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Odayar J, Rusch J, Dave JA, Van Der Westhuizen DJ, Mukonda E, Lesosky M, Myer L. Transfers between health facilities of people living with diabetes attending primary health care services in the Western Cape Province of South Africa: A retrospective cohort study. Trop Med Int Health 2024. [PMID: 38514897 DOI: 10.1111/tmi.13990] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
OBJECTIVES Transfers between health facilities of people living with HIV attending primary health care (PHC) including hospital to PHC facility, PHC facility to hospital and PHC facility to PHC facility transfers occur frequently, affect health service planning, and are associated with disengagement from care and viraemia. Data on transfers among people living with diabetes attending PHC, particularly transfers between PHC facilities, are few. We assessed the transfer incidence rate of people living with diabetes attending PHC, and the association between transfers between PHC facilities and subsequent HbA1c values. METHODS We analysed data on HbA1c tests at public sector facilities in the Western Cape Province (2016-March 2020). Individuals with an HbA1c in 2016-2017 were followed-up for 27 months and included in the analysis if ≥18 years at first included HbA1c, ≥2 HbA1cs during follow-up and ≥1 HbA1c at a PHC facility. A visit interval was the duration between two consecutive HbA1cs. Successive HbA1cs at different facilities of any type indicated any transfer, and HbA1cs at different PHC facilities indicated a transfer between PHC facilities. Mixed effects logistic regression adjusted for sex, age, rural/urban facility attended at the start of the visit interval, disengagement (visit interval >14 months) and a hospital visit during follow-up assessed the association between transfers between PHC facilities and HbA1c >8%. RESULTS Among 102,813 participants, 22.6% had ≥1 transfer of any type. Including repeat transfers, there were 29,994 transfers (14.4 transfers per 100 person-years, 95% confidence interval [CI] 14.3-14.6). A total of 6996 (30.1%) of those who transferred had a transfer between PHC facilities. Visit intervals with a transfer between PHC facilities were longer (349 days, interquartile range [IQR] 211-503) than those without any transfer (330 days, IQR 182-422). The adjusted relative odds of an HbA1c ≥8% after a transfer between PHC facilities versus no transfer were 1.20 (95% CI 1.05-1.37). CONCLUSION The volume of transfers involving PHC facilities requires consideration when planning services. Individuals who transfer between PHC facilities require additional monitoring and support.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Jody Rusch
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Joel A Dave
- Division of Endocrinology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Diederick J Van Der Westhuizen
- Division of Chemical Pathology, Department of Pathology, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Service, Groote Schuur Hospital, Cape Town, South Africa
| | - Elton Mukonda
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
- Department of Clinical Medicine, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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Meghji J, Gunsaru V, Chinoko B, Joekes E, Banda NPK, Marozva N, Rylance J, Squire SB, Mortimer K, Lesosky M. Screening for post-TB lung disease at TB treatment completion: Are symptoms sufficient? PLOS Glob Public Health 2024; 4:e0002659. [PMID: 38285713 PMCID: PMC10824425 DOI: 10.1371/journal.pgph.0002659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 12/12/2023] [Indexed: 01/31/2024]
Abstract
Pulmonary TB survivors face a high burden of post-TB lung disease (PTLD) after TB treatment completion. In this secondary data analysis we investigate the performance of parameters measured at TB treatment completion in predicting morbidity over the subsequent year, to inform programmatic approaches to PTLD screening in low-resource settings. Cohort data from urban Blantyre, Malawi were used to construct regression models for five morbidity outcomes (chronic respiratory symptoms or functional limitation, ongoing health seeking, spirometry decline, self-reported financial impact of TB disease, and death) in the year after PTB treatment, using three modelling approaches: logistic regression; penalised regression with pre-selected predictors; elastic net penalised regression using the full parent dataset. Predictors included demographic, clinical, symptom, spirometry and chest x-ray variables. The predictive performance of models were examined using the area under the receiver-operator curve (ROC AUC) values. Key predictors were identified, and their positive and negative predictive values (NPV) determined. The presence of respiratory symptoms at TB treatment completion was the strongest predictor of morbidity outcomes. TB survivors reporting breathlessness had higher odds of spirometry decline (aOR 20.5, 95%CI:3-199.1), health seeking (aOR 10.2, 2.4-50), and symptoms or functional limitation at 1-year (aOR 16.7, 3.3-133.4). Those reporting activity limitation were more likely to report symptoms or functional limitation at 1-year (aOR 4.2, 1.8-10.3), or severe financial impact of TB disease (aOR2.3, 1.0-5.0). Models were not significantly improved by including spirometry or imaging parameters. ROC AUCs were between 0.65-0.77 for the morbidity outcomes. Activity limitation at treatment completion had a NPV value of 78-98% for adverse outcomes. Our data suggest that whilst challenging to predict the development of post-TB morbidity, the use of symptom screening tools at TB treatment completion to prioritise post-TB care should be explored. We identified little benefit from the additional use of spirometry or CXR imaging.
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Affiliation(s)
- Jamilah Meghji
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
| | - Vester Gunsaru
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Beatrice Chinoko
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Elizabeth Joekes
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Ndaziona P. K. Banda
- Department of Medicine, Kamuzu University of Health Sciences and Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Nicola Marozva
- Division of Epidemiology & Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Jamie Rylance
- Malawi Liverpool Wellcome Clinical Research Programme, Blantyre, Malawi
| | - Stephen B. Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Kevin Mortimer
- Department of Respiratory Medicine, Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Maia Lesosky
- National Heart & Lung Institute, Imperial College London, London, United Kingdom
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3
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Katoto PDMC, Bihehe D, Brand A, Mushi R, Kusinza A, Alwood BW, van Zyl-Smit RN, Tamuzi JL, Sam-Agudu NA, Yotebieng M, Metcalfe J, Theron G, Godri Pollitt KJ, Lesosky M, Vanoirbeek J, Mortimer K, Nawrot T, Nemery B, Nachega JB. Household air pollution and risk of pulmonary tuberculosis in HIV-Infected adults. Environ Health 2024; 23:6. [PMID: 38233832 PMCID: PMC10792790 DOI: 10.1186/s12940-023-01044-0] [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: 10/04/2023] [Accepted: 12/19/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND In low- and middle-income countries countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. METHODS We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB. RESULTS We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/week were more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. CONCLUSION Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.
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Affiliation(s)
- Patrick D M C Katoto
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Office of the President and CEO, South African Medical Research Council, Cape Town, South Africa.
- Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of the Congo.
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Dieudonné Bihehe
- Department of Internal Medicine, Université Evangélique en Afrique, Bukavu, DR, Congo
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Raymond Mushi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Aline Kusinza
- Department of Medicine, Division of Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Brian W Alwood
- Department of Medicine, Division of Pulmonology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Richard N van Zyl-Smit
- Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacques L Tamuzi
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Prevention, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Marcel Yotebieng
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA
| | - John Metcalfe
- Division of Pulmonary and Critical Care Medicine, Trauma Center, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
| | - Grant Theron
- South African Medical Research Council Centre for Tuberculosis Research, Division of Molecular Biology and Human Genetics, Faculty of Medicine and Health Sciences, NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University, Cape Town, South Africa
| | - Krystal J Godri Pollitt
- Department of Environmental Health Sciences, School of Public Health, Yale University, New Haven, CT, USA
| | - Maia Lesosky
- Division of epidemiology and Biostatistics, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Jeroen Vanoirbeek
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Kevin Mortimer
- Liverpool School of Tropical Medicine, Liverpool, L3 5QA, UK
| | - Tim Nawrot
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Centre of Environmental Health, University of Hasselt, Hasselt, Belgium
| | - Benoit Nemery
- Centre for Environment and Health, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Jean B Nachega
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, USA.
- Department of Medicine, Center for Infectious Diseases, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
- Department of Epidemiology and Center for Global Health, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, 130 DeSoto St., Room A522 Crabtree Hall, Pittsburgh, 15260, PA, USA.
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Hazenberg P, Robinson RE, Farrar M, Solorzano C, Hyder-Wright A, Liatsikos K, Brunning J, Fleet H, Bettam A, Howard A, Kenny-Nyazika T, Urban B, Mitsi E, El Safadi D, Davies K, Lesosky M, Gordon SB, Ferreira DM, Collins AM. Serotype 3 Experimental Human Pneumococcal Challenge (EHPC) study protocol: dose ranging and reproducibility in a healthy volunteer population (challenge 3). BMJ Open 2024; 14:e075948. [PMID: 38199622 PMCID: PMC10806732 DOI: 10.1136/bmjopen-2023-075948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/19/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Since the introduction of pneumococcal conjugate vaccines, pneumococcal disease rates have declined for many vaccine-type serotypes. However, serotype 3 (SPN3) continues to cause significant disease and is identified in colonisation epidemiological studies as one of the top circulating serotypes in adults in the UK. Consequently, new vaccines that provide greater protection against SPN3 colonisation/carriage are urgently needed. The Experimental Human Pneumococcal Challenge (EHPC) model is a unique method of determining pneumococcal colonisation rates, understanding acquired immunity, and testing vaccines in a cost-effective manner. To enhance the development of effective pneumococcal vaccines against SPN3, we aim to develop a new relevant and safe SPN3 EHPC model with high attack rates which could be used to test vaccines using small sample size. METHODS AND ANALYSIS This is a human challenge study to establish a new SPN3 EHPC model, consisting of two parts. In the dose-ranging/safety study, cohorts of 10 healthy participants will be challenged with escalating doses of SPN3. If first challenge does not lead into colonisation, participants will receive a second challenge 2 weeks after. Experimental nasopharyngeal (NP) colonisation will be determined using nasal wash sampling. Using the dose that results in ≥50% of participants being colonised, with a high safety profile, we will complete the cohort with another 33 participants to check for reproducibility of the colonisation rate. The primary outcome of this study is to determine the optimal SPN3 dose and inoculation regime to establish the highest rates of NP colonisation in healthy adults. Secondary outcomes include determining density and duration of experimental SPN3 NP colonisation and characterising mucosal and systemic immune responses to SPN3 challenge. ETHICS AND DISSEMINATION This study is approved by the NHS Research and Ethics Committee (reference 22/NW/0051). Findings will be published in peer-reviewed journals and reports will be made available to participants.
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Affiliation(s)
- Phoebe Hazenberg
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ryan E Robinson
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Madlen Farrar
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solorzano
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Angela Hyder-Wright
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Jaye Brunning
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hannah Fleet
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Amy Bettam
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Britta Urban
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Elena Mitsi
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Dima El Safadi
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maia Lesosky
- Global Health Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Stephen B Gordon
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Daniela M Ferreira
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Andrea M Collins
- Liverpool Vaccine Group, Liverpool School of Tropical Medicine, Liverpool, UK
- Respiratory Department, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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5
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Koita K, Bognini JD, Agboraw E, Dembélé M, Yabré S, Bihoun B, Coulibaly O, Niangaly H, N'Takpé JB, Lesosky M, Scaramuzzi D, Worrall E, Hill J, Briand V, Tinto H, Kayentao K. Increasing the uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) through seasonal malaria chemoprevention channel delivery: protocol of a multicenter cluster randomized implementation trial in Mali and Burkina Faso. BMC Public Health 2024; 24:43. [PMID: 38166711 PMCID: PMC10763117 DOI: 10.1186/s12889-023-17529-z] [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: 09/16/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The uptake of Intermittent Preventive Treatment of malaria in pregnancy using Sulfadoxine-Pyrimethamine (IPTp-SP) remains unacceptably low, with more than two-thirds of pregnant women in sub-Saharan Africa still not accessing the three or more doses recommended by the World Health Organisation (WHO). In contrast, the coverage of Seasonal Malaria Chemoprevention (SMC), a more recent strategy recommended by the WHO for malaria prevention in children under five years living in Sahelian countries with seasonal transmission, including Mali and Burkina-Faso, is high (up to 90%). We hypothesized that IPTp-SP delivery to pregnant women through SMC alongside antenatal care (ANC) will increase IPTp-SP coverage, boost ANC attendance, and increase public health impact. This protocol describes the approach to assess acceptability, feasibility, effectiveness, and cost-effectiveness of the integrated strategy. METHODS AND ANALYSIS This is a multicentre, cluster-randomized, implementation trial of IPTp-SP delivery through ANC + SMC vs ANC alone in 40 health facilities and their catchment populations (20 clusters per arm). The intervention will consist of monthly administration of IPTp-SP through four monthly rounds of SMC during the malaria transmission season (July to October), for two consecutive years. Effectiveness of the strategy to increase coverage of three or more doses of IPTp-SP (IPTp3 +) will be assessed using household surveys and ANC exit interviews. Statistical analysis of IPT3 + and four or more ANC uptake will use a generalized linear mixed model. Feasibility and acceptability will be assessed through in-depth interviews and focus group discussions with health workers, pregnant women, and women with a child < 12 months. DISCUSSION This multicentre cluster randomized implementation trial powered to detect a 45% and 22% increase in IPTp-SP3 + uptake in Mali and Burkina-Faso, respectively, will generate evidence on the feasibility, acceptability, effectiveness, and cost-effectiveness of IPTp-SP delivered through the ANC + SMC channel. The intervention is designed to facilitate scalability and translation into policy by leveraging existing resources, while strengthening local capacities in research, health, and community institutions. Findings will inform the local national malaria control policies. TRIAL REGISTRATION Retrospectively registered on August 11th, 2022; registration # PACTR202208844472053. Protocol v4.0 dated September 04, 2023. Trail sponsor: University of Sciences Techniques and Technologies of Bamako (USTTB), Mali.
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Affiliation(s)
- Kadiatou Koita
- Department of Epidemiology of Parasitic Diseases (DEAP), Faculty of Medicine Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali.
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.
| | - Joel D Bognini
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Efundem Agboraw
- Liverpool School of Tropical Medicine, Vector Biology, Liverpool, UK
| | - Mahamadou Dembélé
- Department of Epidemiology of Parasitic Diseases (DEAP), Faculty of Medicine Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Seydou Yabré
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Biébo Bihoun
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Oumou Coulibaly
- Department of Epidemiology of Parasitic Diseases (DEAP), Faculty of Medicine Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
| | - Hamidou Niangaly
- Département Etudes, Institut National de Santé Publique, Recherches Médicale Et Communautaire, Bamako, Mali
| | - Jean-Batiste N'Takpé
- University of Bordeaux, National Institute for Health and Medical Research, Bordeaux, France
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Dario Scaramuzzi
- R-Evolution Worldwide Srl Impresa Sociale (REvoWWIS), Naples, Italy
| | - Eve Worrall
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jenny Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Valérie Briand
- University of Bordeaux, National Institute for Health and Medical Research (INSERM) UMR 1219, Research Institute for Sustainable Development (IRD) EMR 271, Bordeaux Population Health Centre, Bordeaux, France
| | - Halidou Tinto
- Institut de Recherche en Sciences de La Santé (IRSS), Unité de Recherche Clinique de Nanoro, Ouagadougou, Burkina Faso
| | - Kassoum Kayentao
- Department of Epidemiology of Parasitic Diseases (DEAP), Faculty of Medicine Odontostomatology, University of Sciences Techniques and Technologies of Bamako, Bamako, Mali
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Nnaji CA, Wiysonge CS, Cooper S, Mayeye A, Luphondo L, Mabuya T, Kalui N, Lesosky M, Ndwandwe D. Contextualising missed opportunities for children's vaccination: A theory-informed qualitative study in primary care settings in Cape Town, South Africa. Hum Vaccin Immunother 2023; 19:2162771. [PMID: 36601915 PMCID: PMC9980502 DOI: 10.1080/21645515.2022.2162771] [Citation(s) in RCA: 2] [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] [Indexed: 01/06/2023] Open
Abstract
This study aimed to explore the contextual factors that may be associated with missed opportunities for vaccination (MOV) from the perspectives of healthcare providers and caregivers attending primary healthcare facilities in the Cape Town Metro Health District, South Africa. The ultimate goal of the assessment was to help inform the design and implementation of a contextually appropriate quality improvement programme targeted at reducing MOV in primary healthcare settings. We used a theory-informed exploratory qualitative research design involving focus group discussions with caregivers of children aged 0-23 months; and in-depth interviews of facility staff. A thematic template analysis approach, integrating the theoretical domains framework (TDF) and the capability, opportunity and motivation model of behavior (COM-B) was used to code and analyze the data. Three focus group sessions were conducted, each consisting of 5-8 caregivers and five in-depth interviews involving facility staff. Capability factors comprised caregivers' knowledge, attitude and behavior toward children's immunization. Opportunity factors included the organization of immunization services, long waiting time, vaccine stock out, staff shortage and health workers' attitude, knowledge and capability to assess children's immunization status and needs. Motivation factors included optimism and beliefs about immunization, fear of vaccine-preventable diseases and immunization safety concerns. This study identified important caregiver-, provider- and health system-related factors, which influence immunization outcomes; offering useful contextual insights for informing quality improvement strategies for reducing MOV at primary healthcare level.
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Affiliation(s)
- Chukwudi A. Nnaji
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,CONTACT Chukwudi A. Nnaji, Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, 1 Anzio Road, Observatory, Cape Town 7925, South Africa
| | - Charles S. Wiysonge
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Durban, South Africa
| | - Sara Cooper
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa,Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa,Division of Social & Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Asanda Mayeye
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Lucy Luphondo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Thobile Mabuya
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Ntomboxolo Kalui
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
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7
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Labaeka AA, Falade AG, Addo-Yobo EOD, Mortimer K, Zurba L, Lesosky M, Ellwood P, Asher MI. Decreased prevalence and severity of asthma symptoms among adolescents in Ibadan, Nigeria, 1995-2018. Int J Tuberc Lung Dis 2023; 27:925-930. [PMID: 38042979 PMCID: PMC10719893 DOI: 10.5588/ijtld.23.0138] [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: 04/05/2023] [Accepted: 06/27/2023] [Indexed: 12/04/2023] Open
Abstract
BACKGROUND: Phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC) documented increased asthma symptoms among Nigerian 13-14-year old adolescents. We investigated the trend further using the Global Asthma Network (GAN) surveillance.METHODS: Using ISAAC methodology, GAN Phase I data on symptoms and risk factors for asthma and asthma management were obtained from February to July 2018.RESULTS: There were 2,897 adolescents from 23 secondary schools. For current wheeze, there was an absolute prevalence fall per decade of -1.4 with -1 standard error (SE) in 16 years from 2002 (ISAAC Phase III) to 2018 (GAN Phase I). This pattern was evident for prevalence of reported asthma ever, severe asthma symptoms and night cough with ≥1 SE. During the 23-year interval between ISAAC Phase I and GAN Phase I, there was a fall (≥1 SE) in the absolute prevalence of reported asthma ever, severe asthma symptoms and night cough, except for severe asthma symptoms (-0.2 SE). Respectively 36% and 43% of symptomatic adolescents purchased and used salbutamol and prednisolone.CONCLUSION: The prevalence and severity of asthma symptoms remain high among adolescents in Ibadan. This could be mitigated by improved access to affordable and effective asthma treatments.
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Affiliation(s)
- A A Labaeka
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - A G Falade
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - E O D Addo-Yobo
- Kwame Nkrumah University of Science and Technology, Kumasi, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - K Mortimer
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, University of KwaZulu Natal, Durban
| | - L Zurba
- Spirometry Training Services Africa, Durban
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - P Ellwood
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - M I Asher
- Department of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
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8
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Yukich J, Eisele TP, terKuile F, Ashton R, Staedke S, Harris AF, Johnson PCD, Sarrassat S, Lesosky M, Bradley J, Kleinschmidt I, Littrell M. Master statistical analysis plan: attractive targeted sugar bait phase III trials in Kenya, Mali, and Zambia. Trials 2023; 24:771. [PMID: 38031086 PMCID: PMC10685482 DOI: 10.1186/s13063-023-07762-7] [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: 05/30/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
This manuscript is a master statistical analysis plan for each of three-cluster randomized controlled trials to evaluate the efficacy of attractive targeted sugar baits (ATSB) described in an already published protocol. The master SAP contains an overarching plan for all three trials, which can be adapted to trial-specific circumstances. The primary objective of the trials is to evaluate the efficacy of ATSB in the presence of universal vector control coverage with insecticide-treated nets (ITN) or indoor residual spraying (IRS) after two transmission seasons on clinical malaria incidence as compared with universal vector control coverage with ITN or IRS alone. The primary outcome measure is the incidence rate of clinical malaria, assessed in cohorts aged 12 months to less than 15 years (≥ 5 years to 15 years in Mali) during monthly follow-up visits. The primary unadjusted analysis will be conducted on the intention-to-treat analysis population without adjustment for any anticipated confounding variables. The primary outcome will be analyzed using a multi-level model constructed on a generalized linear model framework with a Poisson likelihood and a log link function. Random intercepts will be included for each study cluster and a fixed effect for study-arm. The analyst will be blinded to study arm assignment. Several secondary outcomes will be analyzed, as well as a pooled analysis (individual patient data meta-analysis) across the three trial sites. Additionally, a standard meta-analysis is expected to be conducted using combined data from all sites.
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Affiliation(s)
- Joshua Yukich
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA.
| | - Thomas P Eisele
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Feiko terKuile
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Ruth Ashton
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Sarah Staedke
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Angela F Harris
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Paul C D Johnson
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Sophie Sarrassat
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Maia Lesosky
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - John Bradley
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Immo Kleinschmidt
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
| | - Megan Littrell
- Tulane University School of Public Health and Tropical Medicine, New Orleans, USA
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Odayar J, Phillips TK, Kabanda S, Malaba TR, Mukonda E, Hsiao NY, Lesosky M, Myer L. Mobility during the post-partum period and viraemia in women living with HIV in South Africa. Int Health 2023; 15:692-701. [PMID: 36715066 PMCID: PMC10629960 DOI: 10.1093/inthealth/ihad001] [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: 07/28/2022] [Revised: 12/15/2022] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND We investigated the association between travel and viraemia in post-partum women with human immunodeficiency virus on antiretroviral therapy (ART). METHODS Data are from a trial of post-partum ART delivery strategies. Women who initiated ART during pregnancy, were clinically stable with a viral load (VL) <400 copies/ml and were <10 weeks post-partum were enrolled at a primary care antenatal clinic in Cape Town, South Africa. Study visits at 3, 6, 12, 18 and 24 months post-partum included questions about travel, defined as ≥1 night spent outside of the city, and VL testing. Generalised mixed effects models assessed the association between travel and subsequent VL ≥400 copies/ml. RESULTS Among 402 women (mean age 29 y, 35% born in the Western Cape), 69% reported one or more travel events over 24 months. Being born beyond the Western Cape (adjusted odds ratio [aOR] 2.03 [95% confidence interval {CI} 1.49 to 2.77]), duration post-partum in months (aOR 1.03 [95% CI 1.02 to 1.05]) and living with the child (aOR 0.60 [95% CI 0.38 to 0.93]) were associated with travel. In multivariable analyses, a travel event was associated with a 92% increase in the odds of a VL ≥400 copies/ml (aOR 1.92 [95% CI 1.19 to 3.10]). CONCLUSIONS Interventions to support women on ART who travel are urgently required.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Siti Kabanda
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Elton Mukonda
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Nei-yuan Hsiao
- Division of Medical Virology, National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health, University of Cape Town, Cape Town, South Africa
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10
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Meme H, Amukoye E, Bowyer C, Chakaya J, Das D, Dobson R, Dragosits U, Fuld J, Gray C, Hahn M, Kiplimo R, Lesosky M, Loh MM, McKendree J, Mortimer K, Ndombi A, Netter L, Obasi A, Orina F, Pearson C, Price H, Quint JK, Semple S, Twigg M, Waelde C, Walnycki A, Warwick M, Wendler J, West SE, Wilson M, Zurba L, Devereux G. Asthma symptoms, spirometry and air pollution exposure in schoolchildren in an informal settlement and an affluent area of Nairobi, Kenya. Thorax 2023; 78:1118-1125. [PMID: 37280096 DOI: 10.1136/thorax-2023-220057] [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: 01/23/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although 1 billion people live in informal (slum) settlements, the consequences for respiratory health of living in these settlements remain largely unknown. This study investigated whether children living in an informal settlement in Nairobi, Kenya are at increased risk of asthma symptoms. METHODS Children attending schools in Mukuru (an informal settlement in Nairobi) and a more affluent area (Buruburu) were compared. Questionnaires quantified respiratory symptoms and environmental exposures; spirometry was performed; personal exposure to particulate matter (PM2.5) was estimated. RESULTS 2373 children participated, 1277 in Mukuru (median age, IQR 11, 9-13 years, 53% girls), and 1096 in Buruburu (10, 8-12 years, 52% girls). Mukuru schoolchildren were from less affluent homes, had greater exposure to pollution sources and PM2.5. When compared with Buruburu schoolchildren, Mukuru schoolchildren had a greater prevalence of symptoms, 'current wheeze' (9.5% vs 6.4%, p=0.007) and 'trouble breathing' (16.3% vs 12.6%, p=0.01), and these symptoms were more severe and problematic. Diagnosed asthma was more common in Buruburu (2.8% vs 1.2%, p=0.004). Spirometry did not differ between Mukuru and Buruburu. Regardless of community, significant adverse associations were observed with self-reported exposure to 'vapours, dusts, gases, fumes', mosquito coil burning, adult smoker(s) in the home, refuse burning near homes and residential proximity to roads. CONCLUSION Children living in informal settlements are more likely to develop wheezing symptoms consistent with asthma that are more severe but less likely to be diagnosed as asthma. Self-reported but not objectively measured air pollution exposure was associated with increased risk of asthma symptoms.
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Affiliation(s)
- Hellen Meme
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Evans Amukoye
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cressida Bowyer
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - Jeremiah Chakaya
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Darpan Das
- Institute of Occupational Medicine, Edinburgh, UK
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | - Jonathan Fuld
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cindy Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, Glasgow, UK
| | - Matthew Hahn
- Theatre for Development Facilitator, Folkstone, UK
| | - Richard Kiplimo
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maia Lesosky
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Jean McKendree
- Department of Environment and Geography, University of York, York, UK
| | - Kevin Mortimer
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Medicine, College of Health Sciences University of KwaZulu-Natal, Durban, South Africa
| | - Amos Ndombi
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Louis Netter
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, Liverpool, UK
| | - Fred Orina
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Heather Price
- Biological and Environmental Sciences, University of Stirling, Stirling, UK
| | | | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | | | | | - Anna Walnycki
- International Institute for Environment and Development, London, UK
| | - Melaneia Warwick
- School of Design & Creative Arts, Loughborough University, Loughborough, UK
| | | | - Sarah E West
- Department of Environment and Geography, University of York, York, UK
| | - Michael Wilson
- School of Design & Creative Arts, Loughborough University, Loughborough, UK
| | | | - Graham Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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11
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Katoto PDMC, Bihehe D, Brand A, Mushi R, Kusinza A, Alwood BW, van Zyl-Smit RN, Tamuzi JL, Sam-Agudu NA, Yotebieng M, Metcalfe J, Theron G, Godri Pollitt KJ, Lesosky M, Vanoirbeek J, Mortimer K, Nawrot T, Nemery B, Nachega JB. Household Air Pollution and Risk of Pulmonary Tuberculosis in HIV-Infected Adults. Res Sq 2023:rs.3.rs-3410503. [PMID: 37886487 PMCID: PMC10602081 DOI: 10.21203/rs.3.rs-3410503/v1] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
Background In developing countries, millions of deaths occur annually from household air pollution (HAP), pulmonary tuberculosis (PTB), and HIV-infection. However, it is unknown whether HAP influences PTB risk among people living with HIV-infection. Methods We conducted a case-control study among 1,277 HIV-infected adults in Bukavu, eastern Democratic Republic of Congo (February 2018 - March 2019). Cases had current or recent (<5y) PTB (positive sputum smear or Xpert MTB/RIF), controls had no PTB. Daily and lifetime HAP exposure were assessed by questionnaire and, in a random sub-sample (n=270), by 24-hour measurements of personal carbon monoxide (CO) at home. We used multivariable logistic regression to examine the associations between HAP and PTB. Results We recruited 435 cases and 842 controls (median age 41 years, [IQR] 33-50; 76% female). Cases were more likely to be female than male (63% vs 37%). Participants reporting cooking for >3h/day and ≥2 times/day and ≥5 days/weekwere more likely to have PTB (aOR 1·36; 95%CI 1·06-1·75) than those spending less time in the kitchen. Time-weighted average 24h personal CO exposure was related dose-dependently with the likelihood of having PTB, with aOR 4·64 (95%CI 1·1-20·7) for the highest quintile [12·3-76·2 ppm] compared to the lowest quintile [0·1-1·9 ppm]. Conclusion Time spent cooking and personal CO exposure were independently associated with increased risk of PTB among people living with HIV. Considering the high burden of TB-HIV coinfection in the region, effective interventions are required to decrease HAP exposure caused by cooking with biomass among people living with HIV, especially women.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - John Metcalfe
- Zuckerberg San Francisco General Hospital, University of California
| | - Grant Theron
- NRF-DST Centre of Excellence for Biomedical Tuberculosis Research, Stellenbosch University
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12
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Meme H, Amukoye E, Bowyer C, Chakaya J, Dobson R, Fuld J, Gray CM, Kiplimo R, Lesosky M, Mortimer K, Ndombi A, Obasi A, Orina F, Quint JK, Semple S, West SE, Zurba L, Devereux G. Preterm birth, birth weight, infant weight gain and their associations with childhood asthma and spirometry: a cross-sectional observational study in Nairobi, Kenya. BMJ Open Respir Res 2023; 10:e001895. [PMID: 37735103 PMCID: PMC10514609 DOI: 10.1136/bmjresp-2023-001895] [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: 06/19/2023] [Accepted: 09/08/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND In sub-Saharan Africa, the origins of asthma and high prevalence of abnormal lung function remain unclear. In high-income countries (HICs), associations between birth measurements and childhood asthma and lung function highlight the importance of antenatal and early life factors in the aetiology of asthma and abnormal lung function in children. We present here the first study in sub-Saharan Africa to relate birth characteristics to both childhood respiratory symptoms and lung function. METHODS Children attending schools in two socioeconomically contrasting but geographically close areas of Nairobi, Kenya, were recruited to a cross-sectional study of childhood asthma and lung function. Questionnaires quantified respiratory symptoms and preterm birth; lung function was measured by spirometry; and parents were invited to bring the child's immunisation booklet containing records of birth weight and serial weights in the first year. RESULTS 2373 children participated, 52% girls, median age (IQR), 10 years (8-13). Spirometry data were available for 1622. Child immunisation booklets were available for 500 and birth weight and infant weight gain data were available for 323 and 494 children, respectively. In multivariable analyses, preterm birth was associated with the childhood symptoms 'wheeze in the last 12 months'; OR 1.64, (95% CI 1.03 to 2.62), p=0.038; and 'trouble breathing' 3.18 (95% CI 2.27 to 4.45), p<0.001. Birth weight (kg) was associated with forced expiratory volume in 1 s z-score, regression coefficient (β) 0.30 (0.08, 0.52), p=0.008, FVC z-score 0.29 (95% CI 0.08 to 0.51); p=0.008 and restricted spirometry, OR 0.11 (95% CI 0.02 to 0.78), p=0.027. CONCLUSION These associations are in keeping with those in HICs and highlight antenatal factors in the aetiology of asthma and lung function abnormalities in sub-Saharan Africa.
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Affiliation(s)
- Helen Meme
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Evans Amukoye
- Research and Development, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cressida Bowyer
- Faculty of Creative and Cultural Industries, University of Portsmouth, Portsmouth, UK
| | - Jeremiah Chakaya
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Ruaraidh Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Jonathan Fuld
- Respiratory Medicine, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Cindy M Gray
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - Richard Kiplimo
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Medicine, University of Cambridge, Cambridge, UK
- Department of Medicine, College of Health Sciences University of KwaZulu-Natal, Cambridge, UK
| | - Amos Ndombi
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Axess Sexual Health, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Fred Orina
- Centre for Respiratory Disease Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Sean Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Sarah E West
- Department of Environment and Geography, University of York, York, UK
| | | | - Graham Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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13
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Mogoba P, Lesosky M, Mukonda EE, Zerbe A, Falcao J, Zandamela R, Myer L, Abrams EJ. Positive attitudes toward adoption of a multi-component intervention strategy aimed at improving HIV outcomes among adolescents and young people in Nampula, Mozambique: perspectives of HIV care providers. BMC Health Serv Res 2023; 23:582. [PMID: 37280638 DOI: 10.1186/s12913-023-09630-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 05/31/2023] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Service providers' attitudes toward interventions are essential for adopting and implementing novel interventions into healthcare settings, but evidence of evaluations in the HIV context is still limited. This study is part of the CombinADO cluster randomized trial (ClinicalTrials.gov NCT04930367), which is investigating the effectiveness of a multi-component intervention package (CombinADO strategy) aimed at improving HIV outcomes among adolescents and young adults living with HIV (AYAHIV) in Mozambique. In this paper we present findings on key stakeholder attitudes toward adopting study interventions into local health services. METHODS Between September and December 2021, we conducted a cross-sectional survey with a purposive sample of 59 key stakeholders providing and overseeing HIV care among AYAHIV in 12 health facilities participating in the CombinADO trial, who completed a 9-item scale on attitudes towards adopting the trial intervention packages in health facilities. Data were collected in the pre-implementation phase of the study and included individual stakeholder and facility-level characteristics. We used generalized linear regression to examine the associations of stakeholder attitude scores with stakeholder and facility-level characteristics. RESULTS Overall, service-providing stakeholders within this setting reported positive attitudes regarding adopting intervention packages across study clinic sites; the overall mean total attitude score was 35.0 ([SD] = 2.59, Range = [30-41]). The study package assessed (control or intervention condition) and the number of healthcare workers delivering ART care in participating clinics were the only significant explanatory variables to predict higher attitude scores among stakeholders (β = 1.57, 95% CI = 0.34-2.80, p = 0.01 and β = 1.57, 95% CI = 0.06-3.08, p = 0.04 respectively). CONCLUSIONS This study found positive attitudes toward adopting the multi-component CombinADO study interventions among HIV care providers for AYAHIV in Nampula, Mozambique. Our findings suggest that adequate training and human resource availability may be important in promoting the adoption of novel multi-component interventions in healthcare services by influencing healthcare provider attitudes.
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Affiliation(s)
- Phepo Mogoba
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa.
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Elton E Mukonda
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | | | | | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
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14
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Fyles F, Hill H, Duncan G, Carter E, Solórzano C, Davies K, McLellan L, Lesosky M, Dodd J, Finn A, McNamara PS, Lewis D, Bangert M, Vassilouthis N, Taylor M, Ferreira D, Collins AM. Surveillance towards preventing paediatric incidence of respiratory syncytial virus attributable respiratory tract infection in primary and secondary/tertiary healthcare settings in Merseyside, Cheshire and Bristol, UK. BMJ Open Respir Res 2023; 10:10/1/e001457. [PMID: 37277188 DOI: 10.1136/bmjresp-2022-001457] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION Respiratory syncytial virus (RSV) is a common respiratory virus, particularly affecting children, and can cause respiratory infections such as croup and bronchiolitis. The latter is a leading cause of paediatric hospitalisation within the UK. Children <3 years of age and/or with underlying health conditions are more vulnerable to severe RSV infection.There are currently limited data on the incidence of laboratory-confirmed RSV, particularly within primary care settings and outside the typical 'RSV season', which in the Northern hemisphere tends to coincide with winter months. There is also a lack of data on the health economic impact of RSV infection on families and healthcare systems.This observational surveillance study aims to collect data on the incidence of laboratory-confirmed RSV-attributable respiratory tract infection (RTI) in children aged <3 years presenting to primary, secondary or tertiary care; it also aims to estimate the health economic and quality of life impact of RSV-attributable infection in this cohort. Such data will contribute to informing public health strategies to prevent RSV-associated infection, including use of preventative medications. METHODS AND ANALYSIS Parents/carers of children <3 years of age with RTI symptoms will consent for a respiratory sample (nasal swab) to be taken. Laboratory PCR testing will assess for the presence of RSV and/or other pathogens. Data will be obtained from medical records on demographics, comorbidities, severity of infection and hospitalisation outcomes. Parents will complete questionnaires on the impact of ongoing infection symptoms at day 14 and 28 following enrolment. The primary outcome is incidence of laboratory-confirmed RSV in children <3 years presenting to primary, secondary or tertiary care with RTI symptoms leading to health-seeking behaviours. Recruitment will be carried out from December 2021 to March 2023, encompassing two UK winter seasons and intervening months. ETHICS AND DISSEMINATION Ethical approval has been granted (21/WS/0142), and study findings will be published as per International Committee of Medical Journal Editors' guidelines.
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Affiliation(s)
- Fred Fyles
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Gregory Duncan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Emma Carter
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lauren McLellan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Dodd
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Adam Finn
- University of Bristol Medical School, Bristol, UK
| | - Paul Stephen McNamara
- Department of Child Health, University of Liverpool, Liverpool, UK
- Alder Hey Children's Hospital, Liverpool, UK
| | | | | | | | | | - Daniela Ferreira
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Oxford Vaccine Group, University of Oxford, Oxford, UK
| | - Andrea M Collins
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
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15
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Heany SJ, Levine AJ, Lesosky M, Phillips N, Fouche JP, Myer L, Zar HJ, Stein DJ, Horvath S, Hoare J. Persistent accelerated epigenetic ageing in a longitudinal cohort of vertically infected HIV-positive adolescents. J Neurovirol 2023; 29:272-282. [PMID: 37179258 PMCID: PMC10404174 DOI: 10.1007/s13365-023-01130-6] [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: 07/15/2022] [Revised: 10/24/2022] [Accepted: 03/28/2023] [Indexed: 05/15/2023]
Abstract
We have previously shown accelerated ageing in adolescents perinatally infected with HIV (PHIV +), based on discrepancies between epigenetic and chronological age. The current study examines follow-up longitudinal patterns of epigenetic ageing and the association of epigenetic ageing with cognition as well as whole brain structure changes in PHIV + and healthy controls enrolled in the Cape Town Adolescent Antiretroviral Cohort Study (CTAAC). The Illumina EPIC array was used to generate blood DNA methylation data from 60 PHIV + adolescents and 36 age-matched controls aged 9-12 years old at baseline and again at a 36-month follow-up. Epigenetic clock software estimated two measures of epigenetic age acceleration: extrinsic epigenetic accelerated ageing (EEAA) and age acceleration difference (AAD) at both time points. At follow-up, each participant completed neuropsychological testing, structural magnetic resonance imaging, and diffusion tensor imaging. At follow-up, PHIV infection remains associated with increased EEAA and AAD. Accelerated epigenetic ageing remained positively associated with viral load and negatively associated with CD4 ratio. EEAA was positively associated with whole brain grey matter volume and alterations in whole brain white matter integrity. AAD and EEAA were not associated with cognitive function within the PHIV + group. Measures of epigenetic ageing, as detected in DNA methylation patterns, remain increased in PHIV + adolescents across a 36-month period. Associations between epigenetic ageing measures, viral biomarkers, and alterations in brain micro- and macrostructure also persist at 36-month follow-up. Further study should determine if epigenetic age acceleration is associated with cognitive functional changes due to brain alterations in later life.
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Affiliation(s)
- Sarah J Heany
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa.
| | - Andrew J Levine
- Department of Neurology, David Geffen School of Medicineat the , University of California, Los Angeles, Los Angeles, CA, USA
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicole Phillips
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouche
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Centre for Infectious Disease Epidemiology and Research, Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Medical Research Council Unit On Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA
| | - Jacqueline Hoare
- SA MRC Unit On Risk & Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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16
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Okpokoro E, Lesosky M, Osa-Afiana C, Bada F, Okwor U, Odonye G, Igbinomwanhia V, Abdurrahman S, Medugu N, Kagina B, Abimiku A, Adams S. Prevalence and Risk Factors for Mycobacterium tuberculosis Infection among Health Workers in HIV Treatment Centers in North Central, Nigeria. Am J Trop Med Hyg 2023:tpmd220531. [PMID: 37253444 DOI: 10.4269/ajtmh.22-0531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 03/22/2023] [Indexed: 06/01/2023] Open
Abstract
Mycobacterium tuberculosis and HIV constitute a public health challenge. Health workers (HWs) in HIV clinics maybe at greater risk of M. tuberculosis infection, considering the high rates of HIV/tuberculosis (TB) coinfection among patients. Hence, we measured the prevalence of M. tuberculosis infection and the effect of working in an HIV clinic. We conducted a cross-sectional study in high-HIV burden health-care facilities in Abuja and Nasarawa states and recruited HWs over 4 months. We administered questionnaires and screened for M. tuberculosis infection using QuantiFERON-TB Gold-Plus. A total of 1,043 HWs were enrolled, with the majority being clinical staff (77.4%). Prevalence of interferon gamma release assay (IGRA) positivity was 44.8% (43.8% among HWs from HIV clinic and 45.3% from non-HIV clinics, P = 0.24). Nonoccupational factors such as living in a moderately (odds ratio [OR] = 0.71] or sparsely populated neighborhood (OR = 0.56), remained associated with a reduced risk of IGRA positivity, whereas male gender (OR = 1.37) and having high blood pressure (HBP) (OR = 1.52) remained associated with an increased risk after adjusting. Occupational factors such as length of career as a HW of 10 to 20 years (OR = 1.45) or 20 to 30 years (OR = 1.74) remained associated with an increased risk of IGRA positivity after adjusting. In a final multivariate model, the factors of age between 20 to < 30 years (OR = 0.61), having HBP (OR = 1.56), having a length of career as a HW of 10 to 20 years (OR = 1.66) or 20 to 30 years (OR = 2.09) and being a clinical HW (OR = 0.62) remained associated with IGRA positivity. There is a high prevalence of IGRA positivity among HWs in Nigeria. Working in HIV clinics, however, is not associated with increased risk.
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Affiliation(s)
- Evaezi Okpokoro
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- Division of Epidemiology and Biostatistics, University of Cape Town, School of Public Health, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, University of Cape Town, School of Public Health, Cape Town, South Africa
| | - Chinye Osa-Afiana
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Florence Bada
- Vaccine for Africa, University of Cape Town, Institute of Infectious Disease and Molecular Medicine, School of Public Health, Cape Town, South Africa
| | - Uzoamaka Okwor
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - George Odonye
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Victoria Igbinomwanhia
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Saddiq Abdurrahman
- Department of Public Health, Federal Capital Territory Administration, Abuja, Nigeria
| | - Nubwa Medugu
- Microbiology, National Hospital Abuja, Abuja, Nigeria
| | - Benjamin Kagina
- Vaccine for Africa, University of Cape Town, Institute of Infectious Disease and Molecular Medicine, School of Public Health, Cape Town, South Africa
| | - Alash'le Abimiku
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
- University of Maryland, School of Medicine, Baltimore, Maryland
| | - Shahieda Adams
- Division of Occupational Medicine, University of Cape Town, School of Public Health, Cape Town, South Africa
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17
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Mphahlele R, Lesosky M, Masekela R. Prevalence, severity and risk factors for asthma in school-going adolescents in KwaZulu Natal, South Africa. BMJ Open Respir Res 2023; 10:10/1/e001498. [PMID: 37192778 DOI: 10.1136/bmjresp-2022-001498] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 05/02/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Asthma remains highly prevalent, with more severe symptoms in low-income to middle-income countries (LMICs) compared with high-income countries. Identifying risk factors for severe asthma symptoms can assist with improving outcomes. We aimed to determine the prevalence, severity and risk factors for asthma in adolescents in an LMIC. METHODS A cross-sectional survey using the Global Asthma Network written and video questionnaires was conducted in adolescents aged 13 and 14 from randomly selected schools in Durban, South Africa, between May 2019 and June 2021. RESULTS A total of 3957 adolescents (51.9% female) were included. The prevalence of lifetime, current and severe asthma was 24.6%, 13.7% and 9.1%, respectively. Of those with current and severe asthma symptoms; 38.9% (n=211/543) and 40.7% (n=147/361) had doctor-diagnosed asthma; of these, 72.0% (n=152/211) and 70.7% (n=104/147), respectively, reported using inhaled medication in the last 12 months. Short-acting beta agonists (80.4%) were more commonly used than inhaled corticosteroids (13.7%). Severe asthma was associated with: fee-paying school quintile (adjusted OR (CI)): 1.78 (1.27 to 2.48), overweight (1.60 (1.15 to 2.22)), exposure to traffic pollution (1.42 (1.11 to 1.82)), tobacco smoking (2.06 (1.15 to 3.68)), rhinoconjunctivitis (3.62 (2.80 to 4.67)) and eczema (2.24 (1.59 to 3.14)), all p<0.01. CONCLUSION Asthma prevalence in this population (13.7%) is higher than the global average (10.4%). Although common, severe asthma symptoms are underdiagnosed and associated with atopy, environmental and lifestyle factors. Equitable access to affordable essential controller inhaled medicines addressing the disproportionate burden of asthma is needed in this setting.
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Affiliation(s)
- Reratilwe Mphahlele
- Paediatrics and Child Health, University of KwaZulu Natal, Durban, KwaZulu Natal, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, University of Cape Town, Rondebosch, South Africa
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Refiloe Masekela
- Paediatrics and Child Health, University of KwaZulu Natal, Durban, KwaZulu Natal, South Africa
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18
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Thela L, Decloedt E, Zetterberg H, Gisslén M, Lesosky M, Gleich M, Koutsilieri E, Scheller C, Hye A, Joska J. Blood and cerebrospinal fluid biomarker changes in patients with HIV-associated neurocognitive impairment treated with lithium: analysis from a randomised placebo-controlled trial. J Neurovirol 2023; 29:156-166. [PMID: 36790601 DOI: 10.1007/s13365-023-01116-4] [Citation(s) in RCA: 1] [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: 07/27/2022] [Revised: 12/15/2022] [Accepted: 01/21/2023] [Indexed: 02/16/2023]
Abstract
HIV-associated neurocognitive disorders (HAND) persist in the era of antiretroviral therapy (ART). Thus, ART does not completely halt or reverse the pathological processes behind HAND. Adjuvant mitigating treatments are, therefore, prudent. Lithium treatment is known to promote neuronal brain-derived neurotrophic factors (BDNF). Lithium is also an inhibitor of glycogen synthase kinase-3 beta (GSK-3-β). We analyzed biomarkers obtained from participants in a randomized placebo-controlled trial of lithium in ART-treated individuals with moderate or severe HAND. We assayed markers at baseline and 24 weeks across several pathways hypothesized to be affected by HIV, inflammation, or degeneration. Investigated biomarkers included dopamine, BDNF, neurofilament light chain, and CD8 + lymphocyte activation (CD38 + HLADR +). Alzheimer's Disease (AD) biomarkers included soluble amyloid precursor protein alpha and beta (sAPPα/β), Aβ38, 40, 42, and ten other biomarkers validated as predictors of mild cognitive impairment and progression in previous studies. These include apolipoprotein C3, pre-albumin, α1-acid glycoprotein, α1-antitrypsin, PEDF, CC4, ICAM-1, RANTES, clusterin, and cystatin c. We recruited 61 participants (placebo = 31; lithium = 30). The age baseline mean was 40 (± 8.35) years and the median CD4 + T-cell count was 498 (IQR: 389-651) cells/μL. Biomarker concentrations between groups did not differ at baseline. However, both groups' blood dopamine levels decreased significantly after 24 weeks (adj. p < 002). No other marker was significantly different between groups, and we concluded that lithium did not confer neuroprotection following 24 weeks of treatment. However, the study was limited in duration and sample size.
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Affiliation(s)
- Lindokuhle Thela
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, E Floor, Neuroscience Centre, Anzio Road, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa.
| | - Eric Decloedt
- Division of Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden.,Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden.,Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London, UK.,UK Dementia Research Institute at UCL, London, UK.,Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China
| | - Magnus Gisslén
- Department of Infectious Disease, Institute of Biomedicine, the Sahlngreska Academy at the University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Disease, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Melanie Gleich
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Eleni Koutsilieri
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Carsten Scheller
- Institute of Virology and Immunobiology, University of Würzburg, Würzburg, Germany
| | - Abdul Hye
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, and NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - John Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, E Floor, Neuroscience Centre, Anzio Road, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa
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19
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Robinson RE, Myerscough C, He N, Hill H, Shepherd WA, Gonzalez-Dias P, Liatsikos K, Latham S, Fyles F, Doherty K, Hazenberg P, Shiham F, Mclenghan D, Adler H, Randles V, Zaidi S, Hyder-Wright A, Mitsi E, Burhan H, Morton B, Rylance J, Lesosky M, Gordon SB, Collins AM, Ferreira DM. Comprehensive review of safety in Experimental Human Pneumococcal Challenge. PLoS One 2023; 18:e0284399. [PMID: 37141259 PMCID: PMC10159102 DOI: 10.1371/journal.pone.0284399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/29/2023] [Indexed: 05/05/2023] Open
Abstract
INTRODUCTION Experimental Human Pneumococcal Challenge (EHPC) involves the controlled exposure of adults to a specific antibiotic-sensitive Streptococcus pneumoniae serotype, to induce nasopharyngeal colonisation for the purpose of vaccine research. The aims are to review comprehensively the safety profile of EHPC, explore the association between pneumococcal colonisation and frequency of safety review and describe the medical intervention required to undertake such studies. METHODS A single-centre review of all EHPC studies performed 2011-2021. All recorded serious adverse events (SAE) in eligible studies are reported. An unblinded meta-analysis of collated anonymised individual patient data from eligible EHPC studies was undertaken to assess the association between experimental pneumococcal colonisation and the frequency of safety events following inoculation. RESULTS In 1416 individuals (median age 21, IQR 20-25), 1663 experimental pneumococcal inoculations were performed. No pneumococcal-related SAE have occurred. 214 safety review events were identified with 182 (12.85%) participants presenting with symptoms potentially in keeping with pneumococcal infection, predominantly in pneumococcal colonised individuals (colonised = 96/658, non-colonised = 86/1005, OR 1.81 (95% CI 1.28-2.56, P = <0.001). The majority were mild (pneumococcal group = 72.7% [120/165 reported symptoms], non-pneumococcal = 86.7% [124/143 reported symptoms]). 1.6% (23/1416) required antibiotics for safety. DISCUSSION No SAEs were identified directly relating to pneumococcal inoculation. Safety review for symptoms was infrequent but occurred more in experimentally colonised participants. Most symptoms were mild and resolved with conservative management. A small minority required antibiotics, notably those serotype 3 inoculated. CONCLUSION Outpatient human pneumococcal challenge can be conducted safely with appropriate levels of safety monitoring procedures in place.
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Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Christopher Myerscough
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Nengjie He
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Wendi A Shepherd
- North West Health Protection Team, UK Health Security Agency, Liverpool, United Kingdom
| | - Patricia Gonzalez-Dias
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Konstantinos Liatsikos
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Samuel Latham
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fred Fyles
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Klara Doherty
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- University of Liverpool, Liverpool, United Kingdom
| | - Phoebe Hazenberg
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Fathimath Shiham
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Daniella Mclenghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hugh Adler
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Vicki Randles
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Seher Zaidi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Clinical Research Network, Liverpool, United Kingdom
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Ben Morton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jamie Rylance
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Global Health Trials Unit, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Oxford Vaccine Group, University of Oxford, Oxford, United Kingdom
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20
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Machipisa T, Chishala C, Shaboodien G, Zühlke LJ, Muhamed B, Pandie S, de Vries J, Laing N, Joachim A, Daniels R, Ntsekhe M, Hugo-Hamman CT, Gitura B, Ogendo S, Lwabi P, Okello E, Damasceno A, Novela C, Mocumbi AO, Madeira G, Musuku J, Mtaja A, ElSayed A, Alhassan HH, Bode-Thomas F, Yilgwan C, Amusa G, Nkereuwem E, Mulder N, Ramesar R, Lesosky M, Cordell HJ, Chong M, Keavney B, Paré G, Engel ME. Rationale, Design, and the Baseline Characteristics of the RHDGen (The Genetics of Rheumatic Heart Disease) Network Study†. Circ Genom Precis Med 2022; 16:e003641. [PMID: 36548480 PMCID: PMC9946164 DOI: 10.1161/circgen.121.003641] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The genetics of rheumatic heart disease (RHDGen) Network was developed to assist the discovery and validation of genetic variations and biomarkers of risk for rheumatic heart disease (RHD) in continental Africans, as a part of the global fight to control and eradicate rheumatic fever/RHD. Thus, we describe the rationale and design of the RHDGen study, comprising participants from 8 African countries. METHODS RHDGen screened potential participants using echocardiography, thereafter enrolling RHD cases and ethnically-matched controls for whom case characteristics were documented. Biological samples were collected for conducting genetic analyses, including a discovery case-control genome-wide association study (GWAS) and a replication trio family study. Additional biological samples were also collected, and processed, for the measurement of biomarker analytes and the biomarker analyses are underway. RESULTS Participants were enrolled into RHDGen between December 2012 and March 2018. For GWAS, 2548 RHD cases and 2261 controls (3301 women [69%]; mean age [SD], 37 [16.3] years) were available. RHD cases were predominantly Black (66%), Admixed (24%), and other ethnicities (10%). Among RHD cases, 34% were asymptomatic, 26% had prior valve surgery, and 23% had atrial fibrillation. The trio family replication arm included 116 RHD trio probands and 232 parents. CONCLUSIONS RHDGen presents a rare opportunity to identify relevant patterns of genetic factors and biomarkers in Africans that may be associated with differential RHD risk. Furthermore, the RHDGen Network provides a platform for further work on fully elucidating the causes and mechanisms associated with RHD susceptibility and development.
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Affiliation(s)
- Tafadzwa Machipisa
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.).,Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.)
| | - Chishala Chishala
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Division of Cardiology, University of KwaZulu-Natal, Msunduzi, KwaZulu-Natal (C.C.)
| | - Gasnat Shaboodien
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.)
| | - Liesl J. Zühlke
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.).,Division of Pediatric Cardiology, Department of Pediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Cape Town, South Africa (L.J.Z.).,South African Medical Research Council, Extramural Research and Internal Portfolio, Cape Town, South Africa (L.J.Z.)
| | - Babu Muhamed
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.).,Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.)
| | - Shahiemah Pandie
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Jantina de Vries
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Nakita Laing
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Alexia Joachim
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Rezeen Daniels
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.)
| | - Christopher T. Hugo-Hamman
- Rheumatic Heart Disease Clinic, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Republic of Namibia (C.T.H.-H.)
| | - Bernard Gitura
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya (B.G.)
| | - Stephen Ogendo
- Uganda Heart Inst, Departments of Adult and Pediatric Cardiology, Kampala, Uganda (S.O.)
| | - Peter Lwabi
- School of Medicine, Maseno Univ, Kenya (P.L., E.O.)
| | - Emmy Okello
- School of Medicine, Maseno Univ, Kenya (P.L., E.O.)
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane Univ/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique (A.D., C.N.)
| | - Celia Novela
- Faculty of Medicine, Eduardo Mondlane Univ/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique (A.D., C.N.)
| | - Ana O. Mocumbi
- Instituto Nacional de Saúde Ministério da Saúde, Mozambique (A.O.M.)
| | | | - John Musuku
- University Teaching Hospital, Children’s Hospital, University of Zambia, Lusaka, Zambia (J.M., A.M.)
| | - Agnes Mtaja
- University Teaching Hospital, Children’s Hospital, University of Zambia, Lusaka, Zambia (J.M., A.M.)
| | - Ahmed ElSayed
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Centre, Alzaiem Alazhari University, Khartoum, Sudan (A.E., H.H.M.A.)
| | - Huda H.M. Alhassan
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Centre, Alzaiem Alazhari University, Khartoum, Sudan (A.E., H.H.M.A.)
| | - Fidelia Bode-Thomas
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Christopher Yilgwan
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Ganiyu Amusa
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Esin Nkereuwem
- Deptartments of Pediatrics and Medicine, Jos University Teaching Hospital and University of Jos, Jos, Plateau State, Nigeria (F.B.-T., C.Y., G.A., E.N.)
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences (N.M.), University of Cape Town, Cape Town, South Africa
| | - Raj Ramesar
- Department of Pathology (R.R.), University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine (M.L.), University of Cape Town, Cape Town, South Africa
| | - Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne, UK (H.J.C.)
| | - Michael Chong
- Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.)
| | - Bernard Keavney
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, UK (B.K.).,Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK (B.K.)
| | - Guillaume Paré
- Population Health Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Pathology and Molecular Medicine, Michael G. DeGroote School of Medicine, Hamilton, ON, Canada (T.M., B.M., M.C., G.P.).,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada (G.P.)
| | - Mark E. Engel
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa (T.M., C.C., G.S., L.J.Z., B.M., S.P.; J.d.V., N.L., A.J., R.D., M.N., M.E.E.).,Department of Medicine, Cape Heart Institute, University of Cape Town, Cape Town, South Africa (T.M., G.S., L.J.Z., B.M., M.E.E.)
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21
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Robinson RE, Mitsi E, Nikolaou E, Pojar S, Chen T, Reiné J, Nyazika TK, Court J, Davies K, Farrar M, Gonzalez-Dias P, Hamilton J, Hill H, Hitchins L, Howard A, Hyder-Wright A, Lesosky M, Liatsikos K, Matope A, McLenaghan D, Myerscough C, Murphy A, Solórzano C, Wang D, Burhan H, Gautam M, Begier E, Theilacker C, Beavon R, Anderson AS, Gessner BD, Gordon SB, Collins AM, Ferreira DM. Human Infection Challenge with Serotype 3 Pneumococcus. Am J Respir Crit Care Med 2022; 206:1379-1392. [PMID: 35802840 DOI: 10.1164/rccm.202112-2700oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 12/24/2022] Open
Abstract
Rationale: Streptococcus pneumoniae serotype 3 (SPN3) is a cause of invasive pneumococcal disease and associated with low carriage rates. Following the introduction of pediatric 13-valent pneumococcal conjugate vaccine (PCV13) programs, SPN3 declines are less than other vaccine serotypes and incidence has increased in some populations coincident with a shift in predominant circulating SPN3 clade, from I to II. A human challenge model provides an effective means for assessing the impact of PCV13 on SPN3 in the upper airway. Objectives: To establish SPN3's ability to colonize the nasopharynx using different inoculum clades and doses, and the safety of an SPN3 challenge model. Methods: In a human challenge study involving three well-characterized and antibiotic-sensitive SPN3 isolates (PFESP306 [clade Ia], PFESP231 [no clade], and PFESP505 [clade II]), inoculum doses (10,000, 20,000, 80,000, and 160,000 cfu/100 μl) were escalated until maximal colonization rates were achieved, with concurrent acceptable safety. Measurement and Main Results: Presence and density of experimental SPN3 nasopharyngeal colonization in nasal wash samples, assessed using microbiological culture and molecular methods, on Days 2, 7, and 14 postinoculation. A total of 96 healthy participants (median age 21, interquartile range 19-25) were inoculated (n = 6-10 per dose group, 10 groups). Colonization rates ranged from 30.0-70.0% varying with dose and isolate. 30.0% (29/96) reported mild symptoms (82.8% [24/29] developed a sore throat); one developed otitis media requiring antibiotics. No serious adverse events occurred. Conclusions: An SPN3 human challenge model is feasible and safe with comparable carriage rates to an established Serotype 6B human challenge model. SPN3 carriage may cause mild upper respiratory symptoms.
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Affiliation(s)
- Ryan E Robinson
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Elena Mitsi
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Elissavet Nikolaou
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Sherin Pojar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tao Chen
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jesús Reiné
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Tinashe K Nyazika
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - James Court
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kelly Davies
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Madlen Farrar
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Josh Hamilton
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Helen Hill
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Lisa Hitchins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Ashleigh Howard
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Hyder-Wright
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Maia Lesosky
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Agnes Matope
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Daniella McLenaghan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Annabel Murphy
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Carla Solórzano
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Duolao Wang
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Hassan Burhan
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Manish Gautam
- Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | | | | | | | | | - Stephen B Gordon
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Research Programme, Blantyre, Malawi
| | - Andrea M Collins
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK.,Respiratory Research Group, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Daniela M Ferreira
- Clinical Sciences Department, Liverpool School of Tropical Medicine, Liverpool, UK
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22
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Rutter C, Silverwood R, Pérez Fernández V, Pearce N, Strachan D, Mortimer K, Lesosky M, Asher I, Ellwood P, Chiang CY, García-Marcos L. The Global Burden of Asthma. Int J Tuberc Lung Dis 2022; 26:20-23. [PMID: 36284412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
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23
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Odayar J, Orrell C, Phillips TK, Hu NC, Kabanda S, Malaba TR, Allerton J, Wiesner L, Hsiao NY, Castillo-Mancilla J, Lesosky M, Myer L. Use of Tenofovir Diphosphate Levels to Predict Viremia During the Postpartum Period in Women Living With Human Immunodeficiency Virus (HIV): A Nested Case-Control Study. Clin Infect Dis 2022; 75:761-767. [PMID: 34979553 PMCID: PMC9477450 DOI: 10.1093/cid/ciab1068] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There are few data on the utility of tenofovir diphosphate (TFV-DP) in dried blood spots (DBSs) to predict future viral load (VL) in postpartum women with HIV on antiretroviral therapy (ART). METHODS We conducted a nested case-control study within a trial of postpartum ART delivery strategies. Participants started ART containing tenofovir disoproxil fumarate (TDF) in pregnancy, were <10 weeks postpartum, and had a VL <400 copies/mL. VL and TFV-DP samples were taken every 3-6 months over 24 months. Cases had ≥1 VL ≥20 copies/mL; controls were randomly sampled from women with persistent viral suppression (VS; VL <20 copies/mL). Generalized estimating equations were used to calculate likelihood odds ratios (LORs) for future VL ≥20 copies/mL by TFV-DP concentration at the preceding visit. RESULTS 61 cases and 20 controls contributed 365 DBS-VL pairs (median ART duration, 16 months). Sensitivity and specificity of TFV-DP <700 fmol/punch to detect future viremia were 62.9% (95% CI, 54.7-70.6%) and 89.7% (84.9-93.4%), respectively. Adjusting for age, ART duration, previous VL, and duration between the TFV-DP and VL measures, LORs of viremia for TFV-DP concentrations 350-699 and <350 fmol/punch versus TFV-DP ≥1850 fmol/punch were 3.5 (95% CI, 1.1-10.8; P = .033) and 12.9 (3.6-46.6; P < .0001), respectively. Including only samples taken during VS, the LOR of future viremia for TFV-DP concentration <350 fmol/punch versus TFV-DP ≥1850 fmol/punch was 9.5 (1.9-47.0). CONCLUSIONS TFV-DP concentrations in DBSs were strongly associated with future viremia and appear useful to identify nonadherence and predict future elevated VL.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Catherine Orrell
- Desmond Tutu HIV Centre, Department of Medicine and Institute of Infectious Diseases and Molecular Medicine, University of Cape Town Medical School, Cape Town, South Africa
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nai Chung Hu
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Siti Kabanda
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Joanna Allerton
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Nei yuan Hsiao
- Division of Medical Virology, National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africaand
| | - Jose Castillo-Mancilla
- Division of Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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24
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Binegdie AB, Brenac S, Devereux G, Meme H, El Sony A, Gebremariam TH, Osman R, Miheso B, Mungai B, Zurba L, Lesosky M, Balmes J, Burney PJ, Mortimer K. Post-TB lung disease in three African countries. Int J Tuberc Lung Dis 2022; 26:891-893. [PMID: 35996284 PMCID: PMC9423016 DOI: 10.5588/ijtld.22.0261] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- A B Binegdie
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - S Brenac
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - G Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - H Meme
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - A El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - T H Gebremariam
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - R Osman
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - B Miheso
- Centre for Respiratory Diseases Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - B Mungai
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Centre for Health Solutions-Kenya, Nairobi, Kenya
| | - L Zurba
- Education for Health Africa, Durban, South Africa
| | - M Lesosky
- Division of Epidemiology Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Balmes
- University of California, San Francisco, CA, USA
| | - P J Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK, University of Cambridge, Cambridge, UK
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25
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Odayar J, Chi BH, Phillips TK, Mukonda E, Hsiao NY, Lesosky M, Myer L. Transfer of Patients on Antiretroviral Therapy Attending Primary Health Care Services in South Africa. J Acquir Immune Defic Syndr 2022; 90:309-315. [PMID: 35298449 DOI: 10.1097/qai.0000000000002950] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 02/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients stable on antiretroviral therapy (ART) may require transfer between health care facilities to maintain continuous care, yet data on the frequency, predictors, and virologic outcomes of transfers are limited. METHODS Data for all viral load (VL) testing at public sector health facilities in the Western Cape Province (2011-2018) were obtained. Participant inclusion criteria were a first VL between 2011 and 2013, age >15 years at ART initiation, and >1 VL within 5 years of ART initiation, of which ≥1 was at a primary health care facility. Two successive VLs taken at different facilities indicated a transfer. We assessed predictors of transfer using generalized estimating equations with Poisson regression and the association between transfer and subsequent VL> 1000 copies/mL using generalized mixed effects. RESULTS Overall 84,814 participants (median age at ART initiation 34 years and 68% female) were followed up for up to 4.5 years after their first VL: 34% (n = 29,056) transferred at least once, and among these, 26% transferred twice and 11% transferred thrice or more. Female sex, age <30 years, and first VL > 1000 copies/mL were independently associated with an increased rate of transfer [adjusted rate ratio 1.24, 95% confidence interval (CI): 1.21 to 1.26; 1.34, 95% CI: 1.31 to 1.36; and 1.42, 95% CI: 1.38 to 1.45, respectively]. Adjusting for age, sex, and disengagement, transfer was associated with an increased relative odds of VL > 1000 copies/mL (odds ratio 1.35, 95% CI: 1.29 to 1.42). CONCLUSIONS Approximately one-third of participants transferred and virologic outcomes were poor post-transfer. Stable patients who transfer may require additional support to maintain adherence.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Benjamin H Chi
- Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC; and
| | - Tamsin K Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Elton Mukonda
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, National Health Laboratory Service, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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26
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Madden VJ, Msolo N, Mqadi L, Lesosky M, Bedwell GJ, Hutchinson MR, Peter JG, Parker R, Schrepf A, Edwards RR, Joska JA. Study protocol: an observational study of distress, immune function and persistent pain in HIV. BMJ Open 2022; 12:e059723. [PMID: 36691234 PMCID: PMC9171212 DOI: 10.1136/bmjopen-2021-059723] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 04/28/2022] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Many people with HIV report both distress and pain. The relationship between distress and pain is bidirectional, but the mechanisms by which distress exacerbates pain are unclear. The inflammatory response to challenge (inflammatory reactivity, IR) may be a partial mediator, given that neuroimmune interactions provide a substrate for IR to also influence neurological reactivity and, thus, pain-related neural signalling. This prospective, observational, case-control study will characterise the relationships between distress, IR, pain-related signalling as captured by induced secondary hyperalgesia (SH), and pain, in people with HIV who report persistent pain (PP) (cases) or no pain (controls). METHODS AND ANALYSIS One hundred people with suppressed HIV, reporting either PP or no pain, will be assessed two or four times over 6 months. The primary outcomes are distress (Hopkins 25-item symptom checklist), IR (multiplex assay after LPS challenge), and PP (Brief Pain Inventory), assessed at the baseline timepoint, although each will also be assessed at follow-up time points. Induced SH will be assessed in a subsample of 60 participants (baseline timepoint only). To test the hypothesis that IR partly mediates the relationship between distress and pain, mediation analysis will use the baseline data from the PP group to estimate direct and indirect contributions of distress and IR to pain. To test the hypothesis that IR is positively associated with SH, data from the subsample will be analysed with generalised mixed effects models to estimate the association between IR and group membership, with SH as the dependent variable. ETHICS AND DISSEMINATION Information obtained from this study will be published in peer-reviewed journals and presented at scientific meetings. The study has been approved by the Human Research Ethics Committee of the University of Cape Town (approval number: 764/2019) and the City of Cape Town (ref: 24699). TRIAL REGISTRATION NUMBER NCT04757987.
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Affiliation(s)
- Victoria J Madden
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Ncumisa Msolo
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Luyanduthando Mqadi
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Gillian J Bedwell
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Mark R Hutchinson
- Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jonathan Grant Peter
- Division of Allergy and Clinical Immunology, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Rondebosch, South Africa
- Allergy and Immunology Unit, University of Cape Town Lung Institute, University of Cape Town, Cape Town, South Africa
| | - Romy Parker
- Pain Research Team, Department of Anaesthesia and Perioperative Medicine, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Andrew Schrepf
- Chronic Pain and Fatigue Research Center, Department of Anesthesiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert R Edwards
- Department of Anesthesiology, Perioperative, and Pain Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - John A Joska
- HIV Mental Health Research Unit, Department of Psychiatry and Mental Health, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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27
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Terfa ZG, Nantanda R, Lesosky M, Devereux G, Obasi A, Mortimer K, Khan J, Rylance J, Niessen LW. Household food insecurity, maternal nutrition, environmental risks and infants' health outcomes: protocol of the IMPALA birth cohort study in Uganda. BMJ Open 2022; 12:e050729. [PMID: 35304392 PMCID: PMC8935180 DOI: 10.1136/bmjopen-2021-050729] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION In low- and middle-income countries (LMICs), food insecurity and undernutrition disproportionately affect women of reproductive age, infants and young children. The disease burden from undernutrition in these vulnerable sections of societies remains a major concern in LMICs. Biomass fuel use for cooking is also common in LMICs. Empirical evidence from high-income countries indicates that early life nutritional and environmental exposures and their effect on infant lung function are important; however, data from sub-Saharan Africa are scarce. AIM To estimate the association between infant lung function and household food insecurity, energy poverty and maternal dietary diversity. METHODS AND ANALYSIS Pregnant women will be recruited in an existing Health and Demographic Surveillance Site in South-West Uganda. Household food insecurity, sources and uses of energy, economic measures and maternal dietary diversity will be collected during pregnancy and after birth. Primary health outcomes will be infant lung function determined by tidal breath flow and volume analysis at 6-10 weeks of age. Infant weight and length will also be collected.A household Food Consumption Score and Minimum Dietary Diversity for Women (MDD-W) indicator will be constructed. The involved cost of dietary diversity will be estimated based on MDD-W. The association between household level and mothers' food access indicators and infant lung function will be evaluated using regression models. The Multidimensional Energy Poverty Index (MEPI) will be estimated and used as an indicator of households' environmental exposures. The association between household MEPI and infant lung function will be assessed using econometric models. ETHICS AND DISSEMINATION Ethical approvals have been obtained from Liverpool School of Tropical Medicine (18-059), the Uganda Virus Research Institute Ethics Committee (097/2018) and Uganda National Council for Science and Technology (SS 4846). Study results will be shared with participants, policy-makers, other stakeholders and published in peer-reviewed journals.
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Affiliation(s)
- Zelalem G Terfa
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Center for Environment and Development, College of Development Studies, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca Nantanda
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Public Health & Family Medicine, University of Cape Town, Rondebosch, South Africa
| | - Graham Devereux
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Angela Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Jahangir Khan
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- School of Public Health and Community Medicine, University of Gothenburg, Goteborg, Västra Götaland, Sweden
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Queen Elizabeth Central Hospital, College of Medicine, Blantyre, Malawi
| | - Louis Wihelmus Niessen
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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28
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Mortimer K, Lesosky M, García-Marcos L, Innes Asher M, Pearce N, Ellwood E, Bissell K, El Sony A, Ellwood P, Marks GB, Martínez-Torres A, Morales E, Perez-Fernandez V, Robertson S, Rutter CE, Silverwood RJ, Strachan DP, Chiang CY. The burden of asthma, hay fever and eczema in adults in 17 countries: GAN Phase I study. Eur Respir J 2022; 60:13993003.02865-2021. [PMID: 35210319 PMCID: PMC9474894 DOI: 10.1183/13993003.02865-2021] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [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: 11/05/2021] [Accepted: 02/03/2022] [Indexed: 11/05/2022]
Abstract
Asthma, hay fever and eczema are three common chronic conditions. There are no recent multi-country data on the burden of these three conditions in adults; the aims of this study are to fill this evidence gap.The Global Asthma Network (GAN) Phase I is a multi-country cross-sectional population-based study using the same core methodology as the International Study of Asthma and Allergies in Childhood (ISAAC) Phase III. It provides data on the burden of asthma, hay fever, and eczema not only in children and adolescents but also for the first time in their parents/guardians.Data were available from 193 912 adults (104 061 female; mean age 38 (sd 7.5)) in 43 centres in 17 countries. The overall prevalences (range) of symptoms of current wheeze, asthma ever, hay fever ever and eczema ever were 6.6% (0.9%-32.7%), 4.4%(0.9%-29.0%), 14.4%(2.8%-45.7%), and 9.9%(1.6%-29.5%), respectively. Centre prevalence varied considerably both between countries and within countries. There was a moderate correlation between hay fever ever and asthma ever, and between eczema ever and hay fever ever at the centre level. There were moderate to strong correlations between indicators of the burden of disease reported in adults and the two younger age groups.We found evidence for a substantial burden of asthma, hay fever ever and eczema ever in countries examined highlighting the major public health importance of these diseases. Prevention strategies and equitable access to effective and affordable treatments for these three conditions would help mitigate the avoidable morbidity they cause.
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Affiliation(s)
- Kevin Mortimer
- Department of Medicine, University of Cambridge, Cambridge, UK.,Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Full professor
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,School of Public Health and Family Medicine, University of Cape Town, South Africa.,Full professor
| | - Luis García-Marcos
- Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bio-health Research Institute, Murcia.,ARADyAL Allergy Network, Edificio Departamental-Laib, Murcia, Spain.,Full professor
| | - M Innes Asher
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, , Auckland, New Zealand.,Full professor
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.,Full professor
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, , Auckland, New Zealand
| | - Karen Bissell
- School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Asma El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan.,Full professor
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, , Auckland, New Zealand
| | - Guy B Marks
- Respiratory & Environmental Epidemiology, University of New South Wales, , Sydney , Australia.,Full professor
| | - Antonela Martínez-Torres
- Paediatric Allergy and Pulmonology Units and Nurse Research Group, Virgen de la Arrixaca University Children's Hospital.,IMIB Bio-health Research Institute, Murcia, Edificio Departamental-Laib, Murcia, Spain
| | - Eva Morales
- Department of Public Health Sciences, University of Murcia, and IMIB Bio-health Research Institute, Edificio Departamental-Laib, Murcia, Spain
| | - Virginia Perez-Fernandez
- Department of Biostatistics, University of Murcia, and IMIB Bio-health Research Institute, Edificio Departamental-Laib, Murcia, Spain.,Full professor
| | - Steven Robertson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Charlotte E Rutter
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - Richard J Silverwood
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Longitudinal Studies, UCL Social Research Institute, University College London, , London WC1H 0AL, UK
| | - David P Strachan
- Population Health Research Institute, St George's, University of London, London, UK.,Full professor
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France .,Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, , Taipei , Taiwan.,Full professor.,Global Asthma Network Phase I Study Group listed at the end of the report
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Joseph Davey DL, Mvududu R, Mashele N, Lesosky M, Khadka N, Bekker LG, Gorbach P, Coates TJ, Myer L. Early pre-exposure prophylaxis (PrEP) initiation and continuation among pregnant and postpartum women in antenatal care in Cape Town, South Africa. J Int AIDS Soc 2022; 25:e25866. [PMID: 35138678 PMCID: PMC8826542 DOI: 10.1002/jia2.25866] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [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: 06/25/2021] [Accepted: 12/14/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction Pre‐exposure prophylaxis (PrEP) is a safe and effective prevention strategy to reduce women's risk of HIV in pregnancy and postpartum. Effective PrEP protection requires daily PrEP adherence, but little is known about maternal PrEP continuation and factors that influence PrEP use. Methods The PrEP in pregnancy and postpartum (PrEP‐PP) study enrolled consenting pregnant, HIV‐negative women at first antenatal care (ANC) visit with follow‐up through 12 months postpartum. Eligible and consenting women and girls ≥16 years received HIV prevention counselling and were offered PrEP. Interviewers collected socio‐demographic and behavioural data from participants at each visit. We analysed the proportion of women who initiated PrEP and the proportion who continued PrEP after 3 months with associated correlates by estimating the prevalence ratio adjusting for a priori confounders. Results Between August 2019 and October 2021, we enrolled 1201 pregnant women (median gestation 21 weeks; age 26 years); 84% of women initiated PrEP at their first ANC visit (n = 1014); 55% were married or cohabiting. Overall, 66% of women on PrEP returned for a repeat prescription at 1 month; 58% returned at 3 months (n = 493 of 844). Almost one‐half of women on PrEP reported a side effect at 1 month, mostly nausea/vomiting. Women on PrEP in the first and second trimesters had higher odds of reporting side effects (aOR 2.61; 95% CI 1.17–5.84) versus postpartum women. Women who reported side effects continued with PrEP less than those who did not report side effects (aPR = 0.87; 95% CI 0.77–0.97). Women with ≥1 previous pregnancy (aPR = 0.76; 95% CI 0.57–1.01) or were postpartum (aPR 0.85; 95% CI 0.75–0.97) were less likely to continue PrEP compared to women who were primigravid or pregnant. Women who reported having an HIV+ partner (aPR = 1.45; 95% CI 1.13–1.85) or high HIV risk perception (aPR = 1.20, 95% CI = 1.01–1.41) were more likely to continue on PrEP than those who had HIV‐negative partners or low risk perception. Conclusions PrEP initiation and early continuation were high in this setting, compared to other studies in women. Being postpartum and experiencing side effects were associated with lower PrEP continuation, presenting opportunities for counselling on early transient side effects. Interventions for postpartum women on PrEP are needed.
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Affiliation(s)
- Dvora Leah Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.,The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, South Africa
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nyiko Mashele
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Nehaa Khadka
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Linda-Gail Bekker
- The Desmond Tutu Health Foundation, University of Cape Town, Cape Town, South Africa
| | - Pamina Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California, USA
| | - Thomas J Coates
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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30
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Mogoba P, Lesosky M, Zerbe A, Falcao J, Mellins CA, Desmond C, Arnaldo C, Kapogiannis B, Myer L, Abrams EJ. Correction to: The CombinADO study to assess the impact of a combination intervention strategy on viral suppression, antiretroviral therapy adherence, and retention in HIV care among adolescents and young people living with HIV: protocol for a cluster-randomized controlled trial. Trials 2022; 23:48. [PMID: 35039053 PMCID: PMC8762961 DOI: 10.1186/s13063-022-06008-2] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Phepo Mogoba
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa.
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Joana Falcao
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | - Carlos Arnaldo
- Centro de Estudos Africanos, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
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31
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Binegdie AB, Meme H, El Sony A, Haile T, Osman R, Miheso B, Zurba L, Lesosky M, Balmes J, Burney PJ, Mortimer K, Devereux G. Chronic respiratory disease in adult outpatients in three African countries: a cross-sectional study. Int J Tuberc Lung Dis 2022; 26:18-25. [PMID: 34969424 PMCID: PMC8734192 DOI: 10.5588/ijtld.21.0362] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND: The greatest burden of chronic respiratory disease is in low- and middle-income countries, with recent population-based studies reporting substantial levels of obstructive and restrictive lung function.OBJECTIVE: To characterise the common chronic respiratory diseases encountered in hospital outpatient clinics in three African countries.METHODS This was a cross-sectional study of consecutive adult patients with chronic respiratory symptoms (>8 weeks) attending hospital outpatient departments in Ethiopia, Kenya and Sudan. Patients were assessed using a respiratory questionnaire, spirometry and chest radiography. The diagnoses of the reviewing clinicians were ascertained.RESULT: A total of 519 patients (209 Kenya, 170 Ethiopia, 140 Sudan) participated; the mean age was 45.2 years (SD 16.2); 53% were women, 83% had never smoked. Reviewing clinicians considered that 36% (95% CI 32-40) of patients had asthma, 25% (95% CI 21-29) had chronic bronchitis, 8% (95% CI 6-11) chronic obstructive pulmonary disease (COPD), 5% (95% CI 4-8) bronchiectasis and 4% (95% CI 3-6) post-TB lung disease. Spirometry consistent with COPD was present in 35% (95% CI 30-39). Restriction was evident in 38% (95% CI 33-43). There was evidence of sub-optimal diagnosis of asthma and COPD.CONCLUSION: In Ethiopia, Kenya and Sudan, asthma, COPD and chronic bronchitis account for the majority of diagnoses in non-TB patients with chronic respiratory symptoms. The suboptimal diagnosis of these conditions will require the widespread use of spirometry.
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Affiliation(s)
- A B Binegdie
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - H Meme
- Centre for Respiratory Diseases Research, Kenyan Medical Research Institute (KEMRI), Nairobi, Kenya
| | - A El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - T Haile
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - R Osman
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - B Miheso
- Centre for Respiratory Diseases Research, Kenyan Medical Research Institute (KEMRI), Nairobi, Kenya
| | - L Zurba
- Education for Health Africa, Durban, South Africa
| | - M Lesosky
- Division of Epidemiology Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Balmes
- University of California, San Francisco, CA, USA
| | - P J Burney
- National Heart and Lung Institute, Imperial College London, London, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
| | - G Devereux
- Liverpool School of Tropical Medicine, Liverpool, UK
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32
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Mogoba P, Lesosky M, Zerbe A, Falcao J, Mellins CA, Desmond C, Arnaldo C, Kapogiannis B, Myer L, Abrams EJ. The CombinADO study to assess the impact of a combination intervention strategy on viral suppression, antiretroviral therapy adherence, and retention in HIV care among adolescents and young people living with HIV: protocol for a cluster-randomized controlled trial. Trials 2021; 22:956. [PMID: 34961567 PMCID: PMC8710928 DOI: 10.1186/s13063-021-05943-w] [Citation(s) in RCA: 3] [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: 09/08/2021] [Accepted: 12/15/2021] [Indexed: 11/14/2022] Open
Abstract
Background Adolescents and youth living with HIV (AYAHIV) have worse HIV outcomes than other age groups, particularly in sub-Saharan Africa (SSA). AYAHIV in SSA face formidable health system, interpersonal- and individual-level barriers to retention in HIV care, uptake of ART, and achievement of viral suppression (VS), underscoring an urgent need for multi-component interventions to address these challenges. This cluster-randomized control trial (cRCT) aims to evaluate the effectiveness and monitor implementation of a community-informed multi-component intervention (“CombinADO strategy”) addressing individual-, facility-, and community-level factors to improve health outcomes for AYAHIV. Methods This trial will be conducted in 12 clinics in Nampula Province, Northern Mozambique. All clinics will implement an optimized standard of care (control) including (1) billboards/posters and radio shows, (2) healthcare worker (HCW) training, (3) one-stop adolescent and youth-friendly services, (4) information/motivation walls, (5) pill containers, and (6) tools to be used by HCW during clinical visits. The CombinADO strategy (intervention) will be superadded to control conditions at 6 randomly selected clinics. It will include five additional components: (1) peer support, (2) informational/motivational video, (3) support groups for AYAHIV caregivers, (4) AYAHIV support groups, and (5) mental health screening and linkage to adolescent-focused mental health support. The study conditions will be in place for 12 months; all AYAHIV (ages 10–24 years, on ART) seeking care in the participating sites will be exposed to either the control or intervention condition based on the clinic they attend. The primary outcome is VS (viral load < 50 copies/mL) at 12 months among AYAHIV attending participating clinics. Secondary outcomes include ART adherence (self-reported and TDF levels) and retention in care (engagement in the preceding 90 days). Uptake, feasibility, acceptability, and fidelity of the CombinADO strategy during implementation will be measured. Trial outcomes will be assessed in AYAHIV, caregivers, healthcare workers, and key informants. Statistical analyses will be conducted and reported in line with CONSORT guidelines for cRCTs. Discussion The CombinADO study will provide evidence on effectiveness and inform implementation of a novel community-informed multi-component intervention to improve retention, adherence, and VS among AYAHIV. If found effective, results will strengthen the rationale for scale up in SSA. Trial registration ClinicalTrials.gov NCT04930367. Registered on 18 June 2021 Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05943-w.
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Affiliation(s)
- Phepo Mogoba
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa.
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Joana Falcao
- ICAP at Columbia University, Mailman School of Public Health, New York, USA
| | - Claude Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute and Columbia University Irving Medical Center, New York, NY, USA
| | | | - Carlos Arnaldo
- Centro de Estudos Africanos, Universidade Eduardo Mondlane, Maputo, Mozambique
| | - Bill Kapogiannis
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Level 5, Falmouth Building, Anzio Road, Cape Town, South Africa
| | - Elaine J Abrams
- ICAP at Columbia University, Mailman School of Public Health, New York, USA.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
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Nightingale R, Chinoko B, Lesosky M, Rylance SJ, Mnesa B, Banda NPK, Joekes E, Squire SB, Mortimer K, Meghji J, Rylance J. Respiratory symptoms and lung function in patients treated for pulmonary tuberculosis in Malawi: a prospective cohort study. Thorax 2021; 77:1131-1139. [PMID: 34937802 PMCID: PMC9606518 DOI: 10.1136/thoraxjnl-2021-217190] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 03/04/2021] [Accepted: 11/23/2021] [Indexed: 11/13/2022]
Abstract
Rationale Pulmonary tuberculosis (PTB) can cause post-TB lung disease (PTLD) associated with respiratory symptoms, spirometric and radiological abnormalities. Understanding of the predictors and natural history of PTLD is limited. Objectives To describe the symptoms and lung function of Malawian adults up to 3 years following PTB-treatment completion, and to determine the evolution of PTLD over this period. Methods Adults successfully completing PTB treatment in Blantyre, Malawi were followed up for 3 years and assessed using questionnaires, post-bronchodilator spirometry, 6 min walk tests, chest X-ray and high-resolution CT. Predictors of lung function at 3 years were identified by mixed effects regression modelling. Measurement and main results We recruited 405 participants of whom 301 completed 3 years follow-up (mean (SD) age 35 years (10.2); 66.6% males; 60.4% HIV-positive). At 3 years, 59/301 (19.6%) reported respiratory symptoms and 76/272 (27.9%) had abnormal spirometry. The proportions with low FVC fell from 57/285 (20.0%) at TB treatment completion to 33/272 (12.1%), while obstruction increased from and 41/285 (14.4%) to 43/272 (15.8%) at 3 years. Absolute FEV1 and FVC increased by mean 0.03 L and 0.1 L over this period, but FEV1 decline of more than 0.1 L was seen in 73/246 (29.7%). Higher spirometry values at 3 years were associated with higher body mass index and HIV coinfection at TB-treatment completion. Conclusion Spirometric measures improved over the 3 years following treatment, mostly in the first year. However, a third of PTB survivors experienced ongoing respiratory symptoms and abnormal spirometry (with accelerated FEV1 decline). Effective interventions are needed to improve the care of this group of patients.
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Affiliation(s)
- Rebecca Nightingale
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK .,Liverpool Univeristy Hospitals NHS Foundation Trust, Liverpool, UK.,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Beatrice Chinoko
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Maia Lesosky
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Division of Epidemiology & Biostatistics, University of Cape Town, Rondebosch, South Africa
| | - Sarah J Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Bright Mnesa
- Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | | | - Elizabeth Joekes
- Liverpool Univeristy Hospitals NHS Foundation Trust, Liverpool, UK
| | - Stephen Bertel Squire
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Liverpool Univeristy Hospitals NHS Foundation Trust, Liverpool, UK.,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Liverpool Univeristy Hospitals NHS Foundation Trust, Liverpool, UK
| | - Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Malawi Liverpool Wellcome Trust Clinical Research Programme, Blantyre, Malawi
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Mukonda E, Cleary S, Lesosky M. A review of simulation models for the long-term management of type 2 diabetes in low-and-middle income countries. BMC Health Serv Res 2021; 21:1313. [PMID: 34872555 PMCID: PMC8650231 DOI: 10.1186/s12913-021-07324-0] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 11/18/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The burden of type 2 diabetes is steadily increasing in low-and-middle-income countries, thereby posing a major threat from both a treatment, and funding standpoint. Although simulation modelling is generally relied upon for evaluating long-term costs and consequences associated with diabetes interventions, no recent article has reviewed the characteristics and capabilities of available models used in low-and-middle-income countries. We review the use of computer simulation modelling for the management of type 2 diabetes in low-and-middle-income countries. Methods A search for studies reporting computer simulation models of the natural history of individuals with type 2 diabetes and/or decision models to evaluate the impact of treatment strategies on these populations was conducted in PubMed. Data were extracted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and assessed using modelling checklists. Publications before the year 2000, from high-income countries, studies involving animals and analyses that did not use mathematical simulations were excluded. The full text of eligible articles was sourced and information about the intervention and population being modelled, type of modelling approach and the model structure was extracted. Results Of the 79 articles suitable for full text review, 44 studies met the inclusion criteria. All were cost-effectiveness/utility studies with the majority being from the East Asia and Pacific region (n = 29). Of the included studies, 34 (77.3%) evaluated the cost-effectiveness of pharmacological interventions and approximately 75% of all included studies used HbA1c as one of the treatment effects of the intervention. 32 (73%) of the publications were microsimulation models, and 29 (66%) were state-transition models. Most of the studies utilised annual cycles (n = 29, 71%), and accounted for costs and outcomes over 20 years or more (n = 38, 86.4%). Conclusions While the use of simulation modelling in the management of type 2 diabetes has been steadily increasing in low-and-middle-income countries, there is an urgent need to invest in evaluating therapeutic and policy interventions related to type 2 diabetes in low-and-middle-income countries through simulation modelling, especially with local research data. Moreover, it is important to improve transparency and credibility in the reporting of input data underlying model-based economic analyses, and studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07324-0.
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Affiliation(s)
- Elton Mukonda
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa.
| | - Susan Cleary
- Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town, 7925, South Africa
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Mpagama SG, Msaji KS, Kaswaga O, Zurba LJ, Mbelele PM, Allwood BW, Ngungwa BS, Kisonga RM, Lesosky M, Rylance J, Mortimer K. The burden and determinants of post-TB lung disease. Int J Tuberc Lung Dis 2021; 25:846-853. [PMID: 34615582 PMCID: PMC8504494 DOI: 10.5588/ijtld.21.0278] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/18/2022] Open
Abstract
BACKGROUND: Post-TB lung disease (PTLD) is an important but under-recognised chronic respiratory disease in high TB burden settings such as Tanzania.METHODS: This was a cross-sectional survey of adults within 2 years of completion of TB treatment in Kilimanjaro, Tanzania. Data were collected using questionnaires (symptoms and exposures), spirometry and chest radiographs to assess outcome measures, which were correlated with daily life exposures, including environment and diet.RESULTS: Of the 219 participants enrolled (mean age: 45 years ± 10; 193 88% males), 98 (45%) reported chronic respiratory symptoms; 46 (22%) had received treatment for TB two or more times; and HIV prevalence was 35 (16%). Spirometric abnormalities were observed in 146 (67%). Chest X-ray abnormalities occurred in 177 (86%). A diagnosis of PTLD was made in 200 (91%), and half had clinically relevant PTLD. The prevalence of mMRC ≥Grade 3 chronic bronchitis and dyspnoea was respectively 11% and 26%. Older age, multiple episodes of TB and poverty indicators were linked with clinically relevant PTLD.CONCLUSIONS: We found a substantial burden of PTLD in adults who had recently completed TB treatment in Tanzania. There is a pressing need to identify effective approaches for both the prevention and management of this disease.
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Affiliation(s)
- S G Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania, Kilimanjaro Christian Medical University College, Kilimanjaro, Tanzania
| | - K S Msaji
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - O Kaswaga
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - L J Zurba
- Education for Health Africa, Mount Edgecombe, Durban, South Africa
| | - P M Mbelele
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania, Nelson Mandela African Institution of Science & Technology, Arusha, Tanzania
| | - B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - B-S Ngungwa
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - R M Kisonga
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J Rylance
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Mukonda E, Lesosky M. A comparative analysis and review of how national guidelines for chronic disease monitoring are made in low- and middle-income compared to high-income countries. J Glob Health 2021; 11:04055. [PMID: 34552724 PMCID: PMC8442582 DOI: 10.7189/jogh.11.04055] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Understanding how clinical practice guidelines and recommendations are adopted in high-income and low-income settings will help contextualise the value and validity of recommendations in different settings. We investigate how major guidelines and recommendations are developed for management and monitoring of post-diagnosis treatment for three important chronic diseases: HIV, hypertension and type 2 diabetes mellitus (T2DM). Methods Eligible guidelines were searched for using PubMed, Google, and health ministry websites for all three conditions. Only guidelines published from 2010 to 2020 were included. The source of the guidelines, year of most recent guideline, and basis of the guidelines were assessed. Additionally, recommendations, the strength of the recommendation and the quality of the evidence for treatment goals of non-pregnant adults and the frequency of monitoring were also extracted and assessed. Results Of the 42 countries searched 90%, 71% and 60% had T2DM, hypertension and HIV guidelines outlining targets for long-term management, respectively. Most T2DM guidelines recommend an HbA1c target of ≤7.0% (68%) or ≤6.5% (24%) as the ideal glycaemic target for most non-pregnant adults, while hypertension guidelines recommend blood pressure (systolic blood pressure/diastolic blood pressure) targets of <140/90 mm Hg (94%) and <130/80 mm Hg (6%). Of the identified HIV guidelines, 67% define virological failure as a viral load >1000 copies/mL, with 26%, mostly HICs, defining virological failure as a viral load >200 copies/mL. Recommendations for the frequency of monitoring for any diagnosed patients were available in 18 (55%) of the hypertension guidelines, 25 (93%) of HIV guidelines, and 27 (73%) of the T2DM guidelines. Only a few of the guidelines provide the strength of the recommendation and the quality of the evidence. Conclusions Most guidelines from LMICs are adopted or adapted from existing HIC guidelines or international and regional organisation guidelines with little consideration for resource availability, contextual factors, logistical issues and general feasibility.
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Affiliation(s)
- Elton Mukonda
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Odayar J, Kabanda S, Malaba TR, Lesosky M, Myer L. Brief Report: Viral Load Monitoring in Pregnancy to Predict Peripartum Viremia in South Africa. J Acquir Immune Defic Syndr 2021; 88:6-9. [PMID: 34050102 DOI: 10.1097/qai.0000000000002738] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/20/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Enhanced postnatal prophylaxis is recommended in infants of women with viremia during labor, as identified by viral load (VL) testing late in pregnancy. However, data on the use of antenatal VL to predict peripartum viremia are few, particularly in women starting antiretroviral therapy (ART) in pregnancy who experience initial VL declines. METHODS Between January 2016 and August 2017, we identified HIV-infected women who initiated ART (tenofovir, emtricitabine, and efavirenz) antenatally and had a VL <400 copies/mL before delivery in Cape Town, South Africa. VLs were repeated postdelivery, and sensitivity, specificity, and positive and negative likelihood ratios (LR+ and LR-) for antenatal VL <100 copies/mL in predicting peripartum VLs <100 and <400 copies/mL were calculated. RESULTS Among 322 women (median age 29 years, 44% with a history of ART use, median gestation of antenatal VL 33 weeks), antenatal VL was <100 copies/mL in 89% and 100-400 copies/mL in 11%. At a median 9 days postpartum, 91%, 7%, and 2% of women had a VL <100, 100-400, and >400 copies/mL, respectively. Sensitivity of antenatal VL <100 copies/mL in predicting peripartum VL <100 copies/mL was 0.95 (95% confidence interval: 0.92 to 0.97), and specificity was 0.71 (95% confidence interval: 0.51 to 0.87; LR+ 3.28, LR- 0.07). Performance was slightly weaker to detect peripartum VL <400 copies/mL but was similar across strata of gestation at antenatal VL and history of ART use. DISCUSSION Antenatal VL is a useful predictor of peripartum viremia in women who started ART in pregnancy and attained a VL <400 copies/mL antenatally and may be used to target enhanced postnatal prophylaxis interventions.
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Affiliation(s)
- Jasantha Odayar
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
| | - Siti Kabanda
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
- Currently, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; and
| | - Thokozile R Malaba
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa; and
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
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Machipisa T, Chong M, Muhamed B, Chishala C, Shaboodien G, Pandie S, de Vries J, Laing N, Joachim A, Daniels R, Ntsekhe M, Hugo-Hamman CT, Gitura B, Ogendo S, Lwabi P, Okello E, Damasceno A, Novela C, Mocumbi AO, Madeira G, Musuku J, Mtaja A, ElSayed A, Elhassan HHM, Bode-Thomas F, Okeahialam BN, Zühlke LJ, Mulder N, Ramesar R, Lesosky M, Parks T, Cordell HJ, Keavney B, Engel ME, Paré G. Association of Novel Locus With Rheumatic Heart Disease in Black African Individuals: Findings From the RHDGen Study. JAMA Cardiol 2021; 6:1000-1011. [PMID: 34106200 PMCID: PMC8190704 DOI: 10.1001/jamacardio.2021.1627] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/25/2021] [Indexed: 01/02/2023]
Abstract
Importance Rheumatic heart disease (RHD), a sequela of rheumatic fever characterized by permanent heart valve damage, is the leading cause of cardiac surgery in Africa. However, its pathophysiologic characteristics and genetics are poorly understood. Understanding genetic susceptibility may aid in prevention, control, and interventions to eliminate RHD. Objective To identify common genetic loci associated with RHD susceptibility in Black African individuals. Design, Setting, and Participants This multicenter case-control genome-wide association study (GWAS), the Genetics of Rheumatic Heart Disease, examined more than 7 million genotyped and imputed single-nucleotide variations. The 4809 GWAS participants and 116 independent trio families were enrolled from 8 African countries between December 31, 2012, and March 31, 2018. All GWAS participants and trio probands were screened by use of echocardiography. Data analyses took place from May 15, 2017, until March 14, 2021. Main Outcomes and Measures Genetic associations with RHD. Results This study included 4809 African participants (2548 RHD cases and 2261 controls; 3301 women [69%]; mean [SD] age, 36.5 [16.3] years). The GWAS identified a single RHD risk locus, 11q24.1 (rs1219406 [odds ratio, 1.65; 95% CI, 1.48-1.82; P = 4.36 × 10-8]), which reached genome-wide significance in Black African individuals. Our meta-analysis of Black (n = 3179) and admixed (n = 1055) African individuals revealed several suggestive loci. The study also replicated a previously reported association in Pacific Islander individuals (rs11846409) at the immunoglobulin heavy chain locus, in the meta-analysis of Black and admixed African individuals (odds ratio, 1.16; 95% CI, 1.06-1.27; P = 1.19 × 10-3). The HLA (rs9272622) associations reported in Aboriginal Australian individuals could not be replicated. In support of the known polygenic architecture for RHD, overtransmission of a polygenic risk score from unaffected parents to affected probands was observed (polygenic transmission disequilibrium testing mean [SE], 0.27 [0.16] SDs; P = .04996), and the chip-based heritability was estimated to be high at 0.49 (SE = 0.12; P = 3.28 × 10-5) in Black African individuals. Conclusions and Relevance This study revealed a novel candidate susceptibility locus exclusive to Black African individuals and an important heritable component to RHD susceptibility in African individuals.
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Affiliation(s)
- Tafadzwa Machipisa
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Michael Chong
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Babu Muhamed
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
| | - Chishala Chishala
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gasnat Shaboodien
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Hatter Institute for Cardiovascular Diseases Research in Africa and Cape Heart Institute, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Shahiemah Pandie
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Jantina de Vries
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Nakita Laing
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Alexia Joachim
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Rezeen Daniels
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Mpiko Ntsekhe
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Christopher T. Hugo-Hamman
- Rheumatic Heart Disease Clinic, Windhoek Central Hospital, Ministry of Health and Social Services, Windhoek, Republic of Namibia
| | - Bernard Gitura
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | - Stephen Ogendo
- Cardiology Department of Medicine, Kenyatta National Hospital, University of Nairobi, Nairobi, Kenya
| | | | | | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique
| | - Celia Novela
- Faculty of Medicine, Eduardo Mondlane University/Nucleo de Investigaçao, Departamento de Medicina, Hospital Central de Maputo, Maputo, Mozambique
| | - Ana O. Mocumbi
- Instituto Nacional de Saúde Ministério da Saúde, Maputo, Moçambique
| | - Goeffrey Madeira
- Emergency Department, World Health Organization Mozambique, Maputo, Mozambique
| | - John Musuku
- Department of Paediatrics and Child Health, University Teaching Hospital–Children’s Hospital, University of Zambia, Lusaka, Zambia
| | - Agnes Mtaja
- Department of Paediatrics and Child Health, University Teaching Hospital–Children’s Hospital, University of Zambia, Lusaka, Zambia
| | - Ahmed ElSayed
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Center, Alzaiem Alazhari University, Khartoum, Sudan
| | - Huda H. M. Elhassan
- Department of Cardiothoracic Surgery, Alshaab Teaching Hospital, Alazhari Health Research Center, Alzaiem Alazhari University, Khartoum, Sudan
| | - Fidelia Bode-Thomas
- Department of Paediatrics, Jos University Teaching Hospital and University of Jos, Jos, Plateau State Nigeria
| | - Basil N. Okeahialam
- Department of Paediatrics, Jos University Teaching Hospital and University of Jos, Jos, Plateau State Nigeria
| | - Liesl J. Zühlke
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
- Division of Paediatric Cardiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital and University of Cape Town, South Africa
| | - Nicola Mulder
- Computational Biology Division, Department of Integrative Biomedical Sciences, Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Raj Ramesar
- Department of Pathology, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Tom Parks
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Heather J. Cordell
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, International Centre for Life, Newcastle upon Tyne, United Kingdom
| | - Bernard Keavney
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine, and Health, The University of Manchester, Manchester, United Kingdom
- Manchester University National Health Service Foundation Trust, Manchester Academic Health Science CentreManchester, United Kingdom
| | - Mark E. Engel
- Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Guillaume Paré
- Population Health Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Thrombosis and Atherosclerosis Research Institute, David Braley Cardiac, Vascular and Stroke Research Institute, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Michael G. DeGroote School of Medicine, Hamilton, Ontario, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton Ontario, Canada
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Affiliation(s)
- Chukwudi A Nnaji
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
| | - Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa
| | - Hassan Mahomed
- Western Cape Provincial Department of Health, Cape Town, South Africa; Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Charles S Wiysonge
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town 7925, South Africa; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Mukonda E, Hsiao NY, Vojnov L, Myer L, Lesosky M. Mixed-method estimation of population-level HIV viral suppression rate in the Western Cape, South Africa. BMJ Glob Health 2021; 5:bmjgh-2020-002522. [PMID: 32816953 PMCID: PMC7437711 DOI: 10.1136/bmjgh-2020-002522] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION There are few population-wide data on viral suppression (VS) that can be used to monitor programmatic targets in sub-Saharan Africa. We describe how routinely collected viral load (VL) data from antiretroviral therapy (ART) programmes can be extrapolated to estimate population VS and validate this using a combination of empiric and model-based estimates. METHODS VL test results from were matched using a record linkage algorithm to obtain linked results for individuals. Test-level and individual-level VS rates were based on test VL values <1000 cps/mL, and individual VL <1000 cps/mL in a calendar year, respectively. We calculated population VS among people living with HIV (PLWH) in the province by combining census-derived midyear population estimates, HIV prevalence estimates and individual level VS estimates from routine VL data. RESULTS Approximately 1.9 million VL test results between 2008 and 2018 were analysed. Among individuals in care, VS increased from 85.5% in 2008 to 90% in 2018. Population VS among all PLWH in the province increased from 12.2% in 2008 to 51.0% in 2017. The estimates derived from this method are comparable to those from other published studies. Sensitivity analyses showed that the results are robust to variations in linkage method, but sensitive to the extreme combinations of assumed VL testing coverage and population HIV prevalence. CONCLUSION While validation of this method in other settings is required, this approach provides a simple, robust method for estimating population VS using routine data from ART services that can be employed by national programmes in high-burden settings.
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Affiliation(s)
- Elton Mukonda
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Nei-Yuan Hsiao
- National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa.,Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Lara Vojnov
- World Health Organization, Geneva, GE, Switzerland
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
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Allwood BW, Stolbrink M, Baines N, Louw E, Wademan DT, Lupton-Smith A, Nel S, Maree D, Mpagama S, Osman M, Marx FM, Hoddinott G, Lesosky M, Rylance J, Mortimer K. Persistent chronic respiratory symptoms despite TB cure is poorly correlated with lung function. Int J Tuberc Lung Dis 2021; 25:262-270. [PMID: 33762069 PMCID: PMC8009599 DOI: 10.5588/ijtld.20.0906] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [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] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND: Persistent respiratory symptoms and lung function deficits are common after patients with TB. We aimed to define the burden of post-TB lung disease (PTLD) and assess associations between symptoms and impairment in two high TB incidence communities.METHODS: This was a cross-sectional survey of adults in Cape Town, South Africa who completed TB treatment 1-5 years previously. Questionnaires, spirometry and 6-minute walking distance (6MWD) were used to assess relationships between outcome measures and associated factors.RESULTS: Of the 145 participants recruited (mean age: 42 years, range: 18-75; 55 [38%] women), 55 (38%) had airflow obstruction and 84 (58%) had low forced vital capacity (FVC); the mean 6MWD was 463 m (range: 240-723). Respiratory symptoms were common: chronic cough (n = 27, 19%), wheeze (n = 61, 42%) and dyspnoea (modified MRC dyspnoea score 3 or 4: n = 36, 25%). There was poor correlation between FVC or obstruction and 6MWD. Only low body mass index showed consistent association with outcomes on multivariable analyses. Only 19 (13%) participants had a diagnosis of respiratory disease, and 16 (11%) currently received inhalers.CONCLUSION: There was substantial burden of symptoms and physiological impairment in this "cured" population, but poor correlation between objective outcome measures, highlighting deficits in our understanding of PTLD.
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Affiliation(s)
- B W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - M Stolbrink
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - N Baines
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - E Louw
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - D T Wademan
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A Lupton-Smith
- Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - S Nel
- Department of Physical Medicine and Rehabilitation, School of Medicine, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - D Maree
- Division of Pulmonology, Department of Medicine, Stellenbosch University & Tygerberg Hospital, Tygerberg, South Africa
| | - S Mpagama
- Kibong´oto Infectious Diseases Hospital, Kilimanjaro, Tanzania
| | - M Osman
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - F M Marx
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa, Department of Science and Innovation-National Research Foundation South African Centre for Excellence in Epidemiological Modelling and Analysis (SACEMA), Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - G Hoddinott
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - M Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa, Liverpool School of Tropical Medicine, Liverpool, UK
| | - J Rylance
- Lung Health Group, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi, Liverpool School of Tropical Medicine, Liverpool, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, Liverpool, UK
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Dobson R, Siddiqi K, Ferdous T, Huque R, Lesosky M, Balmes J, Semple S. Diurnal variability of fine-particulate pollution concentrations: data from 14 low- and middle-income countries. Int J Tuberc Lung Dis 2021; 25:206-214. [PMID: 33688809 PMCID: PMC7948758 DOI: 10.5588/ijtld.20.0704] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Scientific understanding of indoor air pollution is predominately based on research carried out in cities in high-income countries (HICs). Less is known about how pollutant concentrations change over the course of a typical day in cities in low- and middle-income countries (LMICs).OBJECTIVE: To understand how concentrations of fine particulate matter smaller than 2.5 microns in diameter (PM2.5) change over the course of the day outdoors (across a range of countries) and indoors (using measurements from Dhaka, Bangladesh).DESIGN: Data on PM2.5 concentrations were gathered from 779 households in Dhaka as part of the MCLASS II (Muslim Communities Learning About Second-hand Smoke in Bangladesh) project, and compared to outdoor PM2.5 concentrations to determine the temporal variation in exposure to air pollution. Hourly PM2.5 data from 23 cities in 14 LMICs, as well as London (UK), Paris (France) and New York (NY, USA), were extracted from publicly available sources for comparison.RESULTS: PM2.5 in homes in Dhaka demonstrated a similar temporal pattern to outdoor measurements, with greater concentrations at night than in the afternoon. This pattern was also evident in 19 of 23 LMIC cities.CONCLUSION: PM2.5 concentrations are greater at night than during the afternoon in homes in Dhaka. Diurnal variations in PM2.5 in LMICs is substantial and greater than in London, Paris or New York. This has implications for public health community approaches to health effects of air pollution in LMICs.
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Affiliation(s)
- R. Dobson
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland
| | - K. Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - T. Ferdous
- Advancement through Research and Knowledge Foundation Bangladesh, Dhaka, Bangladesh
| | - R. Huque
- Advancement through Research and Knowledge Foundation Bangladesh, Dhaka, Bangladesh
| | - M. Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - J. Balmes
- Department of Medicine, University of California, San Francisco, CA
,School of Public Health, University of California, Berkeley, CA, USA
| | - S. Semple
- Institute for Social Marketing and Health, University of Stirling, Stirling, Scotland
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Myer L, Redd AD, Mukonda E, Lynch BA, Phillips TK, Eisenberg A, Hsiao NY, Capoferri A, Zerbe A, Clarke W, Lesosky M, Breaud A, McIntyre J, Bruno D, Martens C, Abrams EJ, Reynolds SJ. Antiretroviral Adherence, Elevated Viral Load, and Drug Resistance Mutations in Human Immunodeficiency Virus-infected Women Initiating Treatment in Pregnancy: A Nested Case-control Study. Clin Infect Dis 2021; 70:501-508. [PMID: 30877752 DOI: 10.1093/cid/ciz209] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 01/03/2019] [Accepted: 03/15/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Elevated viral load (VL) early after antiretroviral therapy (ART) initiation appears frequently in pregnant and postpartum women living with human immunodeficiency virus; however the relative contributions of pre-ART drug resistance mutations (DRMs) vs nonadherence in the etiology of elevated VL are unknown. METHODS Within a cohort of women initiating ART during pregnancy in Cape Town, South Africa, we compared women with elevated VL after initial suppression (cases, n = 80) incidence-density matched to women who maintained suppression over time (controls, n = 87). Groups were compared on pre-ART DRMs and detection of antiretrovirals in stored plasma. RESULTS The prevalence of pre-ART DRMs was 10% in cases and 5% in controls (adjusted odds ratio [aOR], 1.53 [95% confidence interval {CI}, .4-5.9]); all mutations were to nonnucleoside reverse transcriptase inhibitors. At the time of elevated VL, 19% of cases had antiretrovirals detected in plasma, compared with 87% of controls who were suppressed at a matched time point (aOR, 131.43 [95% CI, 32.8-527.4]). Based on these findings, we estimate that <10% of all elevated VL in the cohort may be attributable to pre-ART DRMs vs >90% attributable to ART nonadherence. CONCLUSIONS DRMs account for a small proportion of all elevated VL among women occurring in the 12 months after ART initiation during pregnancy in this setting, with nonadherence appearing to drive most episodes of elevated VL. Alongside the drive for access to more robust antiretroviral agents in resource-limited settings, there is an ongoing need for effective strategies to support ART adherence in this patient population.
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Affiliation(s)
- Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town, South Africa.,Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Andrew D Redd
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elton Mukonda
- Division of Epidemiology and Biostatistics, University of Cape Town, South Africa
| | - Briana A Lynch
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda
| | - Tamsin K Phillips
- Division of Epidemiology and Biostatistics, University of Cape Town, South Africa.,Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | - Anna Eisenberg
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda
| | - Nei-Yuan Hsiao
- Division of Medical Virology, Department of Pathology, University of Cape Town, South Africa.,National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - Adam Capoferri
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Alison Zerbe
- ICAP at Columbia University Mailman School of Public Health, New York, New York
| | - William Clarke
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, University of Cape Town, South Africa
| | - Autumn Breaud
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - James McIntyre
- Division of Epidemiology and Biostatistics, University of Cape Town, South Africa.,Anova Health Institute, Johannesburg, South Africa
| | - Daniel Bruno
- Genomics Unit, Research Technologies Branch, Rocky Mountain Laboratories, NIAID, NIH, Hamilton, Montana
| | - Craig Martens
- Genomics Unit, Research Technologies Branch, Rocky Mountain Laboratories, NIAID, NIH, Hamilton, Montana
| | - Elaine J Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York.,Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Steven J Reynolds
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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Zar HJ, Nduru P, Stadler JAM, Gray D, Barnett W, Lesosky M, Myer L, Nicol MP. Early-life respiratory syncytial virus lower respiratory tract infection in a South African birth cohort: epidemiology and effect on lung health. Lancet Glob Health 2020; 8:e1316-e1325. [PMID: 32971054 PMCID: PMC7511798 DOI: 10.1016/s2214-109x(20)30251-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 02/10/2020] [Revised: 04/15/2020] [Accepted: 05/11/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection (LRTI) in children. Early-life RSV LRTI might affect long-term health but there are few data from low-income and middle-income countries. We investigated the epidemiology and effect of early-life RSV LRTI on lung health in a South African birth cohort. METHODS We conducted the Drakenstein Child Health Study (DCHS), an ongoing birth cohort longitudinal study in the Western Cape province, South Africa. We enrolled pregnant women aged 18 years or older during their second trimester of pregnancy at two public health clinics. We followed up study children from birth to 2 years. The primary outcome of the study was LRTI and RSV LRTI. LRTI and wheezing episodes were identified through active surveillance; respiratory samples were tested for RSV and other pathogens. Wheezing was longitudinally identified by caregiver report and ascertainment at health facilities. Lung function was measured from 6 weeks to 2 years. We analysed the associations between RSV LRTI and subsequent LRTI, wheezing, and lung function using generalised estimating equations and mixed-effects linear regression. FINDINGS We enrolled 1137 mothers between March 5, 2012, and March 31, 2015. Among their 1143 infants, accruing 2093 child-years of follow-up, there were 851 cases of LRTI (incidence 0·41 episodes per child-year, 95% CI 0·38-0·43). Admission to hospital owing to LRTI occurred in 169 (20%) cases (incidence 0·08 episodes per child-year, 0·07-0·09), with a case-fatality ratio of 0·5%. RSV was detected in 164 (21%) of 785 LRTI events with a specimen available for qPCR, an incidence of 0·08 episodes per child-year (0·07-0·09); highest at age 0-6 months (0·15 episodes per child-year, 0·12-0·19). Children with a first RSV LRTI were three times as likely to develop recurrent LRTI compared with those with non-RSV LRTI (0·32 [0·22-0·48] vs 0·10 [0·07- 0·16] episodes per child-year; p<0·0001), particularly following hospitalised RSV LRTI. RSV LRTI and hospitalisation for all-cause LRTI were independently associated with recurrent wheezing (adjusted incident rate ratio 1·41, 95% CI 1·25-1·59, for RSV LRTI and 1·48, 1·30-1·68, for hospitalisation). LRTI or recurrent LRTI was associated with impaired lung function, but a similar outcome was observed following RSV LRTI or non-RSV LRTI. All-cause LRTI was associated with an average 3% higher respiratory rate (95% CI 0·01-0·06; p=0·013) and lower compliance (-0·1, -0·18 to 0·02) at 2 years compared with no LRTI. Recurrent LRTI was associated with further increased respiratory rate (0·01, 0·001-0·02), resistance (0·77 hPa s L-1, 0·07-1·47), and lower compliance (-0·6 mL hPa-1, -0·09 to -0·02) with each additional event. INTERPRETATION RSV LRTI was common in young infants and associated with recurrent LRTI, particularly after hospitalised RSV. Hospitalisation for all-cause LRTI, especially for RSV-LRTI, was associated with recurrent wheezing. Impairments in lung function followed LRTI or recurrent episodes, but were not specific to RSV. New preventive strategies for RSV might have an effect on long-term lung health. FUNDING Bill & Melinda Gates Foundation; South African Medical Research Council; National Research Foundation South Africa; National Institutes of Health, Human Heredity and Health in Africa; Wellcome Trust.
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Affiliation(s)
- Heather J Zar
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa.
| | - Polite Nduru
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Jacob A M Stadler
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Diane Gray
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Whitney Barnett
- Department of Paediatrics and Child Heath, Red Cross War Memorial Children's Hospital and South African Medical Research Council Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mark P Nicol
- Division of Medical Microbiology, University of Cape Town, Cape Town, South Africa; Division of Infection and Immunity, Department of Biomedical Sciences, University of Western Australia, Perth, WA, Australia
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Balle C, Gill K, Konstantinus IN, Jaumdally SZ, Lennard K, Esra R, Happel AU, Barnabas SL, Gamieldien H, Pidwell T, Maseko V, Lesosky M, Myer L, Passmore JAS, Bekker LG, Jaspan HB. Hormonal contraception and risk of STIs and bacterial vaginosis in South African adolescents: secondary analysis of a randomised trial. Sex Transm Infect 2020; 97:112-117. [PMID: 32989170 DOI: 10.1136/sextrans-2020-054483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/17/2020] [Revised: 07/30/2020] [Accepted: 08/29/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Young women in sub-Saharan Africa are at high risk of STIs and unintended pregnancies, yet hormonal contraceptive (HC) use may affect STI risk. We compared the influence of three HCs on the incidence and prevalence of STIs and bacterial vaginosis (BV) in South African adolescents. METHODS One hundred and thirty adolescents between 15 and 19 years were randomised to the injectable norethisterone enanthate (Net-En), combined oral contraceptives (COC) (Triphasil or Nordette) or a combined contraceptive vaginal ring (CCVR; NuvaRing) for 16 weeks (clinicaltrials.gov/NCT02404038). Vaginal samples were collected at baseline and 16 weeks post contraceptive initiation for STI and BV testing. RESULTS In an intention-to-treat analysis, no significant differences in BV prevalence were found between study arms. The overall incidence of any STI at follow-up was high: 16.2% in the COC arm; 25.7% in the Net-En arm; and 37.1% in the CCVR arm. The incidence rate (IR) of any STI was similar between Net-En (IR 0.74 (95% CI 0.34 to 1.41)) and the oestrogen-containing contraceptives (IR 0.78 (95% CI 0.47 to 1.22)). A lower IR of Chlamydia trachomatis (incidence rate ratio (IRR) 0.68 (95% CI 0.19 to 1.99)) and Neisseria gonorrhoeae (IRR 0.25 (95% CI 0.01 to 1.35)) but a higher IR of Mycoplasma genitalium (IRR 16.0 (95% CI 2.96 to 400)), was observed in the Net-En arm compared with the oestrogen-containing contraceptives, although the overall incidence of M. genitalium was low (4.7%). In an exploratory analysis, the risk of any STI and N. gonorrhoeae was lower in the COC arm compared with CCVR. A per-protocol analysis yielded similar results. CONCLUSION Our results suggest that use of Net-En may be associated with increased risk of M. genitalium compared with oestrogen-containing contraceptives but not with overall STI risk. COC use may decrease STI risk relative to CCVR.
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Affiliation(s)
- Christina Balle
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Katherine Gill
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Iyaloo N Konstantinus
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shameem Z Jaumdally
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Katie Lennard
- Department of Integrative Biomedical Sciences, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Rachel Esra
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Anna-Ursula Happel
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Shaun L Barnabas
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.,Family Clinical Research Centre, Stellenbosch University, Stellenbosch, Western Cape, South Africa
| | - Hoyam Gamieldien
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Tanya Pidwell
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Venessa Maseko
- National Institute for Communicable Diseases, Johannesburg, Gauteng, South Africa
| | - Maia Lesosky
- Division of Epidemiology, Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Landon Myer
- Division of Epidemiology, Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Jo-Ann S Passmore
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa.,National Health Laboratory Service, Johannesburg, Gauteng, South Africa
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, Western Cape, South Africa
| | - Heather B Jaspan
- Department of Pathology, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, Western Cape, South Africa .,Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, DC, USA.,Pediatrics and Global Health, University of Washington, Seattle, WA, USA
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Redd AD, Mukonda E, Hu NC, Philips TK, Zerbe A, Lesosky M, Hsiao NY, Clarke W, Reynolds SJ, Abrams EJ, Myer L. ART Adherence, Resistance, and Long-term HIV Viral Suppression in Postpartum Women. Open Forum Infect Dis 2020; 7:ofaa346. [PMID: 33072803 DOI: 10.1093/ofid/ofaa346] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/10/2020] [Indexed: 02/05/2023] Open
Abstract
HIV+ South African women who achieved viral suppression during routine antenatal care, but later experienced a viremic episode (viral load >1000 copies/mL), were examined for presence of antiretrovirals and classified as "nonadherers" or "suboptimal adherers." Women were tested for drug resistance mutations (DRMs) at several time points and underwent viral load testing 36-60 months postpartum. Suboptimal adherers were more likely to have DRM detected during their viremic episode (P = .03) and at a subsequent viremic time point (P = .05). There was no difference in levels of viral suppression 36-60 months later in women with DRM detected vs women who had no evidence of DRM (P = .5).
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Affiliation(s)
- Andrew D Redd
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Elton Mukonda
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Nai-Chung Hu
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Tamsin K Philips
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- ICAP at Columbia University Mailman School of Public Health, New York, New York, USA
| | - Maia Lesosky
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa
| | - Nei-Yuan Hsiao
- Division of Medical Virology, Department of Pathology, University of Cape Town, Cape Town, South Africa.,National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
| | - William Clarke
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Steven J Reynolds
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Rakai Health Sciences Program, Kalisizo, Uganda
| | - Elaine J Abrams
- ICAP at Columbia University Mailman School of Public Health, New York, New York, USA.,Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town, South Africa.,Centre for Infectious Diseases Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Affiliation(s)
- Maia Lesosky
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, 7925, South Africa.
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Lesosky M, Rangaka MX, Pienaar C, Coussens AK, Goliath R, Mathee S, Mwansa-Kambafwile J, Maartens G, Wilkinson RJ, Wilkinson KA. Plasma Biomarkers to Detect Prevalent or Predict Progressive Tuberculosis Associated With Human Immunodeficiency Virus-1. Clin Infect Dis 2020; 69:295-305. [PMID: 30256919 PMCID: PMC6603269 DOI: 10.1093/cid/ciy823] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 05/18/2018] [Accepted: 09/21/2018] [Indexed: 12/14/2022] Open
Abstract
Background The risk of individuals infected with human immunodeficiency virus (HIV)-1 developing tuberculosis (TB) is high, while both prognostic and diagnostic tools remain insensitive. The potential for plasma biomarkers to predict which HIV-1–infected individuals are likely to progress to active disease is unknown. Methods Thirteen analytes were measured from QuantiFERON Gold in-tube (QFT) plasma samples in 421 HIV-1–infected persons recruited within the screening and enrollment phases of a randomized, controlled trial of isoniazid preventive therapy. Blood for QFT was obtained pre-randomization. Individuals were classified into prevalent TB, incident TB, and control groups. Comparisons between groups, supervised learning methods, and weighted correlation network analyses were applied utilizing the unstimulated and background-corrected plasma analyte concentrations. Results Unstimulated samples showed higher analyte concentrations in the prevalent and incident TB groups compared to the control group. The largest differences were seen for C-X-C motif chemokine 10 (CXCL10), interleukin-2 (IL-2), IL-1α, transforming growth factor-α (TGF-α). A predictive model analysis using unstimulated analytes discriminated best between the control and prevalent TB groups (area under the curve [AUC] = 0.9), reasonably well between the incident and prevalent TB groups (AUC > 0.8), and poorly between the control and incident TB groups. Unstimulated IL-2 and IFN-γ were ranked at or near the top for all comparisons, except the comparison between the control vs incident TB groups. Models using background-adjusted values performed poorly. Conclusions Single plasma biomarkers are unlikely to distinguish between disease states in HIV-1 co-infected individuals, and combinations of biomarkers are required. The ability to detect prevalent TB is potentially important, as no blood test hitherto has been suggested as having the utility to detect prevalent TB amongst HIV-1 co-infected persons.
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Affiliation(s)
- Maia Lesosky
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine.,Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Observatory, South Africa
| | - Molebogeng X Rangaka
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Observatory, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.,Institute for Global Health, Faculty of Population Health Sciences, University College London, United Kingdom
| | - Cara Pienaar
- Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine
| | - Anna K Coussens
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Observatory, South Africa.,Department of Pathology, Faculty of Health Sciences, University of Cape Town, Observatory
| | - Rene Goliath
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Observatory, South Africa
| | - Shaheed Mathee
- Site B Khayelitsha Community Health Centre, Western Cape Department of Health, South Africa
| | - Judith Mwansa-Kambafwile
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Observatory, South Africa
| | - Gary Maartens
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Observatory, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.,Department of Medicine, Imperial College London, London, United Kingdom.,The Francis Crick Institute, London, United Kingdom
| | - Katalin Andrea Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Diseases and Molecular Medicine, Observatory, South Africa.,Department of Medicine, Faculty of Health Sciences, University of Cape Town, Observatory, South Africa.,The Francis Crick Institute, London, United Kingdom
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49
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Lesosky M. Robust statistical methods with R, 2nd edition. Int J Epidemiol 2020. [DOI: 10.1093/ije/dyaa046] [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: 11/12/2022] Open
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50
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Mortimer K, Lesosky M, Semple S, Malava J, Katundu C, Crampin A, Wang D, Weston W, Pope D, Havens D, Gordon SB, Balmes J. Pneumonia and Exposure to Household Air Pollution in Children Under the Age of 5 Years in Rural Malawi: Findings From the Cooking and Pneumonia Study. Chest 2020; 158:501-511. [PMID: 32311349 PMCID: PMC7417377 DOI: 10.1016/j.chest.2020.03.064] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/09/2019] [Revised: 03/16/2020] [Accepted: 03/28/2020] [Indexed: 01/06/2023] Open
Abstract
Background Exposure to household air pollution is associated with an increased risk of pneumonia in children in low- and middle-income countries; however, exposure-response data are limited, and there are uncertainties around the extent to which biomass-fueled cookstoves can reduce these exposures. Research Question What is the association between exposure to household air pollution and pneumonia in children under the age of 5 years in rural Malawi and what are the effects of a biomass-fueled cookstove intervention on personal exposure to household air pollution? Study Design and Methods We measured personal exposure to carbon monoxide (CO; 48 hours of continuous measurement and transcutaneous carboxyhemoglobin) every 6 months in children who participated in a cluster-randomized controlled trial of a cleaner burning biomass-fueled cookstove intervention to prevent pneumonia in children under the age of 5 years in rural Malawi (the Cooking And Pneumonia Study). Exposure-response and multivariable analyses were done. Results We recruited 1805 (928 intervention; 877 control) children (mean age, 25.6 months; 50.6% female). We found no evidence of an association between exposure to CO (incident rate ratio, 1.0; 95% CI, 0.967 to 1.014; P = .53) or carboxyhemoglobin (incident rate ratio, 1.00; 95% CI, 0.993 to 1.003; P = .41) in children who experienced pneumonia vs those who did not. Median exposure to CO in the intervention and control groups was was 0.34 (interquartile range, 0.15 to 0.81) and 0.37 parts per million (interquartile range, 0.15 toa 0.97), respectively. The group difference in means was 0.46 (95% CI, −0.95 to 0.012; P = .06). Interpretation Exposure to CO in our population was low with no association seen between exposure to CO and pneumonia incidence and no effect of the Cooking And Pneumonia Study intervention on these exposures. These findings suggest that CO may not be an appropriate measure of household air pollution exposure in settings such as rural Malawi and that there is a need to develop ways to measure particulate matter exposures directly in young children instead. Clinical Trial Registration ISRCTN59448623.
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Affiliation(s)
| | - Maia Lesosky
- University of Cape Town, Cape Town, South Africa
| | | | - Jullita Malava
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Cynthia Katundu
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi
| | - Amelia Crampin
- Malawi Epidemiology and Intervention Research Unit, Chilumba, Malawi; London School of Hygiene and Tropical Medicine, London, UK
| | - Duolao Wang
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Dan Pope
- University of Liverpool, Liverpool, UK
| | | | - Stephen B Gordon
- Liverpool School of Tropical Medicine, Liverpool, UK; Malawi Liverpool Wellcome Trust Programme, Blantyre, Malawi
| | - John Balmes
- University of California, Berkeley, CA; University of California, San Francisco, San Francisco, CA
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