Prevalence of HIV and Associated Risks of Kampala among Youth in the Slums of Kampala

Purpose. 

The purpose of this study is to examine the prevalence of and risk factors for engaging in sex work among youth living in Kampala, Uganda. 

Methods. 

Analyses are based on a cross-sectional study (N = 1,134) of youth aged 12-18 years, living in the slums of Kampala, conducted in Spring of 2014. The analytic sample consisted of only sexually active youth (n = 590). Youth who reported engaging in sex work were compared to youth who did not report sex work. Multivariable analyses were conducted to examine factors associated with sex work. 

Results. 

Among the youth who had ever had sexual intercourse (n = 590), 13.7% (n = 81) reported engaging in sex work. Self-reported HIV prevalence was 13.9% among the total sample (n = 81) and 22.5% (n = 18) among youth engaged in sex work. Engaging in sex work was associated with being female (AOR 10.4; 95% CI: 3.9, 27.4), being an orphan (AOR 3.8; 95% CI: 1.7, 8.4), ever drinking alcohol (AOR 8.3; 95% CI 3.7, 19.0), and experiencing any rape (AOR 5.3; 95% CI: 2.9, 9.5). 

Discussion. 

The reported prevalence of sex work is high among youth in the slums of Kampala and is associated with high HIV prevalence, ever drinking alcohol, previously being raped, and being an orphan.

Table 2

Bivariate and multivariable associations between sex work and covariates among youth living in the slums of Kampala (n = 590).

Variable	Sex workers Yes n (%)	Sex workers No n (%)	Total sample n (%)	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	P
	81 (13.7)	509 (68.3)	590 (100)
Age
12–14 years	4 (4.9)	27 (5.3)	31 (5.3)	Ref	—	0.67
15-16 years	15 (18.5)	116 (22.8)	131 (22.2)	0.9 (0.3–2.8)
17-18 years	62 (76.5)	366 (71.9)	428 (72.5)	1.1 (0.4–3.4)
Sex, n (%)
Females	76 (93.8)	271 (53.2)	347 (58.8)	Ref	Ref	∗∗
Males	5 (6.2)	238 (46.8)	243 (41.2)	13.4 (5.3–33.5)	10.4 (3.9–27.4)
School attendance
Yes	67 (83.7)	480 (94.3)	547 (93.8)	Ref	Ref	∗∗
No	13 (16.3)	23 (5.7)	36 (6.2)	4.1 (2.0–8.4)	2.2 (0.8–5.7)
Religion
Christian Catholic	28 (34.6)	196 (38.5)	224 (38.0)	Ref	—	0.09
Christian (other)	37 (45.7)	169 (33.2)	206 (34.9)	1.5 (0.9–2.6)
Muslim	11 (13.6)	118 (23.2)	129 (21.9)	0.7 (0.3–1.4)
Other	5 (6.2)	26 (5.1)	31 (5.3)	1.3 (0.5–3.8)
Parental drunkenness
Yes	51 (63.0)	259 (51.0)	310 (52.6)	1.6 (1.0–2.7)	—	0.05
No	30 (37.0)	249 (49.0)	279 (47.4)	Ref
No parents alive	36 (44.4)	108 (21.2)	144 (24.4)	5.4 (2.7–10.9)	3.8 (1.7–8.5)	∗∗
1 parent alive	33 (40.7)	205 (40.3)	238 (40.3)	2.6 (1.3–5.2)	1.7 (0.8–3.6)
2 parents alive	12 (14.8)	196 (38.5)	208 (35.3)	Ref	Ref
Ever alcohol use
Yes	72 (90.0)	271 (53.5)	343 (58.4)	7.8 (3.7–16.6)	8.3 (3.7–19.0)	∗∗
No	8 (10.0)	236 (46.5)	244 (41.6)	Ref	Ref
Any rape
Yes	55 (67.9)	98 (19.2)	153 (25.9)	8.9 (5.3–14.9)	5.3 (2.9–9.5)	∗∗
No	26 (32.1)	411 (80.8)	437 (74.0)	Ref	Ref
Parental abuse of youth
Yes	35 (43.2)	197 (38.8)	232 (39.4)	1.8 (1.1–2.9)	0.8 (0.4–1.4)	0.45
No	46 (56.8)	311 (61.2)	357 (60.6)	Ref	Ref
HIVa
Yes	18 (22.5)	63 (12.5)	81 (13.9)	—	—	∗
No	62 (77.5)	440 (87.5)	502 (86.1)
Other STIa
Yes	63 (77.8)	248 (48.7)	311 (52.7)	—	—	∗∗
No	18 (22.2)	261 (51.3)	279 (47.3)

Note: P value is obtained from chi-square analyses.

aHIV and other STIs not included in the logistic regression analyses due to HIV/STI being hypothesized outcomes of commercial sex work instead of risk factors.

Full article at: http://goo.gl/vtZVwm

By:   Swahn MH¹, Culbreth R¹, Salazar LF¹, Kasirye R², Seeley J³.

¹School of Public Health, Georgia State University, P.O. Box 3995, Atlanta, GA 30302-3995, USA.

²Uganda Youth Development Link, P.O. Box 12659, Kampala, Uganda.

³London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.

AIDS Res Treat. 2016;2016:5360180. doi: 10.1155/2016/5360180. Epub 2016 Apr 28. 

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Acceptance of Treatment of Sexually Transmitted Infections for Stable Sexual Partners by Female Sex Workers in Kampala, Uganda

Background

The prevalence of sexually transmitted infections (STIs) among female sex workers (FSWs) in sub-Saharan Africa remains high. Providing treatment to the affected FSWs is a challenge, and more so to their stable sexual partners. There is scanty research information on acceptance of STI treatment for stable sexual partners by FSWs. We conducted a study to assess acceptance of STI treatment for stable sexual partners by FSWs, and to identify factors associated with acceptance.

Methods

We enrolled 241 FSWs in a cross sectional study; they were aged ≥ 18 years, had a stable sexual partner and a diagnosis of STI. Factors associated with acceptance of STI treatment for stable sexual partners were analysed in STATA (12) using Poisson regression. Mantel-Haenszel tests for interaction were performed.

Results

Acceptance of partner treatment was 50.6%. Majority (83.8%) of partners at the last sexual act were stable partners, and 32.4% of participants had asymptomatic STIs. Factors independently associated with acceptance were: earning ≤ $4 USD per sexual act (aPR 0.68; 95% CI: 0.49–0.94) and a clinical STI diagnosis (aPR 1.95; 95% CI: 1.30–2.92). The effect of low income on acceptance of partner treatment was seen in those with less education.

Conclusion

Acceptance of STI treatment for stable sexual partners was lower than that seen in other studies. Interventions to improve economic empowerment among FSWs may increase acceptance of partner treatment.

Below:  Screening profile of women attending month 24 clinic visit in the Good health for Women project cohort

Full article at:  http://goo.gl/RWiFHR

By: Yunia Mayanja,1,* Aggrey David Mukose,2,‡ Susan Nakubulwa,1,‡ Gloria Omosa-Manyonyi,3,‡ Anatoli Kamali,#1 andDavid Guwatudde#2

¹MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

3College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

3College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

²Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda

³College of Health Sciences, School of Medicine, University of Nairobi, Nairobi, Kenya

Simon Fraser University, Canada

Published online 2016 May 12. doi:  10.1371/journal.pone.0155383

1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

1MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda

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Low Frequency Drug Resistance in HIV-infected Ugandans on Antiretroviral Treatment is Associated with Regimen Failure

BACKGROUND:

Most patients failing antiretroviral treatment in Uganda will continue to fail their treatment regimen even if a dominant drug resistant HIV-1 genotype is not detected. In a recent retrospective study we observed that approximately 30% of HIV-infected individuals in the Joint Clinical Research Centre (Kampala, Uganda) experienced virologic failure with a susceptible HIV-1 genotype based on standard Sanger sequencing. Selection of minority drug resistant HIV-1 variants (not detectable by Sanger sequencing) under antiretroviral therapy pressure can lead to a shift in the viral quasispecies distribution, becoming dominant members of the virus population and eventually causing treatment failure.

METHODS AND FINDINGS:

Here we used a novel HIV-1 genotyping assay based on deep sequencing (DEEPGEN) to quantify low-level drug-resistant HIV-1 variants in thirty-three patients failing a first-line antiretroviral treatment regimen in the absence of drug resistant mutations, as screened by standard population-based Sanger sequencing. Using this sensitive assay we observed that 64% (21/33) of these individuals had low-frequency (or minority) drug resistant variants in the intrapatient HIV-1 population, which correlated with treatment failure. Moreover, the presence of these minority HIV-1 variants was associated with higher intrapatient HIV-1 diversity, suggesting a dynamic selection or fading of drug resistance HIV-1 variants from the viral quasispecies in the presence or absence of drug pressure, respectively.

CONCLUSIONS:

This study has identified low-frequency HIV drug resistance mutations by deep sequencing in Uganda patients failing antiretroviral treatment but lacking dominant drug resistance mutations as determined by Sanger sequencing methods. We showed that these low-abundance drug resistant viruses could have significant consequences on clinical outcomes, especially if treatment is not modified based on a susceptible HIV-1 genotype based on Sanger sequencing. Therefore, we propose to base clinical decisions using more sensitive methods to detect minority HIV-1 variants.

Purchase full article at:   http://goo.gl/v4h4F4

By:  Kyeyune F1, Gibson RM2, Nankya I3, Venner C2, Metha S4, Akao J4, Ndashimye E5, Kityo CM4, Salata RA6, Mugyenyi P4, Arts EJ7, Quiñones-Mateu ME8.

• 1Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda Department of Molecular Biology and Microbiology.
• 2Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada.
• 3Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda Department of Medicine, and Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA.
• 4Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda TREAT, Joint Clinical Research Centre, Kampala, Uganda.
• 5Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda.
• 6Department of Medicine, and Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA.
• 7Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada Department of Medicine, and Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA earts@uwo.ca.
• 8Center for AIDS Research Uganda Laboratories, Joint Clinical Research Centre, Kampala, Uganda Department of Medicine, and Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA Department of Medicine, and Department of Pathology, Case Western Reserve University, Cleveland, Ohio, USA University Hospital Translational Laboratory, University Hospitals Case Medical Center, Cleveland, Ohio, USA meq@case.edu. 

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Tuberculosis Incidence Is High in HIV-Infected African Children But Is Reduced by Co-Trimoxazole & Time on Antiretroviral Therapy

BACKGROUND:

There are few data on tuberculosis (TB) incidence in HIV-infected children on antiretroviral therapy (ART). Observational studies suggest co-trimoxazole prophylaxis may prevent TB, but there are no randomized data supporting this. The ARROW trial, which enrolled HIV-infected children initiating ART in Uganda and Zimbabwe and included randomized cessation of co-trimoxazole prophylaxis, provided an opportunity to estimate the incidence of TB over time, to explore potential risk factors for TB, and to evaluate the effect of stopping co-trimoxazole prophylaxis.

METHODS:

Of 1,206 children enrolled in ARROW, there were 969 children with no previous TB history. After 96 weeks on ART, children older than 3 years were randomized to stop or continue co-trimoxazole prophylaxis; 622 were eligible and included in the co-trimoxazole analysis. Endpoints, including TB, were adjudicated blind to randomization by an independent endpoint review committee (ERC). Crude incidence rates of TB were estimated and potential risk factors, including age, sex, center, CD4, weight, height, and initial ART strategy, were explored in multivariable Cox proportional hazards models.

RESULTS:

After a median of 4 years follow-up (3,632 child-years), 69 children had an ERC-confirmed TB diagnosis. The overall TB incidence was 1.9/100 child-years (95 % CI, 1.5-2.4), and was highest in the first 12 weeks following ART initiation (8.8/100 child-years (5.2-13.4) versus 1.2/100 child-years (0.8-1.6) after 52 weeks). A higher TB risk was independently associated with younger age (<3 years), female sex, lower pre-ART weight-for-age Z-score, and current CD4 percent; fewer TB diagnoses were observed in children on maintenance triple nucleoside reverse transcriptase inhibitor (NRTI) ART compared to standard non-NRTI + 2NRTI. Over the median 2 years of follow-up, there were 20 ERC-adjudicated TB cases among 622 children in the co-trimoxazole analysis: 5 in the continue arm and 15 in the stop arm (hazard ratio (stop: continue) = 3.0 (95 % CI, 1.1-8.3), P = 0.028). TB risk was also independently associated with lower current CD4 percent (P <0.001).

CONCLUSIONS:

TB incidence varies over time following ART initiation, and is particularly high during the first 3 months post-ART, reinforcing the importance of TB screening prior to starting ART and use of isoniazid preventive therapy once active TB is excluded. HIV-infected children continuing co-trimoxazole prophylaxis after 96 weeks of ART were diagnosed with TB less frequently, highlighting a potentially important role of co-trimoxazole in preventing TB.

Below:  Tuberculosis incidence over time after antiretroviral therapy initiation

Full article at:   http://goo.gl/vd6abn

By:  Crook AM1, Turkova A2, Musiime V3,4, Bwakura-Dangarembizi M5, Bakeera-Kitaka S4,6, Nahirya-Ntege P7, Thomason M2, Mugyenyi P3, Musoke P4,8,Kekitiinwa A6, Munderi P7, Nathoo K5, Prendergast AJ9, Walker AS2, Gibb DM2; ARROW Trial Team.

• 1MRC Clinical Trials Unit at UCL, London, UK. angela.crook@ucl.ac.uk.
• 2MRC Clinical Trials Unit at UCL, London, UK.
• 3Joint Clinical Research Centre, Kampala, Uganda.
• 4Makerere University College of Health Sciences, Kampala, Uganda.
• 5Department of Paediatrics and Child Health, University of Zimbabwe Medical School, Harare, Zimbabwe.
• 6Baylor College of Medicine Children's Foundation, Kampala, Uganda.
• 7MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
• 8MU-JHU Care Ltd, Kampala, Uganda.
• 9Blizard Institute, Queen Mary University of London, London, UK. 
• BMC Med. 2016 Mar 23;14(1):50. doi: 10.1186/s12916-016-0593-7.

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Cost & Cost-Effectiveness Analysis of a Community Mobilisation Intervention to Reduce Intimate Partner Violence in Kampala, Uganda

BACKGROUND:

Intimate partner violence (IPV) poses a major public health concern. To date there are few rigorous economic evaluations of interventions aimed at preventing IPV in low-income settings. This study provides a cost and cost effectiveness analysis of SASA!, a community mobilisation intervention to change social norms and prevent IPV.

METHODS:

An economic evaluation alongside a cluster randomised controlled trial. Both financial and economic costs were collected retrospectively from the provider's perspective to generate total and unit cost estimates over four years of intervention programming. Univariate sensitivity analysis is conducted to estimate the impact of uncertainty in cost and outcome measures on results.

RESULTS:

The total cost of developing the SASA! Activist Kit is estimated as US$138,598. Total intervention costs over four years are estimated as US$553,252. The annual cost of supporting 351 activists to conduct SASA! activities was approximately US$389 per activist and the average cost per person reached in intervention communities was US$21 over the full course of the intervention, or US$5 annually. The primary trial outcome was past year experience of physical IPV with an estimated 1201 cases averted (90 % CI: 97-2307 cases averted). The estimated cost per case of past year IPV averted was US$460.

CONCLUSION:

This study provides the first economic evaluation of a community mobilisation intervention aimed at preventing IPV. SASA! unit costs compare favourably with gender transformative interventions and support services for survivors of IPV.

Below:  Tornado diagram showing sensitivity of cost per case of past year physical intimate partner violence averted to key assumptions

Full article at:   http://goo.gl/L4uL5w

By:  Michaels-Igbokwe C1, Abramsky T2, Devries K2, Michau L2, Musuya T2, Watts C2.

• 1London School of Hygiene & Tropical Medicine, London, UK. christine.michaels-igbokwe@lshtm.ac.uk.
• 2London School of Hygiene & Tropical Medicine, London, UK. 
• BMC Public Health. 2016 Feb 29;16(1):196. doi: 10.1186/s12889-016-2883-6.

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