Appraisal of Existing HIV/AIDs Prevention and Control Measures and Presentation of Innovative Strategies to End HIV/AIDS Epidemic by 2030

Background: Globally, UNAIDS report 2022 shows, there are 84.2 million people affected by HIV/AIDS and 40.1 million deaths from AIDS since the start of epidemic. In sub-Saharan Africa, women and girls accounted for 63% of all new HIV infections in 2021 with, six in seven new HIV infections among adolescents aged 15 - 19 years being girls. Key populations accounted for 70% of HIV infections globally in 2021, with 51% of these new HIV infections in sub-Saharan Africa. Reflecting on the 4 decades’ journey of HIV epidemic amidst local, national and international efforts, the UN target of ending AIDS as a public health threat by 2030 remains questionable unless new innovative ways are used. This study aimed at analyzing existing HIV/AIDS interventions, discuss UN interventions in line with ending HIV/AIDS by 2030 then, suggest and discuss new innovative ways of ending HIV scourge by 2030. Methods: Systematic literature review methodology was used to extract existing published information on HIV prevention strategies from 1981 to 2023. The articles were previewed by 2 experts for quality and grouped by intervention. Of the 637 articles accessed, on HIV prevention/control only 45 met the inclusion criteria. Data were synthesized using a narrative synthesis approach following standard guidelines on synthesis without meta-analysis. Descriptive analysis was done, strength and limitations were identified. UNAIDS recommendations for ending HIV/AIDS by 2030 identified and analyzed. New Innovations in HIV/AIDS were presented and discussed. The scope of the reviewed literature was limited to HIV preventive strategies practiced between 1981 and 2023. Results: Findings show that, Uganda’s HIV prevalence was at a peak in 1991 of 15% (30% among pregnant women in urban areas). ABC strategy is claimed to have turned sharply downward the prevalence through the mid-1990s and reached 5% (14% for pregnant urban women) by 2001. Analysis of the strategy showed that the achievements of the strategy could not be sustained, subsequently HIV prevalence rose again. This is because none of the ABC components can independently reduce HIV problem. In the real world, 100% abstinence has failed, condom use only reduces infection by 90% (WHO), and lifelong monogamy is impractical. Such limitations weaken ABC strategy. The study established that Post-exposure prophylaxis (PEP) i.e. taking HIV medicines within 72 hours (3 days) after a possible exposure to HIV infection is a safe, effective and a globally practiced HIV preventive intervention in emergency situations of HIV exposure. However, PEP is limited to care sought within 72 hours after exposure and yet timely access especially in rural areas and for key populations remains a big challenge. Oral PrEP was also identified as effective HIV preventive measure that can reduce HIV risk from sex by about 99% and from injection drug users by 74%. However, like PEP, timely access especially in rural areas and for key populations remains a big challenge. The UNAIDS 95-95-95 strategy (i.e. 95% of people know their HIV status, 95% with +HIV status be on sustained ART and 95% on ART get viral load suppression) formed the basis for setting the target of ending HIV/AIDS epidemic by 2030. However, our analysis shows that this target is unrealistic given the above highlighted limitations/ barriers in preventive measures and the unlikely perfect adherence (100%) to ART by all enrolled HIV positive persons. Conclusion: Ending HIV/AIDS by 2030 cannot be achieved by implementing the current preventing strategies and control measures. This study established that most of the existing HIV preventive strategies and control measures have a number of limitations. However, with sustained UN 95-95-95 strategy supplemented with additional innovative ways, there is hope that the UN dream of ending HIV/AIDS though not necessarily by 2030, can in the long run be achieved.

Prevalence and Predisposing Factors of Human Immunodeficiency Virus Infection among the Boda-Boda Riders in Mbarara Municipality-Uganda

Background: Boda-Boda is a well-known and booming motorcycle taxi that employs youths to earn a living. They transport passengers at a faster rate where other means of transport are inaccessible or would be time consuming. Global statistics show that HIV has continued to be a major global Public Health issue especially among the “Most At-risk Populations” (MAPs) that include commercial transporters and Boda-Boda riders. Aim: This study aimed at assessing the prevalence and predisposing factors for HIV/AIDS among Boda-Boda riders living in Mbarara Municipality. Specifically, the study determined the prevalence of HIV among the Boda-Boda riders, identified social demographic predisposing factors for HIV and determined knowledge of Boda riders on prevention of HIV. Study setting: Boda-Boda operators in the transport sector are at high risk of HIV infection but the HIV status of the Boda Riders in Mbarara was not known a reason why the study was instituted: Study design: This was an analytical and descriptive cross-sectional study that employed quantitative methods of data collection. The study population comprised the registered Boda-Boda operators from two divisions of Kakoba and Kakiika in Mbarara municipality. Sample size and sampling methods: Using Morgan’s table (1970), the population of the registered Boda Riders was 15,041;this corresponded to a sample size of 375 respondents by Morgan Table. Systematic sampling procedure was used to get every 3rd registered rider on the list. Data collection: A pre-tested structured tool aided data collection after group pretest counseling. Individual counseling was also done prior to testing and giving results. The laboratory technologists drew blood to determine the sero-status of the respondents. Results were recorded as tested reactive (TRR) or tested non-reactive (TR). Unigold was used as tie breaker to confirm their diagnosis in order to ascertain those who were HIV positive on determine. Data analysis: Analysis was done at univariate, bivariate and multivariate using STATA version 13, Statistical significance of the relationship was determined for the p-value (p ≤ 0.05). Significant variables were then considered at multivariate level of analysis. Results: More than half 195 (52%) of the Boda-Boda cyclist had attained primary level of education and 36.5% secondary education. HIV prevalence among Boda-Boda riders was 9.9%. Riders who had never heard of VCT/HCT screening for HIV were three times likely to acquire HIV compared to those who ever heard of VCT/HCT screening (OR = 3.35;95% CI 1.14 9.83;p = 0.027). Those with multiple partners were six times more likely to acquire HIV/AIDS compared to those who buy sex from prostitutes (OR = 6.13;95% CI 1.54 24.38;p = 0.01). The level of awareness of VCT was found high at (94.7%), and the general knowledge about utilization and importance of VCT services was at 80%, however condom use as a preventive measure was found low at 44.3% among the respondent Boda-Boda riders. Conclusion: Boda-Boda riders had high HIV prevalence of 9.9% compared to that of Mbarara district at 6.1% and much higher than 5.7% national HIV prevalence level. The predisposing factors to acquire HIV/AIDS were having multiple sexual partners, not having heard of HIV counseling and testing as well as low and inconsistent condom use at 44.3%. The study recommends health service providers and HIV counselors to intensify awareness and behavior change campaigns on condom use among the Boda-Boda riders as preventive measure against HIV.

First Hour Initiation of Breast Feeding &Associated Factors, among Mothers at Post Natal Ward in Fort Portal Referral Hospital, Uganda

Background: Breast milk is recommended as the best feeding option to neonates and infants for it confers immunological benefits that help to reduce neonatal and infant morbidities and mortalities. WHO recommends that all infants should start breast feeding within one hour of birth i.e. early initiation of breast feeding (EIBF). Unfortunately, studies show that less than 40% of infants in resource limited settings Uganda inclusive are initiated on breast feeding practice, with no documented study done in Kabarole district to assess the problem. This study therefore, set out to establish the prevalence and associated factors with the practice of first hour initiation of breast feeding at Fort Portal Regional Hospital, Kabarole district, Uganda. Methods: With a cross-sectional design, we collected data from 330 post natal mothers and their live-born infants at Fort Portal Regional Referral hospital from 5th-20th August 2019. With a standard interviewer administered tool, mothers who initiated breast feeding within the first hour after delivery of their newly born babies responded with yes and those that did not with a no. Prevalence of one hour initiation was got considering infants that were initiated on breast within one hour over the total live birth times 100 to get the percent prevalence. With Stata version 13 software, statistically significant relationships of the predisposing factors were determined at a p-value (p ≤ 0.05) at bivariate and at multivariate regression coefficient. Results: A total of 330 postnatal mothers targeted for this study, 100% response rate was covered. Mothers’ age ranged from 18 - 45 years with mean age 31 SD ± 6. The prevalence of initiation of breast feeding in the first hour of birth was 68%, a third of (32%) mothers had not initiated breast feeding in the first hour. A half (50%) of the direct predisposing factors for non-initiation of timely breastfeeding were due to birth asphyxia, almost a quarter 23% due to mother’s ill health and 7% due mother not being guided by the health worker on what to do. In this study mothers’ knowledge and awareness of the practice were very low at 20% while that of health workers was fair at 53%. Social demographic factors that influence 1st hour breast feeding practice were;young maternal age being less than 34 years, mothers occupation being self-employed (83%) or unemployed (73%) with 3 times higher odds of initiating breastfeeding within 1st (OR = 3, p = 0.003) than working class mothers (civil servants). Marital status of mothers being married (73%) significantly influenced early breastfeeding practice (p = 0.001). Health workers’ knowledge of the practice was significantly associated (OR = 2.7, X2 = 11.32, *p = 0.00078) with enforcement of mother initiation of breast feeding in first hour compared to the less knowledgeable ones. Conclusion: The practice of timely initiation of breastfeeding at Fort Portal Regional Referral hospital at 68.2% was sub-optimal against WHO universal practice recommendations. Mothers’ low knowledge on timely initiation of breast feeding practice was the most deterrent factor for first hour initiation of breastfeeding practice. Providing breastfeeding counselling to all mothers during ANC and training on best breastfeeding practices and counselling skills for health staff at Fort Portal Referral hospital are urgent recommendation in this study to improve the practice.

Prevalence and Risk Factors for Hypertension, Diabetes and Obesity among Lecturers and Support Staff of Bishop Stuart University in Mbarara, Uganda

Aim: To establish the prevalence and risk factors for hypertension, diabetes and obesity among teaching and non-teaching staff of Bishop Stuart University, Mbarara-Uganda. Background: None communicable diseases (NCDs) are projected to exceed communicable diseases as the most common causes of death by 2030 in Africa. Most sub-Saharan African countries however lack detailed countrywide data on hypertension and other NCDs risk factors. Cognizant of Uganda’s recent inclusion of Hypertension and diabetes in the health policy agenda, this study was conducted among the university staff in a rural setting to provide benchmark information for design of appropriate interventions. Study Design: This was a descriptive cross-sectional, institutional based survey design. Place and duration of the study: This study was conducted among the teaching and none teaching staff of Bishop Stuart University Mbarara, Uganda from 18th April-6th June 2017. Methodology: A structured questionnaire was used to gather social demographic and risk factors data from the university workers at their work stations. Blood pressure of each participant was measured and Hypertension was defined as systolic BP > 140 and/or diastolic (BP) > 90 mmHg. Anthropometric measurements: Body Mass index (BMI) was done by weight in (Kg) and Height in (M2) to establish weight levels. Obesity was considered at BMI > 40. A random Blood Sugar (RBS) > 200 mg/dl was considered as diabetic. Epi-info version 7 was used to enter data, analyzed using SPSS version 19. Results: A total of 156 University staff aged 25 - 75 years of both sexes, mean age 42 ± 8 were interviewed of whom 51% were males. About 15% were administrative staff, 55% teaching staff, 3% senior lecturers and professors and 25% non-teaching staff. The prevalences of Hypertension, Diabetes, and obesity were 7.7%, 16%, and 28% respectively. But also majority (60.2%) were found at risk of developing both hypertension and diabetes. Less than 20% of the participants were knowledgeable on causes, signs and symptoms and preventive measures for Hypertension but had moderate knowledgeable of the risk factors, the most frequently mentioned risk by 71% was lack of exercise. Despite the awareness of risk factors, majority (61.3%) had not done any form of exercise and 64.1% had not had regular Blood pressure check ups. The study also demonstrated a statistically significant relationship between those aged more than 40 years and having hypertension (X2 = 5.82, P = 0.015, OR = 4.2). Likewise the risk of Diabetes increased with increasing age. Lecturers aged 40 years and above were 5.6 times likely to have diabetes compared to those aged less than 40 years (OR = 5.6, X2 = 16 , P = 0.0005). A significant number of respondents 57/156 (36.5%) reported history of HPT among their family members. Prevalence of obesity and overweight was observed higher in senior administrative staff and lecturers than in lower cadre staff 49% and 34% (p 0.01). Conclusion: Hypertension, Diabetes and obesity are conditions prevalent among the teaching and none teaching staff of BSU, but knowledge on risk factors, clinical presentation and preventive strategies is limited. Routine physical exercises...

Strengthening District Health Teams Capacity in Surveillance Systems and Response to Public Health Threats in Western Uganda through Field Epidemiology Training Program (FETP)

Aim: To strengthen the District Capacity in surveillance for effective detection, Reporting and Response to Public Health threats. Background: The overall aim of a good surveillance system is to strengthen the capacity of a Health system through training of health personnel who can conduct effective surveillance activities. A good surveillance system is achieved through improved use of complete and timely health information to detect changes in time to institute a rapid response to the suspected outbreak of Public Health events. This assessment followed a 3-month Field Epidemiology Training program undertaken by the investigator who applied the acquired knowledge and skills in completion of the assessment. Study Design: It was a descriptive cross-sectional, institutional based epidemiological investigation conducted at district level and Health Centre 1V in Kabarole from 15th December 2019-March 2020. eReports were retrieved from DHIS-2 for epidemiological weeks 44 in 2019 to week 3 in 2020. Data analysis: Micro soft word excel program was used to determine the reporting rates, epidemic disease trends and construction of malaria channel. SWOT analysis was done to identify poor HMIS reporting as the lead surveillance quality challenge and route cause analysis done to determine underlying causes. Results: Weekly reports analyzed were from a total of 53 Health facilities and one Health Centre four for malaria channel construction. Of the 53 functional Health facilities assessed in the district, the average reporting Timeliness was 32% and Completeness at 63% from week 44 in 2019 to week 3 in 2020. This finding shows that the district was not achieving the 80% Timeliness and 80% Completeness national target. The poor reporting situation implies that the district may not detect an emerging Public Health Event and respond in time. Poor reporting rate was linked to knowledge gap among reporting staff in completion of the newly revised HMIS tools and lack of support supervision. The analyzed data revealed that the district had increased dysentery, measles and typhoid fever cases. The dysentery and typhoid fever cases had reached and surpassed the Alert and Action thresh hold levels however there was no reported death from these diseases. Further inquiry revealed that Typhoid fever was being diagnosed using WIDAL test as opposed to WHO recommendation of stool or blood culture. The noted typhoid fever outbreak in the district was therefore being based on wrong laboratory tests hence regarded by the researcher as speculative. Findings on malaria channel revealed a normal and expected trend of malaria in Kabarole district in 2020. Conclusion: knowledge and skills from FETP-training enabled the investigator to establish the fact that the district’s surveillance system was less sensitive in detecting Public Health events for a quick response. Intensified targeted support supervision and mentorships of all health workers on reporting could help improve the districts surveillance system.