Risk Factors Associated with HIV, Sexually Transmitted Infections (STI), and HIV/STI Co-infection Among Youth Living in the Slums of Kampala, Uganda

Culbreth, Rachel; Swahn, Monica H.; Salazar, Laura F.; Ametewee, Lynnette; Kasirye, Rogers

doi:10.1007/s10461-019-02444-5

Cited by 27 publications

(31 citation statements)

References 31 publications

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“…A lifetime STI diagnosis was associated with multiple lifetime sex partners, lower sexual activity and pregnancy stigma, and lower condom use self-efficacy. These findings build on a study with youth in Uganda’s informal settlements that also reported multiple sex partners were associated with a self-reported STI history 14. Condom self-efficacy – knowledge, relationship dynamics and condom access22 23 – was a protective factor associated with reduced odds of STI diagnosis.…”

Section: Discussionsupporting

confidence: 52%

“…Kampala, Uganda has a population of 1.4 million people and hosts over 73 00 refugees who live predominantly in informal settlements (‘slums’) 10. A recent cross-sectional study with youth (n=1134) living in Kampala’s slums found that 42.4% self-reported an STI diagnosis 14. STI testing and treatment services are offered in government hospitals to all Ugandans and refugees.…”

Section: Introductionmentioning

confidence: 99%

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Sexually transmitted infection testing awareness, uptake and diagnosis among urban refugee and displaced youth living in informal settlements in Kampala, Uganda: a cross-sectional study

Logie

Okumu

Mwima

et al. 2019

BMJ Sex Reprod Health

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BackgroundSexually transmitted infection (STI) prevention needs among urban refugee and displaced youth are understudied. The study objective was to explore factors associated with the STI prevention cascade (STI services awareness, testing, diagnosis) among urban refugee and displaced youth in Kampala, Uganda.MethodsWe implemented a cross-sectional survey with youth aged 16–24 years in informal settlements in Kampala. We conducted bivariate and multivariable logistic regression analyses to identify social ecological (intrapersonal, interpersonal, community) level factors associated with STI testing services awareness, lifetime STI testing, and lifetime STI diagnosis.ResultsParticipants (n=445; mean age 19.3, SD 2.6, years) included young women (n=333, 74.8%) and young men (n=112, 25.2%). Less than half (43.8%) were aware of community STI services. One-quarter (26.1%) reported lifetime STI testing. Of these, 39.5% reported a lifetime STI diagnosis. In multivariable analyses among young women, age, lifetime sex partners, and lower adolescent sexual and reproductive health (SRH)-related stigma were associated with STI services awareness; and age, lower adolescent SRH-related stigma, and food security were associated with STI testing. Among young men, time in Uganda and lower HIV-related stigma were associated with STI services awareness; and age, condom self-efficacy, and increased adolescent SRH-related stigma were associated with testing. Lifetime sex partners, lower condom self-efficacy, and lower adolescent SRH-related stigma were associated with lifetime STI diagnosis.ConclusionsSocial ecological factors including stigma (adolescent SRH-related, HIV-related) were associated with STI testing and diagnosis among young urban refugees. Gender, age and stigma-tailored strategies can advance the STI prevention cascade among urban young refugees.

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Section: Discussionsupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Sexually transmitted infection testing awareness, uptake and diagnosis among urban refugee and displaced youth living in informal settlements in Kampala, Uganda: a cross-sectional study

Logie

Okumu

Mwima

et al. 2019

BMJ Sex Reprod Health

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“…(2,3) If left untreated, STIs can result in adverse sexual, reproductive, and maternal-child health consequences including infertility, increased HIV risk, pelvic in ammatory diseases, ectopic pregnancies, and mother-to-child transmissions among others. (4)(5)(6) Although STIs affect all age groups, adolescents and young people aged 15-24 years are particularly more vulnerable. (7,8) A study across three primary African regions (Southern Africa, Southern/Eastern Africa community based and East Africa high risk) revealed that all STIs except herpes simplex virus 2 (HSV 2) were more prevalent among young women, 15-24 years compared to those aged 25-49-years regardless of population type or region.…”

Section: Introductionmentioning

confidence: 99%

“…Notably, STIs increase the risk of HIV acquisition and are the leading cause of disability-adjusted life years (DALYs) among women of reproductive age. (4,12) Moreover, STIs acquired from regular partners account for up to 70% of the burden of female infertility. Through several evidence-based strategies, such as ensuring community awareness on risks, prevention strategies, and treatment of STIs, this high burden of STIs and their effects are largely preventable.…”

Section: Introductionmentioning

confidence: 99%

“…Through several evidence-based strategies, such as ensuring community awareness on risks, prevention strategies, and treatment of STIs, this high burden of STIs and their effects are largely preventable. (2,4,13) The major components of Uganda's current strategy on STI management include primary prevention strategies such as vaccination, male circumcision, behavioral change interventions, and 'syndromic management, which involves the use of signs and symptoms rather than laboratory tests to guide treatment of STIs. (14) Despite these interventions, STIs are on an upward trend (8) and although the incidence is highest among young people, they have the least access to quality STI prevention and management services.…”

Section: Introductionmentioning

confidence: 99%

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Trends and Predictors of Sexually Transmitted Infections Among Sexually Active Ugandan Female Youths: Evidence from Three Demographic and Health Surveys, 2006-2016

Masanja

Wafula

Ssekamatte

et al. 2020

Preprint

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Background: Female adolescents and young women have the highest risk of curable sexually transmitted infections (STIs) globally. Data on the prevalence of STIs among young women in Uganda are limited. In this study, we investigated the time trends and determinants of STIs among adolescent girls and young women (15-24 years) in Uganda. Methods: We estimated the percentage of women 15-24 years from three recent consecutive Uganda Demographic and Health Surveys (2006, 2011, and 2016), who reported acquiring an STI within 12 months of the studies and examined the changes over time. A pooled multivariable logistic regression was used to examine predictors of actors associated with reporting an STI were assessed using.Results: The pooled STI prevalence was 26.0%. About 22.0% of youths reported an STI in 2006. This increased to 36.3% in 2011, before declining to 23.1% in 2016. Youths aged 20-24 years reported a higher STI prevalence (27.3%) compared to young participants (23.6%). Prevalence of STIs was significantly higher among female youths with multiple total lifetime partners (adjusted odds ratio (aOR 1.6, 95% CI 1.4-1.6). Similarly, women who were sexually active in the last 4 weeks prior to the interview (aOR 1.3, 95% CI 1.1-1.6), and women affiliated to Islam (aOR 1.3, 95% CI 1.1-1.6) or other religions (aOR 1.8, 95% CI 1.1-2.9) were more likely to report an STI. Living in Northern Uganda was found protective against STIs (aOR 0.5, 95% CI 0.3-0.7).Conclusion: The prevalence of STIs was high among female youths, 15-24 years. There is a need to adopt a holistic approach to the diagnosis and management of STIs among youths, as well as the integration of STI services in daily health care systems to increase their access to sexual and reproductive health services.

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Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda

Logie,

Okumu,

Berry

et al. 2023

J Int AIDS Soc.

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IntroductionUrban refugee youth remain underserved by current HIV prevention strategies, including HIV self‐testing (HIVST). Examining HIVST feasibility with refugees can inform tailored HIV testing strategies. We examined if HIVST and mobile health (mHealth) delivery approaches could increase HIV testing uptake and HIV status knowledge among refugee youth in Kampala, Uganda.MethodsWe conducted a three‐arm pragmatic controlled trial across five informal settlements grouped into three sites in Kampala from 2020 to 2021 with peer‐recruited refugee youth aged 16–24 years. The intervention was HIVST and HIVST + mHealth (HIVST with bidirectional SMS), compared with standard of care (SOC). Primary outcomes were self‐reported HIV testing uptake and correct status knowledge verified by point‐of‐care testing. Some secondary outcomes included: depression, HIV‐related stigma, and adolescent sexual and reproductive health (SRH) stigma at three time points (baseline [T0], 8 months [T1] and 12 months [T2]). We used generalized estimating equation regression models to estimate crude and adjusted odds ratios comparing arms over time, adjusting for age, gender and baseline imbalances. We assessed study pragmatism across PRECIS‐2 dimensions.ResultsWe enrolled 450 participants (50.7% cisgender men, 48.7% cisgender women, 0.7% transgender women; mean age: 20.0, standard deviation: 2.4) across three sites. Self‐reported HIV testing uptake increased significantly from T0 to T1 in intervention arms: HIVST arm: (27.6% [n = 43] at T0 vs. 91.2% [n = 135] at T1; HIVST + mHealth: 30.9% [n = 47] at T0 vs. 94.2% [n = 113] at T1]) compared with SOC (35.5% [n = 50] at T0 vs. 24.8% [ = 27] at T1) and remained significantly higher than SOC at T2 (p<0.001). HIV status knowledge in intervention arms (HIVST arm: 100% [n = 121], HIVST + mHealth arm: 97.9% [n = 95]) was significantly higher than SOC (61.5% [n = 59]) at T2. There were modest changes in secondary outcomes in intervention arms, including decreased depression alongside increased HIV‐related stigma and adolescent SRH stigma. The trial employed both pragmatic (eligibility criteria, setting, organization, outcome, analysis) and explanatory approaches (recruitment path, flexibility of delivery flexibility, adherence flexibility, follow‐up).ConclusionsOffering HIVST is a promising approach to increase HIV testing uptake among urban refugee youth in Kampala. We share lessons learned to inform future youth‐focused HIVST trials in urban humanitarian settings.

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Risk Factors Associated with HIV, Sexually Transmitted Infections (STI), and HIV/STI Co-infection Among Youth Living in the Slums of Kampala, Uganda

Cited by 27 publications

References 31 publications

Sexually transmitted infection testing awareness, uptake and diagnosis among urban refugee and displaced youth living in informal settlements in Kampala, Uganda: a cross-sectional study

Sexually transmitted infection testing awareness, uptake and diagnosis among urban refugee and displaced youth living in informal settlements in Kampala, Uganda: a cross-sectional study

Trends and Predictors of Sexually Transmitted Infections Among Sexually Active Ugandan Female Youths: Evidence from Three Demographic and Health Surveys, 2006-2016

Findings from the Tushirikiane mobile health (mHealth) HIV self‐testing pragmatic trial with refugee adolescents and youth living in informal settlements in Kampala, Uganda

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