2020
|
EM, Martyn; AS, Bangdiwala; E, Kagimu; MK, Rutakingirwa; J, Kasibante; M, Okirwoth; G, Stead; V, Wadda; MF, Pullen; TD, Bold; DB, Meya; DR, Boulware; EM, Martyn; AS, Bangdiwala; E, Kagimu; MK, Rutakingirwa; J, Kasibante; M, Okirwoth; G, Stead; V, Wadda; MF, Pullen; TD, Bold; ad Boulware DR, Meya DB; NC, Bahr; FV, Cresswell Cerebrospinal fluid bacillary load by Xpert MTB/RIF Ultra PCR Cycle Threshold value predicts two-week mortality in HIV-associated tuberculous meningitis. Journal Article In: Clinical Infectious Diseases, pp. e00838-20, 2020. @article{EM2020,
title = {Cerebrospinal fluid bacillary load by Xpert MTB/RIF Ultra PCR Cycle Threshold value predicts two-week mortality in HIV-associated tuberculous meningitis.},
author = {Martyn EM and Bangdiwala AS and Kagimu E and Rutakingirwa MK and Kasibante J and Okirwoth M and Stead G and Wadda V and Pullen MF and Bold TD and Meya DB and Boulware DR and Martyn EM and Bangdiwala AS and Kagimu E and Rutakingirwa MK and Kasibante J and Okirwoth M and Stead G and Wadda V and Pullen MF and Bold TD and Meya DB ad Boulware DR and Bahr NC and Cresswell FV},
url = {https://europepmc.org/article/med/32986792},
doi = {DOI: 10.1093/cid/ciaa1444 },
year = {2020},
date = {2020-09-28},
journal = {Clinical Infectious Diseases},
pages = {e00838-20},
abstract = { Abstract
Background
The World Health Organization recommends GeneXpert MTB/RIF Ultra (Xpert Ultra), a fully automated PCR assay, as the initial tuberculous meningitis (TBM) diagnostic test. The assay's PCR cycle threshold (Ct) values represent the number of PCR cycles required for probe signal to be detected (low Ct value = high bacillary load) and may approximate TB bacillary load. We measured the relationship between cerebrospinal fluid (CSF) TB bacillary load with mortality.
Methods
We prospectively enrolled 102 HIV-positive Ugandans with probable or definite TBM from April 2015 to August 2019. Xpert Ultra Ct tertiles and semi-quantitative categories were separately analyzed as predictors of 2-week mortality. We investigated associations between CT and baseline clinical and CSF parameters.
Results
Subjects with Ct values in the low tertile (i.e. high bacillary load) had 57% 2-week mortality; worse than the intermediate (17%) and high (25%) Ct tertiles and Xpert Ultra-negative (30%) probable TBM cases (p=.01). In contrast, the reported semi-quantitative Xpert Ultra categorization was less precise; with medium to low category trending towards worse 2-week survival (42%) compared with very low (28%), trace (26%) and negative (30%) categories (p=.48). Ct tertile was significantly associated with baseline CSF lactate (p=.03).
Conclusions
High CSF TB bacillary load, as measured by Xpert Ultra Ct tertile, is associated with an almost 2-fold higher 2-week mortality in HIV-associated TBM and is a better predictor than the reported Xpert Ultra semi-quantitative category. Xpert Ultra Ct values could identify TBM patients at increased risk of death who may benefit from enhanced supportive care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
The World Health Organization recommends GeneXpert MTB/RIF Ultra (Xpert Ultra), a fully automated PCR assay, as the initial tuberculous meningitis (TBM) diagnostic test. The assay's PCR cycle threshold (Ct) values represent the number of PCR cycles required for probe signal to be detected (low Ct value = high bacillary load) and may approximate TB bacillary load. We measured the relationship between cerebrospinal fluid (CSF) TB bacillary load with mortality.
Methods
We prospectively enrolled 102 HIV-positive Ugandans with probable or definite TBM from April 2015 to August 2019. Xpert Ultra Ct tertiles and semi-quantitative categories were separately analyzed as predictors of 2-week mortality. We investigated associations between CT and baseline clinical and CSF parameters.
Results
Subjects with Ct values in the low tertile (i.e. high bacillary load) had 57% 2-week mortality; worse than the intermediate (17%) and high (25%) Ct tertiles and Xpert Ultra-negative (30%) probable TBM cases (p=.01). In contrast, the reported semi-quantitative Xpert Ultra categorization was less precise; with medium to low category trending towards worse 2-week survival (42%) compared with very low (28%), trace (26%) and negative (30%) categories (p=.48). Ct tertile was significantly associated with baseline CSF lactate (p=.03).
Conclusions
High CSF TB bacillary load, as measured by Xpert Ultra Ct tertile, is associated with an almost 2-fold higher 2-week mortality in HIV-associated TBM and is a better predictor than the reported Xpert Ultra semi-quantitative category. Xpert Ultra Ct values could identify TBM patients at increased risk of death who may benefit from enhanced supportive care. |
Nakalembe, Miriam; Makanga, Philippa; Kambugu, Andrew; Laker‐Oketta, Miriam; Huchko, Megan J.; Martin, Jeffrey A public health approach to cervical cancer screening in Africa through community‐based self‐administered HPV testing and mobile treatment provision Journal Article In: Cancer Medicine, vol. 9, no. 22, pp. 8701-8712, 2020. @article{Nakalembe2020,
title = {A public health approach to cervical cancer screening in Africa through community‐based self‐administered HPV testing and mobile treatment provision},
author = {Miriam Nakalembe and Philippa Makanga and Andrew Kambugu and Miriam Laker‐Oketta and Megan J. Huchko and Jeffrey Martin},
url = {https://onlinelibrary.wiley.com/doi/full/10.1002/cam4.3468},
doi = { https://doi.org/10.1002/cam4.3468},
year = {2020},
date = {2020-09-23},
journal = {Cancer Medicine},
volume = {9},
number = {22},
pages = {8701-8712},
abstract = {Abstract
The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub‐Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low‐resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community‐based self‐administered HPV testing and mobile treatment provision. In two rural districts of western‐central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self‐collection of vaginal samples for high‐risk human papillomavirus (hrHPV) testing. High‐risk human papillomavirus‐positive women were re‐contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self‐collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low‐resource settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub‐Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low‐resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community‐based self‐administered HPV testing and mobile treatment provision. In two rural districts of western‐central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self‐collection of vaginal samples for high‐risk human papillomavirus (hrHPV) testing. High‐risk human papillomavirus‐positive women were re‐contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self‐collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low‐resource settings. |
Skipper, Caleb P.; Atukunda, Mucunguzi; Stadelman, Anna; Engen, Nicole W.; Bangdiwala, Ananta S.; Hullsiek, Katherine H.; Abassi, Mahsa; Rhein, Joshua; Nicol, Melanie R.; Laker, Eva; Williams, Darlisha A.; Mannino, Raphael; Matkovits, Theresa; Meya, David B.; Boulware, David R. Phase I EnACT Trial of the Safety and Tolerability of a Novel Oral Formulation of Amphotericin B. Antimicrob Agents Chemother. Journal Article In: Antimicrobial Agents and Chemotherapy, vol. 64, no. 10, pp. e00838-20, 2020. @article{Skipper2020b,
title = {Phase I EnACT Trial of the Safety and Tolerability of a Novel Oral Formulation of Amphotericin B. Antimicrob Agents Chemother.},
author = {Caleb P. Skipper and Mucunguzi Atukunda and Anna Stadelman and Nicole W. Engen and Ananta S. Bangdiwala and Katherine H. Hullsiek and Mahsa Abassi and Joshua Rhein and Melanie R. Nicol and Eva Laker and Darlisha A. Williams and Raphael Mannino and Theresa Matkovits and David B. Meya and David R. Boulware},
url = {https://aac.asm.org/content/64/10/e00838-20.abstract},
doi = {DOI: 10.1128/AAC.00838-20},
year = {2020},
date = {2020-09-21},
journal = {Antimicrobial Agents and Chemotherapy},
volume = {64},
number = {10},
pages = {e00838-20},
abstract = {ABSTRACT
Amphotericin B deoxycholate (AMB) has substantial toxicities. A novel encochleated amphotericin B deoxycholate (cAMB) formulation has oral bioavailability, efficacy in an animal model, and minimal toxicity due to targeted drug delivery into macrophages, where intracellular fungi reside. We conducted a phase I, ascending-dose trial of cAMB administered at 1.0 g, 1.5 g, or 2.0 g per day in 4 to 6 divided doses among HIV-positive survivors of cryptococcosis (n = 9 per cohort). We assessed the tolerability of cAMB and the adverse events (AEs) associated with cAMB treatment over 3 days. A second trial (n = 9) assessed the tolerability of 1.5 g/day given for 7 days. In the single-ascending-dose study, all subjects received their full daily dose without vomiting (100% tolerability). The cohort receiving 1.0 g had 4 transient clinical AEs in 2 subjects within 48 h and 8 laboratory AEs (n = 6 grade 2, n = 2 grade 1). The cohort receiving 1.5 g had 7 clinical AEs in 1 subject attributed to acute gastroenteritis (n = 4 grade 2) and 5 laboratory AEs (n = 1 grade 2). The cohort receiving 2.0 g had 20 clinical AEs among 5 subjects within 48 h (n = 3 grade 2) and 11 laboratory AEs (n = 2 grade 2, n = 1 grade 3). From a qualitative survey, 26 of 27 subjects (96%) preferred their experience with oral cAMB over their prior experience with intravenous (i.v.) AMB. The second, multiple-dose cohort received 1.5 g/day for 1 week, with 98.4% (248/252) of the doses being taken. Overall, 5 clinical AEs (n = 5 grade 1) and 6 laboratory AEs (n = 6 grade 1) occurred without kidney toxicity. Oral cAMB was well tolerated when given in 4 to 6 divided daily doses without the toxicities commonly seen with i.v. AMB. (This study has been registered at ClinicalTrials.gov under registration no. NCT04031833.)},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
ABSTRACT
Amphotericin B deoxycholate (AMB) has substantial toxicities. A novel encochleated amphotericin B deoxycholate (cAMB) formulation has oral bioavailability, efficacy in an animal model, and minimal toxicity due to targeted drug delivery into macrophages, where intracellular fungi reside. We conducted a phase I, ascending-dose trial of cAMB administered at 1.0 g, 1.5 g, or 2.0 g per day in 4 to 6 divided doses among HIV-positive survivors of cryptococcosis (n = 9 per cohort). We assessed the tolerability of cAMB and the adverse events (AEs) associated with cAMB treatment over 3 days. A second trial (n = 9) assessed the tolerability of 1.5 g/day given for 7 days. In the single-ascending-dose study, all subjects received their full daily dose without vomiting (100% tolerability). The cohort receiving 1.0 g had 4 transient clinical AEs in 2 subjects within 48 h and 8 laboratory AEs (n = 6 grade 2, n = 2 grade 1). The cohort receiving 1.5 g had 7 clinical AEs in 1 subject attributed to acute gastroenteritis (n = 4 grade 2) and 5 laboratory AEs (n = 1 grade 2). The cohort receiving 2.0 g had 20 clinical AEs among 5 subjects within 48 h (n = 3 grade 2) and 11 laboratory AEs (n = 2 grade 2, n = 1 grade 3). From a qualitative survey, 26 of 27 subjects (96%) preferred their experience with oral cAMB over their prior experience with intravenous (i.v.) AMB. The second, multiple-dose cohort received 1.5 g/day for 1 week, with 98.4% (248/252) of the doses being taken. Overall, 5 clinical AEs (n = 5 grade 1) and 6 laboratory AEs (n = 6 grade 1) occurred without kidney toxicity. Oral cAMB was well tolerated when given in 4 to 6 divided daily doses without the toxicities commonly seen with i.v. AMB. (This study has been registered at ClinicalTrials.gov under registration no. NCT04031833.) |
Eke, Ahizechukwu C.; Olagunju, Adeniyi; Momper, Jeremiah; Penazzato, Martina; Abrams, Elaine J.; Best, Brookie M.; Capparelli, Edmund V.; Bekker, Adrie; Belew, Yodit; Kiser, Jennifer J.; Struble, Kimberly; Taylor, Graham; Waitt, Catriona; Mirochnick, Mark; Cressey, Tim R.; Colbers, Angela; participants of the WHO‐IMPAACT workshop on “Approaches to Optimize,; in Pregnant, Accelerate Pharmacokinetic Studies; Women”, Lactating Optimizing Pharmacology Studies in Pregnant and Lactating Women Using Lessons from HIV: A Consensus Statement Journal Article In: Clinical Pharmacology & Therapeutics, 2020. @article{Eke2020,
title = {Optimizing Pharmacology Studies in Pregnant and Lactating Women Using Lessons from HIV: A Consensus Statement},
author = {Ahizechukwu C. Eke and Adeniyi Olagunju and Jeremiah Momper and Martina Penazzato and Elaine J. Abrams and Brookie M. Best and Edmund V. Capparelli and Adrie Bekker and Yodit Belew and Jennifer J. Kiser and Kimberly Struble and Graham Taylor and Catriona Waitt and Mark Mirochnick and Tim R. Cressey and Angela Colbers and participants of the WHO‐IMPAACT workshop on “Approaches to Optimize and Accelerate Pharmacokinetic Studies in Pregnant and Lactating Women” },
url = {https://ascpt.onlinelibrary.wiley.com/doi/full/10.1002/cpt.2048},
doi = {https://doi.org/10.1002/cpt.2048},
year = {2020},
date = {2020-09-15},
journal = {Clinical Pharmacology & Therapeutics},
abstract = {
Abstract
Information on the extent of drug exposure to mothers and infants during pregnancy and lactation normally becomes available years after regulatory approval of a drug. Clinicians face knowledge gaps on drug selection and dosing in pregnancy and infant exposure during breastfeeding. Physiological changes during pregnancy often result in lower drug exposures of antiretrovirals, and in some cases a risk of reduced virologic efficacy. The International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) network and the World Health Organization (WHO)–convened Pediatric Antiretrovirals Working Group collaboratively organized a workshop of key stakeholders in June 2019 to define key standards to generate pharmacology data for antiretrovirals to be used among pregnant and lactating women; review the antiretroviral product pipeline; describe key gaps for use in low‐income and middle‐income countries; and identify opportunities to undertake optimal studies allowing for rapid implementation in the clinical field. We discussed ethical and regulatory principles, systemic approaches to obtaining data for pregnancy pharmacokinetic/pharmacodynamic (PK/PD) studies, control groups, optimal sampling times during pregnancy, and pharmacokinetic parameters to be considered as primary end points in pregnancy PK/PD studies. For lactation studies, the type of milk to collect, ascertainment of maternal adherence, and optimal PK methods to estimate exposure were discussed. Participants strongly recommended completion of preclinical reproductive toxicology studies prior to phase III, to allow study protocols to include pregnant women or to allow women who become pregnant after enrolment to continue in the trial. The meeting concluded by developing an algorithm for design and interpretation of results and noted that recruitment of pregnant and lactating women into clinical trials is critical.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Information on the extent of drug exposure to mothers and infants during pregnancy and lactation normally becomes available years after regulatory approval of a drug. Clinicians face knowledge gaps on drug selection and dosing in pregnancy and infant exposure during breastfeeding. Physiological changes during pregnancy often result in lower drug exposures of antiretrovirals, and in some cases a risk of reduced virologic efficacy. The International Maternal Pediatric Adolescent AIDS Clinical Trials (IMPAACT) network and the World Health Organization (WHO)–convened Pediatric Antiretrovirals Working Group collaboratively organized a workshop of key stakeholders in June 2019 to define key standards to generate pharmacology data for antiretrovirals to be used among pregnant and lactating women; review the antiretroviral product pipeline; describe key gaps for use in low‐income and middle‐income countries; and identify opportunities to undertake optimal studies allowing for rapid implementation in the clinical field. We discussed ethical and regulatory principles, systemic approaches to obtaining data for pregnancy pharmacokinetic/pharmacodynamic (PK/PD) studies, control groups, optimal sampling times during pregnancy, and pharmacokinetic parameters to be considered as primary end points in pregnancy PK/PD studies. For lactation studies, the type of milk to collect, ascertainment of maternal adherence, and optimal PK methods to estimate exposure were discussed. Participants strongly recommended completion of preclinical reproductive toxicology studies prior to phase III, to allow study protocols to include pregnant women or to allow women who become pregnant after enrolment to continue in the trial. The meeting concluded by developing an algorithm for design and interpretation of results and noted that recruitment of pregnant and lactating women into clinical trials is critical.
|
Winters Muttamba Bruce Kirenga, Alex Kayongo; Bazeyo, William Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda Journal Article Forthcoming In: BMJ Open Respiratory Research, vol. 7, no. 1, pp. e000646, Forthcoming. @article{Kirenga2020b,
title = {Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda},
author = {Bruce Kirenga, Winters Muttamba, Alex Kayongo, Christopher Nsereko, Trishul Siddharthan, John Lusiba, Levicatus Mugenyi, Rosemary K Byanyima, William Worodria, Fred Nakwagala, Rebecca Nantanda, Ivan Kimuli, Winceslaus Katagira, Bernard Sentalo Bagaya, Emmanuel Nasinghe, Hellen Aanyu-Tukamuhebwa, Beatrice Amuge, Rogers Sekibira, Esther Buregyeya, Noah Kiwanuka, Moses Muwanga, Samuel Kalungi, Moses Lutaakome Joloba, David Patrick Kateete, Baterana Byarugaba, Moses R Kamya, Henry Mwebesa and William Bazeyo},
doi = {doi: 10.1136/bmjresp-2020-000646},
year = {2020},
date = {2020-09-07},
journal = {BMJ Open Respiratory Research},
volume = {7},
number = {1},
pages = {e000646},
abstract = {ABSTRACT
Rationale Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited. Objective We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda. Measurements As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation. Main results The median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance.
Conclusion
Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
ABSTRACT
Rationale Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited. Objective We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda. Measurements As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation. Main results The median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance.
Conclusion
Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19. |
Ngbapai, Jackslina Gaaniri; Izudi, Jonathan; Okoboi, Stephen Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje health center, Uganda: a retrospective cohort study Journal Article In: International Breastfeeding Journal, vol. 15, no. 1, pp. 78, 2020. @article{Ngbapai2020,
title = {Cessation of breastfeeding and associated factors in the era of elimination of mother to child transmission of HIV at Ndejje health center, Uganda: a retrospective cohort study},
author = {Jackslina Gaaniri Ngbapai and Jonathan Izudi and Stephen Okoboi },
url = {https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-020-00323-7},
doi = {https://doi.org/10.1186/s13006-020-00323-7},
year = {2020},
date = {2020-09-07},
journal = {International Breastfeeding Journal},
volume = {15},
number = {1},
pages = {78},
abstract = {Abstract
Background
Breastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at 1 year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.
Methods
This retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at 1 year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results.
Results
Of 235 participants, 150 (63.8%) had ceased breastfeeding at 1 year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95% confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95% CI 1.04–1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95% CI 0.01–0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth.
Conclusion
Suboptimal proportion of infants were ceased from breastfeeding at 1 year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Breastfeeding an infant exposed to Human Immunodeficiency Virus (HIV) carries the risk of HIV acquisition whilst not breastfeeding poses a higher risk of death from malnutrition, diarrhea, and pneumonia. In Uganda, mothers living with HIV are encouraged to discontinue breastfeeding at 12 months but data are limited. We examined the frequency and factors associated with cessation of breastfeeding at 1 year among mothers living with HIV at Ndejje Health Center IV, a large peri-urban health facility in Uganda.
Methods
This retrospective cohort study involved all mothers living with HIV and enrolled in HIV care for ≥12 months between June 2014 and June 2018. We abstracted data from registers, held focus group discussions with mothers living with HIV and key informant interviews with healthcare providers. Cessation of breastfeeding was defined as the proportion of mothers living with HIV who had discontinued breastfeeding at 1 year. We summarized quantitative data descriptively, tested differences in outcome using Chi-square and t - tests, and established independently associated factors using modified Poisson regression analysis at 5% statistical significance level. We thematically analyzed qualitative data to enrich and triangulate the quantitative results.
Results
Of 235 participants, 150 (63.8%) had ceased breastfeeding at 1 year and this was independently associated with the infant being male (Adjusted Risk Ratio [aRR] 1.25, 95% confidence interval [CI] 1.04, 1.50), the mother being multiparous (aRR 1.26, 95% CI 1.04–1.53), and the initiation of breastfeeding being on the same-day as birth (aRR 0.06, 95% CI 0.01–0.41). The reasons for ceasing breastfeeding included male infants over breastfeed than females, maternal literacy and knowledge adequacy about breastfeeding, support and reminders from the partner, and boys can bite once they get teeth.
Conclusion
Suboptimal proportion of infants were ceased from breastfeeding at 1 year and this might increase the risk of mother to child transmission of HIV. Cessation of breastfeeding was more likely among male infants and multiparous mothers but less likely when breastfeeding was initiated on the same-day as birth. Interventions to enhance cessation of breastfeeding should target none multiparous mothers and those with female infants. |
Galukande, Moses; Were, Leonard Francis; Kigozi, Joanita; Kahendeke, Carol; Muganzi, Alex; Kambugu, Andrew Closing the Gap toward Zero Tetanus Infection for Voluntary Medical Male Circumcision: Seven Case Reports and a Review of the Literature Journal Article In: Surgical Infections, vol. 21, no. 7, pp. 599-607, 2020. @article{Galukande2020,
title = {Closing the Gap toward Zero Tetanus Infection for Voluntary Medical Male Circumcision: Seven Case Reports and a Review of the Literature},
author = {Moses Galukande and Leonard Francis Were and Joanita Kigozi and Carol Kahendeke and Alex Muganzi and Andrew Kambugu},
url = {https://www.liebertpub.com/doi/abs/10.1089/sur.2020.103},
doi = {https://doi.org/10.1089/sur.2020.103},
year = {2020},
date = {2020-09-01},
journal = {Surgical Infections},
volume = {21},
number = {7},
pages = {599-607},
abstract = {Abstract
Background:
Voluntary medical male circumcision (VMMC) is important for HIV prevention, providing up to 60% protection. Although VMMC is usually a safe procedure, it is not free of associated serious adverse events. In the Uganda VMMC program, which is available to males 10 years of age and older, 11 individuals were reported with tetanus infection out of almost 3.5 million circumcisions over an eight-year period (2009–2018). The majority had received tetanus vaccination prior to VMMC. Disproportionately and statistically significantly, the elastic collar compression method accounted for half the tetanus infection cases, despite contributing to only less than 10% of circumcisions done. This article describes gaps in presumed tetanus vaccination (TTV) protection along with relevant discussions and recommendations.
Case Presentations: We present seven tetanus case reports and a review of the literature. We were guided by a pre-determined thematic approach, focusing on immune response to TTV in the context of common infections and infestations in a tropical environment that may impair immune response to TTV. It is apparent in the available literature that the following (mostly tropical neglected infections) sufficiently impair antibody response to TTV: human immunodefiency virus (HIV), pulmonary tuberculosis, nematode infections, and schistosomiasis.
Conclusions:
One of seven patients died (14% case fatality). Individuals with prior exposure to certain infection(s) may not mount adequate antibody response to TTV sufficient to protect against acquiring tetanus. Therefore, TTV may not confer absolute protection against tetanus infection in these individuals. More needs to be done to ensure everyone is fully protected against tetanus, especially in the regions where risk of tetanus is heightened. We need to characterize the high-risk individuals (poor responders to TTV) and design targeted protective measures.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background:
Voluntary medical male circumcision (VMMC) is important for HIV prevention, providing up to 60% protection. Although VMMC is usually a safe procedure, it is not free of associated serious adverse events. In the Uganda VMMC program, which is available to males 10 years of age and older, 11 individuals were reported with tetanus infection out of almost 3.5 million circumcisions over an eight-year period (2009–2018). The majority had received tetanus vaccination prior to VMMC. Disproportionately and statistically significantly, the elastic collar compression method accounted for half the tetanus infection cases, despite contributing to only less than 10% of circumcisions done. This article describes gaps in presumed tetanus vaccination (TTV) protection along with relevant discussions and recommendations.
Case Presentations: We present seven tetanus case reports and a review of the literature. We were guided by a pre-determined thematic approach, focusing on immune response to TTV in the context of common infections and infestations in a tropical environment that may impair immune response to TTV. It is apparent in the available literature that the following (mostly tropical neglected infections) sufficiently impair antibody response to TTV: human immunodefiency virus (HIV), pulmonary tuberculosis, nematode infections, and schistosomiasis.
Conclusions:
One of seven patients died (14% case fatality). Individuals with prior exposure to certain infection(s) may not mount adequate antibody response to TTV sufficient to protect against acquiring tetanus. Therefore, TTV may not confer absolute protection against tetanus infection in these individuals. More needs to be done to ensure everyone is fully protected against tetanus, especially in the regions where risk of tetanus is heightened. We need to characterize the high-risk individuals (poor responders to TTV) and design targeted protective measures. |
Shah, Maunank; Sonia Paradis, Joshua Betz; Natalie Beylis, Renu Bharadwaj; Caceres, Tatiana; Gotuzzo, Eduardo; Joloba, Moses; Mave, Vidya; Nakiyingi, Lydia; Nicol, Mark P; Pradhan, Neeta; King, Bonnie; Armstrong, Derek; Knecht, Deborah; Maus, Courtney E; Cooper, Charles K; Dorman, Susan E; Manabe, Yukari C Multicenter Study of the Accuracy of the BD MAX Multidrug-resistant Tuberculosis Assay for Detection of Mycobacterium tuberculosis Complex and Mutations Associated With Resistance to Rifampin and Isoniazid Journal Article In: Clinical Infectious Diseases, vol. 71, no. 5, pp. 1161–1167, 2020. @article{Shah2020,
title = {Multicenter Study of the Accuracy of the BD MAX Multidrug-resistant Tuberculosis Assay for Detection of Mycobacterium tuberculosis Complex and Mutations Associated With Resistance to Rifampin and Isoniazid},
author = {Maunank Shah and Sonia Paradis, Joshua Betz and Natalie Beylis, Renu Bharadwaj and Tatiana Caceres and Eduardo Gotuzzo and Moses Joloba and Vidya Mave and Lydia Nakiyingi and Mark P Nicol and Neeta Pradhan and Bonnie King and Derek Armstrong and Deborah Knecht and Courtney E Maus and Charles K Cooper and Susan E Dorman and Yukari C Manabe},
url = {https://academic.oup.com/cid/article/71/5/1161/5574845?login=true},
doi = {https://doi.org/10.1093/cid/ciz932},
year = {2020},
date = {2020-09-01},
journal = {Clinical Infectious Diseases},
volume = {71},
number = {5},
pages = {1161–1167},
abstract = {Abstract
Background
Tuberculosis (TB) control is hindered by absence of rapid tests to identify Mycobacterium tuberculosis (MTB) and detect isoniazid (INH) and rifampin (RIF) resistance. We evaluated the accuracy of the BD MAX multidrug-resistant (MDR)-TB assay (BD MAX) in South Africa, Uganda, India, and Peru.
Methods
Outpatient adults with signs/symptoms of pulmonary TB were prospectively enrolled. Sputum smear microscopy and BD MAX were performed on a single raw sputum, which was then processed for culture and phenotypic drug susceptibility testing (DST), BD MAX, and Xpert MTB/RIF (Xpert).
Results
1053 participants with presumptive TB were enrolled (47% female; 32% with human immunodeficiency virus). In patients with confirmed TB, BD MAX sensitivity was 93% (262/282 [95% CI, 89–95%]); specificity was 97% (593/610 [96–98%]) among participants with negative cultures on raw sputa. BD MAX sensitivity was 100% (175/175 [98–100%]) for smear-positive samples (fluorescence microscopy), and 81% (87/107 [73–88%]) in smear-negative samples. Among participants with both BD MAX and Xpert, sensitivity was 91% (249/274 [87–94%]) for BD MAX and 90% (246/274 [86–93%]) for Xpert on processed sputa. Sensitivity and specificity for RIF resistance compared with phenotypic DST were 90% (9/10 [60–98%]) and 95% (211/222 [91–97%]), respectively. Sensitivity and specificity for detection of INH resistance were 82% (22/27 [63–92%]) and 100% (205/205 [98–100%]), respectively.
Conclusions
The BD MAX MDR-TB assay had high sensitivity and specificity for detection of MTB and RIF and INH drug resistance and may be an important tool for rapid detection of TB and MDR-TB globally.
HIV, tuberculosis, Mycobacterium infections, diagnosis, multidrug, resistance
Topic:
phenotype hiv rifampin mutation pulmonary tuberculosis drug resistance india isoniazid microscopy, fluorescence mycobacterium tuberculosis peru south africa sputum tuberculosis uganda diagnosis multidrug-resistant tuberculosis tuberculosis and hiv infectious agent drug susceptibility analysis },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Tuberculosis (TB) control is hindered by absence of rapid tests to identify Mycobacterium tuberculosis (MTB) and detect isoniazid (INH) and rifampin (RIF) resistance. We evaluated the accuracy of the BD MAX multidrug-resistant (MDR)-TB assay (BD MAX) in South Africa, Uganda, India, and Peru.
Methods
Outpatient adults with signs/symptoms of pulmonary TB were prospectively enrolled. Sputum smear microscopy and BD MAX were performed on a single raw sputum, which was then processed for culture and phenotypic drug susceptibility testing (DST), BD MAX, and Xpert MTB/RIF (Xpert).
Results
1053 participants with presumptive TB were enrolled (47% female; 32% with human immunodeficiency virus). In patients with confirmed TB, BD MAX sensitivity was 93% (262/282 [95% CI, 89–95%]); specificity was 97% (593/610 [96–98%]) among participants with negative cultures on raw sputa. BD MAX sensitivity was 100% (175/175 [98–100%]) for smear-positive samples (fluorescence microscopy), and 81% (87/107 [73–88%]) in smear-negative samples. Among participants with both BD MAX and Xpert, sensitivity was 91% (249/274 [87–94%]) for BD MAX and 90% (246/274 [86–93%]) for Xpert on processed sputa. Sensitivity and specificity for RIF resistance compared with phenotypic DST were 90% (9/10 [60–98%]) and 95% (211/222 [91–97%]), respectively. Sensitivity and specificity for detection of INH resistance were 82% (22/27 [63–92%]) and 100% (205/205 [98–100%]), respectively.
Conclusions
The BD MAX MDR-TB assay had high sensitivity and specificity for detection of MTB and RIF and INH drug resistance and may be an important tool for rapid detection of TB and MDR-TB globally.
HIV, tuberculosis, Mycobacterium infections, diagnosis, multidrug, resistance
Topic:
phenotype hiv rifampin mutation pulmonary tuberculosis drug resistance india isoniazid microscopy, fluorescence mycobacterium tuberculosis peru south africa sputum tuberculosis uganda diagnosis multidrug-resistant tuberculosis tuberculosis and hiv infectious agent drug susceptibility analysis |
Mostafa, Heba H.; Hardick, Justin; Morehead, Elizabeth; Miller, Jo-Anne; Gaydos, Charlotte A.; Manabe, Yukari C. Comparison of the analytical sensitivity of seven commonly used commercial SARS-CoV-2 automated molecular assays Journal Article In: Journal of Clinical Virology, vol. 130, pp. 104578, 2020. @article{Mostafa2020,
title = {Comparison of the analytical sensitivity of seven commonly used commercial SARS-CoV-2 automated molecular assays},
author = {Heba H. Mostafa and Justin Hardick and Elizabeth Morehead and Jo-Anne Miller and Charlotte A. Gaydos and Yukari C. Manabe},
url = {https://www.sciencedirect.com/science/article/abs/pii/S1386653220303206},
doi = {https://doi.org/10.1016/j.jcv.2020.104578},
year = {2020},
date = {2020-09-01},
journal = {Journal of Clinical Virology},
volume = {130},
pages = {104578},
abstract = {Abstract
The SARS-CoV-2 pandemic has challenged molecular microbiology laboratories to quickly implement and validate diagnostic assays and to expand testing capacity in a short timeframe. Multiple molecular diagnostic methods received FDA emergency use authorization (EUA) and were promptly validated for use nationwide. Several studies reported the analytical and/ or clinical evaluation of these molecular assays, however differences in the viral materials used for these evaluations complicated direct comparison of their analytical performance. In this study, we compared the analytical sensitivity (lower limit of detection, LOD) of seven commonly used qualitative SARS-CoV-2 molecular assays: the Abbott Molecular RealTime SARS-CoV-2 assay, the NeuMoDx™ SARS-CoV-2 assay, the Roche Cobas®SARS-CoV-2 assay, the BD SARS-CoV-2 reagents for BD MAX™ system, the Hologic Aptima® SARS-CoV-2 assay, the Xpert Xpress SARS-CoV-2 test, and the GenMark ePlex SARS-CoV-2 test. The comparison was performed utilizing a single positive clinical specimen that was serially diluted in viral transport media and quantified by the EUA approved SARS-CoV-2 droplet digital PCR (ddPCR) assay. Replicate samples were prepared and evaluated for reproducibility across different molecular assays with multiple replicates per assay. Our data demonstrated that the seven assays could detect 100 % of replicates at a nucleocapsid gene concentration of (N1 = 1,267 and N2 = 1,392) copies/mL. At a one log less concentration, the Abbott, the Roche, and the Xpert Xpress assays detected 100 % of the tested replicates.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
The SARS-CoV-2 pandemic has challenged molecular microbiology laboratories to quickly implement and validate diagnostic assays and to expand testing capacity in a short timeframe. Multiple molecular diagnostic methods received FDA emergency use authorization (EUA) and were promptly validated for use nationwide. Several studies reported the analytical and/ or clinical evaluation of these molecular assays, however differences in the viral materials used for these evaluations complicated direct comparison of their analytical performance. In this study, we compared the analytical sensitivity (lower limit of detection, LOD) of seven commonly used qualitative SARS-CoV-2 molecular assays: the Abbott Molecular RealTime SARS-CoV-2 assay, the NeuMoDx™ SARS-CoV-2 assay, the Roche Cobas®SARS-CoV-2 assay, the BD SARS-CoV-2 reagents for BD MAX™ system, the Hologic Aptima® SARS-CoV-2 assay, the Xpert Xpress SARS-CoV-2 test, and the GenMark ePlex SARS-CoV-2 test. The comparison was performed utilizing a single positive clinical specimen that was serially diluted in viral transport media and quantified by the EUA approved SARS-CoV-2 droplet digital PCR (ddPCR) assay. Replicate samples were prepared and evaluated for reproducibility across different molecular assays with multiple replicates per assay. Our data demonstrated that the seven assays could detect 100 % of replicates at a nucleocapsid gene concentration of (N1 = 1,267 and N2 = 1,392) copies/mL. At a one log less concentration, the Abbott, the Roche, and the Xpert Xpress assays detected 100 % of the tested replicates. |
Marais, Suzaan; Cresswell, Fiona V; Hamers, Raph L.; te Brake, Lindsey H. M.; Ganiem, Ahmad R.; Imran, Darma; Bangdiwala, Ananta; Martyn, Emily; Kasibante, John; Kagimu, Enock; Musubire, Abdu; Maharani, Kartika; Estiasari, Riwanti; Kusumaningrum, Ardiana; Kusumadjayanti, Nadytia; Yunivita, Vycke; Naidoo, Kogieleum; Lessells, Richard; Moosa, Yunus; Svensson, Elin M.; Hullsiek, Katherine Huppler; Aarnoutse, Rob E.; Boulware, David R.; van Crevel, Reinout; Ruslami, Rovina; Meya, David B. High dose oral rifampicin to improve survival from adult tuberculous meningitis: A randomised placebo-controlled double-blinded phase III trial (the HARVEST study) Journal Article In: Wellcome Open Research, vol. 4, pp. 190, 2020. @article{Marais2020,
title = {High dose oral rifampicin to improve survival from adult tuberculous meningitis: A randomised placebo-controlled double-blinded phase III trial (the HARVEST study)},
author = {Suzaan Marais and Fiona V Cresswell and Raph L. Hamers and Lindsey H.M. te Brake and Ahmad R. Ganiem and Darma Imran and Ananta Bangdiwala and Emily Martyn and John Kasibante and Enock Kagimu and Abdu Musubire and Kartika Maharani and Riwanti Estiasari and Ardiana Kusumaningrum and Nadytia Kusumadjayanti and Vycke Yunivita and Kogieleum Naidoo and Richard Lessells and Yunus Moosa and Elin M. Svensson and Katherine Huppler Hullsiek and Rob E. Aarnoutse and David R. Boulware and Reinout van Crevel and Rovina Ruslami and David B. Meya},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7542255/},
doi = {doi: 10.12688/wellcomeopenres.15565.2},
year = {2020},
date = {2020-08-25},
journal = {Wellcome Open Research},
volume = {4},
pages = {190},
abstract = {Abstract
Background:
Tuberculous meningitis (TBM), the most severe form of tuberculosis (TB), results in death or neurological disability in >50%, despite World Health Organisation recommended therapy. Current TBM regimen dosages are based on data from pulmonary TB alone. Evidence from recent phase II pharmacokinetic studies suggests that high dose rifampicin (R) administered intravenously or orally enhances central nervous system penetration and may reduce TBM associated mortality. We hypothesize that, among persons with TBM, high dose oral rifampicin (35 mg/kg) for 8 weeks will improve survival compared to standard of care (10 mg/kg), without excess adverse events.
Protocol:
We will perform a parallel group, randomised, placebo-controlled, double blind, phase III multicentre clinical trial comparing high dose oral rifampicin to standard of care. The trial will be conducted across five clinical sites in Uganda, South Africa and Indonesia. Participants are HIV-positive or negative adults with clinically suspected TBM, who will be randomised (1:1) to one of two arms: 35 mg/kg oral rifampicin daily for 8 weeks (in combination with standard dose isoniazid [H], pyrazinamide [Z] and ethambutol [E]) or standard of care (oral HRZE, containing 10 mg/kg/day rifampicin). The primary end-point is 6-month survival. Secondary end points are: i) 12-month survival ii) functional and neurocognitive outcomes and iii) safety and tolerability. Tertiary outcomes are: i) pharmacokinetic outcomes and ii) cost-effectiveness of the intervention. We will enrol 500 participants over 2.5 years, with follow-up continuing until 12 months post-enrolment.
Discussion:
Our best TBM treatment still results in unacceptably high mortality and morbidity. Strong evidence supports the increased cerebrospinal fluid penetration of high dose rifampicin, however conclusive evidence regarding survival benefit is lacking. This study will answer the important question of whether high dose oral rifampicin conveys a survival benefit in TBM in HIV-positive and -negative individuals from Africa and Asia.
Trial registration: ISRCTN15668391 (17/06/2019)
Keywords:
Tuberculous Meningitis, TB, rifampicin, Xpert Ultra, HIV, treatment, RCT},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background:
Tuberculous meningitis (TBM), the most severe form of tuberculosis (TB), results in death or neurological disability in >50%, despite World Health Organisation recommended therapy. Current TBM regimen dosages are based on data from pulmonary TB alone. Evidence from recent phase II pharmacokinetic studies suggests that high dose rifampicin (R) administered intravenously or orally enhances central nervous system penetration and may reduce TBM associated mortality. We hypothesize that, among persons with TBM, high dose oral rifampicin (35 mg/kg) for 8 weeks will improve survival compared to standard of care (10 mg/kg), without excess adverse events.
Protocol:
We will perform a parallel group, randomised, placebo-controlled, double blind, phase III multicentre clinical trial comparing high dose oral rifampicin to standard of care. The trial will be conducted across five clinical sites in Uganda, South Africa and Indonesia. Participants are HIV-positive or negative adults with clinically suspected TBM, who will be randomised (1:1) to one of two arms: 35 mg/kg oral rifampicin daily for 8 weeks (in combination with standard dose isoniazid [H], pyrazinamide [Z] and ethambutol [E]) or standard of care (oral HRZE, containing 10 mg/kg/day rifampicin). The primary end-point is 6-month survival. Secondary end points are: i) 12-month survival ii) functional and neurocognitive outcomes and iii) safety and tolerability. Tertiary outcomes are: i) pharmacokinetic outcomes and ii) cost-effectiveness of the intervention. We will enrol 500 participants over 2.5 years, with follow-up continuing until 12 months post-enrolment.
Discussion:
Our best TBM treatment still results in unacceptably high mortality and morbidity. Strong evidence supports the increased cerebrospinal fluid penetration of high dose rifampicin, however conclusive evidence regarding survival benefit is lacking. This study will answer the important question of whether high dose oral rifampicin conveys a survival benefit in TBM in HIV-positive and -negative individuals from Africa and Asia.
Trial registration: ISRCTN15668391 (17/06/2019)
Keywords:
Tuberculous Meningitis, TB, rifampicin, Xpert Ultra, HIV, treatment, RCT |
Sanya, Richard E.; Biraro, Irene Andia; Nampijja, Margaret; Zziwa, Christopher; Nanyunja, Carol; Nsubuga, Denis; Kiwanuka, Samuel; Tumusiime, Josephine; Nassuuna, Jacent; Walusimbi, Bridgious; Cose, Stephen; Ocama, Ponsiano; Grencis, Richard K.; Elliott, Alison M.; Webb, Emily L. Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda Journal Article In: Wellcome Open Research, vol. 5, no. 1, pp. 39, 2020. @article{Sanya2020,
title = {Contrasting impact of rural, versus urban, living on glucose metabolism and blood pressure in Uganda},
author = {Richard E. Sanya and Irene Andia Biraro and Margaret Nampijja and Christopher Zziwa and Carol Nanyunja and Denis Nsubuga and Samuel Kiwanuka and Josephine Tumusiime and Jacent Nassuuna and Bridgious Walusimbi and Stephen Cose and Ponsiano Ocama and Richard K. Grencis and Alison M. Elliott and Emily L. Webb},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7447960/},
doi = { doi: 10.12688/wellcomeopenres.15616.2},
year = {2020},
date = {2020-08-24},
journal = {Wellcome Open Research},
volume = {5},
number = {1},
pages = {39},
abstract = {Abstract
Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk.
Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island fishing communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed.
Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] 0.18 [-0.32, -0.05] p=0.01) and HOMA-IR (-0.26 [-0.40, -0.11] p=0.001) but higher blood pressure (systolic, 5.45 [3.75, 7.15] p<0.001; diastolic, 1.93 [0.57, 3.29] p=0.006). Current helminth infection did not explain the observed differences.
Conclusions:
In the Ugandan context, living in rural fishing communities may protect against hypertension but worsen glucose metabolism.
Keywords: Rural, Urban, Metabolic, Hypertension, Diabetes, Insulin resistance, Helminths, Africa},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background: The burden of cardiometabolic diseases, including cardiovascular diseases and diabetes, is increasing in sub-Saharan Africa and this has been linked to urbanisation. Helminths, through their immunomodulatory properties, may protect against these disorders. We hypothesised that the rural environment protects against cardiometabolic diseases and that helminths may influence rural-urban disparity of cardiometabolic disease risk.
Methods: We compared metabolic parameters of individuals aged ≥10 years living in rural, high-helminth-transmission and urban, lower-helminth-transmission settings in Uganda. Cross-sectional surveys were conducted in rural Lake Victoria island fishing communities and in urban sub-wards in Entebbe municipality. Helminth infection and outcomes, including insulin resistance (computed using the homeostatic model assessment of insulin resistance [HOMA-IR]), fasting blood glucose, fasting blood lipids, blood pressure, body mass index (BMI), waist and hip circumference, were assessed.
Results: We analysed 1,898 rural and 930 urban participants. Adjusting for BMI, exercise, smoking, alcohol intake, age and sex, urban residents had lower mean fasting glucose (adjusted mean difference [95%CI] 0.18 [-0.32, -0.05] p=0.01) and HOMA-IR (-0.26 [-0.40, -0.11] p=0.001) but higher blood pressure (systolic, 5.45 [3.75, 7.15] p<0.001; diastolic, 1.93 [0.57, 3.29] p=0.006). Current helminth infection did not explain the observed differences.
Conclusions:
In the Ugandan context, living in rural fishing communities may protect against hypertension but worsen glucose metabolism.
Keywords: Rural, Urban, Metabolic, Hypertension, Diabetes, Insulin resistance, Helminths, Africa |
Sebatta, Deborah Ekusai; Siu, Godfrey; Nabeta, Henry W.; Anguzu, Godwin; Walimbwa, Stephen; Lamorde, Mohammed; Bukenya, Badru; Kambugu, Andrew “You would not be in a hurry to go back home”: patients’ willingness to participate in HIV/AIDS clinical trials at a clinical and research facility in Kampala, Uganda Journal Article In: BMC Medical Ethics, vol. 21, no. 1, pp. 77, 2020. @article{Sebatta2020,
title = {“You would not be in a hurry to go back home”: patients’ willingness to participate in HIV/AIDS clinical trials at a clinical and research facility in Kampala, Uganda},
author = {Deborah Ekusai Sebatta and Godfrey Siu and Henry W. Nabeta and Godwin Anguzu and Stephen Walimbwa and Mohammed Lamorde and Badru Bukenya and Andrew Kambugu },
url = {https://bmcmedethics.biomedcentral.com/articles/10.1186/s12910-020-00516-z},
doi = {https://doi.org/10.1186/s12910-020-00516-z},
year = {2020},
date = {2020-08-24},
journal = {BMC Medical Ethics},
volume = {21},
number = {1},
pages = {77},
abstract = {Abstract
Background
Few studies have examined factors associated with willingness of people living with HIV (PLHIV) to participate in HIV treatment clinical trials in Sub-Saharan Africa. We assessed the factors associated with participation of PLHIV in HIV treatment clinical trials research at a large urban clinical and research facility in Uganda.
Methods
A mixed methods study was conducted at the Infectious Diseases Institute (IDI), adult HIV clinic between July 2016 and January 2017. Data were collected using structured questionnaires, focused group discussions with respondents categorised as either participated or never participated in clinical trials and key informant interviews with IDI staff. A generalized linear model with a logit link function was used for multivariate analyses while the qualitative data were summarized using a thematic approach.
Results
We enrolled a total of 202 and analysed 151 participants, 77 (51%) of whom were male with mean age of 41 years. The majority 127 (84%) expressed willingness to participate in treatment clinical trials if given an opportunity. At bivariate analysis, willingness to participate was significantly associated with respondents’ perception of a satisfactory compensation package (P-value < 0.002, 0.08–0.56), special status accorded (P-value < 0.001, 0.05–0.39) and belief that their health status would improve (P-value< 0.08, 0.03–0.58) while on the clinical trial. At multivariate analysis, a satisfactory compensation package (P-value< 0.030, 0.08–0.88) and special status accorded in clinical trials (P-value< 0.041, 0.01–0.91) remained significant. The qualitative data analysis confirmed these findings as participants valued the privilege of jumping the clinic waiting queues and spending less time in clinic, the wide range of free tests offered to trial participants, unrestricted access to senior physicians and regular communication from study team. Additionally, free meals offered during clinic visits meant that participants were not in a hurry to go back home. Barriers to participation included the perception that new drugs were being tested on them, fear of side effects like treatment failure and the uncertainty about privacy of their data.
Conclusion
We found overwhelming willingness to participate in HIV treatment clinical trials. This was largely extrinsically influenced by the perceived material and health-related benefits. Investigators should pay attention to participants’ concerns for benefits which may override the need to understand study procedures and risks.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Few studies have examined factors associated with willingness of people living with HIV (PLHIV) to participate in HIV treatment clinical trials in Sub-Saharan Africa. We assessed the factors associated with participation of PLHIV in HIV treatment clinical trials research at a large urban clinical and research facility in Uganda.
Methods
A mixed methods study was conducted at the Infectious Diseases Institute (IDI), adult HIV clinic between July 2016 and January 2017. Data were collected using structured questionnaires, focused group discussions with respondents categorised as either participated or never participated in clinical trials and key informant interviews with IDI staff. A generalized linear model with a logit link function was used for multivariate analyses while the qualitative data were summarized using a thematic approach.
Results
We enrolled a total of 202 and analysed 151 participants, 77 (51%) of whom were male with mean age of 41 years. The majority 127 (84%) expressed willingness to participate in treatment clinical trials if given an opportunity. At bivariate analysis, willingness to participate was significantly associated with respondents’ perception of a satisfactory compensation package (P-value < 0.002, 0.08–0.56), special status accorded (P-value < 0.001, 0.05–0.39) and belief that their health status would improve (P-value< 0.08, 0.03–0.58) while on the clinical trial. At multivariate analysis, a satisfactory compensation package (P-value< 0.030, 0.08–0.88) and special status accorded in clinical trials (P-value< 0.041, 0.01–0.91) remained significant. The qualitative data analysis confirmed these findings as participants valued the privilege of jumping the clinic waiting queues and spending less time in clinic, the wide range of free tests offered to trial participants, unrestricted access to senior physicians and regular communication from study team. Additionally, free meals offered during clinic visits meant that participants were not in a hurry to go back home. Barriers to participation included the perception that new drugs were being tested on them, fear of side effects like treatment failure and the uncertainty about privacy of their data.
Conclusion
We found overwhelming willingness to participate in HIV treatment clinical trials. This was largely extrinsically influenced by the perceived material and health-related benefits. Investigators should pay attention to participants’ concerns for benefits which may override the need to understand study procedures and risks. |
Kwizera, Richard; Sadiq, Alisat; Ndyetukira, Jane Frances; Nalintya, Elizabeth; Williams, Darlisha; Rhein, Joshua; Boulware, David R.; for the COAT, David B. Meya; trial teams, ASTRO Impact of community engagement and social support on the outcomes of HIV-related meningitis clinical trials in a resource-limited setting Journal Article In: Research Involvement and Engagement, vol. 6, no. 1, pp. 49, 2020. @article{Kwizera2020e,
title = {Impact of community engagement and social support on the outcomes of HIV-related meningitis clinical trials in a resource-limited setting},
author = {Richard Kwizera and Alisat Sadiq and Jane Frances Ndyetukira and Elizabeth Nalintya and Darlisha Williams and Joshua Rhein and David R. Boulware and David B. Meya for the COAT and ASTRO trial teams},
url = {https://researchinvolvement.biomedcentral.com/articles/10.1186/s40900-020-00228-z},
doi = {https://doi.org/10.1186/s40900-020-00228-z},
year = {2020},
date = {2020-08-20},
journal = {Research Involvement and Engagement},
volume = {6},
number = {1},
pages = {49},
abstract = {Abstract
Background
Clinical trials remain the cornerstone of improving outcomes for HIV-infected individuals with cryptococcal meningitis. Community engagement aims at involving participants and their advocates as partners in research rather than merely trial subjects. Community engagement can help to build trust in communities where these trials are conducted and ensure lasting mutually beneficial relationships between researchers and the community. Similarly, different studies have reported the positive effects of social support on patient’s outcomes. We aimed to describe our approach to community engagement in Uganda while highlighting the benefits of community engagement and social support in clinical trials managing patients co-infected with HIV and cryptococcal meningitis.
Methods
We carried out community engagement using home visits, health talks, posters, music and drama. In addition, social support was given through study staff individually contributing to provide funds for participants’ food, wheel chairs, imaging studies, adult diapers, and other extra investigations or drugs that were not covered by the study budget or protocol. The benefits of this community engagement and social support were assessed during two multi-site, randomized cryptococcal meningitis clinical trials in Uganda.
Results
We screened 1739 HIV-infected adults and enrolled 934 with cryptococcal meningitis into the COAT and ASTRO-CM trials during the period October 2010 to July 2017. Lumbar puncture refusal rates decreased from 31% in 2010 to less than 1% in 2017. In our opinion, community engagement and social support played an important role in improving: drug adherence, acceptance of lumbar punctures, data completeness, rate of screening/referrals, reduction of missed visits, and loss to follow-up.
Conclusions
Community engagement and social support are important aspects of clinical research and should be incorporated into clinical trial design and conduct.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Clinical trials remain the cornerstone of improving outcomes for HIV-infected individuals with cryptococcal meningitis. Community engagement aims at involving participants and their advocates as partners in research rather than merely trial subjects. Community engagement can help to build trust in communities where these trials are conducted and ensure lasting mutually beneficial relationships between researchers and the community. Similarly, different studies have reported the positive effects of social support on patient’s outcomes. We aimed to describe our approach to community engagement in Uganda while highlighting the benefits of community engagement and social support in clinical trials managing patients co-infected with HIV and cryptococcal meningitis.
Methods
We carried out community engagement using home visits, health talks, posters, music and drama. In addition, social support was given through study staff individually contributing to provide funds for participants’ food, wheel chairs, imaging studies, adult diapers, and other extra investigations or drugs that were not covered by the study budget or protocol. The benefits of this community engagement and social support were assessed during two multi-site, randomized cryptococcal meningitis clinical trials in Uganda.
Results
We screened 1739 HIV-infected adults and enrolled 934 with cryptococcal meningitis into the COAT and ASTRO-CM trials during the period October 2010 to July 2017. Lumbar puncture refusal rates decreased from 31% in 2010 to less than 1% in 2017. In our opinion, community engagement and social support played an important role in improving: drug adherence, acceptance of lumbar punctures, data completeness, rate of screening/referrals, reduction of missed visits, and loss to follow-up.
Conclusions
Community engagement and social support are important aspects of clinical research and should be incorporated into clinical trial design and conduct. |
Fatlum Rruga Ruben Magni, Fahad M. Alsaab Lipoarabinomannan antigenic epitope differences in tuberculosis disease subtypes Journal Article Forthcoming In: Scientific Reports, vol. 10, no. 13944, Forthcoming. @article{Magni2020,
title = {Lipoarabinomannan antigenic epitope differences in tuberculosis disease subtypes},
author = {Ruben Magni, Fatlum Rruga, Fahad M. Alsaab, Sara Sharif, Marissa Howard, Virginia Espina, Brianna Kim, Benjamin Lepene, Gwenyth Lee, Mohamad A. Alayouni, Hannah Steinberg, Robyn Araujo, Fatah Kashanchi, Fabio Riccardi, Sargento Morreira, Antonia Araujo, Fernando Poli, Devan Jaganath, Fred C. Semitala, William Worodria, Alfred Andama, Alok Choudhary, William J. Honnen, Emanuel F. Petricoin III, Adithya Cattamanchi, Raffaella Colombatti, Jacobus H. de Waard, Richard Oberhelman, Abraham Pinter, Robert H. Gilman, Lance A. Liotta & Alessandra Luchini },
doi = {https://doi.org/10.1038/s41598-020-70669-9},
year = {2020},
date = {2020-08-18},
journal = {Scientific Reports},
volume = {10},
number = {13944},
abstract = {Abstract
An accurate urine test for diverse populations with active tuberculosis could be transformative for preventing TB deaths. Urinary liporabinomannan (LAM) testing has been previously restricted to HIV co-infected TB patients. In this study we evaluate urinary LAM in HIV negative, pediatric and adult, pulmonary and extrapulmonary tuberculosis patients. We measured 430 microbiologically confirmed pretreatment tuberculosis patients and controls from Peru, Guinea Bissau, Venezuela, Uganda and the United States using three monoclonal antibodies, MoAb1, CS35, and A194, which recognize distinct LAM epitopes, a one-sided immunoassay, and blinded cohorts. We evaluated sources of assay variability and comorbidities (HIV and diabetes). All antibodies successfully discriminated TB positive from TB negative patients. ROAUC from the average of three antibodies’ responses was 0.90; 95% CI 0.87–0.93, 90% sensitivity, 73.5% specificity (80 pg/mL). MoAb1, recognizing the 5-methylthio-d-xylofuranose(MTX)-mannose(Man) cap epitope, performed the best, was less influenced by glycosuria and identified culture positive pediatric (N = 19) and extrapulmonary (N = 24) patients with high accuracy (ROAUC 0.87, 95% CI 0.77–0.98, 0.90 sensitivity 0.80 specificity at 80 pg/mL; ROAUC = 0.96, 95% CI 0.92–0.99, 96% sensitivity, 80% specificity at 82 pg/mL, respectively). The MoAb1 antibody, recognizing the MTX-Man cap epitope, is a novel analyte for active TB detection in pediatric and extrapulmonary disease.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Abstract
An accurate urine test for diverse populations with active tuberculosis could be transformative for preventing TB deaths. Urinary liporabinomannan (LAM) testing has been previously restricted to HIV co-infected TB patients. In this study we evaluate urinary LAM in HIV negative, pediatric and adult, pulmonary and extrapulmonary tuberculosis patients. We measured 430 microbiologically confirmed pretreatment tuberculosis patients and controls from Peru, Guinea Bissau, Venezuela, Uganda and the United States using three monoclonal antibodies, MoAb1, CS35, and A194, which recognize distinct LAM epitopes, a one-sided immunoassay, and blinded cohorts. We evaluated sources of assay variability and comorbidities (HIV and diabetes). All antibodies successfully discriminated TB positive from TB negative patients. ROAUC from the average of three antibodies’ responses was 0.90; 95% CI 0.87–0.93, 90% sensitivity, 73.5% specificity (80 pg/mL). MoAb1, recognizing the 5-methylthio-d-xylofuranose(MTX)-mannose(Man) cap epitope, performed the best, was less influenced by glycosuria and identified culture positive pediatric (N = 19) and extrapulmonary (N = 24) patients with high accuracy (ROAUC 0.87, 95% CI 0.77–0.98, 0.90 sensitivity 0.80 specificity at 80 pg/mL; ROAUC = 0.96, 95% CI 0.92–0.99, 96% sensitivity, 80% specificity at 82 pg/mL, respectively). The MoAb1 antibody, recognizing the MTX-Man cap epitope, is a novel analyte for active TB detection in pediatric and extrapulmonary disease. |
Nelson Kalema Eleanor A. Ochodo, Samuel Schumacher; Cattamanchi, Adithya Variation in the observed effect of Xpert MTB/RIF testing for tuberculosis on mortality: A systematic review and analysis of trial design considerations Journal Article Forthcoming In: Wellcome Open Research, vol. 4, no. 173, Forthcoming. @article{Ochodo2020,
title = {Variation in the observed effect of Xpert MTB/RIF testing for tuberculosis on mortality: A systematic review and analysis of trial design considerations},
author = {Eleanor A. Ochodo, Nelson Kalema, Samuel Schumacher, Karen Steingart, Taryn Young, Susan Mallett, Jon Deeks, Frank Cobelens, Patrick M. Bossuyt, Mark P. Nicol and Adithya Cattamanchi},
doi = {doi: 10.12688/wellcomeopenres.15412.2},
year = {2020},
date = {2020-08-17},
journal = {Wellcome Open Research},
volume = {4},
number = {173},
abstract = {Abstract
Background: Most studies evaluating the effect of Xpert MTB/RIF testing for tuberculosis (TB) concluded that it did not reduce overall mortality compared to usual care. We conducted a systematic review to assess whether key study design and execution features contributed to earlier identification of patients with TB and decreased pre-treatment loss to follow-up, thereby reducing the potential impact of Xpert MTB/RIF testing.
Methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Scopus for literature published from 1 st January 2009 to February 2019. We included all primary intervention studies that had evaluated the effect of Xpert MTB/RIF on mortality compared to usual care in participants with presumptive pulmonary TB. We critically reviewed features of included studies across: Study setting and context, Study population, Participant recruitment and enrolment, Study procedures, and Study follow-up. Results: We included seven randomised and one non-randomised study. All included studies demonstrated relative reductions in overall mortality in the Xpert MTB/RIF arm ranging from 6% to 40%. However, mortality reduction was reported to be statistically significant in two studies. Study features that could explain the lack of observed effect on mortality included: the higher quality of care at study sites; inclusion of patients with a higher pre-test probability of TB leading to higher than expected empirical rates; performance of additional diagnostic testing not done in usual care leading to increased TB diagnosis or empiric treatment initiation; the recruitment of participants likely to return for follow-up; and involvement of study staff in ensuring adherence with care and follow-up. Conclusion: Most studies of Xpert MTB/RIF were designed and conducted in a manner that resulted in more patients being diagnosed and treated for TB, minimising the potential difference in mortality Xpert MTB/RIF testing could have achieved compared to usual care.
Keywords
Tuberculosis diagnosis, methodology, Diagnostic trials, Impact studies},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Abstract
Background: Most studies evaluating the effect of Xpert MTB/RIF testing for tuberculosis (TB) concluded that it did not reduce overall mortality compared to usual care. We conducted a systematic review to assess whether key study design and execution features contributed to earlier identification of patients with TB and decreased pre-treatment loss to follow-up, thereby reducing the potential impact of Xpert MTB/RIF testing.
Methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Scopus for literature published from 1 st January 2009 to February 2019. We included all primary intervention studies that had evaluated the effect of Xpert MTB/RIF on mortality compared to usual care in participants with presumptive pulmonary TB. We critically reviewed features of included studies across: Study setting and context, Study population, Participant recruitment and enrolment, Study procedures, and Study follow-up. Results: We included seven randomised and one non-randomised study. All included studies demonstrated relative reductions in overall mortality in the Xpert MTB/RIF arm ranging from 6% to 40%. However, mortality reduction was reported to be statistically significant in two studies. Study features that could explain the lack of observed effect on mortality included: the higher quality of care at study sites; inclusion of patients with a higher pre-test probability of TB leading to higher than expected empirical rates; performance of additional diagnostic testing not done in usual care leading to increased TB diagnosis or empiric treatment initiation; the recruitment of participants likely to return for follow-up; and involvement of study staff in ensuring adherence with care and follow-up. Conclusion: Most studies of Xpert MTB/RIF were designed and conducted in a manner that resulted in more patients being diagnosed and treated for TB, minimising the potential difference in mortality Xpert MTB/RIF testing could have achieved compared to usual care.
Keywords
Tuberculosis diagnosis, methodology, Diagnostic trials, Impact studies |
Nakanjako, Damalie; Zalwango, Flavia; Wairagala, Pamela; Luboga, Fiona; Biraro, Irene Andia; Bukirwa, Victoria Diana; Mboowa, Mary Gorrethy; Cose, Steve; Seeley, Janet; Elliott, Alison Career development for infection and immunity research in Uganda: a decade of experience from the Makerere University – Uganda Virus Research Institute research and training programme Journal Article In: AAS Open Research, vol. 3, pp. 26, 2020. @article{Nakanjako2020,
title = {Career development for infection and immunity research in Uganda: a decade of experience from the Makerere University – Uganda Virus Research Institute research and training programme},
author = {Damalie Nakanjako and Flavia Zalwango and Pamela Wairagala and Fiona Luboga and Irene Andia Biraro and Victoria Diana Bukirwa and Mary Gorrethy Mboowa and Steve Cose and Janet Seeley and Alison Elliott},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372530.2/},
doi = {doi: 10.12688/aasopenres.13066.2},
year = {2020},
date = {2020-08-17},
journal = {AAS Open Research},
volume = {3},
pages = {26},
abstract = {Abstract
Background:
The Makerere University/Uganda Virus Research Institute (UVRI) Centre of Excellence for Infection & Immunity Research and Training (MUII) is a collaborative programme supporting excellence in Infection and Immunity (I&I) research in Uganda. Set up in 2008, MUII aims to produce internationally competitive Ugandan and East African I&I research leaders, and develop human and infrastructural resources to support research and training excellence. We undertook an internal evaluation of MUII’s achievements, challenges and lessons learned between 08-2008 and 12-2019, to inform programmes seeking to build Africa’s health research expertise.
Methods:
Quantitative data were abstracted from programme annual reports. Qualitative data were obtained in 03-04/2019: a cross-sectional evaluation was undertaken among a purposefully selected representative sample of 27 trainees and two programme staff. Qualitative data was analysed according to pre-determined themes of achievements, challenges, lessons learned and recommendations for improvement.
Results:
By 12-2019, MUII had supported 68 fellowships at master’s-level and above (50% female: 23 Masters, 27 PhD, 15 post-doctoral, three group-leaders) and over 1,000 internships. Fellows reported career advancement, mentorship by experts, and improved research skills and outputs. Fellows have published over 300 papers, secured grants worth over £20m, established over 40 international collaborations, and taken on research and academic leadership positions in the country. Key lessons were: i) Efficient administration provides a conducive environment for high quality research; ii) Institutions need supportive policies for procurement, including provisions for purchases of specific biological research reagents from international manufacturers; iii) Strong international and multi-disciplinary collaboration provides a critical mass of expertise to mentor researchers in development; and iv) Mentorship catalyses young scientists to progress from graduate trainees to productive academic researchers, relevant to society’s most pressing health challenges.
Conclusions:
Sustainable academic productivity can be achieved through efficient operational support, global collaboration and mentorship to provide solutions to Africa’s health challenges.
Keywords:
Academic careers, capacity building for research, Infection and Immunity, Immunology, bioinformatics, mentorship, collaboration, partnership, sub-Saharan Africa},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background:
The Makerere University/Uganda Virus Research Institute (UVRI) Centre of Excellence for Infection & Immunity Research and Training (MUII) is a collaborative programme supporting excellence in Infection and Immunity (I&I) research in Uganda. Set up in 2008, MUII aims to produce internationally competitive Ugandan and East African I&I research leaders, and develop human and infrastructural resources to support research and training excellence. We undertook an internal evaluation of MUII’s achievements, challenges and lessons learned between 08-2008 and 12-2019, to inform programmes seeking to build Africa’s health research expertise.
Methods:
Quantitative data were abstracted from programme annual reports. Qualitative data were obtained in 03-04/2019: a cross-sectional evaluation was undertaken among a purposefully selected representative sample of 27 trainees and two programme staff. Qualitative data was analysed according to pre-determined themes of achievements, challenges, lessons learned and recommendations for improvement.
Results:
By 12-2019, MUII had supported 68 fellowships at master’s-level and above (50% female: 23 Masters, 27 PhD, 15 post-doctoral, three group-leaders) and over 1,000 internships. Fellows reported career advancement, mentorship by experts, and improved research skills and outputs. Fellows have published over 300 papers, secured grants worth over £20m, established over 40 international collaborations, and taken on research and academic leadership positions in the country. Key lessons were: i) Efficient administration provides a conducive environment for high quality research; ii) Institutions need supportive policies for procurement, including provisions for purchases of specific biological research reagents from international manufacturers; iii) Strong international and multi-disciplinary collaboration provides a critical mass of expertise to mentor researchers in development; and iv) Mentorship catalyses young scientists to progress from graduate trainees to productive academic researchers, relevant to society’s most pressing health challenges.
Conclusions:
Sustainable academic productivity can be achieved through efficient operational support, global collaboration and mentorship to provide solutions to Africa’s health challenges.
Keywords:
Academic careers, capacity building for research, Infection and Immunity, Immunology, bioinformatics, mentorship, collaboration, partnership, sub-Saharan Africa |
Kasibante, John; Rutakingirwa, Morris K.; Kagimu, Enock; Ssebambulidde, Kenneth; Ellisa, Jayne; LillianTugume,; Mpoza, Edward; Cresswell, Fiona; Meya, David B. Tuberculosis preventive therapy (TPT) to prevent tuberculosis co-infection among adults with HIV-associated cryptococcal meningitis: A clinician's Journal Article In: Journal of Clinical Tuberculosis and Other Mycobacterial Diseases, vol. 20, 2020. @article{Kasibante2020,
title = {Tuberculosis preventive therapy (TPT) to prevent tuberculosis co-infection among adults with HIV-associated cryptococcal meningitis: A clinician's },
author = {John Kasibante and Morris K. Rutakingirwa and Enock Kagimu and Kenneth Ssebambulidde and Jayne Ellisa and LillianTugume and Edward Mpoza and Fiona Cresswell and David B. Meya},
url = {https://www.sciencedirect.com/science/article/pii/S2405579420300449},
doi = {https://doi.org/10.1016/j.jctube.2020.100180},
year = {2020},
date = {2020-08-13},
journal = {Journal of Clinical Tuberculosis and Other Mycobacterial Diseases},
volume = {20},
abstract = {Abstract
As part of the END TB strategy, the World Health organization (WHO) recommends provision of tuberculosis preventive therapy (TPT) to all people at high risk of developing active TB disease. Patients with HIV-associated cryptococcal meningitis are severely immunocompromised and therefore should be eligible for TPT. In this commentary we discuss the challenges associated with starting tuberculosis preventive therapy in patients with HIV associated cryptococcal meningitis in a clinical setting, we highlight the benefit, existing gaps and research opportunities of tuberculosis preventive therapy in this patient population.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
As part of the END TB strategy, the World Health organization (WHO) recommends provision of tuberculosis preventive therapy (TPT) to all people at high risk of developing active TB disease. Patients with HIV-associated cryptococcal meningitis are severely immunocompromised and therefore should be eligible for TPT. In this commentary we discuss the challenges associated with starting tuberculosis preventive therapy in patients with HIV associated cryptococcal meningitis in a clinical setting, we highlight the benefit, existing gaps and research opportunities of tuberculosis preventive therapy in this patient population. |
Baluku, Joseph Baruch; Anguzu, Godwin; Nassozi, Sylvia; Babirye, Febronius; Namiiro, Sharon; Buyungo, Robert; Sempiira, Mike; Wasswa, Amir; Mulwana, Rose; Ntambi, Samuel; Worodria, William; Andia-Biraro, Irene Prevalence of HIV infection and bacteriologically confirmed tuberculosis among individuals found at bars in Kampala slums, Uganda Journal Article In: Scientific Reports, vol. 10, no. 1, pp. 13438, 2020. @article{Baluku2020b,
title = {Prevalence of HIV infection and bacteriologically confirmed tuberculosis among individuals found at bars in Kampala slums, Uganda},
author = {Joseph Baruch Baluku and Godwin Anguzu and Sylvia Nassozi and Febronius Babirye and Sharon Namiiro and Robert Buyungo and Mike Sempiira and Amir Wasswa and Rose Mulwana and Samuel Ntambi and William Worodria and Irene Andia-Biraro },
url = {https://www.nature.com/articles/s41598-020-70472-6},
doi = {https://doi.org/10.1038/s41598-020-70472-6},
year = {2020},
date = {2020-08-10},
journal = {Scientific Reports},
volume = {10},
number = {1},
pages = {13438},
abstract = {Abstract
Individuals found at bars in slums have several risk factors for HIV and tuberculosis (TB). To determine the prevalence of HIV and TB among individuals found at bars in slums of Kampala, Uganda, we enrolled adults found at bars that provided written informed consent. Individuals with alcohol intoxication were excluded. We performed HIV testing using immunochromatographic antibody tests (Alere Determine HIV-1/2 and Chembio HIV 1/2 STAT-PAK). TB was confirmed using the Xpert MTB/RIF Ultra assay, performed on single spot sputum samples. We enrolled 272 participants from 42 bars in 5 slums. The prevalence of HIV and TB was 11.4% (95% CI 8.1–15.8) and 15 (95% CI 6–39) per 1,000 population respectively. Predictors of HIV were female sex (aOR 5.87, 95% CI 2.05–16.83), current cigarette smoking (aOR 3.23, 95% CI 1.02–10.26), history of TB treatment (aOR 10.19, 95% CI 3.17–32.82) and CAGE scores of 2–3 (aOR 3.90, 95% CI 1.11–13.70) and 4 (aOR 4.77, 95% CI 1.07–21.35). The prevalence of HIV and TB was twice and four times the national averages respectively. These findings highlight the need for concurrent programmatic screening for both HIV and TB among high risk populations in slums.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Individuals found at bars in slums have several risk factors for HIV and tuberculosis (TB). To determine the prevalence of HIV and TB among individuals found at bars in slums of Kampala, Uganda, we enrolled adults found at bars that provided written informed consent. Individuals with alcohol intoxication were excluded. We performed HIV testing using immunochromatographic antibody tests (Alere Determine HIV-1/2 and Chembio HIV 1/2 STAT-PAK). TB was confirmed using the Xpert MTB/RIF Ultra assay, performed on single spot sputum samples. We enrolled 272 participants from 42 bars in 5 slums. The prevalence of HIV and TB was 11.4% (95% CI 8.1–15.8) and 15 (95% CI 6–39) per 1,000 population respectively. Predictors of HIV were female sex (aOR 5.87, 95% CI 2.05–16.83), current cigarette smoking (aOR 3.23, 95% CI 1.02–10.26), history of TB treatment (aOR 10.19, 95% CI 3.17–32.82) and CAGE scores of 2–3 (aOR 3.90, 95% CI 1.11–13.70) and 4 (aOR 4.77, 95% CI 1.07–21.35). The prevalence of HIV and TB was twice and four times the national averages respectively. These findings highlight the need for concurrent programmatic screening for both HIV and TB among high risk populations in slums. |
Eneh, Prosperity C.; Hullsiek, Katherine Huppler; Kiiza, Daniel; Rhein, Joshua; Meya, David B.; Boulware, David R.; Nicol, Melanie R. Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda Journal Article In: BMC Infectious Diseases, vol. 20, no. 1, pp. 572, 2020. @article{Eneh2020,
title = {Prevalence and nature of potential drug-drug interactions among hospitalized HIV patients presenting with suspected meningitis in Uganda},
author = {Prosperity C. Eneh and Katherine Huppler Hullsiek and Daniel Kiiza and Joshua Rhein and David B. Meya and David R. Boulware and Melanie R. Nicol
},
url = {https://link.springer.com/article/10.1186/s12879-020-05296-w},
doi = {https://doi.org/10.1186/s12879-020-05296-w},
year = {2020},
date = {2020-08-05},
journal = {BMC Infectious Diseases},
volume = {20},
number = {1},
pages = {572},
abstract = {Abstract
Background
Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of potential DDIs (pDDIs) in hospitalized HIV patients presenting with suspected cryptococcal or tuberculous meningitis.
Methods
In a retrospective review of three cryptococcal meningitis trials between 2010 and 2017 in Kampala, Uganda, medications received over hospitalization were documented and pDDI events were assessed. IBM Micromedex DRUGDEX® online drug reference system was used to identify and describe potential interactions as either contraindicated, major, moderate or minor. For antiretroviral DDIs, the Liverpool Drug Interactions Checker from the University of Liverpool was also used to further describe interactions observed.
Results
In 1074 patients with suspected meningitis, pDDIs were present in 959 (overall prevalence = 89.3%) during the analyzed 30 day window. In total, 278 unique interacting drug pairs were identified resulting in 4582 pDDI events. Of all patients included in this study there was a mean frequency of 4.27 pDDIs per patient. Of the 4582 pDDI events, 11.3% contraindicated, 66.4% major, 17.4% moderate and 5% minor pDDIs were observed. Among all pDDIs identified, the most prevalent drugs implicated were fluconazole (58.4%), co-trimoxazole (25.7%), efavirenz (15.6%) and rifampin (10.2%). Twenty-one percent of the contraindicated pDDIs and 27% of the major ones involved an antiretroviral drug. Increased likelihood of QT interval prolongation was the most frequent potential clinical outcome. Dissonance in drug interaction checkers was noted requiring clinicians to consult more than one database in making clinical decisions about drug combinations.
Conclusions
The overall prevalence of pDDIs in this population is high. An understanding of drug combinations likely to result in undesired clinical outcomes, such as QT interval prolongation, is paramount. This is especially important in resource limited settings where availability of therapeutic drug monitoring and laboratory follow-up are inconsistent. Adequate quantification of the increased likelihood of adverse clinical outcomes from multiple drug-drug interactions of the same kind in a single patient is needed to aid clinical decisions in this setting.
Key findings
The result of this analysis shows that potential drug-drug interactions, ranging from minor to contradicted interactions, in this subset of the population are significant and sometimes unavoidable. Although frequency and type of drug-drug interactions have been previously characterized in various populations, this is to our knowledge the first description of potential drug-drug interactions among hospitalized patients living with HIV and presenting with co-morbidities like meningitis and tuberculosis. The findings will be of particular interest to clinicians in similar settings as this information can inform their monitoring and care of these patients especially given the vulnerabilities they face due to their comorbidities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Management of co-infections including cryptococcal meningitis, tuberculosis and other opportunistic infections in persons living with HIV can lead to complex polypharmacotherapy and increased susceptibility to drug-drug interactions (DDIs). Here we characterize the frequency and types of potential DDIs (pDDIs) in hospitalized HIV patients presenting with suspected cryptococcal or tuberculous meningitis.
Methods
In a retrospective review of three cryptococcal meningitis trials between 2010 and 2017 in Kampala, Uganda, medications received over hospitalization were documented and pDDI events were assessed. IBM Micromedex DRUGDEX® online drug reference system was used to identify and describe potential interactions as either contraindicated, major, moderate or minor. For antiretroviral DDIs, the Liverpool Drug Interactions Checker from the University of Liverpool was also used to further describe interactions observed.
Results
In 1074 patients with suspected meningitis, pDDIs were present in 959 (overall prevalence = 89.3%) during the analyzed 30 day window. In total, 278 unique interacting drug pairs were identified resulting in 4582 pDDI events. Of all patients included in this study there was a mean frequency of 4.27 pDDIs per patient. Of the 4582 pDDI events, 11.3% contraindicated, 66.4% major, 17.4% moderate and 5% minor pDDIs were observed. Among all pDDIs identified, the most prevalent drugs implicated were fluconazole (58.4%), co-trimoxazole (25.7%), efavirenz (15.6%) and rifampin (10.2%). Twenty-one percent of the contraindicated pDDIs and 27% of the major ones involved an antiretroviral drug. Increased likelihood of QT interval prolongation was the most frequent potential clinical outcome. Dissonance in drug interaction checkers was noted requiring clinicians to consult more than one database in making clinical decisions about drug combinations.
Conclusions
The overall prevalence of pDDIs in this population is high. An understanding of drug combinations likely to result in undesired clinical outcomes, such as QT interval prolongation, is paramount. This is especially important in resource limited settings where availability of therapeutic drug monitoring and laboratory follow-up are inconsistent. Adequate quantification of the increased likelihood of adverse clinical outcomes from multiple drug-drug interactions of the same kind in a single patient is needed to aid clinical decisions in this setting.
Key findings
The result of this analysis shows that potential drug-drug interactions, ranging from minor to contradicted interactions, in this subset of the population are significant and sometimes unavoidable. Although frequency and type of drug-drug interactions have been previously characterized in various populations, this is to our knowledge the first description of potential drug-drug interactions among hospitalized patients living with HIV and presenting with co-morbidities like meningitis and tuberculosis. The findings will be of particular interest to clinicians in similar settings as this information can inform their monitoring and care of these patients especially given the vulnerabilities they face due to their comorbidities. |
Pintye, Jillian; Davey, Dvora L Joseph; Wagner, Anjuli D; John-Stewart, Grace; Baggaley, Rachel; Bekker, Linda-Gail; Celum, Connie; Benjamin,; Coates, Thomas J; Groves, Allison K; Haberer, Jessica E; Heffron, Renee; Kinuthia, John; Matthews, Lynn T; McIntyre, James A; Moodley, Dhayendre; Mofenson, Lynne M; Mugo, Nelly; Mujugira, Andrew; Myer, Landon; Shoptaw, Steven; Stranix-Chibanda, Lynda; Baeten, Jared M; for the PrEP in Pregnancy Working Group, Defining gaps in pre-exposure prophylaxis delivery for pregnant and post-partum women in high-burden settings using an implementation science framework Journal Article In: The Lancet HIV, vol. 7, no. 8, pp. e582-e592, 2020. @article{Pintye2020,
title = {Defining gaps in pre-exposure prophylaxis delivery for pregnant and post-partum women in high-burden settings using an implementation science framework},
author = {Jillian Pintye and Dvora L Joseph Davey and Anjuli D Wagner and Grace John-Stewart and Rachel Baggaley and Linda-Gail Bekker and Connie Celum and Benjamin and Thomas J Coates and Allison K Groves and Jessica E Haberer and Renee Heffron and John Kinuthia and Lynn T Matthews and James A McIntyre and Dhayendre Moodley and Lynne M Mofenson and Nelly Mugo and Andrew Mujugira and Landon Myer and Steven Shoptaw and Lynda Stranix-Chibanda and Jared M Baeten and for the PrEP in Pregnancy Working Group},
url = {https://www.sciencedirect.com/science/article/abs/pii/S2352301820301028},
doi = {https://doi.org/10.1016/S2352-3018(20)30102-8},
year = {2020},
date = {2020-08-04},
journal = {The Lancet HIV},
volume = {7},
number = {8},
pages = {e582-e592},
abstract = {Summary
Pregnancy is a high-risk period for HIV acquisition in African women, and pregnant women who become acutely infected with HIV account for up to a third of vertical HIV transmission cases in African settings. To protect women and eliminate vertical transmission, WHO recommends offering oral pre-exposure prophylaxis (PrEP) based on tenofovir to HIV-negative pregnant and post-partum women with a substantial risk of HIV acquisition. PrEP implementation for pregnant and post-partum women lags behind implementation for other high-risk populations. Unique considerations for PrEP implementation arise during pregnancy and post partum, including the integration of provider training with clinical delivery and monitoring of PrEP exposure and outcomes within existing maternal health systems, yet scarce implementation data are available to generate evidence in this context.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Summary
Pregnancy is a high-risk period for HIV acquisition in African women, and pregnant women who become acutely infected with HIV account for up to a third of vertical HIV transmission cases in African settings. To protect women and eliminate vertical transmission, WHO recommends offering oral pre-exposure prophylaxis (PrEP) based on tenofovir to HIV-negative pregnant and post-partum women with a substantial risk of HIV acquisition. PrEP implementation for pregnant and post-partum women lags behind implementation for other high-risk populations. Unique considerations for PrEP implementation arise during pregnancy and post partum, including the integration of provider training with clinical delivery and monitoring of PrEP exposure and outcomes within existing maternal health systems, yet scarce implementation data are available to generate evidence in this context. |
Muhindo, Richard; Mujugira, Andrew; Castelnuovo, Barbara; Sewankambo, Nelson K.; Parkes-Ratanshi, Rosalind; Kiguli, Juliet; Tumwesigye, Nazarius Mbona; Nakku-Joloba, Edith HIV and syphilis testing behaviors among heterosexual male and female sex workers in Uganda Journal Article In: AIDS Research and Therapy, vol. 17, no. 1, pp. 48, 2020. @article{Muhindo2020,
title = {HIV and syphilis testing behaviors among heterosexual male and female sex workers in Uganda},
author = {Richard Muhindo and Andrew Mujugira and Barbara Castelnuovo and Nelson K. Sewankambo and Rosalind Parkes-Ratanshi and Juliet Kiguli and Nazarius Mbona Tumwesigye and Edith Nakku-Joloba },
url = {https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-020-00306-y},
doi = {https://doi.org/10.1186/s12981-020-00306-y},
year = {2020},
date = {2020-08-01},
journal = {AIDS Research and Therapy},
volume = {17},
number = {1},
pages = {48},
abstract = {Abstract
Background
In Sub-Saharan Africa where HIV disproportionately affects women, heterosexual male sex workers (HMSW) and their female clients are at risk of acquiring or transmitting HIV and other STIs. However, few studies have described HIV and STI risk among HMSW. We aimed to assess and compare recent HIV and syphilis screening practices among HMSW and female sex workers (FSW) in Uganda.
Methods
Between August and December 2019, we conducted a cross-sectional study among 100 HMSW and 240 female sex workers (FSW). Participants were enrolled through snowball sampling, and an interviewer-administered questionnaire used to collect data on HIV and syphilis testing in the prior 12 and 6 months respectively. Integrated change model constructs were used to assess intentions, attitudes, social influences, norms and self-efficacy of 3-monthly Syphilis and 6-monthly HIV testing. Predictors of HIV and syphilis recent testing behaviors were estimated using negative binomial regression.
Results
We enrolled 340 sex workers of whom 100 (29%) were HMSW. The median age was 27 years [interquartile range (IQR) 25–30] for HMSW and 26 years [IQR], (23–29) for FSW. The median duration of sex work was 36 and 30 months for HMSW and FSW, respectively. HMSW were significantly less likely than FSW to have tested for HIV in the prior 12 months (50% vs. 86%; p = 0.001). For MSW, non-testing for HIV was associated with higher education [adjusted prevalence ratio (aPR) 1.66; 95% confidence interval (CI) 1.09–2.50], poor intention to seek HIV testing (aPR 1.64; 95% CI 1.35–2.04), perception that 6-monthly HIV testing was not normative (aPR 1.33; 95% CI 1.09–1.67) and low self-efficacy (aPR 1.41; 95% CI 1.12–1.79). Not testing for syphilis was associated with low intention to seek testing (aPR 3.13; 95% CI 2.13–4.55), low self-efficacy (aPR 2.56; 95% CI 1.35–4.76), negative testing attitudes (aPR 2.33; 95% CI 1.64–3.33), and perception that regular testing was not normative (aPR 1.59; 95% CI 1.14–2.22).
Conclusions
Non-testing for HIV and syphilis was common among HMSW relative to FSW. Future studies should evaluate strategies to increase testing uptake for this neglected sub-population of sex workers.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
In Sub-Saharan Africa where HIV disproportionately affects women, heterosexual male sex workers (HMSW) and their female clients are at risk of acquiring or transmitting HIV and other STIs. However, few studies have described HIV and STI risk among HMSW. We aimed to assess and compare recent HIV and syphilis screening practices among HMSW and female sex workers (FSW) in Uganda.
Methods
Between August and December 2019, we conducted a cross-sectional study among 100 HMSW and 240 female sex workers (FSW). Participants were enrolled through snowball sampling, and an interviewer-administered questionnaire used to collect data on HIV and syphilis testing in the prior 12 and 6 months respectively. Integrated change model constructs were used to assess intentions, attitudes, social influences, norms and self-efficacy of 3-monthly Syphilis and 6-monthly HIV testing. Predictors of HIV and syphilis recent testing behaviors were estimated using negative binomial regression.
Results
We enrolled 340 sex workers of whom 100 (29%) were HMSW. The median age was 27 years [interquartile range (IQR) 25–30] for HMSW and 26 years [IQR], (23–29) for FSW. The median duration of sex work was 36 and 30 months for HMSW and FSW, respectively. HMSW were significantly less likely than FSW to have tested for HIV in the prior 12 months (50% vs. 86%; p = 0.001). For MSW, non-testing for HIV was associated with higher education [adjusted prevalence ratio (aPR) 1.66; 95% confidence interval (CI) 1.09–2.50], poor intention to seek HIV testing (aPR 1.64; 95% CI 1.35–2.04), perception that 6-monthly HIV testing was not normative (aPR 1.33; 95% CI 1.09–1.67) and low self-efficacy (aPR 1.41; 95% CI 1.12–1.79). Not testing for syphilis was associated with low intention to seek testing (aPR 3.13; 95% CI 2.13–4.55), low self-efficacy (aPR 2.56; 95% CI 1.35–4.76), negative testing attitudes (aPR 2.33; 95% CI 1.64–3.33), and perception that regular testing was not normative (aPR 1.59; 95% CI 1.14–2.22).
Conclusions
Non-testing for HIV and syphilis was common among HMSW relative to FSW. Future studies should evaluate strategies to increase testing uptake for this neglected sub-population of sex workers. |
Alhassan, Yussif; Twimukye, Adelline; Malaba, Thoko; Orrell, Catherine; Myer, Landon; Waitt, Catriona; Lamorde, Mohammed; Kambugu, Andrew; Reynolds, Helen; Khoo, Saye; Taegtmeyer, Miriam Engendering health systems in response to national rollout of dolutegravir-based regimens among women of childbearing potential: a qualitative study with stakeholders in South Africa and Uganda Journal Article In: BMC Health Services Research, vol. 20, no. 1, pp. 705, 2020. @article{Alhassan2020,
title = {Engendering health systems in response to national rollout of dolutegravir-based regimens among women of childbearing potential: a qualitative study with stakeholders in South Africa and Uganda},
author = {Yussif Alhassan and Adelline Twimukye and Thoko Malaba and Catherine Orrell and Landon Myer and Catriona Waitt and Mohammed Lamorde and Andrew Kambugu and Helen Reynolds and Saye Khoo and Miriam Taegtmeyer },
url = {https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05580-0},
doi = {https://doi.org/10.1186/s12913-020-05580-0},
year = {2020},
date = {2020-08-01},
journal = {BMC Health Services Research},
volume = {20},
number = {1},
pages = {705},
abstract = {Abstract
Background
In the era of rapid dolutegravir rollout, concerns about neural tube defects have complicated the health systems response among women of childbearing potential. This qualitative study, which was nested within the DolPHIN-2 clinical trial, examined the current and future health system opportunities and challenges associated with the transition to dolutegravir-based regimen as first line antiretroviral therapy among women of childbearing potential in South Africa and Uganda.
Method
Semi-structured in-depth interviews with members of antiretroviral therapy guideline development groups and affiliates were conducted. Thirty-one participants were purposively selected for the study, including senior officials from the Ministry of Health and National Drug Regulatory Authority in Uganda and South Africa as well as health-sector development partners, activists, researchers and health workers. A thematic approach was used to analyse the data.
Findings
Despite differences in health system contexts, several common challenges and opportunities were identified with the transition among women of childbearing potential in South Africa and Uganda. In both contexts national stakeholders identified challenges with ensuring gender equity in roll out due to the potential teratogenicity of dolutegravir, paucity of data on dolutegravir use in pregnancy, potential stock out of effective contraceptives, poorly integrated contraception services, and limited pharmacovigilance in pregnancy. Participants identified opportunities that could be harnessed to accelerate the transition, including high stakeholder interest and commitment to transition, national approval and licensure of a generic tenofovir/lamivudine/dolutegravir regimen, availability of a network of antiretroviral therapy providers, and strong desire among women for newer and more tolerable regimens.
Conclusion
The transition to dolutegravir-based regimens has the potential to strengthen health systems in low- and middle-income countries to engender equitable access to optimised antiretroviral regimen among women. There is the need for a multi-sectoral effort to harness the opportunities of the health systems to addresses the bottlenecks to the transition and initiate extensive community engagement alongside individual and institutional capacity strengthening. Improvements in pregnancy pharmacovigilance and counselling and family planning services are critical to ensuring a successful transition among women of childbearing potential.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
In the era of rapid dolutegravir rollout, concerns about neural tube defects have complicated the health systems response among women of childbearing potential. This qualitative study, which was nested within the DolPHIN-2 clinical trial, examined the current and future health system opportunities and challenges associated with the transition to dolutegravir-based regimen as first line antiretroviral therapy among women of childbearing potential in South Africa and Uganda.
Method
Semi-structured in-depth interviews with members of antiretroviral therapy guideline development groups and affiliates were conducted. Thirty-one participants were purposively selected for the study, including senior officials from the Ministry of Health and National Drug Regulatory Authority in Uganda and South Africa as well as health-sector development partners, activists, researchers and health workers. A thematic approach was used to analyse the data.
Findings
Despite differences in health system contexts, several common challenges and opportunities were identified with the transition among women of childbearing potential in South Africa and Uganda. In both contexts national stakeholders identified challenges with ensuring gender equity in roll out due to the potential teratogenicity of dolutegravir, paucity of data on dolutegravir use in pregnancy, potential stock out of effective contraceptives, poorly integrated contraception services, and limited pharmacovigilance in pregnancy. Participants identified opportunities that could be harnessed to accelerate the transition, including high stakeholder interest and commitment to transition, national approval and licensure of a generic tenofovir/lamivudine/dolutegravir regimen, availability of a network of antiretroviral therapy providers, and strong desire among women for newer and more tolerable regimens.
Conclusion
The transition to dolutegravir-based regimens has the potential to strengthen health systems in low- and middle-income countries to engender equitable access to optimised antiretroviral regimen among women. There is the need for a multi-sectoral effort to harness the opportunities of the health systems to addresses the bottlenecks to the transition and initiate extensive community engagement alongside individual and institutional capacity strengthening. Improvements in pregnancy pharmacovigilance and counselling and family planning services are critical to ensuring a successful transition among women of childbearing potential. |
Skipper, Caleb; Schleiss, Mark R; Bangdiwala, Ananta S; Hernandez-Alvarado, Nelmary; Taseera, Kabanda; Nabeta, Henry W; Musubire, Abdu K; Lofgren, Sarah M; Wiesner, Darin L; Rhein, Joshua; Rajasingham, Radha; Schutz, Charlotte; Meintjes, Graeme; Muzoora, Conrad; Meya, David B; Boulware, David R; the Cryptococcal Optimal Antiretroviral Therapy Timing (COAT) Team., Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa Journal Article In: Clinical Infectious Diseases, vol. 71, no. 3, pp. 525–531, 2020. @article{Skipper2020c,
title = {Cytomegalovirus Viremia Associated With Increased Mortality in Cryptococcal Meningitis in Sub-Saharan Africa },
author = {Caleb Skipper and Mark R Schleiss and Ananta S Bangdiwala and Nelmary Hernandez-Alvarado and Kabanda Taseera and Henry W Nabeta and Abdu K Musubire and Sarah M Lofgren and Darin L Wiesner and Joshua Rhein and Radha Rajasingham and Charlotte Schutz and Graeme Meintjes and Conrad Muzoora and David B Meya and David R Boulware and the Cryptococcal Optimal Antiretroviral Therapy Timing (COAT) Team.},
url = {https://academic.oup.com/cid/article-abstract/71/3/525/5557865},
doi = {https://doi.org/10.1093/cid/ciz864},
year = {2020},
date = {2020-08-01},
journal = {Clinical Infectious Diseases},
volume = {71},
number = {3},
pages = {525–531},
abstract = {Abstract
Background
Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections.
Methods
We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia.
Results
Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259–2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9–70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07–4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49–7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups.
Conclusions
Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect).
Clinical Trials Registration
NCT01075152.
Topic:
hiv acquired immunodeficiency syndrome cryptococcal meningitis viremia cryptococcus cytomegalovirus mortality },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Cryptococcal meningitis and tuberculosis are both important causes of death in persons with advanced human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS). Cytomegalovirus (CMV) viremia may be associated with increased mortality in persons living with HIV who have tuberculosis. It is unknown whether concurrent CMV viremia is associated with mortality in other AIDS-related opportunistic infections.
Methods
We prospectively enrolled Ugandans living with HIV who had cryptococcal meningitis from 2010–2012. Subsequently, we analyzed stored baseline plasma samples from 111 subjects for CMV DNA. We compared 10-week survival rates among those with and without CMV viremia.
Results
Of 111 participants, 52% (58/111) had detectable CMV DNA (median plasma viral load 498 IU/mL, interquartile range [IQR] 259–2390). All samples tested were positive on immunoglobin G serology. The median CD4+ T cell count was 19 cells/µL (IQR 9–70) and did not differ by the presence of CMV viremia (P = .47). The 10-week mortality rates were 40% (23/58) in those with CMV viremia and 21% (11/53) in those without CMV viremia (hazard ratio 2.19, 95% confidence interval [CI] 1.07–4.49; P = .03), which remained significant after a multivariate adjustment for known risk factors of mortality (adjusted hazard ratio 3.25, 95% CI 1.49–7.10; P = .003). Serum and cerebrospinal fluid cytokine levels were generally similar and cryptococcal antigen-specific immune stimulation responses did not differ between groups.
Conclusions
Half of persons with advanced AIDS and cryptococcal meningitis had detectable CMV viremia. CMV viremia was associated with an over 2-fold higher mortality rate. It remains unclear whether CMV viremia in severely immunocompromised persons with cryptococcal meningitis contributes directly to this mortality or may reflect an underlying immune dysfunction (ie, cause vs effect).
Clinical Trials Registration
NCT01075152.
Topic:
hiv acquired immunodeficiency syndrome cryptococcal meningitis viremia cryptococcus cytomegalovirus mortality |
Baluku, Joseph Baruch; Mugabe, Pallen; Mulwana, Rose; Nassozi, Sylvia; Katuramu, Richard; Worodria, William High Prevalence of Rifampicin Resistance Associated with Rural Residence and Very Low Bacillary Load among TB/HIV-Coinfected Patients at the National Tuberculosis Treatment Center in Uganda Journal Article In: BioMed Research International, 2020. @article{Baluku2020,
title = {High Prevalence of Rifampicin Resistance Associated with Rural Residence and Very Low Bacillary Load among TB/HIV-Coinfected Patients at the National Tuberculosis Treatment Center in Uganda},
author = {Joseph Baruch Baluku and Pallen Mugabe and Rose Mulwana and Sylvia Nassozi and Richard Katuramu and William Worodria},
url = {https://www.hindawi.com/journals/bmri/2020/2508283/},
doi = {https://doi.org/10.1155/2020/2508283},
year = {2020},
date = {2020-07-25},
journal = {BioMed Research International},
abstract = {Abstract
Background. Rifampicin resistance (RR) is associated with mortality among tuberculosis (TB) patients coinfected with HIV. We compared the prevalence of RR among TB patients with and without HIV coinfection at the National Tuberculosis Treatment Center (NTTC) in Uganda, a TB/HIV high burdened country. We further determined associations of RR among TB/HIV-coinfected patients. Methods. In this secondary analysis, we included adult (≥18 years) bacteriologically confirmed TB patients that were enrolled in a cross-sectional study at the NTTC in Uganda between August 2017 and March 2018. TB, RR, and bacillary load were confirmed by the Xpert® MTB/RIF assay in the primary study. A very low bacillary load was defined as a cycle threshold value of >28. We compared the prevalence of RR among TB patients with and without HIV coinfection using Pearson’s chi-square test. We performed logistic regression analysis to determine associations of RR among TB/HIV-coinfected patients. Results. Of the 303 patients, 182 (60.1%) were male, 111 (36.6%) had TB/HIV coinfection, and the median (interquartile range) age was 31 (25-39) years. RR was found among 58 (19.1%) patients. The prevalence of RR was 32.4% (36/111) (95% confidence interval (CI): 24-42) among TB/HIV-coinfected patients compared to 11.5% (22/192) (95% CI: 7–17) among HIV-negative TB patients (
). Among TB/HIV-coinfected patients, those with RR were more likely to be rural residents (adjusted odds ratio (aOR): 5.24, 95% CI: 1.51–18.21, ) and have a very low bacillary load (aOR: 13.52, 95% CI: 3.15–58.08, ). Conclusion. There was a high prevalence of RR among TB/HIV-coinfected patients. RR was associated with rural residence and having a very low bacillary load among TB/HIV-coinfected patients. The findings highlight a need for universal access to drug susceptibility testing among TB/HIV-coinfected patients, especially in rural settings.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background. Rifampicin resistance (RR) is associated with mortality among tuberculosis (TB) patients coinfected with HIV. We compared the prevalence of RR among TB patients with and without HIV coinfection at the National Tuberculosis Treatment Center (NTTC) in Uganda, a TB/HIV high burdened country. We further determined associations of RR among TB/HIV-coinfected patients. Methods. In this secondary analysis, we included adult (≥18 years) bacteriologically confirmed TB patients that were enrolled in a cross-sectional study at the NTTC in Uganda between August 2017 and March 2018. TB, RR, and bacillary load were confirmed by the Xpert® MTB/RIF assay in the primary study. A very low bacillary load was defined as a cycle threshold value of >28. We compared the prevalence of RR among TB patients with and without HIV coinfection using Pearson’s chi-square test. We performed logistic regression analysis to determine associations of RR among TB/HIV-coinfected patients. Results. Of the 303 patients, 182 (60.1%) were male, 111 (36.6%) had TB/HIV coinfection, and the median (interquartile range) age was 31 (25-39) years. RR was found among 58 (19.1%) patients. The prevalence of RR was 32.4% (36/111) (95% confidence interval (CI): 24-42) among TB/HIV-coinfected patients compared to 11.5% (22/192) (95% CI: 7–17) among HIV-negative TB patients (
). Among TB/HIV-coinfected patients, those with RR were more likely to be rural residents (adjusted odds ratio (aOR): 5.24, 95% CI: 1.51–18.21, ) and have a very low bacillary load (aOR: 13.52, 95% CI: 3.15–58.08, ). Conclusion. There was a high prevalence of RR among TB/HIV-coinfected patients. RR was associated with rural residence and having a very low bacillary load among TB/HIV-coinfected patients. The findings highlight a need for universal access to drug susceptibility testing among TB/HIV-coinfected patients, especially in rural settings. |
Costa, Cecilia; Scabini, Silvia; Kaimal, Arvind; Kasozi, William; Cusato, Jessica; Kafufu, Bosco; Borderi, Marco; Mwaka, Erisa; Perri, Giovanni Di; Lamorde, Mohammed; Calcagno, Andrea; Castelnuovo, Barbara Calcaneal Quantitative Ultrasonography and Urinary Retinol-Binding Protein in Antiretroviral-Treated Patients With Human Immunodeficiency Virus in Uganda: A Pilot Study Journal Article In: The Journal of Infectious Diseases, vol. 222, no. 2, pp. 263-272, 2020. @article{Costa2020,
title = {Calcaneal Quantitative Ultrasonography and Urinary Retinol-Binding Protein in Antiretroviral-Treated Patients With Human Immunodeficiency Virus in Uganda: A Pilot Study },
author = {Cecilia Costa and Silvia Scabini and Arvind Kaimal and William Kasozi and Jessica Cusato and Bosco Kafufu and Marco Borderi and Erisa Mwaka and Giovanni Di Perri and Mohammed Lamorde and Andrea Calcagno and Barbara Castelnuovo},
url = {https://academic.oup.com/jid/article-abstract/222/2/263/5766432},
doi = {https://doi.org/10.1093/infdis/jiaa088},
year = {2020},
date = {2020-07-15},
journal = {The Journal of Infectious Diseases},
volume = {222},
number = {2},
pages = {263-272},
abstract = {Abstract
Background
Data on bone health and renal impairment in people with human immunodeficiency virus (HIV) in resource-limited settings are limited. The primary aim of this study was to investigate the potential role of calcaneal quantitative ultrasonography (QUS) in predicting bone mineral density (BMD) reduction in a population of Ugandan HIV-infected individuals receiving long-term antiretroviral therapy; the secondary end point was to assess the prevalence of proximal tubular dysfunction and the correlation between elevated urinary retinol-binding protein–urinary creatinine ratio (uRBP/uCr) and reduced BMD.
Methods
We conducted a cross-sectional study at the Infectious Diseases Institute, Kampala, Uganda. We included 101 HIV-infected adults who had been receiving continuous antiretroviral therapy for ≥10 years and had undergone dual-energy x-ray absorptiometry (DXA) during the previous 12 months. All patients underwent calcaneal QUS evaluation and urine sample collection.
Results
DXA BMD measurements were significantly associated (P < .01) with calcaneal speed of sound, broadband ultrasound attenuation, and QUS index. Forty-seven individuals (47%) had abnormal uRBP/uCr values. A significant inverse correlation was observed between uRBP/uCr and DXA T scores (lumbar [P = .03], femoral neck [P < .001], and total hip [P = .002]).
Conclusions
Calcaneal QUS results showed a moderate correlation with DXA outputs. The identified high prevalence of subclinical tubular impairment also highlights the importance of expanding access to tenofovir disoproxil fumarate–sparing regimens in resource-limited settings.
bone metabolic diseases, HIV, calcaneal ultrasound, tubular impairment, resource-limited setting
Topic:
hiv ultrasonography bone mineral density calcaneus retinol binding proteins uganda urinary tract x-ray absorptiometry, dual-energy anti-retroviral agents
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Data on bone health and renal impairment in people with human immunodeficiency virus (HIV) in resource-limited settings are limited. The primary aim of this study was to investigate the potential role of calcaneal quantitative ultrasonography (QUS) in predicting bone mineral density (BMD) reduction in a population of Ugandan HIV-infected individuals receiving long-term antiretroviral therapy; the secondary end point was to assess the prevalence of proximal tubular dysfunction and the correlation between elevated urinary retinol-binding protein–urinary creatinine ratio (uRBP/uCr) and reduced BMD.
Methods
We conducted a cross-sectional study at the Infectious Diseases Institute, Kampala, Uganda. We included 101 HIV-infected adults who had been receiving continuous antiretroviral therapy for ≥10 years and had undergone dual-energy x-ray absorptiometry (DXA) during the previous 12 months. All patients underwent calcaneal QUS evaluation and urine sample collection.
Results
DXA BMD measurements were significantly associated (P < .01) with calcaneal speed of sound, broadband ultrasound attenuation, and QUS index. Forty-seven individuals (47%) had abnormal uRBP/uCr values. A significant inverse correlation was observed between uRBP/uCr and DXA T scores (lumbar [P = .03], femoral neck [P < .001], and total hip [P = .002]).
Conclusions
Calcaneal QUS results showed a moderate correlation with DXA outputs. The identified high prevalence of subclinical tubular impairment also highlights the importance of expanding access to tenofovir disoproxil fumarate–sparing regimens in resource-limited settings.
bone metabolic diseases, HIV, calcaneal ultrasound, tubular impairment, resource-limited setting
Topic:
hiv ultrasonography bone mineral density calcaneus retinol binding proteins uganda urinary tract x-ray absorptiometry, dual-energy anti-retroviral agents
|
Alufandika, Melanie; Lawrence, David S.; Boyer-Chammard, Timothée; Kanyama, Cecilia; Ndhlovu, Chiratidzo E.; Mosepele, Mosepele; Tugume, Lillian; Meya, David; Boulware, David R.; Rhein, Joshua; Muzoora, Conrad; Youssouf, Nabila; Molloy, Síle F.; Schutz, Charlotte; Lortholary, Olivier; Meintjes, Graeme; Mwandumba, Henry C.; Harrison, Thomas S.; Jarvis, Joseph N.; the AMBITION-cm Study Group, A pragmatic approach to managing antiretroviral therapy-experienced patients diagnosed with HIV-associated cryptococcal meningitis: impact of antiretroviral therapy adherence and duration Journal Article In: AIDS (London, England), vol. 34, no. 9, pp. 1425–1428, 2020. @article{Alufandika2020,
title = {A pragmatic approach to managing antiretroviral therapy-experienced patients diagnosed with HIV-associated cryptococcal meningitis: impact of antiretroviral therapy adherence and duration},
author = {Melanie Alufandika and David S. Lawrence and Timothée Boyer-Chammard and Cecilia Kanyama and Chiratidzo E. Ndhlovu and Mosepele Mosepele and Lillian Tugume and David Meya and David R. Boulware and Joshua Rhein and Conrad Muzoora and Nabila Youssouf and Síle F. Molloy and Charlotte Schutz and Olivier Lortholary and Graeme Meintjes and Henry C. Mwandumba and Thomas S. Harrison and Joseph N. Jarvis and the AMBITION-cm Study Group},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473821/},
doi = { doi: 10.1097/QAD.0000000000002556},
year = {2020},
date = {2020-07-15},
journal = {AIDS (London, England)},
volume = {34},
number = {9},
pages = {1425–1428},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Alhassan, Yussif; Twimukye, Adelline; Malaba, Thoko; Orrell, Catherine; Myer, Landon; Waitt, Catriona; Lamorde, Mohammed; Kambugu, Andrew; Reynolds, Helen; Miria, Taegtmeyer Community acceptability of dolutegravir-based HIV treatment in women: a qualitative study in South Africa and Uganda Journal Article In: BMC Public Health, vol. 20, no. 1883, 2020. @article{Alhassan2020b,
title = {Community acceptability of dolutegravir-based HIV treatment in women: a qualitative study in South Africa and Uganda},
author = {Yussif Alhassan and Adelline Twimukye and Thoko Malaba and Catherine Orrell and Landon Myer and Catriona Waitt and Mohammed Lamorde and Andrew Kambugu and Helen Reynolds and Miria, Taegtmeyer},
doi = {doi.org/10.1186/s12889-020-09991-w},
year = {2020},
date = {2020-07-07},
journal = {BMC Public Health},
volume = {20},
number = {1883},
abstract = {Abstract
Background: Despite concerns about dolutegravir use in pregnancy, most low- and middle-income countries are
accelerating the introduction of dolutegravir-based regimens into national antiretroviral treatment programmes.
Questions remain about the acceptability of dolutegravir use in women due to the potential risks in pregnancy.
This study from South Africa and Uganda explored community values, preferences and attitudes towards the use of
dolutegravir-based regimens in women.
Methods: This study employed a qualitative design involving in-depth interviews and focus group discussion
conducted between August 2018 to March 2019. The study was conducted in the months following an
announcement of a potential risk for neural tube defects with dolutegravir use among women during conception
and the first trimester. Participants included HIV positive pregnant and lactating women and their partners. They
were selected purposively from urban poor communities in South Africa and Uganda. Data was analysed
thematically in NVivo.
Results: Forty-four in-depth interviews and 15 focus group discussions were conducted. Most participants had
positive views of dolutegravir-based regimens and perceived it to be more desirable compared with efavirenzcontaining
regimens. There was widespread concern about use of dolutegravir during pregnancy and among
women of childbearing age due to publicity around the possible association with neural tube defects. Acceptability
was gendered, with nearly all male participants preferring their female spouses of childbearing potential not to use
dolutegravir, while most women not planning pregnancy wanted access to contraception alongside dolutegravir.
Community awareness and knowledge of dolutegravir was low and characterised by negative information. Women
were concerned about HIV-related stigma and wanted the privacy features of dolutegravir to be strengthened with
modification of the pill appearance and disguised packaging.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background: Despite concerns about dolutegravir use in pregnancy, most low- and middle-income countries are
accelerating the introduction of dolutegravir-based regimens into national antiretroviral treatment programmes.
Questions remain about the acceptability of dolutegravir use in women due to the potential risks in pregnancy.
This study from South Africa and Uganda explored community values, preferences and attitudes towards the use of
dolutegravir-based regimens in women.
Methods: This study employed a qualitative design involving in-depth interviews and focus group discussion
conducted between August 2018 to March 2019. The study was conducted in the months following an
announcement of a potential risk for neural tube defects with dolutegravir use among women during conception
and the first trimester. Participants included HIV positive pregnant and lactating women and their partners. They
were selected purposively from urban poor communities in South Africa and Uganda. Data was analysed
thematically in NVivo.
Results: Forty-four in-depth interviews and 15 focus group discussions were conducted. Most participants had
positive views of dolutegravir-based regimens and perceived it to be more desirable compared with efavirenzcontaining
regimens. There was widespread concern about use of dolutegravir during pregnancy and among
women of childbearing age due to publicity around the possible association with neural tube defects. Acceptability
was gendered, with nearly all male participants preferring their female spouses of childbearing potential not to use
dolutegravir, while most women not planning pregnancy wanted access to contraception alongside dolutegravir.
Community awareness and knowledge of dolutegravir was low and characterised by negative information. Women
were concerned about HIV-related stigma and wanted the privacy features of dolutegravir to be strengthened with
modification of the pill appearance and disguised packaging. |
Sharon Fonn Sam Kinyanjui, Catherine Kyobutungi Enhancing science preparedness for health emergencies in Africa through research capacity building Journal Article Forthcoming In: BMJ: Global Health, vol. 5, pp. e003072, Forthcoming. @article{Kinyanjui2020,
title = {Enhancing science preparedness for health emergencies in Africa through research capacity building},
author = {Sam Kinyanjui, Sharon Fonn, Catherine Kyobutungi, Marta Vicente-Crespo, Bassirou Bonfoh, Thumbi Ndung’u, Nelson Kaulukusi Sewankambo, Abdoulaye A Djimde, Oumar Gaye, Tobias Chirwa, Eustasius Musenge, Alison Elliott, Damalie Nakanjako, Dixon Chibanda, Gordon Awandare},
doi = {http://dx.doi.org/10.1136/bmjgh-2020-003072},
year = {2020},
date = {2020-07-06},
journal = {BMJ: Global Health},
volume = {5},
pages = {e003072},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
|
Masyuko, Sarah J.; Page, Stephanie T.; and John Kinuthia,; Osoti, Alfred O.; Polyak, Stephen J.; Otieno, Fredrick C.; Kibachio, Joseph M.; Mogaka, Jerusha N.; Temu, Tecla M.; Zifodya, Jerry S.; Otedo, Amos; Nakanjako, Damalie; Hughes, James P.; Farquhar, Carey Metabolic syndrome and 10-year cardiovascular risk among HIV-positive and HIV-negative adults Journal Article In: Medicine (Baltimore)., vol. 99, no. 27, pp. e20845, 2020. @article{Masyuko2020,
title = {Metabolic syndrome and 10-year cardiovascular risk among HIV-positive and HIV-negative adults},
author = {Sarah J. Masyuko and Stephanie T. Page and and John Kinuthia and Alfred O. Osoti and Stephen J. Polyak and Fredrick C. Otieno and Joseph M. Kibachio and Jerusha N. Mogaka and Tecla M. Temu and Jerry S. Zifodya and Amos Otedo and Damalie Nakanjako and James P. Hughes and Carey Farquhar},
url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7337552/},
doi = {doi: 10.1097/MD.0000000000020845},
year = {2020},
date = {2020-07-02},
journal = {Medicine (Baltimore).},
volume = {99},
number = {27},
pages = {e20845},
abstract = {Abstract
To determine the prevalence and correlates of metabolic syndrome (MetS) and compare 10-year cardiovascular disease (CVD) risk among Kenyan adults with and without HIV infection.
We conducted a cross-sectional study among adults ≥30 years of age with and without HIV infection seeking care at Kisumu County Hospital. Participants completed a health questionnaire and vital signs, anthropomorphic measurements, and fasting blood were obtained. MetS was defined using 2009 Consensus Criteria and 10-year Atherosclerotic CVD (ASCVD) risk score was calculated. Chi-square, independent t tests, Wilcoxon ranksum test and multivariable logistic regression were used to determine differences and associations between HIV and MetS, CVD risk factors and ASCVD risk score.
A total of 300 people living with HIV (PLWHIV) and 298 HIV-negative participants with median age 44 years enrolled, 50% of whom were female. The prevalence of MetS was 8.9% overall, but lower among PLWHIV than HIV-negative participants (6.3% vs 11.6%, respectively; P = .001). The most prevalent MetS components were elevated blood pressure, decreased high density lipoprotein, and abdominal obesity. Adjusting for covariates, PLWHIV were 66% less likely to have MetS compared to HIV-negative participants (adjusted odds ratio [aOR] 0.34; 95% confidence interval [95%CI] 0.18, 0.65; P = .005). Median ASCVD risk score was also lower among PLWHIV compared to HIV-negative participants (1.7% vs 3.0%, P = .002).
MetS was more common among HIV-negative than HIV-positive adults, and HIV-negative adults were at greater risk for CVD compared to PLWHIV. These data support integration of routine CVD screening and management into health programs in resource-limited settings, regardless of HIV status.
Keywords: cardiovascular risk score, HIV, Kenya, metabolic syndrome},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
To determine the prevalence and correlates of metabolic syndrome (MetS) and compare 10-year cardiovascular disease (CVD) risk among Kenyan adults with and without HIV infection.
We conducted a cross-sectional study among adults ≥30 years of age with and without HIV infection seeking care at Kisumu County Hospital. Participants completed a health questionnaire and vital signs, anthropomorphic measurements, and fasting blood were obtained. MetS was defined using 2009 Consensus Criteria and 10-year Atherosclerotic CVD (ASCVD) risk score was calculated. Chi-square, independent t tests, Wilcoxon ranksum test and multivariable logistic regression were used to determine differences and associations between HIV and MetS, CVD risk factors and ASCVD risk score.
A total of 300 people living with HIV (PLWHIV) and 298 HIV-negative participants with median age 44 years enrolled, 50% of whom were female. The prevalence of MetS was 8.9% overall, but lower among PLWHIV than HIV-negative participants (6.3% vs 11.6%, respectively; P = .001). The most prevalent MetS components were elevated blood pressure, decreased high density lipoprotein, and abdominal obesity. Adjusting for covariates, PLWHIV were 66% less likely to have MetS compared to HIV-negative participants (adjusted odds ratio [aOR] 0.34; 95% confidence interval [95%CI] 0.18, 0.65; P = .005). Median ASCVD risk score was also lower among PLWHIV compared to HIV-negative participants (1.7% vs 3.0%, P = .002).
MetS was more common among HIV-negative than HIV-positive adults, and HIV-negative adults were at greater risk for CVD compared to PLWHIV. These data support integration of routine CVD screening and management into health programs in resource-limited settings, regardless of HIV status.
Keywords: cardiovascular risk score, HIV, Kenya, metabolic syndrome |
Lamorde, Mohammed; Atwiine, Martha; Owarwo, Noela C; Ddungu, Ahmed; Laker, Eva O; Mubiru, Frank; Kiragga, Agnes; Lwanga, Isaac B; Castelnuovo, Barbara Dolutegravir-associated hyperglycaemia in patients with HIV Journal Article In: The Lancet HIV, vol. 7, no. 7, pp. e461-e462, 2020. @article{Lamorde2020,
title = {Dolutegravir-associated hyperglycaemia in patients with HIV},
author = {Mohammed Lamorde and Martha Atwiine and Noela C Owarwo and Ahmed Ddungu and Eva O Laker and Frank Mubiru and Agnes Kiragga and Isaac B Lwanga and Barbara Castelnuovo},
url = {https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(20)30042-4/fulltext},
doi = {https://doi.org/10.1016/S2352-3018(20)30042-4},
year = {2020},
date = {2020-07-01},
journal = {The Lancet HIV},
volume = {7},
number = {7},
pages = {e461-e462},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
andHailemichael Desalegn, Neil Gupta; Ocama, Ponsiano; Lacombe, Karine; Njouom, Richard; Afihene, Mary; Cunha, Lina; Spearman, C Wendy; Sonderup, Mark W; Kateera, Fredrick Converging pandemics: implications of COVID-19 for the viral hepatitis response in sub-Saharan Africa Journal Article In: The Lancet, Gastroenterology & Hepatology, vol. 5, no. 7, pp. 634-636, 2020. @article{andHailemichaelDesalegn2020,
title = {Converging pandemics: implications of COVID-19 for the viral hepatitis response in sub-Saharan Africa},
author = {Neil Gupta andHailemichael Desalegn and Ponsiano Ocama and Karine Lacombe and Richard Njouom and Mary Afihene and Lina Cunha and C Wendy Spearman and Mark W Sonderup and Fredrick Kateera},
url = {https://www.thelancet.com/journals/langas/article/PIIS2468-1253%2820%2930155-2/fulltext},
doi = {https://doi.org/10.1016/S2468-1253(20)30155-2},
year = {2020},
date = {2020-07-01},
journal = {The Lancet, Gastroenterology & Hepatology},
volume = {5},
number = {7},
pages = {634-636},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Wanga, Valentine; Baeten, Jared M.; Bukusi, Elizabeth A.; Mugo, Nelly R.; Asiimwe, Stephen; Ngure, Kenneth; Mujugira, Andrew; Muwonge, Timothy; Odoyo, Josephine B.; Haberer, Jessica E.; Celum, Connie; on behalf of the Partners Demonstration Project Team, Renee Heffron Sexual Behavior and Perceived HIV Risk Among HIV-Negative Members of Serodiscordant Couples in East Africa Journal Article In: AIDS and Behavior, vol. 24, no. 7, pp. pages2082–2090, 2020. @article{Wanga2020b,
title = {Sexual Behavior and Perceived HIV Risk Among HIV-Negative Members of Serodiscordant Couples in East Africa},
author = {Valentine Wanga and Jared M. Baeten and Elizabeth A. Bukusi and Nelly R. Mugo and Stephen Asiimwe and Kenneth Ngure and Andrew Mujugira and Timothy Muwonge and Josephine B. Odoyo and Jessica E. Haberer and Connie Celum and Renee Heffron on behalf of the Partners Demonstration Project Team},
url = {https://link.springer.com/article/10.1007%2Fs10461-019-02773-5},
doi = {https://doi.org/10.1007/s10461-019-02773-5},
year = {2020},
date = {2020-07-01},
journal = {AIDS and Behavior},
volume = {24},
number = {7},
pages = { pages2082–2090},
abstract = {Abstract
HIV risk perception may influence the use of HIV prevention interventions. Using data from HIV-negative adults enrolled in a study of pre-exposure prophylaxis (PrEP) and antiretroviral therapy for HIV-serodiscordant couples in Kenya and Uganda, we examined associations between: (1) condom use and risk perception and (2) risk perception and PrEP adherence. Two-thirds of HIV-negative partners reported condomless sex with their HIV-positive partner or another partner in the month prior to study enrollment. Compared to those who reported no condomless sex, participants who reported condomless sex during the month prior to study visit had fivefold higher odds of reporting “high risk” vs “no risk” perception (36.3 versus 10.9%: aOR 4.9, 95% CI 3.4–6.9). Reporting condomless sex in the most recent sex act was associated with increased odds of perceiving some HIV risk (aOR for high risk = 7.3, 95% CI 4.9–10.8; aOR for moderate risk = 4.8, 95% CI 3.5–6.7; aOR for low risk = 3.5, 95% CI 2.7–4.6). We found no significant association between risk perception and PrEP adherence. Sexual behavior aligned with perceived HIV risk, which can facilitate an HIV-negative individual’s decisions about PrEP use.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
HIV risk perception may influence the use of HIV prevention interventions. Using data from HIV-negative adults enrolled in a study of pre-exposure prophylaxis (PrEP) and antiretroviral therapy for HIV-serodiscordant couples in Kenya and Uganda, we examined associations between: (1) condom use and risk perception and (2) risk perception and PrEP adherence. Two-thirds of HIV-negative partners reported condomless sex with their HIV-positive partner or another partner in the month prior to study enrollment. Compared to those who reported no condomless sex, participants who reported condomless sex during the month prior to study visit had fivefold higher odds of reporting “high risk” vs “no risk” perception (36.3 versus 10.9%: aOR 4.9, 95% CI 3.4–6.9). Reporting condomless sex in the most recent sex act was associated with increased odds of perceiving some HIV risk (aOR for high risk = 7.3, 95% CI 4.9–10.8; aOR for moderate risk = 4.8, 95% CI 3.5–6.7; aOR for low risk = 3.5, 95% CI 2.7–4.6). We found no significant association between risk perception and PrEP adherence. Sexual behavior aligned with perceived HIV risk, which can facilitate an HIV-negative individual’s decisions about PrEP use. |
Avataneo, Valeria; de Nicolò, Amedeo; Cusato, Jessica; Antonucci, Miriam; Manca, Alessandra; Palermiti, Alice; Waitt, Catriona; Walimbwa, Stephen; Lamorde, Mohammed; di Perri, Giovanni; D’Avolio, Antonio Development and validation of a UHPLC-MS/MS method for quantification of the prodrug remdesivir and its metabolite GS-441524: a tool for clinical pharmacokinetics of SARS-CoV-2/COVID-19 and Ebola virus disease Journal Article In: Journal of Antimicrobial Chemotherapy, vol. 75, no. 7, pp. 1772–1777, 2020. @article{Avataneo2020,
title = {Development and validation of a UHPLC-MS/MS method for quantification of the prodrug remdesivir and its metabolite GS-441524: a tool for clinical pharmacokinetics of SARS-CoV-2/COVID-19 and Ebola virus disease },
author = {Valeria Avataneo and Amedeo de Nicolò and Jessica Cusato and Miriam Antonucci and Alessandra Manca and Alice Palermiti and Catriona Waitt and Stephen Walimbwa and Mohammed Lamorde and Giovanni di Perri and Antonio D’Avolio},
year = {2020},
date = {2020-07-01},
journal = {Journal of Antimicrobial Chemotherapy},
volume = {75},
number = {7},
pages = {1772–1777},
abstract = {Abstract
Background
Remdesivir has received significant attention for its potential application in the treatment of COVID-19, caused by SARS-CoV-2. Remdesivir has already been tested for Ebola virus disease treatment and found to have activity against SARS and MERS coronaviruses. The remdesivir core contains GS-441524, which interferes with RNA-dependent RNA polymerases alone. In non-human primates, following IV administration, remdesivir is rapidly distributed into PBMCs and converted within 2 h to the active nucleoside triphosphate form, while GS-441524 is detectable in plasma for up to 24 h. Nevertheless, remdesivir pharmacokinetics and pharmacodynamics in humans are still unexplored, highlighting the need for a precise analytical method for remdesivir and GS-441524 quantification.
Objectives
The validation of a reliable UHPLC-MS/MS method for remdesivir and GS-441524 quantification in human plasma.
Methods
Remdesivir and GS-441524 standards and quality controls were prepared in plasma from healthy donors. Sample preparation consisted of protein precipitation, followed by dilution and injection into the QSight 220 UHPLC-MS/MS system. Chromatographic separation was obtained through an Acquity HSS T3 1.8 μm, 2.1 × 50 mm column, with a gradient of water and acetonitrile with 0.05% formic acid. The method was validated using EMA and FDA guidelines.
Results
Analyte stability has been evaluated and described in detail. The method successfully fulfilled the validation process and it was demonstrated that, when possible, sample thermal inactivation could be a good choice in order to improve biosafety.
Conclusions
This method represents a useful tool for studying remdesivir and GS-441524 clinical pharmacokinetics, particularly during the current COVID-19 outbreak.
Topic:
ebola virus disease plasma prodrugs quality control united states food and drug administration guidelines pharmacokinetics metabolites remdesivir sars-cov-2 covid-19 },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Remdesivir has received significant attention for its potential application in the treatment of COVID-19, caused by SARS-CoV-2. Remdesivir has already been tested for Ebola virus disease treatment and found to have activity against SARS and MERS coronaviruses. The remdesivir core contains GS-441524, which interferes with RNA-dependent RNA polymerases alone. In non-human primates, following IV administration, remdesivir is rapidly distributed into PBMCs and converted within 2 h to the active nucleoside triphosphate form, while GS-441524 is detectable in plasma for up to 24 h. Nevertheless, remdesivir pharmacokinetics and pharmacodynamics in humans are still unexplored, highlighting the need for a precise analytical method for remdesivir and GS-441524 quantification.
Objectives
The validation of a reliable UHPLC-MS/MS method for remdesivir and GS-441524 quantification in human plasma.
Methods
Remdesivir and GS-441524 standards and quality controls were prepared in plasma from healthy donors. Sample preparation consisted of protein precipitation, followed by dilution and injection into the QSight 220 UHPLC-MS/MS system. Chromatographic separation was obtained through an Acquity HSS T3 1.8 μm, 2.1 × 50 mm column, with a gradient of water and acetonitrile with 0.05% formic acid. The method was validated using EMA and FDA guidelines.
Results
Analyte stability has been evaluated and described in detail. The method successfully fulfilled the validation process and it was demonstrated that, when possible, sample thermal inactivation could be a good choice in order to improve biosafety.
Conclusions
This method represents a useful tool for studying remdesivir and GS-441524 clinical pharmacokinetics, particularly during the current COVID-19 outbreak.
Topic:
ebola virus disease plasma prodrugs quality control united states food and drug administration guidelines pharmacokinetics metabolites remdesivir sars-cov-2 covid-19 |
Ssebambulidde, Kenneth; Segawa, Ivan; Laker, Eva; Lamorde, Mohammed; Castelnuovo, Barbara; Nakasujja, Noeline; Calcagno, Andrea Symptomatic cerebrospinal fluid HIV-1 escape in two patients on second-line antiretroviral therapy in Uganda Journal Article In: Oxford Medical Case Reports, no. 6, pp. omz121, 2020, ( This is a correction to:
Oxford Medical Case Reports, Volume 2019, Issue 2, February 2019, omy132, https://doi.org/10.1093/omcr/omy132
). @article{Ssebambulidde2020,
title = {Symptomatic cerebrospinal fluid HIV-1 escape in two patients on second-line antiretroviral therapy in Uganda },
author = { Kenneth Ssebambulidde and Ivan Segawa and Eva Laker and Mohammed Lamorde and Barbara Castelnuovo and Noeline Nakasujja and Andrea Calcagno},
url = {https://academic.oup.com/omcr/article/2020/6/omz121/5862477},
doi = {doi.org/10.1093/omcr/omz121},
year = {2020},
date = {2020-06-25},
journal = {Oxford Medical Case Reports},
number = {6},
pages = {omz121},
abstract = {Abstract
Two HIV-infected individuals on second-line atazanavir-based antiretroviral therapy presented with neuropsychiatric symptoms. Cerebrospinal fluid HIV RNA was higher than plasma HIV RNA and antiretroviral regimens’ optimization led to prompt resolution of symptoms in one. Patients on second-line atazanavir-based antiretroviral therapy with documented previous treatment failure may be at risk of symptomatic cerebrospinal fluid escape.},
note = { This is a correction to:
Oxford Medical Case Reports, Volume 2019, Issue 2, February 2019, omy132, https://doi.org/10.1093/omcr/omy132
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Two HIV-infected individuals on second-line atazanavir-based antiretroviral therapy presented with neuropsychiatric symptoms. Cerebrospinal fluid HIV RNA was higher than plasma HIV RNA and antiretroviral regimens’ optimization led to prompt resolution of symptoms in one. Patients on second-line atazanavir-based antiretroviral therapy with documented previous treatment failure may be at risk of symptomatic cerebrospinal fluid escape. |
Kwizera, Richard; Wadda, Vincent; Mugenyi, Levicatus; Aanyu-tukamuhebwa, Hellen; Yimer, George Nyale Getnet; Chakaya, Jeremiah; jong, Corina De; der molen, Thys Van; Denning, David W.; Gore, Robin; Kirenga, Bruce J. Skin prick reactivity among asthmatics in East Africa Journal Article In: World Allergy Organization Journal, vol. 13, no. 6, pp. 100130, 2020. @article{Kwizera2020c,
title = {Skin prick reactivity among asthmatics in East Africa},
author = {Richard Kwizera and Vincent Wadda and Levicatus Mugenyi and Hellen Aanyu-tukamuhebwa and George Nyale Getnet Yimer and Jeremiah Chakaya and Corina De jong and Thys Van der molen and David W. Denning and Robin Gore and Bruce J. Kirenga },
url = {https://www.sciencedirect.com/science/article/pii/S1939455120300338},
doi = {https://doi.org/10.1016/j.waojou.2020.100130},
year = {2020},
date = {2020-06-23},
journal = {World Allergy Organization Journal},
volume = {13},
number = {6},
pages = {100130},
abstract = {Abstract
Background
The burden of asthma in Africa is high, and yet the disease is not universally prioritised. Data on allergic asthma and its impact on asthma morbidity are limited in Africa. Our aim was to describe the distribution of skin prick positivity among asthmatics in Eastern Africa.
Methods
From August 2016 to May 2018, 1671 asthmatic patients were enrolled from Uganda, Kenya, and Ethiopia as part of the African Severe Asthma Program clinical study. Skin prick testing was performed at baseline using a panel of 12 allergens, and factors associated with skin prick reactivity determined.
Results
Of the 1, 671 patients recruited, 71% were female with a median age of 40 years, 93.6% were aged >15 years and the patterns of asthma symptom frequency was intermittent in 2.9%, mild persistent in 19.9%, moderate persistent in 42.6% and severe persistent in 34.6% at baseline. Self-reported triggers, were dust (92%), cold weather (89%), upper respiratory infections (84%), strong smells (79%) and exposure to tobacco (78%). The majority (90%) of the participants had at least 1 positive allergen reaction, with 0.9% participants reacting to all the 12 allergens. Participants commonly reacted to house dust mites (66%), Blomia tropicalis (62%), and the German cockroach (52%). Patients sensitized to more allergens (>2) had significantly reduced lung function (FEV ≤ 80%; p = 0.001) and were more likely to visit the emergency department due to asthma (p = 0.012). There was no significant relationship between number of allergens and measures of asthma control, quality of life, and other clinical outcomes. Only the country of origin was independently associated with atopy among African asthmatics.
Conclusion
There is a high prevalence of skin prick positivity among East African patients with asthma, with the commonest allergen being house dust mite. Skin reactivity did not correlate well with asthma severity and poor asthma control. The relation between atopy, measured through skin prick testing, and measures of asthma control among asthma patients in Eastern Africa is unclear and needs further study.
Trial registration
The ASAP study was registered prospectively. ClinicalTrials.gov Identifier: NCT03065920; Registration date: February 28, 2017; Last verified: February 28, 2017.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
The burden of asthma in Africa is high, and yet the disease is not universally prioritised. Data on allergic asthma and its impact on asthma morbidity are limited in Africa. Our aim was to describe the distribution of skin prick positivity among asthmatics in Eastern Africa.
Methods
From August 2016 to May 2018, 1671 asthmatic patients were enrolled from Uganda, Kenya, and Ethiopia as part of the African Severe Asthma Program clinical study. Skin prick testing was performed at baseline using a panel of 12 allergens, and factors associated with skin prick reactivity determined.
Results
Of the 1, 671 patients recruited, 71% were female with a median age of 40 years, 93.6% were aged >15 years and the patterns of asthma symptom frequency was intermittent in 2.9%, mild persistent in 19.9%, moderate persistent in 42.6% and severe persistent in 34.6% at baseline. Self-reported triggers, were dust (92%), cold weather (89%), upper respiratory infections (84%), strong smells (79%) and exposure to tobacco (78%). The majority (90%) of the participants had at least 1 positive allergen reaction, with 0.9% participants reacting to all the 12 allergens. Participants commonly reacted to house dust mites (66%), Blomia tropicalis (62%), and the German cockroach (52%). Patients sensitized to more allergens (>2) had significantly reduced lung function (FEV ≤ 80%; p = 0.001) and were more likely to visit the emergency department due to asthma (p = 0.012). There was no significant relationship between number of allergens and measures of asthma control, quality of life, and other clinical outcomes. Only the country of origin was independently associated with atopy among African asthmatics.
Conclusion
There is a high prevalence of skin prick positivity among East African patients with asthma, with the commonest allergen being house dust mite. Skin reactivity did not correlate well with asthma severity and poor asthma control. The relation between atopy, measured through skin prick testing, and measures of asthma control among asthma patients in Eastern Africa is unclear and needs further study.
Trial registration
The ASAP study was registered prospectively. ClinicalTrials.gov Identifier: NCT03065920; Registration date: February 28, 2017; Last verified: February 28, 2017. |
Bell, David; Hansen, Kristian Schultz; Kiragga, Agnes N.; Kambugu, Andrew; Kissa, John; and Anthony K. Mbonye, Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda Journal Article In: The American Journal of Tropical Medicine and Hygiene, vol. 103, no. 3, pp. 1191–1197 , 2020. @article{Bell2020,
title = {Predicting the Impact of COVID-19 and the Potential Impact of the Public Health Response on Disease Burden in Uganda},
author = {David Bell and Kristian Schultz Hansen and Agnes N. Kiragga and Andrew Kambugu and John Kissa and and Anthony K. Mbonye},
url = {https://www.ajtmh.org/search?f_0=author&q_0=John+Kissa},
doi = {https://doi.org/10.4269/ajtmh.20-0546},
year = {2020},
date = {2020-06-23},
journal = {The American Journal of Tropical Medicine and Hygiene},
volume = {103},
number = {3},
pages = {1191–1197 },
abstract = {The COVID-19 pandemic and public health “lockdown” responses in sub-Saharan Africa, including Uganda, are now widely reported. Although the impact of COVID-19 on African populations has been relatively light, it is feared that redirecting focus and prioritization of health systems to fight COVID-19 may have an impact on access to non–COVID-19 diseases. We applied age-based COVID-19 mortality data from China to the population structures of Uganda and non-African countries with previously established outbreaks, comparing theoretical mortality and disability-adjusted life years (DALYs) lost. We then predicted the impact of possible scenarios of the COVID-19 public health response on morbidity and mortality for HIV/AIDS, malaria, and maternal health in Uganda. Based on population age structure alone, Uganda is predicted to have a relatively low COVID-19 burden compared with an equivalent transmission in comparison countries, with 12% of the mortality and 19% of the lost DALYs predicted for an equivalent transmission in Italy. By contrast, scenarios of the impact of the public health response on malaria and HIV/AIDS predict additional disease burdens outweighing that predicted from extensive SARS-CoV-2 transmission. Emerging disease data from Uganda suggest that such deterioration may already be occurring. The results predict a relatively low COVID-19 impact on Uganda associated with its young population, with a high risk of negative impact on non–COVID-19 disease burden from a prolonged lockdown response. This may reverse hard-won gains in addressing fundamental vulnerabilities in women and children’s health, and underlines the importance of tailoring COVID-19 responses according to population structure and local disease vulnerabilities.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The COVID-19 pandemic and public health “lockdown” responses in sub-Saharan Africa, including Uganda, are now widely reported. Although the impact of COVID-19 on African populations has been relatively light, it is feared that redirecting focus and prioritization of health systems to fight COVID-19 may have an impact on access to non–COVID-19 diseases. We applied age-based COVID-19 mortality data from China to the population structures of Uganda and non-African countries with previously established outbreaks, comparing theoretical mortality and disability-adjusted life years (DALYs) lost. We then predicted the impact of possible scenarios of the COVID-19 public health response on morbidity and mortality for HIV/AIDS, malaria, and maternal health in Uganda. Based on population age structure alone, Uganda is predicted to have a relatively low COVID-19 burden compared with an equivalent transmission in comparison countries, with 12% of the mortality and 19% of the lost DALYs predicted for an equivalent transmission in Italy. By contrast, scenarios of the impact of the public health response on malaria and HIV/AIDS predict additional disease burdens outweighing that predicted from extensive SARS-CoV-2 transmission. Emerging disease data from Uganda suggest that such deterioration may already be occurring. The results predict a relatively low COVID-19 impact on Uganda associated with its young population, with a high risk of negative impact on non–COVID-19 disease burden from a prolonged lockdown response. This may reverse hard-won gains in addressing fundamental vulnerabilities in women and children’s health, and underlines the importance of tailoring COVID-19 responses according to population structure and local disease vulnerabilities. |
Bochner, Aaron F; Baeten, Jared M; Secor, W Evan; van Dam, Govert J; Szpiro, Adam A; Njenga, Sammy M; Corstjens, Paul L A M; Newsam, Austin; Mugo, Nelly R; Celum, Connie; Mujugira, Andrew; McClelland, R Scott; Barnabas, Ruanne V Associations between schistosomiasis and HIV‐1 acquisition risk in four prospective cohorts: a nested case‐control analysis Journal Article In: Journal of the International AIDS Society, vol. 23, no. 6, pp. e25534, 2020. @article{Bochner2020,
title = {Associations between schistosomiasis and HIV‐1 acquisition risk in four prospective cohorts: a nested case‐control analysis},
author = {Aaron F Bochner and Jared M Baeten and W Evan Secor and Govert J van Dam and Adam A Szpiro and Sammy M Njenga and Paul L A M Corstjens and Austin Newsam and Nelly R Mugo and Connie Celum and Andrew Mujugira and R Scott McClelland and Ruanne V Barnabas },
url = {https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25534},
doi = {https://doi.org/10.1002/jia2.25534},
year = {2020},
date = {2020-06-23},
journal = {Journal of the International AIDS Society},
volume = {23},
number = {6},
pages = {e25534},
abstract = {
Abstract
Introduction
Globally, schistosomes infect approximately 200 million people, with 90% of infections in sub‐Saharan Africa. Schistosomiasis is hypothesized to increase HIV‐1 acquisition risk, and multiple cross‐sectional studies reported strong associations. We evaluated this hypothesis within four large
prospective cohorts.
Methods
We conducted nested case‐control analyses within three longitudinal cohorts of heterosexual HIV‐1 serodiscordant couples and one female sex worker (FSW) cohort from Kenya and Uganda. The serodiscordant couples studies were conducted between 2004 and 2012 while the FSW cohort analysis included participant follow‐up from 1993 to 2014. Cases HIV‐1 seroconverted during prospective follow‐up; three controls were selected per case. The presence of circulating anodic antigen in archived serum, collected prior to HIV‐1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species. Data from serodiscordant couples cohorts were pooled, while the FSW cohort was analysed separately to permit appropriate confounder adjustment.
Results
We included 245 HIV‐1 seroconverters and 713 controls from the serodiscordant couples cohorts and 330 HIV‐1 seroconverters and 962 controls from the FSW cohort. The prevalence of active schistosomiasis was 20% among serodiscordant couples and 22% among FSWs. We found no association between schistosomiasis and HIV‐1 acquisition risk among males (adjusted odds ratio (aOR) = 0.99, 95% CI 0.59 to 1.67) or females (aOR = 1.21, 95% CI 0.64 to 2.30) in serodiscordant couples. Similarly, in the FSW cohort we detected no association (adjusted incidence rate ratio (aIRR) = 1.11, 95% CI 0.83 to 1.50). Exploring schistosome species‐specific effects, there was no statistically significant association between HIV‐1 acquisition risk and Schistosoma mansoni (serodiscordant couples: aOR = 0.90, 95% CI 0.56 to 1.44; FSW: aIRR = 0.83, 95% CI 0.53 to 1.20) or Schistosoma haematobium (serodiscordant couples: aOR = 1.06, 95% CI 0.46 to 2.40; FSW: aIRR = 1.64, 95% CI 0.93 to 2.87) infection.
Conclusions
Schistosomiasis was not a strong risk factor for HIV‐1 acquisition in these four prospective studies. S. mansoni was responsible for the majority of schistosomiasis in these cohorts, and our results do not support the hypothesis that S. mansoni infection is associated with increased HIV‐1 acquisition risk. S. haematobium infection was associated with a point estimate of elevated HIV‐1 risk in the FSW cohort that was not statistically significant, and there was no trend towards a positive association in the serodiscordant couples cohorts.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Introduction
Globally, schistosomes infect approximately 200 million people, with 90% of infections in sub‐Saharan Africa. Schistosomiasis is hypothesized to increase HIV‐1 acquisition risk, and multiple cross‐sectional studies reported strong associations. We evaluated this hypothesis within four large
prospective cohorts.
Methods
We conducted nested case‐control analyses within three longitudinal cohorts of heterosexual HIV‐1 serodiscordant couples and one female sex worker (FSW) cohort from Kenya and Uganda. The serodiscordant couples studies were conducted between 2004 and 2012 while the FSW cohort analysis included participant follow‐up from 1993 to 2014. Cases HIV‐1 seroconverted during prospective follow‐up; three controls were selected per case. The presence of circulating anodic antigen in archived serum, collected prior to HIV‐1 seroconversion, identified participants with active schistosomiasis; immunoblots determined the schistosome species. Data from serodiscordant couples cohorts were pooled, while the FSW cohort was analysed separately to permit appropriate confounder adjustment.
Results
We included 245 HIV‐1 seroconverters and 713 controls from the serodiscordant couples cohorts and 330 HIV‐1 seroconverters and 962 controls from the FSW cohort. The prevalence of active schistosomiasis was 20% among serodiscordant couples and 22% among FSWs. We found no association between schistosomiasis and HIV‐1 acquisition risk among males (adjusted odds ratio (aOR) = 0.99, 95% CI 0.59 to 1.67) or females (aOR = 1.21, 95% CI 0.64 to 2.30) in serodiscordant couples. Similarly, in the FSW cohort we detected no association (adjusted incidence rate ratio (aIRR) = 1.11, 95% CI 0.83 to 1.50). Exploring schistosome species‐specific effects, there was no statistically significant association between HIV‐1 acquisition risk and Schistosoma mansoni (serodiscordant couples: aOR = 0.90, 95% CI 0.56 to 1.44; FSW: aIRR = 0.83, 95% CI 0.53 to 1.20) or Schistosoma haematobium (serodiscordant couples: aOR = 1.06, 95% CI 0.46 to 2.40; FSW: aIRR = 1.64, 95% CI 0.93 to 2.87) infection.
Conclusions
Schistosomiasis was not a strong risk factor for HIV‐1 acquisition in these four prospective studies. S. mansoni was responsible for the majority of schistosomiasis in these cohorts, and our results do not support the hypothesis that S. mansoni infection is associated with increased HIV‐1 acquisition risk. S. haematobium infection was associated with a point estimate of elevated HIV‐1 risk in the FSW cohort that was not statistically significant, and there was no trend towards a positive association in the serodiscordant couples cohorts.
|
Mujugira, Andrew; Hendrix, Craig; Glidden, David V; Donnell, Deborah; GuohongWang,; Baeten, Jared M; Marzinke, Mark; Spinelli, Matthew A; Vincent, Michael; Gandhi, Monica; Mugo, Nelly; Team, Partners PrEP Study; Stalter, Randy M; Rodrigues, Warren C Urine Tenofovir Levels Measured by a Novel Immunoassay Predict HIV Protection Journal Article In: National AIDS Treatment Advocacy Project, 2020. @article{Mujugira2020,
title = {Urine Tenofovir Levels Measured by a Novel Immunoassay Predict HIV Protection},
author = {Andrew Mujugira and Craig Hendrix and David V Glidden and Deborah Donnell and GuohongWang and Jared M Baeten and Mark Marzinke and Matthew A Spinelli and Michael Vincent and Monica Gandhi and Nelly Mugo and Partners PrEP Study Team and Randy M Stalter and Warren C Rodrigues},
url = {https://www.natap.org/2020/HIV/ciaa785.pdf},
doi = {doi:10.1093/cid/ciaa785},
year = {2020},
date = {2020-06-23},
journal = {National AIDS Treatment Advocacy Project},
abstract = {Abstract
New tools are needed to support PrEPadherence for individuals at risk for HIV, including those that enable provision of real-time feedback. In a large, completed PrEP trial, adequate urine tenofovir levels measured by a novel immunoassay predicted HIV protection and showed good sensitivity and specificity for detectable plasma tenofovir.
Keywords: PrEP, HIV prevention, urine, immunoassay, ELISA},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
New tools are needed to support PrEPadherence for individuals at risk for HIV, including those that enable provision of real-time feedback. In a large, completed PrEP trial, adequate urine tenofovir levels measured by a novel immunoassay predicted HIV protection and showed good sensitivity and specificity for detectable plasma tenofovir.
Keywords: PrEP, HIV prevention, urine, immunoassay, ELISA |
Nyende, Louis; Kalyesubula, Robert; Sekasanvu, Emmanuel; Byakika-Kibwika, Pauline Prevalence of renal dysfunction among HIV infected patients receiving Tenofovir at Mulago: a cross-sectional study Journal Article In: BMC Nephrology, vol. 21, no. 1, pp. 232, 2020. @article{Nyende2020,
title = {Prevalence of renal dysfunction among HIV infected patients receiving Tenofovir at Mulago: a cross-sectional study},
author = {Louis Nyende and Robert Kalyesubula and Emmanuel Sekasanvu and Pauline Byakika-Kibwika },
url = {https://bmcnephrol.biomedcentral.com/articles/10.1186/s12882-020-01873-y},
doi = {https://doi.org/10.1186/s12882-020-01873-y},
year = {2020},
date = {2020-06-22},
journal = {BMC Nephrology},
volume = {21},
number = {1},
pages = {232},
abstract = {Abstract
Background
There is an increasing burden of non-communicable disease globally. Tenofovir disoproxil fumarate (TDF) is the most commonly prescribed antiretroviral drug globally. Studies show that patients receiving TDF are more prone to renal dysfunction at some point in time during treatment. Evaluation of kidney function is not routinely done in most HIV public clinics. Identification of renal dysfunction is key in resource constrained settings because managing patients with end stage renal disease is costly.
Method
This was a cross-sectional study conducted at an outpatient clinic in 2018 involving patients on TDF for at least 6 months who were 18 years or older. Patients with documented kidney disease and pregnancy were excluded. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula. Renal dysfunction was defined as any of the following; either eGFR< 60 mL/min/1.73m2,or proteinuria of ≥2+ on urine dipstick, glycosuria with normal blood glucose. Electrolyte abnormalities were also documented.
Results
We enrolled 278 participants. One hundred sixty nine (60.8%) were females, majority 234(84.2%) were < 50 years old, 205 (73.74%) were in WHO stage 1, most participants 271(97.5%) in addition to TDF were receiving lamivudine/efavirenz. The median age was 37(IQR 29–45) years; median duration on ART was 36 (IQR 24–60) months. The prevalence of renal dysfunction was 2.52% (7/278). Most noted electrolyte abnormality was hypocalcaemia (15.44%).
Conclusions
The prevalence of renal dysfunction was low though some participants had hypocalcaemia. Screening for kidney disease should be done in symptomatic HIV infected patients on TDF.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
There is an increasing burden of non-communicable disease globally. Tenofovir disoproxil fumarate (TDF) is the most commonly prescribed antiretroviral drug globally. Studies show that patients receiving TDF are more prone to renal dysfunction at some point in time during treatment. Evaluation of kidney function is not routinely done in most HIV public clinics. Identification of renal dysfunction is key in resource constrained settings because managing patients with end stage renal disease is costly.
Method
This was a cross-sectional study conducted at an outpatient clinic in 2018 involving patients on TDF for at least 6 months who were 18 years or older. Patients with documented kidney disease and pregnancy were excluded. Estimated glomerular filtration rate (eGFR) was calculated using the CKD-Epi formula. Renal dysfunction was defined as any of the following; either eGFR< 60 mL/min/1.73m2,or proteinuria of ≥2+ on urine dipstick, glycosuria with normal blood glucose. Electrolyte abnormalities were also documented.
Results
We enrolled 278 participants. One hundred sixty nine (60.8%) were females, majority 234(84.2%) were < 50 years old, 205 (73.74%) were in WHO stage 1, most participants 271(97.5%) in addition to TDF were receiving lamivudine/efavirenz. The median age was 37(IQR 29–45) years; median duration on ART was 36 (IQR 24–60) months. The prevalence of renal dysfunction was 2.52% (7/278). Most noted electrolyte abnormality was hypocalcaemia (15.44%).
Conclusions
The prevalence of renal dysfunction was low though some participants had hypocalcaemia. Screening for kidney disease should be done in symptomatic HIV infected patients on TDF. |
Parkes-Ratanshi, Rosalind; Kimeze, Joshua Mbazira; Nakku-Joloba, Edith; Hamill, Matthew M.; Namawejje, Mariam; Kiragga, Agnes; Byamugisha, Josaphat Kayogoza; Rompalo, Anne; Gaydos, Charlotte; Manabe, Yukari C. Low male partner attendance after syphilis screening in pregnant women leads to worse birth outcomes: the Syphilis Treatment of Partners (STOP) randomised control trial Journal Article In: Sexual Health, vol. 17, no. 3, pp. 214-222, 2020. @article{Parkes-Ratanshi2020,
title = {Low male partner attendance after syphilis screening in pregnant women leads to worse birth outcomes: the Syphilis Treatment of Partners (STOP) randomised control trial},
author = {Rosalind Parkes-Ratanshi and Joshua Mbazira Kimeze and Edith Nakku-Joloba and Matthew M. Hamill and Mariam Namawejje and Agnes Kiragga and Josaphat Kayogoza Byamugisha and Anne Rompalo and Charlotte Gaydos and Yukari C. Manabe },
url = {https://www.publish.csiro.au/SH/SH19092},
doi = {https://doi.org/10.1071/SH19092},
year = {2020},
date = {2020-06-12},
journal = {Sexual Health},
volume = {17},
number = {3},
pages = {214-222},
abstract = {
Abstract
Background: Maternal syphilis causes poor birth outcomes, including congenital syphilis. Testing and treatment of partners prevents reinfection, but strategies to improve partner attendance are failing. The aim of this study was to determine the effectiveness of three partner notification strategies. Methods: Pregnant women with a positive point-of-care treponemal test at three antenatal clinics (ANCs) in Kampala, Uganda, were randomised 1 : 1 : 1 to receive either notification slips (NS; standard of care), NS and a text messages (SMS) or NS and telephone calls. The primary outcome was the proportion of partners who attended the ANC and were treated for syphilis. Results: Between 2015 and 2016, 17 130 pregnant women were screened; 601 (3.5%) had a positive treponemal result, and 442 were enrolled in the study. Only 81 of 442 partners (18.3%; 23/152 (15.1%), 31/144 (21.5%) and 27/146 (18.5%) in the NS only, NS + SMS and NS + telephone call groups respectively) attended an ANC for follow-up; there were no significant differences between the groups. Twelve per cent of women attended the ANC with their male partner, and this proportion increased over time. Partner non-treatment was independently associated with adverse birth outcomes (odds ratio 2.75; 95% confidence interval 2.36–3.21; P < 0.001). Conclusions: Only 18.3% of partners of pregnant women who tested positive for syphilis received treatment. Female partners of non-attendant men had worse birth outcomes. Encouraging men to accompany women to the ANC and testing both may address the urgent need to treat partners of pregnant women in sub-Saharan Africa to reduce poor fetal outcomes.
Additional keywords: maternal syphilis, mobile phones, mother to child transmission, partner notification.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background: Maternal syphilis causes poor birth outcomes, including congenital syphilis. Testing and treatment of partners prevents reinfection, but strategies to improve partner attendance are failing. The aim of this study was to determine the effectiveness of three partner notification strategies. Methods: Pregnant women with a positive point-of-care treponemal test at three antenatal clinics (ANCs) in Kampala, Uganda, were randomised 1 : 1 : 1 to receive either notification slips (NS; standard of care), NS and a text messages (SMS) or NS and telephone calls. The primary outcome was the proportion of partners who attended the ANC and were treated for syphilis. Results: Between 2015 and 2016, 17 130 pregnant women were screened; 601 (3.5%) had a positive treponemal result, and 442 were enrolled in the study. Only 81 of 442 partners (18.3%; 23/152 (15.1%), 31/144 (21.5%) and 27/146 (18.5%) in the NS only, NS + SMS and NS + telephone call groups respectively) attended an ANC for follow-up; there were no significant differences between the groups. Twelve per cent of women attended the ANC with their male partner, and this proportion increased over time. Partner non-treatment was independently associated with adverse birth outcomes (odds ratio 2.75; 95% confidence interval 2.36–3.21; P < 0.001). Conclusions: Only 18.3% of partners of pregnant women who tested positive for syphilis received treatment. Female partners of non-attendant men had worse birth outcomes. Encouraging men to accompany women to the ANC and testing both may address the urgent need to treat partners of pregnant women in sub-Saharan Africa to reduce poor fetal outcomes.
Additional keywords: maternal syphilis, mobile phones, mother to child transmission, partner notification.
|
Workneh, Meklit; Hamill, Matthew M; Kakooza, Francis; Mande, Emmanuel; Wagner, Jessica; Mbabazi, Olive; Mugasha, Rodney; Kajumbula, Henry; Walwema, Richard; Zenilman, Jonathan; Musinguzi, Patrick; Kyambadde, Peter; Lamorde, Mohammed; Manabe, Yukari C Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report Journal Article In: JMIR Public Health Surveillance, vol. 6, no. 2, pp. e17009, 2020. @article{Workneh2020,
title = {Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report },
author = {Meklit Workneh and Matthew M Hamill and Francis Kakooza and Emmanuel Mande and Jessica Wagner and Olive Mbabazi and Rodney Mugasha and Henry Kajumbula and Richard Walwema and Jonathan Zenilman and Patrick Musinguzi and Peter Kyambadde and Mohammed Lamorde and Yukari C Manabe},
url = {https://publichealth.jmir.org/2020/2/e17009},
doi = {doi: 10.2196/17009 },
year = {2020},
date = {2020-06-10},
journal = {JMIR Public Health Surveillance},
volume = {6},
number = {2},
pages = {e17009},
abstract = {Abstract
Background:
Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization’s Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends.
Objective:
This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda.
Methods:
Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization’s EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods—disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing.
Results:
Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity.
Conclusions:
This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.
JMIR Public Health Surveill 2020;6(2):e17009
Keywords
gonorrhea (1); antimicrobial resistance (6); surveillance (107); Uganda; STD; STI; sexually transmitted (1); Neisseria Gonorrhoeae; antibiotic resistance, EGASP },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background:
Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization’s Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends.
Objective:
This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda.
Methods:
Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization’s EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods—disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing.
Results:
Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity.
Conclusions:
This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed.
JMIR Public Health Surveill 2020;6(2):e17009
Keywords
gonorrhea (1); antimicrobial resistance (6); surveillance (107); Uganda; STD; STI; sexually transmitted (1); Neisseria Gonorrhoeae; antibiotic resistance, EGASP |
Nsibirwa, Sara; Anguzu, Godwin; Kamukama, Sam; Ocama, Ponsiano; Nankya-Mutyoba, Joan Herbal medicine use among patients withviral and non-viral Hepatitis in Uganda:prevalence, patterns and related factors Journal Article In: BMC Complementary Medicine and Therapies, vol. 20, no. 1, pp. 169, 2020. @article{Nsibirwa2020,
title = {Herbal medicine use among patients withviral and non-viral Hepatitis in Uganda:prevalence, patterns and related factors},
author = {Sara Nsibirwa and Godwin Anguzu and Sam Kamukama and Ponsiano Ocama and Joan Nankya-Mutyoba},
url = {https://link.springer.com/content/pdf/10.1186/s12906-020-02959-8.pdf},
doi = {https://doi.org/10.1186/s12906-020-02959-},
year = {2020},
date = {2020-06-03},
journal = {BMC Complementary Medicine and Therapies},
volume = {20},
number = {1},
pages = {169},
abstract = {Abstract
Background:There is some evidence that patients with liver diseases commonly use complementary andalternative therapies to address general and liver-disease specific health concerns. The purpose of this study was toassess and describe prevalence, patterns and related factors of herbal medicine use among adults diagnosed withviral and non-viral hepatitis in Kampala, Uganda.Methods:A cross-sectional study was conducted on 310 adult patients attending the gastrointestinal clinic inMulago hospital referral hospital in Kampala. Data on prevalence, types and reasons for herbal medicine use wascollected using standardized questionnaires and focus group discussions. Modified Poisson regression analyseswere used to examine factors related to use.Results:Usage of various herbal remedies within 12 months prior to April 2018 was reported by 46.1% (143/310) ofpatients with 27.3% (39/143) of these reporting having used conventional and herbal therapies concurrently. Herbalremedies were used to treat various health conditions including hepatitis. Patients with hepatitis C virus infection(PRR = 1.16,p= 0.02) compared to those with hepatitis B virus infection, and those who believed that it was safe touse herbal and conventional therapies concurrently (PRR = 1.23,p= 0.008) had higher prevalence odds of herbalmedicine use. Conversely, patients who had been newly diagnosed with hepatitis (PRR = 0.69,p= 0.03) comparedto those who had been diagnosed more than one-year prior, had lower prevalence odds of herbal medicine use.Various types of local herbs were reported as most commonly used however most patients did not know theingredients of commercially prepared herbal therapies.Conclusion:A high prevalence of herbal medicine use was found among newly-diagnosed patients and patientswith hepatitis C more likely to use herbal remedies after adjusting for other factors. Usage was influenced by thebelief that herbal medicine is safe and effective. Health workers need to consistently elicit information about herbalremedy use. Research is needed on benefits, adverse effects and outcomes in patients who use herbal remedies totreat primary liver diseases in order to facilitate evidence of efficacy and product safety.
Keywords:
Complementary and alternative medicine, Hepatitis B, Hepatitis C, Herbal medicine},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background:There is some evidence that patients with liver diseases commonly use complementary andalternative therapies to address general and liver-disease specific health concerns. The purpose of this study was toassess and describe prevalence, patterns and related factors of herbal medicine use among adults diagnosed withviral and non-viral hepatitis in Kampala, Uganda.Methods:A cross-sectional study was conducted on 310 adult patients attending the gastrointestinal clinic inMulago hospital referral hospital in Kampala. Data on prevalence, types and reasons for herbal medicine use wascollected using standardized questionnaires and focus group discussions. Modified Poisson regression analyseswere used to examine factors related to use.Results:Usage of various herbal remedies within 12 months prior to April 2018 was reported by 46.1% (143/310) ofpatients with 27.3% (39/143) of these reporting having used conventional and herbal therapies concurrently. Herbalremedies were used to treat various health conditions including hepatitis. Patients with hepatitis C virus infection(PRR = 1.16,p= 0.02) compared to those with hepatitis B virus infection, and those who believed that it was safe touse herbal and conventional therapies concurrently (PRR = 1.23,p= 0.008) had higher prevalence odds of herbalmedicine use. Conversely, patients who had been newly diagnosed with hepatitis (PRR = 0.69,p= 0.03) comparedto those who had been diagnosed more than one-year prior, had lower prevalence odds of herbal medicine use.Various types of local herbs were reported as most commonly used however most patients did not know theingredients of commercially prepared herbal therapies.Conclusion:A high prevalence of herbal medicine use was found among newly-diagnosed patients and patientswith hepatitis C more likely to use herbal remedies after adjusting for other factors. Usage was influenced by thebelief that herbal medicine is safe and effective. Health workers need to consistently elicit information about herbalremedy use. Research is needed on benefits, adverse effects and outcomes in patients who use herbal remedies totreat primary liver diseases in order to facilitate evidence of efficacy and product safety.
Keywords:
Complementary and alternative medicine, Hepatitis B, Hepatitis C, Herbal medicine |
Ssengooba, Willy; de Dieu Iragena, Jean; Nakiyingi, Lydia; Mujumbi, Serestine; Wobudeya, Eric; Mboizi, Robert; Boulware, David; Meya, David B.; Choo, Louise; Crook, Angela M.; Lebeau, Kristen; Joloba, Moses; Demers, Anne-Marie; Cresswell, Fiona V.; Gibb, Diana M. Accuracy of Xpert Ultra in the diagnosis of pulmonary tuberculosis among children in Uganda: a sub-study from the SHINE trial. Journal Article In: Journal of Clinical Microbiology, 2020. @article{Ssengooba2020,
title = {Accuracy of Xpert Ultra in the diagnosis of pulmonary tuberculosis among children in Uganda: a sub-study from the SHINE trial. },
author = {Willy Ssengooba and Jean de Dieu Iragena and Lydia Nakiyingi and Serestine Mujumbi and Eric Wobudeya and Robert Mboizi and David Boulware and David B. Meya and Louise Choo and Angela M. Crook and Kristen Lebeau and Moses Joloba and Anne-Marie Demers and Fiona V. Cresswell and Diana M. Gibb},
url = {https://jcm.asm.org/content/58/9/e00410-20.full},
doi = {DOI: 10.1128/JCM.00410-20},
year = {2020},
date = {2020-06-03},
journal = {Journal of Clinical Microbiology},
abstract = {ABSTRACT
Childhood tuberculosis (TB) presents significant diagnostic challenges associated with paucibacillary disease and requires a more sensitive test. We evaluated the diagnostic accuracy of Xpert MTB/RIF Ultra (Ultra) compared to other microbiological tests using respiratory samples from Ugandan children in the SHINE trial. SHINE is a randomized trial evaluating shorter treatment in 1,204 children with minimal TB disease in Africa and India. Among 352 samples and one cervical lymph node fine needle aspirate, one sample was randomly selected per patient and tested with the Xpert MTB/RIF assay (Xpert) and with Lowenstein-Jensen medium (LJ) and liquid mycobacterial growth indicator tube (MGIT) cultures. We selected only uncontaminated stored sample pellets for Ultra testing. We estimated the sensitivity of Xpert and Ultra against culture and a composite microbiological reference standard (any positive result). Of 398 children, 353 (89%) had culture, Xpert, and Ultra results. The median age was 2.8 years (interquartile range [IQR], 1.3 to 5.3); 8.5% (30/353) were HIV infected, and 54.4% (192/353) were male. Of the 353, 31 (9%) were positive by LJ and/or MGIT culture, 36 (10%) by Ultra, and 16 (5%) by Xpert. Sensitivities (95% confidence intervals [CI]) were 58% (39 to 65% [18/31]) for Ultra and 45% (27 to 64% [14/31]) for Xpert against any culture-positive result, with false positives of <1% and 5.5% for Xpert and Ultra. Against a composite microbiological reference, sensitivities were 72% (58 to 84% [36/50]) for Ultra and 32% (20 to 47% [16/50]) for Xpert. However, there were 17 samples that were positive only with Ultra (majority trace). Among children screened for minimal TB in Uganda, Ultra has higher sensitivity than Xpert. This represents an important advance for a condition which has posed a diagnostic challenge for decades.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
ABSTRACT
Childhood tuberculosis (TB) presents significant diagnostic challenges associated with paucibacillary disease and requires a more sensitive test. We evaluated the diagnostic accuracy of Xpert MTB/RIF Ultra (Ultra) compared to other microbiological tests using respiratory samples from Ugandan children in the SHINE trial. SHINE is a randomized trial evaluating shorter treatment in 1,204 children with minimal TB disease in Africa and India. Among 352 samples and one cervical lymph node fine needle aspirate, one sample was randomly selected per patient and tested with the Xpert MTB/RIF assay (Xpert) and with Lowenstein-Jensen medium (LJ) and liquid mycobacterial growth indicator tube (MGIT) cultures. We selected only uncontaminated stored sample pellets for Ultra testing. We estimated the sensitivity of Xpert and Ultra against culture and a composite microbiological reference standard (any positive result). Of 398 children, 353 (89%) had culture, Xpert, and Ultra results. The median age was 2.8 years (interquartile range [IQR], 1.3 to 5.3); 8.5% (30/353) were HIV infected, and 54.4% (192/353) were male. Of the 353, 31 (9%) were positive by LJ and/or MGIT culture, 36 (10%) by Ultra, and 16 (5%) by Xpert. Sensitivities (95% confidence intervals [CI]) were 58% (39 to 65% [18/31]) for Ultra and 45% (27 to 64% [14/31]) for Xpert against any culture-positive result, with false positives of <1% and 5.5% for Xpert and Ultra. Against a composite microbiological reference, sensitivities were 72% (58 to 84% [36/50]) for Ultra and 32% (20 to 47% [16/50]) for Xpert. However, there were 17 samples that were positive only with Ultra (majority trace). Among children screened for minimal TB in Uganda, Ultra has higher sensitivity than Xpert. This represents an important advance for a condition which has posed a diagnostic challenge for decades. |
Bongomin, Felix; Asio, Lucy Grace; Baluku, Joseph Baruch; Kwizera, Richard; and David W. Denning, Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist Journal Article In: Journal of Fungi, vol. 6, no. 2, pp. 75, 2020. @article{Bongomin2020,
title = {Chronic Pulmonary Aspergillosis: Notes for a Clinician in a Resource-Limited Setting Where There Is No Mycologist },
author = {Felix Bongomin and Lucy Grace Asio and Joseph Baruch Baluku and Richard Kwizera and and David W. Denning},
url = {https://www.mdpi.com/2309-608X/6/2/75},
doi = {https://doi.org/10.3390/jof6020075},
year = {2020},
date = {2020-06-02},
journal = {Journal of Fungi},
volume = {6},
number = {2},
pages = {75},
abstract = {Abstract
Chronic pulmonary aspergillosis (CPA) is a spectrum of several progressive disease manifestations caused by Aspergillus species in patients with underlying structural lung diseases. Duration of symptoms longer than three months distinguishes CPA from acute and subacute invasive pulmonary aspergillosis. CPA affects over 3 million individuals worldwide. Its diagnostic approach requires a thorough Clinical, Radiological, Immunological and Mycological (CRIM) assessment. The diagnosis of CPA requires (1) demonstration of one or more cavities with or without a fungal ball present or nodules on chest imaging, (2) direct evidence of Aspergillus infection or an immunological response to Aspergillus species and (3) exclusion of alternative diagnoses, although CPA and mycobacterial disease can be synchronous. Aspergillus antibody is elevated in over 90% of patients and is the cornerstone for CPA diagnosis. Long-term oral antifungal therapy improves quality of life, arrests haemoptysis and prevents disease progression. Itraconazole and voriconazole are alternative first-line agents; voriconazole is preferred for patients with contra-indications to itraconazole and in those with severe disease (including large aspergilloma). In patients co-infected with tuberculosis (TB), it is not possible to treat TB with rifampicin and concurrently administer azoles, because of profound drug interactions. In those with pan-azole resistance or intolerance or progressive disease while on oral triazoles, short-term courses of intravenous liposomal amphotericin B or micafungin is used. Surgery benefits patients with well-circumscribed simple aspergillomas and should be offered earlier in low-resource settings. View Full-Text
Keywords: chronic pulmonary aspergillosis; mycoses; lung disease; resource-limited setting; epidemiology; chest X-ray; Aspergillus IgG },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Chronic pulmonary aspergillosis (CPA) is a spectrum of several progressive disease manifestations caused by Aspergillus species in patients with underlying structural lung diseases. Duration of symptoms longer than three months distinguishes CPA from acute and subacute invasive pulmonary aspergillosis. CPA affects over 3 million individuals worldwide. Its diagnostic approach requires a thorough Clinical, Radiological, Immunological and Mycological (CRIM) assessment. The diagnosis of CPA requires (1) demonstration of one or more cavities with or without a fungal ball present or nodules on chest imaging, (2) direct evidence of Aspergillus infection or an immunological response to Aspergillus species and (3) exclusion of alternative diagnoses, although CPA and mycobacterial disease can be synchronous. Aspergillus antibody is elevated in over 90% of patients and is the cornerstone for CPA diagnosis. Long-term oral antifungal therapy improves quality of life, arrests haemoptysis and prevents disease progression. Itraconazole and voriconazole are alternative first-line agents; voriconazole is preferred for patients with contra-indications to itraconazole and in those with severe disease (including large aspergilloma). In patients co-infected with tuberculosis (TB), it is not possible to treat TB with rifampicin and concurrently administer azoles, because of profound drug interactions. In those with pan-azole resistance or intolerance or progressive disease while on oral triazoles, short-term courses of intravenous liposomal amphotericin B or micafungin is used. Surgery benefits patients with well-circumscribed simple aspergillomas and should be offered earlier in low-resource settings. View Full-Text
Keywords: chronic pulmonary aspergillosis; mycoses; lung disease; resource-limited setting; epidemiology; chest X-ray; Aspergillus IgG |
Hoving, J. Claire; Brown, Gordon D.; Gómez, Beatriz L.; Govender, Nelesh P.; Limper, Andrew H.; May, Robin C.; Meya, David B.; from the Workshop on AIDS-related Mycoses, Working Group AIDS-Related Mycoses: Updated Progress and Future Priorities Journal Article In: Trends in Microbiology, vol. 28, no. 6, pp. 425-428, 2020. @article{Hoving2020,
title = {AIDS-Related Mycoses: Updated Progress and Future Priorities},
author = {J. Claire Hoving and Gordon D. Brown and Beatriz L. Gómez and Nelesh P. Govender and Andrew H. Limper and Robin C. May and David B. Meya and Working Group from the Workshop on AIDS-related Mycoses},
year = {2020},
date = {2020-06-01},
journal = {Trends in Microbiology},
volume = {28},
number = {6},
pages = {425-428},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Okurut, Samuel; Boulware, David R.; Olobo, Joseph; Meya, David B. Landmark clinical observations and immunopathogenesis pathways linked to HIV and Cryptococcus fatal central nervous system co‐infection Journal Article In: Mycoses, vol. 63, no. 8, 2020. @article{Okurut2020,
title = {Landmark clinical observations and immunopathogenesis pathways linked to HIV and Cryptococcus fatal central nervous system co‐infection },
author = {Samuel Okurut and David R. Boulware and Joseph Olobo and David B. Meya},
url = {https://onlinelibrary.wiley.com/doi/full/10.1111/myc.13122},
doi = { https://doi.org/10.1111/myc.13122},
year = {2020},
date = {2020-05-30},
journal = {Mycoses},
volume = {63},
number = {8},
abstract = {
Summary
Cryptococcal meningitis remains one of the leading causes of death among HIV‐infected adults in the fourth decade of HIV era in sub‐Saharan Africa, contributing to 10%–20% of global HIV‐related deaths. Despite widespread use and early induction of ART among HIV‐infected adults, incidence of cryptococcosis remains significant in those with advanced HIV disease. Cryptococcus species that causes fatal infection follows systemic spread from initial environmental acquired infection in lungs to antigenaemia and fungaemia in circulation prior to establishment of often fatal disease, cryptococcal meningitis in the CNS. Cryptococcus person‐to‐person transmission is uncommon, and deaths related to blood infection without CNS involvement are rare. Keen to the persistent high mortality associated with HIV‐cryptococcal meningitis, seizures are common among a third of the patients, altered mental status is frequent, anaemia is prevalent with ensuing brain hypoxia and at autopsy, brain fibrosis and infarction are evident. In addition, fungal burden is 3‐to‐4‐fold higher in those with seizures. And high immune activation together with exacerbated inflammation and elevated PD‐1/PD‐L immune checkpoint expression is immunomodulated phenotypes elevated in CSF relative to blood. Lastly, though multiple Cryptococcus species cause disease in this setting, observations are mostly generalised to cryptococcal infection/meningitis or regional dominant species (C neoformans or gattii complex) that may limit our understanding of interspecies differences in infection, progression, treatment or recovery outcome. Together, these factors and underlying mechanisms are hypotheses generating for research to find targets to prevent infection or adequate therapy to prevent persistent high mortality with current optimal therapy.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Summary
Cryptococcal meningitis remains one of the leading causes of death among HIV‐infected adults in the fourth decade of HIV era in sub‐Saharan Africa, contributing to 10%–20% of global HIV‐related deaths. Despite widespread use and early induction of ART among HIV‐infected adults, incidence of cryptococcosis remains significant in those with advanced HIV disease. Cryptococcus species that causes fatal infection follows systemic spread from initial environmental acquired infection in lungs to antigenaemia and fungaemia in circulation prior to establishment of often fatal disease, cryptococcal meningitis in the CNS. Cryptococcus person‐to‐person transmission is uncommon, and deaths related to blood infection without CNS involvement are rare. Keen to the persistent high mortality associated with HIV‐cryptococcal meningitis, seizures are common among a third of the patients, altered mental status is frequent, anaemia is prevalent with ensuing brain hypoxia and at autopsy, brain fibrosis and infarction are evident. In addition, fungal burden is 3‐to‐4‐fold higher in those with seizures. And high immune activation together with exacerbated inflammation and elevated PD‐1/PD‐L immune checkpoint expression is immunomodulated phenotypes elevated in CSF relative to blood. Lastly, though multiple Cryptococcus species cause disease in this setting, observations are mostly generalised to cryptococcal infection/meningitis or regional dominant species (C neoformans or gattii complex) that may limit our understanding of interspecies differences in infection, progression, treatment or recovery outcome. Together, these factors and underlying mechanisms are hypotheses generating for research to find targets to prevent infection or adequate therapy to prevent persistent high mortality with current optimal therapy.
|
Nuwagira, Edwin; Stadelman, Anna; Baluku, Joseph Baruch; Rhein, Joshua; Byakika-Kibwika, Pauline; Mayanja, Harriet; Kunisaki, Ken M. Obstructive lung disease and quality of life after cure of multi-drug-resistant tuberculosis in Uganda: a cross-sectional study Journal Article In: Tropical Medicine and Health, vol. 48, no. 34, 2020. @article{Nuwagira2020,
title = {Obstructive lung disease and quality of life after cure of multi-drug-resistant tuberculosis in Uganda: a cross-sectional study},
author = {Edwin Nuwagira and Anna Stadelman and Joseph Baruch Baluku and Joshua Rhein and Pauline Byakika-Kibwika and
Harriet Mayanja and Ken M. Kunisaki},
doi = {https://doi.org/10.1186/s41182-020-00221-y},
year = {2020},
date = {2020-05-19},
journal = {Tropical Medicine and Health},
volume = {48},
number = {34},
abstract = {Abstract
Background: Pulmonary multi-drug-resistant tuberculosis (MDR TB) alters lung architecture and involves lengthy
treatment duration, high pill burden, drug adverse effects, travel restrictions, and stigma. Literature about
pulmonary function and health-related quality of life (QoL) of patients treated for MDR TB is limited. This study
sought to determine the prevalence of chronic obstructive pulmonary disease (COPD) and QoL of patients who
were treated for pulmonary MDR TB.
Methods: Participants who completed 18 months of pulmonary MDR TB treatment and considered cured were
eligible to be evaluated in a cross-sectional study. We performed post-bronchodilator spirometry to measure forced
expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). COPD was defined as FEV1/FVC < 0.7; health-related
QoL was assessed using the Medical Outcomes Survey for HIV (MOS-HIV) and St. George’s Respiratory Questionnaire
(SGRQ). Linear and logistic regression models were used to assess associations with COPD, health-related QoL, and
other characteristics of the cohort.
Results: A total of 95 participants were enrolled. Median age of the cohort was 39 years (interquartile range (IQR),
29–45), and 55 (58%) were HIV-positive. COPD prevalence was 23% (22/95). Median SGRQ score was normal at 7.8
(IQR, 3.1–14.8). Median mental and physical health summary scores were significantly impaired, at 58.6 (IQR, 52.0–
61.5) and 52.9 (IQR, 47.8–57.9), respectively, on a scale of 0 to 100 where 100 represents excellent physical or
mental health. In this sample, 19% (18/95) of participants were in the lowest relative socioeconomic position (SEP)
while 34% (32/95) were in the highest relative SEP. Belonging in the lowest SEP group was the strongest predictor
of COPD.
Conclusion: Individuals who have completed MDR TB treatment have a high prevalence of COPD and low mental
and physical health summary scores. Our study highlights the need for pulmonary rehabilitation programs in
patients with a low socioeconomic position (SEP) after MDR TB treatment.
Keywords: Multi-drug-resistant tuberculosis, HIV, Uganda, COPD, Quality of life},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background: Pulmonary multi-drug-resistant tuberculosis (MDR TB) alters lung architecture and involves lengthy
treatment duration, high pill burden, drug adverse effects, travel restrictions, and stigma. Literature about
pulmonary function and health-related quality of life (QoL) of patients treated for MDR TB is limited. This study
sought to determine the prevalence of chronic obstructive pulmonary disease (COPD) and QoL of patients who
were treated for pulmonary MDR TB.
Methods: Participants who completed 18 months of pulmonary MDR TB treatment and considered cured were
eligible to be evaluated in a cross-sectional study. We performed post-bronchodilator spirometry to measure forced
expiratory volume in 1 s (FEV1) and forced vital capacity (FVC). COPD was defined as FEV1/FVC < 0.7; health-related
QoL was assessed using the Medical Outcomes Survey for HIV (MOS-HIV) and St. George’s Respiratory Questionnaire
(SGRQ). Linear and logistic regression models were used to assess associations with COPD, health-related QoL, and
other characteristics of the cohort.
Results: A total of 95 participants were enrolled. Median age of the cohort was 39 years (interquartile range (IQR),
29–45), and 55 (58%) were HIV-positive. COPD prevalence was 23% (22/95). Median SGRQ score was normal at 7.8
(IQR, 3.1–14.8). Median mental and physical health summary scores were significantly impaired, at 58.6 (IQR, 52.0–
61.5) and 52.9 (IQR, 47.8–57.9), respectively, on a scale of 0 to 100 where 100 represents excellent physical or
mental health. In this sample, 19% (18/95) of participants were in the lowest relative socioeconomic position (SEP)
while 34% (32/95) were in the highest relative SEP. Belonging in the lowest SEP group was the strongest predictor
of COPD.
Conclusion: Individuals who have completed MDR TB treatment have a high prevalence of COPD and low mental
and physical health summary scores. Our study highlights the need for pulmonary rehabilitation programs in
patients with a low socioeconomic position (SEP) after MDR TB treatment.
Keywords: Multi-drug-resistant tuberculosis, HIV, Uganda, COPD, Quality of life |
Nuwagira, Edwin; Stadelman, Anna; Baluku, Joseph Baruch; Rhein, Joshua; Byakika-Kibwika, Pauline; Mayanja, Harriet; Kunisaki, Ken M. RESEARCHOpen AccessObstructive lung disease and quality of lifeafter cure of multi-drug-resistanttuberculosis in Uganda: a cross-sectionalstudy Journal Article In: Tropical Medicine and Health, vol. 48, no. 48, 2020. @article{Nuwagira2020b,
title = {RESEARCHOpen AccessObstructive lung disease and quality of lifeafter cure of multi-drug-resistanttuberculosis in Uganda: a cross-sectionalstudy},
author = {Edwin Nuwagira and Anna Stadelman and Joseph Baruch Baluku and Joshua Rhein and Pauline Byakika-Kibwika and Harriet Mayanja and Ken M. Kunisaki},
url = {https://link.springer.com/content/pdf/10.1186/s41182-020-00221-y.pdf},
doi = {https://doi.org/10.1186/s41182-020-00221-},
year = {2020},
date = {2020-05-19},
journal = {Tropical Medicine and Health},
volume = {48},
number = {48},
abstract = {AbstractBackground:Pulmonary multi-drug-resistant tuberculosis (MDR TB) alters lung architecture and involves lengthytreatment duration, high pill burden, drug adverse effects, travel restrictions, and stigma. Literature aboutpulmonary function and health-related quality of life (QoL) of patients treated for MDR TB is limited. This studysought to determine the prevalence of chronic obstructive pulmonary disease (COPD) and QoL of patients whowere treated for pulmonary MDR TB.Methods:Participants who completed 18 months of pulmonary MDR TB treatment and considered cured wereeligible to be evaluated in a cross-sectional study. We performed post-bronchodilator spirometry to measure forcedexpiratory volume in 1 s (FEV1) and forced vital capacity (FVC). COPD was defined as FEV1/FVC < 0.7; health-relatedQoL was assessed using the Medical Outcomes Survey for HIV (MOS-HIV) and St. George’s Respiratory Questionnaire(SGRQ). Linear and logistic regression models were used to assess associations with COPD, health-related QoL, andother characteristics of the cohort.Results:A total of 95 participants were enrolled. Median age of the cohort was 39 years (interquartile range (IQR),29–45), and 55 (58%) were HIV-positive. COPD prevalence was 23% (22/95). Median SGRQ score was normal at 7.8(IQR, 3.1–14.8). Median mental and physical health summary scores were significantly impaired, at 58.6 (IQR, 52.0–61.5) and 52.9 (IQR, 47.8–57.9), respectively, on a scale of 0 to 100 where 100 represents excellent physical ormental health. In this sample, 19% (18/95) of participants were in the lowest relative socioeconomic position (SEP)while 34% (32/95) were in the highest relative SEP. Belonging in the lowest SEP group was the strongest predictorof COPD.Conclusion:Individuals who have completed MDR TB treatment have a high prevalence of COPD and low mentaland physical health summary scores. Our study highlights the need for pulmonary rehabilitation programs inpatients with a low socioeconomic position (SEP) after MDR TB treatment.Keywords:Multi-drug-resistant tuberculosis, HIV, Uganda, COPD, Quality of life},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AbstractBackground:Pulmonary multi-drug-resistant tuberculosis (MDR TB) alters lung architecture and involves lengthytreatment duration, high pill burden, drug adverse effects, travel restrictions, and stigma. Literature aboutpulmonary function and health-related quality of life (QoL) of patients treated for MDR TB is limited. This studysought to determine the prevalence of chronic obstructive pulmonary disease (COPD) and QoL of patients whowere treated for pulmonary MDR TB.Methods:Participants who completed 18 months of pulmonary MDR TB treatment and considered cured wereeligible to be evaluated in a cross-sectional study. We performed post-bronchodilator spirometry to measure forcedexpiratory volume in 1 s (FEV1) and forced vital capacity (FVC). COPD was defined as FEV1/FVC < 0.7; health-relatedQoL was assessed using the Medical Outcomes Survey for HIV (MOS-HIV) and St. George’s Respiratory Questionnaire(SGRQ). Linear and logistic regression models were used to assess associations with COPD, health-related QoL, andother characteristics of the cohort.Results:A total of 95 participants were enrolled. Median age of the cohort was 39 years (interquartile range (IQR),29–45), and 55 (58%) were HIV-positive. COPD prevalence was 23% (22/95). Median SGRQ score was normal at 7.8(IQR, 3.1–14.8). Median mental and physical health summary scores were significantly impaired, at 58.6 (IQR, 52.0–61.5) and 52.9 (IQR, 47.8–57.9), respectively, on a scale of 0 to 100 where 100 represents excellent physical ormental health. In this sample, 19% (18/95) of participants were in the lowest relative socioeconomic position (SEP)while 34% (32/95) were in the highest relative SEP. Belonging in the lowest SEP group was the strongest predictorof COPD.Conclusion:Individuals who have completed MDR TB treatment have a high prevalence of COPD and low mentaland physical health summary scores. Our study highlights the need for pulmonary rehabilitation programs inpatients with a low socioeconomic position (SEP) after MDR TB treatment.Keywords:Multi-drug-resistant tuberculosis, HIV, Uganda, COPD, Quality of life |
Bulterys, Michelle A.; Mujugira, Andrew; Nakyanzi, Agnes; Nampala, Miriam; Celum, Geoffrey Taasi Connie; Sharma, Monisha Costs of Providing HIV Self-Test Kits to Pregnant Women Living with HIV for Secondary Distribution to Male Partners in Uganda Journal Article In: MDPI, Diagnostics, vol. 10, no. 5, pp. 318, 2020. @article{Bulterys2020,
title = {Costs of Providing HIV Self-Test Kits to Pregnant Women Living with HIV for Secondary Distribution to Male Partners in Uganda},
author = {Michelle A. Bulterys and Andrew Mujugira and Agnes Nakyanzi and Miriam Nampala and Geoffrey Taasi Connie Celum and Monisha Sharma},
url = {https://www.mdpi.com/2075-4418/10/5/318},
doi = {https://doi.org/10.3390/diagnostics10050318},
year = {2020},
date = {2020-05-19},
journal = {MDPI, Diagnostics},
volume = {10},
number = {5},
pages = {318},
abstract = {Abstract
Background: Secondary distribution of HIV self-testing kits (HIVST) to pregnant women attending antenatal care (ANC) clinics to give to their male partners is a promising strategy to increase testing coverage among men, but its costs are unknown. Methods: We conducted micro-costing of a trial evaluating secondary distribution of HIVST on pregnant women living with HIV (PWLHIV) in an ANC in Kampala, Uganda. Costs (2019 USD) were collected from program budgets, expenditure records, time and motion observations, and staff interviews and estimated for three scenarios: as-studied, reflecting full costs of the research intervention, Ministry of Health (MOH) implementation, reflecting the research intervention if implemented by the MOH, and MOH roll-out, the current strategy being used to roll out HIVST distribution. Results: In the as-studied scenario, cost of HIVST provision was $13.96/PWLHIV reached, and $11.89 and $10.55 per HIV-positive and HIV-negative male partner, respectively, who linked to a clinic for facility-based testing. In the MOH implementation scenario, costs were $9.45/PWLHIV, and $7.87 and $6.99, respectively, per HIV-positive and HIV-negative male partner linking to the clinic. In the MOH roll-out scenario, the cost of HIVST provision to pregnant women regardless of HIV status was $3.70/woman, and $6.65/HIV-positive male partner. Conclusion: Secondary distribution of HIVST from pregnant women can be implemented at reasonable cost to increase testing among men in Uganda and similar settings in Africa. View Full-Text
Keywords:
HIV testing; HIV self-testing; secondary distribution; costing; pregnant women; Africa },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background: Secondary distribution of HIV self-testing kits (HIVST) to pregnant women attending antenatal care (ANC) clinics to give to their male partners is a promising strategy to increase testing coverage among men, but its costs are unknown. Methods: We conducted micro-costing of a trial evaluating secondary distribution of HIVST on pregnant women living with HIV (PWLHIV) in an ANC in Kampala, Uganda. Costs (2019 USD) were collected from program budgets, expenditure records, time and motion observations, and staff interviews and estimated for three scenarios: as-studied, reflecting full costs of the research intervention, Ministry of Health (MOH) implementation, reflecting the research intervention if implemented by the MOH, and MOH roll-out, the current strategy being used to roll out HIVST distribution. Results: In the as-studied scenario, cost of HIVST provision was $13.96/PWLHIV reached, and $11.89 and $10.55 per HIV-positive and HIV-negative male partner, respectively, who linked to a clinic for facility-based testing. In the MOH implementation scenario, costs were $9.45/PWLHIV, and $7.87 and $6.99, respectively, per HIV-positive and HIV-negative male partner linking to the clinic. In the MOH roll-out scenario, the cost of HIVST provision to pregnant women regardless of HIV status was $3.70/woman, and $6.65/HIV-positive male partner. Conclusion: Secondary distribution of HIVST from pregnant women can be implemented at reasonable cost to increase testing among men in Uganda and similar settings in Africa. View Full-Text
Keywords:
HIV testing; HIV self-testing; secondary distribution; costing; pregnant women; Africa |
Johnson, Julia; Robinson, Matthew L; Rajput, Uday C; Valvi, Chhaya; Kinikar, Aarti; Parikh, Tushar B; Vaidya, Umesh; Malwade, Sudhir; Agarkhedkar, Sharad; Randive, Bharat; Kadam, Abhay; Smith, Rachel M; Westercamp, Matthew; Mave, Vidya; Gupta, Amita; Milstone, Aaron M; Manabe, Yukari C High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India Journal Article In: Clinical Infectious Diseases, 2020. @article{Johnson2020,
title = {High Burden of Bloodstream Infections Associated With Antimicrobial Resistance and Mortality in the Neonatal Intensive Care Unit in Pune, India},
author = { Julia Johnson and Matthew L Robinson and Uday C Rajput and Chhaya Valvi and Aarti Kinikar and Tushar B Parikh and Umesh Vaidya and Sudhir Malwade and Sharad Agarkhedkar and Bharat Randive and Abhay Kadam and Rachel M Smith and Matthew Westercamp and Vidya Mave and Amita Gupta and Aaron M Milstone and Yukari C Manabe},
url = {https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa554/5839743?login=true},
doi = {https://doi.org/10.1093/cid/ciaa554},
year = {2020},
date = {2020-05-18},
journal = {Clinical Infectious Diseases},
abstract = {Abstract
Background
Antimicrobial resistance (AMR) is a growing threat to newborns in low- and middle-income countries (LMIC).
Methods
We performed a prospective cohort study in 3 tertiary neonatal intensive care units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSIs). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early-onset BSI was defined as BSI on day of life (DOL) 0–2 and late-onset BSI on DOL 3 or later.
Results
From 1 May 2017 until 30 April 2018, 4073 neonates were enrolled. Among at-risk neonates, 55 (1.6%) developed early-onset BSI and 176 (5.5%) developed late-onset BSI. The majority of BSIs were caused by gram-negative bacteria (GNB; 58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n = 53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early-onset BSI (31% vs 10%, P < .001) and late-onset BSI (24% vs 7%, P < .001). Non–low-birth-weight neonates with late-onset BSI had the greatest excess in mortality (22% vs 3%, P < .001).
Conclusions
In our cohort, neonatal BSIs were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.
neonatal sepsis, antimicrobial resistance, neonatal intensive care unit, low- and middle-income countries
Topic:
developing countries drug resistance, microbial gram-negative bacteria india newborn neonatal intensive care units mortality bloodstream infections },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Abstract
Background
Antimicrobial resistance (AMR) is a growing threat to newborns in low- and middle-income countries (LMIC).
Methods
We performed a prospective cohort study in 3 tertiary neonatal intensive care units (NICUs) in Pune, India, to describe the epidemiology of neonatal bloodstream infections (BSIs). All neonates admitted to the NICU were enrolled. The primary outcome was BSI, defined as positive blood culture. Early-onset BSI was defined as BSI on day of life (DOL) 0–2 and late-onset BSI on DOL 3 or later.
Results
From 1 May 2017 until 30 April 2018, 4073 neonates were enrolled. Among at-risk neonates, 55 (1.6%) developed early-onset BSI and 176 (5.5%) developed late-onset BSI. The majority of BSIs were caused by gram-negative bacteria (GNB; 58%); among GNB, 61 (45%) were resistant to carbapenems. Klebsiella spp. (n = 53, 23%) were the most common cause of BSI. Compared with neonates without BSI, all-cause mortality was higher among neonates with early-onset BSI (31% vs 10%, P < .001) and late-onset BSI (24% vs 7%, P < .001). Non–low-birth-weight neonates with late-onset BSI had the greatest excess in mortality (22% vs 3%, P < .001).
Conclusions
In our cohort, neonatal BSIs were most commonly caused by GNB, with a high prevalence of AMR, and were associated with high mortality, even in term neonates. Effective interventions are urgently needed to reduce the burden of BSI and death due to AMR GNB in hospitalized neonates in LMIC.
neonatal sepsis, antimicrobial resistance, neonatal intensive care unit, low- and middle-income countries
Topic:
developing countries drug resistance, microbial gram-negative bacteria india newborn neonatal intensive care units mortality bloodstream infections |
