Browsing by Author "Patel, Eshan U."

Now showing 1 - 6 of 6
  • Thumbnail Image
    Item
    HIV viral suppression and geospatial patterns of HIV antiretroviral therapy treatment facility use in Rakai, Uganda
    (AIDS (London, England), 2018) Billioux, Veena G.; Grabowski, Mary K.; Ssekasanvu, Joseph; Reynolds, Steven J.; Berman, Amanda; Bazaale, Jeremiah; Patel, Eshan U.; Bugos, Eva; Ndyanabo, Anthony; Kisakye, Alice; Kagaayi, Joseph; Gray, Ronald H.; Nakigozi, Gertrude; Ssekubugu, Robert; Nalugoda, Fred; Serwadda, David; Wawer, Maria J.; Chang, Larry W.
    To assess geospatial patterns of HIV antiretroviral therapy (ART) treatment facility use and whether they were impacted by viral load (VL) suppression. Methods—We extracted data on the location and type of care services utilized by HIV-positive persons accessing ART between February 2015 and September 2016 from the Rakai Community Cohort Study (RCCS) in Uganda. The distance from RCCS households to facilities offering ART was calculated using the open street map road network. Modified Poisson regression was used to identify predictors of distance traveled and, for those traveling beyond their nearest facility, the probability of accessing services from a tertiary care facility. Results—1554 HIV-positive participants were identified, of whom 68% had initiated ART. The median distance from households to the nearest ART facility was 3.10 km (Interquartile range, IQR, 1.65–5.05), but the median distance traveled was 5.26 km (IQR, 3.00–10.03, p<0.001) and 57% of individuals travelled further than their nearest facility for ART. Those with higher education and wealth were more likely to travel further. 93% of persons on ART were virally suppressed, and there was no difference in the distance traveled to an ART facility between those with suppressed and unsuppressed VLs (5.26 km vs. 5.27 km, p=0.650). Conclusions—Distance traveled to HIV clinics was increased with higher socioeconomic status, suggesting that wealthier individuals exercise greater choice. However, distance traveled did not vary by those who were or were not virally suppressed.
  • Thumbnail Image
    Item
    Immunological Signaling During Herpes Simplex Virus-2 and Cytomegalovirus Vaginal Shedding After Initiation of Antiretroviral Treatment
    (Oxford University Press, 2016) Nason, Martha C.; Patel, Eshan U.; Kirkpatrick, Allison R.; Prodger, Jessica L.; Shahabi, Kamnoosh; Tobian, Aaron A. R.; Gianella, Sara; Kalibbala, Sarah; Ssebbowa, Paschal; Kaul, Rupert; Gray, Ronald H.; Quinn, Thomas C.; Serwadda, David; Reynolds, Steven J.; Redd, Andrew D.
    Vaginal proinflammatory cytokine expression during herpes virus reactivation was examined in human immunodeficiency virus infected women before and after initiation of antiretroviral therapy (ART). Vaginal swabs were screened for levels of cytokines interleukin (IL)-1β, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12p70, IL-13, tumor necrosis factor (TNF)-α, and interferon- γ. The relative risk (RR) of herpes simplex virus-2 or cytomegalovirus (CMV) shedding being associated with cytokine levels above the median were estimated. Herpes simplex virus-2 shedding was significantly associated with higher levels of IL-6 (RR = 1.4, P = .003) and TNF-α (RR = 1.3, P = .010), whereas CMV shedding was associated with higher IL-6 (RR = 1.3, P = .006) and IL-2 (RR = 1.4, P = .01). The association of viral shedding with higher IL-6 levels suggests that herpes virus reactivation may be playing a role in immune activation after ART initiation.
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Prevalence and Predictors of Persistent Human Immunodeficiency Virus Viremia and Viral Rebound After Universal Test and Treat: A Population-Based Study
    (The Journal of infectious diseases, 2021) Grabowski, M. Kate; Patel, Eshan U.; Nakigozi, Gertrude; Ssempijja, Victor; Ssekubugu, Robert; Ssekasanvu, Joseph; Ndyanabo, Anthony; Kigozi, Godfrey; Nalugoda, Fred; Gray, Ronald H.; Kalibbala, Sarah; Serwadda, David M.; Laeyendecker, Oliver; Wawer, Maria J.; Chang, Larry W.; Quinn, Thomas C.; Kagaayi, Joseph; Tobian, Aaron A. R.; Reynolds, Steven J.
    UNAIDS targets for human immunodeficiency virus (HIV) epidemic control by 2030 include that 86% of all HIV-positive persons be on antiretroviral therapy (ART) and achieve HIV viral load (VL) suppression [1]. The major policy initiative underpinning this target is universal test and treat (UTT), whereby all HIV-positive persons, irrespective of CD4 count or severity of illness, are immediately prescribed ART [2]. In sub-Saharan Africa, which accounts for more than half of all new HIV diagnoses globally, there has been considerable progress in increasing ART coverage [
  • Thumbnail Image
    Item
    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.
  • Thumbnail Image
    Item
    Vaginal Cytomegalovirus Shedding Before and After Initiation of Antiretroviral Therapy in Rakai, Uganda
    (The Journal of infectious diseases, 2015) Gianella, Sara; Redd, Andrew D.; Grabowski, Mary K.; Tobian, Aaron A. R.; Serwadda, David; Newell, Kevin; Patel, Eshan U.; Kalibbala, Sarah; Ssebbowa, Paschal; Gray, Ronald H.; Quinn, Thomas C.; Reynolds, Steven J.
    Vaginal shedding of cytomegalovirus (CMV) DNA was determined longitudinally among 96 women coinfected with human immunodeficiency virus (HIV), herpes simplex virus 2, and CMV starting antiretroviral therapy (ART) during a placebo-controlled trial of HSV-2 suppression with acyclovir in Rakai, Uganda. Vaginal CMV was detected in 75 of 96 women (78.0%) and 379 of 1080 individual visits (35.1%). ART status, higher HIV RNAviral load before ART initiation, and younger age were significantly associated with increased frequency of CMV shedding (P < .01). Compared to pre- ART, CMV shedding peaked from month 2 to month 4 after ART initiation, suggesting possible immune reconstitution inflammatory syndrome. Further studies need to determine the clinical significance of asymptomatic CMV shedding.