Browsing by Author "Okwir, Mark"

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    Challenges Associated with the Roll-out of HCC Surveillance in Sub-Saharan Africa - the Case of Uganda
    (Journal of Hepatology, 2020) Hees, Stijn Van; Muyindike, Winnie; Erem, Geoffrey; Ocama, Ponsianoo; Seremba, Emmanuel; Apiyo, Paska; Michielsen, Peter; Okwir, Mark; Vanwolleghem, Thomas
    In their recent review article, Singal and coworkers describe the challenges associated with surveillance for hepatocellular carcinoma (HCC) and propose interventions to increase the effectiveness of surveillance. We agree with the authors that improved uptake of screening and performance of HCC surveillance should be considered a high priority in Western countries. In sub-Saharan Africa, where HBV infections are the main cause of HCC, surveillance programs are mostly not available. Nonetheless, with an incidence rate of 8.9 cases per 100,000 inhabitants per year, which is likely to be an underestimate, HCC surveillance is a pressing medical need in this part of the world. The recent introduction of country-wide vaccination programs in these countries will likely result in a drop in HCC incidence a few decades from now, but this does not apply to patients that are currently infected. In a recent African cohort of 1,315 hepatocellular tumors, 84% of the tumors were diagnosed at a late, multifocal disease stage with a mean size of 8 ± 4 cm and a median survival of 2.5 months.Given the strong association between early detection and improved survival, these findings highlight the need to set up surveillance programs in sub-Saharan Africa, provided curative treatment options are available.
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    Poor long-term outcomes despite improved hospital survival for patients with cryptococcal meningitis in rural, Northern Uganda
    (Public Library of Science, 2024-05) Okwir, Mark; Link, Abigail; Opio, Bosco; Okello, Fred; Nakato, Ritah; Nabongo, Betty; Alal, Jimmy; Rhein, Joshua; Meya, David; Liu, Yu; Bohjanen, Paul R
    Cryptococcal meningitis (CM) remains a major cause of death among people living with HIV in rural sub-Saharan Africa. We previously reported that a CM diagnosis and treatment program (CM-DTP) improved hospital survival for CM patients in rural, northern Uganda. This study aimed to evaluate the impact on long-term survival. We conducted a retrospective study at Lira Regional Referral Hospital in Uganda evaluating long-term survival ([greater than or equal to]1 year) of CM patients diagnosed after CM-DTP initiation (February 2017-September 2021). We compared with a baseline historical group of CM patients before CM-DTP implementation (January 2015-February 2017). Using Cox proportional hazards models, we assessed time-to-death in these groups, adjusting for confounders. We identified 318 CM patients, 105 in the Historical Group, and 213 in the CM-DTP Group. The Historical Group had a higher 30-day mortality of 78.5% compared to 42.2% in the CM-DTP Group. The overall survival rate for the CM-DTP group at three years was 25.6%. Attendance at follow-up visits (HR:0.13, 95% CI: [0.03-0.53], p <0.001), ART adherence (HR:0.27, 95% CI: [0.10-0.71], p = 0.008), and fluconazole adherence: (HR:0.03, 95% CI: [0.01-0.13], p 50kg (HR:0.54, 95% CI: [0.35-0.84], p = 0.006), and performance of therapeutic lumbar punctures (HR:0.42, 95% CI: [0.24-0.71], p = 0.001), were associated with lower risk of death. Altered mentation was associated with increased death risk (HR: 1.63, 95% CI: 1.10-2.42, p = 0.016). Long-term survival of CM patients improved after the initiation of the CM-DTP. Despite this improved survival, long-term outcomes remained sub-optimal, suggesting that further work is needed to enhance long-term survival.
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    Prevalence of Intestinal Helminth Coinfection in Drug-Resistant Tuberculosis in Uganda
    (Open Forum Infectious Diseases, 2022) Baluku, Joseph Baruch; Nakazibwe, Bridget; Wasswa, Amir; Naloka, Joshua; Ntambi, Samuel; Waiswa, Damalie; Okwir, Mark; Nabwana, Martin; Bongomin, Felix; Katuramu, Richard; Nuwagira, Edwin; Ntabadde, Kauthrah; Katongole, Paul; Senyimba, Catherine; Andia-Biraro, Irene
    Although a third of people with tuberculosis (TB) are estimated to be coinfected with helminths, the prevalence is largely unknown among people with drug-resistant TB (DR-TB). We determined the prevalence of helminth coinfection among people with DR-TB in Uganda. In a multicenter, cross-sectional study, eligible Ugandan adults with confirmed DR-TB were consecutively enrolled between July to December 2021 at 4 treatment centers. Sociodemographic data were collected using a questionnaire. Participants underwent anthropometric and blood pressure measurements, and blood samples were evaluated for random blood glucose, glycated hemoglobin, nonfasting lipid profile, human immunodeficiency virus (HIV) infection, and a complete blood count. Fresh stool samples were evaluated for adult worms, eggs, and larvae using direct microscopy after Kato-Katz concentration techniques. Of 212 participants, 156 (73.6%) were male, 118 (55.7%) had HIV, and 3 (2.8%) had malaria coinfection. The prevalence of intestinal helminth coinfection was 4.7% (10/212) (95% confidence interval, 2.6%–8.6%). The frequency of helminth infections was Ancylostoma duodenale (n = 4), Schistosoma mansoni (n = 2), Enterobius vermicularis (n = 2), Ascaris lumbricoides (n = 1), and Trichuris trichiura (n = 1). The prevalence of helminth coinfection was low among people with DR-TB. More studies are needed to determine the clinical relevance of helminth/DR-TB coinfection.