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Human immunodeficiency virus (HIV), human papillomavirus (HPV) and cervical cancer prevention in Uganda: prevalence, risk factors, benefits and challenges of post-exposure profylaxis, screening integration and vaccination
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.ORCID iD: 0000-0003-0830-1249
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Place, publisher, year, edition, pages
Örebro: Örebro university , 2015. , 154 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 125
Keyword [en]
HIV, HPV, Cervical cancer, Prevention, Post-exposure prophylaxis, screening integration, vaccination, Uganda
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
URN: urn:nbn:se:oru:diva-44517ISBN: 978-91-7529-084-3 (print)OAI: oai:DiVA.org:oru-44517DiVA: diva2:809485
Public defence
2015-06-09, Universitetssjukhuset, hörsal C3, Södra Grev Rosengatan, Örebro, 09:00 (English)
Opponent
Supervisors
Available from: 2015-05-04 Created: 2015-05-04 Last updated: 2017-10-17Bibliographically approved
List of papers
1. Occupational exposure to HIV: a conflict situation for health workers.
Open this publication in new window or tab >>Occupational exposure to HIV: a conflict situation for health workers.
2011 (English)In: International Nursing Review, ISSN 0020-8132, E-ISSN 1466-7657, Vol. 58, no 4, 454-62 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To determine the frequency of occupational exposure to human immunodeficiency virus (HIV), the circumstances and predisposing factors, the high-risk groups, the extent to which exposures are reported and the post-exposure prophylaxis (PEP) utilized by health-care workers (HCWs) and students in a Ugandan hospital.

BACKGROUND: Occupational exposure to HIV is a low but potential risk of HIV infection to health workers.

METHOD: Self-administered questionnaire was given to 224 participants (including 98 HCWs and 126 students) in Mbarara Hospital, Uganda. Data were analysed with descriptive statistics using the Statistical Package for the Social Sciences version 15.0 (SPSS Inc, Chicago, IL, USA).

FINDINGS: Of the 224 participants surveyed, 19.2% reported having sustained injection needle stick injuries in the previous year, of which 4.46% occurred with HIV-infected blood. Other reported injuries were cannula needle stick injury (0.89%), suture needle stick injuries (3.13%), scalpel cut injuries (0.45%) and muco-cutaneous contamination (10.27%). The most affected groups were nurses-midwives for scalpel injuries and students for stick injuries. The predisposing factors reported included lack of protective devices and recapping of needles. Exposures were under-reported. Uptake of PEP was also low.

CONCLUSION: Occupational exposure to HIV presents a conflict situation for HCWs. It remains a frequent occurrence particularly among student nurses-midwives, despite being avoidable. Its prophylactic treatment is hampered by poor reporting and investigation of exposures, and poor access to PEP. Strict adherence to universal precaution and proper handling of occupational exposure to HIV should be encouraged.

Keyword
HIV, Cervical cancer, Screening, Integration, Uganda
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-44594 (URN)10.1111/j.1466-7657.2011.00887.x (DOI)000297507900011 ()22092324 (PubMedID)2-s2.0-81855182078 (Scopus ID)
Note

Funding Agency: Mbarara University of Science and Technology HIV/AIDS Institutional Policy 

Available from: 2015-05-11 Created: 2015-05-11 Last updated: 2017-12-04Bibliographically approved
2. Integration of HIV and cervical cancer screening perceptions of healthcare providers and policy makers in Uganda
Open this publication in new window or tab >>Integration of HIV and cervical cancer screening perceptions of healthcare providers and policy makers in Uganda
2014 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 14, 810Article in journal (Refereed) Published
Abstract [en]

Background: HIV-positive women have an increased risk of developing cervical cancer (CC) compared to the HIV-negative women. Despite this, HIV and CC screening programs in many developing countries have remained disintegrated. Therefore, the objective of the study was to explore perceptions of healthcare providers (HCP) and policy makers (PM) about integration of HIV and CC screening services in Uganda.

Methods: This was a qualitative study conducted among 16 participants comprising of 12 healthcare providers and 4 policy makers in Uganda. Data were collected through individual interviews. Participants were purposively selected from different level of health facilities with clinics for HIV and CC screening services. Content analysis method was used to analyze the data.

Results: Three themes emerged from the data, namely appreciating benefits of integration, worrying about the limited health system capacity and potential consequences of integration and feeling optimistic about integration under improved health system conditions. The benefits embraced the women - particularly the HIV-positive women- but also men, healthcare providers and the health system or the government. There were worries that HIV stigma and shortage of healthcare workers would affect the effective delivery of the integrated program.

Conclusion: Integration of HIV and CC screening can offer manifold benefits to all stakeholders in the health system, more so to the women. However, its feasibility in developing countries such as Uganda will most likely be hampered by weak and inefficient health systems. Therefore, when considering HIV and CC screening integration, it is important not to only recognize the benefits but also take into account resources requirements for addressing the existing weaknesses and inefficiencies in the health systems such as limited infrastructure, insufficient drugs and supplies, inadequate and poorly motivated healthcare workers.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
HIV, Cervical cancer, Screening, Integration, Uganda
National Category
Environmental Health and Occupational Health
Identifiers
urn:nbn:se:oru:diva-37680 (URN)10.1186/1471-2458-14-810 (DOI)000341734500001 ()25099996 (PubMedID)2-s2.0-84907043465 (Scopus ID)
Note

Funding Agency:

Sida/SAREC

Available from: 2014-10-13 Created: 2014-10-13 Last updated: 2017-12-05Bibliographically approved
3. Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda
Open this publication in new window or tab >>Integration of HIV and cervical cancer screening perceptions and preferences of communities in Uganda
2015 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 15, no 1, 23Article in journal (Refereed) Published
Abstract [en]

Background: Despite the fact that HIV-positive women carry an increased risk of developing cervical cancer (CC) in comparison with HIV-negative women, HIV and CC screening programs in many developing countries have remained unintegrated. The objective of this study is to explore perceptions and preferences of community members in Uganda, including women, men, and village health teams, regarding the integration of HIV and CC screening services in a single-visit approach.

Methods: This qualitative study was conducted in three districts in Uganda. Data were collected through focus group discussions with women and village health teams, and individual interviews with men. Respondents were purposely selected from among those linked to three CC clinics in the three districts. The content analysis method was used to analyze the data.

Results: Three themes emerged from the data, namely appreciating the benefits of integration, worrying about the challenges of integration, and preferences for integration. The women endorsed the benefits. However, there were worries that integration would prolong the waiting time at the health facility and induce tiredness in both the healthcare providers and the women. There were also fears of being found positive for both HIV and CC and the consequences such as stress, self-isolation, and social conflicts. Participants, particularly the women, considered the challenges of screening integration to be manageable by, for example, taking a day off work to visit the hospital, delegating house chores to other family members, or taking a packed lunch on visiting the hospital.

Conclusions: The community members in Uganda perceive the benefits of HIV and CC screening integration to outweigh the challenges, and expect that the challenges can be minimized or managed by the women. Therefore, when considering HIV and CC screening integration, it is important to not only recognize the benefits but also take into consideration the perceived challenges and preferences of community members.

Place, publisher, year, edition, pages
London, United Kingdom: BioMed Central, 2015
Keyword
Cervical cancer, HIV, Integration, Perceptions, Screening, Uganda
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:oru:diva-44236 (URN)10.1186/s12905-015-0183-4 (DOI)000350950300001 ()25783655 (PubMedID)2-s2.0-84925124216 (Scopus ID)
Funder
Sida - Swedish International Development Cooperation Agency
Available from: 2015-04-14 Created: 2015-04-14 Last updated: 2017-12-04Bibliographically approved
4. Prevalence, genotypes and risk factors for vaccine and non-vaccine types of Human Papillomavirus (HPV) infections among Bivalent HPV-16/18 vaccinated and non-vaccinated young women in Ibanda district Uganda: 5 year follow up study
Open this publication in new window or tab >>Prevalence, genotypes and risk factors for vaccine and non-vaccine types of Human Papillomavirus (HPV) infections among Bivalent HPV-16/18 vaccinated and non-vaccinated young women in Ibanda district Uganda: 5 year follow up study
Show others...
(English)Manuscript (preprint) (Other academic)
Keyword
Bivalent HPV16/18 vaccine, Human papillomavirus, genotypes, young women, Uganda
National Category
Medical and Health Sciences Infectious Medicine
Identifiers
urn:nbn:se:oru:diva-44595 (URN)
Available from: 2015-05-11 Created: 2015-05-11 Last updated: 2017-10-17Bibliographically approved

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