1
|
Ario AR, Aliddeki DM, Kadobera D, Bulage L, Kayiwa J, Wetaka MM, Kyazze S, Ocom F, Makumbi I, Mbaka P, Behumbiize P, Ayebazibwe I, Balinandi SK, Lutwama JJ, Crawley A, Divi N, Lule JR, Ojwang JC, Harris JR, Boore AL, Nelson LJ, Borchert J, Jarvis D. Uganda's experience in establishing an electronic compendium for public health emergencies. PLOS Glob Public Health 2023; 3:e0001402. [PMID: 36962840 PMCID: PMC10021891 DOI: 10.1371/journal.pgph.0001402] [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: 08/24/2022] [Accepted: 11/28/2022] [Indexed: 02/12/2023]
Abstract
Uganda has implemented several interventions that have contributed to prevention, early detection, and effective response to Public Health Emergencies (PHEs). However, there are gaps in collecting and documenting data on the overall response to these PHEs. We set out to establish a comprehensive electronic database of PHEs that occurred in Uganda since 2000. We constituted a core development team, developed a data dictionary, and worked with Health Information Systems Program (HISP)-Uganda to develop and customize a compendium of PHEs using the electronic Integrated Disease Surveillance and Response (eIDSR) module on the District Health Information Software version 2 (DHIS2) platform. We reviewed literature for retrospective data on PHEs for the compendium. Working with the Uganda Public Health Emergency Operations Center (PHEOC), we prospectively updated the compendium with real-time data on reported PHEs. We developed a user's guide to support future data entry teams. An operational compendium was developed within the eIDSR module of the DHIS2 platform. The variables for PHEs data collection include those that identify the type, location, nature and time to response of each PHE. The compendium has been updated with retrospective PHE data and real-time prospective data collection is ongoing. Data within this compendium is being used to generate information that can guide future outbreak response and management. The compendium development highlights the importance of documenting outbreak detection and response data in a central location for future reference. This data provides an opportunity to evaluate and inform improvements in PHEs response.
Collapse
Affiliation(s)
- Alex Riolexus Ario
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | | | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Joshua Kayiwa
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Milton M. Wetaka
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Simon Kyazze
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Felix Ocom
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Issa Makumbi
- Uganda National Institute of Public Health, Kampala, Uganda
- Uganda Public Health Emergency Operations Center, Kampala, Uganda
| | - Paul Mbaka
- Uganda National Institute of Public Health, Kampala, Uganda
- Division of Health Information, Ministry of Health, Kampala, Uganda
| | | | | | | | | | - Adam Crawley
- Ending Pandemics, San Francisco, California, United States of America
| | - Nomita Divi
- Ending Pandemics, San Francisco, California, United States of America
| | - John R. Lule
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | | | - Julie R. Harris
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy L. Boore
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Lisa J. Nelson
- US Centers for Disease Control and Prevention, Kampala, Uganda
| | - Jeff Borchert
- Division of Vector-Borne Diseases, National Center for Emerging, Zoonotic, Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, Colorado, United States of America
| | - Dennis Jarvis
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| |
Collapse
|
2
|
Ehlman DC, Magoola J, Tanifum P, Wallace AS, Behumbiize P, Mayanja R, Luzze H, Yukich J, Daniels D, Mugenyi K, Baryarama F, Ayebazibwe N, Conklin L. Evaluating a Mobile Phone-Delivered Text Message Reminder Intervention to Reduce Infant Vaccination Dropout in Arua, Uganda: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e17262. [PMID: 33625372 PMCID: PMC7946592 DOI: 10.2196/17262] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 06/11/2020] [Accepted: 12/30/2020] [Indexed: 11/25/2022] Open
Abstract
Background Globally, suboptimal vaccine coverage is a public health concern. According to Uganda’s 2016 Demographic and Health Survey, only 49% of 12- to 23-month-old children received all recommended vaccinations by 12 months of age. Innovative ways are needed to increase coverage, reduce dropout, and increase awareness among caregivers to bring children for timely vaccination. Objective This study evaluates a personalized, automated caregiver mobile phone–delivered text message reminder intervention to reduce the proportion of children who start but do not complete the vaccination series for children aged 12 months and younger in select health facilities in Arua district. Methods A two-arm, multicenter, parallel group randomized controlled trial was conducted in four health facilities providing vaccination services in and around the town of Arua. Caregivers of children between 6 weeks and 6 months of age at the time of their first dose of pentavalent vaccine (Penta1; containing diphtheria, tetanus, pertussis, hepatitis B, and Haemophilus influenzae type b antigens) were recruited and interviewed. All participants received the standard of care, defined as the health worker providing child vaccination home-based records to caregivers as available and providing verbal instruction of when to return for the next visit. At the end of each day, caregivers and their children were randomized by computer either to receive or not receive personalized, automated text message reminders for their subsequent vaccination visits according to the national schedule. Text message reminders for Penta2 were sent 2 days before, on the day of, and 2 days after the scheduled vaccination visit. Reminders for Penta3 and the measles-containing vaccine were sent on the scheduled day of vaccination and 5 and 7 days after the scheduled day. Study personnel conducted postintervention follow-up interviews with participants at the health facilities during the children’s measles-containing vaccine visit. In addition, focus group discussions were conducted to assess caregiver acceptability of the intervention, economic data were collected to evaluate the incremental costs and cost-effectiveness of the intervention, and health facility record review forms were completed to capture service delivery process indicators. Results Of the 3485 screened participants, 1961 were enrolled from a sample size of 1962. Enrollment concluded in August 2016. Follow-up interviews of study participants, including data extraction from the children’s vaccination cards, data extraction from the health facility immunization registers, completion of the health facility record review forms, and focus group discussions were completed by December 2017. The results are expected to be released in 2021. Conclusions Prompting health-seeking behavior with reminders has been shown to improve health intervention uptake. Mobile phone ownership continues to grow in Uganda, so their use in vaccination interventions such as this study is logical and should be evaluated with scientifically rigorous study designs. Trial Registration ClinicalTrials.gov NCT04177485; https://clinicaltrials.gov/ct2/show/NCT04177485 International Registered Report Identifier (IRRID) DERR1-10.2196/17262
Collapse
Affiliation(s)
- Daniel C Ehlman
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Patricia Tanifum
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Aaron S Wallace
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Henry Luzze
- Uganda National Expanded Program on Immunization, Ministry of Health, Kampala, Uganda
| | - Joshua Yukich
- Department of Tropical Medicine, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Danni Daniels
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Laura Conklin
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| |
Collapse
|
3
|
Lamorde M, Mpimbaza A, Walwema R, Kamya M, Kapisi J, Kajumbula H, Sserwanga A, Namuganga JF, Kusemererwa A, Tasimwa H, Makumbi I, Kayiwa J, Lutwama J, Behumbiize P, Tagoola A, Nanteza JF, Aniku G, Workneh M, Manabe Y, Borchert JN, Brown V, Appiah GD, Mintz ED, Homsy J, Odongo GS, Ransom RL, Freeman MM, Stoddard RA, Galloway R, Mikoleit M, Kato C, Rosenberg R, Mossel EC, Mead PS, Kugeler KJ. A Cross-Cutting Approach to Surveillance and Laboratory Capacity as a Platform to Improve Health Security in Uganda. Health Secur 2019; 16:S76-S86. [PMID: 30480504 DOI: 10.1089/hs.2018.0051] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [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: 12/16/2022] Open
Abstract
Global health security depends on effective surveillance for infectious diseases. In Uganda, resources are inadequate to support collection and reporting of data necessary for an effective and responsive surveillance system. We used a cross-cutting approach to improve surveillance and laboratory capacity in Uganda by leveraging an existing pediatric inpatient malaria sentinel surveillance system to collect data on expanded causes of illness, facilitate development of real-time surveillance, and provide data on antimicrobial resistance. Capacity for blood culture collection was established, along with options for serologic testing for select zoonotic conditions, including arboviral infection, brucellosis, and leptospirosis. Detailed demographic, clinical, and laboratory data for all admissions were captured through a web-based system accessible at participating hospitals, laboratories, and the Uganda Public Health Emergency Operations Center. Between July 2016 and December 2017, the expanded system was activated in pediatric wards of 6 regional government hospitals. During that time, patient data were collected from 30,500 pediatric admissions, half of whom were febrile but lacked evidence of malaria. More than 5,000 blood cultures were performed; 4% yielded bacterial pathogens, and another 4% yielded likely contaminants. Several WHO antimicrobial resistance priority pathogens were identified, some with multidrug-resistant phenotypes, including Acinetobacter spp., Citrobacter spp., Escherichia coli, Staphylococcus aureus, and typhoidal and nontyphoidal Salmonella spp. Leptospirosis and arboviral infections (alphaviruses and flaviviruses) were documented. The lessons learned and early results from the development of this multisectoral surveillance system provide the knowledge, infrastructure, and workforce capacity to serve as a foundation to enhance the capacity to detect, report, and rapidly respond to wide-ranging public health concerns in Uganda.
Collapse
Affiliation(s)
- Mohammed Lamorde
- Mohammed Lamorde, PhD, FRCP, is Head of the Department of Prevention, Care and Treatment, Infectious Diseases Institute, Kampala, Uganda. Co-senior author
| | - Arthur Mpimbaza
- Arthur Mpimbaza, MBChB, MMed, MSc, is Project Coordinator, Infectious Diseases Research Collaboration, Kampala, and Lecturer, Child Health and Development Centre, College of Health Sciences, Makerere University, Kampala. Co-senior author
| | - Richard Walwema
- Richard Walwema, MBA, is with the Infectious Diseases Institute, Kampala
| | - Moses Kamya
- Moses Kamya, MBChB, MMed, MPH, PhD, is Professor and Chair, Makerere University School of Medicine, Kampala. Dr. Kamya is also with the Infectious Diseases Research Collaboration, Kampala
| | - James Kapisi
- James Kapisi, MBChB, MMed, MSc Epid, Infectious Diseases Research Collaboration, Kampala
| | - Henry Kajumbula
- Henry Kajumbula, MBChB, MMed, Department of Medical Microbiology, Makerere University School of Medicine, Kampala
| | - Asadu Sserwanga
- Asadu Sserwanga, MBChB, MPH, Infectious Diseases Research Collaboration, Kampala
| | | | - Abel Kusemererwa
- Abel Kusemererwa, Infectious Diseases Research Collaboration, Kampala
| | - Hannington Tasimwa
- Hannington Tasimwa, Department of Medical Microbiology, Makerere University School of Medicine, Kampala
| | - Issa Makumbi
- Issa Makumbi, MBChB, is with the Uganda Ministry of Health Public Health Emergency Operations Centre, Kampala
| | - John Kayiwa
- John Kayiwa, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda
| | - Julius Lutwama
- Julius Lutwama, PhD, Uganda Virus Research Institute, Entebbe, Wakiso, Uganda
| | - Prosper Behumbiize
- Prosper Behumbiize is with the Health Information Systems Program, Kampala
| | - Abner Tagoola
- Abner Tagoola, MBChB, MMed, MSc, is with the Jinja Regional Referral Hospital Republic of Uganda Ministry of Health, Jinja, Uganda
| | - Jane Frances Nanteza
- Jane Frances Nanteza, MBChB, MMed, is with the Mubende Regional Referral Hospital, Republic of Uganda Ministry of Health, Mubende, Uganda
| | - Gilbert Aniku
- Gilbert Aniku, MBChB, MMed, is with Arua Regional Referral Hospital, Republic of Uganda Ministry of Health, Arua, Uganda
| | - Meklit Workneh
- Meklit Workneh, MD, MPH, is a Medical Microbiology Fellow, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Yukari Manabe
- Yukari Manabe, MD, is Associate Director of Global Health Research and Innovation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Jeff N Borchert
- Jeff N. Borchert, MS, is a Public Health Analyst, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Vance Brown
- Vance Brown, MA, is Deputy Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda
| | - Grace D Appiah
- Grace D. Appiah, MD, MS, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eric D Mintz
- Eric D. Mintz, MD, MPH, is a Medical Epidemiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jaco Homsy
- Jaco Homsy, MD, MPH, is Program Director, Centers for Disease Control and Prevention, Division of Global Health Protection, Kampala, Uganda
| | - George S Odongo
- George S. Odongo, MPH, is a Public Health Informatics Fellow, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Raymond L Ransom
- Raymond L. Ransom is Associate Director for Informatics, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Molly M Freeman
- Molly M. Freeman, PhD, is a Microbiologist, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robyn A Stoddard
- Robyn A. Stoddard, DVM, PhD, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Renee Galloway
- Renee Galloway, MLS, MPH, Microbiologists, Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Matthew Mikoleit
- Matthew Mikoleit, MS, is a Microbiologist, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cecilia Kato
- Cecilia Kato, PhD, is a Biologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ronald Rosenberg
- Ronald Rosenberg, ScD, is Associate Director for Science, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Eric C Mossel
- Eric C. Mossel, PhD, is a Microbiologist, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Paul S Mead
- Paul S. Mead, MD, MPH, is a Medical Officer, Centers for Disease Control and Prevention, Division of Vector-Borne Diseases, Fort Collins, Colorado
| | - Kiersten J Kugeler
- Kiersten Kugeler, PhD, MPH, is an Epidemiologist, Division of Vector-Borne Diseases, Centers for Disease Control and Prevention, Fort Collins, CO
| |
Collapse
|
4
|
Borchert JN, Tappero JW, Downing R, Shoemaker T, Behumbiize P, Aceng J, Makumbi I, Dahlke M, Jarrar B, Lozano B, Kasozi S, Austin M, Phillippe D, Watson ID, Evans TJ, Stotish T, Dowell SF, Iademarco MF, Ransom R, Balajee A, Becknell K, Beauvais D, Wuhib T. Rapidly building global health security capacity--Uganda demonstration project, 2013. MMWR Morb Mortal Wkly Rep 2014; 63:73-6. [PMID: 24476978 PMCID: PMC4584897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Increasingly, the need to strengthen global capacity to prevent, detect, and respond to public health threats around the globe is being recognized. CDC, in partnership with the World Health Organization (WHO), has committed to building capacity by assisting member states with strengthening their national capacity for integrated disease surveillance and response as required by International Health Regulations (IHR). CDC and other U.S. agencies have reinforced their pledge through creation of global health security (GHS) demonstration projects. One such project was conducted during March-September 2013, when the Uganda Ministry of Health (MoH) and CDC implemented upgrades in three areas: 1) strengthening the public health laboratory system by increasing the capacity of diagnostic and specimen referral networks, 2) enhancing the existing communications and information systems for outbreak response, and 3) developing a public health emergency operations center (EOC) (Figure 1). The GHS demonstration project outcomes included development of an outbreak response module that allowed reporting of suspected cases of illness caused by priority pathogens via short messaging service (SMS; i.e., text messaging) to the Uganda District Health Information System (DHIS-2) and expansion of the biologic specimen transport and laboratory reporting system supported by the President's Emergency Plan for AIDS Relief (PEPFAR). Other enhancements included strengthening laboratory management, establishing and equipping the EOC, and evaluating these enhancements during an outbreak exercise. In 6 months, the project demonstrated that targeted enhancements resulted in substantial improvements to the ability of Uganda's public health system to detect and respond to health threats.
Collapse
Affiliation(s)
- Jeff N. Borchert
- Division of Vector-Borne Diseases, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Jordan W. Tappero
- Division of Global Health Protection, Center for Global Health, CDC,Corresponding author: Jordan W. Tappero, , 404-718-4558
| | - Robert Downing
- Division of Global HIV/AIDS, National Center for Global HIV/AIDS, National Center for Global Health, CDC
| | - Trevor Shoemaker
- Division of High Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, CDC
| | - Prosper Behumbiize
- Division of Global HIV/AIDS, National Center for Global HIV/AIDS, National Center for Global Health, CDC
| | | | | | | | - Bassam Jarrar
- Division of Global Health Protection, Center for Global Health, CDC
| | - Briana Lozano
- Division of Global HIV/AIDS, National Center for Global HIV/AIDS, National Center for Global Health, CDC
| | | | - Mark Austin
- Division of Emergency Operations, National Center for Global Health, CDC
| | - Dru Phillippe
- Division of Emergency Operations, National Center for Global Health, CDC
| | - Ian D. Watson
- US Department of Defense, Defense Threat Reduction Agency
| | - Tom J. Evans
- US Department of Defense, Defense Threat Reduction Agency
| | | | - Scott F. Dowell
- Division of Global Health Protection, Center for Global Health, CDC
| | - Michael F. Iademarco
- Division of TB Elimination, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC
| | - Raymond Ransom
- Division of Global HIV/AIDS, National Center for Global HIV/AIDS, National Center for Global Health, CDC
| | | | - Kristin Becknell
- Division of Global Health Protection, Center for Global Health, CDC
| | - Denise Beauvais
- Division of Global Health Protection, Center for Global Health, CDC
| | - Tadesse Wuhib
- Division of Global HIV/AIDS, National Center for Global HIV/AIDS, National Center for Global Health, CDC
| |
Collapse
|
5
|
Mermin J, Were W, Ekwaru JP, Moore D, Downing R, Behumbiize P, Lule JR, Coutinho A, Tappero J, Bunnell R. Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected children: a prospective cohort study. Lancet 2008; 371:752-9. [PMID: 18313504 DOI: 10.1016/s0140-6736(08)60345-1] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antiretroviral therapy (ART) is increasingly available in Africa, but physicians and clinical services are few. We therefore assessed the effect of a home-based ART programme in Uganda on mortality, hospital admissions, and orphanhood in people with HIV-1 and their household members. METHODS In 2001, we enrolled and followed up 466 HIV-infected adults and 1481 HIV-uninfected household members in a prospective cohort study. After 5 months, we provided daily co-trimoxazole (160 mg trimethoprim and 800 mg sulfamethoxazole) prophylaxis to HIV-infected participants. Between May, 2003, and December, 2005, we followed up 138 infected adults who were eligible and 907 new HIV-infected participants and their HIV-negative household members in a study of ART (mainly stavudine, lamivudine, and nevirapine). Households were visited every week by lay providers, and no clinic visits were scheduled after enrolment. We compared rates of death, hospitalisation, and orphanhood during different study periods and calculated the number needed to treat to prevent an outcome. FINDINGS 233 (17%) of 1373 participants with HIV and 40 (1%) of 4601 HIV-uninfected household members died. During the first 16 weeks of ART and co-trimoxazole, mortality in HIV-infected participants was 55% lower than that during co-trimoxazole alone (14 vs 16 deaths per 100 person-years; adjusted hazard ratio 0.45, 95% CI 0.27-0.74, p=0.0018), and after 16 weeks, was reduced by 92% (3 vs 16 deaths per 100 person-years; 0.08, 0.06-0.13, p<0.0001). Compared with no intervention, ART and co-trimoxazole were associated with a 95% reduction in mortality in HIV-infected participants (5 vs 27 deaths per 100 person-years; 0.05, 0.03-0.08, p<0.0001), 81% reduction in mortality in their uninfected children younger than 10 years (0.2 vs 1.2 deaths per 100 person-years; 0.19, 0.06-0.59, p=0.004), and a 93% estimated reduction in orphanhood (0.9 vs 12.8 per 100 person-years of adults treated; 0.07, 0.04-0.13, p<0.0001). INTERPRETATION Expansion of access to ART and co-trimoxazole prophylaxis could substantially reduce mortality and orphanhood among adults with HIV and their families living in resource-poor settings.
Collapse
Affiliation(s)
- Jonathan Mermin
- Centers for Disease Control and Prevention-Uganda, Global AIDS Program, National Center for HIV, Viral Hepatitis, Sexually Transmitted Disease, and Tuberculosis Prevention, Centers for Disease Control and Prevention, Entebbe, Uganda.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Forna F, Liechty CA, Solberg P, Asiimwe F, Were W, Mermin J, Behumbiize P, Tong T, Brooks JT, Weidle PJ. Clinical Toxicity of Highly Active Antiretroviral Therapy in a Home-Based AIDS Care Program in Rural Uganda. J Acquir Immune Defic Syndr 2007; 44:456-62. [PMID: 17279048 DOI: 10.1097/qai.0b013e318033ffa1] [Citation(s) in RCA: 70] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated clinical toxicity in HIV-infected persons receiving antiretroviral therapy (ART) in Uganda. METHODS From May 2003 through December 2004, adults with a CD4 cell count < or =250 cells/microL or World Health Organization stage 3/4 HIV disease were prescribed ART. We calculated probabilities for time to toxicity and single-drug substitution as well as multivariate-adjusted hazard ratios for development of toxicity. RESULTS ART (stavudine plus lamivudine with nevirapine [96%] or efavirenz [4%]) was prescribed for 1029 adults, contributing 11,268 person-months of observation. Toxicities developed in 543 instances in 411 (40%) patients (incidence rate = 4.47/100 person-months): 36% peripheral neuropathy (9% severe); 6% rash (2% severe); 2% hypersensitivity reaction; < or =0.5% acute hepatitis, anemia, acute pancreatitis, or lactic acidosis; and 13% other. Probabilities of remaining free from any toxicity at 6, 12, and 18 months were 0.76, 0.59, and 0.47 and from any severe toxicity at 6, 12, and 18 months were 0.92, 0.86, and 0.85, respectively. For 217 patients (21%), 222 single-drug substitutions were made, mostly because of peripheral neuropathy or rash. CONCLUSIONS Clinical toxicities were common, but no patients discontinued ART because of toxicity. The most common toxicities, peripheral neuropathy and rash, were managed with single-drug substitutions. In resource-limited settings, toxicity from ART regimens containing stavudine or nevirapine is manageable but more tolerable regimens are needed.
Collapse
Affiliation(s)
- Fatu Forna
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Weidle PJ, Wamai N, Solberg P, Liechty C, Sendagala S, Were W, Mermin J, Buchacz K, Behumbiize P, Ransom RL, Bunnell R. Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda. Lancet 2006; 368:1587-94. [PMID: 17084759 DOI: 10.1016/s0140-6736(06)69118-6] [Citation(s) in RCA: 172] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Poverty and limited health services in rural Africa present barriers to adherence to antiretroviral therapy that necessitate innovative options other than facility-based methods for delivery and monitoring of such therapy. We assessed adherence to antiretroviral therapy in a cohort of HIV-infected people in a home-based AIDS care programme that provides the therapy and other AIDS care, prevention, and support services in rural Uganda. METHODS HIV-infected individuals with advanced HIV disease or a CD4-cell count of less than 250 cells per muL were eligible for antiretroviral therapy. Adherence interventions included group education, personal adherence plans developed with trained counsellors, a medicine companion, and weekly home delivery of antiretroviral therapy by trained lay field officers. We analysed factors associated with pill count adherence (PCA) of less than 95%, medication possession ratio (MPR) of less than 95%, and HIV viral load of 1000 copies per mL or more at 6 months (second quarter) and 12 months (fourth quarter) of follow-up. FINDINGS 987 adults who had received no previous antiretroviral therapy (median CD4-cell count 124 cells per muL, median viral load 217,000 copies per mL) were enrolled between July, 2003, and May, 2004. PCA of less than 95% was calculated for 0.7-2.6% of participants in any quarter and MPR of less than 95% for 3.3-11.1%. Viral load was below 1000 copies per mL for 894 (98%) of 913 participants in the second quarter and for 860 (96%) of 894 of participants in the fourth quarter. In separate multivariate models, viral load of at least 1000 copies per mL was associated with both PCA below 95% (second quarter odds ratio 10.6 [95% CI 2.45-45.7]; fourth quarter 14.5 [2.51-83.6]) and MPR less than 95% (second quarter 9.44 [3.40-26.2]; fourth quarter 10.5 [4.22-25.9]). INTERPRETATION Good adherence and response to antiretroviral therapy can be achieved in a home-based AIDS care programme in a resource-limited rural African setting. Health-care systems must continue to implement, evaluate, and modify interventions to overcome barriers to comprehensive AIDS care programmes, especially the barriers to adherence with antiretroviral therapy.
Collapse
Affiliation(s)
- Paul J Weidle
- Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|