Browsing by Author "Ssentongo, Saadick Mugerwa"

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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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    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 prior TB preventive therapy on allcause mortality during TB treatment among people with HIV/TB in rural eastern Uganda: an observational causal analysis
    (Springer Nature, 2026-06-08) Izudi, Jonathan; Bajunirwe, Francis; Ssentongo, Saadick Mugerwa; Appeli, Saidi; Cattamanchi, Adithya
    Background Tuberculosis preventive therapy (TPT) is the cornerstone for preventing TB disease. However, it is uncertain whether prior TPT completion improves survival once TB disease develops in people with human immunodeficiency virus (PWH) while on anti-retroviral therapy (ART). We evaluated the effect of prior TPT completion on all-cause mortality during TB treatment among PWH who developed TB disease while on ART in rural eastern Uganda. Prior TPT completion served as a marker of sustained engagement in HIV care. Methods We applied inverse probability of treatment weighting using propensity scores, a causal inference analysis approach, to mimic a randomized controlled trial using real-world retrospective cohort data. Inverse probability of treatment weighting addresses design flaws in observational studies, such as selection and confounding biases, providing less biased causal effect estimates. Individuals who had completed a full course of TPT before the start of the index TB treatment episode formed the intervention group, while the control group comprised those with no history of TPT before the index TB treatment initiation. Inverse probability of treatment weighting ensured balanced baseline covariates between the exposure groups. We estimated all-cause mortality rates using person-time methods and Kaplan-Meier curves and performed propensity-score weighted Cox proportional hazards analysis for cause-effect estimation. We reported adjusted hazard ratios (aHR) with 95% confidence intervals (CI). Results Of 719 participants, 296 (41.2%) had completed a full course of TPT before the start of the index TB treatment episode, and 83 (11.5%) had died. The mortality rate was 7.13 per 10,000 person-days, higher among participants without prior TPT than those with prior TPT completion (18.0% vs. 2.4%, log-rank χ²(1) = 35.3, p < 0.001). Median survival was 277 days (95% CI: 213–689). Prior TPT completion was associated with an 87% lower hazard of all-cause mortality (aHR 0.13, 95% CI: 0.06–0.29). Conclusion Prior TPT completion substantially reduced all-cause mortality among PWH who developed drug-susceptible TB disease while on ART. Therefore, there is a need to strengthen TPT completion and engagement in HIV care across HIV programs to lower all-cause mortality among PWH.