Jolly Beyeza-kashesya - Academia.edu (original) (raw)

Papers by Jolly Beyeza-kashesya

AIDS and Behavior

Perinatal depression has been shown to impede adherence to antiretroviral therapy (ART) and the p... more Perinatal depression has been shown to impede adherence to antiretroviral therapy (ART) and the prevention of mother-to-child transmission (PMTCT) care continuum; therefore, treating perinatal depression may result in increased viral suppression and PMTCT adherence. We examined the effects of the M-DEPTH (Maternal Depression Treatment in HIV) depression care model (including antidepressants and individual Problem Solving Therapy) on depression, maternal viral suppression and adherence to PMTCT care processes in an ongoing cluster-randomized controlled trial of 391 HIV-infected pregnant women (200 usual care; 191 intervention) with at least mild depressive symptoms enrolled across 8 antenatal care clinics in Uganda. At baseline, 68.3% had clinical depression and 41.7% had detectable HIV viral load. Adjusted repeated-measures multivariable regression models found that the intervention group was nearly 80% less likely to be clinically depressed [Adjusted OR (95% CI) 0.22 (0.05, 0.89)] ...

Introduction: Cervical cancer (CC) rates are high in Uganda, yet CC screening rates are very low.... more Introduction: Cervical cancer (CC) rates are high in Uganda, yet CC screening rates are very low. Our peer advocacy group intervention, Game Changers for Cervical Cancer Prevention (GC-CCP), was shown to increase CC screening uptake among social network members. In this secondary analysis, we examined mediators and moderators of this effect to better understand how and for whom the intervention was most successful in promoting CC screening. Methods: We conducted a pilot randomized controlled trial of GC-CCP in Namayingo district, Eastern Uganda between September 2021 and April 2022. Forty adult women who had screened for CC in the past year (index participants) enrolled at baseline: 20 were randomized to receive the 7-session intervention to empower women to engage in CC prevention advocacy, and 20 were assigned to the waitlist control; from these index participants, 103 unscreened social network members (alters) also enrolled. All participants were assessed at baseline and month 6 ...

Pilot and Feasibility Studies

Introduction Cervical cancer (CC) is the most common cancer and accounts for one quarter of all c... more Introduction Cervical cancer (CC) is the most common cancer and accounts for one quarter of all cancer-related deaths among women in Uganda, where lifetime CC screening is estimated to be as low as 5%. This study will evaluate the feasibility, acceptability, and preliminary efficacy of a social network-based group intervention designed to empower women who have received CC screening to encourage women in their social network to also screen. Methods Forty adult women (index participants) who have recently screened for CC will be recruited, 20 of whom will be randomly assigned to take part in the intervention and 20 to the wait-list control. Each index participant will be asked to recruit up to three female social network members (i.e., alters; maximum total = 120 alters) who have not screened for CC to participate in the study. Assessments (survey and chart abstraction) will be administered at baseline and month 6 to index and alter participants. The primary outcome is CC screening a...

Open Research Africa

Background: Preventable maternal and newborn deaths remain a global concern, particularly in low-... more Background: Preventable maternal and newborn deaths remain a global concern, particularly in low- and middle-income countries. Timely maternal death surveillance and response (MDSR) is a recommended strategy to account for such deaths through identifying contextual factors that contributed to the deaths to inform recommendations to implement in order to reduce future deaths. With the leadership of WHO and UNFPA, there is momentum to roll out MDSR, however, the barriers and enablers for implementation have received limited attention. These have important implications for successful implementation. The aim of this study was: To assess barriers and facilitators to implementation of MDSR at a busy urban National Referral Hospital as perceived by health workers, administrators, and other partners in Reproductive Health. Methods: Qualitative study using in-depth interviews (24), 4 focus-group discussions with health workers, 15 key-informant interviews with health sector managers and impl...

African Health Sciences

Background: Reviewing maternal deaths and drawing out lessons for clinical practice is part of an... more Background: Reviewing maternal deaths and drawing out lessons for clinical practice is part of an effective cohesive intervention strategy to reduce future deaths. Objective: To review maternal deaths at the National Referral hospital in Kampala over a 3-year period (2016-2018) to determine causes of death, extent of preventability, proportion of deaths notified and audited as per national guidelines. Methods: Trained-multidisciplinary panels (obstetricians and senior midwives) conducted retrospective reviews of maternal deaths that occurred. Results: Major causes of deaths: obstetric haemorrhage (158/350; 45%), hypertensive disorders of pregnancy (87/350; 25%) and infection (95/350; 27%). Overall, 294/350 (84%) of maternal deaths were considered preventable. In 95% (332/350) of cases, delays within healthcare facilities were identified (64%; 226/350). We note that only 115/350 (33%) cases had been audited. This proportion did not change during the studied period. In 48% (167/350) o...

Additional file 5: Supplemental Table 4. Bivariate correlates of pregnancy among study completers... more Additional file 5: Supplemental Table 4. Bivariate correlates of pregnancy among study completers who tried to conceive during study (n=265)

Additional file 4: Supplemental Table 3. Criteria for determining accurate use of timed condomles... more Additional file 4: Supplemental Table 3. Criteria for determining accurate use of timed condomless intercourse (TCI) and manual self-insemination (MSI)

To use or not to use a condom: A prospective cohort study comparing contraceptive practices among... more To use or not to use a condom: A prospective cohort study comparing contraceptive practices among HIV-infected and HIV-negative youth in

International Journal of Gynecology & Obstetrics, 2012

AIDS and Behavior, 2022

Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa’s initial ... more Uptake of pre-exposure prophylaxis (PrEP) fell short of targets for Sub-Saharan Africa’s initial rollout, revealing the need for more effective promotion strategies. In Uganda, we explored potential benefits and challenges of integrating safer conception messaging to promote PrEP among serodiscordant couples. In-depth interviews were conducted with clients and personnel at three clinics and analyzed thematically. Participants (n = 58) valued PrEP as a safer conception method (SCM) but described lack of integration of safer conception and PrEP services as well as inconsistent practices in prescribing PrEP to couples pursuing conception. Participants reported that the wider population remains largely unaware of PrEP and SCM or harbors misconceptions that PrEP is primarily for highly stigmatized groups like sex workers. Participants further described how heterosexual couples can still be reluctant to test for HIV, unaware of tools like PrEP and SCM that would allow them to continue their relationship and/or pursuit of childbearing. Overall, findings suggest that integrating PrEP and SCM in messaging and services targeting serodiscordant couples holds untapped benefits throughout the HIV prevention cascade.

Additional file 2: Supplemental Table 1. Our Choice safer conception counseling topics by session

International Journal of Gynecology & Obstetrics, 2009

92% (12/13). A small thymus showed high sensitivity and specificity (91% and 100%) for histologic... more 92% (12/13). A small thymus showed high sensitivity and specificity (91% and 100%) for histological sings of inflammation. Conclusion: We therefore conclude that a normal sized thymus might be useful in ruling out latent intrauterine infection. Moreover, our findings also suggest that small transversal thymic diameter is associated with acute inflammatory changes in all placental tissue samples, and not only with chorioamnionitis and funisitis.

Background: Sexuality and reproduction in mature generalised HIV epidemics pose significant dilem... more Background: Sexuality and reproduction in mature generalised HIV epidemics pose significant dilemma to both HIV infected and negative people. Sexually active young people and HIV serodiscordant couples are faced with difficult decision-making about procreation and HIV transmission. Insufficient data exists about fertility decision-making and how to handle sexuality and fertility among the HIV-infected youth and mutually disclosed discordant couples. Aim: To explore the influence of HIV on fertility decision-making among young people and people in HIV-discordant relationship in Uganda Methods: The four studies used qualitative (focus group discussions-study I, II, and III) and quantitative methods (semi-structured questionnaire-study III and IV). We explored the views of the youth on reasons for high fertility in Uganda and how decisions are made among the youth in the general population (study I) and among HIV-infected youth (study II). A cross sectional study (study III) assessed fertility decision-making among the discordant couples, and a prospective cohort (study IV) assessed how HIV-infected and negative youth sustain their fertility decisions over a period of one year. Thematic and content analysis were used for qualitative data and uni-variate, bi-variate and multivariate analysis for the quantitative data. Results Patriarchy, culture and religion contribute to sustaining high fertility in Uganda (paper I). The majority (57%) would like to have children but have to grapple with the dilemma of HIV transmission to partner (paper II and III). Less than a half (44%) among the HIV-infected youth compared to two thirds (61%) among the HIV-negative youth made a consistent fertility decision, OR = 0.52 (0.38, 0.70). In total, 24% among the HIV-negative and 18% among the HIV-infected continued to use contraception throughout the year, OR 0.63 (0.41, 0.98), while 12% and 28% among the HIV-negative and infected respectively did not use contraception, OR 2.80 (1.80, 4.36) (paper IV). Conclusions: Young people in central Uganda are still strongly influenced by the patriarchal, cultural and religious norms with the male gender enjoying a superior position. This compels women to desire many boys for their security and happiness (paper I). Many HIV serodiscordant couples in central Uganda desire to have children and are planning to conceive but the highest desire for children is among the young people (paper III, IV). The desire to have children hinders safe sex practice among HIV sero-discordant couples (paper II). The discordant couples committed to condom use have to risk HIV transmission, or look for a sero-concordant partner to get children. Others seek high-risk concurrent partnerships for children and sexual pleasure (paper II). HIV infected youth are not empowered to practice or sustain consistent contraceptive use or adopt preventive strategies" (paper I, IV). The current dialogue with health workers is not increasing contraceptive use, especially among the HIV-infected youth (paper IV). Implications: Uganda's cultural norms still favour high fertility and having HIV infection cannot remove the quest to fulfil patriarchal obligations. If not assisted, PLHIV will continue to practice high-risk sex to reproduce. A multi-sectoral approach uniting cultural, political and public institutions is needed to design programs that may stem the HIV epidemic. Strengthening family planning services should include planning for conception for the PLHIV. Critically, in addition to the need for the cultural re-learning processes to desire less children, we need to introduce low-cost harm reduction techniques for reproduction (timed intercourse, sperm washing) to assist PLHIV who want to have children to do so with minimal HIV transmission.

Background The unmet need for contraceptives among refugee adolescents is high globally, leaving ... more Background The unmet need for contraceptives among refugee adolescents is high globally, leaving girls vulnerable to unintended pregnancies. Lack of knowledge and fear of side effects are the most reported reasons for non-use of contraceptives amongst refugee adolescents. Peer counselling, the use of trained adolescents to offer contraceptive counselling to fellow peers, has showed effectiveness in increasing use of contraceptives in non-refugee adolescent resarch. Objective To determine the effect of peer counselling on acceptance of modern contraceptives among female refugee adolescents in northern Uganda. Methods A randomised controlled trial carried out in Palabek refugee settlement in northern Uganda, May to July 2019. Adolescents were included if they were sexually active or in any form of union, wanted to delay child bearing, and were not using any contraceptives. A total of 588 consenting adolescents were randomised to either peer counselling or routine counselling, the stan...

BackgroundPrevention of unplanned pregnancies among HIV-infected individuals is critical to the p... more BackgroundPrevention of unplanned pregnancies among HIV-infected individuals is critical to the prevention of mother to child HIV transmission (PMTCT), but its potential has not been fully utilized by PMTCT programmes. The uptake of family planning methods among women in Uganda is low, with current use of family planning methods estimated at 24%, but available data has not been disaggregated by HIV status. The aim of this study was to assess the utilization of family planning and unintended pregnancies among HIV-infected people in Uganda.MethodsWe conducted exit interviews with 1100 HIV-infected individuals, including 441 men and 659 women, from 12 HIV clinics in three districts in Uganda to assess the uptake of family planning services, and unplanned pregnancies, among HIV-infected people. We conducted multivariate analysis for predictors of current use of family planning among women who were married or in consensual union and were not pregnant at the time of the interview.ResultsO...

Context Among people living with HIV in Uganda, desires to have a child and unplanned pregnancies... more Context Among people living with HIV in Uganda, desires to have a child and unplanned pregnancies are both common, while utilization of safer conception methods (SCM) and modern contraceptives are low. Methods Three hundred eighty-nine HIV clients who reported considering childbearing with their uninfected partner enrolled in a safer conception counseling intervention trial in Uganda. Multiple regression analysis and baseline data were used to examine correlates of reproductive intentions and behaviors, including use of safer conception methods and contraception. Results Most ( n = 313; 80.5%) reported that both they and their partner wanted to have a child now, which was associated with being married, in a longer relationship, not having a child with partner, greater SCM knowledge, lower internalized childbearing stigma, and higher perceived community stigma of childbearing. However, just 117 reported trying to conceive in the prior 6 months, which was associated with being female...

Implementation Science

Background Safer conception counseling (SCC) to promote the use of safer conception methods (SCM)... more Background Safer conception counseling (SCC) to promote the use of safer conception methods (SCM) is not yet part of routine family planning or HIV care. Guidelines for the use of SCM have been published, but to date there are no published controlled evaluations of SCC. Furthermore, it is unknown whether standard methods commonly used in resource constrained settings to integrate new services would be sufficient, or if enhanced training and supervision would result in a more efficacious approach to implementing SCC. Methods In a hybrid, cluster randomized controlled trial, six HIV clinics were randomly assigned to implement the SCC intervention Our Choice using either a high (SCC1) or low intensity (SCC2) approach (differentiated by amount of training and supervision), or existing family planning services (usual care). Three hundred eighty-nine HIV clients considering childbearing with an HIV-negative partner enrolled. The primary outcome was self-reported use of appropriate reprodu...