Browsing by Author "Kumwenda, Newton"
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Item Comparison of HIV-1 Mother-to-Child Transmission After Single-Dose Nevirapine Prophylaxis Among African Women With Subtypes A, C, and D(JAIDS Journal of Acquired Immune Deficiency Syndromes, 2006) Eshleman, Susan; Church, Jessica; Guay, Laura A.; Mwatha, Anthony; Fiscus, Susan A.; Mmiro, Francis; Musoke, Philippa; Kumwenda, Newton; Jackson, J. Brooks; Taha, Taha E.; Hoover, Donald R.The HIVNET 012 trial in Uganda showed that mother-to-child transmission (MTCT) of HIV-1 can be prevented by providing pregnant women and their infants with a single dose (SD) of the antiretroviral drug, nevirapine (NVP).1,2 Safety and efficacy of 1- or 2-dose NVP prophylaxis for prevention of MTCT have been documented in other studies. We have shown that NVP resistance emerges in some women after SD NVP prophylaxis3 and that the portion of women with NVP resistance is influenced by HIV-1 subtype.4 At 6 to 8 weeks after SD NVP, NVP resistance was more common in women with subtype C (69.2%) than in women with subtype D (36.1%, P < 0.0001) or subtype A (19.4%, P < 0.0001).4 Selection of NVP-resistant HIV-1 variants in women after NVP dosing could theoretically lower the efficacy of NVP prophylaxis for prevention of HIV transmission by breast-feeding in the first few weeks after birth. In the HIVNET 012 trial, most women were infected with HIV-1 subtype A or D. Risk of MTCT was slightly (but not statistically) higher in women with subtype D.5 In this report, we combined data from the HIVNET 012 and NVAZ trials6 to compare the risk of MTCT in women with subtype C to the risk of MTCT in women with subtypes A and D in the setting of SD NVP prophylaxis.Item Considerations in Using US-Based Laboratory Toxicity Tables to Evaluate Laboratory Toxicities Among Healthy Malawian and Ugandan Infants(Journal of acquired immune deficiency syndromes, 1999) Lubega, Irene R.; Fowler, Mary Glenn; Musoke, Philippa; Elbireer, Ali; Bagenda, Danstan; Kafulafula, George; Ko, Jeanne; Mipando, Linda; Mubiru, Mike; Kumwenda, Newton; Taha, Taha; Jackson, J. Brooks; Guay, LauraObjectives—To determine normal hematologic and selected blood chemistry values among healthy, full-term, non–HIV-exposed infants in Uganda and Malawi, and to determine the proportion of healthy babies with an apparent laboratory toxicity based on Division of AIDS oxicity tables. Design—This was a cross-sectional laboratory study of infants from birth to 6 months of age. Methods—Blood samples were collected from a total of 561 infants and analyzed according to age categories similar to those in the 2004 Division of AIDS toxicity tables. Select chemistry and hematology parameters were determined and values compared with those in the toxicity tables. Results—In the first 56 days of life, there were few graded toxicities except for neutropenia in 2 of 10 (20%) Ugandan and 13 of 45 (29%) Malawian infants at birth. After 7 days, about 20% of the infants in Uganda and Malawi would have been classified as having a neutropenia whereas 47% and 53% of those more than 2 months of age in Uganda and Malawi respectively, would have been reported as having an abnormal hemoglobin. Chemistry findings were not different from US norms. Conclusions—These findings underscore the importance of establishing relevant local laboratory norms for infants.Item Training for health services and systems research in Sub-Saharan Africa - a case study at four East and Southern African Universities(Human Resources for Health, 2013) Guwatudde, David; Bwanga, Freddie; Dudley, Lilian; Chola, Lumbwe; Henry Leyna, Germana; Mmbaga, Elia John; Kumwenda, Newton; Protsiv, Myroslava; Tumwine, James K.The need to develop capacity for health services and systems research (HSSR) in low and middle income countries has been highlighted in a number of international forums. However, little is known about the level of HSSR training in Sub-Saharan Africa (SSA). We conducted an assessment at four major East and Southern African universities to describe: a) the numbers of HSSR PhD trainees at these institutions, b) existing HSSR curricula and mode of delivery, and c) motivating and challenging factors for PhD training, from the trainees’ experience. Methods: PhD training program managers completed a pre-designed form about trainees enrolled since 2006. A desk review of existing health curricula was also conducted to identify HSSR modules being offered; and PhD trainees completed a self-administered questionnaire on motivating and challenging factors they may have experienced during their PhD training. Results: Of the 640 PhD trainees enrolled in the health sciences since 2006, only 24 (3.8%) were in an HSSR field. None of the universities had a PhD training program focusing on HSSR. The 24 HSSR PhD trainees had trained in partnership with a university outside Africa. Top motivating factors for PhD training were: commitment of supervisors (67%), availability of scholarships (63%), and training attached to a research grant (25%). Top challenging factors were: procurement delays (44%), family commitments (38%), and poor Internet connection (35%). Conclusion: The number of HSSR PhD trainees is at the moment too small to enable a rapid accumulation of the required critical mass of locally trained HSSR professionals to drive the much needed health systems strengthening and innovations in this region. Curricula for advanced HSSR training are absent, exposing a serious training gap for HSSR in this region.