Browsing by Author "Lubega, Irene"

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    Cardiac Dysfunction Among Ugandan HIV-Infected Children on Antiretroviral Therapy
    (The Pediatric infectious disease journal, 2016) Namuyonga, Judith; Lubega, Sulaiman; Musiime, Victor; Lwabi, Peter; Lubega, Irene
    Despite effective antiretroviral therapy (ART), HIV-infected children on treatment have been observed to have cardiac abnormalities. We sought to determine the prevalence, types and factors associated with cardiac abnormalities among HIV-infected Ugandan children on combination ART. Methods—We carried out a cross-sectional study from July 2012 to January 2013, at Joint Clinical Research Centre among HIV infected children aged 1 to 18 years. Cardiac abnormalities were assessed using electrocardiography (EKG) and echocardiography. CD4 counts, viral load and complete blood count were performed at enrollment. The prevalence of cardiac abnormalities was determined using simple proportions with the associated factors ascertained using logistic regression. Results—Among 285 children recruited, the median (IQR) age was 9 (6, 13) years, 54% were female; 72% were on first line cART. Their mean (±sd) CD4 count was 1092 (±868.7) cells/mm3; median (IQR) viral load was 20 (20, 76) copies/ml. 94% had adherence to ART of more than 95%. Cardiac abnormalities were detected in 39 (13.7%) children. The most common abnormalities by EKG and echocardiography were non specific T-wave changes (4.6%) and pericardial disease (thickened pericardium with or without pericardial effusion) (2.8%), respectively. No factor assessed was found to be significantly associated occurrence of cardiac dysfunction. Conclusions—The prevalence of cardiac dysfunction among the HIV-infected children on ART was 13.7 % which was high, with non specific T wave changes and pericardial disease being the most frequent abnormalities observed. No factor assessed was found to be associated with cardiac dysfunction.
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    Distribution of haematological and chemical pathology values among infants in Malawi and Uganda
    (Paediatrics and international child health, 2012) Kumwenda, Newton I.; Khonje, Tiwonge; Mipando, Linda; Nkanaunena, Kondwani; Katundu, Pauline; Lubega, Irene; Bolton, Steve; Bagenda, Danstan; Mubiru, Michael; Glenn Fowler, Mary; Taha, Taha E.; Ali, Elbireer
    Data on paediatric reference laboratory values are limited for sub-Saharan Africa. Objective: To describe the distribution of haematological and chemical pathology values among healthy infants from Malawi and Uganda. Methods: A cross-sectional study was conducted among healthy infants, 0–6 months old, born to HIVuninfected mothers recruited from two settings in Blantyre, Malawi and Kampala, Uganda. Chemical pathology and haematology parameters were determined using standard methods on blood samples. Descriptive analyses by age-group were performed based on 2004 Division of AIDS Toxicity Table age categories. Mean values and interquartile ranges were compared by site and age-group. Results: A total of 541 infants were included altogether, 294 from Malawi and 247 from Uganda. Overall, the mean laboratory values were comparable between the two sites. Mean alkaline phosphatase levels were lower among infants aged (21 days while aspartate aminotransferase, creatinine, total bilirubin and gamma-glutamyl transferase were higher in those aged 0–7 days than in older infants. Mean haematocrit, haemoglobin and neutrophil counts were higher in the younger age-groups (,35 days) and overall were lower than US norms. Red and white blood cell counts tended to decrease after birth but increased after y2 months of age. Mean basophil counts were higher in Malawi than in Uganda in infants aged 0–1 and 2– 7 days; mean counts for eosinophils (for age groups 8–21 or older) and platelets (for all age groups) were higher in Ugandan than in Malawian infants. Absolute lymphocyte counts increased with infant age. Conclusion: The chemical pathology and haematological values in healthy infants born to HIV-uninfected mothers were comparable in Malawi and Uganda and can serve as useful reference values in these settings.
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    Dried Blood Spots on Filter Paper as an Alternative Specimen for Measles Diagnostics: Detection of Measles Immunoglobulin M Antibody by a Commercial Enzyme Immunoassay
    (The Journal of infectious diseases, 2011) Uzicanin, Amra; Lubega, Irene; Nanuynja, Miriam; Mercader, Sara; Rota, Paul; Bellini, William; Helfand, Rita
    We compared the results of a serum-based measles immunoglobulin M (IgM) test with results of tests using paired reconstituted dried filter paper blood spot (DBS) samples to assess the feasibility of using DBS samples for measles diagnostic procedures. Methods. We collected 588 paired serum and DBS samples from 349 children aged 8 months through 12 years at Mulago Hospital in Kampala, Uganda; of these samples, 513 (87%) were collected from children with a clinical diagnosis of measles 0–33 days after rash, and 75(13%) were collected from children hospitalized for other reasons. Eluted DBS and serum samples were tested using a commercial measles IgM enzyme immunoassay. Detection of viral RNA was attempted on a subset of 20 DBS by reverse-transcriptase polymerase chain reaction. Results. Among the 513 sample pairs collected from children with measles, the concordances for samples collected during days 0–6 and.1 week after rash were 95.7% and 100%, respectively (P , .01). The relative sensitivity and specificity of the DBS-based assay during the first week were 98.7%and 88.9%, respectively, and the sensitivity and specificity .1 week after rash were 100% and 100%, respectively. Viral RNA was detected in 5 (26%) of 19 DBS samples tested. Among 75 sample pairs collected fromchildren hospitalized for other reasons, concordance was 94.7%. Conclusions. DBS samples are a feasible alternative sample for measles diagnostic procedures in high-incidence settings.
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    Malaria parasitemia among blood donors in Uganda
    (Transfusion, 2020) Murphy, Kristin J.; Conroy, Andrea L.; Ddungu, Henry; Shrestha, Ruchee; Kyeyune-Byabazaire, Dorothy; Petersen, Molly R.; Musisi, Ezra; Patel, Eshan U.; Kasirye, Ronnie; Bloch, Evan M.; Lubega, Irene; John, Chandy C.; Hume, Heather A.; Tobian, Aaron A.R.
    Malaria remains a leading transfusion associated infectious risk in endemic areas. However, the prevalence of malaria parasitemia has not been well characterized in blood donor populations. This study sought to determine the prevalence of Plasmodium in red blood cell (RBC) and whole blood (WB) units after the rainy season in Uganda. METHODS AND MATERIALS: Between May and July 2018, blood was collected from the sample diversion pouch of 1000 WB donors in Kampala and Jinja, Uganda. The RBC pellet from ethylenediamine tetraacetic acid (EDTA) anticoagulated blood was stored at −80°C until testing. DNA was extracted and nested PCR was used to screen samples at the genus level for Plasmodium, with positive samples further tested for species identification. RESULTS: Malaria parasitemia among asymptomatic, eligible blood donors in two regions of Uganda was 15.4%; 87.7% (135/154) of infections were with P. falciparum, while P. malariae and P. ovale were also detected. There were 4.3% of blood donors who had mixed infection with multiple species. Older donors (>30 years vs. 17-19 years; aPR = 0.31 [95% CI = 0.17-0.58]), females (aPR = 0.60 [95% CI = 0.42-0.87]), repeat donors (aPR = 0.44 [95% CI = 0.27-0.72]) and those donating near the capital city of Kampala versus rural Jinja region (aPR = 0.49 [95% CI = 0.34-0.69]) had a lower prevalence of malaria parasitemia. CONCLUSIONS: A high proportion of asymptomatic blood donors residing in a malaria endemic region demonstrate evidence of parasitemia at time of donation. Further research is needed to quantify the risk and associated burden of transfusion-transmitted malaria (TTM) in order to inform strategies to prevent TTM.
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    Prevalence of latent rheumatic heart disease among HIV-infected children in Kampala, Uganda
    (Journal of acquired immune deficiency syndromes, 2016) Gleason, Brigette; Mirembe, Grace; Namuyonga, Judith; Okello, Emmy; Lwabi, Peter; Lubega, Irene; Lubega, Sulaiman; Musiime, Victor; Kityo, Cissy; Salata, Robert A.; Longenecker, Chris T.
    Rheumatic heart disease (RHD) remains highly prevalent in resource-constrained settings around the world, including countries with high rates of HIV/AIDS. Although both are immune-mediated diseases, it is unknown whether HIV modifies the risk or progression of RHD. We performed screening echocardiography to determine the prevalence of latent rheumatic heart disease in 488 HIV-infected children aged 5-18 in Kampala, Uganda. The overall prevalence of borderline/definite RHD was 0.82% (95% CI 0.26% to 2.23%) which is lower than the published prevalence rates of 1.5-4% among Ugandan children. There may be protective factors that decrease the risk of RHD in HIV-infected children.
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    Prevalence of undetectable and suppressed viral load in HIV‑infected pregnant women initiating Option B+ in Uganda: an observational study nested within a randomized controlled trial
    (Springer Nature, 2021) Gabagaya, Grace; Rukundo, Gordon; Amone, Alexander; Wavamunno, Priscilla; Namale‑Matovu, Joyce; Lubega, Irene; Nakabiito, Clemensia; Namukwaya, Zikulah; Nolan, Monica; Malamba, Samuel S.; King, Rachel; Homsy, Jaco ,; Glenn Fowler, Mary; Musoke, Philippa
    Viral load (VL) testing is key in monitoring adherence to antiretroviral therapy (ART) and documenting HIV treatment response. As per HIV treatment guidelines in Uganda, the first VL test is recommended 6 months after initiation of ART. Undetectable VL (uVL) at ART initiation may be helpful in detecting elite controllers in the absence of previous ART use. We investigated viral suppression at ART initiation among a cohort of HIV-positive pregnant women enrolled in the Friends for Life Circles (FLC) for Option B+ randomized controlled trial (RCT). Methods: Pregnant women ≥ 18 years of age testing positive for HIV at their first antenatal care visit and starting on ART Option B+ as per the National PMTCT Program guidelines were enrolled into the FLC for Option B+ RCT in urban Kampala and rural Mityana districts of Uganda. Each participant had whole blood samples collected at enrolment to assess baseline VL. Plasma HIV-1 RNA was quantified using COBAS Ampliprep /COBAS Taqman. Baseline VL below 400 RNA copies/ml was considered as viral suppression while baseline VL below 20 RNA copies/ml was considered uVL. Results: The mean duration from the date of ART initiation to time of sample collection for baseline VL assessment was 4.4 days (SD 3.6). Of the 532 HIV-positive pregnant women enrolled in the FLC for Option B+ study and newly starting Option B+ without a self-reported history of prior ART use, 29 (5.5%) had uVL and 113 (21.4%) had suppressed VL at baseline. There was no association between participants’ age, gravidity, marital status, mean monthly income, educational level, disclosure of HIV status to partner, and uVL or viral suppression at baseline. However, nondisclosure of HIV status to any other person was associated with decreased odds of viral suppression at baseline (OR 0.640; 0.416–0.982). Conclusion: Twenty-one percent of HIV-positive Ugandan pregnant women initiating ART (Option B+) showed virological suppression at baseline and were presumed to be “elite controllers” or to have misreported being ART-naive.
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    SARS-CoV-2 seroprevalence among blood donors in Uganda: 2019–2022
    (John Wiley & Sons, Ltd, 2023-05-16) Bloch, Evan M; Kyeyune, Dorothy; White, Jodie L; Ddungu, Henry; Ashokkumar, Swetha; Habtehyimer, Feben; Baker, Owen; Kasirye, Ronnie; Patel, Eshan U.; Grabowski, M. Kate; Musisi, Ezra; Moses, Khan; Hume, Heather A; Lubega, Irene; Shrestha, Ruchee; Motevalli, Mahnaz; Fernandez, Reinaldo E; Reynolds, Steven J; Redd, Andrew D; Wambongo Musana, Hellen; Dhabangi, Aggrey; Ouma, Joseph; Eroju, Priscilla; Lange, Telsa; Fowler, Mary Glenn; Musoke, Philippa; Stramer, Susan L.; Whitby, Denise; Zimmerman, Peter A; McCullough, Jeffrey; Sachithanandham, Jaiprasath; Pekosz, Andrew; Goodrich, Raymond; Quinn, Thomas C; Ness, Paul M.; Laeyendecker, Oliver; Tobian, Aaron A. R.
    Abstract Abstract Background The true burden of COVID‐19 in low‐ and middle‐income countries remains poorly characterized, especially in Africa. Even prior to the availability of SARS‐CoV‐2 vaccines, countries in Africa had lower numbers of reported COVID‐19 related hospitalizations and deaths than other regions globally. Methods Ugandan blood donors were evaluated between October 2019 and April 2022 for IgG antibodies to SARS‐CoV‐2 nucleocapsid (N), spike (S), and five variants of the S protein using multiplexed electrochemiluminescence immunoassays (MesoScale Diagnostics, Rockville, MD). Seropositivity for N and S was assigned using manufacturer‐provided cutoffs and trends in seroprevalence were estimated by quarter. Statistically significant associations between N and S antibody seropositivity and donor characteristics in November–December 2021 were assessed by chi‐square tests. Results A total of 5393 blood unit samples from donors were evaluated. N and S seropositivity increased throughout the pandemic to 82.6% in January–April 2022. Among seropositive individuals, N and S antibody levels increased ≥9‐fold over the study period. In November–December 2021, seropositivity to N and S antibody was higher among repeat donors (61.3%) compared with new donors (55.1%; p = .043) and among donors from Kampala (capital city of Uganda) compared with rural regions ( p = .007). Seropositivity to S antibody was significantly lower among HIV‐seropositive individuals (58.8% vs. 84.9%; p = .009). Conclusions Despite previously reported low numbers of COVID‐19 cases and related deaths in Uganda, high SARS‐CoV‐2 seroprevalence and increasing antibody levels among blood donors indicated that the country experienced high levels of infection over the course of the pandemic.
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    Thyroid autoimmunity and function among Ugandan children and adolescents with type-1 diabetes mellitus
    (The Pan African Medical Journal, 2014) Muhame, Rugambwa Michael; Arwanire Mworozi, Edison; McAssey, Karen; Lubega, Irene
    Up to 30% of type-1 diabetes mellitus (T1DM) patients have co-existent thyroid autoimmunity with up to 50% of them having associated thyroid dysfunction. Routine screening for thyroid autoimmunity and dysfunction is recommended in all T1DM patients. However, this was not currently practiced in Ugandan paediatric diabetes clinics. There was also paucity of data regarding thyroid autoimmunity and dysfunction in African children and adolescents with diabetes mellitus. The objective of this study was to quantify the magnitude of thyroid autoimmunity and dysfunction in Ugandan children with TIDM. Methods: This was a cross sectional descriptive study to determine the prevalence of thyroid autoantibodies and describe thyroid function among children and adolescents aged 1-19 years with diabetes mellitus attending the paediatric diabetes clinic at Mulago National Referral Hospital, Kampala, Uganda. Following enrollment, we obtained details of clinical history and performed physical examination. Blood (plasma) was assayed to determine levels of antibodies to thyroid peroxidase (antiTPO), free thyroxine (FT4) and thyrotropin (TSH). Results: The prevalence of thyroid autoimmunity was 7.3% (5/69). All antiTPO positive subjects were post pubertal, aged between 13-17 years with females comprising 3/5 of the antiTPO positive subjects. All study subjects were clinically euthyroid; however, 7.3% (5/69) of the study subjects had subclinical hypothyroidism. Conclusion: These data strengthen the argument for routine screening of all diabetic children and adolescents for thyroid autoimmunity (particularly anti-TPO) as recommended by international guidelines. We also recommend evaluation of thyroid function in diabetic children and adolescents to minimize the risk of undiagnosed thyroid dysfunction.