Browsing by Author "Galiwango, Ronald"
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Item AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV(AIDS Care, 2011) Nakigozi, Gertrude; Makumbi, Fredrick; Reynolds, Steven; Galiwango, Ronald; Kagaayi, Joseph; Nalugoda, Fred; Ssettuba, Absalom; Sekasanvu, Joseph; Musuuza, Jackson; Serwada, David; Gray, Ron; Wawer, MariaImproved understanding of HIV-related health-seeking behavior at a population level is important in informing the design of more effective HIV prevention and care strategies. We assessed the frequency and determinants of failure to seek free HIV care in Rakai, Uganda. HIV-positive participants in a community cohort who accepted VCT were referred for free HIV care (cotrimoxazole prophylaxis, CD4 monitoring, treatment of opportunistic infections, and, when indicated, antiretroviral therapy). We estimated proportion and adjusted Prevalence Risk Ratios (adj. PRR) of non-enrollment into care six months after receipt of VCT using log-binomial regression. About 1145 HIV-positive participants in the Rakai Community Cohort Study accepted VCT and were referred for care. However, 31.5% (361/1145) did not enroll into HIV care six months after referral. Non-enrollment was significantly higher among men (38%) compared to women (29%, p 0.005). Other factors associated with nonenrollment included: younger age (15 24 years, adj. PRR 2.22; 95% CI: 1.64, 3.00), living alone (adj. PRR 2.22; 95% CI: 1.57, 3.15); or in households with 1 2 co-residents (adj. PRR 1.63; 95% CI: 1.31, 2.03) compared to three or more co-residents, or a CD4 count 250 cells/ul (adj. PRR 1.81; 95% CI: 1.38, 2.46). Median (IQR) CD4 count was lower among enrolled 388 cells/ul (IQR: 211,589) compared to those not enrolled 509 cells/ul (IQR: 321,754).About one-third of HIV-positive persons failed to utilize community-based free services. Non-use of services was greatest among men, the young, persons with higher CD4 counts and the more socially isolated, suggesting a need for targeted strategies to enhance service uptakeItem Air pollution and mobility patterns in two Ugandan cities during COVID‑19 mobility restrictions suggest the validity of air quality data as a measure for human mobility(Environmental Science and Pollution Research, 2022) Galiwango, Ronald; Bainomugisha, Engineer; Kivunike, Florence; Kateete, David Patrick; Jjingo, DaudiWe explored the viability of using air quality as an alternative to aggregated location data from mobile phones in the two most populated cities in Uganda. We accessed air quality and Google mobility data collected from 15th February 2020 to 10th June 2021 and augmented them with mobility restrictions implemented during the COVID-19 lockdown. We determined whether air quality data depicted similar patterns to mobility data before, during, and after the lockdown and determined associations between air quality and mobility by computing Pearson correlation coefficients ( R ), conducting multivariable regression with associated confidence intervals (CIs), and visualized the relationships using scatter plots. Residential mobility increased with the stringency of restrictions while both non-residential mobility and air pollution decreased with the stringency of restrictions. In Kampala, PM2.5 was positively correlated with non-residential mobility and negatively correlated with residential mobility. Only correlations between PM2.5 and movement in work and residential places were statistically significant in Wakiso. After controlling for stringency in restrictions, air quality in Kampala was independently correlated with movement in retail and recreation (− 0.55; 95% CI = − 1.01– − 0.10), parks (0.29; 95% CI = 0.03–0.54), transit stations (0.29; 95% CI = 0.16–0.42), work (− 0.25; 95% CI = − 0.43– − 0.08), and residential places (− 1.02; 95% CI = − 1.4– − 0.64). For Wakiso, only the correlation between air quality and residential mobility was statistically significant (− 0.99; 95% CI = − 1.34– − 0.65). These findings suggest that air quality is linked to mobility and thus could be used by public health programs in monitoring movement patterns and the spread of infectious diseases without compromising on individuals’ privacy.Item Assessing a transmission network of Mycobacterium tuberculosis in an African city using single nucleotide polymorphism threshold analysis(MicrobiologyOpen, 2021) Yassine, Edriss; Galiwango, Ronald; Ssengooba, Willy; Ashaba, Fred; Joloba, Moses L.; Zalwango, Sarah; Whalen, Christopher C.; Quinn, FrederickTuberculosis (TB) is the leading cause of death in humans by a single infectious agent worldwide with approximately two billion humans latently infected with the bacterium Mycobacterium tuberculosis. Currently, the accepted method for controlling the disease is Tuberculosis Directly Observed Treatment Shortcourse (TB-DOTS). This program is not preventative and individuals may transmit disease before diagnosis, thus better understanding of disease transmission is essential. Using whole-genome sequencing and single nucleotide polymorphism analysis, we analyzed genomes of 145 M. tuberculosis clinical isolates from active TB cases from the Rubaga Division of Kampala, Uganda. We established that these isolates grouped into M. tuberculosis complex (MTBC) lineages 1, 2, 3, and 4, with the most isolates grouping into lineage 4. Possible transmission pairs containing ≤12 SNPs were identified in lineages 1, 3, and 4 with the prevailing transmission in lineages 3 and 4. Furthermore, investigating DNA codon changes as a result of specific SNPs in prominent virulence genes including plcA and plcB could indicate potentially important modifications in protein function. Incorporating this analysis with corresponding epidemiological data may provide a blueprint for the integration of public health interventions to decrease TB transmission in a region.Item Association between tuberculosis in men and social network structure in Kampala, Uganda(BMC infectious diseases, 2021) Miller, Paige B.; Zalwango, Sarah; Galiwango, Ronald; Kakaire, Robert; Sekandi, Juliet; Steinbaum, Lauren; Drake, John M.; Whalen, Christopher C.; Kiwanuka, NoahGlobally, tuberculosis disease (TB) is more common among males than females. Recent research proposes that differences in social mixing by sex could alter infection patterns in TB. We examine evidence for two mechanisms by which social-mixing could increase men’s contact rates with TB cases. First, men could be positioned in social networks such that they contact more people or social groups. Second, preferential mixing by sex could prime men to have more exposure to TB cases. Methods: We compared the networks of male and female TB cases and healthy matched controls living in Kampala, Uganda. Specifically, we estimated their positions in social networks (network distance to TB cases, degree, betweenness, and closeness) and assortativity patterns (mixing with adult men, women, and children inside and outside the household). Results: The observed network consisted of 11,840 individuals. There were few differences in estimates of node position by sex. We found distinct mixing patterns by sex and TB disease status including that TB cases have proportionally more adult male contacts and fewer contacts with children. Conclusions: This analysis used a network approach to study how social mixing patterns are associated with TB disease. Understanding these mechanisms may have implications for designing targeted intervention strategies in high-burden populations.Item Bioinformatics mentorship in a resource limited setting(Briefings in Bioinformatics, 2021) Jjingo, Daudi; Mboowa, Gerald; Sserwadda, Ivan; Kakaire, Robert; Kiberu, Davis; Amujal, Marion; Galiwango, Ronald; Kateete, David; Joloba, Moses; Whalen, Christopher C.The two recent simultaneous developments of high-throughput sequencing and increased computational power have brought bioinformatics to the forefront as an important tool for effective and efficient biomedical research. Consequently, there have been multiple approaches to developing bioinformatics skills. In resource rich environments, it has been possible to develop and implement formal fully accredited graduate degree training programs in bioinformatics. In resource limited settings with a paucity of expert bioinformaticians, infrastructure and financial resources, the task has been approached by delivering short courses on bioinformatics—lasting only a few days to a couple of weeks. Alternatively, courses are offered online, usually over a period of a few months. These approaches are limited by both the lack of sustained in-person trainer–trainee interactions, which is a key part of quality mentorships and short durations which constrain the amount of learning that can be achieved.Item The Effect of Current Schistosoma Mansoni Infection on the Immunogenicity of A Candidate TB vaccine, MVA85A, in BCG Vaccinated Adolescents: An open-label trial(PLoS neglected tropical diseases, 2017) Wajja, Anne; Kizito, Dennison; Nassanga, Beatrice; Nalwoga, Angela; Kabagenyi, Joyce; Kimuda, Simon; Galiwango, Ronald; Mutonyi, Gertrude; Vermaak, Samantha; Tukahebwa, Edridah; McShane, HelenHelminth infection may affect vaccine immunogenicity and efficacy. Adolescents, a target population for tuberculosis booster vaccines, often have a high helminth burden. We investigated effects of Schistosoma mansoni (Sm) on the immunogenicity and safety of MVA85A, a model candidate tuberculosis vaccine, in BCG-vaccinated Ugandan adolescents.In this phase II open label trial we enrolled 36 healthy, previously BCG-vaccinated adolescents, 18 with no helminth infection detected, 18 with Sm only. The primary outcome was immunogenicity measured by Ag85A-specific interferon gamma ELISpot assay. Tuberculosis and schistosome-specific responses were also assessed by whole-blood stimulation and multiplex cytokine assay, and by antibody ELISAs.Ag85A-specific cellular responses increased significantly following immunisation but with no differences between the two groups. Sm infection was associated with higher pre-immunisation Ag85A-specific IgG4 but with no change in antibody levels following immunisation. There were no serious adverse events. Most reactogenicity events were of mild or moderate severity and resolved quickly.The significant Ag85A-specific T cell responses and lack of difference between Sm-infected and uninfected participants is encouraging for tuberculosis vaccine development. The implications of pre-existing Ag85A-specific IgG4 antibodies for protective immunity against tuberculosis among those infected with Sm are not known. MVA85A was safe in this population.Item HIV Infection in Uncircumcised Men is Associated with Altered CD8 T-cell Function but Normal CD4 T-cell Numbers in the Foreskin(The Journal of infectious diseases, 2014) Prodger, Jessica L.; Hirbod, Taha; Gray, Ronald; Kigozi, Godfrey; Nalugoda, Fred; Galiwango, Ronald; Reynolds, Steven J.; Huibner, Sanja; Wawer, Maria J.; Serwadda, David; Kaul, Rupert; Rakai, Genital Immunology Research GroupHuman immunodeficiency virus (HIV)–infected (HIV+) men are more susceptible to sexually transmitted infections, and may be superinfected by HIV. We hypothesized that HIV induces immune alterations in the foreskin that may impact the subsequent acquisition/clearance of genital coinfections. Methods. Foreskin tissue and blood were obtained from 70 HIV-uninfected and 20 HIV+ men undergoing circumcision. T cells were characterized by flow cytometry, immunohistochemistry, and polymerase chain reaction. Results. There was substantial influx of CD8 T-cells into the foreskins of HIV+ men (108.8 vs 23.1 cells/mm2; P < .001); but foreskin CD4 T-cell density was unchanged (43.0 vs 33.7/mm2; P = .67), despite substantial blood depletion (409.0 vs 877.8 cells/μL; P < .001). While frequencies of foreskin C-C chemokine receptor type 5+ (CCR5+) T cells, T regulatory cells, and T-helper 17 cells were unaltered in HIV+ men, CD8 T-cell production of tumor necrosis factor α (TNFα) was decreased. HIV-specific CD8 T cells were present in the foreskins of HIV+ men, although their frequency and function was reduced compared to the blood. Conclusions. Foreskin CD4 T-cell density and CCR5 expression were not reduced during HIV infection, perhaps explaining susceptibility to HIV superinfection. Foreskin CD8 T-cell density was increased, but decreased production of TNFα may enhance susceptibility to genital coinfections in HIV+ men.Item Validity of Air Quality as a Measure of Human Mobility in Uganda. The COVID-19 Context(Research Square, 2022) Galiwango, Ronald; Bainomugisha, Engineer; Kivunike, Florence; Kateete, David Patrick; Jjingo, DaudiMobility patterns are valuable in identifying transmission patterns for infectious diseases and in deriving contact matrices that are used to parametrize mathematical models. Aggregated location data from mobile phones have been the main means of measuring human mobility on a population level. However, these data come with several limitations related to individual privacy, access and restriction of the GPS location by the user that limit their use. Methods We explored the viability of using ground monitored air quality data as an alternative to aggregated location data from mobile phones, as a measure of human mobility in two cities in Uganda. We determined associations between air quality and human mobility; and the effect of mobility restrictions on mobility and air quality using Pearson correlation (R), multivariate regression and visualized these relationships using scatter plots. Results Daily mean levels for PM2.5 in both cities were consistently higher than the WHO guideline limit, with a mean of 77.0μg/m3 (Range = 22.0–309) for Kampala and 60.0μg/m3 (Range = 18.2–331) for Wakiso. PM10 levels had a mean of 84.6μg/m3 (Range = 25.0–318) in Kampala and 67.9μg/m3 (Range = 21.0– 340) in Wakiso. PM2.5 was negatively correlated with the government response stringency index for Kampala (R = -0.31, p < 0.001) and Wakiso (R = -0.21, p < 0.001). In Kampala, PM2.5 was positively associated with movement in grocery and pharmacy (R = 0.24, p < 0.001), parks (R = 0.25, p < 0.001), retail and recreation (R = 0.24, p < 0.001), transit stations (R = 0.3, p < 0.001) and work places (R = 0.2, p < 0.001); and negatively correlated with movement in residential places (R = -0.3, p < 0.001). Only associations between PM2.5 and movement in workplaces and residential places were statistically significant in Wakiso (R = 0.14, p < 0.001 and R = -0.19, p = 0.003 respectively). Conclusions These findings suggest that air quality data are linked to human mobility data and could thus be used to monitor human movement patterns. This work represents a pioneer study to empirically and quantitatively assess the value of air quality data as a surrogate for human mobility in Uganda.