Prevalence and associated factor of postpartum depression among mothers living with HIV at an urban postnatal clinic in Uganda.

BACKGROUND: Postpartum depression among mothers living with HIV is a significant public health problem due to its effects on engagement in care, HIV disease progression, and an increased risk of mother-to-child transmission of HIV. OBJECTIVE: The objective of this study was to determine the prevalence and factors associated with postpartum depression among mothers living with HIV. DESIGN: The study employed a cross-sectional quantitative research design. METHODS: In this cross-sectional survey, we consecutively recruited 290 participants among mothers attending postnatal, immunization, and family planning clinics at an urban clinic in Uganda. Using an interviewer-administered questionnaire, we collected data on socio-demographics, obstetric, and HIV-related characteristics. Postpartum depression was assessed using the Patient Health Questionnaire version 9. We classified participants with Patient Health Questionnaire version 9 scores of ⩾10 as having postpartum depression. We conducted logistic regression to examine the association between postpartum depression and independent variables. RESULTS: The prevalence of postpartum depression was 15.9%. After controlling for other variables, participants who reported poor male partner support were more likely to experience postpartum depression compared to those who had good partner support (adjusted odds ratio = 4.52, confidence interval = 2.31-8.84, p value < 0.001). CONCLUSION: Mothers living with HIV should be routinely assessed for the presence of depression and male partner support. Health care providers of HIV-infected women should design strategies to promote male partner support for better maternal, infant, and HIV treatment outcomes.

Perceived risk and risk reduction behaviours of female first-degree relatives of breast cancer patients attending care at Uganda cancer institute.

OBJECTIVE: The objective of this study was to assess the perceived risk of breast cancer (BC) and adoption of risk reduction behaviours among female first-degree relatives (FDRs) of BC patients attending care at the Uganda Cancer Institute (UCI). METHODS: A cross-sectional study was performed using a questionnaire to collect data between March to October 2019. Adult female FDRs of patients attending care at UCI were recruited consecutively. Breast cancer perceived risk was assessed using a verbal measure; 'My chances of getting BC are great' on a Likert scale with 5 response alternatives. Chi square tests and modified Poisson regression using generalised estimating equations model were used to determine associations and examine factors associated with perceived risk of BC. RESULTS: We enrolled 296 FDRs from 186 female BC patients. Few participants 118/296 (40%) had high perceived risk of BC. Majority 165/296 (56%), had ever practiced breast self-examination. At the multivariable modified Poisson GEE model, women aged 36-45 years were more likely to perceive themselves to be at high risk of developing BC compared to women aged 18-25 years (adjusted prevalence ratio: 1.174; 95% confidence interval [95%CI] = 1.05-2.88; p value = 0.030) after adjusting for age, religion, educational level and residence. CONCLUSION: Few FDRs of BC patients perceived themselves to be at high risk of developing BC and do not seek risk reduction measures including screening and early diagnosis approaches. Breast cancer health education especially targeting younger women should emphasize the increased risk of BC in FDRs.

Acceptability, Feasibility, and Efficacy of Telehealth Interventions for HIV Testing and Treatment in Adult Populations.

Introduction: The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to the rapid adoption of telehealth to provide HIV care and treatment. However, limited information exists about the feasibility, acceptability, and efficacy of telehealth interventions at different points of the HIV care continuum. Methods: A systematic search was conducted of Ovid MEDLINE, PsycINFO, and CINAHL databases to synthesize evidence regarding the feasibility, acceptability, and efficacy of videoconferencing and video-based interventions for HIV testing and treatment in adult populations. Seventeen articles published through July 2021 were included in the review. We used descriptive methods to analyze data, and findings were reported using frequencies and percentages. Results: Findings show that videoconferencing and video-based interventions are generally feasible and acceptable. Videoconferencing is effective in improving adherence to HIV treatment and in promoting HIV testing. In addition, video-based interventions were effective in promoting HIV testing, treatment initiation, and adherence to medication. Both modalities enhanced linkage and retention in treatment for HIV-positive patients. Conclusions: Video-based and videoconferencing interventions are beneficial in HIV testing and treatment. However, the scarcity of primary studies employing these telehealth modalities means that there is a need for more research in these areas. Also, reviewed studies suffered from several limitations, including reliance on subjective measures, lack of standardized ways of evaluating acceptability and feasibility, use of small sample sizes, and short follow-up durations. In addition, there was less representation of studies from resource-limited settings disproportionately affected by HIV and AIDS. Thus, future research should focus on addressing these challenges.

Women's experiences of living with involuntary childlessness in Uganda: a qualitative phenomenological study.

BACKGROUND: Involuntary childlessness is a global phenomenon that negatively impacts the couple, or the family involved. The experiences of women living with involuntary childlessness have not been well documented in the literature, specifically in the Ugandan context. The purpose of the study was to explore the experiences of women living with involuntary childlessness in Uganda. METHODS: A qualitative phenomenological approach was used. Fifteen in-depth interviews were conducted among women experiencing involuntary childlessness attending a National Referral Hospital. Purposive sampling was, and data saturation determined the actual sample size. Thematic analysis was used for data analysis. The results are presented in the form of text and narrative quotes from participants. RESULTS: Six themes emerged (i) Inadequate social support (ii) psychological torture (iii) continued grief (iv) marital instability (v) failure attributed to childlessness and (vi) financial constraints. Inadequate social support was in the form of having an unsupportive partner, altered social relation, and altered social status, while women experienced name-calling, emotional abuse, stigma, and blame under the psychological torture theme. Women experienced feelings of distress and grief, including anger, irritability, sadness, stress, and feelings of despair. Women with involuntary childlessness recounted experiencing unstable marriages characterized by infidelity, divorce, abandonment, and polygamous marriages. Some women coped positively, while others employed negative coping strategies such as social withdrawal and isolation. Women who their partners and families well supported coped positively. In contrast, those who did not receive as much support were stressed, sad, angry, and had lost hope of pregnancy. CONCLUSIONS: In this study, women with involuntary childlessness lacked social support amidst experiences of marital turmoil, psychological torture, feelings of distress and grief, unfulfilled motherhood expectations, and financial constraints while seeking treatment, therefore, there is a need to screen the women for psychological / mental illness symptoms and provide empathetic care and counseling. The prevalence of involuntary childlessness is not well documented in Uganda and a study can be done to determine its extent.

Linkage to care and treatment among men with reactive HIV self-tests after workplace-based testing in Uganda: A qualitative study.

Introduction: HIV self-testing at workplaces has the potential to reach men at risk of HIV infection with lower access to HIV testing services. While several studies have reported high uptake of HIV self-testing, linkage to HIV care following a positive result remains a challenge. This study, therefore, explored the motivators for and barriers to linkage to HIV care and treatment among men who returned positive results following workplace-based HIV self-testing. Methods: A qualitative descriptive study, among men in private security services in Kampala district, Uganda. The men were eligible to participate if they were aged 18 to 60 years and had worked at the company for more than 6 months. Following HIV self-testing, participants with reactive (positive) self-test results were purposively sampled and engaged in key informant interviews. Inductive content analysis was employed to identify the motivators and barriers to the men's linkage to HIV treatment and care. Results: Overall, 12 men participated in the study, of whom 9 (75%) were security guards, and the rest held management positions. The motivators for linkage to care coalesced under five categories. (i) Communication (open communication, phone reminders, consistent communication) (ii) Navigating health facility systems and processes (enabling health facility environment, easy access to health care, employing ART clinic counselors as part of the study team, health workers) (iii) Linkage support (linkage companions, referral forms, linkage facilitation, individualized linkage plan, pre-arranged clinic appointments) (iv) Psychosocial support (counseling sessions, family support, online and social media support, peer support) (v) workplace environment (employer's support, work schedules and policies). The barriers to linkage to HIV care included (i) Inflexible work schedules, (ii) Far distances to travel to access ART (iii) mandatory work transfers, (iv) disruptive effects of the COVID-19 pandemic, (v) Denial of HIV-positive results and (vi) fear of stigma and discrimination at health facilities. Conclusion: The findings suggest the need for innovative interventions to facilitate regular follow-up and open communication with workplace-based HIV self-testers, to improve linkage to HIV care and treatment. Furthermore, initiating linkage plans during pre-test counseling and working in collaboration with health facilities and clinics may improve linkage to care.

The Effects of Cholesterol Oxidation on Erythrocyte Plasma Membranes: A Monolayer Study.

Cholesterol plays a key role in the molecular and mesoscopic organisation of lipid membranes and it is expected that changes in its molecular structure (e.g., through environmental factors such as oxidative stress) may affect adversely membrane properties and function. In this study, we present evidence that oxidation of cholesterol has significant effects on the mechanical properties, molecular and mesoscopic organisation and lipid-sterol interactions in condensed monolayers composed of the main species found in the inner leaflet of the erythrocyte membrane. Using a combination of experimental methods (static area compressibility, surface dilatational rheology, fluorescence microscopy, and surface sensitive X-ray techniques) and atomistic molecular dynamics simulations, we show that oxidation of cholesterol to 7-ketocholesterol leads to stiffening of the monolayer (under both static and dynamic conditions), significant changes in the monolayer microdomain organisation, disruption in the van der Waals, electrostatic and hydrophobic interactions between the sterol and the other lipid species, and the lipid membrane hydration. Surface sensitive X-ray techniques reveal that, whilst the molecular packing mode is not significantly affected by cholesterol oxidation in these condensed phases, there are subtle changes in membrane thickness and a significant decrease in the coherence length in monolayers containing 7-ketocholesterol.

Assessing impacts of COVID-19 and their responses among smallholder farmers in Brazil, Madagascar and Tanzania.

This study investigates the impacts of the first wave of the COVID-19 pandemic on smallholder farmers and their coping strategies in three contrasting Low- and Middle-Income Countries. The case studies include Brazil (South region), Madagascar (Atsimo Atsinanana region), and Tanzania (Morogoro/Eastern Tanzania). These countries were chosen because i) the economies are strongly influenced by the agricultural sector; ii) their national food security is strongly affected by smallholder production, and, iii) they represent a set of contrasting government responses to COVID-19 including the denial of the pandemic. Data were collected through semi-structured household interviews in all three countries in rural areas. COVID-19 induced effects were found in all three countries, including in Brazil and Tanzania where both national governments initially neglected the existence of COVID-19 and introduced few containment measures only. Here, mobility and trade restrictions of other countries impact also on agricultural trade and production in countries in which governments took less action to COVID-19 and also people remained home and practiced social distancing even if no official government policy was issued. The findings in all three countries suggest that the COVID-19 crisis had negatively affected smallholders' agricultural production, leading to a vicious cycle of low production, low incomes, and higher food insecurity. Results of this study raise the thorny issue of how best to balance containment of pandemic and future shocks against the well-being of the vulnerable rural population in lower- and middle-income countries; especially considering also the degree of global interconnected and the potential of polices to effect people beyond the national scale.

Effects of telehealth-assisted interventions among people living with HIV/AIDS: A systematic review and meta-analysis of randomized controlled studies.

INTRODUCTION: Taking antiretroviral therapy (ART) is a daily necessity for people living with HIV but these individuals experience multiple barriers and challenges to medication adherence. Interventions to support medication adherence have yielded effects in the expected direction, but the extent to which telehealth or virtually delivered interventions to promote adherence are effective among people living with HIV/AIDS remains unknown. We aimed to address this knowledge gap and inform future research and practice that promotes the well-being of people living with HIV/AIDs through telehealth interventions addressing medication use. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted using the following databases: Academic Search Complete, Cochrane library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, MEDLINE, PubMed, OVID (UpToDate), and the Web of Science. Relevant full-text articles published through September 2021 were retrieved. The revised Cochrane risk of bias tool for randomized trials was used to assess the methodological quality of the included studies. A meta-analysis was performed using a random-effects model to calculate the pooled effects of telehealth-assisted interventions for people living with HIV/AIDS. Stata 16.0 was used for statistical analysis. RESULTS: A total of 12 studies (N = 3557 participants) that used telehealth-assisted interventions for people living with HIV/AIDS were included. Telehealth interventions were found to increase the adherence to treatment (standardized mean difference [SMD]: 0.21; 95% confidence interval (CI): 0.03 to 0.40), to reduce depressive symptoms (SMD: -2,74; 95% CI: -3.39 to -2.09), and to improve perceived quality of life (SMD: 0.74; 95% CI: 0.37 to 1.10). DISCUSSION: The meta-effects of telehealth-assisted interventions include significantly enhanced adherence to treatment, improved quality of life, and reduced depressive symptoms among people living with HIV/AIDS. These findings suggesting that delivering health management interventions remotely through telehealth-assisted modalities was both feasible and effective in yielding health benefits for people living with HIV/AIDS. Integrating telehealth-assisted interventions as a modality in HIV/AIDS care might support continuity of care and sustained well-being. Future research should evaluate telehealth intervention outcomes and examine mediating, moderating, or other tailorable variables affecting intervention effectiveness.

Venues and methods to improve professional men's access to HIV self-testing and linkage to HIV prevention or treatment: a qualitative study.

BACKGROUND: HIV testing among men in sub-Saharan Africa is sub-optimal. Despite several strategies to improve access to underserved populations, evidence regarding engaging men in professional and formal occupations in HIV testing is limited. This study explored employed professional men's preferences for uptake of HIV self-testing, and linkage to HIV care, or prevention services. METHODS: This was an explorative-descriptive qualitative study where a sample of 33 men from six Ugandan urban centres. Participants were purposively selected guided by the International Standard Classification of Occupations to participate in in-depth interviews. The data were collected using an interview guide and the sample size was determined by data saturation. Eligibility criteria included fulltime formal employment for over a year at that organization. The data were analyzed manually using thematic content analysis. RESULTS: Three categories emerged: uptake of HIV self-tests, process of HIV self-testing and linkage to post-test services. The different modes of distribution of HIV self-test kits included secondary distribution, self-tests at typically male dominated spaces, delivery to workplaces and technology-based delivery. The process of HIV self-testing may be optimized by providing collection bins, and mHealth or mobile phone applications. Linkage to further care or prevention services may be enhanced using medical insurance providers, giving incentives and tele counselling. CONCLUSION: We recommend utilization of several channels for the uptake of HIV self-tests. These include distribution of test kits both to offices and men's leisure and recreation 'hot spots', Additionally, female partners, peers and established men's group including social media groups can play a role in improving the uptake of HIV self-testing. Mobile phones and digital technology can be applied in innovative ways for the return of test results and to strengthen linkage to care or prevention services. Partnership with medical insurers may be critical in engaging men in professional employment in HIV services.

The Effects of Workplace-Based HIV Self-testing on Uptake of Testing and Linkage to HIV Care or Prevention by Men in Uganda (WISe-Men): Protocol for a Cluster Randomized Trial.

BACKGROUND: HIV testing uptake remains low among men in sub-Saharan Africa. HIV self-testing (HIVST) at the workplace is a novel approach to increase the availability of, and access to, testing among men. However, both access and linkage to posttest services remain a challenge. OBJECTIVE: The aim of this protocol is to describe a cluster randomized trial (CRT)-Workplace-Based HIV Self-testing Among Men (WISe-Men)-to evaluate the effect of HIVST in workplace settings on the uptake of HIV testing services (HTS) and linkage to treatment and prevention services among men employed in private security services in Uganda. METHODS: This is a two-arm CRT involving men employed in private security services in two Ugandan districts. The participants in the intervention clusters will undergo workplace-based HIVST using OraQuick test kits. Those in the control clusters will receive routine HTS at their work premises. In addition to HTS, participants in both the intervention and control arms will undergo other tests and assessments, which include blood pressure assessment, blood glucose and BMI measurement, and rapid diagnostic testing for syphilis. The primary outcome is the uptake of HIV testing. The secondary outcomes include HIV status reporting, linkage into HIV care and confirmatory testing following HIVST, initiation of antiretroviral therapy following a confirmatory HIV test, the uptake of voluntary medical male circumcision, consistent condom use, and the uptake of pre-exposure prophylaxis by the most at-risk populations. RESULTS: Participant enrollment commenced in February 2020, and the trial is still recruiting study participants. Follow-up for currently enrolled participants is ongoing. Data collection and analysis is expected to be completed in December 2021. CONCLUSIONS: The WISe-Men trial will provide information regarding whether self-testing at worksites increases the uptake of HIV testing as well as the linkage to care and prevention services at male-dominated workplaces in Uganda. Additionally, the findings will help us propose strategies for improving men's engagement in HTS and ways to improve linkage to further care following a reactive or nonreactive HIVST result. TRIAL REGISTRATION: ClinicalTrials.gov NCT04164433; https://clinicaltrials.gov/ct2/show/NCT04164433. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/25099.

Use of herbal medicine by caregivers in the management of children with sickle cell disease in Mulago National Referral Hospital - Uganda.

INTRODUCTION: Sickle Cell Disease (SCD) is the leading genetic disease in sub-Saharan Africa and therefore remains a global public health threat. Use of complementary and alternative medicines (CAM) most especially herbal medicine (HM) in chronic diseases such as sickle cell disease has widely been reported in Africa where advanced technologies are greatly lacking. Despite a large presence of the sickle cell disease in Uganda, the extent to which herbal medicines are used in management of children with sickle cell disease has not been documented. This study purposed to determine the prevalence of herbal medicine (HM) use and associated factors among caregivers of children with SCD at Mulago National Referral Hospital. METHODS: a total of 384 child caretakers were interviewed in a descriptive cross-sectional quantitative study conducted at the Mulago Sickle cell clinic in March 2019. Enrolment was done consecutively and a structured interviewer administered questionnaire administered to collect data from the caretakers which was managed using SPSS version 23. Multivariate logistic regression was used to identify the factors associated with herbal medicine (HM) use. Factors with p-value <0.05 were regarded significant. RESULTS: the rate of herbal use was 77.6% (298 of 384 caregivers). At multivariate analysis, the odds of a caregiver who agreed that; HM cures symptoms faster than conventional medicine (CM) were 3 times those who disagreed with this statement (AOR =3.439, 95% CI: 1.447 - 8.176). The odds that a caregiver who agreed that HM has fewer side effects than CM were almost 4 times those that disagreed with this statement (AOR = 3.528, 95% CI: 1.917 -6.494). The odds that a caregiver who agreed that marketing HM through televisions adverts encourages HM use were 4 times those who disagreed with this statement (AOR = 4.185, 95% CI: 2.036 -8.603). CONCLUSION: this study reports a high prevalence of HM use among caregivers of children with SCD at Mulago Hospital, in Uganda. The practice is significantly influenced by caretakers´ perception that HM cures symptoms faster than CM, has fewer side effects and that telemarketing has greatly facilitated its use over CM. More effort is therefore needed to encourage clinic attendances and CM use and limit the unfounded TV adverts on HM. There is also need for studies to identify the common HM used so that their efficacy and safety are well studied.

Conducting an ongoing HIV clinical trial during the COVID-19 pandemic in Uganda: a qualitative study of research team and participants' experiences and lessons learnt.

OBJECTIVE: To explore the experiences and lessons learnt by the study team and participants of the Workplace-based HIV self-testing among Men trial during the COVID-19 pandemic in Uganda. DESIGN: An explorative qualitative study comprising two virtual focus group discussions (FGDs) with 12 trial team members and 32 in-depth participant interviews (N=44). Data were collected via telephone calls for in-depth interviews or Zoom for FGDs and manually analysed by inductive content analysis. SETTING: Fourteen private security companies in two Uganda districts. PARTICIPANTS: Members of the clinical trial study team, and men working in private security companies who undertook workplace-based HIV testing. RESULTS: The key themes for participants experiences were: 'challenges in accessing HIV treatment and care, and prevention services', 'misinformation' and 'difficulty participating in research activities'. The effects on HIV treatment and prevention resulted from; repercussions of the COVID-19 restrictions, participants fear of coinfection and negative experiences at health facilities. The difficulty in participating in research activities arose from: fear of infection with COVID-19 for the participants who tested HIV negative, transport difficulties, limited post-test psychosocial support and lack of support to initiate pre-exposure prophylaxis. The key study team reflections focused on the management of the clinical trial, effects of the local regulations and government policies and the need to adhere to ethical principles of research. CONCLUSIONS: Findings highlight the need to organise different forms of HIV support for persons living with HIV during a pandemic. Additionally, the national research regulators and ethics committees or review boards are strongly urged to develop policies and guidelines for the continuity of research and clinical trials in the event of future shocks. Furthermore, this study calls on the appropriate government agencies to ensure public and researchers' preparedness through continuing education and support. TRIAL REGISTRATION NUMBER: Clinicaltrials.gov NCT04164433; Pre-results.

Outcomes of interventions to optimize linkage to HIV care and antiretroviral therapy (ART) initiation after HIV self-testing: A scoping review.

Background: Human immunodeficiency virus (HIV) self-testing is an innovative solution to the problem of low HIV testing coverage. It can help in realizing the first "95" of the Joint United Nations Programme on HIV/AIDS targets in the HIV treatment cascade. However, there is limited information to guide how those who self-test and show positive results can successfully be linked to HIV care and treatment. Therefore, this scoping review aimed at synthesizing available evidence of the outcomes of intervention strategies to optimize linkage to HIV care after HIV self-testing. Methods: Our methodology followed Arksey and O'Malley's methodological framework. Two independent reviewers screened and extracted data based on predetermined criteria. The databases searched included PubMed, EBSCOhost, Web of Science, Cochrane Library, Scopus, Mednar, and the International Clinical Trials Registry Platform. Results: A total of 4809 records were retrieved. After full-text screening, 14 studies met the inclusion criteria for the review. The intervention strategies reported were classified into four main categories: technology-assisted interventions, innovative HIV self-testing kits distribution mechanisms, financial incentive, social entrepreneurship models, and the use of key community opinion leaders and social media influencers. This scoping review found men who have sex with men as the main recipients of the interventions to improve the rate of linkage to HIV care following HIV self-testing. Studies that met the inclusion criteria reported mixed findings on the outcomes of interventions to improve the rate of linkage to HIV care following HIV self-testing. Financial incentives, interventions leveraging technology, and key opinion leaders were the most effective strategies. Conclusions: Given that the included studies did not employ a uniform system of measurement of effectiveness, there is a need for identification of standardized definitions and clear indicators for evaluating linkage to care and antiretroviral therapy (ART) initiation following HIV self-testing.

Oral Colonization by Candida Species in Patients with Multiple Sclerosis.

INTRODUCTION: Multiple sclerosis (MS) is a chronic inflammatory demyelinating autoimmune disease that affects the central nervous system. Since immune system plays a key role in this disease, patients with MS can present higher risk of infections. PURPOSE: This study aimed to investigate the prevalence of Candida spp. in the oral cavity of MS patients in relation to a control group METHODS: In total, 100 individuals were selected: 55 diagnosed with MS and 45 healthy individuals (control group). Saliva samples were collected and seeded in culture media selecting for Candida. Following an incubation period of 48 h, colony-forming units (CFU mL-1) were counted and colonies were isolated for Candida species identification by multiplex PCR. The results were analysed by chi-squared and Mann-Whitney U statistical tests considering a significance level of 5%. RESULTS: Candida spp. were confirmed in the oral cavity of 50.09% patients in the MS group and 35.55% individuals in the control group. In individuals positive for the growth of Candida spp., the median values of Candida colonies were 220 CFU mL-1 for the MS group and 120 CFU mL-1 for the control group. However, no statistically significant differences were observed between groups for both prevalence and CFU mL-1 count. Of the Candida species identified, 73.91% were C. albicans, 21.73% C. glabrata, 2.17% C. tropicalis, and 2.17% C. krusei. CONCLUSIONS: The colonization of Candida spp. in the oral cavity of individuals with multiple sclerosis was higher than in the control group; however these findings were not proven to be statistically significant.

Hookworm Infection among Pregnant Women at First Antenatal Visit in Lira, Uganda: A Cross-Sectional Study.

BACKGROUND: Hookworm infection in expectant mothers has adverse health effects on both the mothers and their unborn babies. Foetal effects are known to include intrauterine growth retardation and physical and mental growth retardation, while the mothers may develop anemia which could potentially result in death. Unfortunately, little is known about factors that may predispose a pregnant woman to infection by hookworm. In this study, we strived to determine not only the prevalence of hookworm infection among pregnant women attending their first antenatal visit during the current pregnancy in a local health center in northern Uganda but also factors that might predispose them to hookworm infection. METHOD: This cross-sectional study was conducted among 346 pregnant women from Ogur Health Center IV located in Lira district, northern Uganda. Stool samples were collected from each study participant and analyzed for hookworms. The independent variables listed in this study (participant's sociodemographic characteristics, preconception care, and sanitation factors) were obtained using a structured questionnaire. Data analysis, including calculation of adjusted ratios, was performed using STATA software (version 14). RESULTS: Prevalence of hookworm infection among pregnant women who attended their first antenatal visit at Ogur Health Center IV was 11% (n = 38). After controlling for confounders, factors found to be significantly associated with this infection among pregnant women here were gardening barefooted (adjusted odds ratio (AOR), 3.4; 95% confidence interval (CI), 1.6 to 7.5; P < 0.001) and fetching unsafe water shared with animals for domestic uses (AOR, 2.8; 95% CI, 1.3 to 6.2; P value of 0.002). CONCLUSION: Hookworm infection among pregnant women at Ogur Health Center IV in Lira district, at 11%, is a public health concern and significantly associated with barefoot gardening and fetching water from unsafe sources shared with animals. We, therefore, recommend that special emphasis during routine prenatal health education be placed on the use of protective footwear during farming and fetching water for domestic use from protected safe sources. Author Summary. Hookworm infection is a parasitic condition that more often goes unnoticed, yet it presents immense detrimental effects, especially to pregnant women and their unborn children. It is a chronic disease with accruing effects of blood depletion resulting in anemia. Anemia is, by far, one of the major causes of maternal morbidity and mortality in Uganda. Pregnant women are more prone to hookworm infection by virtue of their compromised immunity, secondary to the physiological process of pregnancy. We demonstrated here that hookworm infection still exists among pregnant women in Uganda. We also showed that gardening barefooted and fetching water for domestic uses from unsafe sources shared with animals were major factors associated with this helminthic infection. This study provides evidence necessary to influence decision making on prevention of hookworm infection in the study area.

Nursing and Sustainable Development Goals (SDGs) in a COVID-19 world: The state of the science and a call for nursing to lead.

The World Health Organization declared 2020 the Year of the Nurse and the Midwife well before the world was plunged into a pandemic response to SARS-CoV-2 (COVID-19). Worldwide, nurses are advancing critical research and policy efforts to achieve all 17 of the United Nations Sustainable Development Goals (SDGs). Nursing is best positioned to ask and answer how to achieve the SDGs over the next decade, and in this COVID-19 era. In this article, we summarize the state of the nursing and midwifery literature about the SDGs. Twenty-four publications met criteria for inclusion, with nearly half published in 2019. Findings emphasize a need for: (a) nursing curricula and training revisions to include SDG content and strengthen development of a future nursing workforce comprised of global citizens; (b) innovative and disruptive nursing research documenting advances toward achieving the SDG 2030 agenda; (c) nursing practice that operates within a SDG framework; and (d) responsive and proactive nursing policy development that foresees what is needed to achieve the SDGs. When the urgency of COVID-19 response subsides, the world will adjust to a new normal and nursing must be positioned to lead and contribute to micro- and macro-level efforts toward achieving the SDGs.

Employers' and Employees' Perspectives of HIV Self-Testing at Male-Dominated Work Sites and Linkage to Posttest Services in Uganda.

This study explored men's views of workplace-based HIV self-testing and the barriers and facilitators of linkage to posttest services. Six focus group discussions and individual in-depth interviews were held with employers and employees in private security companies in Uganda (N = 70). Using content analysis, five categories emerged. The first category was the mitigation of potential harm, including reduction of stigma and discrimination, and the need for posttest support. The second category was a perceived need for on-site services where the men proposed on-site prevention services and HIV treatment and care. In the third category, which was strengthening linkage mechanisms, participants proposed expanded clinic hours, improved health facility efficiency, and provision of referral documentation. The fourth and fifth categories were organizational support and social support, respectively. There is need for employers and employees to work together for the success of workplace-based HIV initiatives.

Exploring the way sexually explicit material informs sexual beliefs, understanding and practices of young men: A qualitative survey.

Little research has examined how exposure to sexually explicit material may affect beliefs, attitudes and actions of young men. This study explored self-reported effects on young males. A 'snowballed' sample of males aged 18-25 years was recruited within one workplace (11/40 response rate). The qualitative survey data were analysed using thematic analysis. Key themes included increased levels of availability/extreme content of sexually explicit material, seen by young men having negative effects on sexual attitudes/behaviours. Participants reported confusion between real and sexually explicit material which informed expectations of a healthy sex life but may be mediated by potential 'buffers' of family openness or sex education.

Multiphasic disseminated encephalomyelitis associated with herpes virus infection in a patient with TLR3 deficiency.

We report a case of a 14-year-old girl that presented headache, amaurosis, drowsiness, fever, vomiting and diffuse reduction of muscle strength. She had been diagnosed with ADEM one year before and had a previous diagnosis of Toll-Like 3 receptor deficiency. Cerebrospinal fluid analysis revealed pleocytosis (28/mm3, 12/mm3 red blood cells, 70% lymphocytes cells, 2% monocytes cells, 28% neutrophils), normal total protein (38 pg/mL) and normal glucose level (53/mm3). Studies for CSF oligoclonal bands and serum anti-MOG were negative but polymerase chain reaction (PCR) testing was positive for herpes virus 1. In the first ADEM episode, PCR for herpes virus was also positive. Magnetic resonance imaging (MRI) of the brain revealed disseminated hyperintense lesions on T2-weighted and FLAIR images in the white matter of frontal, parietal and temporal lobes, corresponding to extensive asymmetric areas of demyelination that produced mass effect and gadolinium enhancement. Electroencephalography demonstrated irregular diffuse and generalized slow-wave activity with predominance in frontal region. The diagnosis of multiphasic disseminated encephalomyelitis (MDEM) triggered by herpes simplex virus was made. Herpes virus is a neurotropic virus that can cause a wide variety of neurological infection-triggered autoimmune disorders and that is particularly damaging to the central nervous system in situations of impaired immune system. TLR3 is expressed in astrocytes and dendritic cells of the central nervous system and is essential for natural immunity to herpes simplex. TLR3-deficient patients have already been described with herpes simplex encephalitis. TLR3 deficiency may predispose and explain autoimmune and demyelinating manifestations induced by herpes virus. The association of multiphasic disseminated encephalomyelitis triggered by herpes virus in a patient with TLR3 deficiency has not been previously reported in the literature.

Acceptability of HIV testing for men attending televised football venues in Uganda.

BACKGROUND: Worldwide, HIV remains a major public health challenge, especially in Sub-Saharan Africa. Literature indicates that men's involvement in HIV testing, care, and treatment services is lower compared to women, therefore novel approaches are required to engage men in the cascade of HIV care. This study aimed to explore men's perception on the provision of HIV testing services in venues where English Premier League football games are televised. METHODS: An exploratory qualitative study was conducted between February and May 2018. Six focus group discussions were conducted with 50 conveniently selected men aged 18 years and older using a pre-tested discussion guide. All focus group discussions were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: Overall, HIV testing at venues telecasting English Premier League football games was acceptable to men. There was a very strong preference for health workers providing testing and counseling services be external or unknown in the local community. Possible motivators for testing services provided in these settings include subsidizing or eliminating entrance fee to venues telecasting games, integrating testing and counseling with health promotion or screening for other diseases, use of local football games as mobilization tools and use of expert clients as role models. CONCLUSIONS: This study suggests that HIV testing services at venues where EPL football games are televised is generally acceptable to men. In implementing such services, consideration should be given to preferences for external or unknown health workers and the motivating factors contributing to the use of these services. Given that HIV testing is currently not conducted in these settings, further research should be conducted to evaluate the feasibility of this approach as a means of enhancing HIV testing among Ugandan men.