@article{Tibuakuu2020,

title = {Elevated liver stiffness without histological evidence of liver fibrosis in rural Ugandans},

author = {Martin Tibuakuu and Caroline Jjingo and Gregory Dale Kirk and David Lee Thomas and Ronald Gray and Victor Ssempijja and Fred Nalugoda and David Serwadda and Ponsiano Ocama and Christopher Kenneth Opio and David Erwin Kleiner and Thomas Charles Quinn and Steven James Reynolds},

url = {https://onlinelibrary.wiley.com/doi/abs/10.1111/jvh.13320},

doi = {https://doi.org/10.1111/jvh.13320},

year  = {2020},

date = {2020-05-10},

journal = {Journal of Viral Hepatitis},

abstract = {Abstract



Liver fibrosis may be assessed noninvasively with transient electrography (TE). Data on the performance of TE for detecting liver fibrosis in sub‐Saharan Africa are limited. We evaluated the diagnostic accuracy of TE by performing liver biopsies on persons with liver fibrosis indicated by TE. We enrolled HIV‐infected and HIV‐uninfected participants with TE scores consistent with at least minimal disease (liver stiffness measurement [LSM]≥7.1 kPa). Biopsies were performed and staged using the Ishak scoring system. A concordant result was defined using accepted thresholds for significant fibrosis by TE (LSM ≥ 9.3 kPa) and liver biopsy (Ishak score ≥ 2). We used modified Poisson regression methods to quantify the univariate and adjusted prevalence risk ratios (PRR) of the association between covariates and the concordance status of TE and liver biopsy in defining the presence of liver fibrosis. Of 131 participants with valid liver biopsy and TE data, only 5 participants (3.8%) had Ishak score ≥ 2 of whom 4 had LSM ≥ 9.3 kPa (sensitivity = 80%); of the 126 (96.2%) with Ishak score < 2, 76 had LSM < 9.3 kPa (specificity = 61%). In multivariable analysis, discordance was associated with female gender (adjPRR = 1.80, 95%CI 1.1‐2.9; P = .019), herbal medicine use (adjPRR 1.64, 95% CI = 1.0‐2.5; P = .022), exposure to lake or river water (adjPRR 2.05, 95% CI = 1.1‐3.7; P = .016), and current smoking (adjPRR 1.72, 95%CI 1.0‐2.9; P = .045). These data suggest that TE among rural Ugandans has low specificity for detection of histologically confirmed liver fibrosis. Caution should be exercised when using this tool to confirm significant liver fibrosis.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kintu2020,

title = {Dolutegravir versus efavirenz in women starting HIV therapy in late pregnancy (DolPHIN-2): an open-label, randomised controlled trial},

author = {Kenneth Kintu and Thokozile R Malaba and Jesca Nakibuka and Christiana Papamichael and Angela Colbers and Kelly Byrne and Kay Seden Pharm and Eva Maria Hodel and Tao Chen and AdellineTwimukye and Josaphat Byamugisha and Helen Reynolds and Victoria Watson and David Burger and Duolao Wang and Catriona Waitt and Miriam Taegtmeyer and Catherine Orrell and Saye Khoo},

url = {https://www.sciencedirect.com/science/article/abs/pii/S2352301820300503},

doi = {https://doi.org/10.1016/S2352-3018(20)30050-3},

year  = {2020},

date = {2020-05-01},

journal = {The Lancet, HIV},

volume = {7},

number = {5},

pages = {e332-e339},

abstract = {Summary

Background



Late initiation of HIV antiretroviral therapy (ART) in pregnancy is associated with not achieving viral suppression before giving birth and increased mother-to-child transmission of HIV. We aimed to investigate virological suppression before giving birth with dolutegravir compared with efavirenz, when initiated during the third trimester.

Methods



In this randomised, open-label trial, DolPHIN-2, we recruited pregnant women in South Africa and Uganda aged at least 18 years, with untreated but confirmed HIV infection and an estimated gestation of at least 28 weeks, initiating ART in third trimester. Participants were randomly assigned (1:1) to dolutegravir-based or efavirenz-based therapy. HIV viral load was measured 7 days and 28 days after antiretroviral initiation, at 36 weeks' gestation, and at the post-partum visit (0–14 days post partum). The primary efficacy outcome was a viral load of less than 50 copies per mL at the first post-partum visit, and the primary safety outcome was the occurrence of drug-related adverse events in mothers and infants until the post-partum visit. Longer-term follow-up of mothers and infants continues. This study is registered with ClinicalTrials.gov, NCT03249181.

Findings



Between Jan 23, and Aug 15, 2018, we randomly assigned 268 mothers to dolutegravir (135) or efavirenz (133). All mothers and their infants were included in the safety analysis, and 250 mothers (125 in the dolutegravir group, 125 in the efavirenz group) and their infants in efficacy analyses, by intention-to-treat analyses. The median duration of maternal therapy at birth was 55 days (IQR 33–77). 89 (74%) of 120 in the dolutegravir group had viral loads less than 50 copies per mL, compared with 50 (43%) of 117 in the efavirenz group (risk ratio 1·64, 95% CI 1·31–2·06). 30 (22%) of 137 mothers in the dolutegravir group reported serious adverse events compared with 14 (11%) of 131 in the efavirenz group (p=0·013), particularly surrounding pregnancy and puerperium. We found no differences in births less than 37 weeks and less than 34 weeks gestation (16·4% vs 3·3%, across both groups). Three stillbirths in the dolutegravir group and one in the efavirenz group were considered unrelated to treatment. Three infant HIV infections were detected, all in the dolutegravir group, and were considered likely to be in-utero transmissions.

Interpretation



Our data support the revision to WHO guidelines recommending the transition to dolutegravir in first-line ART for all adults, regardless of pregnancy or child-bearing potential.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ssemwanga2020,

title = {Prevalence of viral load suppression, predictors of virological failure and patterns of HIV drug resistance after 12 and 48 months on first-line antiretroviral therapy: a national cross-sectional survey in Uganda},

author = { Deogratius Ssemwanga and Juliet Asio and Christine Watera and Maria Nannyonjo and Faridah Nassolo and Sandra Lunkuse and Jesus F Salazar-Gonzalez and Maria G Salazar and Grace Sanyu and Tom Lutalo and Usher Kabuga and Isaac Ssewanyana and Faridah Namatovu and Grace Namayanja and Alice Namale and Elliot Raizes and Mugagga Kaggwa and Norah Namuwenge and Wilford Kirungi and Edward Katongole-Mbidde and Pontiano Kaleebu and The Uganda HIV Drug Resistance Technical Working Group },

url = {https://academic.oup.com/jac/article/75/5/1280/5727896?login=true},

doi = {https://doi.org/10.1093/jac/dkz561},

year  = {2020},

date = {2020-05-01},

journal = {Journal of Antimicrobial Chemotherapy},

volume = {75},

number = {5},

pages = {1280–1289},

abstract = {Abstract



Objectives



We implemented the WHO cross-sectional survey protocol to determine rates of HIV viral load (VL) suppression (VLS), and weighted prevalence, predictors and patterns of acquired drug resistance (ADR) in individuals with virological failure (VF) defined as VL ≥1000 copies/mL.



Methods



We enrolled 547 and 1064 adult participants on first-line ART for 12 (±3) months (ADR12) and ≥48 months (ADR48), respectively. Dried blood spots and plasma specimens were collected for VL testing and genotyping among the VFs.



Results

VLS was 95.0% (95% CI 93.4%–96.5%) in the ADR12 group and 87.9% (95% CI 85.0%–90.9%) in the ADR48 group. The weighted prevalence of ADR was 96.1% (95% CI 72.9%–99.6%) in the ADR12 and 90.4% (95% CI 73.6–96.8%) in the ADR48 group, out of the 30 and 95 successful genotypes in the respective groups. Initiation on a zidovudine-based regimen compared with a tenofovir-based regimen was significantly associated with VF in the ADR48 group; adjusted OR (AOR) 1.96 (95% CI 1.13–3.39). Independent predictors of ADR in the ADR48 group were initiation on a zidovudine-based regimen compared with tenofovir-based regimens, AOR 3.16 (95% CI 1.34–7.46) and ART duration of ≥82 months compared with <82 months, AOR 1.92 (95% CI 1.03–3.59).



Conclusions

While good VLS was observed, the high prevalence of ADR among the VFs before they underwent the recommended three intensive adherence counselling (IAC) sessions followed by repeat VL testing implies that IAC prior to treatment switching may be of limited benefit in improving VLS.



Topic:

hiv drug resistance adult anti-hiv agents counseling genotype plasma uganda viral load result world health organization zidovudine virology tenofovir anti-retroviral agents genotype determination blood spot specimen },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{MacCarthy2020b,

title = {Lessons learned from a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda},

author = {Sarah MacCarthy and Alexandra Mendoza-Graf and Uzaib Saya and Clare Samba and Josephine Birungi and Stephen Okoboi and Sebastian Linnemayr },

url = {https://www.tandfonline.com/doi/abs/10.1080/09540121.2019.1622630},

doi = {https://doi.org/10.1080/09540121.2019.1622630},

year  = {2020},

date = {2020-05-01},

journal = {AIDS Care - Psychological and Socio-medical Aspects of AIDS/HIV },

volume = {32},

number = {5},

pages = {616-622},

abstract = {ABSTRACT



Evidence suggests that simple text messaging interventions may not suffice to improve ART adherence among youth in low-resource settings. To address this shortcoming, we developed an intervention that shared weekly real-time adherence feedback to youth in Uganda using short message services (SMS), based on information tracked by an electronic device (Wisepill). We present results from 7 formative and 6 exit focus groups (FGs) in Mulago and Entebbe, Uganda with youth ages 15–24, providers, and Community Advisory Board members. Participants consistently conveyed positive impressions of Wisepill, noting that it helped store their medications, facilitated travel, served as a reminder, and motivated adherence. Participants raised phone-related issues before the study; most were addressed but some remained (e.g., limited network access, electricity for powering phones). Further, they highlighted the importance of carefully crafting text messages (e.g., use slang rather than potentially stigmatizing words) and viewed personalizing messages favorably but were divided on the desirability of including their name in study-related texts. Exit FGs confirmed that sharing group adherence levels with participants tapped into the competitive spirit common among youth. Our results suggest future mobile technology-based interventions can be improved by providing messages that go beyond simple reminders to provide individual and group-level adherence feedback.



KEYWORDS: 

Mobile technologytext messageHIVbehavioral economics},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kwizera2020d,

title = {Mycetoma in Uganda: A neglected tropical disease},

author = {Richard Kwizera and Felix Bongomin and David B. Meya and David W. Denning and Ahmed H. Fahal and Robert Lukande},

url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0008240},

doi = { https://doi.org/10.1371/journal.pntd.0008240},

year  = {2020},

date = {2020-04-29},

journal = {PLOS Neglected Tropical Diseases},

volume = {14},

number = {4},

pages = {e0008240},

abstract = {Abstract



Mycetoma is considered a neglected tropical disease globally. However, data on its burden and the associated complications in Uganda are limited. Hence we aimed to estimate its burden in Uganda. Firstly, a systematic PubMed search for all studies of any design on mycetoma in Uganda without restriction to the year of publication was conducted. A retrospective review of all the biopsy reports at the Pathology Reference Laboratory, Department of Pathology, Makerere University, Kampala, Uganda from January 1950 to September 2019 was conducted to identify any reports on mycetoma histological diagnosis. During the 70-years study period, 30 cases were identified by the literature review, with 249 additional cases identified by review of biopsy reports (total of 279 cases). The average incidence was estimated at 0.32/100,000 persons and prevalence of 8.32/100,000 persons per decade. However, there was a general decline in the number of cases detected recently. Males and the age group of 21–30 years were the most affected by mycetoma in Uganda, and only 7% of the cases were children. The highest number of cases was recorded from Kampala (n = 30) and Jinja (n = 19) districts. The majority of the cases (68%) were referred from surgical units. The foot was the most affected part of the body (72%). Ten per cent of the cases had bone involvement of which 58% required amputation. Fungi were the most common causative agents (89%) followed by Nocardia species (5%) and Actinomycetes (4%). The index of clinical suspicion of mycetoma was low (45%) with a very large differential diagnosis. Mycetoma is a relatively rare disease in Uganda, mostly caused by fungi, and there is a big gap in data and epidemiological studies. More systematic studies are warranted to define the true burden of mycetoma in Uganda.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{McNaughton2020,

title = {Hepatitis B virus seroepidemiology data for Africa: Modelling intervention strategies based on a systematic review and meta-analysis},

author = {Anna L. McNaughton and José Lourenço and Phillip Armand Bester and Jolynne Mokaya and Sheila F. Lumley and Uri Obolski and Donall Forde and Tongai G. Maponga and Kenneth R. Katumba and Dominique Goedhals and Sunetra Gupta and Janet Seeley and Robert Newton and Ponsiano Ocama and Philippa C. Matthew},

url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1003068},

doi = { https://doi.org/10.1371/journal.pmed.1003068},

year  = {2020},

date = {2020-04-21},

journal = {PLOS MEDICINE},

volume = {17},

number = {4},

pages = {e1003068},

abstract = {Abstract

Background



International Sustainable Development Goals (SDGs) for elimination of hepatitis B virus (HBV) infection set ambitious targets for 2030. In African populations, infant immunisation has been fundamental to reducing incident infections in children, but overall population prevalence of chronic hepatitis B (CHB) infection remains high. In high-prevalence populations, adult catch-up vaccination has sometimes been deployed, but an alternative Test and Treat (T&T) approach could be used as an intervention to interrupt transmission. Universal T&T has not been previously evaluated as a population intervention for HBV infection, despite high-profile data supporting its success with human immunodeficiency virus (HIV).

Methods and findings



We set out to investigate the relationship between prevalence of HBV infection and exposure in Africa, undertaking a systematic literature review in November 2019. We identified published seroepidemiology data representing the period 1995–2019 from PubMed and Web of Science, including studies of adults that reported prevalence of both hepatitis B surface antigen (HBsAg; prevalence of HBV infection) and antibody to hepatitis B core antigen (anti-HBc; prevalence of HBV exposure). We identified 96 studies representing 39 African countries, with a median cohort size of 370 participants and a median participant age of 34 years. Using weighted linear regression analysis, we found a strong relationship between the prevalence of infection (HBsAg) and exposure (anti-HBc) (R2 = 0.45, p < 0.001). Region-specific differences were present, with estimated CHB prevalence in Northern Africa typically 30% to 40% lower (p = 0.007) than in Southern Africa for statistically similar exposure rates, demonstrating the need for intervention strategies to be tailored to individual settings. We applied a previously published mathematical model to investigate the effect of interventions in a high-prevalence setting. The most marked and sustained impact was projected with a T&T strategy, with a predicted reduction of 33% prevalence by 20 years (95% CI 30%–37%) and 62% at 50 years (95% CI 57%–68%), followed by routine neonatal vaccination and prevention of mother to child transmission (PMTCT; at 100% coverage). In contrast, the impact of catch-up vaccination in adults had a negligible and transient effect on population prevalence. The study is constrained by gaps in the published data, such that we could not model the impact of antiviral therapy based on stratification by specific clinical criteria and our model framework does not include explicit age-specific or risk-group assumptions regarding force of transmission.

Conclusions



The unique data set collected in this study highlights how regional epidemiology data for HBV can provide insights into patterns of transmission, and it provides an evidence base for future quantitative research into the most effective local interventions. In combination with robust neonatal immunisation programmes, ongoing PMTCT efforts, and the vaccination of high-risk groups, diagnosing and treating HBV infection is likely to be of most impact in driving advances towards elimination targets at a population level.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Francis2020,

title = {An Individual Participant Data Population Pharmacokinetic Meta-analysis of Drug-Drug Interactions between Lumefantrine and Commonly Used Antiretroviral Treatment},

author = {Jose Francis and Karen I. Barnes and Lesley Workman and Tamara Kredo and Lasse S. Vestergaard and Richard M. Hoglund and Pauline Byakika-Kibwika and Mohammed Lamorde and Stephen I. Walimbwa and Ifeyinwa Chijioke-Nwauche and Colin J. Sutherland and Concepta Merry and Kimberley K. Scarsi and Nyagonde Nyagonde and Martha M. Lemnge and Saye H. Khoo and Ib C. Bygbjerg and Sunil Parikh and Francesca T. Aweeka and Joel Tarning, Paolo Denti},

url = {https://aac.asm.org/content/64/5/e02394-19.abstract},

doi = {DOI: 10.1128/AAC.02394-19},

year  = {2020},

date = {2020-04-21},

journal = {America Society for Microbiology, Antimicrobial Agents and Chemotherapy},

volume = {64},

number = {5},

pages = {e02394-19},

abstract = {ABSTRACT



Treating malaria in HIV-coinfected individuals should consider potential drug-drug interactions. Artemether-lumefantrine is the most widely recommended treatment for uncomplicated malaria globally. Lumefantrine is metabolized by CYP3A4, an enzyme that commonly used antiretrovirals often induce or inhibit. A population pharmacokinetic meta-analysis was conducted using individual participant data from 10 studies with 6,100 lumefantrine concentrations from 793 nonpregnant adult participants (41% HIV-malaria-coinfected, 36% malaria-infected, 20% HIV-infected, and 3% healthy volunteers). Lumefantrine exposure increased 3.4-fold with coadministration of lopinavir-ritonavir-based antiretroviral therapy (ART), while it decreased by 47% with efavirenz-based ART and by 59% in the patients with rifampin-based antituberculosis treatment. Nevirapine- or dolutegravir-based ART and malaria or HIV infection were not associated with significant effects. Monte Carlo simulations showed that those on concomitant efavirenz or rifampin have 49% and 80% probability of day 7 concentrations <200 ng/ml, respectively, a threshold associated with an increased risk of treatment failure. The risk of achieving subtherapeutic concentrations increases with larger body weight. An extended 5-day and 6-day artemether-lumefantrine regimen is predicted to overcome these drug-drug interactions with efavirenz and rifampin, respectively.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Byonanebye2020,

title = {High viral suppression and low attrition in healthy HIV-infected patients initiated on ART with CD4 above 500 cells/μL in a program setting in Uganda},

author = {Dathan M Byonanebye, Fred C Semitala, Jackson Katende, Alex Bakenga, Irene Arinaitwe, Peter Kyambadde, Patrick Musinguzi, Irene Andia Biraro, Pauline Byakika-Kibwika, Moses R Kamya},

doi = { DOI: 10.4314/ahs.v20i1.18 },

year  = {2020},

date = {2020-04-20},

journal = { African Health Sciences },

volume = {20},

number = {1},

abstract = {Abstract

Background: The World Health Organization recommends antiretroviral therapy (ART) for all HIV-infected patients at all CD4 counts. However, there are concerns that asymptomatic patients may have poorer viral suppression and high attrition.



Objectives: 

We sought to determine attrition and viral suppression among healthy HIV-infected patients initiated on ART in program settings.



Methods: 

This cross-sectional study enrolled ART-experienced patients attending two PEPFAR-supported, high-volume clinics in Kampala, Uganda. Eligible patients were >18 years and had completed at least six months on ART. Participants were inter- viewed on socio-demographics, ART history and plasma viral load (VL) determined using Abbott Real-time. Predictors of viral suppression (<75 copies/ml) were determined using multivariate logistic regression.



Results: 

Overall, 267 participants were screened, 228 were eligible and 203 (89%) retained in care (visit within 90 days). Of the 203 participants, 115 (56.7%) were key-populations. Viral suppression was achieved in 173 patients (85%; 95% CI, 80.3%- 90.1%). The factors associated with viral suppression were prior VL tests (AOR 6.98; p-value <0.001) and receiving care from a general clinic (AOR 5.41; p=0.009).



Conclusion: 

Asymptomatic patients initiated on ART with high baseline CD4 counts, achieve high viral suppression with low risk of attrition. VL monitoring and clinic type are associated with viral suppression.



Keywords: 

Key populations; viral load; acquired immunodeficiency syndrome. },

keywords = {},

pubstate = {forthcoming},

tppubtype = {article}

}

@article{Naggirinya12020,

title = {Functional adrenal insufficiency among tuberculosis-human immunodeficiency virus co-infected patients: a cross-sectional study in Uganda},

author = {Agnes Bwanika Naggirinya1,2*, Andrew Mujugira2,3, David B. Meya1,2, Irene Andia Biraro1,6, Ezekiel Mupere5,

William Worodria1,2 and Yukari C. Manabe2,4},

url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7169013/},

doi = {https://doi.org/10.1186/s13104-020-05064-8},

year  = {2020},

date = {2020-04-19},

journal = {BMC Research Notes},

volume = {13},

number = {224},

pages = {1-6},

abstract = {Abstract

Objective:Tuberculosis (TB) is the leading cause of adrenal insufficiency in resource-limited settings. The adrenal gland is the most commonly affected endocrine organ in TB infection. We assessed factors associated with functional adrenal insufficiency (FAI) among TB-HIV patients with and without drug-resistance in Uganda. Patients with drug-sensitive and drug-resistant TB were enrolled and examined for clinical signs and symptoms of FAI with an early morn-ing serum cortisol level obtained. FAI was defined as early morning serum cortisol <   414 nmol//L. Associations with FAI were modeled using multivariable logistic regression.Results:We screened 311 TB patients and enrolled 272. Of these, 117 (43%) had drug-resistant TB. Median age was 32 years (IQR 18–66) and 66% were men. The proportion with FAI was 59.8%. Mean cortisol levels were lower in par-ticipants with drug-resistant than susceptible TB (317.4 versus 488.5 nmol/L; p <   0.001). In multivariable analyses, drug-resistant TB (aOR 4.61; 95% CI 2.3–9.1; p < 0.001), treatment duration >   1 month (aOR 2.86; 95% CI 1.4–5.5; p = 0.002) and abdominal pain (aOR 2.06; 95% CI 1.04–4.09; p =0.038) were significantly associated with FAI. Early morning serum cortisol levels should be quantified in TB-HIV co-infected patients with drug-resistant TB.



Keywords:

Adrenal, Insufficiency, HIV, TB, Africa},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Martins2020,

title = {Pre-positioned Outbreak Research: The Joint Medical Emerging Diseases Intervention Clinical Capability Experience in Uganda},

author = {Karen A. Martins and Rodgers R. Ayebare and Nahid Bhadelia and Francis Kiweewa and Peter Waitt and Derrick Mimbe and Stephen Okello and Prossy Naluyima and David M. Brett-Major and James V. Lawler and Monica Millard and Richard Walwema and Anthony P. Cardile and Chi Ritchie and Antonia Kwiecien and Helen Badu and Benjamin J. Espinosa and Charmagne Beckett and Sina Bavari and Saima Zaman and George Christopher and Danielle V. Clark and Mohammed Lamorde and Hannah Kibuuka},

url = {https://www.liebertpub.com/doi/abs/10.1089/hs.2019.0112},

doi = {https://doi.org/10.1089/hs.2019.0112},

year  = {2020},

date = {2020-04-17},

journal = {Health Security},

volume = {18},

number = {2},

pages = {114-124},

abstract = {Abstract



The West Africa Ebola virus disease outbreak of 2014-2016 demonstrated that responses to viral hemorrhagic fever epidemics must go beyond emergency stopgap measures and should incorporate high-quality medical care and clinical research. Optimal patient management is essential to improving outcomes, and it must be implemented regardless of geographical location or patient socioeconomic status. Coupling clinical research with improved care has a significant added benefit: Improved data quality and management can guide the development of more effective supportive care algorithms and can support regulatory approvals of investigational medical countermeasures (MCMs), which can alter the cycle of emergency response to reemerging pathogens. However, executing clinical research during outbreaks of high-consequence pathogens is complicated and comes with ethical and research regulatory challenges. Aggressive care and excellent quality control must be balanced by the requirements of an appropriate infection prevention and control posture for healthcare workers and by overcoming the resource limitations inherent in many outbreak settings. The Joint Mobile Emerging Disease Intervention Clinical Capability was established in 2015 to develop a high-quality clinical trial capability in Uganda to support rigorous evaluation of MCMs targeting high-consequence pathogens like Ebola virus. This capability assembles clinicians, laboratorians, clinical researchers, logisticians, and regulatory professionals trained in infection prevention and control and in good clinical and good clinical laboratory practices. The resulting team is prepared to provide high-quality medical care and clinical research during high-consequence outbreaks.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Nanziri2020,

title = {Ebola Virus Disease Preparedness Assessment and Risk Mapping in Uganda, August September 2018. },

author = {Carol Nanziri and Alex Riolexus Ario and Vivian Ntono and Fred Monje and Dativa Maria Aliddeki and Kenneth Bainomugisha and Daniel Kadobera and Lilian Bulage and Godfrey Nsereko and Joshua Kayiwa and Lydia Nakiire and Richard Walwema and Patrick K. Tusiime and Eldard Mabumba and Issa Makumbi and Felix Ocom and Mohammed Lamorde and Juliet Namugga Kasule and Sarah E. Ward and Rebecca D. Merrill},

url = {https://www.liebertpub.com/doi/abs/10.1089/hs.2019.0118},

doi = {https://doi.org/10.1089/hs.2019.0118},

year  = {2020},

date = {2020-04-17},

journal = {Health Security},

abstract = {Abstract



Uganda's proximity to the tenth Ebola virus disease (EVD) outbreak in the Democratic Republic of the Congo (DRC) presents a high risk of cross-border EVD transmission. Uganda conducted preparedness and risk-mapping activities to strengthen capacity to prevent EVD importation and spread from cross-border transmission. We adapted the World Health Organization (WHO) EVD Consolidated Preparedness Checklist to assess preparedness in 11 International Health Regulations domains at the district level, health facilities, and points of entry; the US Centers for Disease Control and Prevention (CDC) Border Health Capacity Discussion Guide to describe public health capacity; and the CDC Population Connectivity Across Borders tool kit to characterize movement and connectivity patterns. We identified 40 ground crossings (13 official, 27 unofficial), 80 health facilities, and more than 500 locations in 12 high-risk districts along the DRC border with increased connectivity to the EVD epicenter. The team also identified routes and congregation hubs, including origins and destinations for cross-border travelers to specified locations. Ten of the 12 districts scored less than 50% on the preparedness assessment. Using these results, Uganda developed a national EVD preparedness and response plan, including tailored interventions to enhance EVD surveillance, laboratory capacity, healthcare professional capacity, provision of supplies to priority locations, building treatment units in strategic locations, and enhancing EVD risk communication. We identified priority interventions to address risk of EVD importation and spread into Uganda. Lessons learned from this process will inform strategies to strengthen public health emergency systems in their response to public health events in similar settings.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Cresswell2020,

title = {Standardized Urine-Based Tuberculosis (TB) Screening With TB-Lipoarabinomannan and Xpert MTB/RIF Ultra in Ugandan Adults With Advanced Human Immunodeficiency Virus Disease and Suspected Meningitis},

author = {Fiona V Cresswell and Jayne Ellis and Enock Kagimu and Ananta S Bangdiwala and Michael Okirwoth and Gerald Mugumya and Morris Rutakingirwa and John Kasibante and Carson M Quinn and Kenneth Ssebambulidde and Joshua Rhein and Edwin Nuwagira and Lillian Tugume and Emily Martyn and Caleb P Skipper and Conrad Muzoora and Daniel Grint and David B Meya and Nathan C Bahr and Alison M Elliott and David R Boulware},

url = {https://academic.oup.com/ofid/article/7/4/ofaa100/5811128?login=true},

doi = { https://doi.org/10.1093/ofid/ofaa100},

year  = {2020},

date = {2020-04-04},

journal = {Open Forum Infectious Diseases},

volume = {7},

number = {4},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Queen2020,

title = {A high prevalence of hepatitis B virus infection in pregnant, South-South migrating African women: The need for routine screening, vaccination and follow up },

author = {

Gladys Queen and Barbara Castelnuovo and Ponsiano Ocama and Sabine Haller and Christopher Garimoi Orach and George Abongomera

},

url = {https://pubmed.ncbi.nlm.nih.gov/32247930/},

doi = {doi: 10.1016/j.tmaid.2020.101650. },

year  = {2020},

date = {2020-04-02},

journal = {Travel Medicine and Infectious Medicine},

pages = {101650},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Byakika-Kibwika2020,

title = {Ivermectin for mass drug administration against malaria},

author = {Pauline Byakika-Kibwika, Moses R Kamya, Joaniter Nankabirwa},

doi = {DOI:https://doi.org/10.1016/S1473-3099(21)00647-2},

year  = {2020},

date = {2020-04-01},

journal = {The Lance, Infectious Diseases},

volume = {22},

number = {4},

pages = {433-435},

abstract = {Numerous malaria endemic areas have benefitted from substantial declines in malaria burden, raising the possibility of eventual elimination. 1

Declines have been attributed to successful roll-out of effective control interventions including long-lasting insecticide-treated nets, indoor residual spraying with insecticides, prompt and accurate diagnosis, effective case management, active surveillance, and chemoprevention. Despite the marked decline in malaria burden observed between 2000 and 2015, progress in the control of malaria has stalled since then, highlighting the pressing need to optimise the available interventions and find additional strategies to improve and sustain control. One such strategy is the use of drugs to reduce transmission in areas with high coverage of standard control interventions.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Skipper2020,

title = {Evaluation of Serum Cryptococcal Antigen Testing Using Two Novel Semiquantitative Lateral Flow Assays in Persons with Cryptococcal Antigenemia},

author = {Caleb Skipper and Kiiza Tadeo and Emily Martyn and Elizabeth Nalintya and Radha Rajasingham and David B. Meya and Bosco Kafufu and Joshua Rhein and David R. Boulware},

editor = {Kimberly E. Hanson, Editor, University of Utah},

url = {https://jcm.asm.org/content/58/4/e02046-19.abstract},

doi = {DOI: 10.1128/JCM.02046-19},

year  = {2020},

date = {2020-03-25},

journal = {Journal of Clinical Microbiology},

abstract = {ABSTRACT



Early cryptococcal disease can be detected via circulating antigen in blood before fulminant meningitis develops, when early antifungal therapy improves survival. Two semiquantitative cryptococcal antigen (CrAg) lateral flow assays (LFAs) have been developed, but their diagnostic performance has not been defined. Cryopreserved serum samples from HIV-infected Ugandans obtained as part of a prospective CrAg-screening cohort were tested in duplicate for CrAg by the CrAgSQ (IMMY) and CryptoPS (Biosynex) lateral flow assays. Case-controlled diagnostic performance was measured using the FDA-approved CrAg LFA (IMMY) as a reference standard via McNemar’s test. Of 99 serum samples tested, 57 were CrAg positive (CrAg+) by the CrAg LFA reference standard. By CrAgSQ, 57 were read as positive, with 98% sensitivity (56/57; 95% confidence interval [CI], 0.91 to 0.99) and 98% specificity (41/42; 95% CI, 0.88 to 0.99) (McNemar’s, P = 0.99). The sample with a false-negative result by CrAgSQ (n = 1) had a titer of <1:5, while the sample with a false-positive result (n = 1) yielded a 1+ result. By CryptoPS, 52 samples were read as positive, with 88% sensitivity (50/57; 95% CI, 0.76 to 0.95) and 95% specificity (40/42; 95% CI, 0.84 to 0.99) (McNemar’s, P = 0.18). The CryptoPS false-negative results included samples with titers of <1:5 (n = 1), 1:5 (n = 5), and 1:20 (n = 1), while samples with false-positive results by CryptoPS (n = 2) yielded Positive results. The CryptoPS assay missed 35% (7/20) of samples with CrAg LFA titers of ≤1:20. The new semiquantitative CrAg LFAs allow rapid estimation of titer levels in easy-to-perform platforms. The CrAgSQ demonstrated better qualitative sensitivity and specificity than the CryptoPS compared to the reference standard. The exact grading of the CrAgSQ results has some subjectivity, with interreader variability; however, qualitative reads were generally concordant for both assays.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Sekaggya-Wiltshire2020,

title = {Low Antituberculosis Drug Concentrations in HIV-Tuberculosis-Coinfected Adults with Low Body Weight: Is It Time To Update Dosing Guidelines?},

author = {Christine Sekaggya-Wiltshire and Maxwell Chirehwa and Joseph Musaazi and Amrei von Braun and Allan Buzibye and Daniel Muller and Ursula Gutteck and Ilaria Motta and Andrea Calcagno and Jan S. Fehr and Andrew Kambugu and Barbara Castelnuovo and Mohammed Lamorde and Paolo Denti},

url = {https://aac.asm.org/content/63/6/e02174-18.abstract},

doi = {DOI: 10.1128/AAC.02174-18},

year  = {2020},

date = {2020-03-24},

journal = {Antimicrobial Agents and Chemotherapy},

volume = {64},

number = {4},

pages = {e00315-20},

abstract = {ABSTRACT



Antituberculosis drugs display large pharmacokinetic variability, which may be influenced by several factors, including body size, genetic differences, and drug-drug interactions. We set out to determine these factors, quantify their effect, and determine the dose adjustments necessary for optimal drug concentrations. HIV-infected Ugandan adults with pulmonary tuberculosis treated according to international weight-based dosing guidelines underwent pharmacokinetic sampling (1, 2, and 4 h after drug intake) 2, 8, and 24 weeks after treatment initiation. Between May 2013 and November 2015, we enrolled 268 patients (148 males) with a median weight of 53.5 (interquartile range [IQR], 47.5 to 59.0) kg and a median age of 35 (IQR, 29 to 40) years. Population pharmacokinetic modeling was used to interpret the data and revealed that patients weighing <55 kg achieved lower concentrations than those in higher weight bands for all drugs in the regimen. The models predicted that this imbalance could be solved with a dose increment of one fixed-dose combination (FDC) tablet for the weight bands of 30 to 37 and 38 to 54 kg. Additionally, the concomitant use of efavirenz increased isoniazid clearance by 24.1%, while bioavailability and absorption of rifampin and isoniazid varied up to 30% in patients on different formulations. Current dosing guidelines lead to lower drug exposure in patients in the lower weight bands. Simply adding one FDC tablet to current weight band-based dosing would address these differences in exposure and possibly improve outcomes. Lower isoniazid exposures due to efavirenz deserve further attention, as does the quality of currently used drug formulations of anti-TB drugs. (This study has been registered at ClinicalTrials.gov under identifier NCT01782950.)},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Laker-Oketta2020,

title = {Using Media to Promote Public Awareness of Early Detection of Kaposi’s Sarcoma in Africa},

author = {Miriam Laker-Oketta and Lisa Butler and Philippa Kadama-Makanga and Robert Inglis and Megan Wenger and Edward Katongole-Mbidde and Toby Maurer and Andrew Kambugu and Jeffrey Martin},

url = {https://www.hindawi.com/journals/jo/2020/3254820/},

doi = {https://doi.org/10.1155/2020/3254820},

year  = {2020},

date = {2020-03-21},

journal = {Journal of Oncology},

abstract = {Abstract



Background. Despite its hallmark cutaneous presentation, most Kaposi’s sarcoma (KS) in Africa is diagnosed too late for effective treatment. Early diagnosis will only be achievable if patients with KS present earlier for care. We hypothesized that public awareness about KS can be enhanced through exposure to common media. Methods. We developed educational messages regarding early detection of KS for the general African public portraying a three-part theme: “Look” (regularly examine one’s skin/mouth), “Show” (bring to the attention of a healthcare provider any skin/mouth changes), and “Test” (ask for a biopsy for definitive diagnosis). We packaged the messages in three common media forms (comic strips, radio, and video) and tested their effect on increasing KS awareness among adults attending markets in Uganda. Participants were randomized to a single exposure to one of the media and evaluated for change in KS-related knowledge and attitudes. Results. Among 420 participants, media exposure resulted in increased ability to identify KS (from 0.95% pretest to 46% posttest); awareness that anyone is at risk for KS (29% to 50%); belief that they may be at risk (63% to 76%); and knowledge that definitive diagnosis requires biopsy (23% to 51%) (all

). Most participants (96%) found the media culturally appropriate. Conclusion. Exposure to media featuring a theme of “Look,” “Show,” and “Test” resulted in changes in knowledge and attitudes concerning KS among the general public in Uganda. High incidence and poor survival of KS in Africa are an impetus to further evaluate these media, which are freely available online.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Aceng2020,

title = {Uganda’s experience in Ebola virus disease outbreak preparedness, 2018–2019},

author = {Jane Ruth Aceng, Alex R. Ario, Allan N. Muruta, Issa Makumbi, Miriam Nanyunja, Innocent Komakech, Andrew N. Bakainaga, Ambrose O. Talisuna, Collins Mwesigye, Allan M. Mpairwe, Jayne B. Tusiime, William Z. Lali, Edson Katushabe, Felix Ocom, Mugagga Kaggwa, Bodo Bongomin, Hafisa Kasule, Joseph N. Mwoga, Benjamin Sensasi, Edmund Mwebembezi, Charles Katureebe, Olive Sentumbwe, Rita Nalwadda, Paul Mbaka, Bayo S. Fatunmbi, Lydia Nakiire, Mohammed Lamorde, Richard Walwema, Andrew Kambugu, Judith Nanyondo, Solome Okware, Peter B. Ahabwe, Immaculate Nabukenya, Joshua Kayiwa, Milton M. Wetaka, Simon Kyazze, Benon Kwesiga, Daniel Kadobera, Lilian Bulage, Carol Nanziri, Fred Monje, Dativa M. Aliddeki, Vivian Ntono, Doreen Gonahasa, Sandra Nabatanzi, Godfrey Nsereko, Anne Nakinsige, Eldard Mabumba, Bernard Lubwama, Musa Sekamatte, Michael Kibuule, David Muwanguzi, Jackson Amone, George D. Upenytho, Alfred Driwale, Morries Seru, Fred Sebisubi, Harriet Akello, Richard Kabanda, David K. Mutengeki, Tabley Bakyaita, Vivian N. Serwanjja, Richard Okwi, Jude Okiria, Emmanuel Ainebyoona, Bernard T. Opar, Derrick Mimbe, Denis Kyabaggu, Chrisostom Ayebazibwe, Juliet Sentumbwe, Moses Mwanja, Deo B. Ndumu, Josephine Bwogi, Stephen Balinandi, Luke Nyakarahuka, Alex Tumusiime, Jackson Kyondo, Sophia Mulei, Julius Lutwama, Pontiano Kaleebu, Atek Kagirita, Susan Nabadda, Peter Oumo, Robinah Lukwago, Julius Kasozi, Oleh Masylukov, Henry Bosa Kyobe, Viorica Berdaga, Miriam Lwanga, Joe C. Opio, David Matseketse, James Eyul, Martin O. Oteba, Hasifa Bukirwa, Nulu Bulya, Ben Masiira, Christine Kihembo, Chima Ohuabunwo, Simon N. Antara, Wilberforce Owembabazi, Paul B. Okot, Josephine Okwera, Isabelle Amoros, Victoria Kajja, Basnet S. Mukunda, Isabel Sorela, Gregory Adams, Trevor Shoemaker, John D. Klena, Celine H. Taboy, Sarah E. Ward, Rebecca D. Merrill, Rosalind J. Carter, Julie R. Harris, Flora Banage, Thomas Nsibambi, Joseph Ojwang, Juliet N. Kasule, Dan F. Stowell, Vance R. Brown, Bao-Ping Zhu, Jaco Homsy, Lisa J. Nelson, Patrick K. Tusiime, Charles Olaro, Henry G. Mwebesa & Yonas Tegegn Woldemariam },

url = {https://globalizationandhealth.biomedcentral.com/articles/10.1186/s12992-020-00548-5},

doi = {https://doi.org/10.1186/s12992-020-00548-5},

year  = {2020},

date = {2020-03-19},

journal = {Globalization and Health},

volume = {16},

number = {1},

pages = {24},

abstract = {Abstract

Background



Since the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country. We describe Uganda’s experience in EVD preparedness.

Results



On 4 August 2018, the Uganda Ministry of Health (MoH) activated the Public Health Emergency Operations Centre (PHEOC) and the National Task Force (NTF) for public health emergencies to plan, guide, and coordinate EVD preparedness in the country. The NTF selected an Incident Management Team (IMT), constituting a National Rapid Response Team (NRRT) that supported activation of the District Task Forces (DTFs) and District Rapid Response Teams (DRRTs) that jointly assessed levels of preparedness in 30 designated high-risk districts representing category 1 (20 districts) and category 2 (10 districts). The MoH, with technical guidance from the World Health Organisation (WHO), led EVD preparedness activities and worked together with other ministries and partner organisations to enhance community-based surveillance systems, develop and disseminate risk communication messages, engage communities, reinforce EVD screening and infection prevention measures at Points of Entry (PoEs) and in high-risk health facilities, construct and equip EVD isolation and treatment units, and establish coordination and procurement mechanisms.

Conclusion



As of 31 May 2019, there was no confirmed case of EVD as Uganda has continued to make significant and verifiable progress in EVD preparedness. There is a need to sustain these efforts, not only in EVD preparedness but also across the entire spectrum of a multi-hazard framework. These efforts strengthen country capacity and compel the country to avail resources for preparedness and management of incidents at the source while effectively cutting costs of using a “fire-fighting” approach during public health emergencies.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{R2020,

title = {Leveraging investments in Ebola preparedness for COVID-19 in Sub-Saharan Africa},

author = {Ayebare R and Waitt P and Okello S and Kayiira M and Atim Ajok M and Nakatudde I and Bhadelia N and Lamorde M. },

url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236423/},

doi = {doi: 10.12688/aasopenres.13052.1},

year  = {2020},

date = {2020-03-18},

journal = {AAS Open Research},

volume = {3},

number = {3},

abstract = {Abstract



The emergence of SARS-CoV-2 in China and transmission to more than 80 territories worldwide, including nine countries in Africa, presents a delicate situation for low-resource settings. Countries in Eastern and Central Africa have been on high alert since mid-2018 in anticipation of regional spread of the Ebola virus from the Democratic Republic of Congo. Significant investment has been made to support enhanced surveillance at point of entry and hospitals, infection control practices, clinical case management, and clinical research. With a new threat on the horizon, African countries have an opportunity to leverage the existing capacities for Ebola preparedness to brace for the imminent threat.



Keywords: COVID-19 preparedness, Ebola, Coronavirus, SARS-CoV-2},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Rutakingirwa2020,

title = {Tuberculosis in HIV-Associated Cryptococcal Meningitis is Associated with an Increased Risk of Death },

author = {Morris K. Rutakingirwa and Fiona V. Cresswell and Richard Kwizera and Kenneth Ssebambulidde and Enock Kagimu and Edwin Nuwagira and Lillian Tugume and Edward Mpoza and Joanna Dobbin and Darlisha A. Williams and Conrad Muzoora and David B. Meya and David R. Boulware and Kathy H. Hullsiek and Joshua Rhein},

url = {https://www.mdpi.com/2077-0383/9/3/781},

doi = {https://doi.org/10.3390/jcm9030781},

year  = {2020},

date = {2020-03-13},

journal = {Journal of Clinical Medicine},

volume = {9},

number = {3},

pages = {781},

abstract = {Abstract

Tuberculosis (TB) and cryptococcal meningitis are leading causes of morbidity and mortality in advanced HIV disease. Data are limited on TB co-infection among individuals with cryptococcal meningitis. We performed a retrospective analysis of HIV-infected participants with cryptococcal meningitis from 2010–2017. Baseline demographics were compared between three groups: ‘prevalent TB’ if TB treated >14 days prior to cryptococcal meningitis diagnosis, ‘concurrent TB’ if TB treated ± 14 days from diagnosis, or ‘No TB at baseline’. We used time-updated proportional-hazards regression models to assess TB diagnosis as a risk for death. Of 870 participants with cryptococcal meningitis, 50 (6%) had prevalent TB, 67 (8%) had concurrent TB, and 753 (86%) had no baseline TB. Among participants without baseline TB, 67 (9%) were diagnosed with incident TB (after >14 days), with a median time to TB incidence of 41 days (IQR, 22–69). The 18-week mortality was 50% (25/50) in prevalent TB, 46% (31/67) in concurrent TB, and 45% (341/753) in the no TB group (p = 0.81). However, TB co-infection was associated with an increased hazard of death (HR = 1.75; 95% CI, 1.33–2.32; p < 0.001) in a time-updated model. TB is commonly diagnosed in cryptococcal meningitis, and the increased mortality associated with co-infection is a public health concern. View Full-Text

Keywords: Tuberculosis; cryptococcal meningitis; HIV; Cryptococcus; AIDS-related opportunistic infections; co-infection },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ayebare2020,

title = {Adoption of COVID-19 triage strategies for low-income settings},

author = {Rodgers R Ayebare and Robert Flick and Solome Okware and Bongomin Bodo and Mohammed Lamorde},

url = {https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30114-4/fulltext},

doi = { https://doi.org/10.1016/S2213-2600(20)30114-4},

year  = {2020},

date = {2020-03-11},

journal = {The Lancet, Respiratory Medicine},

volume = {8},

number = {4},

pages = {e22},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Ndagire2020,

title = {Dental Caries Pattern and Treatment Needs among Ugandan Adolescent Students: A Cross-Sectional Study},

author = {Barbara Ndagire and Catherine L. Mwesigwa and Juliet M. Ntuulo and Harriet Mayanja-Kizza and Damalie Nakanjako and Charles M. Rwenyonyi},

url = {https://www.hindawi.com/journals/ijd/2020/8135865/},

doi = {https://doi.org/10.1155/2020/8135865},

year  = {2020},

date = {2020-03-10},

journal = {International Journal of Dentistry},

abstract = {Abstract



Dental caries is still a major public health problem owing to its high prevalence and incidence in several regions. Planning and development of effective preventive and treatment modalities for the management of dental caries demand information on disease pattern and treatment needs of the populations. However, there is a paucity of this information in Uganda. The aim of the present study was to identify the dental caries pattern and treatment needs among Ugandan adolescent students. This was a descriptive cross-sectional study conducted among 11- to 19-year-old adolescents attending two secondary schools in Kampala and Mukono districts of Uganda. At both schools, random sampling was used to select the participating classes and the adolescents. Decayed teeth and treatment needs were recorded using the World Health Organization Basic Oral Health Survey criteria. A total of 406 adolescents comprising of 249 female and 157 male students participated in the study. Data were analysed using STATA, version 12.0. The prevalence of decayed teeth (DT) was expressed as a percentage of individuals with DT score ≥1. The treatment needs were categorised into three groups. Associations between dependent and independent variables were evaluated using cross-tabulation, chi-square test, and Poisson regression analysis. The overall prevalence of decayed teeth was 62.6% and mean DT was 1.7 ± 2.3. A total of 696 decayed teeth were observed, and the molar teeth, particularly the second molar (50.6%), were the most significantly affected. The prevalence of caries was higher in the mandible (51.4%) compared to the maxilla though the difference was not statistically significant. Decayed teeth were significantly (

) associated with difficulty in chewing, history of dental pain in the past 12 months, poor perception of tooth state, and the female participants. Majority (59.4%) of the study participants required restorations of teeth. About 83.2% (n = 579) of the teeth needed restorations, while 44 needed extractions. In conclusion, the prevalence of decayed teeth was high among the study population. It is recommended that school health programmes should include oral health preventive and curative interventions to achieve optimum health.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{VCresswell2020,

title = {Xpert MTB/RIF Ultra for the diagnosis of HIV-associated tuberculous meningitis: a prospective validation study},

author = {Fiona VCresswell and LillianTugume and Nathan C Bahr and Richard Kwizera and Ananta S Bangdiwala and Abdu K Musubire Morris Rutakingirwa Enock Kagimu and Edwin Nuwagira and Edward Mpoza and Joshua Rhein and Darlisha A Williams and Conrad Muzoora and Daniel Grint and Alison Elliott and David B Meya and David R Boulware on behalf of the ASTRO-CM team},

url = {https://www.sciencedirect.com/science/article/pii/S147330991930550X},

doi = {https://doi.org/10.1016/S1473-3099(19)30550-X},

year  = {2020},

date = {2020-03-01},

journal = {The Lancet, Infectious Diseases Institute},

volume = {20},

number = {3},

pages = {308-317},

abstract = {Summary



Introduction



Tuberculous meningitis accounts for 1–5% of tuberculosis cases. Diagnostic delay contributes to poor outcomes. We evaluated the performance of the new Xpert MTB/RIF Ultra (Xpert Ultra) for tuberculous meningitis diagnosis.



Methods



In this prospective validation study, we tested the cerebrospinal fluid (CSF) of adults presenting with suspected meningitis (ie, headache or altered mental status with clinical signs of meningism) to the Mulago National Referral Hospital and Mbarara Regional Referral Hospital in Uganda. We centrifuged the CSF, resuspended the cell pellet in 2 mL CSF, and tested 0·5 mL aliquots with Xpert Ultra, Xpert MTB/RIF (Xpert), and mycobacterial growth indicator tube (MGIT) culture. We quantified diagnostic performance against the uniform case definition of probable or definite tuberculous meningitis and a composite microbiological reference standard.



Findings



From Nov 25, 2016, to Jan 24, 2019, we screened 466 adults with suspected meningitis and tested 204 for tuberculous meningitis. Uniform clinical case definition classified 51 participants as having probable or definite tuberculous meningitis. Against this uniform case definition, Xpert Ultra had 76·5% sensitivity (95% CI 62·5–87·2; 39 of 51 patients) and a negative predictive value of 92·7% (87·6–96·2; 153 of 165), compared with 55·6% sensitivity (44·0–70·4; 25 of 45; p=0·0010) and a negative predictive value of 85·8% (78·9–91·1; 121 of 141) for Xpert and 61·4% sensitivity (45·5–75·6; 27 of 44; p=0·020) and negative predictive value of 85·2% (77·4–91·1; 98 of 115) for MGIT culture. Against the composite microbiological reference standard, Xpert Ultra had sensitivity of 92·9% (80·5–98·5; 39 of 42), higher than Xpert at 65·8% (48·6–80·4; 25 of 38; p=0·0063) and MGIT culture at 72·2% (55·9–86·2; 27 of 37; p=0·092). Xpert Ultra detected nine tuberculous meningitis cases missed by Xpert and MGIT culture.

Interpretation



Xpert Ultra detected tuberculous meningitis with higher sensitivity than Xpert and MGIT culture in this HIV-positive population. However, with a negative predictive value of 93%, Xpert Ultra cannot be used as a rule-out test. Clinical judgment and novel highly sensitive point-of-care tests are still required.



Funding



Wellcome Trust, National Institute of Health, National Institute of Neurologic Diseases and Stroke, Fogarty International Center, and National Institute of Allergy and Infectious Diseases.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{C2020,

title = {Calcaneal Quantitative Ultrasonography and Urinary Retinol-Binding Protein in Antiretroviral-Treated Patients With Human Immunodeficiency Virus in Uganda: A Pilot Study.},

author = {Costa C and Scabini S and Kaimal A and Kasozi W and Cusato J and Kafufu B and Borderi M and Mwaka E and 

Di Perri G and Lamorde M and Calcagno A and Castelnuovo B},

url = {https://europepmc.org/article/med/32112093},

doi = {DOI: 10.1093/infdis/jiaa088 },

year  = {2020},

date = {2020-02-28},

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.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kalyango2020,

title = {Intra-cavitary pulmonary cryptococcoma in poorly controlled diabetes mellitus},

author = {Najibu Kalyango and Richard Kwizera and Joseph B.Baluku and Felix Bongomin},

doi = {https://doi.org/10.1016/j.mmcr.2020.02.005},

year  = {2020},

date = {2020-02-24},

journal = {Medical Mycology Case Reports},

volume = {28},

pages = {1-3},

abstract = {Abstract



A 59-year-old HIV-negative Ugandan man presented with a long-standing history of respiratory symptoms and was found to have an intra-cavitary pulmonary cryptococoma by chest imaging and sputum culture. The serum cryptococcal antigen was negative. The sputum Xpert® MTB RIF Ultra assay was negative. He was previously treated for cavitary pulmonary tuberculosis. The patient had poorly controlled diabetes (HbA1c, 9.3%). The patient was successfully treated with oral fluconazole.



Next article in issue

Keywords

Pulmonary cryptococcoma, Diabetes, Cryptococcal antigen test, Tuberculosis, Aspergillus IgG},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{MacCarthy2020,

title = {A randomized controlled trial study of the acceptability, feasibility, and preliminary impact of SITA (SMS as an Incentive To Adhere): a mobile technology-based intervention informed by behavioral economics to improve ART adherence among youth in Uganda},

author = {Sarah MacCarthy and Zachary Wagner and Alexandra Mendoza-Graf and Carlos Ignacio Gutierrez and Clare Samba and Josephine Birungi and Stephen Okoboi and Sebastian Linnemayr },

url = {https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-020-4896-0},

doi = {https://doi.org/10.1186/s12879-020-4896-0},

year  = {2020},

date = {2020-02-24},

journal = {BMC Infectious Diseases},

volume = {20},

number = {1},

pages = {173},

abstract = {Abstract

Background



Studies report serious adherence problems among youth (individuals age 15–24 years of age) in Uganda. Recent growth in mobile phone ownership has highlighted the potential of using text-based interventions to improve antiretroviral treatment (ART) adherence among Ugandan youth. We piloted a randomized controlled trial of a text-based intervention providing weekly real-time antiretroviral adherence feedback, based on information from a smart pill box, to HIV-positive Ugandan youth. In this paper, we report the acceptability, feasibility, and preliminary impact of the intervention.

Methods



We randomized participants to a control group, or to receive messages with information on either their own adherence levels (Treatment 1 - T1), or their own adherence and peer adherence levels (Treatment 2 – T2). We conducted six focus groups from December 2016 to March 2017 with providers and youth ages 15–24, double coded 130 excerpts, and achieved a pooled Cohen’s Kappa of 0.79 and 0.80 based on 34 randomly selected excerpts.

Results



The quantitative and qualitative data show that the intervention was deemed acceptable and feasible. After controlling for baseline adherence, the T1 group had 3.8 percentage point lower adherence than the control group (95% CI -9.9, 2.3) and the T2 group had 2.4 percentage points higher adherence than the control group (95% CI -3.0, 7.9). However, there was an increasing treatment effect over time for the T2 group with the largest effect towards the end of the study; a 2.5 percentage point increase in the initial 9-weeks that grows steadily to 9.0 percentage points by the last 9-weeks of the study. We find negative treatment effects for T1 in 3 of the 4 9-week intervals. This pilot study was not designed to detect statistically significant differences.

Conclusions



Improving youth’s adherence by supplementing information about their adherence with information about the adherence of peers is a promising new strategy that should be further evaluated in a fully-powered study. Providing one’s own adherence information alone appears to have less potential.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kamba2020,

title = {Compliance of private pharmacies in Uganda with controlled prescription drugs regulations: a mixed-methods study},

author = {Pakoyo Fadhiru Kamba and John Mulangwa and Bruhan Kaggwa and Freddy Eric Kitutu and Nelson Kaulukusi Sewankambo and Elly Tebasoboke Katabira and Pauline Byakika-Kibwika and Richard Odoi Adome and Robert Cyril Bollinger },

url = {https://link.springer.com/article/10.1186/s13011-020-00261-x},

doi = {https://doi.org/10.1186/s13011-020-00261-x},

year  = {2020},

date = {2020-02-18},

journal = {Substance Abuse Treatment, Prevention, and Policy volume },

volume = {15},

number = {1},

pages = {16},

abstract = {Abstract



Background



Controlled prescription drug use disorders are a growing global health challenge in Sub-Saharan Africa. Effective supply chain regulations on dispensing and stock control are important for controlling this epidemic. Since compliance with these regulations in resource-limited countries is poor, there is need to understand its predictors in order to reduce the risk of prescription drug use disorders.



Methods



A mixed-methods study utilizing a structured questionnaire and a simulated client guide was undertaken in Kampala and Mbale towns in Uganda. The questionnaire recorded self-reported dispensing and verified stock control practices and their covariates from 101 private pharmacies. The guide recorded actual dispensing practices from 27 pharmacies. Snowball sampling was done to enrich the sample with pharmacies that stock opioids. The mean compliance with good dispensing and stock control practices was calculated. Multivariate logistic regression analyses were applied to identify predictors of compliance.



Results



The mean compliance with dispensing and stock control requirements was 82.9% and 23%, respectively. Twenty percent and 40% of the pharmacies dispensed pethidine without a prescription and with invalid prescriptions, respectively. Having a pharmacist on duty (OR = 5.17; p = 0.02), prior in-service training on narcotics regulations (OR = 3.51; p = 0.04), and previous narcotics audits by the regulator (OR = 5.11; p = 0.01) were independent predictors of compliance with stock control requirements. Pharmacies with a previous history of poor compliance with dispensing requirements were less likely to demonstrate good compliance (OR = 0.21; p = 0.01).



Conclusions



There is suboptimal compliance to controlled prescription drug regulations among Uganda’s pharmacies. A previous history of poor compliance to dispensing requirements predicted low compliance in subsequent assessments. Training and regulatory audits increased compliance in stock control but not dispensing. Expansion of training and audits to more pharmacies and/or incentives for compliance are necessary.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Nabisere2020,

title = {Pharmacokinetics, SAfety/tolerability, and EFficacy of high-dose RIFampicin in tuberculosis-HIV co-infected patients on efavirenz- or dolutegravir-based antiretroviral therapy: study protocol for an open-label, phase II clinical trial (SAEFRIF)},

author = {Ruth Nabisere and Joseph Musaazi and Paolo Denti and Florence Aber and Mohammed Lamorde and Kelly E. Dooley and Rob Aarnoutse and Derek J. Sloan and Christine Sekaggya-Wiltshire },

url = {https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-020-4132-7},

doi = {https://doi.org/10.1186/s13063-020-4132-7},

year  = {2020},

date = {2020-02-13},

journal = {BMC , Trials},

abstract = {Abstract



Background



Tuberculosis (TB) is a significant public health problem that causes substantial morbidity and mortality. Current first-line anti-TB chemotherapy, although very effective, has limitations including long-treatment duration with a possibility of non-adherence, drug interactions, and toxicities. Dose escalation of rifampicin, an important drug within the regimen, has been proposed as a potential route to higher treatment efficacy with shorter duration and some studies have suggested that dose escalation is safe; however, these have almost entirely been conducted among human immunodeficiency (HIV)-negative TB patients. TB-HIV co-infected patients on antiretroviral therapy (ART) are at increased risk of drug-drug interactions and drug-related toxicities. This study aims to determine the safety of higher doses of rifampicin and its effect on the pharmacokinetics of efavirenz (EFV) and dolutegravir (DTG) in TB-HIV co-infected patients.



Methods



This study is a randomized, open-label, phase IIb clinical trial among TB-HIV infected adult outpatients attending an HIV clinic in Kampala, Uganda. Patients newly diagnosed with TB will be randomized to either standard-dose or high-dose rifampicin (35 mg/kg) alongside standard TB treatment. ART-naïve patients will be randomly assigned to first-line ART regimens (DTG or EFV). Those who are already on ART (DTG or EFV) at enrollment will be continued on the same ART regimen but with dose adjustment of DTG to twice daily dosing. Participants will be followed every 2 weeks with assessment for toxicities at each visit and measurement of drug concentrations at week 6. At the end of intensive-phase therapy (8 weeks), all participants will be initiated on continuation-phase treatment using standard-dose rifampicin and isoniazid.



Discussion



This study should avail us with evidence about the effect of higher doses of rifampicin on the pharmacokinetics of EFV and DTG among TB-HIV co-infected patients. The trial should also help us to understand safety concerns of high-dose rifampicin among this vulnerable cohort.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Bogart2020,

title = {A Pilot Test of Game Changers, a Social Network Intervention to Empower People with HIV to be Prevention Advocates in Uganda},

author = {Laura M. Bogart and Joseph K. B. Matovu and Glenn J. Wagner and Harold D. Green and Erik D. Storholm and David J. Klein and Terry Marsh and Sarah MacCarthy and Andrew Kambugu },

url = {https://link.springer.com/article/10.1007%2Fs10461-020-02806-4},

doi = {https://doi.org/10.1007/s10461-020-02806-4},

year  = {2020},

date = {2020-02-06},

journal = {AIDS and Behavior },

volume = {24},

pages = {2490–2508},

abstract = {Abstract



We conducted a pilot randomized controlled trial of Game Changers, a 6-session group intervention that empowers people with HIV to be HIV prevention advocates in their social networks. Ninety-nine people with HIV (51 intervention, 48 wait-list control) and 58 of their social network members (alters) completed baseline and 5- and 8-month post-baseline assessments. Results indicated high acceptability, demonstrated by participants’ and facilitators’ positive attitudes qualitatively and favorable ratings of intervention sessions quantitatively, and high feasibility (76% attended all intervention sessions). Intention-to-treat analyses indicated significantly increased HIV prevention advocacy among HIV-positive participants and alters [b (SE) = 0.4 (0.2), p = .017; b (SE) = 0.4 (0.2), p = .035]; reduced internalized HIV stigma [b (SE) =  − 0.3 (0.1), p = .012], increased HIV-serostatus disclosure [b (SE) = 0.1 (0.1), p = .051], and increased social network density among HIV-positive participants [b (SE) = 0.1 (0.03), p = .004]; and marginally reduced condomless sex among alters [OR (95% CI) = 0.3 (0.1–1.2), p = .08]. Positioning people with HIV as central to prevention has the potential to reduce stigma and improve prevention outcomes throughout social networks.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{JH2020,

title = {Public Health Laboratories: An Important Ally in Sexually Transmitted Infection Control},

author = {Melendez JH and Manabe YC},

url = {https://journals.lww.com/stdjournal/fulltext/2020/02000/public_health_laboratories__an_important_ally_in.10.aspx},

doi = {doi: 10.1097/OLQ.0000000000001118},

year  = {2020},

date = {2020-02-01},

journal = {Journal of American Sexually Transmitted Diseases Association},

volume = {47},

number = {2},

pages = {128-129},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kirenga2020,

title = {Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project},

author = {Bruce Kirenga and Jeremiah Chakaya and Getnet Yimer and George Nyale and Tewodros Haile and Winters Muttamba and Levicatus Mugenyi and Winceslaus Katagira and William Worodria and Hellen Aanyu-Tukamuhebwa and Njira Lugogo and Moses Joloba and Amsalu Bekele and Fred Makumbi and Cindy Green and Corina de Jong and Moses Kamya and Thys van der Molen},

url = {https://bmjopenrespres.bmj.com/content/7/1/e000484.abstract},

doi = {http://dx.doi.org/10.1136/bmjresp-2019-000484},

year  = {2020},

date = {2020-02-01},

journal = {BMJ Open Respiratory Research},

volume = {7},

number = {1},

pages = {e000484},

abstract = {Abstract



Rationale The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known.



Methods 

Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity.



Results 

A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity.



Discussion 

The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.

http://creativecommons.org/licenses/by-nc/4.0/



This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Freeman2020,

title = {Real-world use of chemotherapy for Kaposi’s sarcoma in a large community-based HIV primary care system in Kenya},

author = {Esther E. Freeman and Naftali Busakhala and Susan Regan and Fredrick Chite Asirwa and Megan Wenger and Divya Seth and Khatiya Chelidze Moon and Aggrey Semeere and Toby Maurer and Kara Wools-Kaloustian and Ingrid Bassett and Jeffrey Martin },

url = {https://link.springer.com/article/10.1186/s12885-019-6506-3},

doi = {https://doi.org/10.1186/s12885-019-6506-3},

year  = {2020},

date = {2020-01-29},

journal = {BMC Cancer },

volume = {20},

number = {1},

pages = {71},

abstract = {Abstract



Background



Kaposi’s sarcoma (KS) is one of the most common HIV-associated malignancies in sub-Saharan Africa. Worldwide, the availability of antiretroviral therapy (ART) has improved KS survival. In resource-rich settings, survival has also benefited from chemotherapy, which is widely available. Little is known, however, about the epidemiology of chemotherapy use for HIV-associated KS in resource-limited regions such as sub-Saharan Africa.

Methods



We identified all patients newly diagnosed with HIV-related KS from 2009 to 2012 in the 26-clinic AMPATH network, a large community-based care network in Kenya. We ascertained disease severity at diagnosis, frequency of initiation of chemotherapy, and distribution of chemotherapeutic regimens used. Indications for chemotherapy included AIDS Clinical Trial Group T1 stage and/or “severe” disease defined by WHO KS treatment guidelines.

Results



Of 674 patients diagnosed with KS, charts were available for 588; 61% were men, median age was 35 years, and median CD4 at KS diagnosis was 185 cells/μl. At time of diagnosis, 58% had at least one chemotherapy indication, and 22% had more than one indication. For patients with a chemotherapy indication, cumulative incidence of chemotherapy initiation (with death as a competing event) was 37% by 1 month and 56% by 1 year. Median time from diagnosis to chemotherapy initiation was 25 days (IQR 1–50 days). In multivariable regression, patients with > 3 chemotherapy indications at time of diagnosis had a 2.30 (95% CI 1.46–3.60) increased risk of rapid chemotherapy initiation (within 30 days of diagnosis) compared to those with only one chemotherapy indication (p < 0.001). Initial regimens were bleomycin-vincristine (78%), adriamycin-bleomycin-vincristine (11%), etoposide (7%), and gemcitabine (4%).



Conclusions



A substantial fraction of patients with KS in East Africa are diagnosed at advanced disease stage. For patients with chemotherapy indications, nearly half did not receive chemotherapy by one year. Liposomal anthracyclines, often used in resource-rich settings, were not first line. These findings emphasize challenges in East Africa cancer care, and highlight the need for further advocacy for improved access to higher quality chemotherapy in this setting.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Okoboi2020,

title = {Peer distribution of HIV self-test kits to men who have sex with men to identify undiagnosed HIV infection in Uganda:},

author = {Okoboi, Stephen and Oucul, Lazarus and Castelnuovo, Barbara and Nanfuka, Nanfuka and Kambugu, Andrew and Mujugira, Andrew and King, Rachel},

url = {https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227741},

doi = { https://doi.org/10.1371/journal.pone.0227741},

year  = {2020},

date = {2020-01-23},

journal = {PLOS ONE},

volume = {15},

number = {1},

pages = {e0227741},

abstract = {Abstract



Introduction



One-in-three men who have sex with men (MSM) in Uganda have never tested for HIV. Peer-driven HIV testing strategies could increase testing coverage among non-testers. We evaluated the yield of peer distributed HIV self-test kits compared with standard-of-care testing approaches in identifying undiagnosed HIV infection.



Methods



From June to August 2018, we conducted a pilot study of secondary distribution of HIV self-testing (HIVST) through MSM peer networks at The AIDS Support Organization (TASO) centres in Entebbe and Masaka. Peers were trained in HIVST use and basic HIV counselling. Each peer distributed 10 HIVST kits in one wave to MSM who had not tested in the previous six months. Participants who tested positive were linked by peers to HIV care. The primary outcome was the proportion of undiagnosed HIV infections. Data were analysed descriptively.



Results



A total of 297 participants were included in the analysis, of whom 150 received HIVST (intervention). The median age of HIVST recipients was 25 years (interquartile range [IQR], 22–28) compared to 28 years IQR (25–35) for 147 MSM tested using standard-of-care (SOC) strategies. One hundred forty-three MSM (95%) completed HIVST, of which 32% had never tested for HIV. A total of 12 participants were newly diagnosed with HIV infection: 8 in the peer HIVST group and 4 in the SOC group [5.6% vs 2.7%, respectively; P = 0.02]. All participants newly diagnosed with HIV infection received confirmatory HIV testing and were initiated on antiretroviral therapy.



Conclusion



Peer distribution of HIVST through MSM networks is feasible and effective and could diagnose more new HIV infections than SOC approaches. Public health programs should consider scaling up peer-delivered HIVST for MSM.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Semakula2020,

title = {A cross-sectional evaluation of five warfarin anticoagulation services in Uganda and South Africa. },

author = {Jerome Roy Semakula and Johannes P. Mouton and Andrea Jorgensen and Claire Hutchinson and Shaazia Allie and Lynn Semakula and Neil French and Mohammed Lamorde and Cheng-Hock Toh and Marc Blockman and Christine Sekaggya-Wiltshire and Catriona Waitt and Munir Pirmohamed and Karen Cohen},

url = {https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227458},

doi = { https://doi.org/10.1371/journal.pone.0227458},

year  = {2020},

date = {2020-01-20},

journal = {PLOS ONE},

volume = {15},

number = {1},

pages = {e0227458},

abstract = {Abstract



Introduction



Warfarin is the most commonly prescribed oral anticoagulant in sub-Saharan Africa and requires ongoing monitoring. The burden of both infectious diseases and non-communicable diseases is high and medicines used to treat comorbidities may interact with warfarin. We describe service provision, patient characteristics, and anticoagulation control at selected anticoagulation clinics in Uganda and South Africa.



Methods



We evaluated two outpatient anticoagulation services in Kampala, Uganda and three in Cape Town, South Africa between 1 January and 31 July 2018. We collected information from key staff members about the clinics’ service provision and extracted demographic and clinical data from a sample of patients’ clinic records. We calculated time in therapeutic range (TTR) over the most recent 3-month period using the Rosendaal interpolation method.



Results



We included three tertiary level, one secondary level and one primary level anticoagulation service, seeing between 30 and 800 patients per month. Care was rendered by nurses, medical officers, and specialists. All healthcare facilities had on-site pharmacies; laboratory INR testing was off-site at two. Three clinics used warfarin dose-adjustment protocols; these were not validated for local use. We reviewed 229 patient clinical records. Most common indications for warfarin were venous thrombo-embolism in 112/229 (49%), atrial fibrillation in 74/229 (32%) and valvular heart disease in 30/229 (13%). Patients were generally followed up monthly. HIV prevalence was 20% and 5% at Ugandan and South African clinics respectively. Cardiovascular comorbidity predominated. Furosemide, paracetamol, enalapril, simvastatin, and tramadol were the most common concomitant drugs. Anticoagulation control was poor at all included clinics with median TTR of 41% (interquartile range 14% to 69%).



Conclusions



TTR was suboptimal at all included sites, despite frequent patient follow-up. Strategies to improve INR control in sub-Saharan patients taking warfarin are needed. Locally validated warfarin dosing algorithms in Uganda and South Africa may improve INR control.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Pullen2020,

title = {Change in Plasma Cryptococcal Antigen Titer Is Not Associated With Survival Among Human Immunodeficiency Virus–infected Persons Receiving Preemptive Therapy for Asymptomatic Cryptococcal Antigenemia },

author = { Matthew F Pullen and Francis Kakooza and Elizabeth Nalintya and Agnes N Kiragga and Bozena M Morawski and Radha Rajasingham and Anthony Mubiru and Yukari C Manabe and Jonathan E Kaplan and David B Meya and David R Boulware for the Operational Research for Cryptococcal Antigen Screening (ORCAS) Study Team},

url = {https://academic.oup.com/cid/article/70/2/353/5497490?login=true},

doi = {https://doi.org/10.1093/cid/ciz418},

year  = {2020},

date = {2020-01-15},

journal = {Clinical Infectious Diseases,},

volume = {70},

number = {2},

pages = {353–355},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{DL2020,

title = {Emerging evidence from a systematic review of safety of pre‐exposure prophylaxis for pregnant and postpartum women: where are we now and where are we heading?},

author = {Joseph Davey DL and Pintye J and Baeten JM and Aldrovandi G and Baggaley R and Bekker LG and Celum C and Chi BH and Coates TJ and Haberer JE and Heffron R and Kinuthia J and Matthews LT and McIntyre J and Moodley D and Mofenson LM and Mugo N and Myer L and Mujugira A and Shoptaw S and Stranix-Chibanda L and John-Stewart G and PrEP in Pregnancy Working Group. },

url = {https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25426},

doi = {https://doi.org/10.1002/jia2.25426},

year  = {2020},

date = {2020-01-08},

journal = {Journal of the International AIDS Society},

volume = {23},

number = {1},

pages = {e25426},

abstract = {

Abstract



Introduction



HIV incidence is high during pregnancy and breastfeeding with HIV acquisition risk more than doubling during pregnancy and the postpartum period compared to when women are not pregnant. The World Health Organization recommends offering pre‐exposure prophylaxis (PrEP) to pregnant and postpartum women at substantial risk of HIV infection. However, maternal PrEP national guidelines differ and most countries with high maternal HIV incidence are not offering PrEP. We conducted a systematic review of recent research on PrEP safety in pregnancy to inform national policy and rollout.



Methods



We used a standard Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) approach to conduct a systematic review by searching for completed, ongoing, or planned PrEP in pregnancy projects or studies from clinicaltrials.gov, PubMed and NIH RePORTER from 2014 to March 2019. We performed a systematic review of studies that assess tenofovir disoproxil fumarate (TDF)‐based oral PrEP safety in pregnant and breastfeeding HIV‐uninfected women.



Results and discussion



We identified 14 completed (n = 5) and ongoing/planned (n = 9) studies that evaluate maternal and/or infant outcomes following PrEP exposure during pregnancy or breastfeeding. None of the completed studies found differences in pregnancy or perinatal outcomes associated with PrEP exposure. Nine ongoing studies, to be completed by 2022, will provide data on >6200 additional PrEP‐exposed pregnancies and assess perinatal, infant growth and bone health outcomes, expanding by sixfold the data on PrEP safety in pregnancy. Research gaps include limited data on (1) accurately measured PrEP exposure within maternal and infant populations including drug levels needed for maternal protection; (2) uncommon perinatal outcomes (e.g. congenital anomalies); (3) infant outcomes such as bone growth beyond one year following PrEP exposure; (4) outcomes in HIV‐uninfected women who use PrEP during pregnancy and/or lactation.



Conclusions



Expanding delivery of PrEP is an essential strategy to reduce HIV incidence in pregnancy and breastfeeding women. Early safety studies of PrEP among pregnant women without HIV infection are reassuring and ongoing/planned studies will contribute extensive new data to bolster the safety profile of PrEP use in pregnancy. However, addressing research gaps is essential to expanding PrEP delivery for women in the context of pregnancy.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{qiu2020multib,

title = {Multi-locus phylogeny and taxonomy of an unresolved, heterogeneous species complex within the genus Golovinomyces (Ascomycota, Erysiphales), including G. ambrosiae, G. circumfusus and G. spadiceus},

author = {Peng-Lei Qiu and Shu-Yan Liu and Michael Bradshaw and Suzanne Rooney-Latham and Susumu Takamatsu and Timur S Bulgakov and Shu-Rong Tang and Jing Feng and Dan-Ni Jin and Temitope Aroge and others},

year  = {2020},

date = {2020-01-01},

journal = {BMC microbiology},

volume = {20},

pages = {1--16},

publisher = {Springer},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{qiu2020multi,

title = {Multi-locus phylogeny and taxonomy of an unresolved, heterogeneous species complex within the genus Golovinomyces (Ascomycota, Erysiphales), including G. ambrosiae, G. circumfusus and G. spadiceus},

author = {Peng-Lei Qiu and Shu-Yan Liu and Michael Bradshaw and Suzanne Rooney-Latham and Susumu Takamatsu and Timur S Bulgakov and Shu-Rong Tang and Jing Feng and Dan-Ni Jin and Temitope Aroge and others},

year  = {2020},

date = {2020-01-01},

journal = {BMC microbiology},

volume = {20},

pages = {1--16},

publisher = {Springer},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Manabe2020,

title = {Empirical tuberculosis therapy in advanced HIV disease},

author = {Yukari C Manabe and Mark W Tenforde},

url = {https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(19)30327-3/fulltext},

doi = {DOI:https://doi.org/10.1016/S2352-3018(19)30327-3},

year  = {2020},

date = {2020-01-01},

journal = {The Lancet HIV},

volume = {7},

number = {1},

pages = {e3-e5,},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Perumal2020,

title = {A systematic review and meta-analysis of first-line tuberculosis drug concentrations and treatment outcomes },

author = {Perumal, R. and Naidoo, K. and Naidoo, A. and Ramachandran, G. and Requena-Mendez, A. and Sekaggya-Wiltshire, C. and Mpagama, S. G. and Matteelli, A. and Fehr, J. and Heysell, S. K. and Padayatchi, N. },

url = {https://www.ingentaconnect.com/content/iuatld/ijtld/2020/00000024/00000001/art00010},

doi = {DOI: https://doi.org/10.5588/ijtld.19.0025},

year  = {2020},

date = {2020-01-01},

journal = {The International Journal of Tuberculosis and Lung Disease, },

volume = {24},

number = {1},

pages = {48-64},

abstract = {Abstract:



Low serum concentrations of first-line tuberculosis (TB) drugs have been widely reported. However, the impact of low serum concentrations on treatment outcome is less well studied. A systematic search of MEDLINE/Pubmed and the Cochrane Central Register of Controlled Trials up to 31 March 2018 was conducted for articles describing drug concentrations of first-line TB drugs and treatment outcome in adult patients with drug-susceptible TB. The search identified 3073 unique publication abstracts, which were reviewed for suitability: 21 articles were acceptable for inclusion in the qualitative analysis comprising 13 prospective observational cohorts, 4 retrospective observational cohorts, 1 case-control study and 3 randomised controlled trials. Data for meta-analysis were available for 15 studies, 13 studies of rifampicin (RMP), 10 of isoniazid (INH), 8 of pyrazinamide (PZA) and 4 of ethambutol (EMB). This meta-analysis revealed that low PZA concentration appears to increase the risk of poor outcomes (8 studies, n = 2727; RR 1.73, 95%CI 1.10–2.72), low RMP concentrations may slightly increase the risk of poor outcomes (13 studies, n = 2753; RR 1.40, 95%CI 0.91–2.16), whereas low concentrations of INH (10 studies, n = 2640; RR 1.32, 95%CI 0.66–2.63) and EMB (4 studies, n = 551; RR 1.12, 95%CI 0.41–3.05) appear to make no difference to treatment outcome. There was no significant publication bias or between-study heterogeneity in any of the analyses. The potential clinical impact of low concentrations of PZA and RMP warrants further evaluation. Also, comprehensive assessments of the complex pharmacokinetic-pharmacodynamic relationships in the treatment of TB are urgently needed.



Keywords: TB; drug concentration; pharmacokinetics; treatment outcomes },

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Kwizera2020,

title = {Algorithm-aided diagnosis of chronic pulmonary aspergillosis in low- and middle-income countries by use of a lateral flow device},

author = {Richard Kwizera and Andrew Katende and Anneth Teu and Denise Apolot and William Worodria and Bruce J. Kirenga and Felix Bongomin },

url = {https://link.springer.com/article/10.1007/s10096-019-03782-x},

doi = {https://doi.org/10.1007/s10096-019-03782-x},

year  = {2020},

date = {2020-01-01},

journal = {European Journal of Clinical Microbiology & Infectious Diseases},

volume = {39},

number = {1},

pages = {1-3},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Nankya-Mutyoba2019b,

title = {Correction to: Hepatitis B virus perceptions and health seeking behaviors among pregnant women in Uganda: implications for prevention and policy},

author = {Joan Nankya-Mutyoba, Jim Aizire, Fredrick Makumbi, Ponsiano Ocama and Gregory D. Kirk},

doi = {doi:10.1186/s12913-019-4767},

year  = {2019},

date = {2019-12-20},

journal = {BMC Health Services Research},

volume = {19},

number = {1},

pages = {982},

keywords = {},

pubstate = {forthcoming},

tppubtype = {article}

}

@article{Nankya-Mutyoba2019,

title = {Hepatitis B virus perceptions and health seeking behaviors amoCorrection to: Hepatitis B virus perceptionsngpregnant women in Uganda: implicationsfor prevention and policy},

author = {Joan Nankya-Mutyoba and Jim Aizire and Fredrick Makumbi and Ponsiano Ocama and Gregory D. Kirk},

doi = {doi: 10.1186/s12913-019-4767-9. },

year  = {2019},

date = {2019-12-20},

journal = {BMC Health Services Research},

volume = {19},

number = {1},

pages = {982},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Opio2019,

title = {The Diagnostic Accuracy of Routine Clinical Findings for Detection of Esophageal Varices in Rural sub-Saharan Africa Where Schistosomiasis Is Endemic },

author = {Christopher K Opio and Lalitha Rejani and Francis Kazibwe and Ponsiano Ocama},

url = {https://www.ajol.info/index.php/ahs/article/view/192308},

doi = { DOI: 10.4314/ahs.v19i4.46 },

year  = {2019},

date = {2019-12-19},

journal = { African Health Sciences},

volume = {19},

number = {4},

abstract = {

Abstract



Background: Variceal upper gastrointestinal bleeding (UGIB) is common in sub-Saharan Africa (SSA). However, poor access to endoscopy services precludes the diagnosis of varices.

Objectives: We determined the diagnostic accuracy of routine clinical findings for detection of esophageal varices among patients with UGIB in rural SSA where schistosomiasis is endemic.

Methods: We studied patients with a history of UGIB. The index tests included routine clinical findings and the reference test was diagnostic endoscopy. Multivariable regression with post-estimation provided measures of association and diagnostic accuracy.

Results: We studied 107 participants with UGIB and 21% had active bleeding. One hundred and three (96%) had liver disease and 86(80%) varices. Factors associated with varices (p-value <0.05) were ≥ 4 lifetime episodes of UGIB, prior blood transfusion, splenomegaly, liver fibrosis, thrombocytopenia, platelet count spleen diameter ratio <909, and a dilated portal vein. Two models showed an overall diagnostic accuracy of > 90% in detection of varices with a number needed to misdiagnose of 13(number of patients who needed to be tested in order for one to be misdiagnosed by the test).

Conclusion: Where access to endoscopy is limited, routine clinical findings could improve the diagnosis of patients with UGIB in Africa.



Keywords: The diagnostic accuracy of routine clinical findings for detection of esophageal varices in rural sub-Saharan Africa where schistosomiasis is endemic.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Naluyima2019,

title = {The Joint Mobile Emerging Disease Clinical Capability (JMEDICC) laboratory approach: Capabilities for high-consequence pathogen clinical research},

author = {Prossy Naluyima and Willy Kayondo and Chi Ritchie and Joseph Wandege and Sharon Kagabane and Lydia Tumubeere and Brenda Kusiima and Daniel Kibombo and Sharon Atukunda and Christine Nanteza and Harriet Nabirye and Francis Bunjo Mugabi and Sarah Namuyanja and Christopher Hatcher and Hypaitia Rauch and Moses Mukembo and Patrick Musinguzi and JMEDICC Consortium and Nathan Sanders and Elizabeth Turesson and Christian Cando and Richard Walwema and Derrick Mimbe and Janice Hepburn and Danielle Clark and Mohammed Lamorde and Hannah Kibuuka and Saima Zaman and Anthony P. Cardile and Karen A. Martins},

url = {https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0007787},

doi = { https://doi.org/10.1371/journal.pntd.0007787},

year  = {2019},

date = {2019-12-19},

journal = {PLOS Neglected Tropical Diseases},

volume = {13},

number = {12},

abstract = {Abstract



Following the 2013–2016 Ebola virus outbreak in West Africa, numerous groups advocated for the importance of executing clinical trials in outbreak settings. The difficulties associated with obtaining reliable data to support regulatory approval of investigational vaccines and therapeutics during that outbreak were a disappointment on a research and product development level, as well as on a humanitarian level. In response to lessons learned from the outbreak, the United States Department of Defense established a multi-institute project called the Joint Mobile Emerging Disease Intervention Clinical Capability (JMEDICC). JMEDICC’s primary objective is to establish the technical capability in western Uganda to execute clinical trials during outbreaks of high-consequence pathogens such as the Ebola virus. A critical component of clinical trial execution is the establishment of laboratory operations. Technical, logistical, and political challenges complicate laboratory operations, and these challenges have been mitigated by JMEDICC to enable readiness for laboratory outbreak response operations.

},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Lwanga2019,

title = {Implementing routine physical function screening among elderly HIV-positive patients in Uganda},

author = {Isaac Lwanga, Maria Sarah Nabaggala, Agnes, Andrea Calcagno, Giovanni Guaraldi, Mohammed Lamorde, Barbara Castelnuovo},

doi = {doi.org/10.1080/09540121.2019.1703888},

year  = {2019},

date = {2019-12-17},

journal = {AIDS Care, Psychological and Socio-medical Aspects of AIDS/HIV},

volume = {32},

number = {11},

pages = {1467-1470},

abstract = {ABSTRACT



We conducted a cross-sectional study to describe routine physical function assessment for HIV-infected adults aged ≥60 years attending a large urban HIV clinic in Kampala, Uganda. Assessed demographic and clinical factors associated with low physical function in the population, generalized linear regression model was used to estimate factors associated with low physical function. Of the 93 elderly patients that underwent the Short Physical Performance Battery (SPPB) assessment, 43/93 (44.1%) scored 1–8 points at the SPPB evaluation and were categorized as low function, 45/93 (48.4%) scored 9–11 points and were categorized as moderate function and 7/93 (7.5%) scored 12 points and were categorized as high (normal) function. Women (adjusted risk ratio (ARR) 2.57; 95% confidence interval (CI): 1.54–4.29, p = 0.000) had increased risk of low physical function compared to men. A one-year increase in age (ARR = 1.09; CI: 1.03–1.15, p = 0.004) and being overweight (BMI > 25.0, ARR = 1.96; CI: 1.89–3.24, p = 0.008) also carried an increased risk of low physical function status. A higher number 13/41(32%) of falls was recorded in female than among male 3/53(5.8%) patients (p = 0.001). The SPPB assessment is a starting point for clinicians to comprehensively evaluate and consider the management of physical function limitation among older HIV-positive patients.



KEYWORDS: HIV, elderly patients, physical function, sub-Saharan Africa},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Mark2019,

title = {Evaluation of the Management of Patients with Detectable Viral Load after the Implementation of Routine Viral Load Monitoring in an Urban HIV Clinic in Uganda},

author = {Nsumba Steven Mark and Musomba Rachel and Arvind Kaimal and Mubiru Frank and Tibakabikoba Harriet and Lwanga Isaac and Mohammed Lamorde and Castelnuovo Barbara },

url = {https://www.hindawi.com/journals/art/2019/9271450/},

doi = {https://doi.org/10.1155/2019/9271450},

year  = {2019},

date = {2019-12-15},

journal = {AIDS Research and Treatment},

abstract = {Abstract



Objective. To describe the clinical decisions taken for patients failing on treatment and possible implementation leakages within the monitoring cascade at a large urban HIV Centre in Kampala, Uganda. Methods. As per internal clinic guidelines, VL results >1,000 copies/ml are flagged by a quality assurance officer and sent to the requesting clinician. The clinician fills a “decision form” choosing: (1) refer for adherence counselling, (2) repeat VL after 3 months, and (3) switch to second line. We performed data extraction on a random sample of 100 patients with VL test >1,000 copies/ml between January and August 2015. For each patient, we described the action taken by the clinicians. Results. Of 6,438 patients with VL performed, 1,021 (16%) had >1,000 copies/ml. Of the 100 (10.1%) clinical files sampled, 61% were female, median age was 39 years (IQR: 32–47), 81% were on 1st-line ART, 19% on 2nd-line, median CD4 count was 249 cells/µL (IQR: 145–390), median log10 VL 4.42 (IQR: 3.98–4.92). Doctors’ decisions were; refer for adherence counseling 49%, repeat VL for 25%, and switch to second line for 24% patients. Forty-one percent were not managed according to the guidelines. Of these, 29 (70.7%) were still active in care, 7 were tracked [5 (12.2%) lost to program, 2 (4.9%) dead] and 5 patients were not tracked. Conclusion. Despite the implementation of internal systems to manage patients failing ART, we found substantial leakages in the monitoring “cascade”. Additional measures and stronger clinical supervision are needed to make every test count, and to ensure appropriate management of patients failing on ART.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Gupta2019,

title = {Is resistance to direct-acting antivirals in sub-Saharan Africa a threat to HCV elimination? Recommendations for action},

author = {Neil Gupta and Fredrick Kateera and Hailemichael Desalegn and Ponsiano Ocama and Richard Njouom and Karine Lacombe},

url = {https://www.journal-of-hepatology.eu/article/S0168-8278(19)30644-0/abstract#%20},

doi = {DOI:https://doi.org/10.1016/j.jhep.2019.10.017},

year  = {2019},

date = {2019-12-10},

journal = {Journal of Hepatology},

volume = {72},

number = {3},

pages = {583-584},

keywords = {},

pubstate = {published},

tppubtype = {article}

}

@article{Buzibye2019,

title = {Antiretroviral concentration measurements as an additional tool to manage virologic failure in resource limited settings: a case control study. },

author = {Allan Buzibye and Joseph Musaazi and Amrei von Braun and Sarah Nanzigu and Christine Sekaggya-Wiltshire and Andrew Kambugu and Jan Fehr and Mohammed Lamorde and Ursula Gutteck, Daniel Muller and Stefanie Sowinski and Steven J. Reynolds and Barbara Castelnuovo },

url = {https://aidsrestherapy.biomedcentral.com/articles/10.1186/s12981-019-0255-x},

doi = {https://doi.org/10.1186/s12981-019-0255-x},

year  = {2019},

date = {2019-12-06},

journal = {AIDS Research and Therapy},

volume = {16},

number = {1},

pages = {39},

abstract = {Abstract



Background



Several studies demonstrate a correlation between sub-therapeutic concentrations of antiretroviral drugs and virologic failure. We examined the sensitivity, specificity and predictive values of sub-therapeutic drug levels in predicting viralogic failure.



Methods



This was a case control study with cases being samples of participants with virologic failure, and controls samples of participants with virologic suppression. We analyzed samples obtained from participants that had been on antiretroviral treatment (ART) for at least 6 months. Virologic failure was defined as HIV-RNA viral load ≥ 1000 copies/ml. Sub-therapeutic drug levels were defined according to published reference cutoffs. The diagnostic validity of drug levels for virologic failure was assessed using plasma viral loads as a gold standard.



Results



Sub-therapeutic ART concentrations explained only 38.2% of virologic failure with a probability of experiencing virologic failure of 0.66 in a patient with low drug levels versus 0.25 for participants with measurements within or above the normal range. Approximately 90% of participants with ART concentrations above the lower clinical cut off did not have virologic failure.



Conclusions



These results support prior indication for therapeutic drug monitoring in cases of suspected virologic failure.},

keywords = {},

pubstate = {published},

tppubtype = {article}

}