2017
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Godwin T. Anguzu Kuteesa R. Bisaso, Susan A. Karungi A survey of machine learning applications in HIV clinical research and care Journal Article Forthcoming In: Computers in Biology and Medicine, vol. 91, pp. 366-371, Forthcoming. @article{Bisaso2017,
title = {A survey of machine learning applications in HIV clinical research and care},
author = {Kuteesa R. Bisaso, Godwin T. Anguzu, Susan A. Karungi, Agnes Kiragga, Barbara Castelnuovo},
doi = {https://doi.org/10.1016/j.compbiomed.2017.11.001},
year = {2017},
date = {2017-12-01},
journal = {Computers in Biology and Medicine},
volume = {91},
pages = {366-371},
abstract = {Abstract
A wealth of genetic, demographic, clinical and biomarker data is collected from routine clinical care of HIV patients and exists in the form of medical records available among the medical care and research communities. Machine learning (ML) methods have the ability to identify and discover patterns in complex datasets and predict future outcomes of HIV treatment. We survey published studies that make use of ML techniques in HIV clinical research and care. An advanced search relevant to the use of ML in HIV research was conducted in the PubMed biomedical database. The survey outcomes of interest include data sources, ML techniques, ML tasks and ML application paradigms.
A growing trend in application of ML in HIV research was observed. The application paradigm has diversified to include practical clinical application, but statistical analysis remains the most dominant application. There is an increase in the use of genomic sources of data and high performance non-parametric ML methods with a focus on combating resistance to antiretroviral therapy (ART). There is need for improvement in collection of health records data and increased training in ML so as to translate ML research into clinical application in HIV management.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Abstract
A wealth of genetic, demographic, clinical and biomarker data is collected from routine clinical care of HIV patients and exists in the form of medical records available among the medical care and research communities. Machine learning (ML) methods have the ability to identify and discover patterns in complex datasets and predict future outcomes of HIV treatment. We survey published studies that make use of ML techniques in HIV clinical research and care. An advanced search relevant to the use of ML in HIV research was conducted in the PubMed biomedical database. The survey outcomes of interest include data sources, ML techniques, ML tasks and ML application paradigms.
A growing trend in application of ML in HIV research was observed. The application paradigm has diversified to include practical clinical application, but statistical analysis remains the most dominant application. There is an increase in the use of genomic sources of data and high performance non-parametric ML methods with a focus on combating resistance to antiretroviral therapy (ART). There is need for improvement in collection of health records data and increased training in ML so as to translate ML research into clinical application in HIV management. |
Kuznik, Andreas; Iliyasu, Garba; Lamorde, Mohammed; Mahmud, Mustapha; Musa, Baba M.; Nashabaru, Ibrahim; Obaro, Stephen; Mohammed, Idris; Habi, Abdulrazaq G. Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt Journal Article In: 2017. @article{Kuznik2017,
title = {Cost-effectiveness of expanding childhood routine immunization against Neisseria meningitidis serogroups C, W and Y with a quadrivalent conjugate vaccine in the African meningitis belt},
author = {Andreas Kuznik and Garba Iliyasu and Mohammed Lamorde and Mustapha Mahmud and Baba M. Musa and Ibrahim Nashabaru and Stephen Obaro and Idris Mohammed and Abdulrazaq G. Habi},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Cost-effectiveness-of-expanding-childhood-routine-immunization-against-Neisseria-meningitidis-serogroups-C-W-and-Y-with-a-quadrivalent-conjugate-vaccine-in-the-African-meningitis-belt.pdf},
doi = {10.1371/journal.pone.0188595},
year = {2017},
date = {2017-11-30},
abstract = {Background
Neisseria meningitidis constitutes a major public health problem among countries in the African meningitis belt. Following regional vaccination campaigns for serogroup A and subsequent increases in protection against this serogroup, non-A serogroups such as C and W now pose significant epidemic threats, particularly in young children.
Objective
To evaluate the cost-effectiveness of broadening coverage from conjugate serogroup A to quadrivalent ACWY vaccination.
Methods
We developed a 40-year Markov state transition model with annual cycles to simulate costs and clinical outcomes in children aged 1 to 10 in the 26 countries of the African meningitis belt. The incidence of CWY meningitis cases among an unvaccinated population was held constant at inter-epidemic rates of 50 per 100,000/year and 150 per 100,000/year. The country-specific cost and probability of access to meningitis care, vaccine efficacy, the mortality risk among treated and untreated meningitis cases, the risk of clinical sequelae and their respective disability weights were based on published sources. Vaccination cost was based on international prices lists, presented in 2014 US$.
Results
At an incidence rate of 50 per 100,000/year, routine conjugate vaccination is highly costeffective in 14 out of 26 countries with a cost/DALY averted ranging from US$555-US$787. At the higher incidence rate of 150 per 100,000/year, quadrivalent vaccination is cost-effective in all 26 countries with a cost/DALY averted ranging from US$105-US$250. The annual incidence rate at which routine conjugate quadrivalent vaccination is expected to be economically justifiable ranges from 13 per 100,000/year in Nigeria to 142 per 100,000/year in Burundi.
Conclusion
Routine quadrivalent conjugate vaccination against Neisseria meningitidis is cost-effective at incidence rates well below the epidemic threshold among children living in the African meningitis belt.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Neisseria meningitidis constitutes a major public health problem among countries in the African meningitis belt. Following regional vaccination campaigns for serogroup A and subsequent increases in protection against this serogroup, non-A serogroups such as C and W now pose significant epidemic threats, particularly in young children.
Objective
To evaluate the cost-effectiveness of broadening coverage from conjugate serogroup A to quadrivalent ACWY vaccination.
Methods
We developed a 40-year Markov state transition model with annual cycles to simulate costs and clinical outcomes in children aged 1 to 10 in the 26 countries of the African meningitis belt. The incidence of CWY meningitis cases among an unvaccinated population was held constant at inter-epidemic rates of 50 per 100,000/year and 150 per 100,000/year. The country-specific cost and probability of access to meningitis care, vaccine efficacy, the mortality risk among treated and untreated meningitis cases, the risk of clinical sequelae and their respective disability weights were based on published sources. Vaccination cost was based on international prices lists, presented in 2014 US$.
Results
At an incidence rate of 50 per 100,000/year, routine conjugate vaccination is highly costeffective in 14 out of 26 countries with a cost/DALY averted ranging from US$555-US$787. At the higher incidence rate of 150 per 100,000/year, quadrivalent vaccination is cost-effective in all 26 countries with a cost/DALY averted ranging from US$105-US$250. The annual incidence rate at which routine conjugate quadrivalent vaccination is expected to be economically justifiable ranges from 13 per 100,000/year in Nigeria to 142 per 100,000/year in Burundi.
Conclusion
Routine quadrivalent conjugate vaccination against Neisseria meningitidis is cost-effective at incidence rates well below the epidemic threshold among children living in the African meningitis belt.
|
Edward Mpoza, Joshua Rhein; Abassi, Mahsa Emerging fluconazole resistance: Implications for the management of cryptococcal meningitis Journal Article Forthcoming In: Medical Mycology Case Reports, vol. 19, pp. 30-32, Forthcoming. @article{Mpoza2017,
title = {Emerging fluconazole resistance: Implications for the management of cryptococcal meningitis},
author = {Edward Mpoza, Joshua Rhein and Mahsa Abassi},
doi = {https://doi.org/10.1016/j.mmcr.2017.11.004},
year = {2017},
date = {2017-11-26},
journal = {Medical Mycology Case Reports},
volume = {19},
pages = {30-32},
abstract = {Abstract
We present the case of an HIV-seropositive individual with cryptococcal meningitis who was found to have a fluconazole resistant strain of Cryptococcus neoformans. The individual required multiple rounds of amphotericin and fluconazole 800–1200 mg after several episodes of clinical relapse. Cerebrospinal fluid sterilization was achieved and maintained with high doses of fluconazole. This case demonstrates the emerging dilemma of increasing rates of fluconazole resistance in Cryptococcus and the clinical difficulties in meningitis management.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Abstract
We present the case of an HIV-seropositive individual with cryptococcal meningitis who was found to have a fluconazole resistant strain of Cryptococcus neoformans. The individual required multiple rounds of amphotericin and fluconazole 800–1200 mg after several episodes of clinical relapse. Cerebrospinal fluid sterilization was achieved and maintained with high doses of fluconazole. This case demonstrates the emerging dilemma of increasing rates of fluconazole resistance in Cryptococcus and the clinical difficulties in meningitis management. |
Andrew D Redd Denali Boon, Oliver Laeyendecker Hepatitis E Virus Seroprevalence and Correlates of Anti-HEV IgG Antibodies in the Rakai District, Uganda Journal Article Forthcoming In: The Journal of Infectious Diseases, vol. 217, no. 5, pp. 785–789, Forthcoming. @article{Boon2017,
title = {Hepatitis E Virus Seroprevalence and Correlates of Anti-HEV IgG Antibodies in the Rakai District, Uganda},
author = { Denali Boon, Andrew D Redd, Oliver Laeyendecker, Ronald E Engle, Hanh Nguyen, Ponsiano Ocama, Iga Boaz, Anthony Ndyanabo, Valerian Kiggundu, Steven J Reynolds, Ronald H Gray, Maria J Wawer, Robert H Purcell, Gregory D Kirk, Thomas C Quinn, Lara Stabinski, Rakai Health Sciences Program},
doi = {https://doi.org/10.1093/infdis/jix610},
year = {2017},
date = {2017-11-23},
journal = {The Journal of Infectious Diseases},
volume = {217},
number = {5},
pages = {785–789},
abstract = {Abstract
A cross-sectional study was conducted of 500 human immunodeficiency virus (HIV)-infected adults frequency matched on age, sex, and community to 500 HIV-uninfected individuals in the Rakai District, Uganda to evaluate seroprevalence of anti-hepatitis E virus (HEV) IgG antibodies. HEV seroprevalence was 47%, and 1 HIV-infected individual was actively infected with a genotype 3 virus. Using modified Poisson regression, male sex (prevalence ratios [PR] = 1.247; 95% confidence interval [CI], 1.071–1.450) and chronic hepatitis B virus infection (PR = 1.377; 95% CI, 1.090–1.738) were associated with HEV seroprevalence. HIV infection status (PR = 0.973; 95% CI, 0.852–1.111) was not associated with HEV seroprevalence. These data suggest there is a large burden of prior exposure to HEV in rural Uganda.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Abstract
A cross-sectional study was conducted of 500 human immunodeficiency virus (HIV)-infected adults frequency matched on age, sex, and community to 500 HIV-uninfected individuals in the Rakai District, Uganda to evaluate seroprevalence of anti-hepatitis E virus (HEV) IgG antibodies. HEV seroprevalence was 47%, and 1 HIV-infected individual was actively infected with a genotype 3 virus. Using modified Poisson regression, male sex (prevalence ratios [PR] = 1.247; 95% confidence interval [CI], 1.071–1.450) and chronic hepatitis B virus infection (PR = 1.377; 95% CI, 1.090–1.738) were associated with HEV seroprevalence. HIV infection status (PR = 0.973; 95% CI, 0.852–1.111) was not associated with HEV seroprevalence. These data suggest there is a large burden of prior exposure to HEV in rural Uganda. |
Kwizera, Richard; Parkes-Ratanshi, Rosalind; Page, Iain D.; Sekaggya-Wiltshire, Christine; Musaazi, Joseph; Fehr, Jan; Castelnuovo, Barbara; Kambugu, Andrew; Denning, David W. Elevated Aspergillus-specific antibody levels among HIV infected Ugandans with pulmonary tuberculosis Journal Article In: BMC Pulmonary MedicineBMC series – open, 2017. @article{Kwizera2017,
title = {Elevated Aspergillus-specific antibody levels among HIV infected Ugandans with pulmonary tuberculosis},
author = {Richard Kwizera and Rosalind Parkes-Ratanshi and Iain D. Page and Christine Sekaggya-Wiltshire and Joseph Musaazi and Jan Fehr and Barbara Castelnuovo and Andrew Kambugu and David W. Denning},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Elevated-Aspergillus-specific-antibody-levels-among-HIV-infected-Ugandans-with-pulmonary-tuberculosis.pdf},
doi = {0.1186/s12890-017-0500-9},
year = {2017},
date = {2017-11-21},
journal = {BMC Pulmonary MedicineBMC series – open},
abstract = {
Background
The incidence of tuberculosis (TB) is high among human immunodeficiency virus (HIV) infected Ugandans. Recent evidence suggests that Chronic Pulmonary Aspergillosis and Aspergillus sensitisation might be responsible for significant mortality in patients treated for tuberculosis in Uganda.
Methods
We retrieved and tested paired serum aliquots for 101 HIV-TB co-infected patients at the beginning and week 24 of TB treatment. We tested samples for Aspergillus-specific immunoglobulin G (IgG) and immunoglobulin E (IgE) using ImmunoCAP®; and Aspergillus-specific IgG and total serum IgE using Immulite® immunoassays. We compared antibody levels between baseline and week 24, relating them to selected baseline characteristics.
Results
10% of the patients had elevated Aspergillus-specific IgE (Aspergillus sensitization) and Aspergillus-specific IgG antibodies were elevated in 9% of the patients at the end of TB treatment. There was a significant fall in the Aspergillus-specific IgG antibody levels between baseline and week 24 (P = 0.02). Patients with cluster of differentiation 4 (CD4) T-cell count <100 cells/μl and those who were not on anti-retroviral therapy at baseline had more elevated Aspergillus-specific IgG antibodies (P = 0.01, P = 0.03). The ImmunoCAP® Aspergillus-specific IgG antibody titres were higher at week 24 than baseline with more positives at week 24; even though the difference in means was small. However, this difference was statistically significant (P = 0.02). Pulmonary infiltrates were the commonest x-ray abnormality and only 5% of the patients had pulmonary cavities on chest x-ray at week 24.
Conclusion
These results suggest that Aspergillus infection may complicate active pulmonary TB and further studies including fungal culture and thoracic imaging may now be indicated to measure the prevalence of pulmonary aspergillosis complicating tuberculosis.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
The incidence of tuberculosis (TB) is high among human immunodeficiency virus (HIV) infected Ugandans. Recent evidence suggests that Chronic Pulmonary Aspergillosis and Aspergillus sensitisation might be responsible for significant mortality in patients treated for tuberculosis in Uganda.
Methods
We retrieved and tested paired serum aliquots for 101 HIV-TB co-infected patients at the beginning and week 24 of TB treatment. We tested samples for Aspergillus-specific immunoglobulin G (IgG) and immunoglobulin E (IgE) using ImmunoCAP®; and Aspergillus-specific IgG and total serum IgE using Immulite® immunoassays. We compared antibody levels between baseline and week 24, relating them to selected baseline characteristics.
Results
10% of the patients had elevated Aspergillus-specific IgE (Aspergillus sensitization) and Aspergillus-specific IgG antibodies were elevated in 9% of the patients at the end of TB treatment. There was a significant fall in the Aspergillus-specific IgG antibody levels between baseline and week 24 (P = 0.02). Patients with cluster of differentiation 4 (CD4) T-cell count <100 cells/μl and those who were not on anti-retroviral therapy at baseline had more elevated Aspergillus-specific IgG antibodies (P = 0.01, P = 0.03). The ImmunoCAP® Aspergillus-specific IgG antibody titres were higher at week 24 than baseline with more positives at week 24; even though the difference in means was small. However, this difference was statistically significant (P = 0.02). Pulmonary infiltrates were the commonest x-ray abnormality and only 5% of the patients had pulmonary cavities on chest x-ray at week 24.
Conclusion
These results suggest that Aspergillus infection may complicate active pulmonary TB and further studies including fungal culture and thoracic imaging may now be indicated to measure the prevalence of pulmonary aspergillosis complicating tuberculosis.
|
Epiu, Isabella; Wabule, Agnes; Kambugu, Andrew; Mayanja-Kizza, Harriet; Tindimwebwa, Jossy Verel Bahe; Dubowitz, Gerald Key bottlenecks to the provision of safe obstetric anaesthesia in low- income countries; a cross-sectional survey of 64 hospitals in Uganda. Journal Article In: BMC Pregnancy and Childbirth, 2017, ISBN: 1471-2393. @article{Epiu2017,
title = {Key bottlenecks to the provision of safe obstetric anaesthesia in low- income countries; a cross-sectional survey of 64 hospitals in Uganda. },
author = {Isabella Epiu and Agnes Wabule and Andrew Kambugu and Harriet Mayanja-Kizza and Jossy Verel Bahe Tindimwebwa and Gerald Dubowitz},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Key-bottlenecks-to-the-provision-of-safe-obstetric-anaesthesia-in-low-income-countries-a-cross-sectional-survey-of-64-hospitals-in-Uganda.pdf},
doi = {10.1186/s12884-017-1566-3},
isbn = {1471-2393},
year = {2017},
date = {2017-11-17},
journal = {BMC Pregnancy and Childbirth},
abstract = {
Background
Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries. WFSA; 2014 http://wfsa.newsweaver.com/Newsletter/p8c8ta4ri7a1wsacct9y3u?a=2&p=47730565&t=27996496). In spite of this evidence, factors contributing to maternal mortality related to anaesthesia in LMICs and the magnitude of these issues have not been comprehensively studied. We therefore set out to assess regional referral, district, private for profit and private not-for profit hospitals in Uganda.
Methods
We conducted a cross-sectional survey at 64 government and private hospitals in Uganda using pre-set questionnaires to the anaesthetists and hospital directors. Access to the minimum requirements for safe obstetric anaesthesia according to WFSA guidelines were also checked using a checklist for operating and recovery rooms.
Results
Response rate was 100% following personal interviews of anaesthetists, and hospital directors. Only 3 of the 64 (5%) of the hospitals had all requirements available to meet the WFSA International guidelines for safe anaesthesia. Additionally, 54/64 (84%) did not have a trained physician anaesthetist and 5/64 (8%) had no trained providers for anaesthesia at all. Frequent shortages of drugs were reported for regional/neuroaxial anaesthesia, and other essential drugs were often lacking such as antacids and antihypertensives. We noted that many of the anaesthesia machines present were obsolete models without functional safety alarms and/or mechanical ventilators. Continuous ECG was only available in 3/64 (5%) of hospitals.
Conclusion
We conclude that there is a significant lack of essential equipment for the delivery of safe anaesthesia across this region. This is compounded by the shortage of trained providers and inadequate supervision. It is therefore essential to strengthen anaesthesia services by addressing these specific deficiencies. This will include improved training of associate clinicians, training more physician anaesthetists and providing the basic equipment required to provide safe and effective care. These services are key components of comprehensive emergency obstetric care and anaesthetists are crucial in managing critically ill mothers and ensuring good surgical outcomes.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Despite recent advances in surgery and anaesthesia which significantly improve safety, many health facilities in low-and middle-income countries (LMICs) remain chronically under-resourced with inability to cope effectively with serious obstetric complications (Knight et al., PLoS One 8:e63846, 2013). As a result many of these countries still have unacceptably high maternal and neonatal mortality rates. Recent data at the national referral hospitals in East Africa reported that none of the national referral hospitals met the World Federation of Societies of Anesthesiologists (WFSA) international standards required to provide safe obstetric anaesthesia (Epiu I: Challenges of Anesthesia in Low-and Middle-Income Countries. WFSA; 2014 http://wfsa.newsweaver.com/Newsletter/p8c8ta4ri7a1wsacct9y3u?a=2&p=47730565&t=27996496). In spite of this evidence, factors contributing to maternal mortality related to anaesthesia in LMICs and the magnitude of these issues have not been comprehensively studied. We therefore set out to assess regional referral, district, private for profit and private not-for profit hospitals in Uganda.
Methods
We conducted a cross-sectional survey at 64 government and private hospitals in Uganda using pre-set questionnaires to the anaesthetists and hospital directors. Access to the minimum requirements for safe obstetric anaesthesia according to WFSA guidelines were also checked using a checklist for operating and recovery rooms.
Results
Response rate was 100% following personal interviews of anaesthetists, and hospital directors. Only 3 of the 64 (5%) of the hospitals had all requirements available to meet the WFSA International guidelines for safe anaesthesia. Additionally, 54/64 (84%) did not have a trained physician anaesthetist and 5/64 (8%) had no trained providers for anaesthesia at all. Frequent shortages of drugs were reported for regional/neuroaxial anaesthesia, and other essential drugs were often lacking such as antacids and antihypertensives. We noted that many of the anaesthesia machines present were obsolete models without functional safety alarms and/or mechanical ventilators. Continuous ECG was only available in 3/64 (5%) of hospitals.
Conclusion
We conclude that there is a significant lack of essential equipment for the delivery of safe anaesthesia across this region. This is compounded by the shortage of trained providers and inadequate supervision. It is therefore essential to strengthen anaesthesia services by addressing these specific deficiencies. This will include improved training of associate clinicians, training more physician anaesthetists and providing the basic equipment required to provide safe and effective care. These services are key components of comprehensive emergency obstetric care and anaesthetists are crucial in managing critically ill mothers and ensuring good surgical outcomes.
|
Haijing Huang Sebastian Linnemayr, Jill Luoto; Mukasa, Barbara Text Messaging for Improving Antiretroviral Therapy Adherence: No Effects After 1 Year in a Randomized Controlled Trial Among Adolescents and Young Adults Journal Article Forthcoming In: American Journal of Public Health , vol. 107, no. 12, pp. 1944-1950, Forthcoming. @article{Linnemayr2017,
title = {Text Messaging for Improving Antiretroviral Therapy Adherence: No Effects After 1 Year in a Randomized Controlled Trial Among Adolescents and Young Adults },
author = {Sebastian Linnemayr, Haijing Huang, Jill Luoto, Andrew Kambugu, Harsha Thirumurthy, Jessica E. Haberer, Glenn Wagner, and Barbara Mukasa},
doi = {https://doi.org/10.2105/AJPH.2017.304089},
year = {2017},
date = {2017-11-08},
journal = {American Journal of Public Health },
volume = {107},
number = {12},
pages = {1944-1950},
abstract = {Objectives.
To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option.
Methods.
Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group.
Results.
We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups.
Conclusions.
Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Objectives.
To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option.
Methods.
Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group.
Results.
We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups.
Conclusions.
Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial. |
Sekaggya-Wiltshirea, Christine; Lamordea, Mohammed; Kiraggaa, Agnes N.; Dooleyc, Kelly E.; Kamyad, Moses R.; Kambugua, Andrew; Fehrb, Jan; Manabec, Yukari C.; Castelnuovo, Barbara The utility of pharmacokinetic studies for the evaluation of exposure response relationships for standard dose anti-tuberculosis drugs Journal Article In: Elsevier Tuberculosis, vol. 108, pp. 77-82, 2017. @article{Sekaggya-Wiltshirea2017,
title = {The utility of pharmacokinetic studies for the evaluation of exposure response relationships for standard dose anti-tuberculosis drugs },
author = {Christine Sekaggya-Wiltshirea and Mohammed Lamordea and Agnes N. Kiraggaa and Kelly E. Dooleyc and Moses R. Kamyad and Andrew Kambugua and Jan Fehrb and Yukari C. Manabec and Barbara Castelnuovo},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/The-utility-of-pharmacokinetic-studies-for-the-evaluation-of-exposureresponse-relationships-for-standard-dose-anti-tuberculosis-drugs-.pdf},
year = {2017},
date = {2017-11-06},
journal = {Elsevier Tuberculosis},
volume = {108},
pages = {77-82},
abstract = {Tuberculosis (TB) is a major public health problem. Many countries still fall below the minimum World Health Organization (WHO) TB treatment target success rate. There is conflicting evidence about whether concentrations of anti-tuberculosis drugs given at standard doses have an effect on treatment outcomes. The current data correlating anti-TB drug concentrations and treatment outcome is limited. This article summarized the existing literatureand theirutilityinevaluating theassociation betweeneachanti-TBdrug'sconcentrations using current target concentrations and treatment outcomes in patients with pulmonary tuberculosis receiving standard WHOrecommended dosing.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Tuberculosis (TB) is a major public health problem. Many countries still fall below the minimum World Health Organization (WHO) TB treatment target success rate. There is conflicting evidence about whether concentrations of anti-tuberculosis drugs given at standard doses have an effect on treatment outcomes. The current data correlating anti-TB drug concentrations and treatment outcome is limited. This article summarized the existing literatureand theirutilityinevaluating theassociation betweeneachanti-TBdrug'sconcentrations using current target concentrations and treatment outcomes in patients with pulmonary tuberculosis receiving standard WHOrecommended dosing. |
Coffie, Patrick A.; Egger, Matthias; Vinikoor, Michael J.; Zannou, Marcel; Diero, Lameck; Patassi, Akouda; Kuniholm, Mark H.; Seydi, Moussa; Bado, Guillaume; Ocama, Ponsiano; Andersson, Monique I.; Messou, Eugène; Minga, Albert; Easterbrook, Philippa; Anastos, Kathryn; Dabis, François; Wandeler, Gilles; for the IeDEA collaboration, Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa. Journal Article In: BMC Infectious Diseases, vol. 17, no. 1, pp. 706, 2017. @article{Coffie12017,
title = {Trends in hepatitis B virus testing practices and management in HIV clinics across sub-Saharan Africa.},
author = {Patrick A. Coffie and Matthias Egger and Michael J. Vinikoor and Marcel Zannou and Lameck Diero and Akouda Patassi and Mark H. Kuniholm and Moussa Seydi and Guillaume Bado and Ponsiano Ocama and Monique I. Andersson and Eugène Messou and Albert Minga and Philippa Easterbrook and Kathryn Anastos and François Dabis and Gilles Wandeler and for the IeDEA collaboration},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Trends-in-hepatitis-B-virus-testing-practices-and-management-in-HIV-clinics-across-sub-Saharan-Africa..pdf},
doi = {https://dx.doi.org/10.1186%2Fs12879-017-2768-z},
year = {2017},
date = {2017-11-01},
journal = {BMC Infectious Diseases},
volume = {17},
number = {1},
pages = {706},
abstract = {Background: Approximately 8% of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. Methods: A medical chart review was conducted in large urban HIV treatment centers in Côte d’Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. Results: Overall, 3579 charts of patients initiating ART (64.4% female, median age 37 years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8% in 2010 to 24.4% in 2012 overall, and ranged from 0.7% in Kenya to 96% in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6%; 95% confidence interval [CI] 9.4–14.1) were HBV-infected, of whom 71 (80.7%) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7% vs. 40.3%, p < 0.001). The proportion of patients on TDF-containing ART increased from 57.9% in 2010 to 90.2% in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p = 0.01). Only 114 (5.0%) patients were screened for anti-HCV antibodies and one of them (0.9%, 95% CI 0.02–4.79) had a confirmed HCV infection. Conclusions: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90% of HIV/HBV-coinfected patients receiving this drug in 2012.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Approximately 8% of HIV-infected individuals are co-infected with hepatitis B virus (HBV) in sub-Saharan Africa (SSA). Knowledge of HBV status is important to guide optimal selection of antiretroviral therapy (ART) and monitor/prevent liver-related complications. We describe changes in testing practices and management of HBV infection over a 3-year period in HIV clinics across SSA. Methods: A medical chart review was conducted in large urban HIV treatment centers in Côte d’Ivoire (3 sites), Benin, Burkina Faso, Cameroon, Kenya, Senegal, South Africa, Togo, Uganda and Zambia (1 site each). Of the patients who started ART between 2010 and 2012, 100 per year were randomly selected from each clinic. Demographic, clinical and laboratory information as well as individual treatment histories were collected using a standardized questionnaire. We examined changes over time in the proportion of patients screened for HBV infection (HBV surface antigen [HBsAg]-positivity), identified predictors of HBV testing using logistic regression, and assessed the proportion of patients initiating a tenofovir (TDF)-containing ART regimen. Results: Overall, 3579 charts of patients initiating ART (64.4% female, median age 37 years) were reviewed in 12 clinics. The proportion of patients screened for HBsAg increased from 17.8% in 2010 to 24.4% in 2012 overall, and ranged from 0.7% in Kenya to 96% in South Africa. In multivariable analyses, age and region were associated with HBsAg screening. Among 759 individuals tested, 88 (11.6%; 95% confidence interval [CI] 9.4–14.1) were HBV-infected, of whom 71 (80.7%) received a TDF-containing ART regimen. HBsAg-positive individuals were twice as likely to receive a TDF-containing first-line ART regimen compared to HBsAg-negative patients (80.7% vs. 40.3%, p < 0.001). The proportion of patients on TDF-containing ART increased from 57.9% in 2010 to 90.2% in 2012 in HIV/HBV-co-infected patients (Chi-2 test for trend: p = 0.01). Only 114 (5.0%) patients were screened for anti-HCV antibodies and one of them (0.9%, 95% CI 0.02–4.79) had a confirmed HCV infection. Conclusions: The systematic screening for HBV infection in HIV-positive patients before ART initiation was limited in most African countries and its uptake varied widely across clinics. Overall, the prescription of TDF increased over time, with 90% of HIV/HBV-coinfected patients receiving this drug in 2012.
|
Tucker, Joseph D.; Meyers, Kathrine; Best, John; Kaplan, Karyn; Pendse, Razia; Fenton, Kevin A.; Andrieux-Meyer, Isabelle; Figueroa, Carmen; Goicochea, Pedro; Gore, Charles; Ishizaki, Azumi; Khwairakpam, Giten; Miller, Veronica; Mozalevskis, Antons; Ninburg, Michael; Ocam, Ponsiano; Peeling, Rosanna; Walsh, Nick; Colombo, Massimo G.; Easterbrook1, Philippa The HepTestContest: a global innovation contest to identify approaches to hepatitis B and C testing. Journal Article In: BMC Infectious Diseases, vol. 17, no. 1, 2017. @article{Tucker2017,
title = {The HepTestContest: a global innovation contest to identify approaches to hepatitis B and C testing. },
author = {Joseph D. Tucker and Kathrine Meyers and John Best and Karyn Kaplan and Razia Pendse and Kevin A. Fenton and Isabelle Andrieux-Meyer and Carmen Figueroa and Pedro Goicochea and Charles Gore and Azumi Ishizaki and Giten Khwairakpam and Veronica Miller and Antons Mozalevskis and Michael Ninburg and Ponsiano Ocam and Rosanna Peeling and Nick Walsh and Massimo G. Colombo and Philippa Easterbrook1},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/The-HepTestContest-a-global-innovation-contest-to-identify-approaches-to-hepatitis-B-and-C-testing.pdf},
doi = {0.1186/s12879-017-2771-4},
year = {2017},
date = {2017-11-01},
journal = {BMC Infectious Diseases},
volume = {17},
number = {1},
abstract = {Background: Innovation contests are a novel approach to elicit good ideas and innovative practices in various areas of public health. There remains limited published literature on approaches to deliver hepatitis testing. The purpose of this innovation contest was to identify examples of different hepatitis B and C approaches to support countries in their scale-up of hepatitis testing and to supplement development of formal recommendations on service delivery in the 2017 World Health Organization hepatitis B and C testing guidelines. Methods: This contest involved four steps: 1) establishment of a multisectoral steering committee to coordinate a call for contest entries; 2) dissemination of the call for entries through diverse media (Facebook, Twitter, YouTube, email listservs, academic journals); 3) independent ranking of submissions by a panel of judges according to prespecified criteria (clarity of testing model, innovation, effectiveness, next steps) using a 1-10 scale; 4) recognition of highly ranked entries through presentation at international conferences, commendation certificate, and inclusion as a case study in the WHO 2017 testing guidelines. Results: The innovation contest received 64 entries from 27 countries and took a total of 4 months to complete. Sixteen entries were directly included in the WHO testing guidelines. The entries covered testing in different populations, including primary care patients (n = 5), people who inject drugs (PWID) (n = 4), pregnant women (n = 4), general populations (n = 4), high-risk groups (n = 3), relatives of people living with hepatitis B and C (n = 2), migrants (n = 2), incarcerated individuals (n = 2), workers (n = 2), and emergency department patients (n = 2). A variety of different testing delivery approaches were employed, including integrated HIV-hepatitis testing (n = 12); integrated testing with harm reduction and addiction services (n = 9); use of electronic medical records to support targeted testing (n = 8); decentralization (n = 8); and task shifting (n = 7). Conclusion: The global innovation contest identified a range of local hepatitis testing approaches that can be used to inform the development of testing strategies in different settings and populations. Further implementation and evaluation of different testing approaches is needed.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Innovation contests are a novel approach to elicit good ideas and innovative practices in various areas of public health. There remains limited published literature on approaches to deliver hepatitis testing. The purpose of this innovation contest was to identify examples of different hepatitis B and C approaches to support countries in their scale-up of hepatitis testing and to supplement development of formal recommendations on service delivery in the 2017 World Health Organization hepatitis B and C testing guidelines. Methods: This contest involved four steps: 1) establishment of a multisectoral steering committee to coordinate a call for contest entries; 2) dissemination of the call for entries through diverse media (Facebook, Twitter, YouTube, email listservs, academic journals); 3) independent ranking of submissions by a panel of judges according to prespecified criteria (clarity of testing model, innovation, effectiveness, next steps) using a 1-10 scale; 4) recognition of highly ranked entries through presentation at international conferences, commendation certificate, and inclusion as a case study in the WHO 2017 testing guidelines. Results: The innovation contest received 64 entries from 27 countries and took a total of 4 months to complete. Sixteen entries were directly included in the WHO testing guidelines. The entries covered testing in different populations, including primary care patients (n = 5), people who inject drugs (PWID) (n = 4), pregnant women (n = 4), general populations (n = 4), high-risk groups (n = 3), relatives of people living with hepatitis B and C (n = 2), migrants (n = 2), incarcerated individuals (n = 2), workers (n = 2), and emergency department patients (n = 2). A variety of different testing delivery approaches were employed, including integrated HIV-hepatitis testing (n = 12); integrated testing with harm reduction and addiction services (n = 9); use of electronic medical records to support targeted testing (n = 8); decentralization (n = 8); and task shifting (n = 7). Conclusion: The global innovation contest identified a range of local hepatitis testing approaches that can be used to inform the development of testing strategies in different settings and populations. Further implementation and evaluation of different testing approaches is needed.
|
Osingada, Charles Peter; MonicaOkuga,; RoseChaloNabirye,; Sewankambo, Nelson Kaulukusi; DamalieNakanjako, Disclosure of Parental HIV Status to Children: Experiences of Adults Receiving Antiretroviral Treatment at an Urban Clinic in Kampala, Uganda Journal Article In: AIDS Research and Treatment, pp. 11, 2017. @article{Osingada2017,
title = {Disclosure of Parental HIV Status to Children: Experiences of Adults Receiving Antiretroviral Treatment at an Urban Clinic in Kampala, Uganda},
author = {Charles Peter Osingada and MonicaOkuga and RoseChaloNabirye and Nelson Kaulukusi Sewankambo and DamalieNakanjako},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Disclosure-of-Parental-HIV-Status-to-Children-Experiences-of-Adults-Receiving-Antiretroviral-Treatment-at-an-Urban-Clinic-in-Kampala-Uganda.pdf},
doi = {10.1155/2017/3458684},
year = {2017},
date = {2017-10-25},
journal = {AIDS Research and Treatment},
pages = {11},
abstract = {Limited data are available on the experiences of parental HIV disclosure to children in Uganda. We conducted a qualitative study comprising sixteen in-depth interviews and four focus group discussions with parents receiving highly active antiretroviral therapy. Analysis was done using Atlas.ti qualitative research software. Back-and-forth triangulation was done between transcripts of the in-depth interviews and focus group discussions, and themes and subthemes were developed. Barriers to parents' disclosure included perceptions that children are too young to understand what HIV infection means and fears of secondary disclosure by the children. Immediate outcomes of disclosure included children getting scared and crying, although such instances often gave way to more enduring positive experiences for the parents, such as support in adherence to medical care, help in household chores, and a decrease in financial demands from the children. Country-specific interventions are needed to improve the process of parental HIV disclosure to children and this should encompass preparation on how to deal with the immediate psychological challenges associated with the parent's disclosure.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Limited data are available on the experiences of parental HIV disclosure to children in Uganda. We conducted a qualitative study comprising sixteen in-depth interviews and four focus group discussions with parents receiving highly active antiretroviral therapy. Analysis was done using Atlas.ti qualitative research software. Back-and-forth triangulation was done between transcripts of the in-depth interviews and focus group discussions, and themes and subthemes were developed. Barriers to parents' disclosure included perceptions that children are too young to understand what HIV infection means and fears of secondary disclosure by the children. Immediate outcomes of disclosure included children getting scared and crying, although such instances often gave way to more enduring positive experiences for the parents, such as support in adherence to medical care, help in household chores, and a decrease in financial demands from the children. Country-specific interventions are needed to improve the process of parental HIV disclosure to children and this should encompass preparation on how to deal with the immediate psychological challenges associated with the parent's disclosure. |
Ritesh Ramchandani Gregory P. Bisson, Sachiko Miyahara; for the Adult AIDS Clinical Trials Group A5274 (REMEMBER) Study Team, Risk Factors for Early Mortality on Antiretroviral Therapy in Advanced HIV-Infected Adults Journal Article Forthcoming In: AIDS, vol. 36, no. 16, pp. 2217–2225, Forthcoming. @article{Bisson2017,
title = {Risk Factors for Early Mortality on Antiretroviral Therapy in Advanced HIV-Infected Adults},
author = {Gregory P. Bisson, Ritesh Ramchandani, Sachiko Miyahara, Rosie Mngqibisa, Mitch Matoga, McNeil Ngongondo, Wadzanai Samaneka, Lucy Koech, Kogieleum Naidoo, Mohammed Rassool, Fredrick Kirui, Peter Banda, Vidya Mave, Dileep Kadam, Paul Leger, German Henostroza, Yukari C. Manabe, Jing Bao, Johnstone Kumwenda, Amita Gupta, Mina C. Hosseinipour and for the Adult AIDS Clinical Trials Group A5274 (REMEMBER) Study Team},
doi = {doi: 10.1097/QAD.0000000000001606},
year = {2017},
date = {2017-10-23},
journal = {AIDS},
volume = {36},
number = {16},
pages = {2217–2225},
abstract = {Background
Many HIV-infected individuals present with advanced HIV disease. These patients are at high risk of death after antiretroviral therapy (ART) initiation, but risk factors for death in these patients are unclear.
Methods
We used data from a multi-site randomized trial comparing empiric versus preventive TB therapy in HIV-infected adults initiating ART with CD4 counts <50 cells/mm3 to evaluate risk factors for death within 48 weeks after ART initiation. Cox proportional hazards models were fit to evaluate characteristics present at baseline and at 4 weeks after ART initiation, including the week 4 CD4 cell response and new opportunistic infections (OIs).
Findings
Of 850 enrolled, the median pre-ART CD4 count was 18 cells/mm3 and 67 (7.9%) died. Baseline risk factors for death included lymphadenopathy, lower CD4 count, lower serum albumin, high white blood cell (WBC) count, elevated neutrophil percent, and lower hemoglobin. Among 746 participants with data at week 4, the median changes in CD4 count and viral load for those who died (n=43) vs. survived were 26 vs. 56 cells/mm3 and −2.7 vs. −2.7 log10 copies/mL, respectively. Each 20 cell/mm3 lower change in week 4 CD4 count was associated with a 20% increased risk of post week-4 mortality (adj. HR 1.20, 1.01–1.42, p=.038).
Interpretation
Evidence of active infection and sub-optimal immunologic response during the first month of ART are associated with death in the first year after ART initiation in those with advanced HIV disease taking TB preventative therapy. Strategies to reduce early mortality in this population warrant further investigation.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Background
Many HIV-infected individuals present with advanced HIV disease. These patients are at high risk of death after antiretroviral therapy (ART) initiation, but risk factors for death in these patients are unclear.
Methods
We used data from a multi-site randomized trial comparing empiric versus preventive TB therapy in HIV-infected adults initiating ART with CD4 counts <50 cells/mm3 to evaluate risk factors for death within 48 weeks after ART initiation. Cox proportional hazards models were fit to evaluate characteristics present at baseline and at 4 weeks after ART initiation, including the week 4 CD4 cell response and new opportunistic infections (OIs).
Findings
Of 850 enrolled, the median pre-ART CD4 count was 18 cells/mm3 and 67 (7.9%) died. Baseline risk factors for death included lymphadenopathy, lower CD4 count, lower serum albumin, high white blood cell (WBC) count, elevated neutrophil percent, and lower hemoglobin. Among 746 participants with data at week 4, the median changes in CD4 count and viral load for those who died (n=43) vs. survived were 26 vs. 56 cells/mm3 and −2.7 vs. −2.7 log10 copies/mL, respectively. Each 20 cell/mm3 lower change in week 4 CD4 count was associated with a 20% increased risk of post week-4 mortality (adj. HR 1.20, 1.01–1.42, p=.038).
Interpretation
Evidence of active infection and sub-optimal immunologic response during the first month of ART are associated with death in the first year after ART initiation in those with advanced HIV disease taking TB preventative therapy. Strategies to reduce early mortality in this population warrant further investigation. |
Morgan J Katz Meklit Workneh, Mohammed Lamorde Antimicrobial Resistance of Sterile Site Infections in Sub-Saharan Africa: A Systematic Review Journal Article Forthcoming In: Open Forum Infectious Diseases, vol. 4, no. 4, pp. ofx209, Forthcoming. @article{Workneh2017,
title = {Antimicrobial Resistance of Sterile Site Infections in Sub-Saharan Africa: A Systematic Review},
author = {Meklit Workneh, Morgan J Katz, Mohammed Lamorde, Sara E Cosgrove, Yukari C Manabe},
doi = { https://doi.org/10.1093/ofid/ofx209},
year = {2017},
date = {2017-10-06},
journal = {Open Forum Infectious Diseases},
volume = {4},
number = {4},
pages = {ofx209},
abstract = {Abstract
Sparse data exist from sub-Saharan Africa (SSA) on the prevalence of antimicrobial resistance (AMR). A prior review of antimicrobial resistance in SSA from 1990 to 2013 showed a high prevalence of AMR to commonly used antibiotics in this setting. We reviewed the literature published since 2013. Four databases (PubMed, EMBASE, Cochrane, and African Journals Online) were searched for articles between February 2013 and March 2016 with a focus on sterile site infections (bacteremia, urinary tract infections [UTIs], and meningitis). We focused on the original World Health Organization–identified priority pathogens and antibiotics, prior to the release of the most recently updated and expanded list in 2017. There were 19 eligible studies: bacteremia (12), UTI (6), and meningitis (1). Eight studies were from Western and Central Africa, 8 from Eastern Africa, and 4 from Southern Africa. Prevalence of Escherichia coli resistance to third-generation cephalosporins ranged from 0% to 75%. No studies reported resistance to carbapenems among Klebsiella spp. Prevalence of fluoroquinolone resistance ranged from 8.3% to 100% among E. coli and 0% to 15% among Salmonella spp. Prevalence of resistance to penicillin among Streptococcus pneumoniae isolates ranged from 25% to 100%. Testing for extended-spectrum beta-lactamase was reported in 7 studies (range, 1.3–60% among tested isolates). Methods for evaluating AMR varied across studies; standardized approaches are needed in the region. Testing for mechanisms of resistance is low even in research settings, but important mechanisms of resistance such as ESBL production are present.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Abstract
Sparse data exist from sub-Saharan Africa (SSA) on the prevalence of antimicrobial resistance (AMR). A prior review of antimicrobial resistance in SSA from 1990 to 2013 showed a high prevalence of AMR to commonly used antibiotics in this setting. We reviewed the literature published since 2013. Four databases (PubMed, EMBASE, Cochrane, and African Journals Online) were searched for articles between February 2013 and March 2016 with a focus on sterile site infections (bacteremia, urinary tract infections [UTIs], and meningitis). We focused on the original World Health Organization–identified priority pathogens and antibiotics, prior to the release of the most recently updated and expanded list in 2017. There were 19 eligible studies: bacteremia (12), UTI (6), and meningitis (1). Eight studies were from Western and Central Africa, 8 from Eastern Africa, and 4 from Southern Africa. Prevalence of Escherichia coli resistance to third-generation cephalosporins ranged from 0% to 75%. No studies reported resistance to carbapenems among Klebsiella spp. Prevalence of fluoroquinolone resistance ranged from 8.3% to 100% among E. coli and 0% to 15% among Salmonella spp. Prevalence of resistance to penicillin among Streptococcus pneumoniae isolates ranged from 25% to 100%. Testing for extended-spectrum beta-lactamase was reported in 7 studies (range, 1.3–60% among tested isolates). Methods for evaluating AMR varied across studies; standardized approaches are needed in the region. Testing for mechanisms of resistance is low even in research settings, but important mechanisms of resistance such as ESBL production are present. |
O’Hara, Geraldine A.; McNaughton, Anna L.; Maponga, Tongai; Jooste, Pieter; Ocama, Ponsiano; Chilengi, Roma; Mokaya, Jolynne; Liyayi, Mitchell I.; Wachira, Tabitha; Gikungi, David M.; Burbridge, Lela; O’Donnell, Denise; Akiror, Connie S.; Sloan, Derek; Torimiro, Judith; Yindom, Louis Marie; Walton, Robert; Andersson, Monique; Marsh, Kevin; Newton, Robert; Matthew, Philippa C. Hepatitis B virus infection as a neglected tropical disease. Journal Article In: PloS Neglected Tropical Diseases, vol. 11, no. 10, 2017. @article{O’Hara2017,
title = {Hepatitis B virus infection as a neglected tropical disease.},
author = {Geraldine A. O’Hara and Anna L. McNaughton and Tongai Maponga and Pieter Jooste and Ponsiano Ocama and Roma Chilengi and Jolynne Mokaya and Mitchell I. Liyayi and Tabitha Wachira and David M. Gikungi and Lela Burbridge and Denise O’Donnell and Connie S. Akiror and Derek Sloan and Judith Torimiro and Louis Marie Yindom and Robert Walton and Monique Andersson and Kevin Marsh and Robert Newton and Philippa C. Matthew},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Hepatitis-B-virus-infection-as-a-neglected-tropical-disease.-1.pdf},
doi = { 10.1371/journal.pntd.0005842},
year = {2017},
date = {2017-10-05},
journal = {PloS Neglected Tropical Diseases},
volume = {11},
number = {10},
abstract = {The Global Hepatitis Health Sector Strategy is aiming for “elimination of viral hepatitis as a public health threat” by 2030 [1], while enhanced elimination efforts for hepatitis are also promoted under the broader remit of global Sustainable Development Goals (SDGs) [2]. This is an enormous challenge for hepatitis B virus (HBV) given the estimated global burden of 260 million chronic carriers, of whom the majority are unaware of their infection [3] (Fig 1). We here present HBV within the framework for neglected tropical diseases (NTDs) [4] in order to highlight the ways in which HBV meets NTD criteria and to discuss the ways in which the NTD management paradigm could be used to strengthen a unified global approach to HBV elimination [5]. The major burden of morbidity and mortality from HBV is now borne by tropical and subtropical countries [6]. Many African populations epitomize specific vulnerability to HBV [7], so we here focus particular attention on Africa, both through focus on the existing published literature and through presentation of a unique data set of opinion and experience (see S1 Supporting Information). However, the themes we represent are transferable to other low- and middle-income settings and are relevant on the global stage.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The Global Hepatitis Health Sector Strategy is aiming for “elimination of viral hepatitis as a public health threat” by 2030 [1], while enhanced elimination efforts for hepatitis are also promoted under the broader remit of global Sustainable Development Goals (SDGs) [2]. This is an enormous challenge for hepatitis B virus (HBV) given the estimated global burden of 260 million chronic carriers, of whom the majority are unaware of their infection [3] (Fig 1). We here present HBV within the framework for neglected tropical diseases (NTDs) [4] in order to highlight the ways in which HBV meets NTD criteria and to discuss the ways in which the NTD management paradigm could be used to strengthen a unified global approach to HBV elimination [5]. The major burden of morbidity and mortality from HBV is now borne by tropical and subtropical countries [6]. Many African populations epitomize specific vulnerability to HBV [7], so we here focus particular attention on Africa, both through focus on the existing published literature and through presentation of a unique data set of opinion and experience (see S1 Supporting Information). However, the themes we represent are transferable to other low- and middle-income settings and are relevant on the global stage. |
Clair, Nicole E. St; Pitt, Michael B.; Bakeera-Kitaka, Sabrina; McCall, Natalie; Lukolyo, Heather; Linda D. Arnold, Tobey Audcent; Batra, Maneesh; Chan, Kevin; Jacquet, Gabrielle A.; Schutze, Gordon E.; Butteris, Sabrina Global Health: Preparation for Working in Resource-Limited Settings Journal Article In: American Board of Pediatrics, 2017. @article{Clair2017,
title = {Global Health: Preparation for Working in Resource-Limited Settings},
author = {Nicole E. St Clair and Michael B. Pitt and Sabrina Bakeera-Kitaka and Natalie McCall and Heather Lukolyo and Linda D. Arnold, Tobey Audcent and Maneesh Batra and Kevin Chan and Gabrielle A. Jacquet and Gordon E. Schutze and Sabrina Butteris
},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Global-Health-Preparation-for-Working-in-Resource-Limited-Settings.-1.pdf},
year = {2017},
date = {2017-10-02},
journal = {American Board of Pediatrics},
abstract = {Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Trainees and clinicians from high-income countries are increasingly engaging in global health (GH) efforts, particularly in resource-limited settings. Concomitantly, there is a growing demand for these individuals to be better prepared for the common challenges and controversies inherent in GH work. This is a state-of-the-art review article in which we outline what is known about the current scope of trainee and clinician involvement in GH experiences, highlight specific considerations and issues pertinent to GH engagement, and summarize preparation recommendations that have emerged from the literature. The article is focused primarily on short-term GH experiences, although much of the content is also pertinent to long-term work. Suggestions are made for the health care community to develop and implement widely endorsed preparation standards for trainees, clinicians, and organizations engaging in GH experiences and partnerships. |
Amata Kwizera Cintia Spira, Sue Jacob Improving the quality of maternity services in Uganda through accelerated implementation of essential interventions by healthcare professional associations Journal Article Forthcoming In: International Journal of Gynecology & Obstetrics, vol. 139, no. 1, pp. 107-113, Forthcoming. @article{Spira2017,
title = {Improving the quality of maternity services in Uganda through accelerated implementation of essential interventions by healthcare professional associations},
author = {
Cintia Spira, Amata Kwizera, Sue Jacob, Dinah Amongin, Joseph Ngonzi, Charles P. Namisi, Romano Byaruhanga, Hamid Rushwan, Peter Cooper, Frances Day-Stirk, Mabel Berrueta, Ezequiel García-Elorrio, José M. Belizán},
doi = {https://doi.org/10.1002/ijgo.12241},
year = {2017},
date = {2017-10-01},
journal = {International Journal of Gynecology & Obstetrics},
volume = {139},
number = {1},
pages = {107-113},
abstract = {Objective
To assess whether the implementation of a package of activities through the joint action of the three international healthcare professionals associations (HCPAs) increased the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Uganda.
Methods
A non-controlled before-and-after study was undertaken to evaluate the effect of a package of activities designed to change practice relating to nine EIs among providers. Coverage of the EIs was measured in a 3-month pre-implementation period and a 3-month post-implementation period in 2014. Data were obtained for women older than 18 years who delivered vaginally or by cesarean.
Results
Overall, 4816 women were included. Level of use remained high for EIs used widely at baseline. Some EIs that had low use at baseline did not show improvement after the implementation. Promotion of breastfeeding showed a significant improvement in the Kampala hospital, from 8.5% (8/94) to 25.6% (30/117; P=0.001), whereas promotion of hygiene in cord care improved at the Mbarara hospital, from 0.1% (2/1592) to 46.0% (622/1351; P<0.001).
Conclusion
These exploratory results show that a package delivered through the joint work of the three HCPAs was feasible to implement along with rigorous data collection. Although the data show disparities, trends suggest that improvement could be achieved.},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Objective
To assess whether the implementation of a package of activities through the joint action of the three international healthcare professionals associations (HCPAs) increased the use of intrapartum and postnatal essential interventions (EIs) in two hospitals in Uganda.
Methods
A non-controlled before-and-after study was undertaken to evaluate the effect of a package of activities designed to change practice relating to nine EIs among providers. Coverage of the EIs was measured in a 3-month pre-implementation period and a 3-month post-implementation period in 2014. Data were obtained for women older than 18 years who delivered vaginally or by cesarean.
Results
Overall, 4816 women were included. Level of use remained high for EIs used widely at baseline. Some EIs that had low use at baseline did not show improvement after the implementation. Promotion of breastfeeding showed a significant improvement in the Kampala hospital, from 8.5% (8/94) to 25.6% (30/117; P=0.001), whereas promotion of hygiene in cord care improved at the Mbarara hospital, from 0.1% (2/1592) to 46.0% (622/1351; P<0.001).
Conclusion
These exploratory results show that a package delivered through the joint work of the three HCPAs was feasible to implement along with rigorous data collection. Although the data show disparities, trends suggest that improvement could be achieved. |
Sekaggya-Wiltshire, Christine; Castelnuovo, Barbara; von Braun, Amrei; Musaazi, Joseph; Muller, Daniel; Buzibye, Allan; Gutteck, Ursula; Henning, Lars; Ledergerber, Bruno; Corti, Natascia; Lamorde, Mohammed; Fehr, Jan; Kambugu, Andrew Cohort profile of a study on outcomes related to tuberculosis and antiretroviral drug concentrations in Uganda: design, methods and patient characteristics of the SOUTH study Journal Article In: BMJ Open, vol. 7, no. 9, 2017. @article{Sekaggya-Wiltshire2017,
title = {Cohort profile of a study on outcomes related to tuberculosis and antiretroviral drug concentrations in Uganda: design, methods and patient characteristics of the SOUTH study},
author = {Christine Sekaggya-Wiltshire and Barbara Castelnuovo and Amrei von Braun and Joseph Musaazi and Daniel Muller and Allan Buzibye and Ursula Gutteck and Lars Henning and Bruno Ledergerber and Natascia Corti and Mohammed Lamorde and Jan Fehr and Andrew Kambugu },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Cohort-profile-of-a-study-on-outcomes-related-to-tuberculosis-and-antiretroviral-drug-concentrations-in-Uganda-design-methods-and-patient-characteristics-of-the-SOUTH-study.pdf},
doi = {10.1136/bmjopen-2016-014679.},
year = {2017},
date = {2017-09-18},
journal = {BMJ Open},
volume = {7},
number = {9},
abstract = {AbstrAct Purpose Tuberculosis (TB) is a leading cause of death among people living with HIV in sub-Saharan Africa. Several factors influence the efficacy of TB treatment by leading to suboptimal drug concentrations and subsequently affecting treatment outcome. The aim of this cohort is to determine the association between anti-TB drug concentrations and TB treatment outcomes. Participants Patients diagnosed with new pulmonary TB at the integrated TB-HIV outpatient clinic in Kampala, Uganda, were enrolled into the study and started on firstline anti-TB treatment. Findings to date Between April 2013 and April 2015, the cohort enrolled 268 patients coinfected with TB/HIV ; 57.8% are male with a median age of 34 years (IQR 29–40). The median time between the diagnosis of HIV and the diagnosis of TB is 2 months (IQR 0–22.5). The majority of the patients are antiretroviral therapy naive (75.4%). Our population is severely immunosuppressed with a median CD4 cell count at enrolment of 163 cells/µL (IQR 46–298). Ninety-nine per cent of the patients had a diagnosis of pulmonary TB confirmed by sputum microscopy, Xpert/RIF or culture and 203 (75.7%) have completed TB treatment with 5099 aliquots of blood collected for pharmacokinetic analysis. Future plans This cohort provides a large database of well-characterised patients coinfected with TB/HIV which will facilitate the description of the association between serum drug concentrations and TB treatment outcomes as well as provide a research platform for future substudies including evaluation of virological outcomes. trial registration number NCT01782950; Pre-results},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
AbstrAct Purpose Tuberculosis (TB) is a leading cause of death among people living with HIV in sub-Saharan Africa. Several factors influence the efficacy of TB treatment by leading to suboptimal drug concentrations and subsequently affecting treatment outcome. The aim of this cohort is to determine the association between anti-TB drug concentrations and TB treatment outcomes. Participants Patients diagnosed with new pulmonary TB at the integrated TB-HIV outpatient clinic in Kampala, Uganda, were enrolled into the study and started on firstline anti-TB treatment. Findings to date Between April 2013 and April 2015, the cohort enrolled 268 patients coinfected with TB/HIV ; 57.8% are male with a median age of 34 years (IQR 29–40). The median time between the diagnosis of HIV and the diagnosis of TB is 2 months (IQR 0–22.5). The majority of the patients are antiretroviral therapy naive (75.4%). Our population is severely immunosuppressed with a median CD4 cell count at enrolment of 163 cells/µL (IQR 46–298). Ninety-nine per cent of the patients had a diagnosis of pulmonary TB confirmed by sputum microscopy, Xpert/RIF or culture and 203 (75.7%) have completed TB treatment with 5099 aliquots of blood collected for pharmacokinetic analysis. Future plans This cohort provides a large database of well-characterised patients coinfected with TB/HIV which will facilitate the description of the association between serum drug concentrations and TB treatment outcomes as well as provide a research platform for future substudies including evaluation of virological outcomes. trial registration number NCT01782950; Pre-results |
Mohammed LAMORDE Catherine A. CHAPPELL, Shadia NAKALEMA; SCARSI, Kimberly K. Efavirenz decreases etonogestrel exposure: a pharmacokinetic evaluation of implantable contraception with antiretroviral therapy Journal Article Forthcoming In: AIDS, vol. 31, no. 14, pp. 1965–1972, Forthcoming. @article{CHAPPELL2017,
title = {Efavirenz decreases etonogestrel exposure: a pharmacokinetic evaluation of implantable contraception with antiretroviral therapy},
author = {Catherine A. CHAPPELL, Mohammed LAMORDE, Shadia NAKALEMA, Beatrice A. CHEN, Hope MACKLINE, Sharon A. RIDDLER, Susan E. COHN, Kristin M. DARIN, Sharon L. ACHILLES and Kimberly K. SCARSI},
doi = {doi: 10.1097/QAD.0000000000001591},
year = {2017},
date = {2017-09-10},
journal = {AIDS},
volume = {31},
number = {14},
pages = {1965–1972},
abstract = {Objectives
The primary objective of this study was to characterize the pharmacokinetics of etonogestrel (ENG) released from a contraceptive implant in Ugandan women living with HIV who were receiving efavirenz (EFV)- or nevirapine (NVP)-based antiretroviral therapy (ART), compared to ART-naïve women over 24 weeks.
Design
Non-randomized, parallel-group study with 3 arms: ART-naïve, NVP-, or EFV-based ART (N=20 per group).
Methods
Sparse pharmacokinetic sampling of ENG, NVP or EFV were performed at screening, entry, and then 1, 4, 12 and 24 weeks post-implant insertion. The primary endpoint was ENG concentrations at week 24, compared between the ART-naïve group and each ART group, using geometric mean ratio (GMR) with 90% confidence intervals.
Results
Sixty participants competed the study and data from 58 participants are included; one participant each was excluded from the NVP group and EFV group due to a sample processing error and ART nonadherence, respectively. At week 24, geometric mean (GM) ENG was 362, 341, and 66 pg/mL in the ART-naïve, NVP, and EFV groups, respectively [GMR: NVP:ART-naïve 0.94 (0.90–1.01); EFV:ART-naïve 0.18 (0.17–0.20)]. NVP and EFV concentrations were lower at week 24 compared to pre-implant [NVP: GM 5.7 versus 6.8 mg/L, respectively, GMR 0.84 (0.83–0.85); EFV: GM 3.6 versus 4.9mg/L, respectively, GMR 0.73 (0.69–0.80)].
Conclusions
After 24 weeks of combined use, ENG exposure was 82% lower in women using EFV-based ART compared to ART-naïve women. In contrast, NVP did not significantly impact ENG exposure. These results raise concerns about reduced effectiveness of implantable contraception for women taking EFV-based ART.
Keywords: contraceptive implant, etonogestrel, efavirenz, nevirapine, family planning, antiretroviral therapy, drug-drug interaction},
keywords = {},
pubstate = {forthcoming},
tppubtype = {article}
}
Objectives
The primary objective of this study was to characterize the pharmacokinetics of etonogestrel (ENG) released from a contraceptive implant in Ugandan women living with HIV who were receiving efavirenz (EFV)- or nevirapine (NVP)-based antiretroviral therapy (ART), compared to ART-naïve women over 24 weeks.
Design
Non-randomized, parallel-group study with 3 arms: ART-naïve, NVP-, or EFV-based ART (N=20 per group).
Methods
Sparse pharmacokinetic sampling of ENG, NVP or EFV were performed at screening, entry, and then 1, 4, 12 and 24 weeks post-implant insertion. The primary endpoint was ENG concentrations at week 24, compared between the ART-naïve group and each ART group, using geometric mean ratio (GMR) with 90% confidence intervals.
Results
Sixty participants competed the study and data from 58 participants are included; one participant each was excluded from the NVP group and EFV group due to a sample processing error and ART nonadherence, respectively. At week 24, geometric mean (GM) ENG was 362, 341, and 66 pg/mL in the ART-naïve, NVP, and EFV groups, respectively [GMR: NVP:ART-naïve 0.94 (0.90–1.01); EFV:ART-naïve 0.18 (0.17–0.20)]. NVP and EFV concentrations were lower at week 24 compared to pre-implant [NVP: GM 5.7 versus 6.8 mg/L, respectively, GMR 0.84 (0.83–0.85); EFV: GM 3.6 versus 4.9mg/L, respectively, GMR 0.73 (0.69–0.80)].
Conclusions
After 24 weeks of combined use, ENG exposure was 82% lower in women using EFV-based ART compared to ART-naïve women. In contrast, NVP did not significantly impact ENG exposure. These results raise concerns about reduced effectiveness of implantable contraception for women taking EFV-based ART.
Keywords: contraceptive implant, etonogestrel, efavirenz, nevirapine, family planning, antiretroviral therapy, drug-drug interaction |
Surowiec, Izabella; Gouveia‑Figueira, Sandra; Orikiiriza, Judy; Lindquist, Elisabeth; Bonde, Mari; Magambo, Jimmy; Muhinda, Charles; Bergström, Sven; Normark, Johan; Trygg, Johan The oxylipin and endocannabidome responses in acute phase Plasmodium falciparum malaria in children. Journal Article In: |Malaria Journal , vol. 16, no. 1, pp. 358, 2017. @article{Surowiec2017,
title = {The oxylipin and endocannabidome responses in acute phase Plasmodium falciparum malaria in children. },
author = {Izabella Surowiec and Sandra Gouveia‑Figueira and Judy Orikiiriza and Elisabeth Lindquist and Mari Bonde and Jimmy Magambo and Charles Muhinda and Sven Bergström and Johan Normark and Johan Trygg},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/The-oxylipin-and-endocannabidome-responses-in-acute-phase-Plasmodium-falciparum-malaria-in-children.pdf},
doi = { 10.1186/s12936-017-2001-y},
year = {2017},
date = {2017-09-08},
journal = {|Malaria Journal },
volume = {16},
number = {1},
pages = {358},
abstract = {Background: Oxylipins and endocannabinoids are low molecular weight bioactive lipids that are crucial for initia‑ tion and resolution of inflammation during microbial infections. Metabolic complications in malaria are recognized contributors to severe and fatal malaria, but the impact of malaria infection on the production of small lipid derived signalling molecules is unknown. Knowledge of immunoregulatory patterns of these molecules in malaria is of great value for better understanding of the disease and improvement of treatment regimes, since the action of these classes of molecules is directly connected to the inflammatory response of the organism. Methods: Detection of oxylipins and endocannabinoids from plasma samples from forty children with uncompli‑ cated and severe malaria as well as twenty controls was done after solid phase extraction followed by chromatog‑ raphy mass spectrometry analysis. The stable isotope dilution method was used for compound quantification. Data analysis was done with multivariate (principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS‑DA®) and univariate approaches (receiver operating characteristic (ROC) curves, t tests, correlation analysis). Results: Forty different oxylipin and thirteen endocannabinoid metabolites were detected in the studied samples, with one oxylipin (thromboxane B2, TXB2) in significantly lower levels and four endocannabinoids (OEA, PEA, DEA and EPEA) at significantly higher levels in infected individuals as compared to controls according to t test analysis with Bonferroni correction. Three oxylipins (13‑HODE, 9‑HODE and 13‑oxo‑ODE) were higher in severe compared to uncomplicated malaria cases according to the results from multivariate analysis. Observed changes in oxylipin levels can be connected to activation of cytochrome P450 (CYP) and 5‑lipoxygenase (5‑LOX) metabolic pathways in malaria infected individuals compared to controls, and related to increased levels of all linoleic acid oxylipins in severe patients compared to uncomplicated ones. The endocannabinoids were extremely responsive to malaria infection with majority of this class of molecules found at higher levels in infected individuals compared to controls. Conclusions: It was possible to detect oxylipin and endocannabinoid molecules that can be potential biomarkers for differentiation between malaria infected individuals and controls and between different classes of malaria. Metabolic pathways that could be targeted towards an adjunctive therapy in the treatment of malaria were also pinpointed. Keywords: Oxylipins, Endocannabinoids, Malaria infection, Plasmodium falciparum
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Oxylipins and endocannabinoids are low molecular weight bioactive lipids that are crucial for initia‑ tion and resolution of inflammation during microbial infections. Metabolic complications in malaria are recognized contributors to severe and fatal malaria, but the impact of malaria infection on the production of small lipid derived signalling molecules is unknown. Knowledge of immunoregulatory patterns of these molecules in malaria is of great value for better understanding of the disease and improvement of treatment regimes, since the action of these classes of molecules is directly connected to the inflammatory response of the organism. Methods: Detection of oxylipins and endocannabinoids from plasma samples from forty children with uncompli‑ cated and severe malaria as well as twenty controls was done after solid phase extraction followed by chromatog‑ raphy mass spectrometry analysis. The stable isotope dilution method was used for compound quantification. Data analysis was done with multivariate (principal component analysis (PCA), orthogonal partial least squares discriminant analysis (OPLS‑DA®) and univariate approaches (receiver operating characteristic (ROC) curves, t tests, correlation analysis). Results: Forty different oxylipin and thirteen endocannabinoid metabolites were detected in the studied samples, with one oxylipin (thromboxane B2, TXB2) in significantly lower levels and four endocannabinoids (OEA, PEA, DEA and EPEA) at significantly higher levels in infected individuals as compared to controls according to t test analysis with Bonferroni correction. Three oxylipins (13‑HODE, 9‑HODE and 13‑oxo‑ODE) were higher in severe compared to uncomplicated malaria cases according to the results from multivariate analysis. Observed changes in oxylipin levels can be connected to activation of cytochrome P450 (CYP) and 5‑lipoxygenase (5‑LOX) metabolic pathways in malaria infected individuals compared to controls, and related to increased levels of all linoleic acid oxylipins in severe patients compared to uncomplicated ones. The endocannabinoids were extremely responsive to malaria infection with majority of this class of molecules found at higher levels in infected individuals compared to controls. Conclusions: It was possible to detect oxylipin and endocannabinoid molecules that can be potential biomarkers for differentiation between malaria infected individuals and controls and between different classes of malaria. Metabolic pathways that could be targeted towards an adjunctive therapy in the treatment of malaria were also pinpointed. Keywords: Oxylipins, Endocannabinoids, Malaria infection, Plasmodium falciparum
|
Semeere, Aggrey; Freeman, Esther; Wenger, Megan; Glidden, David; Bwana, Mwebesa; Kanyesigye, Micheal; Asirwa, Fredrick Chite; Rotich, Elyne; Busakhala, Naftali; Oga, Emmanuel; Jedy-Agba, Elima; Kwaghe, Vivian; Iregbu, Kenneth; Adebamowo, Clement; Jaquet, Antoine; Dabis, Francois; Phiri, Sam; Bohlius, Julia; Egger, Matthias; Yiannoutsos, Constantin T.; Wools-Kaloustian, Kara; Martin, Jeffrey Updating vital status by tracking in the community among patients with epidemic Kaposi sarcoma who are lost to follow-up in sub-Saharan Africa. Journal Article In: BMC Cancer, vol. 17, no. 1, pp. 611, 2017. @article{Semeere2017,
title = {Updating vital status by tracking in the community among patients with epidemic Kaposi sarcoma who are lost to follow-up in sub-Saharan Africa.},
author = {Aggrey Semeere and Esther Freeman and Megan Wenger and David Glidden and Mwebesa Bwana and Micheal Kanyesigye and Fredrick Chite Asirwa and Elyne Rotich and Naftali Busakhala and Emmanuel Oga and Elima Jedy-Agba and Vivian Kwaghe and Kenneth Iregbu and Clement Adebamowo and Antoine Jaquet and Francois Dabis and Sam Phiri and Julia Bohlius and Matthias Egger and Constantin T. Yiannoutsos and Kara Wools-Kaloustian and Jeffrey Martin
},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Updating-vital-status-by-tracking-in-the-community-among-patients-with-epidemic-Kaposi-sarcoma-who-are-lost-to-follow-up-in-sub-Saharan-Afric.pdf},
doi = {10.1186/s12885-017-3549-1},
year = {2017},
date = {2017-09-02},
journal = {BMC Cancer},
volume = {17},
number = {1},
pages = {611},
abstract = {Background: Throughout most of sub-Saharan Africa (and, indeed, most resource-limited areas), lack of death registries prohibits linkage of cancer diagnoses and precludes the most expeditious approach to determining cancer survival. Instead, estimation of cancer survival often uses clinical records, which have some mortality data but are replete with patients who are lost to follow-up (LTFU), some of which may be caused by undocumented death. The end result is that accurate estimation of cancer survival is rarely performed. A prominent example of a common cancer in Africa for which survival data are needed but for which frequent LTFU has precluded accurate estimation is Kaposi sarcoma (KS). Methods: Using electronic records, we identified all newly diagnosed KS among HIV-infected adults at 33 primary care clinics in Kenya, Uganda, Nigeria, and Malawi from 2009 to 2012. We determined those patients who were apparently LTFU, defined as absent from clinic for ≥90 days at database closure and unknown to be dead or transferred. Using standardized protocols which included manual chart review, telephone calls, and physical tracking in the community, we attempted to update vital status amongst patients who were LTFU. Results: We identified 1222 patients with KS, of whom 440 were LTFU according to electronic records. Manual chart review revealed that 18 (4.1%) were classified as LFTU due to clerical error, leaving 422 as truly LTFU. Of these 422, we updated vital status in 78%; manual chart review was responsible for updating in 5.7%, telephone calls in 26%, and physical tracking in 46%. Among 378 patients who consented at clinic enrollment to be tracked if they became LTFU and who had sufficient geographic contact/locator information, we updated vital status in 88%. Duration of LTFU was not associated with success of tracking, but tracking success was better in Kenya than the other sites. Conclusion: It is feasible to update vital status in a large fraction of patients with HIV-associated KS in sub-Saharan Africa who have become LTFU from clinical care. This finding likely applies to other cancers as well. Updating vital status amongst lost patients paves the way towards accurate determination of cancer survival. Keywords: Loss to follow-up, Tracking, Tracing, Updating vital status, Survival, Mortality, Kaposi sarcoma, HIV/AIDS, Cancer, Resource-limited settings, Sub-Saharan Africa
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Throughout most of sub-Saharan Africa (and, indeed, most resource-limited areas), lack of death registries prohibits linkage of cancer diagnoses and precludes the most expeditious approach to determining cancer survival. Instead, estimation of cancer survival often uses clinical records, which have some mortality data but are replete with patients who are lost to follow-up (LTFU), some of which may be caused by undocumented death. The end result is that accurate estimation of cancer survival is rarely performed. A prominent example of a common cancer in Africa for which survival data are needed but for which frequent LTFU has precluded accurate estimation is Kaposi sarcoma (KS). Methods: Using electronic records, we identified all newly diagnosed KS among HIV-infected adults at 33 primary care clinics in Kenya, Uganda, Nigeria, and Malawi from 2009 to 2012. We determined those patients who were apparently LTFU, defined as absent from clinic for ≥90 days at database closure and unknown to be dead or transferred. Using standardized protocols which included manual chart review, telephone calls, and physical tracking in the community, we attempted to update vital status amongst patients who were LTFU. Results: We identified 1222 patients with KS, of whom 440 were LTFU according to electronic records. Manual chart review revealed that 18 (4.1%) were classified as LFTU due to clerical error, leaving 422 as truly LTFU. Of these 422, we updated vital status in 78%; manual chart review was responsible for updating in 5.7%, telephone calls in 26%, and physical tracking in 46%. Among 378 patients who consented at clinic enrollment to be tracked if they became LTFU and who had sufficient geographic contact/locator information, we updated vital status in 88%. Duration of LTFU was not associated with success of tracking, but tracking success was better in Kenya than the other sites. Conclusion: It is feasible to update vital status in a large fraction of patients with HIV-associated KS in sub-Saharan Africa who have become LTFU from clinical care. This finding likely applies to other cancers as well. Updating vital status amongst lost patients paves the way towards accurate determination of cancer survival. Keywords: Loss to follow-up, Tracking, Tracing, Updating vital status, Survival, Mortality, Kaposi sarcoma, HIV/AIDS, Cancer, Resource-limited settings, Sub-Saharan Africa
|
Kwizera, Richard; Akampurira, Andrew; Kandole, Tadeo K.; Nielsen, Kirsten; Kambugu, Andrew; Meya, David B.; Boulware, David R.; Rhein, Joshua; on behalf of the ASTRO-CM Study Team, Evaluation of trypan blue stain in a haemocytometer for rapid detection of cerebrospinal fluid sterility in HIV patients with cryptococcal meningitis. Journal Article In: BMC Microbiology, vol. 17, no. 1, pp. 182, 2017. @article{Kwizera2017c,
title = {Evaluation of trypan blue stain in a haemocytometer for rapid detection of cerebrospinal fluid sterility in HIV patients with cryptococcal meningitis.},
author = {Richard Kwizera and Andrew Akampurira and Tadeo K. Kandole and Kirsten Nielsen and Andrew Kambugu and David B. Meya and David R. Boulware and Joshua Rhein and on behalf of the ASTRO-CM Study Team},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Evaluation-of-trypan-blue-stain-in-a-haemocytometer-for-rapid-detection-of-cerebrospinal-fluid-sterility-in-HIV-patients-with-cryptococcal-meningitis-1.pdf},
year = {2017},
date = {2017-08-22},
journal = {BMC Microbiology},
volume = {17},
number = {1},
pages = {182},
abstract = {Background: Quantitative culture is the most common method to determine the fungal burden and sterility of cerebrospinal fluid (CSF) among persons with cryptococcal meningitis. A major drawback of cultures is a long turnaround-time. Recent evidence demonstrates that live and dead Cryptococcus yeasts can be distinguished using trypan blue staining. We hypothesized that trypan blue staining combined with haemocytometer counting may provide a rapid estimation of quantitative culture count and detection of CSF sterility. To test this, we evaluated 194 CSF specimens from 96 HIV-infected participants with cryptococcal meningitis in Kampala, Uganda. Cryptococcal meningitis was diagnosed by CSF cryptococcal antigen (CRAG). We stained CSF with trypan blue and quantified yeasts using a haemocytometer. We compared the haemocytometer readings versus quantitative Cryptococcus CSF cultures. Results: Haemocytometer counting with trypan blue staining had a sensitivity of 98% (64/65), while CSF cultures had a sensitivity of 95% (62/65) with reference to CSF CRAG for diagnostic CSF specimens. For samples that were positive in both tests, the haemocytometer had higher readings compared to culture. For diagnostic specimens, the median of log10 transformed counts were 5.59 (n = 64, IQR = 5.09 to 6.05) for haemocytometer and 4.98 (n = 62, IQR = 3.75 to 5.79) for culture; while the overall median counts were 5.35 (n = 189, IQR = 4.78–5.84) for haemocytometer and 3.99 (n = 151, IQR = 2.59–5.14) for cultures. The percentage agreement with culture sterility was 2.4% (1/42). Counts among non-sterile follow-up specimens had a median of 5.38 (n = 86, IQR = 4.74 to 6.03) for haemocytometer and 2.89 (n = 89, IQR = 2.11 to 4.38) for culture. At diagnosis, CSF quantitative cultures correlated with haemocytometer counts (R2 = 0.59,P < 0.001). At 7–14 days, quantitative cultures did not correlate with haemocytometer counts (R2 = 0.43, P = 0.4). Conclusion: Despite a positive correlation, the haemocytometer counts with trypan blue staining did not predict the outcome of quantitative cultures in patients receiving antifungal therapy. Keywords: Trypan blue, Cryptococcal meningitis, HIV, Diagnostic techniques and procedures, Point-of-care systems
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Quantitative culture is the most common method to determine the fungal burden and sterility of cerebrospinal fluid (CSF) among persons with cryptococcal meningitis. A major drawback of cultures is a long turnaround-time. Recent evidence demonstrates that live and dead Cryptococcus yeasts can be distinguished using trypan blue staining. We hypothesized that trypan blue staining combined with haemocytometer counting may provide a rapid estimation of quantitative culture count and detection of CSF sterility. To test this, we evaluated 194 CSF specimens from 96 HIV-infected participants with cryptococcal meningitis in Kampala, Uganda. Cryptococcal meningitis was diagnosed by CSF cryptococcal antigen (CRAG). We stained CSF with trypan blue and quantified yeasts using a haemocytometer. We compared the haemocytometer readings versus quantitative Cryptococcus CSF cultures. Results: Haemocytometer counting with trypan blue staining had a sensitivity of 98% (64/65), while CSF cultures had a sensitivity of 95% (62/65) with reference to CSF CRAG for diagnostic CSF specimens. For samples that were positive in both tests, the haemocytometer had higher readings compared to culture. For diagnostic specimens, the median of log10 transformed counts were 5.59 (n = 64, IQR = 5.09 to 6.05) for haemocytometer and 4.98 (n = 62, IQR = 3.75 to 5.79) for culture; while the overall median counts were 5.35 (n = 189, IQR = 4.78–5.84) for haemocytometer and 3.99 (n = 151, IQR = 2.59–5.14) for cultures. The percentage agreement with culture sterility was 2.4% (1/42). Counts among non-sterile follow-up specimens had a median of 5.38 (n = 86, IQR = 4.74 to 6.03) for haemocytometer and 2.89 (n = 89, IQR = 2.11 to 4.38) for culture. At diagnosis, CSF quantitative cultures correlated with haemocytometer counts (R2 = 0.59,P < 0.001). At 7–14 days, quantitative cultures did not correlate with haemocytometer counts (R2 = 0.43, P = 0.4). Conclusion: Despite a positive correlation, the haemocytometer counts with trypan blue staining did not predict the outcome of quantitative cultures in patients receiving antifungal therapy. Keywords: Trypan blue, Cryptococcal meningitis, HIV, Diagnostic techniques and procedures, Point-of-care systems
|
Ssempijja, Victor; Nakigozi, Gertrude; Chang, Larry; Gray, Ron; Wawer, Maria; Ndyanabo, Anthony; Kasule, Jingo; Serwadda, David; Castelnuovo, Barbara; van’t Hoog, Anja; Reynolds, Steven James Rates of switching to second-line antiretroviral therapy and impact of delayed switching on immunologic, virologic, and mortality outcomes among HIV-infected adults with virologic failure in Rakai, Uganda Journal Article In: BMC Infectious Diseases, vol. 17, no. 1, 2017. @article{Ssempijja2017,
title = {Rates of switching to second-line antiretroviral therapy and impact of delayed switching on immunologic, virologic, and mortality outcomes among HIV-infected adults with virologic failure in Rakai, Uganda},
author = {Victor Ssempijja and Gertrude Nakigozi and Larry Chang and Ron Gray and Maria Wawer and Anthony Ndyanabo and Jingo Kasule and David Serwadda and Barbara Castelnuovo and Anja van’t Hoog and Steven James Reynolds},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Rates-of-switching-to-second-line-antiretroviral-therapy-and-impact-of-delayed-switching-on-immunologic.pdf},
doi = {10.1186/s12879-017-2680-6},
year = {2017},
date = {2017-08-22},
journal = {BMC Infectious Diseases},
volume = {17},
number = {1},
abstract = {Background: Switch from first to second-line ART is recommended by WHO for patients with virologic failure. Delays in switching may contribute to accumulated drug resistance, advanced immunosuppression, increased morbidity and mortality. The 3rd 90′ of UNAIDS 90:90:90 targets 90% viral suppression for persons on ART. We evaluated the rate of switching to second-line antiretroviral therapy (ART), and the impact of delayed switching on immunologic, virologic, and mortality outcomes in the Rakai Health Sciences Program (RHSP) Clinical Cohort Study which started providing ART in 2004 and implemented 6 monthly routine virologic monitoring beginning in 2005. Methods: Retrospective cohort study of HIV-infected adults on first-line ART who had two consecutive viral loads (VLs) >1000 copies/ml after 6 months on ART between June 2004 and June 2011 was studied for switching to second-line ART. Immunologic decline after virologic failure was defined as decrease in CD4 count of ≥50 cells/ul and virologic increase was defined as increase of 0.5 log 10 copies/ml. Competing risk models were used to summarize rates of switching to second-line ART while cox proportional hazard marginal structural models were used to assess the risk of virologic increase or immunologic decline associated with delay to switch first line ART failing patients. Results: The cumulative incidence of switching at 6, 12, and 24 months following virologic failure were 30.2%, 44.6%, and 65.0%, respectively. The switching rate was increased with higher VL at the time of virologic failure; compared to those with VLs ≤ 5000 copies/ml, patients with VLs = 5001–10,000 copies/ml had an aHR = 1.81 (95% CI = 0.9–3.6), and patients with VLs > 10,000 copies/ml had an aHR = 3.38 (95%CI = 1.9–6.2). The switching rate was also increased with CD4 < 100 cells/ul at ART initiation, compared to those with CD4 ≥ 100 cells/ul (aHR = 2.30, 95% CI = 1.5–3.6). Mortality in patients not switched to second-line ART was 11.9%, compared to 1.2% for those who switched (p = 0.009). Patients switched after 12 months of of virologic failure were more likely to experience CD4 decline and/or further VL increases. (Continued on next page)
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Switch from first to second-line ART is recommended by WHO for patients with virologic failure. Delays in switching may contribute to accumulated drug resistance, advanced immunosuppression, increased morbidity and mortality. The 3rd 90′ of UNAIDS 90:90:90 targets 90% viral suppression for persons on ART. We evaluated the rate of switching to second-line antiretroviral therapy (ART), and the impact of delayed switching on immunologic, virologic, and mortality outcomes in the Rakai Health Sciences Program (RHSP) Clinical Cohort Study which started providing ART in 2004 and implemented 6 monthly routine virologic monitoring beginning in 2005. Methods: Retrospective cohort study of HIV-infected adults on first-line ART who had two consecutive viral loads (VLs) >1000 copies/ml after 6 months on ART between June 2004 and June 2011 was studied for switching to second-line ART. Immunologic decline after virologic failure was defined as decrease in CD4 count of ≥50 cells/ul and virologic increase was defined as increase of 0.5 log 10 copies/ml. Competing risk models were used to summarize rates of switching to second-line ART while cox proportional hazard marginal structural models were used to assess the risk of virologic increase or immunologic decline associated with delay to switch first line ART failing patients. Results: The cumulative incidence of switching at 6, 12, and 24 months following virologic failure were 30.2%, 44.6%, and 65.0%, respectively. The switching rate was increased with higher VL at the time of virologic failure; compared to those with VLs ≤ 5000 copies/ml, patients with VLs = 5001–10,000 copies/ml had an aHR = 1.81 (95% CI = 0.9–3.6), and patients with VLs > 10,000 copies/ml had an aHR = 3.38 (95%CI = 1.9–6.2). The switching rate was also increased with CD4 < 100 cells/ul at ART initiation, compared to those with CD4 ≥ 100 cells/ul (aHR = 2.30, 95% CI = 1.5–3.6). Mortality in patients not switched to second-line ART was 11.9%, compared to 1.2% for those who switched (p = 0.009). Patients switched after 12 months of of virologic failure were more likely to experience CD4 decline and/or further VL increases. (Continued on next page)
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Shete, Priya B.; Ravindran, Resmi; Chang, Emily; Worodria, William; Chaisson, Lelia H.; Alfred Andama4, J. Lucian Davis; Luciw, Paul A.; Huang, Laurence; Khan, Imran H.; Cattamanchi, Adithya . Evaluation of antibody responses to panels of M. tuberculosis antigens as a screening tool for active tuberculosis in Uganda. Journal Article In: PloS One, vol. 12, no. 8, 2017. @article{Shete2017,
title = {. Evaluation of antibody responses to panels of M. tuberculosis antigens as a screening tool for active tuberculosis in Uganda.},
author = {Priya B. Shete and Resmi Ravindran and Emily Chang and William Worodria and Lelia H. Chaisson and Alfred Andama4, J. Lucian Davis and Paul A. Luciw and Laurence Huang and Imran H. Khan and Adithya Cattamanchi},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Evaluation-of-antibody-responses-to-panels-of-M.-tuberculosis-antigens-as-a-screening-tool-for-active-tuberculosis-in-Uganda.pdf},
doi = {10.1371/journal.pone.0180122},
year = {2017},
date = {2017-08-02},
journal = {PloS One},
volume = {12},
number = {8},
abstract = {Background
Improved systematic screening of high-risk groups is a key component of the tuberculosis (TB) elimination strategy endorsed by the World Health Organization (WHO). We used a multiplex microbead immunoassay to measure antibody responses to 28 M. tuberculosis (M.tb) antigens, and assessed whether combinations of antibody responses achieve accuracy thresholds required for a TB screening test.
Methods
A random selection of plasma samples obtained from consecutive HIV-negative adults who were admitted to Mulago Hospital in Kampala, Uganda with cough2 weeks’ but<6 months’ duration were analyzed for serological response to 28 M.tb antigens using an inhouse multiplex microbead immunoassay. We compared the median difference of the antibody response to each antigen between patients with and without culture-confirmed TB, ranked each antigen according to variable importance (VIM), and assessed the sensitivity and specificity of combinations of antibody responses using an advanced classification algorithm, SuperLearner.
Results
Among the 237 patients included in the analysis, 119 (50%) were female, median age was 32 years (IQR 25, 46), and 113 (48%) had TB. Median antibody levels to eight antigens ere significantly different between patients with and without TB. A panel including eight of the top ranked antigens had a sensitivity of 90.6% (95% CI 89.4, 93.8) and a specificity of 88.6% (95% CI 78.2, 97.6) (Ag85B, Ag85A, Ag85C, Rv0934-P38, Rv3881, BfrB, Rv3873, and Rv2878c). With sensitivity constrained to be>90%, specificity remained close to 70% with as few as 3 antigens included in the panels.
Conclusions
Measuring antibody responses to combinations of antigens could facilitate TB screening and should be further evaluated in populations being targeted for systematic screening.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Improved systematic screening of high-risk groups is a key component of the tuberculosis (TB) elimination strategy endorsed by the World Health Organization (WHO). We used a multiplex microbead immunoassay to measure antibody responses to 28 M. tuberculosis (M.tb) antigens, and assessed whether combinations of antibody responses achieve accuracy thresholds required for a TB screening test.
Methods
A random selection of plasma samples obtained from consecutive HIV-negative adults who were admitted to Mulago Hospital in Kampala, Uganda with cough2 weeks’ but<6 months’ duration were analyzed for serological response to 28 M.tb antigens using an inhouse multiplex microbead immunoassay. We compared the median difference of the antibody response to each antigen between patients with and without culture-confirmed TB, ranked each antigen according to variable importance (VIM), and assessed the sensitivity and specificity of combinations of antibody responses using an advanced classification algorithm, SuperLearner.
Results
Among the 237 patients included in the analysis, 119 (50%) were female, median age was 32 years (IQR 25, 46), and 113 (48%) had TB. Median antibody levels to eight antigens ere significantly different between patients with and without TB. A panel including eight of the top ranked antigens had a sensitivity of 90.6% (95% CI 89.4, 93.8) and a specificity of 88.6% (95% CI 78.2, 97.6) (Ag85B, Ag85A, Ag85C, Rv0934-P38, Rv3881, BfrB, Rv3873, and Rv2878c). With sensitivity constrained to be>90%, specificity remained close to 70% with as few as 3 antigens included in the panels.
Conclusions
Measuring antibody responses to combinations of antigens could facilitate TB screening and should be further evaluated in populations being targeted for systematic screening.
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Kwizera, Richard; Akampurira, Andrew; Williams, Darlisha; Meya, David R. Boulware David B.; on behalf of the ASTRO-CM Study Team, Acridine orange fluorescent microscopy is more sensitive than India ink light microscopy in the rapid detection of cryptococcosis among CrAg positive HIV patients Journal Article In: PloS One, vol. 12, no. 7, 2017. @article{Kwizera2017b,
title = {Acridine orange fluorescent microscopy is more sensitive than India ink light microscopy in the rapid detection of cryptococcosis among CrAg positive HIV patients},
author = {Richard Kwizera and Andrew Akampurira and Darlisha Williams and David R. Boulware David B. Meya and on behalf of the ASTRO-CM Study Team},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Acridine-orange-fluorescent-microscopy-is-more-sensitive-than-India-ink-light-microscopy-in-the-rapid-detection-of-cryptococcosis-among-CrAg-positive-HIV-patients.pdf},
doi = {10.1371/journal.pone.0182108},
year = {2017},
date = {2017-07-27},
journal = {PloS One},
volume = {12},
number = {7},
abstract = {Background
India ink microscopy on cerebrospinal fluid is still utilized in resource limited settings for the diagnosis of cryptococcal meningitis despite its poor sensitivity. We hypothesized that staining fungal nucleic acids with fluorescent dyes instead of the capsule with India ink might improve sensitivity for the diagnosis of cryptococcal meningitis.
Methods
We enrolled 96 HIV-infected participants with cryptococcal meningitis who provided 194 CSF specimens at serial time points in Kampala, Uganda. Cryptococcosis was diagnosed by cerebrospinal fluid (CSF) cryptococcal antigen (CrAg) test and only positive samples were included. We stained CSF with India ink and acridine orange. We cultured the same samples on standard fungal media. We compared acridine orange to CrAg, India ink and CSF culture.
Results
Acridine orange was more sensitive (96%) than India ink (79%) with reference to CSF CrAg. Acridine orange and India ink had a statistically significant difference (P<0.001) with a 25% correlation for detection of Cryptococcus yeasts. India ink had more negative results (22%) than acridine orange (4%). The sensitivity for India ink increased (86%) while that of acridine orange did not change (97%) when compared to CSF culture. However, both India ink and acridine orange had poor predictive values with reference to culture.
Conclusion
Acridine orange is a better alternative to India ink in the rapid detection of cryptococcosis among CrAg positive HIV patients},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
India ink microscopy on cerebrospinal fluid is still utilized in resource limited settings for the diagnosis of cryptococcal meningitis despite its poor sensitivity. We hypothesized that staining fungal nucleic acids with fluorescent dyes instead of the capsule with India ink might improve sensitivity for the diagnosis of cryptococcal meningitis.
Methods
We enrolled 96 HIV-infected participants with cryptococcal meningitis who provided 194 CSF specimens at serial time points in Kampala, Uganda. Cryptococcosis was diagnosed by cerebrospinal fluid (CSF) cryptococcal antigen (CrAg) test and only positive samples were included. We stained CSF with India ink and acridine orange. We cultured the same samples on standard fungal media. We compared acridine orange to CrAg, India ink and CSF culture.
Results
Acridine orange was more sensitive (96%) than India ink (79%) with reference to CSF CrAg. Acridine orange and India ink had a statistically significant difference (P<0.001) with a 25% correlation for detection of Cryptococcus yeasts. India ink had more negative results (22%) than acridine orange (4%). The sensitivity for India ink increased (86%) while that of acridine orange did not change (97%) when compared to CSF culture. However, both India ink and acridine orange had poor predictive values with reference to culture.
Conclusion
Acridine orange is a better alternative to India ink in the rapid detection of cryptococcosis among CrAg positive HIV patients |
Kranzer, Katharina; Bradley, John; Musaazi, Joseph; Nyathi, Mary; Gunguwo, Hilary; Ndebele, Wedu; Dixon, Mark; Ndhlovu, Mbongeni; Rehman, Andrea; Khan, Palwasha; Vogt, Florian; Apollo, Tsitsi; Ferrand, Rashida Abbas Loss to follow‐up among children and adolescents growing up with HIV infection: age really matters Journal Article In: Journal of the International AIDS Society, vol. 20, no. 1, 2017. @article{Kranzer2017,
title = {Loss to follow‐up among children and adolescents growing up with HIV infection: age really matters},
author = {Katharina Kranzer and John Bradley and Joseph Musaazi and Mary Nyathi and Hilary Gunguwo and Wedu Ndebele and Mark Dixon and Mbongeni Ndhlovu and Andrea Rehman and Palwasha Khan and Florian Vogt and Tsitsi Apollo and Rashida Abbas Ferrand},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Loss-to-follow‐up-among-children-and-adolescents-growing-up-with-HIV-infection-age-really-matters.pdf},
doi = {10.7448/IAS.20.1.21737},
year = {2017},
date = {2017-07-17},
journal = {Journal of the International AIDS Society},
volume = {20},
number = {1},
abstract = {
Introduction: Globally, increasing numbers of HIV‐infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss‐to‐follow‐up (LTFU) from HIV care services among children as they transition from childhood through adolescence.
Methods: Individuals aged 5–19 years initiated on ART in a public‐sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age‐bands namely: 5–9 (children), 10–14 (young adolescents) and 15–19 (older adolescents). The effect of age at ART initiation, current age (using a time‐updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression.
Results: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5–9, 10–14 and 15–19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age‐band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94–2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05–3.07). In older adolescents, the LTFU rate among those who started ART in that age‐band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age‐groups.
Conclusions: Adolescents had higher rates of LTFU compared to other age‐groups, with older adolescents at particularly high risk in all analyses. Age‐updated analyses that examine movement across narrow age‐bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Introduction: Globally, increasing numbers of HIV‐infected children are reaching adolescence due to antiretroviral therapy (ART). We investigated rates of loss‐to‐follow‐up (LTFU) from HIV care services among children as they transition from childhood through adolescence.
Methods: Individuals aged 5–19 years initiated on ART in a public‐sector HIV clinic in Bulawayo, Zimbabwe, between 2005 and 2009 were included in a retrospective cohort study. Participants were categorized into narrow age‐bands namely: 5–9 (children), 10–14 (young adolescents) and 15–19 (older adolescents). The effect of age at ART initiation, current age (using a time‐updated Lexis expansion) and transitioning from one age group to the next on LTFU was estimated using Poisson regression.
Results: Of 2273 participants, 1013, 875 and 385 initiated ART aged 5–9, 10–14 and 15–19 years, respectively. Unlike those starting ART as children, individuals starting ART as young adolescents had higher LTFU rates after moving to the older adolescent age‐band (Adjusted rate ratio (ARR) 1.54; 95% CI: 0.94–2.55) and similarly, older adolescents had higher LTFU rates after transitioning to being young adults (ARR 1.79; 95% CI: 1.05–3.07). In older adolescents, the LTFU rate among those who started ART in that age‐band was higher compared to the rate among those starting ART at a younger age (ARR = 1.70; 95% CI: 1.05, 2.77). This however did not hold true for other age‐groups.
Conclusions: Adolescents had higher rates of LTFU compared to other age‐groups, with older adolescents at particularly high risk in all analyses. Age‐updated analyses that examine movement across narrow age‐bands are paramount in understanding how developmental heterogeneity in children affects HIV outcomes.
|
Richard Harding Katie Wakeham, Jonathan Levin The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study Journal Article In: BMC Palliat Care, vol. 17, no. 1, pp. 51, 2017. @article{Wakeham2017,
title = {The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study},
author = {Katie Wakeham, Richard Harding, Jonathan Levin, Rosalind Parkes-Ratanshi, Anatoli Kamali & David G Lalloo },
doi = {https://doi.org/10.1186/s12904-017-0215-y},
year = {2017},
date = {2017-07-13},
journal = {BMC Palliat Care},
volume = {17},
number = {1},
pages = {51},
abstract = {Background
Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.
Methods
HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures.
Results
During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more.
Conclusion
Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.
Methods
HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures.
Results
During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more.
Conclusion
Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes. |
Meyer, Amanda J.; Atuheire, Collins; Worodria, William; Kizito, Samuel; Katamba, Achilles; Sanyu, Ingvar; Andama, Alfred; Ayakaka, Irene; Cattamanchi, Adithya; Bwanga, Freddie; Huang, Laurence; Davis, J. Lucian Sputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Uganda. Journal Article In: vol. 12, no. 7, 2017. @article{Meyer2017,
title = {Sputum quality and diagnostic performance of GeneXpert MTB/RIF among smear-negative adults with presumed tuberculosis in Uganda. },
author = {Amanda J. Meyer and Collins Atuheire and William Worodria and Samuel Kizito and Achilles Katamba and Ingvar Sanyu and Alfred Andama and Irene Ayakaka and Adithya Cattamanchi and Freddie Bwanga and Laurence Huang and J. Lucian Davis},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Sputum-quality-and-diagnostic-performance-of-GeneXpert-MTBRIF-among-smear-negative-adults-with-presumed-tuberculosis-in-Uganda.pdf},
doi = {10.1371/journal.pone.0180572},
year = {2017},
date = {2017-07-07},
volume = {12},
number = {7},
abstract = {Background
Introduction of GeneXpert MTB/RIF (Xpert) assay has constituted a major breakthrough for tuberculosis (TB) diagnostics. Several patient factors may influence diagnostic performance of Xpert including sputum quality.
Objective
We carried out a prospective, observational, cross-sectional study to determine the effect of sputum quality on diagnostic performance of Xpert among presumed TB patients in Uganda.
Methods
We collected clinical and demographic information and two sputum samples from participants. Staff recorded sputum quality and performed LED fluorescence microscopy and mycobacterial culture on each sample. If both smear examinations were negative, Xpert testing was performed. We calculated diagnostic yield, sensitivity, specificity, and other indicators for Xpert for each stratum of sputum quality in reference to a standard of mycobacterial culture.
Results
Patients with salivary sputum showed a trend towards a substantially higher proportion of samples that were Xpert-positive (54/286, 19%, 95% CI 15–24) compared with those with all other sputum sample types (221/1496, 15%, 95% CI 13–17). Blood-stained sputum produced the lowest sensitivity (28%; 95% CI 12–49) and salivary sputum the highest (66%; 95% CI 53–77). Specificity didn’t vary meaningfully by sample types. Salivary sputum was significantly more sensitive than mucoid sputum (+13%, 95% CI +1 to +26), while bloodstained sputum was significantly less sensitive (-24%, 95% CI -42 to -5).
Conclusions
Our findings demonstrate the need to exercise caution in collecting sputum for Xpert and in interpreting results because sputum quality may impact test yield and sensitivity. In particular, it may be wise to pursue additional testing should blood-stained sputum test negative while salivary sputum should be readily accepted for Xpert testing given its higher sensitivity and potentially higher yield than other sample types. These findings challenge conventional recommendations against collecting salivary sputum for TB diagnosis and could inform new standards for sputum quality.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Introduction of GeneXpert MTB/RIF (Xpert) assay has constituted a major breakthrough for tuberculosis (TB) diagnostics. Several patient factors may influence diagnostic performance of Xpert including sputum quality.
Objective
We carried out a prospective, observational, cross-sectional study to determine the effect of sputum quality on diagnostic performance of Xpert among presumed TB patients in Uganda.
Methods
We collected clinical and demographic information and two sputum samples from participants. Staff recorded sputum quality and performed LED fluorescence microscopy and mycobacterial culture on each sample. If both smear examinations were negative, Xpert testing was performed. We calculated diagnostic yield, sensitivity, specificity, and other indicators for Xpert for each stratum of sputum quality in reference to a standard of mycobacterial culture.
Results
Patients with salivary sputum showed a trend towards a substantially higher proportion of samples that were Xpert-positive (54/286, 19%, 95% CI 15–24) compared with those with all other sputum sample types (221/1496, 15%, 95% CI 13–17). Blood-stained sputum produced the lowest sensitivity (28%; 95% CI 12–49) and salivary sputum the highest (66%; 95% CI 53–77). Specificity didn’t vary meaningfully by sample types. Salivary sputum was significantly more sensitive than mucoid sputum (+13%, 95% CI +1 to +26), while bloodstained sputum was significantly less sensitive (-24%, 95% CI -42 to -5).
Conclusions
Our findings demonstrate the need to exercise caution in collecting sputum for Xpert and in interpreting results because sputum quality may impact test yield and sensitivity. In particular, it may be wise to pursue additional testing should blood-stained sputum test negative while salivary sputum should be readily accepted for Xpert testing given its higher sensitivity and potentially higher yield than other sample types. These findings challenge conventional recommendations against collecting salivary sputum for TB diagnosis and could inform new standards for sputum quality.
|
Kharono, Brenda; Nabisere, Ruth; Persis, Nabyonga Kiddu; Nakakeeto, Jackie; Openy, Abraham; Kitaka, Sabrina Bakeera Knowledge, Attitudes, and Perceived Risks Related to Diabetes Mellitus Among University Students in Uganda: A Cross-Sectional Study. Journal Article In: East African Research Journal, vol. 1, no. 2, pp. 105-112, 2017. @article{Kharono2017,
title = {Knowledge, Attitudes, and Perceived Risks Related to Diabetes Mellitus Among University Students in Uganda: A Cross-Sectional Study.},
author = {Brenda Kharono and Ruth Nabisere and Nabyonga Kiddu Persis and Jackie Nakakeeto and Abraham Openy and Sabrina Bakeera Kitaka},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Knowledge-Attitudes-and-Perceived-Risks-Related-to-Diabetes-Mellitus-Among-University-Students-in-Uganda-A-CrossSectional-Study.pdf},
year = {2017},
date = {2017-07-01},
journal = {East African Research Journal},
volume = {1},
number = {2},
pages = {105-112},
abstract = {Background—Diabetes mellitus is on the rise in low-income countries, including Uganda, owing to the ‘westernization’ of individual lifestyles. It remains unanswered whether the majority of university students who are rapidly embracing ‘western’ lifestyles have any knowledge of diabetes or perceive themselves to be at risk of acquiring the disease. The aim of the study was to assess the knowledge, attitudes, and perceived risks related to diabetes mellitus among university students in Uganda.
Methods—This descriptive cross-sectional study was conducted in 4 universities in Uganda from August to November 2013. The data collection tool included questions on risk factors, symptoms, personal risks, and practices to prevent diabetes mellitus. We interviewed 378 university students using pretested self-administered semi-structured questionnaires. Only students who consented to participate in the study were included. Data were entered into EpiData version 3.1 and analysed using SPSS version 18.
Results—Almost all (99%) of the students had knowledge about diabetes mellitus. The majority (83.1%) reported that diabetes mellitus is not completely a genetic/hereditary disease. Only a minority of respondents reported that they should worry about diabetes before 45 years of age. Common symptoms of diabetes reported by the respondents included constant hunger, blurred vision, fatigue, and frequent urination.
Conclusions—Our study revealed that the majority of university students in Uganda had good knowledge about the risk factors and symptoms of diabetes mellitus. The majority also perceived themselves to be at risk of diabetes.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background—Diabetes mellitus is on the rise in low-income countries, including Uganda, owing to the ‘westernization’ of individual lifestyles. It remains unanswered whether the majority of university students who are rapidly embracing ‘western’ lifestyles have any knowledge of diabetes or perceive themselves to be at risk of acquiring the disease. The aim of the study was to assess the knowledge, attitudes, and perceived risks related to diabetes mellitus among university students in Uganda.
Methods—This descriptive cross-sectional study was conducted in 4 universities in Uganda from August to November 2013. The data collection tool included questions on risk factors, symptoms, personal risks, and practices to prevent diabetes mellitus. We interviewed 378 university students using pretested self-administered semi-structured questionnaires. Only students who consented to participate in the study were included. Data were entered into EpiData version 3.1 and analysed using SPSS version 18.
Results—Almost all (99%) of the students had knowledge about diabetes mellitus. The majority (83.1%) reported that diabetes mellitus is not completely a genetic/hereditary disease. Only a minority of respondents reported that they should worry about diabetes before 45 years of age. Common symptoms of diabetes reported by the respondents included constant hunger, blurred vision, fatigue, and frequent urination.
Conclusions—Our study revealed that the majority of university students in Uganda had good knowledge about the risk factors and symptoms of diabetes mellitus. The majority also perceived themselves to be at risk of diabetes. |
Martaa ; Lamorde Boffito, Mohammed; Watkins Antiretroviral dose optimization the future of efavirenz 400 mg dosing Journal Article In: Current Opinion in HIV and AIDS, vol. 14, no. 4, pp. 339-342, 2017. @article{Boffito2017,
title = {Antiretroviral dose optimization the future of efavirenz 400 mg dosing},
author = {Boffito, Martaa ; Lamorde, Mohammed; Watkins, Melynda; Pozniak, Antona},
doi = {doi: 10.1097/COH.0000000000000385},
year = {2017},
date = {2017-07-01},
journal = {Current Opinion in HIV and AIDS},
volume = {14},
number = {4},
pages = {339-342},
abstract = {Purpose of review
Antiretroviral (ARV) therapy costs in low-income and middle-income countries are major concerns, and lower doses of first-line treatment components, when possible, would save millions of dollars, which could be used to treat more people living with HIV.
Recent findings
The Encore-1 study, followed by a detailed pharmacokinetic analysis of efavirenz 400 versus 600 mg once daily, produced enough information for the most recent ARV treatment WHO guidelines to include efavirenz 400 mg among agents used for first-line treatment. However, data on efavirenz 400 mg plasma concentrations during pregnancy and when coadministered with rifampicin-containing antituberculosis (TB) treatment are not yet available as formal pharmacokinetic studies under these circumstances are ongoing.
Summary
Although efavirenz at a daily dose of 400 mg once daily in combination with tenofovir disoproxil fumarate and emtricitabine has shown noninferiority to the approved 600 mg once-daily dose, large global uptake has been delayed by the lack of data on drug exposure during pregnancy and anti-TB treatment. Knowledge on efavirenz 400 mg exposure in these scenarios will arise in mid-late 2017.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Purpose of review
Antiretroviral (ARV) therapy costs in low-income and middle-income countries are major concerns, and lower doses of first-line treatment components, when possible, would save millions of dollars, which could be used to treat more people living with HIV.
Recent findings
The Encore-1 study, followed by a detailed pharmacokinetic analysis of efavirenz 400 versus 600 mg once daily, produced enough information for the most recent ARV treatment WHO guidelines to include efavirenz 400 mg among agents used for first-line treatment. However, data on efavirenz 400 mg plasma concentrations during pregnancy and when coadministered with rifampicin-containing antituberculosis (TB) treatment are not yet available as formal pharmacokinetic studies under these circumstances are ongoing.
Summary
Although efavirenz at a daily dose of 400 mg once daily in combination with tenofovir disoproxil fumarate and emtricitabine has shown noninferiority to the approved 600 mg once-daily dose, large global uptake has been delayed by the lack of data on drug exposure during pregnancy and anti-TB treatment. Knowledge on efavirenz 400 mg exposure in these scenarios will arise in mid-late 2017. |
Wandera, Bonnie; Tumwesigye, Nazarius M.; Nankabirwa, Joaniter I.; Kambugu, Andrew D.; Mafigiri4, David K.; Kapiga, Saidi; Sethi, Ajay K. Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study Journal Article In: PloS One, vol. 12, no. 6, 2017. @article{Wandera2017,
title = {Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study},
author = {Bonnie Wandera and Nazarius M. Tumwesigye and Joaniter I. Nankabirwa and Andrew D. Kambugu and David K. Mafigiri4 and Saidi Kapiga and Ajay K. Sethi},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Hazardous-alcohol-consumption-is-not-associated-with-CD4-T-cell-count-decline-among-PLHIV-in-Kampala-Uganda-A-prospective-cohort-study.pdf},
doi = {10.1371/journal.pone.0180015},
year = {2017},
date = {2017-06-30},
journal = {PloS One},
volume = {12},
number = {6},
abstract = {Introduction
There is limited data on the effects of alcohol on immunological response among persons living with HIV (PLHIV) in sub-Saharan Africa. We assessed the relationship between hazardous alcohol use and CD4+ T-cell count, among PLHIV in Uganda.
Methods PLHIV aged18 years were enrolled in a cohort study at the Infectious diseases clinic Kampala, Uganda. Alcohol consumption was assessed at enrolment (baseline) and 6 monthly thereafter using the alcohol use disorders identification test (AUDIT). The CD4+ Tcell counts, assessed at baseline and over the next 12 months were compared between alcohol use strata, using linear mixed effects regression. Using longitudinal mediation analysis methods, we estimated the effect of alcohol induced ART non-adherence on CD4+ Tcell count.
Results
Of the 1566 participants enrolled, 863(44.1%) were non-alcohol users (AUDIT score = 0), 433(27.7%) were non-hazardous (AUDIT score 1–7) alcohol users while 270 (17.2%) were hazardous (AUDIT score8) alcohol users. The overall median (IQR) baseline CD4+ T-cell count was 356 (243–516) cells/μl. There were no differences in the median baseline CD4+ T-cell count between hazardous and nonhazardous alcohol users compared to non-alcohol users in both the non-ART (p = 0.43) and ART group (p = 0.77).
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Introduction
There is limited data on the effects of alcohol on immunological response among persons living with HIV (PLHIV) in sub-Saharan Africa. We assessed the relationship between hazardous alcohol use and CD4+ T-cell count, among PLHIV in Uganda.
Methods PLHIV aged18 years were enrolled in a cohort study at the Infectious diseases clinic Kampala, Uganda. Alcohol consumption was assessed at enrolment (baseline) and 6 monthly thereafter using the alcohol use disorders identification test (AUDIT). The CD4+ Tcell counts, assessed at baseline and over the next 12 months were compared between alcohol use strata, using linear mixed effects regression. Using longitudinal mediation analysis methods, we estimated the effect of alcohol induced ART non-adherence on CD4+ Tcell count.
Results
Of the 1566 participants enrolled, 863(44.1%) were non-alcohol users (AUDIT score = 0), 433(27.7%) were non-hazardous (AUDIT score 1–7) alcohol users while 270 (17.2%) were hazardous (AUDIT score8) alcohol users. The overall median (IQR) baseline CD4+ T-cell count was 356 (243–516) cells/μl. There were no differences in the median baseline CD4+ T-cell count between hazardous and nonhazardous alcohol users compared to non-alcohol users in both the non-ART (p = 0.43) and ART group (p = 0.77).
|
Musaazi, J.; Kiragga, A. N.; Castelnuovo, B.; Kambugu, A.; Bradley, J.; Rehman, A. M. Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective studyy. Journal Article In: vol. 7, no. 2, pp. 100-109, 2017. @article{Musaazi2017,
title = {Tuberculosis treatment success among rural and urban Ugandans living with HIV: a retrospective studyy.},
author = {J. Musaazi and A. N. Kiragga and B. Castelnuovo and A. Kambugu and J. Bradley and A. M. Rehman
},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Tuberculosis-treatment-success-among-rural-and-urban-Ugandans-living-with-HIV-a-retrospective-study..pdf},
doi = {10.5588/pha.16.0115},
year = {2017},
date = {2017-06-21},
volume = {7},
number = {2},
pages = {100-109},
abstract = {Setting: Government health centres and hospitals (six urban and 20 rural) providing tuberculosis (TB) treatment for people living with the human immunodeficiency virus (PLHIV) in central and western Uganda. Objective: To identify and quantify modifiable factors that limit TB treatment success among PLHIV in rural Uganda. Design: A retrospective cross-sectional review of routine Uganda National Tuberculosis and Leprosy Programme clinic registers and patient files of HIV-positive patients who received anti-tuberculosis treatment in 2014. Results: Of 191 rural patients, 66.7% achieved treatment success compared to 81.1% of 213 urban patients. Adjusted analysis revealed higher average treatment success in urban patients than in rural patients (OR 3.95, 95%CI 2.70-5.78, P < 0.01, generalised estimating equation model). Loss to follow-up was higher and follow-up sputum smear results were less frequently recorded in TB clinic registers among rural patients. Patients receiving treatment at higher-level facilities in rural settings had greater odds of treatment success, while patients receiving treatment at facilities where drug stock-outs had occurred had lower odds of treatment success. Conclusion: Lower reported treatment success in rural settings is mainly attributed to clinic-centred factors such as treatment monitoring procedures. We recommend strengthening treatment monitoring and delivery.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Setting: Government health centres and hospitals (six urban and 20 rural) providing tuberculosis (TB) treatment for people living with the human immunodeficiency virus (PLHIV) in central and western Uganda. Objective: To identify and quantify modifiable factors that limit TB treatment success among PLHIV in rural Uganda. Design: A retrospective cross-sectional review of routine Uganda National Tuberculosis and Leprosy Programme clinic registers and patient files of HIV-positive patients who received anti-tuberculosis treatment in 2014. Results: Of 191 rural patients, 66.7% achieved treatment success compared to 81.1% of 213 urban patients. Adjusted analysis revealed higher average treatment success in urban patients than in rural patients (OR 3.95, 95%CI 2.70-5.78, P < 0.01, generalised estimating equation model). Loss to follow-up was higher and follow-up sputum smear results were less frequently recorded in TB clinic registers among rural patients. Patients receiving treatment at higher-level facilities in rural settings had greater odds of treatment success, while patients receiving treatment at facilities where drug stock-outs had occurred had lower odds of treatment success. Conclusion: Lower reported treatment success in rural settings is mainly attributed to clinic-centred factors such as treatment monitoring procedures. We recommend strengthening treatment monitoring and delivery. |
Schutz, Charlotte; Boulware, David R.; Huppler-Hullsiek, Katherine; von Hohenberg, Maximilian; Rhein, Joshua; Taseera, Kabanda; Thienemann, Friedrich; Muzoora, Conrad; Meya, David B.; Meintjes, Graeme Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus–Associated Cryptococcal Meningitis Journal Article In: Open Forum Infectious Diseases, vol. 11, no. 2, 2017. @article{Schutz2017,
title = {Acute Kidney Injury and Urinary Biomarkers in Human Immunodeficiency Virus–Associated Cryptococcal Meningitis},
author = {Charlotte Schutz and David R. Boulware and Katherine Huppler-Hullsiek and Maximilian von Hohenberg and Joshua Rhein and Kabanda Taseera and Friedrich Thienemann and Conrad Muzoora and David B. Meya and Graeme Meintjes},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Acute-Kidney-Injury-and-Urinary-Biomarkers-in-Human-Immunodeficiency-Virus–Associated-Cryptococcal-Meningitis-1.pdf},
doi = {10.1093/ofid/ofx127},
year = {2017},
date = {2017-06-20},
journal = {Open Forum Infectious Diseases},
volume = {11},
number = {2},
abstract = {Background. Cryptococcus is the most common etiology of adult meningitis in Africa. Amphotericin B deoxycholate remains paramount to treatment, despite toxicities, including acute kidney injury (AKI). We assessed the ability of the following urine markers to predict AKI in patients who received amphotericin B: urine neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), tissue inhibitor of metalloproteinases-2 (TIMP-2), and protein. Methods. One hundred and thirty human immunodeficiency virus (HIV)–infected participants with cryptococcal meningitis were enrolled and received amphotericin and fluconazole for 2 weeks. We defined AKI as glomerular filtration rate (GFR) < 60 mL/ min/1.73 m2; measured urine NGAL, CysC, TIMP-2, and protein; and explored AKI incidence, risk factors, and associations with mortality using Cox proportional hazards models. Results. Participants were 48% female with a median age of 35 years, a median CD4 count of 21 cells/μL, and 44% died within 12 months. Incident AKI occurred in 42% and was associated with mortality (adjusted hazard ratio [aHR] = 2.8; P < .001). Development of AKI was associated with female sex (P = .04) and with higher CD4 count (49 vs 14 cells/μL; P < .01). Urine protein level in the highest quartile independently predicted AKI and mortality (aHR = 1.64, P = .04; aHR = 2.13, P = .02, respectively). Urine NGAL levels in the highest quartile independently predicted AKI (aHR = 1.65; P = .04). Conclusions. Acute kidney injury occurred in 42% of patients, and AKI was associated with mortality. Urine biomarkers, specifically urine protein, may be useful for antecedent prediction of amphotericin-associated AKI but need further evaluation. Keywords. acute kidney injury; amphotericin B; biological marker; cystatin C; neutrophil gelatinase-associated lipocalin; protein; tissue inhibitor of metalloproteinase-2.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background. Cryptococcus is the most common etiology of adult meningitis in Africa. Amphotericin B deoxycholate remains paramount to treatment, despite toxicities, including acute kidney injury (AKI). We assessed the ability of the following urine markers to predict AKI in patients who received amphotericin B: urine neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC), tissue inhibitor of metalloproteinases-2 (TIMP-2), and protein. Methods. One hundred and thirty human immunodeficiency virus (HIV)–infected participants with cryptococcal meningitis were enrolled and received amphotericin and fluconazole for 2 weeks. We defined AKI as glomerular filtration rate (GFR) < 60 mL/ min/1.73 m2; measured urine NGAL, CysC, TIMP-2, and protein; and explored AKI incidence, risk factors, and associations with mortality using Cox proportional hazards models. Results. Participants were 48% female with a median age of 35 years, a median CD4 count of 21 cells/μL, and 44% died within 12 months. Incident AKI occurred in 42% and was associated with mortality (adjusted hazard ratio [aHR] = 2.8; P < .001). Development of AKI was associated with female sex (P = .04) and with higher CD4 count (49 vs 14 cells/μL; P < .01). Urine protein level in the highest quartile independently predicted AKI and mortality (aHR = 1.64, P = .04; aHR = 2.13, P = .02, respectively). Urine NGAL levels in the highest quartile independently predicted AKI (aHR = 1.65; P = .04). Conclusions. Acute kidney injury occurred in 42% of patients, and AKI was associated with mortality. Urine biomarkers, specifically urine protein, may be useful for antecedent prediction of amphotericin-associated AKI but need further evaluation. Keywords. acute kidney injury; amphotericin B; biological marker; cystatin C; neutrophil gelatinase-associated lipocalin; protein; tissue inhibitor of metalloproteinase-2.
|
Waitta, Catriona; Penchalaa, Sujan Diliiy; Olagunjua, Adeniyi; Amaraa, Alieu; Elsea, Laura; Lamordeb, Mohammed; Khooa, Saye Development, validation and clinical application of a method for the simultaneous quantification of lamivudine, emtricitabine and tenofovir in dried blood and dried breast milk spots using LC-MS/MS. Journal Article In: Journal of Chromatograpy B, vol. 1060, pp. 300-307, 2017. @article{Waitta2017,
title = {Development, validation and clinical application of a method for the simultaneous quantification of lamivudine, emtricitabine and tenofovir in dried blood and dried breast milk spots using LC-MS/MS. },
author = {Catriona Waitta and Sujan Diliiy Penchalaa and Adeniyi Olagunjua and Alieu Amaraa and Laura Elsea and Mohammed Lamordeb and Saye Khooa },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Development-validation-and-clinical-application-of-a-method-for-the-simultaneous-quantification-of-lamivudine-emtricitabine-and-tenofovir-in-dried-blood-and-dried-breast-milk-spots-using.pdf},
doi = {10.1016/j.jchromb.2017.06.012},
year = {2017},
date = {2017-06-17},
journal = {Journal of Chromatograpy B},
volume = {1060},
pages = {300-307},
abstract = {Objectives: To present the validation and clinical application of a LC–MS/MS method for the quantification of lamivudine (3TC), emtricitabine (FTC) and tenofovir (TFV) in dried blood spots (DBS) and dried breast milk spots (DBMS). Methods: DBS and DBMS were prepared from 50 and 30μL of drug-spiked whole blood and human breast milk, respectively. Following extraction with acetonitrile and water, chromatographic separation utilised a Synergi polar column with a gradient mobile phase program consisting of 0.1% formic acid in water and 0.1% formic acid in acetonitrile. Detection and quantification was performed using a TSQ Quantum Ultra triple quadrupole mass spectrometer. The analytical method was used to evaluate NRTI drug levels in HIV-positive nursing mothers-infant pairs. Results: The assay was validated over the concentration range of16.6–5000 ng/mL for 3TC, FTC and TFV inDBS and DBMS except for TFV in DBMS where linearity was established from 4.2–1250 ng/mL. Intra and inter-day precision (%CV) ranged from 3.5–8.7 and accuracy was within 15% for all analytes in both matrices. The mean recovery in DBS was>61% and in DBMS>43% for all three analytes. Matrix effect was insignificant. Median AUC0-8 values in maternal DBS and DBMS, respectively, were 4683 (4165–6057) and 6050 (5217–6417) ng h/mL for 3TC, 3312 (2259–4312) and 4853 (4124–6691) ng h/mL for FTC and 1559 (930–1915) and 56 (45–80) ngh/mL for TFV. 3TC and FTC were quantifiable (>16.6 ng/mL) in DBS from 2/6 and 1/6 infants respectively whereas TFV was undetectable in all infants. Conclusions: DBS and DBMS sampling for bioanalysis of 3TC, FTC and TFV is straightforward, robust, accurate and precise, and ideal for use in low-resource settings.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Objectives: To present the validation and clinical application of a LC–MS/MS method for the quantification of lamivudine (3TC), emtricitabine (FTC) and tenofovir (TFV) in dried blood spots (DBS) and dried breast milk spots (DBMS). Methods: DBS and DBMS were prepared from 50 and 30μL of drug-spiked whole blood and human breast milk, respectively. Following extraction with acetonitrile and water, chromatographic separation utilised a Synergi polar column with a gradient mobile phase program consisting of 0.1% formic acid in water and 0.1% formic acid in acetonitrile. Detection and quantification was performed using a TSQ Quantum Ultra triple quadrupole mass spectrometer. The analytical method was used to evaluate NRTI drug levels in HIV-positive nursing mothers-infant pairs. Results: The assay was validated over the concentration range of16.6–5000 ng/mL for 3TC, FTC and TFV inDBS and DBMS except for TFV in DBMS where linearity was established from 4.2–1250 ng/mL. Intra and inter-day precision (%CV) ranged from 3.5–8.7 and accuracy was within 15% for all analytes in both matrices. The mean recovery in DBS was>61% and in DBMS>43% for all three analytes. Matrix effect was insignificant. Median AUC0-8 values in maternal DBS and DBMS, respectively, were 4683 (4165–6057) and 6050 (5217–6417) ng h/mL for 3TC, 3312 (2259–4312) and 4853 (4124–6691) ng h/mL for FTC and 1559 (930–1915) and 56 (45–80) ngh/mL for TFV. 3TC and FTC were quantifiable (>16.6 ng/mL) in DBS from 2/6 and 1/6 infants respectively whereas TFV was undetectable in all infants. Conclusions: DBS and DBMS sampling for bioanalysis of 3TC, FTC and TFV is straightforward, robust, accurate and precise, and ideal for use in low-resource settings.
|
Hermans, Sabine M.; Babirye, Juliet A.; Mbabazi, Olive; Kakooza, Francis; Colebunders, Robert; Castelnuovo, Barbara; Sekaggya-Wiltshire, Christine; Parkes-Ratanshi, Rosalind; Manabe, Yukari C. Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpert® MTB/RIF era: a cohort study Journal Article In: BMC Infectious Diseases, vol. 17, no. 1, 2017. @article{Hermans2017,
title = {Treatment decisions and mortality in HIV-positive presumptive smear-negative TB in the Xpert® MTB/RIF era: a cohort study},
author = {Sabine M. Hermans and Juliet A. Babirye and Olive Mbabazi and Francis Kakooza and Robert Colebunders and Barbara Castelnuovo and Christine Sekaggya-Wiltshire and Rosalind Parkes-Ratanshi and Yukari C. Manabe
},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Treatment-decisions-and-mortality-in-HIV-positive-presumptive-smear-negative-TB-in-the-Xpert®-MTBRIF-era-a-cohort-study.pdf},
doi = { 10.1186/s12879-017-2534-2},
year = {2017},
date = {2017-06-16},
journal = {BMC Infectious Diseases},
volume = {17},
number = {1},
abstract = {Background: The Xpert® MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). Methods: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda. Prior to testing clinicians were asked to decide whether they would treat empirically prior to Xpert result; actual treatment was decided upon receipt of the XP result. We compared empirical and XP-informed treatment decisions and all-cause mortality in the first year. Results: Of 411 smear-negative presumptive TB patients, 175 (43%) received an XP; their baseline characteristics did not differ. XP positivity was similar in patients with a pre-XP empirical diagnosis and those without (9/29 [17%] versus 14/142 [10%], P = 0.23). Despite XP testing high levels of empirical treatment prevailed (18%), although XP results did change who ultimately was treated for TB. When adjusted for CD4 count, empirical treatment was not associated with higher mortality compared to no or microbiologically confirmed treatment. Conclusions: XP usage was lower than expected. The lower sensitivity of XP in smear-negative HIV-positive patients led experienced clinicians to use XP as a “rule-in” rather than “rule-out” test, with the majority of patients still treated empirically. Keywords: Empirical treatment, Molecular diagnostic techniques/methods, Tuberculosis, pulmonary/diagnosis, Tuberculosis, pulmonary/epidemiology, HIV Infections/complications
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: The Xpert® MTB/RIF (XP) has a higher sensitivity than sputum smear microscopy (70% versus 35%) for TB diagnosis and has been endorsed by the WHO for TB high burden countries to increase case finding among HIV co-infected presumptive TB patients. Its impact on the diagnosis of smear-negative TB in a routine care setting is unclear. We determined the change in diagnosis, treatment and mortality of smear-negative presumptive TB with routine use of Xpert MTB/RIF (XP). Methods: Prospective cohort study of HIV-positive smear-negative presumptive TB patients during a 12-month period after XP implementation in a well-staffed and trained integrated TB/HIV clinic in Kampala, Uganda. Prior to testing clinicians were asked to decide whether they would treat empirically prior to Xpert result; actual treatment was decided upon receipt of the XP result. We compared empirical and XP-informed treatment decisions and all-cause mortality in the first year. Results: Of 411 smear-negative presumptive TB patients, 175 (43%) received an XP; their baseline characteristics did not differ. XP positivity was similar in patients with a pre-XP empirical diagnosis and those without (9/29 [17%] versus 14/142 [10%], P = 0.23). Despite XP testing high levels of empirical treatment prevailed (18%), although XP results did change who ultimately was treated for TB. When adjusted for CD4 count, empirical treatment was not associated with higher mortality compared to no or microbiologically confirmed treatment. Conclusions: XP usage was lower than expected. The lower sensitivity of XP in smear-negative HIV-positive patients led experienced clinicians to use XP as a “rule-in” rather than “rule-out” test, with the majority of patients still treated empirically. Keywords: Empirical treatment, Molecular diagnostic techniques/methods, Tuberculosis, pulmonary/diagnosis, Tuberculosis, pulmonary/epidemiology, HIV Infections/complications
|
Montgomery, Martha P.; Nakasujja, Noeline; Morawski, Bozena M.; Rajasingham, Radha; Rhein, Joshua; Nalintya, Elizabeth; Williams, Darlisha A.; Hullsiek, Kathy Huppler; Kiragga, Agnes; Rolfes, Melissa A.; Carlson, Renee Donahue; Bahr, Nathan C.; Birkenkamp, Kate E.; Manabe, Yukari C.; Bohjanen, Paul R.; Kaplan, Jonathan E.; Kambugu, Andrew; Meya, David B.; Boulware, David R.; on behalf of the COAT,; Teams, ORCAS Trial Neurocognitive function in HIV-infected persons with asymptomatic cryptococcal antigenemia: a comparison of three prospective cohorts. Journal Article In: BMC Nuerology, vol. 17, no. 1, pp. p.110, 2017. @article{Montgomery2017,
title = {Neurocognitive function in HIV-infected persons with asymptomatic cryptococcal antigenemia: a comparison of three prospective cohorts.},
author = {Martha P. Montgomery and Noeline Nakasujja and Bozena M. Morawski and Radha Rajasingham and Joshua Rhein and Elizabeth Nalintya and Darlisha A. Williams and Kathy Huppler Hullsiek and Agnes Kiragga and Melissa A. Rolfes and Renee Donahue Carlson and Nathan C. Bahr and Kate E. Birkenkamp and Yukari C. Manabe and Paul R. Bohjanen and Jonathan E. Kaplan and Andrew Kambugu and David B. Meya and David R. Boulware and on behalf of the COAT and ORCAS Trial Teams},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Neurocognitive-function-in-HIV-infected-persons-with-asymptomatic-cryptococcal-antigenemia-a-comparison-of-three-prospective-cohorts.pdf},
doi = { doi: 10.1186/s12883-017-0878-2},
year = {2017},
date = {2017-06-12},
journal = {BMC Nuerology},
volume = {17},
number = {1},
pages = {p.110},
abstract = {Background: HIV-infected persons with detectable cryptococcal antigen (CrAg) in blood have increased morbidity and mortality compared with HIV-infected persons who are CrAg-negative. This study examined neurocognitive function among persons with asymptomatic cryptococcal antigenemia. Methods: Participants from three prospective HIV cohorts underwent neurocognitive testing at the time of antiretroviral therapy (ART) initiation. Cohorts included persons with cryptococcal meningitis (N = 90), asymptomatic CrAg + (N = 87), and HIV-infected persons without central nervous system infection (N = 125). Z-scores for each neurocognitive test were calculated relative to an HIV-negative Ugandan population with a composite quantitative neurocognitive performance Z-score (QNPZ-8) created from eight tested domains. Neurocognitive function was measured pre-ART for all three cohorts and additionally after 4 weeks of ART (and 6 weeks of pre-emptive fluconazole) treatment among asymptomatic CrAg + participants. Results: Cryptococcal meningitis and asymptomatic CrAg + participants had lower median CD4 counts (17 and 26 cells/μL, respectively) than the HIV-infected control cohort (233 cells/μL) as well as lower Karnofsky performance status (60 and 70 vs. 90, respectively). The composite QNPZ-8 for asymptomatic CrAg + (−1.80 Z-score) fell between the cryptococcal meningitis cohort (−2.22 Z-score, P=0.02) and HIV-infected controls (−1.36, P=0.003). After four weeks of ART and six weeks of fluconazole, the asymptomatic CrAg + cohort neurocognitive performance improved (−1.0 Z-score, P<0.001). Conclusion: Significant deficits in neurocognitive function were identified in asymptomatic CrAg + persons with advanced HIV/AIDS even without signs or sequelae of meningitis. Neurocognitive function in this group improves over time after initiation of pre-emptive fluconazole treatment and ART, but short term adherence support may be necessary. Keywords: AIDS dementia complex, Neurocognitive disorders, Cryptococcal meningitis, HIV, Neuropsychological tests, Cryptococcus
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: HIV-infected persons with detectable cryptococcal antigen (CrAg) in blood have increased morbidity and mortality compared with HIV-infected persons who are CrAg-negative. This study examined neurocognitive function among persons with asymptomatic cryptococcal antigenemia. Methods: Participants from three prospective HIV cohorts underwent neurocognitive testing at the time of antiretroviral therapy (ART) initiation. Cohorts included persons with cryptococcal meningitis (N = 90), asymptomatic CrAg + (N = 87), and HIV-infected persons without central nervous system infection (N = 125). Z-scores for each neurocognitive test were calculated relative to an HIV-negative Ugandan population with a composite quantitative neurocognitive performance Z-score (QNPZ-8) created from eight tested domains. Neurocognitive function was measured pre-ART for all three cohorts and additionally after 4 weeks of ART (and 6 weeks of pre-emptive fluconazole) treatment among asymptomatic CrAg + participants. Results: Cryptococcal meningitis and asymptomatic CrAg + participants had lower median CD4 counts (17 and 26 cells/μL, respectively) than the HIV-infected control cohort (233 cells/μL) as well as lower Karnofsky performance status (60 and 70 vs. 90, respectively). The composite QNPZ-8 for asymptomatic CrAg + (−1.80 Z-score) fell between the cryptococcal meningitis cohort (−2.22 Z-score, P=0.02) and HIV-infected controls (−1.36, P=0.003). After four weeks of ART and six weeks of fluconazole, the asymptomatic CrAg + cohort neurocognitive performance improved (−1.0 Z-score, P<0.001). Conclusion: Significant deficits in neurocognitive function were identified in asymptomatic CrAg + persons with advanced HIV/AIDS even without signs or sequelae of meningitis. Neurocognitive function in this group improves over time after initiation of pre-emptive fluconazole treatment and ART, but short term adherence support may be necessary. Keywords: AIDS dementia complex, Neurocognitive disorders, Cryptococcal meningitis, HIV, Neuropsychological tests, Cryptococcus
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Robinson, Matthew L.; Manabe, Yukari C. Reducing Uncertainty for Acute Febrile Illness in Resource-Limited Settings: The Current Diagnostic Landscape. Journal Article In: American Journal of Tropical Medicine and Hygiene, vol. 96, no. 6, pp. 1285-1295, 2017. @article{Robinson2017,
title = {Reducing Uncertainty for Acute Febrile Illness in Resource-Limited Settings: The Current Diagnostic Landscape.},
author = {Matthew L. Robinson and Yukari C. Manabe},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Reducing-Uncertainty-for-Acute-Febrile-Illness-in-Resource-Limited-Settings-The-Current-Diagnostic-Landscape.pdf},
doi = {10.4269/ajtmh.16-0667},
year = {2017},
date = {2017-06-07},
journal = {American Journal of Tropical Medicine and Hygiene},
volume = {96},
number = {6},
pages = {1285-1295},
abstract = { Diagnosing the cause of acute febrile illness in resource-limited settings is important—to give the correct antimicrobials to patients who need them, to prevent unnecessary antimicrobial use, to detect emerging infectious diseases early, and to guide vaccine deployment. A variety of approaches are yielding more rapid and accurate tests that can detect more pathogens in a wider variety of settings. After decades of slow progress in diagnostics for acute febrile illness in resource-limited settings, a wave of converging advancements will enable clinicians in resource-limited settings to reduce uncertainty for the diagnosis of acute febrile illness},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Diagnosing the cause of acute febrile illness in resource-limited settings is important—to give the correct antimicrobials to patients who need them, to prevent unnecessary antimicrobial use, to detect emerging infectious diseases early, and to guide vaccine deployment. A variety of approaches are yielding more rapid and accurate tests that can detect more pathogens in a wider variety of settings. After decades of slow progress in diagnostics for acute febrile illness in resource-limited settings, a wave of converging advancements will enable clinicians in resource-limited settings to reduce uncertainty for the diagnosis of acute febrile illness |
Kekitiinwa, Adeodata; MMed,; Szubert, Alexander J.; MSc2,; Spyer, Moira; Katuramu, Richard; and Victor Musiime,; Mhute, Tawanda; BakeeraKitaka, Sabrina; Senfuma, Oscar; Walker, Ann Sarah; Gibb, Diana M; for the ARROW Trial Tea, Virologic Response to First-Line Efavirenz- or Nevirapine-Based Anti-Retroviral Therapy in HIV-Infected African Children Journal Article In: Pediatric Infectious Diseases Journal, vol. 36, no. 6, pp. 588-594, 2017. @article{Kekitiinwa2017,
title = {Virologic Response to First-Line Efavirenz- or Nevirapine-Based Anti-Retroviral Therapy in HIV-Infected African Children},
author = {Adeodata Kekitiinwa and MMed and Alexander J. Szubert and MSc2 and Moira Spyer and Richard Katuramu and and Victor Musiime and Tawanda Mhute and Sabrina BakeeraKitaka and Oscar Senfuma and Ann Sarah Walker and Diana M Gibb and for the ARROW Trial Tea},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Virologic-Response-to-First-Line-Efavirenz-or-Nevirapine-Based-Anti-Retroviral-Therapy-in-HIV-Infected-African-Children.pdf},
doi = {10.1097/INF.0000000000001505.},
year = {2017},
date = {2017-06-05},
journal = {Pediatric Infectious Diseases Journal},
volume = {36},
number = {6},
pages = {588-594},
abstract = {BACKGROUND:
Poorer virologic response to nevirapine- versus efavirenz-based antiretroviral therapy (ART) has been reported in adult systematic reviews and pediatric studies.
METHODS:
We compared drug discontinuation and viral load (VL) response in ART-naïve Ugandan/Zimbabwean children ≥3 years of age initiating ART with clinician-chosen nevirapine versus efavirenz in the ARROW trial. Predictors of suppression <80, <400 and <1000 copies/mL at 36, 48 and 144 weeks were identified using multivariable logistic regression with backwards elimination (P = 0.1).
RESULTS:
A total of 445 (53%) children received efavirenz and 391 (47%) nevirapine. Children receiving efavirenz were older (median age, 8.6 vs. 7.5 years nevirapine, P < 0.001) and had higher CD4% (12% vs. 10%, P = 0.05), but similar pre-ART VL (P = 0.17). The initial non-nucleoside-reverse-transcriptase-inhibitor (NNRTI) was permanently discontinued for adverse events in 7 of 445 (2%) children initiating efavirenz versus 9 of 391 (2%) initiating nevirapine (P = 0.46); at switch to second line in 17 versus 23, for tuberculosis in 0 versus 26, for pregnancy in 6 versus 0 and for other reasons in 15 versus 5. Early (36-48 weeks) virologic suppression <80 copies/mL was superior with efavirenz, particularly in children with higher pre-ART VL (P = 0.0004); longer-term suppression was superior with nevirapine in older children (P = 0.05). Early suppression was poorer in the youngest and oldest children, regardless of NNRTI (P = 0.02); longer-term suppression was poorer in those with higher pre-ART VL regardless of NNRTI (P = 0.05). Results were broadly similar for <400 and <1000 copies/mL.
CONCLUSION:
Short-term VL suppression favored efavirenz, but long-term relative performance was age dependent, with better suppression in older children with nevirapine, supporting World Health Organization recommendation that nevirapine remains an alternative NNRTI.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
Poorer virologic response to nevirapine- versus efavirenz-based antiretroviral therapy (ART) has been reported in adult systematic reviews and pediatric studies.
METHODS:
We compared drug discontinuation and viral load (VL) response in ART-naïve Ugandan/Zimbabwean children ≥3 years of age initiating ART with clinician-chosen nevirapine versus efavirenz in the ARROW trial. Predictors of suppression <80, <400 and <1000 copies/mL at 36, 48 and 144 weeks were identified using multivariable logistic regression with backwards elimination (P = 0.1).
RESULTS:
A total of 445 (53%) children received efavirenz and 391 (47%) nevirapine. Children receiving efavirenz were older (median age, 8.6 vs. 7.5 years nevirapine, P < 0.001) and had higher CD4% (12% vs. 10%, P = 0.05), but similar pre-ART VL (P = 0.17). The initial non-nucleoside-reverse-transcriptase-inhibitor (NNRTI) was permanently discontinued for adverse events in 7 of 445 (2%) children initiating efavirenz versus 9 of 391 (2%) initiating nevirapine (P = 0.46); at switch to second line in 17 versus 23, for tuberculosis in 0 versus 26, for pregnancy in 6 versus 0 and for other reasons in 15 versus 5. Early (36-48 weeks) virologic suppression <80 copies/mL was superior with efavirenz, particularly in children with higher pre-ART VL (P = 0.0004); longer-term suppression was superior with nevirapine in older children (P = 0.05). Early suppression was poorer in the youngest and oldest children, regardless of NNRTI (P = 0.02); longer-term suppression was poorer in those with higher pre-ART VL regardless of NNRTI (P = 0.05). Results were broadly similar for <400 and <1000 copies/mL.
CONCLUSION:
Short-term VL suppression favored efavirenz, but long-term relative performance was age dependent, with better suppression in older children with nevirapine, supporting World Health Organization recommendation that nevirapine remains an alternative NNRTI. |
Meya, David B.; Okurut, Samuel; Zziwa, Godfrey; Cose, Stephen; Bohjanen, Paul R.; Mayanja-Kizza, Harriet; Joloba, Moses; Boulware, David R.; Manabe, Carol Yukari; Wahl, Sharon; Janoff, Edward N. Monocyte Phenotype and IFN-γ-Inducible Cytokine Responses Are Associated with Cryptococcal Immune Reconstitution Inflammatory Syndrome. Journal Article In: Journal of Fungi, 2017. @article{Meya2017,
title = {Monocyte Phenotype and IFN-γ-Inducible Cytokine Responses Are Associated with Cryptococcal Immune Reconstitution Inflammatory Syndrome. },
author = {David B. Meya and Samuel Okurut and Godfrey Zziwa and Stephen Cose and Paul R. Bohjanen and Harriet Mayanja-Kizza and Moses Joloba and David R. Boulware and Carol Yukari Manabe and Sharon Wahl and Edward N. Janoff},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Monocyte-Phenotype-and-IFN-γ-Inducible-Cytokine-Responses-Are-Associated-with-Cryptococcal-Immune-Reconstitution-Inflammatory-Syndrome.pdf},
doi = { 10.3390/jof3020028},
year = {2017},
date = {2017-06-02},
journal = {Journal of Fungi},
abstract = { A third of adults with AIDS and cryptococcal meningitis (CM) develop immune reconstitution inflammatory syndrome (IRIS) after initiating antiretroviral therapy (ART), which is thoughttoresultfromexaggeratedinflammatoryantigen-specificTcellresponses. Thecontributionof monocytestotheimmunopathogenesisofcryptococcalIRISremainsunclear. Wecomparedmonocyte subset frequencies and immune responses in HIV-infected Ugandans at time of CM diagnosis (IRIS-Baseline) for those who later developed CM-IRIS, controls who did not develop CM-IRIS (Control-Baseline)atCM-IRIS(IRIS-Event),andforcontrolsatatimepointmatchedforARTduration (Control-Event) to understand the association of monocyte distribution and immune responses with cryptococcal IRIS. At baseline, stimulation with IFN-γ ex vivo induced a higher frequency of TNF-αand IL-6-producing monocytes among those who later developed IRIS. Among participants who developed IRIS, ex vivo IFN-γ stimulation induced higher frequencies of activated monocytes, IL-6+, TNF-α+ classical, and IL-6+ intermediate monocytes compared with controls. In conclusion, we have demonstrated that monocyte subset phenotype and cytokine responses prior to ART are associated with and may be predictive of CM-IRIS. Larger studies to further delineate innate immunological responses and the efficacy of immunomodulatory therapies during cryptococcal IRIS are warranted},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
A third of adults with AIDS and cryptococcal meningitis (CM) develop immune reconstitution inflammatory syndrome (IRIS) after initiating antiretroviral therapy (ART), which is thoughttoresultfromexaggeratedinflammatoryantigen-specificTcellresponses. Thecontributionof monocytestotheimmunopathogenesisofcryptococcalIRISremainsunclear. Wecomparedmonocyte subset frequencies and immune responses in HIV-infected Ugandans at time of CM diagnosis (IRIS-Baseline) for those who later developed CM-IRIS, controls who did not develop CM-IRIS (Control-Baseline)atCM-IRIS(IRIS-Event),andforcontrolsatatimepointmatchedforARTduration (Control-Event) to understand the association of monocyte distribution and immune responses with cryptococcal IRIS. At baseline, stimulation with IFN-γ ex vivo induced a higher frequency of TNF-αand IL-6-producing monocytes among those who later developed IRIS. Among participants who developed IRIS, ex vivo IFN-γ stimulation induced higher frequencies of activated monocytes, IL-6+, TNF-α+ classical, and IL-6+ intermediate monocytes compared with controls. In conclusion, we have demonstrated that monocyte subset phenotype and cytokine responses prior to ART are associated with and may be predictive of CM-IRIS. Larger studies to further delineate innate immunological responses and the efficacy of immunomodulatory therapies during cryptococcal IRIS are warranted |
Ocama, Ponsiano; Opio, Kenneth Christopher; Seremba, Emmanuel; Ajal, Paul; Apica, Betty Stephanie; Aginya, Emmanuel Odongo The burden, pattern and factors that contribute to periportal fibrosis in HIV-infected patients in an S. mansoni endemic rural Uganda. Journal Article In: African Health Science, vol. 17, no. 2, pp. 301–307, 2017. @article{Ocama2017,
title = {The burden, pattern and factors that contribute to periportal fibrosis in HIV-infected patients in an S. mansoni endemic rural Uganda. },
author = {Ponsiano Ocama and Kenneth Christopher Opio and Emmanuel Seremba and Paul Ajal and Betty Stephanie Apica and Emmanuel Odongo Aginya},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/The-burden-pattern-and-factors-that-contribute-to-periportal-fibrosis-in-HIV-infected-patients-in-an-S.-mansoni-endemic-rural-Uganda..pdf},
doi = {10.4314/ahs.v17i2.2},
year = {2017},
date = {2017-06-01},
journal = {African Health Science},
volume = {17},
number = {2},
pages = {301–307},
abstract = {Introduction
Both Human Immunodeficiency Virus (HIV) and S.mansoni infections are common in Uganda and can cause liver disease. No study has determined co-infection significance in Uganda. We carried out a study on the burden, pattern and factors that contribute to peri-portal fibrosis (PPF) in HIV infected patients attending a Primary healthcare setting at Pakwach.
Methodology
We conducted a cross-sectional study in the HIV clinic at Pakwach health centre IV. Data on demographics, contact with the Nile, CD4+ cell count, ART and alcohol use were collected. Urinary Circulating Cathodic Antigen (CCA), was done for S. Mansoni detection. Liver scan was done for presence and pattern of PPF. HBsAg testing was performed on all participants. Data was analyzed using Stata Version 10.
Results
We enrolled 299 patients, median age 39 years (IQR 16), most were female, 210 (73%). Overall, 206 (68.9%) had PPF, majority 191 (92.7%) had pattern c, either alone (63 participants) or in combination with pattern d (128 participants). Age of 30–50 years was significantly associated with PPF (OR 2.28 p-value-0.003)
Conclusion
We found high prevalence of S. mansoni and PPF in the HIV infected population and age was a significant factor for PPF. We recommend all HIV infected patients be examined routinely for S. mansoni infection for early anti-schistosomal treatment.
Keywords: HIV, S.Mansoni, peri-portal fibrosis},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Introduction
Both Human Immunodeficiency Virus (HIV) and S.mansoni infections are common in Uganda and can cause liver disease. No study has determined co-infection significance in Uganda. We carried out a study on the burden, pattern and factors that contribute to peri-portal fibrosis (PPF) in HIV infected patients attending a Primary healthcare setting at Pakwach.
Methodology
We conducted a cross-sectional study in the HIV clinic at Pakwach health centre IV. Data on demographics, contact with the Nile, CD4+ cell count, ART and alcohol use were collected. Urinary Circulating Cathodic Antigen (CCA), was done for S. Mansoni detection. Liver scan was done for presence and pattern of PPF. HBsAg testing was performed on all participants. Data was analyzed using Stata Version 10.
Results
We enrolled 299 patients, median age 39 years (IQR 16), most were female, 210 (73%). Overall, 206 (68.9%) had PPF, majority 191 (92.7%) had pattern c, either alone (63 participants) or in combination with pattern d (128 participants). Age of 30–50 years was significantly associated with PPF (OR 2.28 p-value-0.003)
Conclusion
We found high prevalence of S. mansoni and PPF in the HIV infected population and age was a significant factor for PPF. We recommend all HIV infected patients be examined routinely for S. mansoni infection for early anti-schistosomal treatment.
Keywords: HIV, S.Mansoni, peri-portal fibrosis |
Jessica E Haberer Kerry A. Thomson, Mark Marzinke; Jared M. Baeten, for the Partners PrEP Study Team Medication Sharing is Rare among African HIV-1 Serodiscordant Couples Enrolled in an Efficacy Trial of Oral Pre-exposure Prophylaxis (PrEP) for HIV-1 Prevention Journal Article In: J Acquir Immune Defic Syndr., vol. 75, no. 2, pp. 184–189, 2017. @article{Thomson2017,
title = {Medication Sharing is Rare among African HIV-1 Serodiscordant Couples Enrolled in an Efficacy Trial of Oral Pre-exposure Prophylaxis (PrEP) for HIV-1 Prevention},
author = {Kerry A. Thomson, Jessica E Haberer, Mark Marzinke, Andrew Mujugira, Craig Hendrix, Connie Celum, Patrick Ndase, Allan Ronald, David R Bangsberg, and Jared M. Baeten, for the Partners PrEP Study Team},
doi = {doi: 10.1097/QAI.0000000000001356},
year = {2017},
date = {2017-06-01},
journal = {J Acquir Immune Defic Syndr.},
volume = {75},
number = {2},
pages = {184–189},
abstract = {Sharing of pre-exposure prophylaxis (PrEP) medications is a concern for PrEP implementation. For HIV-1 serodiscordant couples, sharing may undermine HIV-1 prevention benefits and also cause antiretroviral resistance if taken by HIV-1 infected partners. Within a PrEP efficacy trial among HIV-1 serodiscordant couples, we assessed the occurrence of PrEP sharing by self-report and plasma tenofovir concentrations in HIV-1 infected partners. PrEP sharing was self-reported at <0.01% of visits and 0–1.6% of randomly selected and 0% of purposively selected specimens from HIV-1 infected participants had detectable tenofovir concentrations (median: 66.5 ng/mL, range: 1.3–292 ng/mL). PrEP sharing within HIV-1 serodiscordant couples was extremely rare.
Keywords: HIV-1, pre-exposure prophylaxis, HIV-1 serodiscordant couples, adherence, prescription drug diversion},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Sharing of pre-exposure prophylaxis (PrEP) medications is a concern for PrEP implementation. For HIV-1 serodiscordant couples, sharing may undermine HIV-1 prevention benefits and also cause antiretroviral resistance if taken by HIV-1 infected partners. Within a PrEP efficacy trial among HIV-1 serodiscordant couples, we assessed the occurrence of PrEP sharing by self-report and plasma tenofovir concentrations in HIV-1 infected partners. PrEP sharing was self-reported at <0.01% of visits and 0–1.6% of randomly selected and 0% of purposively selected specimens from HIV-1 infected participants had detectable tenofovir concentrations (median: 66.5 ng/mL, range: 1.3–292 ng/mL). PrEP sharing within HIV-1 serodiscordant couples was extremely rare.
Keywords: HIV-1, pre-exposure prophylaxis, HIV-1 serodiscordant couples, adherence, prescription drug diversion |
Morawski, Bozena M.; Yunus, Miya; Kerukadho, Emmanuel; Turyasingura, Grace; Barbra, Logose; Ojok, Andrew Mijumbi; DiNardo, Andrew R.; Sowinski, Stefanie; Boulware, David R.; Mejia, Rojelio Hookworm infection is associated with decreased CD4+ T cell counts in HIV-infected adult Ugandans Journal Article In: PloS Neglected Tropical Diseases, vol. 11, no. 5, 2017. @article{Morawski2017,
title = {Hookworm infection is associated with decreased CD4+ T cell counts in HIV-infected adult Ugandans},
author = {Bozena M. Morawski and Miya Yunus and Emmanuel Kerukadho and Grace Turyasingura and Logose Barbra and Andrew Mijumbi Ojok and Andrew R. DiNardo and Stefanie Sowinski and David R. Boulware and Rojelio Mejia},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Hookworm-infection-is-associated-with-decreased-CD4-T-cell-counts-in-HIV-infected-adult-Ugandans.pdf},
doi = {10.1371/journal.pntd.0005634},
year = {2017},
date = {2017-05-25},
journal = {PloS Neglected Tropical Diseases},
volume = {11},
number = {5},
abstract = {Most studies evaluating epidemiologic relationships between helminths and HIV have been conducted in the pre-ART era, and evidence of the impact of helminth infections on HIV disease progression remains conflicting. Less is known about helminth infection and clinical outcomes in HIV-infected adults receiving antiretroviral therapy (ART). We sampled HIV-infected adults for eight gastrointestinal parasites and correlated parasitic infection with demographic predictors, and clinical and immunologic outcomes. Contrasting with previous studies, we measured parasitic infection with a quantitative, highly sensitive and specific polymerase chain reaction (PCR) method. This cohort study enrolled HIV-infected Ugandans from August-September 2013 in Mbale, Uganda and collected stool and blood samples at enrollment. Real-time PCR quantified stool: Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica, and Giardia intestinalis infection. Generalized linear models assessed relationships between parasitic infection and clinical or demographic data. 35% of participants (71/202) tested positive for1 helminth, mainly N. americanus (55/199, 28%), and 4.5% (9/202) were infected with2 stool parasites. Participants with hookworm infection had lower average CD4+ cell counts (-94 cells/mcL, 95%CI: -141, -48 cells/mcL; p<0.001) after adjustment for sex, CD4+ nadir at clinic entry, and time on ART. The high prevalence of parasitic infection and correlation with decreased CD4+ concentrations highlight the need to re-examine the effects of invasive helminth co-infection in rural, HIV-infected populations in the era of widely available ART. Elucidating the relationship between hookworm infection and immune recovery could provide opportunities for health optimization, e.g. integrated deworming, in these vulnerable populations.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Most studies evaluating epidemiologic relationships between helminths and HIV have been conducted in the pre-ART era, and evidence of the impact of helminth infections on HIV disease progression remains conflicting. Less is known about helminth infection and clinical outcomes in HIV-infected adults receiving antiretroviral therapy (ART). We sampled HIV-infected adults for eight gastrointestinal parasites and correlated parasitic infection with demographic predictors, and clinical and immunologic outcomes. Contrasting with previous studies, we measured parasitic infection with a quantitative, highly sensitive and specific polymerase chain reaction (PCR) method. This cohort study enrolled HIV-infected Ugandans from August-September 2013 in Mbale, Uganda and collected stool and blood samples at enrollment. Real-time PCR quantified stool: Ascaris lumbricoides, Ancylostoma duodenale, Necator americanus, Strongyloides stercoralis, Trichuris trichiura, Cryptosporidium spp., Entamoeba histolytica, and Giardia intestinalis infection. Generalized linear models assessed relationships between parasitic infection and clinical or demographic data. 35% of participants (71/202) tested positive for1 helminth, mainly N. americanus (55/199, 28%), and 4.5% (9/202) were infected with2 stool parasites. Participants with hookworm infection had lower average CD4+ cell counts (-94 cells/mcL, 95%CI: -141, -48 cells/mcL; p<0.001) after adjustment for sex, CD4+ nadir at clinic entry, and time on ART. The high prevalence of parasitic infection and correlation with decreased CD4+ concentrations highlight the need to re-examine the effects of invasive helminth co-infection in rural, HIV-infected populations in the era of widely available ART. Elucidating the relationship between hookworm infection and immune recovery could provide opportunities for health optimization, e.g. integrated deworming, in these vulnerable populations.
|
J.P. Van Geertruyden E. Seremba, R. Ssenyonga Early childhood transmission of hepatitis B prior to the first hepatitis B vaccine dose is rare among babies born to HIV-infected and non-HIV infected mothers in Gulu, Uganda Journal Article In: Vaccine, vol. 35, no. 22, pp. 2937-2942, 2017. @article{Seremba2017b,
title = {Early childhood transmission of hepatitis B prior to the first hepatitis B vaccine dose is rare among babies born to HIV-infected and non-HIV infected mothers in Gulu, Uganda},
author = {E. Seremba, J.P. Van Geertruyden, R. Ssenyonga, C.K. Opio, J.M. Kaducu, J.B. Sempa, R. Colebunders, P. Ocama},
doi = {https://doi.org/10.1016/j.vaccine.2017.04.020},
year = {2017},
date = {2017-05-19},
journal = {Vaccine},
volume = {35},
number = {22},
pages = {2937-2942},
abstract = {Background
Hepatitis B (HBV) in sub-Saharan Africa is believed to be horizontally acquired. However, because of the high HBV prevalence in northern Uganda, no hepatitis B vaccination at birth and no access to HBV immunoglobulin, we hypothesize that vertical transmission also could also play an important role. We therefore investigated the incidence of HBV among babies presenting for their first HBV vaccine dose in Gulu, Uganda.
Methods
We recruited mothers and their babies (at least 6-week old) presenting for their postnatal care and first HBV vaccine dose respectively. Socio-demographic and risk factors for HBV transmission were recorded. Mothers were tested for Hepatitis B core antibody (anti-HBc-IgG) and hepatitis B surface antigen (HBsAg). HBsAg-positive sera were tested for hepatitis B e antigen (HBeAg) and HBV viral load (HBVDNA). Babies were tested for HBsAg at presentation and at the last immunization visit. A sample of HBsAg-negative babies were tested for HBVDNA. Incident HBV infection was defined by either a positive HBsAg or HBVDNA test. Chi-square or fisher’s exact tests were utilized to investigate associations and t-tests or Wilcoxon rank-sum test for continuous differences.
Results
We recruited 612 mothers, median age 23 years (IQR 20–28). 53 (8.7%) were HBsAg-positive and 339 (61.5%) were anti-HBc-IgG-positive. Ten (18.9%) of the HBsAg-positive mothers were HBeAg-positive. Median HBVDNA levels of HBV-infected mothers was 5.7log (IQR 4.6–7.0) IU/mL with 9 (17.6%) having levels ≥ 105 IU/mL. Eighty (13.3%) mothers were HIV-infected of whom 9 (11.5%) were co-infected with HBV. No baby tested HBsAg or HBVDNA positive.
Conclusion
Vertical transmission does not seem to contribute substantially to the high HBV endemicity in northern Uganda. The current practice of administering the first HBV vaccine to babies in Uganda at six weeks of age may be adequate in control of HBV transmission.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Hepatitis B (HBV) in sub-Saharan Africa is believed to be horizontally acquired. However, because of the high HBV prevalence in northern Uganda, no hepatitis B vaccination at birth and no access to HBV immunoglobulin, we hypothesize that vertical transmission also could also play an important role. We therefore investigated the incidence of HBV among babies presenting for their first HBV vaccine dose in Gulu, Uganda.
Methods
We recruited mothers and their babies (at least 6-week old) presenting for their postnatal care and first HBV vaccine dose respectively. Socio-demographic and risk factors for HBV transmission were recorded. Mothers were tested for Hepatitis B core antibody (anti-HBc-IgG) and hepatitis B surface antigen (HBsAg). HBsAg-positive sera were tested for hepatitis B e antigen (HBeAg) and HBV viral load (HBVDNA). Babies were tested for HBsAg at presentation and at the last immunization visit. A sample of HBsAg-negative babies were tested for HBVDNA. Incident HBV infection was defined by either a positive HBsAg or HBVDNA test. Chi-square or fisher’s exact tests were utilized to investigate associations and t-tests or Wilcoxon rank-sum test for continuous differences.
Results
We recruited 612 mothers, median age 23 years (IQR 20–28). 53 (8.7%) were HBsAg-positive and 339 (61.5%) were anti-HBc-IgG-positive. Ten (18.9%) of the HBsAg-positive mothers were HBeAg-positive. Median HBVDNA levels of HBV-infected mothers was 5.7log (IQR 4.6–7.0) IU/mL with 9 (17.6%) having levels ≥ 105 IU/mL. Eighty (13.3%) mothers were HIV-infected of whom 9 (11.5%) were co-infected with HBV. No baby tested HBsAg or HBVDNA positive.
Conclusion
Vertical transmission does not seem to contribute substantially to the high HBV endemicity in northern Uganda. The current practice of administering the first HBV vaccine to babies in Uganda at six weeks of age may be adequate in control of HBV transmission. |
Judya; Nakawesi Orikiiriza, Janeb; Kikaire Unmet needs persist in pediatric HIV programs lessons from selected case studies in Uganda Journal Article In: AIDS, vol. 3, no. 8, pp. 1196-1199, 2017. @article{Orikiiriza2017b,
title = {Unmet needs persist in pediatric HIV programs lessons from selected case studies in Uganda},
author = {Orikiiriza, Judya; Nakawesi, Janeb; Kikaire, Bena,c; Turitwenka, Dorothya; Schlech, Walterd; Kambugu, Andrewa; Lamorde, Mohammeda; Normark, Johane; Hennessy, Martinaf; Musiime, Victorg; Rujumba, Josephg; Ndeezi, Graceg; Tumwesigye, Nazarius M.h; Doherty, Derek G.c; Achan, Janei},
doi = {doi: 10.1097/QAD.0000000000001436},
year = {2017},
date = {2017-05-15},
journal = {AIDS},
volume = {3},
number = {8},
pages = {1196-1199},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Musomba, Rachel; Mubiru, Frank; Nakalema, Shadia; Mackline, Hope; Kalule, Ivan; Kiragga, Agnes N.; Ratanshi, Rosalind Parkes; Castelnuovo, Barbara Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda Journal Article In: AIDS Research and Treatment, 2017. @article{Musomba2017,
title = {Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda},
author = {Rachel Musomba and Frank Mubiru and Shadia Nakalema and Hope Mackline and Ivan Kalule and Agnes N. Kiragga and Rosalind Parkes Ratanshi and Barbara Castelnuovo},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Describing-Point-of-Entry-into-Care-and-Being-Lost-to-Program-in-a-Cohort-of-HIV-Positive-Pregnant-Women-in-a-Large-Urban-Centre-in-Uganda.pdf},
doi = {10.1155/2017/3527563},
year = {2017},
date = {2017-05-13},
journal = {AIDS Research and Treatment},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
|
Paton, Nicholas I; Kityo, Cissy; Thompson, Jennifer; Nankya, Immaculate; Bagenda, Leonard; Hoppe, Anne; Hakim, James; Kambugu, Andrew; van Oosterhout, Joep J; Kiconco, Mary; Bertagnolio, Silvia; Easterbrook, Philippa J; Mugyenyi, Peter; A Sarah Walker, for the Europe Africa Research Network for Evaluation of Second-line Therapy (EARNEST) Trial Team Nucleoside reverse-transcriptase inhibitor cross-resistance and outcomes from second-line antiretroviral therapy in the public health approach: an observational analysis within the randomised, open-label, EARNEST trial. Journal Article In: Lancent HIV, vol. 4, no. 8, pp. 341-348, 2017. @article{Paton2017,
title = {Nucleoside reverse-transcriptase inhibitor cross-resistance and outcomes from second-line antiretroviral therapy in the public health approach: an observational analysis within the randomised, open-label, EARNEST trial.},
author = {Nicholas I Paton and Cissy Kityo and Jennifer Thompson and Immaculate Nankya and Leonard Bagenda and Anne Hoppe and James Hakim and Andrew Kambugu and Joep J van Oosterhout and Mary Kiconco and Silvia Bertagnolio and Philippa J Easterbrook and Peter Mugyenyi and A Sarah Walker, for the Europe Africa Research Network for Evaluation of Second-line Therapy (EARNEST) Trial Team },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Nucleoside-reverse-transcriptase-inhibitor-cross-resistance-and-outcomes-from-second-line-antiretroviral-therapy-in-the-public-health-approach.pdf},
doi = {10.1016/S2352-3018(17)30065-6.},
year = {2017},
date = {2017-05-08},
journal = {Lancent HIV},
volume = {4},
number = {8},
pages = {341-348},
abstract = {Background
Cross-resistance after first-line antiretroviral therapy (ART) failure is expected to impair activity of nucleoside reverse-transcriptase inhibitors (NRTIs) in second-line therapy for patients with HIV, but evidence for the effect of cross-resistance on virological outcomes is limited. We aimed to assess the association between the activity, predicted by resistance testing, of the NRTIs used in second-line therapy and treatment outcomes for patients infected with HIV.
Methods
We did an observational analysis of additional data from a published open-label, randomised trial of secondline ART (EARNEST) in sub-Saharan Africa. 1277 adults or adolescents infected with HIV in whom first-line ART had failed (assessed by WHO criteria with virological confirmation) were randomly assigned to a boosted protease inhibitor (standardised to ritonavir-boosted lopinavir) with two to three NRTIs (clinician-selected, without resistance testing); or with raltegravir; or alone as protease inhibitor monotherapy (discontinued after week 96). We tested genotypic resistance on stored baseline samples in patients in the protease inhibitor and NRTI group and calculated the predicted activity of prescribed second-line NRTIs. We measured viral load in stored samples for all patients obtained every 12–16 weeks. This trial is registered with Controlled-Trials.com (number ISRCTN 37737787) and ClinicalTrials.gov (number NCT00988039).
Findings
Baseline genotypes were available in 391 (92%) of 426 patients in the protease inhibitor and NRTI group. 176 (89%) of 198 patients prescribed a protease inhibitor with no predicted-active NRTIs had viral suppression (viral load <400 copies per mL) at week 144, compared with 312 (81%) of 383 patients in the protease inhibitor and raltegravir group at week 144 (p=0·02) and 233 (61%) of 280 patients in the protease inhibitor monotherapy group at week 96 (p<0·0001). Compared with results with no active NRTIs, 95 (85%) of 112 patients with one predicted-active NRTI had viral suppression (p=0·3) and 20 (77%) of 26 patients with two or three active NRTIs had viral suppression (p=0·08). Over all follow-up, greater predicted NRTI activity was associated with worse viral load suppression (global p=0·0004).
Interpretation Genotypic resistance testing might not accurately predict NRTI activity in protease inhibitor-based second-line ART. Our results do not support the introduction of routine resistance testing in ART programmes in low-income settings for the purpose of selecting second-line NRTIs.
Funding European and Developing Countries Clinical Trials Partnership, UK Medical Research Council, Institito de Salud Carlos III, Irish Aid, Swedish International Development Cooperation Agency, Instituto Superiore di Sanita, WHO, Merck.
Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. },
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background
Cross-resistance after first-line antiretroviral therapy (ART) failure is expected to impair activity of nucleoside reverse-transcriptase inhibitors (NRTIs) in second-line therapy for patients with HIV, but evidence for the effect of cross-resistance on virological outcomes is limited. We aimed to assess the association between the activity, predicted by resistance testing, of the NRTIs used in second-line therapy and treatment outcomes for patients infected with HIV.
Methods
We did an observational analysis of additional data from a published open-label, randomised trial of secondline ART (EARNEST) in sub-Saharan Africa. 1277 adults or adolescents infected with HIV in whom first-line ART had failed (assessed by WHO criteria with virological confirmation) were randomly assigned to a boosted protease inhibitor (standardised to ritonavir-boosted lopinavir) with two to three NRTIs (clinician-selected, without resistance testing); or with raltegravir; or alone as protease inhibitor monotherapy (discontinued after week 96). We tested genotypic resistance on stored baseline samples in patients in the protease inhibitor and NRTI group and calculated the predicted activity of prescribed second-line NRTIs. We measured viral load in stored samples for all patients obtained every 12–16 weeks. This trial is registered with Controlled-Trials.com (number ISRCTN 37737787) and ClinicalTrials.gov (number NCT00988039).
Findings
Baseline genotypes were available in 391 (92%) of 426 patients in the protease inhibitor and NRTI group. 176 (89%) of 198 patients prescribed a protease inhibitor with no predicted-active NRTIs had viral suppression (viral load <400 copies per mL) at week 144, compared with 312 (81%) of 383 patients in the protease inhibitor and raltegravir group at week 144 (p=0·02) and 233 (61%) of 280 patients in the protease inhibitor monotherapy group at week 96 (p<0·0001). Compared with results with no active NRTIs, 95 (85%) of 112 patients with one predicted-active NRTI had viral suppression (p=0·3) and 20 (77%) of 26 patients with two or three active NRTIs had viral suppression (p=0·08). Over all follow-up, greater predicted NRTI activity was associated with worse viral load suppression (global p=0·0004).
Interpretation Genotypic resistance testing might not accurately predict NRTI activity in protease inhibitor-based second-line ART. Our results do not support the introduction of routine resistance testing in ART programmes in low-income settings for the purpose of selecting second-line NRTIs.
Funding European and Developing Countries Clinical Trials Partnership, UK Medical Research Council, Institito de Salud Carlos III, Irish Aid, Swedish International Development Cooperation Agency, Instituto Superiore di Sanita, WHO, Merck.
Copyright © The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. |
Angol, Denish Calmax; Ocama, Ponsiano; Kirabo, Tess Ayazika; Okeng, Alfred; Najjingo, Irene; Bwanga, Freddie Helicobacter pylori from Peptic Ulcer Patients in Uganda Is Highly Resistant to Clarithromycin and Fluoroquinolones Results of the GenoType HelicoDR Test Directly Applied on Stool Journal Article In: BoiMed International, 2017. @article{Angol2017,
title = {Helicobacter pylori from Peptic Ulcer Patients in Uganda Is Highly Resistant to Clarithromycin and Fluoroquinolones Results of the GenoType HelicoDR Test Directly Applied on Stool},
author = {Denish Calmax Angol and Ponsiano Ocama and Tess Ayazika Kirabo and Alfred Okeng and Irene Najjingo and Freddie Bwanga},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Helicobacter-pylori-from-Peptic-Ulcer-Patients-in-Uganda-Is-Highly-Resistant-to-Clarithromycin-and-Fluoroquinolones-Results-of-the-GenoType-HelicoDR-Test-Directly-Applied-on-Stool.pdf},
doi = { 10.1155/2017/5430723},
year = {2017},
date = {2017-05-07},
journal = {BoiMed International},
abstract = {BACKGROUND:
Around 70-90% of peptic ulcer disease (PUD) is due to Helicobacter pylori and requires treatment with antimicrobials to which these bacteria are susceptible. Common H. pylori diagnostic tests do not provide drug susceptibility data. Using the GenoType HelicoDR PCR test designed for gastric biopsies for simultaneous detection of H. pylori and its resistance to clarithromycin (CLA)/fluoroquinolones (FLQ), we present evidence for stool as an optional test specimen and also provide data on prevalence of H. pylori resistance to CLA and FLQ in Uganda.
METHODS:
Stool from 142 symptomatic PUD patients at three hospitals in Kampala was screened for H. pylori using a rapid antigen test. The GenoType HelicoDR test was run on all H. pylori antigen positives to determine PCR positivity and resistance to CLA/FLQ.
RESULTS:
Thirty-one samples (22%) were H. pylori antigen positive, and 21 (68%) of these were H. pylori PCR positive. Six of the 21 (29%) were resistant to CLA and eight to FLQ (42%), while two gave invalid FLQ resistance results.
CONCLUSION:
Stool is a possible specimen for the GenoType HelicoDR test for rapid detection of H. pylori and drug resistance. In Uganda, Helicobacter pylori is highly resistant to CLA and FLQ.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
Around 70-90% of peptic ulcer disease (PUD) is due to Helicobacter pylori and requires treatment with antimicrobials to which these bacteria are susceptible. Common H. pylori diagnostic tests do not provide drug susceptibility data. Using the GenoType HelicoDR PCR test designed for gastric biopsies for simultaneous detection of H. pylori and its resistance to clarithromycin (CLA)/fluoroquinolones (FLQ), we present evidence for stool as an optional test specimen and also provide data on prevalence of H. pylori resistance to CLA and FLQ in Uganda.
METHODS:
Stool from 142 symptomatic PUD patients at three hospitals in Kampala was screened for H. pylori using a rapid antigen test. The GenoType HelicoDR test was run on all H. pylori antigen positives to determine PCR positivity and resistance to CLA/FLQ.
RESULTS:
Thirty-one samples (22%) were H. pylori antigen positive, and 21 (68%) of these were H. pylori PCR positive. Six of the 21 (29%) were resistant to CLA and eight to FLQ (42%), while two gave invalid FLQ resistance results.
CONCLUSION:
Stool is a possible specimen for the GenoType HelicoDR test for rapid detection of H. pylori and drug resistance. In Uganda, Helicobacter pylori is highly resistant to CLA and FLQ. |
Nakanjako, Damalie; Akena, Dickens; Kaye, Dan K.; Tumwine, James; Okello, Elialilia; Nakimuli, Annettee; Kambugu, Andrew; McCullough, Hazel; Mayanja-Kizza, Harriet; Kamya, Moses R.; Sewankambo, Nelson K. A need to accelerate health research productivity in an African University the case of Makerere University College of Health Sciences Journal Article In: Health Research Policy and Systems, vol. 15, no. 1, pp. p.33, 2017. @article{Nakanjako2017,
title = {A need to accelerate health research productivity in an African University the case of Makerere University College of Health Sciences },
author = {Damalie Nakanjako and Dickens Akena and Dan K. Kaye and James Tumwine and Elialilia Okello and Annettee Nakimuli and Andrew Kambugu and Hazel McCullough and Harriet Mayanja-Kizza and Moses R. Kamya and Nelson K. Sewankambo
},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/A-need-to-accelerate-health-research-productivity-in-an-African-University-the-case-of-Makerere-University-College-of-Health-Sciences.pdf},
doi = {10.1186/s12961-017-0196-6.},
year = {2017},
date = {2017-04-21},
journal = {Health Research Policy and Systems},
volume = {15},
number = {1},
pages = {p.33},
abstract = {BACKGROUND:
In the last decade, Makerere University College of Health Sciences (MakCHS) has taken strides in research and training to improve healthcare through collaborative training and research programs. However, there is limited data on the trends of MakCHS faculty contributions to research and on faculty growth to take leading roles in health research. This paper reviews MakCHS faculty research publications over 15.5 years and outlines possible strategies to enhance faculty research outputs.
METHODS:
We used a mixed methods approach. A systematic review of research publications by faculty at MakCHS (PubMed and Google Scholar from January 1, 2000, to June 30, 2015) to quantify the number of research articles, areas researched, authorship contribution by MakCHS faculty, source of funding, as well as affiliated local and international collaborations. Graphs were used to shown trends in publications and leadership of authorship by faculty. Annual individual faculty research productivity was presented as publication per capita. Qualitative data on high priority needs to improve research outputs was collected through focus group discussions (FGDs) with faculty members, and analysed manually into emerging themes.
RESULTS:
Of 298 faculty at MakCHS at 2015, 89 (30%) were female and 229 (77%) were junior and mid-level faculty (senior lecturer and below). The PubMed and Google Scholar searches yielded 6927 published articles, of which 3399 (49%) full-text articles were downloaded for analysis, 426/3825 (11%) available as titles/abstracts only, and 598/4423 (14%) were excluded. Only 614 articles were published in 2014, giving a publication per capita of 2.1 for any authorship, and 0.3 for first and last authorship positions. MakCHS faculty increasingly contributed as first, second, third, and last authors. Up to 57% of research was in infectious diseases, followed by non-communicable diseases (20%) and non-communicable maternal child health (11%). Priority needs to improve research outputs, as expressed by faculty, were (1) an institutionally led faculty career development program, (2) skills building in research methods and scientific writing, (3) protected time for research related activities, (4) opportunities for collaborative research, and (5) use of individual development plans.
CONCLUSION:
Faculty research productivity was low and dominated by infectious diseases and non-communicable disease research. There is a need for structured institutional support to optimise faculty research outputs. Only with increased research productivity will MakCHS and other academic institutions be able to make a significant contribution in addressing national health challenges},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
BACKGROUND:
In the last decade, Makerere University College of Health Sciences (MakCHS) has taken strides in research and training to improve healthcare through collaborative training and research programs. However, there is limited data on the trends of MakCHS faculty contributions to research and on faculty growth to take leading roles in health research. This paper reviews MakCHS faculty research publications over 15.5 years and outlines possible strategies to enhance faculty research outputs.
METHODS:
We used a mixed methods approach. A systematic review of research publications by faculty at MakCHS (PubMed and Google Scholar from January 1, 2000, to June 30, 2015) to quantify the number of research articles, areas researched, authorship contribution by MakCHS faculty, source of funding, as well as affiliated local and international collaborations. Graphs were used to shown trends in publications and leadership of authorship by faculty. Annual individual faculty research productivity was presented as publication per capita. Qualitative data on high priority needs to improve research outputs was collected through focus group discussions (FGDs) with faculty members, and analysed manually into emerging themes.
RESULTS:
Of 298 faculty at MakCHS at 2015, 89 (30%) were female and 229 (77%) were junior and mid-level faculty (senior lecturer and below). The PubMed and Google Scholar searches yielded 6927 published articles, of which 3399 (49%) full-text articles were downloaded for analysis, 426/3825 (11%) available as titles/abstracts only, and 598/4423 (14%) were excluded. Only 614 articles were published in 2014, giving a publication per capita of 2.1 for any authorship, and 0.3 for first and last authorship positions. MakCHS faculty increasingly contributed as first, second, third, and last authors. Up to 57% of research was in infectious diseases, followed by non-communicable diseases (20%) and non-communicable maternal child health (11%). Priority needs to improve research outputs, as expressed by faculty, were (1) an institutionally led faculty career development program, (2) skills building in research methods and scientific writing, (3) protected time for research related activities, (4) opportunities for collaborative research, and (5) use of individual development plans.
CONCLUSION:
Faculty research productivity was low and dominated by infectious diseases and non-communicable disease research. There is a need for structured institutional support to optimise faculty research outputs. Only with increased research productivity will MakCHS and other academic institutions be able to make a significant contribution in addressing national health challenges |
G. Flynn, Andrew; B. Meya, David; Huppler Hullsiek, Katherine; Joshua Rhein,; A. Williams, Darlisha; Abdu Musubire,; M. Morawski, Bozena; Kabanda Taseera,; Alisat Sadiq,; Liberica Ndyatunga,; Mollie Roediger,; Radha Rajasingham,; R. Bohjanen, Paul; Conrad Muzoora,; R. Boulware, David Evolving Failures in the Delivery of Human Immunodeficiency Virus Care: Lessons From a Ugandan Meningitis Cohort 2006-2016 Journal Article In: Open Forum Infectious Diseases, vol. 4, no. 2, 2017. @article{G. Flynn2017,
title = {Evolving Failures in the Delivery of Human Immunodeficiency Virus Care: Lessons From a Ugandan Meningitis Cohort 2006-2016},
author = {Andrew G. Flynn and David B. Meya and Katherine Huppler Hullsiek and Joshua Rhein and Darlisha A. Williams and Abdu Musubire and Bozena M. Morawski and Kabanda Taseera and Alisat Sadiq and Liberica Ndyatunga and Mollie Roediger and Radha Rajasingham and Paul R. Bohjanen and Conrad Muzoora and David R. Boulware },
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Evolving-Failures-in-the-Delivery-of-Human-Immunodeficiency-Virus-Care-Lessons-From-a-Ugandan-Meningitis-Cohort-2006–2016.pdf},
doi = {10.1093/ofid/ofx077},
year = {2017},
date = {2017-04-19},
journal = {Open Forum Infectious Diseases},
volume = {4},
number = {2},
abstract = {Background. Because of investments in human immunodeficiency virus (HIV) care in sub-Saharan Africa, the number of people aware of their status and receiving antiretroviral therapy (ART) has increased; however, HIV/acquired immune deficiency syndrome (AIDS) mortality still remains high. Methods. We performed retrospective analysis of 3 sequential prospective cohorts of HIV-infected Ugandan adults presenting with AIDS and meningitis from 2006 to 2009, 2010 to 2012, and 2013 to 2016. Participants were categorized as follows: (1) unknown HIV status; (2) known HIV+ without ART; (3) known HIV+ with previous ART. We further categorized 2006 and 2013 cohort participants by duration of HIV-status knowledge and of ART receipt. Results. We screened 1353 persons with suspected meningitis. Cryptococcus was the most common pathogen (63%). Over the decade, we observed an absolute increase of 37% in HIV status knowledge and 59% in antecedent ART receipt at screening. The 2006 cohort participants were new/recent HIV diagnoses (65%) or known HIV+ but not receiving ART (35%). Many 2013 cohort participants were new/recent HIV diagnoses (34%) and known HIV+ with <1 month ART (20%), but a significant proportion were receiving ART 1–4 months (11%) and >4 months (30%). Four percent of participants discontinued ART. From 2010 to 2016, meningitis cases per month increased by 33%. Conclusions. Although improved HIV screening and ART access remain much-needed interventions in resource-limited settings, greater investment in viral suppression and opportunistic infection care among the growing HIV-infected population receiving ART is essential to reducing ongoing AIDS mortality. Keywords: antiretroviral therapy; cryptococcal meningitis; HIV/AIDS; HIV care continuum; sub-Saharan Africa.
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background. Because of investments in human immunodeficiency virus (HIV) care in sub-Saharan Africa, the number of people aware of their status and receiving antiretroviral therapy (ART) has increased; however, HIV/acquired immune deficiency syndrome (AIDS) mortality still remains high. Methods. We performed retrospective analysis of 3 sequential prospective cohorts of HIV-infected Ugandan adults presenting with AIDS and meningitis from 2006 to 2009, 2010 to 2012, and 2013 to 2016. Participants were categorized as follows: (1) unknown HIV status; (2) known HIV+ without ART; (3) known HIV+ with previous ART. We further categorized 2006 and 2013 cohort participants by duration of HIV-status knowledge and of ART receipt. Results. We screened 1353 persons with suspected meningitis. Cryptococcus was the most common pathogen (63%). Over the decade, we observed an absolute increase of 37% in HIV status knowledge and 59% in antecedent ART receipt at screening. The 2006 cohort participants were new/recent HIV diagnoses (65%) or known HIV+ but not receiving ART (35%). Many 2013 cohort participants were new/recent HIV diagnoses (34%) and known HIV+ with <1 month ART (20%), but a significant proportion were receiving ART 1–4 months (11%) and >4 months (30%). Four percent of participants discontinued ART. From 2010 to 2016, meningitis cases per month increased by 33%. Conclusions. Although improved HIV screening and ART access remain much-needed interventions in resource-limited settings, greater investment in viral suppression and opportunistic infection care among the growing HIV-infected population receiving ART is essential to reducing ongoing AIDS mortality. Keywords: antiretroviral therapy; cryptococcal meningitis; HIV/AIDS; HIV care continuum; sub-Saharan Africa.
|
Buyego, Paul; Nakiyingi, Lydia; Ddungu, Henry; Walimbwa, Stephen; Nalwanga, Damalie; Reynolds, Steven J; Parkes‑Ratanshi, Rosalind Possible misdiagnosis of HIV associated lymphoma as tuberculosis among patients attending Uganda Cancer Institute Journal Article In: BMC AIDS Research and Therapy, vol. 14, no. 1, 2017. @article{Buyego2017,
title = {Possible misdiagnosis of HIV associated lymphoma as tuberculosis among patients attending Uganda Cancer Institute},
author = {Paul Buyego and Lydia Nakiyingi and Henry Ddungu and Stephen Walimbwa and Damalie Nalwanga and Steven J Reynolds and Rosalind Parkes‑Ratanshi},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Possible-misdiagnosis-of-HIV-associated-lymphoma-as-tuberculosis-among-patients-attending-Uganda-Cancer-Institute.pdf},
doi = {10.1186/s12981-017-0139-x},
year = {2017},
date = {2017-04-14},
journal = {BMC AIDS Research and Therapy},
volume = {14},
number = {1},
abstract = {Background: Early diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available. As a consequence, diagnosis may be delayed increasing the risk of mortality. We set out to determine the frequency and risk factors associated with the misdiagno‑ sis of HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI). Methods: A retrospective cohort study design was used among HIV patients with associated lymphoma patients attending the UCI, Kampala, Uganda between February and March 2015. Eligible patient charts were reviewed for information on TB treatment, socio‑demographics, laboratory parameters (Hemoglobin, CD4cells count and lactate dehydrogenase) and clinical presentation using a semi structured data extraction form. Results: A total of 183 charts were reviewed; 106/183 were males (57.9%), the median age was 35 (IQR, 28–45). Fifty six (30.6%) patients had a possible misdiagnosis as TB and their median time on TB treatment was 3.5 (1–5.3) months. In multivariate analysis the presence of chest pain had an odd ratio (OR) of 4.4 (95% CI 1.89–10.58, p < 0.001) and stage III and IV lymphoma disease had an OR of 3.22 (95% CI 1.08–9.63, p < 0.037) for possible misdiagnosis of lym‑ phoma as TB. Conclusion: A high proportion of patients with HIV associated lymphoma attending UCI are misdiagnosed and treated as TB. Chest pain and stage III and IV of lymphoma were associated with an increased risk of a possible misdi‑ agnosis of lymphoma as TB. Keywords: Tuberculosis, Uganda, Lymphoma, HIV, Misdiagnosis
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Early diagnosis of HIV associated lymphoma is challenging because the definitive diagnostic procedure of biopsy, requires skills and equipment that are not readily available. As a consequence, diagnosis may be delayed increasing the risk of mortality. We set out to determine the frequency and risk factors associated with the misdiagno‑ sis of HIV associated lymphoma as tuberculosis (TB) among patients attending the Uganda Cancer Institute (UCI). Methods: A retrospective cohort study design was used among HIV patients with associated lymphoma patients attending the UCI, Kampala, Uganda between February and March 2015. Eligible patient charts were reviewed for information on TB treatment, socio‑demographics, laboratory parameters (Hemoglobin, CD4cells count and lactate dehydrogenase) and clinical presentation using a semi structured data extraction form. Results: A total of 183 charts were reviewed; 106/183 were males (57.9%), the median age was 35 (IQR, 28–45). Fifty six (30.6%) patients had a possible misdiagnosis as TB and their median time on TB treatment was 3.5 (1–5.3) months. In multivariate analysis the presence of chest pain had an odd ratio (OR) of 4.4 (95% CI 1.89–10.58, p < 0.001) and stage III and IV lymphoma disease had an OR of 3.22 (95% CI 1.08–9.63, p < 0.037) for possible misdiagnosis of lym‑ phoma as TB. Conclusion: A high proportion of patients with HIV associated lymphoma attending UCI are misdiagnosed and treated as TB. Chest pain and stage III and IV of lymphoma were associated with an increased risk of a possible misdi‑ agnosis of lymphoma as TB. Keywords: Tuberculosis, Uganda, Lymphoma, HIV, Misdiagnosis
|
Wamulugwa, Joan; Kakooza, Angelina; Kitaka, Sabrina Bakeera; Nalugya, Joyce; Kaddumukasa, Mark; Moore, Shirley; Sajatovic, Martha; Katabira, Elly Prevalence and associated factors of attention deficit hyperactivity disorder (ADHD) among Ugandan children; a cross-sectional study. Child Adolesc Psychiatry Ment Health Journal Article In: Child and Adolescent Psychiatry and Mental Health, vol. 14, no. 1, 2017. @article{Wamulugwa2017,
title = {Prevalence and associated factors of attention deficit hyperactivity disorder (ADHD) among Ugandan children; a cross-sectional study. Child Adolesc Psychiatry Ment Health},
author = {Joan Wamulugwa and Angelina Kakooza and Sabrina Bakeera Kitaka and Joyce Nalugya and Mark Kaddumukasa and Shirley Moore and Martha Sajatovic and Elly Katabira},
url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Prevalence-and-associated-factors-of-attention-deficit-hyperactivity-disorder-ADHD-among-Ugandan-children-a-cross-sectional-study.-Child-Adolesc-Psychiatry-Ment-Health.pdf},
doi = {10.1186/s13034-017-0155-6},
year = {2017},
date = {2017-04-14},
journal = {Child and Adolescent Psychiatry and Mental Health},
volume = {14},
number = {1},
abstract = {Background: Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder among the children. The burden of ADHD or its associated factors in Uganda are not known. The objective of this study was to determine the prevalence and the associated factors of ADHD among children attending the neurology and psychiatry clinics at Mulago National Referral Hospital. Methods: Using the disruptive behavior scale (45 items), we investigated the presence of ADHD symptoms among children attending Mulago Hospital. Questionnaires were administered to the primary care-takers of the study participants to gather information on the factors associated with ADHD. All children were subject to a clinical examination. Children presumed to have ADHD, using the aforementioned rating scale were further assessed by a child psychiatrist to confirm the diagnosis and associated co-morbid conditions. Results: The estimated prevalence of DSM-IV ADHD symptoms was 11%. Children aged less than 10 years were four times likely to have ADHD (OR 4.1, 95% CI 1.7–9.6, p < 0.001). The demographic factors independently associated with ADHD were age less than 10 years, male gender, history of maternal abnormal vaginal discharge during pregnancy, and no formal education or the highest level of education being primary school. Conclusion: The prevalence of ADHD among children attending the pediatric neurology and psychiatry clinics is high in our settings and is associated with delayed milestones. Early identification and addressing the co-morbid conditions associated with ADHD such as epilepsy, autism spectrum of disorder, conduct disorder, opposition defiant disorder and intellectual disability in our setting is needed. Keywords: ADHD, DSM IV, Associated factors, Specialized clinic
},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background: Attention deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder among the children. The burden of ADHD or its associated factors in Uganda are not known. The objective of this study was to determine the prevalence and the associated factors of ADHD among children attending the neurology and psychiatry clinics at Mulago National Referral Hospital. Methods: Using the disruptive behavior scale (45 items), we investigated the presence of ADHD symptoms among children attending Mulago Hospital. Questionnaires were administered to the primary care-takers of the study participants to gather information on the factors associated with ADHD. All children were subject to a clinical examination. Children presumed to have ADHD, using the aforementioned rating scale were further assessed by a child psychiatrist to confirm the diagnosis and associated co-morbid conditions. Results: The estimated prevalence of DSM-IV ADHD symptoms was 11%. Children aged less than 10 years were four times likely to have ADHD (OR 4.1, 95% CI 1.7–9.6, p < 0.001). The demographic factors independently associated with ADHD were age less than 10 years, male gender, history of maternal abnormal vaginal discharge during pregnancy, and no formal education or the highest level of education being primary school. Conclusion: The prevalence of ADHD among children attending the pediatric neurology and psychiatry clinics is high in our settings and is associated with delayed milestones. Early identification and addressing the co-morbid conditions associated with ADHD such as epilepsy, autism spectrum of disorder, conduct disorder, opposition defiant disorder and intellectual disability in our setting is needed. Keywords: ADHD, DSM IV, Associated factors, Specialized clinic
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