Facilitators and barriers to initiating and completing tuberculosis preventive treatment among children and adolescents living with HIV in Uganda: a qualitative study of adolescents, caretakers and health workers.

INTRODUCTION: People living with HIV (PLHIV) have a 20-fold risk of tuberculosis (TB) disease compared to HIV-negative people. In 2021, the uptake of TB preventive treatment among the children and adolescents living with HIV at the Baylor-Uganda HIV clinic was 45%, which was below the national target of 90%. Minimal evidence documents the enablers and barriers to TB preventive treatment (TPT) initiation and completion among children and adolescents living with HIV(CALHIV). We explored the facilitators and barriers to TPT initiation and completion among CALHIV among adolescents aged 10-19years and caretakers of children below 18years. METHODS: We conducted a qualitative study from February 2022 to March 2023, at three paediatric and adolescent HIV treatment centers in Uganda. In-depth interviews were conducted at TPT initiation and after completion for purposively selected health workers, adolescents aged 10-19 years living with HIV, and caretakers of children aged below 18years. RESULTS: The desire to avoid TB disease, previous TB treatment, encouragement from family members, and ministry of health policies emerged as key facilitators for the children and adolescents to initiate TPT. Barriers to TPT initiation included; TB and HIV-related stigma, busy carer and adolescent work schedules, reduced social support from parents and family, history of drug side effects, high pill burden and fatigue, and perception of not being ill. TPT completion was enabled by combined TPT and ART refill visits, delivery of ART and TPT within the community, and continuous education and counseling from health workers. Reported barriers to TPT completion included TB and HIV-related stigma, long waiting time. Non-disclosure of HIV status by caretakers to CALHIV and fear of side effects was cited by health workers as a barrier to starting TPT. Facilitators of TPT initiation and completion reported by healthcare workers included patient and caretaker health education, counselling about benefits of TPT and risk of TB disease, having same appointment for TPT and ART refill to reduce patient waiting time, adolescent-friendly services, and appointment reminder phone calls. CONCLUSION: The facilitators and barriers of TPT initiation and completion among CALHIV span from individual, to health system and structural factors. Health education about benefits of TPT and risk of TB, social support, adolescent-friendly services, and joint appointments for TPT and ART refill are major facilitators of TPT initiation and completion among CALHIV in Uganda.

Knowledge and perceptions of religious leaders toward HIV prevention among young people in a resource-limited setting: A qualitative study.

Background: Currently, 410,000 new HIV infections among youth occur worldwide, which is a significant public health issue. Members of the clergy can be trustworthy allies in the reduction of HIV infections among the youth. However, little is known regarding their knowledge as well as the perceptions they hold towards HIV prevention among young people. Thus, we explored the knowledge and perceptions of religious leaders regarding HIV prevention among young people (15-24 years) in Lira district. Methods: This was a cross-sectional qualitative study conducted among 20 religious leaders in March 2021 in Lira district. Religious leaders were sampled purposively and recruited from modern religions (beliefs influenced by Christianity or Islam) in Lira district. Guides for key informant interviews were utilized to gather information. Each interview was audio recorded, transcribed, and entered into NVivo version 12 software, and the data was then ready for analysis. The main themes were determined using thematic analysis. Results: Although a few individuals had some misconceptions, the majority of participants had good knowledge about the transmission and prevention of HIV. Participants knew awareness creation, abstinence, and faithfulness in marriage as HIV prevention strategies and held positive perceptions. Perceived barriers to HIV prevention involvement were lack of knowledge and training, and inadequate resources whereas motivating factors were; being respected, and trusted, and having easy access to young people. Conclusion: In conclusion, religious leaders show limited HIV prevention knowledge due to religious beliefs, but understand the importance of measures like abstinence. Despite challenges, their involvement is crucial. Addressing knowledge gaps and providing support is vital. Future efforts should emphasize both behavioral measures and interventions like condom use, Post Exposure Prophylaxis, and Pre-Exposure Prophylaxis.

The role of religious leaders on the use of HIV/AIDS prevention strategies among young people (15-24) in Lira district, Uganda.

BACKGROUND: Young people (15-24 years) bear the highest burden of new infections and are particularly vulnerable because of their highly risky behavior such as early sexual activity. There is paucity of information on the role of religious leaders in the multi-sectoral fight against HIV/AIDS. We examined the role of religious leaders in the use of HIV prevention strategies among young people. METHODS: A cross sectional study was conducted between March and April 2021 among 422 randomly selected young people in Lira district, Uganda. An interviewer administered a questionnaire to the young people in order to collect quantitative data. A total 20 key informants were purposively sampled and interviews were conducted with religious leaders using a key informant's interview guide. Data was collected on social demographics, HIV prevention messages, and awareness about HIV prevention strategies. Data was analyzed using Stata version 15 using proportions, means, percentages, frequencies, and logistic regression analysis at a 95% level of significance. Qualitative data was analyzed using thematic content analysis and the major themes were generated from the participants' responses. RESULTS: About 57.1% (241/422) of the respondents were females. The prevalence of use of HIV prevention strategies among young people was 69.4%. Factors significantly associated with the use of HIV prevention included completing the primary level (aOR 4.95, p< 0.05), completing at least A level (aOR 8.85, p < <0.05), Awareness of HIV prevention strategies advocated for by religious leaders (aOR 0.02, p<0.001), religious leaders provided targeted HIV prevention messages (aOR 2.53, p<0.01), Advocacy for abstinence outside marriage and fidelity in marriage (aOR 35.6, p<0.01), Religious leaders preaching about HIV prevention (aOR 4.88, p<0.001). Qualitative data indicated that a section of religious leaders recommended abstinence/faithfulness. Condom use was the most discouraged HIV prevention strategy. However, most religious leaders agree with the fact that they have a role to play in HIV prevention, which includes sensitization, teaching and organizing sermons about HIV prevention. CONCLUSION: The use of HIV prevention strategies advocated for by religious leaders among young people was nearly 70%. This finding indicates that religious leaders have a role to play in HIV/AIDS prevention among young people in the Lira district. This calls for the involvement of religious leaders in HIV prevention programs tailored to prevent new infections of HIV among young people.