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Mayanja Y, Rida W, Kimani J, Ssetala A, Mpendo J, Nanvubya A, Mutua G, Anzala O, Price MA. Hepatitis B status and associated factors among participants screened for simulated HIV vaccine efficacy trials in Kenya and Uganda. PLoS One 2023; 18:e0288604. [PMID: 37459311 PMCID: PMC10351693 DOI: 10.1371/journal.pone.0288604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 07/02/2023] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Hepatitis B (HBV) prevalence remains high in Sub Saharan Africa and among some key populations such as those with continued exposure through sexual contact. We assessed the HBV status among potential participants who were screened for simulated HIV vaccine efficacy trials in Kenya and Uganda. METHODS We conducted a cross sectional analysis of data collected from individuals who were screened in Kenya (Nairobi) and Uganda (Entebbe and Kampala). The studies followed hypothetical procedures of an HIV vaccine efficacy trial and aimed to enroll HIV negative key and vulnerable populations at elevated risk of HIV acquisition. HBV status was the main outcome categorized using Hepatitis B surface antigen (HBsAg) and total Hepatitis B core antibody (HBcAb). Baseline characteristics potentially associated with never being infected were analyzed using logistic regression. RESULTS We screened 1,366 participants with mean age (SD) 28.7 (7.3) years. Overall, 46.6% were from Entebbe, 50.7% had secondary or higher level of education, 76.4% had informal high-risk jobs and 56.3% were male. Kampala had only female participants contributing 60.6% of females screened. Of the screened participants, 94.7% and 3.4% were negative and positive for HBsAg respectively. The prevalence on HBV infection was 3.9% among males and 2.8% among females while prevalence by site was: Entebbe (4.9%); Kampala (4.1%) and Nairobi (0.3%). The highest HBV prevalence was found among participants aged 25-29-years (5.2%), those with primary level education (4.5%), and those in informal low risk jobs (6.5%). Considering 1265 participants with complete data on HBsAg and HBcAb-Total, HBV status was never infected (67.9%), past infection (28.5%), chronic infection (3.2%) and acute infection (0.5%). Of 859 who were never infected, 685 (79.7%) were tested for anti-HBs titers of whom 60 (8.8%) had titers >10IU/L (immune due to vaccination). The odds of never being HBV infected were lower among older individuals 25-29 years (AOR 0.51; 95%CI 0.36-0.71) and ≥30 years (AOR 0.35; 95% CI 0.25-0.49). The odds were higher among participants with informal high-risk jobs from Kampala (AOR 2.21; 95% CI 1.41-3.47) and Nairobi (AOR 2.61; 95% CI 1.72-4.00) compared to those from Entebbe. CONCLUSION HBV prevalence and immunity due to vaccination were low among HIV negative individuals who are eligible for HIV vaccine trials and prevalence varies by age, education level and main occupation. Younger individuals and those recruited from existing cohorts/ clinics have a higher likelihood of having no prior HBV infection. HIV prevention intervention trials are a platform to identify individuals that need HBV vaccination.
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Affiliation(s)
- Yunia Mayanja
- Medical Research Council/ Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine (MRC/UVRI & LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Wasima Rida
- Biostatistics Consultant, Arlington, Virginia, United States of America
| | - Joshua Kimani
- SWOP-PHDA, University of Nairobi/University of Manitoba, Nairobi, Kenya
| | - Ali Ssetala
- Uganda Virus Research Institute/ International AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Programme, Entebbe, Uganda
| | - Juliet Mpendo
- Uganda Virus Research Institute/ International AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Programme, Entebbe, Uganda
| | - Annet Nanvubya
- Uganda Virus Research Institute/ International AIDS Vaccine Initiative (UVRI-IAVI) HIV Vaccine Programme, Entebbe, Uganda
| | | | - Omu Anzala
- KAVI- Institute for Clinical Research, Nairobi, Kenya
| | - Matt A. Price
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, United States of America
- IAVI, New York, New York, United States of America
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Muir R, Metcalf T, Fourati S, Bartsch Y, Kyosiimire-Lugemwa J, Canderan G, Alter G, Muyanja E, Okech B, Namatovu T, Namara I, Namuniina A, Ssetaala A, Mpendo J, Nanvubya A, Kitandwe PK, Bagaya BS, Kiwanuka N, Nassuna J, Biribawa VM, Elliott AM, de Dood CJ, Senyonga W, Balungi P, Kaleebu P, Mayanja Y, Odongo M, Connors J, Fast P, Price MA, Corstjens PLAM, van Dam GJ, Kamali A, Sekaly RP, Haddad EK. Schistosoma mansoni infection alters the host pre-vaccination environment resulting in blunted Hepatitis B vaccination immune responses. PLoS Negl Trop Dis 2023; 17:e0011089. [PMID: 37406029 PMCID: PMC10351710 DOI: 10.1371/journal.pntd.0011089] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 07/17/2023] [Accepted: 06/20/2023] [Indexed: 07/07/2023] Open
Abstract
Schistosomiasis is a disease caused by parasitic flatworms of the Schistosoma spp., and is increasingly recognized to alter the immune system, and the potential to respond to vaccines. The impact of endemic infections on protective immunity is critical to inform vaccination strategies globally. We assessed the influence of Schistosoma mansoni worm burden on multiple host vaccine-related immune parameters in a Ugandan fishing cohort (n = 75) given three doses of a Hepatitis B (HepB) vaccine at baseline and multiple timepoints post-vaccination. We observed distinct differences in immune responses in instances of higher worm burden, compared to low worm burden or non-infected. Concentrations of pre-vaccination serum schistosome-specific circulating anodic antigen (CAA), linked to worm burden, showed a significant bimodal distribution associated with HepB titers, which was lower in individuals with higher CAA values at month 7 post-vaccination (M7). Comparative chemokine/cytokine responses revealed significant upregulation of CCL19, CXCL9 and CCL17 known to be involved in T cell activation and recruitment, in higher CAA individuals, and CCL17 correlated negatively with HepB titers at month 12 post-vaccination. We show that HepB-specific CD4+ T cell memory responses correlated positively with HepB titers at M7. We further established that those participants with high CAA had significantly lower frequencies of circulating T follicular helper (cTfh) subpopulations pre- and post-vaccination, but higher regulatory T cells (Tregs) post-vaccination, suggesting changes in the immune microenvironment in high CAA could favor Treg recruitment and activation. Additionally, we found that changes in the levels of innate-related cytokines/chemokines CXCL10, IL-1β, and CCL26, involved in driving T helper responses, were associated with increasing CAA concentration. This study provides further insight on pre-vaccination host responses to Schistosoma worm burden which will support our understanding of vaccine responses altered by pathogenic host immune mechanisms and memory function and explain abrogated vaccine responses in communities with endemic infections.
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Affiliation(s)
- Roshell Muir
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Talibah Metcalf
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Slim Fourati
- PATRU, School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Yannic Bartsch
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, United States of America
| | | | - Glenda Canderan
- Department of Medicine, Allergy and Immunology, University of Virginia, Charlottesville, Virginia, United States of America
| | - Galit Alter
- Ragon Institute of MGH, MIT, and Harvard, Cambridge, Massachusetts, United States of America
| | - Enoch Muyanja
- PATRU, School of Medicine, Emory University, Atlanta, Georgia, United States of America
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | | | | | | | | | | | | | | | | | - Bernard S. Bagaya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Jacent Nassuna
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, College of Health Sciences, Kampala, Uganda
| | | | - Alison M. Elliott
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Claudia J. de Dood
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | - Yunia Mayanja
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Matthew Odongo
- MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda
| | - Jennifer Connors
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
| | - Pat Fast
- International AIDS Vaccine Initiative, New York, New York, United States of America
- Pediatric Infectious Diseases, Stanford University School of Medicine, Palo Alto, California, United States of America
| | - Matt A. Price
- International AIDS Vaccine Initiative, New York, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, United States of America
| | - Paul L. A. M. Corstjens
- Department of Cell and Chemical Biology, Leiden University Medical Center, Leiden, Netherlands
| | - Govert J. van Dam
- Department of Parasitology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anatoli Kamali
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
- International AIDS Vaccine Initiative, New York, New York, United States of America
- IAVI, New York, New York, United States of America, and Nairobi, Kenya
| | - Rafick Pierre Sekaly
- PATRU, School of Medicine, Emory University, Atlanta, Georgia, United States of America
| | - Elias K. Haddad
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States of America
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Muir R, Metcalf T, Fourati S, Bartsch Y, Lugemwa JK, Canderan G, Alter G, Muyanja E, Okech B, Namatovu T, Namara I, Namuniina A, Ssetaala A, Mpendo J, Nanvubya A, Kitandwe PK, Bagaya BS, Kiwanuka N, Nassuna J, Biribawa VM, Elliott AM, de Dood CJ, Senyonga W, Balungi P, Kaleebu P, Mayanja Y, Odongo M, Fast P, Price MA, Corstjens PLAM, van Dam GJ, Kamali A, Sekaly RP, Haddad EK. Schistosoma mansoni infection alters the host pre-vaccination environment resulting in blunted Hepatitis B vaccination immune responses. medRxiv 2023:2023.02.24.23284435. [PMID: 36865336 PMCID: PMC9980246 DOI: 10.1101/2023.02.24.23284435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The impact of endemic infections on protective immunity is critical to inform vaccination strategies. In this study, we assessed the influence of Schistosoma mansoni infection on host responses in a Ugandan fishing cohort given a Hepatitis B (HepB) vaccine. Concentrations of schistosome-specific circulating anodic antigen (CAA) pre-vaccination showed a significant bimodal distribution associated with HepB titers, which were lower in individuals with high CAA. We established that participants with high CAA had significantly lower frequencies of circulating T follicular helper (cTfh) subpopulations pre- and post-vaccination and higher regulatory T cells (Tregs) post-vaccination. Polarization towards higher frequencies of Tregs: cTfh cells can be mediated by changes in the cytokine environment favoring Treg differentiation. In fact, we observed higher levels of CCL17 and soluble IL-2R pre-vaccination (important for Treg recruitment and development), in individuals with high CAA that negatively associated with HepB titers. Additionally, alterations in pre-vaccination monocyte function correlated with HepB titers, and changes in innate-related cytokines/chemokine production were associated with increasing CAA concentration. We report, that by influencing the immune landscape, schistosomiasis has the potential to modulate immune responses to HepB vaccination. These findings highlight multiple Schistosoma -related immune associations that could explain abrogated vaccine responses in communities with endemic infections. Author Summary Schistosomiasis drives host immune responses for optimal pathogen survival, potentially altering host responses to vaccine-related antigen. Chronic schistosomiasis and co-infection with hepatotropic viruses are common in countries where schistosomiasis is endemic. We explored the impact of Schistosoma mansoni ( S. mansoni ) infection on Hepatitis B (HepB) vaccination of individuals from a fishing community in Uganda. We demonstrate that high schistosome-specific antigen (circulating anodic antigen, CAA) concentration pre-vaccination, is associated with lower HepB antibody titers post-vaccination. We show higher pre-vaccination levels of cellular and soluble factors in instances of high CAA that are negatively associated with HepB antibody titers post-vaccination, which coincided with lower frequencies of circulating T follicular helper cell populations (cTfh), proliferating antibody secreting cells (ASCs), and higher frequencies of regulatory T cells (Tregs). We also show that monocyte function is important in HepB vaccine responses, and that high CAA is associated with alterations in the early innate cytokine/chemokine microenvironment. Our findings suggest that in individuals with high CAA and likely high worm burden, schistosomiasis creates and sustains an environment that is polarized against optimal host immune responses to the vaccine, which puts many endemic communities at risk for infection against HepB and other diseases that are preventable by vaccines.
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Nanvubya A, Wanyenze RK, Abaasa A, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Bagaya B, Chinyenze K, Price MA, Van Geertruyden JP. Evaluating the effectiveness of enhanced family planning education on knowledge and use of family planning in fishing communities of Lake Victoria in Uganda: a randomized controlled trial. BMC Health Serv Res 2022; 22:506. [PMID: 35421987 PMCID: PMC9012015 DOI: 10.1186/s12913-022-07898-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Family planning knowledge is poor and use is low in Ugandan fishing communities. We compared the effectiveness of enhanced family planning (FP) education with routine counselling on FP knowledge and use.
Methods
Individuals aged 15–49 years were randomly assigned to intervention or control arm. The intervention constituted enhanced FP education based on a simplified handout extracted from the WHO FP guidance tool called, “Family planning: A global handbook for FP providers” which participants took home for additional reading. The control arm constituted FP counselling following Uganda Ministry of Health guidelines. FP knowledge score and contraceptive prevalence rate (CPR) were compared between trial arms at baseline and at 12 months. Negative binomial regression models were used to estimate the effect of the intervention on FP knowledge and use.
Results
Overall, 1410 participants were screened to enrol 1004 (502 per study arm, 48.5% women). Subsequently, 384 (76.5%) and 383 (76.3%) completed the 12 months’ follow-up in the intervention and control arms respectively. At baseline, a median FP knowledge score of 8 and a < 70% FP knowledge score was observed for all participants with a CPR of 36.8%. At month-12, the median FP knowledge score improved in both arms, higher in the intervention arm than the control arm (46 vs 30; p < 0.001). In the intervention arm, 304 (79.2%) had a score of ≥70 compared with 21 (5.5%) in the control arm (p < 0.001). In the negative binomial regression model, the change in FP knowledge score was 47% higher in the intervention arm than in the control arm (score ratio: 1.47, 95%CI: 1. 43-1.51, p < 0.001). The change in CPR was 16% higher in the intervention arm than in the control arm (Prevalence ratio: 1.16, 95%CI: 1.01-1.34, p < 0.040).
Interpretation
Enhanced FP education using a simplified FP education handout was more effective in increasing FP knowledge and use compared to routine FP counselling for people living in fishing communities. Innovative FP education interventions are recommended for improving FP knowledge and optimizing uptake in remote-rural settings where literacy levels are low.
Trial registration
The study was registered by the Pan African Clinical Trial Registry on 03 July 2021 with a Trial Registration Number PACTR202107891858045. “Retrospectively registered”.
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Nanvubya A, Wanyenze RK, Kamacooko O, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Bagaya B, Chinyenze K, Price M, Van Geertruyden JP. Barriers and Facilitators of Family Planning Use in Fishing Communities of Lake Victoria in Uganda. J Prim Care Community Health 2021; 11:2150132720943775. [PMID: 32698653 PMCID: PMC7378720 DOI: 10.1177/2150132720943775] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Family planning (FP) is a key element in the conduct of research and is essential in managing family sizes. Although fishing communities (FCs) are targeted populations for HIV prevention research, their FP practices are poorly understood. We explored barriers and facilitators of FP use in FCs of Lake Victoria in Uganda. Methods: We employed a mixed-methods approach comprising a cross-sectional survey, in-depth interviews, and focus group discussions in 2 FCs. Multivariable logistic regression was used to analyze quantitative data and a thematic approach to generate themes from the qualitative data. Results: Up to 1410 individuals participated in the survey and 47 in the qualitative study. Just over a third (35.6%) used FP. The most commonly used methods were condoms, pills, and injectables. In Kigungu community, participants whose religion was Anglican and Muslim were more likely to use FP than Catholics (adjusted odds ratio [aOR] 1.45; 95% CI 1.05-1.99 and aOR 1.45; 95% CI 1.05-2.07, respectively). Participants were more likely to use FP if they had satisfactory FP knowledge compared to those with no satisfactory FP knowledge (aOR 1.79; 95% CI 1.23-2.61), or if they were married compared to their single counterparts (aOR 1.84; 95% CI 1.32-2.57). In both communities, participants were more likely to use FP if they had 2 or more sexual partners in the past 12 months than those with less than 2 sexual partners (aOR 1.41 95% CI 1.07-1.87 and aOR 2.60; 95% CI 1.36-4.97). Excessive bleeding and delayed fecundity; fertility desire; gender preferences of children; method stock outs and lack of FP trained personnel constituted barriers to FP use. There were also cultural influences in favor of large families. Conclusion: FP use in FCs is suboptimal. Barriers of FP use were mainly biomedical, religious, social, and cultural, which underscores a need for FP education and strengthening of FP service provision in FCs.
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Affiliation(s)
- Annet Nanvubya
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda.,Global Health Institute, University of Antwerp, Antwerp, Belgium
| | | | | | | | | | | | | | | | | | - Jed Kaweesi
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | - John Ndugga
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
| | | | | | - Matt Price
- IAVI, New York, NY, USA.,University of California at San Francisco, San Francisco, CA, USA
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Kitandwe PK, Muyanja E, Nakaweesa T, Nanvubya A, Ssetaala A, Mpendo J, Okech B, Bagaya BS, Kiwanuka N, Price MA. Hepatitis B prevalence and incidence in the fishing communities of Lake Victoria, Uganda: a retrospective cohort study. BMC Public Health 2021; 21:394. [PMID: 33622281 PMCID: PMC7903724 DOI: 10.1186/s12889-021-10428-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/04/2021] [Indexed: 01/21/2023] Open
Abstract
Introduction Hepatitis B is a serious potentially fatal hepatocellular disease caused by the hepatitis B virus. In the fishing communities of Lake Victoria Uganda, the hepatitis B virus infection burden is largely unknown. This study assessed the prevalence and incidence of hepatitis B in these communities. Methods This was a retrospective cohort study that tested serum samples collected from 13 to 49-year-old study participants that were residing in two Ugandan Lake Victoria fishing communities of Kasenyi (a mainland) and Jaana (an island). The samples were collected between 2013 and 2015 during the conduct of an HIV epidemiological cohort study in these communities. A total of 467 twelve-month follow-up and 50 baseline visit samples of participants lost to follow-up were tested for hepatitis B serological markers to determine prevalence. To determine hepatitis B virus incidence, samples that were hepatitis B positive at the follow-up visit had their baseline samples tested to identify hepatitis B negative samples whose corresponding follow-up samples were thus incident cases. Results The baseline mean age of the 517 study participants was 31.1 (SD ± 8.4) years, 278 (53.8%) of whom were females. A total of 36 (7%) study participants had hepatitis B virus infection, 22 (61.1%) of whom were male. Jaana had a higher hepatitis B virus prevalence compared to Kasenyi (10.2% vs 4.0%). In total, 210 (40.6%) study participants had evidence of prior hepatitis B virus infection while 48.6% had never been infected or vaccinated against this disease. A total of 20 (3.9%) participants had results suggestive of prior hepatitis B vaccination. Hepatitis B incidence was 10.5 cases/100PY (95% CI: 7.09–15.53). Being above 25 years of age and staying in Jaana were significant risk factors for hepatitis B virus acquisition (AOR 1.6, 95% CI: 1.1–2.2; p < 0.01 and 1.4, 95% CI: 1.1–1.8; p < 0.01 respectively). Conclusion Hepatitis B virus incidence in Lake Victoria fishing communities of Uganda is very high, particularly in the islands. Interventions to lower hepatitis B virus transmission in these communities are urgently needed.
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Affiliation(s)
| | | | | | | | | | | | | | - Bernard S Bagaya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences Makerere University, Kampala, Uganda
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences Makerere University, Kampala, Uganda
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA.,Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Matovu F, Nanvubya A, Abaasa A, Mayanja Y, Nakaweesa T, Mpendo J, Kawoozo B, Chinyenze K, Price M, Wanyenze R, Van geertruyden J. Abortion and its correlates among female fisherfolk along Lake Victoria in Uganda. J Family Med Prim Care 2021; 10:3968-3975. [PMID: 35136754 PMCID: PMC8797134 DOI: 10.4103/jfmpc.jfmpc_771_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/10/2021] [Accepted: 07/11/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: In Uganda, people living in fishing communities tend to engage in high-risk sexual activity which leads to unintended pregnancies that may end in abortions. Abortion has negative social, psychological, and medical impacts. We determined the frequency of abortion and its correlates among female fisher-folk along Lake Victoria in Uganda. Methods: A cross-sectional survey was conducted among women aged 15– 49 years from Kigungu and Nsazi fishing communities. Data were collected on socio-demographic characteristics, abortion, and family planning use. Associations between abortion and participant characteristics were assessed using logistic regression models. Results: Of the 713 women interviewed, 36, 5% were pregnant and 247, 34.6 % were using contraception. Majority (600, 84.2%) of those interviewed reported ever being pregnant. Approximately 45% of the pregnancies were un-intended while a third of those who had ever been pregnant (195, 32.5%) reported having aborted before. Slightly over a third (247, 34.6%) reported currently using or ever using family planning. Women aged 30+ years were more likely to abort compared to those aged 15-29 years (aOR: 2.7; 95% CI: 1.23-5.91). Women who had living children were less likely to abort compared to those who didn’t have any living child (aOR: 0.06; 95% CI: 0.01 – 0.17). Conclusion: The rate of abortion among female fisher-folk in Uganda is substantial. Family planning use is still low and unintended pregnancies are common. Abortion risk increased with the age of the mother. Continuous behavioral change communication and optimization of family planning use are recommended to reduce abortions.
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Nanvubya A, Wanyenze RK, Nakaweesa T, Mpendo J, Kawoozo B, Matovu F, Nabukalu S, Omoding G, Kaweesi J, Ndugga J, Kamacooko O, Chinyenze K, Price M, Van Geertruyden JP. Correlates of knowledge of family planning among people living in fishing communities of Lake Victoria, Uganda. BMC Public Health 2020; 20:1642. [PMID: 33143684 PMCID: PMC7607714 DOI: 10.1186/s12889-020-09762-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 10/25/2020] [Indexed: 11/23/2022] Open
Abstract
Background Knowledge of family planning (FP) is a key determinant of contraceptive use which ultimately plays a role in attainment of good health and in conduct of clinical research. People living in fishing communities (FCs) have limited access to health services including FP and are targeted for future clinical research but their knowledge of FP and its correlates are scantily known. We determined correlates of knowledge of FP among people living in FCs of L. victoria in Uganda to inform future FP education programs in FCs. Methods We conducted a comparative cross-sectional survey among participants aged 15–49 years from Kigungu and Nsazi. Participants were asked if they were aware of any FP method. All those who responded in the affirmative were further asked to mention what FP methods they had heard of or knew. Those who reported knowledge of at least one FP method were asked a series of questions about FP methods and their side effects. Knowledge was categorized into good or poor knowledge based on their mean total score. Poor knowledge constituted a score below the mean while good knowledge constituted a score of more than or equal to the mean total score. To further explore attitudes and perceptions of FP, ten in-depth interviews and four focus group discussions were conducted. Results Of the 1410 screened participants, 94.5% were aware of at least one FP method. Pills and injectable hormonal methods were the most commonly known methods. Slightly over a third (38%) had good knowledge of FP. Correlates of knowledge of FP were; being female (aOR: 1.92 95% CI: 1.39–2.67), residing in Kigungu (aOR: 4.01 95% CI: 2.77–5.81), being married (aOR: 1.59 95% CI: 1.11–2.28) and currently being in a sexual relationship (aOR: 1.75 95% CI: 1.18–2.60). Concerns about safety and effectiveness of some modern FP methods exist. Misconceptions on effects of FP like sterility, cancers and foetal abnormalities were common. Conclusion FP awareness among people living in FCs of L. Victoria in Uganda is high. However, good knowledge about specific methods tends to be low. Correlates of knowledge of FP include gender, residence, marital status and sexual engagement. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-020-09762-7.
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Affiliation(s)
- Annet Nanvubya
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda. .,Global Health Institute, University of Antwerp, Antwerp, Belgium.
| | - Rhoda K Wanyenze
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Teddy Nakaweesa
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Juliet Mpendo
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Barbarah Kawoozo
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Francis Matovu
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Sarah Nabukalu
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Geoffrey Omoding
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - Jed Kaweesi
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | - John Ndugga
- UVRI-IAVI HIV Vaccine Program, Plot 51-59, Nakiwogo Road, P.O Box 49, Entebbe, Uganda
| | | | | | - Matt Price
- IAVI, New York, NY, USA.,Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
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9
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Nanyonjo G, Asiki G, Ssetaala A, Nakaweesa T, Wambuzi M, Nanvubya A, Mpendo J, Okech B, Kitandwe PK, Nielsen L, Nalutaaya A, Welsh S, Bagaya BS, Chinyenze K, Fast P, Price M, Kiwanuka N. Prevalence and correlates of HIV infection among adolescents and young people living in fishing populations along Lake Victoria Fishing Communities in Uganda. Pan Afr Med J 2020; 37:208. [PMID: 33505576 PMCID: PMC7813648 DOI: 10.11604/pamj.2020.37.208.26124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 10/01/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION fishing communities in Uganda are key populations for HIV, with persistently higher prevalence and incidence than the general population. METHODS between March and August 2014, a cross sectional survey was conducted in 10 fishing communities of Lake Victoria in Uganda. Data was collected on socio-behavioural characteristics using interviewer administered questionnaires and venous blood collected for HIV testing. Prevalent HIV infections among adolescents and young people aged 13 to 24 years was estimated and the factors associated with those infections determined using multi variable logistic regression modelling. RESULTS HIV prevalence was 10.8% among the 630 (96.5%) who provided a blood sample. Females were 3.5 times as likely to have HIV infection as males (aOR=3.52, 95% CI: 1.34-9.22). Young people aged 20-24 years were twice as likely to be HIV infected as those aged 13-19 years (aOR=1.77, 95% CI: 0.05-2.10), participants without formal education or those who had studied up to primary level were more likely to be HIV infected than those who had post primary education ((aOR=2.45, 95% CI: 1.19-5.07) or (5.29 (1.35-20.71) respectively). Reporting more than one sexual partner in the past 6 months was associated with HIV prevalent infection than those reporting no sexual partners (aOR=6.44, 95% CI: 1.27-32.83). CONCLUSION adolescents and young people aged 13-24 years in fishing communities around Lake Victoria, Uganda, have a high HIV prevalence, with females having a three-fold higher level than males. These findings highlight-the need to improve HIV prevention among young females living in these fishing communities.
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Affiliation(s)
| | - Gershim Asiki
- African Population and Health Research Center, Nairobi, Kenya
| | - Ali Ssetaala
- UVRI/IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | | | | | | | - Juliet Mpendo
- UVRI/IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | - Brenda Okech
- UVRI/IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | | | - Leslie Nielsen
- Partnership for Research on Ebola Virus in Liberia (PREVAIL), Monrovia, Liberia
| | - Annet Nalutaaya
- Makerere University, College of Health Sciences, Uganda Tuberculosis and Implementation Research Consortium, Kampala, Uganda
| | | | - Bernard Ssentalo Bagaya
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | - Matt Price
- IAVI, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, CA, USA
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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10
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Mpendo J, Mutua G, Nanvubya A, Anzala O, Nyombayire J, Karita E, Dally L, Hannaman D, Price M, Fast PE, Priddy F, Gelderblom HC, Hills NK. Acceptability and tolerability of repeated intramuscular electroporation of Multi-antigenic HIV (HIVMAG) DNA vaccine among healthy African participants in a phase 1 randomized controlled trial. PLoS One 2020; 15:e0233151. [PMID: 32469893 PMCID: PMC7259687 DOI: 10.1371/journal.pone.0233151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 04/24/2020] [Indexed: 12/04/2022] Open
Abstract
Introduction Intramuscular electroporation (IM/EP) is a vaccine delivery technique that improves the immunogenicity of DNA vaccines. We evaluated the acceptability and tolerability of electroporation among healthy African study participants. Methods Forty-five participants were administered a DNA vaccine (HIV-MAG) or placebo by electroporation at three visits occurring at four week-intervals. At the end of each visit, participants were asked to rate pain at four times: (1) when the device was placed on the skin and vaccine injected, before the electrical stimulation, (2) at the time of electrical stimulation and muscle contraction, and (3) at 10 minutes and (4) 30 minutes after the procedure was completed. For analyses, pain level was dichotomized as either “acceptable” (none/slight/uncomfortable) or “too much” (Intense, severe, and very severe) and examined over time using repeated measures models. Optional brief comments made by participants were summarized anecdotally. Results All 45 participants completed all three vaccination visits; none withdrew from the study due to the electroporation procedure. Most (76%) reported pain levels as acceptable at every time point across all vaccination visits. The majority of “unacceptable” pain was reported at the time of electrical stimulation. The majority of the participants (97%) commented that they preferred electroporation to standard injection. Conclusion Repeated intramuscular electroporation for vaccine delivery was found to be acceptable and feasible among healthy African HIV vaccine trial participants. The majority of participants reported an acceptable pain level at all vaccination time points. Further investigation may be warranted into the value of EP to improve immunization outcomes. ClinicalTrials.gov NCT01496989
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Affiliation(s)
- Juliet Mpendo
- Uganda Virus Research Institute-International AIDS Vaccine Initiative, HIV Vaccine Program, Entebbe, Uganda
- * E-mail:
| | - Gaudensia Mutua
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Annet Nanvubya
- Uganda Virus Research Institute-International AIDS Vaccine Initiative, HIV Vaccine Program, Entebbe, Uganda
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | | | | | - Len Dally
- EMMES Corporation, Rockville, Maryland, United States of America
| | - Drew Hannaman
- Ichor Medical Systems, Inc., San Diego, California, United States of America
| | - Matt Price
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States of America
| | - Patricia E. Fast
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States of America
| | - Frances Priddy
- International AIDS Vaccine Initiative (IAVI), New York, NY, United States of America
| | - Huub C. Gelderblom
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America
| | - Nancy K. Hills
- University of California at San Francisco, San Francisco, California, United States of America
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11
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Galiwango RM, Bagaya B, Mpendo J, Joag V, Okech B, Nanvubya A, Ssetaala A, Muwanga M, Kaul R. Protocol for a randomized clinical trial exploring the effect of antimicrobial agents on the penile microbiota, immunology and HIV susceptibility of Ugandan men. Trials 2019; 20:443. [PMID: 31324206 PMCID: PMC6642556 DOI: 10.1186/s13063-019-3545-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 06/29/2019] [Indexed: 04/16/2023] Open
Abstract
Background The foreskin is the main site of HIV acquisition in a heterosexual uncircumcised man, but many men in endemic countries are reluctant to undergo penile circumcision (PC). Observational studies suggest that proinflammatory anaerobic bacteria are enriched on the uncircumcised penis, where they may enhance HIV susceptibility through increased foreskin inflammatory cytokines and the recruitment of HIV-susceptible CD4+ target cells. This trial will examine the impact of systemic and topical antimicrobials on ex vivo foreskin HIV susceptibility. Methods/design This randomized, open-label clinical trial will randomize 125 HIV-negative Ugandan men requesting voluntary PC to one of five arms (n = 25 each). The control group will receive immediate PC, while the four intervention groups will defer PC for 1 month and be provided in the interim with either oral tinidazole, penile topical metronidazole, topical clindamycin, or topical hydrogen peroxide. The impact of these interventions on HIV entry into foreskin-derived CD4+ T cells will be quantified ex vivo at the time of PC using a clade A, R5 tropic HIV pseudovirus assay (primary endpoint); secondary endpoints include the impact of antimicrobials on immune parameters and the microbiota of the participant’s penis and of the vagina of their female partner (if applicable), assessed by multiplex enzyme-linked immunosorbent assay and 16S rRNA sequencing. Discussion There is a critical need to develop acceptable, simple, and effective means of HIV prevention in men unwilling to undergo PC. This trial will provide insight into the causative role of the foreskin microbiota on HIV susceptibility, and the impact of simple microbiota-focused clinical interventions. This may pave the way for future clinical trials using low-cost, nonsurgical intervention(s) to reduce HIV risk in uncircumcised heterosexual men. Trial registration ClinicalTrials.gov, NCT03412071. Retrospectively registered on 26 January 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3545-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ronald M Galiwango
- Department of Immunology, University of Toronto, St. George Campus Medical Sciences Building #6356 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Bernard Bagaya
- HIV Vaccine Program, Uganda Virus Research Institute-International AIDS Vaccine Initiative, Entebbe, Uganda.,Department of Microbiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Mpendo
- HIV Vaccine Program, Uganda Virus Research Institute-International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Vineet Joag
- Department of Immunology, University of Toronto, St. George Campus Medical Sciences Building #6356 1 King's College Circle, Toronto, ON, M5S 1A8, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brenda Okech
- HIV Vaccine Program, Uganda Virus Research Institute-International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Annet Nanvubya
- HIV Vaccine Program, Uganda Virus Research Institute-International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Ali Ssetaala
- HIV Vaccine Program, Uganda Virus Research Institute-International AIDS Vaccine Initiative, Entebbe, Uganda
| | | | - Rupert Kaul
- Department of Immunology, University of Toronto, St. George Campus Medical Sciences Building #6356 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. .,Department of Medicine, University of Toronto, Toronto, ON, Canada. .,Department of Medicine, University Health Network, Toronto, ON, Canada.
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12
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Galiwango RM, Yegorov S, Joag V, Prodger J, Shahabi K, Huibner S, Muyanja E, Kabuubi BR, Namuniina A, Nalutaaya A, Ssemaganda A, Lutwama F, Kitandwe PK, Nanvubya A, Mpendo J, Bagaya B, Kiwanuka N, Kaul R. Characterization of CD4 + T cell subsets and HIV susceptibility in the inner and outer foreskin of Ugandan men. Am J Reprod Immunol 2019; 82:e13143. [PMID: 31081958 DOI: 10.1111/aji.13143] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 11/27/2022] Open
Abstract
PROBLEM Biological mechanisms of foreskin HIV acquisition are poorly defined. The inner foreskin is preferentially infected in explant models, so we hypothesized that this site would be enriched for HIV-susceptible CD4+ T cells and proinflammatory/chemoattractant cytokines. METHOD OF STUDY A total of 42 HIV-uninfected Ugandan men without genital symptoms provided foreskin tissues and swabs at the time of elective penile circumcision. The immune phenotype of foreskin-derived CD4+ T cells and entry of a CCR5-tropic HIV pseudovirus was characterized, and specific cytokine levels assayed by multiplexed chemiluminescent ELISA. RESULTS Unexpectedly, outer foreskin CD4+ T cells more frequently expressed CCR5 (median 29.2% vs 22.9%, P = 0.01) and CD69 (median 36.5% vs 15%, P < 0.01), and on a per-cell basis, HIV entry was higher. However, overall CD4+ T cell density was approximately twofold higher in the inner foreskin, and several highly susceptible T cell subsets were increased at this site, including Th17 cells (20.0% vs 14.1%, P = 0.0021). Specific pro-inflammatory cytokine levels were also higher on the inner foreskin surface (IL-17, IL-8, RANTES and IL-1β; all P < 0.05). CONCLUSION There was marked heterogeneity in CD4+ T cell populations and immune milieu between inner and outer foreskin tissues. Despite higher per-cell viral entry into CD4+ T cells from the outer foreskin, the higher target cell density and enriched pro-inflammatory cytokines of the inner foreskin suggest that this may be a preferential site for HIV acquisition.
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Affiliation(s)
| | - Sergey Yegorov
- Department of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vineet Joag
- Department of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jessica Prodger
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Kamnoosh Shahabi
- Department of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sanja Huibner
- Department of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Enoch Muyanja
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Brian Roy Kabuubi
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Annmarie Namuniina
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Annet Nalutaaya
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Aloysius Ssemaganda
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda.,Laboratory of Vaccines for the Developing World, Institute for Glycomics, Griffith University, Mount Gravatt, Queensland, Australia
| | - Fredrick Lutwama
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Paul Kato Kitandwe
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Annet Nanvubya
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Juliet Mpendo
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Bernard Bagaya
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Noah Kiwanuka
- HIV Vaccine Program, Uganda Virus Research Institute - International AIDS Vaccine Initiative, Entebbe, Uganda
| | - Rupert Kaul
- Department of Immunology and Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada
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13
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Namuniina A, Lutwama F, Biribawa VM, Kizza D, Kabuubi BR, Kitandwe PK, Mpendo J, Nanvubya A, Ssempiira J, Nalutaaya A, Ssetaala A, Welsh S, Price MA, Kiwanuka N, Bagaya BS. Field Performance of PIMA Point-of-Care Machine for CD4 Enumeration Under a Mobile HIV Counseling and Testing Program in Remote Fishing Communities of Lake Victoria, Uganda. AIDS Res Hum Retroviruses 2019; 35:382-387. [PMID: 30560683 DOI: 10.1089/aid.2018.0223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Uganda is among the most HIV/AIDS-afflicted countries, and many HIV-infected persons live in remote areas with poor access to health care. The success of HIV care programs relies in part on patient monitoring using CD4 T cell counts. We conducted an evaluation of the point-of-care PIMA test using BD FACSCount as a gold standard. One hundred fifty-one participants were enrolled, provided venous blood and samples tested at the point of care with the Alere PIMA™ CD4 Analyzer and the BD FACSCount in the UVRI-IAVI main laboratory. Correlation between the methods was assessed, as was the ability of the Pima Analyzer to predict values <200, <350, and ≥500 CD4 cells/mm3 when compared with BD FACSCount as the gold standard. A near-perfect positive Pearson correlation coefficient (r = 0.948; p < .0001) between the two methods was observed. The Alere PIMA Analyzer had a mean bias of -32.5 cells/mm3. The sensitivity and specificity, for PIMA to predict CD4 lymphocyte count less than 200 cells/mm3, were 71.4% and 100%, respectively; less than 350 cells/mm3 were 84.6% and 94.6%, respectively; and at CD4 count less than 500 cells/mm3 were 94.4% and 100%. The Alere Pima Analyzer provides reliable CD4 cell count measurement and is suitable for monitoring and screening eligible HIV patients in hard-to-reach settings.
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Affiliation(s)
| | - Fredrick Lutwama
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - David Kizza
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | | | | | - Juliet Mpendo
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | | | | | | | - Ali Ssetaala
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
| | - Sabrina Welsh
- International AIDS Vaccine Initiative (IAVI), New York, New York
| | - Matt A. Price
- International AIDS Vaccine Initiative (IAVI), New York, New York
- Department of Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California
| | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Bernard Ssentalo Bagaya
- UVRI-IAVI HIV Vaccine Program Limited, Entebbe, Uganda
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, College of Health Sciences, Makerere University, Kampala, Uganda
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14
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Kiwanuka N, Mpendo J, Asiimwe S, Ssempiira J, Nalutaaya A, Nambuusi B, Wambuzi M, Kabuubi B, Namuniina A, Oporia F, Nanvubya A, Ssetaala A. A randomized trial to assess retention rates using mobile phone reminders versus physical contact tracing in a potential HIV vaccine efficacy population of fishing communities around Lake Victoria, Uganda. BMC Infect Dis 2018; 18:591. [PMID: 30463524 PMCID: PMC6249980 DOI: 10.1186/s12879-018-3475-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/31/2018] [Indexed: 11/10/2022] Open
Abstract
Background High retention (follow-up) rates improve the validity and statistical power of outcomes in longitudinal studies and the effectiveness of programs with prolonged administration of interventions. We assessed participant retention in a potential HIV vaccine trials population of fishing communities along Lake Victoria, Uganda. Methods In a community-based individual randomized trial, 662 participants aged 15–49 years were randomized to either mobile phone or physical contact tracing reminders and followed up at months 1, 2, 3, 6, 12 and 18 post-enrolment. The visit schedules aimed at mimicking a vaccine efficacy trial representing an early interval (months 1–6) where most vaccinations would be administered and a later period of post-vaccination follow-up. The primary outcome was retention measured as the proportion of post-baseline follow up visits completed by a participant. Retention was estimated in early and later follow-up intervals, and overall for all the six follow-up visits. Adjusted differences in retention between the study arms were determined by multivariable logistic regression using Stata® 14. One participant was later dropped from the analysis because of age ineligibility discovered after enrolment. Results Of the expected total follow up visits of 3966 among 661 participants, 84.1% (3334) were attained; 82.1% (1626/1980) in the phone arm and 86% (1708/1986) in the physical tracing arm (p = 0.001). No statistically significant differences in retention were observed between the study arms in the first 6 months but thereafter, retention was significantly higher for physical contact reminders than mobile phones; 91.5% versus 82.1% (p < 0.0001) at month 12 and 82.8% versus 75.4%, (p = 0.021) at month 18. Controlling for sex, age, education, occupation, community location, length of stay and marital status, the odds of good retention (completing 5 out of 6 follow-up visits) were 1.56 (95% CI;1.08–2.26, p = 0.018) for physical contact tracing compared to mobile phone tracing. Other statistically significant predictors of good retention were residing on islands and having stayed in the fishing communities for 5 or more years. Conclusions Among fishing communities of Lake Victoria, Uganda, 84% of follow-up visits can be attained and participant retention is higher using physical contact reminders than mobile phones. Trial registration number PACTR201311000696101 (http://www.pactr.org/). retrospectively registered on 05 November, 2013.
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Affiliation(s)
- Noah Kiwanuka
- School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda. .,Clinical Trials Unit, College of Health Sciences, Makerere University, Kampala, Uganda.
| | | | | | - Julius Ssempiira
- School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda
| | | | - Betty Nambuusi
- Clinical Trials Unit, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | | | | | - Frederick Oporia
- School of Public Health, College of Health Sciences, Makerere University, P.O.Box 7072, Kampala, Uganda
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15
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Kaleebu P, Levin J, Nanvubya A, Kibengo F, Jaoko W, Pala P, Perreau M, Namuniina A, Kitandwe P, Tapia G, Serwanga J, Yates N, Fast P, Mayer B, Montefiori D, Tomaras G, Robb M, Lee C, Wagner R, Sanders E, Kilembe W, Kiwanuka N, Gilmour J, Kuipers H, Vooij D, Chinyenze K, Priddy F, Ding S, Hanke T, Pantaleo G. THE RESULTS OF THE EV06 DNA-PROTEIN COMBINATION TRIAL AND PLANS FOR GREAT, AN EDCTP2-FUNDED CONSERVED-MOSAIC EPITOPE HIV VACCINE TRIAL. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Miiro G, Mbidde E, Peshu N, Kivaya E, Mfinanga G, Ngowi B, Kavishe R, Maowia M, Lang T, Sandstrom E, Ayuo E, Nanvubya A, Mmbaga B, Kaleebu P. ACHIEVEMENTS AND PRIMED PROSPECTS OF INCREASING CAPABILITIES FOR MULTISITE CLINICAL TRIALS IN THE EASTERN AFRICA NETWORK OF EXCELLENCE. BMJ Glob Health 2017. [DOI: 10.1136/bmjgh-2016-000260.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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17
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Nanvubya A, Ssempiira J, Mpendo J, Ssetaala A, Nalutaaya A, Wambuzi M, Kitandwe P, Bagaya BS, Welsh S, Asiimwe S, Nielsen L, Makumbi F, Kiwanuka N. Correction: Use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, Uganda. PLoS One 2015; 10:e0143988. [PMID: 26599276 PMCID: PMC4657975 DOI: 10.1371/journal.pone.0143988] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Nanvubya A, Ssempiira J, Mpendo J, Ssetaala A, Nalutaaya A, Wambuzi M, Kitandwe P, Bagaya BS, Welsh S, Asiimwe S, Nielsen L, Makumbi F, Kiwanuka N. Use of Modern Family Planning Methods in Fishing Communities of Lake Victoria, Uganda. PLoS One 2015; 10:e0141531. [PMID: 26512727 PMCID: PMC4626115 DOI: 10.1371/journal.pone.0141531] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 10/10/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Fishing communities (FCs) in Uganda have high HIV infection rates but poor access to health services including family planning (FP). Although FP is a cost-effective public health intervention, there is a paucity of data on knowledge and use of modern FP in FCs. This study determined knowledge and use of modern FP methods in FCs of Uganda. Methods Data were accrued from a 12-month follow up of 1,688 HIV-uninfected individuals, 18–49 years from 8 FCs along Lake Victoria, between September 2011 and March 2013. Data on knowledge and use of modern FP were collected through a semi-structured questionnaire. Prevalence Risk Ratios with corresponding 95% CIs were used to determine factors associated with Modern FP knowledge and use. Results The mean age was 31.4 years, with nearly half (48.8%) being females while more than half (58.6%) had attained up to primary education level. Knowledge of modern FP was high, 87.5% (1477/1688); significantly higher among females [adj. PRR = 4.84 (95% CI; 3.08, 7.61)], among older respondents (25–29 years) [adj. PRR = 1.83 (95% CI; 1.12, 2.99)] compared to younger ones (18–24 years) and among those conducting business [adj. PRR = 2.42(95% CI; 1.02, 5.74)] relative to those primarily in fishing. Just over a third (35.2%, 595/1688) reported use of at least one modern FP method. Use of modern FP methods was significantly higher among females [adj. PRR = 2.04 (95% CI; 1.56, 2.65, and among those reporting multiple sexual partnerships [adj. PRR = 2.12, 95% CI; 1.63, 2.76)]. Nonuse of modern methods was mostly due to desire for more children (30.6%), fear of side effects (12.2%) and partner refusal (5.2%). Conclusion Despite their high knowledge of FP, FCs have low use of modern FP methods. Key barriers to use of modern FP methods were high fertility desires, fear of perceived side effects and partner refusal of methods.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Sabrina Welsh
- Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda
| | | | - Leslie Nielsen
- Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda
| | - Fredrick Makumbi
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Noah Kiwanuka
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Ssetaala A, Nakiyingi-Miiro J, Asiimwe S, Nanvubya A, Mpendo J, Asiki G, Nielsen L, Kiwanuka N, Seeley J, Kamali A, Kaleebu P. Recruitment and retention of women in fishing communities in HIV prevention research. Pan Afr Med J 2015; 21:104. [PMID: 26379811 PMCID: PMC4554809 DOI: 10.11604/pamj.2015.21.104.4962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 05/21/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Women in fishing communities in Uganda are more at risk and have higher rates of HIV infection. Socio-cultural gender norms, limited access to health information and services, economic disempowerment, sexual abuse and their biological susceptibility make women more at risk of infection. There is need to design interventions that cater for women's vulnerability. We explore factors affecting recruitment and retention of women from fishing communities in HIV prevention research. METHODS An HIV incidence cohort screened 2074 volunteers (1057 men and 1017 women) aged 13-49 years from 5 fishing communities along Lake Victoria using demographic, medical history, risk behaviour assessment questionnaires.1000 HIV negative high risk volunteers were enrolled and followed every 6 months for 18 months. Factors associated with completion of study visits among women were analyzed using multivariable logistic regression. RESULTS Women constituted 1,017(49%) of those screened, and 449(45%) of those enrolled with a median (IQR) age of 27 (22-33) years. Main reasons for non-enrolment were HIV infection (33.9%) and reported low risk behaviour (37.5%). A total of 382 (74%) women and 332 (69%) men completed all follow up visits. Older women (>24 yrs) and those unemployed, who had lived in the community for 5 years or more, were more likely to complete all study visits. CONCLUSION Women had better retention rates than men at 18 months. Strategies for recruiting and retaining younger women and those who have stayed for less than 5 years need to be developed for improved retention of women in fishing communities in HIV prevention and research Programs.
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Affiliation(s)
| | | | - Stephen Asiimwe
- University of Georgia, Athens, GA, USA ; Kabwohe Clinical Reserach Center(KCRC), Kabwohe, Uganda
| | | | | | | | - Leslie Nielsen
- International AIDS Vaccine Initiative (IAVI), New York, USA
| | - Noah Kiwanuka
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda ; Makerere College of Health Sciences, School of Public Health, Makerere, Kampala, Uganda
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Muyanja E, Ssemaganda A, Ngauv P, Cubas R, Perrin H, Srinivasan D, Canderan G, Lawson B, Kopycinski J, Graham AS, Rowe DK, Smith MJ, Gaucher D, Isern S, Michael S, Silvestri G, Vanderford TH, Castro E, Pantaleo G, Singer J, Gillmour J, Kiwanuka N, Nanvubya A, Schmidt C, Birungi J, Cox J, Haddad EK, Kaleebu P, Fast P, Sekaly RP, Trautmann L. Immune activation alters cellular and humoral responses to yellow fever 17D vaccine. J Clin Invest 2014. [DOI: 10.1172/jci77956] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Nanvubya A, Mpendo J, Ssetaala A, Ssempiira J, Nalutaaya A, Wambuzi M, Asiimwe S, Nielsen L, Makumbi F, Kiwanuka N. Knowledge and Use of Modern Family Planning Methods in Fishing Communities along Lake Victoria, Uganda. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5190.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Steven Asiimwe
- Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda
| | - Leslie Nielsen
- International AIDS Vaccine Initiative, New York, NY, United States
| | - Fredrick Makumbi
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Noah Kiwanuka
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Mpendo J, Nanvubya A, Ssetaala A, Ssempiira J, Nalutaaya A, Wambuzi M, Nielsen L, Asiimwe S, Kiwanuka N. Assessment of Retention Rates Using Mobile Phones versus Physical Contact Tracing among Fishing Communities Along the Shores of Lake Victoria, Uganda. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5354.abstract] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Juliet Mpendo
- UVRI-IAVI HIV Vaccine Program, Clinical & Epidemiological Sciences, Entebbe, Uganda
| | - Annet Nanvubya
- UVRI-IAVI HIV Vaccine Program, Clinical & Epidemiological Sciences, Entebbe, Uganda
| | - Ali Ssetaala
- UVRI-IAVI HIV Vaccine Program, Clinical & Epidemiological Sciences, Entebbe, Uganda
| | | | - Annet Nalutaaya
- UVRI-IAVI HIV Vaccine Program, Data Management, Entebbe, Uganda
| | - Matthias Wambuzi
- UVRI-IAVI HIV Vaccine Program, Clinical & Epidemiological Sciences, Entebbe, Uganda
| | - Leslie Nielsen
- International AIDS Vaccine Initiative, New York, NY, United States
| | - Steven Asiimwe
- Kabwohe Clinical Research Center (KCRC), Kabwohe, Uganda
| | - Noah Kiwanuka
- UVRI-IAVI HIV Vaccine Program, Clinical & Epidemiological Sciences, Entebbe, Uganda
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Kiwanuka N, Mpendo J, Nalutaaya A, Wambuzi M, Nanvubya A, Kitandwe PK, Muyanja E, Ssempiira J, Balyegisawa A, Ssetaala A. An assessment of fishing communities around Lake Victoria, Uganda, as potential populations for future HIV vaccine efficacy studies: an observational cohort study. BMC Public Health 2014; 14:986. [PMID: 25242015 PMCID: PMC4194358 DOI: 10.1186/1471-2458-14-986] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 09/18/2014] [Indexed: 12/20/2022] Open
Abstract
Background An effective HIV vaccine is still elusive. Of the 9 HIV preventive vaccine efficacy trials conducted to-date, only one reported positive results of modest efficacy. More efficacy trials need to be conducted before one or more vaccines are eventually licensed. We assessed the suitability of fishing communities in Uganda for future HIV vaccine efficacy trials. Methods A community-based cohort study was conducted among a random sample of 2191 participants aged 18–49 years. Data were collected on socio-demographic characteristics, HIV risky behaviors, and willingness to participate in future HIV vaccine trials (WTP). Venous blood was collected for HIV serological testing. Retention/follow rates and HIV incidence rates per 100 person years at-risk (pyar) were estimated. Adjusted prevalence proportion ratios (PPRs) of retention and odds ratios (ORs) of lack of WTP were estimated using log-binomial and logistic regression models respectively. Results Overall retention rate was 76.9% (1685/2191), highest (89%) among participants who had spent 5+ years in the community and lowest (54.1%) among those with <1 year stay. Significant predictors of retention included tribe/ethnicity, baseline HIV negative status, and longer than 1 year stay in the community. Overall WTP was 89.1% (1953/2191). Lack of WTP was significantly higher among women than men [adj.OR = 1.51 (95% CI, 1.14- 2.00)] and among participants who had stayed in fishing communities for 10 or more years relative to those with less than one year [adj.OR = 1.78 (95% CI, 1.11 - 2.88)]. Overall HIV incidence rate per 100 pyar was 3.39 (95% CI; 2.55 - 4.49). Participants aged 25–29 years had highest incidence rates (4.61 - 7.67/100 pyar) and high retention rates between 78.5 and 83.1%. In a combined analysis of retention and incidence rates participants aged 30+ years had retention rates ~80% but low incidence rates (2.45 - 3.57 per 100 pyar) while those aged 25–29 years had the highest incidence rates (4.61 - 7.67/100 pyar) and retention rates 78.5 - 83.1%. Conclusions There is high HIV incidence, retention and WTP among fishing communities around L. Victoria, Uganda which make these communities appropriate for future HIV prevention efficacy studies including vaccine trials.
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Affiliation(s)
- Noah Kiwanuka
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda.
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Muyanja E, Ssemaganda A, Ngauv P, Cubas R, Perrin H, Srinivasan D, Canderan G, Lawson B, Kopycinski J, Graham AS, Rowe DK, Smith MJ, Isern S, Michael S, Silvestri G, Vanderford TH, Castro E, Pantaleo G, Singer J, Gillmour J, Kiwanuka N, Nanvubya A, Schmidt C, Birungi J, Cox J, Haddad EK, Kaleebu P, Fast P, Sekaly RP, Trautmann L, Gaucher D. Immune activation alters cellular and humoral responses to yellow fever 17D vaccine. J Clin Invest 2014; 124:3147-58. [PMID: 24911151 DOI: 10.1172/jci75429] [Citation(s) in RCA: 145] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 04/24/2014] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Defining the parameters that modulate vaccine responses in African populations will be imperative to design effective vaccines for protection against HIV, malaria, tuberculosis, and dengue virus infections. This study aimed to evaluate the contribution of the patient-specific immune microenvironment to the response to the licensed yellow fever vaccine 17D (YF-17D) in an African cohort. METHODS We compared responses to YF-17D in 50 volunteers in Entebbe, Uganda, and 50 volunteers in Lausanne, Switzerland. We measured the CD8+ T cell and B cell responses induced by YF-17D and correlated them with immune parameters analyzed by flow cytometry prior to vaccination. RESULTS We showed that YF-17D-induced CD8+ T cell and B cell responses were substantially lower in immunized individuals from Entebbe compared with immunized individuals from Lausanne. The impaired vaccine response in the Entebbe cohort associated with reduced YF-17D replication. Prior to vaccination, we observed higher frequencies of exhausted and activated NK cells, differentiated T and B cell subsets and proinflammatory monocytes, suggesting an activated immune microenvironment in the Entebbe volunteers. Interestingly, activation of CD8+ T cells and B cells as well as proinflammatory monocytes at baseline negatively correlated with YF-17D-neutralizing antibody titers after vaccination. Additionally, memory T and B cell responses in preimmunized volunteers exhibited reduced persistence in the Entebbe cohort but were boosted by a second vaccination. CONCLUSION Together, these results demonstrate that an activated immune microenvironment prior to vaccination impedes efficacy of the YF-17D vaccine in an African cohort and suggest that vaccine regimens may need to be boosted in African populations to achieve efficient immunity. TRIAL REGISTRATION Registration is not required for observational studies. FUNDING This study was funded by Canada's Global Health Research Initiative, Defense Threat Reduction Agency, National Institute of Allergy and Infectious Diseases, Bill & Melinda Gates Foundation, and United States Agency for International Development.
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Kiwanuka N, Ssetaala A, Nalutaaya A, Mpendo J, Wambuzi M, Nanvubya A, Sigirenda S, Kitandwe PK, Nielsen LE, Balyegisawa A, Kaleebu P, Nalusiba J, Sewankambo NK. High incidence of HIV-1 infection in a general population of fishing communities around Lake Victoria, Uganda. PLoS One 2014; 9:e94932. [PMID: 24866840 PMCID: PMC4035272 DOI: 10.1371/journal.pone.0094932] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 03/21/2014] [Indexed: 11/19/2022] Open
Abstract
Background High HIV-1 incidence rates were reported among persons in fisherfolk communities (FFC) in Uganda who were selected for high risk behaviour. We assessed the incidence of HIV-1 and associated risk factors in a general population FFC to determine population-wide HIV rates. Methods A community-based cohort study was conducted among a random sample of 2191 participants aged 18–49 years. At baseline and 12 months post-baseline, data were collected on socio-demographic characteristics and risky behaviors (including number of partners, new partners, condom use, use of alcohol and illicit drug use). Venous blood was collected for HIV serological testing. HIV incidence was calculated per 100 person years at-risk (pyar) and adjusted incidence rate ratios (Adj.IRR) were estimated by multivariable Poisson regression. Results Overall follow up at 12 months was 76.9% (1685/2191) and was significantly higher among HIV uninfected persons and those with at least 1 year duration of stay in community. Overall HIV-1 incidence was 3.39/100 pyar (95% CI: 2.55–4.49). Among the 25–29 years who drank alcohol, HIV incidence was 7.67/100pyar (95% CI;4.62–12.7) while it was 5.67/100pyar (95% CI;3.14–10.2) for 18–24 year olds who drank alcohol. The risk of HIV infection was higher among 25–29 years (adj.IRR = 3.36; 95% CI: 1.48–7.65) and 18–24 years (adj.IRR = 2.65; 95% CI: 1.05–6.70) relative to 30+ years. Compared to non-drinkers, HIV incidence increased by frequency of alcohol drinking - occasional drinkers (adj.IRR = 3.18; 95% CI: 1.18–8.57) and regular drinkers (adj.IRR = 4.93; 95% CI: 1.91–12.8). Conclusion HIV-1 incidence in general fisherfolk population along L.Victoria, Uganda, is high and is mainly associated with young age and alcohol drinking. HIV prevention and control strategies are urgently needed in this population.
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Affiliation(s)
- Noah Kiwanuka
- Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
- * E-mail:
| | - Ali Ssetaala
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Annet Nalutaaya
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Juliet Mpendo
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Matthias Wambuzi
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Annet Nanvubya
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Simon Sigirenda
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | - Paul Kato Kitandwe
- Uganda Virus Research Institute-International AIDS Vaccine Initiate HIV Vaccine Program, Entebbe, Uganda
| | | | - Apolo Balyegisawa
- International AIDS Vaccine Initiative (IAVI), New York, New York, United States of America
| | - Pontiano Kaleebu
- Medical Research Council/Uganda Virus Research Insitute, Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Josephine Nalusiba
- Makerere University College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda
| | - Nelson Kaulukusi Sewankambo
- Makerere University College of Health Sciences, School of Medicine, Clinical Epidemiology Unit, Kampala, Uganda
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Chantler T, Cheah PY, Miiro G, Hantrakum V, Nanvubya A, Ayuo E, Kivaya E, Kidola J, Kaleebu P, Parker M, Njuguna P, Ashley E, Guerin PJ, Lang T. International health research monitoring: exploring a scientific and a cooperative approach using participatory action research. BMJ Open 2014; 4:e004104. [PMID: 24534257 PMCID: PMC3927800 DOI: 10.1136/bmjopen-2013-004104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To evaluate and determine the value of monitoring models developed by the Mahidol Oxford Tropical Research Unit and the East African Consortium for Clinical Research, consider how this can be measured and explore monitors' and investigators' experiences of and views about the nature, purpose and practice of monitoring. RESEARCH DESIGN A case study approach was used within the context of participatory action research because one of the aims was to guide and improve practice. 34 interviews, five focus groups and observations of monitoring practice were conducted. SETTING AND PARTICIPANTS Fieldwork occurred in the places where the monitoring models are coordinated and applied in Thailand, Cambodia, Uganda and Kenya. Participants included those coordinating the monitoring schemes, monitors, senior investigators and research staff. ANALYSIS Transcribed textual data from field notes, interviews and focus groups was imported into a qualitative data software program (NVIVO V. 10) and analysed inductively and thematically by a qualitative researcher. The initial coding framework was reviewed internally and two main categories emerged from the subsequent interrogation of the data. RESULTS The categories that were identified related to the conceptual framing and nature of monitoring, and the practice of monitoring, including relational factors. Particular emphasis was given to the value of a scientific and cooperative style of monitoring as a means of enhancing data quality, trust and transparency. In terms of practice the primary purpose of monitoring was defined as improving the conduct of health research and increasing the capacity of researchers and trial sites. CONCLUSIONS The models studied utilise internal and network wide expertise to improve the ethics and quality of clinical research. They demonstrate how monitoring can be a scientific and constructive exercise rather than a threatening process. The value of cooperative relations needs to be given more emphasis in monitoring activities, which seek to ensure that research protects human rights and produces reliable data.
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Affiliation(s)
- Tracey Chantler
- Nuffield Department of Clinical Medicine, The Global Health Network, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Nuffield Department of Clinical Medicine, Worldwide Antimalarial Resistance Network (WWARN), Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Nuffield Department for Population Health, The George Institute for Global Health, University of Oxford, Oxford, UK
| | - Phaik Yeong Cheah
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - George Miiro
- East African Consortium for Clinical Research, Uganda Virus Research Institute, Entebbe, Uganda
- Ugandan Virus Research Institute, Entebbe, Uganda
| | - Viriya Hantrakum
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Annet Nanvubya
- East African Consortium for Clinical Research, Uganda Virus Research Institute, Entebbe, Uganda
- Ugandan Virus Research Institute, Entebbe, Uganda
| | - Elizabeth Ayuo
- East African Consortium for Clinical Research, Uganda Virus Research Institute, Entebbe, Uganda
- Kenyan Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Esther Kivaya
- Kenyan Medical Research Institute, Centre for Geographical Medicine Research-Coast CGMRC, Kilifi, Kenya
| | - Jeremiah Kidola
- East African Consortium for Clinical Research, Uganda Virus Research Institute, Entebbe, Uganda
- National Institute for Medical Research, Mwanza Research Centre, Tanzania
| | - Pontiano Kaleebu
- East African Consortium for Clinical Research, Uganda Virus Research Institute, Entebbe, Uganda
- Ugandan Virus Research Institute, Entebbe, Uganda
| | - Michael Parker
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Nuffield Department of Population Health, The Ethox Centre, University of Oxford, Oxford, UK
| | - Patricia Njuguna
- Kenyan Medical Research Institute, Centre for Geographical Medicine Research-Coast CGMRC, Kilifi, Kenya
| | - Elizabeth Ashley
- Nuffield Department of Clinical Medicine, Worldwide Antimalarial Resistance Network (WWARN), Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Philippe J Guerin
- Nuffield Department of Clinical Medicine, Worldwide Antimalarial Resistance Network (WWARN), Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
| | - Trudie Lang
- Nuffield Department of Clinical Medicine, The Global Health Network, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
- Nuffield Department of Clinical Medicine, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, UK
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Schmidt C, Jaoko W, Omosa-Manyonyi G, Kaleebu P, Mpendo J, Nanvubya A, Karita E, Bayingana R, Bekker LG, Chomba E, Kilembe W, Nchabeleng M, Nyombayire J, Stevens G, Chetty P, Lehrman J, Cox J, Allen S, Dally L, Smith C, Fast PE. Long-term follow-up of study participants from prophylactic HIV vaccine clinical trials in Africa. Hum Vaccin Immunother 2013; 10:714-23. [PMID: 24374365 DOI: 10.4161/hv.27559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Long-term safety is critical for the development and later use of a vaccine to prevent HIV/AIDS. Likewise, the persistence of vaccine-induced antibodies and their impact on HIV testing must be established. IAVI has sponsored several Phase I and IIA HIV vaccine trials enrolling healthy, HIV-seronegative African volunteers. Plasmid DNA and viral vector based vaccines were tested. No vaccine-related serious adverse events were reported. After completion of vaccine trials conducted between 2001-2007, both vaccine and placebo recipients were offered enrolment into an observational long-term follow-up study (LTFU) to monitor potential late health effects and persistence of immune responses. At scheduled 6-monthly clinic visits, a health questionnaire was administered; clinical events were recorded and graded for severity. Blood was drawn for HIV testing and cellular immune assays. 287 volunteers were enrolled; total follow-up after last vaccination was 1463 person years (median: 5.2 years). Ninety-three (93)% of volunteers reported good health at their last LTFU visit. Infectious diseases and injuries accounted for almost 50% of the 175 reported clinical events, of which over 95% were mild or moderate in severity. There were 30 six pregnancies, six incident HIV infections and 14 volunteers reported cases of social harm. Persistence of immune responses was rare. No safety signal was identified. No potentially vaccine-related medical condition, no immune mediated disease, or malignancy was reported. HIV vaccines studied in these trials had a low potential of induction of persisting HIV antibodies.
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Affiliation(s)
| | - Walter Jaoko
- Kenya AIDS Vaccine Initiative (KAVI); University of Nairobi, Kenya
| | | | | | | | | | | | | | | | - Elwyn Chomba
- Zambia Emory HIV Research Program (ZEHRP); Lusaka, Zambia
| | | | - Maphoshane Nchabeleng
- Department of Medical Microbiology; University of Limpopo, Medunsa Campus; Pretoria, South Africa
| | | | - Gwynn Stevens
- IAVI; Clinical (Immunology) Laboratory; Parktown, South Africa
| | - Paramesh Chetty
- IAVI; Clinical (Immunology) Laboratory; Parktown, South Africa
| | | | - Josephine Cox
- IAVI; Human Immunology Laboratory (HIL); Imperial College; London, UK
| | | | - Len Dally
- EMMES: The EMMES Corporation; Rockville, MD USA
| | - Carol Smith
- EMMES: The EMMES Corporation; Rockville, MD USA
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Nazziwa J, Njai HF, Ndembi N, Birungi J, Lyagoba F, Gershim A, Nakiyingi-Miiro J, Nielsen L, Mpendo J, Nanvubya A, Debont J, Grosskurth H, Kamali A, Seeley J, Kaleebu, and the CHIVTUM Study Team P. Short communication: HIV type 1 transmitted drug resistance and evidence of transmission clusters among recently infected antiretroviral-naive individuals from Ugandan fishing communities of Lake Victoria. AIDS Res Hum Retroviruses 2013; 29:788-95. [PMID: 23173702 DOI: 10.1089/aid.2012.0123] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) prevalence and incidence in the fishing communities on Lake Victoria in Uganda are high. This population may play a role in driving the HIV epidemic in Uganda including the spread of transmitted drug resistance (TDR). We report data on TDR in this population among antiretroviral (ARV)-naive, recently infected individuals about 5 years after ARV scaling-up in Uganda. We identified phylogenetic transmission clusters and combined these with volunteer life histories in order to understand the sexual networks within this population. From a prospective cohort of 1,000 HIV-negative individuals recruited from five communities, 51 seroconverters were identified over a period of 2 years. From these, whole blood was collected and population sequencing of the HIV-1 pol gene (protease/reverse transcriptase) was performed from plasma. Drug resistance mutations (DRMs) were scored using the 2009 WHO list for surveillance of TDR. TDR prevalence categories were estimated using the WHO recommended truncated sampling technique for the surveillance of TDR for use in resource-limited settings (RLS). Of the samples 92% (47/51) were successfully genotyped. HIV-1 subtype frequencies were 15/47 (32%) A1, 20/47 (43%) D, 1/47 (2%) C, 1/47 (2%) G, and 10/47 (21%) unique recombinant forms. Nonnucleoside reverse transcriptase inhibitor (NNRTI) drug resistance mutation K103N was identified in two individuals and V106A in one (6%) suggesting that the level of TDR was moderate in this population. No nucleoside/tide reverse transcriptase inhibitor (NRTI) or protease inhibitor (PI) DRMs were detected. In this study, we identified five transmission clusters supported by high bootstrap values and low genetic distances. Of these, one pair included the two individuals with K103N. Two of the genotypic clusters corresponded with reported sexual partnerships as detected through prior in-depth interviews. The level of TDR to NNRTIs in these ARV-naive individuals was moderate by WHO threshold survey categorization. The transmission clusters suggest a high degree of sexual partner mixing between members of these communities.
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Affiliation(s)
- Jamirah Nazziwa
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- Uganda Virus Research Institute/IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Harr Freeya Njai
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Josephine Birungi
- Uganda Virus Research Institute/IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Fred Lyagoba
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | - Asiki Gershim
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
| | | | - Leslie Nielsen
- International AIDS Vaccine Initiative, New York, New York
| | - Juliet Mpendo
- Uganda Virus Research Institute/IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Annet Nanvubya
- Uganda Virus Research Institute/IAVI HIV Vaccine Program, Entebbe, Uganda
| | - Jan Debont
- International AIDS Vaccine Initiative, New York, New York
| | - Heiner Grosskurth
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anatoli Kamali
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of International Development, University of East Anglia, Norwich, United Kingdom
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Bayingana R, Nanvubya A, Karita E, Nyombayire J, Ingabire R, Chinyenze K, Lehrman J, Schimidt C, Hannaman D, Allen S, Fast P. Electroporation (EP)-related technical errors experienced during an HIV vaccine clinical trial conducted in Rwanda and Uganda: lessons learned. Retrovirology 2012. [PMCID: PMC3441335 DOI: 10.1186/1742-4690-9-s2-p113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ssetaala A, Mpendo J, Nanvubya A, Sigirenda S, Nielsen L, Kiwanuka N. Are fishing communities another most-at-risk-population? Results of a community-based study along Lake Victoria, Uganda. Retrovirology 2012. [PMCID: PMC3441780 DOI: 10.1186/1742-4690-9-s2-p216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ssekandi I, Ssetaala A, Mpendo J, Nanvubya A, Nielsen L, Kiwanuka N. Alcohol and illicit drug use among potential HIV vaccine efficacy trial volunteers along Lake Victoria, Uganda. Retrovirology 2012. [PMCID: PMC3441264 DOI: 10.1186/1742-4690-9-s2-p219] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mpendo J, Bayingana R, Nanvubya A, Karita E, Ssetaala A, Kiwanuka N, Lehrman J, Schmidt C, Hannaman D, Allen S, Fast P. Tolerability and acceptability of electroporation during a Phase 1 vaccine trial at two sites in Uganda and Rwanda. Retrovirology 2012. [PMCID: PMC3441912 DOI: 10.1186/1742-4690-9-s2-p126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nanvubya A, Mpendo J, Ssetaala A, Kidega W, Sigirenda S, Nielsen L, Kiwanuka N. Willingness to participate in HIV vaccine efficacy trials in a population of fishing communities, Uganda. Retrovirology 2012. [PMCID: PMC3441841 DOI: 10.1186/1742-4690-9-s2-p235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
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Ngongo BP, Priddy F, Park H, Bender B, Fast P, Anzala O, Mutua G, Ruzagira E, Kamali A, Karita E, Mugo P, Chomba E, Bekker L, Roux S, Nanvubya A, Mebrahtu T. Developing standards of care for HIV prevention research in developing countries – a case study of ten research centers in Eastern and Southern Africa. Retrovirology 2012. [PMCID: PMC3442024 DOI: 10.1186/1742-4690-9-s2-p117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ngongo PB, Priddy F, Park H, Becker J, Bender B, Fast P, Anzala O, Mutua G, Ruzagira E, Kamali A, Karita E, Mugo P, Chomba E, Bekker LG, Roux S, Nanvubya A, Mebrahtu T. Developing standards of care for HIV prevention research in developing countries -- a case study of 10 research centers in Eastern and Southern Africa. AIDS Care 2012; 24:1277-89. [PMID: 22452384 DOI: 10.1080/09540121.2012.656572] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Standards of care provided to volunteers in HIV prevention research in developing countries are evolving. Inconsistency in standards, particularly within a research network highlights the need to balance volunteers' health and wellness with the efficient conduct of research. Ten research centers (RC's) in East and Southern Africa affiliated with the International AIDS Vaccine Initiative (IAVI) were studied using a mixed methods approach to understand variations, similarities and gaps in services provided, recipients of services, referral systems, and barriers to referral uptake. These data were then used to develop expected standards across the 10 RCs. Findings indicated that RCs consistently provided HIV risk reduction and family planning (FP) counseling, male condoms, management of sexually transmitted infections, CD-4 counts, and general medical care to volunteers and non-research volunteers. Services that were less consistently provided on-site included: female condoms, adult male circumcision (AMC), antiretroviral therapy (ART) and post-exposure prophylaxis (PEP) in case of rape. The FP options provided on-site varied, with few providing implants, intrauterine devices, tubal ligation, and vasectomy. Most RCs had established referral systems for ART, AMC, PEP, and FP, but few had referral points for psychosocial services. Few RCs had comprehensive guidelines on referrals other than those related to adverse events. Findings indicate that the greatest challenges for referral uptake were transportation and health care costs, poor quality and inconsistency of services at some referral points. Few RCs covered the cost of referrals for non-study related adverse events. A collaborative process between IAVI and the RCs was undertaken to reach consensus on expected standards of care. A set of required and recommended services to be provided on-site or by referral was developed. In developing such standards, we tried to balance scientific priorities, equity, contextual realities, community expectations, and cost-effectiveness.
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Affiliation(s)
- Prince Bahati Ngongo
- International AIDS Vaccine Initiative, Country and Regional Programs, New York, USA.
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Asiki G, Mpendo J, Abaasa A, Agaba C, Nanvubya A, Nielsen L, Seeley J, Kaleebu P, Grosskurth H, Kamali A. HIV and syphilis prevalence and associated risk factors among fishing communities of Lake Victoria, Uganda. Sex Transm Infect 2011; 87:511-5. [PMID: 21835763 DOI: 10.1136/sti.2010.046805] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Recent publications suggest that fishing populations may be highly affected by the HIV epidemic. However, accurate data are scarce. The authors determined HIV and syphilis prevalence and associated risk factors in a fishing population of Lake Victoria in Uganda. METHODS 10,188 volunteers aged ≥ 13 years from a census carried out in five fishing communities between February and August 2009 were invited to attend central study clinics established in each community. After informed consent, 2005 randomly selected volunteers responded to socio-demographic and risk assessment questions, provided blood for HIV testing and 1618 volunteers were also tested for syphilis. Risk factors were analysed using logistic regression. RESULTS HIV and active syphilis (rapid plasma reagin titre ≥ 1:8) prevalences were 28.8% (95% CI 26.8 to 30.8) and 4.3% (95% CI 3.3 to 5.4), respectively, and high risk sexual behaviour was frequently reported. HIV prevalence was independently associated with female sex, increasing age, occupation (highest in fishermen), relationship to household head, self-reported genital sores and knowledge of an HIV infected partner. Alcohol consumption, syphilis and sexually transmitted infections (STIs) reported by health workers were associated with HIV in women, and genital discharge and inconsistent condom use in men. Syphilis prevalence was independently associated with age and alcohol consumption in women, and recent genital sores and sex under the influence of drugs in men. CONCLUSION This fishing population characterised by a very high HIV prevalence, high syphilis prevalence and frequently reported sexual risk behaviours, urgently needs improved STI services and targeted behavioural interventions.
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Affiliation(s)
- Gershim Asiki
- Medical Research Council(MRC)/Uganda Virus Research Institute (UVRI)--Uganda Research Unit on AIDS, Entebbe, Uganda.
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Mpendo J, Mwapasa V, Kamali A, Seeley J, Birungi J, Njai H, Ssemaganda A, de Bont J, Mebrahtu T, Nanvubya A, Asiki G, Kintu E, Moore M, Kaleebu P. P06-06. Capacity building for HIV vaccine trials in Africa through South-South collaboration. Retrovirology 2009. [PMCID: PMC2768001 DOI: 10.1186/1742-4690-6-s3-p95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Karita E, Ketter N, Price MA, Kayitenkore K, Kaleebu P, Nanvubya A, Anzala O, Jaoko W, Mutua G, Ruzagira E, Mulenga J, Sanders EJ, Mwangome M, Allen S, Bwanika A, Bahemuka U, Awuondo K, Omosa G, Farah B, Amornkul P, Birungi J, Yates S, Stoll-Johnson L, Gilmour J, Stevens G, Shutes E, Manigart O, Hughes P, Dally L, Scott J, Stevens W, Fast P, Kamali A. CLSI-derived hematology and biochemistry reference intervals for healthy adults in eastern and southern Africa. PLoS One 2009; 4:e4401. [PMID: 19197365 PMCID: PMC2632744 DOI: 10.1371/journal.pone.0004401] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 11/24/2008] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clinical laboratory reference intervals have not been established in many African countries, and non-local intervals are commonly used in clinical trials to screen and monitor adverse events (AEs) among African participants. Using laboratory reference intervals derived from other populations excludes potential trial volunteers in Africa and makes AE assessment challenging. The objective of this study was to establish clinical laboratory reference intervals for 25 hematology, immunology and biochemistry values among healthy African adults typical of those who might join a clinical trial. METHODS AND FINDINGS Equal proportions of men and women were invited to participate in a cross sectional study at seven clinical centers (Kigali, Rwanda; Masaka and Entebbe, Uganda; two in Nairobi and one in Kilifi, Kenya; and Lusaka, Zambia). All laboratories used hematology, immunology and biochemistry analyzers validated by an independent clinical laboratory. Clinical and Laboratory Standards Institute guidelines were followed to create study consensus intervals. For comparison, AE grading criteria published by the U.S. National Institute of Allergy and Infectious Diseases Division of AIDS (DAIDS) and other U.S. reference intervals were used. 2,990 potential volunteers were screened, and 2,105 (1,083 men and 1,022 women) were included in the analysis. While some significant gender and regional differences were observed, creating consensus African study intervals from the complete data was possible for 18 of the 25 analytes. Compared to reference intervals from the U.S., we found lower hematocrit and hemoglobin levels, particularly among women, lower white blood cell and neutrophil counts, and lower amylase. Both genders had elevated eosinophil counts, immunoglobulin G, total and direct bilirubin, lactate dehydrogenase and creatine phosphokinase, the latter being more pronounced among women. When graded against U.S. -derived DAIDS AE grading criteria, we observed 774 (35.3%) volunteers with grade one or higher results; 314 (14.9%) had elevated total bilirubin, and 201 (9.6%) had low neutrophil counts. These otherwise healthy volunteers would be excluded or would require special exemption to participate in many clinical trials. CONCLUSIONS To accelerate clinical trials in Africa, and to improve their scientific validity, locally appropriate reference ranges should be used. This study provides ranges that will inform inclusion criteria and evaluation of adverse events for studies in these regions of Africa.
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Affiliation(s)
| | - Nzeera Ketter
- Johnson and Johnson, New Brunswick, New Jersey, United States of America
| | - Matt A. Price
- International AIDS Vaccine Initiative - New York, New York, United States of America
| | | | | | | | - Omu Anzala
- Kenya AIDS Vaccine Initiative (KAVI), Nairobi, Kenya
| | - Walter Jaoko
- Kenya AIDS Vaccine Initiative (KAVI), Nairobi, Kenya
| | | | - Eugene Ruzagira
- MRC/UVRI Uganda Virus Research Unit on AIDS, Masaka Site, Masaka, Uganda
| | - Joseph Mulenga
- Zambia Emory HIV Research Project (ZEHRP), Lusaka, Zambia
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research-Coast (CGMRC), Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Mary Mwangome
- Centre for Geographic Medicine Research-Coast (CGMRC), Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Susan Allen
- Emory University, Atlanta, Georgia, United States of America
| | - Agnes Bwanika
- MRC/UVRI Uganda Virus Research Unit on AIDS, Masaka Site, Masaka, Uganda
| | - Ubaldo Bahemuka
- MRC/UVRI Uganda Virus Research Unit on AIDS, Masaka Site, Masaka, Uganda
| | - Ken Awuondo
- Centre for Geographic Medicine Research-Coast (CGMRC), Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Gloria Omosa
- Kenya AIDS Vaccine Initiative (KAVI), Nairobi, Kenya
| | - Bashir Farah
- Kenya AIDS Vaccine Initiative (KAVI), Nairobi, Kenya
| | - Pauli Amornkul
- International AIDS Vaccine Initiative - New York, New York, United States of America
| | - Josephine Birungi
- International AIDS Vaccine Initiative - New York, New York, United States of America
| | - Sarah Yates
- International AIDS Vaccine Initiative - New York, New York, United States of America
| | | | - Jill Gilmour
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Gwynn Stevens
- International AIDS Vaccine Initiative - New York, New York, United States of America
| | | | | | - Peter Hughes
- Uganda Virus Research Institute (UVRI), Entebbe, Uganda
| | - Len Dally
- The EMMES Corporation, Rockville, Maryland, United States of America
| | - Janet Scott
- University of Oxford, Oxford, United Kingdom
| | - Wendy Stevens
- University of the Witwatersrand, Johannesburg, South Africa and National Health Laboratory Services, Johannesburg, South Africa
| | - Pat Fast
- International AIDS Vaccine Initiative - New York, New York, United States of America
| | - Anatoli Kamali
- MRC/UVRI Uganda Virus Research Unit on AIDS, Masaka Site, Masaka, Uganda
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Jaoko W, Nakwagala FN, Anzala O, Manyonyi GO, Birungi J, Nanvubya A, Bashir F, Bhatt K, Ogutu H, Wakasiaka S, Matu L, Waruingi W, Odada J, Oyaro M, Indangasi J, Ndinya-Achola J, Konde C, Mugisha E, Fast P, Schmidt C, Gilmour J, Tarragona T, Smith C, Barin B, Dally L, Johnson B, Muluubya A, Nielsen L, Hayes P, Boaz M, Hughes P, Hanke T, McMichael A, Bwayo J, Kaleebu P. Safety and immunogenicity of recombinant low-dosage HIV-1 A vaccine candidates vectored by plasmid pTHr DNA or modified vaccinia virus Ankara (MVA) in humans in East Africa. Vaccine 2008; 26:2788-95. [PMID: 18440674 DOI: 10.1016/j.vaccine.2008.02.071] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Revised: 02/21/2008] [Accepted: 02/28/2008] [Indexed: 10/22/2022]
Abstract
The safety and immunogenicity of plasmid pTHr DNA, modified vaccinia virus Ankara (MVA) human immunodeficiency virus type 1 (HIV-1) vaccine candidates were evaluated in four Phase I clinical trials in Kenya and Uganda. Both vaccines, expressing HIV-1 subtype A gag p24/p17 and a string of CD8 T-cell epitopes (HIVA), were generally safe and well-tolerated. At the dosage levels and intervals tested, the percentage of vaccine recipients with HIV-1-specific cell-mediated immune responses, assessed by a validated ex vivo interferon gamma (IFN-gamma) ELISPOT assay and Cytokine Flow Cytometry (CFC), did not significantly differ from placebo recipients. These trials demonstrated the feasibility of conducting high-quality Phase 1 trials in Africa.
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Affiliation(s)
- Walter Jaoko
- Kenya AIDS Vaccine Initiative (KAVI), University of Nairobi, Department of Medical Microbiology, P.O. Box 19676, Nairobi 00202, Kenya.
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