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Reducing Hiv Risk Among Young Women And Their Partners: Highlights From The Dreams Implementation Science Research Portfolio, Population Council

HIV and AIDS

The Population Council, with funding from the Bill & Melinda Gates Foundation and the U.S. Agency for International Development through Project SOAR, led a set of implementation science studies to capture multiple perspectives that reflect the innovative aspects of DREAMS. These mixed-method studies conducted across seven countries (Eswatini, Kenya, Malawi, South Africa, Tanzania, Uganda, and Zambia) provide critical evidence that fill knowledge gaps on how to reduce HIV risk among AGYW and their male partners. This brief presents key findings grouped around four areas of inquiry: 1) HIV vulnerability and risk; 2) social drivers of HIV risk; 3) effects of …

From Evidence To Practice: Promoting Continued And Exclusive Breastfeeding In Rural Eastern Uganda, Katherine Judge

College of Nursing and Health Sciences Doctor of Nursing Practice (DNP) Project Publications

Purpose: Malnutrition is responsible for about one third of deaths globally among children under age five. Over 65% of these deaths, often associated with inappropriate feeding practices, occur during the first year of life and disproportionately affect those living in resource poor countries. Breastfeeding has been established as uniquely effective in providing infants with nutrients for healthy growth and development. Ugandan demographic surveys (2016) indicate less than 43% of infants age 4-5 months are breastfed.

Methods: The objective was to equip Community Health Educators (CHEs) with evidence-based practice guidelines for promoting continued exclusive breastfeeding to postpartum women. This project was …

Stigma Gets In My Way: Factors Affecting Client-Provider Communication Regarding Childbearing Among People Living With Hiv In Uganda., Jolly Beyeza-Kashesya, Rhoda K. Wanyenze, Kathy Goggin, Sarah Finocchario-Kessler, Mahlet Atakilt Woldetsadik, Deborah Mindry, Josephine Birungi, Glenn J. Wagner

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: Many HIV-affected couples living in sub-Saharan Africa desire to have children, but few quantitative studies have examined support for their childbearing needs. Our study explored client-provider communication about childbearing and safer conception among HIV clients in Uganda.

METHODS: 400 Ugandan HIV clients in committed relationships and with intentions to conceive were surveyed. Knowledge, attitudes and practices related to childbearing, and use of safer conception methods were assessed, including communication with providers about childbearing needs, the correlates of which were examined with bivariate statistics and logistic multivariate analysis.

RESULTS: 75% of the sample was female; 61% were on antiretroviral therapy; …

Modeling The Expected Cost-Effectiveness And Impact Of Oral Pre-Exposure Prophylaxis In Uganda And Swaziland, Project Soar

HIV and AIDS

Clinical trials have shown that oral antiretrovirals (ARVs) containing tenofovir/emtricitabine used by HIV-negative individuals to prevent HIV acquisition, called oral pre-exposure prophylaxis (PrEP), are safe and effective in several populations. Prior modeling work has demonstrated that oral PrEP is most cost effective when targeted to populations at very high risk of infection, with risk dependent on a combination of individual behavior and epidemic contexts. This brief describes a study Project SOAR is conducting to assist Uganda and Swaziland in making critical decisions about oral PrEP introduction and scale up by modeling the expected cost effectiveness and impact of oral PrEP …

Do Marketing Strategies Impact Condom Sales In Uganda?, Meyhar Mohammed

Master's Theses

What attracts people to buy condoms? HIV/AIDS remain one of the biggest health dangers of the world, especially in Sub-Saharan Africa. A lot of efforts have been pursued in the past two decades to drastically reduce prevalence of HIV and increase awareness about preventive mechanisms. In order to prevent relapse of success achieved so far, it is important to recognize transformation of consumer behavior due to growth in social networks, education and awareness over time. There are a lot of behavioral triggers captured by social marketing interventions in the field of public health. In an attempt to investigate the role …

Reducing Barriers To Accessing Fistula Repair: Establishing A Baseline In Uganda, Population Council

Reproductive Health

As a partner on the Fistula Care Plus (FC+) project, the Population Council is conducting implementation research that tests solutions to treatment barriers. Formative research in Uganda found that a lack of knowledge among lower-level providers and women and families of how the condition occurs, where treatment is available, and the signs and symptoms of obstetric fistula, as well as transportation costs, affect women’s access to screening and repair. Baseline data reveal the necessity of a comprehensive intervention to address fistula treatment barriers in Uganda. Not only do primary healthcare providers lack adequate knowledge of fistula, referral, and counseling, but …

Effective Engagement Of Male Partners Of Adolescent Girls And Young Women In Uganda, Population Council

HIV and AIDS

The Population Council is conducting implementation research in Uganda, in collaboration with local partner organizations, to learn more about men’s relationships with adolescent girls and young women (AGYW) and how HIV services can better engage them—two neglected areas of research. Similar studies are being conducted in South Africa, Swaziland, and Malawi. Learnings from these studies will be valuable for informing ongoing programming in Uganda and the region, as well as HIV prevention, care, and treatment efforts for AGYW and their male partners globally, particularly in this era of test and start.

Uganda Retail Audit: Analysis And Report, The Evidence Project

Reproductive Health

This brief presents results of a retail audit, carried out in January 2016, that was commissioned as part of PATH’s work under the USAID-funded Evidence Project to conduct a landscape assessment of the feasibility of a Total Market Approach (TMA) in Uganda. This project also involved key informant interviews with stakeholders on their attitudes toward TMA principles and the collection of a Uganda Market Research Summary of existing family planning knowledge. The approach is based on an understanding that equitably meeting the diverse needs of different population segments requires increased coordination across sectors, including the public, private for-profit, and not-for-profit …

Screening For Sexual And Gender-Based Violence In Emergency Settings In Uganda: An Assessment Of Feasibility, Chi-Chi Undie, Harriet Birungi, Jane Harriet Namwebya, Wossen Taye, Lilian Maate, Margaret Mak'anyengo, Anne Katahoire, David Apollo Kazungu, Darlson Kusasira, Zahra Mirghani, Joanina Karugaba

Reproductive Health

Sexual and gender-based violence (SGBV) is a global predicament to which over a third of women worldwide are exposed. Its negative consequences for reproductive, maternal, adolescent, and mental health are well-documented, however there is sparse evidence for the feasibility of SGBV screening interventions in emergency contexts. Employing a descriptive case study design, this study assessed the feasibility of implementing SGBV screening and referral protocols within health facilities in the emergency setting in Western Uganda. Providers from two health facilities were trained to screen female clients routinely for current exposure to intimate partner violence and lifetime exposure to nonpartner sexual violence. …

The Africa Regional Sgbv Network Learning Brief Series: Learning Updates From Uganda (Brief #7), Population Council

Reproductive Health

Sexual and gender-based violence (SGBV) in humanitarian contexts is recognized by the UN Refugee Agency as a global concern and as a priority in its programming. Crisis-affected populations often face multiple forms of SGBV at multiple time periods (during conflict, during flight from conflict, and within post-conflict settings). The Africa Regional SGBV Network, set up in 2006, is addressing SGBV in humanitarian contexts in East and Southern Africa. This Learning Brief is one in a series of two that share critical findings on effective responses to the issue in Uganda. This brief highlights the endline evaluation which measured the effectiveness …

The Africa Regional Sgbv Network Learning Brief Series: Learning Updates From Uganda (Brief #6), Population Council

Reproductive Health

Sexual and gender-based violence (SGBV) in humanitarian contexts is recognized by the UN Refugee Agency as a global concern and as a priority in its programming. Crisis-affected populations often face multiple forms of SGBV at multiple time periods (during conflict, during flight from conflict, and within post-conflict settings). The Africa Regional SGBV Network, set up in 2006, is addressing SGBV in humanitarian contexts in East and Southern Africa. This Learning Brief is one in a series of two that share critical findings on effective responses to the issue in Uganda. This brief notes that relatively higher screening, disclosure, referral, and …

Barriers To Fistula Repair In Uganda: A Formative Study, Population Council

Reproductive Health

This brief describes a formative research study conducted in Uganda by the Population Council, building on the results of a systematic review, to better understand the barriers and enabling factors for fistula repair care delivery and access. Understanding how Ugandan women living with fistula decide to seek care, identify and reach medical centers, and receive adequate and appropriate care is integral and continues to influence the design of a larger implementation pilot. This study focuses on Fistula Care Plus project-supported treatment facilities where fistula camps are routinely held. Results show that while it is difficult to measure the relative influence …

Effectiveness Of A Community-Based Sgbv Prevention Model In Emergency Settings In Uganda: Testing The 'Zero Tolerance Village Alliance' Intervention, Chi-Chi Undie, Harriet Birungi, Francis Obare, George Odwe, Jane Harriet Namwebya, Paul Orikushaba, Prosmolly Ayebale, William Onen, Fiona Nicholson, Rachel Chisinga-Francis, Peter Netshabako, Anne Katahoire, David Apollo Kazungu, Darlson Kusasira, Zahra Mirghani, Joanina Karugaba

Reproductive Health

Although sexual and gender-based violence (SGBV) is recognized as a growing problem in emergency settings, and the highest number of forcibly displaced people in recorded history were reported by UNHCR in 2015, evaluations of primary SGBV prevention models in these contexts have remained sparse. This study assessed the effectiveness of implementing a community-based SGBV prevention—the ‘Zero Tolerance Village Alliance’ intervention—in Western Uganda. The study demonstrated that the model is an effective means of fostering SGBV prevention in emergency settings. It proved to be particularly effective in: moderating negative gender attitudes and beliefs related to SGBV; positively changing perceptions of community …

Sexual And Reproductive Health Knowledge, Attitudes, And Practices Among Early Adolescents And Young Adults In Uganda: Findings From A Link Up Exploratory Study, Population Council

HIV and AIDS

The Population Council collaborated with Makerere University’s Child Health and Development Centre to conduct a study of males and females ages 10–24 to help inform future programs and policies affecting these young people. This study was conducted as part of the Link Up project, a global consortium led by the International HIV/AIDS Alliance that aims to improve the sexual and reproductive health and rights (SRHR) of young vulnerable people. Results indicate that adolescents and young adults have broad gaps in their knowledge about HIV and SRHR; early adolescents fared significantly worse in these areas than their older counterparts, suggesting that …

Using Peers To Improve Sexual And Reproductive Health And Rights Of Young People Living With Hiv In Uganda: Findings From A Link Up Evaluation, Population Council

HIV and AIDS

Link Up, a global consortium led by the International HIV/AIDS Alliance, sought to meet the immediate HIV care needs and also the broader sexual and reproductive health and rights (SRHR) for Ugandan young people living with HIV (YPLHIV), by creating linkages between comprehensive community- and facility-based HIV and SRHR services. In addition, Link Up delivered health education, counseling, and peer support tailored to the needs of YPLHIV in order to educate and empower them to recognize their rights, and feel confident in seeking health services. This brief presents findings from the Population Council’s evaluation of Link Up activities among YPLHIV …

Retrospective Review Of Task-Shifting Community-Based Programs Supporting Arv Treatment And Retention In Uganda, Sam Kalibala, Jerry Okal, Brady Zieman, Nrupa Jani, Lung Vu, Josephine Birungi, Stephen Okoboi, Jonathan Wangisi, Christine Nabiryo, Joanne Lyavala Okullu, Michael Etukoit, Lydia Buzaalirwa, Augustine Lubanga, Paul Kiyingi, Jonathan Ikapule, Syson Nakyeyune, Stephen Nakibinge, Penninah Lutung, Samuel Waliggo, Joseph Nsamba, Yashien Wamanga, Joseph Kamya, Robina Sentongo, Robert Yiga

HIV and AIDS

The purpose of this study was to examine examples of task-shifting programs in Uganda with the aim of generating data that could inform the development of task-shifting policies, guidelines, and practices. The overall purpose of the study was to contribute to the growing knowledge base about task-shifting by describing the service delivery approaches of three purposively selected major AIDS service organizations (ASOs) in Uganda that have adopted task-shifting. The study showed that in the three ASOs, almost all key tasks in antiretroviral therapy (ART), including determining eligibility, initiating ART, and dispensing antiretrovirals, can be feasibly shifted to lower-level cadres or …

Formative Research On Factors Influencing Access To Fistula Care And Treatment In Uganda, Pooja Sripad, Charlotte E. Warren

Reproductive Health

This formative research builds upon the results of a systematic review by the Population Council for better understanding of the barriers and enabling factors for fistula repair care and access in Uganda. The study focuses on Fistula Care Plus project-supported treatment facilities where fistula camps are routinely held. Results reveal the nuances of women’s experiences, along with the additional perspectives of their spouses, family members, community stakeholders, and fistula camp care providers including nurses/counselors, surgeons, and facility and district managers. Barriers and enablers to fistula repair care are clustered around the following factors: psychosocial, cultural, social, financial, transportation, facility shortages, …

In Search Of Safety, Negotiating Everyday Forms Of Risk: Sex Work, Criminalization, And Hiv/Aids In The Slums Of Kampala, Serena Cruz

FIU Electronic Theses and Dissertations

This dissertation offers an in-depth descriptive account of how women manage daily risks associated with sex work, criminalization, and HIV/AIDS. Primary data collection took place within two slums in Kampala, Uganda over the course of fourteen months. The emphasis was on ethnographic methodologies involving participant observation and informal and unstructured interviewing. Insights then informed document analysis of international and national policies concerning HIV prevention and treatment strategies in the context of Uganda. The dissertation finds social networks and social capital provide the basis for community formation in the sex trade. It holds that these interpersonal processes are necessary components for …

Proposed Indicators To Measure Adherence To And Effects Of Rights-Based Family Planning: Resource Guide, Kelsey Wright, Karen Hardee

Reproductive Health

At the London Summit on Family Planning in 2012, the goal of expanding access to FP programs by 120 million additional women and girls by 2020 was established. This goal calls attention to the need for FP information and services to be delivered in ways that are voluntary and respect human rights. While human rights have been codified and affirmed in declarations, conventions, and treaties, operationalizing rights in FP programs is still in an early stage of development. With the recent emergence of global numeric benchmarks for FP programs, there is the risk that the focus will move away from …

Social Accountability For Family Planning: A Case Study Of The Healthy Action Project In Uganda, The Evidence Project

Reproductive Health

In July 2014, the Evidence Project gathered 26 experts for a two-day meeting on Strengthening the Evidence Base on Social Accountability for Improving Family Planning and Reproductive Health Programs. Participants included social accountability experts from diverse fields (governance, maternal health, family planning) as well as researchers, implementers, and activists. The meeting was one of the first public discussions that addressed social accountability in the context of family planning and reproductive health (FP/RH). Meeting participants agreed on the need for case studies of FP/RH initiatives to identify “good practices” in order to advance the application of social accountability to the FP/RH …

Sexual And Reproductive Health And Rights Among Young People Living With Hiv In Uganda: Findings From The Link Up Baseline Survey, Population Council

HIV and AIDS

An estimated 3.7 percent of young people aged 15–24 years are living with HIV in Uganda, and face unique challenges in navigating a wide array of social, health, and developmental challenges as they transition to adulthood. Like all young people, those who live with HIV are starting to learn about their sexuality, often beginning to have intimate relationships or marry. In addition, they confront a myriad of complex issues associated with HIV status disclosure, initiation of and adherence to antiretroviral therapy, and deeply entrenched HIV-related stigma and discrimination. Young women bear a disproportionate share of this burden. Compared with men …

Burnout At The Frontline: The Effect Of A Reproductive Health Voucher Program On Health Workers In Uganda, Carinne M. Brody, John Micheal Irige, Ben Bellows

Background: Low job satisfaction among healthcare workers in developing countries can increase risk of burnout and have a negative effect on the quality of services. Novel financing strategies such as voucher programs, which aim to increase the utilization of services by the poor by offering physical vouchers for subsidized care, may unintentionally exacerbate burnout for health care workers by creating higher workloads.

Methods: A semi-structured survey that included both closed and open-ended questions as well as a locally-adapted job satisfaction scale was used to collect information on provider perceptions of changes in job satisfaction, workload, staffing and salaries …

Education Sector Response To Early And Unintended Pregnancy: A Review Of Country Experiences In Sub-Saharan Africa, Harriet Birungi, Chi-Chi Undie, Ian Mackenzie, Anne Katahoire, Francis Obare, Patricia Machawira

Reproductive Health

In Sub-Saharan Africa (SSA), early and unintended pregnancy leads to a colossal loss of educational opportunities for girls. Existing studies that show associations between early/unintended pregnancy and school dropout lead to critical questions about how the education sector is responding to the issue in SSA. Conducted from August 2014 to April 2015, this review was devoted to an examination of such responses across six countries: Botswana, Kenya, Malawi, Tanzania, Uganda, and Zambia. The review focused on several key issues, including: education-sector policies for pregnant students and adolescent mothers; integration of pregnancy prevention into sexuality education curricula; the school environment as …

Burundi Program Implementation Workshop, 3–5 June 2014: Link Up Meeting Report, Population Council, Alliance Burundaise Contre Le Sida

HIV and AIDS

Link Up is a global consortium of international and local nongovernmental organizations led by the International HIV/AIDS Alliance. Link Up aimed to improve the sexual and reproductive health and rights of young people in Bangladesh, Burundi, Ethiopia, Myanmar, and Uganda who are living with HIV or are affected by the HIV pandemic. At a workshop held in Burundi, 3–5 June 2014, the Population Council, Alliance Burundaise contre le SIDA, and local partners in Burundi identified successful activities, highlighted important challenges and best practices, and found innovative ways to improve Link Up programming. This document contains a selection of the most …

Hiv/Aids Vulnerabilities, Discrimination, And Service Accessibility Among Africa's Youth: Insights From A Multi-Country Study, Babatunde A.O. Ahonsi, Nahla G. Abdel-Tawab, Scott Geibel, Sam Kalibala, Jerry Okal, Babacar Mane, Nathi Sohaba, Julialynne Walker, Eric P. Green

HIV and AIDS

This report contains information from a study implemented between August 2011 and July 2012 that sought to provide a comprehensive, evidence-based picture of the HIV-related issues facing young people across Africa, and the prevailing legal, policy, and programmatic responses. The study was designed to establish a basis for a sharper focus on youth within the response to HIV on the continent. Researchers conducted country-specific analytical reviews of the relevant literature on factors associated with HIV risk-taking and health-seeking behaviors among young people aged 15–24 in six countries across Africa—Egypt, Kenya, Nigeria, Senegal, South Africa, and Uganda. In addition, qualitative and …

Retention Of Adolescents Living With Hiv In Care, Treatment, And Support Programs In Uganda, Livingstone Ssali, Sam Kalibala, Josephine Birungi, Aggrey Egessa, Jonathan Wangisi, Joanne Lyavala Okullu, Celestin Bakanda, Stephen Okoboi, Francis Obare

HIV and AIDS

Understanding the extent to which adolescents aged 10–19 years who are living with HIV are retained in HIV care, treatment, and support is important for informing the design of effective services for this population to better meet their needs across three main areas of HIV and AIDS programming: treatment; care and support; and prevention. Retention in HIV programs is, in turn, important for positive clinical outcomes including viral suppression and survival. In 2013–2014, The AIDS Support Organization and the Population Council undertook a study to generate evidence on factors associated with retention of adolescents in HIV and AIDS programs in …

Situation Analysis Of Programs To Meet The Hiv Prevention, Care, And Treatment Needs Of Persons With Disabilities In Ghana, Uganda, And Zambia, Waimar Tun, Jerry Okal, Katie D. Schenk, Meredith Sheehy, Emmanuel Kuffour, Selina F. Esantsi, Hilary Asiah, Grimond Moono, Felix Mutale, Rita Kyeremaa, Edson Ngirabakunzi, Atwijukire Justus

HIV and AIDS

National HIV strategic plans, HIV-related services, and HIV outreach efforts have tended to overlook persons with disabilities, and persons with disabilities are not reached by general HIV prevention, care, support, and treatment campaigns and services. To increase our understanding of how to make HIV programming more inclusive for persons with disabilities, HIVCore and partners conducted a three-country situation analysis (Uganda, Zambia, and Ghana). The study explored existing HIV services for persons with disabilities and determined the factors affecting their access to and use of HIV/sexual and reproductive health (SRH) services. Key findings: Persons with disabilities experience greater sexual vulnerability to …

Safe And Smart Savings Products For Vulnerable Adolescent Girls In Kenya And Uganda: Evaluation Report, Karen Austrian, Eunice N. Muthengi

Poverty, Gender, and Youth

The decision to engage in the development of girl-friendly savings accounts was made as part of the Population Council’s work with adolescent girls in Kenya. In June 2008 the Council and MicroSave Consulting started the Safe and Smart Savings Products for Vulnerable Adolescent Girls. Based on the market research and prior experience with developing programs for adolescent girls, a product concept for a group-based savings account was developed, in which the group model was used to address the legal constraints of minors not being able to hold individual accounts. In Kenya and Uganda, two financial institutions were identified, and the …

The Adolescent Girls Vulnerability Index: Guiding Strategic Investment In Uganda, Sajeda Amin, Karen Austrian, Michelle Chau, Kimberly Glazer, Eric P. Green, David Stewart, Marie Stoner

Poverty, Gender, and Youth

Adolescence (from the ages of 10 to 19 years) is a critical stage of human development during which children experience rapid social, physical, psychological, and emotional changes on the path from childhood to adulthood. The decisions that are made during this period of life affect not only the individual well-being of young people, but also the well-being of the entire society. The Adolescent Girls Multilevel Vulnerability Index (AGI) was developed based on a growing recognition of the need to channel resources to vital—yet highly vulnerable and vastly underserved—populations of adolescent girls in Uganda specifically, and the East and Southern Africa …

Evaluating The Efficacy Of Training Programs For Community Health Workers In Rural Uganda, Elizabeth Butler, Edward O’Neil, Zachary Tabb, Edward Mwebe, John Mukadde, Prossy Jim, Michael A. Godkin, Judith A. Savageau, Safi Ahmed, Arwen Wolfe

Judith A. Savageau

Background: The Ministry of Health and Omnimed, a non-profit U.S.-based organization that works with international communities to provide basic health education, have partnered to provide health training to community health workers (henceforth referred to as village health workers or VHWs) in rural villages in Uganda. The training is provided via an intensive five-day long session that introduces a wide variety of themes in basic health education taught by experts in the respective fields. The participants are selected by the local government based on their age, reliability, level of education and availability. On the first day, the participants are given a …