Browsing by Author "Katabira, E."
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Item Concordance in Reporting of Sexual Risk Behaviors in the HIV Sero Discordant Couples From Central Region, Uganda.(MARY ANN LIEBERT, INC., 2018) Muwonge, Timothy R.; Nakku-Joloba, E.; Mugwanya, K.; Brown, Charles; Naggayi, G.; Nakyanzi, A.; Sserwada, D.; Nankabirwa, V.; Katabira, E.Measurement and evaluation of sexual risk behavior in at-risk populations has been critical to HIV epidemiology and the targeting of HIV prevention responses. Evaluation of concordance of reports of sexual behavior within couples offers insight into potential bias and the direction of the bias in different populations, whether men or women, HIV-infected or HIV-uninfected partners tend to under or over report certain behaviors. This study examined HIV sero discordant couples (SDCs)' concordance of self-reported sexual behavior and predictors of discordant reporting for couples who had been in a relationship longer than 6 months.Item Daily Co-Trimoxazole Prophylaxis in Severely Immunosuppressed HIV-Infected Adults in Africa Started on Combination Antiretroviral Therapy: An Observational Analysis of the DART Cohort(The Lancet, 2010) Walker, A.S.; Munderi, P.; Katabira, E.; Mugyenyi, P.; Ssali, F.; Hakim, J.; Babiker, A. G.Co-trimoxazole prophylaxis can reduce mortality from untreated HIV infection in Africa; whether benefits occur alongside combination antiretroviral therapy (ART) is unclear. We estimated the effect of prophylaxis after ART initiation in adults. Participants in our observational analysis were from the DART randomised trial of management strategies in HIV-infected, symptomatic, previously untreated African adults starting triple-drug ART with CD4 counts lower than 200 cells per μL. Co-trimoxazole prophylaxis was not routinely used or randomly allocated, but was variably prescribed by clinicians. We estimated effects on clinical outcomes, CD4 cell count, and body-mass index (BMI) using marginal structural models to adjust for time-dependent confounding by indication. DART was registered, number ISRCTN13968779. 3179 participants contributed 14 214 years of follow-up (8128 [57%] person-years on co-trimoxazole). Time-dependent predictors of co-trimoxazole use were current CD4 cell count, haemoglobin concentration, BMI, and previous WHO stage 3 or 4 events on ART. Present prophylaxis significantly reduced mortality (odds ratio 0·65, 95% CI 0·50–0·85; p=0·001). Mortality risk reduction on ART was substantial to 12 weeks (0·41, 0·27–0·65), sustained from 12–72 weeks (0·56, 0·37–0·86), but not evident subsequently (0·96, 0·63–1·45; heterogeneity p=0·02). Variation in mortality reduction was not accounted for by time on co-trimoxazole or current CD4 cell count. Prophylaxis reduced frequency of malaria (0·74, 0·63–0·88; p=0·0005), an effect that was maintained with time, but we observed no effect on new WHO stage 4 events (0·86, 0·69–1·07; p=0·17), CD4 cell count (difference vs non-users, −3 cells per μL [−12 to 6]; p=0·50), or BMI (difference vs non-users, −0·04 kg/m2 [−0·20 to 0·13); p=0·68]. Our results reinforce WHO guidelines and provide strong motivation for provision of co-trimoxazole prophylaxis for at least 72 weeks for all adults starting combination ART in Africa.