School of Public Health (Public-Health) Collections

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    Assessing the performance of the results-based monitoring tool and its influence on program performance in Uganda’s national HIV response
    (Makerere University, 2026) Okello, Andrew
    Background: Uganda continues to face a significant HIV burden, with 4.9% prevalence and 37,000 new infections annually. To strengthen monitoring, accountability, and decision-making, the Uganda AIDS Commission (UAC) introduced the Result-Based Monitoring (RBM) Tool. While the tool provides a structured framework for performance tracking, challenges such as incomplete reporting, limited flexibility, and uneven staff capacity affect its optimal use. Objectives: This study evaluated the RBM Tool’s performance and its influence on performance monitoring and decision-making. It specifically examined trends in activity completion rates and data completeness, stakeholder perspectives, implementation challenges, and enabling factors for tool optimization. Methods: A process evaluation using an explanatory sequential mixed-methods approach was applied. Secondary data (n = 370 activity records, 2022–2024) from UAC database were analyzed using descriptive statistics and trend analysis. Qualitative data were collected through 16 key informant interviews with UAC staff (n = 10) and Self-Coordinating Entities (n = 6), and analyzed thematically using NVivo 15. Results: Activity completion averaged 82.7%, with stable annual performance scores (84.2% in 2022, 81.8% in 2023, 82.1% in 2024). Data completeness improved after 2022, yet over half of submissions in 2023–2024 remained incomplete. Stakeholders emphasized the tool’s value in standardizing reporting, aligning planning with national priorities, and fostering accountability. However, they cited constraints in capturing process-based achievements, limited narrative space, and capacity gaps among SCEs. Enabling factors included peer learning, quarterly feedback loops, financial facilitation, and a user-friendly interface. Conclusions: The RBM Tool has reinforced structured performance monitoring and accountability in Uganda’s HIV response but requires technical refinements, sustained capacity building, and integration with national digital systems to maximize effectiveness, adaptability, and sustainability.
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    Exploring the influence of psychosocial support on ART adherence among adolescents living with HIV at Reach Out Mbuya, Kampala, uganda.
    (Makerere Uinversity, 2026) Musiimenta, Abraham.
    Background: Adolescents living with HIV (ALHIV) face unique challenges in adhering to ART, including stigma, mental health difficulties, and inconsistent psychosocial support. Psychosocial interventions are increasingly recognized as critical for improving adherence and overall well-being, yet gaps remain in how this support is perceived and accessed in Uganda. This study explored how psychosocial support influences ART adherence among adolescents receiving care at Reach Out Mbuya Community Health Initiative. Methods: A phenomenological qualitative design was employed, drawing primarily on in-depth interviews with 19 adolescents aged 12–19 years living with HIV, complemented with 11 key informant interviews with caregivers, peer supporters, counsellors, and health workers to provide contextual insights. Participants were purposively sampled to capture a diverse range of experiences. Data were transcribed, translated, and thematically analyzed to identify patterns related to adolescents’ lived experiences, psychosocial support, stigma, mental health challenges, and gaps in care. Results: Findings revealed that adolescents valued psychosocial support through peer groups, counselling, and recreational programs, which fostered openness, reduced loneliness, and motivated adherence. Stigma, particularly fear of disclosure in schools and communities, remained a barrier, often leading to concealment or avoidance of medication. Mental health challenges such as loneliness, sadness, and stress were reported to directly disrupt adherence, though coping mechanisms like music, trusted friendships, and supportive caregivers provided resilience. Caregivers and peers played an active role by reminding or supervising ART use, while health worker counselling was key in regaining adherence after lapses. Gaps were noted in emotional support from some providers, breaches of confidentiality in school settings, and limited livelihood opportunities, which compounded adherence difficulties. Conclusion: Psychosocial support significantly influenced ART adherence among ALHIV, with peer and caregiver support, counselling, and recreational activities serving as key facilitators. However, stigma, mental health challenges, and inconsistent provider support hinder adherence. Strengthening adolescent-friendly psychosocial interventions, ensuring confidentiality in schools, and expanding livelihood opportunities are essential to improve the ART adherence outcome.
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    Prediction of risk of pre-eclampsia among pregnant women at the China-Uganda Friendship Hospital, Naguru
    (Makerere University, 2025) Kahura, Winfred
    Background: Preeclampsia presents a highly prevalent burden on pregnant women with a global estimated incidence of 4.6%. Preeclampsia increases the maternal risk of death and is one of the leading causes of perinatal morbidity and mortality. In Uganda, 336 women die per 100,000 live births due to pregnancy-related causes. The Department of Obstetrics and Gynecology of China-Uganda Friendship Hospital in Naguru, receives about 520 mothers with severe preeclampsia, 132 with eclampsia, 14 with postpartum eclampsia, and 12 maternal deaths in 2017. The continued occurrence of maternal death and other adverse outcomes due to hypertensive disorders of pregnancy in Uganda is an indication of failure to effectively identify the disease early enough. Objective: The aim of the study was to develop, train, and test a prediction model for the risk of pre-eclampsia among pregnant women and to develop a web-based application that uses machine-learning algorithms to predict women’s risk of preeclampsia, to be used by healthcare workers. Method: A retrospective study utilizing data from 2,193 antenatal care records and key predictors such as maternal age, symptoms (headaches, visual disturbances), and clinical signs (blood pressure, proteinuria), was analyzed using advanced machine learning algorithms including Logistic Regression, Decision Trees, and Gradient Boosting Classifier. The Gradient Boosting Classifier emerged as the optimal model, achieving an Area Under the ROC Curve (AUC) of 0.85, indicative of robust discriminative ability. The study highlights age and proteinuria as critical factors influencing preeclampsia risk assessment. Ethical considerations were upheld throughout, ensuring confidentiality and data protection. Results: Of the five models developed, the Gradient Boosting Classifier performed the best with an accuracy of 87.42% and an AUC of 0.85, indicating excellent discriminative ability. The key factors identified as predictors of preeclampsia included maternal age, proteinuria, systolic blood pressure, and the presence of headaches or visual disturbances. These factors contributed significantly to the model’s predictive power, highlighting the potential for improving early detection in clinical settings. Conclusion: Machine learning, particularly the Gradient Boosting Classifier, shows strong potential for predicting preeclampsia and aiding in early interventions. The web-based tool developed in this study can support healthcare workers in timely diagnosis, potentially improving maternal health outcomes in resource-limited settings.
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    Contraceptive utilization among hiv-positive women aged 15-49 years accessing art services at Kotor PHCC in Juba City Council, South Sudan
    (Makerere University, 2025) Mawadri, Innocent.
    Women of reproductive age living with HIV face a dual challenge of unintended pregnancies and the risk of mother-to-child transmission (MTCT). Family planning (FP) is critical for addressing these risks, yet contraceptive use in South Sudan remains among the lowest globally. Understanding utilization and the barriers HIV-positive women face is vital for designing effective interventions. This study assessed contraceptive utilization among HIV-positive women aged 15–49 years accessing ART services at Kotor Primary Health Care Centre (PHCC) in Juba City Council. Specifically, it determined the prevalence of modern contraceptive use, identified associated factors, and explored women’s perceptions and experiences regarding FP. A sequential explanatory mixed-methods design was used. Quantitative data were collected from 439 HIV-positive women through structured questionnaires, whereas qualitative data were obtained from key informant interviews to explore socio-cultural and systemic factors influencing contraceptive decisions. Data were analyzed using multivariable logistic regression and thematic analysis, guided by the Health Belief Model. Of the 439 participants,75.2% (95% CI: 70.9% -78.9%) reported using modern contraceptive methods, with condom being the most commonly used method. The results indicated that the following groups of women were more likely to utilize modern contraceptive methods; women with multiple sexual partners (adj. PR= 1.45, 95%CI: 1.00-2.10, p=0.048), and history of abortion (adj. PR=1.16, 95%CI: 1.01-1.33, p=0.035). Whereas women aged 45 years and above (adj. PR=0.27, 95%CI:0.07-1.00, p=0.050), those who rarely engage in sexual activity (adj. PR= 0.68, 95%CI: 0.51-0.90, p=0.006), with increasing age at menstruation (adj. PR= 0.93, 95%CI: 0.88-0.99, p=0.016) were less likely to utilize modern contraceptive methods. Qualitative findings revealed barriers such as stigma, cultural and religious opposition, stockouts, limited provider training, and myths around infertility and Antiretro Viral Therapy contraceptive interactions. Despite these barriers, provider counseling and partner support emerged as important facilitators of uptake. Contraceptive use among HIV-positive women in Juba is high and is shaped by a complex interplay of individual, socio-economic, cultural, and health system factors. While knowledge and empowerment predict use, stigma, misconceptions, and weak service delivery continue to hinder uptake. Integrating family planning within HIV care, addressing myths and stigma through community engagement, and strengthening provider capacity are essential strategies to improve under utilized contraceptive methods, reduce mother to child transmission, and enhance reproductive health outcomes in South Sudan.
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    Determinants of timeliness in the routine monitoring of HIV-Exposed Infants (HEI) at health facilities in Kampala district.
    (Makerere university, 2026-01-27) Nyiramugisha, Emily.
    Background: Early Infant Diagnosis (EID) testing is a critical strategy for improving early detection and monitoring of HIV among HIV-Exposed infants (HEIs). Uganda implemented EID services across all HIV points of care in 2018. However, challenges in ensuring timely implementation of EID indicators persist. This study assessed determinants of timeliness in the routine monitoring of HIV-Exposed Infants (HEI) at health facilities in Kampala district. Methods: A mixed-methods study design using an explanatory concurrent approach was employed, integrating both quantitative and qualitative data. Quantitative data were collected using a customized data abstraction tool from EID registers (HMIS ACP: 017), while qualitative data were obtained through open-ended questionnaires administered to healthcare workers. Quantitative data were analyzed using descriptive statistics (frequencies and percentages), and associations were assessed using chi-square tests. A modified Poisson regression model was used to identify factors independently associated with the timeliness of EID indicators, with adjusted Prevalence Ratios (aPRs) reported at a 5% level of significance. Qualitative data were analyzed thematically, and closed-ended responses were summarized using a 5-point Likert scale. Results: A total of 300 HIV-exposed infants were included in the quantitative analysis, of whom 159 (53%) were male. The mean age was 8 months (range: 3–17 months; SD = 2). Overall, 198 (66%) HEIs received EID program indicators in a timely manner. Factors independently associated with poor timeliness included a history of poor maternal ART adherence in the preceding six months, long distance from home to the health facility (>20 km), and younger maternal age (≤24 years). Good maternal ART adherence in the past six months was identified as a protective factor. Qualitative findings from 16 healthcare workers revealed key challenges, including gaps in knowledge of EID indicator definitions, shortages of healthcare personnel, inadequate availability of computers, and limited HMIS tools. Conclusion and recommendations. Timely monitoring of EID program indicators remains suboptimal and is influenced by both individual and health system–related factors. Missed or delayed clinic visits undermine the effectiveness of EID services and increase the risk of mother-to-child HIV transmission. Strengthening maternal appointment adherence, improving availability of essential infrastructure such as computers and HMIS tools, and enhancing healthcare worker capacity through regular training and mentorship are recommended to improve the timeliness of EID program indicators.