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Happi AN, Ogunsanya OA, Ayinla AO, Sijuwola AE, Saibu FM, Akano K, Nwofoke C, Elias OT, Achonduh-Atijegbe O, Daodu RO, Adedokun OA, Adeyemo A, Ogundana KE, Lawal OZ, Parker E, Nosamiefan I, Okolie J, Parker ZF, McCauley MD, Eller LA, Lombardi K, Tiamiyu AB, Iroezindu M, Akinwale E, Njatou TLFA, Mebrahtu T, Broach E, Zuppe A, Prins P, Lay J, Amare M, Modjarrad K, Collins ND, Vasan S, Tucker C, Daye S, Happi CT. Lassa virus in novel hosts: insights into the epidemiology of lassa virus infections in southern Nigeria. Emerg Microbes Infect 2024; 13:2294859. [PMID: 38088796 PMCID: PMC10810657 DOI: 10.1080/22221751.2023.2294859] [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: 10/03/2023] [Accepted: 12/11/2023] [Indexed: 01/24/2024]
Abstract
Identification of the diverse animal hosts responsible for spill-over events from animals to humans is crucial for comprehending the transmission patterns of emerging infectious diseases, which pose significant public health risks. To better characterize potential animal hosts of Lassa virus (LASV), we assessed domestic and non-domestic animals from 2021-2022 in four locations in southern Nigeria with reported cases of Lassa fever (LF). Birds, lizards, and domestic mammals (dogs, pigs, cattle and goats) were screened using RT-qPCR, and whole genome sequencing was performed for lineage identification on selected LASV positive samples. Animals were also screened for exposure to LASV by enzyme-linked immunosorbent assay (ELISA). Among these animals, lizards had the highest positivity rate by PCR. Genomic sequencing of samples in most infected animals showed sub-lineage 2 g of LASV. Seropositivity was highest among cattle and lowest in pigs. Though the specific impact these additional hosts may have in the broader virus-host context are still unknown - specifically relating to pathogen diversity, evolution, and transmission - the detection of LASV in non-rodent hosts living in proximity to confirmed human LF cases suggests their involvement during transmission as potential reservoirs. Additional epidemiological data comparing viral genomes from humans and animals, as well as those circulating within the environment will be critical in understanding LASV transmission dynamics and will ultimately guide the development of countermeasures for this zoonotic health threat.
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Affiliation(s)
- Anise Nkenjop Happi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Olusola Akinola Ogunsanya
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Akeemat Opeyemi Ayinla
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Ayotunde Elijah Sijuwola
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Femi Mudasiru Saibu
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Kazeem Akano
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
- Redeemer’s University, Ede, Osun, Nigeria
| | - Cecilia Nwofoke
- Alex Ekwueme Federal University Teaching Hospital, Abakaliki, Ebonyi State, Nigeria
| | | | | | - Richard Olumide Daodu
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Oluwatobi Abel Adedokun
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Abraham Adeyemo
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | | | | | - Edyth Parker
- Scripps Translational Science Institute, La Jolla, CA, USA
| | - Iguosadolo Nosamiefan
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Johnson Okolie
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
| | - Zahra F. Parker
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Melanie D. McCauley
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Leigh Anne Eller
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kara Lombardi
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Abdulwasiu Bolaji Tiamiyu
- Henry M. Jackson Foundation Medical Research International Ltd/Gte, Abuja, Nigeria
- Emerging Infectious Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Michael Iroezindu
- Henry M. Jackson Foundation Medical Research International Ltd/Gte, Abuja, Nigeria
- Emerging Infectious Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Edward Akinwale
- Henry M. Jackson Foundation Medical Research International Ltd/Gte, Abuja, Nigeria
- Emerging Infectious Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | - Tsedal Mebrahtu
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Erica Broach
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Anastasia Zuppe
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Petra Prins
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jenny Lay
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Mihret Amare
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Natalie D. Collins
- Viral Diseases Program, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sandhya Vasan
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Cynthia Tucker
- One Health Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Sharon Daye
- One Health Branch, Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Christian Tientcha Happi
- African Centre of Excellence for Genomics of Infectious Diseases, Redeemer’s University, Ede, Osun State, Nigeria
- Redeemer’s University, Ede, Osun, Nigeria
- Department of Immunology and Infectious Diseases, Harvard T H Chan School of Public Health, Boston, MA, USA
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Sing’oei V, Nwoga C, Yates A, Owuoth J, Otieno J, Broach E, Li Q, Hassen Z, Imbach M, Milazzo M, Mebrahtu T, Robb ML, Ake JA, Polyak CS, Crowell TA. HIV prevalence and awareness among adults presenting for enrolment into a study of people at risk for HIV in Kisumu County, Western Kenya. PLoS One 2024; 19:e0294860. [PMID: 38166089 PMCID: PMC10760834 DOI: 10.1371/journal.pone.0294860] [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: 07/13/2023] [Accepted: 11/08/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION Despite declines in new HIV diagnoses both globally and in Kenya, parts of Western Kenya still report high HIV prevalence and incidence. We evaluated HIV prevalence to inform the development of policies for strategic and targeted HIV prevention interventions. METHODS Adult participants aged 18-35 years were recruited in Kisumu County and screened for HIV for a prospective HIV incidence cohort. Questionnaires assessed HIV-associated risk behaviors. Participants who tested positive for HIV were disaggregated into groups based on prior knowledge of their HIV status: previously-diagnosed and newly-diagnosed. In separate analyses by prior knowledge, robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with a positive HIV test in each group, as compared to participants without HIV. RESULTS Of 1059 participants tested for HIV, 196 (18.5%) had a positive HIV test. Among PLWH, 78 (39.8%) were newly diagnosed with HIV at screening. After adjusting for other variables, previously-diagnosed HIV was more common among females than males (PR 2.70, 95%CI 1.69-4.28), but there was no observed sex difference in newly-diagnosed HIV prevalence (PR 1.05, 95%CI 0.65-1.69). Previously-diagnosed HIV was also more common among people reporting consistent use of condoms with primary sexual partners as compared to inconsistent condom use (PR 3.19, 95%CI 2.09-4.86), but newly-diagnosed HIV was not associated with such a difference between consistent and inconsistent condom use (PR 0.73, 95%CI 0.25-2.10). CONCLUSION Prevalence of newly-diagnosed HIV was high, at approximately 8% of participants, and not statistically different between genders, highlighting the need for improved HIV case finding regardless of sex. The higher prevalence of previously-diagnosed HIV in female participants may reflect higher rates of HIV testing through more encounters with the healthcare system. Higher prevalence of consistent condom use amongst those previously-diagnosed suggests behavioral change to reduce HIV transmission, a potential benefit of policies to facilitate earlier HIV diagnosis.
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Affiliation(s)
- Valentine Sing’oei
- HJF Medical Research International, Kisumu, Kenya
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - June Otieno
- United States Army Medical Research Directorate-Africa, Nairobi, Kenya
| | - Erica Broach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Qun Li
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Zebiba Hassen
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Michelle Imbach
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Mark Milazzo
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Tsedal Mebrahtu
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Merlin L. Robb
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Julie A. Ake
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Christina S. Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
| | - Trevor A. Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, United States of America
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States of America
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Koren MA, Lin L, Eckels KH, De La Barrera R, Dussupt V, Donofrio G, Sondergaard EL, Mills KT, Robb ML, Lee C, Adedeji O, Keiser PB, Curley JM, Copeland NK, Crowell TA, Hutter JN, Hamer MJ, Valencia-Ruiz A, Darden J, Peel S, Amare MF, Mebrahtu T, Costanzo M, Krebs SJ, Gromowski GD, Jarman RG, Thomas SJ, Michael NL, Modjarrad K. Safety and immunogenicity of a purified inactivated Zika virus vaccine candidate in adults primed with a Japanese encephalitis virus or yellow fever virus vaccine in the USA: a phase 1, randomised, double-blind, placebo-controlled clinical trial. Lancet Infect Dis 2023; 23:1175-1185. [PMID: 37390836 PMCID: PMC10877583 DOI: 10.1016/s1473-3099(23)00192-5] [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] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/27/2023] [Accepted: 03/08/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND Zika virus infection is a threat to at-risk populations, causing major birth defects and serious neurological complications. Development of a safe and efficacious Zika virus vaccine is, therefore, a global health priority. Assessment of heterologous flavivirus vaccination is important given co-circulation of Japanese encephalitis virus and yellow fever virus with Zika virus. We investigated the effect of priming flavivirus naive participants with a licensed flavivirus vaccine on the safety and immunogenicity of a purified inactivated Zika vaccine (ZPIV). METHODS This phase 1, placebo-controlled, double-blind trial was done at the Walter Reed Army Institute of Research Clinical Trials Center in Silver Spring, MD, USA. Eligible participants were healthy adults aged 18-49 years, with no detectable evidence of previous flavivirus exposure (by infection or vaccination), as measured by a microneutralisation assay. Individuals with serological evidence of HIV, hepatitis B, or hepatitis C infection were excluded, as were pregnant or breastfeeding women. Participants were recruited sequentially into one of three groups (1:1:1) to receive no primer, two doses of intramuscular Japanese encephalitis virus vaccine (IXIARO), or a single dose of subcutaneous yellow fever virus vaccine (YF-VAX). Within each group, participants were randomly assigned (4:1) to receive intramuscular ZPIV or placebo. Priming vaccinations were given 72-96 days before ZPIV. ZPIV was administered either two or three times, at days 0, 28, and 196-234. The primary outcome was occurrence of solicited systemic and local adverse events along with serious adverse events and adverse events of special interest. These data were analysed in all participants receiving at least one dose of ZPIV or placebo. Secondary outcomes included measurement of neutralizing antibody responses following ZPIV vaccination in all volunteers with available post-vaccination data. This trial is registered at ClinicalTrials.gov, NCT02963909. FINDINGS Between Nov 7, 2016, and Oct 30, 2018, 134 participants were assessed for eligibility. 21 did not meet inclusion criteria, 29 met exclusion criteria, and ten declined to participate. 75 participants were recruited and randomly assigned. 35 (47%) of 75 participants were male and 40 (53%) were female. 25 (33%) of 75 participants identified as Black or African American and 42 (56%) identified as White. These proportions and other baseline characteristics were similar between groups. There were no statistically significant differences in age, gender, race, or BMI between those who did and did not opt into the third dose. All participants received the planned priming IXIARO and YF-VAX vaccinations, but one participant who received YF-VAX dropped out before receipt of the first dose of ZPIV. 50 participants received a third dose of ZPIV or placebo, including 14 flavivirus-naive people, 17 people primed with Japanese encephalitis virus vaccine, and 19 participants primed with yellow fever vaccine. Vaccinations were well tolerated across groups. Pain at the injection site was the only adverse event reported more frequently in participants who received ZPIV than in those who received placebo (39 [65%] of 60 participants, 95% CI 51·6-76·9 who received ZPIV vs three [21·4%] of 14 who received placebo; 4·7-50·8; p=0·006). No patients had an adverse event of special interest or serious adverse event related to study treatment. At day 57, the flavivirus-naive volunteers had an 88% (63·6-98·5, 15 of 17) seroconversion rate (neutralising antibody titre ≥1:10) and geometric mean neutralising antibody titre (GMT) against Zika virus of 100·8 (39·7-255·7). In the Japanese encephalitis vaccine-primed group, the day 57 seroconversion rate was 31·6% (95% CI 12·6-56·6, six of 19) and GMT was 11·8 (6·1-22·8). Participants primed with YF-VAX had a seroconversion rate of 25% (95% CI 8·7-49·1, five of 20) and GMT of 6·6 (5·2-8·4). Humoral immune responses rose substantially following a third dose of ZPIV, with seroconversion rates of 100% (69·2-100; ten of ten), 92·9% (66·1-99·8; 13 of 14), and 60% (32·2-83·7, nine of 15) and GMTs of 511·5 (177·6-1473·6), 174·2 (51·6-587·6), and 79 (19·0-326·8) in the flavivirus naive, Japanese encephalitis vaccine-primed, and yellow fever vaccine-primed groups, respectively. INTERPRETATION We found ZPIV to be well tolerated in flavivirus naive and primed adults but that immunogenicity varied significantly according to antecedent flavivirus vaccination status. Immune bias towards the flavivirus antigen of initial exposure and the timing of vaccination may have impacted responses. A third ZPIV dose overcame much, but not all, of the discrepancy in immunogenicity. The results of this phase 1 clinical trial have implications for further evaluation of ZPIV's immunisation schedule and use of concomitant vaccinations. FUNDING Department of Defense, Defense Health Agency; National Institute of Allergy and Infectious Diseases; and Division of Microbiology and Infectious Disease.
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Affiliation(s)
- Michael A Koren
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA.
| | - Leyi Lin
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kenneth H Eckels
- Pilot Bioproduction Facility, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Rafael De La Barrera
- Pilot Bioproduction Facility, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Vincent Dussupt
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Gina Donofrio
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Erica L Sondergaard
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kristin T Mills
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Merlin L Robb
- Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Christine Lee
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | | | - Paul B Keiser
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Justin M Curley
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nathanial K Copeland
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Trevor A Crowell
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Jack N Hutter
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Melinda J Hamer
- Clinical Trials Center, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Anais Valencia-Ruiz
- Diagnostic Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Janice Darden
- Diagnostic Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Sheila Peel
- Diagnostic Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Mihret F Amare
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Tsedal Mebrahtu
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Margaret Costanzo
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Shelly J Krebs
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA; US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA; Henry M Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Gregory D Gromowski
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Richard G Jarman
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Stephen J Thomas
- Viral Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Nelson L Michael
- Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Kayvon Modjarrad
- Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD, USA
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Dear N, Esber A, Iroezindu M, Bahemana E, Kibuuka H, Maswai J, Owuoth J, Polyak CS, Ake JA, Crowell TA, Bartolanzo D, Reynolds A, Song K, Milazzo M, Francisco L, Mankiewicz S, Schech S, Golway A, Omar B, Mebrahtu T, Lee E, Bohince K, Parikh A, Hern J, Duff E, Lombardi K, Imbach M, Eller LA, Kibuuka H, Semwogerere M, Naluyima P, Zziwa G, Tindikahwa A, Mutebe H, Kafeero C, Baghendaghe E, Lwebuge W, Ssentogo F, Birungi H, Tegamanyi J, Wangiri P, Nabanoba C, Namulondo P, Tumusiime R, Musingye E, Nanteza C, Wandege J, Waiswa M, Najjuma E, Maggaga O, Kenoly IK, Mukanza B, Maswai J, Langat R, Ngeno A, Korir L, Langat R, Opiyo F, Kasembeli A, Ochieng C, Towett J, Kimetto J, Omondi B, Leelgo M, Obonyo M, Rotich L, Tonui E, Chelangat E, Kapkiai J, Wangare S, Kesi ZB, Ngeno J, Langat E, Labosso K, Rotich J, Cheruiyot L, Changwony E, Bii M, Chumba E, Ontango S, Gitonga D, Kiprotich S, Ngtech B, Engoke G, Metet I, Airo A, Kiptoo I, Owuoth J, Sing’oei V, Rehema W, Otieno S, Ogari C, Modi E, Adimo O, Okwaro C, Lando C, Onyango M, Aoko I, Obambo K, Meyo J, Suja G, Iroezindu M, Adamu Y, Azuakola N, Asuquo M, Tiamiyu AB, Kokogho A, Mohammed SS, Okoye I, Odeyemi S, Suleiman A, Umejo L, Enas O, Mbachu M, Chigbu-Ukaegbu I, Adai W, Odo FA, Abdu R, Akiga R, Nwandu H, Okolo CH, Okeke N, Parker Z, Linus AU, Agbaim CA, Adegbite T, Harrison N, Adelakun A, Chioma E, Idi V, Eluwa R, Nwalozie J, Faith I, Okanigbuan B, Emmanuel A, Nnadi N, Rosemary N, Natalie UA, Owanza OT, Francis FI, Elemere J, Lauretta OI, Akinwale E, Ochai I, Maganga L, Bahemana E, Khamadi S, Njegite J, Lueer C, Kisinda A, Mwamwaja J, Mbwayu F, David G, Mwaipopo M, Gervas R, Mkondoo D, Somi N, Kiliba P, Mwaisanga G, Msigwa J, Mfumbulwa H, Edwin P, Olomi W. Routine HIV clinic visit adherence in the African Cohort Study. AIDS Res Ther 2022; 19:1. [PMID: 34996470 PMCID: PMC8742415 DOI: 10.1186/s12981-021-00425-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background Retention in clinical care is important for people living with HIV (PLWH). Evidence suggests that missed clinic visits are associated with interruptions in antiretroviral therapy (ART), lower CD4 counts, virologic failure, and overlooked coinfections. We identified factors associated with missed routine clinic visits in the African Cohort Study (AFRICOS). Methods In 2013, AFRICOS began enrolling people with and without HIV in Uganda, Kenya, Tanzania, and Nigeria. At enrollment and every 6 months thereafter, sociodemographic questionnaires are administered and clinical outcomes assessed. Missed clinic visits were measured as the self-reported number of clinic visits missed in the past 6 months and dichotomized into none or one or more visits missed. Logistic regression with generalized estimating equations was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between risk factors and missed visits. Results Between January 2013 and March 2020, 2937 PLWH were enrolled, of whom 2807 (95.6%) had initiated ART and 2771 had complete data available for analyses. Compared to PLWH 50+, missed clinic visits were more common among those 18–29 years (aOR 2.33, 95% CI 1.65–3.29), 30–39 years (aOR 1.59, 95% CI 1.19–2.13), and 40–49 years (aOR 1.42, 95% CI 1.07–1.89). As compared to PLWH on ART for < 2 years, those on ART for 4+ years were less likely to have missed clinic visits (aOR 0.72, 95% CI 0.55–0.95). Missed clinic visits were associated with alcohol use (aOR 1.34, 95% CI 1.05–1.70), a history of incarceration (aOR 1.42, 95% CI 1.07–1.88), depression (aOR 1.47, 95% CI 1.13–1.91), and viral non-suppression (aOR 2.50, 95% CI 2.00–3.12). As compared to PLWH who did not miss any ART in the past month, missed clinic visits were more common among those who missed 1–2 days (aOR 2.09, 95% CI 1.65–2.64) and 3+ days of ART (aOR 7.06, 95% CI 5.43–9.19). Conclusions Inconsistent clinic attendance is associated with worsened HIV-related outcomes. Strategies to improve visit adherence are especially needed for young PLWH and those with depression. Supplementary Information The online version contains supplementary material available at 10.1186/s12981-021-00425-0.
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Ejo M, Van Deun A, Nunn A, Meredith S, Ahmed S, Dalai D, Tumenbayar O, Tsogt B, Dat PT, Ha DTM, Hang PT, Kokebu D, Teferi M, Mebrahtu T, Ngubane N, Moodliar R, Duckworth L, Conradie F, Enduwamahoro E, Keysers J, De Rijk P, Mulders W, Diro E, Rigouts L, de Jong BC, Torrea G. Effectiveness of GenoType MTBDR sl in excluding TB drug resistance in a clinical trial. Int J Tuberc Lung Dis 2021; 25:839-845. [PMID: 34615581 DOI: 10.5588/ijtld.21.0212] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES: To assess the performance of the GenoType MTBDRsl v1, a line-probe assay (LPA), to exclude baseline resistance to fluoroquinolones (FQs) and second-line injectables (SLIs) in the Standard Treatment Regimen of Anti-tuberculosis Drugs for Patients With MDR-TB 1 (STREAM 1) trial.METHODS: Direct sputum MTBDRsl results in the site laboratories were compared to indirect phenotypic drug susceptibility testing (pDST) results in the central laboratory, with DNA sequencing as a reference standard.RESULTS: Of 413 multidrug-resistant TB (MDR-TB) patients tested using MTBDRsl and pDST, 389 (94.2%) were FQ-susceptible and 7 (1.7%) FQ-resistant, while 17 (4.1%) had an inconclusive MTBDRsl result. For SLI, 372 (90.1%) were susceptible, 5 (1.2%) resistant and 36 (8.7%) inconclusive. There were 9 (2.3%) FQ discordant pDST/MTBDRsl results, of which 3 revealed a mutation and 5 (1.3%) SLI discordant pDST/MTBDRsl results, none of which were mutants on sequencing. Among the 17 FQ- and SLI MTBDRsl-inconclusive samples, sequencing showed 1 FQ- and zero SLI-resistant results, similar to frequencies among the conclusive MTBDRsl. The majority of inconclusive MTBDRsl results were associated with low bacillary load samples (acid-fast bacilli smear-negative or scantily positive) compared to conclusive results (P < 0.001).CONCLUSION: MTBDRsl can facilitate the rapid exclusion of FQ and SLI resistances for enrolment in clinical trials.
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Affiliation(s)
- M Ejo
- Institute of Tropical Medicine, Antwerp, Belgium, University of Gondar, Gondar, Ethiopia, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - A Van Deun
- Institute of Tropical Medicine, Antwerp, Belgium, Independent Consultant, Leuven, Belgium
| | - A Nunn
- Medical Research Council Clinical Trials at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Meredith
- Medical Research Council Clinical Trials at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - S Ahmed
- Medical Research Council Clinical Trials at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - D Dalai
- National Centre of Infectious Diseases, National Tuberculosis Reference Laboratory, Ulaanbaatar, Mongolia
| | - O Tumenbayar
- National Centre of Infectious Diseases, National Tuberculosis Reference Laboratory, Ulaanbaatar, Mongolia
| | - B Tsogt
- Mongolian TB Coalition, Ulaanbaatar, Mongolia
| | - P T Dat
- Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - D T M Ha
- Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - P T Hang
- Pham Ngoc Thach Hospital, Ho Chi Minh, Vietnam
| | - D Kokebu
- Saint Peter´s TB Specialized Hospital, Addis Ababa, Ethiopia
| | - M Teferi
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - T Mebrahtu
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - N Ngubane
- Doris Goodwin Hospital, Pietermaritzburg, South Africa
| | - R Moodliar
- King Dinuzulu Hospital, Durban, South Africa
| | - L Duckworth
- King Dinuzulu Hospital, Durban, South Africa
| | - F Conradie
- Sizwe Tropical Disease, Johannesburg, South Africa
| | | | - J Keysers
- Institute of Tropical Medicine, Antwerp, Belgium
| | - P De Rijk
- Institute of Tropical Medicine, Antwerp, Belgium
| | - W Mulders
- Institute of Tropical Medicine, Antwerp, Belgium
| | - E Diro
- University of Gondar, Gondar, Ethiopia
| | - L Rigouts
- Institute of Tropical Medicine, Antwerp, Belgium, Department of Biomedical Sciences, University of Antwerp, Antwerp, Belgium
| | - B C de Jong
- Institute of Tropical Medicine, Antwerp, Belgium
| | - G Torrea
- Institute of Tropical Medicine, Antwerp, Belgium
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Analogbei T, Dear N, Reed D, Esber A, Akintunde A, Bahemana E, Adamu Y, Iroezindu M, Maganga L, Kiweewa F, Maswai J, Owuoth J, Ake JA, Polyak CS, Crowell TA, Falodun O, Song K, Milazzo M, Mankiewicz S, Schech S, Golway A, Mebrahtu T, Lee E, Bohince K, Hamm T, Parikh A, Hern J, Lombardi K, Imbach M, Eller L, Peel S, Malia J, Kroidl A, Kroidl I, Geldmacher C, Kafeero C, Nambuya A, Tegamanyi J, Birungi H, Mugagga O, Nassali G, Wangiri P, Nantabo M, Nambulondo P, Atwijuka B, Asiimwe A, Nabanoba C, Semwogerere M, Mwesigwa R, Jjuuko S, Namagembe R, Bagyendagye E, Tindikahwa A, Rwomushana I, Ssentongo F, Kibuuka H, Millard M, Kapkiai J, Wangare S, Mangesoi R, Chepkwony P, Bor L, Maera E, Kasembeli A, Rotich J, Kipkoech C, Chepkemoi W, Rono A, Kesi Z, Ngeno J, Langat E, Labosso K, Langat K, Kirui R, Rotich L, Mabwai M, Chelangat E, Agutu J, Tonui C, Changwony E, Bii M, Chumba E, Korir J, Sugut J, Gitonga D, Ngetich R, Kiprotich S, Rehema W, Ogari C, Ouma I, Adimo O, Ogai S, Okwaro C, Maranga E, Ochola J, Obambo K, Sing'oei V, Otieno L, Nyapiedho O, Sande N, Odemba E, Wanjiru F, Khamadi S, Chiweka E, Lwilla A, Mkondoo D, Somi N, Kiliba P, Mwaipopo M, Mwaisanga G, Muhumuza J, Mkingule N, Mwasulama O, Sanagare A, Kishimbo P, David G, Mbwayu F, Mwamwaja J, Likiliwike J, Muhumuza J, Mcharo R, Mkingule N, Mwasulama O, Mtafya B, Lueer C, Kisinda A, Mbena T, Mfumbulwa H, Mwandumbya L, Edwin P, Olomi W, Adamu Y, Akintunde A, Tiamiyu A, Afoke K, Mohammed S, Harrison N, Agbaim U, Adegbite O, Parker Z, Adelakun G, Oni F, Ndbuisi R, Elemere J, Azuakola N, Williams T, Ayogu M, Enas O, Enameguono O, Odo A, Ukaegbu I, Ugwuezumba O, Odeyemi S, Okeke N, Umeji L, Rose A, Daniel H, Nwando H, Nicholas E, Iyanda T, Okolo C, Mene V, Dogonyaro B, Olabulo O, Akinseli O, Onukun F, Knopp G. Predictors and Barriers to Condom Use in the African Cohort Study. AIDS Patient Care STDS 2020; 34:228-236. [PMID: 32396478 DOI: 10.1089/apc.2019.0302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Consistent condom use is an inexpensive and efficacious HIV prevention strategy. Understanding factors associated with condom use and barriers to use can inform strategies to increase condom uptake. The ongoing African Cohort Study prospectively enrolls adults at 12 clinical sites in Uganda, Kenya, Tanzania, and Nigeria. At enrollment, participants are asked about condom use at last sex with a regular partner. Robust Poisson regression models were used to evaluate predictors of self-reported condom use. Participants who reported not using condoms were asked to provide reasons. From January 2013 to September 2019, 2482 participants reported having at least one regular sexual partner in the preceding 6 months. Of those, 1577 (63.5%) reported using a condom at last sex. Condom use was more common among older participants, males, HIV-infected participants, and those with an HIV-infected partner. Married participants, those with a partner of unknown HIV status, and those reporting alcohol use were less likely to report condom use at last sex. Condom use at last sex also varied significantly by clinical site. Partner disapproval or refusal to use a condom was a consistent driver of disparities in condom use among participants who were HIV infected, female, and aged 18-24 years. Effective HIV prevention programs should integrate condom education with the tools necessary to negotiate condom use with regular partners.
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Affiliation(s)
- Tope Analogbei
- Health Implementation Program, Nigerian Ministry of Defense, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
| | - Nicole Dear
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Domonique Reed
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Allahna Esber
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Akindiran Akintunde
- US Army Medical Research Directorate—Africa, Abuja, Nigeria
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
| | - Emmanuel Bahemana
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Mbeya, Tanzania
| | - Yakubu Adamu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Michael Iroezindu
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry Jackson Foundation MRI, Abuja, Nigeria
- US Army Medical Research Directorate—Africa, Nairobi, Kenya
| | - Lucas Maganga
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- National Institute of Medical Research—Mbeya Medical Research Centre, Mbeya, Tanzania
| | | | - Jonah Maswai
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kericho, Kenya
| | - John Owuoth
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Kenya Medical Research Institute, Nairobi, Kenya
- Henry Jackson Foundation MRI, Kisumu, Kenya
| | - Julie A. Ake
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
| | - Christina S. Polyak
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | - Trevor A. Crowell
- US Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, Maryland
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
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Abstract
BACKGROUND Resistance to anti-tuberculosis drugs threatens to undermine effective control of tuberculosis (TB). In areas with weak TB control and misuse of anti-tuberculosis drugs, hotspots of multidrug-resistant TB (MDR-TB) have appeared. The aim of this review is to determine the prevalence rate of any anti-tuberculosis drug resistance, monoresistance and MDR-TB in Ethiopia. METHODS A systematic review of the literature on any resistance, monoresistance and MDR-TB was conducted. RESULTS Of the total 468 articles found using electronic search, 14 met the eligibility criteria and were included in the review. The prevalence rate of any drug resistance, polyresistance and MDR-TB was respectively 6.7-72.9%, 0-54% and 0-46%. A higher rate of streptomycin monoresistance (1.5-20.4%) was observed. CONCLUSION The prevalence and distribution of drug-resistant TB remains a serious public health problem in Ethiopia. Rapid, advanced diagnostic tools should be introduced, along with strong treatment and follow-up strategies.
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Affiliation(s)
- S Weldegebreal
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - T Mebrahtu
- Unit of Biomedical Science, School of Medicine, College of Health Sciences and Referral Hospital, Axum University, Axum, Ethiopia
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Mebrahtu T, Mersie W, Rangappa M. Path coefficient analysis of ozone effects on seed yield and seed yield components of bean (Phaseolus vulgarisL.). ACTA ACUST UNITED AC 2015. [DOI: 10.1080/00221589.1991.11516125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ngongo BP, Priddy F, Park H, Bender B, Fast P, Anzala O, Mutua G, Ruzagira E, Kamali A, Karita E, Mugo P, Chomba E, Bekker L, Roux S, Nanvubya A, Mebrahtu T. Developing standards of care for HIV prevention research in developing countries – a case study of ten research centers in Eastern and Southern Africa. Retrovirology 2012. [PMCID: PMC3442024 DOI: 10.1186/1742-4690-9-s2-p117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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10
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Mbogua J, Mebrahtu T, Lindegger G, Sabrina W, Anzala O, Mutua G, Mpendo J, Karita E, Singh S. Training trial staff in the use of a mixed method assessment of understanding tool in HIV vaccine trials. Retrovirology 2012. [PMCID: PMC3441720 DOI: 10.1186/1742-4690-9-s2-p237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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11
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Ngongo PB, Priddy F, Park H, Becker J, Bender B, Fast P, Anzala O, Mutua G, Ruzagira E, Kamali A, Karita E, Mugo P, Chomba E, Bekker LG, Roux S, Nanvubya A, Mebrahtu T. Developing standards of care for HIV prevention research in developing countries -- a case study of 10 research centers in Eastern and Southern Africa. AIDS Care 2012; 24:1277-89. [PMID: 22452384 DOI: 10.1080/09540121.2012.656572] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Standards of care provided to volunteers in HIV prevention research in developing countries are evolving. Inconsistency in standards, particularly within a research network highlights the need to balance volunteers' health and wellness with the efficient conduct of research. Ten research centers (RC's) in East and Southern Africa affiliated with the International AIDS Vaccine Initiative (IAVI) were studied using a mixed methods approach to understand variations, similarities and gaps in services provided, recipients of services, referral systems, and barriers to referral uptake. These data were then used to develop expected standards across the 10 RCs. Findings indicated that RCs consistently provided HIV risk reduction and family planning (FP) counseling, male condoms, management of sexually transmitted infections, CD-4 counts, and general medical care to volunteers and non-research volunteers. Services that were less consistently provided on-site included: female condoms, adult male circumcision (AMC), antiretroviral therapy (ART) and post-exposure prophylaxis (PEP) in case of rape. The FP options provided on-site varied, with few providing implants, intrauterine devices, tubal ligation, and vasectomy. Most RCs had established referral systems for ART, AMC, PEP, and FP, but few had referral points for psychosocial services. Few RCs had comprehensive guidelines on referrals other than those related to adverse events. Findings indicate that the greatest challenges for referral uptake were transportation and health care costs, poor quality and inconsistency of services at some referral points. Few RCs covered the cost of referrals for non-study related adverse events. A collaborative process between IAVI and the RCs was undertaken to reach consensus on expected standards of care. A set of required and recommended services to be provided on-site or by referral was developed. In developing such standards, we tried to balance scientific priorities, equity, contextual realities, community expectations, and cost-effectiveness.
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Affiliation(s)
- Prince Bahati Ngongo
- International AIDS Vaccine Initiative, Country and Regional Programs, New York, USA.
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Mpendo J, Mwapasa V, Kamali A, Seeley J, Birungi J, Njai H, Ssemaganda A, de Bont J, Mebrahtu T, Nanvubya A, Asiki G, Kintu E, Moore M, Kaleebu P. P06-06. Capacity building for HIV vaccine trials in Africa through South-South collaboration. Retrovirology 2009. [PMCID: PMC2768001 DOI: 10.1186/1742-4690-6-s3-p95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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13
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Kumwenda NI, Hoover DR, Mofenson LM, Thigpen MC, Kafulafula G, Li Q, Mipando L, Nkanaunena K, Mebrahtu T, Bulterys M, Fowler MG, Taha TE. Extended antiretroviral prophylaxis to reduce breast-milk HIV-1 transmission. N Engl J Med 2008; 359:119-29. [PMID: 18525035 DOI: 10.1056/nejmoa0801941] [Citation(s) in RCA: 268] [Impact Index Per Article: 16.8] [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] [Indexed: 11/19/2022]
Abstract
BACKGROUND Effective strategies are urgently needed to reduce mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) through breast-feeding in resource-limited settings. METHODS Women with HIV-1 infection who were breast-feeding infants were enrolled in a randomized, phase 3 trial in Blantyre, Malawi. At birth, the infants were randomly assigned to one of three regimens: single-dose nevirapine plus 1 week of zidovudine (control regimen) or the control regimen plus daily extended prophylaxis either with nevirapine (extended nevirapine) or with nevirapine plus zidovudine (extended dual prophylaxis) until the age of 14 weeks. Using Kaplan-Meier analyses, we assessed the risk of HIV-1 infection among infants who were HIV-1-negative on DNA polymerase-chain-reaction assay at birth. RESULTS Among 3016 infants in the study, the control group had consistently higher rates of HIV-1 infection from the age of 6 weeks through 18 months. At 9 months, the estimated rate of HIV-1 infection (the primary end point) was 10.6% in the control group, as compared with 5.2% in the extended-nevirapine group (P<0.001) and 6.4% in the extended-dual-prophylaxis group (P=0.002). There were no significant differences between the two extended-prophylaxis groups. The frequency of breast-feeding did not differ significantly among the study groups. Infants receiving extended dual prophylaxis had a significant increase in the number of adverse events (primarily neutropenia) that were deemed to be possibly related to a study drug. CONCLUSIONS Extended prophylaxis with nevirapine or with nevirapine and zidovudine for the first 14 weeks of life significantly reduced postnatal HIV-1 infection in 9-month-old infants. (ClinicalTrials.gov number, NCT00115648.)
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Affiliation(s)
- Newton I Kumwenda
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Gasasira AF, Kamya MR, Achan J, Mebrahtu T, Kalyango JN, Ruel T, Charlebois E, Staedke SG, Kekitiinwa A, Rosenthal PJ, Havlir D, Dorsey G. High risk of neutropenia in HIV-infected children following treatment with artesunate plus amodiaquine for uncomplicated malaria in Uganda. Clin Infect Dis 2008; 46:985-91. [PMID: 18444813 DOI: 10.1086/529192] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Artemisinin-based combination therapies are rapidly being adopted for the treatment of malaria in Africa; however, there are limited data on their safety and efficacy among human immunodeficiency virus (HIV)-infected populations. METHODS We compared malaria treatment outcomes between cohorts of HIV-infected and HIV-uninfected children in Uganda who were observed for 18 and 29 months, respectively. Malaria was treated with artesunate plus amodiaquine, and outcomes were assessed using standardized guidelines. HIV-infected children received trimethoprim-sulfamethoxazole prophylaxis and antiretroviral therapy in accordance with current guidelines. RESULTS Twenty-six HIV-infected participants experiencing 35 episodes of malaria and 134 HIV-uninfected children experiencing 258 episodes of malaria were included in the study. Twelve HIV-infected children were receiving antiretroviral therapy, 11 of whom were receiving zidovudine. Malaria treatment was highly efficacious in both the HIV-infected and HIV-uninfected cohorts (28-day risk of recrudescence, 0% and 3.6%, respectively); however, there was a trend towards increased risk of recurrent malaria among the HIV-uninfected children (2.9% vs. 13.2%; p = .08). Importantly, the risk of neutropenia 14 days after initiation of treatment with artesunate plus amodiaquine was higher among HIV-infected children than among HIV-uninfected children (45% vs. 6%; p < .001). The severity of all episodes of neutropenia in HIV-uninfected children was mild to moderate, and 16% of episodes of neutropenia in the HIV-infected cohort were severe or life-threatening (neutrophil count, <750 cells/mm(3)). In the HIV-infected cohort, the risk of neutropenia was significantly higher among children who received antiretroviral therapy than among those who did not receive antiretroviral therapy (75% vs. 26%; p < .001). CONCLUSIONS Artesunate plus amodiaquine was highly efficacious for malaria treatment in HIV-infected children but was associated with a high risk of neutropenia, especially in the context of concurrent antiretroviral use. Our findings highlight an urgent need for evaluation of alternative antimalarial therapies for HIV-infected individuals.
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Affiliation(s)
- Anne F Gasasira
- Department of Internal Medicine, Makerere University, Mulago Hospital, Kampala, Uganda.
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Kamya MR, Gasasira AF, Achan J, Mebrahtu T, Ruel T, Kekitiinwa A, Charlebois ED, Rosenthal PJ, Havlir D, Dorsey G. Effects of trimethoprim-sulfamethoxazole and insecticide-treated bednets on malaria among HIV-infected Ugandan children. AIDS 2007; 21:2059-66. [PMID: 17885296 DOI: 10.1097/qad.0b013e3282ef6da1] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [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: 11/27/2022]
Abstract
BACKGROUND Trimethoprim-sulfamethoxazole (TMP/SMX) prophylaxis and insecticide-treated bednets reduce malaria risk among HIV-infected adults. The efficacy of TMP/SMX may be diminished where antifolate resistance to malaria is high. We evaluated the efficacy of these interventions for malaria prevention among Ugandan children. METHODS We concurrently followed 300 HIV-infected children aged 1-10 years and a community-based cohort of 561 healthy children aged 1-11 years over 11 months in Kampala, Uganda. The HIV-infected children received TMP/SMX prophylaxis and insecticide treated bednets. In the community cohort, insecticide-treated bednets were introduced during the observation period. Children from both cohorts were followed using a standardized protocol to measure the incidence of malaria. RESULTS Only nine episodes of malaria were diagnosed among HIV-infected children (incidence = 0.07/person-year) in comparison with 440 episodes among children from the community (incidence = 0.90/person-year; P < 0.0001). The use of insecticide-treated bednets was associated with a 43% reduction in malaria incidence (P < 0.001), and a combination of TMP/SMX and use of insecticide-treated bednets with a 97% reduction in malaria incidence (P < 0.001). The prevalence of five mutations associated with antifolate resistance was high among malaria cases detected in both the HIV (100%) and community cohorts (75%). Malaria accounted for only 4% of febrile episodes in the HIV cohort in comparison with 33% in the community-based cohort (P < 0.0001). CONCLUSION In a malaria endemic area with a high level of molecular markers of antifolate resistance, the combined use of TMP/SMX prophylaxis and insecticide-treated bednets was associated with a dramatic reduction in malaria incidence among HIV-infected children.
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Affiliation(s)
- Moses R Kamya
- Makerere University Medical School, Kampala, Uganda.
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16
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Mebrahtu T, Stoltzfus RJ, Chwaya HM, Jape JK, Savioli L, Montresor A, Albonico M, Tielsch JM. Low-dose daily iron supplementation for 12 months does not increase the prevalence of malarial infection or density of parasites in young Zanzibari children. J Nutr 2004; 134:3037-41. [PMID: 15514272 DOI: 10.1093/jn/134.11.3037] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [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: 11/13/2022] Open
Abstract
Conflicting evidence exists on the possible role of iron supplementation in the predisposition to malaria infection or the enhancement of its clinical severity. Where anemia prevalence is >40%, current guidelines are to provide low-dose daily iron to young children for up to 18 mo. Earlier studies used doses higher than the current guidelines, intermittent doses, or have supplemented for durations < or = 4 mo. We aimed to assess the effect of low-dose, long-term iron supplementation on malaria infection using a double-blind, placebo-controlled, randomized design, and to examine possible subgroup effects by season and child age. The study was conducted in Pemba Island, Zanzibar, where Plasmodium falciparum malaria has year-round high transmission. A community-based sample of 614 children 4-71 mo old was randomly allocated to 10 mg/d iron or placebo for 12 mo. Outcome measures were the prevalence and density of malaria infection, which was assessed by blood films at monthly intervals. At baseline, 94.4% were anemic (hemoglobin < 110 g/L), 48.1% were stunted (height-for-age Z-score less than -2) and >80% had malaria-positive blood films. No significant differences in malariometric indices were observed between children in the iron-supplemented and placebo groups. Parasite density was higher in certain months and in younger children, but iron supplementation was not associated with any malarial infection outcome in any season or age subgroup. We conclude that in this environment of high malaria transmission, daily oral low-dose supplementation of iron for 12 mo did not affect the prevalence of malaria infection or parasite density.
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Affiliation(s)
- Tsedal Mebrahtu
- Department of International Health, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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17
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Abstract
Over a comparatively short period of time, the development and distribution of ivermectin (Mectizan) has radically altered the consequences of infection with Onchocerca volvulus. To achieve this required the fostering of many partnerships and the development of new tools and methods. The long-term commitment of Merck, the World Bank and other sponsors, as well as governments and non-governmental organizations, has been crucial. Yet the enthusiasm with which communities have taken up the delivery of ivermectin among themselves is perhaps the greatest reason for the success of this programme. The present challenge is sustaining the methods that have brought success so far, and making them part of health services and disease control programmes in some of the world's most impoverished and unstable areas. A major part of this challenge is continuing the commitment to controlling onchocerciasis as memory of the disease is fading, and while the hope of elimination or eradication for most endemic countries remains distant.
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Affiliation(s)
- G Burnham
- The Johns Hopkins Bloomberg School of Public Health, Department of International Health, Baltimore, MD 21205, USA.
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18
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Abstract
In addition to oil and soyfoods, soybean is also produced for vegetable use. The importance of consuming vegetable soybean for the prevention of chronic diseases is well documented. The objectives of this study were to determine the magnitude of genotype x year interactions for isoflavone concentration and pattern, estimate heritabilities, and identify genotypes with a stable isoflavone concentration and pattern. Thirty-one soybean genotypes from maturity groups (MGs) III to VI were grown at Randolph Research Farm of Virginia State University, Petersburg, Virginia, during 3 years. The genotypes were harvested at immature green pod stage (R6-R7) and analyzed for isoflavone contents. Significant (P < 0.05) differences among the genotypes were found for genistein, daidzein, glycitein, and total isoflavones. The genotype x year interactions were also significant (P < 0.05) for the seed traits analyzed, indicating that the performance of the genotype changes from year to year. However, genotypes Pella and Aoda consistently showed with higher means than the overall means for all the seed traits throughout the 3 years. MG differences were also observed for genistein, daidzein, and total isoflavone content. Low- to moderate-heritability estimates of 54, 45, 58, and 64% were observed for genistein, daidzein, glycitein, and total isoflavone content, respectively, suggesting that the seed traits are equally influenced by environments and genetic variations. In general, for all seed traits with the exception of daidzein, the percentage contribution of genotype to the total sum of square was higher than the genotype x year interaction. The seed traits were interdependent and the associations among them were positive and significant suggesting that simultaneous selection and improvements are possible.
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Affiliation(s)
- T Mebrahtu
- Virginia State University Agricultural Research Station and Department of Nutrition, Food Science, and Hospitality, South Dakota State University, Brookings, SD 57007, USA.
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19
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Abstract
A profile of the sensory characteristics of green soybean and consumer intent of purchasing the product were determined. Thirty-one green soybean genotypes from maturity groups III to VI harvested between R6 and R7 were frozen, boiled, shelled, and evaluated for color, texture, sweetness, nuttiness, beaniness, oiliness, aftertaste and overall eating quality by three sensory panels. Results showed highly significant (p <0.01) variabilities among the genotypes in all sensory parameters and highly significant correlations among several parameters. The green soybeans, when boiled, ranged from lightly green to green, were slightly resistant to chewing, slightly nutty, slightly beany, not oily, imparted a pleasant aftertaste and had a fairly good overall eating quality. The green soybeans would be potentially acceptable as a vegetable in the frozen state and for use in recipes. When selecting genotypes for production, consideration should be given to the sensory attributes of the genotypes, because there was significant variability among the characteristics of the green soybeans, and several characteristics together enhanced the overall acceptability of the vegetable soybeans. To further increase the acceptability of green soybeans as a vegetable, geneticists need to consider breeding a vegetable soybean that has as many desirable sensory attributes as possible.
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Affiliation(s)
- G Young
- Virginia State University, Agriculture Research Station and Virginia Polytechnic Institute and State University, Department of Human Nutrition and Foods, Petersburg 23806, USA.
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21
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Mebrahtu T, Mohamed A, Elmi A. Accumulation of phytate in vegetable-type soybean genotypes harvested at four developmental stages. Plant Foods Hum Nutr 1997; 50:179-87. [PMID: 9373869 DOI: 10.1007/bf02436055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
A total of 17 vegetable-type soybean (Glycine max [L.] Merr) genotypes were planted in four-row plots arranged in a randomized complete block design in 1988 and 1989 at Petersburg, Virginia. Each genotype was harvested at four developmental stages and evaluated for phytate content. Highly significant differences for phytate content were observed among the stages of harvest and genotypes, and there was an interaction between genotype x stage of harvest. The significant differences observed for phytate content among genotypes indicated that genetic variation exists among the tested genotypes for selection and improvement through hybridization. Among the genotypes, 'Kingston' and PI 423852 had the highest phytate content in most stages of harvest while PI 416771, 'Emperor', and PI 416982 had the lowest phytate values. A heritability estimate of 81 percent was observed for phytate content. This high heritability value indicates that selecting genotypes for lower phytate content would be effective. Significant correlations were observed for phytate content among genotypes harvested at R6, R7, R8, and overall. The magnitude of association of R6 with the overall phytate mean was especially high. These results illustrate that determining the phytate content of genotypes at the R6 growth stage would be a good predictor of the overall genotypic performance.
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Affiliation(s)
- T Mebrahtu
- Virginia State University, Petersburg 23806, USA
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22
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Abstract
Two rapid assays for the soluble epoxide hydrolase (sEH) are described. First, a sensitive radiometric assay based on thin-layer chromatography of [(14)C]-cis-9,10-epoxystearic acid and its corresponding diol ((14)C]-9,10-dihydroxystearic acid) is described. The cis fatty acid oxide exhibits higher specific activity of hydration with sEH from mouse, rat, human, and potato compared to trans-stilbene oxide (TSO). The K(m) and V(max) obtained for [(14)C]-cis-9,10-epoxystearic acid with mouse sEH are 11.0 microM and 3460 nmol/min/mg protein, respectively. [(14)C]-cis-9,10- Epoxystearic acid might more closely mimic the structures of natural substrates for sEH. Second, [2-(3)H]-trans-1,3-diphenyl-propene oxide ([(3)H]-tDPPO) and [2-(3)H]-cis-1,3-diphenylpropene oxide ([(3)H]-cDPPO) were synthesized and rapid radiometric assays for epoxide hydrolases (EHs) were developed by differential partitioning of the epoxide into iso-octane and its corresponding diol into aqueous phase containing methanol. It was shown that sEHs from mouse, rat, human, and potato rapidly hydrolyze [(3)H]-tDPPO and in comparison to TSO have 20-,49-,28-, and 7-fold higher rates, respectively. Mouse sEH hydrates [(3)H]-tDPPO at 26,200 nmol/min/mg protein, and a K(m)p4 of 2.80 microM is observed.
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Affiliation(s)
- B Borhan
- Department of Chemistry, University of California, Davis 95616, USA
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23
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Mebrahtu T, Hanover JW. Family variation in gas exchange, growth and leaf traits of black locust half-sib families. Tree Physiol 1991; 8:185-193. [PMID: 14972889 DOI: 10.1093/treephys/8.2.185] [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] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Variations in several growth, gas exchange and leaf traits among greenhouse-grown black locust (Robinia pseudoacacia L.) seedlings from 11 half-sib families were investigated. Three weeks after germination, early growth rates ranged from a minimum of 1 cm d(-1) in the slowest growing family, to a maximum of 3 cm d(-1) in the fastest growing family. Significant family variation in net photosynthetic rate per unit leaf area (P(N)), stomatal conductance, chlorophyll content, height, diameter, stem dry weight and total dry weight was observed. Net photosynthetic rate declined with seedling age. Net photosynthetic rate per unit leaf area was significantly correlated (r < 0.4) with specific leaf area, total chlorophyll, root dry weight, foliage dry weight and total dry weight. The correlation coefficients were higher (r >/= 0.55) between P(N) x total leaf area and growth traits (height, stem dry weight, foliage dry weight and total dry weight). The study indicated that variation in leaf area among the families was one reason for the lack of a strong relationship between P(N) and growth.
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Affiliation(s)
- T Mebrahtu
- Department of Forestry, Michigan State University, East Lansing, Michigan 48824-1222, USA
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24
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Mohamed AI, Mebrahtu T, Rangappa M. Nutrient composition and anti-nutritional factors in selected vegetable soybean (Glycine max [L.] Merr.). Plant Foods Hum Nutr 1991; 41:89-100. [PMID: 2017430 DOI: 10.1007/bf02196385] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
The genetic variation in the nutrient composition and anti-nutritional factors of 17 vegetable soybean genotypes were determined and a wide variation in protein %, total phosphorus (TPi) and available phosphorus (AP) was found among these genotypes. Variations in Ca, K, Fe, Mn, and Cu were also documented. Variation was also found for trypsin inhibitor (TI) activity and Phytate (PA) content. A highly significant and negative correlation (r = -0.533, P less than 0.01) was observed between TI and total protein. Strong positive correlation (r = 0.90) was also found between TPi and AP. Several genotypes (Sooty, Emperor, Wilson-5, PI 416771, PI 417322) showed good nutritional potential and can be used in the breeding program. High protein %, TPi, and minerals are desirable qualities for vegetable-type soybeans that make it as food with high nutrient density. Studies on the nutritional evaluation of immature vegetable type soybean seeds at different reproductive stages are also underway.
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Affiliation(s)
- A I Mohamed
- Cooperative State Research Service (CSRS), Virginia State University, Petersburg 23803
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25
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Mebrahtu T, Mersie W, Rangappa M. Inheritance of ambient ozone insensitivity in common bean (Phaseolus vulgaris L.). Environ Pollut 1990; 67:79-89. [PMID: 15092227 DOI: 10.1016/0269-7491(90)90173-a] [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] [Subscribe] [Scholar Register] [Received: 12/20/1989] [Accepted: 06/01/1990] [Indexed: 05/24/2023]
Abstract
The inheritance of ozone (O(3)) insensitivity in common bean (Phaseolus vulgaris L.) was evaluated using F(2) and F(3) populations under ambient conditions. This study was conducted over two growing seasons (1987, 1988) at Virginia State University, Randolph Research Farm, Petersburg, Virginia. Two populations were obtained by crossing insensitive plant introductions with sensitive commercial cultivars. Ratings on the scale of 1 to 5 (1 = 0 to 20% leaf injury, 2 = 21 to 40%, 3 = 41 to 60%, 4 = 61 to 80%, and 5 > 80%) were made on 160 F(2), F(3) progenies, and parental lines. Population mean injury ratings were recorded and estimates of genotypic, environmental, and phenotypic variances were computed. Estimates of heritability in the broadsense and of genetic advance were calculated for each population using F(2) and family component variance methods. Population means of the F(2) and F(3) progenies were not significantly different from their mid-parent values, suggesting that genetic variance was primarily additive. Broad-sense heritability estimates using F(2) variance method ranged from 51.4 to 70.5% and using family component variance method ranged from 62.1 to 75.6%. In this study, the computed genetic advance values closely parallel those of heritability estimated values. The high heritable nature of insensitivity would indicate that effective levels of insensitivity could be transferred to agronomically superior cultivars in a relatively short time.
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Affiliation(s)
- T Mebrahtu
- Virginia State University, PO Box 318, Petersburg, VA 23803, USA
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