Browsing by Author "Appeli, Saidi"

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    Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study
    (Elsevier, 2025-10-22) Ssentongo, Saadick Mugerwa; Appeli, Saidi; Izudi, Jonathan
    Objectives Advanced HIV disease (AHD) at diagnosis substantially contributes to HIV-related morbidity and mortality but has been understudied. We determined the prevalence and factors associated with AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. Methods We conducted a retrospective cohort study of newly diagnosed PWH between May 2020 and July 2023 across 23 public health facilities in 14 districts in rural eastern Uganda. AHD at diagnosis was defined by a cluster of differentiation 4 count <200 cells/µL or World Health Organization clinical stage 3-4 disease. A generalized linear mixed model was used to identify factors associated with AHD at diagnosis. Results Among 1233 participants, we found that 24/1233 (1.9%) had AHD at diagnosis. In adjusted analysis, AHD at diagnosis was independently associated with being male rather than female (adjusted odds ratio, 3.84; 95% confidence interval, 1.53-9.61). Conclusions The low prevalence of AHD at diagnosis among newly diagnosed PWH suggests progress toward earlier diagnosis in rural eastern Uganda. Men tended to present with AHD at diagnosis more than women, although the finding is imprecise. Our findings highlight the need for targeted, gender-sensitive interventions to promote early diagnosis and care linkage.
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    Advanced HIV disease at diagnosis among newly diagnosed people with HIV in rural eastern Uganda: a retrospective cohort study
    (Elsevier, 2025-10-04) Ssentongo, Saadick Mugerwa; Appeli, Saidi; Izudi, Jonathan
    Objectives Advanced HIV disease (AHD) at diagnosis substantially contributes to HIV-related morbidity and mortality but has been understudied. We determined the prevalence and factors associated with AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. Methods We conducted a retrospective cohort study of newly diagnosed PWH between May 2020 and July 2023 across 23 public health facilities in 14 districts in rural eastern Uganda. AHD at diagnosis was defined by a cluster of differentiation 4 count <200 cells/µL or World Health Organization clinical stage 3-4 disease. A generalized linear mixed model was used to identify factors associated with AHD at diagnosis. Results Among 1233 participants, we found that 24/1233 (1.9%) had AHD at diagnosis. In adjusted analysis, AHD at diagnosis was independently associated with being male rather than female (adjusted odds ratio, 3.84; 95% confidence interval, 1.53-9.61). Conclusions The low prevalence of AHD at diagnosis among newly diagnosed PWH suggests progress toward earlier diagnosis in rural eastern Uganda. Men tended to present with AHD at diagnosis more than women, although the finding is imprecise. Our findings highlight the need for targeted, gender-sensitive interventions to promote early diagnosis and care linkage.
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    Determinants of underweight and overweight/ obesity among people with tuberculosis in Kampala, Uganda: A cross-sectional study
    (PLOS, 2026-02-13) Kyazze, Simon; Appeli, Saidi; Baluku, Joseph Baruch; Izudi, Jonathan
    Background Malnutrition significantly contributes to mortality among people with tuberculosis (TB). However, evidence on factors associated with the specific forms of malnutrition, specifically underweight and overweight/obesity, beyond clinical determinants, remains limited in many settings. We investigated the prevalence and determinants of underweight and overweight/obesity among people with pulmonary TB across five health facilities in Kampala, Uganda. Methods This analytic cross-sectional study involved people with pulmonary TB, either clinically diagnosed or bacteriologically confirmed, aged ≥18 years sampled across five health facilities in Kampala, Uganda. Nutritional status was assessed using body mass index (BMI, kg/m²) and categorized as underweight (<18.5), normal weight (18.5–24.9), and overweight/obese (≥25.0). To identify factors independently associated with nutritional status, normal weight was considered as the reference category in a multinomial logistic regression analysis, adjusting for multiple covariates and clustering at the health facility level. The measure of association was the adjusted relative risk ratios (aRRR) and the corresponding 95% confidence intervals (CI). Results Of the 818 participants studied, 417 (51.0%) had normal weight, 302 (36.9%) were underweight, and 99 (12.1%) were overweight or obese. Adjusted analysis showed that being underweight was associated with household food insecurity (aRRR 2.04, 95% CI: 1.48–2.80) while being overweight or obese was associated with self-employment (aRRR 2.26, 95% CI: 1.35–3.79) and being newly diagnosed with TB (aRRR 2.10, 95% CI: 1.30–3.41). Conclusion This study, conducted among people with pulmonary TB in an urban setting in Uganda, showed that underweight and overweight/obesity are prevalent. Furthermore, the study showed that food insecurity is associated with being underweight, while being overweight or obese is associated with being self-employed or newly diagnosed with TB. Therefore, TB control programs need to regularly assess the nutritional status of people with TB to mitigate the effect of being underweight or overweight on treatment outcomes.
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    Effect of facility- versus community-based HIV testing services on the diagnosis of advanced HIV disease in Uganda: a quasi-experimental study
    (Springer Nature, 2025-12-30) Izudi, Jonathan; Ssentongo, Saadick Mugerwa; Appeli, Saidi; Bajunirwe, Francis
    Background Advanced HIV disease (AHD) at first diagnosis remains a significant barrier to HIV epidemic control. We evaluated whether health facility-based or community-based HIV testing services (HTS) better impact the yield of AHD at diagnosis among newly diagnosed people with HIV (PWH) in rural eastern Uganda. Methods We designed a quasi-experimental study and applied instrumental variable analysis, a causal inference methodology, to compare the effect of facility-based HTS versus community-based HTS on the yield of AHD at diagnosis among newly diagnosed PWH. The exposure was HTS comparing community-based versus facility-based, and the outcome was AHD at diagnosis, defined as CD4 < 200 cells/µL or WHO clinical stage 3 or 4 disease at baseline. The instrumental variable was the HTS access radius that reflects the HTS geographical coverage for each health facility. The instrumental variable ensured the categorization of health facilities as offering HTS within a 5 km radius only or both within and beyond 5 km. The relevance of the instrumental variable was assessed using the F-statistic and independence from measured covariates. We used a two-stage residual inclusion approach to estimate the effect of HTS on AHD at diagnosis. Causal effect was reported as an odds ratio (OR) and 95% confidence interval (CI). Results Of 1,233 participants included in the analysis, AHD prevalence was 1.9% (24/1,233). The instrumental variable was strongly correlated with HTS (First-stage F-statistic = 28.05, p < 0.0001) and uncorrelated with AHD and all measured covariates. Facility-based HTS has no significant effect on AHD at diagnosis compared to community-based HTS (OR 1.20, 95% CI 0.49–2.90). Conclusions Persons with AHD at diagnosis are a minority. Facility- and community-based HTS do not differ in identifying AHD among newly diagnosed PWH, but moderate effects cannot be excluded. These findings support efforts to implement both strategies for HIV testing to reach and test persons with advanced HIV.
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    Effect of food insecurity on hazardous alcohol consumption and psychological well-being among people with tuberculosis in Kampala, Uganda
    (Elsevier, 2025-11-27) Izudi, Jonathan; Appeli, Saidi; Bajunirwe, Francis
    Rationale: Food insecurity (FI), hazardous alcohol consumption (HAC), and poor mental health are common among people with tuberculosis (TB), yet empirical evidence on their interrelationships remains limited. Objective: We evaluated the effect of FI on HAC and psychological well-being among people with pulmonary TB in Kampala, Uganda. Methods: We collected data across five TB clinics and constructed a quasi-experimental design. FI was the exposure, measured using the FI Experience Scale (FIES). FIES scores range between 0 and 8, and individuals were classified as food insecure if they scored ≥ 4. The primary outcome was HAC, assessed using the Alcohol Use Disorders Identification Test (AUDIT) tool. Participants with AUDIT scores ≥ 16, indicating high-risk drinking or possible alcohol dependence, were categorized as having HAC. The secondary outcome was psychological well-being measured using the World Health Organization’s Five Well-Being Index, with a total score of <15 indicating poor psychological well-being. We used doubly robust estimation to report causal risk ratios (RR) and 95 % confidence intervals (CI). Results: Of 818 participants, 475 (58.1 %) were from food-insecure households, 153 (18.7 %) had HAC, and 316 (38.6 %) had poor psychological well-being. FI was independently associated with HAC (RR 1.43, 95 % CI: 1.21–1.69), but not poor psychological well-being (RR 1.06, 95 % CI: 0.81–1.37). Conclusion: FI is associated with a higher likelihood of HAC but not psychological well-being among people with TB in Kampala, Uganda. Given their high prevalence, there is a need to address food insecurity, HAC, and poor psychological well-being within TB control programs.
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    Effect of food insecurity on hazardous alcohol consumption and psychological well-being among people with tuberculosis in Kampala, Uganda
    (Elsevier, 2025-11-27) Izudi, Jonathan; Appeli, Saidi; Bajunirwe, Francis
    Rationale Food insecurity (FI), hazardous alcohol consumption (HAC), and poor mental health are common among people with tuberculosis (TB), yet empirical evidence on their interrelationships remains limited. Objective We evaluated the effect of FI on HAC and psychological well-being among people with pulmonary TB in Kampala, Uganda. Methods We collected data across five TB clinics and constructed a quasi-experimental design. FI was the exposure, measured using the FI Experience Scale (FIES). FIES scores range between 0 and 8, and individuals were classified as food insecure if they scored ≥ 4. The primary outcome was HAC, assessed using the Alcohol Use Disorders Identification Test (AUDIT) tool. Participants with AUDIT scores ≥ 16, indicating high-risk drinking or possible alcohol dependence, were categorized as having HAC. The secondary outcome was psychological well-being measured using the World Health Organization’s Five Well-Being Index, with a total score of <15 indicating poor psychological well-being. We used doubly robust estimation to report causal risk ratios (RR) and 95 % confidence intervals (CI). Results Of 818 participants, 475 (58.1 %) were from food-insecure households, 153 (18.7 %) had HAC, and 316 (38.6 %) had poor psychological well-being. FI was independently associated with HAC (RR 1.43, 95 % CI: 1.21–1.69), but not poor psychological well-being (RR 1.06, 95 % CI: 0.81–1.37). Conclusion FI is associated with a higher likelihood of HAC but not psychological well-being among people with TB in Kampala, Uganda. Given their high prevalence, there is a need to address food insecurity, HAC, and poor psychological well-being within TB control programs.