Uganda

Health indicators are improving in certain regions of Uganda, yet many deaths are caused by preventable diseases such as malaria and HIV/AIDS. According to WHO, HIV/AIDS has a national prevalance of 5.4% and is the leading cause of death among adults, followed by tuberculosis (TB) and malaria. In addition, UNAIDS reports that HIV/AIDS is responsible for nearly half of the Ugandan orphan population, which exceeds an estimated two million. Uganda is one of 15 US President's Emergency Plan for AIDS Relief (PEPFAR) focus countries currently receiving support for comprehensive HIV/AIDS prevention, treatment and care programs.

CCGHE RESPONDS

CCGHE has partnered with Medical Education Services to All Ugandans (MESAU), a consortium of five Ugandan medical schools, to provide support among five strategic areas: monitoring and evaluation, research capacity building, IRB strengthening, curriculum development and information technology (IT)/distance learning. Accordingly, CCGHE and colleagues in Uganda have engaged in a number of in-country education, distance learning and mobile technology initiatives, including development of mHealth tools to optimize HIV prevention efforts, continuing clinical education conferences and courses, building in-country capacity in curriculum development and distance learning, and interprofessional team-building among physicians, nurses, pharmacists, medical students and administrators.

CCGHE-UGANDA ACTIVITIES

Hard-to-Reach Populations: Implications for Ending the AIDS Epidemic

Post Date: 
2019-04-25
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Countries: 
The Rakai region in Uganda was the initial epicenter of the HIV epidemic in East Africa and continues to be a high burden area, with an HIV prevalence of ~13%. Through the open, population-based Rakai Community Cohort Study (RCCS), we reported that combination HIV prevention (CHP) decreased...

Health Professions Education and Training for Strengthening the Health System and Services in Uganda

Post Date: 
2018-09-19
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Countries: 
Led by Sarah Kiguli at the Makerere University College of Health Sciences, the goal of this effort is to improve service delivery of the Ugandan health system through strengthened health professional interdisciplinary education and research training to produce graduates with competencies to address...

RCT to Reduce HIV Acquisition and Viral Load among Migrants, Rakai, Uganda

Post Date: 
2018-08-01
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Countries: 
The Rakai Health Sciences Program (RHSP), Uganda, proposes an implementation science community- randomized controlled trial (CRCT) of a novel intervention to newly in-migrated individuals (Welcome In-coming Neighbor [WIN]), to optimize their rapid linkage to combination HIV prevention (CHP)...

Multidisciplinary Research Training to Understand and Reduce HIV Incidence in Uganda

Post Date: 
2018-05-10
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Countries: 
Dr. Larry Chang is PI for this multi-year (2018-2023) training grant sponsored by the Fogarty International Center at the National Institute of Health. Abstract While substantial progress has been made in the global HIV response, impact has been uneven. Uganda provides a prime case study. Uganda...

Community Health Workers, mHealth, and Combination HIV Prevention in a Hotspot: A Randomized Trial (mLAKE)

Post Date: 
2015-04-01
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Countries: 
Led by Dr. Larry Chang, the mLAKE study in Uganda is examining whether community health workers equipped with cellphones and the emocha Mobile Health platform are able to successfully promote HIV treatment and prevention services in households in a fishing community in East Africa with a very high...

Project S.O.A.R. (Supporting Operational AIDS Research): Positive Health Dignity and Prevention Sub-Project

Post Date: 
2014-09-15
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Countries: 
Dr. Larry Chang is a Co-Investigator for this effort. Purpose The goal of Project SOAR (Supporting Operational AIDS Research) is to improve the quality and impact of HIV and AIDS program outcomes by strengthening operations research and evaluation activities. Project SOAR supports the PEPFAR...

Evaluating Demand Generation (Stylish Man) for HIV/Family Planning Services, Rakai, Uganda

Post Date: 
2014-08-01
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Countries: 
Dr. Larry Chang is co-investigator of this effort to test a novel approach to promoting HIV services in Rakai, Uganda. The Stylish Man Program, attempts to “demedicalize” HIV prevention and care in a public health campaign designed to normalize HIV care as part of self care for African men. The...

Analysis of Data Collected from the Evaluation of Community-Based Education, Research and Service (COBERS)

Post Date: 
2012-06-12
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Countries: 
This effort ended in June 2015. Makerere University College of Health Sciences (MakCHS), the Medical Schools at Gulu University (GU), Mbarara University of Science and Technology (MUST), Kampala International University (KIU) and Busitema University (BU) came together with Johns Hopkins University...

Adult Male Circumcision Training

Post Date: 
2012-01-01
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Countries: 
Adult Male Circumcision is a self-paced, online education program developed by CCGHE in collaboration wth the Rakai Health Sciences Program and the Uganda PEPFAR Distance Learning Initiative. This 60-minute course was designed to provide an introduction to adult male circumcision and act as a...

Course Evaluation of a Continuing Medical Education Program for Nurses and Midwives in Uganda

Post Date: 
2011-02-15
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Countries: 
This course evaluation was conducted in 2011. Hypertension presents a substantial burden on the world and Uganda is not immune to this disease. In a recent study, adults in the Rukungiri district in southwestern Uganda were shown to have a 30.5% prevalence of hypertension. (1) Hypertension needs to...

PreventionRx Study: Home-based Counseling and Testing in Uganda

Post Date: 
2010-10-21
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Countries: 
This study was terminated August 29, 2014. A ‘platform’ for evaluating combination HIV prevention & care-HIV counseling & testing is essential to optimize HIV services. In collaboration with the University of Washington and the Integrated Community Based Initiatives (ICOBI) NGO in Uganda,...

P1070: Dose-Finding and Pharmacogenetic Study of Efavirenz in HIV-Infected and HIV/TB Co-Infected Infants and Children ≥ 3 Months to < 36 Months of Age

Post Date: 
2008-12-05
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Clinical Sites: 
This study ended March 10, 2015. This multi-country trial was conducted in India, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe, under the International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) Network and funded by the U.S. National Institutes of Health. Efavirenz (EFV)...

Peer Community-based Assistant in REtention: Effect of Peer Health Workers on People Living with HIV Not on Antiretroviral Therapy—A Randomized Operations Research Trial

Post Date: 
2007-03-29
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Countries: 
Human resource limitations, long travel times, and a weak health care infrastructure pose significant challenges to the delivery of anti-retroviral therapy (ART) in rural settings such as the Rakai District in southwestern Uganda. HIV increases demand for health services and also impacts the health...

A5207: Maintaining Options for Mothers Study (MOMS): A Phase II Randomized Comparison of Three Antiretroviral Strategies Administered for 7 or 21 Days to Reduce the Emergence of Nevirapine Resistant HIV-1 Following a Single Intrapartum Dose of Nevirapine

Post Date: 
2004-12-20
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This study was terminated January 16, 2014; it was conducted under the AIDS Clinical Trials Group (ACTG) and funded by the U.S. National Institutes of Health. A major disadvantage of giving SD NVP is the potential for maternal development of NVP resistance and additional resistance to other...

Isoniazid preventive therapy in HIV-infected pregnant and postpartum women

Post Date: 
2019-10-03
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Clinical Sites: 
Publication: 
New England Journal of Medicine
New England Journal of Medicine: Dr. Amita Gupta and colleagues found that the current standard of care given to HIV+ pregnant women to prevent TB should wait until 12 weeks after delivery. The study underscores the need to include pregnant women in clinical trials.

Results of early virologic monitoring may facilitate differentiated care monitoring strategies for clients on ART, Rakai, Uganda

Post Date: 
2018-10-15
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Countries: 
Publication: 
Open Forum Infectious Diseases
BACKGROUND: Viral load (VL) monitoring is standard of care in HIV-infected persons initiated on antiretroviral therapy (ART). We evaluated the predictive value of VL measurements at 6 and 12 months after initiation of firstline ART to estimate the future risk of virologic failure (VF). METHODS: HIV...

Group mentorship model to enhance the efficiency and productivity of PhD research training in Sub-Saharan Africa

Post Date: 
2018-05-04
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Countries: 
Publication: 
Annals of Global Health
Annals of Global Health : Systems capacity building approach to PhD training allowed strong outputs at lower cost and with relatively few additional mentors to train independent scientists able to conduct original research and mentor others.

Migration and risk of HIV acquisition in Rakai, Uganda: a population-based cohort study

Post Date: 
2018-04-15
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Countries: 
Publication: 
Lancet HIV
BACKGROUND: In sub-Saharan Africa, migrants typically have higher HIV prevalence than non-migrants; however, whether HIV acquisition typically precedes or follows migration is unknown. We aimed to investigate the risk of HIV after migration in Rakai District, Uganda. METHODS: In a prospective...

HIV viral suppression and geospatial patterns of HIV antiretroviral therapy treatment facility use in Rakai, Uganda

Post Date: 
2018-03-27
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Countries: 
Publication: 
AIDS
OBJECTIVE: To assess geospatial patterns of HIV antiretroviral therapy (ART) treatment facility use and whether they were impacted by viral load suppression. METHODS: We extracted data on the location and type of care services utilized by HIV-positive persons accessing ART between February 2015 and...

The validity of self-reported antiretroviral use in persons living with HIV: a population-based study

Post Date: 
2018-01-28
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Countries: 
Publication: 
AIDS
OBJECTIVE: To assess the validity of self-reported antiretroviral therapy use (ART) using population-based cohort data. METHODS: Self-reported ART use and nonuse was compared with a validated laboratory assay in 557 HIV-positive participants in the Rakai Community Cohort Study surveyed between...

Identifying models of HIV care and treatment service delivery in Tanzania, Uganda, and Zambia using cluster analysis and Delphi survey

Post Date: 
2017-12-06
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Countries: 
Publication: 
BMC Health Services Research
BACKGROUND: Organization of HIV care and treatment services, including clinic staffing and services, may shape clinical and financial outcomes, yet there has been little attempt to describe different models of HIV care in sub-Saharan Africa (SSA). Information about the relative benefits and...

HIV prevention efforts and incidence in HIV in Uganda

Post Date: 
2017-11-30
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Countries: 
Publication: 
New England Journal of Medicine
In a large study in Uganda, Dr. Larry Chang and colleagues found that combination HIV prevention has population level implications, reducing new infections by 42%.

Impact of a community health worker HIV treatment and prevention intervention in an HIV hotspot fishing community in Rakai, Uganda (mLAKE): study protocol for a randomized controlled trial

Post Date: 
2017-10-23
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Countries: 
Publication: 
Trials
Abstract Background: Effective yet practical strategies are needed to increase engagement in HIV treatment and prevention services, particularly in high-HIV-prevalence hotspots. We designed a community-based intervention called "Health Scouts" to promote uptake and adherence to HIV services in a...

Design and implementation of a community health worker HIV treatment and prevention intervention in an HIV hot spot fishing community in Rakai, Uganda

Post Date: 
2017-05-22
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Countries: 
Publication: 
Journal of the International Association of Providers of AIDS Care
Abstract Innovative approaches are needed to increase engagement in HIV treatment and prevention services, particularly in HIV hot spots. Here, we detail our design, training approach, and early implementation experiences of a community-based HIV intervention called "health scouts." The...

Cost-effectiveness of CRAG-LFA screening for cryptococcal meningitis among people living with HIV in Uganda

Post Date: 
2017-03-23
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Countries: 
Publication: 
BMC Infectious Diseases
Background : Cryptococcal meningitis (CM) constitutes a significant source of mortality in resource-limited regions. Cryptococcal antigen (CRAG) can be detected in the blood before onset of meningitis. We sought to determine the cost-effectiveness of implementing CRAG screening using the recently...

Qualitative insights into implementation, processes, and outcomes of a randomized trial on peer support and HIV care engagement in Rakai, Uganda

Post Date: 
2017-01-10
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Countries: 
Publication: 
BMC Infectious Diseases
BACKGROUND: People living with human immunodeficiency virus (HIV) who have not yet initiated antiretroviral therapy (ART) can benefit from being engaged in care and utilizing preventive interventions. Community-based peer support may be an effective approach to promote these important HIV services...

Heterogeneity of the HIV epidemic in agrarian, trading, and fishing communities in Rakai, Uganda: an observational epidemiological study

Post Date: 
2016-08-15
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Countries: 
Publication: 
The Lancet HIV
Background : Understanding the extent to which HIV burden differs across communities and the drivers of local disparities is crucial for an effective and targeted HIV response. We assessed community-level variations in HIV prevalence, risk factors, and treatment and prevention service uptake in...

Community-based interventions to improve and sustain antiretroviral therapy adherence, retention in HIV care and clinical outcomes in low- and middle-income countries for achieving the UNAIDS 90-90-90 targets

Post Date: 
2016-07-30
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Countries: 
Publication: 
Current HIV/AIDS Reports
Little is known about the effect of community versus health facility-based interventions to improve and sustain antiretroviral therapy (ART) adherence, virologic suppression, and retention in care among HIV-infected individuals in low- and middle-income countries (LMICs). We systematically searched...

Association of medical male circumcision and antiretroviral therapy scale-up with community HIV incidence in Rakai, Uganda

Post Date: 
2016-07-12
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Countries: 
Publication: 
JAMA
Importance Medical male circumcision (MMC) and antiretroviral therapy (ART) are proven HIV prevention interventions, but there are limited data on the population-level effect of scale-up of these interventions in sub-Saharan Africa. Such evaluation is important for planning and resource allocation...

Empirical tuberculosis therapy versus isoniazid in adult outpatients with advanced HIV initiating antiretroviral therapy (REMEMBER): a multicountry open-label randomised controlled trial

Post Date: 
2016-03-19
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Clinical Sites: 
Publication: 
The Lancet
Background: Mortality within the first 6 months after initiating antiretroviral therapy is common in resource-limited settings and is often due to tuberculosis in patients with advanced HIV disease. Isoniazid preventive therapy is recommended in HIV-positive adults, but subclinical tuberculosis can...

Effectiveness of peer support on care engagement and preventive care intervention utilization among pre-antiretroviral therapy, HIV-infected adults in Rakai, Uganda: a randomized trial

Post Date: 
2015-08-14
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Countries: 
Publication: 
AIDS and Behavior
442 pre-ART, HIV-infected adults were randomized to peer support consisting of structured home visits to promote clinic attendance and preventive care intervention use or standard of care. At baseline, 62 % reported previously visiting an HIV clinic, 45 % reported taking cotrimoxazole prophylaxis,...

Impact of patient-selected care buddies on adherence to HIV care, disease progression and conduct of daily life among pre-antiretroviral HIV-infected patients in Rakai, Uganda: a randomized controlled trial

Post Date: 
2015-06-01
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Countries: 
Publication: 
Journal of Acquired Immune Deficiency Syndromes
Background: Data are limited on effects of household or community support persons ("care buddies") on enrollment into and adherence to pre-antiretroviral HIV care. We assessed the impact of care buddies on adherence to HIV clinic appointments, HIV progression, and conduct of daily life among pre-...

Durable suppression of HIV-1 after virologic monitoring-based antiretroviral adherence counseling in Rakai, Uganda

Post Date: 
2015-05-26
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Countries: 
Publication: 
PLOS One
Objectives: HIV viral load is recommended for monitoring antiretroviral treatment and identifying treatment failure. We assessed the durability of viral suppression after viral load-triggered adherence counseling among patients with HIV viremia 6 months after ART initiation. Design: Observational...

Predictors and outcomes of mycobacteremia among HIV-infected smear- negative presumptive tuberculosis patients in Uganda

Post Date: 
2015-02-15
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Countries: 
Publication: 
BMC Infectious Diseases
Background : Sputum smear microscopy for tuberculosis (TB) diagnosis lacks sensitivity in HIV-infected symptomatic patients and increases the likelihood that mycobacterial infections particularly disseminated TB will be missed; delays in diagnosis can be fatal. Given the duration for MTB growth in...

Pages

A Cluster-Randomized Trial to Promote Combination HIV Prevention Using M-health-Supported CHWs in a High-Prevalence Fishing Community: Design and Baseline Characteristics of the mLAKE Trial in Rakai, Uganda

Post Date: 
2016-07-21
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Countries: 
Chang L, Mbabali I, Kong X, Hutton H, Long A, Thomas A, Bugos E, Ssekasanvu J, Kennedy C, Amico R, Nalugoda F, Reynolds S, Quinn T, Serwadda D, Wawer M, Gray R, Nakigozi G. A Cluster-Randomized Trial to Promote Combination HIV Prevention Using M-health-Supported CHWs in a High-Prevalence Fishing...

Combination HIV Prevention and HIV Incidence in a Ugandan Hotspot Fishing Community

Post Date: 
2016-02-23
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Countries: 
Kagaayi J, Grabowski MK, Nakigozi G, Kigozi G, Nalugoda F, Ssekubugu R, Gray RH, Serwadda D, Wawer MJ, Chang L. Combination HIV Prevention and HIV Incidence in a Ugandan Hotspot Fishing Community. Conference on Retroviruses and Opportunistic Infections 2016. Boston, MA. 2016.

Migration, HIV Infection, and Combination HIV Prevention Access in Rakai, Uganda

Post Date: 
2016-02-23
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Countries: 
Grabowski MK, Lessler J, Bazaale JM, Chang L, Nabukalu D, Wawer M, Nalugoda F, Ssekubugu R, Nakigozi G, Gray RH. Migration, HIV Infection, and Combination HIV Prevention Access in Rakai, Uganda. Conference on Retroviruses and Opportunistic Infections 2016. Boston, MA. 2016.

Rakai Health Sciences Program: Social, Behavioral, and Biomedical Research in HIV Dynamics, Prevention, and Care

Post Date: 
2015-10-30
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Countries: 
Chang, L. Rakai Health Sciences Program: Social, Behavioral, and Biomedical Research in HIV Dynamics, Prevention, and Care. CFAR National Social and Behavioral Sciences Research Network Annual Meeting. Baltimore, MD.

Global Teaching of Global Health Competencies for Medical Students in Uganda

Post Date: 
2015-07-15
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Countries: 
Bollinger, R. Global Teaching of Global Health Competencies for Medical Students in Uganda. Medical Education Partnership Initiative (MEPI) Innovation Session. Harare, Zimbabwe.

mHealth Research: A Case Study from Uganda

Post Date: 
2012-04-05
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Countries: 
Chang. L. mHealth Research: A Case Study from Uganda. Special Studies and Research: Advanced Topics in Mobile Health (mHealth). Johns Hopkins Bloomberg School of Public Health. Baltimore, MD.

Use of a Smartphone Application (eMOCHA) to Provide Targeted HIV Prevention Referrals in Rural Uganda

Post Date: 
2010-11-08
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Countries: 
Chang, L. Use of a Smartphone Application (eMOCHA) to Provide Targeted HIV Prevention Referrals in Rural Uganda. mHealth Summit Technology Demonstration. Washington, DC.
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