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Community health workers (CHWs) can help to redress the shortages of health human resources needed to scale up antiretroviral treatment (ART). However, the selection of CHWs could influence the effectiveness of a CHW programme. The purpose of this observational study was to assess whether sociodemographic characteristics and geographic proximity to patients of volunteer CHWs were predictors of clinical outcomes in a community-based ART (CBART) programme in Kabarole, Uganda. Data from CHW surveys for 41 CHWs and clinic charts for 185 patients in the CBART programme were analysed using multivariable logistic and Cox regression models. Time to travel to patients was the only statistically significant characteristic of CHWs associated with ART outcomes. Patients whose CHWs had to travel one or more hours had a 71% lower odds of virologic suppression (adjusted OR = 0.29, 95% CI = 0.13–0.65,p = .002) and a 4.52 times higher mortality hazard rate (adjusted HR = 4.52, 95% CI = 1.20–17.09,p = .026) compared to patients whose CHWs had to travel less than one hour. The findings show that the sociodemographic characteristics of CHWs were not as important as the geographic distance they had to travel to patients. [ABSTRACT FROM PUBLISHER]

The threat of tuberculosis (TB) in Uganda cannot be considered in isolation from the HIV/AIDS epidemic. Stigma contributes to delays in seeking treatment and poor adherence for both TB and HIV patients. This study aims to assess and describe stigma and predictors of stigma related to TB and HIV in the population of western Uganda. This was a cross-sectional mixed methods study. A survey was administered to 360 individuals, randomly selected from one district in western Uganda. Participants were classified as low/high stigma based on weighted scores built from survey questions. Logistic regression was used to determine significant predictors for high stigma. Six focus groups were conducted to inform survey findings; themes were developed using content analysis. Twenty-six per cent of respondents were found to have stigmatising attitudes towards HIV and 47% towards TB. Multivariate logistic regression models included age, sex, marital status, education, residence and having a friend with HIV/TB. Those who had an HIV-positive friend were less likely to have high HIV stigma (OR: 0.41, 95% CI: 0.23–0.72). Those with secondary education or more were half as likely to have high TB stigma (OR: 0.50, 95% CI: 0.27–0.91). Focus group participants felt that “normalisation” of HIV has contributed to reduced HIV stigma, but there is still a fear of being recognised at the HIV clinic. TB stigma causes patients to remain silent instead of seeking care. Fear of TB is driven by the assumption that “TB means HIV”. Declining HIV stigma is encouraging but more effort needs to be made to improve confidentiality. TB stigma is high and is likely affecting care seeking behaviour; TB awareness campaigns should be a priority and emphasise the treatability and curability of TB, regardless of HIV status. [ABSTRACT FROM PUBLISHER]

Background: In sub-Saharan Africa, a shortage of trained health professionals and limited geographical access to health facilities present major barriers to the expansion of antiretroviral therapy (ART). We tested the utility of a health centre (HC)/ community-based approach in the provision of ART to persons living with HIV in a rural area in western Uganda. Methods: The HIV treatment outcomes of the HC/community-based ART program were evaluated and compared with those of an ART program at a best-practice regional hospital. The HC/community-based cohort comprised 185 treatmentnaïve patients enrolled in 2006. The hospital cohort comprised of 200 patients enrolled in the same time period. The HC/ community-based program involved weekly home visits to patients by community volunteers who were trained to deliver antiretroviral drugs to monitor and support adherence to treatment, and to identify and report adverse reactions and other clinical symptoms. Treatment supporters in the homes also had the responsibility to remind patients to take their drugs regularly. ART treatment outcomes were measured by HIV-1 RNA viral load (VL) after two years of treatment. Adherence was determined through weekly pill counts. Results: Successful ART treatment outcomes in the HC/community-based cohort were equivalent to those in the hospitalbased cohort after two years of treatment in on-treatment analysis (VL≤400 copies/mL, 93.0% vs. 87.3%, p=0.12), and in intention-to-treat analysis (VL≤400 copies/mL, 64.9% and 62.0%, p = 0.560). In multivariate analysis patients in the HC/ community-based cohort were more likely to have virologic suppression compared to hospital-based patients (adjusted OR = 2.47, 95% CI 1.01-6.04). Conclusion: Acceptable rates of virologic suppression were achieved using existing rural clinic and community resources in a HC/community-based ART program run by clinical officers and supported by lay volunteers and treatment supporters. The results were equivalent to those of a hospital-based ART program run primarily by doctors. [ABSTRACT FROM AUTHOR]

Onchocercal skin disease was measured in 72 onchocerciasis patients from western Uganda, where Simulium neavei is the main transmitting vector of Onchocerca volvulus. The onchocerciasis patients who were HIV-positive had a higher onchocercal skin score compared with those who were HIV-negative (33.7 vs. 19.4, P < 0.001). [Copyright &y& Elsevier]