Muni Repository :: Browsing by Author "Izudi, Jonathan"

Browsing by Author "Izudi, Jonathan"

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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.
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.
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.
Appropriateness, barriers, and facilitators of multi-month dispensing of tuberculosis drugs in rural eastern Uganda: A qualitative study to inform a non-inferiority randomized trial
(PLOS, 2025-09-05) Izudi, Jonathan; Bajunirwe, Francis; Adithya, Cattamanchi; West, Nora
Multi-month dispensing of tuberculosis (TB) drugs is an innovative strategy that may reduce frequent clinic visits and travel costs among people with TB (PWTB) in rural areas. To inform a planned trial, we explored the appropriateness, barriers, and facilitators to multi-month dispensing among PWTB and healthcare providers in rural eastern Uganda. We used qualitative methods situated within the Consolidated Framework for Implementation Research to explore two refill schedules for multi-month dispensing of TB drugs—a four- or five-visit refill schedule. In December 2024, we collected data through interviews with PWTB, their treatment supporters, and healthcare providers at the regional, district, and health facility levels. Data were analyzed using thematic analysis. All participants (n = 39; 22 healthcare providers, 12 PWTB, and five treatment supporters) expressed willingness to adopt multi-month dispensing, with a four-visit schedule as the preferred option. Healthcare providers preferred the five-visit schedule for individuals with complex health conditions: severe illness, clinical instability, or bacteriologically confirmed pulmonary TB. Multi-month dispensing was perceived to benefit healthcare providers by reducing workload, improving patient flow, and enhancing patient management. Perceived benefits to PWTB included reduced clinic visits and travel costs, time savings, improved treatment adherence, reduced wait times and TB-related stigma, and increased satisfaction with care. Facilitators included integration with existing treatment models, person-centeredness, community and family support, reliable drug supply, clear operational guidelines, healthcare provider training and readiness, enhanced monitoring and evaluation, clinic accessibility, readiness to utilize multi-month dispensing, and leadership support. Barriers included undefined eligibility criteria, uncertain effects of multi-month dispensing, differing refill schedules for PWTB and HIV, treatment non-adherence due to forgetfulness and medication sharing, and patient disengagement due to insufficient follow-up. Multi-month dispensing is perceived to benefit PWTB and healthcare providers. Further studies to measure the impact on treatment outcomes should leverage facilitators and address barriers to adoption and effectiveness.
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.
Effect of alcohol consumption and tobacco smoking on psychological distress: a quasi-experimental study using the 2022 Kenya demographic health survey data
(BMJ Group, 2025-06-16) Kamau, Kennedy; Andeso, Pauline; Muga, Winstoun; Karisa, Amani; Musyoki, Davis; Kuria, Joseph Mutura; Kadengye, Damazo T; Izudi, Jonathan
Methods: We analysed the 2022 Kenya Demographic Health Survey data. The primary exposure was alcohol consumption, and tobacco smoking was the secondary exposure. The outcome was psychological distress. We employed propensity score matching to achieve comparability on observed covariates between the exposed and unexposed groups. We then performed conditional logistic regression analysis, adjusting for matched pairs to establish a cause-effect relation between the exposures of interest and the outcome. We reported the OR and 95% CI. We conducted a sensitivity analysis using Mantel-Haenszel bounds to check for the robustness of the cause-effect findings to unmeasured confounders. Results: Of the 46 609 participants included in the study, 6450 (13.8%) consumed alcohol, while 2353 (5.0%) smoked tobacco. Overall, 1091 (2.3%) participants reported psychological distress. Among alcohol consumers, 352 (32.3%) reported psychological distress, compared with 115 (10.5%) among tobacco smokers. In a 1:1 ratio, we matched 10 070 individuals based on alcohol consumption and 4270 based on tobacco smoking status. In propensity-score-matched analysis, alcohol consumption (OR 2.76, 95% CI 2.06 to 3.70) and tobacco smoking (OR 2.04, 95% CI 1.29 to 3.24) showed an effect on psychological distress. Conclusion: This study found that alcohol consumption and tobacco smoking increase psychological distress among adults aged 15-54 years in Kenya. There is, therefore, a need to screen for psychological distress among people who drink alcohol or smoke tobacco to provide them with prompt mental health interventions.
Effect of healthcare worker vs. non-health worker delivered health education on modern contraceptive uptake among women in Malawi: a quasi-experimental study
(Springer Nature, 2025-10-29) Salamba, Thom; Izudi, Jonathan; Masegese, Tumaini; Mwila, Gabriel; Gueye, Ibrahima; Kyule, Grace; Khakayi, Sadie; Karan, Annaline; Vellemu, Ruth; Mwanga, Daniel; Gerbaba, Mulusew J.
Background Most women receive health education from healthcare workers. However, the same information can be delivered by non-health workers such as religious and traditional leaders, and peers, among others. The effectiveness of non-health worker-delivered health education on the uptake of hormonal contraceptives, however, remains uncertain. We compared the effectiveness of health worker and non-health worker-delivered health education on the uptake of modern contraceptives among women of reproductive age in two large districts in Malawi. Methods We designed a quasi-experimental study in two Malawian districts (Mangochi and Chikwawa). The intervention was health education delivered by either a health worker, such as a nurse (intervention group), while the comparator was health education delivered by a non-health worker, like a religious or traditional leader, peer, or the media, among others (comparison group). The main outcome was the uptake of modern contraceptives. To remove systematic differences between the two groups and achieve comparability on observed covariates, we used inverse probability of treatment weighting to emulate a randomized trial. After achieving covariate comparability, we performed a binary logistic regression to estimate the effect of health worker-delivered health education on contraceptive uptake, adjusting for the inverse probability of treatment weights. We reported the odds ratios (OR) and 95% confidence intervals (CI). Results We studied 414 participants aged 15–49 years (median age 29 years, interquartile range 23–36). There were 316 participants in the intervention group, and 143 (45.3%) of them used modern contraceptives. The comparison group had 98 participants, and 41 (41.8%) of them used modern contraceptives (p = 0.552). Participants in the intervention group tended to have an increased modern contraceptive uptake compared to those in the comparison group, although the difference was statistically insignificant (OR 1.45, 95% CI 0.74–2.89). Conclusions Modern contraceptive uptake did not differ between health worker and non-health worker-delivered health education approaches in the two Malawian districts. Non-health worker-delivered health education could be an additional tool for reaching several women of reproductive age with modern contraceptive information. This would contribute to increasing the contraceptive prevalence rate and reducing maternal and neonatal morbidity and mortality in these districts and similar settings.
Effect of safe water delivery plus water and sanitation hygiene behavior change communication on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya: a quasi-experimental study
(Springer Nature, 2025-10-28) Izudi, Jonathan; Muchiri, Evans; Musyoka, Dennis; Simiyu, Sheillah; Tumwebaze, Innocent K.; Mbaya, Nelson; Sidze, Estelle; Musau, Kelvin; Abajobir, Amanuel
Background Diarrheal diseases are prevalent among children under five years of age in slum areas. We evaluated the effect of safe water delivery plus water, sanitation, and hygiene (WASH)-Behavior Change Communication (WASH-BCC on diarrheal disease prevalence among children under 5 years in a slum setting in Nairobi, Kenya. Methods We designed a quasi-experimental study, with the intervention as safe water delivery plus WASH-BCC. The intervention arm consisted of 2 slum villages that received safe water plus WASH-BCC, while the comparison arm comprised 2 slum villages that did not receive the intervention. The primary outcome was diarrheal disease in a child under five years of age in the past 2 weeks in both study arms, defined as the passage of ≥ 3 watery stools in the past 24 h. Data were collected at the baseline and endline from a random sample of eligible households in the villages. Propensity score weighting was used to achieve similarity in measured covariates between both arms. Binary logistic regression analysis, adjusting for propensity-score weights, was utilized to estimate the causal effect of the intervention, reported as odds ratio (OR) and 95% confidence interval (CI). Results We analyzed data from 1,876 participants in a 1:1 ratio and found 382 (20.4%) children under five years of age had diarrheal disease at the endline. Diarrheal disease prevalence declined in the intervention villages (33.3% baseline vs. 23.5% endline) but increased in the comparison villages (15.7% baseline vs. 17.5% endline). We found a 31% decline in diarrheal disease in the intervention villages relative to the comparison villages (OR 0.69, 95% CI 0.55–0.86). In a difference-in-differences analysis, the decline was 11.4%. The findings remained robust in a sensitivity analysis. Conclusion The intervention significantly reduced diarrheal disease prevalence in children under five years of age in the slum setting. Therefore, there is a need to expand the intervention to the remaining areas to reduce diarrheal disease morbidity and mortality.
High prevalence of malaria in pregnancy among women attending antenatal care at a large referral hospital in northwestern Uganda:
(PLOS One, 2023-04-05) Mangusho, Caleb; Mwebesa, Edson; Izudi, Jonathan; Aleni, Mary; Dricile, Ratib; Mangwi, Richard Ayiasi; Legason, Ismail Draguma
Background Malaria in pregnancy contributes to substantial morbidity and mortality among women in Uganda. However, there is limited information on the prevalence and factors associated with malaria in pregnancy among women in Arua district, northwestern Uganda. We, therefore, assessed the prevalence and factors associated with malaria in pregnancy among women attending routine antenatal care (ANC) clinics at Arua regional referral hospital in north-western Uganda. Methods We conducted an analytic cross-sectional study between October and December 2021. We used a paper-based structured questionnaire to collect data on maternal socio-demographic and obstetric factors and malaria preventive measures. Malaria in pregnancy was defined as a positive rapid malarial antigen test during ANC visits. We performed a modified Poisson regression analysis with robust standard errors to determine factors independently associated with malaria in pregnancy, reported as adjusted prevalence ratios (aPR) and 95% confidence intervals (CI). Results We studied 238 pregnant women with a mean age of 25.32±5.79 years that attended the ANC clinic, all without symptomatic malaria. Of the participants, 173 (72.7%) were in their second or third trimester, 117 (49.2%) were first or second-time pregnant women, and 212 (89.1%) reported sleeping under insecticide-treated bednets (ITNs) every day. The prevalence of malaria in pregnancy was 26.1% (62/238) by rapid diagnostic testing (RDT), with the independently associated factors being daily use of insecticide-treated bednets (aPR 0.41, 95% CI 0.28, 0.62), first ANC visit after 12 weeks of gestation (aPR1.78, 95% CI 1.05, 3.03), and being in the second or third trimester (aPR 0.45, 95% CI 0.26, 0.76). Conclusion The prevalence of malaria in pregnancy among women attending ANC in this setting is high. We recommend the provision of insecticide-treated bednets to all pregnant women and early ANC attendance to enable access to malaria preventive therapy and related interventions.
Initiation of breastfeeding among mothers attending a regional referral hospital in central Uganda: a cross-sectional study
(Springer Nature, 2025-06-16) Nakayiza, Vivianne; Izudi, Jonathan; Nasuuna, Esther M; Atim, Fiona
Background: Breastfeeding initiation within the first hour of birth is beneficial in reducing the risk of maternal and neonatal mortality. However, a significant proportion of mothers delay initiating breastfeeding within an hour of birth, but the association with age has not been rigorously studied. We examined the association between maternal age and delayed initiation of breastfeeding in a large urban referral hospital in central Uganda. Methods: This analytic cross-sectional study was conducted at the Entebbe Regional Referral Hospital in Central Uganda. Data were collected using a researcher-administered questionnaire between October 1, 2019, and December 20, 2019. Delayed initiation of breastfeeding was the primary outcome, defined as putting the newborn to the breast after one hour of birth. The primary exposure was maternal age categorized as 15–24, 25–34, and 35–45 years. We performed a modified Poisson regression analysis to determine the independent association between maternal age and delayed initiation of breastfeeding, adjusting for other confounders. We stated the findings as an adjusted prevalence ratio (aPR) and 95% confidence interval (CI). Results: We studied 384 participants with a mean age of 27.5 ± 5.5 years. Of the 384 participants studied, 275 (71.6%) had delayed initiating breastfeeding, with the majority aged 15–24 years. In a multivariable analysis, delayed initiation of breastfeeding was significantly associated with maternal age groups of 15–24 years (aPR 1.28, 95% CI 1.01,1.63) and 25–34 years (aPR 1.28, 95% CI 1.01–1.60) compared to the reference group of 35–45 years. Additionally, delivery through cesarean section compared to spontaneous vaginal delivery was associated with delayed initiation of breastfeeding (aPR 1.93, 95% CI 1.49–2.49). Conclusion: Delayed initiation of breastfeeding is common and is associated with maternal age (15–24 and 25–34 years) as well as delivery through cesarean section. Routine health education and staff mentoring are needed to enhance early initiation of breastfeeding to prevent maternal and neonatal morbidity and mortality.
Missed opportunities in engaging community pharmacies for integrated tuberculosis care in Sub-Saharan Africa: A Call to Action.
(American Society of Tropical Medicine and Hygiene (ASTMH), 2025-11-06) Izudi, Jonathan; Sekaggya-Wiltshire, Christine; Adithya, Cattamanch
Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. Community pharmacies, which are often the first point of contact for people with TB, are underutilized in expanding TB care. Engaging community pharmacies in TB care could facilitate personalized adherence counseling, the timely detection and reporting of medication side effects, and the integration of TB and HIV services for individuals with both TB and HIV. Pharmacies can reduce stigma and address social and psychological barriers by offering person-centered care in convenient, accessible settings, including for working people and hard-to-reach communities. Integrating community pharmacies into national TB programs could strengthen adherence, reduce loss to follow-up, improve case detection, and help achieve End TB Strategy goals. The authors of the present study advocate for deliberate policy, training, and data linkages to realize this scalable opportunity, including implementation research.
Retreatment TB is a risk factor for multidrug-resistant TB among people with HIV in rural eastern Uganda: A nested case-control study
(Elsevier, 2025-09-12) Opolot, Godfrey; Olupot-Olupot, Peter; Okware, Samuel; Izudi, Jonathan
Rationale People with human immunodeficiency virus (PWH) have an increased risk of multidrug-resistant TB (MDR-TB) compared to those without HIV. Objective To investigate the risk factors for MDR-TB among PWH in rural eastern Uganda. Methods We conducted a nested case–control study at Soroti Regional Referral Hospital in rural eastern Uganda. TB records from January 2017 to May 2024 were retrospectively reviewed to identify all PWH. MDR-TB was defined as resistance to at least both Isoniazid and Rifampicin following GeneXpert Mycobacterium TB and Rifampicin assay and culture-based drug-susceptible testing. Cases were PWH with MDR-TB, while controls were a random sample of PWH without MDR-TB, in a 1:3 ratio. Multivariable binary logistic regression was used to identify factors independently associated with being a case rather than a control. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were reported. Results We included 37 cases and 111 controls, and found retreatment TB was associated with being a case rather than a control (aOR 6.97; 95% CI 2.65–19.46). Male sex (aOR: 1.59; 95% CI: 0.67–3.93), clinically diagnosed pulmonary TB (aOR: 0.38; 95% CI: 0.10–1.23) or extrapulmonary TB (aOR: 0.37; 95% CI: 0.05–1.62), and recent anti-retroviral therapy initiation (aOR: 2.07; 95% CI: 0.83–5.28) were insignificantly associated with being a case. Conclusion This study showed that retreatment TB is associated with a higher likelihood of MDR-TB among PWH in a referral hospital in rural eastern Uganda. These findings underscore the need for intensified drug resistance surveillance and adherence support among PWH with prior TB treatment.
Return to care of children and adolescents living with HIV who missed their clinic visits or were lost to follow-up: a continuous quality improvement study in Uganda
(Springer Nature, 2025-06-13) Ssentongo, Mugerwa Saadick; Izudi, Jonathan; Oryokot, Boniface; Opito, Ronald; Bakashaba, Baker; Munina, Abel; Opolot, Kokas; Ogwal, Daniel; Ssendiwala, Julius; Mugisha, Kenneth
Background: While the UNAIDS 95-95-95 targets have been met among adults, those for children and adolescents remain suboptimal. This study aimed to improve the return-to-care rates among children and adolescents living with HIV (CALHIV) who missed clinic appointments at a county-level rural health facility in eastern Uganda. Methods: Between January 2023 and January 2024, we conducted a continuous quality improvement (CQI) study. A CQI committee was established through entry meetings and training, and quality of care gaps were identified through data reviews. We prioritised one gap for CQI through ranking, performed a root-cause analysis using a fishbone diagram, and developed and ranked improvement changes using the impact-effort matrix. The improvement changes were implemented using Plan-Do-Study-Act cycles. The changes included (1) line listing CALHIV with missed appointments and following up via phone calls; (2) weekly data reviews to harmonise missed appointments and (3) assigning community health workers (CHWs) to trace and return CALHIV to care. We tracked and plotted the proportion of CALHIV returning to care over time to assess improvements. Results: Before the implementation of CQI initiatives (August 2022-January 2023), the average return-to-care rate was 35% (baseline). Following the initiation of CQI in February 2023, the average return-to-care rate increased to 59% from February to May 2023 with the introduction of line listing (phase 1), to 69% from June to September 2023 with the implementation of weekly data reviews (phase 2), and to 88% from October 2023 to January 2024 with the involvement of CHWs (phase 3), ultimately reaching a peak of 100% in January 2024. Conclusion: The CQI approach improved the return to care of CALHIV who missed clinic appointments, allowing access to optimal care and better health outcomes. These findings should serve as preliminary data for larger randomised studies.

Browsing by Author "Izudi, Jonathan"

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