Initial Development of Scales to Assess Self-Efficacy for Disclosing HIV Status and Negotiating Safer Sex in HIV-Positive Persons

Two studies were conducted to develop scales for assessing self-efficacy to disclose HIV status to sex partners and negotiate safer sex practices among people living with HIV/AIDS. Elicitation research was used to derive 4 sets of scenarios with graduated situational demands that serve as stimulus materials in assessing self-efficacy. Two studies demonstrated that the self-efficacy scales for effective disclosure and negotiating safer sex practices were internally consistent, time stable over 1 month, and demonstrated evidence for validity. Self-efficacy scales also demonstrated evidence of criterion-related, convergent, and divergent validity. Reliable and valid instruments for assessing self-efficacy to make effective HIV status disclosure decisions and practice safer sex were therefore developed and these scales can be used in research to explain, predict, and enhance self-efficacy for these important behaviors.     

Adherence to a six-dose regimen of artemether-lumefantrine for treatment of uncomplicated Plasmodium falciparum malaria in Uganda

Measuring baseline levels of adherence and identifying risk factors for non-adherence are important steps before the introduction of new antimalarials. In Mbarara in southwestern Uganda, we assessed adherence to artemether-lumefantrine (Coartem) in its latest World Health Organization blister formulation. Patients with uncomplicated Plasmodium falciparum malaria were prescribed artemether-lumefantrine and received an explanation of how to take the following five doses at home. A tablet count was made and a questionnaire was completed during a home visit. Among 210 analyzable patients, 21 (10.0%) were definitely or probably non-adherent, whereas 189 (90.0%) were probably adherent. Age group was not associated with adherence. Lack of formal education was the only factor associated with non-adherence after controlling for confounders (odds ratio = 3.1, 95% confidence interval [CI] = 1.1-9.7). Mean lumefantrine blood levels were lower among non-adherent (n = 16) (2.76 microg/mL, 95% CI = 1.06-4.45) than among adherent (n = 171) (3.19 microg/mL, 95% CI = 2.84-3.54) patients, but this difference was not statistically significant. The high adherence to artemether-lumefantrine found in our study suggest that this drug is likely to be very effective in Mbarara provided that patients receive clear dosage explanations.     

HIV treatment adherence in women living with HIV/AIDS: research based on the Information-Motivation-Behavioral Skills model of health behavior.

Close and consistent adherence to anti-HIV medication regimens is necessary to achieve the maximum benefit of these potentially effective treatments. The authors examined cognitive and behavioral factors associated with HIV treatment adherence in a convenience sample of 112 women, 72 of whom were currently taking HIV treatments at the time of the study. Women completed confidential surveys and interviews to assess HIV-related health status, treatment regimens, and cognitive behavioral characteristics derived from the Information-Motivation-Behavioral Skills model of health promotion behaviors. Results showed that women who had missed at least one dose of their HIV medications in the past week reported lower intentions (motivation) to remain adherent and lower adherence self-efficacy (skills). Structural equation modeling showed that motivational and skills-building factors significantly predicted the number of medication doses missed. However, treatment-related information did not predict treatment adherence. In addition, women who had missed a dose of medication in the past week were more likely to have ever used devices and strategies to remind them of doses, but were no more likely to currently use such strategies. Interventions that enhance treatment adherence motivation and build adherence skills may help improve HIV treatment adherence in women receiving anti-HIV therapies.     

Medicinal plants used in malaria treatment by Prometra herbalists in Uganda

Ethnopharmacological relevance

The aim of the survey was to document medicinal plants used in malaria treatment by Prometra (Promocion de la medicina tradicional amazonica) Traditional Medical Practitioners (TMPs) of Uganda and for search of new antiplasmodial herbal medicines (HMs) for further phytochemical analysis.

Materials and methods

In this study, semi structured guided open and close ended questionnaires were used. Focus group discussions were conducted and key informants were chosen within the TMPs who helped in further discussions of how the herbal remedies where collected, prepared and administered.

Results

A sample size of 51 respondents was randomly selected among the TMPs with the help of their leader. 86 species distributed over 81 genera and 39 families were reportedly being used as herbal remedies in malaria treatment. The TMPs use symptoms like high temperature, shivering, among others in malaria diagnosis an indication that they understand malaria. They emphasized the use of leaves and bark in treatment because they can regenerate and therefore ensure sustainable use of plants rather than the use of roots which would be destructive. These TMPS treat and also advise their patients on preventive measures against malaria attacks like sleeping under mosquito nets, clearing bushes near homesteads, among others which is an indication that they help in the prevention and mitigation of malaria incidences and prevalence in the areas where they live. The Informant Consensus Factor (FIC) value of 0.8 demonstrated that the TMPs of Prometra-Uganda tend to agree with each other in terms of the plant species they use in malaria treatment an indication of quality control in as far as administration of the herbal remedies. Vernonia amygdalina Delile, Bidens pilosa L., Justicia betonica L. were highly cited as being used in malaria treatment with frequencies of mention of 38, 28 and 25, respectively.

Conclusion

TMPs of Prometra-Uganda understand and treat malaria using the available plant diversity from their huge forest and the herbal gardens within Buyija forest. The healers are very keen at plant conservation which is a good practice. Species like Justica betonica may be investigated further for antiplasmodial assays to justify its efficacy.     

Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people.

BACKGROUND: As many as one in three HIV-positive people continue unprotected sexual practices after learning that they are HIV infected. This article reports the outcomes of a theory-based intervention to reduce risk of HIV transmission for people living with HIV infection. METHODS: Men (n=233) and women (n=99) living with HIV-AIDS were randomly assigned to receive either (1) a five-session group intervention focused on strategies for practicing safer sexual behavior, or (2) a five-session, contact-matched, health-maintenance support group (standard-of-care comparison). Participants were followed for 6 months post-intervention. RESULTS: The intervention to reduce risk of HIV transmission resulted in significantly less unprotected intercourse and greater condom use at follow-up. Transmission-risk behaviors with non-HIV-positive sexual partners and estimated HIV transmission rates over a 1-year horizon were also significantly lower for the behavioral risk-reduction intervention group. CONCLUSIONS: This study is among the first to demonstrate successful HIV-transmission risk reduction resulting from a behavioral intervention tailored for HIV-positive men and women.     

Ethnobotanical study of indigenous knowledge on medicinal and nutritious plants used to manage opportunistic infections associated with HIV/AIDS in western Uganda

Ethnopharmacological relevance

Traditional medicine plays an important role in the daily lives of the people of Uganda to treat a wide range of health problems. Our study presents results of an ethnobotanical inventory conducted to identify and document medicinal and nutritional plants used in the management of opportunistic infections associated with human immunodeficiency virus / acquired immunodeficiency syndrome (HIV/AIDS), the plant parts used, preparation and administration methods of herbal remedies.

Materials and methods

We performed semi-structured interviews with 79 respondents (women 78%, men 22%), who included specialists in medicinal plants (such as traditional birth attendants and herbalists) and non specialists with general knowledge of plant use. Respondents answered a semi-structured questionnaire regarding their knowledge of plants and general treatment practices including management of HIV/AIDS opportunistic infections. The reported plants were collected and identified. Data were analyzed using factor informant consensus and fidelity level to determine homogeneity of informants? knowledge on medicinal and nutritional plants suitable for different ailment categories and the most preferred plant species used to treat each ailment category in the study areas.

Results

The study revealed 148 plant species belonging to 54 families, most of which were herbs (50.7%). Leaves (61.6%) were the most frequently used parts in remedy preparations which were mainly administered orally (72%). The majority of plants (62%) were harvested from wild habitats. The most important species according to fidelity values are Hibiscus sabdariffa L. for anaemia, Mangifera indica L. for cough, Zehneria scabra (L. F.) Sond. for skin infections, Rhus natalensis Bernh.ex.Krauss for diarrhoea and Tarenna pavettoides (Harv.) Sim for appetite boosting. The factor informant consensus highlighted the agreement in the use of plants and showed that the respiratory infections category had the greatest agreement (0.60). Family Asteraceae accounted for 15% of the total species recorded. Sixty plant species (40%) of the plants provide nutritional support.

Conclusion

The study revealed that folk medicine is still widely practised. Fidelity level values indicate that these plants are the most preferred species for particular ailments. The high consensus value (0.6) indicated that there was high agreement in the use of plants for respiratory ailments among others. These preferred plant species could be prioritized for conservation and subjected to chemical screening to ascertain their pharmacological activities.     

Partner testing with HIV self-test distribution by Ugandan pregnant women living with HIV: a randomized trial

Introduction

Secondary distribution of HIV self-tests (HIVST) by HIV-negative pregnant women to male partners increases men's testing rates. We examined whether this strategy promotes male partner testing for pregnant women living with HIV (PWLHIV).

Methods

We conducted an open-label individually randomized trial in Kampala, Uganda, in which PWLHIV ≥18 years who reported a partner of unknown HIV status were randomized 2:1 to secondary distribution of HIVST for male partner(s) or standard-of-care (SOC; invitation letter to male partner for fast-track testing). Women were followed until 12 months post-partum. Male partners were offered confirmatory HIV testing and facilitated linkage to antiretroviral treatment (ART) or oral pre-exposure prophylaxis (PrEP). Using intention-to-treat analysis, primary outcomes were male partner testing at the clinic and initiation on PrEP or ART evaluated through 12 months post-partum (ClinicalTrials.gov, NCT03484533).

Results

From November 2018 to March 2020, 500 PWLHIV were enrolled with a median age of 27 years (interquartile range [IQR] 23–30); 332 were randomized to HIVST and 168 to SOC with 437 PWLHIV (87.4%) completing 12 months follow-up post-partum. Of 236 male partners who tested at the clinic and enrolled (47.2%), their median age was 31 years (IQR 27–36), 45 (88.3%) men with HIV started ART and 113 (61.1%) HIV-negative men started PrEP. There was no intervention effect on male partner testing (hazard ratio [HR] 1.04; 95% confidence interval [CI]: 0.79–1.37) or time to ART or PrEP initiation (HR 0.96; 95% CI: 0.69–1.33). Two male partners and two infants acquired HIV for an incidence of 0.99 per 100 person-years (95% CI: 0.12–3.58) and 1.46 per 100 person-years (95% CI: 0.18%–5.28%), respectively. Social harms related to study participation were experienced by six women (HIVST = 5, SOC = 1).

Conclusions

Almost half of the partners of Ugandan PWLHIV tested for HIV with similar HIV testing rates and linkage to ART or PrEP among the secondary distribution of HIVST and SOC arms. Although half of men became aware of their HIV serostatus and linked to services, additional strategies to reach male partners of women in antenatal care are needed to increase HIV testing and linkage to services among men.