Journal Articles

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Child sexual abuse and situational context: children’s experiences in post-conflict northern Uganda
(Taylor&Francis Online: Journal of Child Sexual Abuse, 2019) Nyangoma, Anicent; Ebila, Florence; Omona, Julius
Although substantial literature exists on child sexual abuse (CSA), little is known about abuses children encounter in northern Uganda, a post-conflict area. Media reports have indicated a high incidence for CSA. The study, firstly, explored boys’ and girls’ experiences of sexual abuse by adults in this post-conflict region and secondly, interventions directed at improving the current situation of children at risk of child abuse and the survivors were investigated as well. The study was guided by radical feminism and nested ecological framework theories. Semi-structured interviews were conducted involving 43 sexually abused children. Narrative responses were audio recorded and transcribed. Content qualitative analysis was used to understand sexual offenses from children’s perspectives. Participants mentioned the following as the most perilous situations; laxity in parental roles, cultural norms, and practices, patriarchal attitudes, child sexual desires and attitudes, family breakdown and alcoholism. The study found many reported cases of CSA in the region. The results imply the exigent need of separate units specifically for reporting and handling child sexual offenses, need for personnel training on gender issues and filing system in child protection agencies and family programs for both fathers and mothers on child protection strategies for prevention and mitigation of CSA.
Deconstructing the psychosexual myths of female circumcision among the Pokot in Eastern Uganda: hints for public health campaigns
(Journal of Ethnic & Cultural Diversity in Social Work, 2023-05) Noah, Kalengo; Japheth, Nkiriyehe Kwiringira; Isabirye, Alone; Laban .K., Musinguzi; Janestic, Mwende Twikirize
Sexualization of the woman’s body has for years been used to promote the practice of female circumcision in practicing communities. In this study, we provide an insight into the constructive psychosexual experiences of uncir- cumcised Pokot women in Eastern Uganda. This phenomenological study was based on thirty-five In-depth interviews with uncircumcised women. A thematic analysis revealed six constructive psychosexual experiences; less exposure to early marriages, fewer complications during menstrual periods, amplified sexual pleasure, ease to reach orgasms, less exposure to sexually transmitted infections, and good reception by men from non-female circumcision communities. These experiences provide grounds for public health campaigns against female circumcision and fighting stigmatization of uncircumcised women.
Descending the sanitation ladder in urban Uganda: evidence from Kampala slums
(Springer Nature: BMC Public Health volume ., 2014) Kwiringira, Japheth; Atekyereza, Peter; Niwagaba, Charles; Günther, Isabel
While the sanitation ladder is useful in analysing progressive improvements in sanitation, studies in Uganda have not indicated the sanitation barriers faced by the urban poor. There are various challenges in shared latrine use, cleaning and maintenance. Results from Kampala city indicate that, failure to clean and maintain sanitation infrastructure can lead to a reversal of the potential benefits that come with various sanitation facilities. Methods: A cross sectional qualitative study was conducted between March and May 2013. Data were collected through 18 focus group discussions (FGDs) held separately; one with women, men and youth respectively. We also used pictorial methods; in addition, 16 key informant interviews were conducted. Data were analysed using content thematic approach. Relevant quotations per thematic area were identified and have been used in the presentation of the results. Results: Whether a shared sanitation facility was improved or not, it was abandoned once it was not properly used and cleaned. The problem of using shared latrines began with the lack of proper latrine training when people do not know how to squat on the latrine hole. The constrained access and security concerns, obscure paths that were filthy especially at night, lack of light in the latrine cubicle, raised latrines sometimes up to two metres above the ground, coupled with lack of cleaning and emptying the shared facilities only made a bad situation worse. In this way, open defecation gradually substituted use of the available sanitation facilities. This paper argues that, filthy latrines have the same net effect as crude open defection. Conclusion: Whereas most sanitation campaigns are geared towards provision of improved sanitation infrastructure, these findings show that mere provision of infrastructure (improved or not) without adequate emphasis on proper use, cleaning and maintenance triggers an involuntary descent off the sanitation ladder. Understanding this reversal movement is critical in sustainable sanitation services and should be a concern for all actors.
Diversifying Research Methods in Studying Male Officer Perpetrated IPV in Sensitive Security Government Entities: A Case of Jinja Police Barracks in Uganda
(SAGE Publications Ltd, 2024-05-08) Asiimwe, Stedia; Namuggala, Victoria F.
Sensitive security government agencies present unique contexts and challenges for researchers. Entry into such spaces and fruitful engagement with participants demand particular research methodologies. In this piece we describe steps critical for navigating sensitive field sites by drawing on a multi-method qualitative approach that employed interviews, focus group discussions, and observations to study a police barracks in Uganda. Our overall goal is to guide readers on how to navigate contentious ethical research issues as well as challenges that might be encountered. We argue that researching sensitive security entities requires decolonial approaches that shift beyond traditional steps for conducting research to appreciating unique study-site contexts. Researchers further ought to understand the entity under study—its structure and mode of operation.
Experiences of gender based violence among refugee populations in Uganda: evidence from four refugee camps
(Eastern Africa Social Science Research Review., 2018-01) Kwiringira, Japheth Nkiriyehe; Mutabazi, Marion Mugisha; Mugumya, Firminus; Kaweesi, Edward; Munube, Deogratias; Rujumba, Joseph
In refugee generating situations, flight conditions and actual refugee circumstances, Gender Based Violence take different forms like rape, female genital mutilation, physical, psychological and emotional abuse, defilement and bride kidnapping in the name of 'early marriage' and sexual harassment among others. These forms are heightened by the adverse conditions of lack of basic needs, unequal power relations, breakdown of institutions of social control and order, exposure to the dangers of group violence and low capacity of protection agencies both local and international, and the host governments. This study intended to detail refugee experiences of Gender Based Violence among refugees in Uganda as well as the associated factors. We conducted a qualitative study and used content-thematic approach analysis. While there was high GBV awareness; this did not translate into reduced susceptibility. Detection, prevention and response to GBV were curtailed by an intersectionality of unequal power relations, poverty, and a multiplicity of cultures that concealed the nature, extent and reality of GBV. Effective GBV prevention requires an array of interventions and 'capacities' especially access to basic needs for individuals and households. Our findings aver that, gender based violence is endemic in peripheral hard to reach, conflict and post-conflict settings than in more stable communities due to underreporting and concealment that are associated with numerous capacity challenges in access and utilisation of the available services. The extreme conditions that refugees go through during displacement, flight and resettlement tend to exacerbate and sustain GBV.
Gender variations in access, choice to use and cleaning of shared latrines; experiences from Kampala slums, Uganda
(Springer Link: BMC Public Health., 2014-11-19) Kwiringira, Japheth; Atekyereza, Peter; Niwagaba, Charles; Günther, Isabel
Sanitation is one of the most intimate issues that affect women, especially in slums of developing countries. There are few studies that have paid attention to the gender variations in access, choice to use and cleaning of shared latrines in slums. Methods: This paper draws on qualitative data from a cross sectional study conducted between 2012 and 2013 in six slums of Kampala City, Uganda. The study involved both women and men. Data were collected from 12 Focus Group Discussions (FGDs), 15 Key informant interviews; community transects and photographs of shared latrines. Results: Location of a shared latrine facility, distance, filthy, narrow and irregular paths; the time when a facility is visited (day or night), privacy and steep inclines were gender ‘filters’ to accessing shared latrines. A full latrine pit was more likely to inhibit access to and choice of a facility for women than men. Results indicate that the available coping mechanisms turned out to be gendered, with fewer options available for women than men. On the whole, women sought for privacy, easy reach, self-respect and esteem, cleanliness and privacy than men. While men like women also wanted clean facilities for use; they (men) were not keen on cleaning these facilities. The cleaning of shared latrines was seen by both women and men as a role for women. Conclusion: The presence of sanitation facilities as the first step in the access, choice, use, and cleaning by both women and men has distinct motivations and limitations along gender lines. The study confirms that the use and cleaning of latrines is regulated by gender in daily living. Using a latrine for women was much more than relieving oneself: it involved security, intimacy and health concerns.
“Here, your only relative is money…” why slum social networks do not facilitate neighborhood community development: insights through a sanitation lens
(BMC Public Health, 2023-11) Japheth, Nkiriyehe Kwiringira; Joseph, Rujumba; Paulino, Ariho; James, Mugisha; Henry, Zakumumpa; Liz, Perry Mohlin; Mathias, Akugizibwe; Innocent, Kamara Tumwebaze; Charles, Onyutha
Introduction Though social networks which are deemed vehicles of community development exist in slum areas, underdevelopment still persists in these areas. We explored the nature and role of social networks in facilitating community development in the slums of Kampala through a sanitation lens. Methods Qualitative Social Network Analysis (SNA) was done to understand the nature of slum social networks primarily through the analysis of sanitation behavior. Data were collected through six Focus Group Discussions (FGD), six In-depth Interviews (IDIs), and 18 Key Informant Interviews (KII) with Government, civil society and private stakeholders. We used both inductive and deductive thematic analysis. Results Four themes emerged in our analysis; i); Unsupportive environments, uncooperative neighbours and uncertainty of tenure: participants reported slums as unsupportive of community development due to a shortage of space, poverty and unplanned services. Tenants perceived landlords as exploitative and predatory and wished the tables are turned. This notion of cyclic exploitation did not encourage collective action for community good. Short-term economic survival trumped long-term community interests ii) Patronage and poor service delivery: varying degrees of patronage led to multiple forms of illegalities and violations such as tax evasion. Due to vested interests and corruption among public officials, the slum population was lethargic. iii) Intersecting realities of poverty and unemployment: slum dwellers lived on the margins daily. Hence, poor living conditions were a secondary concern. iv) Social relations for personal development: Slum social networks were driven by individual interests rather than community good. Slum dwellers prioritized connections with people of common socio-economic interests. As such social networks were instrumental only if they ‘added value’. Conclusion Social networks in slums are only concerned about survival needs. Slums require responses that address the complexity of slum formation and broader livelihood challenges, as well as re-assessing the meaning of community. We posit that more needs to be done in understanding the meaning and workings of a sociology beyond physical societies. Poverty is a modifier of social systems and processes and should be a concern for all stakeholders involved in slum development.
Interface of culture, insecurity and HIV and AIDS: lessons from displaced communities in Pader district, northern Uganda
(Springer Nature: Conflict and Health., 2010-11-22) Rujumba, Joseph; Kwiringira, Japheth
Northern Uganda unlike other rural regions has registered high HIV prevalence rates comparable to those of urbanized Kampala and the central region. This could be due to the linkages of culture, insecurity and HIV. We explored community perceptions of HIV and AIDS as a problem and its inter-linkage with culture and insecurity in Pader District. Methods: A cross sectional qualitative study was conducted in four sub-counties of Pader District, Uganda between May and June 2008. Data for the study were collected through 12 focus group discussions (FGDs) held separately; 2 FGDs with men, 6 FGDs with women, and 4 FGDs with the youth (2 for each sex). In addition we conducted 15 key informant interviews with; 3 health workers, 4 community leaders at village and parish levels, 3 persons living with HIV and 5 district officials. Data were analysed using the content thematic approach. This process involved identification of the study themes and sub-themes following multiple reading of interview and discussion transcripts. Relevant quotations per thematic area were identified and have been used in the presentation of study findings. Results: The struggles to meet the basic and survival needs by individuals and households overshadowed HIV as a major community problem. Conflict and risky sexual related cultural practices were perceived by communities as major drivers of HIV and AIDS in the district. Insecurity had led to congestion in the camps leading to moral decadence, rape and defilement, prostitution and poverty which increased vulnerability to HIV infection. The cultural drivers of HIV and AIDS were; widow inheritance, polygamy, early marriages, family expectations, silence about sex and alcoholism. Conclusions: Development partners including civil society organisations, central government, district administration, religious and cultural leaders as well as other stakeholders should mainstream HIV in all community development and livelihood interventions in the post conflict Pader district to curtail the likely escalation of the HIV epidemic. A comprehensive behaviour change communication strategy is urgently needed to address the negative cultural practices. Real progress in the region lies in advocacy and negotiation to realise lasting peace.
Livelihood risk, culture, and the HIV interface: evidence from lakeshore border communities in Buliisa district, Uganda
(Journal of Tropical Medicine., 2019) Kwiringira, Japheth Nkiriyehe; Ariho, Paulino; Zakumumpa, Henry; Mugisha, James; Rujumba, Joseph; Mugisha, Marion Mutabazi
While studies have focused on HIV prevalence and incidence among fishing communities, there has been inadequate attention paid to the construction and perception of HIV risk among fisher folk. There has been limited research with respect to communities along Lake Albert on the border between Uganda and the Democratic Republic of Congo (DRC). Methods. We conducted a qualitative study on three landing sites of Butiaba, Bugoigo, and Wanseko on the shores of Lake Albert along the border of Uganda and the Democratic Republic of Congo. Data were collected using 12 Focus Group Discussions and 15 key informant interviews. Analysis was done manually using content and thematic approaches. Results. Lakeshore livelihoods split families between men, women, and children with varying degrees of exposure to HIV infection risk. Sustaining a thriving fish trade was dependent on taking high risks. For instance, profits were high when the lake was stormy. Landing sites were characterized by widespread prostitution, alcohol consumption, drug abuse, and child labour. Such behaviors negatively affected minors and in many ways predisposed them to HIV infection. The lake shore-border heterogeneity resulted in a population with varying HIV knowledge, attitudes, behavior, and competencies to risk perception and adaptation amidst negative masculinities and negative resilience. Conclusion. The susceptibility of lakeshore communities to HIV is attributable to a complex combination of geo-socio, the available (health) services, economic, and cultural factors which converged around the fishing livelihood. This study reveals that HIV risk assessment is an interplay of plural rationalities within the circumstances and constraints that impinge on the daily lives by different actors. A lack of cohesion in a multiethnic setting with large numbers of outsiders and a large transient population made the available HIV interventions less effective.
Safety, health and environmental impacts of commercial motorcycles in Sub-Saharan African cities
(Routledge, 2023-09) Simon, Ntramah; Krijn, Peters; Jack, Jenkins; Marion, M. Mugisha; Reginald, Chetto; Fredrick, Owino; Patrick O., Hayombe; Paul, Opiyo; Rosemarie T., Santos; Ted, Johnson
In Sub-Saharan Africa, vulnerable road users make up approxi- mately 50% of all traffic fatalities. Despite the dangers of using motorcycles for transportation, the usage of motorcycles—and more recently, motor tricycles—for both personal and commercial purposes has increased exponentially in most Sub-Saharan African cities. The study sought to study the safety, health and environ- mental impact of commercial motorcycles in Sub-Saharan African cities. Two cities—the national capital and a secondary city—were selected in each of our five study countries: Ghana, Liberia, Kenya, Tanzania and Uganda. Using a mixed-methods approach, motor- cycle taxi operators were surveyed and key transport stakeholders were interviewed in these ten cities. In Ghana, where both motor- cycle and motor-tricycle taxis are officially banned but continue to operate, we also surveyed motor-tricycle taxi operators. The results indicated variability in accident occurrence across countries for both minor and major road traffic collisions (RTCs) among motor- cycle/tricycle taxi riders. Apart from Liberia, motorcycle/tricycle taxi unions in our study countries contribute to improving the safety of their riders. Interest in electric bikes is low amongst riders in all five countries, with education and infrastructure provision required to cause a shift from conventional bikes to electric bikes.
Seasonal variations and shared latrine cleaning practices in the slums of Kampala city, Uganda
(Springer Link: BMC Public Health., 2016-04-27) Kwiringira, Japheth; Atekyereza, Peter; Niwagaba, Charles; Kabumbuli, Robert; Rwabukwali, Charles; Kulabako, Robinah; Günther, Isabel
The effect of seasons on health outcomes is a reflection on the status of public health and the state of development in a given society. Evidence shows that in Sub-Saharan Africa, most infectious diseases flourish during the wet months of the year; while human activities in a context of constrained choices in life exacerbate the effects of seasons on human health. The paper argues that, the wet season and when human activities are at their peak, sanitation is most dire poor slum populations. Methods: A shared latrine cleaning observation was undertaken over a period of 6 months in the slums of Kampala city. Data was collected through facility observations, user group meetings, Focus group discussions and, key informant interviews. The photos of the observed sanitation facilities were taken and assessed for facility cleanliness or dirt. Shared latrine pictures, observations, Focus Group Discussion, community meetings and key informant interviews were analysed and subjected to an analysis over the wet, dry and human activity cycles before a facility was categorised as either ‘dirty’ or ‘clean’. Results: Human activity cycles also referred to as socio-economic seasons were, school days, holidays, weekends and market days. These have been called ‘impure’ seasons, while the ‘pure’ seasons were the wet and dry months: improved and unimproved facilities were negatively affected by the wet seasons and the peak seasons of human activity. Wet seasons were associated with, mud and stagnant water, flooding pits and a repugnant smell from the latrine cubicle which made cleaning difficult. During the dry season, latrines became relatively cleaner than during the wet season. The presence of many child(ren) users during school days as well as the influx of market goers for the roadside weekly markets compromised the cleaning outcomes for these shared sanitation facilities. Conclusion: Shared latrine cleaning in slums is impacted by seasonal variations related to weather conditions and human activity. The wet seasons made the already bad sanitation situation worse. The seasonal fluctuations in the state of shared slum sanitation relate to a wider malaise in the population and an implied capacity deficit among urban authorities. Poor sanitation in slums is part of a broader urban mismanagement conundrum pointing towards the urgent need for multiple interventions aimed at improving the general urban living conditions well beyond sanitation.
Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda
(BMC Health Services Research, 2020) Henry, Zakumumpa; Joseph, Rujumba; Japheth, Kwiringira; Cordelia, Katureebe; Neil, Spicer
Background: Although Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)‘s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perspectives on barriers to implementation of Differentiated ART service delivery in Uganda. Methods: We employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context. Results: Our data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in communitybased models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. Context: Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups. Conclusion: This is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).
Understanding implementation barriers in the national scale-up of differentiated ART delivery in Uganda
(Springer nature: BMC Health Services Research., 2020-03-17) Zakumumpa, Henry; Rujumba, Joseph; Kwiringira, Japheth; Katureebe, Cordelia; Spicer, Neil
Although Differentiated Service Delivery (DSD) for anti-retroviral therapy (ART) has been rolled-out nationally in several countries since World Health Organization (WHO)‘s landmark 2016 guidelines, there is little research evaluating post-implementation outcomes. The objective of this study was to explore patients’ and HIV service managers’ perspectives on barriers to implementation of Differentiated ART service delivery in Uganda. Methods: We employed a qualitative descriptive design involving 124 participants. Between April and June 2019 we conducted 76 qualitative interviews with national-level HIV program managers (n = 18), District Health Team leaders (n = 24), representatives of PEPFAR implementing organizations (11), ART clinic in-charges (23) in six purposively selected Uganda districts with a high HIV burden (Kampala, Luwero, Wakiso, Mbale, Budadiri, Bulambuli). Six focus group discussions (48 participants) were held with patients enrolled in DSD models in case-study districts. Data were analyzed by thematic approach as guided by a multi-level analytical framework: Individual-level factors; Health-system factors; Community factors; and Context. Results: Our data shows that multiple barriers have been encountered in DSD implementation. Individual-level: Individualized stigma and a fear of detachment from health facilities by stable patients enrolled in communitybased models were reported as bottlenecks. Socio-economic status was reported to have an influence on patient selection of DSD models. Health-system: Insufficient training of health workers in DSD delivery and supply chain barriers to multi-month ART dispensing were identified as constraints. Patients perceived current selection of DSD models to be provider-intensive and not sufficiently patient-centred. Community: Community-level stigma and insufficient funding to providers to fully operationalize community drug pick-up points were identified as limitations. Context: Frequent changes in physical addresses among urban clients were reported to impede the running of patient groups of rotating ART refill pick-ups. Conclusion: This is one of the first multi-stakeholder evaluations of national DSD implementation in Uganda since initial roll-out in 2017. Multi-level interventions are needed to accelerate further DSD implementation in Uganda from demand-side (addressing HIV-related stigma, community engagement) and supply-side dimensions (strengthening ART supply chain capacities, increasing funding for community models and further DSD program design to improve patient-centeredness).
Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives
(Springer nature: BMC Health Services Research., 2018-09-05) Zakumumpa, Henry; Rujumba, Joseph; Kwiringira, Japheth; Kiplagat, Jepchirchir; Namulema, Edith; Muganzi, Alex
Although there is mounting evidence and policy guidance urging the integration of HIV services into general health systems in countries with a high HIV burden, vertical (stand-alone) HIV clinics are still common in Uganda. We sought to describe the specific contexts underpinning the endurance of vertical HIV clinics in Uganda. Methods: A qualitative research design was adopted. Semi-structured interviews were conducted with the heads of HIV clinics, clinicians and facility in-charges (n = 78), coupled with eight focus group discussions (64 participants) with patients from 16 health facilities purposively selected, from a nationally-representative sample of 195 health facilities across Uganda, because they run stand-alone HIV clinics. Data were analyzed by thematic approach as guided by the theory proposed by Shediac-Rizkallah & Bone (1998) which identifies; Intervention characteristics, organizational context, and broader environment factors as potentially influential on health programme sustainability. Results: Intervention characteristics: Provider stigma was reported to have been widespread in the integrated care experience of participating health facilities which necessitated the establishment of stand-alone HIV clinics. HIV disease management was described as highly specialized which necessitated a dedicated workforce and vertical HIV infrastructure such as counselling rooms. Organizational context: Participating health facilities reported health-system capacity constraints in implementing integrated systems of care due to a shortage of ART-proficient personnel and physical space, a lack of laboratory capacity to concurrently conduct HIV and non-HIV tests and increased workloads associated with implementing integrated care. Broader environment factors: Escalating HIV client loads and external HIV funding architectures were perceived to have perpetuated verticalized HIV programming over the past decade. Conclusion: Our study offers in-depth, contextualized insights into the factors contributing to the endurance of vertical HIV clinics in Uganda. Our analysis suggests that there is a complex interaction in supply-side constraints (shortage of ART-proficient personnel, increased workloads, laboratory capacity deficiencies) and demand-side factors (escalating demand for HIV services, psychosocial barriers to HIV care) as well as the specialized nature of HIV disease management which pose challenges to the integrated-health services agenda.
Understanding Uganda’s early adoption of novel differentiated HIV treatment services: a qualitative exploration of drivers of policy uptake
(2023-04) Henry, Zakumumpa; Japheth, Kwiringira; Cordelia, Katureebe; Neil, Spicer
Background Although differentiated service delivery (DSD) for HIV treatment was endorsed by the WHO in its landmark 2016 guidelines to lessen patients’ need to frequently visit clinics and hence to reduce unnecessary burdens on health systems, uptake has been uneven globally. This paper is prompted by the HIV Policy Lab’s annual report of 2022 which reveals substantial variations in programmatic uptake of differentiated HIV treatment services across the globe. We use Uganda as a case study of an ‘early adopter’ to explore the drivers of programmatic uptake of novel differentiated HIV treatment services. Methods We conducted a qualitative case-study in Uganda. In-depth interviews were held with national-level HIV program managers (n = 18), district health team members (n = 24), HIV clinic managers (n = 36) and five focus groups with recipients of HIV care (60 participants) supplemented with documentary reviews. Our thematic analysis of the qualitative data was guided by the Consolidated Framework for Implementation Research (CFIR)’s five domains (inner context, outer setting, individuals, process of implementation). Results Our analysis reveals that drivers of Uganda’s ‘early adoption’ of DSD include: having a decades-old HIV treatment intervention implementation history; receiving substantial external donor support in policy uptake; the imperatives of having a high HIV burden; accelerated uptake of select DSD models owing to Covid-19 ‘lockdown’ restrictions; and Uganda’s participation in clinical trials underpinning WHO guidance on DSD. The identified processes of implementation entailed policy adoption of DSD (such as the role of local Technical Working Groups in domesticating global guidelines, disseminating national DSD implementation guidelines) and implementation strategies (high-level health ministry buy-in, protracted patient engagement to enhance model uptake, devising metrics for measuring DSD uptake progress) for promoting programmatic adoption. Conclusion Our analysis suggests early adoption derives from Uganda’s decades-old HIV intervention implementation experience, the imperative of having a high HIV burden which prompted innovations in HIV treatment delivery as well as outer context factors such as receiving substantial external assistance in policy uptake. Our case study of Uganda offers implementation research lessons on pragmatic strategies for promoting programmatic uptake of differentiated treatment HIV services in other countries with a high HIV burden.

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