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Jaguga F, Kirwa P, Gakinya B, Manji I, Andale T, Kinyanjui D, Kwobah EK, Mwangi F, Werunga K, Kerema J, Kwobah C, Temet E, Songok J, Aruasa WK. Intravenous ketamine for severe alcohol use disorder at Moi Teaching & Referral Hospital, Kenya: a case report. Subst Abuse Treat Prev Policy 2023; 18:11. [PMID: 36803380 PMCID: PMC9936629 DOI: 10.1186/s13011-023-00519-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/28/2023] [Indexed: 02/19/2023] Open
Abstract
BACKGROUND Alcohol use disorder is prevalent globally and in Kenya, and is associated with significant health and socio-economic consequences. Despite this, available pharmacological treatment options are limited. Recent evidence indicates that intravenous (IV) ketamine can be beneficial for the treatment of alcohol use disorder, but is yet to be approved for this indication. Further, little has been done to describe the use of IV ketamine for alcohol use disorder in Africa. The goal of this paper, is to: 1) describe the steps we took to obtain approval and prepare for off-label use of IV ketamine for patients with alcohol use disorder at the second largest hospital in Kenya, and 2) describe the presentation and outcomes of the first patient who received IV ketamine for severe alcohol use disorder at the hospital. CASE PRESENTATION In preparing for the off-label use of ketamine for alcohol use disorder, we brought together a multi-disciplinary team of clinicians including psychiatrists, pharmacists, ethicists, anesthetists, and members of the drug and therapeutics committee, to spearhead the process. The team developed a protocol for administering IV ketamine for alcohol use disorder that took into account ethical and safety issues. The national drug regulatory authority, the Pharmacy and Poison's Board, reviewed and approved the protocol. Our first patient was a 39-year-old African male with severe alcohol use disorder and comorbid tobacco use disorder and bipolar disorder. The patient had attended in-patient treatment for alcohol use disorder six times and each time had relapsed between one to four months after discharge. On two occasions, the patient had relapsed while on optimal doses of oral and implant naltrexone. The patient received IV ketamine infusion at a dose of 0.71 mg/kg. The patient relapsed within one week of receiving IV ketamine while on naltrexone, mood stabilizers, and nicotine replacement therapy. DISCUSSION & CONCLUSIONS This case report describes for the first time the use of IV ketamine for alcohol use disorder in Africa. Findings will be useful in informing future research and in guiding other clinicians interested in administering IV ketamine for patients with alcohol use disorder.
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Affiliation(s)
- Florence Jaguga
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
| | - Philip Kirwa
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
| | - Benson Gakinya
- grid.79730.3a0000 0001 0495 4256School of Medicine, Moi University College of Health Sciences, PO BOX 4606, Eldoret, Kenya
| | - Imran Manji
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
| | - Thomas Andale
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
| | - Daniel Kinyanjui
- grid.79730.3a0000 0001 0495 4256School of Medicine, Moi University College of Health Sciences, PO BOX 4606, Eldoret, Kenya
| | - Edith Kamaru Kwobah
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
| | - Felicita Mwangi
- grid.499694.f0000 0004 0528 0638Albury Wodonga Health, Kerferd Unit 37/45 corner Dixon and docker streets, Wangaratta, Victoria 3677 Australia
| | - Kituyi Werunga
- grid.79730.3a0000 0001 0495 4256School of Medicine, Moi University College of Health Sciences, PO BOX 4606, Eldoret, Kenya
| | - Josephat Kerema
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
| | - Charles Kwobah
- grid.79730.3a0000 0001 0495 4256School of Medicine, Moi University College of Health Sciences, PO BOX 4606, Eldoret, Kenya
| | - Eunice Temet
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
| | - Julia Songok
- grid.79730.3a0000 0001 0495 4256School of Medicine, Moi University College of Health Sciences, PO BOX 4606, Eldoret, Kenya
| | - Wilson K. Aruasa
- grid.513271.30000 0001 0041 5300Moi Teaching and Referral Hospital, PO BOX -30100, Eldoret, Kenya
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Omulo S, Oluka M, Achieng L, Osoro E, Kinuthia R, Guantai A, Opanga SA, Ongayo M, Ndegwa L, Verani JR, Wesangula E, Nyakiba J, Makori J, Sugut W, Kwobah C, Osuka H, Njenga MK, Call DR, Palmer GH, VanderEnde D, Luvsansharav UO. Point-prevalence survey of antibiotic use at three public referral hospitals in Kenya. PLoS One 2022; 17:e0270048. [PMID: 35709220 PMCID: PMC9202938 DOI: 10.1371/journal.pone.0270048] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 06/02/2022] [Indexed: 11/18/2022] Open
Abstract
Antimicrobial stewardship encourages appropriate antibiotic use, the specific activities of which will vary by institutional context. We investigated regional variation in antibiotic use by surveying three regional public hospitals in Kenya. Hospital-level data for antimicrobial stewardship activities, infection prevention and control, and laboratory diagnostic capacities were collected from hospital administrators, heads of infection prevention and control units, and laboratory directors, respectively. Patient-level antibiotic use data were abstracted from medical records using a modified World Health Organization point-prevalence survey form. Altogether, 1,071 consenting patients were surveyed at Kenyatta National Hospital (KNH, n = 579), Coast Provincial General Hospital (CPGH, n = 229) and Moi Teaching and Referral Hospital (MTRH, n = 263). The majority (67%, 722/1071) were ≥18 years and 53% (563/1071) were female. Forty-six percent (46%, 489/1071) were receiving at least one antibiotic. Antibiotic use was higher among children <5 years (70%, 150/224) than among other age groups (40%, 339/847; P < 0.001). Critical care (82%, 14/17 patients) and pediatric wards (59%, 155/265) had the highest proportion of antibiotic users. Amoxicillin/clavulanate was the most frequently used antibiotic at KNH (17%, 64/383 antibiotic doses), and ceftriaxone was most used at CPGH (29%, 55/189) and MTRH (31%, 57/184). Forty-three percent (326/756) of all antibiotic prescriptions had at least one missed dose recorded. Forty-six percent (204/489) of patients on antibiotics had a specific infectious disease diagnosis, of which 18% (37/204) had soft-tissue infections, 17% (35/204) had clinical sepsis, 15% (31/204) had pneumonia, 13% (27/204) had central nervous system infections and 10% (20/204) had obstetric or gynecological infections. Of these, 27% (56/204) had bacterial culture tests ordered, with culture results available for 68% (38/56) of tests. Missed antibiotic doses, low use of specimen cultures to guide therapy, high rates of antibiotic use, particularly in the pediatric and surgical population, and preference for broad-spectrum antibiotics suggest antibiotic use in these tertiary care hospitals is not optimal. Antimicrobial stewardship programs, policies, and guidelines should be tailored to address these areas.
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Affiliation(s)
- Sylvia Omulo
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
- University of Nairobi Institute of Tropical and Infectious Diseases, Nairobi, Kenya
| | - Margaret Oluka
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Loice Achieng
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | - Eric Osoro
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | | | - Anastasia Guantai
- Department of Pharmacology and Pharmacognosy, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Sylvia Adisa Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Linus Ndegwa
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jennifer R Verani
- Division of Global Health Protection, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Eveline Wesangula
- Patient and Health Workers Safety Unit, Ministry of Health, Nairobi, Kenya
| | - Jarred Nyakiba
- Patient and Health Workers Safety Unit, Ministry of Health, Nairobi, Kenya
| | - Jones Makori
- Coast Provincial General Hospital, Mombasa, Kenya
| | - Wilson Sugut
- Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Charles Kwobah
- Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Medicine, Moi University School of Medicine, Eldoret, Kenya
| | - Hanako Osuka
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - M Kariuki Njenga
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Douglas R Call
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
| | - Guy H Palmer
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, United States of America
- Washington State University Global Health-Kenya, Nairobi, Kenya
| | - Daniel VanderEnde
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Ulzii-Orshikh Luvsansharav
- National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Muro FJ, Lyamuya FS, Kwobah C, Bollinger J, Bodinayake CK, Nagahawatte A, Piyasiri B, Kurukulasooriya R, Ali S, Mallya R, Rolfe R, Ruwanpathirana A, Sheng T, Østbye T, Drew R, Kussin P, Woods CW, Anderson DJ, Mmbaga BT, Tillekeratne LG. Opportunities for Improving Antimicrobial Stewardship: Findings From a Prospective, Multi-Center Study in Three Low- or Middle-Income Countries. Front Public Health 2022; 10:848802. [PMID: 35548085 PMCID: PMC9081325 DOI: 10.3389/fpubh.2022.848802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/24/2022] [Indexed: 11/26/2022] Open
Abstract
Background To develop effective antimicrobial stewardship programs (ASPs) for low- and middle-income countries (LMICs), it is important to identify key targets for improving antimicrobial use. We sought to systematically describe the prevalence and patterns of antimicrobial use in three LMIC hospitals. Methods Consecutive patients admitted to the adult medical wards in three tertiary care hospitals in Tanzania, Kenya, and Sri Lanka were enrolled in 2018-2019. The medical record was reviewed for clinical information including type and duration of antimicrobials prescribed, indications for antimicrobial use, and microbiologic testing ordered. Results A total of 3,149 patients were enrolled during the study period: 1,103 from Tanzania, 750 from Kenya, and 1,296 from Sri Lanka. The majority of patients were male (1,783, 56.6% overall) with a median age of 55 years (IQR 38-68). Of enrolled patients, 1,573 (50.0%) received antimicrobials during their hospital stay: 35.4% in Tanzania, 56.5% in Kenya, and 58.6% in Sri Lanka. At each site, the most common indication for antimicrobial use was lower respiratory tract infection (LRTI; 40.2%). However, 61.0% received antimicrobials for LRTI in the absence of LRTI signs on chest radiography. Among patients receiving antimicrobials, tools to guide antimicrobial use were under-utilized: microbiologic cultures in 12.0% and microbiology consultation in 6.5%. Conclusion Antimicrobials were used in a substantial proportion of patients at tertiary care hospitals across three LMIC sites. Future ASP efforts should include improving LRTI diagnosis and treatment, developing antibiograms to direct empiric antimicrobial use, and increasing use of microbiologic tests.
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Affiliation(s)
- Florida J. Muro
- Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
- Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
| | - Furaha S. Lyamuya
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
- Internal Medicine Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
| | - Charles Kwobah
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - John Bollinger
- Duke-Margolis Center for Health Policy, Washington, DC, United States
- Duke Global Health Institute, Durham, NC, United States
- Duke University, Durham, NC, United States
| | - Champica K. Bodinayake
- Duke Global Health Institute, Durham, NC, United States
- University of Ruhuna, Galle, Sri Lanka
| | - Ajith Nagahawatte
- Duke Global Health Institute, Durham, NC, United States
- University of Ruhuna, Galle, Sri Lanka
| | | | | | - Shamim Ali
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Rose Mallya
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
- Reproductive and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Robert Rolfe
- Duke Global Health Institute, Durham, NC, United States
- Duke University, Durham, NC, United States
| | | | - Tianchen Sheng
- Duke Global Health Institute, Durham, NC, United States
- Duke University, Durham, NC, United States
| | - Truls Østbye
- Duke Global Health Institute, Durham, NC, United States
- Duke University, Durham, NC, United States
| | - Richard Drew
- Duke University, Durham, NC, United States
- Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, United States
| | | | - Christopher W. Woods
- Duke Global Health Institute, Durham, NC, United States
- Duke University, Durham, NC, United States
| | - Deverick J. Anderson
- Duke University, Durham, NC, United States
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, United States
| | - Blandina T. Mmbaga
- Kilimanjaro Christian Research Institute, Moshi, Tanzania
- Duke Global Health Institute, Durham, NC, United States
- Paediatric and Child Health Department, Kilimanjaro Christian Medical Centre, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - L. Gayani Tillekeratne
- Duke Global Health Institute, Durham, NC, United States
- Duke University, Durham, NC, United States
- University of Ruhuna, Galle, Sri Lanka
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Rolfe R, Kwobah C, Muro F, Ruwanpathirana A, Lyamuya F, Bodinayake C, Nagahawatte A, Piyasiri B, Sheng T, Bollinger J, Zhang C, Ostbye T, Ali S, Drew R, Kussin P, Anderson DJ, Woods CW, Watt MH, Mmbaga BT, Tillekeratne LG. Barriers to implementing antimicrobial stewardship programs in three low- and middle-income country tertiary care settings: findings from a multi-site qualitative study. Antimicrob Resist Infect Control 2021; 10:60. [PMID: 33766135 PMCID: PMC7993456 DOI: 10.1186/s13756-021-00929-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/19/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Antimicrobial resistance has been named as one of the top ten threats to public health in the world. Hospital-based antimicrobial stewardship programs (ASPs) can help reduce antimicrobial resistance. The purpose of this study was to determine perceived barriers to the development and implementation of ASPs in tertiary care centers in three low- and middle-income countries (LMICs). METHODS Interviews were conducted with 45 physicians at tertiary care hospitals in Sri Lanka (n = 22), Kenya (12), and Tanzania (11). Interviews assessed knowledge of antimicrobial resistance and ASPs, current antimicrobial prescribing practices, access to diagnostics that inform antimicrobial use, receptiveness to ASPs, and perceived barriers to implementing ASPs. Two independent reviewers coded the interviews using principles of applied thematic analysis, and comparisons of themes were made across the three sites. RESULTS Barriers to improving antimicrobial prescribing included prohibitively expensive antimicrobials, limited antimicrobial availability, resistance to changing current practices regarding antimicrobial prescribing, and limited diagnostic capabilities. The most frequent of these barriers in all three locations was limited drug availability. Many physicians in all three sites had not heard of ASPs before the interviews. Improved education was a suggested component of ASPs at all three sites. The creation of guidelines was also recommended, without prompting, by interviewees at all three sites. Although most participants felt microbiological results were helpful in tailoring antibiotic courses, some expressed distrust of laboratory culture results. Biomarkers like erythrocyte sedimentation rate and c-reactive protein were not felt to be specific enough to guide antimicrobial therapy. Despite limited or no prior knowledge of ASPs, most interviewees were receptive to implementing protocols that would include documentation and consultation with ASPs regarding antimicrobial prescribing. CONCLUSIONS Our study highlighted several important barriers to implementing ASPs that were shared between three tertiary care centers in LMICs. Improving drug availability, enhancing availability of and trust in microbiologic data, creating local guidelines, and providing education to physicians regarding antimicrobial prescribing are important steps that could be taken by ASPs in these facilities.
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Affiliation(s)
- Robert Rolfe
- Duke University, Durham, NC, USA.
- Duke Global Health Institute, Durham, NC, USA.
| | - Charles Kwobah
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Florida Muro
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | | | - Furaha Lyamuya
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Champica Bodinayake
- Duke Global Health Institute, Durham, NC, USA
- University of Ruhuna, Galle, Sri Lanka
| | - Ajith Nagahawatte
- Duke Global Health Institute, Durham, NC, USA
- University of Ruhuna, Galle, Sri Lanka
| | | | | | | | - Chi Zhang
- Duke Global Health Institute, Durham, NC, USA
| | | | - Shamim Ali
- Moi University/Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Richard Drew
- Duke University, Durham, NC, USA
- Campbell University College of Pharmacy and Health Sciences, Buies Creek, NC, USA
| | | | - Deverick J Anderson
- Duke University, Durham, NC, USA
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | - Christopher W Woods
- Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
| | | | - Blandina T Mmbaga
- Duke Global Health Institute, Durham, NC, USA
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
- Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - L Gayani Tillekeratne
- Duke University, Durham, NC, USA
- Duke Global Health Institute, Durham, NC, USA
- University of Ruhuna, Galle, Sri Lanka
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Kambugu A, Thompson J, Hakim J, Tumukunde D, van Oosterhout JJ, Mwebaze R, Hoppe A, Abach J, Kwobah C, Arenas-Pinto A, Walker SA, Paton NI. Neurocognitive Function at the First-Line Failure and on the Second-Line Antiretroviral Therapy in Africa: Analyses From the EARNEST Trial. J Acquir Immune Defic Syndr 2016; 71:506-13. [PMID: 26579985 DOI: 10.1097/qai.0000000000000898] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 01/04/2023]
Abstract
OBJECTIVE To assess neurocognitive function at the first-line antiretroviral therapy failure and change on the second-line therapy. DESIGN Randomized controlled trial was conducted in 5 sub-Saharan African countries. METHODS Patients failing the first-line therapy according to WHO criteria after >12 months on non-nucleoside reverse transcriptase inhibitors-based regimens were randomized to the second-line therapy (open-label) with lopinavir/ritonavir (400 mg/100 mg twice daily) plus either 2-3 clinician-selected nucleoside reverse transcriptase inhibitors, raltegravir, or as monotherapy after 12-week induction with raltegravir. Neurocognitive function was tested at baseline, weeks 48 and 96 using color trails tests 1 and 2, and the Grooved Pegboard test. Test results were converted to an average of the 3 individual test z-scores. RESULTS A total of 1036 patients (90% of those >18 years enrolled at 13 evaluable sites) had valid baseline tests (58% women, median: 38 years, viral load: 65,000 copies per milliliter, CD4 count: 73 cells per cubic millimeter). Mean (SD) baseline z-score was -2.96 (1.74); lower baseline z-scores were independently associated with older age, lower body weight, higher viral load, lower hemoglobin, less education, fewer weekly working hours, previous central nervous system disease, and taking fluconazole (P < 0.05 in multivariable model). Z-score was increased by mean (SE) of +1.23 (0.04) after 96 weeks on the second-line therapy (P < 0.001; n = 915 evaluable), with no evidence of difference between the treatment arms (P = 0.35). CONCLUSIONS Patients in sub-Saharan Africa failing the first-line therapy had low neurocognitive function test scores, but performance improved on the second-line therapy. Regimens with more central nervous system-penetrating drugs did not enhance neurocognitive recovery indicating this need not be a primary consideration in choosing a second-line regimen.
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Affiliation(s)
- Andrew Kambugu
- *Research Program, Infectious Diseases Institute, Makerere University, Kampala, Uganda; †MRC Clinical Trials Unit at UCL, London, United Kingdom; ‡University of Zimbabwe Clinical Research Centre, Harare, Zimbabwe; §Research Department, Joint Clinical Research Centre (JCRC), Kampala, Uganda; ‖Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi; ¶Dignitas International, Zomba, Malawi; #Department of Medicine, St. Francis of Nsambya Hospital, Kampala, Uganda; **Clinical Research Centre, Moi University School of Medicine, Eldoret, Kenya; and ††Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Abstract
Sickle cell disease (SCD) is a genetic disorder resulting from a mutation in the hemoglobin (Hb) gene. Sickle cell disease results in chronic anemia and a variety of acute and chronic complications that can lead to early mortality. A child with both SCD and HIV presents a management challenge, particularly in a resource-limited setting. In this case report, we describe the case of an 18-month-old Kenyan girl with SCD and HIV who developed a severe hypersensitivity reaction to first-line antiretroviral therapy (ART). Selecting an appropriate drug substitute for a child with SCD and HIV presents a management dilemma when the available options have problematic side effect profiles or are inaccessible or inappropriate according to national guidelines. The challenges in choosing an appropriate ART regimen for a child with SCD and HIV highlight the lack of data and scarcity of treatment options for pediatric patients.
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Affiliation(s)
| | - Charles Kwobah
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Geren Stone
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - Faraj Some
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Rachel Christine Vreeman
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Indiana University School of Medicine, Indianapolis, IN, USA
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