Of the 2472 respondents, 48% had ever tested and received their HIV test results while 23% tested and received their HIV results in the past 12 months or already knew that they are HIV positive. Individuals with the following characteristics had higher odds of being aware of their HIV status: being female (adjusted Odds Ratio (AOR) = 1.26; 95% CI: (1.04, 1.53), having high comprehensive knowledge of HIV/AIDS (AOR = 1.28; 95% CI: 1.04, 1.58), having attended secondary school education (AOR = 2.10; 95% CI: 1.47, 2.99) and engagement in high risk sexual behaviors (AOR = 1.53; 95% CI: (1.11, 2.10). A high level of stigma (holding at least three stigmatizing attitudes toward people living with HIV) was negatively correlated with awareness of HIV status (AOR=0.60; 95% CI: (0.45, 0.78). Conclusion Less than a quarter of older Ugandans are aware of their current HIV status. High levels of stigma and low comprehensive knowledge of HIV/AIDS remained critical barriers to HIV testing and awareness of HIV status. These findings suggest a need for innovative HIV testing strategies to increase HIV status awareness among older adults in Uganda.
Opt-out cervical cancer screening increases coverage of cervical cancer screening in HIV clinical care settings: Experiences from Mildmay, Uganda
(BioMed Central, 2014-05) Nabukenya, Anne M.; Matovu, Joseph K. B.; Nangiya, Joan; Kawuma, Esther; Odiit, Mary; Mukasa, Barbara
Background: Cervical cancer is highly prevalent in developing countries. In Uganda, overall incidence rate is estimated at 44 per 100,000 women and 60 per 100,000 among HIV infected women. However, only 30% of women have ever been screened for cervical cancer and linkage to treatment after diagnosis is suboptimal. For HIV infected women, who are at highest risk of cervical cancer, the HIV care delivery system provides an opportunity for cervical cancer services. In this paper we share the Mildmay Uganda (MUg) experiences in integrating cervical cancer services into HIV care. Program implementation: The MUg clinic is a centre of excellence that has been delivering HIV clinical care since 1998 and has supported over 60,000 clients to date. In 2008, MUg started screening the HIV infected women for pre-cancerous lesions using PAP smears, and eventually introduced visual inspection with acetic acid (VIA) in 2011. Screening is conducted by trained nurses through an opt-out model and an onsite see-and-treat (same-day treatment) with cryotherapy for women with growing lesions. Program outcomes: The introduction of the opt-out model and screening by nurses has led to drastic increases in the number of women screened and treated for cervical cancer since 2012. In 2011, a total of 730 women were screened, while in 2012, 3,857 women were screened. In 2013, 2,580 women were screened. Overall, refusal of screening was less than 5%. The number of women observed with advanced cancerous lesions has drastically reduced since introduction of the opt-out screening. For example, in the first half of 2012, of the 96 women who were VIA positive, 56% had advanced lesions compared to 41% in the latter half of 2012, 32% in the first half of 2013, and 15% in the latter half of 2013. Lessons learnt: Integration of cervical cancer services in HIV care programs is possible, cost-effective and makes the screening service more accessible by a vulnerable population. Using an opt-out approach and same-day treatment increases access to cervical cancer screening and reduces the proportion of women presenting with advanced lesions. Trained nurses ably deliver cervical cancer services. See-and-treat approach reduces cases who fail to access treatment due to gaps in health care linkages.