Psychological distress among healthcare professionals in Mbarara, following the 2022 Ebola Virus Disease outbreak in Uganda: a mixed methods study.

BACKGROUND: The 2022 Ebola Virus Disease (EVD) outbreak occurred at a time when Uganda was still battling the social and psychological challenges of the COVID-19 pandemic; placing health care professionals (HCPs) at a much higher risk of developing psychological distress. Psychological distress among HCPs can cause decreased workplace productivity and ineffective management of their patients. The current study aimed to investigate and understand psychological distress among HCPS in Mbarara city in Southwestern Uganda following the 2022 EVD outbreak. METHOD: We enrolled 200 HCPs through convenient sampling from one private and one public health facility in Mbarara city in Southwestern Uganda, in a cross-sectional convergent parallel mixed method approach where qualitative and quantitative data were collected concurrently. Quantitative data, utilizing the Kessler Psychological Distress (K10) Scale, provided us with a quantitative measure of the prevalence of psychological distress among HCPs, and were analyzed using STATA version 16. Qualitative data, on the other hand, offered deeper insights into the nature, perceptions, and contextual factors influencing this distress, and were analyzed using emergent theme analysis. RESULTS: The prevalence of psychological distress was 59.5% and it was higher among females (63.9%) compared to males (36.1%). HCPs vividly expressed distress and anxiety, with heightened suspicion that every patient might be an EVD carrier, creating a pervasive sense of unsafety in the workplace. However, the outbreak had an educational affect where concerns about the announcement of another EVD outbreak were diverse, with HCPs expressing anxiety, despair, and dissatisfaction with the country's management of potential outbreaks. CONCLUSION: High levels of psychological distress were experienced by HCPs in Southwestern Uganda as a result of the 2022 EVD pandemic. HCPs express a wide range of feelings, such as dread, anxiety, despair, pessimism, and discontent with the way the outbreaks are handled throughout the nation. We recommend implementation of comprehensive psychosocial support programs tailored to the unique needs of HCPs, including counseling services, stress management workshops, and peer support networks.

Sexual decision making of Ugandan young adults: findings from national online discussions.

Fifty-one 18-22-year-old Ugandans took part in asynchronous online discussions about sexual decision-making. To increase generalizability and variability of experience, youth were recruited across the country using social media advertising. Participants were stratified into 8 groups by sex and sexual experience (e.g., women who had not had sex). Participants were asked questions such as, "What role do you think [men/women] play in deciding when a couple is going to play sex?" Several themes emerged. Both young men and women articulated social pressures to be abstinent, particularly to avoid STIs and pregnancy moreso than saving oneself for marriage. That said, women noted pressures to be seen as "pure". There also were pressures to have sex: Men were expected to have sex to demonstrate their virility. Women were expected to have sex if they accepted gifts or other commodities from their partners. It seemed that the specter of HIV and other STIs, as well as unwanted pregnancy, served to mitigate these expectations however, resulting in self-efficacy to use condoms among both men and women. Nonetheless, both men and women acknowledged that it could be hard for women to negotiate condoms. Implications for HIV prevention are discussed.

Involvement and burden of informal caregivers of patients with mental illness: the mediating role of affiliated stigma.

BACKGROUND: The fear and lack of understanding of mental illness can lead to stigma. The stigma of mental illness affects not only individuals who suffer from it, but also the caregivers. Stigma among caregivers can lead to delay in seeking care, poor adherence to treatment and a high risk of relapse. Caregivers of patients with mental illness are at an increased risk of distress due to the burden to stigma and caregiving burden. An increase in caregivers' burden can lead to a reduction in caregivers' involvement. There is a relationship between caregivers' involvement, burden, and affiliated stigma. The present study examined the mediating role of affiliated stigma in the relationship between caregivers' burden and involvement among informal caregivers of hospital-admitted patients with mental illness in Uganda. METHODS: A cross-sectional study was conducted among 428 informal caregivers (mean age: 39.6 years [SD±14.6]; females = 62.1%). Information was collected regarding sociodemographic characteristics, affiliated stigma, and the involvement and burden of informal caregivers. RESULTS: The findings indicate that affiliated stigma serves as a full mediator between the caregiver's roles and involvement (ß=15.97, p<0.001). Being female increased the caregivers' burden of caregiving (ß= -0.23, p<0.001). CONCLUSION: The findings in the present study suggest that intervention to address affiliated stigma among caregivers of patients with mental illness should be incorporated into mainstream mental health care to reduce the caregiving burden.

Length of stay of hospitalized patients at tertiary psychiatry facilities in Uganda: the role of caregiver's presence.

BACKGROUND: Whether the presence of caregivers during the hospital stay of patients with mental illness affects the length of hospital stay (LoS) remains inconclusive. AIMS: (1) To determine the average LoS and the associated factors, and (2) to determine the role of caregivers' presences during inpatient stay on LoS. METHODS: We conducted a cross-sectional study in two hospitals in Uganda; one with caregivers and the other without caregivers between July to November 2020. Mann-Whitney U test was used to compare LoS in the two selected hospitals and linear regression was used to determine factors associated with LoS. RESULTS: A total of 222 participants were enrolled, the majority were males (62.4%). Mean age was 36.3 (standard deviation (SD) = 13.1) years. The average LoS was 18.3 (SD = 22.3) days, with patients in a hospital without caregivers having a longer median LoS (i.e., (30 (interquartile range (IQR) = 30) vs. 7 (7) days; χ2 = 68.95, p < 0.001). The factors significantly associated a longer LoS among our study participants included; being admitted in a hospital without caregivers (adjusted coefficient [aCoef]: 14.88, 95% CI 7.98-21.79, p < 0.001), a diagnosis of schizophrenia (aCoef: 10.68, 95 %CI 5.53-15.83, p < 0.001), being separated or divorced (aCoef: 7.68, 95% CI 1.09-14.27, p = 0.023), and increase in money spent during the admission (aCoef: 0.14, 95% CI 0.09-0.18, p < 0.001). CONCLUSION: Patients with mental illness in southwestern Uganda have a short LoS (below 28 days), and the stay was much shorter for patients with fulltime caregivers. We recommend caregivers presence during patient's hospital stay to reduce the LoS and minimize healthcare expenditure.

A Pilot RCT Evaluating InThistoGether, an mHealth HIV Prevention Program for Ugandan Youth.

Despite data suggesting that older adolescence is an important period of risk for HIV acquisition in Uganda, tailored HIV prevention programming is lacking. To address this gap, we developed and tested nationally, InThistoGether (ITG), a text messaging-based HIV prevention program for 18-22 year-old Ugandan youth. To assess feasibility and acceptability, and preliminary indications of behavior change, a randomized controlled trial was conducted with 202 youth. Participants were assigned either to ITG or an attention-matched control group that promoted general health (e.g., self-esteem). They were recruited between December 2017 and April 2018 on Facebook and Instagram, and enrolled over the telephone. Between 5-10 text messages were sent daily for seven weeks. Twelve weeks later, the intervention ended with a one-week 'booster' that reviewed the main program topics. Measures were assessed at baseline and intervention end, 5 months post-randomization. Results suggest that ITG is feasible: The retention rate was 83%. Ratings for the content and program features met acceptability thresholds; program experience ratings were mixed. ITG also was associated with significantly higher rates of condom-protected sex (aIRR = 1.68, p < 0.001) and odds of HIV testing (aOR = 2.41, p = 0.03) compared to the control group. The odds of abstinence were similar by experimental arm however (aOR = 1.08, p = 0.86). Together, these data suggest reason for optimism that older adolescent Ugandans are willing to engage in an intensive, text messaging-based HIV prevention programming. Given its wide reach and low cost, text messaging should be better utilized as an intervention delivery tool in low-income settings like Uganda. Findings also suggest that ITG may be associated with behavior change in the short-term. (Trial registration: ClinicalTrials.gov ID# NCT02729337).

RESUMEN: A pesar de que los datos sugieren que la adolescencia mayor es un período importante de riesgo de contraer el VIH en Uganda, hace falta una programación de prevención del VIH personalizados. Para abordar esta brecha, desarrollamos y probamos a nivel nacional, InThistoGether (ITG), un programa de prevención del VIH basado en mensajes de texto para jóvenes ugandeses de 18 a 22 años. Para evaluar la viabilidad y aceptabilidad, y las indicaciones preliminares del cambio de comportamiento, se realizó un ensayo controlado aleatorio con 202 jóvenes. Los participantes fueron asignados a ITG o a un grupo de control de atención que promovía la salud general (p.ej., la autoestima). Fueron reclutados entre diciembre de 2017 y abril de 2018 en Facebook e Instagram y se inscribieron por teléfono. Se enviaron entre 5 y 10 mensajes de texto diariamente durante siete semanas. Doce semanas después, la intervención terminó con un "refuerzo" de una semana que repasó los principales temas del programa. Las medidas se evaluaron al inicio y al final de la intervención, 5 meses después de la aleatorización. Los resultados sugieren que ITG es factible: la tasa de retención fue 83%. Las calificaciones del contenido y las características del programa alcanzaron los umbrales de aceptabilidad; las calificaciones de experiencia del programa fueron mixtas. La ITG también se asoció con tasas significativamente más altas de relaciones sexuales protegidas con condón (aIRR = 1.68, p < 0.001) y probabilidades de pruebas de VIH (aOR = 2.41, p = 0.03) en comparación con el grupo de control. Sin embargo, las probabilidades de abstinencia fueron similares en el grupo experimental (ORa = 1,08, p = 0,86). Juntos, estos datos sugieren razones para el optimismo de que los adolescentes ugandeses mayores están dispuestos a participar en un programa intensivo de prevención del VIH basado en mensajes de texto. Dado su amplio alcance y bajo costo, los mensajes de texto deberían utilizarse como una herramienta de entrega de intervenciones en lugares de bajos ingresos como Uganda. Los hallazgos también sugieren que ITG puede estar asociada con cambios de comportamiento a corto plazo.

Opportunities to Harness Technology to Deliver HIV Prevention / Healthy Sexuality Programming to Sexual and Gender Minority Adults Living in East Africa.

Because of stigmatization of and discrimination against lesbian, gay, bisexual, transgender, and other sexual and gender minority (SGM) people in East Africa, there is paucity of SGM-focused sexual health research. Technology-based outreach efforts may represent a feasible way to reach and engage this population. They also may be a way to deliver important yet sensitive sexual health information in a stigma-free, anonymous atmosphere. We explored the feasibility of recruiting and surveying East African SGM adults online, and examined their interest in technology-based sexual health programming. Over a 14-month period, 2451 respondents were surveyed. They were, on average, 26.7 years of age. Fifty-four percent identified as lesbian, gay, and/or bisexual (LGB); a similar percentage (49%) reported having sex with a same-sex partner. Sixteen percent identified as gender minority (i.e. transgender or non-binary); and 29% were assigned female at birth. Almost half (48%) of SGM adults expressed interest in an SGM-focused healthy sexuality program delivered online. Enthusiasm also was noted for email (43%) and text messaging (41%). Compared to face-to-face settings, technology-based settings were more commonly  appraised  as the safest mode through which one could engage in sexual health programming. People who had a same sex partner and those who identified as sexual minority were especially likely to want to engage in technology-based programs. Interest in technology-based programming was similar for adults across gender identities, sex assigned at birth, and age however. Findings suggest that technology may be an underutilized opportunity to reach and engage SGM East Africans in a safe and private manner. Given levels of acceptability indicated by SGM adults across age, sex assigned at birth, and gender and sexual identities in this study, it seems possible that technology-based sexual health and HIV prevention and intervention programs could have the potential to be transformative in East Africa.

Debido a la estigmatización y discriminación contra lesbianas, gays, bisexuales, transgénero y otras personas de minorías sexuales y de género en África Oriental, hay limitadas investigaciones sobre salud sexual centradas en minorías sexuales y de género. Los esfuerzos de divulgación basados en la tecnología pueden representar una forma factible de llegar e involucrar a esta población. También pueden ser una forma de entregar información importante pero sensible sobre la salud sexual en una atmósfera anónima y libre de estigma. Exploramos la viabilidad de reclutar y encuestar a adultos de minorías sexuales y de género de África Oriental en línea y examinamos su interés en la programación de salud sexual basada en tecnología. Durante un período de 14 meses, 2451 personas fueron encuestadas. Tenían, en promedio, 26.7 años. El cincuenta y cuatro por ciento se identificó como lesbiana, gay y / o bisexual (LGB); un porcentaje similar (49%) reporto haber tenido relaciones sexuales con una pareja del mismo sexo. El dieciséis por ciento se identificó como una minoría de género (es decir, transgénero o no binario); y al 29% se les asignó mujeres al nacer. Casi la mitad (48%) de los adultos de minorías sexuales y de género expresaron interés en un programa de sexualidad saludable centrado en minorías sexuales y de género que se ofrece en línea. También se notó entusiasmo por el correo electrónico (43%) y los mensajes de texto (41%). En comparación con los entornos cara a cara, los entornos basados en la tecnología se consideraban más comúnmente el modo más seguro a través del cual uno podía participar en programas de salud sexual. Las personas que tenían una pareja del mismo sexo y las que se identificaban como minorías sexuales eran especialmente propensas a querer participar en programas basados en tecnología. Sin embargo, el interés en la programación basada en tecnología fue similar para los adultos en todas las identidades de género, sexo asignado al nacer y edad. Este estudio sugiere que la tecnología podría ser una oportunidad aún subutilizada para llegar e involucrar a los africanos del este de minoría sexual y de género de una manera segura y privada. Dados los niveles de aceptabilidad indicados por los adultos de minoría sexual y de género de todas las edades, el sexo asignado al nacer, y las identidades sexuales y de género en este estudio, parece posible que los programas de prevención e intervención del VIH basados en la tecnología puedan ser transformadores en África Oriental.

Iterative Development of In This toGether, the First mHealth HIV Prevention Program for Older Adolescents in Uganda.

In Uganda, HIV prevention programming for older adolescents is noticeably lacking, even though HIV incidence rates increase dramatically from adolescence into young adulthood. Here we describe the development of In This toGether (ITG), the first-of-its-kind, comprehensive text messaging-based HIV prevention program for both sexually active and abstinent 18- to 22-year-old Ugandans. Five iterative development activities are described: (1) conducting focus groups (FGs) to better understand the sexual decision-making of older adolescents across Uganda and to gain 'voice' of older adolescents; (2) the drafting of intervention content based on FG data; (3) testing of the drafted content with two Content Advisory Teams (CATs) that reviewed and provided feedback on the messages; (4) alpha-testing the program among the research team; and (5) beta-testing the intervention and protocol with people in the target population. Participants were recruitment nationally via Facebook and Instagram, and enrolled over the telephone by research staff. Results suggest that men were easier to reach and engage across all intervention development steps. As such, specific efforts to enroll women were made to ensure that feedback from both sexes was taken into account. FG participants said they were interested in learning more about sexual positions, how to prepare for sex, the consequences of unprotected sex, benefits of protected sex, masturbation, and how to be a good sexual partner. In both the FGs (n = 202) and CATs (n = 143) however, some noted that masturbation, oral sex, and anal sex were particularly sensitive topics. These messages were rewritten to address the cultural sensitivity. Feedback from beta test participants (n = 34) suggested that text messaging-based HIV prevention programming that is intense (e.g., 5-11 messages per day) and extends for two months, is both feasible and acceptable. In conclusion, the engagement of older adolescents at each step of the iterative intervention development process increased the likelihood that the final product would resonate with 18- to 22-year-old Ugandan youth across the country. Furthermore, social media appears to be a feasible method for recruiting national samples of Ugandan older adolescents into HIV-focused research.