Anne Katahoire - Academia.edu (original) (raw)

Papers by Anne Katahoire

Studies on adult learning and education, Dec 31, 2022

Arise (Kampala, Uganda), 1993

Research Square (Research Square), Feb 15, 2022

BACKGROUND: High prevalence of HIV and hypertension in sub-Saharan Africa puts HIV-infected adult... more BACKGROUND: High prevalence of HIV and hypertension in sub-Saharan Africa puts HIV-infected adults are at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among HIV-infected adults on antiretroviral therapy(ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities. METHODS: Using an explanatory mixed-methods approach we reviewed patient records, and interviewed both patients and providers during 2017 and 2018. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted log binomial regression to evaluate for predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening. RESULTS: Records for 1426 HIV-infected adults were reviewed. Patients had a median age of 35 years and 65% of them were female. Most were on ART (89% on first-line) with median duration was 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) >25 Kg/M2. In 2017 or 2018 patients made a median of 3 visits and 783 patients had a BP recorded, hence a period prevalence 55%. Older age, male sex, more clinic visits, and clinic site were associated with screening in the adjusted analyses. Erratic BP screening was collaborated by patients’ and providers’ interviews. This was attributed to challenges that included; patient numbers, staffing, provider apathy, access to treatment, and availability and function of BP equipment. CONCLUSION: Almost half of regular HIV clinic attendees at these prototypical primary care HIV clinics were not screened for hypertension for a whole year. Improving BP screening requires attention to addressing modifiable challenges and ensuring local buy-in beyond just providing equipment.

A critical analysis was conducted of content published in newspapers or aired on radio programs t... more A critical analysis was conducted of content published in newspapers or aired on radio programs that cover health systems and health systems research, as well as interviews of media staff and researchers. The study posits that the limited health systems research coverage may be due to a problematic lack of professional linkages between health researchers and media practitioners in Uganda. This project brief provides an overview of the analysis

PLOS global public health, Aug 15, 2022

Sepsis is a major global health problem, especially in sub-Saharan Africa. Improving patient care... more Sepsis is a major global health problem, especially in sub-Saharan Africa. Improving patient care requires that healthcare providers understand patients' priorities and provide quality care within the confines of the context they work. We report the perspectives of patients, caregivers and healthcare workers regarding care quality for patients admitted for sepsis to public hospitals in Uganda and Malawi. This qualitative descriptive study in two hospitals included face-to face semi-structured interviews with purposively selected patients recovering from sepsis, their caregivers and healthcare workers. In both Malawi and Uganda, sepsis care often occurred in resource-constrained environments which undermined healthcare workers' capacity to deliver safe, consistent and accessible care. Constraints included limited space, strained; water, sanitation and hygiene (WASH) amenities and practices, inadequate human and material resources and inadequate provision for basic needs including nutrition. Heavy workloads for healthcare workers strained relationships, led to poor communication and reduced engagement with patients and caregivers. These consequences were exacerbated by understaffing which affected handover and continuity of care. All groups (healthcare workers, patients and caregivers) reported delays in care due to long queues and lack of compliance with procedures for triage, treatment, stabilization and monitoring due to a lack of expertise, supervision and context-specific sepsis management guidelines. Quality sepsis care relies on effective severity-based triaging, rapid treatment of emergencies and individualised testing to confirm diagnosis and monitoring. Hospitals in resource-constrained systems contend with limitations in key resources, including for PLOS GLOBAL PUBLIC HEALTH

... Research Methods for Adult Educators in Africa Bagele Chilisa and Julia Preece ■ Developing P... more ... Research Methods for Adult Educators in Africa Bagele Chilisa and Julia Preece ■ Developing Programmes for Adult Learners in Africa Mathew Gboku and Nthogo Lekoko ■ The Social Context of Adult Learning in Africa Sabo Indabawa with Stanley Mpofu The Editorial Board ...

PLOS Medicine, Dec 16, 2021

Background Scaling up shorter regimens for tuberculosis (TB) prevention such as once weekly isoni... more Background Scaling up shorter regimens for tuberculosis (TB) prevention such as once weekly isoniazid-rifapentine (3HP) taken for 3 months is a key priority for achieving targets set forth in the World Health Organization's (WHO) END TB Strategy. However, there are few data on 3HP patient acceptance and completion in the context of routine HIV care in sub-Saharan Africa. Methods and findings The 3HP Options Trial is a pragmatic, parallel type 3 effectiveness-implementation randomized trial comparing 3 optimized strategies for delivering 3HP-facilitated directly observed

Global health, science and practice, Aug 12, 2022

Access to vaccination services for children in Kampala is high; however, vaccination uptake and t... more Access to vaccination services for children in Kampala is high; however, vaccination uptake and timeliness decrease over time, as indicated by the high percentage of partially vaccinated children (58.6%). n Parents of partially vaccinated children stated that receiving inadequate information about immunization from health workers was a barrier to vaccination. This highlights the need for tailored health education and social mobilization efforts in Kampala taking into consideration the transient and diverse populations. n Vaccine stock-outs and long waiting times prevented parents from vaccinating their children. Stronger public-private partnerships in urban areas could help address these barriers. n A primary health care model that harnesses the strengths of the private sector can help address the barrier of hidden immunization costs that deter people from seeking immunization services. n Innovative survey methods that capture data from the highly mobile nonresidents in urban settings need to be developed as this population contributes to the pool of children that need to be immunized but also to the risk of disease outbreaks.

BMC Health Services Research, Aug 15, 2022

Background: High prevalence of HIV and hypertension in sub-Saharan Africa puts adults living with... more Background: High prevalence of HIV and hypertension in sub-Saharan Africa puts adults living with HIV (ALWH) at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among ALWH on antiretroviral therapy (ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities. Methods: Using a sequential explanatory mixed-methods approach, we reviewed patient records, and interviewed both patients and providers during 2018 and 2019. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted modified Poisson regression models to evaluate predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening. Results: Records for 1426 ALWH were reviewed. Patients had a median age of 35 years and 65% of them were female. Most were on ART (89% on first-line) with a median duration of 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) > 25 Kg/M 2. In 2017 or 2018 patients made a median of 3 visits and 783 patients had a BP recorded, hence a period prevalence 55%. Older age, male sex, more clinic visits, and clinic site were associated with screening in the adjusted analyses. Erratic BP screening was corroborated by patients' and providers' interviews. Challenges included; high patient numbers, low staffing, provider apathy, no access to treatment, and lack of functioning of BP equipment. Conclusion: Almost half of regular HIV clinic attendees at these prototypical primary care HIV clinics were not screened for hypertension for a whole year. Improving BP screening requires attention to address modifiable challenges and ensure local buy-in beyond just providing equipment.

PLOS Global Public Health

Early initiation of antiretroviral therapy (ART) after HIV diagnosis prevents HIV transmission, p... more Early initiation of antiretroviral therapy (ART) after HIV diagnosis prevents HIV transmission, progression of HIV to AIDS and improves quality of life. However, little is known about the barriers to timely ART initiation among patients who test HIV positive in settings different from where they will receive HIV treatment, hence are referred in the routine setting. Therefore, we explored the perspectives of people living with HIV on barriers faced to initiate ART following HIV testing and referral for treatment. In this qualitative study, we purposively sampled and enrolled 17 patients attending the Mulago ISS clinic. We selected patients (≥18 years) who previously were received as referrals for HIV treatment and had delayed ART initiation, as ascertained from their records. We conducted in-depth interviews, which were audio recorded, transcribed and translated. We used Atlas.ti version 9 software for data management. Data analysis followed thematic and framework analysis techniques...

Journal of Contextual Behavioral Science

The Global Health Network Conference Proceedings 2022

Introduction Community Client-Led ART Delivery (CCLAD) is a community HIV care model. In this mod... more Introduction Community Client-Led ART Delivery (CCLAD) is a community HIV care model. In this model, a group of persons living with HIV (PLHIV) in a specific location, take turns going to the HIV clinic to pick up Antiretroviral Treatment refills for members. The uptake of this model, however, remains low despite its improvements in patient retention. In this study, we explored PLHIV's perceptions of this model and identified the factors associated with its low uptake. Methods This was a mixed methods study based on a retrospective review of records of PLHIV and in-depth interviews. We reviewed the medical records of people receiving ART to determine their current model of ART delivery and conducted in-depth interviews with 30 participants who were eligible to be enrolled in the CCLAD model at the Mulago ISS clinic. We performed logistic regression to identify factors associated with the uptake of the CCLAD model and inductive thematic analysis to explore PLHIV's perceptions of the CCLAD model. Results A total of 776 PLHIV were sampled for the study, 545 (70.2%) of whom were female. The mean age (standard deviation) was 42 (± 9.3) years. Overall, 55 (7.1%) received ART using the CCLAD model. Compared to other ARTdelivery models, CCLAD was associated with being on ART for at least eight years (AOR 3.72; 95% CI: 1.35-10.25) and having no prior missed clinic appointments (AOR 10.68; 95% CI: 3.31-34.55). Mixed perceptions were expressed about the CCLAD model. Participants interviewed appreciated CCLAD for its convenience and the opportunities it offered members to talk and support each other. Others however, expressed concerns about the process of group formation, and feeling detached from the health facility with consequences of lack of confidentiality. Conclusion The current uptake of the CCLAD model is lower than the national recommended percentage of 15%. Its uptake was associated with those who had been in care for a longer period and who did not miss appointments.

The International Journal of Tuberculosis and Lung Disease

BACKGROUND: Twelve weeks of weekly isoniazid and rifapentine (3HP) prevents TB disease among peop... more BACKGROUND: Twelve weeks of weekly isoniazid and rifapentine (3HP) prevents TB disease among people with HIV (PWH), but the costs to people of taking TB preventive treatment is not well described.METHODS: We surveyed PWH who initiated 3HP at a large urban HIV/AIDS clinic in Kampala, Uganda, as part of a larger trial. We estimated the cost of one 3HP visit from the patient perspective, including both out-of-pocket costs and estimated lost wages. Costs were reported in 2021 Ugandan shillings (UGX) and US dollars (USD; USD1 = UGX3,587)RESULTS: The survey included 1,655 PWH. The median participant cost of one clinic visit was UGX19,200 (USD5.36), or 38.5% of the median weekly income. Per visit, the cost of transportation was the largest component (median: UGX10,000/USD2.79), followed by lost income (median: UGX4,200/USD1.16) and food (median: UGX2,000/USD0.56). Men reported greater income loss than women (median: UGX6,400/USD1.79 vs. UGX3,300/USD0.93), and participants who lived further...

Health Research Policy and Systems

BackgroundIn Uganda and other resource-poor countries, relevant research findings face a tortuous... more BackgroundIn Uganda and other resource-poor countries, relevant research findings face a tortuous path to translation into policy and routine practice. Implementation science (ImSc) research could facilitate faster translation. Presently it is unclear what ImSc research capacity and possible training needs exist among Ugandan researchers. To assess both components, we interviewed potential trainees in Kampala, Uganda.MethodsWe used a cross-sectional design to survey potential ImSc trainees who had some research training and involvement in generating or utilizing research. Using a questionnaire, we documented eligibility for ImSc training, knowledge and interest in training, existing self-assessed confidence in initiating clinical research (SCICR) and self-assessed confidence in initiating ImSc research (SCIIR), availability for training and preferred modes of training. We developed scores from the Likert scales and used descriptive statistics, logistic regression and ordinal logisti...

In this cohort study, we determined time to blood pressure (BP) control and its predictors among ... more In this cohort study, we determined time to blood pressure (BP) control and its predictors among hypertensive PLHIV enrolled in integrated hypertension-HIV care based on the World Health Organization (WHO) HEARTS strategy at Mulago Immunosuppression Clinic in Uganda. From August 2019 to March 2020, we enrolled hypertensive PLHIV aged \(\ge\)18 years and initiated Amlodipine 5mg mono-therapy for BP (140–159)/(90–99) mmHg or Amlodipine 5mg/Valsartan 80mg duo-therapy for BP ≥ 160/90mmHg. Patients were followed with a treatment escalation plan until BP control, defined as BP < 140/90 mmHg. We used Cox proportional hazards models to identify predictors of time to BP control. Of 877 PLHIV enrolled (mean age 50.4 years, 62.1% female), 30% received mono-therapy and 70% received duo-therapy. In the monotherapy group, 66%, 88% and 96% attained BP control in the first, second and third months, respectively. For patients on duo-therapy, 56%, 83%, 88% and 90% achieved BP control in the first,...

BMJ Global Health

IntroductionUganda’s district-level administrative units buttress the public healthcare system. I... more IntroductionUganda’s district-level administrative units buttress the public healthcare system. In many districts, however, local capacity is incommensurate with that required to plan and implement quality health interventions. This study investigates how a district management strategy informed by local data and community dialogue influences health services.MethodsA 3-year randomised controlled trial (RCT) comprised of 16 Ugandan districts tested a management approach, Community and District-management Empowerment for Scale-up (CODES). Eight districts were randomly selected for each of the intervention and comparison areas. The approach relies on a customised set of data-driven diagnostic tools to identify and resolve health system bottlenecks. Using a difference-in-differences approach, the authors performed an intention-to-treat analysis of protective, preventive and curative practices for malaria, pneumonia and diarrhoea among children aged 5 and younger.ResultsIntervention distr...