Directorate of Graduate Training, Research, and Innovations

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Browsing Directorate of Graduate Training, Research, and Innovations by Subject "Antiretroviral therapy"

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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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    Underweight is associated with detectable viral load among adolescents with HIV in rural eastern Uganda: a retrospective cohort study
    (Springer Nature, 2026-03-08) Auca, Agnes; Logose, Barbara Shalah; Izudi, Jonathan
    Background Detectable viral load (DVL) after ≥ 6 months of antiretroviral therapy (ART) and underweight are common among adolescents with HIV (AWH) but remain understudied. We assessed the association between underweight at ART initiation and DVL among AWH in rural eastern Uganda. Methods We retrospectively reviewed program data for AWH aged 10–19 years from 11 clinics in eight districts. Underweight was defined as body mass index (BMI) for age <5th percentile at ART initiation. DVL was defined as the first viral load ≥ 1,000 copies/mL after ≥ 6 months on ART. Associations were examined using multi-level mixed-effects Poisson regression, adjusting for individual-level factors and accounting for clustering by district and health facility. Results We analyzed 525 AWH, of whom 47.6% were aged 10–14 years and 51.0% were male. At ART initiation, 79.2% were underweight, and 19.0% had DVL after ≥ 6 months on ART. In multivariable analysis, underweight at ART initiation was significantly associated with DVL (adjusted risk ratio [aRR] 1.66, 95% confidence interval [CI] 1.07–2.56). DVL was also associated with baseline CD4 count ≤ 200 cells/µL (aRR 1.36, 95% CI 1.12–1.66), and there was no statistically significant association with interruption in ART (aRR 1.43, 95% CI 0.89–2.29). Conclusion Among AWH in rural eastern Uganda, the prevalence of DVL was nearly four times the UNAIDS target of ≤ 5%. DVL was linked to underweight and severe immunodeficiency. Interventions such as nutritional support, targeted adherence counseling, early HIV diagnosis, and prompt ART initiation are critical to achieving viral suppression in this setting.