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Kirenga BJ, Chakaya J, Yimer G, Nyale G, Haile T, Muttamba W, Mugenyi L, Katagira W, Worodria W, Aanyu-Tukamuhebwa H, Lugogo N, Joloba M, Mersha TB, Bekele A, Makumbi F, Mekasha A, Green CL, de Jong C, Kamya M, van der Molen T. The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project. J Allergy Clin Immunol Glob 2024; 3:100209. [PMID: 38328803 PMCID: PMC10847773 DOI: 10.1016/j.jacig.2024.100209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 08/29/2023] [Accepted: 09/30/2023] [Indexed: 02/09/2024]
Abstract
Background Severe asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown. Objective We sought to determine the burden (prevalence, mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethiopia. Methods Using the American Thoracic Society/European Respiratory Society case definition of severe asthma, we analyzed for the prevalence of severe asthma (requiring Global Initiative for Asthma [GINA] steps 4-5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4-5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA-recommended medications. Asthma control was assessed by the asthma control questionnaire (ACQ). Results Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% confidence interval [CI], 23.1-28.3) and 4.6% (95% CI, 3.5-6.0), respectively. Patients with severe asthma were (nonsevere vs severe vs severe refractory) older (39, 42, 45 years, P = .011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, P = .004), had lower forced expiratory volume in 1 second percentage (81%, 61%, 55.5%, P < .001), had lower quality of life score (129, 127 vs 121, P < .001), and had higher activity impairment (10%, 30%, 50%, P < .001). Factors independently associated with severe asthma were hypertension comorbidity; adjusted odds ratio 2.21 (1.10-4.47), P = .027, high bronchial hyperresponsiveness questionnaire score; adjusted odds ratio 2.16 (1.01-4.61), P = .047 and higher ACQ score at baseline 2.80 (1.55-5.08), P = .001. Conclusion The prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.
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Affiliation(s)
- Bruce J. Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Jeremiah Chakaya
- Kenya Association of Physicians Against TB and Lung Diseases, Nairobi, Kenya
| | - Getnet Yimer
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - George Nyale
- Kenya Association of Physicians Against TB and Lung Diseases, Nairobi, Kenya
- Kenyatta National Hospital, Nairobi, Kenya
| | - Tewodros Haile
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Winters Muttamba
- Makerere University Lung Institute, Kampala, Uganda
- Division of Infection and Global Health, School of Medicine, University of St Andrews, St Andrews, United Kingdom
| | - Levicatus Mugenyi
- Makerere University Lung Institute, Kampala, Uganda
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene and Tropical Medicine Research Unit, Entebbe, Uganda
| | | | | | | | - Njira Lugogo
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Moses Joloba
- Department of Medical Microbiology, Makerere University, Kampala, Uganda
| | - Tesfaye B. Mersha
- Division of Asthma Research, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amsalu Bekele
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Fred Makumbi
- School of Public Health, Makerere University, Kampala, Uganda
| | - Amha Mekasha
- Addis Ababa University College of Health Sciences, Addis Ababa, Ethiopia
| | - Cynthia L. Green
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC
| | - Corina de Jong
- Department of General Practice and Elderly Care, GRIAC-Primary Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Moses Kamya
- Department of Medicine, Makerere University, Kampala, Uganda
| | - Thys van der Molen
- Department of General Practice and Elderly Care, GRIAC-Primary Care, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Santelli JS, Chen IS, Nabukalu D, Lutalo T, Spindler EJ, Chang LW, Grabowski MK, Grilo SA, Kreniske P, Wei Y, Nalugoda F, Hoffman S, Maru M, Chu S, Ssewamala FM, Byansi W, Kagaayi J, Wawer MJ, Gray RH, Serwadda D, Makumbi F. HIV combination prevention and declining orphanhood among adolescents, Rakai, Uganda, 2001-18: an observational community cohort study. Lancet HIV 2022; 9:e32-e41. [PMID: 34973171 PMCID: PMC9125395 DOI: 10.1016/s2352-3018(21)00275-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 09/12/2021] [Accepted: 10/11/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Orphanhood increased markedly in the 1980s and 1990s in sub-Saharan Africa because of HIV-related mortality. Little is known about the contribution of HIV interventions, such as antiretroviral therapy (ART) and male medical circumcision, to more recent trends in orphanhood. In this study, we examined trends over time in maternal-only, paternal-only, and double orphanhood among adolescents before and after ART and male medical circumcision became widely available in the Rakai region of south-central Uganda. We sought to understand the association between adolescent orphanhood and HIV combination prevention (community-level ART use and prevalence of male medical circumcision). We hypothesised that increasing combination prevention, including greater use of ART and higher prevalence of male medical circumcision, would be associated with a lower probability of orphanhood. METHODS We examined the prevalence of orphanhood among adolescents aged 15-19 years, before and after roll-out of ART in mid-2004 and male medical circumcision in 2007, using data from 28 continuously followed communities within the Rakai Community Cohort Study. We used multinomial logistic regression with clustered SEs to estimate adjusted relative risk ratios (RRs) for maternal-only, paternal-only, and double orphanhood compared with non-orphanhood over 11 survey rounds between 2001 and 2018. Controlling for community HIV prevalence, household socioeconomic status, and adolescent age, we examined the association between community prevalence of ART use among people living with HIV and prevalence of male circumcision, including traditional circumcision. The primary outcome was orphanhood among adolescents aged 15-19 years. FINDINGS Orphanhood declined from 52% (920 of 1768 participants) in 2001-02 to 23% (592 of 2609 participants) by 2016-18 (p<0·0001), while double orphanhood declined from 20% (346 of 1768 participants) to 3% (86 of 2609 participants) (p<0·0001). Community prevalence of ART use among people living with HIV increased from 11% (105 of 945 participants) in 2005-06 to 78% (1163 of 1485 participants) in 2016-18. Male circumcision rates rose from 19% (147 of 790 participants) in 2005-06 to 65% (3535 of 5433 participants) in 2016-18. In the multinomial logistic regression model, a 10% increase in community prevalence of ART use was associated with a decrease in maternal orphanhood (adjusted relative RR 0·90, 95% CI 0·85-0·95) and double orphanhood (0·80, 0·75-0·85). In the post-ART era, a 10% increase in the community prevalence of male circumcision was associated with a decrease in paternal orphanhood (2005-18, adjusted relative RR 0·92, 0·87-0·97) and double orphanhood (0·91, 0·85-0·98). INTERPRETATION Widespread availability and uptake of HIV combination prevention was associated with marked reductions in orphanhood among adolescents. Reductions in orphanhood promise improved health and social outcomes for young people. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Allergy and Infectious Diseases, the National Institute of Mental Health, and the Division of Intramural Research of the National Institute for Allergy and Infectious Diseases.
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Affiliation(s)
- John S Santelli
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Ivy S Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Kalisizo, Uganda
| | - Esther J Spindler
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Larry W Chang
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Mary Kate Grabowski
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Pathology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Stephanie A Grilo
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Philip Kreniske
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY, USA,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Mahlet Maru
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sofia Chu
- Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | | | | | - Joseph Kagaayi
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
| | - Maria J Wawer
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Ronald H Gray
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Serwadda
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Fred Makumbi
- Rakai Health Sciences Program, Kalisizo, Uganda,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda
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Santelli JS, Chen I, Makumbi F, Wei Y, Nalugoda F, Lutalo T, Spindler E, Grilo SA, Deisher A, Grabowski K, Hoffman S, Kagaayi J, Chang LW, Gray R, Wawer M, Serwadda D. Household wealth and HIV incidence over time, rural Uganda, 1994-2018. AIDS 2021; 35:1835-1843. [PMID: 34132219 PMCID: PMC8373447 DOI: 10.1097/qad.0000000000002989] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/25/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the relationship between household wealth and HIV incidence in rural Uganda over time from 1994 to 2018. In research conducted early in the epidemic, greater wealth (i.e. higher socioeconomic status, SES) was associated with higher HIV prevalence in sub-Saharan Africa (SSA); this relationship reversed in some settings in later years. DESIGN Analysis of associations over time in a population-based open cohort of persons 15-49 years from 17 survey-rounds in 28 continuously followed communities of the Rakai Community Cohort Study (RCCS). METHODS The RCCS sample averaged 8622 individuals and 5387 households per round. Principal components analysis was used to create a nine-item asset-based measure of household wealth. Poisson regression with generalized estimating equation (GEE) and exchangeable correlation structure was used to estimate HIV incidence rate ratios (IRRs) by SES quartile, survey-round, sex, and age group. RESULTS From 1994 to 2018, SES rose considerably, and HIV incidence declined from 1.45 to 0.40 per 100 person-years (IRR = 0.39, 95% CI = 0.32--0.47, P < 0.001). HIV incidence was similar by SES category in the initial survey intervals (1994-1997); however, higher SES groups showed greater declines in HIV incidence over time. Multivariable analyses showed significant associations between HIV incidence and SES (IRR = 0.55 for highest compared with lowest quartile, 95% CI = 0.45--0.66, P < 0.001) controlling for time, sex, and age group. CONCLUSION Beyond the early years of the RCCS, higher SES was associated with lower HIV incidence and SES gradients widened over time. The poor, like other key populations, should be targeted for HIV prevention, including treatment as prevention.
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Affiliation(s)
- John S. Santelli
- Department of Population and Family Health, Mailman School of Public Health
- Department of Pediatrics, Vagelos College of Physicians and Surgeons
| | - Ivy Chen
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | - Fred Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Ying Wei
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York
| | | | - Tom Lutalo
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Esther Spindler
- Department of Population and Family Health, Mailman School of Public Health
| | - Stephanie A. Grilo
- Department of Population and Family Health, Mailman School of Public Health
| | - Andrea Deisher
- Department of Population and Family Health, Mailman School of Public Health
| | - Katherine Grabowski
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Susie Hoffman
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Joseph Kagaayi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala
- Rakai Health Sciences, Program, Kalisizo, Uganda
| | - Larry W. Chang
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Ronald Gray
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - Maria Wawer
- Rakai Health Sciences, Program, Kalisizo, Uganda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
| | - David Serwadda
- Rakai Health Sciences, Program, Kalisizo, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
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4
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Kirenga B, Chakaya J, Yimer G, Nyale G, Haile T, Muttamba W, Mugenyi L, Katagira W, Worodria W, Aanyu-Tukamuhebwa H, Lugogo N, Joloba M, Bekele A, Makumbi F, Green C, de Jong C, Kamya M, van der Molen T. Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project. BMJ Open Respir Res 2021; 7:7/1/e000484. [PMID: 32054641 PMCID: PMC7047479 DOI: 10.1136/bmjresp-2019-000484] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/20/2022] Open
Abstract
RATIONALE The relationship between clinical and biomarker characteristics of asthma and its severity in Africa is not well known. METHODS Using the Expert Panel Report 3, we assessed for asthma severity and its relationship with key phenotypic characteristics in Uganda, Kenya and Ethiopia. The characteristics included adult onset asthma, family history of asthma, exposures (smoking and biomass), comorbidities (HIV, hypertension, obesity, tuberculosis (TB), rhinosinusitis, gastro-oesophageal disease (GERD) and biomarkers (fractional exhaled nitric oxide (FeNO), skin prick test (SPT) and blood eosinophils). We compared these characteristics on the basis of severity and fitted a multivariable logistic regression model to assess the independent association of these characteristics with asthma severity. RESULTS A total of 1671 patients were enrolled, 70.7% women, with median age of 40 years. The prevalence of intermittent, mild persistent, moderate persistent and severe persistent asthma was 2.9%, 19.9%, 42.6% and 34.6%, respectively. Only 14% were on inhaled corticosteroids (ICS). Patients with severe persistent asthma had a higher rate of adult onset asthma, smoking, HIV, history of TB, FeNO and absolute eosinophil count but lower rates of GERD, rhinosinusitis and SPT positivity. In the multivariate model, Ethiopian site and a history of GERD remained associated with asthma severity. DISCUSSION The majority of patients in this cohort presented with moderate to severe persistent asthma and the use of ICS was very low. Improving access to ICS and other inhaled therapies could greatly reduce asthma morbidity in Africa.
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Affiliation(s)
- Bruce Kirenga
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jeremiah Chakaya
- Kenya Association of Physicians against TB and Lung Diseases (KAPTLD), Nairobi, Kenya
| | - Getnet Yimer
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - George Nyale
- Department of Medicine, Kenyatta National Hospital, Nairobi, Kenya
| | - Tewodros Haile
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Winters Muttamba
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Levicatus Mugenyi
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Winceslaus Katagira
- Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Mulago National Referral Hospital, Uganda Ministry of Health, Kampala, Uganda
| | | | - Njira Lugogo
- Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Moses Joloba
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Amsalu Bekele
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fred Makumbi
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Cindy Green
- Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Corina de Jong
- Department of General Practice, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Moses Kamya
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Thys van der Molen
- University Medical Center Groningen (UMCG), University of Groningen, Groningen, Netherlands
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5
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Nabukalu D, Reniers G, Risher KA, Blom S, Slaymaker E, Kabudula C, Zaba B, Nalugoda F, Kigozi G, Makumbi F, Serwadda D, Reynolds SJ, Marston M, Eaton JW, Gray R, Wawer M, Sewankambo N, Lutalo T. Population-level adult mortality following the expansion of antiretroviral therapy in Rakai, Uganda. Popul Stud (Camb) 2020; 74:93-102. [PMID: 31117928 PMCID: PMC6891159 DOI: 10.1080/00324728.2019.1595099] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 02/01/2019] [Indexed: 12/03/2022]
Abstract
There are limited data on the impact of antiretroviral therapy (ART) on population-level adult mortality in sub-Saharan Africa. We analysed data for 2000-14 from the Rakai Community Cohort Study (RCCS) in Uganda, where free ART was scaled up after 2004. Using non-parametric and parametric (Weibull) survival analysis, we estimated trends in average person-years lived between exact ages 15 and 50, per capita life-years lost to HIV, and the mortality hazards of people living with HIV (PLHIV). Between 2000 and 2014, average adult life-years lived before age 50 increased significantly, from 26.4 to 33.5 years for all women and from 28.6 to 33.8 years for all men. As of 2014, life-years lost to HIV had declined significantly, to 1.3 years among women and 0.4 years among men. Following the roll-out of ART, mortality reductions among PLHIV were initially larger in women than men, but this is no longer the case.
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Affiliation(s)
| | - Georges Reniers
- London School of Hygiene and Tropical Medicine
- University of the Witwatersrand
| | | | - Sylvia Blom
- London School of Hygiene and Tropical Medicine
| | | | | | - Basia Zaba
- London School of Hygiene and Tropical Medicine
| | | | | | - Fred Makumbi
- Rakai Health Sciences Program
- Makerere University
| | | | - Steven J Reynolds
- National Institutes of Health
- Johns Hopkins Bloomberg School of Public Health
| | | | | | - Ron Gray
- Rakai Health Sciences Program
- Johns Hopkins Bloomberg School of Public Health
| | - Maria Wawer
- Rakai Health Sciences Program
- Johns Hopkins Bloomberg School of Public Health
| | | | - Tom Lutalo
- Rakai Health Sciences Program
- Uganda Virus Research Institute
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6
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Ekirapa-Kiracho E, Tetui M, Bua J, Muhumuza Kananura R, Waiswa P, Makumbi F, Atuyambe L, Ajeani J, George A, Mutebi A, Kakaire A, Namazzi G, Paina L, Namusoke Kiwanuka S. Maternal and neonatal implementation for equitable systems. A study design paper. Glob Health Action 2018; 10:1346925. [PMID: 28849723 PMCID: PMC5645657 DOI: 10.1080/16549716.2017.1346925] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach.
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Affiliation(s)
| | - Moses Tetui
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,b Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - John Bua
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Rornald Muhumuza Kananura
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Peter Waiswa
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,c Global Health Division , Karolinska Institutet , Stockholm , Sweden.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Fred Makumbi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Lynn Atuyambe
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Judith Ajeani
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Asha George
- e Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,f School of Public Health , University of the Western Cape , Robert Sobukwe Road , Bellville 7535 , Republic of South Africa
| | - Aloysuis Mutebi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Ayub Kakaire
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Gertrude Namazzi
- a Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda.,d Maternal and Neonatal Health Center of Excellence, Makerere University School of Public Health (MakSPH) , Makerere University , Kampala , Uganda
| | - Ligia Paina
- e Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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7
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Ekirapa-Kiracho E, Muhumuza Kananura R, Tetui M, Namazzi G, Mutebi A, George A, Paina L, Waiswa P, Bumba A, Mulekwa G, Nakiganda-Busiku D, Lyagoba M, Naiga H, Putan M, Kulwenza A, Ajeani J, Kakaire-Kirunda A, Makumbi F, Atuyambe L, Okui O, Namusoke Kiwanuka S. Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts. Glob Health Action 2018; 10:1363506. [PMID: 28871853 PMCID: PMC5645678 DOI: 10.1080/16549716.2017.1363506] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.17–1.74] and saving for maternal health (aOR 2.11, 95% CI 1.39–3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Rornald Muhumuza Kananura
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Moses Tetui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,b Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine , Umeå University , Umeå , Sweden
| | - Gertrude Namazzi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Aloysius Mutebi
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Asha George
- c Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,d School of Public Health , University of the Western Cape , Bellville , South Africa
| | - Ligia Paina
- c Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Peter Waiswa
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda.,e Makerere University Centre of Excellence for Maternal and Newborn Health Research , Kampala , Uganda.,f Global Health Division , Karolinska Institutet , Stockholm , Sweden
| | - Ahmed Bumba
- g Kibuku District Health Office , Kibuku , Uganda
| | | | | | | | | | - Mary Putan
- h Pallisa District Health Office , Pallisa , Uganda
| | | | - Judith Ajeani
- j Department of Obstetrics and Gynaecology , Makerere University Medical School , Kampala , Uganda
| | - Ayub Kakaire-Kirunda
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Fred Makumbi
- k Department of Epidemiology and Biostatistics , Makerere University School of Public Health , Kampala , Uganda
| | - Lynn Atuyambe
- l Department of Community Health and Behavioural Sciences , Makerere University School of Public Health , Kampala , Uganda
| | - Olico Okui
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
| | - Suzanne Namusoke Kiwanuka
- a Department of Health Policy Planning and Management , Makerere University School of Public Health , Kampala , Uganda
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Wanyenze RK, Bwanika JB, Beyeza-Kashesya J, Mugerwa S, Arinaitwe J, Matovu JKB, Gwokyalya V, Kasozi D, Bukenya J, Makumbi F. Uptake and correlates of cervical cancer screening among HIV-infected women attending HIV care in Uganda. Glob Health Action 2018; 10:1380361. [PMID: 29035163 PMCID: PMC5678455 DOI: 10.1080/16549716.2017.1380361] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Background: Human immunodeficiency virus (HIV)-infected women are at high risk of cervical cancer. Objective: This study assessed uptake and correlates of cervical screening among HIV-infected women in care in Uganda. Methods: A nationally representative cross-sectional survey of HIV-infected women in care was conducted from August to November 2016. Structured interviews were conducted with 5198 women aged 15–49 years, from 245 HIV clinics. Knowledge and uptake of cervical screening and human papillomavirus (HPV) vaccination were determined. Correlates of cervical screening were assessed with modified Poisson regression to obtain prevalence ratios (PRs) using Stata version 12.0. Results: Overall, 94.0% (n = 4858) had ever heard of cervical screening and 66% (n = 3732) knew a screening site. However, 47.4% (n = 2302) did not know the schedule for screening and 50% (n = 2409) did not know the symptoms of cervical cancer. One-third (33.7%; n = 1719) rated their risk of cervical cancer as low. Uptake of screening was 30.3% (n = 1561). Women who had never been screened cited lack of information (29.6%; n = 1059) and no time (25.5%; n = 913) as the main reasons. Increased likelihood of screening was associated with receipt of HIV care at a level II health center [adj. PR 1.89, 95% confidence interval (CI) 1.29–2.76] and private facilities (adj. PR 1.68, 95% CI 1.16–3.21), knowledge of cervical screening (adj. PR 2.19, 95% CI 1.78–2.70), where to go for screening (adj. PR 6.47, 95% CI 3.69–11.36), and low perception of risk (adj. PR 1.52, 95% CI 1.14–2.03). HPV vaccination was 2%. Conclusions: Cervical screening and HPV vaccination uptake were very low among HIV-infected women in care in Uganda. Improved knowledge of cervical screening schedules and sites, and addressing fears and risk perception may increase uptake of cervical screening in this vulnerable population.
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Affiliation(s)
- Rhoda K Wanyenze
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - John Baptist Bwanika
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
| | - Jolly Beyeza-Kashesya
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
| | - Shaban Mugerwa
- c AIDS Control Program, Ministry of Health , Kampala , Uganda
| | - Jim Arinaitwe
- d Global Fund Focal Coordination Office, Ministry of Health , Kampala , Uganda
| | - Joseph K B Matovu
- e Department of Community Health, Makerere University School of Public Health , Kampala , Uganda
| | - Violet Gwokyalya
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Dickson Kasozi
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Justine Bukenya
- a Department of Disease Control and Environmental Health, Makerere University School of Public Health , Kampala , Uganda
| | - Fred Makumbi
- b Department of Epidemiology and Statistics , Makerere University School of Public Health , Kampala , Uganda
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Mamudu H, Namusisi K, Bazeyo W, Olando Y, Surabhi J, Makumbi F, Pack R, Rutebemberwa E. Change in knowledge of tobacco use and secondhand smoke exposure among health workers in Uganda. Tob Induc Dis 2018. [DOI: 10.18332/tid/84518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Grabowski MK, Serwadda DM, Gray RH, Nakigozi G, Kigozi G, Kagaayi J, Ssekubugu R, Nalugoda F, Lessler J, Lutalo T, Galiwango RM, Makumbi F, Kong X, Kabatesi D, Alamo ST, Wiersma S, Sewankambo NK, Tobian AAR, Laeyendecker O, Quinn TC, Reynolds SJ, Wawer MJ, Chang LW. HIV Prevention Efforts and Incidence of HIV in Uganda. N Engl J Med 2017; 377:2154-2166. [PMID: 29171817 PMCID: PMC5627523 DOI: 10.1056/nejmoa1702150] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined. METHODS Between 1999 and 2016, data were collected from 30 communities with the use of 12 surveys in the Rakai Community Cohort Study, an open, population-based cohort of persons 15 to 49 years of age. We assessed trends in the incidence of HIV on the basis of observed seroconversion data, participant-reported use of ART, participant-reported male circumcision, viral-load suppression, and sexual behaviors. RESULTS In total, 33,937 study participants contributed 103,011 person-visits. A total of 17,870 persons who were initially HIV-negative were followed for 94,427 person-years; among these persons, 931 seroconversions were observed. ART was introduced in 2004, and by 2016, ART coverage was 69% (72% among women vs. 61% among men, P<0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P<0.001). The percentage of adolescents 15 to 19 years of age who reported never having initiated sex (i.e., delayed sexual debut) increased from 30% in 1999 to 55% in 2016 (P<0.001). By 2016, the mean incidence of HIV infection had declined by 42% relative to the period before 2006 (i.e., before the scale-up of the combination strategy for HIV prevention) - from 1.17 cases per 100 person-years to 0.66 cases per 100 person-years (adjusted incidence rate ratio, 0.58; 95% confidence interval [CI], 0.45 to 0.76); declines were greater among men (adjusted incidence rate ratio, 0.46; 95% CI, 0.29 to 0.73) than among women (adjusted incidence rate ratio, 0.68; 95% CI, 0.50 to 0.94). CONCLUSIONS In this longitudinal study, the incidence of HIV infection declined significantly with the scale-up of a combination strategy for HIV prevention, which provides empirical evidence that interventions for HIV prevention can have a population-level effect. However, additional efforts are needed to overcome disparities according to sex and to achieve greater reductions in the incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others.).
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Affiliation(s)
- M Kate Grabowski
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - David M Serwadda
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Ronald H Gray
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Gertrude Nakigozi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Godfrey Kigozi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Joseph Kagaayi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Robert Ssekubugu
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Fred Nalugoda
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Justin Lessler
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Thomas Lutalo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Ronald M Galiwango
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Fred Makumbi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Xiangrong Kong
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Donna Kabatesi
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Stella T Alamo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Steven Wiersma
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Nelson K Sewankambo
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Aaron A R Tobian
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Oliver Laeyendecker
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Thomas C Quinn
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Steven J Reynolds
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Maria J Wawer
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
| | - Larry W Chang
- From the Department of Pathology (M.K.G., A.A.R.T.) and the Division of Infectious Diseases, Department of Medicine (O.L., T.C.Q., S.J.R., L.W.C.), Johns Hopkins School of Medicine, and the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health (M.K.G., R.H.G., J.L., X.K., A.A.R.T., O.L., T.C.Q., S.J.R., M.J.W., L.W.C.), Baltimore, and the Laboratory of Immunoregulation, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda (O.L., T.C.Q., S.J.R.) - all in Maryland; and Rakai Health Sciences Program, Entebbe (M.K.G., D.M.S., R.H.G., G.N., G.K., J.K., R.S., F.N., T.L., R.M.G., F.M., N.K.S., A.A.R.T., S.J.R., M.J.W., L.W.C.), and Centers for Disease Control and Prevention (D.K., S.T.A., S.W.), Makerere University School of Public Health (D.M.S., F.M.), and Makerere University School of Medicine (N.K.S.), Kampala - all in Uganda
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11
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Buregyeya E, Naigino R, Mukose A, Makumbi F, Esiru G, Arinaitwe J, Musinguzi J, Wanyenze RK. Facilitators and barriers to uptake and adherence to lifelong antiretroviral therapy among HIV infected pregnant women in Uganda: a qualitative study. BMC Pregnancy Childbirth 2017; 17:94. [PMID: 28320347 PMCID: PMC5360052 DOI: 10.1186/s12884-017-1276-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 03/14/2017] [Indexed: 11/15/2022] Open
Abstract
Background In 2012, Uganda started implementing lifelong antiretroviral therapy (ART) for prevention of mother to child transmission (PMTCT) in line with the WHO 2012 guidelines. This study explored experiences of HIV infected pregnant and breastfeeding women regarding barriers and facilitators to uptake and adherence to lifelong ART. Methods This was a cross-sectional qualitative study conducted in three districts (Masaka, Mityana and Luwero) in Uganda, between February and May 2014. We conducted in-depth interviews with 57 pregnant and breastfeeding women receiving care in six health facilities, who had been on lifelong ART for at least 6 months. Data analysis was done using a content thematic approach with Atlas-ti software. Results Initiation of lifelong ART was done the same day the mother tested HIV positive. Several women felt the counselling was inadequate and had reservations about taking ART for life. The main motivation to initiate and adhere to ART was the desire to have an HIV-free baby. Adherence was a challenge, ranging from not taking the drugs at the right time, to completely missing doses and clinic appointments. Support from their male partners and peer family support groups enhanced good adherence. Fear to disclose HIV status to partners, drug related factors (side effects and the big size of the tablet), and HIV stigma were major barriers to ART initiation and adherence. Transition from antenatal care to HIV chronic care clinics was a challenge due to fear of stigma and discrimination. Conclusions In order to maximize the benefits of lifelong ART, adequate preparation of women before ART initiation and on-going support through family support groups and male partner engagement are critical, particularly after birth and cessation of breastfeeding.
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Affiliation(s)
- Esther Buregyeya
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Rose Naigino
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Aggrey Mukose
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Fred Makumbi
- Department of Epidemiology and Biostatics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Godfrey Esiru
- AIDS Control Program, Ministry of Health, Kampala, Uganda
| | - Jim Arinaitwe
- Global Fund Focal Coordination Office, Ministry of Health, Kampala, Uganda
| | | | - Rhoda K Wanyenze
- Department of Disease Control and Environmental Health, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
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12
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Butler E, Tran T, Fuller A, Luboga S, Haglund M, Makumbi F, Galukande M, Chipman J. Optimizing surgical care delivery in Uganda to address untreated
abdominal surgical conditions. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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13
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Tran T, Farber SH, Vissoci JR, Fuller A, Butler E, Andrade L, Staton C, Makumbi F, Luboga S, Muhumza C, Chipman J, Galukande M, Haglund M. Geographic access and relationship to unmet surgical need in Uganda: a
geospatial analysis of a household survey on burden of surgical conditions
in Uganda. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Muhumza C, Tran T, Butler E, Fuller A, Haglund M, Luboga S, Chipman J, Galukande M, Makumbi F. Reproductive health contribution to the burden of surgical conditions in
Uganda. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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15
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Grabowski MK, Gray RH, Makumbi F, Kagaayi J, Redd AD, Kigozi G, Reynolds SJ, Nalugoda F, Lutalo T, Wawer MJ, Serwadda D, Quinn TC, Tobian AAR. Use of injectable hormonal contraception and women's risk of herpes simplex virus type 2 acquisition: a prospective study of couples in Rakai, Uganda. Lancet Glob Health 2015; 3:e478-e486. [PMID: 26094162 DOI: 10.1016/s2214-109x(15)00086-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/03/2015] [Accepted: 02/11/2015] [Indexed: 01/09/2023]
Abstract
BACKGROUND The injectable hormonal contraceptive depo-medroxyprogesterone acetate (DMPA) has been associated with increased risk of HIV acquisition, but findings are inconsistent. Whether DMPA increases the risk of other sexually transmitted viral infections is unknown. We assessed the association between DMPA use and incident herpes simplex virus type 2 (HSV2) infection in women. METHODS In this prospective study, we enrolled HIV-negative and HSV2-negative women aged 15-49 years whose HIV-negative male partners were concurrently enrolled in a randomised trial of male circumcision in Rakai, Uganda. We excluded women if either they or their male partners HIV seroconverted. The primary outcome was HSV2 seroconversion, assessed annually. The male circumcision trial was registered with ClinicalTrials.gov, number NCT00425984. FINDINGS Between Aug 11, 2003, and July 6, 2006, we enrolled 682 women in this study. We noted HSV2 seroconversions in 70 (10%) women. Incidence was 13·5 per 100 person-years in women consistently using DMPA (nine incident infections per 66·5 person-years), 4·3 per 100 person-years in pregnant women who were not using hormonal contraception (18 incident infections per 423·5 person-years), and 6·6 per 100 person-years in women who were neither pregnant nor using hormonal contraception (35 incident infections per 529·5 person-years). Women consistently using DMPA had an adjusted hazard ratio for HSV2 seroconversion of 2·26 (95% CI 1·09-4·69; p=0·029) compared with women who were neither pregnant nor using hormonal contraception. Of 132 women with HSV2-seropositive partners, seroconversion was 36·4 per 100 person-years in consistent DMPA users (four incident infections per 11 person-years) and 10·7 per 100 person-years in women who were neither pregnant nor using hormonal contraception (11 incident infections per 103 person-years; adjusted hazard ratio 6·23, 95% CI 1·49-26·3; p=0·012). INTERPRETATION Consistent DMPA use might increase risk of HSV2 seroconversion; however, study power was low. These findings should be assessed in larger populations with more frequent follow-up than in this study, and other contraceptive methods should also be assessed. Access to a wide range of highly effective contraceptive methods is needed for women, particularly in sub-Saharan Africa. FUNDING Bill and Melinda Gates Foundation, Doris Duke Charitable Foundation, US National Institutes of Health, and Fogarty International Center.
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Affiliation(s)
- Mary K Grabowski
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Ronald H Gray
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda
| | | | | | - Andrew D Redd
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | | | - Steven J Reynolds
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | | | - Tom Lutalo
- Rakai Health Sciences Program, Entebbe, Uganda
| | - Maria J Wawer
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda
| | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda; School of Public Health, Makerere University, Kampala, Uganda
| | - Thomas C Quinn
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, US National Institutes of Health, Bethesda, MD, USA
| | - Aaron A R Tobian
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, MD, USA; Rakai Health Sciences Program, Entebbe, Uganda.
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Fuller A, Butler E, Tran T, Makumbi F, Luboga S, Muhumuza C, Chipman J, Galukande M, Haglund M. Surgeons OverSeas Assessment of Surgical Need (SOSAS) Methodology Update
and mobile-assisted data dissemination system (mADDS) Platform for Scale in
Larger Low- and Middle-income Countries. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nanzigu S, Kiguba R, Kabanda J, Mukonzo JK, Waako P, Kityo C, Makumbi F. Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans. HIV AIDS (Auckl) 2013; 5:309-19. [PMID: 24348073 PMCID: PMC3857165 DOI: 10.2147/hiv.s50614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Introduction CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented. Objective This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts. Methods Patients’ records at two HIV/ART sites – the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda – were reviewed. Records of 426 patients – 68.3% female and 63.2% from JCRC – who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/μL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ≥50, <100 with ≥100, <200 with ≥200, and ≥200 with ≥250 cells/μL. Results The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ≥ 200 cells/μL reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/μL. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara. Conclusion Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses.
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Affiliation(s)
- Sarah Nanzigu
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda ; Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Joseph Kabanda
- Institute of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jackson K Mukonzo
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Waako
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cissy Kityo
- Joint Clinic Research Centre, Kampala, Uganda
| | - Fred Makumbi
- Institute of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
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Kigozi G, Musoke R, Kighoma N, Kiwanuka N, Makumbi F, Nalugoda F, Wabwire-Mangen F, Serwadda D, Wawer MJ, Gray RH. Safety of medical male circumcision in human immunodeficiency virus-infected men in Rakai, Uganda. Urology 2013; 83:294-7. [PMID: 24286598 DOI: 10.1016/j.urology.2013.08.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/14/2013] [Accepted: 08/17/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the safety of medical male circumcision (MMC) among human immunodeficiency virus (HIV)-infected men with CD4 levels <350 cells/mm(3), CD4 counts ≥ 350 cells/mm(3), and HIV-negative men. METHODS Two hundred forty-two HIV-infected men and a sample of 262 HIV-negative consenting men aged 12 years or older who requested free MMC were enrolled in a prospective study. Blood for HIV testing and a CD4 count were collected before surgery. During weekly follow-up over 6 weeks, data were collected on wound healing and adverse events (AEs) by examination, and resumption of sex and condom use ascertained by interview. Surgery-related AEs were characterized by type, severity, management, and resolution. Chi-square and Fisher's exact tests were used to test for differences in AE proportions. RESULTS Overall, only 2 of the 453 men experienced moderate AEs, a rate of 0.44 per 100 surgeries. No AE occurred among HIV-negative men, whereas the AE rate among HIV-infected men with CD4 counts ≥ 350 cells/mm(3) was 0.79 per 100 surgeries, and among men with CD4 counts <350 cells/mm(3) the rate was 1.19 per 100 surgeries (P = .214). AE rates were comparable for all characteristics (P >.05). CONCLUSION HIV-positive men can be safely included in MMC roll out programs without necessitating presurgery CD4 counts determination.
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Affiliation(s)
| | | | | | - Noah Kiwanuka
- Department of Epidemiology and Biostatistics, the School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Makumbi
- Rakai Health Sciences Program, Entebbe, Uganda; Department of Epidemiology and Biostatistics, the School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Fred Wabwire-Mangen
- Department of Epidemiology and Biostatistics, the School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Serwadda
- Rakai Health Sciences Program, Entebbe, Uganda; Department of Epidemiology and Biostatistics, the School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maria Joan Wawer
- Rakai Health Sciences Program, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
| | - Ronald Henry Gray
- Rakai Health Sciences Program, Entebbe, Uganda; Department of Epidemiology, Johns Hopkins University, Bloomberg School of Public Health, Baltimore, MD
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Kisa R, Mukose A, Makumbi F. P2.106 Utilization of Sexually Transmitted Infection Services by Male Partners of Antenatal Care Attendees in Jinja District-Uganda: A Case Control Study. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Reynolds SJ, Makumbi F, Newell K, Kiwanuka N, Ssebbowa P, Mondo G, Boaz I, Wawer MJ, Gray RH, Serwadda D, Quinn TC. Effect of daily aciclovir on HIV disease progression in individuals in Rakai, Uganda, co-infected with HIV-1 and herpes simplex virus type 2: a randomised, double-blind placebo-controlled trial. Lancet Infect Dis 2012; 12:441-8. [PMID: 22433279 DOI: 10.1016/s1473-3099(12)70037-3] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Daily suppression of herpes simplex virus type 2 (HSV-2) reduces plasma HIV-1 concentrations and modestly delayed HIV-1 disease progression in one clinical trial. We investigated the effect of daily suppressive aciclovir on HIV-1 disease progression in Rakai, Uganda. METHODS We did a single site, parallel, randomised, controlled trial of HIV-1, HSV-2 dually infected adults with CD4 cell counts of 300-400 cells per μL. We excluded individuals who had an AIDS-defining illness or active genital ulcer disease, and those that were taking antiretroviral therapy. Participants were randomly assigned (1:1) with computer-generated random numbers in blocks of four to receive either aciclovir 400 mg orally twice daily or placebo; participants were followed up for 24 months. All study staff and participants were masked to treatment, except for the two statisticians. The primary outcome was CD4 cell count less than 250 cells per μL or initiation of antiretroviral therapy for WHO stage 4 disease. Our intention-to-treat analysis used Cox proportional hazards models, adjusting for baseline log(10) viral load, CD4 cell count, sex, and age to assess the risk of disease progression. We also investigated the effect of suppressive HSV-2 treatment stratified by baseline HIV viral load with a Cox proportional hazards model. This trial is registered with ClinicalTrials.gov, number NCT00405821. FINDINGS 440 participants were randomly assigned, 220 to each group. 110 participants in the placebo group and 95 participants in the treatment group reached the primary endpoint (adjusted hazard ratio [HR] 0·75, 95% CI 0·58-0·99; p=0·040). 24 participants in the placebo group and 22 in the treatment group were censored, but all contributed data for the final analysis. In a subanalysis stratified by baseline HIV viral load, participants with a baseline viral load of 50,000 copies mL or more in the treatment group had a reduced HIV disease progression compared with those in the placebo group (0·62, 0·43-0·96; p=0·03). No significant difference in HIV disease progression existed between participants in the treatment group and those in the placebo group who had baseline HIV viral loads of less than 50,000 copies per mL (0·90, 0·54-1·5; p=0·688). No safety issues related to aciclovir treatment were identified. INTERPRETATION Aciclovir reduces the rate of disease progression, with the greatest effect in individuals with a high baseline viral load. Suppressive aciclovir might be warranted for individuals dually infected with HSV-2 and HIV-1 with viral loads of 50,000 copies per mL or more before initiation of antiretroviral treatment. FUNDING National Institute of Allergy and Infectious Diseases, National Cancer Institute (National Institutes of Health, USA).
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Affiliation(s)
- Steven J Reynolds
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA.
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Nanzigu S, Eriksen J, Makumbi F, Lanke S, Mahindi M, Kiguba R, Beck O, Ma Q, Morse GD, Gustafsson LL, Waako P. Pharmacokinetics of the nonnucleoside reverse transcriptase inhibitor efavirenz among HIV-infected Ugandans. HIV Med 2011; 13:193-201. [PMID: 22107359 DOI: 10.1111/j.1468-1293.2011.00952.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pharmacokinetic variability of the nonnucleoside reverse transcriptase inhibitor efavirenz has been documented, and high variation in trough concentrations or clearance has been found to be a risk for virological failure. Africans population exhibits greater variability in efavirenz concentrations than other ethnic groups, and so a better understanding of the pharmacokinetics of the drug is needed in this population. This study characterized efavirenz pharmacokinetics in HIV-infected Ugandans. METHODS Efavirenz plasma concentrations were obtained for 66 HIV-infected Ugandans initiating efavirenz- based regimens, with blood samples collected at eight time-points over 24 h on day 1 of treatment, and at a further eight time-points on day 14. Noncompartmental analysis was used to describe the pharmacokinetics of efavirenz. RESULTS The mean steady-state minimum plasma concentration (C(min) ) of efavirenz was 2.9 µg/mL, the mean area under the curve (AUC) was 278.5 h µg/mL, and mean efavirenz clearance was 7.4 L/h. Although overall mean clearance did not change over the 2 weeks, 41.9% of participants showed an average 95.8% increase in clearance. On day 14, the maximum concentration (C(max) ) of efavirenz was >4 µg/mL in 96.6% of participants, while C(min) was <1 µg/mL in only 4.5%. Overall, 69% of participants experienced adverse central nervous system (CNS) symptoms attributable to efavirenz during the 2-week period, and 95% of these participants were found to have efavirenz plasma concentrations >4 µg/mL, although only half maintained a high concentration until at least 8 h after dosing. CONCLUSION The findings of this study show that HIV-infected patients on efavirenz may exhibit autoinduction to various extents, and this needs to be taken into consideration in the clinical management of individual patients. Efavirenz CNS toxicity during the initial phase of treatment may be related to C(max) , regardless of the sampling time.
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Affiliation(s)
- S Nanzigu
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda.
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Kagulire SC, Opendi P, Stamper PD, Nakavuma JL, Mills LA, Makumbi F, Gray RH, Shott JP, Serwadda D, Reynolds SJ. Field evaluation of five rapid diagnostic tests for screening of HIV-1 infections in rural Rakai, Uganda. Int J STD AIDS 2011; 22:308-9. [PMID: 21680664 DOI: 10.1258/ijsa.2009.009352] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The performance characteristics of HIV rapid diagnostic tests (RDTs) vary by test and by population. We assessed five commercial RDTs in Uganda where all but one RDT (Determine; Abbott Laboratories, Germany) performed close to manufacturer's expectations. Determine had low specificity (85.2%, positive predictive value 67.3%) due to false-positive results with weak-positive bands. Properly trained staff, good quality control programmes and validation of RDTs with laboratories having confirmatory testing capacity may be warranted to assure accuracy in each setting.
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Konde-Lule J, Makumbi F, Pakker N, Muyinda A, Mubiru M, Cobelens FGJ. Effect of changing antiretroviral treatment eligibility criteria on patient load in Kampala, Uganda. AIDS Care 2011; 23:35-41. [PMID: 20924829 DOI: 10.1080/09540121.2010.498869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In many resource-poor countries, CD4 count thresholds of eligibility for antiretroviral treatment (ART) were initially low (<200 cells/mm(3)) but are now being increased to improve patient survival and to reduce HIV transmission. There are few quantitative data on the effect of such increases on the demand for ART. The objective of this study was to measure HIV prevalence and the proportion of HIV-positives eligible for antiretroviral therapy at different CD4 cut-off levels among users of public health care services in Kampala, Uganda. We recruited 1200 adults from three primary care clinics in Kampala, including equal numbers of family planning (FP) clients, pregnant women, adult patients with any complaint, and persons seeking HIV counseling and testing. All participants were screened for HIV and those positive had a CD4 count done. HIV prevalence in all patients was 16.9% (203/1200). ART eligibility based on CD4 counts significantly increased from 36% at a 200 cells/mm(3) cut-off to 44% at 250 cells and to 57% at 350 cells cut-off (p for χ(2) trend<0.001). We concluded that changing cut-off levels to higher CD4 counts will significantly increase patient load in Kampala's primary care clinics, but a phased implementation should minimize negative effects on quality of care.
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Ekirapa-Kiracho E, Waiswa P, Rahman MH, Makumbi F, Kiwanuka N, Okui O, Rutebemberwa E, Bua J, Mutebi A, Nalwadda G, Serwadda D, Pariyo GW, Peters DH. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study. BMC Int Health Hum Rights 2011; 11 Suppl 1:S11. [PMID: 21410998 PMCID: PMC3059470 DOI: 10.1186/1472-698x-11-s1-s11] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders. Methods This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented. Results Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from <200 deliveries/month to over 500 deliveries/month in the intervention arm. Voucher revenues have been used to obtain needed supplies to improve quality and to pay health workers, ensuring their availability at a time when workloads are increasing. Conclusions Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.
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Affiliation(s)
- Elizabeth Ekirapa-Kiracho
- Department of Health Policy, Planning and Management, School of Public Health, Makerere University College of Health Sciences P,O,Box 7072, Kampala, Uganda.
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Nanzigu S, Waako P, Petzold M, Kiwanuka G, Dungu H, Makumbi F, Gustafsson LL, Eriksen J. CD4-T-Lymphocyte Reference Ranges in Uganda and Its Influencing Factors. Lab Med 2011. [DOI: 10.1309/lmft0vce1ugo9ygd] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Opollo MS, Makumbi F, Mukanga D, Namusisi O, Ayebazibwe N, Tweheyo R. Factors associated with DPT 1-3 vaccine dropout in Kabarole district, western Uganda. Int J Infect Dis 2010. [DOI: 10.1016/j.ijid.2010.02.626] [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: 11/15/2022] Open
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Kiwanuka N, Laeyendecker O, Robb M, Kigozi G, Arroyo M, McCutchan F, Eller LA, Eller M, Makumbi F, Birx D, Wabwire-Mangen F, Serwadda D, Sewankambo NK, Quinn TC, Wawer M, Gray R. Effect of human immunodeficiency virus Type 1 (HIV-1) subtype on disease progression in persons from Rakai, Uganda, with incident HIV-1 infection. J Infect Dis 2008; 197:707-13. [PMID: 18266607 DOI: 10.1086/527416] [Citation(s) in RCA: 208] [Impact Index Per Article: 13.0] [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 Human immunodeficiency virus type 1 (HIV-1) subtypes differ in biological characteristics that may affect pathogenicity. METHODS We determined the HIV-1 subtype-specific rates of disease progression among 350 HIV-1 seroconverters. Subtype, viral load, and CD4(+) cell count were determined. Cox proportional hazards regression modeling was used to estimate adjusted hazard ratios (HRs) of progression to acquired immunodeficiency syndrome (AIDS) (defined as a CD4(+) cell count of < or =250 cells/mm(3)) and to AIDS-associated death. RESULTS A total of 59.1% of study subjects had subtype D strains, 15.1% had subtype A, 21.1% had intersubtype recombinant subtypes, 4.3% had multiple subtypes, and 0.3% had subtype C. Of the 350 subjects, 129 (37%) progressed to AIDS, and 68 (19.5%) died of AIDS. The median time to AIDS onset was shorter for persons with subtype D (6.5 years), recombinant subtypes (5.6 years), or multiple subtypes (5.8 years), compared with persons with subtype A (8.0 years; P = .022). Relative to subtype A, adjusted HRs of progression to AIDS were 2.13 [95% confidence interval {CI}, 1.10-4.11] for subtype D, 2.16 [95% CI, 1.05-4.45] for recombinant subtypes, and 4.40 [95% CI, 1.71-11.3] for multiple subtypes. The risk of progression to death was significantly higher for subtype D (adjusted HR, 5.65; 95% CI, 1.37-23.4), recombinant subtypes (adjusted HR, 6.70; 95% CI, 1.56-28.8), and multiple subtypes (adjusted HR, 7.67; 95% CI, 1.27-46.3), compared with subtype A. CONCLUSIONS HIV disease progression is affected by HIV-1 subtype. This finding may impact decisions on when to initiate antiretroviral therapy and may have implications for future trials of HIV-1 vaccines aimed at slowing disease progression.
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Kagulire SC, Stamper PD, Opendi P, Nakavuma JL, Mills LA, Makumbi F, Gray RH, Serwadda D, Reynolds SJ. Performance of two commercial immunochromatographic assays for rapid detection of antibodies specific to human immunodeficiency virus types 1 and 2 in serum and urine samples in a rural community-based research setting (Rakai, Uganda). Clin Vaccine Immunol 2007; 14:738-40. [PMID: 17428950 PMCID: PMC1951076 DOI: 10.1128/cvi.00442-06] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Rapid detection of human immunodeficiency virus (HIV) antibodies is of great importance in developing and developed countries to diagnose HIV infections quickly and at low cost. In this study, two new immunochromatographic rapid tests for the detection of HIV antibodies (Aware HIV-1/2 BSP and Aware HIV-1/2 U; Calypte Biomedical Corporation) were evaluated in rural Africa to determine the tests' performance and comparability to commercially available conventional enzyme immunoassay (EIA) and Western blot (WB) tests. This prospective study was conducted from March 2005 through May 2005 using serum and urine from respondents in the Rakai Community Cohort Survey. Nine hundred sixty-three serum samples were tested with the Aware blood rapid assay (Aware-BSP) and compared to two independent EIAs for HIV plus confirmatory Calypte WB for any positive EIAs. The sensitivity of Aware-BSP was 98.2%, and the specificity was 99.8%. Nine hundred forty-two urine samples were run using the Aware urine assay (Aware-U) and linked to blood sample results for analysis. The sensitivity of Aware-U was 88.7% and specificity was 99.9% compared to blood EIAs confirmed by WB analysis. These results support the adoption of the Aware-BSP rapid test as an alternative to EIA and WB assays for the diagnosis of HIV in resource-limited settings. However, the low sensitivity of the Aware-U assay with its potential for falsely negative HIV results makes the urine assay less satisfactory.
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Affiliation(s)
- S C Kagulire
- Rakai Health Sciences Program, Kalisizo, Uganda.
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Nalugoda F, Gray RH, Serwadda D, Sewankambo NK, Wabwire-Mangen F, Kiwanuka N, Lutalo T, Kigozi G, Li C, Makumbi F, Kiddugavu M, Paxton L, Zawedde S, Wawer M. Burden of infection among heads and non-head of rural households in Rakai, Uganda. AIDS Care 2004; 16:107-15. [PMID: 14660148 DOI: 10.1080/09540120310001634010] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The objective was to determine HIV prevalence, symptomatology and mortality among adult heads and non-heads of households, in order to assess the burden of HIV on households. It was a community study of 11,536 adults aged 15-59, residing in 4,962 households in 56 villages, Rakai district, Uganda. First, 4,962 heads and 6,574 non-heads of households were identified from censuses. Interviews were then used to determine socio-demographic/behavioural characteristics. HIV seroprevalence was diagnosed by two EIAs with Western blot confirmation. The adjusted odds ratio (OR) and 95% confidence intervals (CI) of HIV infection in household heads and non-heads were estimated by multivariate logistic regression. Age-adjusted mortality was also assessed. HIV prevalence was 16.9% in the population, and 21.5% of households had at least one HIV-infected person (<0.0001). HIV prevalence was higher among heads than non-heads of households (21.5 and 13.3%, respectively, OR=1.79; CI 1.62-1.97). Most household heads were males (70.5%), and HIV prevalence was 17.8% among male heads compared with 6.6% in male non-heads of households (OR=2.31; CI 1.65-2.52). Women heading households were predominantly widowed, separated or divorced (64.4%). HIV prevalence was 30.5% among female heads, compared with 15.6% in female non-household heads (OR=1.42; CI 1.15-1.63). Age-adjusted mortality was significantly lower among male household heads than non-heads, both for the HIV-positive (RR=0.68) and HIV-negative men (RR=0.63). Among women, HIV-negative female household heads had significantly higher mortality than HIV-uninfected female non-heads (RR=1.72). HIV disproportionately affects heads of households, particularly males. Mortality due to AIDS is likely to increase the proportion of female-headed households, and adversely affect the welfare of domestic units.
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Affiliation(s)
- F Nalugoda
- Rakai Project, Uganda Virus Research Institute, Entebbe
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Kiddugavu M, Makumbi F, Wawer MJ, Serwadda D, Sewankambo NK, Wabwire-Mangen F, Lutalo T, Meehan M, Gray RH. Hormonal contraceptive use and HIV-1 infection in a population-based cohort in Rakai, Uganda. AIDS 2003; 17:233-40. [PMID: 12545084 DOI: 10.1097/00002030-200301240-00014] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [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: 11/25/2022]
Abstract
BACKGROUND Hormonal contraceptives have been associated with increased risk of HIV acquisition. METHODS The association between hormonal contraception use and HIV acquisition was assessed in a rural community-based cohort in Rakai District, Uganda. A group of 5117 sexually active HIV-negative women were surveyed at 10 month intervals between 1994 and 1999. Information on demographic and sociobehavioral characteristics, use of hormonal contraception (pill and injectable methods), condoms and the number of sexual partners was obtained by home-based interview. HIV incidence rate ratios (IRR) and 95% confidence intervals (CI) associated with hormonal contraception were estimated by multivariate Poisson regression after adjustment for age, condom use, number of sexual partners, marital status, education and history of genital ulcer disease. RESULTS At one or more interviews, 16.6% of women reported use of hormonal contraceptives and 23.0% reported condom use. HIV incidence was 2.3/100 person-years in hormonal contraceptive users compared with 1.5/100 person-years in non-hormonal contraceptive users (unadjusted IRR, 1.56; 95% CI, 1.00-2.33). After multivariate adjustment, the IRR associated with hormonal contraceptives was reduced to 0.94 (95% CI, 0.53-1.64). The adjusted IRR was 1.12 (95% CI, 0.48-2.56) with oral contraceptive use and 0.84 (95%CI, 0.41-1.72) with injectable methods. CONCLUSION Use of hormonal contraception is not associated with HIV acquisition after adjustment for behavioral confounding.
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Nyblade LC, Menken J, Wawer MJ, Sewankambo NK, Serwadda D, Makumbi F, Lutalo T, Gray RH. Population-based HIV testing and counseling in rural Uganda: participation and risk characteristics. J Acquir Immune Defic Syndr 2001; 28:463-70. [PMID: 11744836 DOI: 10.1097/00042560-200112150-00010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [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
OBJECTIVES To assess self-selection in a population-based voluntary HIV testing and counseling (VTC) program by comparing the HIV risk characteristics of users and nonusers of VTC in rural Uganda. DESIGN A 1994 to 1995 community-randomized trial in the Rakai District of Uganda enrolled adults aged 15 to 59 years and ascertained their HIV status, sociodemographic characteristics, risk behaviors, and AIDS-associated symptoms. All subjects were offered confidential individual VTC at no cost. METHODS We compared users and nonusers of VTC among 10,950 participants (4764 male and 6186 female) enrolled at baseline using multivariate logistic regression. RESULTS Women were significantly less likely to receive VTC than men (31.5% vs. 34.8%, p <.001). In multivariate analysis, younger age, HIV-positive status, and having no sexual partners in the past 5 years (and, significant for women only, having 2 or more sexual partners) were associated with lower VTC participation for both men and women. Among women, higher VTC participation was associated with symptoms suggestive of AIDS and other illnesses and shopkeeper occupations. CONCLUSIONS During the initial phase of a population-based free VTC program in rural Uganda, certain high-risk groups were underrepresented among VTC recipients. There is a need to target VTC to ensure participation by high-risk individuals most in need of services.
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Affiliation(s)
- L C Nyblade
- International Center for Research on Women, Washington, District of Columbia 20037, USA.
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Ahmed S, Lutalo T, Wawer M, Serwadda D, Sewankambo NK, Nalugoda F, Makumbi F, Wabwire-Mangen F, Kiwanuka N, Kigozi G, Kiddugavu M, Gray R. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS 2001; 15:2171-9. [PMID: 11684937 DOI: 10.1097/00002030-200111090-00013] [Citation(s) in RCA: 157] [Impact Index Per Article: 6.8] [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: 11/26/2022]
Abstract
OBJECTIVE Evidence of condom effectiveness for HIV and sexually transmitted disease (STD) prevention is based primarily on high-risk populations. We examined condom effectiveness in a general population with high HIV prevalence in rural Africa. METHODS Data were from a randomized community trial in Rakai, Uganda. Condom usage information was obtained prospectively from 17,264 sexually active individuals aged 15-59 years over a period of 30 months. HIV incidence and STD prevalence was determined for consistent and irregular condom users, compared to non-users. Adjusted rate ratios (RR) of HIV acquisition were estimated by Poisson multivariate regression, and odds ratios of STDs estimated by logistic regression. RESULTS Only 4.4% reported consistent condom use and 16.5% reported inconsistent use during the prior year. Condom use was higher among males, and younger, unmarried and better educated individuals, and those reporting multiple sex partners or extramarital relationships. Consistent condom use significantly reduced HIV incidence [RR, 0.37; 95% confidence interval (CI), 0.15-0.88], syphilis [odds ratio (OR), 0.71; 95% CI, 0.53-0.94] and gonorrhea/Chlamydia (OR, 0.50; 95% CI, 0.25-0.97) after adjustment for socio-demographic and behavioral characteristics. Irregular condom use was not protective against HIV or STD and was associated with increased gonorrhea/Chlamydia risk (OR, 1.44; 95% CI, 1.06-1.99). The population attributable fraction of consistent use for prevention of HIV was -4.5% (95% CI, -8.3 to 0.0), due to the low prevalence of consistent use in the population. CONCLUSIONS Consistent condom use provides protection from HIV and STDs, whereas inconsistent use is not protective. Programs must emphasize consistent condom use for HIV and STD prevention.
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Affiliation(s)
- S Ahmed
- Johns Hopkins University School of Public Health, Baltimore, Maryland 21205, USA
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Abstract
OBJECTIVE To examine the role played by mobile residents in the spread of HIV through rural Uganda. DESIGN Travel history and sexual network data were collected from a random sample of 1627 residents aged 15-49 years in Rakai District, Uganda during 1994. METHODS Travelers and non-travelers are compared with respect to socio-demographic attributes, risk exposure, knowledge, attitudes and use of condoms using descriptive statistics and multivariate logistic regression. A demographic profile of travelers' partners is developed using information from a local network survey module. RESULTS The population is highly mobile, with over 70% reporting travel to a potentially higher risk destination in the past year. Travelers are somewhat more likely to have higher levels of sexual risk behavior, but the risk appears to be offset by significantly greater knowledge, acceptance, and use of condoms. In multivariate analysis, the sexual risk differential for travelers is explained by occupational exposure and higher socio-economic status. The differential in condom acceptance, by contrast, appears to be associated with travel itself. Condom use with non-spousal partners is three times higher among travelers than non-travelers (P< 0.001), and travel remains a significant predictor after controlling for age, education, residence, occupation and multiple partners. Travelers are more likely to use condoms with both their local and non-local partners. Partners of male travelers are likely to be younger and better educated than those of male non-travelers. CONCLUSIONS The mobile population in this rural region appears willing to adopt risk reduction measures appropriate to their exposure. This suggests that targeting condom promotion programs to travelers and their partners is likely to be effective in reducing the spatial diffusion of HIV, and may be an efficient method for spreading behavioral change into rural areas.
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Affiliation(s)
- M Morris
- Department of Sociology, The Pennsylvania State University, University Park 16802, USA
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Kelly R, Kiwanuka N, Wawer MJ, Serwadda D, Sewankambo NK, Wabwire-Mangen F, Li C, Konde-Lule JK, Lutalo T, Makumbi F, Gray RH. Age of male circumcision and risk of prevalent HIV infection in rural Uganda. AIDS 1999; 13:399-405. [PMID: 10199231 DOI: 10.1097/00002030-199902250-00013] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.6] [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: 11/25/2022]
Abstract
OBJECTIVE To assess whether circumcision performed on postpubertal men affords the same level of protection from HIV-1 acquisition as circumcisions earlier in childhood. DESIGN Cross-sectional study of a population-based cohort. SETTING Rakai district, rural Uganda. METHODS A total of 6821 men aged 15-59 years were surveyed and venous blood samples were tested for HIV-1 and syphilis. Age at circumcision was dichotomized into men who were circumcised before or at age 12 years (prepubertal) and men circumcised after age 12 years (postpubertal). Postpubertal circumcised men were also subdivided into those reporting circumcision at ages 13-20 years and > or = 21 years. RESULTS HIV-1 prevalence was 14.1% in uncircumcised men, compared with 16.2% for men circumcised at age > or = 21 years, 10.0% for men circumcised at age 13-20 years, and 6.9% in men circumcised at age < or = 12 years. On bivariate analysis, lower prevalence of HIV-1 associated with prepubertal circumcision was observed in all age, education, ethnic and religious groups. Multivariate adjusted odds ratio of prevalent HIV-1 infection associated with prepubertal circumcision was 0.39 [95% confidence interval (CI), 0.29-0.53]. In the postpubertal group, the adjusted odds ratio for men circumcised at ages 13-20 years was 0.46 (95% CI, 0.28-0.77), and 0.78 (95% CI, 0.43-1.43) for men circumcised after age 20 years. CONCLUSIONS Prepubertal circumcision is associated with reduced HIV risk, whereas circumcision after age 20 years is not significantly protective against HIV-1 infection. Age at circumcision and reasons for circumcision need to be considered in future studies of circumcision and HIV risk.
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Affiliation(s)
- R Kelly
- Department of Population Dynamics, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, Maryland 21205, USA
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Sathar MA, Simjee AE, Coovadia YM, Soni PN, Moola SA, Insam B, Makumbi F. Ascitic fluid gamma interferon concentrations and adenosine deaminase activity in tuberculous peritonitis. Gut 1995; 36:419-21. [PMID: 7698702 PMCID: PMC1382457 DOI: 10.1136/gut.36.3.419] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The gamma interferon (gamma-IFN) concentration and the adenosine deaminase (ADA) activity were evaluated in 30 patients with tuberculous peritonitis, 21 patients with ascites due to a malignant disorder, and 41 patients with cirrhosis. The gamma-IFN concentrations were significantly higher (p < 0.0001) in tuberculous peritonitis patients (mean: 6.70 U/ml) than in the malignant (mean: 3.10 U/ml) and cirrhotic (mean: 3.08 U/ml) groups. Use of a cut off value of > or = 3.2 U/ml gave the assay a sensitivity of 93% (25 of 27), a specificity of 98% (54 of 55), positive (P+) and negative (P-) predictive values of 96% and a test accuracy of 96%. The ADA activity was significantly (p < 0.0001) higher in the tuberculous peritonitis group (mean: 101.84 U/l) than in the control groups (cirrhosis (mean: 13.49 U/l) and malignancy (mean: 19.35 U/l)). A cut off value of > 30 U/l gave the ADA test a sensitivity of 93% (26 of 28) a specificity of 96% (51 of 53), a (P+) value of 93%, a (P-) value of 96%, and a test accuracy of 95%. There was a significant (p < 0.0001) correlation (r = 0.72) between ADA activity and gamma-IFN values in patients with tuberculous peritonitis. These results show that a high concentration of gamma-IFN in ascitic fluid is as valuable as the ADA activity in the diagnosis of tuberculous peritonitis. Both are rapid non-invasive diagnostic tests for tuberculous peritonitis.
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Affiliation(s)
- M A Sathar
- Department of Medicine, University of Natal, King Edward VIII Hospital, Durban, South Africa
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