Browsing by Author "Kalyesubula, Israel"

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    Adherence To Antiretroviral Therapy In Children Attending Mulago Hospital, Kampala
    (Annals of tropical paediatrics, 2007) Barungi, Nicolette Nabukeera; Kalyesubula, Israel; Kekitiinwa, Addy; Tusiime, Jayne Byakika; Musoke, Philippa
    Non-adherence reduces the effectiveness of antiretroviral therapy in children attending the paediatric HIV/AIDS clinic at Mulago Hospital, Kampala.To determine the levels of adherence to HAART and identify factors associated with non-adherence.A cross-sectional study of 170 children aged 2–18 years. Adherence to HAART was defined as taking ≥95% of prescribed medication. It was determined using three measures: a 3-day self-report by the caregivers, clinic-based pill counts at enrolment and home-based unannounced pill counts 2–3 weeks later.The 3-day self-reported ≥95% adherence was 89.4% (n=170). Using clinic-based pill counts, 94.1% (n=170) had ≥95% adherence to treatment compared with only 72% (n=164) by unannounced pill counts. When the primary caregiver was the only one who knew the child's serostatus, he/she was three times more likely to be non-adherent (p=0.02, OR 3.34, 95% CI 1.14–9.82). Those who had been hospitalised twice or more before starting HAART were more likely to have ≥95% adherence (p=0.02, OR 0.44, 95% CI 0.20–0.92). The majority of children had good adherence levels when estimated by unannounced pill counts. Disclosing the child's HIV serostatus only to the primary caregiver and having been hospitalised only once or not at all were associated with poor adherence.
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    Adherence to antiretroviral therapy in children attending Mulago Hospital, Kampala
    (Annals of tropical Paediatrics, 2007) Nabukeera-Barungi, Nicolette; Kalyesubula, Israel; Kekitiinwa, Addy; Byakika-Tusiime, Jayne; Musoke, Philippa
    Background: Non-adherence reduces the effectiveness of antiretroviral therapy in children attending the paediatric HIV/AIDS clinic at Mulago Hospital, Kampala. Aim: To determine the levels of adherence to HAART and identify factors associated with non-adherence. Methods: A cross-sectional study of 170 children aged 2–18 years. Adherence to HAART was defined as taking >95% of prescribed medication. It was determined using three measures: a 3-day self-report by the caregivers, clinic-based pill counts at enrolment and home-based unannounced pill counts 2–3 weeks later. Results: The 3-day self-reported >95% adherence was 89.4% (n5170). Using clinic-based pill counts, 94.1% (n5170) had >95% adherence to treatment compared with only 72% (n5164) by unannounced pill counts. When the primary caregiver was the only one who knew the child’s serostatus, he/she was three times more likely to be non-adherent (p50.02, OR 3.34, 95% CI 1.14–9.82). Those who had been hospitalised twice or more before starting HAART were more likely to have >95% adherence (p50.02, OR 0.44, 95% CI 0.20–0.92). Conclusion: The majority of children had good adherence levels when estimated by unannounced pill counts. Disclosing the child’s HIV serostatus only to the primary caregiver and having been hospitalised only once or not at all were associated with poor adherence.
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    Virologic, Immunologic And Clinical Response Of Infants To Antiretroviral Therapy In Kampala, Uganda
    (BMC pediatrics, 2013) Tukei, Vincent J.; Murungi, Miriam; Asiimwe, Alice R.; Migisha, Daniella; Maganda, Albert; Kitaka, Sabrina Bakeera; Kalyesubula, Israel; Musoke, Philippa; Kekitiinwa, Adeodata
    Antiretroviral therapy (ART) is known to save lives. Among HIV-infected infants living in resource constrained settings, the short and long term benefits of ART are only partially known. This study was designed to determine the virologic, immunologic and clinical outcomes of antiretroviral therapy in a cohort of HIV-infected infants receiving care from an outpatient clinic in Kampala, Uganda.A prospective cohort of HIV-infected infants receiving treatment at the Baylor-Uganda clinic was analyzed. Patients were diagnosed, enrolled and followed up at the clinic. HIV viral load, CD4 cell counts and clinical progress were assessed during follow-up. Descriptive statistical analysis and logistic regression modeling to determine predictors of treatment success were conducted.Of 91 HIV-infected infants enrolled into the cohort, 53 (58.2%) infants were female; 43 (47.3%) were 6 months of age or younger, and 50 (55.6%) had advanced HIV/AIDS disease (Clinical stage 3 or 4). Eighty four infants started ART and 78 (92.9%) completed 6 months of treatments. Fifty six (71.8%) infants attained virologic suppression by month-6 of ART, and at month-12 of ART, the cumulative probability of attaining viral suppression was 83.1%. None of the baseline infant factors (age, sex, WHO stage, CD4 cell percent, weight for age, or height for age z-score) predicted treatment success. There was an increase in CD4 cells from a baseline mean of 23% to 30% at month-6 of treatment (p<0.001) and by month-24 of ART, the mean CD4 percent was 36%. A total of 7 patients died while on ART and another 7 experienced adverse events that were related to treatment.Our results show that, even among very young patients from resource constrained settings, ART dramatically suppresses HIV replication, allows immune recovery and clinical improvement, and is safe. However, baseline characteristics do not predict recovery in this age group.