Browsing by Author "Lindan, Christina"

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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.
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    The relationship between spirituality/religiousness and unhealthy alcohol use among HIV-infected adults in southwestern Uganda
    (AIDS and Behavior, 2018) Adong, Julian; Lindan, Christina; Fatch, Robin; Emenyonu, Nneka I.; Muyindike, Winnie R.; Ngabirano, Christine; Winter, Michael R.; Lloyd-Travaglini, Christine; Samet, Jeffrey H.; Cheng, Debbie M.; Hahn, Judith A.
    HIV and alcohol use are two serious and co-existing problems in sub-Saharan Africa. We examined the relationship between spirituality and/or religiousness (SR) and unhealthy alcohol use among treatment-naïve HIV-infected adults attending the HIV clinic in Mbarara, Uganda. Unhealthy alcohol was defined as having either an Alcohol Use Disorders Identification Test – Consumption score of ≥4 for men or ≥3 for women, or having a phosphatidylethanol level of ≥50ng/ml based on analysis of dried blood-spot specimens. Of the 447 participants, 67.8% were female; the median age was 32 years (interquartile range [IQR]: 27–40). About half reported being Protestant (49.2%), 35.1 % Catholic, and 9.2% Muslim. The median SR score was high (103 [IQR: 89–107]); 43.3% drank at unhealthy levels. Higher SR scores were associated with lower odds of unhealthy drinking (adjusted odds ratio [aOR]: 0.83 per standard deviation [SD] increase; 95% confidence interval [CI] 0.66–1.03). The “religious behavior” SR sub-scale was significantly associated with unhealthy alcohol use (aOR: 0.72 per SD increase; 95% CI 0.58–0.88). Religious institutions, which facilitate expression of religious behavior, may be helpful in promoting and maintaining lower levels of alcohol use.