Nafuna Wamai

Centers for Disease Control and Prevention

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Rebecca Bunnell

President's Emergency Plan for AIDS Relief

Jonathan Mermin

Centers for Disease Control and Prevention

Peter Solberg

Dartmouth–Hitchcock Medical Center

Carlos Toledo

Centers for Disease Control and Prevention

James Exnobert Zulu

Zambia National Public Health Institute

Alex Coutinho

Infectious Diseases Institute

Anna Awor

Centers for Disease Control and Prevention

Stephanie M. Davis

Centers for Disease Control and Prevention

Anne Thomas

Laboratoire d'Écologie Alpine

Willy Were

East, Central and Southern Africa Health Community

Cooperative Institutions

Centers for Disease Control and Prevention

Center for Global Health

Uganda Virus Research Institute

United States Agency for International Development

National Center for HIV/AIDS Viral Hepatitis STD and TB Prevention

Centers for Disease Control and Prevention

Center for Surveillance, Epidemiology, and Laboratory Services

Johns Hopkins University

AIDS United

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Coming back from the dead: living with HIV as a chronic condition in rural Africa

Health Policy and Planning (2007)

Steven Russell Janet Seeley E. Ezati Nafuna Wamai Willy Were

Scaling-up of anti-retroviral therapy (ART) in resource-poor settings has dramatically reduced mortality and morbidity for those with access, but considerable challenges remain for people who are trying to live with HIV as a manageable chronic condition. A return to 'normal life' for people on ART depends on the assurance of an uninterrupted, affordable and accessible supply of medication. However, many poor people also require economic support to re-establish their livelihoods, particularly where productive and financial assets have been depleted because of long-term illness. ART programmes need to seek convergence with economic programmes that have expertise in livelihood support and promotion, and with social protection initiatives. The future for those on ART depends not only on the provision of medicine but also on economic and social support for rebuilding lives and livelihoods.

Promotion (chess)

10.1093/heapol/czm023

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Citations (91)

“Maybe his blood is still strong”: a qualitative study among HIV-sero-discordant couples on ART in rural Uganda

BMC Public Health (2012)

Rachel King Nafuna Wamai Kenneth Khana Eva Johansson P Lindkvist

HIV-negative members of sero-discordant couples are at high risk for HIV acquisition but few behavioral prevention interventions have been implemented in sub-Saharan Africa and discordance is not well understood by couples themselves. In this nested sub-study, we interviewed 40 HIV sero-discordant couples before and after a 6-month behavioral intervention that was comprised of four group discussions on specific HIV prevention and care topics. The content of the sessions included: 1) understanding HIV serodiscordance and reducing risk, 2) couple communication, 3) reproductive health and HIV serodiscordance, 4) coping with HIV serodiscordance and ongoing support. Couple members were interviewed individually. Data were analyzed thematically using 'Framework Analysis' which incorporated dyadic factors to address couple issues. Analysis revealed pre-identified concepts and emergent themes that were relevant to the final conceptual model. Four major categories of factors affecting couple relations, beliefs and current risk behaviors emerged: intervention factors, structural/contextual factors, physical health factors, and past risk behavior. The topics within the intervention most relevant were communication and reproductive health. The contextual factors highlighted by couples were gender norms around sexual decision-making and multiple partnerships. Individual beliefs regarding HIV serodiscordance persisted over all time points for some couples. Interestingly, some couple members had divergent views about their HIV status; some believing the HIV-negative member was negative while others described multiple beliefs around the negative member's blood surely being positive for HIV. Couple communication emerged as an important theme mediating beliefs and behavior. In addition to biomedical and behavioral interventions, HIV-serodiscordant couple interventions must embrace the contextual complexity and cultural understanding of HIV infection and discordance as well as the dynamic nature of couple communication to influence risk behavior.

Biostatistics

10.1186/1471-2458-12-801

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Citations (27)

Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention - Eastern and Southern Africa, 2012-2015

Jonathan M. Grund Carlos Toledo Stephanie M. Davis Renée Ridzon Edna Moturi

Abstract : Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60 percent, and the Presidents Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.During April 2012November 2015, PEPFARs VMMC program reported 12 tetanus cases in five sub-Saharan African countries. Three cases occurred in 20122013 (one in Uganda and two in Zambia), six in 2014 (one each in Kenya, Rwanda, and Tanzania and three in Uganda), and three in 2015 (one in Rwanda and two in Uganda). Eight patients received conventional VMMC surgery, and four received PrePex, a nonsurgical male circumcision device. No other VMMC-related tetanus cases had been previously reported. Intensified adverse event and death monitoring and reporting were instituted in July 2014 in all 14 PEPFAR-supported countries providing VMMC for HIV prevention.

Male Circumcision

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Women and Children Situation Analysis: Iganga District Report: First Draft

Nafuna Wamai Thomas Barton Gimono Wamai

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Trends and predictors of quality of life among HIV-infected adults taking highly active antiretroviral therapy in rural Uganda

AIDS Care (2007)

Anne Stangl Nafuna Wamai Jonathan Mermin Anna Awor Rebecca Bunnell

Abstract We examined trends and predictors of quality of life (QOL) over 12 months among a prospective cohort of 947 HIV-1-infected adults initiating highly active antiretroviral therapy (HAART) between May 2003 and May 2004 in rural Uganda. Participants provided clinical, demographic and psychosocial data at baseline and every three months thereafter. Outcome measures included physical and mental health summary scores based on the Medical Outcomes Study-HIV Health Survey (MOS-HIV). Generalised estimating equations were used to assess magnitude of change in summary scores and factors associated with QOL. Of 710 women and 237 men enroled, the mean age was 38.7 years and mean baseline CD4 cell count was 124.1 cells/µL. At enrolment, physical and mental health summary scores were 39.2 and 40, respectively. By 12 months of HAART, scores increased by 11.2 points (p <0.001) and 7.4 points (p <0.001), respectively. For both scores, most gains were achieved by the third month of therapy. While several clinical, psychosocial and sociodemographic factors predicted QOL at HAART initiation, financial dependence on others was the only remaining predictor after controlling for time on HAART. Interventions to enhance the economic and employment opportunities of patients taking HAART in rural Africa may help maximise gains in QOL.

10.1080/09540120701203915

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Citations (109)

Measuring quality of life in rural Uganda: reliability and validity of summary scores from the Medical Outcomes Study HIV Health Survey (MOS-HIV)

Quality of Life Research (2011)

Anne Stangl Rebecca Bunnell Nafuna Wamai Humphrey Masaba Jonathan Mermin

Discriminant validity

SF-36

10.1007/s11136-011-0075-5

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Citations (54)

Bleeding and Blood Disorders in Clients of Voluntary Medical Male Circumcision for HIV Prevention — Eastern and Southern Africa, 2015–2016

MMWR Morbidity and Mortality Weekly Report (2018)

Lawrence E. Hinkle Carlos Toledo Jonathan M. Grund Vanessa R. Byams Naomi Bock

A new CDC analysis of data from eight African countries shows the importance of screening for bleeding disorders before voluntary medical male circumcision (VMMC), promptly detecting and managing bleeding complications, and maintaining surveillance systems to monitor adverse events.

Male Circumcision

10.15585/mmwr.mm6711a6

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Citations (12)

Urethrocutaneous fistulas after voluntary medical male circumcision for HIV prevention—15 African Countries, 2015–2019

BMC Urology (2021)

Todd Lucas Jonas Z. Hines Julia Samuelson T. B. Hargreave Stephanie M. Davis

Abstract Background Voluntary medical male circumcision (VMMC) is an HIV prevention strategy recommended to partially protect men from heterosexually acquired HIV. From 2015 to 2019, the President’s Emergency Plan for AIDS Relief (PEPFAR) has supported approximately 14.9 million VMMCs in 15 African countries. Urethrocutaneous fistulas, abnormal openings between the urethra and penile skin through which urine can escape, are rare, severe adverse events (AEs) that can occur with VMMC. This analysis describes fistula cases, identifies possible risks and mechanisms of injury, and offers mitigation actions. Methods Demographic and clinical program data were reviewed from all reported fistula cases during 2015 to 2019, descriptive analyses were performed, and an odds ratio was calculated by patient age group. Results In total, 41 fistula cases were reported. Median patient age for fistula cases was 11 years and 40/41 (98%) occurred in patients aged < 15 years. Fistulas were more often reported among patients < 15 compared to ≥ 15 years old (0.61 vs. 0.01 fistulas per 100,000 VMMCs, odds ratio 50.9 (95% confidence interval [CI] = 8.6–2060.0)). Median time from VMMC surgery to appearance of fistula was 20 days (interquartile range (IQR) 14–27). Conclusions Urethral fistulas were significantly more common in patients under age 15 years. Thinner tissue overlying the urethra in immature genitalia may predispose boys to injury. The delay between procedure and symptom onset of 2–3 weeks indicates partial thickness injury or suture violation of the urethral wall as more likely mechanisms of injury than intra-operative urethral transection. This analysis helped to inform PEPFAR’s recent decision to change VMMC eligibility policy in 2020, raising the minimum age to 15 years.

Interquartile range

10.1186/s12894-021-00790-y

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Citations (15)

Depression and CD4 Cell Count Among Persons with HIV Infection in Uganda

AIDS and Behavior (2006)

Frank Kaharuza Rebecca Bunnell Susan Moss David W. Purcell Winnie Bikaako-Kajura

Health psychology

Depression

10.1007/s10461-006-9142-2

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Citations (209)

Notes from the Field: Tetanus Cases After Voluntary Medical Male Circumcision for HIV Prevention — Eastern and Southern Africa, 2012–2015

MMWR Morbidity and Mortality Weekly Report (2016)

Jonathan M. Grund Carlos Toledo Stephanie M. Davis Renée Ridzon Edna Moturi

Voluntary medical male circumcision (VMMC) decreases the risk for female-to-male HIV transmission by approximately 60%, and the President's Emergency Plan for AIDS Relief (PEPFAR) is supporting the scale-up of VMMC for adolescent and adult males in countries with high prevalence of human immunodeficiency virus (HIV) and low coverage of male circumcision. As of September 2015, PEPFAR has supported approximately 8.9 million VMMCs.

Male Circumcision

Adult male

10.15585/mmwr.mm6502a5

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Citations (19)