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Item Pre-exposure prophylaxis use among female sex workers in Gulu city, Uganda:(Sage Publications, 2023-08-14) Bongomin, Felix; Kibone, Winnie; Okot, Jerom; Ouma, Simple; Madraa, Grace; Ojara, Francis Williams; Musoke, David; Pebalo, Francis PeboloBackground: Pre-exposure prophylaxis (PrEP) is an important intervention for reducing the risk of HIV transmission among high-risk populations such as female sex workers in Africa, where HIV prevalence remains high. We aimed to assess the use of PrEP among female sexworkers in Gulu, Uganda. Methods: In this community-based cross-sectional study, we included HIV-negative female sex workers purposely selected from hotspots within Gulu city, Uganda between February and March 2023. A semi-structured questionnaire was administered to collect data on sociodemographic characteristics, reproductive data, sexual practices, and self-reported PrEP use in the past 3months. Symptoms of depression were screened using Patient Health Questionnaire-2 tool. Predictors of PrEP use was determined using modified Poisson regression analysis model. p<0.05 was considered statistically significant. Results: We enrolled 273 female sex workers with a median age of 27 (interquartile range:24–32) years. Overall, 181 (66.3%) participants used PrEP. PrEP use was associated with;regular source of income beside sex work [adjusted prevalence ratio (aPR): 3.7, 95% confidence interval (CI): 2.11–6.35, p<0.001], being in a polygamous marriage (aPR: 6.9, 95% CI: 1.32–35.77, p=0.022), practicing sex work in both rural and urban areas (aPR: 2.5, 95% CI:1.49–4.35, p<0.001), having symptoms of depression (aPR: 3.3, 95% CI: 1.43–7.74, p=0.005), and use of postexposure prophylaxis (PEP) in the past 12months (aPR: 0.31, 95% CI: 0.17–0.59,p<0.001). Conclusion: Almost two in three of the female sex workers in Gulu city were currently using PrEP. Previous use of PEP was associated with lower use of PrEP. These findings suggest the need for targeted interventions to increase PrEP uptake and decrease HIV acquisition in this high-risk population among female sex workers, especially those with low income and limited access to healthcare.Item Comparing Flipped Classroom with Traditional Instruction for Post-Partum Intra-Uterine Device Training Among Medical Students in a Ugandan Public University:(Research squares, 2023-09-07) Pebalo, Francis Pebolo; Bongomin, Felix; Awor, Sylvia; Arwinyo, Baifa; Ojara, Sande; Opee, Jimmy; Ayikoru, Jackline; Okot, Jerom; Ssenuni, Eric; Ouma, Simple; Nakimuli, AnnetteeA two-arm, quasi-experimental design was used. The FC group underwent a pre-recorded lecture and video on PPIUD insertion, followed by interactive sessions and procedural practice. The traditional group received an hour-long lecture and onsite skills demonstration, followed by skill practice. Paired t tests were used to determine knowledge and skills acquisition in each group and independent samples t tests was be used to compare groups. Stata version 17 and GraphPad Prism version 9 were used for analysis. Results A total of 67 students were included in the final analysis, 37 in the traditional group and 30 in the FC group. There was a significant improvement in post-test scores compared to pre-test scores in both groups p < 0.001. The mean post-test score was higher for FC compared to the traditional teaching methods group although, it was not statistically significant (p = 0.069). Certain categories of students performed better with FC, especially those who failed pre-tests p = 0.021), in bachelor or of medicine and bachelor of surgery (MBChB) year 3 class (p = 0.011), students who joined the university directly from advanced level certificate (p = 0.018) and aged younger than 25 years (p = 0.002). There was no statistically significant difference in the mean procedure performance score between the intervention and the traditional teaching methods (p = 0.634). Conclusion The FC had shown a positive impact on the knowledge and skills of medical students indicating its role in reproductive health training in resource-limited settings. Additionally, future studies could investigate how FC can combined with other teaching methods to create a blended learning approach that maximizes the benefits and enhanced learning.Item Factors associated with utilization of standard days method of family planning among market vendors in Gulu City(PAMJ Clinical Medicine., 2021-12-09) Acire, Robin; Acidri, Philip; Angolere, Pasquale; Pebalo, Francis PeboloIntroduction: standard days method (SDM) is a family planning method in which users avoid unprotected sexual intercourse during cycle days 8 through 19. Its efficacy is 95% and 88% in perfect and typical use respectively when used among women whose cycles are between 26-32 days. Classified as a modern contraceptive, can be used to bridge the gap brought by fear of side effects, cost, cultural and religious opposition to the modern hormonal method. The study, therefore, seeks to look at the factors associated with choosing or continuing to use SDM as a method of family planning in the Gulu City main market. Methods: this was a cross-sectional analytical study among women of reproductive age in Gulu main. Results: a total of 248 women were included in the final analysis. Women who heard about SDM, understand their menstrual cycle, believe in a high possibility of conception within their cycle, have very good thoughts and good thoughts about the method were more likely to choose or continue using the method; P-values 0.061, 0.08, 0.002,0.001 and, 0.001 respectively. Recommendation to use the method was a positive predictor for using the method, P-value <0.001, meanwhile, some knowledge and little knowledge about the method were negative predictive factors for using SDM, P-values 0.038 and 0.020 respectively. Conclusion: intervention aimed at improving knowledge about SDM among the population may help increase use of SDM to reduce incidences of unintended pregnancies and meet contraceptive unmet needs among women not comfortable using the modern hormonal contraceptives.Item “I Use Strawberry Flavoured Condoms during My Periods”:(MDPI, 2023-08-28) Bongomin, Felix; Kibone, Winnie; Pebalo, Francis Pebolo; Laker, Fiona Gladys; Okot, Jerom; Kaducu, Felix Ocaka; Madraa, Grace; Labongo Loum, Constantine Steven; Awor, Silvia; Napyo, Agnes; Musoke, David; Ouma, SimpleBackground: Female sex workers (FSWs) are at a higher risk of contracting and transmitting HIV and other sexually transmitted infections (STIs). We aimed to explore the sexual behaviour, knowledge and attitudes towards STIs, barriers, support and intervention for STI screening. Methods: In this community-based, concurrent quantitative–qualitative, exploratory mixed-methods study, we administered 87 semi-structured quantitative and six in-depth interviews to purposively select FSWs in Gulu City, Uganda. The qualitative methodology was based on descriptive phenomenology. Results: The quantitative study included 87 FSWs, with a median age of 28 years. Overall, 87.4% (n = 76) participants reported condom use during their last sexual encounter. Eighty-three (95.4%) participants were aware of their HIV status, with 6% (n = 5) reporting being HIV-positive. Seventy-six (87.4%) participants reported contracting at least one STI during sex work. In addition, 66.7% (n = 58) of the participants reported being screened for STIs in the past three months, with vulvovaginal candidiasis (55.3%, n = 42) and syphilis (32.9%, n = 25) being the most common STIs. However, only 2.3% (n = 2) of the participants reported current STIs symptoms. In the qualitative study, the main themes encompassed sexual behaviour, including condom-use negotiation strategies and challenges, as well as screening facilitators and barriers. Condom-use negotiation tactics involved leveraging healthrisk information, increased charges for unprotected sex, and outright refusal. Complex challenges included limited agency in promoting safe sex due to economic reliance, vulnerability to violence, and difficulties in controlling the sexual environment. Facilitators for regular screening included social influences, emotional relief, established testing habits, and accessible clinics, while barriers encompassed cost, stigma, doubts about test accuracy, and inconvenient clinic hours. Conclusions: FSWs face significant vulnerabilities in Gulu City, Uganda, regarding STIs. While encouraging trends such as high HIV awareness and condom usage were observed, persistent challenges in STI screening, negotiation of safe sex practices, and access to prevention and treatment remain evident. To address these concerns, targeted interventions should be developed to enhance STI screening accessibility empower sex workers with effective negotiation skills, and provide comprehensive support for STI prevention and treatment, thereby contributing to improved overall sexual health and well-being among this marginalized populationItem Utilization of cervical cancer screening services and associated factors among HIV positive women receiving care at an antiretroviral therapy clinic in Gulu Regional Referral Hospital(PAMJ Clinical Medicine, 2022-02-22) Gwokyalya, Ginall Bagala; Ayebazibwe, Ambrose; Kinyera, Cynthia; Nabanoba, Shamirah; Pebalo, Francis PeboloIntroduction: cervical cancer is the 3rd most common cancer among women globally,accounting for 7.9% of all cancers in women, and the leading cause of gynecological cancer deathsin low to middle-income countries, resulting in 85% of cancer-related deaths in sub-Saharan Africa. It isknown to be caused by the human papillomavirus (HPV). Co-infection with HIV makes women more susceptible to premalignant lesions of the cervix and faster progression to cervical cancer.Screening services are relatively low among women living with HIV despite this elevated risk.This study aimed to assess the level of utilization of cervical cancer screening services and associatedfactors among HIV-positive women receiving care at Gulu Regional Referral Hospital. Methods: across-sectional study was conducted among HIVpositive women receiving care at Gulu Regional Referral Hospital antiretroviral therapy clinic. Results: a total of 160 women were recruited; 70(43.75%) had screened at least once and almost half 34 (48.5%) of those that had screened did so because they were aware of being at risk of getting cervical cancer, 33 (47.14%) or knew of someone suffering from cervical cancer. Half 45(50%) of those that had not screened was due to alack of knowledge about cervical cancer screening.However, 83 (92%) of those who had not screened were willing to screen if services were integrated into the ART clinic. The main source of the screening information was from health workers, 47(67.14%), and more than half got screened from government health facilities and 42 (60%). Conclusion: there is a generally low level of utilization of cervical cancer screening services among HIV-positive women. Healthcare providers were the main source of information, this can form the basis of health education including information related to the national cervical cancer screening program among HIV-positive women. Integrationof cervical cancer screening services within the ART clinic will promote utilization among this highly susceptible groupItem Dual contraceptive use and associated factors among female sex workers in Gulu City, Uganda in 2023(BioMed Central, 2023-08-16) Bongomin, Felix; Pebalo, Francis Pebolo; Kibone, Winnie; Okwir Apio, Pamela; Nsenga, Lauryn; Okot, Jerom; Madraa, Grace; Laker, Fiona Gladys; Akello, Martha; Ouma, Simple; Musoke, DavidBackground: Dual contraception is an essential approach to mitigating the heightened risks of unintended pregnancies and sexually transmitted infections faced by female sex workers (FSWs). We determined the prevalence and factors associated with dual contraceptive use among FSWs in Northern Uganda. Methods: A cross-sectional study was conducted in Gulu city, Uganda between February, and March 2023. Purposively selected FSWs aged 18 years or older who provided verbal informed consent were enrolled in the study. A sample size of 374 was estimated. Data on sociodemographic and reproductive health characteristics were collected using an interviewer-administered semi-structured questionnaire. Current dual contraception was defned the as concurrent use of a barrier and any other modern contraceptive methods within the last 3 months. Continuous variables were summarized using mean and standard deviation and categorical variables were summarized using frequencies and percentages. Modifed Poisson regression analysis was used to determine factors associated with dual contraceptive use. Results: We enrolled 314 FSWs, with a mean age of 28.8±6.4 years. About 13.8% (n=41) were living with HIV. In total, 66.2% (95%CI 60.8–71.3) of the participants (n=208) reported current dual contraceptive use. The most common modern contraceptive method used was the implants (52.4%, n=109), followed by injectable contraceptives (22.6.0%, n=47), and bilateral tubal ligation (0.5%, n=1) was the least utilized. Having had at least one previous pregnancy was positively associated with dual contraceptive use (adjusted PR: 1.87, 95%CI 1.40–2.51, p<0.001). Conclusions: A high proportion of FSWs in Gulu city were currently using dual contraceptives. Interventions are needed to facilitate the use of dual contraception, particularly among FSWs without a history of previous pregnancies.