Research Articles

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Browsing Research Articles by Author "Cattamanchi, Adithya"

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    Addressing stigma, mental well-being, and alcohol use among people with tuberculosis in Sub-Saharan Africa: A Call for an integrated care model
    (American Society of Tropical Medicine and Hygiene (ASTMH), 2025-07-29) Izudi, Jonathan; Bajunirwe, Francis; Cattamanchi, Adithya; West, Nora
    Tuberculosis (TB) remains a major public health challenge in sub-Saharan Africa (SSA), with stigma, mental health issues, and alcohol use significantly affecting treatment outcomes. Stigma delays TB diagnosis, reduces treatment adherence, and disrupts care continuity. Mental health conditions, such as depression and anxiety, further undermine adherence, whereas alcohol use accelerates TB disease progression and leads to poor treatment outcomes. Current TB care models in SSA lack integrated support for psychosocial and behavioral health needs. This article advocates for a comprehensive care model that integrates mental health screening, counseling, psychosocial support, alcohol use disorder screening, and harm reduction strategies into TB programs. Effective implementation requires collaboration among TB care providers, mental health specialists, and alcohol use counselors supported by research, provider training, and community engagement. By addressing stigma, mental health, and alcohol use, this model can enhance treatment adherence and outcomes, advancing the WHO’s End TB Strategy in SSA.
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    Barriers and facilitators to integrating tuberculosis treatment into community pharmacies for people with TB/HIV in Kampala, Uganda: A qualitative study
    (PLOS, 2025-11-21) Izudi, Jonathan; Cattamanchi, Adithya; Sekaggya-Wiltshire, Christine; Kiwanuka, Noah; Sammann, Amanda; King, Rachel
    Community pharmacies (private retail drug shops or pharmacies) have proven successful for delivering anti-retroviral therapy to people living with human immunodeficiency virus (HIV). Leveraging this model for tuberculosis (TB) treatment integration could improve access to both TB and HIV treatment among people with TB/HIV. We identified the barriers and facilitators to integrating TB treatment into community pharmacies for people with TB/HIV in Kampala, Uganda, using a qualitative study across six public health facilities. Participants included people with TB/HIV; healthcare providers (HCPs) from the six facilities and their affiliated community pharmacies; and experts from the Ministry of Health. Data were collected through interviews guided by the Consolidated Framework for Implementation Research (CFIR). We performed framework analysis and mapped the emergent sub-themes to the relevant CFIR domains. We enrolled 47 participants: six TB focal persons, six HIV focal persons, nine pharmacy HCPs, three Ministry of Health staff, and 23 people with TB/HIV. Major facilitators included the convenience of accessing both TB and HIV treatment at a single location; enhanced privacy and reduced stigma; improved accessibility through extended hours, shorter wait times, and proximity; readiness of community pharmacy HCPs to deliver TB treatment; willingness of people with TB/HIV to engage in self-managed care; and training of pharmacy HCPs in TB care. Key barriers included unclear eligibility criteria for enrolling people with TB/HIV, absence of TB counseling services at pharmacies, inadequate infrastructure for TB drug storage, limited confidence among pharmacy HCPs in delivering TB care, and unclear logistics and operational procedures for implementation. Therefore, context-specific interventions that are developed in collaboration with key stakeholders, address barriers like eligibility criteria refinement, enhanced pharmacy HCP training, and financial incentives, and leverage facilitators like policy support and stakeholder readiness, are needed for the successful integration of TB treatment into community pharmacies for people with TB/HIV in Uganda.
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    Person-centered strategies for integrating TB treatment into community pharmacies for people with TB/HIV in Uganda: A human-centered design methodology study protocol
    (PLOS, 2026-03-12) Izudi, Jonathan; Cattamanchi, Adithya; Sekaggya-Wiltshire, Christine; King, Rachel; Kiwanuka, Noah; Sammann, Amanda
    Background Community pharmacies (private retail drug shops or pharmacies) have successfully delivered antiretroviral therapy (ART) to people with human immunodeficiency virus (HIV) and could support integrated tuberculosis (TB) treatment, but the implementation strategies are unclear. To inform a planned pilot randomized trial, we aim to develop person-centered strategies for integrating TB treatment into community pharmacies targeting people with TB/HIV using a Human-Centered Design (HCD) methodology. Here, we describe the study protocol. Methods We will employ a three-phased HCD methodology comprising inspiration, ideation, and implementation across six primary health facilities in Kampala, Uganda. Eligible participants will include people with TB/HIV, focal persons for TB and HIV, Ministry of Health officials, and community pharmacy healthcare providers. The inspiration phase will build the themes on barriers and facilitators to integrating TB treatment into community pharmacies from a qualitative study, complemented by participant observations at selected 2–3 community pharmacies to understand the care pathway of people with TB/HIV (journey mapping), including sketching the ideal pharmacy-based TB treatment pick-up. The ideation phase will use design workshops to consolidate identified themes, generate insight statements, including translating them into design opportunities, and conclude with forming low and high-fidelity prototypes. The implementation phase will comprise two rounds of prototype testing, low and high fidelity, with 12–16 participants per round, including people with TB/HIV, focal persons, Ministry of Health officials, and pharmacy health workers. Feedback on usability, desirability, feasibility, and viability will guide iterative refinement, with high-scoring prototypes in system usability surveys prioritized for trial. Discussion Through iterative user engagement, we will adapt contextually relevant strategies that will leverage key facilitators and address barriers to TB treatment integration. Strategies demonstrating perceived usefulness, user-friendliness, high acceptability, person-centeredness, and contextual relevance will be adapted and piloted in a planned randomized trial aiming to determine feasibility, acceptability, and fidelity, including preliminary effectiveness.
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    Viral load suppression after intensive adherence counselling among previously non-suppressed adolescents and young people with HIV in East-Central Uganda
    (Taylor & Francis, 2026-03-03) Ejalu, David Livingstone; Okello, Peter Simon; Puleh, Sean Steven; Nangendo, Joanita; Izudi, Jonathan; Bakeera-Kitaka, Sabrina; Katamba, Achilles; Katahoire, Anne R; Kalyango, Joan N; Cattamanchi, Adithya; Semitala, Fred C; Kamya, Moses R
    Background: Viral load suppression remains suboptimal among adolescents and young people living with HIV in Uganda (AYPLHIV). Although Intensive Adherence Counselling is recommended for individuals who remain virally non-suppressed while on antiretroviral therapy, its contribution to suppression among AYPLHIV is not well understood. This study aimed to determine the level of viral load suppression achieved following intensive adherence counselling among previously non-suppressed AYPLHIV in east central Uganda. Methods: We conducted a sequential explanatory mixed methods study among 580 participants aged 10– 24 years receiving care at 32 health facilities. Quantitative data were abstracted covering a five-year period from 2019– 2024. Suppression levels and subgroup differences were assessed using chi-square tests. A qualitative study was conducted with 12 purposively selected participants and thematic analysis were guided by the Capability, Opportunity, Motivation and Behavior framework. Results: Participants had a median age of 16.4 years and a median ART duration of 4 years. Overall, out of the 580 participants, 313 (53.9%) achieved viral load suppression after counselling. Participants living more than 5 km compared to less than 5km from a health facility (p=0.003) and those counselled by counsellors rather than nurses (p< 0.001) had significantly higher suppression level. Lower suppression level was observed among participants who had not disclosed their HIV status versus those who disclosed (p=0.011) and those reporting fear or stigma compared to those not reporting (p=0.010). Qualitative findings indicated that understanding the purpose and benefits of intensive adherence counselling (Capability), financial barriers and provider interactions (Opportunity), and non-disclosure (Motivation) influenced suppression outcomes among AYPLHIV. Conclusion: IAC resulted in modest improvements in VL suppression among AYPLHIV. Low retention and contextual barriers, including distance, stigma and non-disclosure, limited its effectiveness. Tailored IAC strategies addressing subgroup-specific barriers are needed to improve VL suppression.