HIV and transgender women in Kampala, Uganda - Double Jeopardy.

Transgender women in Kampala face stigma, high HIV acquisition or transmission risk and poor access to health services. We explored the HIV and gender-related contexts of their lives. Snowball sampling was used to enrol 45 participants between July-October 2013. Data collection included audio-computer-assisted self-interviews, qualitative face-to-face interviews and blood tests for HIV and CD4. One in five respondents tested HIV positive. Emergent themes revealed highly varied forms of gender identity and gender expression. Almost all respondents asserted that they frequently engaged in sex work, mainly due to lack of employment. HIV-related themes included limited access to non-stigmatising health services, inconsistent condom use, inaccurate perceptions of self and partners' risk, alcohol use, receptive anal sex with men, multiple sex partners, frequent self and enacted stigma, and violence. Findings highlight the urgency of providing members of this marginalised population with tailored, innovative, comprehensive and effective HIV prevention programmes that address structural issues such as access to HIV services and limited employment as well as behavioural issues such as inconsistent condom use, multiple sexual partners, self and enacted stigma, violence and alcohol use.

Turnaround time and barriers to treatment of newly diagnosed cancer in Uganda: a mixed-methods longitudinal study.

Introduction: Cancer represents a growing public health concern. Late-stage at diagnosis, limited access to effective treatment, and loss to follow-up are responsible for dismal outcomes. Objective: To describe care pathways, turnaround times, and identify barriers to timely initiation of cancer treatment. Methods: Using a sequential mixed-methods design involving focus group discussions, we followed up 50 participants between January, and June 2018. We computed the median observed turnaround time to treatment (TTT) at each care step and reported delay as deviations from the proposed ideal turnaround times. Results: The ideal TTT with either chemotherapy, or radiotherapy, or surgery was 8, 14, and 21 days respectively. At a median follow-up time of 35.5 days (IQR 17-66), only 29 of the 50 study participants had completed all steps between registration and initiation of treatment, and the observed median TTT was 16 days (9 - 22 days) for chemotherapy, and 30 days (17 - 49 days) for radiotherapy, reflecting a significant delay (p-value = 0.017). Reported barriers were; shortage of specialists, patients required visits to outside facilities for staging investigations, prohibitive costs, poor navigation system and time wastage. Conclusions: When compared to the recommended ideal turnaround time, there was significant institutional delay in access to chemotherapy and radiotherapy attributed to multiple external and internal healthcare system barriers.