Stella Alamo

Reach Out Mbuya · Execctive Directors office

Introduction Certain occupations have been associated with heightened risk of HIV acquisition and spread in sub-Saharan Africa, including bar work and transportation. However, data on changes in prevalence of untreated HIV infection and HIV incidence within occupations following rollout of antiretroviral therapy and voluntary medical male circumcis...

Background: Male circumcision (MC) offers men lifelong partial protection from heterosexually-acquired HIV infection. The impact of MC on HIV incidence has not been quantified in nationally-representative samples. Data from the Population-based HIV Impact Assessments (PHIAs) were used to compare incidence by MC status in countries implementing vol...

Background The efficacy of voluntary male medical circumcision (VMMC) for HIV prevention in men was demonstrated in three randomized trials. This led to the adoption of VMMC as an integral component of the President’s Emergency Plan for AIDS Relief (PEPFAR) combination HIV prevention program in sub-Saharan Africa. However, evidence on the individua...

Objective To study temporal trends of mortality in HIV-infected adults who attended an HIV clinic in Kampala, Uganda, between 2002 and 2012. Design Descriptive retrospective study. Methods Two doctors independently reviewed the clinic database that contained information derived from the clinic files and assigned one or more causes of death to each...

Background: Socioeconomic support reduced nonretention in a community-based antiretroviral therapy (ART) program in Uganda. However, resource implications of expanding socioeconomic support are large, and cost-effectiveness analysis can inform budget priorities. We compared the incremental benefits and costs of providing education, food, or both f...

To determine the optimal time to track patients, we evaluated the outcomes of patients traced after missing their return visits at 3 periods, 8, 30, or 90 days, at the Infectious Diseases Clinic in Kampala, Uganda. During the study period from January to December 2011, the proportion of untraceable patients was 2 (4%) after 8 days, 12 (10%) after 3...

Objective To determine the retention rate of patients infected with HIV who resumed care after being tracked at the Infectious Diseases Clinic (IDC) in Kampala, Uganda.Methods Between April 2011 and September 2013, patients who missed their clinic appointment for 8-90 days were tracked, and those who returned to the clinic within 120 days were foll...

To delineate the association between baseline socioeconomic status (SES) indicators and mortality and lost to follow-up (LTFU) in a cohort of HIV-infected individuals enrolled in antiretroviral treatment (ART) in urban Uganda. Retrospective cohort study nested in an antiretroviral clinic-based cohort. SES indicators including education, employment...

Background: The purpose of this case-control study was to identify risk factors for loss to follow-up (LTFU). Methods: Cases and controls were selected from HIV-positive patients, aged 18 years and older, on antiretroviral therapy (ART) at the Infectious Diseases Clinic (IDC) in January 2008. As cases, we selected 209 patients who in 2008 did no...

BackgroundA Pharmacy-only Refill Program is a type of task shifting in which stable HIV-positive patients are managed through pharmacy-only visits instead of physician visits. The purpose of this study was to identify factors for being removed from the Pharmacy-only Refill Program in order to establish better referring criteria.Methods The study wa...

Abstract Mobile technologies for health (mHealth) represents a growing array of tools being applied in diverse health care settings. mHealth interventions for improving HIV/AIDS care is a promising strategy, but its evidence base is limited. We conducted a formative research evaluation to inform the development of novel mHealth HIV/AIDS care interv...

To understand reasons for lost-to-follow-up (LTFU) from a community-based antiretroviral therapy program in Uganda. Retrospective cohort of patients LTFU between May 31, 2001, to May 31, 2010, was examined. A representative sample of 579 patients traced to ascertain their outcomes. Mixed methods were used. Using "stopped care" as the hazard and "se...

We address a critical aspect of antiretroviral therapy (ART) scale-up: poor clinic organization leading to long waiting times and reduced patient retention. Using a before and after study design, time and motion studies and qualitative methods we evaluated the impact of triage and longer clinic appointment intervals (triage) on clinic efficiency in...

To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03). A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum communit...

We evaluated the benefit of socioeconomic support (S-E support), comprising various financial and nonfinancial services that are available based on assessment of need, in reducing mortality and lost to follow-up (LTFU) at Reach Out Mbuya, a community-based, antiretroviral therapy program in Uganda. Retrospective observational cohort data from adult...

OBJECTIVES: To understand reasons for lost to follow-up (LTFU) from a community-based antiretroviral therapy (ART) program in Uganda. STUDY DESIGN: Retrospective cohort of patients LTFU between May 31, 2001-May 31, 2010 was examined. A representative sample of 579 patients traced to ascertain their outcomes. METHODS: Mixed methods were used. Using...

Task shifting to community health workers (CHW) has received recognition. We examined the performance of community antiretroviral therapy and tuberculosis treatment supporters (CATTS) in scaling up antiretroviral therapy (ART) in Reach Out, a community-based ART program in Uganda. Retrospective data on home visits made by CATTS were analyzed to exa...

Developing capacity for HIV research and clinical practice is critically needed in resource-limited countries. The purpose of this study was to evaluate a research capacity-building program for community-based participants in the preparation and conduct of mobile phone-based technology interventions. A descriptive, cross-sectional design was used....

Patients who miss clinic appointments make unscheduled visits which compromise the ability to plan for and deliver quality care. We implemented Electronic Medical Records (EMR) and same day patient tracing to minimize missed appointments in a community-based HIV clinic in Kampala. Missed, early, on-schedule appointments and waiting times were evalu...

Global scale-up of antiretroviral therapy (ART) has focused on clinical outcomes with little attention on its impact on existing health systems. In June-August 2008, we conducted a formative evaluation on ART scale-up and clinic operations at three clinics in Uganda to generate lessons for informing policy and larger public health care systems. Sit...

With dramatic increases in antiretroviral therapy (ART) provision, many clinics in sub-Saharan Africa are congested, but little attention has focused on the efficiency of clinics. Between April and June 2008, we conducted a time-and-motion study to assess patient flow at three HIV clinics in Uganda. Mulago HIV Clinic had 6,700 active patients, comp...

There is growing concern about the human resources needed to care for increasing numbers of patients receiving antiretroviral therapy in resource-limited settings. We evaluated an alternative model, community-based, comprehensive antiretroviral program staffed primarily by peer health workers and nurses. We conducted a retrospective cohort study of...