Browsing by Author "Kiragga, Agnes"

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    Analysis of the Prevalence of the Preferred Methods of Contraception During the COVID 19 Lockdown in Uganda: A Multinomial Logistic Regression Study
    (A Multinomial Logistic Regression Study, 2021) Sseninde, Julius; Kabagenyi, Allen; Kyadondo, Betty; Nyachwo, Evelyne; Kiragga, Agnes; Wasswa, Ronald
    In 2020 limitations to family planning information, access and utilization were exacerbated by the COVID-19 pandemic and lockdown, globally incapacitating various channels to family planning information, access and, utilization. This study sought to analyze the prevalence of the preferred methods of contraception during the COVID 19 lockdown in Uganda using multinomial logistic regression. Method Data were analyzed using univariate, bivariate, logistic, and multinomial logistic regression models from the post-intervention telehealth cross-sectional survey. Results Out of the 244 women surveyed, more than three quarters (80%) used their preferred methods of family planning, while almost half of the participants (46%) used the Short-Acting Methods as a preferred method of Family planning. The logistic regression showed that older-aged participants, fear of security personnel, and fear that my spouse will know that the partner is using family planning as their biggest challenge plus participants who agreed that they won’t continue using family planning after the lockdown were less likely to use the preferred method of family planning. However, participants whose biggest challenge to accessing family planning information, and utilization was lack of money, those who received an extremely adequate number of messages during the intervention, and those who were already using family planning before the intervention were more likely to use their preferred method of family planning. From the multinomial model, participants whose biggest challenges in accessing family planning services during the lockdown were fear of unwanted pregnancy, and fear if implant expires in her body were relatively more likely to use Long-term Acting Reversible Contraceptives than Short-Acting Contraceptives as their preferred method of Family Planning. While participants who were relatively less likely to use LARC compared to SAC were those already using family planning before the start of the intervention. Conclusions We recommend prioritizing family planning information, access and utilization as one of the essential services during the lockdown, with more emphasis on an intervention that addresses age-specific needs and partner privacy issues. Addressing the use of LARC among women who are already using contraceptives is equally paramount in cases of lockdown and health facility closures
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    Atorvastatin reduces T-cell activation and exhaustion among HIV-infected cART-treated suboptimal immune responders in Uganda: a randomised crossover placebo-controlled trial
    (Tropical medicine & international health, 2015) Nakanjako, Damalie; Ssinabulya, Isaac; Nabatanzi, Rose; Bayigga, Lois; Kiragga, Agnes; Joloba, Moses; Kaleebu, Pontiano; Kambugu, Andrew D.; Kamya, Moses R.; Sekaly, Rafick; Elliott, Alison; Mayanja-Kizza, Harriet
    T-cell activation independently predicts mortality, poor immune recovery and non-AIDS illnesses during combination antiretroviral therapy (cART). Atorvastatin showed anti-immune activation effects among HIV-infected cART-naïve individuals. We investigated whether adjunct atorvastatin therapy reduces T-cell activation among cART-treated adults with suboptimal immune recovery.A randomised double-blind placebo-controlled crossover trial, of atorvastatin 80 mg daily vs. placebo for 12 weeks, was conducted among individuals with CD4 increase <295 cells/μl after seven years of suppressive cART. Change in T-cell activation (CD3 + CD4 + /CD8 + CD38 + HLADR+) and in T-cell exhaustion (CD3 + CD4 + /CD8 + PD1 + ) was measured using flow cytometry.Thirty patients were randomised, 15 to each arm. Atorvastatin resulted in a 28% greater reduction in CD4 T-cell activation (60% reduction) than placebo (32% reduction); P = 0.001. Atorvastatin also resulted in a 35% greater reduction in CD8-T-cell activation than placebo (49% vs. 14%, P = 0.0009), CD4 T-cell exhaustion (27% vs. 17% in placebo), P = 0.001 and CD8 T-cell exhaustion (27% vs. 16%), P = 0.004. There was no carry-over/period effect. Expected adverse events were comparable in both groups, and no serious adverse events were reported.Atorvastatin reduced T-cell immune activation and exhaustion among cART-treated adults in a Ugandan cohort. Atorvastatin adjunct therapy should be explored as a strategy to improve HIV treatment outcomes among people living with HIV in sub-Saharan Africa.
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    Boosted Lopinavir vs Boosted Atazanavir in Patients Failing a NNRTI first line Regimen in an Urban Clinic in Kampala
    (Journal of the International AIDS Society, 2014) Laker, Eva; Mambule, Ivan; Nalwanga, Damalie; Musaazi, Joseph; Kiragga, Agnes; Parkes-Ratanshi, Rosalind
    In 2011 Uganda recommended boosted atazanavir (ATV/r) as the preferred PI for second line due to once daily dosing, replacing aluvia (LPV/r) [1,2]. The evidence was based on the BMS O45 trial, of LPV/r vs ATV/r was performed in a highincome setting, on patients with prior PI use and resistance testing [2,3]. There are no RCTs or observational studies comparing use of ATV/r with LPV/r in patients failing NNRTI first line antiretroviral therapy in sub-Saharan Africa [3,4]. The Infectious Diseases Institute (IDI) has a large second line cohort (1838). This aims to compare clinical, immunologic and virologic response of LPV/r versus ATV/r at IDI. Retrospective cohort analysis on routinely collected data of patients switched to second line with NRTI backbones TDF/3TC or FTC, AZT/3TC, ABC/3TC from January 2009 to December 2013. Students T-tests and Chi-square tests were used in this analysis. A total of 1286 (73.5% female) patients were switched to LPV/r 991 (77%) and ATV/r 295 (23%) (pB0.001). NRTI backbones were 760 on TDF/3TC (66.8% LPV/r vs 33.2% on ATV/r), 504 on AZT/3TC (93.3% vs 6.7%), and 22 on ABC/3TC (59% vs 41%). Median (IQR) time on first line for LPV/r was 21 (144) months and for ATV/r was 41 months (2268). Median CD4 (IQR) at switch to LPV/r was 181 cells/uL (66424) and to ATV/r was 122 (57238) (p50.001). A total of 366 patients had CD4 done at six months after switch and the mean (IQR) CD4 increase was 153 (54241) for LPV/r versus 116 (52171) for ATV/r (p0.232). Additionally, 304 had a CD4 at 12 months and the means were 172 (45272) for LPV/r vs 179 (60271) for ATV/r (p0.426). There was no significant difference in the mean increment by NRTI backbone or by stratifying to viral load (VL) at time of switch to VL B100,000 and ]100,000. Median (IQR) VL at switch was 61,000 (13,0002,030,000) LPV/r and 51,000 (14,000_151,000) ATV/r. 269 had a VL done in the first 12 months and 178/250 (71.2%) on LPV/r versus 16/19 (84.2%) on ATV/r were undetectable (p0.228). 259 (26%) LPV/r versus 33(11%) ATV/r had ]1 opportunistic infections on second line (pB0.001). This is an observational study based on our experience at IDI. Like elsewhere in Africa, there is no routine viral load testing, making it difficult to get sensitive analysis of data on ART efficacy within routine clinical practice. Nevertheless, this observational study is reassuring in terms of efficacy of both ATV/r and LPV/r for patients failing first line therapy in our setting.
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    Differences in Adverse Events Related to Voluntary Male Medical Circumcision Between Civilian and Military Health Facilities in Uganda
    (Research Square, 2021) Ogweng Obangaber, Lucky; Seruwagi, Gloria; Nabaggala, Maria Sarah; Lugada, Eric; Bwayo, Denis; Nyanzi, Abdul; Rwegyema, Twaha; Wamundu, Cassette; Lawoko, Stephen; Kasujja, Vincent; Asiimwe, Evarlyne; Musinguzi, Ambrose; Kikaire, Bernard; Kiragga, Agnes
    Voluntary medical male circumcision (VMMC) significantly reduces the risk of acquiring HIV in men. Despite the percentage of circumcised men (15-49 years) in Uganda increasing over time, some populations are not taking up the surgical procedure. The government of Uganda and implementing partners have responded to this lack of VMMC coverage among key populations by intensifying introducing innovative strategies that increase demand particularly among military personnel using the WHO’s MOVE strategy. As a surgical intervention, it is critical that VMMC services are safe for clients and that adverse events or complications are minimized. This paper describes the prevalence and trends of adverse events reported among military mobile camps in comparison to civilian sites in Uganda. Methods: A prospective study conducted in eighteen (18) public health facilities between March and August 2019. Of these nine (9) were providing care to civilian populations while nine (9) served the military population and catchment areas. Descriptive statistics, Chi-square test and trends analysis were carried out to describe profile of advance events among civilian and military facilities over the study period. Results: The highest proportions of VMMC were done among persons aged 15 to 19 years whereas among military camps the highest proportions of circumcision among males aged 20 to 24 years. Regarding site of circumcision, the highest proportions of VMMC were done at outreaches, with higher levels in military camps compared to civilian camps. For the proportions of adverse events reported, higher proportions were reported in civilian camps compared to military camps (Total – 1.3% vs 0.2%; p- value<0.05). For trends analysis, results indicate that there was no statistically significant trend for both civilian and military number of adverse events reported for the four quarters in 2020 (P-value =0.315 for civilian and P=0.094 for the military). Conclusions: The MOVE model is great for scaling up VMMC 48 in specialized populations such as military. Can also be adapted in other populations if contextual bottlenecks are identified and collectively addressed by key stakeholders – leadership, community engagement and using a largely horizontal approach offer promising possibilities and outcomes.
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    Disruption in Essential Health Service Delivery: A Qualitative Study on Access to Family Planning Information and Service Utilization During the First Wave of COVID-19 Pandemic in Uganda
    (Open Access Journal of Contraception, 2022) Kabagenyi, Allen; Kyaddondo, Betty; Baelvina Nyachwo, Evelyne; Wasswa, Ronald; Bwanika, John Mark; Kabajungu, Enid; Kiragga, Agnes
    Coronavirus disease 2019 (COVID-19) remains a challenge to public health with profound impact on people’s lives. With several mitigation measures implemented to curb the spread of COVID-19, these impacted on access and utilization of general health services including family planning (FP) services. The objective of the study was to understand the extent to which COVID-19 interrupted access and utilization of FP services as well as highlight the challenges faced during the lockdown in Uganda. Methods: A qualitative study was carried out in August and September 2020 across the country. A total of 21 key informant interviews among researchers, policy makers, funding agencies, district family planning focal persons, district health officers and service providers with implementing partners were conducted. These were conducted using face to face (7), phone calls (11) and zoom (3) meetings. All interviews were audio recorded and transcribed verbatim. Transcripts were used to identify and generate codes, sub themes and themes. Analysis was done using the thematic framework analysis and results presented in themes. Results: Five themes were identified in this study which included; (i) financial and psychosocial needs, (ii) mobility hindrances, (iii) disrupted service delivery, (iv) responsive reproductive health services. The financial and psychosocial needs themes included: household and individual financial constraints, unpredictable future and community acceptance, loss of employment and unemployment, misconceptions and unintended pregnancies; while mobility hindrances included; restricted movement, high transport costs, and difficulty in finding transport. Conclusion: Results showed that the pandemic had immediate and significant long-term effects on family planning service accessibility, utilization and delivery. The study recommends implementation of telehealth services, country-wide sensitization on use of long-term contraceptive methods, empowering village health teams and making family planning services mandatory and free to all private facilities in order to lower any disruptions during pandemics.
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    Effect of the COVID-19 Pandemic Restrictions on Outcomes of HIV Care among Adults in Uganda
    (Medicine, 2022) Izudi, Jonathan; Kiragga, Agnes; Kalyesubula, Philip; Okoboi, Stephen; Castelnuovo, Barbara
    Uganda enforced several stringent restrictions such as night-time curfews, travel bans, school closure, and physical and social distancing among others that constituted a national lockdown to prevent the spread of the Coronavirus disease 2019 (COVID-19). These restrictions disrupted the delivery of health services but the impact on outcomes of human immunodeficiency virus (HIV) care has not been rigorously studied. We evaluated the effect of the COVID-19 pandemic restrictions on outcomes of HIV care among people living with HIV (PLHIV) aged ≥15 years in Kampala, Uganda. We designed a nonrandomized, quasi-experimental study using observational data retrieved from six large HIV clinics and used the data to construct two cohorts: a comparison cohort nonexposed to the restrictions and an exposed cohort that experienced the restrictions. The comparison cohort consisted of PLHIV commenced on anti-retroviral therapy (ART) between March 1, 2018, and February 28, 2019, followed for ≥1 year with outcomes assessed in March 2020, just before the restrictions were imposed. The exposed cohort comprised of PLHIV started on ART between March 1, 2019, and February 28, 2020, followed for ≥1 year with outcomes assessed in June 2021. The primary outcomes are retention, viral load testing, viral load suppression, and mortality. We employed inverse probability of treatment weighting using propensity score (IPTW-PS) to achieve comparability between the two cohorts on selected covariates. We estimated the effect of the restriction on the outcomes using logistic regression analysis weighted by propensity scores (PS), reported as odds ratio (OR) and 95% confidence interval (CI). We analyzed data for nine, 952 participants, with 5094 (51.2%) in the exposed group. The overall mean age was 32.7 ± 8.8 years. In the exposed group relative to the comparison group, viral load testing (OR, 1.68; 95% CI, 1.59–1.78) and viral load suppression (OR, 1.34; 95% CI, 1.110–1.63) increased while retention (OR, 0.76; 95% CI, 0.70–0.81) and mortality (OR, 0.75; 95% CI, 0.64–0.88) reduced. Among PLHIV in Kampala, Uganda, viral load testing and suppression improved while retention and mortality reduced during the COVID-19 pandemic restrictions due to new approaches to ART delivery and the scale-up of existing ART delivery models.
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    Evaluation of Cepheid’s Xpert MTB/RIF Test on Pleural Fluid in the Diagnosis of Pleural Tuberculosis in a High Prevalence HIV/TB Setting
    (PLoS ONE, 2014) Lusiba, John K.; Nakiyingi, Lydia; Kirenga, Bruce J.; Kiragga, Agnes; Lukande, Robert; Nsereko, Maria; Ssengooba, Willy; Katamba, Achilles; Worodria, William; Joloba, Moses L.; Mayanja-Kizza, Harriet
    Diagnosis of pleural tuberculosis (TB) using routinely available diagnostic methods is challenging due to the paucibacillary nature of the disease. Histopathology and pleural tissue TB culture involves an invasive procedure which requires expertise and appropriate equipment, both often unavailable in many health units. Xpert MTB/Rif test has been widely evaluated in sputum specimens but data on its performance in pleural TB is scarce. We evaluated the accuracy of Cepheid’s Xpert MTB/Rif test on pleural fluid in the diagnosis of pleural TB in Uganda. Methods: Consenting adult patients with exudative pleural effusions underwent pleural biopsy and the tissue obtained subjected to Lowenstein-Jensen and mycobacterial growth indicator tube MTB cultures and histopathology. Pleural fluid for Xpert MTB/Rif testing was also collected. Data on socio-demographic characteristics, clinical symptoms, HIV status and CD4 count were also collected. Sensitivity, specificity, positive and negative predictive values of Xpert MTB/Rif test on pleural fluid in pleural TB diagnosis were calculated using pleural tissue MTB culture and/or histopathology as the reference standard. Results: Of the 116 participants [female 50%, mean age 34 (SD 613], 87/116 (75%) had pleural TB confirmed on pleural tissue culture and/or histopathology. The Xpert MTB/Rif test identified 25 (28.7%) of the 87 confirmed pleural TB cases. The sensitivity and specificity of Xpert MTB/Rif test were 28.7% and 96.6% respectively while the positive and negative predictive values were 96.1% and 31.1% respectively. Conclusion: Xpert MTB/Rif test on pleural fluid does not accurately diagnose pleural TB and therefore cannot be used as an initial evaluation test in patients with suspected pleural TB. New, rapid and accurate tests for the diagnosis of pleural TB are still warranted.
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    High T-cell immune activation and immune exhaustion among individuals with suboptimal CD4 recovery after 4 years of antiretroviral therapy in an African cohort
    (BMC infectious diseases, 2011) Nakanjako, Damalie; Ssewanyana, Isaac; Mayanja-Kizza, Harriet; Kiragga, Agnes; Manabe, Yukari C.; Nabatanzi, Rose; Kamya, Moses R.; Cao, Huyen
    Antiretroviral therapy (ART) partially corrects immune dysfunction associated with HIV infection. The levels of T-cell immune activation and exhaustion after long-term, suppressive ART and their correlation with CD4 T-cell count reconstitution among ART-treated patients in African cohorts have not been extensively evaluated.T-cell activation (CD38+HLA-DR+) and immune exhaustion (PD-1+) were measured in a prospective cohort of patients initiated on ART; 128 patient samples were evaluated and subcategorized by CD4 reconstitution after long-term suppressive treatment: Suboptimal [median CD4 count increase 129 (-43-199) cells/μl], N = 34 ], optimal [282 (200-415) cells/μl, N = 64] and super-optimal [528 (416-878) cells/μl, N = 30].Both CD4+ and CD8 T-cell activation was significantly higher among suboptimal CD4 T-cell responders compared to super-optimal responders. In a multivariate model, CD4+CD38+HLADR+ T-cells were associated with suboptimal CD4 reconstitution [AOR, 5.7 (95% CI, 1.4-23, P = 0.014)]. T-cell exhaustion (CD4+PD1+ and CD8+PD1+) was higher among suboptimal relative to optimal (P < 0.001) and super-optimal responders (P < 0.001). T-cell exhaustion was significantly associated with suboptimal responders [AOR, 1.5 (95%CI, 1.1-2.1), P = 0.022].T-cell activation and exhaustion persist among HIV-infected patients despite long-term, sustained HIV-RNA viral suppression. These immune abnormalities were associated with suboptimal CD4 reconstitution and their regulation may modify immune recovery among suboptimal responders to ART.
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    Implementation of Provider-Based Electronic Medical Records and Improvement of the Quality of Data in a Large HIV Program in Sub-Saharan Africa
    (PLoS ONE, 2012) Castelnuovo, Barbara; Kiragga, Agnes; Afayo, Victor; Ncube, Malisa; Orama, Richard; Magero, Stephen; Okwi, Peter; Manabe, Yukari C.; Kambugu, Andrew
    Starting in June 2010 the Infectious Diseases Institute (IDI) clinic (a large urban HIV out-patient facility) switched to provider-based Electronic Medical Records (EMR) from paper EMR entered in the database by data-entry clerks. Standardized clinics forms were eliminated but providers still fill free text clinical notes in physical patients’ files. The objective of this study was to compare the rate of errors in the database before and after the introduction of the providerbased EMR. Methods and Findings: Data in the database pre and post provider-based EMR was compared with the information in the patients’ files and classified as correct, incorrect, and missing. We calculated the proportion of incorrect, missing and total error for key variables (toxicities, opportunistic infections, reasons for treatment change and interruption). Proportions of total errors were compared using chi-square test. A survey of the users of the EMR was also conducted. We compared data from 2,382 visits (from 100 individuals) of a retrospective validation conducted in 2007 with 34,957 visits (from 10,920 individuals) of a prospective validation conducted in April–August 2011. The total proportion of errors decreased from 66.5% in 2007 to 2.1% in 2011 for opportunistic infections, from 51.9% to 3.5% for ART toxicity, from 82.8% to 12.5% for reasons for ART interruption and from 94.1% to 0.9% for reasons for ART switch (all P,0.0001). The survey showed that 83% of the providers agreed that provider-based EMR led to improvement of clinical care, 80% reported improved access to patients’ records, and 80% appreciated the automation of providers’ tasks. Conclusions: The introduction of provider-based EMR improved the quality of data collected with a significant reduction in missing and incorrect information. The majority of providers and clients expressed satisfaction with the new system. We recommend the use of provider-based EMR in large HIV programs in Sub-Saharan Africa.
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    An Interactive Voice Response Software to Improve the Quality of Life of People Living With HIV in Uganda: Randomized Controlled Trial
    (JMIR mHealth and uHealth, 2021) Byonanebye, Dathan Mirembe; Nabaggala, Maria S.; Naggirinya, Agnes Bwanika; Lamorde, Mohammed; Oseku, Elizabeth; King, Rachel; Owarwo, Noela; Laker, Eva; Orama, Richard; Castelnuovo, Barbara; Kiragga, Agnes; Ratanshi, Rosalind Parkes
    Following the successful scale-up of antiretroviral therapy (ART), the focus is now on ensuring good quality of life (QoL) and sustained viral suppression in people living with HIV. The access to mobile technology in the most burdened countries is increasing rapidly, and therefore, mobile health (mHealth) technologies could be leveraged to improve QoL in people living with HIV. However, data on the impact of mHealth tools on the QoL in people living with HIV are limited to the evaluation of SMS text messaging; these are infeasible in high-illiteracy settings.The primary and secondary outcomes were to determine the impact of interactive voice response (IVR) technology on Medical Outcomes Study HIV QoL scores and viral suppression at 12 months, respectively.Within the Call for Life study, ART-experienced and ART-naïve people living with HIV commencing ART were randomized (1:1 ratio) to the control (no IVR support) or intervention arm (daily adherence and pre-appointment reminders, health information tips, and option to report symptoms). The software evaluated was Call for Life Uganda, an IVR technology that is based on the Mobile Technology for Community Health open-source software. Eligibility criteria for participation included access to a phone, fluency in local languages, and provision of consent. The differences in differences (DIDs) were computed, adjusting for baseline HIV RNA and CD4.Overall, 600 participants (413 female, 68.8%) were enrolled and followed-up for 12 months. In the intervention arm of 300 participants, 298 (99.3%) opted for IVR and 2 (0.7%) chose SMS text messaging as the mode of receiving reminders and health tips. At 12 months, there was no overall difference in the QoL between the intervention and control arms (DID=0.0; P=.99) or HIV RNA (DID=0.01; P=.94). At 12 months, 124 of the 256 (48.4%) active participants had picked up at least 50% of the calls. In the active intervention participants, high users (received >75% of reminders) had overall higher QoL compared to low users (received <25% of reminders) (92.2 versus 87.8, P=.02). Similarly, high users also had higher QoL scores in the mental health domain (93.1 versus 86.8, P=.008) and better appointment keeping. Similarly, participants with moderate use (51%-75%) had better viral suppression at 12 months (80/94, 85% versus 11/19, 58%, P=.006).Overall, there was high uptake and acceptability of the IVR tool. While we found no overall difference in the QoL and viral suppression between study arms, people living with HIV with higher usage of the tool showed greater improvements in QoL, viral suppression, and appointment keeping. With the declining resources available to HIV programs and the increasing number of people living with HIV accessing ART, IVR technology could be used to support patient care. The tool may be helpful in situations where physical consultations are infeasible, including the current COVID epidemic.
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    An Observational Study in an Urban Ugandan Clinic comparing Virological Outcomes of Patients Switched from first-line Antiretroviral Regimens to Second-line Regimens containing Ritonavir-boosted Atazanavir or Ritonavir-boosted Lopinavir
    (BMC Infectious Diseases, 2019) Laker, Eva Agnes Odongpiny; Nabaggala, Maria Sarah; Kaimal, Arvind; Nalwanga, Damalie; Abdu Musubire, Abdu Musubire; Kiragga, Agnes; Lamorde, Mohammed; Parkes- Ratanshi, Rosalind
    The World Health Organisation approved boosted atazanavir as a preferred second line protease inhibitor in 2010. This is as an alternative to the current boosted lopinavir. Atazanavir has a lower genetic barrier than lopinavir. We compared the virological outcomes of patients during the roll out of routine viral load monitoring, who had switched to boosted second- line regimens of either atazanavir or lopinavir.
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    Performance of Cryptococcal Antigen Lateral Flow Assay Using Saliva in Ugandans with CD4 ,<100
    (PloS one, 2014) Kwizera, Richard; Nguna, Joyce; Kiragga, Agnes; Nakavuma, Jesca; Rajasingham, Radha; Boulware, David R.; Meya, David B.
    Cryptococcal meningitis can best be diagnosed by cerebrospinal fluid India ink microscopy, cryptococcal antigen detection, or culture. These require invasive lumbar punctures. The utility of cryptococcal antigen detection in saliva is unknown. We evaluated the diagnostic performance of the point-of-care cryptococcal antigen lateral flow assay (CrAg LFA) in saliva.We screened HIV-infected, antiretroviral therapy naïve persons with symptomatic meningitis (n = 130) and asymptomatic persons with CD4+<100 cells/µL entering into HIV care (n = 399) in Kampala, Uganda. The diagnostic performance of testing saliva was compared to serum/plasma cryptococcal antigen as the reference standard.The saliva lateral flow assay performance was overall more sensitive in symptomatic patients (88%) than in asymptomatic patients (27%). The specificity of saliva lateral flow assay was excellent at 97.8% in the symptomatic patients and 100% in asymptomatic patients. The degree of accuracy of saliva in diagnosing cryptococcosis and the level of agreement between the two sample types was better in symptomatic patients (C-statistic 92.9, κ-0.82) than in asymptomatic patients (C-statistic 63.5, κ-0.41). Persons with false negative salvia CrAg tests had lower levels of peripheral blood CrAg titers (P<0.001).There was poor diagnostic performance in testing saliva for cryptococcal antigen, particularly among asymptomatic persons screened for preemptive treatment of cryptococcosis.
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    The Potential Teratogenicity Alert for Women Conceiving on Dolutegravir‑Based Regimens: An Assessment of Risk Communication by an Urban HIV Clinic in Uganda and Choices made by Women
    (Drug Safety, 2020) Laker, Eva Agnes Odongpiny; Arinaitwe, Arnold; Owarwo, Noela; Onzia, Annet; Nasasira, Benson; Wailagala, Abdullah; Kalule, Ivan; Anguzu, Godwin; Kiragga, Agnes; Lwanga, Isaac; Castelnuovo, Barbara; Musomba, Rachel; Lamorde, Mohammed
    In May 2018, the World Health Organization and other regulatory authorities released a safety alert for dolutegravir related to a risk of neural tube defects among women exposed to dolutegravir at the time of conception. Models of how drug safety information can be shared effectively in the shortest time are necessary to prevent interruptions of public health programs. We sought to describe an implementation process to inform and support women already on dolutegravir-based regimens at the time of conception to make informed choices following the safety alert of a potential teratogenicity risk. We describe the choices made by women, as well as determine the factors associated with women’s choices to switch off dolutegravir.
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    Relating CYP2B6 Genotype and EFV Resistance Among Women Living With HIV With High Viremia in Uganda: A Nested Cross-Sectional Study.
    (Research Square, 2021) Buzibye, Allan; Wools-Kaloustian, Kara; Olagunju, Adeniyi; Twinomuhwezi, Ellon; Yiannoutsos, Constantin; Owen, Andrew; Neary, Megan; Matovu, Joshua; Banturaki, Grace; Castelnuovo, Barbara; Lamorde, Mohammed; Khoo, Saye; Waitt, Catriona; Kiragga, Agnes
    We investigated the association between CYP2B6 polymorphisms and efavirenz drug resistance among women living with HIV started on anti-retroviral therapy during pregnancy and with high viremia during post-partum. Methods This was a cross sectional study. Women between 6-12 weeks post-partum with viral load >1000 copies/ml were eligible. Sanger sequencing to detect resistant mutations and host genotyping were performed. We categorized efavirenz metabolizer genotype according to the AIDS clinical trials group algorithm as slow, intermediate and extensive; and compared efavirenz resistance among the metabolizer genotypes. Results Over a one-year period (July 2017-July 2018), three hundred and thirty two women were screened of whom 112 (34.8%) had viral load ≥1000 copies/ml of whom 62 had whole blood available for genotyping. Fifty-nine of these women had both viral resistance and human host genotypic results. We observed a higher frequency of efavirenz resistance among slow metabolizers (47% versus 34% in extensive and 28% in intermediate, metabolizers) but due to low numbers, this was not statistically significant. Conclusions Our findings raise the possibility that CYP2B6 polymorphism may contribute to efavirenz drug resistance in women started on antiretroviral therapy during pregnancy and with high viremia in the post-partum period. If confirmed in a larger study, this would have important implications for all patients in sub- Saharan Africa receiving efavirenz and add further support to the changes in World Health Organization policy to switch away from efavirenz as first line antiretroviral therapy in countries with a high prevalence of CYP2B6 polymorphisms.
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    Re‑engagement in HIV care following a missed visit in rural Uganda
    (BMC research notes, 2018) Nabaggala, Maria Sarah; Parkes‑Ratanshi, Rosalind; Kasirye, Ronnie; Kiragga, Agnes; Castlenuovo, Barbara; Ochaka, Ian; Nakakawa, Lilian; Asiimwe Bena, Diana; Mujugira, Andrew
    We conducted a retrospective cohort study to assess the effect of tracking People Living with HIV (PLHIV) after missed clinic visits and factors associated with return to care in rural Uganda. We assessed retention in care among 650 HIV-infected women and men. We used univariable and multivariable generalized linear models to assess demographic and self-reported factors associated with re-engagement in HIV care. Results: Of 381 PLHIV who ever missed a scheduled appointment, 68% were female and most (80%) had initiated ART. Most (70%) of those tracked returned to care. Relative to men, women (adjusted risk ratio [ARR] 1.23; 95% confidence interval (CI) 1.05–1.43; p = 0.009) were more likely to return to care after active tracking. PLHIV who missed scheduled visits for other reasons (forgetting, adequate drug supplies, or long distance to clinic) had reduced odds of return to care (ARR 0.41; 95% CI 0.28–0.59; p < 0.001). These data support close monitoring of patient retention in HIV care and active measures to re-engage those who miss an appointment. Furthermore, they highlight the need for targeted interventions to those more resistant to re-engagement such as men.
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    Sexual Behaviors over a 3-Year Period among Individuals with Advanced HIV/AIDS Receiving Antiretroviral Therapy in an Urban HIV Clinic in Kampala, Uganda
    (Journal of acquired immune deficiency syndromes, 2011) Wandera, Bonnie; Kamya, Moses R.; Castelnuovo, Barbara; Kiragga, Agnes; Kambugu, Andrew; Wanyama, Jane N.; Easterbrook, Philippa; Sethi, Ajay K.
    Few studies have prospectively examined sexual behaviors of HIV-infected person on antiretroviral therapy (ART) in Sub-Saharan Africa.From 2004 to 2005, 559 HIV-infected, ART-naïve individuals initiating ART at an HIV clinic in Kampala, Uganda were enrolled into a prospective study and followed to 2008. Clinical and sexual behavior information was assessed at enrollment and semi-annually for three years after ART initiation. Using log-binomial regression models, we estimated prevalence ratios (PRs) to determine factors associated with being sexually active and having unprotected sex over three-years after initiating ART.559 adults contributed 2,594 person-visits of follow-up. At the time of ART initiation, 323 (57.9%) were sexually active of which 176 (54.5%) had unprotected sex at last sexual intercourse. Majority (63.4%) of married individuals were unaware of their partner’s HIV status. Female gender (PR=2.97; 95% CI: 1.85, 4.79), being married (PR=1.48; 95% CI: 1.06, 2.06), and reporting unprotected sex prior to ART (PR=1.68; 95% CI: 1.16, 2.42) were among factors independently associated with unprotected sex while on ART. Overall, 7.3% of visit intervals of unprotected sex, 1.0% of intervals of sexual activity, occurred when plasma viral load >1,500 copies/ml, representing periods of greater HIV transmission risk.Although unprotected sex reduced over time, women reported unprotected sex more often than men. Disclosure of HIV status was low. Integration of comprehensive prevention programs into HIV care is needed, particularly ones specific for women.
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    A survey of machine learning applications in HIV clinical research and care
    (Computers in biology and medicine, 2017) Bisaso, Kuteesa R.; Anguzu, Godwin T.; Karungi, Susan A.; Kiragga, Agnes; Castelnuovo, Barbara
    A wealth of genetic, demographic, clinical and biomarker data is collected from routine clinical care of HIV patients and exists in the form of medical records available among the medical care and research communities. Machine learning (ML) methods have the ability to identify and discover patterns in complex datasets and predict future outcomes of HIV treatment. We survey published studies that make use of ML techniques in HIV clinical research and care. An advanced search relevant to the use of ML in HIV research was conducted in the PubMed biomedical database. The survey outcomes of interest include data sources, ML techniques, ML tasks and ML application paradigms. A growing trend in application of ML in HIV research was observed. The application paradigm has diversified to include practical clinical application, but statistical analysis remains the most dominant application. There is an increase in the use of genomic sources of data and high performance non-parametric ML methods with a focus on combating resistance to antiretroviral therapy (ART). There is need for improvement in collection of health records data and increased training in ML so as to translate ML research into clinical application in HIV management.