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Mapaona R, Williams V, Musarapasi N, Kibwana S, Maseko T, Chekenyere R, Gumbo S, Mdluli P, Byarugaba H, Galagedera D, Mafukidze A, Hurtado-de-Mendoza A, Adsul P, Bongomin P, Loffredo C, Dlamini X, Bazira D, Ojoo S, Haumba S. Cervical cancer screening outcomes for HIV-positive women in the Lubombo and Manzini regions of Eswatini-Prevalence and predictors of a positive visual inspection with acetic acid (VIA) screen. PLOS Glob Public Health 2024; 4:e0002760. [PMID: 38625931 PMCID: PMC11020862 DOI: 10.1371/journal.pgph.0002760] [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: 12/11/2023] [Accepted: 03/04/2024] [Indexed: 04/18/2024]
Abstract
This study aimed to describe the prevalence and predictors of a positive VIA (visual inspection with acetic acid) cervical cancer screening test in women living with human immunodeficiency virus (HIV). We retrospectively analysed data from women aged ≥15 who accessed VIA screening from health facilities in the Lubombo and Manzini regions of Eswatini. Sociodemographic and clinical data from October 2020 to June 2023 were extracted from the client management information system (CMIS). VIA screening outcome was categorised into negative, positive, or suspicious. A logistic regression model estimated the adjusted odds ratio (AOR) of the predictors of a positive VIA screen at p<0.05 with 95% confidence intervals. Of 23,657 participants, 60.8% (n = 14,397) were from the Manzini region. The mean age was 33.3 years (standard deviation 7.0), and 33% (n = 7,714) were first-time screens. The prevalence of a positive VIA was 2.6% (95% CI: 2.2%, 3.0%): 2.8% (95% CI: 2.2%, 3.5%) in Lubombo and 2.4% (95% CI: 2.0%, 2.9%) in Manzini (p = 0.096). Screening at mission-owned (AOR 1.40; p = 0.001), NGO-owned (AOR 3.08; p<0.001) and industrial/workplace-owned health facilities (AOR 2.37; p = 0.044) were associated with increased odds of a positive VIA compared to government-owned health facilities. Compared to those aged 25-34, the odds of a positive VIA increased by 1.26 for those in the 35-44 age group (AOR 1.26; p = 0.017). Predictors with lower odds for a positive VIA test were: being on anti-retroviral therapy (ART) for 5-9 years (AOR 0.76; p = 0.004) and ≥10 years (AOR 0.66; p = 0.002) compared to <5 years; and having an undetectable viral load (AOR 0.39; p<0.001) compared to unsuppressed. Longer duration on ART and an undetectable viral load reduced the odds, while middle-aged women and screening at non-public health facilities increased the odds of a positive VIA screen.
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Affiliation(s)
- Rufaro Mapaona
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Victor Williams
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Normusa Musarapasi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sharon Kibwana
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Thokozani Maseko
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Rhinos Chekenyere
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sidumo Gumbo
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Phetsile Mdluli
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Hugben Byarugaba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Dileepa Galagedera
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | - Prajakta Adsul
- University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico, United States of America
| | - Pido Bongomin
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Christopher Loffredo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America
| | - Xolisile Dlamini
- National Cancer Control Program, Ministry of Health, Mbabane, Eswatini
| | - Deus Bazira
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Sylvia Ojoo
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
| | - Samson Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Center for Global Health Practice and Impact, Georgetown University Medical Center, Washington, DC, United States of America
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Williams V, Haumba S, Ngwenya-Ngcamphalala F, Mafukidze A, Musarapasi N, Byarugaba H, Chiripashi S, Dlamini M, Maseko T, Dlamini NA, Nyapokoto C, Kibwana S, Bongomin P, Mazibuko S, Bhembe F, Ojoo S, Okello V, Bazira D. Implementation of the Automated Medication Dispensing System-Early Lessons From Eswatini. Int J Public Health 2023; 68:1606185. [PMID: 37901592 PMCID: PMC10600347 DOI: 10.3389/ijph.2023.1606185] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Objectives: This article describes the implementation of an automated medication dispensing system (AMDS) in Eswatini to increase medication access and presents the early lessons from this implementation. Methods: The AMDS was installed at four health facilities across two regions through collaborative stakeholder engagement. Healthcare workers were trained, and clients who met the inclusion criteria accessed their medications from the system. Each step of the implementation was documented and summarised in this article. Results: Early lessons suggest that implementation of the AMDS is acceptable and feasible to clients and healthcare workers and that phased introduction of medication classes, commencing with antiretroviral therapy (ART) and incorporating other medications in later phases is feasible. Additionally, improved client-centred messaging and communication, consistent power supply and internet network connectivity, and scheduling medication pickup with other services increase AMDS system utilisation. Conclusion: Eswatini has many clients living with HIV and non-communicable diseases (NCDs). Easy, convenient, quick, non-stigmatising and client-centred access to ART and medication for NCDs is critical in addressing retention in care and achieving optimal treatment outcomes.
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Affiliation(s)
- Victor Williams
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Samson Haumba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | - Fikile Ngwenya-Ngcamphalala
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
- Eswatini National AIDS Program, Mbabane, Eswatini
| | - Arnold Mafukidze
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Normusa Musarapasi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Hugben Byarugaba
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Simbarashe Chiripashi
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Makhosazana Dlamini
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Thokozani Maseko
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | | | | | - Sharon Kibwana
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | - Pido Bongomin
- Center for Global Health Practice and Impact, Georgetown University, Mbabane, Eswatini
| | - Sikhathele Mazibuko
- Division of Global HIV and TB, Centers for Disease Control and Prevention, Mbabane, Eswatini
| | | | - Sylvia Ojoo
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
| | | | - Deus Bazira
- Center for Global Health Practice and Impact, Georgetown University, Washington, DC, United States
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Paton NI, Musaazi J, Kityo C, Walimbwa S, Hoppe A, Balyegisawa A, Asienzo J, Kaimal A, Mirembe G, Lugemwa A, Ategeka G, Borok M, Mugerwa H, Siika A, Odongpiny ELA, Castelnuovo B, Kiragga A, Kambugu A, Kambugu A, Kaimal A, Castelnuovo B, Kiiza D, Asienzo J, Kisembo J, Nsubuga J, Okwero M, Muyise R, Kityo C, Nasaazi C, Nakiboneka DL, Mugerwa H, Namusanje J, Najjuuko T, Masaba T, Serumaga T, Alinaitwe A, Arinda A, Rweyora A, Ategeka G, Kangah MG, Lugemwa A, Kasozi M, Tukumushabe P, Akunda R, Makumbi S, Musumba S, Myalo S, Ahuura J, Namusisi AM, Kibirige D, Kiweewa F, Mirembe G, Mabonga H, Wandege J, Nakakeeto J, Namubiru S, Nansalire W, Siika AM, Kwobah CM, Mboya CS, Mokaya MMB, Karoney MJ, Cheruiyot PC, Cherutich S, Njuguna SW, Kirui VC, Borok M, Chidziva E, Musoro G, Hakim J, Bhiri J, Phiri M, Mudzingwa S, Manyanga T, Kiragga A, Banegura AM, Hoppe A, Balyegisawa A, Agwang B, Isaaya B, Tumwine C, Odongpiny ELA, Asienzo J, Musaazi J, Paton N, Senkungu P, Walimbwa S, Kamara Y, Amperiize M, Allen E, Opondo C, Mohammed P, van Rein-van der Horst W, Van Delft Y, Boateng FA, Namara D, Kaleebu P, Ojoo S, Bwakura T, Katana M, Venter F, Phiri S, Walker S. Efficacy and safety of dolutegravir or darunavir in combination with lamivudine plus either zidovudine or tenofovir for second-line treatment of HIV infection (NADIA): week 96 results from a prospective, multicentre, open-label, factorial, randomised, non-inferiority trial. The Lancet HIV 2022; 9:e381-e393. [DOI: 10.1016/s2352-3018(22)00092-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 12/28/2022]
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Koech E, Stafford KA, Mutysia I, Katana A, Jumbe M, Awuor P, Lavoie MC, Ngunu C, Riedel DJ, Ojoo S. Factors Associated with Loss to Follow-Up Among Patients Receiving HIV Treatment in Nairobi, Kenya. AIDS Res Hum Retroviruses 2021; 37:642-646. [PMID: 33913735 DOI: 10.1089/aid.2020.0292] [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] [Indexed: 11/13/2022] Open
Abstract
We investigated factors associated with loss to follow-up (LTFU) in 24 urban health facilities in Nairobi, Kenya. We conducted a retrospective analysis of routinely collected data to assess factors associated with LTFU in the period October 1, 2016, to June 30, 2017. LTFU was defined as no antiretroviral therapy (ART) refill for ≥90 days and no documentation of transfer, death, or treatment cessation in the patient chart, and if no lapse of ≥90 days between ART refills, patients were considered retained in care. Multivariable logistic regression modeling was used to compute odds ratios and 95% confidence interval (CI) for LTFU. Our analysis included 633 individuals who were LTFU and 13,098 individuals retained in care. Most participants (69.6%) were women, and median age was 33.0 years (interquartile range, 27.2-38.3 years). Median ART duration was shorter among those LTFU (0.4 years) than retained patients (2.5 years, p < .0001). Being male [adjusted odds ratio (aOR) 1.30; 95% CI: 1.04-1.63, p = .02], transferring into facilities while already receiving ART (aOR 11.58; 95% CI: 8.23-16.29, p < .0001), and having a shorter ART duration (<6 months) were associated with increased odds of LTFU. Patients who transferred into a facility while already receiving ART had the highest adjusted odds of being LTFU compared with those retained in care. In this urban and highly mobile population, transferring into facilities while already receiving ART was strongly associated with LTFU. Focusing programming efforts on patients transferring between urban clinics to identify reasons for transfer and potential barriers to treatment adherence could help improve patient outcomes. Supplementary case management and support may be needed to promote a seamless transition and ensure uninterrupted engagement in HIV care and treatment.
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Affiliation(s)
- Emily Koech
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Immaculate Mutysia
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marline Jumbe
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
| | - Patrick Awuor
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
| | - Marie-Claude Lavoie
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - David J. Riedel
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Sylvia Ojoo
- Center for International Health, Education, and Biosecurity Kenya, University of Maryland, Nairobi, Kenya
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Hanschke C, Baer J, Gangaramany A, Verheijen J, Kilonzo N, Okiya B, Ranji LK, Amolo SA, Zwane S, Nkambule R, Buluma V, Ojoo S, Kim S, Kibwana S, Dybul M, Kretschmer S. Supporting communities of practice – A Journey to effective problem-solving. Gates Open Res 2021. [DOI: 10.12688/gatesopenres.13149.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In contexts of scarce resources, varied assets, and diverse communities, engaging local stakeholders in the problem-solving process is critical to develop interventions for HIV prevention and treatment. Communities of practice (CoPs) – groups of people organized around a key purpose and a delivery point – can develop expertise in identifying their local community’s key challenges and selecting viable solutions. We propose a framework, adapted from the CoP model developed by Etienne Wenger, for systematically understanding the stages a CoP may go through as it develops its capacity to identify and solve problems and implement good practices. Our framework is based on the experience of practitioners of the LISTEN model (Local Initiatives Scaled Through Enterprise Networks) in eight local-level CoPs in Kenya and Eswatini. LISTEN seeks to help CoPs integrate continuous improvement processes, data, and human-centered design into their development and solutioning activities. The four stages in our framework for a CoP’s problem-solving journey are: 1) Community Identity: Identify and understand the CoP’s purpose and goals, and build rapport with its members and leaders; 2) Quick Win: Use a process of human-centered design to obtain a rapid and clear success in addressing a problem that the CoP has identified for itself and which it can tackle with its own resources; 3) Stewardship: Support the CoP in addressing more complex or long-term issues, including links to other CoPs at the local-community or higher levels to disseminate knowledge and obtain resources and support, where needed; and 4) Evolution: Support the CoP as it transitions into potentially new structures or functions. For each stage of the framework, we describe the kinds of support that may be provided to the CoP in the LISTEN model, and the types of tools that could be developed to assist them in problem-solving and in disseminating sustainable solutions.
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Hanschke C, Baer J, Gangaramany A, Verheijen J, Kilonzo N, Okiya B, Ranji LK, Amolo SA, Zwane S, Nkambule R, Buluma V, Ojoo S, Kim S, Kibwana S, Dybul M, Kretschmer S. Supporting communities of practice – A Journey to effective problem-solving. Gates Open Res 2020. [DOI: 10.12688/gatesopenres.13149.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In contexts of scarce resources, varied assets, and diverse communities, engaging local stakeholders in the problem-solving process is critical to develop interventions for HIV prevention and treatment. Communities of practice (CPs) – groups of people organized around a key purpose and a delivery point – can develop expertise in identifying their local community’s key challenges and selecting viable solutions. We propose a framework for systematically understanding the stages a CP may go through as it develops its capacity to identify and solve problems and implement good practices. Our framework is based on the experience of practitioners of the LISTEN model (Local Initiatives Scaled Through Enterprise Networks) in eight local-level CPs in Kenya and Eswatini. LISTEN seeks to help CPs integrate continuous improvement processes, data, and human-centered design into their development and solutioning activities. The four stages in our framework for a CP’s problem-solving journey are: 1) Community Identity: Identify and understand the community’s purpose and goals, and build rapport with its members and leaders; 2) Quick Win: Use a process of human-centered design to obtain a rapid and clear success in addressing a problem that the local community has identified for itself and which it can tackle with its own resources; 3) Stewardship: Support the CP in addressing more complex or long-term issues, including links to other CPs at the local-community or higher levels to disseminate knowledge and obtain resources and support, where needed; and 4) Evolution: Support the CP as it transitions into potentially new structures or functions. For each stage of the framework, we describe the kinds of support that may be provided to the CP in the LISTEN model, and the types of tools that could be developed to assist them in problem-solving and in disseminating sustainable solutions.
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Memiah P, Makokha V, Mbuthia W, Kiiru GW, Agbor S, Odhiambo F, Ojoo S, Mbizo J, Muhula S, Mahasi G, Biadgilign S. Epidemiology of Cervical Squamous Intraepithelial Lesions in HIV Infected Women in Kenya: a cross-Sectional Study. Afr J Reprod Health 2015; 19:133-139. [PMID: 26103703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cervical cancer is the second most common cancer among women worldwide. Infection with the human immunodeficiency virus (HIV) and its related immunosuppression are associated with an increased risk of prevalent, incident, and persistent squamous intraepithelial lesions (SILs) of the cervix. The objective of the study was to describe the prevalence and predictors of high-risk HPV and cervical cancer to support the need for strengthening cervical cancer screening programs for HIV infected women in Kenya. A cross sectional study was conducted in a hospital in Central Kenya, Kiambu district. The study population constituted of HIV positive women attending the ART treatment clinic. A total of 715 HIV positive women initiated on Antiretroviral Therapy (ART) were enrolled in this study. About 359 (52.1%) were less than 40 years of age and 644 (90.3%) of the patients were widowed. About 642 (92.6%) of the HIV infected women were in follow-up period of ≥ 1 year. The outcome/prognosis of the patients undergoing ICC was 3 cured, 5 good and 4 poor respectively. In a multivariable ordinal logistic regression analysis showed that for a one-unit decrease of CD4, we expect 1.23 log odds of increasing the severity of cervical cancer (B = 1.23, P < 0.0 15), given that all of the other variables in the model are held constant. In conclusion screening of all HIV infected women, who are under HIV care and treatment, enrolling patients on HAART with higher CD4 counts is recommended to see the net effect of HAART response.
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Ojoo S. Clinical Practice in Sexually Transmissible Infections: Ed by A. McMillan, H. Young, M. M. Ogilvie, G. R. Scott. Pp608; 93, 99, 2002. ISBN 0702025380. Sex Transm Infect 2003. [DOI: 10.1136/sti.79.5.429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ojoo S, Harry TC. Maternal health in developing countries. Lancet 1996; 347:400. [PMID: 8598725] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Godfrey-Faussett P, Githui W, Batchelor B, Brindle R, Paul J, Hawken M, Gathua S, Odhiambo J, Ojoo S, Nunn P. Recurrence of HIV-related tuberculosis in an endemic area may be due to relapse or reinfection. Tuber Lung Dis 1994; 75:199-202. [PMID: 7919312 DOI: 10.1016/0962-8479(94)90008-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
SETTING Two Research Clinics within Nairobi, Kenya, one in the Infectious Diseases Hospital, the national referral centre for tuberculosis, and one in a community based project in Pumwani district, and the Bacterial Molecular Genetics Unit at the London School of Hygiene and Tropical Medicine. OBJECTIVE To determine whether recurrence of tuberculosis after 'adequate' treatment was due to reinfection with a different isolate of Mycobacterium tuberculosis or to relapse of the original infection. DESIGN A retrospective comparison by DNA fingerprinting of sets of isolates of M. tuberculosis from patients with recurrence of tuberculosis and in whom isolates from the original episode had been stored was made. Five patients with recurrence of tuberculosis two to nineteen months after adequate treatment and documented clearance of disease were studied. RESULTS In one patient, fingerprints of the isolates of M. tuberculosis from the recurrence were quite different to those from the original episode; in the other four, the fingerprints were identical. CONCLUSION Reinfection rather than relapse was the cause of recurrence in at least one patient. The high 'relapse' rates seen in HIV-related tuberculosis in Africa may in part be due to increased susceptibility to reinfection and not to treatment failure.
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Affiliation(s)
- P Godfrey-Faussett
- Clinical Sciences Department, London School of Hygiene and Tropical Medicine
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Lewis DJ, Gilks CF, Ojoo S, Castello-Branco LR, Dougan G, Evans MR, McDermott S, Griffin GE. Immune response following oral administration of cholera toxin B subunit to HIV-1-infected UK and Kenyan subjects. AIDS 1994; 8:779-85. [PMID: 8086136 DOI: 10.1097/00002030-199406000-00009] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To determine the effect of HIV-1 infection on immunoglobulin (Ig) G and IgA antibody response and circulating antibody forming cell response to oral immunization with the B subunit of cholera toxin. DESIGN Healthy UK volunteers, and HIV-1-positive UK and Kenyan volunteers at different clinical stages of HIV-1 infection received two oral immunizations. CD4+ T cells, serum beta 2-microglobulin and neopterin were measured as surrogate markers of disease stage, and correlated with immunization response. METHODS Serum antitoxin IgG and IgA measured by enzyme-linked immunosorbent assay and antitoxin IgG, IgA and IgM antibody-forming cells detected by enzyme-linked immunospot assay at different times after two oral immunizations. RESULTS UK HIV-positive volunteers (mean CD4+ T cell count, 52 x 10(6)/l) responded poorly to primary and booster immunization. HIV-infected Kenyans (752 x 10(6)/l CD4+ T cells) had a significant primary and booster antibody response, whereas those with a mean CD4+ T cell count 186 x 10(6)/l had an insignificant primary, but significant booster response. Two oral immunizations induced antibody responses in HIV-positive Kenyan groups (who may have prior immunity from exposure to environmental bacterial toxins) of similar or greater magnitude to healthy UK volunteers. CONCLUSIONS Mucosal immunization may recall immune memory and be of benefit in early and moderately advanced clinical HIV disease. The findings have important clinical implications in that mucosally targeted vaccines are potentially useful in this group of patients.
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Affiliation(s)
- D J Lewis
- Division of Communicable Diseases, St George's Hospital Medical School, London, UK
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