Browsing by Author "Katagira, Winceslaus"

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    Access to affordable medicines and diagnostic tests for asthma and COPD in sub Saharan Africa: the Ugandan perspective
    (BMC pulmonary medicine, 2017) Kibirige, Davis; Kampiire, Leaticia; Atuhe, David; Mwebaze, Raymond; Katagira, Winceslaus; Muttamba, Winters; Nantanda, Rebecca; Worodria, William; Kirenga, Bruce
    Equitable access to affordable medicines and diagnostic tests is an integral component of optimal clinical care of patients with asthma and chronic obstructive pulmonary disease (COPD). In Uganda, we lack contemporary data about the availability, cost and affordability of medicines and diagnostic tests essential in asthma and COPD management.
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    The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project
    (Elsevier Inc, 2024-01-09) Kirenga, Bruce J; Chakaya, Jeremiah; Yimer, Getnet; Nyale, George; Haile, Tewodros; Muttamba, Winters; Mugenyi, Levicatus; Katagira, Winceslaus; Worodria, William; Aanyu-Tukamuhebwa, Hellen; Lugogo, Njira; Joloba, Moses; Mersha, Tesfaye B.; Bekele, Amsalu; Makumbi, Fred; Mekasha, Amha; Green, Cynthia L.; de Jong, Corina; Kamya, Moses; van der Molen, Thys
    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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    Deriving personalised physical activity intensity thresholds by merging accelerometry with field-based walking tests: Implications for pulmonary rehabilitation
    (Chronic Respiratory Disease, 2022) Pina, Ilaria; Ndagire, Pauline; Katagira, Winceslaus; Kirenga, Bruce; Singh, Sally J.; Orme, Mark W.
    During pulmonary rehabilitation (PR), patients receive individually tailored walking exercise training. The personalised nature of exercise prescription is a fundamental component of PR. Despite this, the measurement of physical activity (PA) has been limited to a ‘one size fits all’ approach and can be challenging to translate into clinically meaningful or real-world units, such as cadence. This discrepancy may partly explain the inconsistent evidence for the impact of PR on PA. It may also provide an opportunity to standardise PA assessment in the context of chronic respiratory disease (CRD) and PR, where field-based walking tests are routine measures. This technical note provides an example of how to develop personalised PA intensity thresholds, calibrated against an individual’s performance on the Incremental Shuttle Walking Test (ISWT; maximal) and Endurance Shuttle Walk Test (ESWT; sub-maximal). These are externally paced tests, with each level (speed) of the tests denoting a specific speed (intensity); ranging 1.8 km/h (ISWT Level 1) to 8.5 km/h (ISWT Level 12). From the ESWT, it becomes possible to evaluate adherence to each individual’s walking exercise prescription. Future research should explore this approach and its responsiveness to PR. It may be possible to extend this methodology with the inclusion of physiological parameters (e.g., heart rate, calorimetry, and oxygen consumption) to derive relative intensity markers (e.g. moderate-to-vigorous), accounting for individual differences in exercise capacity, under the same paradigm as PR exercise prescription.
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    Diagnostic performance of blood inflammatory markers for tuberculosis screening in people living with HIV
    (PLoS ONE, 2018) Farr, Katherine; Ravindran, Resmi; Strnad, Luke; Chang, Emily; Chaisson, Lelia H.; Yoon, Christina; Worodria, William; Andama, Alfred; Ayakaka, Irene; Bbosa Nalwanga, Priscilla; Byanyima, Patrick; Kalema, Nelson; Kaswabuli, Sylvia; Katagira, Winceslaus; Denise Aman, Kyomugisha; Musisi, Emmanuel; Tumwine, Nuwagaba Wallen; Sanyu, Ingvar; Ssebunya, Robert; Davis, J. Lucian; Huang, Laurence; Khan, Imran H.; Cattamanchi, Adithya
    Approaches to screening for active tuberculosis (TB) among people living with HIV are inadequate, leading to missed diagnoses and poor implementation of preventive therapy. Methods Consecutive HIV-infected adults hospitalized at Mulago Hospital (Kampala, Uganda) between June 2011 and July 2013 with a cough � 2 weeks were enrolled. Patients underwent extensive evaluation for pulmonary TB. Concentrations of 43 cytokines/chemokines were measured at the same time point as C-reactive protein (CRP) in banked plasma samples using commercially-available multiplex kits. Advanced classification algorithms were used to rank cytokines/chemokines for their ability to identify TB, and to model the specificity of the top-ranked cytokines/chemokines individually and in combination with sensitivity constrained to � 90% as recommended for TB screening. Results The median plasma level of 5 biomarkers (IL-6, INF-γ, MIG, CRP, IL-18) was significantly different between patients with and without TB. With sensitivity constrained to 90%, all had low specificity with IL-6 showing the highest specificity (44%; 95% CI 37.4–49.5). Biomarker panels were found to be more valuable than any biomarker alone. A panel combining IFN-γ and IL-6 had the highest specificity (50%; 95% CI 46.7–53.3). Sensitivity remained high (>85%) for all panels among sputum smear-negative TB patients. Conclusions Direct measurement of unstimulated plasma cytokines/chemokines in peripheral blood is a promising approach to TB screening. Cytokine/chemokine panels retained high sensitivity for smear-negative TB and achieved improved specificity compared to individual cytokines/ chemokines. These markers should be further evaluated in outpatient settings where most TB screening occurs and where other illnesses associated with systematic inflammation are less common.
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    Discordance of the Repeat GeneXpert MTB/RIF Test for Rifampicin Resistance Detection Among Patients Initiating MDR-TB Treatment in Uganda
    (In Open forum infectious diseases, 2021) Ssengooba, Willy; Iragena, Jean de Dieu; Komakech, Kevin; Okello, Iginitius; Nalunjogi, Joanitah; Katagira, Winceslaus; Kimuli, Ivan; Adakun, Susan; Joloba, Moses L.; Torrea, Gabriela; Kirenga, Bruce J.
    The Global Laboratory Initiative (GLI) guidelines recommend repeat for GeneXpertMTB/RIF (XpertMTB/RIF) in patients with a low pretest probability of rifampicin resistance (RR). This was a cross-sectional study using results of sputum specimens collected from participants screened for the STREAM 2 trial. We recruited all patients with XpertMTB/RIF RR-TB detected who were referred for RR/multidrug-resistant (MDR) TB treatment initiation at Mulago National Referral Hospital, Kampala, between September 2017 and October 2019. At baseline, smear microscopy, repeat XpertMTB/RIF, Xpert Ultra, and MTBDRplus assays were done on sputum specimens. Culturebased drug susceptibility testing (DST) was performed on discordant specimens. We analyzed the prevalence and factors associated with discordance between initial and repeat XpertMTB/RIF RR and false XpertMTB/RIF RR. False XpertMTB/RIF RR was defined as no RR detected by any of Xpert Ultra, LPA, or culture DST (reference comparator).
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    Efficacy of convalescent plasma for treatment of COVID-19 in Uganda
    (BMJ Open Resp Res, 2021) Kirenga, Bruce; Byakika-Kibwika, Pauline; Muttamba, Winters; Kayongo, Alex; Namakula, Olive Loryndah,; Mugenyi, Levicatus; Kiwanuka, Noah; Lusiba, John; Atukunda, Angella; Mugume, Raymond; Ssali, Francis; Ddungu, Henry; Katagira, Winceslaus; Sekibira, Rogers; Kityo, Cissy; Kyeyune, Dorothy; Acana, Susan; Aanyu-Tukamuhebwa, Hellen; Kabweru, Wilberforce; Nakwagala, Fred; Sentalo Bagaya, Bernard; Kimuli, Ivan; Nantanda, Rebecca; Buregyeya, Esther; Byarugaba, Baterana; Olaro, Charles; Mwebesa, Henry; Lutaakome Joloba, Moses; Siddharthan, Trishul; Bazeyo, William
    Convalescent plasma (CCP) has been studied as a potential therapy for COVID-19, but data on its efficacy in Africa are limited. Objective In this trial we set out to determine the efficacy of CCP for treatment of COVID-19 in Uganda. Measurements Patients with a positive SARS-CoV- 2 reverse transcriptase (RT)-PCR test irrespective of disease severity were hospitalized and randomized to receive either COVID-19 CCP plus standard of care (SOC) or SOC alone. The primary outcome was time to viral clearance, defined as having two consecutive RT-PCR- negative tests by day 28. Secondary outcomes included time to symptom resolution, clinical status on the modified WHO Ordinal Clinical Scale (≥1-point increase), progression to severe/ critical condition (defined as oxygen saturation <93% or needing oxygen), mortality and safety.
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    Ethics approval fees constrain early career researchers in Africa: a call for alternative financing for ethics committees
    (Therapeutic Advances in Infectious Disease, 2021) Baruch Baluku, Joseph; Olum, Ronald; Katagira, Winceslaus; Namaganda, Rehema; Iyabo Osaigbovo, Iriagbonse; Dhiblawe, Abdirahman; Sambani, Clara; Magumba, Caeser; Muchiri, Joseph
    Although the research outputs of African scholars have increased over the years, the continent contributes less than 5% of global scientific publications. 1,2 Early career researchers (ECRs) are key in undertaking research that will shape the future of clinical care and public health in Africa, where the burden of infectious and non-communicable diseases is converging.3 An ERC is one within their first 5 years of academic or research-related employment following completion of postgraduate research training.4 In Africa, ERCs are usually at assistant lecturer or lecturer level in research institutes, universities, polytechnics or colleges.5 The foremost challenge faced by ECRs in Africa is lack of funding.1 In one survey, ERCs in Africa were reported to receive a median of US$5000 funding for research projects.1 This is very low considering the amount of ethics approval fees levied by research and ethics committees (RECs) in Africa. While academic research protocols are reviewed for as low as US$5, non-student ERCs can be expected to pay up to US$600 or 10% of the study project budget.6–8 This is often in addition to other permit fees charged by national bodies that regulate institutional RECs. Fees payable to these national bodies range from US$300 to US$2000 for clinical trials.9 Additional fees are required for protocol amendments and annual renewal of approvals, where applicable. Essentially, ERCs can expect to spend almost 40% of the small research grants they receive on ethics approvals. Clearly, these fees are a barrier for ERCs who have valuable ideas but lack access to substantial funding.
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    Feasibility of collecting and processing of COVID-19 convalescent plasma for treatment of COVID-19 in Uganda
    (PLoS ONE, 2021) Muttamba, Winters; Lusiba, John; Namakula, Loryndah Olive; Byakika-Kibwika, Pauline; Ssali, Francis; Ddungu, Henry; Mugenyi, Levicatus; Kiwanuka, Noah; Sekibira, Rogers; Kityo, Cissy; Keyune, Dorothy; Acana, Susan; Musinguzi, Ambrose; Masasi, Ayub; Byamugisha, Joseph; Mpanju, David; Musoki, Walter Jack; Tukamuhebwa, Hellen Aanyu; Nakwagala, Fred; Sentalo Bagaya, Bernard; Kayongo, Alex; Kimuli, Ivan; Nantanda, Rebecca; Katagira, Winceslaus; Buregyeya, Esther; Byanyima, Rosemary; Byarugaba, Baterana; Siddharthan, Trishul; Mwebesa, Henry; Charles, Olaro; Lutaakome Joloba, Moses; Bazeyo, William; Kirenga, Bruce
    Evidence that supports the use of COVID-19 convalescent plasma (CCP) for treatment of COVID-19 is increasingly emerging. However, very few African countries have undertaken the collection and processing of CCP. The aim of this study was to assess the feasibility of collecting and processing of CCP, in preparation for a randomized clinical trial of CCP for treatment of COVID-19 in Uganda. Methods In a cross-sectional study, persons with documented evidence of recovery from COVID-19 in Uganda were contacted and screened for blood donation via telephone calls. Those found eligible were asked to come to the blood donation centre for further screening and consent. Whole blood collection was undertaken from which plasma was processed. Plasma was tested for transfusion transmissible infections (TTIs) and anti-SARS CoV-2 antibody titers. SARS-CoV-2 testing was also done on nasopharyngeal swabs from the donors.
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    Identifying Appropriate Delivery of and Referral to Pulmonary Rehabilitation in Uganda: A Survey Study of People Living with Chronic Respiratory Disease and Health Care Workers
    (International journal of chronic obstructive pulmonary disease, 2021) Katagira, Winceslaus; Ndagire, Pauline; Nanyonga, Jaliah; Kasiita, Richard; Kasolo, Josephine N.; Kirenga, Bruce; Singh, Sally J.
    Pulmonary rehabilitation (PR) is a low cost, high impact intervention that ameliorates the disability associated with chronic respiratory diseases (CRD). PR is becoming increasingly recognized in low resource settings where the burden of CRD is rapidly increasing. To aid the implementation of PR in Uganda, we conducted a study to assess the attitudes and opinions towards PR among patients with CRD in Uganda and explore barriers faced by health care workers (HCWs) in referring to PR. A cross-sectional study comprising two survey populations: people living with CRD and HCWs regarded as potential PR referrers and PR deliverers. This exploratory study sought initial opinions and thoughts regarding PR, as well as baseline knowledge and potential barriers faced in the referral process. Overall, 30 HCWs (53% female, 43% doctors) and 51 adults with CRD (63% female) participated in the survey. Among those with CRD, the majority reported breathlessness as a major problem (86%) and breathlessness affected their ability to do paid and unpaid work (70%). Interest in PR was high amongst adults with CRD (92%) with preference for a hospital-based programme (67%) as opposed to community-based (16%) or home-based (17%). All HCWs considered PR important in lung disease management, but 77% do not refer patients due to a lack of information about PR. HCWs’ free-text responses identified the need for training in PR, patient education and streamlining the referral process as key elements to develop successful PR referral services. To successfully set up a PR service for people with CRD in Uganda, there is a great need for appropriately tailored training and education of prospective referrers about CRD and PR programs. Educating patients about the benefits of PR as well as streamlining the referral process is critical in expanding PR services across Uganda to fulfill this unmet need.
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    Music and Dance in respiratory disease management in Uganda: A qualitative study of patient and healthcare professional perspectives
    (medRxiv, 2021) Philip, Keir E. J.; Cartwright, Lucy L.; Westlake, Debra; Nyakoojo, Grace; Kimuli, Ivan; Kirenga, Bruce; Brakema, Evelyn A.; Orme, Mark W.; Fancourt, Daisy; Hopkinson, Nicholas S.; Jones, Rupert; Katagira, Winceslaus
    Music and dance are increasingly used as adjunctive arts-in-health interventions in high-income settings, with a growing body of research suggesting biopsychosocial benefits. Such low-cost, low-resource interventions may have application in low-resource settings such as Uganda. However, research on perceptions of patients and healthcare professionals regarding such approaches is lacking. We delivered taster music and dance for chronic respiratory disease (CRD) sessions to patients and healthcare professionals. We then conducted an exploratory qualitative study, using thematic analysis of semi-structured interviews with the healthcare professionals and patients regarding i) the role of music and dance in Ugandan life and ii) the perceived acceptability and feasibility of using music and dance in CRD management in Uganda.
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    One Dollar Incentive Improves Tuberculosis Treatment Outcomes in Programmatic Settings in Rural Uganda
    (Scientific Reports, 2021) Baluku, Joseph Baruch; Nakazibwe, Bridget; Twinomugisha, Bright; Najjuuko, Rebecca; Isabella, Nyirazihawe; Nassozi, Sylvia; Namiiro, Sharon; Katagira, Winceslaus; Byonanebye, Dathan Mirembe; Sekaggya‑Wiltshire, Christine; Muchiri, Joseph; Ndungu, Elizabeth; Anguzu, Godwin; Mayanja‑Kizza, Harriet; Andia‑Biraro, Irene
    The study aim was to determine the association of a one United States dollar (USD) dollar incentive and tuberculosis (TB) treatment outcomes among people with TB receiving treatment at a rural hospital in Uganda under programmatic settings. We conducted a quasi-experiment in which people with TB were randomised (1:1 ratio) to receive either a one USD incentive at months 0, 2, 5 and 6 (Dollar arm) or routine care (Routine arm). A second control group (Retrospective controls) consisted of participants who had a treatment outcome in the preceding 6 months. Treatment outcomes were compared between the intervention and control groups using Pearson’s chi-square and Fisher’s exact tests. The association between the incentive and treatment outcomes was determined using Poisson regression analysis with robust variances. Between November 2018 and October 2019, we enrolled 180 participants (60 in the Dollar arm and 120 in the Control group). TB cure (33.3% vs. 20.8%, p = 0.068) and treatment success (70.0% vs. 59.2% p = 0.156) were higher in the Dollar arm than the Control group, while loss-to-follow-up was lower in the Dollar arm (10.0% vs. 20.8% p = 0.070). Participants in the Dollar arm were more likely to be cured (adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.04–2.44, p = 0.032) and less likely to be lost to follow-up (aIRR: 0.44, 95% CI 0.20–0.96, p = 0.040). A one-dollar incentive was associated with higher TB cure and lower loss-to-follow-up among people with TB in rural Uganda.
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    One dollar incentive improves tuberculosis treatment outcomes in programmatic settings in rural Uganda
    (Scientific Reports, 2021) Baluku, Joseph Baruch; Nakazibwe, Bridget; Twinomugisha, Bright; Najjuuko, Rebecca; Nyirazihawe, Isabella; Nassozi, Sylvia; Namiiro, Sharon; Katagira, Winceslaus; Byonanebye, Dathan Mirembe; Sekaggya-Wiltshire, Christine; Muchiri, Joseph; Ndungu, Elizabeth; Anguzu, Godwin; Mayanja-Kizza, Harriet; Andia-Biraro, Irene
    The study aim was to determine the association of a one United States dollar (USD) dollar incentive and tuberculosis (TB) treatment outcomes among people with TB receiving treatment at a rural hospital in Uganda under programmatic settings. We conducted a quasi-experiment in which people with TB were randomised (1:1 ratio) to receive either a one USD incentive at months 0, 2, 5 and 6 (Dollar arm) or routine care (Routine arm). A second control group (Retrospective controls) consisted of participants who had a treatment outcome in the preceding 6 months. Treatment outcomes were compared between the intervention and control groups using Pearson’s chi-square and Fisher’s exact tests. The association between the incentive and treatment outcomes was determined using Poisson regression analysis with robust variances. Between November 2018 and October 2019, we enrolled 180 participants (60 in the Dollar arm and 120 in the Control group). TB cure (33.3% vs. 20.8%, p = 0.068) and treatment success (70.0% vs. 59.2% p = 0.156) were higher in the Dollar arm than the Control group, while loss-to-follow-up was lower in the Dollar arm (10.0% vs. 20.8% p = 0.070). Participants in the Dollar arm were more likely to be cured (adjusted incidence rate ratio (aIRR): 1.59, 95% CI 1.04–2.44, p = 0.032) and less likely to be lost to follow-up (aIRR: 0.44, 95% CI 0.20–0.96, p = 0.040). A one-dollar incentive was associated with higher TB cure and lower loss-to-follow-up among people with TB in rural Uganda.
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    Predictors and short-term outcomes of recurrent pulmonary tuberculosis, Uganda: a cohort study
    (South African respiratory journal, 2017) Kalema, Nelson; Lindan, Christina; Glidden, Dave; Yoo, Samuel D.; atamba, Achilles K; Alfred, Andama; Katagira, Winceslaus; Byanyima, Patrick; Musisi, Emmanuel; Kaswabuli, Sylvia; Ingvar, Sanyu; Zawedde, Josephine; Yoon, Christina; Ayakaka, Irene; Lucian Davis, J.; Huang, Laurence; Worodria, William; Cattamanchi, Adithya
    Recurrent tuberculosis (TB) occurring >2 years after completing treatment for a prior TB episode is most often due to reinfection with a new strain of M. tuberculosis. Objectives—We determined the prevalence and outcome of late recurrent TB among hospitalized patients in Kampala, Uganda. Methods—We conducted a retrospective analysis of patients admitted to Mulago Hospital who had cough of >2 weeks’ duration and completed TB treatment >2 years prior to admission. All patients had mycobacterial culture performed on two sputum specimens and vital status ascertained 2-months post-enrollment. We performed logistic regression and Cox proportional hazards modelling to identify predictors of recurrent TB and survival, respectively. Results—Among 234 patients, 84 (36%) had recurrent TB. Independent predictors included younger age (aOR=0.64, 95% CI=0.42-0.97, p=0.04), chest pain >2 weeks (aOR=3.32, 95% CI=1.38-8.02, p=0.007), severe weight loss ≥5 kilograms (aOR=4.88, 95% CI=1.66-14.29, p=0.004) and presence of ≥1 WHO danger sign of severe illness (aOR=3.55, 95% CI=1.36-9.29, p=0.01). Two-month mortality was 17.8% (95% CI=10.5-29.2%), and was higher among patients who were not initiated on TB treatment (aHR=16.67, 95% CI=1.18-200, p=0.04), those who were HIV-positive and not on antiretroviral treatment (aHR=16.99, 95% CI=1.17-246.47, p=0.04) and those with a history of smoking (aHR=1.20, 95% CI=1.03-1.40, p=0.02). Conclusion—The high prevalence of late recurrent TB likely reflects high levels of TB transmission in Kampala. Increased use of empiric TB treatment and early ART treatment initiation if HIV-positive should be considered in patients with a prior history of TB, particularly if they are young, with weight loss ≥5kgs, chest pain >2 weeks or ≥1 WHO danger sign of severe illness.