Introduction: In Kampala Uganda, female sex workers (FSWs) have high HIV prevalence (33%). Oral PrEP is a novel HIV prevention intervention that offers hope to decrease HIV incidence in key populations especially among FSWs. Studies have shown that with poor adherence, oral PrEP has no efficacy, and therefore adherence to PrEP is critical among FSWs to maximize HIV prevention. However, implementation data on adherence to PrEP among FSWs is limited so this study sought to assess adherence to PrEP. Specifically, we sought to 1) determine the level of adherence to PrEP among FSWs, and 2) determine factors associated with PrEP adherence. Methods: This cross-sectional study was conducted from November to December 2018; 126 FSWs using PrEP were inter- viewed using a questionnaire. Adherence was categorically defined as high adherence and low adherence. Logistic regression was done. Results: Using long-term contraception methods (OR 0.06, 95% CI: 0.04-0.77) and not using condoms with clients (OR 0.07, 95% CI: 0.01-0.42) were negatively associated with high PrEP adherence. Conclusion: Barriers to PrEP adherence need to be addressed for successful PrEP implementation to improve adherence going forward. Service care providers should reinforce positive behaviors such as use of condoms devotedly during PrEP breaks. Keywords: Oral PrEP; adherence; female sex workers.
Background: Human Immunodeficiency Virus is a major global public health issue affecting millions of people, and sub-Saharan Africa where Uganda lies is is disproportionately affected. There has been an increase in cancer among HIV patients which has resulted into use of co-medications that sometimes affect ART and cancer chemotherapy adherence. We aimed to determine adherence to antiretroviral and cancer chemotherapy and the associated factors among patients with HIV-cancer co-morbidity at the Uganda Cancer Institute.Methods: We conducted a cross-sectional study among 200 randomly selected adult cancer patients infected with HIV, attending Uganda cancer institute. Antiretroviral and anti-cancer chemotherapy adherences with associated factors were assessed quantitatively. We collected the data using interviewer administered semi-structured questionnaires. Modified Poisson regression with robust standard errors was used to estimate prevalence ratios at 95% confidence intervals for factors associated with adherence to ART and cancer chemotherapy.Results: Overall, 54% (107/200) of the study participants adhered to both ART and chemotherapy, and 55% (110/200) adhered to ART while 65% (129/200) adhered to cancer chemotherapy. A majority, 61% (122/200) of the respondents were males. The mean age of the respondents was 42(SD±11years), and at least 43% (86/200) belonged to protestant religion. More than half, 56.5% (113/200) were married and at least 45% (90/200) had attained a primary level of education. Patients with good adherence to antiretroviral therapy and chemotherapy were 107(54%, 95% CI=46.5-60.4). No knowledge of cancer stage (PR=0.4, 95% CI=0.25-0.56, P<0.0001), having an AIDS defining cancer (PR=0.7, 95% CI=0.50-0.88, P=0.005), ART clinic in district not near Uganda Cancer Institute (PR=0.7,95% CI=0.84-0.96, P=0.027) and affordability of cancer chemotherapy (PR=1.4, 95% CI=1.02-1.87, P=0.037) were associated with adherence to both ART and cancer chemotherapy.Conclusion: Adherence to both ART and cancer chemotherapy was low. Factors significantly associated with adherence were: knowledge of the cancer stage by the patient, the type of cancer diagnosis, source of ART and affordability/ availability of medications. There is need to provide information on stage of cancer and adherence counseling to patients. Furthermore, Integration of HIV- cancer care will be necessary for efficient and effective care for the patients.
Background Human Immunodeficiency Virus is a major global public health issue affecting millions of people, and sub-Saharan Africa where Uganda lies is disproportionately affected. There has been an increase in cancer among HIV patients which has resulted into use of co-medications that sometimes affect ART and cancer chemotherapy adherence. We aimed to determine adherence to antiretroviral and cancer chemotherapy and the associated factors among patients with HIV-cancer co-morbidity at the Uganda Cancer Institute. Methods We conducted a cross-sectional study among 200 randomly selected adult cancer patients infected with HIV and attending the Uganda cancer institute. Antiretroviral and anti-cancer chemotherapy adherence with associated factors were assessed quantitatively. We collected the data using interviewer administered semi-structured questionnaires. Modified Poisson regression with robust standard errors was used to estimate the prevalence ratios (PR) and its 95% confidence intervals (CI) for the factors associated with adherence to Antiretroviral Therapy (ART) and cancer chemotherapy. Results Overall, 54% of the study participants adhered to both ART and chemotherapy, and 55% adhered to ART while 65% adhered to cancer chemotherapy. The mean age of the respondents was 42 (SD ± 11years), and a majority, 61% were males.More than half, 56.5% were married and at least 45% had attained a primary level of education. Patients with good adherence to antiretroviral therapy and chemotherapy were 54%. No knowledge of cancer stage (PR = 0.4, 95% CI = 0.3–0.6, P < 0.0001), having an AIDS defining cancer (PR = 0.7, 95% CI = 0.5–0.9, P = 0.005), ART clinic in district not near Uganda Cancer Institute (PR = 0.7,95% CI = 0.8-1.0, P = 0.027) and affordability of cancer chemotherapy (PR = 1.4, 95% CI = 1.0-1.9, P = 0.037) were associated with adherence to both ART and cancer chemotherapy. Conclusion Adherence to both ART and cancer chemotherapy was low. Factors significantly associated with adherence were: knowledge of the cancer stage by the patient, the type of cancer diagnosis, source of ART and affordability/ availability of medications. There is a need to provide information on the stage of cancer and adherence counseling to patients. Furthermore, Integration of HIV- cancer care will be necessary for efficient and effective care for the patients.
Background Late diagnosis of prostate cancer is common in Uganda and elsewhere. Diagnosis in advanced stages is associated with high mortality, morbidity and low quality of life. We estimated time taken from perception of symptoms attributable to prostate cancer to biopsy among patients with prostate cancer at the Uganda Cancer Institute (UCI) and the associated factors. Methods We conducted a retrospective cohort analysis of records of 280 patients with histologically confirmed diagnosis of prostate cancer at UCI from January 2016 to December 2017. Time to diagnosis was obtained from the difference between approximate date of onset of initial symptoms and date when a biopsy was taken. Late diagnosis was that when an individual was diagnosed with prostate cancer stage III or IV whereas stages I and II were classified as early. We used modified Poisson regression to assess factors associated with timing of diagnosis among the patients. Results The median time from first perceived symptoms to biopsy for prostate cancer patients was 12 (IQR 5-24) months and 76% were diagnosed after 4 months of symptoms. Median age at time of diagnosis of patients was 70 (IQR66-74.5) years and at least 50% were aged between 65-74 years. About 81.8% of patients were diagnosed late; of which 35.7% were in stage III and 46.1% were in stage IV. Nearly all patients presented with raised prostate specific antigen with a median prostate specific antigen of 100.2 (IQR 36.02-350) ng/ml of blood at the time of admission. In adjusted analysis, patients whose biopsies were taken before 5 months of recognising symptoms were two times as likely to have cancer stage I and II compared to those patients in whom the biopsies were taken after 4 months. Conclusion More than three in four patients were diagnosed late. Taking a biopsy after 4 months of initiation of symptoms was partially responsible for the delay. To improve time to diagnosis, communities should be educated about symptoms of prostate cancer and advised to seek health care early. Health care workers should be sensitised to suspect prostate cancer among patients to allow timely referral for specialised assessment and management.
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