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Nizeyimana G, Vudriko P, Erume J, Mubiru F, Eneku W, Biryomumaisho S, Mwebe R, Arinaitwe E, Ademun R, Atim S, Ayebazibwe C, Muhanguzi D, Tweyongyere R. Spatio-temporal analysis of sheep and goat pox outbreaks in Uganda during 2011-2022. BMC Vet Res 2023; 19:224. [PMID: 37891597 PMCID: PMC10612334 DOI: 10.1186/s12917-023-03788-w] [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: 11/22/2022] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Sheep and goat pox (SGP) caused by sheep poxvirus (SPV) and goat poxvirus (GPV) respectively; are transboundary and World Organisation for Animal Health (WOAH)-notifiable viral diseases. There is barely any coherent information about the distribution and prevalence of SGP for Uganda. We therefore conducted this study to describe the temporal and spatial distribution of SGP suspected outbreaks in Uganda for the period 2011-2020 as well as serologically confirm presence of SGP antibodies in suspected SGP outbreaks reported in 2021-2022. RESULTS Thirty-seven [37] SGP outbreaks were reported across the country during the study period. North-eastern region [that comprises of Karamoja region] had the highest number of outbreaks [n = 17, 45%]; followed by Central [n = 9, 2.4%], Northern [n = 8, 2.2%] and Western region [n = 3, 0.08%]. Reports from district veterinary personnel indicate that the prevalence of; and mortality rate and case fatality rate associated with SGP were 0.06%, 0.02% and 32% respectively. There was a steady increase in the number of reported SGP outbreaks [x̄ = 4] over the study period. Seropositivity of SGPV antibodies in outbreak sheep and goats that were investigated during the study period [2021-2022] was [n = 41, 27%, 95 CI;] CONCLUSION: Our analyses of SGPV passive and active reports indicate that SGP is present in Uganda with a decade long average of four outbreaks per annum. During this period, about a third of all SGPV-clinically infected animals died. SPG is therefore a major constraint to small ruminant health and productivity in Uganda. Introduction of animals from infected herds and breach in farm biosecurity were the most important predictors of SGP outbreaks. In addition to the already existing SGP commercial vaccines, small ruminant screening for SGPV before introducing them to naïve herds and ensuring on farm biosecurity should be part of the SGP control tool pack for Ugandan small ruminant farmers.
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Affiliation(s)
- Gerald Nizeyimana
- Department of Pharmacy Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Patrick Vudriko
- Department of Pharmacy Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Joseph Erume
- Department of Bimolecular and Bio Lab Sciences, School of Biosecurity, Biotechnology and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Frank Mubiru
- Emergency Centre for Transboundary Animal Diseases, Food and Agriculture Organisation of the United Nations, Kampala, Uganda
| | - Wilfred Eneku
- Department of Pharmacy Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Savino Biryomumaisho
- Department of Pharmacy Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Robert Mwebe
- National Animal Disease Diagnostics and Epidemiology Centre, Directorate of Animal Resources, Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Eugene Arinaitwe
- National Animal Disease Diagnostics and Epidemiology Centre, Directorate of Animal Resources, Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Rose Ademun
- National Animal Disease Diagnostics and Epidemiology Centre, Directorate of Animal Resources, Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Stella Atim
- National Animal Disease Diagnostics and Epidemiology Centre, Directorate of Animal Resources, Ministry of Agriculture, Animal Industry and Fisheries, Entebbe, Uganda
| | - Chrisostom Ayebazibwe
- Emergency Centre for Transboundary Animal Diseases, Food and Agriculture Organisation of the United Nations, Kampala, Uganda
| | - Dennis Muhanguzi
- Department of Bimolecular and Bio Lab Sciences, School of Biosecurity, Biotechnology and Laboratory Sciences, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Robert Tweyongyere
- Department of Pharmacy Clinical and Comparative Medicine, School of Veterinary Medicine and Animal Resources, College of Veterinary Medicine Animal Resources and Biosecurity, Makerere University, Kampala, Uganda.
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Gumisiriza N, Kugler M, Brusselaers N, Mubiru F, Anguzu R, Ningwa A, Ogwang R, Akun P, Mwaka AD, Abbo C, Sekibira R, Hotterbeekx A, Colebunders R, Marsh K, Idro R. Risk Factors for Nodding Syndrome and Other Forms of Epilepsy in Northern Uganda: A Case-Control Study. Pathogens 2021; 10:pathogens10111451. [PMID: 34832607 PMCID: PMC8621683 DOI: 10.3390/pathogens10111451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 11/26/2022] Open
Abstract
Epidemiological studies suggest a link between onchocerciasis and various forms of epilepsy, including nodding syndrome (NS). The aetiopathology of onchocerciasis associated epilepsy remains unknown. This case-control study investigated potential risk factors that may lead to NS and other forms of non-nodding epilepsy (OFE) in northern Uganda. We consecutively recruited 154 persons with NS (aged between 8 and 20 years), and age-frequency matched them with 154 with OFE and 154 healthy community controls. Participants’ socio-demography, medical, family, and migration histories were recorded. We tested participants for O. volvulus serum antibodies. The 154 controls were used for both OFE and NS separately to determine associations. We recruited 462 people with a median age of 15 years (IQR 14, 17); 260 (56.4%) were males. Independent risk factors associated with the development of NS were the presence of O. volvulus antibodies [aOR 8.79, 95% CI (4.15–18.65), p-value < 0.001] and preterm birth [aOR 2.54, 95% CI (1.02–6.33), p-value = 0.046]. Risk factors for developing OFE were the presence of O. volvulus antibodies [aOR 8.83, 95% CI (4.48–17.86), p-value < 0.001] and being born in the period before migration to IDP camps [aOR 4.28, 95% CI (1.20–15.15), p-value = 0.024]. In conclusion, O. volvulus seropositivity was a risk factor to develop NS and OFE; premature birth was a potential co-factor. Living in IDP camps was not a risk factor for developing NS or OFE.
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Affiliation(s)
- Nolbert Gumisiriza
- Department of Mental Health, Kabale University School of Medicine, Kabale P.O. Box 317, Uganda;
| | - Marina Kugler
- Global Health Institute, University of Antwerp, 2600 Antwerp, Belgium; (M.K.); (N.B.); (A.H.); (R.C.)
| | - Nele Brusselaers
- Global Health Institute, University of Antwerp, 2600 Antwerp, Belgium; (M.K.); (N.B.); (A.H.); (R.C.)
- Centre for Translational Microbiome Research, Karolinska Institute, 17177 Stockholm, Sweden
| | - Frank Mubiru
- Department of Statistical methods, School of Statistics and Planning, College of Business and Management Sciences, Makerere University, Kampala P.O. Box 7062, Uganda;
| | - Ronald Anguzu
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
- Division of Epidemiology, Institute for Health and Equity, Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Albert Ningwa
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
- Centre of Tropical Neuroscience, Kitgum Site, Kampala P.O. Box 27520, Uganda
| | - Rodney Ogwang
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
- Centre of Tropical Neuroscience, Kitgum Site, Kampala P.O. Box 27520, Uganda
- KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Coast, Kilifi P.O. Box 230-80108, Kenya
| | - Pamela Akun
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
- Centre of Tropical Neuroscience, Kitgum Site, Kampala P.O. Box 27520, Uganda
| | - Amos Deogratius Mwaka
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
| | - Catherine Abbo
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
| | - Rogers Sekibira
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
| | - An Hotterbeekx
- Global Health Institute, University of Antwerp, 2600 Antwerp, Belgium; (M.K.); (N.B.); (A.H.); (R.C.)
| | - Robert Colebunders
- Global Health Institute, University of Antwerp, 2600 Antwerp, Belgium; (M.K.); (N.B.); (A.H.); (R.C.)
| | - Kevin Marsh
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK;
| | - Richard Idro
- College of Health Sciences, Makerere University, Kampala P.O. Box 7072, Uganda; (R.A.); (A.N.); (R.O.); (P.A.); (A.D.M.); (C.A.); (R.S.)
- Centre of Tropical Neuroscience, Kitgum Site, Kampala P.O. Box 27520, Uganda
- Centre for Tropical Medicine and Global Health, University of Oxford, Oxford OX3 7LG, UK;
- Correspondence: author: ; Tel.: +256-774274173
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Nakiyingi L, Bwanika JM, Ssengooba W, Mubiru F, Nakanjako D, Joloba ML, Mayanja-Kizza H, Manabe YC. Chest X-ray interpretation does not complement Xpert MTB/RIF in diagnosis of smear-negative pulmonary tuberculosis among TB-HIV co-infected adults in a resource-limited setting. BMC Infect Dis 2021; 21:63. [PMID: 33435896 PMCID: PMC7805204 DOI: 10.1186/s12879-020-05752-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 09/26/2020] [Accepted: 12/27/2020] [Indexed: 12/22/2022] Open
Abstract
Background Chest X-ray (CXR) interpretation remains a central component of the current World Health Organization recommendations as an adjuvant test in diagnosis of smear-negative tuberculosis (TB). With its low specificity, high maintenance and operational costs, utility of CXR in diagnosis of smear-negative TB in high HIV/TB burden settings in the Xpert MTB/RIF era remains unpredictable. We evaluated accuracy and additive value of CXR to Xpert MTB/RIF in the diagnosis of TB among HIV-positive smear-negative presumptive TB patients. Methods HIV co-infected presumptive TB patients were recruited from the Infectious Diseases Institute outpatient clinic and in-patient medical wards of Mulago Hospital, Uganda. CXR films were reviewed by two independent radiologists using a standardized evaluation form. CXR interpretation with regard to TB was either positive (consistent with TB) or negative (normal or unlikely TB). Sensitivity, specificity and predictive values of CXR and CXR combined with Xpert MTB/RIF for diagnosis of smear-negative TB in HIV-positive patients were calculated using sputum and/or blood mycobacterial culture as reference standard. Results Three hundred sixty-six HIV co-infected smear-negative participants (female, 63.4%; hospitalized, 68.3%) had technically interpretable CXR. Median (IQR) age was 32 (28–39) years and CD4 count 112 (23–308) cells/mm3. Overall, 22% (81/366) were positive for Mycobacterium tuberculosis (Mtb) on culture; 187/366 (51.1%) had CXR interpreted as consistent with TB, of which 55 (29.4%) had culture-confirmed TB. Sensitivity and specificity of CXR interpretation in diagnosis of culture-positive TB were 67.9% (95%CI 56.6–77.8) and 53.7% (95%CI 47.7–59.6) respectively, while Xpert MTB/RIF sensitivity and specificity were 65.4% (95%CI 54.0–75.7) and 95.8% (95%CI 92.8–97.8) respectively. Addition of CXR to Xpert MTB/RIF had overall sensitivity and specificity of 87.7% (95%CI 78.5–93.9) and 51.6% (95%CI 45.6–57.5) respectively; 86.2% (95%CI 75.3–93.5) and 48.1% (95%CI 40.7–55.6) among inpatients and 93.8% (95%CI 69.8–99.8) and 58.0% (95%CI 47.7–67.8) among outpatients respectively. Conclusion In this high prevalence TB/HIV setting, CXR interpretation added sensitivity to Xpert MTB/RIF test at the expense of specificity in the diagnosis of culture-positive TB in HIV-positive individuals presenting with TB symptoms and negative smear. CXR interpretation may not add diagnostic value in settings where Xpert MTB/RIF is available as a TB diagnostic tool.
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Affiliation(s)
- Lydia Nakiyingi
- Research Department, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. .,Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda.
| | - John Mark Bwanika
- Research Department, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Willy Ssengooba
- Department of Medical Microbiology and Immunology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Frank Mubiru
- Research Department, Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses L Joloba
- Department of Medical Microbiology and Immunology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Harriet Mayanja-Kizza
- Department of Medicine, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yukari C Manabe
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Gumisiriza N, Kaiser C, Asaba G, Onen H, Mubiru F, Kisembo D, Siewe Fodjo JN, Colebunders R. Changes in epilepsy burden after onchocerciasis elimination in a hyperendemic focus of western Uganda: a comparison of two population-based, cross-sectional studies. Lancet Infect Dis 2020; 20:1315-1323. [PMID: 32598869 DOI: 10.1016/s1473-3099(20)30122-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 01/13/2020] [Accepted: 02/13/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In 1994, prevalence and incidence of epilepsy were high in the Itwara onchocerciasis focus (western Uganda), and cases of nodding and Nakalanga syndrome were documented. Onchocerciasis transmission was interrupted successfully in 2001. 17 years later, we re-investigated the epilepsy burden in this area. METHODS From Dec 11 to Dec 15, 2018, a door-to-door survey was done in the three villages (Kabende Centre, Masongora South, and Rwesenene) with the highest epilepsy rates in 1994 to identify people with suspected epilepsy. Epilepsy diagnoses were confirmed by an interview and physical examination by a study clinician. The prevalence and incidence of epilepsy were measured using methods consistent with those used in 1994. Results from 2018 were compared with those from 1994. FINDINGS The overall crude prevalence of epilepsy in the study villages decreased from 3·0% (35 of 1169) in 1994 to 1·2% (27 of 2325) in 2018 (p=0·0002), with a concomitant decrease in the proportion of people with epilepsy with unknown cause (p=0·037). Between 1994 and 2018, the overall incidence of epilepsy decreased from 418 cases per 100 000 person-years (95% CI 265-626) to 73 new cases per 100 000 person-years (32-114; p<0·0001); this reduction was more pronounced for cases having the first seizure between ages 3 years and 18 years (p<0·0001). No new case of nodding or Nakalanga syndromes had occurred since the interruption of onchocerciasis transmission. INTERPRETATION Our findings support the existence of a negative association between onchocerciasis elimination and epilepsy burden in previously hyperendemic areas. Therefore, onchocerciasis elimination efforts should be intensified in endemic regions with a high prevalence of epilepsy, which might reduce the burden of epilepsy. FUNDING Flemish University Development Cooperation and the European Research Council.
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Affiliation(s)
| | | | - George Asaba
- Department of Pediatrics, Regional Referral Hospital, Fort Portal, Uganda
| | - Henry Onen
- Infectious Disease Institute, Makerere University, Kampala, Uganda
| | - Frank Mubiru
- Infectious Disease Institute, Makerere University, Kampala, Uganda
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Siewe Fodjo JN, Mubiru F, Ukaga C, Logora MY, Mmbando BP, Mandro M, Njamnshi AK, Colebunders R. Low ivermectin use among 5- to 6-year-old children: observations from door-to-door surveys in onchocerciasis-endemic regions in Africa. Int Health 2020; 12:72-75. [PMID: 31251354 PMCID: PMC6964214 DOI: 10.1093/inthealth/ihz044] [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: 03/18/2019] [Revised: 05/02/2019] [Accepted: 06/06/2019] [Indexed: 12/03/2022] Open
Abstract
During door-to-door surveys in onchocerciasis-endemic regions in Africa, the age-specific ivermectin coverage in 29 722 individuals was assessed. Children 5–6 y of age had significantly lower coverage compared with older participants. Insufficient ivermectin intake among young children could prolong onchocerciasis elimination prospects, as they may serve as human reservoirs of Onchocerca volvulus; moreover, it increases the risk of developing onchocerciasis-associated epilepsy (OAE). The causes of the low ivermectin coverage observed among children 5–6 y of age need to be explored. Integrating ivermectin distribution into chemoprophylaxis strategies for other neglected diseases could increase coverage in a cost-effective manner.
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Affiliation(s)
- J N Siewe Fodjo
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium
| | - F Mubiru
- Infectious Disease Institute, Makerere University, P.O. Box 22418, Kampala, Uganda
| | - C Ukaga
- Imo State University, PMB 2000, Okigwe Rd, Ugwu Orji, Owerri, Nigeria
| | - M Y Logora
- Neglected Tropical Diseases Unit, Ministry of Health, Ministry of Health Ministerial Complex, P.O. Box 88, Juba, South Sudan
| | - B P Mmbando
- National Institute for Medical Research, Tanga Center, P.O. Box 5004, Tanga, Tanzania
| | - M Mandro
- Provincial Health Division Ituri, Ministry of Health, P.O. Box 185, Bunia, Democratic Republic of Congo
| | - A K Njamnshi
- Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Cameroon & Brain Research Africa Initiative (BRAIN), P. O. Box 87, Yaounde, Cameroon
| | - R Colebunders
- Global Health Institute, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Antwerp, Belgium
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Lamorde M, Atwiine M, Owarwo NC, Ddungu A, Laker EO, Mubiru F, Kiragga A, Lwanga IB, Castelnuovo B. Dolutegravir-associated hyperglycaemia in patients with HIV. Lancet HIV 2020; 7:e461-e462. [PMID: 32105626 DOI: 10.1016/s2352-3018(20)30042-4] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 01/24/2020] [Accepted: 02/04/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Mohammed Lamorde
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda.
| | - Martha Atwiine
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
| | - Noela C Owarwo
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
| | - Ahmed Ddungu
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
| | - Eva O Laker
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
| | - Isaac B Lwanga
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University College of Health Sciences, PO Box 22418, Kampala, Uganda
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Castelnuovo B, Mubiru F, Kalule I, Kiragga A. Reasons for first line ART modification over the years during the ART scale up in Uganda. AIDS Res Ther 2019; 16:31. [PMID: 31597561 PMCID: PMC6785877 DOI: 10.1186/s12981-019-0246-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/28/2019] [Indexed: 12/13/2022] Open
Abstract
Background During the initial scale up of ART in sub-Saharan Africa, prescribed regimens included drugs with high potential for toxicity (particularly stavudine). More recently a growing number of patients requires second line treatment due to treatment failure, especially following the expansion of viral load testing. We aim to determine the reasons and risk factors for modification of first line ART across the years. Methods We included patients started on standard first line ART (2NRTI + 1 NNRTI) between 2005 and 2016 at the Infectious Diseases Institute, Kampala, Uganda. We described the reasons for treatment modification categorized in (1) toxicity (2) treatment failure (3) other reason (new TB treatment, new pregnancy). We used Cox proportional hazard to identify factors associated with treatment modification due to toxicity. Results We included 14,261 patients; 9114 (63.9%), were female, the median age was 34 years (IQR: 29–40), 60.8% were in WHO stage 3 and 4. The median BMI and CD4 count were 21.9 (IQR: 19.6–24.8) and 188 cell/µL (IQR: 65–353) respectively; 27.5% were started on stavudine, 46% on zidovudine, and 26.5% on a tenofovir containing regimens. We observed 6248 ART modifications in 4868/14,261 patients (34.1%); 1615 were due to toxicity, 1077 to treatment failure, 1330 to contraindications, and 1860 patients following WHO recommendation of phasing out stavudine and substituting with another NRTI. Modification for drug toxicity declined rapidly after the phase out of stavudine (2008), while switches to second line regimes increased after the implementation of viral load monitoring (2015). Patients with normal BMI compared to underweight, (HR: 0.79, CI 0.69–0.91), with CD4 counts 200–350 cells/µL compared to < 200 cells/µL (HR: 0.81− CI 0.71–0.93), and started on zidovudine (HR: 0.51 CI 0.44–0.59) and tenofovir (HR: 0.16, CI 0.14–0.22) compared to stavudine were less likely to have ART modification due to toxicity. Older patients (HR: 1.14 per 5-year increase CI 1.11–1.18), those in WHO stage 3 and 4 (HR: 1.19, CI 1.06–1.34) were more likely to have ART modification due to toxicity. Conclusions Toxicity as reason for drugs substitution decreased over time mirroring the phase out of stavudine, while viral load expansion identified more patients in need of second line treatment.
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Nakalembe M, Makanga P, Mubiru F, Swanson M, Martin J, Huchko M. Prevalence, correlates, and predictive value of high-risk human papillomavirus mRNA detection in a community-based cervical cancer screening program in western Uganda. Infect Agent Cancer 2019; 14:14. [PMID: 31114629 PMCID: PMC6515623 DOI: 10.1186/s13027-019-0230-0] [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: 02/27/2019] [Accepted: 05/07/2019] [Indexed: 12/26/2022] Open
Abstract
Background New strategies are needed to combat the high incidence of cervical cancer in resource-limited settings such as sub-Saharan Africa. Screening for high-risk human papillomavirus (hrHPV) DNA is sensitive for pre-cancer, but its lack of specificity results in substantial overtreatment in low resource settings where additional testing (e.g., colposcopy) is rarely available. Testing for hrHPV E6/E7 mRNA may enhance specificity, but little is known about its performance characteristics in resource-limited settings. Methods In a series of community health fairs in rural Uganda, women aged 25 to 49 years provided self-collected vaginal samples, which were tested for hrHPV (types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68) E6/E7 mRNA with the Aptima® assay. Positive specimens underwent testing for HPV-16 and 18/45. After excluding pregnant women, all women testing positive for any hrHPV subsequently were offered cervical biopsy to determine pathology. Results A total of 1892 women provided a vaginal sample for hrHPV testing during 24 health fairs. The median age was 34 years, HIV prevalence was 10, and 95% had not been previously screened. Prevalence of any hrHPV E6/E7 mRNA was 21% (95% confidence interval (CI): 19 to 23%); the prevalence of HPV-16 was 2.6%, HPV-18/45 1.9%, and HPV 16 and 18/45 were jointly found in 0.1% of the study population. Younger age, pregnancy and HIV-positivity were independently associated with any hrHPV infection. Of the 255 evaluable cervical biopsies, the positive predictive value of detecting any hrHPV E6/E7 mRNA for presence of cervical intraepithelial neoplasia grade 2 or higher ("CIN 2+") was 8.2% (95% CI: 5.1 to 12%). The positive predictive value associated with detection of HPV-16 mRNA (15%) or HPV-18/45 mRNA (15%) was only slightly higher. Conclusion Among community-based women in Uganda, the prevalence of any hrHPV E6/E7 mRNA in vaginal samples was high, but the prevalence of the most oncogenic HPV types (16, 18, or 45) was substantially lower. Positive predictive value of hrHPV mRNA-positivity for CIN 2+ was also low, including when restricting to HPV 16/18/45-positivity. The findings emphasize the need to identify more specific screening approaches for cervical cancer.
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Affiliation(s)
- Miriam Nakalembe
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Philippa Makanga
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Frank Mubiru
- 1Department of Obstetrics and Gynecology, Infectious Diseases Institute, Makerere University Kampala, Kampala, Uganda
| | - Megan Swanson
- Department of Obstetrics and Gynecology, University of California, San Francisco, Uganda
| | - Jeffrey Martin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, Uganda
| | - Megan Huchko
- 4Department of Obstetrics and Gynecology, Global Health Institute, Duke University, Durham, North Carolina USA
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9
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Castelnuovo B, Mubiru F, Nakalema S, Twimukye A, Kiragga A. Describing the retention in care of human immunodeficiency virus-positive young adults who transition from adolescent to adult care. Int Health 2019; 10:318-320. [PMID: 29401288 DOI: 10.1093/inthealth/ihx063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Accepted: 11/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background There is a high rate of lost to programme (LTP) in human immunodeficiency virus (HIV)-positive young adults transitioning from paediatric/adolescent to adult care. Methods We describe and identify risk factors for LTP in all patients 18-23 y of age at the Infectious Diseases Institute (Kampala, Uganda) from 2010 to 2014. Results A total of 260 of 907 young adults (28.6%) became LTP. Among those on antiretroviral treatment, 39.3% became LTP. We found that the only risk factor associated with LTP was being in World Health Organization stage 3 or 4. Conclusion There is a need for tracing studies to evaluate the true vital status of LTP in this group.
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Affiliation(s)
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Shadia Nakalema
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | | | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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10
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Kiragga AN, Mubiru F, Kambugu AD, Kamya MR, Castelnuovo B. A decade of antiretroviral therapy in Uganda: what are the emerging causes of death? BMC Infect Dis 2019; 19:77. [PMID: 30665434 PMCID: PMC6341568 DOI: 10.1186/s12879-019-3724-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/14/2019] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The roll out of antiretroviral therapy (ART) in Sub-Saharan Africa led to a decrease in mortality. Few studies have documented the causes of deaths among patients on long term antiretroviral therapy in Sub-Saharan Africa. Our objective was to describe the causes of death among patients on long term ART in Sub-Saharan Africa. METHODS We used data from a prospective cohort of ART naïve patients receiving care and treatment at the Infectious Diseases Institute in Kampala, Uganda. Patients were followed up for 10 years. All deaths were recorded and possible causes established using verbal autopsy. Deaths were grouped as HIV-related (ART toxicities, any opportunistic infections (OIs) and HIV-related malignancies) and non-HIV related deaths while some remained unknown. We used Kaplan Meier survival methods to estimate cumulative incidence and rates of mortality for all causes of death. RESULTS Of the 559, (386, 69%) were female, median age 36 years (IQR: 21-44), 89% had WHO clinical stages 3 and 4, and median CD4 count at ART initiation was 98 cells/μL (IQR: 21-163). A total of 127 (22.7%) deaths occurred in 10 years. The HIV related causes of death (n = 70) included the following; Tuberculosis 17 (24.3%), Cryptococcal meningitis 10 (15.7%), Kaposi's Sarcoma 7(10%), HIV related toxicity 6 (8.6%), HIV related anemia 5(7.1%), Pneumocystis carinii Pneumonia (PCP) 5 (7.1%), HIV related chronic diarrhea 4 (5.7%), Non-Hodgkin Lymphoma 3 (4.3%), Herpes Zoster 2 (2.8%), other 10 (14.3%). The non-HIV related causes of death (n = 20) included non-communicable diseases (diabetes, hypertension, stroke) 6 (30%), malaria 3 (15%), pregnancy-related death 2 (10%), cervical cancer 2 (10%), trauma 1(5%) and others 6 (30%). CONCLUSION Despite the higher rates of deaths from OIs in the early years of ART initiation, we observed an emergence of non-HIV related causes of morbidity and mortality. It is recommended that HIV programs in resource-limited settings start planning for screening and treatment of non-communicable diseases.
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Affiliation(s)
- Agnes N. Kiragga
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Frank Mubiru
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew D. Kambugu
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Research Department, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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11
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Ibanda HA, Mubiru F, Musiba R, Itaya S, Craig J, Young M, Waako P. Adjunctive moxibustion treatment for tuberculosis: A randomised clinical trial investigating potential efficacy and comparative safety. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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12
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Castelnuovo B, Mubiru F, Kiragga AN, Musomba R, Mbabazi O, Gonza P, Kambugu A, Ratanshi RP. Antiretroviral treatment Long-Term (ALT) cohort: a prospective cohort of 10 years of ART-experienced patients in Uganda. BMJ Open 2018; 8:e015490. [PMID: 29467129 PMCID: PMC5855467 DOI: 10.1136/bmjopen-2016-015490] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 11/26/2022] Open
Abstract
PURPOSE Little information is available on patients on antiretroviral treatment (ART) after a long-term period from sub-Saharan Africa, with the longest follow-up and related outcomes being after 10 years on ART. At the Infectious Diseases Institute (IDI) (Kampala, Uganda), we set up a cohort of patients already on ART for 10 years at the time of enrolment, who will be followed up for additional 10 years. PARTICIPANTS A prospective observational cohort of 1000 adult patients previously on ART for 10 years was enrolled between May 2014 and September 2015. Patients were eligible for enrolment if they were in their consecutive 10th year of ART regardless of the combination of drugs for both first- and second-line ART. Data were collected at enrolment and all annual study visits. Follow-up visits are scheduled once a year for 10 years. Biological samples (packed cells, plasma and serum) are stored at enrolment and follow-up visits. FINDINGS TO DATE Out of 1000 patients enrolled, 345 (34.5%) originate from a pre-existing research cohort at IDI, while 655 (65.5%) were enrolled from the routine clinic. Overall, 81% of the patients were on first line at the time of the enrolment in the ART long-term cohort, with the more frequent regimen being zidovudine plus lamivudine plus nevirapine (44% of the cohort), followed by zidovudine plus lamivudine plus efavirenz (22%) and tenofovir plus lamivudine or emtricitabine plus efavirenz (10%). At cohort enrolment, viral suppression was defined as HIV-RNA <400 copies/mL was 95.8%. FUTURE PLANS Through collaboration with other institutions, we are planning several substudies, including the evaluation of the risk for cardiovascular diseases, the assessment of bone mineral density, screening for liver cirrhosis using fibroscan technology and investigation of drug-drug interactions between ART and common drugs used for non-communicable diseases.
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Affiliation(s)
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Agnes N Kiragga
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Rachel Musomba
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Olive Mbabazi
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Paul Gonza
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University, Kampala, Uganda
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13
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Nakiyingi L, Nakanwagi P, Briggs J, Agaba T, Mubiru F, Mugenyi M, Ssengooba W, Joloba ML, Manabe YC. Performance of loop-mediated isothermal amplification assay in the diagnosis of pulmonary tuberculosis in a high prevalence TB/HIV rural setting in Uganda. BMC Infect Dis 2018; 18:87. [PMID: 29466946 PMCID: PMC5822669 DOI: 10.1186/s12879-018-2992-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 08/13/2017] [Accepted: 02/12/2018] [Indexed: 11/10/2022] Open
Abstract
Background Smear microscopy lacks sensitivity especially in HIV co-infection, resulting in undiagnosed tuberculosis (TB) and high mortality. The loop-mediated isothermal amplification (TB-LAMP) assay can be staged with minimal infrastructure, is rapid, low cost and detection can be with the naked eye. We assessed feasibility and performance of Eiken TB-LAMP test at point-of-need in TB diagnosis in a high prevalence TB/HIV rural setting in Uganda. Methods From October 2013-February 2014, TB-LAMP testing was performed on sputum specimens from outpatient presumptive TB adults at a district hospital and two low-level health centers in Kiboga District where smear microscopy is the available routine diagnostic option. TB-LAMP was performed by a technician after a week of training in the district hospital. The technician had no prior experience in the technology. Samples from the low-level health centers were transported to the district hospital for TB-LAMP. Results Of the 233 presumptive TB (126 at hospital); 113 (48.5%) were HIV-infected; 129 (55%) male; median age 40 (IQR 30-53). Compared to MTB culture, overall sensitivity and specificity of TB-LAMP were 55.4% (95 CI 44.1-66.3) and 98.0% (95 CI 94.3-99.6) respectively. Among HIV-infected participants, TB-LAMP sensitivity and specificity were 52.3% (95 CI 36.7-67.5%) and 97.1% (95 CI 89.9-99.6) respectively; and 24.4% (95% CI 12.9-39.5) and 98.6% (95% CI 95.1-99.8) respectively among smear-negatives. TB-LAMP sensitivity and specificity were 62.2% (95% CI 44.8-77.5) and 97.8% (95% CI 92.1-99.7) in the hospital setting where central testing occurred compared to 50.0% (95% CI 34.9-65.1) and 98.4% (95% CI 91.2-100) respectively in low-level health centers where specimens were transported centrally. Conclusions In this high prevalence TB/HIV rural setting, TB-LAMP performs better than conventional smear microscopy in diagnosis of MTB among presumptive TB patients although the sensitivity is lower than that reported by the World Health Organization. TB-LAMP can easily be performed following a short training period and in absence of sophisticated infrastructure and expertise.
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Affiliation(s)
- Lydia Nakiyingi
- Infectious Diseases Institute, Makerere University College of Health Sciences, P.O. Box, 7072, Kampala, Uganda. .,Department of Medicine, School of Medicine, Makerere University College of Heath Sciences, Kampala, Uganda.
| | - Prossy Nakanwagi
- Baylor College of Medicine Children's Foundation of Uganda, Kampala, Uganda
| | - Jessica Briggs
- Division of Infectious Diseases, Department of Medicine, University of California, San Francisco, USA
| | - Tifu Agaba
- Infectious Diseases Institute, Makerere University College of Health Sciences, P.O. Box, 7072, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University College of Health Sciences, P.O. Box, 7072, Kampala, Uganda
| | - Mark Mugenyi
- National Tuberculosis and Leprosy Program, Kiboga District Hospital, Kiboga, Uganda
| | - Willy Ssengooba
- Department of Microbiology, School of Biomedical Sciences, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Moses L Joloba
- Department of Microbiology, School of Biomedical Sciences, Makerere University College of Heath Sciences, Kampala, Uganda
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University , Baltimore, USA
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14
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Buckee CO, Cardenas MIE, Corpuz J, Ghosh A, Haque F, Karim J, Mahmud AS, Maude RJ, Mensah K, Motaze NV, Nabaggala M, Metcalf CJE, Mioramalala SA, Mubiru F, Peak CM, Pramanik S, Rakotondramanga JM, Remera E, Sinha I, Sovannaroth S, Tatem AJ, Zaw W. Productive disruption: opportunities and challenges for innovation in infectious disease surveillance. BMJ Glob Health 2018. [PMID: 29527343 PMCID: PMC5841510 DOI: 10.1136/bmjgh-2017-000538] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Caroline O Buckee
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Maria I E Cardenas
- Centro de Atención y Diagnóstico de Enfermedades Infecciosas, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - June Corpuz
- Epidemiology Bureau, Department of Health of the Philippines, Manila, Philippines
| | - Arpita Ghosh
- Public Health Foundation of India, Vasant Kunj, New Delhi, India
| | - Farhana Haque
- Programme for Emerging Infections (PEI), Infectious Diseases Division (IDD), ICDDR, B, Dhaka, Bangladesh
| | - Jahirul Karim
- Disease Control Department, Directorate General of Health Services, Dhaka, Bangladesh.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ayesha S Mahmud
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Richard J Maude
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA.,Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Keitly Mensah
- Dept of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | | | - Maria Nabaggala
- Infectious Disease Institute, College of Health Sciences, Makarere University, Uganda
| | | | | | - Frank Mubiru
- Infectious Disease Institute, College of Health Sciences, Makarere University, Uganda
| | - Corey M Peak
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Santanu Pramanik
- Public Health Foundation of India, Vasant Kunj, New Delhi, India
| | | | | | - Ipsita Sinha
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Siv Sovannaroth
- Technical Bureau, National Malaria Control Program, Pnom Penh, Cambodia
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Win Zaw
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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15
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Buckee CO, Cardenas MIE, Corpuz J, Ghosh A, Haque F, Karim J, Mahmud AS, Maude RJ, Mensah K, Motaze NV, Nabaggala M, Metcalf CJE, Mioramalala SA, Mubiru F, Peak CM, Pramanik S, Rakotondramanga JM, Remera E, Sinha I, Sovannaroth S, Tatem AJ, Zaw W. Productive disruption: opportunities and challenges for innovation in infectious disease surveillance. BMJ Glob Health 2018; 3:e000538. [PMID: 29527343 DOI: 10.1136/bmjgh-2017-00053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/16/2017] [Accepted: 11/17/2017] [Indexed: 05/27/2023] Open
Affiliation(s)
- Caroline O Buckee
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Maria I E Cardenas
- Centro de Atención y Diagnóstico de Enfermedades Infecciosas, Universidad Industrial de Santander, Bucaramanga, Colombia
| | - June Corpuz
- Epidemiology Bureau, Department of Health of the Philippines, Manila, Philippines
| | - Arpita Ghosh
- Public Health Foundation of India, Vasant Kunj, New Delhi, India
| | - Farhana Haque
- Programme for Emerging Infections (PEI), Infectious Diseases Division (IDD), ICDDR, B, Dhaka, Bangladesh
| | - Jahirul Karim
- Disease Control Department, Directorate General of Health Services, Dhaka, Bangladesh
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Ayesha S Mahmud
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Richard J Maude
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Keitly Mensah
- Dept of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | | | - Maria Nabaggala
- Infectious Disease Institute, College of Health Sciences, Makarere University, Uganda
| | | | | | - Frank Mubiru
- Infectious Disease Institute, College of Health Sciences, Makarere University, Uganda
| | - Corey M Peak
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Santanu Pramanik
- Public Health Foundation of India, Vasant Kunj, New Delhi, India
| | | | | | - Ipsita Sinha
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Siv Sovannaroth
- Technical Bureau, National Malaria Control Program, Pnom Penh, Cambodia
| | - Andrew J Tatem
- WorldPop, Department of Geography and Environment, University of Southampton, Southampton, UK
| | - Win Zaw
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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16
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Flynn AG, Anguzu G, Mubiru F, Kiragga AN, Kamya M, Meya DB, Boulware DR, Kambugu A, Castelnuovo BC. Socioeconomic position and ten-year survival and virologic outcomes in a Ugandan HIV cohort receiving antiretroviral therapy. PLoS One 2017; 12:e0189055. [PMID: 29244807 PMCID: PMC5731768 DOI: 10.1371/journal.pone.0189055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 01/26/2017] [Accepted: 11/18/2017] [Indexed: 11/18/2022] Open
Abstract
Lifelong ART is essential to reducing HIV mortality and ending the epidemic, however the interplay between socioeconomic position and long-term outcomes of HIV-infected persons receiving antiretroviral therapy (ART) in sub-Saharan Africa is unknown. Furthering the understanding of factors related to long-term ART outcomes in this important region will aid the successful scale-up of ART programs. We enrolled 559 HIV-infected Ugandan adults starting ART in 2004-2005 at the Infectious Diseases Institute in Kampala, Uganda and followed them for 10 years. We documented baseline employment status, regular household income, education level, housing description, physical ability, and CD4 count. Viral load was measured every six months. Proportional hazard regression tested for associations between baseline characteristics and 1) mortality, 2) virologic failure, and 3) mortality or virologic failure as a composite outcome. Over ten years 23% (n = 127) of participants died, 6% (n = 31) were lost-to-follow-up and 23% (107/472) experienced virologic treatment failure. In Kaplan-Meier analysis we observed an association between employment and mortality, with the highest cumulative probability of death occurring in unemployed individuals. In univariate analysis unemployment and disease severity were associated with mortality, but in multivariable analysis the only association with mortality was disease severity. We observed an association between higher household income and an increased incidence of both virologic failure and the combined outcome, and an association between self-employment and lower incidence of virologic failure and the combined outcome when compared to unemployment. Formal education level and housing status were unrelated to outcomes. It is feasible to achieve good ten-year survival, retention-in-care, and viral suppression in a socioeconomically diverse population in a resource-limited setting. Unemployment appears to be related to adverse 10-year ART outcomes. A low level of formal education does not appear to be a barrier to successful long-term ART.
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Affiliation(s)
| | | | | | | | - Moses Kamya
- School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David B. Meya
- Infectious Diseases Institute, Kampala, Uganda
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - David R. Boulware
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Andrew Kambugu
- Infectious Diseases Institute, Kampala, Uganda
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
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17
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Musomba R, Mubiru F, Nakalema S, Mackline H, Kalule I, Kiragga AN, Ratanshi RP, Castelnuovo B. Describing Point of Entry into Care and Being Lost to Program in a Cohort of HIV Positive Pregnant Women in a Large Urban Centre in Uganda. AIDS Res Treat 2017; 2017:3527563. [PMID: 28469942 PMCID: PMC5392405 DOI: 10.1155/2017/3527563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 01/19/2017] [Accepted: 02/19/2017] [Indexed: 11/24/2022] Open
Abstract
Introduction. We aim to describe the time of entry into care and factors associated with being lost to program (LTP) in pregnant women on Option B Plus in an integrated HIV and antenatal care (ANC) clinic in Uganda. Methods. We included all pregnant women enrolled into the integrated HIV-ANC clinic from January 2012 to 31st July 2014, while the follow up period extended up to October 30th 2015. LTP was defined as being out of care for ≥3 months. Results. Overall 856 women were included. Only 36.4% (86/236) of the women were enrolled in the first trimester. Overall 69 (8.1%) were LTP. In the multivariate analysis older women (HR: 0.80 per five-year increase, CI: 0.64-1.0, and P = 0.060) and women on ART at the time of pregnancy (0.58, CI: 0.34-0.98, and P = 0.040) were more likely not to be LTP. Among women already on ART at the time of pregnancy no factor was associated with LTP. Conclusion. Our results suggest the need for interventions to enhance prompt linkage of HIV positive women to HIV services for ART initiation and for increased retention particularly in young and ART naive women.
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Affiliation(s)
- Rachel Musomba
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Shadia Nakalema
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Hope Mackline
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Ivan Kalule
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Agnes N. Kiragga
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Rosalind Parkes Ratanshi
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
- Cambridge Institute of Public Health, Cambridge, UK
| | - Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
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18
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Castelnuovo B, Kiragga A, Musaazi J, Sempa J, Mubiru F, Wanyama J, Wandera B, Kamya MR, Kambugu A. Outcomes in a Cohort of Patients Started on Antiretroviral Treatment and Followed up for a Decade in an Urban Clinic in Uganda. PLoS One 2015; 10:e0142722. [PMID: 26642214 PMCID: PMC4671641 DOI: 10.1371/journal.pone.0142722] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/25/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Short-medium term studies from sub-Saharan Africa show that, despite high early mortality, substantial loss to program, and high rates toxicity, patients on antiretroviral treatment have achieved outcomes comparable to those in developed settings. However, these studies were unable to account for long term outcomes of patients as they stayed longer on treatment. OBJECTIVES We aim to describe ten years outcomes of one of the first cohort of HIV positive patients started on antiretroviral treatment (ART) in Sub-Saharan Africa. METHODS We report 10-years outcomes including mortality, retention, CD4-count response, virological outcomes, ART regimens change from a prospective cohort of 559 patients initiating ART and followed up for 10 years Uganda. RESULTS Of 559 patients, 69.1% were female, median age (IQR) was 38 (33-44) years, median CD4-count (IQR) 98 (21-163) cell/μL; 74% were started on stavudine, lamivudine and nevirapine, 26% on zidovudine, lamivudine and efavirenz. After 10 years 361 (65%) patients were still in the study; 127 (22.7%) had died; 30 (5%) were lost to follow-up; 27 (5%) transferred; 18 (3%) withdrew consent. The probability of death was high in the first year (0.15, 95%, CI 0.12-0.18). The median CD4 count increased from 98 to 589 cell/μL (IQR: 450-739 cell/μL) with a median increase of 357 cells/μL (IQR: 128-600 cells/μL); 7.4% never attained initial viral suppression and of those who did 31.7% experienced viral failure. Three hundred and two patients had at least one drug substitution while on first line after a median of 40 months; 66 (11.9%) of the patients were switched to a second line PI-based regimen due to confirmed treatment failure. CONCLUSIONS Despite the high rate of early mortality due to advanced disease at presentation the outcomes from this cohort are encouraging, particularly the remarkable and incremental immune-recovery and a satisfactory rate of virologic suppression.
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Affiliation(s)
- Barbara Castelnuovo
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
- * E-mail:
| | - Agnes Kiragga
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Joseph Musaazi
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Joseph Sempa
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Frank Mubiru
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Jane Wanyama
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Bonnie Wandera
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Moses Robert Kamya
- School of medicine, Makerere University, Mulago Hospital, Kampala, Uganda
| | - Andrew Kambugu
- Infectious Diseases Institute, Makerere University, Mulago Hospital, Kampala, Uganda
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Mayanja-Kizza H, Wajja A, Wu M, Peters P, Nalugwa G, Mubiru F, Aung H, Vanham G, Hirsch C, Whalen C, Ellner J, Toossi Z. Activation of β‐Chemokines and CCR5 in Persons Infected with Human Immunodeficiency Virus Type 1 and Tuberculosis. J Infect Dis 2001; 183:1801-4. [PMID: 11372034 DOI: 10.1086/320724] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 11/14/2000] [Revised: 03/09/2001] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis (TB) in human immunodeficiency virus type 1 (HIV-1)-infected persons is associated with progression of HIV-1 disease. The expression of macrophage inflammatory protein (MIP)-1alpha and CCR5 was assessed in HIV-1-infected patients with pulmonary TB (HIV-1/PTB) and without PTB (HIV-1/C), PTB patients not infected with HIV-1 (PTB), and control subjects. Mycobacterium tuberculosis (MTB)-induced MIP-1alpha production was lower in peripheral blood mononuclear cells (PBMC) of HIV-1/PTB patients than in those of PTB patients (P< .05) and was lower in PBMC of HIV-1/C patients than in those of control subjects (P< .005). However, MIP-1alpha production was higher in PBMC of HIV/PTB patients than in those of HIV-1/C patients (P< .01). The pattern of MTB-induced RANTES production was similar to that of MIP-1alpha. However, MTB induced greater expression of mRNA for CCR5 in PBMC of HIV-1/PTB patients than in those of HIV-1/C patients (P< .04). Furthermore, the MTB-induced HIV p24 antigen level in PBMC of HIV-1/PTB patients with a CD4 cell count <500 cells/microL was higher (P< .05) than that in HIV-1/C patients. Thus, perturbations in chemokine pathways in HIV-1/PTB patients may accelerate HIV-1 disease.
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Affiliation(s)
- H Mayanja-Kizza
- Department of Internal Medicine, Makerere University Medical School, Kampala, Uganda
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Mayanja-Kizza H, Johnson JL, Hirsch CS, Peters P, Surewicz K, Wu M, Nalugwa G, Mubiru F, Luzze H, Wajja A, Aung H, Ellner JJ, Whalen C, Toossi Z. Macrophage‐Activating Cytokines in Human Immununodeficiency Virus Type 1–Infected and –Uninfected Patients with Pulmonary Tuberculosis. J Infect Dis 2001; 183:1805-9. [PMID: 11372035 DOI: 10.1086/320725] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/04/2000] [Revised: 03/09/2001] [Indexed: 11/03/2022] Open
Abstract
Tuberculosis (TB) is the most common opportunistic infection in human immunodeficiency virus type 1 (HIV-1)-infected patients globally and occurs throughout the course of HIV-1 disease. Here the production of interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha by peripheral blood mononuclear cells (PBMC) of HIV-1-infected versus -uninfected patients with newly diagnosed pulmonary TB (PTB) was compared. Findings were correlated with cytokine profiles, clinical presentation, and expression of inducible nitric oxide (iNOS). Most HIV-1/PTB patients with a CD4 cell count of 200-500 cells/microL had high IFN-gamma production and radiographic evidence of atypical PTB. Low IFN-gamma production and radiographic evidence of reactivated PTB characterized both HIV-1/PTB patients with a CD4 cell count >or=500 cells/microL and HIV-1-uninfected patients. TNF-alpha levels were similar in all HIV-1/PTB patients, regardless of CD4 cell count. Induction of iNOS in PBMC was low and was associated with low IFN-gamma production. These data underscore the potential pathogenic role of macrophage-activating cytokines in TB in HIV-1-infected patients.
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Affiliation(s)
- H Mayanja-Kizza
- Department of Internal Medicine, Makerere University Medical School, Kampala, Uganda
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21
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Yoshimine H, Oishi K, Mubiru F, Nalwoga H, Takahashi H, Amano H, Ombasi P, Watanabe K, Joloba M, Aisu T, Ahmed K, Shimada M, Mugerwa R, Nagatake T. Community-acquired pneumonia in Ugandan adults: short-term parenteral ampicillin therapy for bacterial pneumonia. Am J Trop Med Hyg 2001; 64:172-7. [PMID: 11442214 DOI: 10.4269/ajtmh.2001.64.172] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A hospital-based prospective study of 99 patients with community-acquired pneumonia (CAP) was carried out in Kampala, Uganda. We evaluated microbiological etiologies, clinical features and effectiveness of short-term parenteral ampicillin followed by oral amoxicillin for these patients in relation to HIV-status. We demonstrated a very high prevalence (75%) of HIV-1 infection. No significant difference was observed with respect to age, gender, prior antibiotic usage, symptoms, laboratory data or bacterial etiology between HIV-1-infected and HIV-uninfected CAP patients. Most strains of Streptococcus pneumoniae (n = 19) and Haemophilus influenzae (n = 8) isolated from HIV-1-infected patients were penicillin-resistant (95%) and beta-lactamase producing (75%) strains, respectively. A high percentage of good clinical response was found in both HIV-1-infected (81%) and HIV-uninfected (86%) among 39 patients with CAP due to a defined bacterial pathogen. These data support the use of short-term parenteral ampicillin for patients with bacterial CAP irrespective of HIV-status.
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Affiliation(s)
- H Yoshimine
- Department of Internal Medicine and Information and Reference Center, Institute of Tropical Medicine, Nagasaki University, Japan
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Homsy J, Katabira E, Kabatesi D, Mubiru F, Kwamya L, Tusaba C, Kasolo S, Mwebe D, Ssentamu L, Okello M, King R. Evaluating herbal medicine for the management of Herpes zoster in human immunodeficiency virus-infected patients in Kampala, Uganda. J Altern Complement Med 1999; 5:553-65. [PMID: 10630349 DOI: 10.1089/acm.1999.5.553] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was carried out to evaluate the potential effectiveness of herbal treatments used for herpes zoster (HZ) by a great number of people living with acquired immunodeficiency syndrome (PLWAs) in Uganda. SETTING Kampala, Uganda. Clinics of indigenous traditional healers, at the Department of Medicine of Mulago Hospital, Makerere University, and at The AIDS Support Organization (TASO) Clinic, providing primary care to people living with HIV and AIDS. DESIGN, PATIENTS, AND PARTICIPANTS: Nonrandomized, nonplacebo controlled, observational study in two phases. Inclusion criteria included HIV seropositivity and a recent HZ attack. In phase 1, 52 patients were enrolled, treated, and followed for up to 3 months at three healers' clinics, and compared to 52 TASO Clinic controls receiving ambulatory care. Phase 2 was similar in design to phase 1, but lasted longer (6-month follow-up) and involved 154 hospital outpatients treated with herbal medicine and 55 TASO controls. In both phases, healer patients were given herbal treatment according to healers' prescriptions, while controls received either symptomatic treatment or acyclovir. RESULTS Healer patients and controls experienced similar rates of resolution of their HZ attacks. Fewer healer patients than controls experienced superinfection in phase 1 (18% versus 42%, p < 0.02) and fewer healer patients showed keloid formation in either phase. This difference was not statistically significant. In both phases, zoster-associated pain resolved substantially faster among healer patients with a higher degree of significance in phase 2 where the progression of pain over time could be seen because of the longer follow-up (phase 1: maximum p value (pmax) < pmax < 0.02 at 1 month, pmax < 0.005 at 2 months, pmax < 0.0001 at 3 months). CONCLUSION Herbal treatment is an important local and affordable primary care alternative for the management of HZ in HIV-infected patients in Uganda and similar settings.
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Affiliation(s)
- J Homsy
- Traditional and Modern Health Practitioners Together Against AIDS (THETA), Kampala, Uganda
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Kaleebu P, Cheingsong-Popov R, Callow D, Katabira E, Mubiru F, Biryahwaho B, Sempala S, Gilks C, Brindle R, Were JB. Comparative humoral responses to HIV-1 p24gag and gp120env in subjects from East Africa and the UK. AIDS 1991; 5:1015-9. [PMID: 1777160 DOI: 10.1097/00002030-199108000-00014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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] [Indexed: 12/28/2022]
Abstract
We compared 1616 sera from HIV-1-infected subjects and matched HIV-negative local controls in Uganda, Kenya and the UK. Sera were screened for specific antibody to HIV-1 p24 Gag and gp120 Env proteins and for p24 antigenaemia. In contrast to the UK, the majority of African HIV-1-infected subjects maintained detectable anti-p24 antibodies. However, lower reactivity of anti-p24 was observed in African AIDS patients, compared with those with asymptomatic HIV-1 infection. This reduction in anti-p24 reactivity with more advanced clinical stage was less marked in African HIV-1 infection than in the UK. Correspondingly, p24 antigenaemia was more common in patients with AIDS from the UK than in African patients (65 versus 4%). Reductions in anti-gp120 reactivity were observed in African AIDS patients, compared with the asymptomatic group. However, median reactivity of anti-gp120 in UK patients remained unchanged in both asymptomatic and AIDS subjects. The differences in humoral response to p24 and gp120 between Africa and the UK are semi-quantitative rather than qualitative and could be explained by initial higher antibody response to HIV-1 in African subjects.
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Affiliation(s)
- P Kaleebu
- Department of Medicine, St Mary's Hospital Medical School, London, UK
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