Browsing by Author "Laker, Eva"

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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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    Factors associated with poor social support among Persons Living with HIV/AIDS at the Infectious Disease Institute HIV/AIDS clinic in Uganda, 2019: A cross-sectional study
    (Research Square, 2019) Nakamanya Kitibwakye, Sharon; Kitutu, Freddy Eric; Nabakooza Kigongo, Angella; Olum, Ronald; Katana, Elizabeth; Laker, Eva
    Social support is known to influence desired health outcomes resulting in decrease in morbidity and mortality. HIV patients with poor social support are at risk of worse health outcomes. Little is known about the determinants of social support in the HIV population in Uganda. This study examined the determinants of social support among HIV patients on Atazanavir-based regimen at the Infectious Disease Institute HIV/AIDS clinic in Uganda. Methods We carried out a secondary analysis of data nested in a cross-sectional study to determine the prevalence of clinical jaundice among patients on Atazanavir-based second-line therapy, which was conducted at a specialist HIV center, Infectious Disease Institute (IDI) in Kampala, Uganda from April to May 2019. IDI is a specialist HIV center in Kampala, Uganda with over 7000 patients in care. The primary study consecutively sampled patients on an Atazanavir- based regimen. Social support was assessed by using a 3-item Oslo social scale. Logistic regression was used to determine the association between social support and its correlates. Results Data from 236 participants with the mean age of 40 years ±11 was analyzed. The majority were females (66.5%) and 34% were married. Up to 16.5% (39/236) had other comorbidities and less than 1% (2/236) were depressed. There was a high level of disclosure of status to either a family member, friend, spouse, or children (94%; 221/236). The prevalence of internalized stigma (4%; 9/236) and depression (2/236; 1%) was low. Only disclosure of HIV status was associated with social support (OR= 4.9, 95% CI 1.1 – 21.3, p-value= 0.038). There was no significant association of age, sex, marital status, education status, religion, other chronic comorbidities, depression, drug fatigue, and stigma with social support. Conclusion We found that good/ moderate social support was associated with disclosure of HIV status. However, the relationship between social support and disclosure of HIV status warrants further exploration using qualitative research methods.
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    Factors Associated with Uptake of Contraceptives among HIV Positive Women on Dolutegravir based Anti-Retroviral Treatment at Health Centres of Kampala Capital City Authority. A cross sectional study in Uganda.
    (BMC Women's Health, 2022) Mbabazi, Leah; Nabaggala, Mariah Sarah; Kiwanuka, Suzanne; Kiguli, Juliet; Okoboi, Stephen; Laker, Eva; Castelnuovo, Barbara; Lamorde, Mohammed; Kiconco, Arthur; Amperiize, Mathius
    In May 2018, the World Health Organisation issued a teratogenicity alert for HIV positive women using dolutegravir (DTG) and emphasised increased integration of sexual and reproductive services into HIV care to meet contraceptive needs of HIV positive women. However, there are scarce data on the impact of this guidance on contraceptive uptake. Objective To investigate the uptake of contraceptives and the factors affecting the uptake of contraceptive services among the HIV positive women of reproductive age who use DTG. Methods A cross-sectional survey was conducted from April 2019 to July 2019, in five government clinics in central Uganda where DTG was offered as the preferred first-line antiretroviral treatment (ART) regimen. We randomly selected 359 non-pregnant women aged 15-49 years using DTG-based regimens. We used interviewer administered questionnaires to collect data on demographics, contraceptive use, social and health system factors. We defined contraceptive uptake as the proportion of women using any method of contraception divided by the total number of women on DTG during the review period. We described patients’ characteristics using descriptive statistics. Factors associated with contraceptive uptake were investigated using Poisson regression at multivariable analysis (STATA 14). Results Of the 359 participants, the mean age was 37(SD=6.8), half 50.7% had attained primary level of education and average monthly income <100,000Ushs. The overall level of Contraceptive uptake was 38.4%, modern contraceptive uptake was 37.6% and 96.4% of the participants had knowledge of contraceptives. The most utilised method was the injectable at 58.4% followed by condoms 15%, IUD 10.7%, pills 6.4%, implants 5.4%, and least used was sterilization at 0.7%. Predictor factors that increased likelihood of contraceptive uptake were; religion of others category AIRR=1.53(95% CI: 1.01, 2.29) and parity 3-4 children AIRR=1.48(95% CI: 1.14, 1.92). Reduced rates were observed for age 40-49 years AIRR=0.45(95% CI: 0.21, 0.94), unemployment AIRR 0.63(95% CI: 0.42, 0.94), not discussing FP with partner AIRR=0.39(95% CI: 0.29, 0.52) and not receiving FP counselling AIRR=2.86 (95% CI: 0.12, 0.73). Non-significant variables were facility, education level, marital status, sexual activity, experienced side effects of FP and knowledge on both contraceptives and DTG. Conclusion This study shows a low-level uptake of contraceptives and injectable was the most used method. It also indicated that FP counselling and partner discussion on FP increased contraceptive uptake. Therefore, more strategies should be put in place to increase male involvement in family planning programs and scale up the integration of family planning services into HIV care and management programs.
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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.