Browsing by Author "Shade, Starley B."

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    Alcohol Use and HIV Disease Progression in an Antiretroviral Naïve Cohort
    (Journal of acquired immune deficiency syndromes, 2018) Hahn, Judith A.; Cheng, Debbie M.; Emenyonu, Nneka I.; Lloyd-Travaglini, Christine; Fatch, Robin; Shade, Starley B.; Ngabirano, Christine; Adong, Julian; Bryant, Kendall; Muyindike, Winnie R.; Samet, Jeffrey H.
    Alcohol use has been shown to accelerate disease progression in experimental studies of simian immunodeficiency virus in macaques, but the results in observational studies of HIV have been conflicting. We conducted a prospective cohort study of the impact of unhealthy alcohol use on CD4 cell count among HIV-infected persons in southwestern Uganda not yet eligible for antiretroviral treatment (ART). Unhealthy alcohol consumption was 3-month Alcohol Use Disorders Identification Test – Consumption (AUDIT-C) positive (≥3 for women, ≥4 for men) and/or phosphatidylethanol (PEth - an alcohol biomarker) ≥50 ng/ml, modeled as a time-dependent variable in a linear mixed effects model of CD4 count.
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    Costs of Streamlined HIV Care Delivery in Rural Ugandan and Kenyan Clinics in the SEARCH Study
    (AIDS, 2018) Shade, Starley B.; Osmand, Thomas; Aine, Ronald; Mwebaza, Betty; Owaraganise, Asiphas; Mwangwa, Florence; Kwarisiima, Dalsone; Bukusi, Elizabeth A.; Kamya, Moses R.; Petersenk, Maya L.; Havlir, Diane V.; Jain, Vivek
    As antiretroviral therapy (ART) rapidly expands in sub-Saharan Africa using new efficient care models, data on costs of these approaches are lacking. We examined costs of a streamlined HIV care delivery model within a large HIV test-and-treat study in Uganda and Kenya. We calculated observed per-person-per-year (ppy) costs of streamlined care in 17 health facilities in SEARCH Study intervention communities (NCT: 01864603) via micro-costing techniques, time-and-motion studies, staff interviews, and administrative records. Cost categories included salaries, ART, viral load testing, recurring goods/services, and fixed capital/facility costs. We then modeled costs under three increasingly efficient scale-up scenarios: lowest-cost ART, centralized viral load testing, and governmental healthcare worker salaries. We assessed the relationship between community-specific ART delivery costs, retention in care, and viral suppression. Estimated streamlined HIV care delivery costs were $291/ppy. ART ($117/ppy for TDF/3TC/EFV [40%]) and viral load testing ($110/ppy for 2 tests/year [39%]) dominated costs versus salaries ($51/ppy), recurring costs ($5/ppy), and fixed costs ($7/ppy). Optimized ART scale-up with lowest-cost ART ($100/ppy), annual viral load testing ($24/ppy), and governmental healthcare salaries ($27/ppy), lowered streamlined care cost to $163/ppy. We found clinic-to-clinic heterogeneity in retention and viral suppression levels versus streamlined care delivery costs, but no correlation between cost and either retention or viral suppression. In the SEARCH Study, streamlined HIV care delivery costs were similar to or lower than prior estimates despite including viral load testing; further optimizations could substantially reduce costs further. These data can inform global strategies for financing ART expansion to achieve UNAIDS 90–90–90 targets.
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    Fertility Desires and Intentions among HIV-Positive Women during the Post-natal period in Uganda
    (African journal of reproductive health, 2014) Gutin, Sarah A.; Namusoke, Fatuma; Shade, Starley B.; Mirembe, Florence
    This study describes the fertility intentions and discusses the potential reproductive health needs of post-natal HIV-infected Ugandan women. HIV-infected mothers attending post-natal services in Kampala, Uganda participated in this cross-sectional study using structured interviewer administered questionnaires. Descriptive statistics and logistic regression models were used to identify predictors of desire for more children. Among 403 participants, 35% desired more children. Of these, 25% wanted another child within 2 years and 75% within 3 years or more. In multivariable analyses, believing that one’s partners wanted more children (OR=2.44; 95% CI = 1.30, 4.59) was associated with the desire for future children while having more living children was negatively associated with the desire for future children (OR=0.08; 95% CI = 0.02, 0.39). A minority of women desired future pregnancies, and most wanted to delay pregnancy for 3 years. These women are in need of family planning (FP) methods to meet stated desires to delay or end future pregnancies. Perceived partner desire for children also impacts on women’s fertility intentions, highlighting the importance of engaging men during the post-natal period