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    Acceptability of pre-exposure prophylaxis and associated factors among HIV-negative young men in Kagwara fishing community-Serere district, Uganda: A cross-sectional study
    (PLOS ONE, 2025-06-04) Alex Omoding; Ronald Opito; Paul Oboth; Francis Okello; Joseph K. B. Matovu
    Background Despite the potential efficacy of Pre-Exposure Prophylaxis (PrEP) in reducing HIV risk, Oral PrEP acceptability remains strikingly varied by populations and locations. We assessed PrEP acceptability and associated factors among at-risk HIV-negative young men. Methods A cross-sectional analytical study design was used. Data were collected among 409 at-risk HIV-negative young men aged 15–24 years living in Kagwara fishing community- Serere district, Uganda between August and October 2023. Quantitative data were collected on socio-demographic characteristics, sexual risk behaviors and concerns about PrEP. Data was analyzed using Stata version 15.0 statistical software. Summary statistics were computed and presented as tables, frequencies and proportions. Bivariate analysis was conducted using binary logistic regression to identify independent factors associated with PrEP acceptability. All factors that had p < 0.10 at the bivariate analysis and confounders were entered into the final logistic regression model. All factors with p < 0.05 were considered significantly associated with the primary outcome Results The average age of 409 respondents was 21.8 (Standard Deviation [SD]=1.9) years. Majority, (97.8%, n = 393) had unprotected penetrative sex. PrEP acceptability was high as majority of the participants accepted to use PrEP based on the six constructs of acceptability (93.6%, n = 383). Participants with perceived risk of getting HIV infection had higher odds of PrEP acceptability, (adjusted odds ratio [aOR]=4.23, 95%CI = 1.05–17.04). Participants who knew their partner’s HIV status (aOR=0.25, 95%CI = 0.07–0.88), those who felt embarrassed to ask for PrEP from the facility (aOR=0.12, 95%CI = 0.04–0.39), and those who had stigma associated with use of PrEP (aOR=0.13, 95%CI = 0.04–0.41) had reduced odds of PrEP acceptability. Conclusion We found a high level of PrEP acceptability among young men at risk of HIV acqui sition in Kagwara fishing community. Improving access to PrEP services among high risk young men in the fishing communities may increase PrEP uptake in this population and across similar settings. The Ministry of health needs to use multiple approaches to provide PrEP such as peer-led models, drug distribution points, short message reminders for refills, pharmacies and retail drug shops.
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    Bottlenecks and opportunities towards achieving the targeted 95-95-95 HIV services in a rural district in Eastern Uganda
    (Health Services gateway, 2022-12-21) Monkya Samuel Namenkere; Ayaa Mary Stella; Sukuku Linda; Kharono Juliet; Mugabi Charles; Chelangat Benina; Mary Abwola Olwedo; Carol Nabasumba; Paul Oboth; Julius Osele; Rebecca Nekaka; Jacob Stanley Iramiot
    Background: Uganda has made progress in reducing its HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the World Health Organization (WHO) target of 95% of the population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in the Bukedea district. Methods: A mixed-methods cross-sectional study was conducted in the Bukedea district covering males and females aged 18-65 years who had consented to participate in the study. We used a purposive sampling procedure to select our study participants. Qualitative data was collected through focus group discussions, key informant interviews, and document reviews for quantitative data. Quantitative data were analyzed using STATA v 14 whereas qualitative data were analyzed using the thematic analysis approach. Results: The challenges were grouped as patient-related, medication-related, and facility-related. The patient-related challenges were stigma, fear of taking the medication, poor nutrition, long distances, alcoholism, busy working schedules, and domestic violence. The medication-related challenges were side effects and pill burden. The facility-related challenges were inadequate pretest counseling and stock-outs. The use of anti-retroviral drugs (ART) was common in piggery and poultry and the sources of these drugs were reported to be the people on ART and the health workers. The opportunities included home-based counseling, organizing more outreaches, counseling and health education, targeted testing, and strengthening the Village Health Teams (VHT) networks. Conclusions: The study revealed that the major challenges towards achieving the targeted 95-95-95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of anti-retroviral drugs in animal husbandry was common in the Bukedea District. Keywords enrolment to care, HIV testing, Viral load suppression, HIV infection, HAART, expert clients, HIV care, Adherence to HIV treatment.
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    Community perspectives and insights into cancer surveillance, prevention, and research: an engaged participatory approach to cancer epidemiology research in remote areas of Northeastern Uganda
    (Springer Nature, 2026-04-24) Ronald Opito; Alfred Jatho; Wilber Sabiiti; Hellen Akurut; Emmanuel Othieno; Lawrence Obado Osuwat; Anthony Mugeere; Patrick Igulot; Jackson Orem
    Background There is limited research on cancer screening, prevention and treatment in the remote areas of Northeastern Uganda. Specifically, there is limited research presenting cancer control stakeholder perspectives in remote settings, whereas stakeholders’ perspectives are critical for an engaged participatory approach to cancer control. This study therefore aimed to establish the community (patients, caretakers, opinion leaders, health managers and policy makers) perspectives on cancer surveillance, prevention, treatment and identify priorities for cancer research in Northeastern Uganda. Methods This qualitative research was part of a stakeholder’s consultation on cancer research priorities in Northeastern Uganda for Wellcome Trust research grant application, conducted by a consortium of research partners. Six semi structured Key Informant Interviews (KIIs), two focus group discussions (FGDs) and one community dialogue meeting were conducted between July and August 2025. Thematic data analysis was conducted to identify emergent themes from the interviews. Findings are presented using the key emergent themes, supporting quotes, and are presented in tables and text. This study is reported in accordance with Consolidated Criteria for Reporting Qualitative Research (COREQ). Key Findings There was delayed diagnosis in most cases for cancer patients. After the cancer diagnosis, patients were referred to Mulago Hospital, approximately 300Km away from their homes for further treatment, with many hesitations and incapacity to go to Mulago due to many social and economic challenges. There is no stand-alone cancer surveillance system in the country and currently it depends on health facility data which have lots of weaknesses including incompleteness and inaccuracy. Health facilities are ill-prepared to respond to the growing burden of cancers. Priorities for cancer research include epidemiology and etiology of cancer and a focus on population-based registry for unique populations in Uganda and strengthening cancer surveillance systems. Conclusion This study highlights the importance of an engaged approach based on Participatory Action Research theory to identify problems. Through this approach, the research team was able to accurately understand the research context, identify research issues, and priorities. Priorities for cancer research identified by this study include epidemiology and etiology of cancer, including the incidence studies and geographical mapping of these cancers, conducting cancer disease surveillance at the landing site and investigating the contribution of the locally available foods and environment to cancers. There is need for community sensitization and screening for cancers in the entire region. Involvement of community team leaders such as village health teams (VHTs), local council I (LCIs), traditional and church leaders in cancer surveillance should be encouraged and the community case definitions of common cancers should be refined and the capacity of the community workers (VHTs) built to detect cancers at community level. Through this preliminary research, the groundwork for science anchored on the realities of the affected people has been firmly laid upon which science can build on to solve the problem in a sustainable and equitable way.
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    Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study
    (BMC Women's Health, 2023-11-03) Jackie Lalam Lacika; Henry Wabinga; Joseph Kagaayi; Ronald Opito; Christopher Garimoi Orach; Amos Deogratius Mwaka
    Background Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. Methods This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. Results The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4–8.2) months and 2.4 (IQR: 1.2–4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemo radiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60–3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07–2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60–0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61–0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55–0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18–5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41–0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). Conclusion Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy. Keywords Cervical cancer, Diagnostic intervals, Pre-treatment intervals, Advanced stage
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    Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study
    (BMC Women's Health, 2023-11-27) Jackie, Lalam Lacika; Henry, Wabinga; Joseph, Kagaayi; Ronald, Opito; Christopher, Garimoi Orach; Amos Deogratius, Mwaka
    Abstract Background Majority of patients with cervical cancer in the low- and middle-income countries experience long diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and pre-treatment intervals among patients with cervical cancer. Methods This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals, defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late. Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to determine socio-demographic and clinical factors associated with the intervals. Results The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals were 3.1 (IQR: 1.4–8.2) months and 2.4 (IQR: 1.2–4.1) months respectively. Half of the participants, 49.6% (200/403) were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemoradiotherapy. Participants more likely to be diagnosed early included those referred from district hospitals (level 5) (aPR = 2.29; 95%CI: 1.60–3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07–2.23). Participants more likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI: (0.60–0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61–0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68; 95%CI: 0.55–0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60 years) (aPR = 2.44; 95%CI: 1.18–5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41–0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR = 0.52;95%CI: 0.29 - 0.95). Conclusion Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of chemo-radiation therapy.
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    Effect of corticosteroids on haemoglobinuria resolution among children with blackwater fever at Soroti regional referral hospital, Uganda: a retrospective cohort study
    (Springer Nature, 2025-11-03) Amos Odiit; Patrick Lubogo; Moses Ochora; Isaac Ebiju; Ronald Opito
    Background Corticosteroids are sometimes used in clinical practice in the treatment of blackwater fever (BWF), a complication of severe malaria, despite limited evidence of benefit. This study aimed to compare the time to haemoglobinuria resolution between children with BWF who received corticosteroids and those who did not, and determine if corticosteroid use significantly influences this outcome. Methods This was a retrospective cohort study carried out at Soroti Regional Referral Hospital in Soroti, Uganda, among children diagnosed with blackwater fever (BWF), between 1st January 2023 to 31st December 2024. Participants included in the study were 889. Time to haemoglobinuria resolution was determined using the Kaplan–Meier survival function and compared using log rank test. Predictors of time to haemoglobinuria resolution were determined using an extended cox proportional hazard model, with results expressed as adjusted hazard ratios (aHR) and 95% confidence intervals (CI). Results The median time to haemoglobinuria resolution was 3 days in both the corticosteroid and non-corticosteroid groups. Corticosteroid use was not significantly associated with time to haemoglobinuria resolution (aHR: 0.90; 95% CI 0.75–1.07, p = 0.239). The predictors of time to haemoglobinuria resolution were: antibiotic use (aHR: 0.68; 95% CI 0.58–0.81, p < 0.001), blood transfusion (specifically for those who received transfusions twice [aHR: 0.78; 95% CI 0.62–0.97, p = 0.024], three times [aHR: 0.59; 95% CI 0.40–0.88, p = 0.010], and four times [aHR: 0.36; 95% CI 0.24–0.53, p < 0.001]), presence of jaundice (aHR: 1.49; 95% CI 1.14–1.94, p = 0.003), and administration of normal saline (aHR: 0.57, 95% CI 0.45–0.74, p < 0.001). Conclusion Corticosteroid use did not accelerate haemoglobinuria resolution in children with blackwater fever, supporting current WHO guidance against their use. These findings suggest limited benefit of corticosteroids in BWF management.
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    Facilitators and Barriers to Cervical Cancer Screening Among Women in a Rural District of Northeastern Uganda, a Qualitative Study
    (Dove Medical Press Limited, 2026-04-23) Ibra Mutyaba; Hellen Akurut; Racheal Nabaasa; Jonathan Limo; Emmanuel Okupa; Christine Acari Omuke; Ronald Opito
    Introduction: Cervical cancer screening in Uganda has remained relatively low, with fewer than one in 10 of eligible women screened, despite the availability of cervical cancer screening services in most health facilities. The barriers and facilitators of cervical cancer screening in remote rural settings of Northeastern Uganda like Ngora are not yet well understood. This study therefore aimed to assess the barriers and facilitators to cervical cancer screening among women of reproductive age in a remote rural district Ngora, Northeastern Uganda. Methods: This study employed a qualitative approach to gather in-depth insight into the barriers and facilitators of cervical cancer screening. We conducted six focused group discussions (FGDs) (4 females and 2 males) with the community members and nine key informant interviews (KIIs) with the health workers in Ngora district. The participants for FGDs were chosen through convenient sampling while those for KIIs were chosen through purposive sampling methods. The interviews were audio-recorded and subse quently transcribed for analysis. Data was analyzed using thematic analysis techniques to identify significant patterns and themes related to cervical cancer screening behaviors, while inductive coding was conducted to identify codes and create meaning around the texts. Results: The facilitators of cervical cancer screening were active community sensitization, availability of screening services at designated facilities, supportive national policies, and integration with other health services, while the barriers included myths and misconceptions about cervical cancer screening, stock-outs of essential commodities for screening, long distances to the health facilities, limited human resources, and informal costs charged by the health facilities. Conclusion: Improving cervical cancer screening uptake requires a multi-pronged approach that strengthens health systems, addresses myths and misinformation, reduces financial and logistical burdens, and mobilizes community support. Keywords: cervical cancer, facilitators, barriers, community sensitization
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    Factors Associated with Cervical Cancer Screening Uptake Among Women Attending Outpatient Department in a Rural District Hospital in Uganda. A Cross-Sectional Study
    (International Journal of Women's Health, 2025-08-21) Jimmy Ekinu; Emmanuel Tiyo Ayikobua; Elizabeth Icodu; Hellen Akurut; Olympia Olivia Akot; Steven Oder; John Micheal Opinya; Tonny Egau; David Aderu; Moses Eremu; James Daniel Odongo; Walter Dreak Erabu; Ronald Opito
    Background: Sub-Saharan Africa (SSA) faces persistently low cervical cancer screening uptake, averaging only 13% over the past f ive years, with Uganda reporting less than 5%. This study aimed to assess the factors influencing cervical cancer screening uptake in a rural district hospital to inform targeted interventions that enhance screening coverage for the rural community. Methods: This was a cross-sectional study conducted at Kaberamaido General Hospital (KGH) outpatient department. A total of 422 participants aged between 25 and 49 years were interviewed and data analyzed using STATA version 16.0. Bivariate and multivariate analyses were performed using modified Poisson regression with robust error estimates to identify key factors associated with cervical cancer screening uptake. Variables with P-value <0.05 were considered statistically significant. Results: The average age of participants was 32 (SD ±7) years. 77.5% (n=327) of participants were married, had primary level of education, 69.2% (n=292), and were unemployed, 89.3% (n=377). Awareness about screening was high as 85.5% (n=360) of respondents had heard about cervical cancer screening. Cervical cancer screening uptake was low, as only 20.4% (n=86) had been screened in the past five years. Factors significantly associated with increased screening uptake, including age older than 35 years, adjusted Prevalence Ratio [aPR]= 1.7 (95% CI: 1.08–2.69), availability of free government screening services, aPR = 1.6 (95% CI: 1.09–2.38), provision of screening service at the nearest health facility, aPR = 2.1 (95% CI: 1.09–3.97), and a positive family history of cervical cancer, aPR = 1.7 (95% CI: 1.14–2.65). Conclusion: Our study confirms that cervical cancer screening uptake in Kaberamaido District remains low, highlighting the need for enhanced awareness campaigns and improved access to screening services. Our findings emphasize the need for policies that strengthen community outreach programs and expand cervical cancer screening services at primary healthcare facilities. Keywords: uterine cervical neoplasms, cervical cancer screening, women, cervical cancer awareness
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    Factors Associated with Cervical Cancer Screening Uptake Among Women Attending Outpatient Department in a Rural District Hospital in Uganda. A Cross-Sectional Study
    (International Journal of Women’s Health, 2025-08-21) Jimmy Ekinu; Emmanuel Tiyo Ayikobua; Elizabeth Icodu; Hellen Akurut; Olympia Olivia Akot; Steven Oder; John Micheal Opinya; Tonny Egau; David Aderu; Moses Eremu; James Daniel Odongo; Walter Dreak Erabu; Ronald Opito
    Background: Sub-Saharan Africa (SSA) faces persistently low cervical cancer screening uptake, averaging only 13% over the past five years, with Uganda reporting less than 5%. This study aimed to assess the factors influencing cervical cancer screening uptake in a rural district hospital to inform targeted interventions that enhance screening coverage for the rural community. Methods: This was a cross-sectional study conducted at Kaberamaido General Hospital (KGH) outpatient department. A total of 422 participants aged between 25 and 49 years were interviewed and data analyzed using STATA version 16.0. Bivariate and multivariate analyses were performed using modified Poisson regression with robust error estimates to identify key factors associated with cervical cancer screening uptake. Variables with P-value <0.05 were considered statistically significant. Results: The average age of participants was 32 (SD ±7) years. 77.5% (n=327) of participants were married, had primary level of education, 69.2% (n=292), and were unemployed, 89.3% (n=377). Awareness about screening was high as 85.5% (n=360) of respondents had heard about cervical cancer screening. Cervical cancer screening uptake was low, as only 20.4% (n=86) had been screened in the past five years. Factors significantly associated with increased screening uptake, including age older than 35 years, adjusted Prevalence Ratio [aPR]= 1.7 (95% CI: 1.08–2.69), availability of free government screening services, aPR = 1.6 (95% CI: 1.09–2.38), provision of screening service at the nearest health facility, aPR = 2.1 (95% CI: 1.09–3.97), and a positive family history of cervical cancer, aPR = 1.7 (95% CI: 1.14–2.65). Conclusion: Our study confirms that cervical cancer screening uptake in Kaberamaido District remains low, highlighting the need for enhanced awareness campaigns and improved access to screening services. Our findings emphasize the need for policies that strengthen community outreach programs and expand cervical cancer screening services at primary healthcare facilities. Keywords: uterine cervical neoplasms, cervical cancer screening, women, cervical cancer awareness
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    Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute
    (John Wiley & Sons Ltd., 2023) Jennifer, Achan; Francis Xavier, Kasujja; Ronald, Opito; Henry, Wabinga; Christopher Garimoi, Orach; Amos Deogratius, Mwaka
    Abstract Background: Most breast cancer (BC) patients in Uganda are diagnosed with advanced-stage disease and experience poor outcomes. This study examined the diagnostic and pre-treatment intervals and factors associated with these intervals among BC patients attending care at the Uganda Cancer Institute (UCI). Methods: This was a cross-sectional, facility-based study. Data were collected using structured questionnaire administered by trained research assistants and analyzed using STATA version 14.0. Modified Poisson regressions models were used to determine the strength of associations between independent variables and diagnostic and pre-treatment intervals. Results: The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140) stage IV cancers. The median interval from first consultation to diagnosis diagnostic interval (DI) was 5.6 months (IQR: 1.5–17.0), while the median interval from histological diagnosis to start of chemotherapy pre-treatment interval (PTI) was 1.7 months (IQR: 0.7–4.5). Majority (85%, n = 341) of participants were diagnosed at ≥3 months from first consultation with clinicians. Participants with tertiary education and those who lived within 100–199 km from the UCI were about four times and twice more likely to be diagnosed early (DI <3 months from first consultation) ([aPR = 3.88; 95% CI: 1.15–13.0] and [aPR = 2.19; 95% CI: 1.06–4.55]), respectively. About half (48.3%; n = 176) of participants started chemotherapy within 1 month of cancer diagnosis. Patients who lived more than 300 km from the UCI were less likely to start chemotherapy within 1 month of histology diagnosis of cancer. Conclusion: Majority of breast cancer patients are diagnosed late and in advanced stages. There is need to promote all efforts toward timely diagnosis when cancers are still in early stages by identifying factors responsible for prolonged diagnostic intervals among breast cancer patients.
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    Factors associated with modern contraceptive use among sexually active youths attending secondary schools in Mbale City, Uganda
    (PLOS Global Public Health, 2025-10-03) Mary Abwola Olwedo; Nelson Bunani
    Sexual and reproductive health of youths constitutes a significant public health challenge because of the high risk for morbidity and mortality. There is low uptake of modern contraceptives among the sexually active youths despite availability. We investigated the factors associated with the uptake of modern contraceptives among youths attending secondary schools in Mbale City. This was a cross-sectional study that enrolled 2,690 students from six purposively selected high-volume secondary schools in Mbale City. Data were collected using a validated semi-structured questionnaire and analyzed using descriptive statistics and multivariable logistic regression to identify factors associated with modern contraceptive use. The factors associated with modern contraceptive were stratified by sex. Statistical significance was set at 5% confidence level. Out of 2690 participants, 38.0% were sexually active. The proportion of sexually active participants who had ever used modern contraceptives was 60.9%. Factors associated with modern contraceptive use among male participants were not knowing the fertility days of the female (AOR = 0.49; 95% CI: 0.32-0.77; p = 0.002) and not receiving health education from a health worker (AOR = 0.44; 95% CI: 0.30-0.64; p < 0.001). Among females, factors associated with modern contraceptive use were knowledge of fertility days (AOR = 0.39; 95% CI: 0.18-0.85; p = 0.018), history of abortion (AOR = 0.10; 95% CI: 0.02-0.62; p = 0.014), and receiving health education from a health worker (AOR = 0.36; 95% CI: 0.22-0.59; p < 0.001). Modern contraceptive use was low compared to the national average, with knowledge of fertility days and health education significantly influencing uptake. Among males, lack of fertility knowledge and absence of health education were associated with low use of modern contraceptives. Among females, knowledge of fertility, history of abortion, and health education were key factors. Strengthening school-based sexuality education and increasing health worker-led reproductive health counselling can improve modern contraceptive knowledge and uptake, with gender-specific interventions needed to address barriers to access and use.
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    Factors associated with modern contraceptive use among sexually active youths attending secondary schools in Mbale City, Uganda
    (PLOS, 2025-10-03) Mary Abwola Olwedo; Nelson Bunani
    Sexual and reproductive health of youths constitutes a significant public health challenge because of the high risk for morbidity and mortality. There is low uptake of modern contraceptives among the sexually active youths despite availability. We investigated the factors associated with the uptake of modern contraceptives among youths attending secondary schools in Mbale City. This was a cross-sectional study that enrolled 2,690 students from six purposively selected high-volume secondary schools in Mbale City. Data were collected using a validated semi-structured questionnaire and analyzed using descriptive statistics and multivariable logistic regression to identify factors associated with modern contraceptive use. The factors associated with modern contraceptive were stratified by sex. Statistical significance was set at 5% confidence level. Out of 2690 participants, 38.0% were sexually active. The proportion of sexually active participants who had ever used modern contra ceptives was 60.9%. Factors associated with modern contraceptive use among male participants were not knowing the fertility days of the female (AOR = 0.49; 95% CI: 0.32-0.77; p = 0.002) and not receiving health education from a health worker (AOR = 0.44; 95% CI: 0.30-0.64; p < 0.001). Among females, factors associated with modern contraceptive use were knowledge of fertility days (AOR = 0.39; 95% CI: 0.18-0.85; p = 0.018), history of abortion (AOR = 0.10; 95% CI: 0.02-0.62; p = 0.014), and receiving health education from a health worker (AOR = 0.36; 95% CI: 0.22-0.59; p < 0.001). Modern contraceptive use was low compared to the national average, with knowledge of fertility days and health education significantly influencing uptake. Among males, lack of fertility knowledge and absence of health education were associated with low use of modern contraceptives. Among females, knowledge of fertility, history of abortion, and health education were key factors. Strengthening school-based sexuality education and increasing health worker-led reproductive health counselling can improve modern contraceptive knowledge and uptake, with gender-specific interventions needed to address barriers to access and use.
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    Factors associated with retention of mother baby pairs in the elimination of mother-to child transmission of HIV program in Kaberamaido district: A longitudinal analysis
    (PLOS ONE, 2023-07-21) JamesDanielOdongo; RonaldOpito; BenonWanume; DenisBwayo; DavidMukunya; SamuelOkware; JosephK.B.Matovu
    Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in Ugandaremains poor asonly 62.7%-69.5% are followed up to 18months. The objective of this study was to determine the rates of retention of mother-baby pairs at two levels of the eMTCTcascade(12and18months)andassociated factors. Methods This was alongitudinal analysis of 368 mother-baby pairs who were enrolled into the eMTCTprograminKaberamaido district from January 2013 to December 2018. Data was extracted from early infant diagnosis (EID) and mothers’ ART registers, entered into Micro soft Excel and then exported to Stata statistical software package version 14.0 for manage ment andanalysis. Descriptive statistics such as mean and frequencies were computed at univariate level. At the bivariate level, Cox proportional hazard regression was performed to assess the level of association between the primary outcome and each independent vari able, while Cox proportional hazard regression model was built at multivariate level to deter mine the factors independently associated with retention of mother-baby pairs in the eMTCTprogram. Results Of the 368mothers enrolled into the study, their average age was 29.7years (SD = 6.6). Nearly two-thirds of the mothers were married/cohabiting, (n = 232, 63.0%). The 368 mother baby pairs were observed for a total time of 6340 person months, with majority, 349 (94.8%, 95%CI=92.0–96.7) still active in eMTCT care, while 19(5.2%, 95%CI = 3.3–8.0) were lost to follow up at 12months. At 18 months, 323 (87.8%, 95%CI = 84.0–90.8) were active in eMTCTprogramwhile45(12.2%, 95CI=9.2–16.0) were lost to follow up. At bivariate level, marital status, health facility level of enrolment, mothers’ ART treatment supporter, and mothers’ ART enrolment time were significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs along the eMTCT cascade. At multivariable level, the mothers’ time of ARTinitiation was significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs at along the eMTCT cascade, with mothers-baby pairs who were initiated during the antenatal/post-natal periods having higher hazards of LTFU compared to those whoinitiated ART before Antenatal period (before pregnancy), aHR = 4.37(95%CI, 1.62 11.76, P = 0.003). Mother-baby pairs who were enrolled into the eMTCT program after the implementation of HIV test and treat policy (year 2017 and 2018) had higher hazards of LTFUascomparedtothoseenrolled before the implementation of test and treat policy in Uganda(year 2013–2016), aHR =2.22(95% CI, 1.15–4.30, P =0.017). All the other factors hadnosignificant association with lost to follow up and cascade completion at multivariate level. Conclusion There washigh level of retention of mother-baby pairs in the eMTCT program in Kabera maido at 12months, but it was suboptimal at 18months. ART initiation during the antenatal and/or post-natal period was significantly associated with suboptimal retention of mother baby pairs along the eMTCT cascade.
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    Factors associated with retention of motherbaby pairs in the elimination of mother-tochild transmission of HIV program in Kaberamaido district: A longitudinal analysis
    (PLOS One Publishers, 2023-07-21) James Daniel, Odongo; Ronald, Opito; Benon, Wanume; Denis, Bwayo; David, Mukunya; Samuel, Okware; Joseph K. B., Matovu
    Abstract Background Retention along the elimination of Mother to Child Transmission (eMTCT) cascade in Uganda remains poor as only 62.7%-69.5% are followed up to 18months. The objective of this study was to determine the rates of retention of mother-baby pairs at two levels of the eMTCT cascade (12 and 18 months) and associated factors. Methods This was a longitudinal analysis of 368 mother-baby pairs who were enrolled into the eMTCT program in Kaberamaido district from January 2013 to December 2018. Data was extracted from early infant diagnosis (EID) and mothers’ ART registers, entered into Microsoft Excel and then exported to Stata statistical software package version 14.0 for management and analysis. Descriptive statistics such as mean and frequencies were computed at univariate level. At the bivariate level, Cox proportional hazard regression was performed to assess the level of association between the primary outcome and each independent variable, while Cox proportional hazard regression model was built at multivariate level to determine the factors independently associated with retention of mother-baby pairs in the eMTCT program. Results Of the 368 mothers enrolled into the study, their average age was 29.7years (SD = 6.6). Nearly two-thirds of the mothers were married/cohabiting, (n = 232, 63.0%). The 368 mother baby pairs were observed for a total time of 6340 person months, with majority, 349 (94.8%, 95%CI = 92.0–96.7) still active in eMTCT care, while 19(5.2%, 95%CI = 3.3–8.0) were lost to follow up at 12months. At 18 months, 323 (87.8%, 95%CI = 84.0–90.8) were active in eMTCT program while 45(12.2%, 95 CI = 9.2–16.0) were lost to follow up. At bivariate level, marital status, health facility level of enrolment, mothers’ ART treatment supporter, and mothers’ ART enrolment time were significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs along the eMTCT cascade. At multivariable level, the mothers’ time of ART initiation was significantly associated with survival/lost to follow up (LTFU) of mother-baby pairs at along the eMTCT cascade, with mothers-baby pairs who were initiated during the antenatal/post-natal periods having higher hazards of LTFU compared to those who initiated ART before Antenatal period (before pregnancy), aHR = 4.37(95%CI, 1.62– 11.76, P = 0.003). Mother-baby pairs who were enrolled into the eMTCT program after the implementation of HIV test and treat policy (year 2017 and 2018) had higher hazards of LTFU as compared to those enrolled before the implementation of test and treat policy in Uganda (year 2013–2016), aHR = 2.22(95% CI, 1.15–4.30, P = 0.017). All the other factors had no significant association with lost to follow up and cascade completion at multivariate level. Conclusion There was high level of retention of mother-baby pairs in the eMTCT program in Kaberamaido at 12 months, but it was suboptimal at 18months. ART initiation during the antenatal and/or post-natal period was significantly associated with suboptimal retention of motherbaby pairs along the eMTCT cascade.
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    Factors associated with uptake and acceptability of cervical cancer screening among female sex workers in Northeastern Uganda: A cross-sectional study
    (PLOS One, 2025-01-24) Ronald Opito; Emmanuel Tiyo Ayikobua; Hellen Akurut; Susan Alwedo; Saadick Mugerwa Ssentongo; Walter Drake Erabu; Lazarus Oucul; Musa Kirya; Lameck Lumu Bukenya; Elly Ekwamu; Abraham Ignatius Oluka; Samuel Kabwigu; Emmanuel Othieno; Amos Deogratius Mwaka
    Background Cervical cancer screening program in Uganda is opportunistic and focuses mainly on women aged 25–49 years. Female sex workers (FSWs) are at increased risk of developing invasive cervical cancer. There is limited data regarding the uptake and acceptability of cervical cancer screening among FSWs in Uganda. This study aimed at identifying factors associated with uptake and acceptability of cervical cancer screening among FSWs in Eastern Uganda. Methods This was a cross-sectional study conducted among 423 FSWs aged 18–49 years attending care at six health facilities serving Key Populations (FSWs, Men who have sex with men, transgender people, people who inject drugs and people in prisons) in the Teso sub-region. Data was collected using structured investigator administered questionnaire and analyzed using Stata statistical software version 15.0 (Stata Corp, Texas, USA). The primary outcome was uptake of cervical cancer screening measured as the proportion of female sex workers who have ever been screened for cervical cancer. Chi-square test was used to compare the differences in uptake of cervical cancer screening by HIV status. Modified Poisson regres sion model with a robust variance estimator was used to determine association between the outcome variables and selected independent variables including demographic charac teristics. Prevalence ratios (PR) with accompanying 95% confidence intervals have been reported. Statistical significance was considered at two-sided p-values ≤ 0.05. Results The mean age of the participants was 28.1 (±SD = 6.6) years. The self-reported HIV prevalence was 21.5% (n = 91). There were 138 (32.6%) participants who had ever been screened for cervical cancer (uptake), while 397 (93.9%) were willing to be screened (acceptability). There was a significant difference in cervical cancer screening uptake between women living with HIV (WLHIV) and those who were HIV negative, 59.3% vs 26.9% respectively (P < 0.001). The significant factors associated with uptake of cervical cancer screening included living with HIV, adjusted prevalence ratio (aPR) = 1.53 (95%CI: 1.15–2.07), increasing number of biological children, aPR = 1.14 (1.06–1.24) living near a private not for profit (PNFP) facility, aPR = 2.84 (95% CI; 1.68–4.80) and availability of screening services at the nearest health facility, aPR = 1.83 (95% CI, 1.30–2.57). Factors significantly associated with acceptability of cervical cancer screening included being 40 years or older, aPR = 1.22 (95%CI: 1.01–1.47), having a family history of cervical cancer, aPR = 1.05 (1.01–1.10), and living near a PNFP facility, aPR = 1.17 (95% CI, 1.09–1.27) and having ever screened before, aPR = 0.92 (0.86–0.98). Conclusion Female sex workers living with HIV are more likely to screen for cervical cancer than the HIV negative clients. Cervical cancer screening uptake is relatively low among the female sex workers. However, majority of the FSWs are willing to be screened for cervical cancer if the services are provided in the nearby healthcare facilities. There is need to make cer vical cancer screening services available to all eligible women especially the female sex workers and integrate the services with sexual reproductive health services in general and not just HIV/ART clinics services
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    Isoniazid preventive therapy completion between July-September 2019: A comparison across HIV differentiated service delivery models in Uganda
    (PLOS One Publishers, 2024-01-02) Levicatus, Mugenyi; Proscovia, Mukonzo Namuwenge; Simple, Ouma; Baker, Bakashaba; Mastula, Nanfuka; Jennifer, Zech; Collins, Agaba; Andrew, Mijumbi Ojok; Fedress, Kaliba; John, Bossa Kato; Ronald, Opito; Yunus, Miya; Cordelia, Katureebe; Yael, Hirsch-Moverman
    Background Tuberculosis (TB) remains the leading cause of death among people living with HIV (PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective way of delivering ART. DSD models include Community Drug Distribution Point (CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management (FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is known about the impact of delivering IPT through DSD. Methods We reviewed medical records of PLHIV who initiated IPT between June-September 2019 at TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH). We defined IPT completion as completing a course of isoniazid within 6–9 months. We utilized a modified Poisson regression to compare IPT completion across DSD models and determine factors associated with IPT completion in each DSD model. Results Data from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females: 60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen: 61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile range [IQR]; 32.3–50.2) and 6.0 (IQR: 3.7–8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8–93.7%); highest in CDDP (98.1%, 95%CI: 95.0–99.3%) and lowest in FBG (85.8%, 95%CI: 79.0–90.7%). Compared to FBIM, IPT completion was significantly higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09–1.22) and CCLAD (aRR = 1.09, 95% CI 1.02–1.16). In facility-based models, IPT completion differed between sites (p<0.001). IPT completion increased with age for FBIM and CCLAD and was lower among female participants in the CCLAD (aRR = 0.82, 95%CI 0.67–0.97). Conclusion IPT completion was high overall but highest in community-based models. Our findings provide evidence that supports integration of IPT within DSD models for ART delivery in Uganda and similar settings.
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    Prevalence and factors associated with teenage pregnancy among girls aged 13 to 19 years in Atutur sub-county, Kumi district, Eastern Uganda: a community-based cross sectional study
    (Reproductive Health, 2025-06-25) Michael Akol; Ronald Opito; Bonniface Oryokot; Hellen Akurut; James Kalema; Maxwell Chekwoti; John Paul Matovu; Nasta Mayamba Chelimo; Hannah Muwanguzi; Moses Eremu; Samuel Kabwigu
    Abstract Background Teenage pregnancy remains a pressing public health issue with profound effects on health, education, and socio-economic outcomes. Rural areas, such as parts of Teso, often face higher prevalence of teenage pregnancy due to socioeconomic challenges. This study aimed at determining the prevalence of teenage pregnancy and associated factors in Atutur sub-county, Kumi district. Methodology The authors employed a cross-sectional study design and sampled 444 teenage girls aged 13–19 years from 12 randomly selected villages in Atutur sub-county, Kumi district in April 2024. They were interviewed using structured researcher administered questionnaire. Data was collected using kobo collect tool, downloaded, cleaned and exported to SPPS version 27.0 for further management and analysis. Descriptive statistics was conducted to determine the prevalence of teenage pregnancy. After adjusting for covariates, multivariate analysis was conducted using modified Poisson regression to determine predictors of teenage pregnancy. Results were reported with a 95% confidence interval (CI) and factors whose CI did not contain a null (1.0), with p-value (P < 0.05) for adjusted PR, were considered statistically significant. Results Of the 444 teenage girls, the mean age was 17 (standard deviation = 1.9) years. About one third of the participants, 132(29.7%) had ever conceived. Teenage girls in cohabitation were 3.0 times more likely to have conceived (aPR = 3.0, 95% CI: 2.23–4.10, P < 0.001) compared to those staying with their parents. Teenagers with both parents deceased were 1.9 times more likely to conceive (aPR = 1.9, 95% CI: 1.15–3.31, P = 0.032) compared to those whose parents were both alive. Teenage girls who were not satisfied with basic needs provided by parents were 3.3 times more likely to conceive (aPR = 3.3, 95% CI: 2.26–4.85, P < 0.001) compared to those satisfied with the basic needs provided by their parents. Conclusion Teenage pregnancy rates in Atutur sub-county Kumi district was higher than the national average, due to adverse socio-economic situation. Strengthening parental support of the girl child, with legal and community measures to reduce early marriages in rural settings may reduce teenage pregnancy. There is need to make deliberate efforts to provide socio-economic strengthening for the teenage girls to reduce their vulnerability. Keywords Teenage pregnancy, Prevalence, Cross-sectional, Early marriage
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    Prevalence and factors associated with mental health problems among adolescents living with HIV as screened by youth peers in rural Uganda: A cross-sectional study
    (PLOS Global Public Health, 2026-04-29) Mary Abwola Olwedo; Simon Eleku; Emmanuel Ayikobua Tiyo; Richard Mpango; Alex Imalingat; Fred Kirya; Derrick Amone; Hellen Akurut; Nelson Bunani
    Adolescents living with HIV face numerous psychosocial challenges that increase their vulnerability to mental health problems. However, limited evidence exists on the prev alence and contributing factors among this population in the Teso region of Uganda. This study assessed the prevalence of mental health problems and associated fac tors among adolescents living with HIV in the Teso region. A cross-sectional study was conducted among adolescents aged 10–19 years receiving HIV care in selected high-volume health facilities in the Teso region. Data were collected using the Home, Education/Employment, Activities, Drugs, Sexuality, Suicide/Depression psychosocial assessment tool (HEADSS tool), uploaded onto Kobo Collect for digital data collection. The data were exported to Microsoft Excel, cleaned, and analyzed using STATA version 17. Descriptive statistics were used to summarize sociodemo graphic characteristics and estimate the prevalence of mental health problems. Logistic regression analysis was used to identify factors associated with mental health prob lems. The prevalence of mental health problems was 35.2%, with suicidal tendencies being the most common (31%). Factors significantly associated with mental health problems included staying with one parent (AOR = 0.71; 95% CI: 0.55-0.92; p = 0.001) and not working (AOR = 4.4; 95% CI: 1.66–11.62; p = 0.03). Mental health problems are prevalent among adolescents living with HIV in the Teso region. Supportive living arrangements were protective, while employment was associated with increased risk. Peer-led screening can aid early identification, emphasizing the need to integrate men tal health services into adolescent HIV care, strengthen family and caregiver support
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    Prevalence, factors associated, and negative outcomes of "probable PTSD" among HIV infected children and adolescents: CHAKA study 2014-2017
    (Advances in Global Health, 2025-09-29) Richard Stephen Mpango; Wilber Ssembajjwe; Godfrey Zari Rukundo; Philip Amanyire; Tatiana Taylor Salisbury; Jonathan Levin; Kenneth D. Gadow; Vikram Patel; Eugene Kinyanda
    The aim of this study was to determine the prevalence of “probable post-traumatic stress disorder (PTSD),” factors associated with probable P-T-S-DPTSD, and its relationship with clinical and behavioral problems among children and adolescents with H-I-V/A-I-D-S (CA-HIV). A random sample of 1,339 C-A-H-I-V (aged 5–18 years, living with H-I-VHIV) whose caregivers completed an extensive battery of measures. The caregivers evaluated psychiatric symptom severity using a standardized D-S-MDSM-5-referenced psychiatric rating scale, the Child and Adolescent Symptom Inventory-5. The prevalence of “probable P-T-S-DPTSD” was estimated with 95% confidence intervals (95% C-ICI). Logistic and ordinal regression models were fitted to determine factors associated with probable P-T-S-D P-T-S-D , including study site, sex of the child, age of the child, caregiver religion, caregiver psychological distress, any anxiety and any attention-deficit/hyperactivity disorder (ADHD). Logistic and ordinal regression models were fitted to determine factors associated with probable P-T-S-D and to evaluate the relationship between probable P-T-S-D and clinical and behavioral outcomes. The overall prevalence of “probable P-T-S-DPTSD” was 19.6%. C-A-H-I-V with “probable P-T-S-DPTSD” were more likely to have had their sexual debut (a-o-r = 2.78; 95% C-I 1.12–6.55; P = 0.02). “Probable P-T-S-DPTSD” was marginally associated with poor adherence to H-I-V medication (a-o-r = 0.13, 95% C-I 0.02–0.97; P = 0.05).The study identified a high prevalence of “probable P-T-S-DPTSD” among C-A-H-I-V HIV, with significant associations with caregiver psychological distress, anxiety, and A-D-H-D . These findings underscore the need for targeted mental health interventions tailored to the unique needs of C-A-H-I-V in Uganda. Furthermore, integrating mental health services into routine H-I-V care could address the significant burden of P-T-S-D and its comorbidities in this vulnerable population in Uganda.
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    Profiling the disease burden in Teso subregion during community-based medical education and research services at Soroti University: a prospective study protocol
    (Archives of Public Health, 2026-06-18) Opito Ronald; Amos Odiit; Hellen Akurut; Emmanuel Ayikobua Tiyo; Joash Okoboi; Letizia Maria Atim; Clement Munguiko; Lawrence Obado; Bonniface Oryokot; Fred Kirya; Ruth Muhindo; David Aderu; Patrick Lubogo; Stephen Econyu; Simon Icumar Omeke; Samuel Kabwigu; Amos Deogratius Mwaka
    Background: Community-based medical education and research services (COBMERS) place medical students in primary health care facilities to strengthen their skills in community health service delivery, teamwork, leadership and professional ethics within limited-resource settings. Beyond training, COBMERS enables universities to generate evidence on local disease epidemiology, transmission dynamics, and control practices, resulting in a tangible, contextualized impact on the communities. There is however limited data on disease profile in Teso subregion, with limited epidemiological research in the area. This prospective study aims to profile the disease burden in the Teso subregion through COBMERS, thereby informing community-level interventions and health policy. Methods: The study will employ convergent parallel mixed-methods design, integrating quantitative and qualitative approaches. Quantitative ARTICLE IN PRESS components will include cross-sectional surveys to determine prevalence of non-communicable diseases (NCDs), neglected tropical diseases (NTDs), and ACCEPTED MANUSCRIPT ARTICLE IN PRESS infectious diseases, complemented by prospective cohort studies to assess temporal trends. Qualitative data will be gathered through focus group discussions and key informant interviews to explore community perceptions, health system capacity, and effectiveness of preventive measures. A community-based participatory research (CBPR) approach will guide all phases, ensuring that research is co-designed with community members, health practitioners, and local authorities. Medical students, under the supervision of faculty and site mentors, will serve as primary data collectors, integrating research with their COBMERS training. Discussion: The study is expected to provide evidence on the prevalence, trends, and risk factors of major diseases in the Teso subregion, alongside community perspectives on health priorities and barriers to care. Findings will stir up debates to inform tailored interventions, strengthen primary health care, and guide policy formulation. Additionally, embedding research within COBMERS is expected to build local research capacity among site mentors and students, fostering sustainability and continued community university collaboration. This protocol therefore provides an integrated framework that combines epidemiological surveillance, community engagement, and capacity building. By leveraging COBMERS and CBPR, the study seeks to provide actionable evidence to reduce the burden of NCDs, infectious diseases, and NTDs while promoting health system resilience in ARTICLE IN PRESS Eastern Uganda.