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Wekiya E, Mujuzi GP, Nakiyingi J, Sanya J, Matovu M, Guido O, Nakaweesi J, Karamagi C, Nakayaga JK, Mutebi EI, Nakanjako D. The clinical utility of cystatin C based eGFR in assessing renal function among HIV/AIDs patients on ART at Mildmay Uganda. BMC Nephrol 2024; 25:144. [PMID: 38654183 PMCID: PMC11036554 DOI: 10.1186/s12882-024-03581-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/18/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND In clinical practice, Measurement of estimated glomerular filtration rates (eGFR) is the gold standard assessing renal function the glomerular filtration rate often estimated from plasma creatinine. Several studies have shown Cystatin C based eGFR (Cys C) to be a better parameter for the diagnosis of impaired renal function. Cystatin C based eGFR has been proposed as a potential renal function marker but its use in HIV&AIDS patients has not been well evaluated. METHODS A cross sectional study was carried out on 914 HIV&AIDS patients on antiretroviral therapy (ART) attending Mildmay Uganda for care and treatment between January to March 2015. Serum Cystatin C based eGFR was measured using the particle enhanced immunoturbidimetric assay. Creatinine was analyzed using enzymatic Creatinine PAP method and creatinine clearance was calculated according to C&G. RESULTS The sensitivity of Cystatin C based eGFR was 15.1% (95% CI = 8.4, 24) with specificity 99.3% (95% CI = 98- 99.7). The positive and negative predictive values were 70.0% (95% CI 45.7-88.1) and 91.2% (95% CI 98.11-92.94) respectively. The positive likelihood ratio was 18.81 and negative likelihood ratio was 0.85. Cystatin C based eGFR had diagnostic accuracy of 90.7 and area under curve was 0.768. CONCLUSION Cystatin C based eGFR exhibited a high specificity and a high positive likelihood ratio in diagnosis of kidney disease among HIV&AIDS patients. Cystatin C based eGFR can be used as a confirmatory test.
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Affiliation(s)
- Enock Wekiya
- Mildmay Uganda, P.O Box 24985, Kampala, Uganda.
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda.
| | - Godfrey P Mujuzi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | | | - Moses Matovu
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Ocung Guido
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | | | - Charles Karamagi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Joan K Nakayaga
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Edrisa I Mutebi
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Damalie Nakanjako
- College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
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Nsawotebba A, Ibanda I, Mujuni D, Nabadda S, Nadunga D, Kabugo J, Adam I, Wekiya E, Nyombi A, Nsubuga R, Ademun P, Musisi K, Kangave F, Joloba M. Impact of randomized blinded rechecking program on the performance of the AFB Microscopy Laboratory Network in Uganda: a decadal retrospective study. BMC Infect Dis 2023; 23:494. [PMID: 37495964 PMCID: PMC10373387 DOI: 10.1186/s12879-023-08406-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/19/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Smear microscopy has remained the initial diagnostic test for presumptive tuberculosis (TB) patients in health facilities without the World Health Organization (WHO) recommended rapid diagnostic tools. In the Uganda TB laboratory network, the technique remains the only tool to monitor response to treatment among drug susceptible TB patients, with the country currently having over 1,600 microscopy TB testing units. It has been evidenced that acid-fast bacilli (AFB) microscopy's yield highly depends on the staining technique and reading ability of the laboratory personnel. For the quality of TB testing in the country, the TB control program set up a Randomized Blinded Rechecking (RBRC) program in 2008 to monitor the testing performance of laboratories to continuously improve the reliability and efficiency of results. This is the first study to determine the effectiveness and impact of the RBRC program on the performance of the participating laboratories in Uganda. METHODS This was a retrospective cross-sectional study based on a record review of the RBRC's annual results compilations between January 2008 and December 2017. RESULTS Between January 2008 and December 2017, a total of 265,523 smears were re-checked during the RBRC program. The number of enrolled laboratories in the RBRC program rose from 660 to 2008 to 1,406 in 2017. The RBRC program resulted in a statistically significant reduction in microscopy errors, with false positives decreasing from 12.8% to 2008 to 7.6% in 2017, false positive errors decreasing from 10 to 6.3%, false negative errors decreasing from 2.9 to 0.7%, quantification errors decreasing from 6.0 to 1.8%, and the overall sensitivity of smear microscopy compared to the controllers increased with statistical significance from 93 to 97%. CONCLUSION The study reveals an overall significant error reduction and an improved sensitivity of smear microscopy upon continuous implementation of the RBRC program in an AFB microscopy TB laboratory network. Implementation of a RBRC program is crucial and essential to maintaining a reliable TB laboratory service that can facilitate accurate diagnosis and offset the disadvantages of using smear microscopy.
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Affiliation(s)
- Andrew Nsawotebba
- Department of National Health Laboratory and Diagnostic Services, National Health Laboratory Services, Kampala, Uganda.
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda.
| | - Ivan Ibanda
- Department of National Health Laboratory and Diagnostic Services, National Health Laboratory Services, Kampala, Uganda
- Department of Pharmacology and Pharmacotherapeutics, School of Medicine and Surgery, King Ceasor University, Kampala, Uganda
| | - Dennis Mujuni
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Susan Nabadda
- Department of National Health Laboratory and Diagnostic Services, National Health Laboratory Services, Kampala, Uganda
| | - Diana Nadunga
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Joel Kabugo
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Isa Adam
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Enock Wekiya
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Abdunoor Nyombi
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Richard Nsubuga
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Patrick Ademun
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Kenneth Musisi
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Fredrick Kangave
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
| | - Moses Joloba
- World Health Organisation Supranational Reference Laboratory - Uganda National TB Reference Laboratory, Kampala, Uganda
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University, Kampala, Uganda
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Manyame-Murwira B, Takarinda KC, Thekkur P, Payera B, Mutunzi H, Simbi R, Siziba N, Sibanda E, Banana C, Muleya N, Makombe E, Jongwe PL, Bhebhe R, Mangwanya D, Dzangare J, Mudzengerere FH, Timire C, Wekiya E, Sandy C. Prevalence, risk factors and treatment outcomes of isoniazid resistant TB in Bulawayo city, Zimbabwe: A cohort study. J Infect Dev Ctries 2020; 14:893-900. [PMID: 32903234 PMCID: PMC8655986 DOI: 10.3855/jidc.12319] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 12/15/2019] [Accepted: 03/13/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction: The isoniazid-resistant TB poses a threat to TB control efforts. Zimbabwe, one of the high TB burden countries, has not explored the burden of isoniazid resistant TB. Hence among all bacteriologically-confirmed TB patients diagnosed in Bulawayo City during March 2017 and December 2018, we aimed to assess the proportion with isoniazid resistant TB and associated factors. Also, we aimed to describe the TB treatment outcomes. Methodology: A cohort study involving routinely collected data by the National TB Reference Laboratory (NTBRL) in Bulawayo City and National TB programme of Zimbabwe. The percentage with 95% confidence interval (CI) was used to express the proportion with isoniazid-resistant TB. The modified Poisson regression was used to assess the association of demographic and clinical characteristics with isoniazid mono-resistant TB. Results: Of 2160 bacteriologically-confirmed TB patients, 1612 (74.6%) had their sputum received at the NTBRL and 743 (46.1%) had culture growth. Among those with culture growth, 34 (4.6%, 95% CI: 3.5–6.7) had isoniazid mono-resistant TB, 25 (3.3%, 95% CI: 2.2–4.9) had MDR-TB. Thus, 59 (7.9%, 95% CI: 6.1–10.1) had isoniazid-resistant TB. Children < 15 years had a higher prevalence of isoniazid mono-resistant TB (aPR= 3.93; 95% CI: 1.24–12.45). Among those with rifampicin sensitive TB, patients with isoniazid-sensitive TB had higher favourable treatment outcomes compared to those with isoniazid-resistant TB (86.3% versus 75.5%, p = 0.039). Conclusions: The prevalence of isoniazid-resistant TB was low compared to neighbouring countries with high burden of TB-HIV. However, Zimbabwe should consider reviewing treatment guidelines for isoniazid mono-resistant TB due to the observed poor treatment outcomes.
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Affiliation(s)
- Barbara Manyame-Murwira
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | | | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
| | - Bright Payera
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | - Herbert Mutunzi
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Raiva Simbi
- Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Nicholas Siziba
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Edwin Sibanda
- Department of Health, Bulawayo City Council, Zimbabwe.
| | | | - Norbert Muleya
- Department of Environmental Health Services, Ministry of Health and Childcare, Matebeleland South, Zimbabwe.
| | - Evidence Makombe
- Department of laboratory Services, Ministry of Health and Childcare, Midlands Province, Zimbabwe.
| | - Paula Littia Jongwe
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | - Regina Bhebhe
- National Tuberculosis Reference Laboratory, Ministry of Health and Child Care, Bulawayo, Zimbabwe.
| | - Douglas Mangwanya
- Department of Laboratory Services, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Janet Dzangare
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | | | - Collins Timire
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
| | - Enock Wekiya
- WHO Supra National Reference Laboratory/National Tuberculosis Reference Laboratory, Uganda.
| | - Charles Sandy
- AIDS and TB Department, Ministry of Health and Child Care, Harare, Zimbabwe.
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