Browsing by Author "Nyegenye, Wilson"

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    Cryptococcal Antigenemia in Human Immunodeficiency Virus Antiretroviral Therapy–Experienced Ugandans With Virologic Failure
    (Clinical infectious diseases, 2020) Mpoza, Edward; Radha, Rajasingham; Tugume, Lillian; Joshua, Rhein; Nabaggala, Maria Sarah; Ssewanyana, Isaac; Nyegenye, Wilson; Kushemererwa, Grace Esther; Mulema, Vivienne; Kalamya, Julius; Kiyaga, Charles; Kabanda, Joseph; Ssali, Mina; Boulware, David R.; Meya, David B.
    Detectable serum or plasma cryptococcal antigen (CrAg) precedes symptomatic cryptococcal meningitis. The World Health Organization recommends CrAg screening for human immunodeficiency virus–positive persons with CD4 count <100 cells/μL initiating antiretroviral therapy (ART). However, an increasing proportion of patients with cryptococcosis are now ART experienced. Whether CrAg screening is cost-effective in those with virologic failure is unknown. Methods We retrospectively performed nationwide plasma CrAg testing among ART-experienced Ugandan adults with virologic failure (≥1000 copies/mL) using leftover plasma after viral load testing during September 2017–January 2018. For those who were CrAg positive, we obtained ART history, meningitis occurrence, and 6-month survival via medical records review. Results Among 1186 subjects with virologic failure, 35 (3.0%) were CrAg positive with median ART duration of 41 months (interquartile range, 10–84 months). Among 25 subjects with 6-month outcomes, 16 (64%) survived, 7 (28%) died, and 2 (8%) were lost. One survivor had suffered cryptococcal meningitis 2 years prior. Two others developed cryptococcal meningitis and survived. Five survivors were known to have received fluconazole. Thus, meningitis-free survival at 6 months was 61% (14/23). Overall, 91% (32/35) of CrAg-positive persons had viral load ≥5000 copies/mL compared with 64% (735/1151) of CrAg-negative persons (odds ratio, 6.0 [95% confidence interval, 1.8–19.8]; P = .001). CrAg prevalence was 4.2% (32/768) among those with viral loads ≥5000 copies/mL and 0.7% (3/419) among those with viral loads <5000 copies/mL. Conclusions In addition to the CD4 threshold of <100 cells/μL, reflexive CrAg screening should be considered in persons failing ART in Uganda with viral loads ≥5000 copies/mL.
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    Trends and Determinants of Neonatal Mortality in Uganda: Analysis of the Uganda Demographic and Health Surveys
    (African Population Studies, 2020) Asiime, John Bosco; Nyegenye, Wilson; Muyingo, Edmond
    Uganda’s neonatal mortality has stagnated at 27 deaths per 1,000 live births over the past decade. Studying consistent factors could inform policy to reduce it. We used Uganda Demographic and Health Surveys (2001 to 2016) in analyses. Children who were not put on breast milk immediately after birth and children of mothers with multiple maternal risk factors were associated with higher odds (3.1 and 2.0 respectively) of neonatal deaths in 2016. The maternal risk factors include: young mothers, too old, short birth intervals or many children. Neonatal deaths was also higher among male compared to female newborns. There is a need to raise awareness about the importance of breastfeeding newborns immediately after birth. Interventions to reduce maternal risk factors are critical to reducing neonatal mortality in Uganda. Programmes need measures that can reduce more neonatal deaths among male than female.