Browsing by Author "Kibone, Winnie"

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    Breakthrough mother-to-child transmission of HIV in a low-health facility in Uganda
    (Elsevier Ltd, 2023-07-29) Okello, Benjamin; Nyana, Harriet; Luwukya, Richards; Odongkara, Moses; Kibone, Winnie; Bongomin, Felix
    Objectives: Mother-to-child transmission (MTCT) of HIV can be minimized using elimination of MTCT (eMTCT) services. This study aimed to determine the proportion of infants who tested positive for HIV despite receiving eMTCT services in a rural setting in Northern Uganda. Methods: We retrospectively reviewed the early infant diagnosis register for the year January 2019 through June 2021 to collect data on participants enrolled in eMTCT services at Lalogi Health Centre IV in Omoro district, Uganda. Breakthrough HIV infection was defined as a positive HIV RNA on a dried blood sample at 18 months in a patient who received eMTCT services as recommended by national guidelines. Results: A total of 118 infants were enrolled in the study, 64 (54.2%) of whom were female. Most of the participants (n = 111, 94.1%) were on nevirapine prophylaxis for at least 6 weeks, 115 (97.5%) were exclusively breastfed, two (1.7%) were on complementary feeding, and one (0.8%) was not breastfed. Only five (4.2%) infants were lost to follow-up, four (3.4%) had incomplete data, and three (2.5%) had breakthrough HIV infections (positive HIV RNA and HIV antibody tests). All three cases of breakthrough HIV infection (one male and two female infants) were born to mothers who were diagnosed with HIV at delivery and were on nevirapine prophylaxis for less than 6 weeks. Conclusion: Our findings indicate that while eMTCT services were largely successful in minimizing vertical transmission of HIV in the rural setting in Northern Uganda, there were still some cases of breakthrough HIV infection associated with non-adherence to nevirapine prophylaxis and delayed maternal HIV diagnosis. Therefore, adhering to the national guidelines on nevirapine prophylaxis for at least 6 weeks for children born to mothers with HIV is recommended to further reduce the risk of vertical transmission of HIV.
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    Dual contraceptive use and associated factors among female sex workers in Gulu City, Uganda in 2023
    (BioMed Central, 2023-08-16) Bongomin, Felix; Pebalo, Francis Pebolo; Kibone, Winnie; Okwir Apio, Pamela; Nsenga, Lauryn; Okot, Jerom; Madraa, Grace; Laker, Fiona Gladys; Akello, Martha; Ouma, Simple; Musoke, David
    Background: Dual contraception is an essential approach to mitigating the heightened risks of unintended pregnancies and sexually transmitted infections faced by female sex workers (FSWs). We determined the prevalence and factors associated with dual contraceptive use among FSWs in Northern Uganda. Methods: A cross-sectional study was conducted in Gulu city, Uganda between February, and March 2023. Purposively selected FSWs aged 18 years or older who provided verbal informed consent were enrolled in the study. A sample size of 374 was estimated. Data on sociodemographic and reproductive health characteristics were collected using an interviewer-administered semi-structured questionnaire. Current dual contraception was defned the as concurrent use of a barrier and any other modern contraceptive methods within the last 3 months. Continuous variables were summarized using mean and standard deviation and categorical variables were summarized using frequencies and percentages. Modifed Poisson regression analysis was used to determine factors associated with dual contraceptive use. Results: We enrolled 314 FSWs, with a mean age of 28.8±6.4 years. About 13.8% (n=41) were living with HIV. In total, 66.2% (95%CI 60.8–71.3) of the participants (n=208) reported current dual contraceptive use. The most common modern contraceptive method used was the implants (52.4%, n=109), followed by injectable contraceptives (22.6.0%, n=47), and bilateral tubal ligation (0.5%, n=1) was the least utilized. Having had at least one previous pregnancy was positively associated with dual contraceptive use (adjusted PR: 1.87, 95%CI 1.40–2.51, p<0.001). Conclusions: A high proportion of FSWs in Gulu city were currently using dual contraceptives. Interventions are needed to facilitate the use of dual contraception, particularly among FSWs without a history of previous pregnancies.
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    “I Use Strawberry Flavoured Condoms during My Periods”:
    (MDPI, 2023-08-28) Bongomin, Felix; Kibone, Winnie; Pebalo, Francis Pebolo; Laker, Fiona Gladys; Okot, Jerom; Kaducu, Felix Ocaka; Madraa, Grace; Labongo Loum, Constantine Steven; Awor, Silvia; Napyo, Agnes; Musoke, David; Ouma, Simple
    Background: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging healthrisk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized population
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    Improving mycetoma case detection through the training of community health workers in Northern Uganda: protocol for a steppedwedge cluster-randomized trial
    (Therapeutic Advances in Infectious Disease, 2023-08-14) Kibone, Winnie; Semulimi, Andrew Weil; Kwizera, Richard; Bongomin, Felix
    Introduction: The World Health Organization acknowledges the need for countries to incorporate neglected tropical disease care into their routine health care system. However, low detection rates and late presentation of mycetoma to health facilities have been observed in endemic countries, including Uganda. Objective: To empower community health workers (CHWs) in Northern Uganda to recognize and refer suspects of mycetoma to health facilities. Design: This will be a stepped-wedge cluster-randomized trial based in Gulu and Pader districts over a period of 9months with sequential crossover from intervention phase to the control phase at different time points until both districts are exposed to the intervention. Methods and Analysis: The study will leverage on the ongoing partnership between Northern Uganda Medical Mission and the Uganda Ministry of Health that has trained over 300 CHWs in Gulu and Pader. The study evaluation will be done using the RE-AIM (Reach, Effectiveness,Adoption, Implementation, and Maintenance) framework. The expected outcome of the study is increased detection and referral of suspects of mycetoma. Data will be analyzed using STATA 17.0 and Friedman statistics or Analysis of Variance to determine increase in case identifications and referrals.
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    Invasive Fungal Diseases in Africa:
    (MDPI, 2022-11-22) Bongomin, Felix; Ekeng, Bassey E.; Kibone, Winnie; Nsenga, Lauryn; Olum, Ronald; Itam-Eyo, Asa; Ngouanom Kuate, Marius Paulin; Pebolo, Francis Pebalo; Davies, Adeyinka A; Manga, Musa; Ocansey, Bright; Kwizera, Richard; Baluku, Joseph Baruch
    Invasive fungal diseases (IFDs) are of huge concern in resource-limited settings, particularly in Africa, due to the unavailability of diagnostic armamentarium for IFDs, thus making definitive diagnosis challenging. IFDs have non-specific systemic manifestations overlapping with more frequent illnesses, such as tuberculosis, HIV, and HIV-related opportunistic infections and malignancies. Consequently, IFDs are often undiagnosed or misdiagnosed. We critically reviewed the available literature on IFDs in Africa to provide a better understanding of their epidemiology, disease burden to guide future research and interventions. Cryptococcosis is the most encountered IFD in Africa, accounting for most of the HIV-related deaths in sub-Saharan Africa. Invasive aspergillosis, though somewhat underdiagnosed and/or misdiagnosed as tuberculosis, is increasingly being reported with a similar predilection towards people living with HIV. More cases of histoplasmosis are also being reported with recent epidemiological studies, particularly from Western Africa, showing high prevalence rates amongst presumptive tuberculosis patients and patients living with HIV. The burden of pneumocystis pneumonia has reduced significantly probably due to increased uptake of anti-retroviral therapy among people living with HIV both in Africa, and globally. Mucormycosis, talaromycosis, emergomycosis, blastomycosis, and coccidiomycosis have also been reported but with very few studies from the literature. The emergence of resistance to most of the available antifungal drugs in Africa is yet of huge concern as reported in other regions. IFDs in Africa is much more common than it appears and contributes significantly to morbidity and mortality. Huge investment is needed to drive awareness and fungi related research especially in diagnostics and antifungal therapy.
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    Isolated renal and urinary tract aspergillosis: a systematic review
    (Sage Publications, 2023-11-16) Bongomin, Felix; Ekeng, Bassey E.; Mushi, Martha F.; Kibone, Winnie; Olum, Ronald; Meya, David B.; Hamer, Davidson H.; Denning, David W.; Morgan, Bethan
    Abstract Background: Aspergillosis localized to the kidneys and the urinary tract is uncommon. We conducted a comprehensive systematic review to evaluate risk factors and clinical outcomes of patients with isolated renal and genito-urinary tract aspergillosis. Methods: We systematically searched Medline, CINAHL, Embase, African Journal Online, Google Scholar, and the Cochrane Library, covering the period from inception to August2023 using the key terms ‘renal’ OR ‘kidney*’ OR ‘prostate’ OR ‘urinary bladder’ OR ‘urinary tract*AND ‘aspergillosis’ OR ‘aspergillus’ OR ‘aspergilloma’ OR ‘mycetoma’. We included single case reports or case series. Review articles, guidelines, meta-analyses, animal studies,protocols, and cases of genitourinary and /or renal aspergillosis occurring as a part of disseminated disease were excluded. Results: We identified 91 renal and urinary aspergillosis cases extracted from 76 publications spanning 1925–2023. Among the participants, 79 (86.8%) were male, with a median age of 46years. Predominantly, presentations consisted of isolated renal infections (74 instances,81.3%), followed by prostate (5 cases, 5.5%), and bladder (7 cases, 7.7%) involvement. Aspergillus fumigatus (42.9%), Aspergillus flavus (9.9%), and Aspergillus niger/glaucus (1.1% each) were isolated. Underlying risk factors included diabetes mellitus (29.7%), HIV (12.1%), haematological malignancies (11%), and liver cirrhosis (8.8%), while common symptoms encompassed flank pain (36.3%), fever (33%), and lower urinary tract symptoms (20.9%). An autopsy was conducted in 8.8% of cases. Diagnostic work-up involved histopathology (70.5%), renal CT scans and urine microscopy and culture (52.6% each), and abdominal ultrasound (17.9%). Treatments included amphotericin B (34 cases, 37.4%) and azole-based regimens (29 cases, 31.9%). Nephrectomy was performed in 16 of 78 renal cases (20.5%). All-cause mortality was 24.4% (19 cases). No significant mortality rate difference was observed among antifungal regimens (p=0.739) or nephrectomy status (p=0.8). Conclusion: Renal and urinary aspergillosis is an important cause of morbidity and mortality, particularly in immunocompromised and people with diabetes mellitus. While varied treatment strategies were observed, mortality rates showed no significant differences based on treatments or nephrectomy status. Further research is needed to refine diagnostics, optimize treatments, and enhance awareness among clinicians for early detection and management.
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    Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda:
    (Sage Publications, 2023-08-14) Bongomin, Felix; Kibone, Winnie; Okot, Jerom; Ouma, Simple; Madraa, Grace; Ojara, Francis Williams; Musoke, David; Pebalo, Francis Pebolo
    Background: Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sexworkers in Gulu, Uganda. Methods: In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p<0.05 was considered statistically significant. Results: We enrolled 273 female sex workers with a median age of 27 (interquartile range:24–32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with;regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11–6.35, p<0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32–35.77, p=0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI:1.49–4.35, p<0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43–7.74, p=0.005), and use of postexposure prophylaxis (PEP) in the past 12months (aPR: 0.31, 95% CI: 0.17–0.59,p<0.001). Conclusion: Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare.
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    Prevalence of chronic pulmonary aspergillosis along the continuum of pulmonary tuberculosis care: A protocol for a living systematic review and meta-analysis
    (PLOS ONE, 2023-12-15) Bongomin, Felix; Olum, Ronald; Kibone, Winnie; Namusobya, Martha; Rhijn, Norman van; Denning, David W.
    Introduction Chronic pulmonary aspergillosis (CPA) is a debilitating disease estimated to affect over 3million people worldwide. Pulmonary tuberculosis (PTB) is the most significant risk factor for CPA. However, the true burden of CPA at the time of PTB diagnosis, during, and after PTB treatment remains unknown. In this paper, we present a protocol for a living systematic review aimed at estimating the current burden of CPA along the continuum of PTB care. Materials and methods We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines to formulate this protocol, which is registered with the International Prospective Register of Systematic Reviews (PROSPERO: CRD42023453900). We will identify primary literature through various electronic databases, including CINAHL, Ovid MEDLINE, MEDLINE (PubMed), EMBASE, Google Scholar, Cochrane Database of Systematic Reviews, and African Journal Online. The search will encompass articles from inception to December 31st, 2023, using medical subject heading search terms "pulmonary tuberculosis" AND "chronic pulmonary aspergillosis". Two reviewers will independently assess titles, abstracts, and full texts for eligibility using the Covidence web-based software.The eligible studies will comprise original observational research that reports on the prevalence of CPA diagnosed in individuals with PTB, based on established criteria, without language or geographic restriction. We intend to exclude single case reports and case series with fewer than 10 participants, as well as review articles, guidelines, and letters to the editors. Cochrane Risk of Bias Tools (ROB2 and ROBINS-I) will used to assess study quality and risk of bias and the quality of the evidence will be rated using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. Our data syntheses will encompass meta-analysis and meta-regression, conducted using STATA version 18 and R- Studio version 4.0.2. This systematic review will be updated every 3–5years as more data emerges. Conclusions The findings of this proposed systematic review will summarize the available evidence on the occurrence of CPA, at the time of PTB diagnosis, during and after PTB treatment. The study results have the potential to guide healthcare policies regarding screening for CPA,enhance clinical decision-making, and catalyse further research into understanding the interplay between PTB and CPA. By shedding light on the current burden of CPA along the continuum of PTB care, we aspire to contribute to the betterment of patient care, disease management, and global health outcomes.
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    Prevalence of Teenage Pregnancy and Associated Factors in Agago District, Uganda:
    (Taylor & Francis, 2023-08-07) Okot, Christopher; Laker, Florence; Okwir Apio, Pamela; Madraa, Grace; Kibone, Winnie; Pebolo, Francis Pebalo; Bongomin, Felix
    Background: Teenage pregnancy remains a common public health and social problem associated with negative health outcomes. Wedetermined the prevalence and factors associated with teenage pregnancy among teenage girls aged 13–17 years in Agago district,Uganda. Methods: We conducted a community-based, cross-sectional study between October and November 2020 in Lapono Sub-County, Agago district among teenage girls 13–17 years. Multi-stage sampling technique was used. Parishes, villages, and households were randomly selected (computer generated random numbers were used for household selection). In each household, one participant was randomly selected for interview and pregnancy testing. We collected data on socio-demographic factors using a pre-tested semistructured questionnaire. All eligible participants were tested for urine human chorionic gonadotropin (hCG). Multivariable logistic regression analysis was done to determine independent predictors of teenage pregnancy, with p<0.05 considered statistically significant. Results: A total of 289 eligible participants, with a mean age of 15.1±1.5 years, were enrolled. Most (n=246, 81.5%) participants had attained primary education, 18 (6.2%) were married, 41 (14.2%) used alcohol, 62 (21.5%) had a history of sexual intercourse and 32 (11.1%) were sexually abused. The prevalence of teenage pregnancy was 2.8% (n=8). Factors significantly associated with teenage pregnancy were alcohol consumption (adjusted odds ratio (aOR): 13.2, 95% Confidence Interval (95% CI): 1.7–100.6, p=0.013) and having secondary/tertiary education (aOR: 10.2, 95% CI: 1.5–71.9, p=0.02). Conclusion: The study findings suggest that teenage pregnancy is still a public health and social problem in Agago district, Uganda. Interventions discouraging alcohol consumption and promoting education among teenagers are key in addressing the burden of teenage pregnancies in the district.
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    Self-Reported Hypertension and Associated Factors Among Adults in Butambala District, Central Uganda: A Community-Based Prevalence Study
    (Integrated Blood Pressure Control, 2023-11-08) Male Kato, Alex; Kibone, Winnie; Okot, Jerom; Bongomin, Felix; Baluku, Joseph Baruch
    Background: The prevalence of hypertension (HTN) differs among regions and income groups, showing a substantial increase in low- and middle-income countries. The development of hypertension is modulated by modifiable lifestyle factors, and uncontrolled hypertension poses a risk for the onset of cardiovascular diseases. Objective: To determine the community-level point-prevalence and factors associated with self-reported HTN among adults in Butambala district, central Uganda. Methods: A community-based cross-sectional study was conducted among adults aged ≥18 years in Budde subcounty, central Uganda. Data on sociodemographic characteristics and behavior were collected using a semistructured questionnaire. Self-reported HTN was assessed using a single question: “Do you have high blood pressure?” Bivariate and multivariate logistic regression analyses were performed to identify predictors of self-reported HTN. Results: A total of 565 participants (53.5% female) with a median age of 38 years (IQR: 26–52) were included in the study. The prevalence of self-reported hypertension was 18.9%. Factors independently associated with HTN were age 60 years or older (aOR: 2.9, 95% CI: 1.64–5.23, p<0.001), female sex (aOR: 3.3, 95% CI: 2.3–6.3, p<0.001), being widowed (aOR: 10.4, 95% CI: 1.25–87.14, p=0.03), secondary (aOR: 0.4, 95% CI: 0.20–0.85, p=0.016) and tertiary (aOR: 0.2, 95% CI: 0.09–0.64, p=0.005) education,unemployment (aOR: 3.0, 95% CI: 1.11–7.96, p=0.03), tobacco use (aOR: 2.9, 95% CI: 1.83–4.53, p<0.001), having had at least one blood pressure measurement during antenatal visit (aOR: 4.7, 95% CI: 1.97–11.33, p<0.001) or medical checkup (aOR: 10.7, 95% CI: 6.06–18. Conclusion: We observed a high prevalence of self-reported HTN affecting approximately one in five participants. More efforts are required to enhance routine screening, health education, and accessibility to HTN services in rural areas, with a particular emphasis on implementing HTN prevention and control strategies to effectively reduce the prevalence of HTN