Peer Reviewed Publications
2005 |
Colebunders, R; Kamya, M R; Laurence, J; Kambugu, A; Byakwaga, H; Mwebaze, P S; A., Muganga. M; Katwere, M; Katabira, E First-line antiretroviral therapy in Africa--how evidence-base are our recommendations? Journal Article AIDS, reviews, 7 (3), pp. 148-54, 2005. @article{Colebunders2005, title = {First-line antiretroviral therapy in Africa--how evidence-base are our recommendations?}, author = {Colebunders, R. and Kamya, M. R. and Laurence, J. and Kambugu, A. and Byakwaga, H. and Mwebaze, P. S. and M. Muganga. A. and Katwere, M. and Katabira, E.}, url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/First-line-antiretroviral-therapy-in-Africa-how-evidence-base-are-our-recommendations.pdf}, year = {2005}, date = {2005-07-31}, journal = {AIDS, reviews}, volume = {7}, number = {3}, pages = {148-54}, abstract = {According to the World Health Organization guidelines, a non-nucleoside reverse transcriptase inhibitor (NNRTI) along with two nucleoside reverse transcriptase inhibitors (NRTI) is the treatment of choice as first-line antiretroviral therapy. The results of the 2NN and different cohort studies performed in developed countries do not provide sufficient evidence by which to select between nevirapine and efavirenz as the first-line NNRTI for antiretroviral therapy in Africa. The current first-line NNRTI-containing antiretroviral therapy regimens used in Africa are certainly not ideal. Nevirapine interacts with rifampicin and therefore is not indicated in patients with tuberculosis. On the other hand, efavirenz should not be given to pregnant women. NNRTI-containing regimens may be less effective in women who received nevirapine monotherapy at delivery. Stavudine, used in the nucleoside backbone, may lead to lipoatrophy, lactic acidosis and polyneuritis. Zidovudine may cause serious anemia. Mainly because of cost considerations, the generic fixed-drug combination of nevirapine plus two NRTI seems at the moment to be the best choice. It is clear, however, that antiretroviral programs should not rely only on this combination for initial antiretroviral treatment. Most importantly, more HIV clinical trials need to be conducted in Africa, and African cohorts of patients on antiretroviral therapy need to be established in order to develop recommendations that are evidence based.}, keywords = {}, pubstate = {published}, tppubtype = {article} } According to the World Health Organization guidelines, a non-nucleoside reverse transcriptase inhibitor (NNRTI) along with two nucleoside reverse transcriptase inhibitors (NRTI) is the treatment of choice as first-line antiretroviral therapy. The results of the 2NN and different cohort studies performed in developed countries do not provide sufficient evidence by which to select between nevirapine and efavirenz as the first-line NNRTI for antiretroviral therapy in Africa. The current first-line NNRTI-containing antiretroviral therapy regimens used in Africa are certainly not ideal. Nevirapine interacts with rifampicin and therefore is not indicated in patients with tuberculosis. On the other hand, efavirenz should not be given to pregnant women. NNRTI-containing regimens may be less effective in women who received nevirapine monotherapy at delivery. Stavudine, used in the nucleoside backbone, may lead to lipoatrophy, lactic acidosis and polyneuritis. Zidovudine may cause serious anemia. Mainly because of cost considerations, the generic fixed-drug combination of nevirapine plus two NRTI seems at the moment to be the best choice. It is clear, however, that antiretroviral programs should not rely only on this combination for initial antiretroviral treatment. Most importantly, more HIV clinical trials need to be conducted in Africa, and African cohorts of patients on antiretroviral therapy need to be established in order to develop recommendations that are evidence based. |
Sande, M; Ronald, A HIV/AIDS care in Africa today Journal Article Clinical Infectious Diseases, 40 (7), pp. 1045-8, 2005. @article{Sande2005, title = {HIV/AIDS care in Africa today}, author = {Sande, M. and Ronald, A.}, doi = {DOI: 10.1086/428360}, year = {2005}, date = {2005-04-01}, journal = {Clinical Infectious Diseases}, volume = {40}, number = {7}, pages = {1045-8}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Ryan, M; Tchum, I; Coakley, P; Merry, C Healthcare worker crisis in Africa jeopardises the fight against HIV/AIDS Journal Article Irish Medical Journal, 98 (2), pp. 61, 2005. @article{Ryan2005, title = {Healthcare worker crisis in Africa jeopardises the fight against HIV/AIDS}, author = {Ryan, M. and Tchum, I. and Coakley, P. and Merry, C.}, year = {2005}, date = {2005-02-01}, journal = {Irish Medical Journal}, volume = {98}, number = {2}, pages = {61}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Feld, Jordan. J; Ocama, Ponsiano ; Ronald, Allan. The liver in HIV in Africa Journal Article Ativiral Therapy, 10 (8), pp. 953-965, 2005. @article{Feld2005, title = {The liver in HIV in Africa}, author = {Feld, Jordan. J. and Ocama, Ponsiano and Ronald, Allan.}, url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/The-liver-in-HIV-in-Africa.pdf}, year = {2005}, date = {2005-01-01}, journal = {Ativiral Therapy}, volume = {10}, number = {8}, pages = {953-965}, abstract = {As access to antiretroviral therapy improves across the African continent, liver disease is emerging as an important cause of morbidity and mortality among HIV-infected individuals. Although coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV), along with highly active antiretroviral therapy (HAART)-induced hepatotoxicity appear to be the major causes of liver disease in this population, other diseases endemic to Africa with hepatic manifestations are influenced by HIV infection as well. In this review we present the available data on liver disease in HIV-infected populations in Africa and discuss relevant data from the rest of the world. In addition, we highlight important areas for further study.}, keywords = {}, pubstate = {published}, tppubtype = {article} } As access to antiretroviral therapy improves across the African continent, liver disease is emerging as an important cause of morbidity and mortality among HIV-infected individuals. Although coinfection with hepatitis B virus (HBV) and hepatitis C virus (HCV), along with highly active antiretroviral therapy (HAART)-induced hepatotoxicity appear to be the major causes of liver disease in this population, other diseases endemic to Africa with hepatic manifestations are influenced by HIV infection as well. In this review we present the available data on liver disease in HIV-infected populations in Africa and discuss relevant data from the rest of the world. In addition, we highlight important areas for further study. |
Byakika-Tusiime, J; Oyugi, J H; Tumwikirize, W A; Katabira, E T; Mugyenyi, P N; Bangsberg, D R Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy Journal Article International Journal of STD & AIDS, 16 (1), pp. 38, 2005. @article{Byakika-Tusiime2005, title = {Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy}, author = {Byakika-Tusiime, J. and Oyugi, J. H. and Tumwikirize, W. A. and Katabira, E. T. and Mugyenyi, P. N. and Bangsberg, D. R.}, url = {https://www.idi-makerere.com/wp-content/uploads/2018/07/Adherence-to-HIV-antiretroviral-therapy-in-HIV-Ugandan-patients-purchasing-therapy.pdf}, year = {2005}, date = {2005-01-01}, journal = {International Journal of STD & AIDS}, volume = {16}, number = {1}, pages = {38}, abstract = {Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at ±95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32–6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64–4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at ±95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32–6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64–4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence. |
2004 |
Wabinga, HR; Colebunders, B; Odida, M; Ocama, P; Colebunders, R Risk Risk factors for and types of oesophageal cancer. Journal Article Lancet, (London, England)., 364 (9450), pp. 2018, 2004. @article{Wabinga2004, title = {Risk Risk factors for and types of oesophageal cancer.}, author = {HR Wabinga and B Colebunders and M Odida and P Ocama and R Colebunders}, doi = {10.1016/S0140-6736(04)17508-9}, year = {2004}, date = {2004-12-04}, journal = {Lancet, (London, England).}, volume = {364}, number = {9450}, pages = {2018}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Resneck, JS Jr. ; M., Van Beek; Furmanski, L; J., Oyugi; LeBoit, PE. ; Katabira, E; Kambugu, F; Maurer, T; Berger, T; Pletcher, MJ. ; Machtinger, EL. Etiology of pruritic papular eruption with HIV infection in Uganda. Journal Article JAMA, 292 (21), pp. 2614-21, 2004. @article{Resneck2004, title = {Etiology of pruritic papular eruption with HIV infection in Uganda.}, author = {Resneck, JS Jr. and Van Beek M. and Furmanski, L. and Oyugi J. and LeBoit, PE. and Katabira, E. and Kambugu, F. and Maurer, T. and Berger, T. and Pletcher, MJ. and Machtinger, EL.}, year = {2004}, date = {2004-12-01}, journal = {JAMA}, volume = {292}, number = {21}, pages = {2614-21}, abstract = {CONTEXT: A frequent cause of human immunodeficiency virus (HIV)-related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive. OBJECTIVE: To determine the etiology of PPE occurring in HIV-infected individuals. DESIGN, SETTING, AND PATIENTS: Cross-sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist. MAIN OUTCOME MEASURES: Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity. RESULTS: Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/microL) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P<.001 for trend). Eighty-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/microL; P = .02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/microL; P = .07) than those without histological evidence of arthropod bites. CONCLUSIONS: Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients.}, keywords = {}, pubstate = {published}, tppubtype = {article} } CONTEXT: A frequent cause of human immunodeficiency virus (HIV)-related morbidity in sub-Saharan Africa is a commonly occurring, intensely pruritic skin rash. The resulting scars are disfiguring and stigmatizing. Despite the substantial prevalence of pruritic papular eruption (PPE) among HIV-infected Africans, the cause has been elusive. OBJECTIVE: To determine the etiology of PPE occurring in HIV-infected individuals. DESIGN, SETTING, AND PATIENTS: Cross-sectional study of HIV-infected patients with active PPE from clinics in Uganda conducted from May 19 through June 6, 2003. Enrollment occurred in the month preceding May 19. Each participant was clinically examined by 2 dermatologists, had laboratory studies performed, was administered an epidemiologic questionnaire, and had a skin biopsy of a new lesion evaluated by a dermatopathologist. MAIN OUTCOME MEASURES: Histological characteristics of new pruritic lesions. Other assessments included CD4 cell count, eosinophil count, and physician-assessed rash severity. RESULTS: Of 109 patients meeting inclusion criteria, 102 (93.6%) completed the study. The CD4 cell counts in this study population were generally low (median, 46/microL) and inversely related to increasing rash severity (median CD4 cell counts: 122 for mild, 41 for moderate, and 9 for severe; P<.001 for trend). Eighty-six patients (84%; 95% confidence interval, 77%-91%) had biopsy findings characteristic of arthropod bites. Patients with arthropod bites on biopsy had significantly higher peripheral eosinophil counts (median, 330 vs 180/microL; P = .02) and had a trend toward lower CD4 cell counts (median, 40 vs 99/microL; P = .07) than those without histological evidence of arthropod bites. CONCLUSIONS: Pruritic papular eruption occurring in HIV-infected individuals may be a reaction to arthropod bites. We hypothesize that this condition reflects an altered and exaggerated immune response to arthropod antigens in a subset of susceptible HIV-infected patients. |
Oyugi, JH. ; Byakika-Tusiime, J; Charlebois, ED. ; Kityo, C; Mugerwa, R; Mugyenyi, P; Bangsberg, DR Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting Journal Article Journal of Acquired Immune Deficiency Syndrome (1999), 36 (5), pp. 1100-2, 2004. @article{Oyugi2004, title = {Multiple Validated Measures of Adherence Indicate High Levels of Adherence to Generic HIV Antiretroviral Therapy in a Resource-Limited Setting}, author = {Oyugi, JH. and Byakika-Tusiime, J. and Charlebois, ED. and Kityo, C. and Mugerwa, R. and Mugyenyi, P. and Bangsberg, DR}, year = {2004}, date = {2004-08-15}, journal = {Journal of Acquired Immune Deficiency Syndrome (1999)}, volume = {36}, number = {5}, pages = {1100-2}, abstract = {BACKGROUND: There are no validated measures of adherence to HIV antiretroviral therapy in resource-poor settings. Such measures are essential to understand the unique barriers to adherence as access to HIV antiretroviral therapy expands. METHODS: We assessed correspondence between multiple measures of adherence and viral load suppression in 34 patients purchasing generic Triomune antiretroviral therapy (coformulated stavudine, lamivudine, and nevirapine; CIPLA, Ltd., Mumbai, India) in Kampala, Uganda. Measures included 3-day patient self-report, 30-day visual analog scale, electronic medication monitoring, and unannounced home pill count. HIV-1 load was determined at baseline and 12 weeks. RESULTS: Mean adherence was 91%-94% by all measures. Seventy-six percent of subjects had a viral load of <400 copies/mL at 12 weeks. All measures were closely correlated with each other (R = 0.77-0.89). Each measure was also significantly associated with 12-week HIV load. There was no significant difference between patient-reported and objective measures of adherence. CONCLUSIONS: This sample of patients purchasing generic HIV antiretroviral therapy has among the highest measured adherence reported to date. Patient-reported measures were closely associated with objective measures. The relative ease of administration of the 30-day visual analog scale suggests that this may be the preferred method to assess adherence in resource-poor settings.}, keywords = {}, pubstate = {published}, tppubtype = {article} } BACKGROUND: There are no validated measures of adherence to HIV antiretroviral therapy in resource-poor settings. Such measures are essential to understand the unique barriers to adherence as access to HIV antiretroviral therapy expands. METHODS: We assessed correspondence between multiple measures of adherence and viral load suppression in 34 patients purchasing generic Triomune antiretroviral therapy (coformulated stavudine, lamivudine, and nevirapine; CIPLA, Ltd., Mumbai, India) in Kampala, Uganda. Measures included 3-day patient self-report, 30-day visual analog scale, electronic medication monitoring, and unannounced home pill count. HIV-1 load was determined at baseline and 12 weeks. RESULTS: Mean adherence was 91%-94% by all measures. Seventy-six percent of subjects had a viral load of <400 copies/mL at 12 weeks. All measures were closely correlated with each other (R = 0.77-0.89). Each measure was also significantly associated with 12-week HIV load. There was no significant difference between patient-reported and objective measures of adherence. CONCLUSIONS: This sample of patients purchasing generic HIV antiretroviral therapy has among the highest measured adherence reported to date. Patient-reported measures were closely associated with objective measures. The relative ease of administration of the 30-day visual analog scale suggests that this may be the preferred method to assess adherence in resource-poor settings. |
Sande, MA. ; A., Ronald Treatment of HIV/AIDS: do the dilemmas only increase? Journal Article JAMA, 292 (2), pp. 266-8, 2004. @article{Sande2004, title = {Treatment of HIV/AIDS: do the dilemmas only increase?}, author = {Sande, MA. and Ronald A.}, doi = {10.1001/jama.292.2.266}, year = {2004}, date = {2004-07-14}, journal = {JAMA}, volume = {292}, number = {2}, pages = {266-8}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
0000 |
Ocama, P; Castelnuovo, B; Kamya, M R; Kirk, G D; Reynolds, S J; Kiragga, A; Colebunders, R; Thomas, D L Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda. Journal Article International Journal of STD & AIDS, 21 (8), pp. 553-7, 0000. @article{Ocama2010c, title = {Low frequency of liver enzyme elevation in HIV-infected patients attending a large urban treatment centre in Uganda.}, author = {P. Ocama and B. Castelnuovo and M.R. Kamya and G.D Kirk and S.J. Reynolds and A. Kiragga and R. Colebunders and D. L. Thomas}, url = {https://www.idi-makerere.com/wp-content/uploads/2018/09/Low-frequency-of-liver-enzyme-elevation-in-HIV-infected-patients-attending-a-large-urban-treatment-centre-in-Uganda..pdf}, doi = {10.1258/ijsa.2010.010027.}, journal = {International Journal of STD & AIDS}, volume = {21}, number = {8}, pages = {553-7}, abstract = {Liver enzyme elevations among patients on antiretroviral therapy (ART) were determined by prospectively evaluating aspartate aminotransferase (AST) data in a cohort of patients in Kampala over 36 months. A proportion of patients had hepatitis B virus (HBV) status determined. Hepatotoxicity was graded I to IV according to the AIDS Clinical Trial Group criteria. Of 546 patients, 377 (69%) were women; overall median baseline CD4+ T-cell was 97/μL (interquartile range [IQR] 20-164). Hepatitis B surface antigen (HBsAg) was detected in 42 (9%) of 470 persons. ART included lamivudine, with either nevirapine and d4T (74%) or efavirenz and AZT (26%). Median (IQR) AST level at baseline was 35 (27, 53 IU/L). Over 36 months, only eight patients had grade III AST elevation. Neither HBsAg nor ART regimen influenced AST levels. Male gender and CD4+ change from baseline were correlated with AST elevation. Patients with HIV/HBV co-infection were not at an increased risk of AST elevation, which occurred uncommonly in this setting.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Liver enzyme elevations among patients on antiretroviral therapy (ART) were determined by prospectively evaluating aspartate aminotransferase (AST) data in a cohort of patients in Kampala over 36 months. A proportion of patients had hepatitis B virus (HBV) status determined. Hepatotoxicity was graded I to IV according to the AIDS Clinical Trial Group criteria. Of 546 patients, 377 (69%) were women; overall median baseline CD4+ T-cell was 97/μL (interquartile range [IQR] 20-164). Hepatitis B surface antigen (HBsAg) was detected in 42 (9%) of 470 persons. ART included lamivudine, with either nevirapine and d4T (74%) or efavirenz and AZT (26%). Median (IQR) AST level at baseline was 35 (27, 53 IU/L). Over 36 months, only eight patients had grade III AST elevation. Neither HBsAg nor ART regimen influenced AST levels. Male gender and CD4+ change from baseline were correlated with AST elevation. Patients with HIV/HBV co-infection were not at an increased risk of AST elevation, which occurred uncommonly in this setting. |
Seremba, E; Ocama, P; Opio, CK. ; Kagimu, M; Thomas, DL. ; Yuan, HJ. ; Attar, N; Lee, WM Poor performance of hepatitis C antibody tests in hospital patients in Uganda. Journal Article Journal of Medical Virology, 82 (8), pp. 1371-8, 0000. @article{Seremba2010, title = {Poor performance of hepatitis C antibody tests in hospital patients in Uganda.}, author = {Seremba, E. and Ocama, P. and Opio, CK. and Kagimu, M. and Thomas, DL. and Yuan, HJ. and Attar, N. and Lee, WM}, doi = {10.1002/jmv.21817.}, journal = {Journal of Medical Virology}, volume = {82}, number = {8}, pages = {1371-8}, abstract = {Most hepatitis C testing in Uganda is performed using commercial rapid strip assays (RSA) to detect antibodies to hepatitis C virus (anti‐HCV), rather than enzyme immunoassays (EIA). The prevalence of hepatitis C antibodies in a Ugandan hospital population was determined using both methods to test their accuracy using nucleic acid testing (NAT) as a reference. Sera from 380 consecutive hospitalized Ugandan patients were tested for anti‐HCV using an RSA in Uganda, with subsequent automated third‐generation EIA testing in the United States, followed by NAT. Recombinant immunoblot assays (RIBA) were used as a supplementary test to detect anti‐HCV epitopes. Overall, anti‐HCV was detected in 48/380 (13%) by one or both antibody tests. Anti‐HCV was detected in 19 (5.0%) patients by RSA and in 33 (8.7%) patients by EIA; only four patients were anti‐HCV positive by both methods. Fourteen of the 48 anti‐HCV positive patients had detectable serum HCV RNA, 7 each by bDNA assay or by PCR. RSA detected only 7 of 14 HCV RNA positive sera. Of 29 RNA negative but anti‐HCV positive patients tested by RIBA, only two were anti‐HCV positive; 27 were anti‐HCV negative or indeterminate. Anti‐HCV testing by RSA and/or EIA was neither sensitive nor specific for detection of ongoing HCV infection in hospitalized Ugandan patients. Our findings underscore the importance of confirmatory nucleic acid testing, which, despite its increased cost, appears essential to manage African patients with HCV. J. Med. Virol. 82:1371–1378, 2010. © 2010 Wiley‐Liss, Inc.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Most hepatitis C testing in Uganda is performed using commercial rapid strip assays (RSA) to detect antibodies to hepatitis C virus (anti‐HCV), rather than enzyme immunoassays (EIA). The prevalence of hepatitis C antibodies in a Ugandan hospital population was determined using both methods to test their accuracy using nucleic acid testing (NAT) as a reference. Sera from 380 consecutive hospitalized Ugandan patients were tested for anti‐HCV using an RSA in Uganda, with subsequent automated third‐generation EIA testing in the United States, followed by NAT. Recombinant immunoblot assays (RIBA) were used as a supplementary test to detect anti‐HCV epitopes. Overall, anti‐HCV was detected in 48/380 (13%) by one or both antibody tests. Anti‐HCV was detected in 19 (5.0%) patients by RSA and in 33 (8.7%) patients by EIA; only four patients were anti‐HCV positive by both methods. Fourteen of the 48 anti‐HCV positive patients had detectable serum HCV RNA, 7 each by bDNA assay or by PCR. RSA detected only 7 of 14 HCV RNA positive sera. Of 29 RNA negative but anti‐HCV positive patients tested by RIBA, only two were anti‐HCV positive; 27 were anti‐HCV negative or indeterminate. Anti‐HCV testing by RSA and/or EIA was neither sensitive nor specific for detection of ongoing HCV infection in hospitalized Ugandan patients. Our findings underscore the importance of confirmatory nucleic acid testing, which, despite its increased cost, appears essential to manage African patients with HCV. J. Med. Virol. 82:1371–1378, 2010. © 2010 Wiley‐Liss, Inc. |
Seremba, E; Ocama, P; Opio, C K; Kagimu, M; Yuan, H J; Attar, N; Thomas, D L; Lee, W M Validity of the rapid strip assay test for detecting HBsAg in patients admitted to hospital in Uganda Journal Article Journal of Medical Virology, 82 (8), pp. 1334-40, 0000. @article{Seremba2010b, title = {Validity of the rapid strip assay test for detecting HBsAg in patients admitted to hospital in Uganda}, author = {E. Seremba and P. Ocama and C.K. Opio and M. Kagimu and H.J. Yuan and N. Attar and D.L. Thomas and W.M. Lee}, doi = {https://doi.org/10.1002/jmv.21813}, journal = {Journal of Medical Virology}, volume = {82}, number = {8}, pages = {1334-40}, abstract = {Commercially available rapid strip assays (RSAs) for hepatitis B surface antigen (HBsAg) are used for most routine clinical testing in sub-Saharan Africa. This study evaluated the validity of RSA and a more sophisticated enzyme immunoassay (EIA) with confirmation by nucleic acid testing (NAT) in hospitalized patients in Uganda. Sera from 380 consecutive patients collected and tested for HBsAg and anti-HIV in Kampala, Uganda by RSA were sent frozen to Dallas for EIA including HBsAg, total anti-hepatitis B core, hepatitis B e antigen, and anti-HIV. NAT was performed on all HBsAg-positives and on a random sample of 102 patients that were HBsAg-negative by both assays. Overall, 31 (8%) were HBsAg positive by RSA while 50 (13%) were HBsAg-positive by EIA; 26 were concordant between the two assays. Of 55 HBsAg-positive patients, nearly all showed detectable serum hepatitis B virus (HBV) DNA by bDNA (46) or PCR (4) assay. The 26 patients who were HBsAg positive by both EIA and RSA had significantly higher median serum HBV DNA levels than the 24 patients who were HBsAg positive by EIA alone. An additional 12/102 (12%) HBsAg negative patients had very low serum HBV DNA levels by NAT. Several differences in expected results of serologic testing were observed in this large series of African patients. RSA HBsAg testing is less sensitive than EIA; even EIA failed to detect all HBV DNA positive sera. A more complex testing protocol than RSA alone will be needed in Africa to improve patient care.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Commercially available rapid strip assays (RSAs) for hepatitis B surface antigen (HBsAg) are used for most routine clinical testing in sub-Saharan Africa. This study evaluated the validity of RSA and a more sophisticated enzyme immunoassay (EIA) with confirmation by nucleic acid testing (NAT) in hospitalized patients in Uganda. Sera from 380 consecutive patients collected and tested for HBsAg and anti-HIV in Kampala, Uganda by RSA were sent frozen to Dallas for EIA including HBsAg, total anti-hepatitis B core, hepatitis B e antigen, and anti-HIV. NAT was performed on all HBsAg-positives and on a random sample of 102 patients that were HBsAg-negative by both assays. Overall, 31 (8%) were HBsAg positive by RSA while 50 (13%) were HBsAg-positive by EIA; 26 were concordant between the two assays. Of 55 HBsAg-positive patients, nearly all showed detectable serum hepatitis B virus (HBV) DNA by bDNA (46) or PCR (4) assay. The 26 patients who were HBsAg positive by both EIA and RSA had significantly higher median serum HBV DNA levels than the 24 patients who were HBsAg positive by EIA alone. An additional 12/102 (12%) HBsAg negative patients had very low serum HBV DNA levels by NAT. Several differences in expected results of serologic testing were observed in this large series of African patients. RSA HBsAg testing is less sensitive than EIA; even EIA failed to detect all HBV DNA positive sera. A more complex testing protocol than RSA alone will be needed in Africa to improve patient care. |
Katusiime, C; Ocama, P; Kambugu, A A case of palatal perforation caused by toxoplasmosis Journal Article Southern African Journal of HIV Medicine, 0000. @article{Katusiime2010c, title = {A case of palatal perforation caused by toxoplasmosis}, author = {C. Katusiime and P. Ocama and A Kambugu}, url = {https://www.idi-makerere.com/wp-content/uploads/2018/09/A-case-of-palatal-perforation-caused-by-toxoplasmosis.pdf}, journal = {Southern African Journal of HIV Medicine}, abstract = {HIV infection has several oral manifestations, including oral candidiasis and oral hairy leucoplakia. Occasionally unusual presentations requiring rigorous investigations are seen, and in these cases the diagnosis sometimes remains a dilemma owing to limited investigation facilities. (1-3) We present the case of a patient who presented with a puzzling oral lesion.}, keywords = {}, pubstate = {published}, tppubtype = {article} } HIV infection has several oral manifestations, including oral candidiasis and oral hairy leucoplakia. Occasionally unusual presentations requiring rigorous investigations are seen, and in these cases the diagnosis sometimes remains a dilemma owing to limited investigation facilities. (1-3) We present the case of a patient who presented with a puzzling oral lesion. |
Nakanjako D.1; Mayanja-Kizza, Ouma Wanyenze Mwesigire Namale Ssempiira Senkusu Colebunders Kamya H 1; J 2; R 2; D 2; A 1; J 2; J 2; R 3; M R 1 Tuberculosis and human immunodeficiency virus co-infections and their predictors at a hospital-based HIV/AIDS clinic in Uganda Journal Article The International Journal of Tuberculosis and Lung Disease,, 14 (12), pp. 1621-1628, 0000. @article{Nakanjako2010, title = {Tuberculosis and human immunodeficiency virus co-infections and their predictors at a hospital-based HIV/AIDS clinic in Uganda}, author = {Nakanjako, D.1; Mayanja-Kizza, H.1; Ouma, J.2; Wanyenze, R.2; Mwesigire, D.2; Namale, A.1; Ssempiira, J.2; Senkusu, J.2; Colebunders, R.3; Kamya, M. R.1}, url = {https://www.idi-makerere.com/wp-content/uploads/2018/09/Tuberculosis-and-human-immunodeficiency-virus-co-infections-and-their-predictors-at-a-hospital-based-HIV-AIDS-clinic-in-Uganda.pdf}, journal = {The International Journal of Tuberculosis and Lung Disease,}, volume = {14}, number = {12}, pages = {1621-1628}, abstract = {SETTING: Mulago Hospital, Uganda. OBJECTIVE: To evaluate the burden of TB-HIV (tuberculosis-human immunodeficiency virus) co-infections and their predictors in an urban hospital-based HIV programme. DESIGN: Prospective observational study. METHODS: Clinicians screened all patients with HIV/AIDS (acquired immune-deficiency syndrome) for previous and current TB treatment at enrolment and throughout follow-up. RESULTS: Of 10 924 patients enrolled between August 2005 and February 2009, co-prevalent TB was 157/10 924 (1.4%), which included 88/157 (56%) with TB confirmed at enrolment and 65/157 (41%) with TB diagnoses established during follow-up in whom symptoms were present at enrolment. Male sex (adjusted odds ratio [aOR] 2.3, 95%CI 1.6–3.2) and body mass index (BMI) ≤20 kg/m2 (aOR 3.8, 95%CI 2.5–5.4) were associated with co-prevalent TB. Overall, 749/10 767 (7%) were diagnosed with incident TB at a higher rate among antiretroviral treatment (ART) patients (8/100 patient years of observation [PYO]) than non-ART patients (5/100 PYO, log rank P < 0.001). Female sex (adjusted hazard ratio [aHR] 1.4, 95%CI 1.2–1.7) and baseline BMI ≤ 20 (aHR 1.9, 95%CI 1.6–2.2) predicted incident TB. CONCLUSION: Routine TB screening in the HIV/AIDS care programme identified a significant number of TB-HIV co-infections among patients with and without ART, and is therefore a potential strategy to improve HIV treatment outcomes in resource-limited settings. }, keywords = {}, pubstate = {published}, tppubtype = {article} } SETTING: Mulago Hospital, Uganda. OBJECTIVE: To evaluate the burden of TB-HIV (tuberculosis-human immunodeficiency virus) co-infections and their predictors in an urban hospital-based HIV programme. DESIGN: Prospective observational study. METHODS: Clinicians screened all patients with HIV/AIDS (acquired immune-deficiency syndrome) for previous and current TB treatment at enrolment and throughout follow-up. RESULTS: Of 10 924 patients enrolled between August 2005 and February 2009, co-prevalent TB was 157/10 924 (1.4%), which included 88/157 (56%) with TB confirmed at enrolment and 65/157 (41%) with TB diagnoses established during follow-up in whom symptoms were present at enrolment. Male sex (adjusted odds ratio [aOR] 2.3, 95%CI 1.6–3.2) and body mass index (BMI) ≤20 kg/m2 (aOR 3.8, 95%CI 2.5–5.4) were associated with co-prevalent TB. Overall, 749/10 767 (7%) were diagnosed with incident TB at a higher rate among antiretroviral treatment (ART) patients (8/100 patient years of observation [PYO]) than non-ART patients (5/100 PYO, log rank P < 0.001). Female sex (adjusted hazard ratio [aHR] 1.4, 95%CI 1.2–1.7) and baseline BMI ≤ 20 (aHR 1.9, 95%CI 1.6–2.2) predicted incident TB. CONCLUSION: Routine TB screening in the HIV/AIDS care programme identified a significant number of TB-HIV co-infections among patients with and without ART, and is therefore a potential strategy to improve HIV treatment outcomes in resource-limited settings. |
Quinn, T C The Academic Alliance for AIDS Care and Prevention in Africa Journal Article The Hopkins HIV Report, 13 (6), pp. 1-4, 0000. @article{Quinn2001, title = {The Academic Alliance for AIDS Care and Prevention in Africa}, author = {Quinn, T. C. }, journal = {The Hopkins HIV Report}, volume = {13}, number = {6}, pages = {1-4}, keywords = {}, pubstate = {published}, tppubtype = {article} } |
Kamya, Moses R; Semitala, Fred C; Quinn, Thomas C; Ronald, Allan; Njama-Meya, Denise; Mayanja-Kizza, Harriet; Katabira, Elly T; Spacek, Lisa A Total lymphocyte count of 1200 is not a sensitive predictor of CD4 lymphocyte count among patients with HIV disease in Kampala, Uganda Journal Article African Health Sciences, 4 (2), pp. 94-101, 0000. @article{Kamya2004, title = {Total lymphocyte count of 1200 is not a sensitive predictor of CD4 lymphocyte count among patients with HIV disease in Kampala, Uganda}, author = {Moses R Kamya and Fred C Semitala and Thomas C Quinn and Allan Ronald and Denise Njama-Meya and Harriet Mayanja-Kizza and Elly T Katabira and Lisa A Spacek}, url = {https://www.idi-makerere.com/wp-content/uploads/2018/09/Total-lymphocyte-count-of-1200-is-not-a-sensitive-predictor-of-CD4-lymphocyte-count-among-patients-with-HIV-disease-in-Kampala-Uganda.pdf}, journal = {African Health Sciences}, volume = {4}, number = {2}, pages = {94-101}, abstract = {INTRODUCTION: Total Lymphocyte Count (TLC) has been found to be an inexpensive and useful marker for staging disease, predicting progression to AIDS and death and monitoring response to ART. However, the correlation between TLC and CD4 has not been consistent. Access to HAART is expanding in Kampala, Uganda, yet there are no published data evaluating the utility of TLC as inexpensive surrogate marker of CD4 cell count to help guide therapeutic decisions. OBJECTIVE: To evaluate clinical illnesses and total lymphocyte count (TLC) as surrogate markers of the CD4 cell count in HIV infected persons being considered for ART. METHODS: A total of 131 patients were enrolled and evaluated by clinical assessment, TLC and CD4 count. Clinical illnesses and TLC dichotomized at various cut-point values were used to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for the diagnosis of CD4 count <200 cells/mm 3 among 100 participants fulfilling criteria for WHO clinical stage 2 and 3. RESULTS: A strong correlation was observed between TLC and CD4 (r = 0.73, p<0.0001). For all clinical syndromes, except pulmonary tuberculosis, the positive predictive values (PPV) for a CD4 count <200 cells/mm 3 were high (>80%) but the negative predictive values (NPV) were low. Using the WHO recommended TLC cut-off of 1200 cells/mm 3 to diagnose a CD4 less than 200 cells/mm 3 , the PPV was 100%, and the NPV was 32%. CONCLUSION: Our data showed a good correlation between TLC and CD4 cell count. However, the WHO recommended TLC cut-off of 1200 did not identify the majority of WHO stage 2 and 3 patients with CD4 counts less than 200 cells/mm 3 . A more rational use of TLC counts is to treat all patients with WHO stage 2 and 3 who have a TLC <1200 and to limit CD4 counts to patients who are symptomatic but have TLC of >1200.}, keywords = {}, pubstate = {published}, tppubtype = {article} } INTRODUCTION: Total Lymphocyte Count (TLC) has been found to be an inexpensive and useful marker for staging disease, predicting progression to AIDS and death and monitoring response to ART. However, the correlation between TLC and CD4 has not been consistent. Access to HAART is expanding in Kampala, Uganda, yet there are no published data evaluating the utility of TLC as inexpensive surrogate marker of CD4 cell count to help guide therapeutic decisions. OBJECTIVE: To evaluate clinical illnesses and total lymphocyte count (TLC) as surrogate markers of the CD4 cell count in HIV infected persons being considered for ART. METHODS: A total of 131 patients were enrolled and evaluated by clinical assessment, TLC and CD4 count. Clinical illnesses and TLC dichotomized at various cut-point values were used to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) for the diagnosis of CD4 count <200 cells/mm 3 among 100 participants fulfilling criteria for WHO clinical stage 2 and 3. RESULTS: A strong correlation was observed between TLC and CD4 (r = 0.73, p<0.0001). For all clinical syndromes, except pulmonary tuberculosis, the positive predictive values (PPV) for a CD4 count <200 cells/mm 3 were high (>80%) but the negative predictive values (NPV) were low. Using the WHO recommended TLC cut-off of 1200 cells/mm 3 to diagnose a CD4 less than 200 cells/mm 3 , the PPV was 100%, and the NPV was 32%. CONCLUSION: Our data showed a good correlation between TLC and CD4 cell count. However, the WHO recommended TLC cut-off of 1200 did not identify the majority of WHO stage 2 and 3 patients with CD4 counts less than 200 cells/mm 3 . A more rational use of TLC counts is to treat all patients with WHO stage 2 and 3 who have a TLC <1200 and to limit CD4 counts to patients who are symptomatic but have TLC of >1200. |
S, Prasad; E, Sopdie; D, Meya; A, Kalbarczyk; PJ., Garcia Conceptual Framework of Mentoring in Low- and Middle-Income Countries to Advance Global Health Journal Article The American Journal of Tropical Medicine and Hygiene , 100 (1_Suppl), pp. 9-14, 0000. @article{S2019b, title = {Conceptual Framework of Mentoring in Low- and Middle-Income Countries to Advance Global Health}, author = {Prasad S and Sopdie E and Meya D and Kalbarczyk A and Garcia PJ. }, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6329351/}, doi = {doi: 10.4269/ajtmh.18-0557}, journal = {The American Journal of Tropical Medicine and Hygiene }, volume = {100}, number = {1_Suppl}, pages = {9-14}, abstract = {Although mentoring is not a common practice in low- and middle-income countries (LMICs), there is a strong need for it. Conceptual frameworks provide the structure to design, study, and problem-solve complex phenomena. Following four workshops in South America, Asia, and Africa, and borrowing on theoretical models from higher education, this article proposes two conceptual frameworks of mentoring in LMICs. In the first model, we propose to focus the mentor-mentee relationship and interactions, and in the second, we look at mentoring activities from a mentees' perspective. Our models emphasize the importance of an ongoing dynamic between the mentor and mentee that is mutually beneficial. It also emphasizes the need for institutions to create enabling environments that encourage mentorship. We expect that these frameworks will help LMIC institutions to design new mentoring programs, clarify expectations, and analyze problems with existing mentoring programs. Our models, while being framed in the context of global health, have the potential for wider application geographically and across disciplines.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Although mentoring is not a common practice in low- and middle-income countries (LMICs), there is a strong need for it. Conceptual frameworks provide the structure to design, study, and problem-solve complex phenomena. Following four workshops in South America, Asia, and Africa, and borrowing on theoretical models from higher education, this article proposes two conceptual frameworks of mentoring in LMICs. In the first model, we propose to focus the mentor-mentee relationship and interactions, and in the second, we look at mentoring activities from a mentees' perspective. Our models emphasize the importance of an ongoing dynamic between the mentor and mentee that is mutually beneficial. It also emphasizes the need for institutions to create enabling environments that encourage mentorship. We expect that these frameworks will help LMIC institutions to design new mentoring programs, clarify expectations, and analyze problems with existing mentoring programs. Our models, while being framed in the context of global health, have the potential for wider application geographically and across disciplines. |
E, Nakku-Joloba; EE, Pisarski; MA, Wyatt; TR, Muwonge; S, Asiimwe; CL, Celum; JM, Baeten; ET, Katabira; NC, Ware Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples Journal Article Journal of International AIDS society, 22 (1), 0000. @article{E2019c, title = {Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples}, author = {Nakku-Joloba E and Pisarski EE and Wyatt MA and Muwonge TR and Asiimwe S and Celum CL and Baeten JM and Katabira ET and Ware NC}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6338102/}, doi = {10.1002/jia2.25225}, journal = {Journal of International AIDS society}, volume = {22}, number = {1}, abstract = {INTRODUCTION: Pre-exposure prophylaxis (PrEP) to prevent HIV infection is being rolled out in Africa. The uptake of PrEP to date has varied across populations and locations. We seek to understand the drivers of demand for PrEP through analysis of qualitative data collected in conjunction with a PrEP demonstration project involving East African HIV serodiscordant couples. Our goal was to inform demand creation by understanding what PrEP means - beyond HIV prevention - for the lives of users. METHODS: The Partners Demonstration Project evaluated an integrated strategy of PrEP and antiretroviral therapy (ART) delivery in which time-limited PrEP served as a "bridge" to long-term ART. Uninfected partners in HIV serodiscordant couples were offered PrEP at baseline and encouraged to discontinue once infected partners had taken ART for six months. We conducted 274 open-ended interviews with 93 couples at two Ugandan research sites. Interviews took place one month after enrolment and at later points in the follow-up period. Topics included are as follows: (1) discovery of serodiscordance; (2) decisions to accept/decline PrEP and/or ART; (3) PrEP and ART initiation; (4) experiences of using PrEP and ART; (5) PrEP discontinuation; (6) impact of PrEP and ART on the partnered relationship. Interviews were audio-recorded and transcribed. We used an inductive, content analytic approach to characterize meanings of PrEP stemming from its effectiveness for HIV prevention. Relevant content was represented as descriptive categories. RESULTS: Discovery of HIV serodiscordance resulted in fear of HIV transmission for couples, which led to loss of sexual intimacy in committed relationships, and to abandonment of plans for children. As a result, partners became alienated from each other. PrEP countered the threat to the relationship by reducing fear and reinstating hopes of having children together. Condom use worked against the re-establishment of intimacy and closeness. By increasing couples' sense of protection against HIV infection and raising the prospect of a return to "live sex" (sex without condoms), PrEP was perceived by couples as solving the problem of serodiscordance and preserving committed relationships. CONCLUSIONS: The most effective demand creation strategies for PrEP may be those that address the everyday life priorities of potential users in addition to HIV prevention.}, keywords = {}, pubstate = {published}, tppubtype = {article} } INTRODUCTION: Pre-exposure prophylaxis (PrEP) to prevent HIV infection is being rolled out in Africa. The uptake of PrEP to date has varied across populations and locations. We seek to understand the drivers of demand for PrEP through analysis of qualitative data collected in conjunction with a PrEP demonstration project involving East African HIV serodiscordant couples. Our goal was to inform demand creation by understanding what PrEP means - beyond HIV prevention - for the lives of users. METHODS: The Partners Demonstration Project evaluated an integrated strategy of PrEP and antiretroviral therapy (ART) delivery in which time-limited PrEP served as a "bridge" to long-term ART. Uninfected partners in HIV serodiscordant couples were offered PrEP at baseline and encouraged to discontinue once infected partners had taken ART for six months. We conducted 274 open-ended interviews with 93 couples at two Ugandan research sites. Interviews took place one month after enrolment and at later points in the follow-up period. Topics included are as follows: (1) discovery of serodiscordance; (2) decisions to accept/decline PrEP and/or ART; (3) PrEP and ART initiation; (4) experiences of using PrEP and ART; (5) PrEP discontinuation; (6) impact of PrEP and ART on the partnered relationship. Interviews were audio-recorded and transcribed. We used an inductive, content analytic approach to characterize meanings of PrEP stemming from its effectiveness for HIV prevention. Relevant content was represented as descriptive categories. RESULTS: Discovery of HIV serodiscordance resulted in fear of HIV transmission for couples, which led to loss of sexual intimacy in committed relationships, and to abandonment of plans for children. As a result, partners became alienated from each other. PrEP countered the threat to the relationship by reducing fear and reinstating hopes of having children together. Condom use worked against the re-establishment of intimacy and closeness. By increasing couples' sense of protection against HIV infection and raising the prospect of a return to "live sex" (sex without condoms), PrEP was perceived by couples as solving the problem of serodiscordance and preserving committed relationships. CONCLUSIONS: The most effective demand creation strategies for PrEP may be those that address the everyday life priorities of potential users in addition to HIV prevention. |
J, Edwards; P, Arimi; F, Ssengooba; G, Mulholland; M, Markiewicz; EA, Bukusi; JT, Orikiiriza; A, Virkud; S, Weir The HIV care continuum among resident and non-resident populations found in venues in East Africa cross-border areas Journal Article BMC Infectious Diseases, 22 (1), 0000. @article{J2019, title = {The HIV care continuum among resident and non-resident populations found in venues in East Africa cross-border areas}, author = {Edwards J and Arimi P and Ssengooba F and Mulholland G and Markiewicz M and Bukusi EA and Orikiiriza JT and Virkud A and Weir S}, doi = {10.1002/jia2.25226.}, journal = {BMC Infectious Diseases}, volume = {22}, number = {1}, abstract = {INTRODUCTION: HIV care and treatment in cross-border areas in East Africa face challenges perhaps not seen to the same extent in other geographic areas, particularly for mobile and migrant populations. Here, we estimate the proportion of people with HIV found in these cross-border areas in each stage of the HIV care and treatment cascade, including the proportion who knows their status, the proportion on treatment and the proportion virally suppressed. METHODS: Participants (n = 11,410) working or socializing in public places in selected East Africa cross border areas were recruited between June 2016 and February 2017 using the Priorities for Local AIDS Control Efforts method and administered a behavioural survey and rapid HIV test. This approach was designed to recruit a stratified random sample of people found in public spaces or venues in each cross border area. For participants testing positive for HIV, viral load was measured from dried blood spots. The proportion in each step of the cascade was estimated using inverse probability weights to account for the sampling design and informative HIV test refusals. Estimates are reported separately for residents of the cross border areas and non-residents found in those areas. RESULTS: Overall, 43% of participants with HIV found in cross-border areas knew their status, 87% of those participants were on antiretroviral therapy (ART), and 80% of participants on ART were virally suppressed. About 20% of people with HIV found in cross border areas were sampled outside their subdistrict or subcounty of residence. While both resident and non-resident individuals who knew their status were likely to be on ART (85% and 96% respectively), people on ART recruited outside their area of residence were less likely to be suppressed (64% suppressed; 95% CI: 43, 81) compared to residents (84% suppressed; 95% CI: 75, 93). CONCLUSIONS: People living in or travelling through cross-border areas may face barriers in learning their HIV status. Moreover, while non-residents were more likely to be on treatment than residents, they were less likely to be suppressed, suggesting gaps in continuity of care for people in East Africa travelling outside their area of residence despite timely initiation of treatment.}, keywords = {}, pubstate = {published}, tppubtype = {article} } INTRODUCTION: HIV care and treatment in cross-border areas in East Africa face challenges perhaps not seen to the same extent in other geographic areas, particularly for mobile and migrant populations. Here, we estimate the proportion of people with HIV found in these cross-border areas in each stage of the HIV care and treatment cascade, including the proportion who knows their status, the proportion on treatment and the proportion virally suppressed. METHODS: Participants (n = 11,410) working or socializing in public places in selected East Africa cross border areas were recruited between June 2016 and February 2017 using the Priorities for Local AIDS Control Efforts method and administered a behavioural survey and rapid HIV test. This approach was designed to recruit a stratified random sample of people found in public spaces or venues in each cross border area. For participants testing positive for HIV, viral load was measured from dried blood spots. The proportion in each step of the cascade was estimated using inverse probability weights to account for the sampling design and informative HIV test refusals. Estimates are reported separately for residents of the cross border areas and non-residents found in those areas. RESULTS: Overall, 43% of participants with HIV found in cross-border areas knew their status, 87% of those participants were on antiretroviral therapy (ART), and 80% of participants on ART were virally suppressed. About 20% of people with HIV found in cross border areas were sampled outside their subdistrict or subcounty of residence. While both resident and non-resident individuals who knew their status were likely to be on ART (85% and 96% respectively), people on ART recruited outside their area of residence were less likely to be suppressed (64% suppressed; 95% CI: 43, 81) compared to residents (84% suppressed; 95% CI: 75, 93). CONCLUSIONS: People living in or travelling through cross-border areas may face barriers in learning their HIV status. Moreover, while non-residents were more likely to be on treatment than residents, they were less likely to be suppressed, suggesting gaps in continuity of care for people in East Africa travelling outside their area of residence despite timely initiation of treatment. |
S, Okoboi; A, Twimukye; O, Lazarus; B, Castelnuovo; Agaba C, Immaculate M; M, Nanfuka; A, Kambugu; R., King Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda: a qualitative study. Journal Article Journal of International AIDS society, 22 (3), 0000. @article{S2019c, title = {Acceptability, perceived reliability and challenges associated with distributing HIV self-test kits to young MSM in Uganda: a qualitative study.}, author = {Okoboi S and Twimukye A and Lazarus O and Castelnuovo B and Agaba C, Immaculate M and Nanfuka M and Kambugu A and King R. }, url = {https://onlinelibrary.wiley.com/doi/full/10.1002/jia2.25269}, doi = {org/10.1002/jia2.25269}, journal = {Journal of International AIDS society}, volume = {22}, number = {3}, abstract = { Introduction HIV self‐testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the acceptability, perceived reliability and challenges associated with distributing HIV self‐test (HIVST) to young men who have sex with men (MSM) in Uganda. Methods Between February and May, 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management. Results MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non‐painful; and non‐stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop‐in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services. Conclusions Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow‐up, linkage to HIV care and prevention services are needed for effective results. }, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction HIV self‐testing is a flexible, accessible and acceptable emerging technology with a particular potential to identify people living with HIV who are reluctant to interact with conventional HIV testing approaches. We assessed the acceptability, perceived reliability and challenges associated with distributing HIV self‐test (HIVST) to young men who have sex with men (MSM) in Uganda. Methods Between February and May, 2018, we enrolled 74 MSM aged ≥18 years purposively sampled and verbally consented to participate in six focus group discussions (FGDs) in The AIDS Support Organization (TASO Masaka and Entebbe). We also conducted two FGDs of 18 health workers. MSM FGD groups included individuals who had; (1) tested greater than one year previously; (2) tested between six months and one year previously; (3) tested three to six months previously; (4) never tested. FGDs examined: (i) the acceptability of HIVST distribution; (iii) preferences for various HIVST distribution channels; (iv) perceptions about the accuracy of HIVST; (v) challenges associated with HIVST distribution. We identified major themes, developed and refined a codebook. We used Nvivo version 11 for data management. Results MSM participants age ranged between 19 and 30 years. Participants described HIVST as a mechanism that would facilitate HIV testing uptake in a rapid, efficient, confidential, non‐painful; and non‐stigmatizing manner. Overall, MSM preferred HIVST to the conventional HIV testing approaches. Health workers were in support of distributing HIVST kits through MSM peers. MSM participants were willing to distribute the kits and recommended HIVST to their peers and sexual partners. They suggested HIVST kit distribution model work similarly to the current condom and lubricant peer model being implemented by TASO. Preferred channels were peers, hot spots, drop‐in centres, private pharmacies and MSM friendly health facilities. Key concerns regarding use of HIVST were; unreliable HIVST results, social harm due to a positive result, need for a confirmatory test and linking both HIV positive and negative participants for additional HIV services. Conclusions Distribution of HIVST kits by MSM peers is an acceptable strategy that can promote access to testing. HIVST was perceived by participants as beneficial because it would address many barriers that affect their acceptance of testing. However, a combined approach that includes follow‐up, linkage to HIV care and prevention services are needed for effective results. |
R, Nabatanzi; L, Bayigga; S, Cose; S, Rowland-Jones; G, Canderan; M, Joloba; D, Nakanjako Aberrant natural killer (NK) cell activation and dysfunction among ART-treated HIV-infected adults in an African cohort Journal Article Clinical Immunology (0lando, Fla), pp. 55-60, 0000. @article{R2019d, title = {Aberrant natural killer (NK) cell activation and dysfunction among ART-treated HIV-infected adults in an African cohort}, author = {Nabatanzi R and Bayigga L and Cose S and Rowland-Jones S and Canderan G and Joloba M and Nakanjako D}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6448528/}, doi = { 10.1016/j.clim.2019.02.010.}, journal = {Clinical Immunology (0lando, Fla)}, pages = {55-60}, abstract = {BACKGROUND: We examined NK cell phenotypes and functions after seven years of ART and undetectable viral loads (<50 copies/ml) with restored CD4 T-cell counts (≥500 cells/μl) and age-matched healthy-HIV-uninfected individuals from the same community. METHODS: Using flow-cytometry, NK cell phenotypes were described using lineage markers (CD56+/-CD16+/-). NK cell activation was determined by expression of activation receptors (NKG2D, NKp44 and NKp46) and activation marker CD69. NK cell function was determined by CD107a, granzyme-b, and IFN-gamma production. RESULTS: CD56 dim and CD56 bright NK cells were lower among ART-treated-HIV-infected than among age-matched-HIV-negative individuals; p = 0.0016 and p = 0.05 respectively. Production of CD107a (P = 0.004) and Granzyme-B (P = 0.005) was lower among ART-treated-HIV-infected relative to the healthy-HIV-uninfected individuals. NKG2D and NKp46 were lower, while CD69 expression was higher among ART-treated-HIV-infected than healthy-HIV-uninfected individuals. CONCLUSION: NK cell activation and dysfunction persisted despite seven years of suppressive ART with "normalization" of peripheral CD4 counts.}, keywords = {}, pubstate = {published}, tppubtype = {article} } BACKGROUND: We examined NK cell phenotypes and functions after seven years of ART and undetectable viral loads (<50 copies/ml) with restored CD4 T-cell counts (≥500 cells/μl) and age-matched healthy-HIV-uninfected individuals from the same community. METHODS: Using flow-cytometry, NK cell phenotypes were described using lineage markers (CD56+/-CD16+/-). NK cell activation was determined by expression of activation receptors (NKG2D, NKp44 and NKp46) and activation marker CD69. NK cell function was determined by CD107a, granzyme-b, and IFN-gamma production. RESULTS: CD56 dim and CD56 bright NK cells were lower among ART-treated-HIV-infected than among age-matched-HIV-negative individuals; p = 0.0016 and p = 0.05 respectively. Production of CD107a (P = 0.004) and Granzyme-B (P = 0.005) was lower among ART-treated-HIV-infected relative to the healthy-HIV-uninfected individuals. NKG2D and NKp46 were lower, while CD69 expression was higher among ART-treated-HIV-infected than healthy-HIV-uninfected individuals. CONCLUSION: NK cell activation and dysfunction persisted despite seven years of suppressive ART with "normalization" of peripheral CD4 counts. |
Damalie Nakanjako Diane Kendall, Nelson Sewankambo Myat Htoo Razak Bonface Oduor Theresa Odero Patricia Garcia K; Farquhar, Carey Building and Sustaining Effective Partnerships for Training the Next Generation of Global Health Leaders Journal Article Annals of Global Health, 87 (1), pp. 66, 0000. @article{Nakanjako2021, title = {Building and Sustaining Effective Partnerships for Training the Next Generation of Global Health Leaders}, author = {Damalie Nakanjako, Diane Kendall, Nelson K. Sewankambo, Myat Htoo Razak, Bonface Oduor, Theresa Odero, Patricia Garcia and Carey Farquhar}, doi = {DOI: 10.5334/aogh.3214}, journal = {Annals of Global Health}, volume = {87}, number = {1}, pages = {66}, abstract = {Introduction: Partnerships are essential to creating effective global health leadership training programs. Global pandemics, including the HIV/AIDS pandemic, and more recently the COVID-19 pandemic, have tested the impact and stability of healthcare systems. Partnerships must be fostered to prepare the next generation of leaders to collaborate effectively and improve health globally. Objectives: We provide key matrices that predict success of partnerships in building global health leadership capacity. We highlight opportunities and challenges to building effective partnerships and provide recommendations to promote development of equitable and mutually beneficial partnerships. Findings: Critical elements for effective partnership when building global health leadership capacity include shared strategic vision, transparency and excellent communication, as well as intentional monitoring and evaluation of the partnership, not just the project or program. There must be recognition that partnerships can be unpredictable and unequal, especially if the end is not defined early on. Threats to equitable and effective partnerships include funding and co-funding disparities between partners from high-income and low-income countries, inequalities, unshared vision and priorities, skewed decision-making levels, and limited flexibility to minimize inequalities and make changes. Further, imbalances in power, privilege, position, income levels, and institutional resources create opportunities for exploitation of partners, particularly those in low-income countries, which widens the disparities and limits success and sustainability of partnerships. These challenges to effective partnering create the need for objective documentation of disparities at all stages, with key milestones to assess success and the environment to sustain the partnerships and their respective goals. Conclusions: Developing effective and sustainable partnerships requires a commitment to equality from the start by all partners and an understanding that there will be challenges that could derail otherwise well-intended partnerships. Guidelines and training on evaluation of partnerships exist and should be used, including generic indicators of equity, mutual benefit, and the added value of partnering. Key Takeaways Effective partnerships in building global health leadership capacity require shared strategic vision and intentional monitoring and evaluation of goals Inequalities in partnerships may arise from disparities in infrastructure, managerial expertise, administrative and leadership capacity, as well as limited mutual benefit and mutual respect To promote equitable and effective partnerships, it is critical to highlight and monitor key measures for success of partnerships at the beginning of each partnership and regularly through the lifetime of the partnership. We recommend that partnerships should have legal and financial laws through executed memoranda of understanding, to promote accountability and facilitate objective monitoring and evaluation of the partnership itself. More research is needed to understand better the contextual predictors of the broader influence and sustainability of partnership networks in global health leadership training.}, keywords = {}, pubstate = {published}, tppubtype = {article} } Introduction: Partnerships are essential to creating effective global health leadership training programs. Global pandemics, including the HIV/AIDS pandemic, and more recently the COVID-19 pandemic, have tested the impact and stability of healthcare systems. Partnerships must be fostered to prepare the next generation of leaders to collaborate effectively and improve health globally. Objectives: We provide key matrices that predict success of partnerships in building global health leadership capacity. We highlight opportunities and challenges to building effective partnerships and provide recommendations to promote development of equitable and mutually beneficial partnerships. Findings: Critical elements for effective partnership when building global health leadership capacity include shared strategic vision, transparency and excellent communication, as well as intentional monitoring and evaluation of the partnership, not just the project or program. There must be recognition that partnerships can be unpredictable and unequal, especially if the end is not defined early on. Threats to equitable and effective partnerships include funding and co-funding disparities between partners from high-income and low-income countries, inequalities, unshared vision and priorities, skewed decision-making levels, and limited flexibility to minimize inequalities and make changes. Further, imbalances in power, privilege, position, income levels, and institutional resources create opportunities for exploitation of partners, particularly those in low-income countries, which widens the disparities and limits success and sustainability of partnerships. These challenges to effective partnering create the need for objective documentation of disparities at all stages, with key milestones to assess success and the environment to sustain the partnerships and their respective goals. Conclusions: Developing effective and sustainable partnerships requires a commitment to equality from the start by all partners and an understanding that there will be challenges that could derail otherwise well-intended partnerships. Guidelines and training on evaluation of partnerships exist and should be used, including generic indicators of equity, mutual benefit, and the added value of partnering. Key Takeaways Effective partnerships in building global health leadership capacity require shared strategic vision and intentional monitoring and evaluation of goals Inequalities in partnerships may arise from disparities in infrastructure, managerial expertise, administrative and leadership capacity, as well as limited mutual benefit and mutual respect To promote equitable and effective partnerships, it is critical to highlight and monitor key measures for success of partnerships at the beginning of each partnership and regularly through the lifetime of the partnership. We recommend that partnerships should have legal and financial laws through executed memoranda of understanding, to promote accountability and facilitate objective monitoring and evaluation of the partnership itself. More research is needed to understand better the contextual predictors of the broader influence and sustainability of partnership networks in global health leadership training. |
