Tom R . Muyunga-Mukasa | The George Washington University (original) (raw)

Papers by Tom R . Muyunga-Mukasa

DOAJ (DOAJ: Directory of Open Access Journals), 2021

This article explores the role of poetry and narrative methods in African-centred queer biblical ... more This article explores the role of poetry and narrative methods in African-centred queer biblical studies and theology. As a case in point, it presents a poem, titled "Accused of a Sodomy Act," by Tom Muyunga-Mukasa, that was written as part of a queer Bible reading project with Ugandan LGBTQ refugees. The poem is a contemporary re-telling of the gospel story about Jesus and the "woman caught in adultery" in the context of socio-political homophobia in Uganda. The poem is complemented by an autobiographical reflection by the writer, providing insight into his personal experiences of growing up as gay and religious in Uganda. This is embedded in a more general discussion, relating the poem to trends of life storytelling in African LGBTQ activism, and to established narrative methodologies in African theological and biblical studies scholarship. Overall, the article makes a methodological contribution, by foregrounding queer poetry and storytelling as innovations in African narrative hermeneutics that expand the established concern with gender and sexuality beyond a heterosexual framework, and that include the marginalised voices and experiences of LGBTQ people.

Boydell UK eBooks, Nov 19, 2021

Stressors Specific to Refugees, Asylum Seekers and Displaced Persons That Can Inform the TBHLM at UNGA78: Lessons from Kenya 2018-2023, 2023

There is a mantra that goes as follows :"we can't end TB if we cannot find those living with TB."... more There is a mantra that goes as follows :"we can't end TB if we cannot find those living with TB." In this paper we characterize the experiences of refugees, asylum seekers and displaced persons who are part of communities but may be not targeted by TB Prevention and Elimination initiatives. We show why they may not be willing participants in such drives to end TB given competing externalities and self-preservation interests.

Vaccines, Roll-out And Equity: A Scoping Exercise Among Refugees to Characterize TB Prevention and Elimination in Forced Migration Contexts; A Case from Kenya, December 2022, 2022

Introduction: Mobilization, material access and meaningful engagement of refugees in health p... more Introduction:

Mobilization, material access and meaningful engagement of refugees in health promotion initiatives of local host countries improves uptake of vaccines. Vaccine uptake is higher following targeted campaigns because they are strategic and improve vaccine uptake and efforts to vaccinate larger populations (Osumba, 2021). This is true for refugees too. Unlike in the general population who are citizens and enjoy several amenities, refugees are disproportionately impacted by cultural, social, political, economic, civil and gender enabling and responsive determinants.

Findings:

The pre-disposing factors or variables that influence contexts of equity and inequity in the case of refugees are: social, cultural, economic, political, civil and gender enabling and responsive contexts.

Conclusion:

Pre-disposing factors impact quality of life, health seeking practices and contexts driving healthy living among refugees.

Recommendations:

Vaccines whether new (e.g., TB Vaccine) or the ones we have been using over time provide long-term immunity. They are provided as single or multiple doses which makes them the tools to offset barriers such as transport to clinics and may minimize hesitancy inclinations for marginalised populations. Further investigations of the causes of differential inequity, poor vaccine coverage and the effectiveness of interventions for increasing vaccine uptake are urgently needed for refugees to address vaccination and immunization disparities.

Characterizing and Calibrating Beneficiary Needs, Preferences and Interests on The Road To HIV, TB and Malaria Eradication By 2030 Integrating COVID-19 Recovery and Response for Communities in 3 East African Countries, September 2022, 2022

There is a disparity of expectations between TB care and Prevention service providers and the ben... more There is a disparity of expectations between TB care and Prevention service providers and the beneficiaries. Between January to September 2022, we conducted community-wide-active-case finding, engaged in planned activities to reduce prevalence of TB such as linking those in need to care services and promoted practices geared at reducing risk of getting TB at individual and household levels for 10 identified communities. The international TB Treatment Goals are testing; treatment; adherence until cured. But the local realities are different. This paper seeks to showcase the localized needs of Persons living With TB in Uganda, Kenya, and Tanzania.

80 percent of 11-25-Year-old Respondents Know a Peer Who Had Unprotected Sexual Intercourse, Used Alcohol and Drugs During the COVID-19 Lockdown in Uganda: Who Promotes Temperance and Delaying sex, 2022

Background: Education Institutes play a leading role for learners to engage in ageappropriate act... more Background: Education Institutes play a leading role for learners to engage in ageappropriate activities whose outcomes foster growth and development. More learners are retained in the school system, acquire the required competencies, benefit from the right social capital through which they can overcome hardships, gain a mind-set that enhances career-oriented efforts, ambition for higher qualifications, and education reduces chances for girls of marrying as children. The objective of the study was to show the importance of schools in fostering decisions for engaging in quality life promoting practices for school-going population groups 11-25 years old.

Most Health Care Providers Think Taking Tablets Is All That Health Care Seekers Need To Be Told: Healthy Living Advocacy Is More Than A Pill, 2022

Scoping A Culture of "Equity" and Addressing "Disparity" With Examples From Kenya, Tanzania and Uganda, 2022

Where people live and how people live matters to quality life outcomes. If they are not housed, f... more Where people live and how people live matters to quality life outcomes. If they are not housed, fed and not in a trade, people are likely to fall through the safety-net through isolation, alienation, and no form of contact. If they are housed but congested, if they are fed but on an unbalanced diet and in a trade but not paid or treated with dignity, the likelihood of morbidity is high. Housing stability, food security, livelihood and economic production and environment conservation practices as well as involving communities empowers people to see themselves as contributors to the eradication of HIV, TB, and Malaria by 2030, they become fully engaged. But, when it comes to zero HIV, TB, and Malaria by 2030 goal, there are different levels of engagement and motivation by communities of the 3 East African countries. This paper shows that the different levels of engagement are due to (1) the near absence or existence of social welfare facilities linking civil, economic, cultural, political, social and gender determinants as mediators to good health and wellbeing aspirations; (2) the motivation to disengage/engage in social transforming and purposedriven activities; (3) high inflation, which creates issues of internal inequity and exclusionit is true those who are sick are getting the initial care services, but the cost of living is affecting existing health seekers and in turn adherence; and (4) the realities of elective politics for positions from bottom to top which in introducing power and authority at the communities have also monetized social connections and hierarchies. This in turn has affected the way people interact or address issues of scarcity, fulfillment, stigma, and discrimination in East African countries. The question is now how near or far is one from the holder of power and authority centers which include the traditional altruistic kinship most African communities are known for. We defined the health care index as the ability to navigate the upstream, midstream, and downstream prevention value chain without housing, food and income hardships or catastrophes; an estimation of the overall quality of the health care system, health care professionals, equipment, staff, doctors, cost, and committing to adherence practices. A Nubeo ranking of 7 African countries health care systems: South Africa: Has a health care index score of 63.97 Kenya: Has a health care index score of 63.40 Tunisia: Has a health care index score of 56.54 Algeria: Has a health care index score of 52.88 Nigeria: Has a health care index score of 48.49 Egypt: Has a health care index score of 47.01 Morocco: Has a health care index score of 46.69

Integrated Care, Diabetes, TB, Forced Migration and Quality Health Outcomes: A Scoping Study, April 2022-November 2022, 2022

Several studies such as those done by Azevedo (2017) and Oleribe (2019) highlight interesting les... more Several studies such as those done by Azevedo (2017) and Oleribe (2019) highlight interesting lessons drawn from the larger population that can inform targeted health and development services benefitting refugees, asylum seekers and migrants. Up to 76%-80% Africans living on less than 2.00aday,and46.52.00 a day, and 46.5% on less than 2.00aday,and46.51.08 a day; have Communicable and Non-Communicable Diseases (C/NCDs) which have never been diagnosed. In the case of refugees, medical checkups may not be prioritised until a few days before resettlement. Yet, they have unmet medical needs ranging from infectious diseases such as HIV Hepatitis, Tuberculosis or intestinal parasites, chronic illnesses such as sickle-cell anaemia, diabetes, hypertension, and mental health issues such as anxiety, posttraumatic stress disorder and depression. Conflict and displacement lead to public health risks for refugees and local host communities in form of weakened health systems; loose or overwhelmed protection and security structures and systems; unstable housing, food insecurity; and a lack of protection of life and property. These are the underlying risk factors which increase vulnerability to communicable and non-communicable diseases because of weakened health systems, overcrowding, poor water and sanitation conditions, interrupted immunization activities and delayed or late diagnoses. preventing communicable and noncommunicable diseases reduce the major risk factors for communicable and noncommunicable diseases such as substance abuse, tobacco use, physical inactivity, unhealthy diet and the harmful use of alcohol.

The Character of Lived Experiences Among Refugees in Kenya Following the COVID-19 Lockdown Generated in A Study Conducted Between September to November 2021, 2022

There is a large amount of researched evidence linking pandemics to displacement of people. Howev... more There is a large amount of researched evidence linking pandemics to displacement of people. However, the uniqueness of COVID-19 also raises a different set of scenarios ranging from politically determined lockdowns that are enforced differently along rural and urban divides; disruption of lifestyles; differences in policy on day to day conduct of activities during the lockdown; character of services demanded and provided. This research was conducted among 119 respondents who identify as refugees living in Nairobi, Tala, Kakuma and Dadaab to identify the challenges that these refugees faced between March 2020 to October 2021 during the COVID-19 Pandemic and attendant restrictions in Kenya. The COVID-19 pandemic lockdown led to restrictions against mobility on the one hand this led to less transmission but for refugees this translates into lack of earning money to pay rent for housing, nutrition, medication, transport means and staying connected. Some repercussions include not getting updates in form of resettlement notices and cash disbursements to support sustenance.

Challenges of Navigating the Social Service System in Kenya by Queer Refugees 2019-2020, 2022

What about Queer Refugees in African countries, who makes a case for them? Many studies show that... more What about Queer Refugees in African countries, who makes a case for them? Many studies show that refugees claim their Gender, social, economic, and cultural rights manifesting as social services which include support for stable housing, food security, healthy living and livelihood projects. These rights are public goods which if denied lead to all sorts of vulnerabilities which in turn affect their mental health experiences. There are few studies characterizing this vulnerability among Queer refugees. This study sought to find out how the challenges brought about by identity, gender, and sexuality related issues affect perceptions and attributes of respectability and dignity affirmation leading to life promoting or degrading practices among Queer refugees. This has implications for policy makers, programmes and plans debunking stigma and discrimination.

A Study into Interventions to Establish Resilience Against Discrimination and Stigma: the state of 5 Urban-based Refugee-led Support Spaces from September to November 2021, 2022

Background There is vast literature on the nature of mental health-related stigma and the process... more Background There is vast literature on the nature of mental health-related stigma and the processes by which it severely affects the life chances of people with mental health problems. However, applying this knowledge to deliver and evaluate interventions to reduce the adverse effects of discrimination and stigma in a lasting way among refugees is a complex and long-term challenge. This study sought to identify the character and meaning of discrimination and stigma and how these affect day to day life experiences among refugees.

Challenges in Continuance, Linkage and Adherence to Optimal Anti-AIDS and TB Care Goals Among 5 Urban-based Refugee-led Support Spaces from September to November 2021, 2022

There is effort by the state, local governments, sub-counties, and NGOs/CBOs to provide opportuni... more There is effort by the state, local governments, sub-counties, and NGOs/CBOs to provide opportunities or mechanisms for beneficiaries to engage in continued care, linkage, and adherence to practices that promote optimal care for those living with HIV and TB. However, for refugees living with HIV there are factors that severely affect continued engagement in care which in turn affect linkage and adherence. Between September to November, this study sought to identify different social factors refugees face and mental health needs other than stable housing, food security and state of documentation to address comprehensive quality life goals.

Public-Private Mix (PPM) and Communities of Practice (COP): Appropriating the International Global Fund Goals to Advance Localized Social-ecological Facilitation on The Road to Zero HIV, TB, and Malaria by 2030, 2022

Introduction: Communities and the private sector are crucial players as we aspire for UNAIDS 95:9... more Introduction: Communities and the private sector are crucial players as we aspire for UNAIDS 95:95:95 Goal; ensuring that all PLHIV are provided TB Preventive treatment; and bringing anti-malarial services to the communities. But this is to put it bluntly. However, an understanding of vulnerability, appropriation, and adaptation through data appraisal, anecdotally, scholarship, policies and programmes reveal that discrepancies and disproportionalities abound which affect traction toward zero HIV, TB and Malaria by 2030. At the Global Fund/UN/WHO and government levels, focus is exclusively on the germ theory and good health, but less action in form funding that drives aspirations for wellness of people and their communities. Doing good is not antithetical to doing well. This paper explored the categories of the multiple exposures to formulate a clear conceptual framework which would facilitate analysis of vulnerability and adaptation to multiple interacting socioeconomic and biophysical changes for communities adapting to the end to HIV, TB, Malaria by 2030 integrating COVID-19 response and recovery.

Meaningful HIV, TB and Malaria Prevention Integrated Service Delivery Promoting a Culture of “Equity” and Addressing “Disparity” With Examples from Grassroots-Based Urban, Rural and Semi-Urban Communities of Kinondoni in Tanzania, Langata in Kenya, and Wakiso in Uganda 2021-2022, 2022

All three East African countries have several healthcare reforms, through which financial risk pr... more All three East African countries have several healthcare reforms, through which financial risk protection and service coverage for key, vulnerable, priority populations, the marginalized, poor and vulnerable groups are possible. Whereas in say, Kenya there is provision of free maternity services, user-fee removal in public primary health facilities and a health insurance subsidy programme (HISP) for the poor, health seekers must pay for medication and other attendant needs. In Uganda, a low-income health seeker has to forego meals, rely on extended families while recuperating or sell of family assets. In Tanzania the picture is somewhat like that of Kenya and Uganda. This is evidence of inequity and the likelihood that the poor will still be left behind with regards to financial risk protection and service coverage. This study examined the experiences of the poor with such concepts like PPM, COP and health financing reforms that target them.
Methods: We conducted a qualitative cross-sectional study in three purposively selected regions of Uganda, Tanzania, and Kenya. We collected data through focus group discussions (n = 21) and in-depth interviews (n = 40) with people in the lowest wealth quintile residing in the health and demographic surveillance systems and exit interviews at selected hospitals. We analyzed the data using a framework approach focusing on the three public health goals and the four-healthcare access dimensions: geographical accessibility, affordability, availability, and acceptability.
Results: PPM, COP and Health financing policies reduced financial barriers and improved access to health services for the poor in the study counties. However, for many it was limited, and this limitation was a barrier limited the extent to which they benefited from these reforms. Responses on barriers were: Staying with members of an extended family/clan was a burden, long distances, expensive medication, lack of food, lack of public transport, poor condition of the roads and high transport costs especially in rural areas limited access to health facilities. Continued charging of user fees despite their abolition, delayed insurance reimbursements to health facilities where beneficiaries were seeking care from, and informal fees exposed the poor to out of pocket payments. Stock-outs of medicine and other medical supplies, dysfunctional medical equipment, shortage of healthcare workers, and frequent strikes adversely affected the availability of health services. Acceptability of care was further limited by ridicule from the healthcare providers, discrimination by healthcare workers and ineffective grievance redress mechanisms which led to a feeling of disempowerment among the poor. Conclusions: Pro-poor health financing reforms improved access to care for the poor to some extent. Low-Income friendly reforms can be effective, there is a need to address barriers to healthcare seeking through addressing the civil, social, political, economic, cultural and gender determinants. This in turn leads to full engagement by all actors.
Conclusion: When communities are fully engaged, it creates a feeling of being connected to one another individually and feeling part of a bigger purpose as a team working together on a collective endeavour. When everyone feels recognized and appreciated, they are motivated to collaborate, and this addresses social isolation. Empowering community members to be part of the efforts to eradicate HIV, TB and Malaria by 2030, enables them to rethink their role and giving agency and autonomy to be innovative and entrepreneurial — to lead new projects and shape their own contributions to the effort instead of having tasks imposed on them in a top-to-bottom approach.

Endocrinology and Metabolic Syndrome, 2013

According to the UN Special High Level meeting on global non-communicable diseases, high fat diet... more According to the UN Special High Level meeting on global non-communicable diseases, high fat diet, inactivity and substance abuse are risk factors. These exacerbate events for cardio-vascular diseases, lung diseases, hormonal deficiencies, obesity and cancer. Medical check-ups make it possible for earlier diagnosis of CV risk factors. Physical exercises help reduce CV risks. Early, timely and regular medical check-ups, active lifestyle, moderate use of alcohol and non-smoking help in timely diagnosis and management of metabolic-syndromes. This study sought to gauge these levels of activity, risk-factors and attendances for medical check-ups among Ugandan-Americans. By Ugandan-Americans is meant, that community of Ugandan extract that has stayed in USA for over 6 months to 20 years.

Stage Dependent Interventions as Refugees Await Resettlement (RAR); Critical Path Analysis done at 3 Kenya-based Mutual Aid Groups, 2014-2019, 2019

INTRODUCTION: "Politicizing" the human body can be done at biological, spiritual, psychological, ... more INTRODUCTION: "Politicizing" the human body can be done at biological, spiritual, psychological, emotional, mental, wellness, physical, political, social, citizen status, identity, citizenship, economic, education, cultural and religious dimensions. The state prescribes humanization or dehumanization contexts through identity and citizen status. These two increasingly play roles on self-determination, agency and autonomy. Agency is like car-wheels; autonomy the engine with specific power equated to identity. This study sought to categorize critical paths or stages catalysing refugee readiness for resettlement. METHODOLOGY: Meta-analysis of migration and immigration policy documents to elicit registration and eligibility steps; familiarization tour to Nyayo House; and Key Informant Interviews of 17 respondents. FINDINGS: Interventions are status-based and three types: Wellness (biological, psychological, emotional, mental and spiritual); eligibility (political, cultural, citizenship and identity); and systemic referral-based services (physical, political, social, citizenship, economic, education, cultural and religious). Respondents linked all three and were able to plot strategies necessary to fulfil access and affordability goals. CONCLUSION: Strategy is necessary while seeking refuge. Refuge as one awaits resettlement (ROAR) is influenced by status. The status is ongoing and linked to components/conditions of short or long term nature. Wellness based conditions are at primary stage, systemic based services take on secondary stage and eligibility based services are tertiary stage. RECOMMENDATION: Future research into how groups provide education, counselling, guidance and economic empowerment to influence quality refugee life seeking practices.

Popular Vote Model of Political Dispensation Can be Tempered with Ubuntu, Equality and Justice Aspirations to Humanize Refugees in Kenya; Stories from 17 Nairobi Based Refugees, 2019

INTRODUCTION: Economic emancipation and engagement in productivity, is a proxy for contexts upho... more INTRODUCTION: Economic emancipation and engagement in productivity, is a proxy for contexts upholding Universal Declaration of Human Rights (UDHR) Principles. Others are: right to seek asylum, freedom from persecution and right to justice, equality, dignified treatment, respect and fairness. This study aims at showing how dehumanizing refugees is a direct result of political dispensation of any given country.
METHODOLOGY: Key Informant interviews of 22 refugee respondents who have been in Kenya since 2016. Literature review of 100 dailies from September to October 2019 on minority and marginalized strategies and counter strategies to address inequality, promote visibility and inclusion.
FINDINGS: Minority inclusivity requires understanding of the politics of popular vote; and organizing for movement building to address systemic injustices with refugee input. They participate in poverty eradication drives; access health, opportunities for housing, affordable education, participation in livelihood activities and demand for quality before the law.
CONCLUSION: Humans are connected to animate and non-animate worlds (Ubuntu wisdom). These connections are market-places. Governments can promote contexts for harmony (equality enforcement) and stabilize institutionalized service delivery. This builds a culture of justice which defends civic, religious and identity-related freedoms and enshrines protections. Leading, to economic emancipation, humanization of refugees and asylum seekers.
RECOMMENDATION: Research into services targeting refugees influence engagement in economic activities will throw light on social mobility and economic prosperity.

DOAJ (DOAJ: Directory of Open Access Journals), 2021

Boydell UK eBooks, Nov 19, 2021

Stressors Specific to Refugees, Asylum Seekers and Displaced Persons That Can Inform the TBHLM at UNGA78: Lessons from Kenya 2018-2023, 2023

Vaccines, Roll-out And Equity: A Scoping Exercise Among Refugees to Characterize TB Prevention and Elimination in Forced Migration Contexts; A Case from Kenya, December 2022, 2022

Introduction: Mobilization, material access and meaningful engagement of refugees in health p... more Introduction:

Findings:

Conclusion:

Pre-disposing factors impact quality of life, health seeking practices and contexts driving healthy living among refugees.

Recommendations:

Most Health Care Providers Think Taking Tablets Is All That Health Care Seekers Need To Be Told: Healthy Living Advocacy Is More Than A Pill, 2022

Scoping A Culture of "Equity" and Addressing "Disparity" With Examples From Kenya, Tanzania and Uganda, 2022

Integrated Care, Diabetes, TB, Forced Migration and Quality Health Outcomes: A Scoping Study, April 2022-November 2022, 2022

The Character of Lived Experiences Among Refugees in Kenya Following the COVID-19 Lockdown Generated in A Study Conducted Between September to November 2021, 2022

Challenges of Navigating the Social Service System in Kenya by Queer Refugees 2019-2020, 2022

A Study into Interventions to Establish Resilience Against Discrimination and Stigma: the state of 5 Urban-based Refugee-led Support Spaces from September to November 2021, 2022

Challenges in Continuance, Linkage and Adherence to Optimal Anti-AIDS and TB Care Goals Among 5 Urban-based Refugee-led Support Spaces from September to November 2021, 2022

Endocrinology and Metabolic Syndrome, 2013

Stage Dependent Interventions as Refugees Await Resettlement (RAR); Critical Path Analysis done at 3 Kenya-based Mutual Aid Groups, 2014-2019, 2019

Popular Vote Model of Political Dispensation Can be Tempered with Ubuntu, Equality and Justice Aspirations to Humanize Refugees in Kenya; Stories from 17 Nairobi Based Refugees, 2019

Muyunga-Mukasa T.R., 2024

Advancing a better learning environment for learners with autism meant that Disability Justice wa... more Advancing a better learning environment for learners with autism meant that Disability Justice was the medium to establish politico-legal contexts fostering access to education for Learners with disabilities. The researcher used SWOT analysis to synthesize a narrative establishing policy. Systems, structures and changes evolve over time. These very changes are used to feed into the data making the SWOT analysis a source establishing definitive characters considered strengths, weaknesses (gaps), opportunities and threats. One of the lessons learnt is the need to ensure that the education space contributes and promotes quality of life measured against equity, accessibility, affordability, acceptability and availability leading to better life outcomes for the different disability categories.
Key words: Autism Spectrum Disorder, Contexts, Education, School District,

Tuberculosis prevention knowledge, attitude, practices and behavior among non-U.S. born Americans of African descent in the District of Columbia, Maryland and Virginia (DMV) area, 2024: The end of TB is possible if these are advanced, 2024

Scaling TB Prevention practices will contribute to optimal outcomes for non U.S. born persons of ... more Scaling TB Prevention practices will contribute to optimal outcomes for non U.S. born persons of African descent in the DMV November 2023-May 2024.

Grandparent Headed Households Are Under Tapped Health Championing Spaces in Modern Uganda: A Qualitative Description from Kiyovu Village, Rakai District and Kimaanya-Kabonera Division, Masaka City in Greater Masaka Region, Uganda, 2023, 2023

Introduction: Grandparents are living longer, staying stronger, avoiding being loners but their p... more Introduction:
Grandparents are living longer, staying stronger, avoiding being loners but their pockets are not deeper. This study used context specific methods to generate the character of the unique socio ecological contexts in which Grandparent Headed Households (GHH) thrive, ensure survival and sustenance turning these households into spaces for the development of culturally-appropriate interventions that might impact their health and the health of those in their care.

Methods:
This qualitative descriptive study was based on the conduct of in-depth, semi-structured interviews and Focus Group Discussions with 92 grandparents residing in Kiyovu village (Rakai) (22) and Kimaanya (Masaka City) (70), who are the primary caretakers for grandchildren. A rapid appraisal was used to identify the households; key informant interviews were conducted based on the premises of the Life course perspectives and the Social Ecological Model (SEM). The basic assumptions were that enabling and responsive contexts including intrapersonal, social-cultural, organizational, and policy factors influence individual health and health practices and that these influences are interrelated and reciprocal. Data was analyzed by the research team using line by line coding of the audio recorded transcriptions of the interviews.

Findings:
All ninety-two (92) respondents had grandchildren under their care. 13 households had both grandparents; 52 were grandmother headed households; and 25 were grandfather headed households. 75 Households had 8 grandchildren and above with some not biological relations; 15 had 5 grandchildren; 2 had 4 grandchildren each. All 92 claimed that assumptions of invincibility prevail in many Ugandan communities yet GHH experience both barriers and facilitators to maintaining the healthy lifestyles; 80 claimed prestige connected to being a GHH, which is a space invigorating self-esteem, self-respect, self-recognition and self-preservation. 12 claimed that being a GHH is not enough without economic sustenance. They relied on formal and informal networks to help with caretaking responsibilities. All 92 stated that they experienced notable barriers to self-care and personal health related to having the primary responsibility of their grandchildren, including lack of resources and unresolved traumas due to loss of their children who are the biological parents of the grandchildren.

Conclusions:
GHH are increasingly taking up care roles but this is making grandparents more vulnerable to health threats elevating their risk for many chronic diseases.

Recommendation:
There is need for a health and ageing policy in Uganda to promote health related interventions targeting seniors/elderly persons because many are ageing actively.

Aversion, Access and Adherence: The Challenges to Anti-TB, ART and Anti-Malaria Treatment Across the Three (3) Diseases in Rakai, Kyotera and Ssembabule Districts of Greater Masaka Region, Uganda February 2023-July 2023, 2023

Background: More and more people are settling in semi-urban or rural communities. This is the ca... more Background:

More and more people are settling in semi-urban or rural communities. This is the case of Greater Masaka Region of Uganda which is the bread-basket of Uganda. But it was an epicenter for the spread of HIV with numerous high prevalence and hotspots such as Lyantonde, Lukaya, Kasensero, Kalangala, Kyabakuza and Nyendo in the 1980s. But, with the advent of ARVs more people are living longer and able to engage in productive lifestyles as well as get sustenance. The aim of this study was to characterise factors that affect uptake of medicines against TB, Malaria and HIV in three districts that make up the Greater Masaka Region. At the same time, this study characterised the different experiences at a time when more people are living longer, ageing with HIV and resettling in rural Ugandan communities.

Methods:

99 long HIV Survivors followed since 2010 and who made a conscious decision to live in rural communities were enrolled in the study. Thirty-three (33) from Rakai (20 females: 13 males); 33 from Ssembabule (13 males: 20 females); and 33 from Kyotera (25 females: 8 males). Context-specific methods used for data collection were: Rapid Appraisal; Semi-structured Interviews; Focus Group Discussions; Exit Interview for sharing information between health seekers and providers; and using a quantitative survey instrument embedded with qualitative questions to characterize responses. Interviews were transcribed and analyzed using descriptive statistics and deductive-inductive content analyses. A ranking of responses informed our results.

Results:

In all 3 districts, Hunger (95); Food security (76); Housing stability (72); Transport costs (71); Waiting time (71); Access to treatment (67); Community Health Volunteers (55); and Adherence Counsellors (54) were highlighted as enablers or disablers to uptake of services and adherence.

In all 3 FGDs, Hunger (15); Food security (12); Housing stability (12); Transport costs (11); Waiting time (11); Access to treatment (10); Community Health Volunteers (5); and Adherence Counsellors (4) were highlighted as enablers or disablers to uptake of services and adherence.

10 Health-workers who were identified as Key Informants highlighted: work-related pressures (10); attendances and appointments (9); Stockouts (9); access to social support networks (8); access to treatment (9);and access to counselling (8) were enablers and disablers to uptake of services and adherence on top of Hunger (10); Food security (10); Housing stability (10); Transport costs (10); Waiting time (10); Access to treatment (10); Community Health Volunteers (5); and Adherence Counsellors (6).

Conclusion:

Ageing with HIV is a risk factor for heart disease and diabetes. Deterioration of adherence may compound life of people ageing with HIV due to social determinants of health. This contributes to optimal and sub-optimal prevention decisions across the three diseases (TB, Malaria and HIV). Future studies should explore how prevention interventions may address risks and vulnerabilities to avoid drug-resistance or sub-optimal adherence.

VMMC Naïve Partners Contribute to Hesitancy or Uptake of VMMC By Eligible Bisexual Male VMMC Candidates: An Analysis of Responses from Selected Sexually Active MSM and Their Partners in Uganda 2021-2022

Introduction: In predominantly heterosexual settings, anal-sex debut disinhibition and subsequent... more Introduction:
In predominantly heterosexual settings, anal-sex debut disinhibition and subsequent repeat events are not frequent topics yet these events are mentioned anecdotally. This study sought to find out how knowledge of the benefits of VMMC can be a motivator or demotivator drive uptake of Voluntary Male Medical Circumcision (VMMC). VMMC has several benefits which include reducing vulnerability to acquiring cervical or anal cancer, HIV, STIs among sexual partners.

Methodology:
A big N (110); purposive study of sexually active female and male spouses/partners whose male spouses were legible for circumcision; screening out those with views against circumcision; enlisted Peer Counsellors engaged in direct interventions to be our key informants (10); and the use of Focus Group Discussions (FGDs).

Findings/Results:
Several reasons for discouraging their male partners arose: low (10 responses) reduced penis size; medium (30 responses) loss of self-esteem; high (80 responses) sex starvation (depravation of conjugal enjoyment). Eighty (80) which is 73% of the respondents claimed that sex starvation during the period of healing was the reason to why they didn’t support their male partners to opt for this operation. FGD outcomes revealed other demotivators: sixty-six (66) which is 60% said that insertive role spouses are the bread winners, they claimed the healing period takes long hence impacts sex-for-finances favours; forty (40) which is 40% asserted VMMC reduced the penis size after the fore skin is removed hence reducing sexual pleasure and make it painful for because circumcised males took long to reach orgasm; thirty (30) which is 30% remarked that they preferred their men unique due to the fact that circumcision was a preference for the majority of people. They added that circumcision would make the spouses a choice for other people who preferred circumcised men. Twenty (20) which is 20% remarked that they had reached the period where sex wasn’t the principal entity in their marriage so there was no reason for a man to circumcise unless he has some other people outside their marriage (infidelity). Ten (10) which is 10% said VMMC was a method brought to Africa to make men impotent. On the VHTs, five (5) mentioned that women who don’t not accept husbands to go for circumcision give starvation as the main reason; (3) said the main reason was that they had fear of impotency in their husbands; and two (2) claimed VMMC fueled infidelity.

Conclusion:
Lack of conjugal enjoyment during the3-4 weeks of healing may be a cause of disputes which spill into Sexual/Gender-Based Violence (SGBV). In addition to sensitization, people need to learn and understand the advantages of circumcision, further research on how partners can become champions of circumcision as a component of the HIV prevention continuum in high-risk hetero-bisexual populations in Uganda is called for.

SRH/HIV/TB Quality Life Promoting Services Are Not High on The Agenda of Young Refugees in Post-COVID-19 Era; A Case Study from 3 Key Refugee-Led CBOs In Kenya, 2023

Background: Facilitated social support and protection spaces empower refugees (19-29 years) to ac... more Background: Facilitated social support and protection spaces empower refugees (19-29 years) to acquire health promotion knowledge and skills to make positive SRH-related practices. But with other competing interests in a Post-COVID-19 era making SRH or general health priorities have been impacted negatively. This report shows that the frequently demanded needs among young refugees are based on identity, integration status, and age of people. This study was limited to Young Refugee-Led CBO issues and aimed at characterizing the elements of empowerment that catalyze participation in healthy living and health seeking practices ensuring quality life goals.

Methods: A qualitative study, using administered questionnaires to 42 persons in 3 Community Based Organizations (CBOs) who were followed for 12 months (August 2021-July 2022), anecdotal recollections and desk review of literature on unique Refugee Status Determination (RSD), HIV/AIDS, TB and SRH issues.

Results: In a post-COVID19 era, Refugee-Led CBOs are opportunities for empowerment that facilitates optimal health outcomes but these are impacted negatively due to issues are unstable housing, unsecure nutrition, lack of livelihood projects, living in fear, restricted liberties, no routine targeted sexual reproductive health services and no disposable cash to be used for transport to facilitate timely and regular clinic attendance reduce instances of catastrophic events and meeting the needs.

Conclusion: Culturally sensitive integrated service delivery targeting refugees is missing yet it catalyses quality life and optimal care outcomes.

Characterising TB-related Stakeholders and Strategies to Inform Evidence Use for TB Prevention and Health Promotion Policymaking, Programming and Planning April 2022-November 2022: Lessons from Kenya, Tanzania and Uganda, 2022

Characterising TB-related Stakeholders and Strategies to Inform Evidence Use for TB Prevention an... more Characterising TB-related Stakeholders and Strategies to Inform Evidence Use for TB Prevention and Health Promotion Policymaking, Programming and Planning April 2022-November 2022: Lessons from Kenya, Tanzania and Uganda

Introduction:
Between April 2022-November 2022 we collected all reports to analyse them for iteration that addressed apparent fitting in with international and local TB Prevention goals and Health Promotion work.
We have the following aims:
-gauge progress toward defeating HIV, TB and malaria and ensure a healthier, safer, more equitable future for all.
- informing interventions in low-and middle-income countries-based contexts and actors such as government, civil society, international organizations, private sector actors, academia, media and cultural institutes.
-translate the lessons to improve evidence use in TB Prevention health policy programming and planning.
-showcasing local application of strategies for ensuring Broadness, Evidence, Boldness and Advocacy (BEBA) iterative tools to meet the needs and preferences of TB affected in Kenya, Tanzania and Uganda.
Methodology:
The engagements included: the development of an in-house health promotion cultural stimulation tailored along the days of the week: 32 Lung Health-Mondays; 32 Trek, find, test and treat Tuesdays; 32 Wellness Wednesdays; 32 TB Thursdays; 32 Fix-it-N-Fit-in Fridays; 32 Saturate best practices Saturdays; 32 Self-care Sundays; 123 physical Focus Group Discussions; attending 12 Virtual-based Public dialogues (2 Uganda-based; 8 Kenya-based; and 2 Tanzania-based); 102 Zoom meetings; and literature reviews of 305 internet and email-based correspondences; 27 Organization Development trainings; and working with 187 CBOs (founded by women, youth, adolescents, TB Affected Persons, PLHIV Positive Clubs, TB Survivor Clubs, People With Disabilities, Refugee-Led Organisations, working with Soccer/Football Clubs and other entities).

Conclusion:
Our motto is: Think local and act global. Our work showcases local examples that cascade into international goals. We hope with this kind of information, consumers will access the kind of healthcare-related data they will use to inform decisions for preventing diseases, prolonging life and promoting health at different levels, engage in practices promoting their own health and the health of others.
Three (3) specific achievements made in progress towards TB elimination by our organization since 2018 are:

1. Mainstreaming Global Fund funding aspirations in 1,187 CBOs in 25 African countries through Organisation Development trainings.
2. Strategic Public Health Promotion to ensure science and lived experience stories inform each other.
3. Animate "leave no one behind" through affirmatively working with Key Populations, Vulnerable Populations, Priority Populations; Injecting, Drug, Alcohol and Substance Users; Persons with co-morbidities; Persons with Disabilities and Refugees.

We saw little to no progress toward TB elimination due to the following challenges which we feel impeded progress:

1. Support for Housing stability for 197/302 Persons with TB (beneficiaries).
2. Support for food security for 231/578 beneficiaries.
3. Transport vouchers to attend clinics following a Positive AAFBs test for 172/263 beneficiaries.
Recommendation for national and global decision-makers to address TB in the communities:
TB should be considered as both a Clinical manifestation and a non-clinical (civic, cultural, political, social, economic and gender) enabling and responsive contexts.

• Reaching all people through TB detection, diagnosis, treatment, care and prevention
1. Strategic Reach Out: Use various means to reach beneficiaries such as football, community events, market days, music, dance and drama and talent exhibition events to attract beneficiaries.
2. Testing: A move away from the microscope to molecular tests.
3. Treat: treatment that addresses all demography and vulnerabilities of the populations, e.g., Children, adolescents, adults, seniors, persons with disabilities and the like.
4. Detection: Detect Drug sensitivity; Drug resistance; and other barriers to healthy outcomes
5. Care: People centered care that addresses needs and preferences for all TB affected persons as well as no to stigma/discrimination.
6. Prevention: Primary/Secondary/Tertiary/Quaternary Prevention at upstream, midstream and downstream levels (comprehensive approach).

• Accelerating the development of, and access to, essential new tools to end TB” (e.g., rapid molecular tests, vaccine, digital tools for real-time data)

1. Provide ICT literacy and numeracy skilling.
2.Rapid molecular tests, vaccine and New Medicines provided at subsidised costs at all levels of health facilities.
3. Provide nutrition advise and address hygiene needs and preferences.

• Investing the funds necessary to end TB (e.g., domestic funding, Global Fund)

1. Involve public and private institutions; Commit to making the investments as well as improving community-built structures.

2. Committing to accountability, multi-sectorality and leadership on TB (e.g., from Heads of State, country coordinating mechanism).

3. Involve all actors in promoting TB Prevention and elimination activities.

• Leveraging COVID-19 as a strategic opportunity to end TB

1. Ensure housing stability
2. food security
3. livelihood projects
4. eco-conservation

• TB response be strengthened or transformed in a post-pandemic world as follows:

1. Provide funds, logistics and training to grassroots-based organisations to engage in End TB goal-oriented activities.
2. Improve community-built structures.
3. Housing stability, food security, livelihood assurance and eco-conservation must be emphasized.

COVID-19, Universal Health Coverage, Stigma and Uptake of TB Prevention Services Among At-Risk Populations With TB in Uganda 2020-2022, 2022

Background: COVID-19 lockdown restrictions affected at-risk population groups along these themes:... more Background: COVID-19 lockdown restrictions affected at-risk population groups along these themes: irregular income, food insecurity and housing instability. Optimal utilization of TB prevention services is subverted by frequent change of addresses, social stigma, lack of funds to pay to access services and frequent abuses faced by at-risk population groups. This study sought to inform programming by lower-level local governments, FBOs, CSOs and Community groups to include at-risk population needs.
Design/Methods: We administered a structured short questionnaire to respondents and conducted 5 focus group discussions inquiring into services and what the unique characteristics attributed to at-risk groups were. Respondents included: 650 MSM, 11 lesbians, 3 indigenous MSM from Benets and 7 Ndorobo tribes, 71 regular substance users, 47 were living with TB, 02 intersex, 05 transgender, 195 female sex-workers, 82 fisher folk and 150 leaders.
Results: At-risk population groups face barriers determined by socioeconomic standing, lack of insurance, safety concerns, social norms, family obligations, shortage of culturally sensitive/trained personnel in the service sector, and services or equipment that are not adapted to address the diverse needs and requirements representative of at-risk population groups. Identity and gender shape access, use, adherence and outcomes of prevention, curative, and care services. At-risk population groups faced hardships accessing opportunities for Universal Health Coverage and engaging in HIV Prevention practices. The difficulties were enhanced by ridicule, frequent residential changes, difficulty in accessing services such as sex/gender re-assignment, violence, abuses, religious and media-led stigmatizing campaigns. These affect agency, self-determination, productivity, autonomy and health seeking practices for individuals in these at-risk groups.
Conclusions: Identity or gender-responsive and culturally sensitive services leverage Universal Health Coverage and attaining of Sustainable Development Goal 3. A further disaggregated study into how each at-risk population group is affected can inform programming to challenge injustices pandered by criminalization. Summary: The socioeconomic standing or social spaces (towns, suburbs of Kampala, CBOs/CSOs/FBOs/ LLGs, Village Health Teams, men and young males’ board game spots, repair garages, furniture marts, and kiosks}; security, as well as political, legal, cultural and media organs impact health seeking practices of at-risk populations e,g., those with TB.

An analysis of costs and pathways to care after a negative TB evaluation August 2021-April 2022, 2022

Background and challenges to implementation: Studies show that Persons who were living with TB u... more Background and challenges to implementation:
Studies show that Persons who were living with TB upon testing negative after completion of medication need further support. That support comes with costs and in this study, we find out that the costs are characterized as: social, spiritual, psychological, mental, physical, financial, and cultural aspects which must be fulfilled to ensure completeness and full recovery. We followed 197 Persons in 6 TB Survivor Support Clubs in Kenya to characterize the costs and pathways to care after a negative TB evaluation.
Intervention or response:
A person recuperating needs reconnection, reassurance and counselling which restores dignity and at the same time prepares them for self-esteem building. These individuals return to the clinic or hospital for regular check-up, rebuild and reconnect with members of the social networks and pursue means to support themselves. We conducted a cross-sectional study of 197 patients with a negative TB evaluation at six (6) TB Survivor Support Clubs in Machakos, Kajiado, Nairobi Counties. Patients were traced 9 months post-evaluation using contact information from TB registers. We collected information on healthcare visits and implemented locally validated cost characterizing questionnaires to assess the social, psychological, mental, physical, cultural, and financial impact of their symptoms post-evaluation.
Results/Impact:
197 (100%) surveyed participants returned to healthcare facilities post-evaluation, with a median of 3 visits each. All incurred catastrophic costs (i.e., spent >30% annual household income); 100/197 reported indirect costs related to lost work. All 197 responded that costs are incurred before and after they test negative are financial, social, cultural, mental, psychological, and physical.
Conclusion:
Costs after a negative TB evaluation need to be captured by existing definitions of non-TB catastrophic health reports as these affect biosocial-cultural-medical facets of life. This can inform better policy, planning and programming if we are to eradicate TB by 2030and shows the relevancy of TB Survivor Support Clubs. Summary: TB Survivor support comes with costs characterized as: social, spiritual, psychological, mental, physical, financial, and cultural aspects. We followed 197 Persons in 6 TB Survivor Support Clubs in Kenya to characterize the costs and pathways to care after a negative TB evaluation.

Post-test and TB survivor grassroots-based CBOs leverage HIV/TB care at The Last Mile; a case of 7 expert PWD-led mobilization HIV prevention groups in Uganda, August 2021-May 2022

BACKGROUND: People living with HIV, key populations, and people at risk of HIV grasp such concept... more BACKGROUND: People living with HIV, key populations, and people at risk of HIV grasp such concepts like Public-Private Mix (PPM), Communities of Practice (CoP), Integrated Service Delivery (ISD), human rights, equality, and dignity, action against harmful practices, stigma, and discrimination when there is deliberate, strategic action to take them through participatory training sessions. This study followed groups from August 2021 to May 2022 and it aimed at gauging TB/HIV-related Prevention campaigns by CBOs which were formed as PWD-led Post-Test and TB Survivor Support Clubs in Uganda.

DESCRIPTION: A 9-month cross-sectional study, using contacts to regularly check compliance to strategic plans, updates of record books, checklists and minutes to track community outreach events promoting prevention.

LESSONS LEARNED: The report indicates that the CBOs connected beneficiaries to HIV testing, access to treatment, promoting care, referrals for non-communicable diseases care, attending clinic check-ups for viral suppression and uptake of integrated services including addressing vertical HIV transmission, SRH services, dental and ear, Family planning, spacing cancer screening, paediatric AIDS and other services. It is clear that the 7 CBOs were the constant reminders and motivation to adherence during the COVID-19 lockdown and during the easing for 784 Persons Living with HIV and 54 Living with TB. Through constant visibility and mobilization, they maintained a food supply-chain, checked in on each other and mobilized money which sustained 48 who would have faced housing instability and food insecurity.

CONCLUSIONS: Grassroots-based systems can be leveraged as health and social protection continuum spaces. This in turn supports wellness, livelihood, and enabling environments for people living with, at risk of, or affected by HIV to reduce inequalities and allow them to live and thrive.

Introduction: We aspire for UNAIDS 95:95:95 Goal; ensuring that all PLHIV are provided TB Prevent... more Introduction: We aspire for UNAIDS 95:95:95 Goal; ensuring that all PLHIV are provided TB Preventive treatment; and bringing anti-malarial services to the communities. But this is to put it bluntly. However, an understanding of vulnerability, appropriation, and adaptation through data appraisal, anecdotally, scholarship, policies and programmes reveal that discrepancies and disproportionalities abound which affect traction toward zero HIV, TB and Malaria by 2030. At the Global Fund/UN/WHO and government levels, focus is exclusively on the germ theory and good health, but less action in form funding that drives aspirations for wellness of people and their communities. Doing good is not antithetical to doing well. This paper explored the categories of the multiple exposures to formulate a clear conceptual framework which would facilitate analysis of vulnerability and adaptation to multiple interacting socioeconomic and biophysical changes for communities adapting to the end to HIV, TB, Malaria by 2030 integrating COVID-19 response and recovery.
Methodology: Between October 2021 to September 2022, we interacted with people using different methodologies such as Key Informant interviews (in our case: 2,930). We were able to characterize lived experiences, impacts, explored synergies and identified solutions and respondents’ priorities.
Findings: Communities have indigenous solutions to most of their needs and have ways to navigate the different categories of supply chains through identified resources. The resources are the local systems and structures which can be tapped into to address issues as they arise. All respondents revealed that family members, extended families or clans, support groups, area leaders (at traditional, cultural, civil society, religious, educational, industrial or production levels), local government structures (social services, roads, security, and state structures) and development partners included what they understood as PPM and COP.
The needs expressed at individuals, households, communities, local governments, and sectors levels feature a broad array of multi-scalar and multi-temporal, social, political, economic, and environmental determinants which may act as facilitators of barriers to the Zero HIV, TB, and Malaria by 2030 goal.
Conclusion: This presentation forms a conceptual framework that can be used to facilitate assessments and comparative analyses of vulnerability, develop a comprehensive typology of an enabling and responsive context. Our results reveal essential elements of a pragmatic approach for local- or wider scale vulnerability analysis and for planning appropriate solutions within the context of multiple interacting determinants.
Recommendations: This review focuses on community understanding of PPM and COP as aspirations of the Global Fund. However, the framework, typology and approach will be useful for understanding civil, economic, political, cultural, gender and social determinants as we strive for zero HIV, TB and Malaria by 2030.

When We Say, “Harm Reduction,” This Is How We See It Applied as We Go About Mobilizing CBOs Towards Zero HIV, TB, and Malaria by 2030: A Case of PWDs, Substance and Injecting Drug Users in Kenya, Tanzania and Uganda, 2022

Introduction: Harm reduction saves lives and protect the health of both people who use drugs an... more Introduction: Harm reduction saves lives and protect the health of both people who use drugs and their communities. 145 PWD were followed between October 2021-September 2022. This paper explored how ‘harm reduction’ can be used contextually, explored the categories of the multiple exposures to formulate a clear conceptual framework which would facilitate analysis of vulnerability and adaptation to multiple interacting socioeconomic and biophysical changes for communities adapting to the end to HIV, TB, Malaria by 2030 integrating COVID-19 response and recovery.
Methodology: Key informant interviews of 145 respondents, characterizing of vulnerability, appropriation, and adaptation through data appraisal.
Findings: All access anti-malarial services. 12 are injecting drug users; 32 are People living with sickle cell disease (SCD), 12 use tramadol infusion IV combined with nonopioids was effective to relieve moderate to severe pain due to Vaso-occlusive crisis and 10 had mild VOC-associated pain that required non-steroidal anti-inflammatory drugs (NSAIDs) e.g., Diclofenac and ibuprofen. All 67 PLHIV were virally suppressed and were provided TB Preventive treatment: 65 in all receive pain relief support; 10 have antidepressant withdrawal effects following tapering and use. 13 Persons with Epilepsy received medication, counselling about epilepsy, capacity building to live positively with epilepsy, and self-esteem building sessions. For Key, vulnerable and priority populations, harm reduction goes beyond just drugs because they need other support services such as transport to/from clinics, constant follow up, stable housing and food security.
Conclusion: A broad array of multi-scalar and multi-temporal, social, political, economic, and environmental determinants form the comprehensive typology of drivers and vulnerabilities experienced by the respondents. This in turn informs the essential elements for planning appropriate interventions.
Recommendations: This review provides insights for a framework, typology and approach useful for understanding vulnerability and planning adaptation to multiple vulnerabilities of different Key, vulnerable and priority populations in various social-ecological contexts.

Characterizing and Calibrating Household Interests on The Road To HIV, TB and Malaria Eradication By 2030 Integrating COVID-19 Recovery and Response for Communities in 3 East African Countries, September 2022, 2022

Introduction: There is a disparity of expectations between TB care and Prevention service provid... more Introduction:
There is a disparity of expectations between TB care and Prevention service providers and the beneficiaries. Between January to September 2022, we conducted community-wide-active-case finding, engaged in planned activities to reduce prevalence of TB such as linking those in need to care services and promoted practices geared at reducing risk of getting TB at individual and household levels for 10 identified communities. The international TB Treatment Goals are testing; treatment; adherence until cured. But the local realities are different. This paper seeks to showcase the localized needs of Persons living With TB in Uganda, Kenya, and Tanzania.

Method:
We reached 1,120 persons (200 in Tanzania; 600 in Uganda; and 320 in Kenya). 591 had tested negative following completion of TB treatment and were part of TB Survivor Clubs; 521 were on TB treatment medication. The COVID-19 Pandemic has had a negative impact on health seeking practices of the people already made hard by civil, social, economic, political, cultural and gender determinants.
Findings:
All respondents living with tuberculosis had zero monthly income but relied on the community social support and philanthropy networks. 591 admitted that they almost discontinued their medicines because of housing instability (120); food insecurity (140); and loss of economic livelihood (70). 70 admitted that engaging in eco-conservation friendly projects were opportunities for them to regain their self-esteem in communities that tended to stigmatize Persons with TB or an active TB history.
Conclusion:
community-wide-active-case finding, engaging in planned activities to reduce prevalence of TB such as linking those in need to care services and promoting practices geared at reducing risk of getting TB at individual and household levels foster Tuberculosis elimination programmes. Such practices address income loss for households and restoration of income which impact self-esteem, housing stability, food security and eco-conservation programmes.
Recommendations:
Planning, programming, and policy priorities must target the civil, social, economic, political, cultural and gender determinants which are key in ensuring the well-being of those living with tuberculosis or have got cured and have a negative TB diagnosis but need to be part of the TB Survivor Clubs to avoid relapse.

Background and challenges to implementation: Studies show that Persons who were living with TB up... more Background and challenges to implementation: Studies show that Persons who were living with TB upon testing negative after completion of medication need further support. That support comes with costs and in this study we find out that the costs are characterized as: social, spiritual, psychological, mental, physical, financial, and cultural aspects which must be fulfilled to ensure completeness and full recovery. We followed 197 respondents to gain insights used to generate this paper.

Background: Uganda's secularist stance is subverted by a lack of monopoly for human and social de... more Background: Uganda's secularist stance is subverted by a lack of monopoly for human and social development services, most are run by religious or private entities which are claiming greater social and community relevance. For at-risk populations, this is connected to disproportionate access and fuels TB prevention and health literacy inequity, violence, abuse, discrimination, and stigma. This study informs policy on how optimal access to TB Prevention literacy can catalyze inclusion, universal access and paths to HIV, TB and Malaria eradication by 2030 for all integrating COVID-19 response and recovery.

Demystify the "Hard" in The "Hard To Reach" Moniker, 2022

INTRODUCTION: Services can be out of reach for many population groups due to many factors. Champi... more INTRODUCTION: Services can be out of reach for many population groups due to many factors. Championing reforms and carrying out advocacy initiatives promote engagement in quality life seeking practices by MARPs, Key and Vulnerable Populations in Tanzania, Uganda, Kenya, and Burundi as local solutions close this gap and contribute to a critical mass of action that leads to service demand and delivery fostering quality life outcomes. This paper aims (a) to analyse the term "hard to reach" and the lived experiences of People with Disabilities (PWDs) (b) to gain insight into meaning-making around health seeking practices and (c) how self-help groups/CBOs have targeted life promoting benefits, ensure inclusion, equity, equality and quality life outcomes vis-à-vis HIV, TB and Malaria integrating COVID-19 Response and Recovery. METHODOLOGY: Research design N-1,150; research methods were Key Informant, questionnaire administering, checklist analysis and eligibility testing (1,150 eligible out of 2,100).

Tom Rogers Muyunga-Mukasa, 2024

For effective TB Prevention Literacy Campaigns: Facilitate TB prevention vaccine development, Pre... more For effective TB Prevention Literacy Campaigns:
Facilitate TB prevention vaccine development, Prevention Literacy to inform health seeking habits, stabilize housing, ensure food security, empower people to take charge and participate in efforts to end TB epidemic. Tuberculosis (TB) is an ancient disease; widely distributed across the world; and is the leading cause of death from bacterial infections. TB’s unclear pathogenic mechanisms, difficulty in screening for specific antigens, lack of ideal adjuvants, and the limitations of animal models make it harder to get a vaccine yet. Outcomes of TB are related to its virulence and the immunity of TB patients. Due to adverse effects, co-morbidities and social determinants of TB, without effective vaccines prevention is better than cure (Singh-Minot, et al., 2008; WHO, 2024; Zhuang, et al., 2023; 7 Zumla, et al., 2013).