Partners In Uganda Research Articles

Erratum: Development of Livelihood Skills through School-Based, Agripreneurship Projects Integrating Youth-Adult Partnerships: The Experiences of Youth Partners in Uganda

Erratum: Development of Livelihood Skills through School-Based, Agripreneurship Projects Integrating Youth-Adult Partnerships: The Experiences of Youth Partners in Uganda

Community engagement enhances undergraduate civil engineering capstone design projects

Abstract Over the past several decades numerous studies have shown the value of community engagement in global water, sanitation, and hygiene (WASH) programs. Engaging and collaborating with communities through the design process enables wider community acceptance and ownership of WASH interventions, ensures a more functional and impactful design, and opens the door for co-benefits of these systems. Accounting for a range of dimensions within a community is critical to creating WASH designs that provide the most benefits. Undergraduate engineering curriculums focus on design, but often do not explicitly account for the social, environmental, and economic elements that affect the success, efficacy, and sustainability of a design. There is increasing emphasis on educating engineers on sustainability and systems thinking so they are equipped to solve complex, multidisciplinary problems. To understand how social, environmental, and economic elements fit into engineering design and how to create sustainable WASH interventions, undergraduate engineering students benefit from participating in WASH design projects that engage and collaborate with communities. This perspective highlights the value of community engagement with partners in Uganda in teaching water resources and environmental engineering design to undergraduate civil engineering students.

‘If there is joy… I think it can work well’: a qualitative study investigating relationship factors impacting HIV self-testing acceptability among pregnant women and male partners in Uganda

ObjectivesSecondary distribution of HIV self-test (HIVST) kits from pregnant women attending antenatal care (ANC) to their male partners is shown to increase HIV couples testing and disclosure, and is being...

The effectiveness of a behavioral science and design intervention for family savings on use of maternal health services and male involvement: study protocol for a randomized controlled trial

BackgroundLack of financial preparedness for pregnancy can lead to adverse outcomes during childbirth. Behavioral science interventions have been shown to influence savings behavior. Financial savings interventions can be adapted for the purpose of encouraging individuals to save towards maternal healthcare costs. This article describes a protocol to assess the effectiveness of an intervention formulated with a behavioral science approach for encouraging use of maternal health services through increased financial savings for birth preparedness and maternal healthcare costs among pregnant women or their partners in Uganda.MethodsA randomized controlled trial will be conducted to assess the effectiveness of the intervention among pregnant women or their partners in Uganda’s central region, including the capital of Kampala. Seven hundred pregnant women (12–35 gestational weeks) or their partners will be recruited. All participants will receive access to a committed mobile money health savings account provided by a local organization that also offers savings targets and reminders for antenatal care appointments and health tips as part of a “Mamas Program” offered to expectant mothers. The time period in the intervention is from the day of enrollment until two weeks after the delivery date. The control group will receive the standard Mama Program offering. The intervention group will receive the standard Mama Program offering plus behavioral designs encouraging savings behavior through short-message service (SMS) text messages. The primary outcome is usage of maternal health services measured by level of birth preparedness and delivery at a health facility. Secondary outcomes include male involvement in maternal healthcare, measured by financial support, as well as total savings for healthcare, assessed using the validated amount of savings accrued in participants’ clinicPesa accounts from the day of enrollment plus any withdrawals for healthcare expenditures during the intervention period.DiscussionThe study will contribute to a better understanding of the effectiveness of behavioral designs encouraging financial savings during pregnancy into committed mobile money health savings accounts. The study could contribute to demonstrating the effectiveness of savings on birth preparedness, usage of maternal health services, and male involvement in maternal healthcare.Trial registrationUMIN-CTR Clinical Trial, UMIN000046472. Registered on 19 January 2022. https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000053008

Sexual and Relationship Benefits of a Safer Conception Intervention Among Men with HIV Who Seek to Have Children with Serodifferent Partners in Uganda.

Many men with HIV (MWH) in Uganda desire children, yet seldom receive reproductive counseling related to HIV care. Because men are under engaged in safer conception programming, they miss opportunities to reap the benefits of these programs. The objective of this sub-analysis was to explore the relationship and intimacy benefits of integrating safer conception counseling and strategies into HIV care, an emergent theme from exit interviews with men who participated in a pilot safer conception program and their partners. Twenty interviews were conducted with MWH who desired a child in the next year with an HIV-uninfected/status unknown female partner, and separate interviews were conducted with female partners (n = 20); of the 40 interviews, 28 were completed by both members of a couple. Interviews explored experiences participating in The Healthy Families program, which offered MWH safer conception counseling and access to specific strategies. Data were analyzed using thematic analysis. Three major subthemes or "pathways" to the relationship and intimacy benefits associated with participation in the program emerged: (1) improved dyadic communication; (2) joint decision-making and power equity in the context of reproduction; and (3) increased sexual and relational intimacy, driven by reduced fear of HIV transmission and relationship dissolution. These data suggest that the intervention not only helped couples realize their reproductive goals; it also improved relationship dynamics and facilitated intimacy, strengthening partnerships and reducing fears of separation. Directly addressing these benefits with MWH and their partners may increase engagement with HIV prevention strategies for conception.

71461 Intimate Partner Violence and HIV Testing among Women in Rural Southwestern Uganda

ABSTRACT IMPACT: This research shows that physical intimate partner violence was associated with never testing for HIV while verbal intimate partner violence was associated with increased testing for HIV suggesting that HIV testing interventions should consider intimate partner violence prevention. OBJECTIVES/GOALS: HIV incidence is higher among women who experience intimate partner violence (IPV). However, few studies have assessed the association between HIV testing (regardless of the result) and the experience of IPV. Our objective was to assess the relationship between IPV and HIV testing among women from rural southwestern Uganda. METHODS/STUDY POPULATION: We conducted a whole-population, cross-sectional study including women ?18 years of age who were permanent residents in 8 villages of Rwampara District, southwestern Uganda from 2011-2012 who reported having a primary partner in the past 12 months. We surveyed participants to assess their exposure to 12 different forms of verbal, physical, and/or sexual IPV, and whether they had ever been tested for HIV. We used three separate modified Poisson regression models, clustering by village, to estimate the association between each type of IPV and ever testing for HIV, adjusting for categorical age, completion of more than primary education, and any food insecurity measured by the nine-item Household Food Insecurity Access Scale. RESULTS/ANTICIPATED RESULTS: Among 496 women with a primary partner (>95% response rate), 64 (13%) had never tested for HIV, 297 (60%) reported verbal IPV, 81 (16%) reported physical IPV, and 131 (26%) reported sexual IPV. Further, among these women, 208 (42%) were aged <30 years, 378 (76%) had a primary or no education, and 390 (79%) experienced food insecurity. Never having been tested for HIV was positively associated with physical IPV (adjusted risk ratio (ARR): 1.61, 95% confidence interval (CI): 1.02-2.56) and negatively associated with verbal IPV (ARR: 0.67, 95% CI: 0.44-0.99), but not sexual IPV (ARR: 1.05, 95% CI: 0.51-2.12). DISCUSSION/SIGNIFICANCE OF FINDINGS: Among this population of adult women with partners in Uganda, physical IPV was associated with never testing for HIV while verbal IPV was associated with increased testing for HIV. Evidence suggests that HIV testing interventions should consider IPV prevention, and future studies should focus on why certain IPV types impact HIV testing rates.

Ease of understanding and performing HIV self-tests by pregnant women and their male partners in Uganda: a cross-sectional study.

Understanding and following HIV self-testing (HIVST) instructions is a critical step in the use of HIVST kits. We analyzed data on pregnant women and their partners' self-assessment on the usability of kits delivered by their pregnant women. Quantitative data were collected on 399 pregnant women and 238 male partners enrolled in the intervention arm of a large cluster-randomized HIVST trial. Each pregnant woman received HIVST demonstrations, detailed pictorial instructions on how to use OraQuick HIVST kits, and two kits; for herself and her male partner. Follow-up was at one month (baseline for male partners) and 3months. Descriptive statistics were conducted to compare understanding and following of HIVST instructions by age and education level. The proportion of those who understood HIVST instructions was almost the same (98%) for women and their partners, although partners (26.5%) were nearly twice as likely than women (16.0%) to report needing pretest counseling (Odds ratio [OR] = 1.9, 95% CI: 1.27-2.79). Partners' understanding of the HIVST instructions did not vary by education level, but 4.4% of women with primary education reported difficulty in understanding HIVST instructions compared with 0.5% and 0% of those with secondary and university education, respectively (p = 0.05). However, 5.6% of women aged 30-68years and 3.3% of partners aged 20-24years found it more difficult to understand the HIVST instructions. Both pregnant women and their male partners were correctly able to perform an HIVST without or (with minimal) support suggesting that this mode of delivery will help the national program reach more men. Because more male partners than women required HIVST pretest counseling support, male-targeted HIVST promotional messages may be needed to increase men's self-efficacy to perform HIVST unsupported.

Development of Livelihood Skills through School-Based, Agripreneurship Projects Integrating Youth-Adult Partnerships: The Experiences of Youth Partners in Uganda

quipping young people with livelihood skills is essential for positive youth development and empowerment as they transition into adulthood to become productive and engaged members of their communities. In Uganda, which may be the case in other nations of Sub-Saharan Africa, and elsewhere, even though many youth are becoming better educated and graduating from high schools and colleges, a majority of these graduates remain either unemployed or underemployed. Many have not acquired the necessary skills to transition from school to becoming employable and self-reliant. This phenomenon has been attributed to an outdated curriculum that does not meet the needs of contemporary times. Further, the mode of instruction in most of Uganda’s schools is teacher-centered and provides little room for student engagement and creativity to generate new knowledge, to have authentic learning experiences, or to reflect. Such challenges may be overcome through student-centered learning approaches involving School-Based, Agripreneurship Projects (SAPs) that integrate Youth-Adult Partnerships (YAPs), as were explored in this study. Evaluation of the students’ experiences through deductive and inductive thematic analysis indicated that they acquired knowledge in poultry science, business, agripreneurship, and life skills, including better communication, leadership, and conflict resolution practices. Longitudinal studies should be conducted to determine the longterm effectiveness and impact of SAPs facilitated by Y-APs on improving youth livelihoods, especially that prepare them with the life skills necessary to be productive citizens. Such research could involve cohort or panel investigations. Keywords: entrepreneurship; positive youth development (PYD); project-based learning (PjBL)

Correlates of HIV Status Nondisclosure by Pregnant Women Living With HIV to Their Male Partners in Uganda: A Cross-Sectional Study.

HIV status disclosure by pregnant women living with HIV (PWLHIV) to their male partners is associated with improved maternal and infant outcomes. Understanding relationship factors associated with nondisclosure of HIV status by PWLHIV to their partners can inform the design of interventions to facilitate disclosure. We conducted a cross-sectional study using enrollment data from 500 PWLHIV unaware of their male partners' HIV status and participating in a randomized clinical trial assessing secondary distribution of HIV self-testing kits in Kampala, Uganda. The primary outcome was women's HIV status nondisclosure to their partners. We conducted univariate and multivariate binomial regressions to assess the association between baseline sociodemographic, HIV history, and relationship characteristics with HIV status nondisclosure. 68.2% of the 500 PWLHIV had not disclosed their HIV status to their partner(s). Factors associated with higher likelihood of nondisclosure included relationship duration <1 year [adjusted prevalence ratio (aPR = 1.25); 95% confidence interval (CI): 1.02 to 1.54], being in a polygamous relationship (aPR = 1.21; 95% CI: 1.07 to 1.36), unmarried (aPR = 1.20; 95% CI: 1.07 to 1.35), uncertainty about whether their partner had ever tested for HIV (aPR = 1.55; 95% CI: 1.28 to 1.88), and a lack of social support from people aware of their status (aPR = 1.32; 95% CI: 1.18 to 1.49). Relationship factors, including shorter-term, unmarried, and polygamous relationships and uncertainty about partner's HIV testing history, were associated with higher likelihood of pregnant women's nondisclosure of HIV status to their partner. Interventions that facilitate couples' HIV testing and disclosure, provide counseling to reduce relationship dissolution in serodiscordant couples, and offer peer support for women may increase disclosure. Clinicaltrials.gov ID number: NCT03484533.

Costs of Providing HIV Self-Test Kits to Pregnant Women Living with HIV for Secondary Distribution to Male Partners in Uganda.

Background: Secondary distribution of HIV self-testing kits (HIVST) to pregnant women attending antenatal care (ANC) clinics to give to their male partners is a promising strategy to increase testing coverage among men, but its costs are unknown. Methods: We conducted micro-costing of a trial evaluating secondary distribution of HIVST on pregnant women living with HIV (PWLHIV) in an ANC in Kampala, Uganda. Costs (2019 USD) were collected from program budgets, expenditure records, time and motion observations, and staff interviews and estimated for three scenarios: as-studied, reflecting full costs of the research intervention, Ministry of Health (MOH) implementation, reflecting the research intervention if implemented by the MOH, and MOH roll-out, the current strategy being used to roll out HIVST distribution. Results: In the as-studied scenario, cost of HIVST provision was $13.96/PWLHIV reached, and $11.89 and $10.55 per HIV-positive and HIV-negative male partner, respectively, who linked to a clinic for facility-based testing. In the MOH implementation scenario, costs were $9.45/PWLHIV, and $7.87 and $6.99, respectively, per HIV-positive and HIV-negative male partner linking to the clinic. In the MOH roll-out scenario, the cost of HIVST provision to pregnant women regardless of HIV status was $3.70/woman, and $6.65/HIV-positive male partner. Conclusion: Secondary distribution of HIVST from pregnant women can be implemented at reasonable cost to increase testing among men in Uganda and similar settings in Africa.

Improving Livelihoods through Youth-Adult Partnerships involving School-based, Agripreneurship Projects: The Experiences of Adult Partners in Uganda

The increasing number of unemployed and underemployed youth across the globe, especially in developing countries, has reached alarming levels. In Africa, for example, this phenomenon has led to some youth making treacherous journeys across the Mediterranean Sea to Europe and other parts of the world in search of better livelihoods. Such an influx of immigrants, primarily to Europe and North America, has caused resentment and outcries by many citizens of the affected nations. Some of these challenges, however, could be allayed by engaging youth in income-generating projects, including agricultural entrepreneurship, i.e., agripreneurship, to create jobs and improve livelihoods. This may be achieved through Youth-Adult Partnerships (YAPs) by which youth and adults work together on agricultural projects of mutual interest. This study explored the experiences of adult partners in Uganda who collaborated with youth on their school-based, agripreneurial projects (SAPs) involving the raising of broiler chickens. Because of their partnership working on SAPs, both the youths’ and adults’ knowledge and understanding of concepts related to agripreneurship and raising of broilers chickens improved. The need exists to provide an enabling environment to promote an agripreneurial culture among youth through Y-APs if we seek to inspire them to pursue agripreneurship and related opportunities for job creation while also enabling the food security of communities and improved livelihoods for their citizens. Keywords: agripreneurship; improving livelihoods; project-based learning; school-based agripreneurial projects; youth unemployment; youth-adult partnerships

Improving Livelihoods through Youth-Adult Partnerships involving School-based,Agripreneurship Projects: The Experiences of Adult Partners in Uganda

The increasing number of unemployed and underemployed youth across the globe, especially indeveloping countries, has reached alarming levels. In Africa, for example, this phenomenon hasled to some youth making treacherous journeys across the Mediterranean Sea to Europe and other parts of the world in search of better livelihoods. Such an influx of immigrants, primarily to Europe and North America, has caused resentment and outcries by many citizens of the affected nations. Some of these challenges, however,could be allayed by engaging youth in income-generating projects, including agricultural entrepreneurship, i.e., agripreneurship,tocreate jobs and improve livelihoods. This maybe achieved through Youth-Adult Partnerships (Y-APs) by which youth and adults work together on agricultural projects of mutual interest. This study explored the experiences of adult partners in Uganda who collaborated with youth on their school-based, agripreneurial projects (SAPs) involving the raising of broiler chickens. Because of their partnership working on SAPs, both the youths’and adults’ knowledge and understanding of concepts related to agripreneurship and raising of broilers chickens improved. The need exists to provide an enabling environment to promote an agripreneurial culture among youth through Y-APs if we seek to inspire them to pursue agripreneurship and related opportunities for job creation while also enabling the food security of communities and improved livelihoods for their citizens.

Implementation science in global health settings: Collaborating with governmental & community partners in Uganda

Approximately 450 million people, many of whom live in poverty and are from low and middle-income countries (LMICs), experience serious mental health challenges. Children in sub-Saharan Africa comprise half of the total regional population, yet existing mental health services are severely under-equipped to meet their needs and evidence-based practices (EBPs) are scarce. In Uganda, one in five children present mental health challenges, including disruptive behavior disorders. Guided by the Practical, Robust Implementation and Sustainability (PRISM) framework, this paper describes the strategies by which we have engaged community and government partners to invest in a collaborative, longitudinal study in Uganda aimed at improving youth behavioral health outcomes by testing a collaboratively adapted EBP. We emphasize that implementation scientists should be prepared and willing to invest time and effort engaging key stakeholders and sustain relationships through a full range of collaborative activities; ensure that their science meets a felt need among the stakeholders; and translate their research findings rapidly into accessible and actionable policy recommendations. Finally, we highlight that collaboration with global communities and governments plays a critical role in the adaptation, uptake, scalability, and sustainability of EBPs, and that the process of engagement and collaboration can be guided by conceptual frameworks.

Why do men often not use condoms in their relationships with casual sexual partners in Uganda?

With a focus on Uganda, this paper examines men’s condom use in sexual relationships with casual partners and what this might tell us about men’s vulnerability to HIV-infection. We carried out repeat interviews with 31 men attending a clinic serving women at high risk for HIV infection and their partners in Kampala. We found that the experience of condom-less sex in the men’s youth, itself the outcome of a restrictive home environment, was perceived as influencing later unsafe sexual behaviour. Peer pressure encouraged men to have multiple partners. Alcohol negatively affected condom use. Men often opted not to use a condom with women they thought looked healthy, particularly if they had had sex with the same woman before. Some men who were HIV-positive said they saw little point in using condoms since they were already infected. A concerted effort is required to reach men, like those in our study, to halt HIV and the transmission of other sexually transmitted infections.

What's shame got to do with it: forced sex among married or steady partners in Uganda.

Research objectives were to understand the relationship between sexual, domestic and civil violence and the transmission of HIV/AIDS in Uganda. The focus of this paper is on forced marital sex within the context of Ugandan marital and steady partner relations. Qualitative unstructured interviews were conducted in focus group discussions and private in-depth interviews with 450 Ugandan men and women. Data analysis focused on patterns in respondents' experiences, interpretations and dialogue. Research findings illuminated how forced marital sex is induced by feelings of shame and could play a significant role in HIV/AIDS transmission. Findings suggest five interrelated reasons for forced marital sex: the absence of sexual pleasure, pregnancy, poverty, infidelity and alcohol use. Influencing the nature and extent of public and private conversations between spouses, men in drinking groups, family members and friends about the health and relational consequences of sexual violence is critical to changing normative beliefs and behavior.

Dramatic and sustained increase in HIV-testing rates among antenatal attendees in Eastern Uganda after a policy change from voluntary counselling and testing to routine counselling and testing for HIV: a retrospective analysis of hospital records, 2002-2009

BackgroundThe burden of mother-to-child transmission of HIV in Uganda is high. The aim of this paper is to describe the experience of the first 7 years of the prevention of mother- to- child transmission of HIV (PMTCT) programme in Mbale Regional Hospital, Eastern Uganda, with particular reference to the lessons learnt in changing from voluntary counselling and testing (VCT) to routine counselling and testing (RCT) for HIV testing in antenatal services.MethodsThe study was a retrospective analysis of the PMTCT records of Mbale Regional Referral Hospital, Uganda, from May 2002 to April 2009. The data on HIV testing of pregnant women and their male partners was extracted from the reports and registers using a standardized data extraction form, and data was analysed using descriptive statistics. Permission to conduct the study was obtained from School of Medicine, Makerere University College of Health Sciences; Uganda National Council of Science and Technology, and Mbale Hospital.ResultsA total of 54 429 new antenatal (ANC) attendees and 469 male-partners accessed antenatal services at Mbale Regional Referral Hospital. There was a sustained, significant increase in HIV testing among new ANC attendees from 22% during the VCT period to 88% during the RCT period (p = 0.002), while among male partners, HIV testing increased from 88% to 100% (p = 0.010) However, the overall number of male partners who tested for HIV remained very low despite the change from VCT to RCT approach in HIV testing.ConclusionsRoutine offer of antenatal HIV testing dramatically increased HIV testing in pregnant women and their partners in Uganda. Our findings call for further strengthening of the policy for routine HIV testing in antenatal clinics. Our study also showed that male partner HIV testing in antenatal clinics is low and this area needs further work through research and innovative interventions in order to improve male partner involvement.