Background:HIV-related stigma remains a primary barrier to the elimination of the HIV epidemic worldwide. No studies have examined long-term changes in the distribution of stigmatizing attitudes within populations. Methods:We conducted a whole-population, open cohort study of adults in 8 villages in rural southwestern Uganda, with 5 biennial surveys spanning 2014-2024 (N=1,776 at baseline; 869 participated in all waves). We measured individual negative attitudes toward people with HIV ("public stigma") and perceptions of negative attitudes among others ("perceived stigma") using parallel 15-item scales. We estimated mean stigma scores, computed inequality measures at each wave, and decomposed inequality by sociodemographic characteristics. Leveraging the cohort design, we estimated intraclass correlation coefficients and rank-order stability over time. Results:Both public and perceived stigma declined substantially from baseline to endline and became concentrated in an increasingly smaller subgroup of the population. Theil decomposition failed to identify any stratifying variables that explained more than 3% of this variation: nearly all the inequality in HIV stigma occurred within population subgroups rather than between them. In longitudinal analyses, public stigma showed trait-like properties (intraclass correlation coefficient=0.35; 95% CI, 0.31-0.38) and meaningful rank-order stability (baseline-to-endline r=0.41). Perceived stigma showed no rank-order stability, no appreciable between-person variance, and universal convergence to low levels regardless of baseline. Conclusions:Both public and perceived HIV stigma declined substantially in this rural Ugandan population, but remaining public stigma has become concentrated within a persistent minority. Sociodemographic profiling to target individuals who carry persistently negative attitudes toward people with HIV is unlikely to succeed.

Background Severe mental illness (SMI), including schizophrenia, bipolar disorder, and major depressive disorder, adversely affects multiple dimensions of quality of life, limiting individuals' ability to participate in everyday activities and maintain meaningful social and occupational roles. Globally, nearly one in seven people live with a mental disorder, and approximately 24.2% of Ugandan adults have at least one mental disorder. However, evidence on factors associated with mental health-related quality of life (MHQoL) among people living with SMI in Uganda remains limited. This study examined factors associated with MHQoL among adults living with SMI. Methods A cross-sectional study was conducted among 422 adults with schizophrenia, bipolar disorder, or major depressive disorder attending the outpatient psychiatry clinic at Mbarara Regional Referral Hospital between May and June 2024. MHQoL was assessed using the Mental Health-related Quality of Life questionnaire. Sociodemographic, clinical, and psychosocial factors were measured using validated instruments. Bivariate and multivariable linear regression analyses identified factors associated with MHQoL. Results Higher medication adherence (b = 0.96; 95% CI: 0.10–1.83), family support (b = 0.13; 95% CI: 0.05–0.22), friend support (b = 0.05; 95% CI: 0.004–0.10), religiosity (b = 0.13; 95% CI: 0.003–0.26), and stigma resistance (b = 0.16; 95% CI: 0.02–0.29) were independently associated with better MHQoL. Social withdrawal (b = −0.13; 95% CI: −0.26 to −0.004) and stereotype endorsement (b = −0.14; 95% CI: −0.26 to −0.02) were associated with poorer MHQoL. Conclusion Greater perceived social support, religiosity, and stigma resistance were associated with better MHQoL, whereas social withdrawal and stereotype endorsement were associated with poorer MHQoL among people living with SMI. These findings highlight the importance of addressing psychosocial factors alongside pharmacological treatment. Longitudinal and intervention studies are needed to determine whether targeting these factors improves MHQoL.

BACKGROUND:Adverse drug reactions (ADRs) are associated with hospitalization, increased healthcare cost, morbidity and mortality. This study aimed to investigate the prevalence, severity and associated factors of ADRs among patients taking antipsychotics at Mbarara Regional Referral Hospital (MRRH). METHOD:A cross-sectional study was conducted among patients taking antipsychotics at the psychiatric clinic from March to May 2025. Consecutive sampling was employed whereby all eligible patients attending the psychiatric clinic during the study period were recruited until the required sample size was attained. All patients aged 18 years and above, diagnosed with a psychotic disorder, and who had received an antipsychotic for at least the previous one month were interviewed. STATA version 17 was used for statistical data analysis. Descriptive statistics were presented as mean and standard deviation or median and interquartile ranges. ADRs were analyzed for severity using the modified Hartwig and Siegel scale. We run multivariable logistic regression analysis to determine factors associated with ADRs. RESULTS:A total of 415 participants were included in the study with a mean age of 38. Fifteen ADRs were commonly reported among patients taking antipsychotics. More than half of the participants (256/415, 61.70%) experienced at least one ADR, with sedation being the most frequent (31.3%). Of the reported ADRs, 12/15 (80%) were moderate in severity. Separation from spouses (AOR = 2.01, 95% CI [1.08-3.77], p = 0.029), diagnosed with bipolar disorder (AOR = 2.09, 95% CI [1.07-4.07], p = 0.031), and co-administering both IM & oral antipsychotic (AOR = 1.95, 95% CI [1.03-3.70], p = 0.041) were significantly associated with ADRs. CONCLUSION:The current study showed that over 6 in 10 participants taking antipsychotics experienced at least one ADR, the majority of which were moderate in severity. Separation from a spouse, bipolar disorder, concomitant use of oral and intramascular antipsychotics were independently associated with ADRs. These findings highlight the need for strengthen monitoring and preventive strategies, particularly among high-risk patients taking antipsychotics. Integration of clinical pharmacists into the psychiatry care teams may further enhance ADR detection, monitoring and management.

Background: Narrative exposure therapy (NET) is a form of treatment for trauma disorders, particularly in individuals suffering from complex and multiple traumas. It is an evidence-based trauma-focused therapeutic approach designed to help individuals process and manage experiences of trauma, especially in the context of cumulative or complex trauma. Information on the effectiveness of narrative exposure therapy in managing post-traumatic stress disorder and appetitive aggression among retiring soldiers is limited. This study aimed to determine the effectiveness of narrative exposure therapy as a form of treatment for post-traumatic stress disorder (PTSD) and appetitive aggression (AA) among soldiers retiring from active service in Uganda. Methods : An interventional study was conducted among 70 retired Uganda People’s Defence Forces (UPDF) soldiers who had earlier been screened for post-traumatic stress disorder (PTSD) and appetitive aggression at Gaddafi Barracks in Jinja District, eastern Uganda, in preparation for retirement. At baseline, participants underwent narrative exposure therapy comprising eight 90-minute sessions delivered biweekly over four months. Sessions were conducted either at nearby barracks or within participants’ homes or community settings after retirement. Following completion of the four-month intervention period, participants were reassessed for PTSD and AA at endline. Results : Mean PTSD scores decreased from 19.96 (SD = 15.00) at baseline to 13.93 (SD = 8.96) at endline, representing a mean reduction of 6.04 points. This reduction was statistically significant, t (55) = 3.57, p < .001, indicating a significant decline in PTSD symptom severity following the intervention. Similarly, mean appetitive aggression scores decreased from 34.11 (SD = 6.59) at baseline to 10.39 (SD = 4.09) at endline, representing a mean reduction of 23.71 points. This reduction was statistically significant, t (58) = 20.29, p < .001, indicating a substantial decrease in appetitive aggression following narrative exposure therapy. Conclusion : Narrative exposure therapy demonstrated effectiveness in reducing symptoms of post-traumatic stress disorder and appetitive aggression among retiring soldiers in Uganda. These findings support consideration of integrating narrative exposure therapy into the UPDF retirement process prior to community reintegration.

Background:Blood transfusions are essential in the supportive care of patients with hematological malignancies but carry a risk of adverse reactions. Data on the incidence of transfusion reactions remain scarce in Uganda. This study evaluated the incidence of hemolytic and serologic transfusion reactions among patients with hematological malignancies at Mbarara Regional Referral Hospital and the Uganda Cancer Institute in Uganda. Materials and Methods:This prospective cohort study enrolled hospitalized patients aged ≥2 years with hematological malignancies and a history of prior red blood cell (RBC) transfusions. Participants received additional transfusions and were monitored for up to 14 days. Blood samples were collected on day 0 (transfusion day), days 7, and 14 to assess hemoglobin (Hb) levels, lactate dehydrogenase (LDH), and perform direct and indirect antiglobulin tests. Participants' medical records were also reviewed for transfusion and pregnancy histories. Repeated Measures-Analysis of Variance was used to compare mean Hb and LDH levels over time points. Results:Of the 467 participants enrolled (median age: 36.4 years, interquartile range: 27.3-46.9), 382 completed the follow-up period. A progressive increase in mean Hb levels (g/dL) was observed: 6.6 (95% confidence interval [CI]: 6.1-8.9) on day 0, 7.5 (7.3-10.1) on day 7, and 8.9 (8.4-10.6) on day 14. No acute or delayed hemolytic reactions occurred. The incidence of delayed serologic transfusion reactions (DSTRs) was 0.86 in 100 (95% CI: 0.02-1.69), while the overall RBC alloantibody prevalence was 2.4% (95% CI: 0.98-3.74). The identified alloantibodies were directed against antigens in the Rh, Kell, Lewis, and MNS group systems. Conclusion:Despite a low incidence of DSTRs, a notable prevalence of RBC alloimmunization was observed among patients with hematological malignancies. These findings underscore the need to strengthen pre-transfusion antibody testing to prevent hemolytic complications and improve transfusion outcomes in this population.

Traumatic brain injuries (TBI) are frequently accompanied by neuropsychiatric disturbances. Failure to quickly assess and manage these disturbances results in neurobehavioral syndromes, with deleterious effects on recovery and rehabilitation outcomes. This study determined the prevalence and predictors of severe neurobehavioral disorders among patients with TBI at Mbarara Regional Referral Hospital in southwestern Uganda. In this cross-sectional study, we enrolled participants aged 18 years or older who were able to communicate meaningfully and had been discharged by the neurosurgical team. We obtained information on socio-demographic characteristics, alcohol use, length of stay in the hospital, Glasgow Coma Scale (GCS) score at admission, clinical diagnosis, treatments given, and investigations, including brain computed tomography scans. Neurobehavioral disorders were determined using the Neurobehavioral Rating Scale. Predictors of neurobehavioral disorders were determined using logistic regression. Of the 196 participants, 139 (70.8

Background:Transition from adolescent to adult HIV care is a vulnerable period for adolescents and young people living with HIV (AYLHIV). It is marked by increasing responsibility for health management alongside ongoing psychosocial, developmental, and structural challenges. Many AYLHIV report limited preparation for adult care. Existing transition interventions often prioritize biomedical outcomes and are developed in high-income settings, with less emphasis on empowerment and contextual relevance in low- and middle-income countries. This study aimed to develop and assess the feasibility and acceptability of an empowerment-focused intervention to support AYLHIV during transition to adult HIV care. Methods:We developed the Empowerment and Personal Transformation (EPT) intervention, a six-module psychosocial program designed to address communication, self-management, emotional regulation, and personal growth during transition. Intervention content was informed by qualitative data collected through in-depth interviews with AYLHIV and key stakeholders during the intervention development phase. The intervention was subsequently implemented, and feasibility and acceptability were assessed using quantitative measures. Internal consistency of feasibility and acceptability scales was evaluated using Cronbach's alpha coefficients. Results:The EPT intervention demonstrated high feasibility and acceptability among participants. The intervention was perceived as practical to deliver, not burdensome, and responsive to participants' transition-related experiences. Acceptability findings indicated strong participant engagement and approval, with participants describing the intervention as relevant to their psychosocial needs, including experiences of stigma and challenges related to transitioning to independent HIV care. The acceptability subscale demonstrated excellent internal reliability (Cronbach's alpha = 0.92), while the feasibility subscale showed good internal consistency (Cronbach's alpha = 0.86). Conclusions:Findings suggest that empowerment-focused interventions are feasible and acceptable for supporting AYLHIV transitioning to adult HIV care.

Background Stigma remains a major barrier to mental health care in low- and middle-income countries (LMICs), yet little is known about how stigma operates for common mental illnesses (CMIs) and alcohol use disorder (AUD) in rural Uganda. Methods We conducted 80 in-depth interviews (IDIs) with individuals and family members affected by CMIs (n=34) or AUD (n=46) in Buyende District, Uganda. Interviews were analyzed inductively using the framework method to identify cross-cutting themes. Results Three interlocking themes emerged: Internal Dysphoria, Community Dynamics, and Family Burden. Internalized stigma manifested as denial, concealment, shame, and helplessness. AUD participants resisted moral judgment through denial, while those with CMIs internalized stigma through concealment. Communities perpetuated stigma via misinformation, moralization, indifference, and alienation—framing AUD as moral failure and CMIs as irrational or contagious. Families faced emotional exhaustion, economic strain, and religious or moral conflict. AUD households reported sharper public condemnation and financial collapse, while CMI households experienced chronic caregiving stress and hidden grief. Conclusions Stigma toward people with CMIs and AUD in rural Uganda is pervasive, multilayered, and sustained by moral and structural factors. AUD is publicly moralized, while CMIs are concealed and pathologized. Stigma-reduction strategies should integrate psychoeducation, community and religious engagement, family-centered support, and economic empowerment to disrupt cycles of exclusion and improve care uptake.

Suicidality is one of the leading causes of mortality worldwide. Mental disorders are major predictors of suicidality. Individuals with severe symptoms of mental disorders face marked distress, significant restrictions in functioning across several life domains, and a higher risk of suicidality. The risk of suicidality is even higher among people with mental illness following discharge from hospital due to challenges of adjusting to life with a mental illness in the community, taking psychotropic medications which are life long, and acceptance of the diagnosis. Information on suicidality and associated factors among people with mental disorders especially in Uganda is sparse. This study aimed to determine the prevalence of suicidality and factors associated among people with mental illness attending an outpatient clinic at a tertiary hospital in Uganda. A cross sectional quantitative study design was adapted for this study. We used consecutive sampling to enroll 400 participants as determined by the Kish and Leslie formula. Recent suicidality (both ideation and attempts) was evaluated using the Columbia-Suicide Severity Rating Scale (C-SSRS). All the factors significant at bivariate analysis were entered into a multivariable regression model to determine the factors that were statistically significantly associated with suicidality. A p-value of ≤ 0.05 was considered statistically significant. The study found that 8.50

Blood transfusion is crucial in supporting the treatment of patients with cancer. However, in poor-resource settings, blood and blood components remain scarce, and their perceived health risks may hinder their use. This study explored the perceptions of blood availability, safety, and acceptability among caregivers and healthcare providers of patients with cancer at Mbarara Regional Referral Hospital in southwestern Uganda. This study employed a qualitative design involving in-depth interviews and key informant interviews with caregivers of patients with cancer and healthcare providers, between September and December 2024. The interviews were audio-recorded, transcribed, translated, and analyzed using thematic content analysis. Of the 30 participants enrolled, 16 were caregivers of patients with cancer (mean age: 36; standard deviation, SD: 10.65 years) and 14 were healthcare providers (mean: 6.5; SD: 5.77 years of practice). Blood availability relied mostly on volunteer donors in educational institutions, and blood shortages were common during school recesses. Other highlighted additional constraints included donor complacency, limited availability of some blood groups, and disruptions during disease outbreaks. While most caregivers trusted that transfused blood was safe, some expressed concerns regarding adverse events and infection risks. Caregivers highly accepted blood transfusion as a life-saving intervention, but concerns relating it to end-of-life care, as well as cultural and religious beliefs were documented, and these were reported to influence transfusion acceptance. These findings reveal persistent blood shortages, with transfusion acceptance influenced by system-level and sociocultural constraints. Since patients with cancer require frequent transfusions, addressing challenges of blood supply and transfusion uptake through coordinated interventions is essential to support cancer care.

BACKGROUND AND OBJECTIVES:Patients with haematological malignancies often require blood transfusion support. Multiple allogeneic blood transfusions may result in alloimmunization, complicating future transfusions. This study determined alloantibody prevalence, specificities and factors associated with the presence of red blood cell (RBC) alloantibodies among transfused patients with haematological malignancies at Mbarara Regional Referral Hospital (MRRH) and the Uganda Cancer Institute (UCI). MATERIALS AND METHODS:This was a cross-sectional study among patients with haematological malignancies who had been multiply transfused and were seeking cancer care at MRRH and the UCI, in Uganda. Patient plasma was screened for the presence of RBC alloantibodies using haemagglutination testing with a 3-cell commercial reagent RBC and antibody identification with 11-cell antibody panels. RESULTS:A total of 427 patients with a median age of 36 (inter-quartile range: 26-56 years) were investigated. Twenty-five participants (5.9%) possessed RBC alloantibodies whose specificities were as follows: anti-C, two; anti-D, four; anti-E, six; anti-K, four; and anti-c, anti-Fya, anti-Jka, anti-Lea and anti-M, one each. Four patients possessed pan-reactive antibodies. Patients with chronic cancer (adjusted odds ratio [AOR] = 2.62, 95% confidence interval [CI]: 1.16-7.21), leukaemia (AOR = 2.71, 95% CI: 1.81-4.03), human immunodeficiency virus (HIV) infection (AOR = 4.34, 95% CI: 1.69-5.11), antibiotic use (AOR = 5.08, 95% CI: 2.11-7.41) and a history of ≥5 transfusions were significantly associated with RBC alloimmunization (p ≤ 0.05). CONCLUSION:RBC alloimmunization prevalence was 5.9% and associated with clinical and transfusion-related factors. Alloantibodies to Rh, Kell, MNS, Duffy, Kidd and Lewis blood group systems were detected, underscoring the need for improved pre-transfusion testing in Uganda.

Ivan Mugisha Taremwa,1,2 Scholastic Ashaba,3 Deusdedit Tusubira,4 Aggrey Dhabangi,5 Robert Bortolussi,6 Noni MacDonald,6 Lisa M Bebell,7 Nixon Niyonzima,8 Bernard Natukunda11Department of Medical Laboratory Science, Mbarara University of Science and Technology, Mbarara, Uganda; 2Institute of Allied Health Sciences, Clarke International University, Kampala, Uganda; 3Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda; 4Department of Biochemistry, Mbarara University of Science and Technology, Mbarara, Uganda; 5Child Health and Development Centre, Makerere University, Kampala, Uganda; 6Department of Pediatrics, Dalhousie University, MicroResearch International and IWK Health Centre, Halifax, Nova Scotia, Canada; 7Department of Medicine, Massachusetts General Hospital; and Harvard Medical School, Boston, MA, USA; 8Research and Training Directorate, Uganda Cancer Institute, Kampala, UgandaCorrespondence: Ivan Mugisha Taremwa, Email imugisha@ymail.comBackground: Patients with cancer often require supportive transfusion therapy. However, this approach is undermined by the risk of bacterial contamination. This study assessed the bacterial contamination rate, identified the bacterial contaminants and their antimicrobial susceptibility patterns; and the associated infectious risk to patients with cancer at Mbarara Regional Referral Hospital, in southwestern Uganda.Materials and Methods: This prospective cohort study used a pre-transfusion aliquot of donor blood or components for blood culture. Positive cultures were identified and their antibiotic susceptibility testing was performed using the bioMerieux VITEK 2 compact system. Recipients were assessed for bacterial infection at 48 hours post-transfusion. Data were analyzed using R software and presented as proportions.Results: We evaluated 376 blood units, with 275 (73.1%) of these being red cell concentrates (RCC). The median storage times for RCC and whole blood (WB) were 23 days (IQR, 18– 29 days) and 3 days (IQR, 1– 5 days) for platelets (PLT), respectively. Four units (3RCC, 1PLT) had bacterial growth, yielding a contamination rate of 1.1% (95% confidence interval, 0.4– 1.8%). Staphylococcus hominis and Bacillus subtlis were isolated from RCC, while Staphylococcus capitis was isolated from PLT. The isolates exhibited variable resistance to erythromycin, clindamycin, teicoplanin, vancomycin, tetracycline, nitrofurantoin, rifampicin, and trimethoprim-sulfamethoxazole. There were 211 recipients whose mean age was 34.1 years (standard deviation: 2.84 years). Of these, 62 (29.4%) had received ≥ 3 donor units, and 146 had been on antibiotics. None of the investigated recipients had a positive bacterial blood culture.Conclusion: The study found a low bacterial contamination rate of stored blood components underscoring the importance of stringent blood collection precautionary measures. The four bacterial isolates were resistant to common antibiotics, which poses a risk of transmission of antibiotic-resistant strains to immunocompromised recipients with cancer. Notably, there was no infectious risk posed post-transfusion presumably due to the concurrent antibiotic therapy.Keywords: antibiotic susceptibility, bacterial contamination, patients with cancer, blood, transfusion

BACKGROUND:Physical discipline is associated with negative developmental, social, and emotional outcomes in children. However, social influences on caregivers' use of physical discipline, including perceived norms and social network exposure, remain understudied. OBJECTIVES:To assess whether caregivers' use of physical discipline was associated with perceived norms and social network exposure to physical discipline. PARTICIPANTS AND SETTING:Adult caregivers (N = 1026) in rural Uganda. METHODS:In this sociocentric study, participants reported their past-week use of physical discipline and perceptions of how often most caregivers in their villages used physical discipline. Participants also named other caregivers with whom they interacted across life domains. We compared perceived norms with aggregated self-reports of behavior and used multivariable Poisson regression models with cluster-robust standard errors to estimate associations between perceived norms, social network exposure to caregivers who used physical discipline, and personal engagement in physical discipline. RESULTS:Most caregivers overestimated the prevalence and frequency of physical discipline among other caregivers in their villages. Misperceiving physical discipline as normative was positively associated with personal physical discipline behavior. For example, women who (mistakenly) perceived that most other women used physical discipline multiple times in the past week were almost twice as likely to use physical discipline themselves (adjusted relative risk [aRR] = 1.97, 95% confidence interval [CI] 1.40-2.77, p < .001). Network exposure to caregivers who used physical discipline was not associated with physical discipline use among women and was negatively associated with physical discipline use among men. CONCLUSIONS:Interventions that correct misperceived norms may be used to reduce physical discipline behaviors.

Early testing of infants exposed to HIV can significantly decrease mortality for those linked to HIV treatment. Infants exposed to HIV should first be tested at 6 weeks of age, but only 60% are tested as recommended. Little research has focused on the role of social networks in disseminating information about infant HIV testing. We conducted a cross-sectional, sociocentric network study of all adults living in a rural parish in Uganda (N=1,383) and gathered data on socio-demographic characteristics, self-reported HIV status, and knowledge about infant testing recommendations. We administered a culturally-adapted name generator to measure the parish health network. We fitted a multivariable generalized linear regression model with a logit distribution to estimate the association between having at least one social tie with correct knowledge about early infant testing and individual knowledge about infant testing. Having at least one social tie who knew about infant HIV testing at 6 weeks was positively associated with correct knowledge about early infant testing (adjusted odds ratio [aOR] 1.42, 95% confidence interval [CI] 1.07- 1.88, p-value=0.02). Correct knowledge about early infant testing was also associated with having daily contact with social ties (aOR 1.31, 95% CI 1.00-1.71, p-value=0.05) and being considered an authority for health advice within the network (aOR 1.81, 95% CI 1.18-2.77, p-value=0.01). These findings suggest that interventions to enhance peer-to-peer information exchange could increase knowledge about early infant testing, since individuals rely on close, frequently contacted social ties. Network-central individuals can also be engaged to disseminate information about early infant testing

Depression is a serious mental health condition whose risk is highest among women during pregnancy. The risk is high among pregnant teenagers due to intertwined developmental, hormone-mediated physical and psychosocial changes of pregnancy, with significant negative impacts on the unborn baby and the mother. This study aimed to determine the prevalence of depression and associated factors among pregnant teenagers in Mbarara city, southwestern Uganda. This was a cross-sectional study where we enrolled pregnant teenagers (13–19 years) attending antenatal care at 4 selected lower healthcare facilities in Mbarara City southwestern Uganda. We collected information on depression, resilience, social support and household food insecurity. Depression was defined as a score > 10 on the Edinburgh Postnatal Depression Scale (EPDS). Resilience was assessed using the 14-item Wagnild and Young Resilience Scale, Multi-dimensional Scale of perceived social support (MDSPSS) assessed perceived social support, and Household Food Insecurity Access Scale (HFIAS) assessed food insecurity in addition to sociodemographic variables. We run logistic regression analysis to determine factors associated with depression. A total of 373 participants were recruited; median age was 19 (IQR: 18–19) years, 59

BACKGROUND:HIV status disclosure remains a major challenge among children living with perinatally acquired HIV with many taking treatment up to adolescence without knowing their serostatus. This non-disclosure is influenced by factors like fear of the negative consequences of disclosure. Since HIV status disclosure has been found to have good effects including improving treatment adherence and better mental health outcomes, there is a need to design interventions aimed at improving disclosure rates among children living with HIV. This study aims at adapting a clinic-based pediatric HIV status disclosure intervention and tasking shifting from healthcare workers to caregiver peer supporters in Eastern Uganda. METHODS:The adaptation process involved consultations with caregivers, healthcare workers involved in the care of children living with HIV, researchers in this field, intervention developers, and other experts and stakeholders. This was done through conducting FGDs with HCWs, caregivers, and peer supporters and consultations with researchers in the field of HIV. The original intervention manual was translated to Lusoga which is the commonly spoken dialect in this region. Collected qualitative data were analyzed using an inductive approach to develop themes and subthemes. Written informed consent will be obtained from all participants before participation in the study. RESULTS:A total of 28 participants were involved in the FGDs, while two pediatricians and two HIV researchers/specialists were consulted. Six themes were generated in relation to all suggested changes to the original manual which were related to: (1) sociocultural beliefs/norms/perceptions (5 FGDs), (2) boosting caregiver's confidence for disclosure (5FGDs), (3) disclosure mode, environment, and person (4 FGDs), (4) health facility/system related changes (3 FGDs), (5) reorganization/paraphrasing (3FGDs) and (6) age appropriateness (2FGDs). CONCLUSION:This study emphasized that whereas some aspects of intervention can apply to various contexts, there is a need for cross-cultural adaptation of interventions before being implemented in settings where they were not developed.

Background: Appetitive aggression is a type of aggression that is characterized by a fascination with violence and a desire to inflict pain on the perceived enemy. This type of aggression has mainly been studied among former child soldiers and demobilized combatants. Information on appetitive aggression among retiring active service officers is limited. This study aimed to determine the prevalence of appetitive aggression and the associated factors among soldiers who are retiring from active service in Uganda.Methods: A sample of 247 retiring military soldiers from the Uganda People’s Defence Force (UPDF), who had assembled at Gaddafi Barracks in Jinja district in eastern Uganda in preparation for the retirement exercise, was randomly selected for this cross-sectional study. We assessed participants for appetitive aggression using the Appetitive Aggression Scale, and also collected information on alcohol and drug use, exposure to traumatic life events, post-traumatic stress disorder, childhood trauma, and depression. We ran logistic regression models to determine the factors associated with appetitive aggression among the study participants.Results: Ninety-seven per cent (n = 239) of the participants were male and the mean age was 46 years. The prevalence of appetitive aggression was 58%. Not being depressed (p = .040) and experience of traumatic events (p = .001) were associated with high odds of appetitive aggression.Conclusion: The prevalence of appetitive aggression among the study participants was high. Having experienced traumatic events was associated with a greater odds of appetitive aggression, while having depression was protective against appetitive aggression. Interventions aimed at preventing appetitive aggression among soldiers should target addressing the trauma experienced during their line of duty.

INTRODUCTION:We assessed the extent to which portrayals of AUD treatment effectiveness influenced multiple domains of stigma. METHODS:This cross-sectional, whole-population survey experiment was conducted with 1363 adults living in eight villages of southwestern Uganda in 2021-2022. Participants were randomly assigned to receive a vignette describing a typical man (control) or one of six vignette variants describing a man with untreated AUD, treated AUD, or other variations of treated or untreated AUD with differing outcomes. OUTCOMES:personal willingness to have the man marry into their family, belief that he is receiving divine punishment, and belief that he brings shame on his family. Participants also reported their perceptions about whether most people in their villages would hold those stigmatizing attitudes (i.e., perceived norms). We fitted multivariable Poisson regression models to estimate the effect of vignette assignment on personal beliefs and perceived norms. RESULTS:Participants reported more stigmatizing personal beliefs across all AUD vignettes compared to control. Average marginal effects (AME) of assignment on the excess probability of stigmatizing personal beliefs ranged from 0.57 (95 % Confidence Interval CI=0.43-0.71) to 0.74 (CI=0.58-0.90) for unwillingness to have the man marry into their family, 0.66 (CI=0.53-0.80) to 0.81 (CI=0.67-0.95) for believing the man brings shame upon his family, and 0.29 (CI=0.20-0.38) to 0.36 (CI=0.27-0.46) for believing the man is receiving divine punishment. AMEs of vignette assignment on perceived norms were similar. CONCLUSION:Stigma toward men with AUD in rural Uganda was high regardless of AUD treatment effectiveness. Culturally-tailored stigma reduction interventions are needed.

The stigma surrounding mental illnesses is widespread and informal caregivers of patients with mental illness face stigma because of their relationship with the patients they care for. Despite the key role played by these informal caregivers in the management of people with mental illness, few studies have assessed affiliate stigma and its factors associated among this population. This study aimed to investigate the prevalence of affiliate stigma and associated factors among caregivers of patients with mental illness in southwestern Uganda. We used a cross-sectional study design and enrolled 385 caregivers. We assessed affiliate stigma, depression, and social support using the affiliate stigma scale, patient health questionnaire-9 and social support using the social provision scale respectively. We ran multivariable logistic regression models to assess for the factors associated with affiliate stigma among caregivers. The prevalences of affiliate stigma and depression were 65.97% and 25.2% respectively. Factors associated with affiliate stigma included caregiving for one year or longer (AOR: 1.89; 95% CI: 01.07–03.35; p = 0.03), having more than one patient to care for (AOR: 3.40; 95% CI: 01.39–08.36; p = 0.01), being the only caregiver to the patient (AOR: 2.60; 95% CI: 1.27–5.33; p = 0.01), being depressed (AOR: 75.76; 95% CI: 10.03–572.26; p < 0.001), and social support (AOR: 0.14; 95% CI: 0.06–0.29; p = 0.04). This prevalence of affiliate stigma among caregivers of patients with mental illness is high in southwestern Uganda and depression is a key predictor. Considering the important role played by informal caregivers, more studies are necessary to inform interventions to address affiliate stigma, depression, and overall mental health of caregivers.

PURPOSE:To understand the experiences and coping mechanisms of children and adolescents living with HIV (CALH) after HIV disclosure. METHODS:We conducted a qualitative study among CALH after HIV disclosure receiving care from two referral hospitals in eastern Uganda. In-depth interviews were conducted using an interview guide during routine outpatient visits to HIV clinics until data saturation was achieved. All interviews were audiotaped, and the collected data were analyzed using an inductive thematic approach. RESULTS:We conducted 23 interviews with CALH aged 11-17 years. Participants' experiences of disclosure were categorized into two major themes: (1) negative experiences, including HIV-related stigma, loss of social support and trust, and emotional and behavioral challenges, and (2) positive experiences, including improved self-efficacy and adherence. Coping mechanisms after disclosure were categorized into two themes (1) healthy (adherence to treatment, distraction, guidance and counseling, social support, and cognitive restructuring) and (2) non-healthy (alcohol and other substance use) coping mechanisms. CONCLUSION:The above experiences and coping mechanisms highlight the need to develop interventions that promote planned early disclosure of HIV status to children, supported by trained healthcare workers with rigorous counseling for better physical and mental health outcomes.