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1.
Front Reprod Health ; 6: 1256485, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38770113

RESUMEN

Introduction: Young migrants may engage in risky behaviours due to social, economic, and psychological challenges as they try to "get by" in their new host communities. This can result in unintended pregnancies, sexually transmitted infections including HIV, and poor mental health outcomes.During a study to test the feasibility and acceptability of an early intervention to reduce the harm of patterns of risk associated with migration, we assessed access to and utilization of sexual and reproductive health services (SRH) among recent migrants (14-24 years) in south-western Uganda. Methods: The intervention conducted in 2022/23 involved training peer supporters to provide referral advice and support to young people. Between March-November 2022, 20 young migrants (11 males and 9 females) were purposively selected to participate in two in-depth interviews each to explore their experiences during the intervention. Data were analysed thematically. Results: Women engaged in transactional sex to supplement their low pay while men got involved in risky behaviour once they had earned some money. Many suffered from sexually transmitted infections-related symptoms, were at risk for HIV infection and some women had fears of unwanted pregnancy. While some tried to seek for SRH services from public facilities, poor health service delivery such as long queues and shortages of drugs, discouraged them from going there. Young people tried to access treatment from private facilities but could not afford the costs. The intervention increased knowledge about SRH and supported young people to access services from the public health facilities at no cost thus increasing utilization. Conclusion: Sexual health risks were experienced differently by women and men. The women were likely to experience symptoms related to sexually transmitted infections (including HIV) much earlier than men and this could increase their likelihood to engage with SRH services. The intervention served to increase men's readiness to access SRH services by providing them at a time and place that is convenient. Recognizing the different risk profiles of young people is important in tailoring appropriate interventions to promote equitable access and utilization of SRH services for both genders in this vulnerable population.

2.
Glob Public Health ; 19(1): 2323028, 2024 01.
Artículo en Inglés | MEDLINE | ID: mdl-38471036

RESUMEN

ABSTRACTScientific evidence on the safety and efficacy of pharmaceutical drugs, substances and herbal medicines is important in medical advertising and promotion. Following guidelines for conducting a scoping review, we systematically searched PubMed, SCOPUS and Web of Science to identify in peer reviewed articles medications that were promoted and used widely in Africa during the COVID-19 pandemic. We also searched for information about how safety concerns about untested/or not properly tested drugs were communicated to the public during the pandemic. Of the 2043 articles identified, 41 papers were eligible for inclusion. Most studies were clinical trials (n = 11), systematic reviews (n = 9), quantitative studies (n = 9) the rest were qualitative studies, reviews and reports. We found that following global trends, several drugs, traditional and herbal treatments were used and repurposed for the treatment of respiratory symptoms of COVID-19 in Africa. The results highlighted the value of some herbal medicines for treatment during the COVID-19 pandemic, as well as the risks posed by the unregulated sharing of advice and recommendations on treatments in Africa, and globally.


Asunto(s)
COVID-19 , Medicina Tradicional , Humanos , África , Pandemias
3.
Front Reprod Health ; 5: 1198672, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37649966

RESUMEN

Background: Adolescent girls and young women involved in risky behaviors are vulnerable to multiple health problems, yet sexual and reproductive health services remain underutilized. We evaluated factors associated with non-uptake of contraceptives and barriers to use among adolescent girls and young women (14-24 years old) at high risk of HIV infection in an environment where contraceptives were provided at no cost. Methods: We conducted a mixed methods study, utilizing data from a baseline cross sectional survey and qualitative in-depth interviews. Survey participants tested negative for pregnancy and reported willingness to use contraception. Non-uptake of contraceptives was defined as not taking contraception at any study visit (baseline and throughout the study). Logistic regression model was used to assess factors associated with non-uptake of contraceptives. We purposively selected participants for interviews to discuss their knowledge and experiences with contraceptives and make suggestions to improve uptake. Qualitative data were analyzed thematically. Results: All 285 participants were included in the analysis. Out of the 285 participants 127 were not using contraceptives and of the 127, 44 (34.6%) did not take up any method throughout the study while 43 of the 83 remaining participants (who took up a method) chose male condoms only. Non-uptake of contraceptives was less likely among older women (20-24 years) (aOR = 0.32, 95% CI 0.16-0.89) compared to younger women (less than 20 years). Qualitative data showed that concerns about future fertility, fear of associated side effects and influence from close relations contributed to non-uptake of contraception. Conclusion: Non-uptake of contraceptives was common despite the promotion and provision of contraceptives in the context of a research study mainly because adolescents lack autonomy while making contraceptive decisions. Identifying and addressing their concerns and continued counselling on contraceptive use alongside condom promotion may improve uptake and utilization of contraceptives.

4.
J Migr Health ; 8: 100191, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37440919

RESUMEN

Young migrants in resource-constrained settings face multiple challenges when they move away from home for work and try to make their way in a new place. In Uganda, with a growing youthful population increasing numbers of young people are leaving home to look for opportunities in urban areas, often facing a precarious existence as they try to make money. Using data from in-depth interviews we investigate the lived experience of precarity of 20 young men who had recently migrated to a small town in south-west Uganda. We adopt a case study approach to look in-depth at the experience of three of the young men, showing how they engage in a continual evaluation of risk in their day to day lives, as they face multiple challenges related to their insecure employment and poor access to health services. We found that the risks that the young men are willing to take to maximise their limited opportunities changed over time. Our findings provide valuable insights into the gendered risks faced by young male migrants and illustrate the ways in which young migrants, many of whom may only have travelled a relatively short distance from home, face risks and challenges to their health and wellbeing, and need to be recognised as a population in need of attention and support.

5.
Glob Public Health ; 18(1): 2191689, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-36973188

RESUMEN

Impeded access to health services is a major factor influencing migrant health. In Uganda, previous research has shown lower utilisation of health services for young rural-urban migrants compared to their non-migrant counterparts. However, access to health services does not start at utilisation, but can be hampered by being able to identify a need for care. Using qualitative methods, we aimed to explore young rural-urban migrants' perceptions of health and patterns of engagement with health services. We analysed, using thematic analysis, a purposive sample of 18 in-depth interviews with 10 young people who had recently migrated within Uganda. Our results are presented through a framework conceptualising access at the intersection between abilities of people and characteristics of services. Participants perceived a need for care mostly through serious crises. Their ability to obtain care was hindered by a lack of resources, as well as the relative social isolation brought by migration. Our study highlights other barriers to accessing care such as the role of social norms and HIV-related stigma in health issues prioritisation, and healthcare workers' attitudes. This knowledge can inform approaches to ensure that community-based services are able to support healthcare access and improved health outcomes for this vulnerable group.


Asunto(s)
Accesibilidad a los Servicios de Salud , Migrantes , Humanos , Adolescente , Investigación Cualitativa , Uganda , Servicios de Salud
6.
BMC Health Serv Res ; 22(1): 1336, 2022 Nov 10.
Artículo en Inglés | MEDLINE | ID: mdl-36357877

RESUMEN

BACKGROUND: PrEP literacy is influenced by many factors including the types of information available and how it is interpreted. The level of PrEP literacy may influence acceptability and uptake. METHODS: We conducted 25 in-depth interviews in a HIV vaccine trial preparedness cohort study. We explored what participants knew about PrEP, sources of PrEP knowledge and how much they know about PrEP. We used the framework approach to generate themes for analysis guided by the Social Ecological Model and examined levels of PrEP literacy using the individual and interpersonal constructs of the SEM. RESULTS: We found that PrEP awareness is strongly influenced by external factors such as social media and how much participants know about HIV treatment and prevention in the local community. However, while participants highlighted the importance of the internet/social media as a source of information about PrEP they talked of low PrEP literacy in their communities. Participants indicated that their own knowledge came as a result of joining the HIV vaccine trial preparedness study. However, some expressed doubts about the effectiveness of the drug and worried about side effects. Participants commented that at the community level PrEP was associated with being sexually active, because it was used to prevent the sexual transmission of HIV. As a result, some participants commented that one could feel judged by the health workers for asking for PrEP at health facilities in the community. CONCLUSION: The information collected in this study provided an understanding of the different layers of influence around individuals that are important to address to improve PrEP acceptability and uptake. Our findings can inform strategies to address the barriers to PrEP uptake, particularly at structural and community levels. TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT04066881.


Asunto(s)
Vacunas contra el SIDA , Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Humanos , Vacunas contra el SIDA/uso terapéutico , Estudios de Cohortes , Alfabetización , Infecciones por VIH/prevención & control , Infecciones por VIH/tratamiento farmacológico , Fármacos Anti-VIH/uso terapéutico
7.
PLoS One ; 17(7): e0271104, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35905052

RESUMEN

BACKGROUND: Daily oral pre-exposure prophylaxis (PrEP) use is highly effective against HIV infection. However, the uptake of PrEP among individuals at high-risk of HIV acquisition in sub-Saharan Africa varies because of availability and acceptability. We assessed the acceptability of PrEP among participants in a prospective HIV vaccine preparedness study in Masaka, southwestern Uganda. METHODS: From November 2018 to August 2019, 20 participants (10 female) were purposively selected for in-depth interviews (IDIs) at 3 and 9 months' post-enrolment in the vaccine preparedness study. Four focus group discussions (FGD) (two among men) were conducted with 29 individuals categorized as: younger (18-24 years) men, younger (18-24 years) women, older (≥30 years) men, and older (≥30 years) women. Apart from IDI specific questions on recent life history including work experience, relationship history and places lived, topics for IDIs and FGDs included knowledge of HIV, perceptions of HIV risk (including own risk), knowledge of and use of PrEP. The Theoretical Framework of Acceptability was used to structure a thematic framework approach for data analysis. RESULTS: Participants understood that PrEP was an oral pill taken daily by HIV negative individuals to prevent acquisition of HIV. Overall, interest in and acceptability of PrEP was high, more than half expressed positivity towards PrEP but were not ready to initiate taking it citing the burden of daily oral pill taking, related side effects, stigma and distrust of PrEP. Fourteen participants (from IDI and FGD) initiated PrEP, although some (one FGD and two IDI participants) stopped taking it due to side effects or perceived reduced risk. CONCLUSION: We observed a keen interest in PrEP initiation among our study participants. However, a limited understanding of PrEP and associated concerns impeded uptake and sustained use. Hence, interventions are needed to address end-user challenges to increase uptake and support adherence.


Asunto(s)
Vacunas contra el SIDA , Fármacos Anti-VIH , Infecciones por VIH , Profilaxis Pre-Exposición , Vacunas contra el SIDA/uso terapéutico , Fármacos Anti-VIH/uso terapéutico , Femenino , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/prevención & control , Humanos , Masculino , Estudios Prospectivos , Uganda
8.
Afr J AIDS Res ; 21(1): 8-14, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35361065

RESUMEN

There is limited information about the use of on-demand and daily pre-exposure prophylaxis (PrEP) among adolescents and young people (AYP) in sub-Saharan Africa. We explored perceptions of both regimens among 14- to 19-year-olds perceived to be at high risk of HIV infection in Kampala, Uganda, using qualitative data collection methods. Data were analysed by theme and interpreted based on constructs from the framework of acceptability. Although there were no noticeable gender differences in preferences for a particular regimen, acceptability of PrEP depended on individual AYP sexual behaviour at the time of the study. Those who perceived themselves to be at increased risk of acquiring HIV preferred using daily PrEP, citing the consistency that comes from taking a pill daily and which they considered to be efficacious and safe. AYP who had less frequent sex preferred on-demand PrEP because it would enable them to "plan for sex". However, both groups perceived taking daily PrEP to be a burden, which was an impediment to acceptance of this form of PrEP. AYP anticipated that daily pill taking would be very stressful, requiring a lot of effort and would interrupt their daily routine. Therefore, while both on-demand and daily PrEP were acceptable and beneficial to these AYP, preferences for either regimen depended on self-perceived risk. Thus, oral PrEP use should be tailored to end-user preferences and risk profiles.


Asunto(s)
Infecciones por VIH , Profilaxis Pre-Exposición , Adolescente , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Masculino , Profilaxis Pre-Exposición/métodos , Conducta Sexual , Uganda
9.
Prog Dev Stud ; 21(4): 419-434, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34733113

RESUMEN

We examine data from young women and men in South Africa and young female sex workers in Uganda to explore the inequalities and hardships experienced during the COVID-19 pandemic and investigate the opportunities and ability presented to navigate in a virtual world to build an inclusive supportive future for young people on the move. We argue that against the backdrop of a fragile past, young people who see their today disturbed, tomorrow reshaped and their futures interrupted, need support to interact with their social environment and adjust their lives and expectations amidst the changing influences of social forces.

10.
Glob Health Action ; 14(1): 1955476, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-34420494

RESUMEN

BACKGROUND: Over-the-counter (OTC) analgesics are safe for pain-management when used as recommended. Misuse can increase the risk of hypertension and gastrointestinal problems. OBJECTIVE: To conduct a scoping review of the uses and misuses of OTC analgesics in sub-Saharan Africa, to inform strategies for correct use. METHOD: Following guidelines for conducting a scoping review, we systematically searched Pubmed, ResearchGate and Google Scholar databases for published articles on OTC analgesic drug use in sub-Saharan Africa, without restrictions on publication year or language. Search terms were 'analgesics', 'non-prescription drugs', 'use or dependence or patterns or misuse or abuse' and 'sub-Saharan Africa'. Articles focusing on prescription drugs were excluded. RESULTS: Of 1381 articles identified, 35 papers from 13 countries were eligible for inclusion. Most were quantitative cross-sectional studies, two were mixed-methods studies, and one used qualitative methods only. About half (n = 17) the studies recorded prevalence of OTC drug use above 70%, including non-analgesics. Headache and fever were the most common ailments for which OTC drugs were taken. Primary sources of OTC drugs were pharmacy and drug shops, and family, friends and relatives as well as leftover drugs from previous treatment. The main reasons for OTC drug use were challenges in health service access, perception of illness as minor, and knowledge gained from treating a previous illness. Information regarding self-medication came from family, friends and neighbours, pharmacies and reading leaflets either distributed in the community or at institutions of learning. OTC drug use tended to be more commonly reported among females, those with an education lower than secondary level, and participants aged ≥50 years. CONCLUSION: Self-medicating with OTC drugs including analgesics is prevalent in sub-Saharan Africa. However, literature on reasons for this, and misuse, is limited. Research is needed to educate providers and the public on safe use of OTC drugs.


Asunto(s)
Analgésicos , Medicamentos sin Prescripción , Analgésicos/uso terapéutico , Estudios Transversales , Femenino , Humanos , Medicamentos sin Prescripción/efectos adversos , Percepción , Automedicación
11.
SSM Popul Health ; 13: 100746, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33604448

RESUMEN

Pre-exposure prophylaxis (PrEP), antiretroviral medication for prevention of HIV-acquisition, is part of biomedical HIV prevention strategies recommended for people at risk of HIV-infection. A decision to take PrEP depends on an assessment of 'being at risk' either by an individual, or healthcare provider. In this paper, we draw on the concept of 'candidacy' to examine the different ways in which women attending a dedicated clinic in Kampala, Uganda, for women at risk of HIV infection (including sex workers), assessed their suitability for PrEP. We conducted in-depth interviews with 30 HIV negative women up to four different times, to gather information on the motives for taking PrEP, and their life history and daily life. All the women described the relevance of PrEP to mitigate their risk of HIV infection. However, there were challenges to adherence because of alcohol use, irregular working hours and a fear of being seen taking pills that others might assume to be HIV treatment. The ways in which the different women used PrEP and interpreted the place of PrEP in their lives were not solely based on their assessment of protecting themselves during sex work. They also used PrEP to guard against infection from their regular partners, and as a tool to allow them to make more money safely, by having sex without a condom with clients. While eligibility to access PrEP was predicated on the women's being in an 'at risk' population group, an incentive to use PrEP was to protect themselves from HIV acquisition from a long-term partner and preserve the 'trust' in their intimate relationship by having condom-less sex. Applying a candidacy lens we highlight the complexity in how women experience and present as being 'at risk' and query the criteria on which categories of risk and PrEP eligibility are determined.

12.
Nurs Open ; 6(4): 1551-1558, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31660183

RESUMEN

AIM: We assessed the burden and experiences of caregivers looking after stroke patients in Kampala, Uganda. DESIGN: We conducted a qualitative cross-sectional study between May 2018-July 2018 among primary caregivers of stroke patients. METHODS: The primary caregiver was defined as the person spending most of the time providing daily care for the stroke patient for at least four months. Purposive sampling was used to consecutively recruit the primary caregivers. In-depth interviews were conducted, and audiotape recorded, and observations were also made. Data were managed using NVIVO 12.0 following thematic approach. RESULTS: Twenty-five caregivers were included in the analysis with a mean age of 39.3, SD 10.7. Four themes were identified from the qualitative analysis on caregivers' experiences of looking after stroke patients: taking on new responsibilities, factors that protected caregivers from breaking down, limited resources and experiences with patient outcomes. Our findings highlight the need for interventions to support stroke patients and their caregivers.

13.
Afr J AIDS Res ; 17(3): 217-225, 2018 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-30132397

RESUMEN

We examined the logic that individuals use to account for delaying HIV testing and/or initiating HIV treatment. Our qualitative study, situated within the REALITY trial (Reduction of EArly mortaLITY in HIV infected adults and children starting antiretroviral therapy), was conducted in Uganda and Zimbabwe in 2015. Forty-eight participants (different age groups, sex and viral load/WHO disease stage) were included. Each participant had 2 interviews (1 after 4 weeks of participation in the trial the other after 12 weeks). If a person could manage presenting symptoms, they felt they had "more time" before starting antiretroviral therapy (ART). Their reluctance to have an HIV test (despite deteriorating health) arose from a belief that they were not "sick", that treatment was "not yet necessary". People in our study did not consider themselves as presenting "late", and treatment was not considered urgent as long as they considered their health to be "good enough".


Asunto(s)
Antirretrovirales/uso terapéutico , Diagnóstico Tardío/psicología , Infecciones por VIH/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Tiempo de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Niño , Recolección de Datos , Femenino , VIH , Humanos , Masculino , Tamizaje Masivo , Persona de Mediana Edad , Investigación Cualitativa , Uganda , Carga Viral , Adulto Joven , Zimbabwe
14.
Afr J AIDS Res ; 13(2): 189-95, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-25174636

RESUMEN

HIV-positive children and young people may face substantial social barriers to maintaining appropriate levels of adherence to antiretroviral therapy (ART) during childhood and adolescence. In this paper, we focus on these children's voices and the challenges they face growing up living with HIV in Uganda. Drawing on retrospective self-reports of 26 children living with HIV, taking ART and attending a clinic in central Uganda, we examine the reasons for non-adherence to ART among children and why they may not report when they miss their treatment. The reasons why children may not take their treatment are socially complex and similar to adult experiences and the struggles people face in adhering to life-long treatment of a condition that is stigmatised. Children are aware of the stigma that surrounds their condition and respond to adults who stress the importance of keeping their condition secret. The causes of non-adherence are not necessarily due to forgetting, but because of concerns about secrecy and children deliberately avoiding being seen taking their treatment, for example, to avoid identification. Children's desire to maintain and protect relationships explains non-adherence as well as their failure to report it to adults. The clinical focus on exemplary adherence makes it more difficult for healthcare workers to discuss with children the social challenges that they may experience in taking treatment every day. If adults could approach non-adherence with greater empathy, recognising that children too are juggling treatment taking and social concerns then children may feel more willing to tell them about missed doses. Their poor adherence is not an inevitable element of the experience of being a child, but rather, like many adults, a substantial challenge if they are to manage their life-long treatment.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Cumplimiento de la Medicación , Adolescente , Fármacos Anti-VIH/administración & dosificación , Terapia Antirretroviral Altamente Activa , Actitud del Personal de Salud , Cuidadores/psicología , Niño , Femenino , Humanos , Entrevistas como Asunto , Masculino , Percepción , Estudios Retrospectivos , Estigma Social , Revelación de la Verdad , Uganda
15.
AIDS Patient Care STDS ; 27(12): 697-706, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24219780

RESUMEN

There is increasing interest in promoting and supporting self-management of HIV and antiretroviral treatment (ART), including in resource-limited settings. Although the impact of HIV and ART on people in Uganda has been explored, little attention has been paid to how people self-manage. This qualitative study collected data from 20 participants on ART in Wakiso district, Uganda, using in-depth interviews, life histories, and observations to explore the tasks and strategies of living with ART. The identified strategies were compared to two existing self-management frameworks. Results highlighted a range of tasks including obtaining, taking, and adhering to ART medication, monitoring their condition, living with stigma and managing disclosure, maintaining general health, and adjusting to new roles. Participants described a range of strategies or behaviors to manage, which they actively created and used, tailored to their needs and environment. Comparison with existing frameworks revealed many similarities, with some local differences in enactment, and greater emphasis in our sample on obtaining the medication. Interventions to support people with self-management in Uganda, and possibly other resource-limited settings, require careful adaptation to local settings. The degree to which each of these strategies may improve health and quality of life requires further investigation.


Asunto(s)
Adaptación Psicológica , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Autocuidado , Actividades Cotidianas , Adulto , Femenino , Infecciones por VIH/psicología , Humanos , Entrevistas como Asunto , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Investigación Cualitativa , Calidad de Vida , Estigma Social , Revelación de la Verdad , Uganda
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