Browsing by Author "Martin, Jeffrey"

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    Depression and All-Cause Mortality in an HIV Treatment Cohort in Rural Uganda!
    (U.S. National Institutes of Health, 2005) Tsai, Alexander; Chan, Brian; Yap, Boum; Jessica, Haberer; Kembabazi, Annet; Mocello, A. Rain; Hunt, Peter; Martin, Jeffrey; Bangsberg, David
    To determine the extent to which depression is associated with mortality among persons living with HIV (PLHIV) initiating antiretroviral therapy (ART).! 694 treatment-naïve PLHIV in rural Uganda were followed from initiation of ART. Each participant provided quarterly data through blood draws and structured interviews. Baseline depression symptom severity and mental health status were measured using locally adapted versions of the Hopkins Symptom Checklist and MOS-HIV mental health summary. Vital status was ascertained through participant tracing after missed study visits. We fit Cox proportional hazards regression models, adjusting our estimates for baseline age, sex, marital status, educational attainment, household asset wealth, CD4+ T-lymphocyte cell count, body mass index, and MOS-HIV physical health summary.! Over 4.3 median years of follow-up, only 48 participants (7%) were lost to follow-up and there were 44 deaths. After multivariable adjustment, probable depression was associated with increased mortality (AHR=2.24; 95% CI, 1.08-4.62), while mental health-related quality of life was not (AHR=0.98; 95% CI, 0.94-1.03).! Conclusions: Depressed mood is associated with increased mortality among HIV+ persons initiating ART. Screening for depression may be a relatively low-cost method of identifying HIV+ persons at high risk for mortality. Whether pre-ART depression reflects underlying immune activation or poor overall health status should be addressed in future studies.!
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    Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda
    (AIDS (London, England), 2014) Weiser, Sheri D.; Palar, Kartika; Frongillo, Edward A.; Tsai, Alexander C.; Kumbakumba, Elias; dePee, Saskia; Hunta, Peter W.; Ragland, Kathleen; Martin, Jeffrey; Bangsber, David R.
    Food insecurity is a potentially important barrier to the success of antiretroviral therapy (ART) programs in resource-limited settings. We undertook a longitudinal study in rural Uganda to estimate the associations between food insecurity and HIV treatment outcomes. Longitudinal cohort study. Participants were from the Uganda AIDS Rural Treatment Outcomes study and were followed quarterly for blood draws and structured interviews. We measured food insecurity with the validated Household Food Insecurity Access Scale. Our primary outcomes were: ART nonadherence (adherence <90%) measured by visual analog scale; incomplete viral load suppression (>400 copies/ml); and low CD4þ T-cell count (<350 cells/ml). We used generalized estimating equations to estimate the associations, adjusting for socio-demographic and clinical variables.
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    Usability of a smartphone-compatible, confocal micro-endoscope for cervical cancer screening in resource-limited settings
    (BioMed Central, 2024-09-02) Kadama-Makanga, Philippa; Semeere, Aggrey; Laker-Oketta, Miriam; Mubiru, Musa; Lukande, Robert; Huchko, Megan; Freeman, Esther; Kulkarni, Nachiket; Martin, Jeffrey; Kang, Dongkyun; Nakalembe, Miriam
    More efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff.BACKGROUNDMore efficient methods to detect and treat precancerous lesions of the cervix at a single visit, such as low-cost confocal microscopy, could improve early diagnosis and hence outcomes. We piloted a prototype smartphone-compatible confocal micro-endoscope (SCME) among women presenting to a public cervical cancer screening clinic in Kampala, Uganda. We describe the piloting of the SCME device at an urban clinic used by lower cadre staff.We screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O'clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women's experiences after screening, and the experience of the nurses who operated the SCME.METHODSWe screened women aged 18 and 60 years, who presented for cervical cancer screening at the Kawempe National Referral Hospital Kampala, and evaluated the experience of their providers (nurses). Nurses received a 2-day training by the study doctors on how to use the SCME, which was added to the standard Visual Inspection with Acetic acid (VIA)-based cervical cancer screening. The SCME was used to take colposcopy images before and after VIA at positions 12 and 6 O'clock if VIA negative, and on precancer-suspicious lesions if VIA positive. We used questionnaires to assess the women's experiences after screening, and the experience of the nurses who operated the SCME.Between November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME's usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME.RESULTSBetween November 2021 and July 2022, we screened 291 women with a median age of 36 years and 65.7% were HIV positive. Of the women screened, 146 were eligible for VIA, 123 were screened with the SCME, and we obtained confocal images from 103 women. Of those screened with the SCME, 60% found it comfortable and 81% were willing to screen again with it. Confocal images from 79% of the women showed distinguishable cellular features, while images from the remaining 21% were challenging to analyze. Nurses reported a mean score of 85% regarding the SCME's usefulness to their work, 71% regarding their satisfaction and willingness to use it again, 63% in terms of ease of use, and 57% concerning the ease of learning how to operate the SCME.Our findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images.CONCLUSIONOur findings demonstrate the feasibility of using the SCME by lower cadre staff in low-resource settings to aid diagnosis of precancerous lesions. However, more work is needed to make it easier for providers to learn how to operate the SCME and capture high-quality confocal images. MEDLINE - Academic