Muni Repository (MR)
This repository contains open access publications of Muni University Library.
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Recent Submissions
Tuberculosis-related stigma and associated factors among people with pulmonary tuberculosis predominantly co-infected with HIV in Kampala, Uganda: a cross-sectional study
(Elsevier, 2026-03-18) Izudi, Jonathan; Kyazze, Simon; Bajunirwe, Francis
Rationale
Stigma has a profound effect on the well-being and treatment outcomes of people with tuberculosis (PWTB). Despite its negative effects, TB-related stigma remains underexplored in high-burden TB settings such as Uganda.
Objective
To examine the factors associated with tuberculosis (TB)-related stigma among people with drug-susceptible pulmonary TB aged ≥18 years in Kampala, Uganda.
Methods
We conducted a cross-sectional study across five primary health facilities. The primary exposure was psychological well-being and was assessed using the World Health Organization (WHO) Five Well-Being Index (WHO-5). Scores ranged from 0 to 20, with ≥15 indicating good psychological well-being, and <15 indicating poor psychological well-being. TB-related stigma was the primary outcome measured using the Van Rie Stigma Scale, ranging from 0 to 48. We applied Generalized Estimating Equations, adjusting for important covariates and clustering by health facility to determine associated factors. Beta coefficients (β) and 95% confidence intervals (CI) were reported.
Results
We analyzed data from 818 participants, with normally distributed TB-related stigma scores: 25.3 ± 6.45. Higher TB-related stigma scores were statistically significantly associated with poor psychological well-being (β = 0.86, 95% CI: 0.60–1.13) and being a male (β = 0.77, 95% CI: 0.53–1.00). Individuals aged ≥25 years showed a borderline statistically significant association with TB-related stigma (β = 0.83, 95% CI: 0.11–1.55).
Conclusion
This study showed that poor psychological well-being and being male are associated with higher TB-related stigma scores among PWTB in Kampala, Uganda. TB programs should integrate mental health and implement stigma-reduction strategies that address underlying causes.
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.
Effect of community awareness, screening, testing, and treatment campaigns on TB prevention.
(International Union Against Tuberculosis and Lung Disease, 2026-02-27) Mulebeke, R; Izudi, Jonathan; Agaba, S.; walatum, J.E.O.; Jaganath, D.
Background: Tuberculosis preventive treatment (TPT) is a critical intervention for reducing TB incidence among high-risk groups, including people with HIV (PWH) and household contacts (HHCs). Despite its effectiveness, global TPT coverage remains suboptimal, particularly in high-burden settings like Uganda.
Objective: To evaluate the effect of community-based CAST-TB campaigns on TPT initiations among PWH and HHCs in central Uganda.
Methods: This single-group interrupted time series analysis used de-identified, aggregated TPT data from 105 TB clinics across eight districts in central Uganda (January 2020–December 2021). The intervention phase (2021) was compared with a pre-intervention phase (2020) using Bayesian Structural Time Series modeling to estimate pointwise and cumulative causal effects.
Results: Among HHCs, TPT initiations increased by 1,853 (95% CrI: 1,102–2,691), representing a relative increase of 121% (95% CrI: 72–176; p = 0.001). Among PWH, initiations increased by 1,346 (95% CrI: –729 to 3,680), with a relative increase of 12% (95% CrI: –6.3–32; p = 0.069), which was not statistically significant. Children under five years experienced a significant relative increase of 84% (95% CrI: 68–102; p = 0.001).
Conclusion: CAST-TB campaigns significantly improved TPT initiation among HHCs and young children, with more modest effects among PWH. Community-based, integrated campaigns can enhance TPT uptake in resource-limited settings. Sustaining gains will require strengthening follow-up systems and ensuring uninterrupted TPT supply.
Molecular characterization of extended-spectrum beta-lactamase- producing bacteria isolated from pregnant women’s urine at Itojo Hospital, South Western Uganda
(Microbiology Society, 2026-03-11) Twinomujuni, Muzafaru; Musinguzi, Benson; Asiimwe, Moses; Mpiima, Stephen Samuel; Zamarano, Henry; Orikushaba, Isaac; Muhanguzi, Deus; Twinamatsiko, Crinad; Mallya, Sarapia Paul; Samiri, Jamiru; Kamugisha, Joseph; Nalumaga, Pauline Petra; Kabanda, Taseera; Kassaza, Kennedy; Bagenda, Charles Nkubi; Tuhamize, Barbra; Bazira, Joel; Ricciardelli, Rosemary; Mpeirwe, Moses
Background: Extended-spectrum β-lactamase (ESBL)-producing bacteria pose a global challenge because of resistance developing against a wide range of antimicrobial agents, complicating available treatment options. Thus, identifying the prevalent bacterial species producing ESBL enzymes and understanding how they are susceptible to antibiotics is necessary to inform effective treatment guidelines.
Objective: We sought to characterize ESBL-producing bacteria isolated from pregnant women’s urine at Itojo Hospital, Ntungamo district, Southwestern Uganda.
Methods: We conducted a cross-sectional study where we collected and analysed 340 urine samples from 340 pregnant women. We did antimicrobial susceptibility testing using the Kirby–Bauer disc diffusion method. Isolates were screened for ESBL production and confirmed using the combination disc test. Genotypic characterization was confirmed using multiplex PCR to detect blaTEM, blaCTX-M and blaSHV genes.
Results: The prevalence of ESBL-producing bacteria was 29.7% (101/340). Escherichia coli 36/101 (35.6%) and Klebsiella species 33/101 (32.7%) were predominant ESBL producers. Genotypic analysis revealed blaTEM 50/101 (49.5%) and blaCTX-M 31/101 (30.7%) as the most prevalent genes, while blaSHV was less common, 8/101 (7.9%)
Conclusion. The high prevalence of ESBL-producing bacteria and their resistance to commonly used antibiotics highlighted the need for targeted antibiotic therapy, antimicrobial stewardship and regular molecular surveillance.
Association between non-high-density lipoprotein cholesterol and non-alcoholic fatty liver disease among people living with HIV on dolutegravir-based antiretroviral therapy: A cross-sectional study in Southwestern Uganda
(Springer Nature, 2026-02-20) Bagenda, Charles Nkubi; Nantongo, Carol; Ssemwanga, Elastus; Mugisa, Michael Junior; Akoth, Jesca Wafwoyo; Nzaramba, Daniel; Kalyetsi, Rogers; John, Elizabeth A.; Tumusiime, Jazira; Ainebyoona, Blendar; Omara, Shadrach; Mwesigye, Vicent; Lumumba, Sylvia Achieng; Lubwama, Conrad; Musinguzi, Benson; Ampaire, Lucas; Nassali, Rose; Itabangi, Herbert; Osuwat, Lawrence Obado; Ssenkumba, Brian; Omolo, Ronald Ouma
Non-high-density lipoprotein cholesterol, an aggregate marker of atherogenic lipoproteins, has been implicated in metabolic dysfunction and may predict non-alcoholic fatty liver disease risk. Our study investigated the association between non-high-density lipoprotein cholesterol and non-alcoholic fatty liver disease among people living with Human Immunodeficiency Virus on dolutegravir-based antiretroviral therapy in southwestern Uganda. We conducted a secondary analysis of data obtained from a cross-sectional study of 377 adults who had been on dolutegravir-based antiretroviral therapy for ≥ 12 months at Ruhoko Health Centre IV, southwestern Uganda.
Of the 377 participants, 42(11.1%; 95CI: 8.3–14.8) had non-alcoholic fatty liver disease. We observed a significant association between high non-high-density lipoprotein cholesterol and non-alcoholic fatty liver disease; second tertile (aOR = 3.08, 95% CI: 1.06–8.99, p = 0.039) and third tertile (aOR = 4.46, 95% CI: 1.25–15.88, p = 0.021). At an optimal cut-off of ≥ 113.4 with a sensitivity of 69% and specificity of 48%, non-high-density lipoprotein cholesterol had a significant discriminative ability; AUC = 0.654(95%CI:0.561–0.747) to distinguish participants with from those without non-alcoholic fatty liver disease. Therefore, High non-high-density lipoprotein cholesterol is a potential predictor for non-alcoholic fatty liver disease.