Access to HIV/AIDS or TB care among refugees in Kampala, Uganda: exploring the enablers and barriers during the COVID-19 pandemic

Palattiyil, George; Mwenyango, Hadijah; Katongole, Simon Peter; Mulekya, Francis; Sidhva, Dina; Nair, Harish; Bukuluki, Paul

doi:10.1016/j.jmh.2022.100098

Cited by 9 publications

(39 citation statements)

References 28 publications

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“…In this respect qualitative results show that people tended to prioritize survival and meeting basic needs especially food and shelter over seeking SRHR services. This is similar to findings of other studies conducted in low-income settings [8,13,31,35].…”

Section: Discussionsupporting

confidence: 91%

“…This study shows that most respondents in border areas experienced disruptions in access to SRHR services due to COVID-19 and its control measures such as lockdowns and restrictions in movement. It reaffirms findings from related studies showing that COVID-19 disrupted access to sexual and reproductive health services for mobile populations including those at border points or areas [9,[31][32][33][34]. This implies that guaranteeing the SRHR of populations living in fragile settings including cross border settings like Mutukula and Busia amidst border closures and other movement restrictions similar to those experienced during lockdowns is essential and constitutes a basic human right [9,31,35].…”

Section: Discussionsupporting

confidence: 81%

“…In addition, some inherently high-risk women were unable to deliver in centres with more skilled and specialized care. Our study also demonstrates disruptions in access to antenatal and postnatal care for expectant mothers due to COVID-19 and its control measures [8,35] including lockdowns, border closures limiting crossing the border to seek services from the nearest hospitals across the border, skyrocketing of transport costs due to banning of public transport and difficulties in accessing movement or travel permits during lockdowns [8,13,31,33]. Our results are similar to those of Church et al [8] who observed that restrictions in movement coupled with reduction or suspension of mobile outreach programmes offering SRHR services heavily restricted women and girls from accessing essential SRHR services.…”

Section: Discussionmentioning

confidence: 68%

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Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

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BackgroundThe spread of COVID-19 exposed the inadequacies inherent in the health care systems of many countries. COVID-19 and the attendant demands for emergency treatment and management put a significant strain on countries' health care systems, including hitherto strong health systems. In Uganda, as the government strived to contain COVID-19, other essential health care services were either disrupted or completely crowded out. Balancing the provision of COVID-19 treatment and management services and at the same time offering sexual and reproductive health and rights services (SRHR) proved to be a considerable challenge in these circumstances. COVID-19 prevention-related travel restrictions and border closures had far-reaching negative consequences on the mobility of individuals to access essential health services in Uganda. The situation may have been worse for cross-border communities that sometimes access services across the borders.Methods Using quantitative data from 1521 respondents and qualitative data (20 key informant interviews and 12 focus group discussions), we investigate the disruption in accessing SRHR services for border communities in Uganda during COVID-19. ResultsResults indicate that females (adjusted odds ratio (aOR) = 1.3; 95% confidence interval CI = 1.08-1.79), those with primary education (aOR = 1.47; 95% CI = 1.61-2.57), currently employed (aOR = 2.03; 95% CI = 1.61-2.57) and those with the intention to leave current residence (aOR = 2.09; 95% CI = 1.23-3.55) were more likely to have experienced a disruption in accessing SRHR services. However, respondents aged 35 years, or more were less likely to have experienced a disruption compared to their younger counterparts.Conclusions Results shed light on the disruption of access toSRHR services during pandemics such as COVID-19 among a highly mobile population. There is a need to invest in building strong and resilient health care systems that can guarantee continuous access to essential health services including SRHR provisions among mobile populations during pandemics.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 68%

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Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

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“…Studies were conducted in a variety of locations. In total, 13 studies were carried out in high-income countries (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35), and 11 in low-to middle-income countries (36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46). There is a diversity of research designs in the studies that were included.…”

Section: Resultsmentioning

confidence: 99%

Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review

Arab

Somerville

Abuadas

et al. 2023

Front. Public Health

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ObjectivesThe objective of this scoping review was to identify what is known about the impact of COVID-19 on the physical and mental well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons. The aim was also to identify barriers influencing access to treatment or prevention.MethodsThe search was conducted using PubMed/Medline, CINAHL, Scopus, and ScienceDirect. A mixed methods appraisal tool was used to assess methodological rigor. The study findings were synthesized using a thematic analysis approach.Results and DiscussionThis review comprised 24 studies and were conducted utilizing a mixed method approach incorporating both quantitative and qualitative methodologies. Two major themes were identified related to the impact of COVID-19 on the health and wellbeing of refugees, asylum seekers, undocumented migrants, and internally displaced persons and the key barriers influencing access to treatment or prevention of COVID-19. They often have barriers to accessing healthcare due to their legal status, language barriers, and limited resources. The pandemic has further strained already limited health resources, making it even more challenging for these populations to receive healthcare. This review reveals that refugees and asylum seekers in receiving facilities face a higher risk of COVID-19 infection than the general population due to their less favorable living conditions. The various health impacts stem from a lack of access to accurate information about the pandemic, misinformation, and the exacerbation of pre-existing mental health issues caused by heightened stress, anxiety, and uncertainty, fear of deportation among undocumented migrants, and overcrowding camps and detention facilities that increase exposure risk. Social distancing measures are difficult to implement in these settings, and inadequate sanitation, hygiene, and a lack of personal protective equipment further compound the problem. Moreover, the pandemic has had significant economic consequences for these populations. Many of them rely on informal or precarious employment, which has been disproportionately affected by the pandemic. Job losses and reduced working hours, and limited access to social protection can lead to increased poverty, and food insecurity. Children faced specific challenges, such as disruptions to education, additionally, interruptions in support services for pregnant women. Some pregnant women have avoided seeking maternity care due to fears of contracting COVID-19, resulting in increased home births and delays in accessing healthcare services. Factors that play a role in vaccination reluctance include uncertainty of undocumented migrants’ inclusion in vaccination programs, furthermore, a growing vaccine hesitancy in the population; skepticism about the safety of vaccines, inadequate knowledge/education, a variety of access barriers such as language barriers, and logistical challenges including remote locations, and inaccurate information.ConclusionThis review highlights that the physical health of refugees, asylum seekers, undocumented migrants, and internally displaced persons has been significantly impacted by various barriers to healthcare access during the pandemic. These barriers include legal and administrative challenges, such as a lack of documentation. Additionally, the shift to digital tools has introduced new obstacles, not only due to language barriers or limited technical knowledge but also because of structural barriers, such as the requirement of a bank ID that is often inaccessible to these groups. Other factors contributing to limited healthcare access include financial constraints, language barriers, and discrimination. Additionally, limited access to accurate information about health services, prevention measures, and available resources may hinder them from seeking care or following public health guidelines. Misinformation and lack of trust in healthcare systems can also contribute to a reluctance to access care or vaccination programs. There is concerning evidence regarding vaccine hesitancy that needs to be addressed to reduce any future pandemic outbreak, in addition there is a need to explore the factors that play a role in vaccination reluctance among children in these populations.

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“…However, only a few facilities in the settlement offer comprehensive HIV care such as Prevention of Mother to Child Transmission services. Moreover, there are reported challenges including lack of facility accreditation to offer HIV care, drug and test kits stock out and poor adherence to ART by the refugees 50 51…”

Section: Methodsmentioning

confidence: 99%

Todurujo na Kadurok (empowering youth): study protocol of an HIV self-testing and edutainment comic cluster randomised trial among refugee youth in a humanitarian setting in Uganda

et al. 2022

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IntroductionRefugees experience HIV vulnerabilities due to the confluence of displacement, violence and poverty. HIV self-testing, understudied with refugees, is a promising method to increase testing uptake, yet challenges remain with linkages to confirmatory testing following a positive HIV self-test. This study aims to evaluate the effectiveness of HIV self-testing kits and ‘edutainment’ comics in increasing HIV testing and HIV status knowledge among refugee youth aged 16–24 years in Bidi Bidi Refugee Settlement, Uganda.Methods and analysisThis study will be conducted in Bidi Bidi. We conducted a qualitative formative phase with focus groups (n=40) to generate knowledge of barriers and facilitators of HIV prevention, testing and care among refugee youth (aged 16–24) in Bidi Bidi. These findings were used to create comic scenarios aligning with edutainment approaches to health promotion and inform a four-arm cluster randomised controlled trial in Bidi Bidi using a 2×2 factorial design: (1) HIV self-testing alongside edutainment comics, (2) HIV self-testing alone, (3) edutainment comic alone and (4) standard of care. The target sample size will be 120 youth (30 per arm), who will be enrolled in the trial and followed for 3 months. Data will be collected at baseline and 3 months after enrolment. The primary outcomes (HIV testing frequency, HIV status knowledge) and secondary outcomes (linkage to confirmatory HIV testing, HIV care linkage, HIV self-test kit use, HIV-related stigma, HIV knowledge, safer sex efficacy, condom use, adolescent sexual and reproductive health (SRH) stigma, sexual relationship power, access to SRH services) will be evaluated using descriptive statistics and regression analyses.Ethics and disseminationThis study was approved by the University of Toronto Research Ethics Board, Mildmay Uganda Research Ethics Committee and the Uganda National Council for Science and Technology. Results will be shared in peer-reviewed publications and community knowledge sharing.Trial registration numberNCT05213689.

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Access to HIV/AIDS or TB care among refugees in Kampala, Uganda: exploring the enablers and barriers during the COVID-19 pandemic

Cited by 9 publications

References 28 publications

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

Disruption in accessing sexual and reproductive health services among border populations during COVID-19 lockdown in Uganda

Health and well-being of refugees, asylum seekers, undocumented migrants, and internally displaced persons under COVID-19: a scoping review

Todurujo na Kadurok (empowering youth): study protocol of an HIV self-testing and edutainment comic cluster randomised trial among refugee youth in a humanitarian setting in Uganda

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