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A 10 years Trend of Peptic Ulcer Disease and other Gastrointestinal Disorders in Northern Uganda
(East and Central African Journal of Surgery, 2016) Okello, T.R.; Ogwang, D.M; Pecorella, I.
The changing trend of GI disorders has not been expounded in our setting, there is need to examine the extent to which major endoscopically diagnosed upper GI disorders have changed in the last 10 years (2005 to 2015). Methods: This was a retrospective study in which endoscopically diagnosed GI disorders of Jan-Jun 2005 were compared with 2015 (10 years) for the same period Results: In the 10 years (2005 to 2015), the prevalence of peptic ulcer disease (PUD) reduced from 9.6% to 2.9% (P value 0.000), followed by esophageal varices from 10.3% to 4.0%, and duodenitis from 3.2% to 0.7% respectively. Gastritis increased from 18.4% to 48.2% (P value 0.000), followed by cancer esophagus from 3.2% to 5.1%. Conclusion: As the prevalence of PUD decreases in our community, gastritis increases hence patients with upper GI symptoms tend to suffer gastritis thus clinicians should focus on treating gastritis and eradication of Helicobacter pylori.
A 10-year retrospective study of lung cancer in Uganda
(BioMed Central Ltd, 2022-02) Bogere, Naghib; Bongomin, Felix; Katende, Andrew; Omaido, Blair Andrew; Namukwaya, Elizabeth; Mayanja-Kizza, Harriet; Walusansa, Victoria
Abstract Background Lung cancer is a leading cause of cancer-related deaths in Uganda. In this study, we aimed to describe the baseline characteristics and survival of patients with lung cancer at the Uganda Cancer Institute (UCI). Methods We retrospectively reviewed medical records of all patients with a histological diagnosis of lung cancer registered at UCI between January 2008 and August 2018. Data on demographic, clinical, and treatment characteristics, and vital status were abstracted and analyzed. Patients with undocumented vital status on the medical records were contacted through phone calls. We determined survival as time from histological diagnosis to death. The Kaplan-Meier survival analysis was performed to estimate the median survival time and the 5-year overall survival rate. Results Of the 207 patients enrolled, 56.5% (n = 117) were female, median age was 60 years (range: 20–94), 78.7% (n = 163) were never-smokers and 18 (8.7%) were living with HIV. Presumptive anti-tuberculosis treatment was given to 23.2% (n = 48). Majority had non-small cell lung cancer (96.6%, n = 200) with 74.5% (n = 149) adenocarcinoma and 19% (n = 38) squamous cell carcinoma. All had advanced (stage III or IV) disease with 96.1% (n = 199) in stage IV. Chemotherapy (44.9%, n = 93) and biological therapy (34.8%, n = 72) were the commonest treatments used. Overall survival at 6 months, 1-, 2- and 5-years was 41.7, 29.7, 11.8, and 1.7%, respectively. The median survival time of 4.4 months was not statistically significantly different between participants with NSCLC or SCLC (4.5 versus 3.9 months, p = .335). Conclusion In Uganda, adenocarcinoma is the predominant histologic subtype of lung cancer and patients are predominantly females, and non-smokers. Patients present late with advanced disease and poor overall survival. Public awareness should be heightened to facilitate early detection and improve outcomes.
A 10-Year Risk of Cardiovascular Disease among Patients with Severe Mental Illness at Mbarara Regional Referral Hospital, Southwestern Uganda
(BioMed Research International, 2020) Agaba, David Collins; Migisha, Richard; Lugobe, Henry Mark; Katamba, Godfrey; Ashaba, Scholastic
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide. Patients with severe mental illness (SMI) are at a higher risk for developing CVD and have a higher risk for harboring factors related to CVD. In addition to the effects of antipsychotic medications, unhealthy lifestyle factors, such as poor diet, inadequate physical activity, cigarette smoking, and sedentary behaviors, are known to be risk factors that may contribute to poor cardiovascular health in patients with SMI. Early identification of individuals at elevated risk of CVD is essential so that dietary and lifestyle modifications or pharmacological interventions can be prescribed to alleviate the risk of cardiovascular disease. The objective of the study was to determine the 10-year risk of cardiovascular disease among patients with severe mental illness at Mbarara Regional Referral Hospital, southwestern Uganda. We conducted a cross-sectional study at the outpatient mental health clinic of Mbarara Regional Referral Hospital, between October 2018 and March 2019. We used the Globorisk CVD risk score to estimate the 10-year risk of CVD among patients with SMI, using the online Globorisk calculator. Participants were then assigned to one of three categories depending on their 10-year CVD risk score: <3% (low), 3–10% (intermediate), and >10% (high). We calculated the risk scores of 125 participants aged 40-74 years. Most of the participants were female 75 (60%), had a diagnosis of bipolar disorder 75 (60%), and had mental illness for ≥10 years 57 (46%). Eighty five percent (85%) of the participants had intermediate to high 10-year risk of CVD (64% with intermediate and 21% with high risk). The average risk score was significantly higher in males compared to females, 8.82% versus 6.43%, p = 0:016. We detected a high 10-year risk of CVD in a significant proportion of patients with SMI in southwestern Uganda. We recommend lifestyle modifications and pharmacological interventions to reverse risk or delay progression to CVD in this patient population.
2353.Distance and Time to Clinic Are Associated with Increased Risk of Detectable HIV-1 Viral Load at a Peripheral Health Center in Rural Western Uganda
(US: Oxford University Press., 2022) Hendren, Cate; Ndizeye, Ronnie; Mumbere, Nobert; Rubinstein, Rebecca J.; Baguma, Emma; Muhindo, Rabbison; Goel, Varun; Ntaro, Moses; Siedner, Mark; Mulogo, Edgar
Antiretroviral therapy (ART) improves the health of people living with HIV (PLHIV) and reduces HIV transmission. While availability and efficacy of ART have improved in sub-Saharan Africa (SSA), access remains a challenge. Travel burden, measured as travel time, distance, and cost, has been posited as a potential barrier to ART. For example, a previous study at a large, urban referral center in Uganda showed GPS-measured distance was associated with clinic absenteeism. However, others suggest that PLHIV are willing to travel farther for HIV care because of stigma or for higher quality care. Less is known about the effect of travel burden in rural settings where transportation infrastructure is sparse, and there are few transportation options. Therefore, the objective of this study funded by the IDSA GERM Program was to explore potential associations between distance- and time-to-clinic in a highland area of rural western Uganda with HIV outcomes including viral suppression.
72 Weeks Post-Partum Follow-Up of Dolutegravir Versus Efavirenz Initiated in Late Pregnancy (DolPHIN-2): An Open-Label, Randomised Controlled Study
(The Lancet HIV, 2022) Malaba, Thokozile R.; Nakatudde, Irene; Kintu, Kenneth; Reynolds, Helen; Mrubata, Megan; Seden, Kay; Twimukye, Adelline; Hodel, Eva Maria; Wang, Duolao; Byamugisha, Josaphat; Bokako, Sharon; Waitt, Catriona
Late initiation of antiretrovirals in pregnancy is associated with increased risk of perinatal transmission and higher infant mortality. We report the final 72-week postpartum results for efficacy and safety of dolutegravir-based compared with efavirenz-based regimens in mothers and infants. DolPHIN-2 was a randomised, open-label trial. Pregnant women in South Africa and Uganda aged at least 18 years, with untreated but confirmed HIV infection and an estimated gestation of at least 28 weeks, initiating antiretroviral therapy in third trimester were eligible for inclusion. Eligible women were randomly assigned (1:1) to receive either dolutegravir-based (50 mg dolutegravir, 300 mg tenofovir disoproxil fumarate, and either 200 mg emtricitabine in South Africa or 300 mg lamivudine in Uganda) or efavirenz-based (fixed dose combination 600 mg tenofovir disoproxil fumarate plus either emtricitabine in South Africa or lamivudine in Uganda) therapy. The primary efficacy outcome was the time to a viral load of less than 50 copies per mL measured at 6, 12, 24, 48, and 72 weeks postpartum with a Cox model adjusting for viral load and CD4 cell count. Safety endpoints were summarised by the number of women and infants with events. This trial is registered with ClinicalTrials.gov, NCT03249181. Between Jan 23 and Aug 15, 2018, 280 women were screened for inclusion, of whom 268 (96%) women were randomly assigned: 133 (50%) to the efavirenz group and 135 (50%) to the dolutegravir group. 250 (93%; 125 [50%] in the efavirenz group and 125 [50%] in the dolutegravir group) women were included in the intention-to-treat analysis of efficacy. Median time to viral load of less than 50 copies per mL was 4·1 weeks (IQR 4·0–5·1) in the dolutegravir group compared with 12·1 weeks (10·7–13·3) in the efavirenz group (adjusted hazard ratio [HR] 1·93 [95% CI 1·5–2·5]). At 72 weeks postpartum, 116 (93%) mothers in the dolutegravir group and 114 (91%) in the efavirenz group had a viral load of less than 50 copies per mL. Of 57 (21%) mothers with a severe adverse event, three (2%) in the dolutegravir group and five (4%) in the efavirenz group were related to the drug (dolutegravir drug-related events were one woman each with suicidal ideation, suicide attempt, herpes zoster meningitis; efavirenz drug-related events were one woman each with suicide attempt and liver cirrhosis, and three people with drug-induced liver injury). Of 136 (56%) infants in whom severe adverse events were recorded, none were related to the study drugs. In addition to the three infant HIV infections detected at birth in the dolutegravir group that have been previously reported, an additional transmission in the efavirenz group occurred during breastfeeding despite optimal maternal viral suppression and serial negative infant tests in the first year of life. Dolutegravir was safe and well tolerated, supporting updated WHO treatment recommendations in pregnant and breastfeeding women. Infant HIV transmissions can occur during breastfeeding despite persistently undetectable maternal viral load highlighting the need for continued infant testing.
A case of forensic genomics in Uganda reveals animal ownership and low exotic genetic introgression in indigenous cattle
(Veterinary Medicine and Science, 2023-09-19) Masembe, Charles; Benda, Kirungi Katali; Opoola, Oluyinka; Ndinawe, Ruth Pamela; Beine, Peter; Mukiibi, Robert
The cattle industry contributes to Uganda's agricultural output. It faces challenges that include theft and parentage ascertainment. These challenges can benefit from recent molecular genomics and bioinformatics technologies. We employed genomic analyses to establish potential ownership of a group of nine cattle that were being claimed by two farmers in Uganda. We investigated the genetic relationship of Ugandan cattle with regional indigenous breeds as well as exotic breeds that are currently present in Uganda. In addition, we investigated regions that are likely to be under selection in the Ugandan cattle. Hair samples were collected from seven and two animals from farmers A and B, respectively. They were genotyped for 53,218 Single Nucleotide Polymorphism markers. To establish genetic relationships between the sampled animals, we performed genomic analyses including, principal component analysis (PCA), hierarchical clustering analysis and identity by state/descent. We also performed admixture and runs of homozygosity analyses to assess the ancestry composition and identify regions potentially under selection in Ugandan cattle, respectively. The seven animals from Farmer A were genetically close to each other but showed minimal relationship with the disputed animals. The two animals from Farmer B were genetically distant from each other but showed greater similarity to four of the disputed animals. Four of the disputed animals showed great dissimilarity from the animals of both farmers. Comparison of these with the reference breeds revealed minimal European exotic genetic introgression into these animals, but rather high similarity to the Sheko. Results also revealed high homozygosity in the major histocompatibility complex regions. Our results demonstrate the use of currently available genomic tools to empirically establish the ownership of cattle; these could be scaled up as a resourceful and viable tool that could be employed to support conflict resolution where reliable livestock identification is unavailable.
A cluster randomised trial to evaluate the effectiveness of household alcohol‑based hand rub for the prevention of sepsis, diarrhoea, and pneumonia in Ugandan infants (the BabyGel trial): a study protocol
(Trials, 2023-04-17) Chebet, Martin; Mukunya, David; Faragher, Eric Brian; Wandabwa, Julius; Weeks, Andrew
Infections are one of the leading causes of death in the neonatal period. This trial aims to evaluate if the provision of alcohol-based hand rub (ABHR) to pregnant women for postnatal household use prevents severe infections (including sepsis, diarrhoea, pneumonia, or death) among infants during the first three postnatal months.
A cross-sectional study of point-of-care lactate testing in integrated community care management (ICCM) for children with acute respiratory illness in rural uganda
(2024-11) Matte, Michael; Koyama, Natsumi; Giandomenico, Dana; Baguma, Emmanuel; Kibaba, Georget; Ntaro, Moses; Reyes, Raquel; Mulogo, Edgar M; Boyce, Ross M; Ciccone, Emily Jxx
Abstract Background Integrated community case management (iCCM) programs leverage lay village health workers (VHWs) to carry out the initial evaluation of children with common conditions including malaria, pneumonia and diarrhea. Therefore, it is imperative that VHWs are able to identify children who are critically ill and require referral to a health facility. Elevated venous lactate levels have been associated with severe illness and adverse health outcomes, including death. However, lactic acidosis may not be recognized in rural settings because it is not routinely measured outside of hospitals and research studies. Point-of-care lactate tests may help identify patients in need of a higher level of care and improve VHWs’ ability to make timely and appropriate referrals. Methods The study was a cross-sectional evaluation of children aged <5 y presenting to VHWs in rural southwestern Uganda with complaints of fever and cough. Demographics, clinical presentation, evaluation, management and disposition were recorded. VHWs were trained and instructed to perform lactate testing using a point-of-care assay in eligible participants. Results During the study period, 238 children were enrolled and completed an initial assessment. Of the 204 participants included in the analysis, 113 (55.4%) were female, and the median (IQR) age was 23 (9–36) months. Most participants, 139/200 (69.5%), had negative results on the malaria rapid diagnostic test. The median lactate level was 2.1 mmol/L; 12% (24/204) had a lactate ≥3.5 mmol/L and only nine participants (4.4%) had a lactate ≥5 mmol/L. Having a lactate level above either cut-off was not associated with the presence of danger signs at presentation. Conclusions Few children presenting with fever and cough to VHWs in western Uganda had elevated lactate levels. However, most of the children with elevated lactate levels did not otherwise satisfy established iCCM criteria based on physical examination findings for referral to a health facility. Therefore, while elevated lactate was not associated with danger signs in this small study, it is possible that there is under-recognition of severe illness using current iCCM guidelines.
A Description of Experiences of Women and Significant others in Accessing Comprehensive Healthcare in the First 1000 Days of Life Post-conception During COVID-19 in Rural Uganda
(BMC Pregnancy and Childbirth, 2022-09-28) Nakate, Mary-Grace; MacKay, Sean; Ndirangu-Mugo, Eunice
COVID-19 presented an unprecedented global public health challenge because of its rapid and relentless spread, and many countries instituted lockdowns to prevent the spread of infection. Although this strategy may have been appropriate to reduce infection, it presented unintended difficulties in rural Uganda, especially in maternal and newborn care. For example, some services were suspended, meaning the nearest health facility was at a considerable distance.
A guide for self-help guides: best practice implementation
(Routledge, 2024-09) Shafran, Roz; Egan, Sarah J; de Valle, Madelaine; Davey, Emily; Carlbring, Per; Creswell, Cathy; Wade, Tracey D.
Guided self-help is an evidence-based intervention used globally. Self-help is a fundamental part of the stepped care model of mental health services that enables the efficient use of limited resources. Despite its importance, there is little information defining the role of the guide and the key competences required. In this context, the guide is defined as the person who facilitates and supports the use self-help materials. This article sets out the role of the guide in guided self-help. It considers practical issues such as the importance of engagement to motivate clients for early change, personalising the intervention, structuring sessions, how best to use routine outcome monitoring and supervision requirements. Key competences are proposed, including generic competences to build the relationship as well as specific competences such as being able to clearly convey the role of the guide to clients. Guides should be prepared for “self-help drift”, a concept akin to therapist drift in more traditional therapies. Knowing how to identify mental health problems, use supervision and manage risk and comorbidity are all key requirements for guides. The paper concludes by calling for increased recognition and value of the role of the guide within mental health services. ProQuest Criminal Justice (Alumni)
A highly tunable biocompatible and multifunctional biodegradable elastomer
(Advanced materials (Deerfield Beach, Fla.), 2012-12-12) Maria, José Nunes Pereira; Ouyang, Ben; Mark, C. Mochel; Mwizerwa, Olive; Karp, Jeffrey M.
Biodegradable elastomers have emerged as promising materials for their potential to mimic the viscoelastic properties of several tissues and exhibit compliance with dynamic environments without damaging the surrounding tissue.[1, 2] Several elastomers have been recently proposed;[3–8] however, the development of highly tunable biodegradable elastomers that can effectively and controllably present biological and physical signals and withstand repeated cycles of physiologic loads, has remained elusive. Such materials should be useful for a broad range of clinically-relevant applications, such as cardiac therapy. For example, following myocardial infarction, the local controlled delivery of bioactive cues[9] or the physical support of the left ventricle wall[10] have been shown to improve cardiac function. The synergistic therapeutic effect of biochemical and biophysical cues has not yet been explored using degradable materials given the absence of materials that can simultaneously deliver bioactive cues and maintain mechanical integrity in a dynamic environment such as the beating heart. Here, we describe a novel biocompatible and mechanically tunable elastomer, poly(glycerol sebacate urethane) (PGSU), suitable for efficient encapsulation and controlled delivery of bioactive macromolecules and with the potential to be applied to cardiac drug delivery.
A One Health approach toward the control and elimination of soil-transmitted helminthic infections in endemic areas
(IJID One Health, 2024-03-22) Lapat, Jolly Joe; Opee, Jimmyy; Apio, Monica Clara; Akello, Susan; Ojul, Christine Lakop; Ochola, Emmanuel; Bongomin, Felix
Soil-transmitted helminths (STHs) pose significant health challenges, particularly in developing countries. Over 2 billion people are estimated to have been infected with at least one STH species. These parasites rely on the soil for part of their life cycle and are transmitted to humans through ova ingestion or skin penetration. Key risk factors include poor water, sanitation, hygiene practices, limited healthcare access, and poverty. Globally, STHs are primarily controlled through chemo-preventive deworming of high-risk groups in moderate (where prevalence of STHs is between 20 % and 50 %) to highly endemic areas (prevalence >50 %). Despite the use of deworming to control the STHs in endemic areas, infections still occur. The aim of this article is to explore the potential for enhancing STH control and elimination as Neglected Tropical Diseases (NTDs) in endemic areas through an integrated approach—the One Health approach. The current control program has a single strategy of chemoprophylaxis; in the integrated approach to control of STHs, the parasite control strategies besides being based on the epidemiology of the parasite (endemicity), also include strategies based on the biology (transmission cycle) of the parasites and human behavior patterns in endemic areas. Through the involvement of local communities, healthcare authorities, and stakeholders, participatory approaches foster collaborative efforts to devise and implement control measures. By integrating this integrated approach into existing healthcare and educational initiatives, more effective results can be achieved. The promotion of health education, clean water access, improved sanitation, and hygiene awareness can further enhance control strategies and reduce STH prevalence sustainably. Here, we highlight the benefits of adopting an integrated (One Health) approach to tackle STHs in endemic areas. Through community empowerment and multi-sectorial collaboration, we can strengthen our collective efforts to combat STHs and alleviate the burden of these NTDs.
A paradoxical population structure of var DBLα types in Africa
(Public Library of Science, 2025-02-04) Tan, Mun Hua;; Tiedje, Kathryn E.;; Feng, Qian ;; Zhan, Qi;; Pascual, Mercedes;; Shim, Heejung;; Chan, Yao-ban;; Day, Karen P.
The var multigene family encodes Plasmodium falciparum erythrocyte membrane protein 1 (PfEMP1), central to host-parasite interactions. Genome structure studies have identified three major groups of var genes by specific upstream sequences (upsA, B, or C). Var with these ups groups have different chromosomal locations, transcriptional directions, and associations with disease severity. Here we explore temporal and spatial diversity of a region of var genes encoding the DBLα domain of PfEMP1 in Africa. By applying a novel ups classification algorithm ( cUps ) to publicly-available DBLα sequence datasets, we categorised DBLα according to association with the three ups groups, thereby avoiding the need to sequence complete genes. Data from deep sequencing of DBLα types in a local population in northern Ghana surveyed seven times from 2012 to 2017 found variants with rare-to-moderate-to-extreme frequencies, and the common variants were temporally stable in this local endemic area. Furthermore, we observed that every isolate repertoire, whether mono- or multiclonal, comprised DBLα types occurring with these frequency ranges implying a common genome structure. When comparing African countries of Ghana, Gabon, Malawi, and Uganda, we report that some DBLα types were consistently found at high frequencies in multiple African countries while others were common only at the country level. The implication of these local and pan-Africa population patterns is discussed in terms of advantage to the parasite with regards to within-host adaptation and resilience to malaria control.
A Pilot Experience of Common European Infectious Diseases Curriculum for Medical Students: The IDEAL Summer School
(Future Microbiology, 2019-03-22) Caroline, Charlier; Ogavu,Joseph; Nabankema,Evelyn; Omona,Venice; Cauda, Roberto
Are we able to tackle the unprecedented global challenges in microbiology and infectious diseases? Uncontrolled antibiotic prescription and misuse led to the ever-rising emergence of multiresistant bacteria such as extended spectrum beta-lactamases (ESBL)-producing enterobacteria, multi and extremely-resistant mycobacteria [1,2]. Human activities, including extensive deforestation and climate change, have fueled the emergence of new pathogens like Zika virus, while massive migration and travel patterns, alongside other aspects of globalization, drive fast dissemination of these threats [3,4]. To address this ever-evolving scenario, education of the 14,000 European medical students [5] is of paramount importance [6], and our teaching work urgently requires re-appraisal. In sharp contrast with the huge efforts conducted in the last decades; improving European epidemiological surveillance, harmonizing antimicrobial susceptibility testing, developing joint therapeutic recommendations and research projects, European teaching initiatives have essentially stayed focused on postgraduate students. Undergraduate infectious diseases teaching remains heterogeneous in content, duration and methods, and is delivered at the local level without an inter-European emphasis. To foster students’ awareness of the upcoming challenges and to teach ways for handling those issues, we need to create a single community and abolish the current barriers hampering the circulation of students or teachers among
A randomised, double-blind clinical phase II trial of the efficacy, safety, tolerability and pharmacokinetics of a single dose combination treatment with artefenomel and piperaquine in adults and children with uncomplicated Plasmodium falciparum malaria
(BMC medicine, 2017-10-09) Macintyre, Fiona; Adoke, Yeka; Kibuuka, Afizi; Tshefu, Antoinette Kitoto; Phuc, Bui Quang; Ouedraogo, Alphonse; Ramharter, Michael
The clinical development of a single encounter treatment for uncomplicated malaria has the potential to significantly improve the effectiveness of antimalarials. Exploratory data suggested that the combination of artefenomel and piperaquine phosphate (PQP) has the potential to achieve satisfactory cure rates as a single dose therapy. The primary objective of the study was to determine whether a single dose of artefenomel (800 mg) plus PQP in ascending doses is an efficacious treatment for uncomplicated Plasmodium falciparum malaria in the 'target' population of children ≤ 5 years of age in Africa as well as Asian patients of all ages.
Abacavir, zidovudine, or stavudine as paediatric tablets for African HIV-infected children (CHAPAS-3): an open-label, parallel-group, randomised controlled trial
(The Lancet Infectious Diseases, 2016) Mulenga, Veronica; Musiime, Victor.; Kekitiinwa, Adeodata; Cook, Adrian D; Abongomera, George; Kenny, Julia; Chabala, Chisala; Mirembe, Grace; Asiimwe, Alice; Owen-Powell, Ellen; Burger, David; McIlleron, Helen; Klein, Nigel.; Chintu, Chifumbe; Thomason, Margaret J.; Kityo, Cissy.; Walker, Sarah A.; Gibb, Diana M
Background WHO 2013 guidelines recommend universal treatment for HIV-infected children younger than 5 years. No paediatric trials have compared nucleoside reverse-transcriptase inhibitors (NRTIs) in first-line antiretroviral therapy (ART) in Africa, where most HIV-infected children live. We aimed to compare stavudine, zidovudine, or abacavir as dual or triple fi xed-dose-combination paediatric tablets with lamivudine and nevirapine or efavirenz. Methods In this open-label, parallel-group, randomised trial (CHAPAS-3), we enrolled children from one centre in Zambia and three in Uganda who were previously untreated (ART naive) or on stavudine for more than 2 years with viral load less than 50 copies per mL (ART experienced). Computer-generated randomisation tables were incorporated securely within the database. The primary endpoint was grade 2–4 clinical or grade 3/4 laboratory adverse events. Analysis was intention to treat. This trial is registered with the ISRCTN Registry number, 69078957. Findings Between Nov 8, 2010, and Dec 28, 2011, 480 children were randomised: 156 to stavudine, 159 to zidovudine, and 165 to abacavir. After two were excluded due to randomisation error, 156 children were analysed in the stavudine group, 158 in the zidovudine group, and 164 in the abacavir group, and followed for median 2·3 years (5% lost to follow-up). 365 (76%) were ART naive (median age 2·6 years vs 6·2 years in ART experienced). 917 grade 2–4 clinical or grade 3/4 laboratory adverse events (835 clinical [634 grade 2]; 40 laboratory) occurred in 104 (67%) children on stavudine, 103 (65%) on zidovudine, and 105 (64%), on abacavir (p=0·63; zidovudine vs stavudine: hazard ratio [HR] 0·99 [95% CI 0·75–1·29]; abacavir vs stavudine: HR 0·88 [0·67–1·15]). At 48 weeks, 98 (85%), 81 (80%) and 95 (81%) ART-naive children in the stavudine, zidovudine, and abacavir groups, respectively, had viral load less than 400 copies per mL (p=0·58); most ART-experienced children maintained suppression (p=1·00). Interpretation All NRTIs had low toxicity and good clinical, immunological, and virological responses. Clinical and subclinical lipodystrophy was not noted in those younger than 5 years and anaemia was no more frequent with zidovudine than with the other drugs. Absence of hypersensitivity reactions, superior resistance profi le and oncedaily dosing favours abacavir for African children, supporting WHO 2013 guidelines.
Abbreviated HIV counselling and testing and enhanced referral to care in Uganda: a factorial randomised controlled trial
(The Lancet Global Health, 2013) Wanyenze, Rhoda K.; Kamya, Moses R.; Fatch, Robin; Mayanja-Kizza, Harriet; Baveewo, Steven; Szekeres, Gregory; Bangsberg, David; Coates, Thomas; Hahn, Judith A.
HIV counselling and testing and linkage to care are crucial for successful HIV prevention and treatment. Abbreviated counselling could save time; however, its eff ect on HIV risk is uncertain and methods to improve linkage to care have not been studied. We did this factorial randomised controlled study at Mulago Hospital, Uganda. Participants were randomly assigned to abbreviated or traditional HIV counselling and testing; HIV-infected patients were randomly assigned to enhanced linkage to care or standard linkage to care. All study personnel except counsellors and the data offi cer were masked to study group assignment. Participants had structured interviews, given once every 3 months. We compared sexual risk behaviour by counselling strategy with a 6·5% non-inferiority margin. We used Cox proportional hazards analyses to compare HIV outcomes by linkage to care over 1 year and tested for interaction by sex. This trial is registered with ClinicalTrials.gov (NCT00648232). We enrolled 3415 participants; 1707 assigned to abbreviated counselling versus 1708 assigned to traditional. Unprotected sex with an HIV discordant or status unknown partner was similar in each group (232/823 [27·9%] vs 251/890 [28·2%], diff erence –0·3%, one-sided 95% CI 3·2). Loss to follow-up was lower for traditional counselling than for abbreviated counselling (adjusted hazard ratio [HR] 0·61, 95% CI 0·44–0·83). 1003 HIV-positive participants were assigned to enhanced linkage (n=504) or standard linkage to care (n=499). Linkage to care did not have a signifi cant eff ect on mortality or receipt of co-trimoxazole. Time to treatment in men with CD4 cell counts of 250 cells per μL or fewer was lower for enhanced linkage versus standard linkage (adjusted HR 0·60, 95% CI 0·41–0·87) and time to HIV care was decreased among women (0·80, 0·66–0·96).
ABC for people with HIV: responses to sexual behaviour recommendations among people receiving antiretroviral therapy in Jinja, Uganda
(Taylor & Francis, 2011) Allen, Caroline; Mbonye, Martin; Seeley, Janet; Birungi, Josephine; Wolff, Brent; Coutinh, Alex; Jaffar, Shabbar
People living with HIV who are taking antiretroviral therapy (ART) are increasingly involved in ‘positive prevention’ initiatives. These are generally oriented to promoting abstinence, ‘being faithful’ (partner reduction) and condom use (ABC). We conducted a longitudinal qualitative study with people living with HIV using ART, who were provided with adherence education and counselling support by a Ugandan non- governmental organisation, The AIDS Support Organisation (TASO). Forty people were selected sequentially as they started ART, stratified by sex, ART delivery mode (clinic- or home-based) and HIV progression stage (early or advanced) and interviewed at enrolment and at 3, 6, 18 and 30 months. At initiation of ART, participants agreed to follow TASO’s positive-living recommendations. Initially poor health prevented sexual activity. As health improved, participants prioritised resuming economic production and support for their children. With further improvements, sexual desire resurfaced and people in relationships cemented these via sex. The findings highlight the limitations of HIV prevention based on medical care/personal counselling. As ART leads to health improvements, social norms, economic needs and sexual desires increasingly influence sexual behaviour. Positive prevention interventions need to seek to modify normative and economi
Abnormal obstetric shock index and associated factors among immediate postpartum women following vaginal delivery at a tertiary hospital in Southwestern Uganda
(Research Square, 2022) Agaba, David Collins; Lugobe, Henry Mark; Migisha, Richard; Jjuuko, Mark; Saturday, Pascal; Kisombo, Dean; Mlangwa Atupele, Subira; Kirabira, Justus; Tumusiime, Matthew; Katamba, Godfrey; Mugyenyi, Godfrey; Masembe, Sezalio; Kayondo, Musa; Ngonzi, Joseph
Early recognition of haemodynamic instability after birth and prompt interventions are necessary to reduce adverse maternal outcomes due to postpartum haemorrhage. Obstetric shock Index (OSI) has been recommended as a simple, accurate, reliable, and low-cost early diagnostic measure that identifies hemodynamically unstable women. Objectives We determined the prevalence of abnormal obstetric shock index and associated factors among women in the immediate postpartum period following vaginal delivery at Mbarara Regional Referral Hospital (MRRH) in southwestern Uganda. Methods We conducted a cross-sectional study at the labour suite and postnatal ward of MRRH from January 2022 to April 2022. We systematically sampled women who had delivered vaginally, and measured their blood pressures and pulse rates at 1 hour postpartum. We excluded mothers with hypertensive disorders of pregnancy. Sociodemographic, medical and obstetric data were obtained through intervieweradministered questionnaires. The prevalence of abnormal OSI was the proportion of participants with an OSI ≥ 0.9 (calculated as the pulse rate divided by the systolic BP). Logistic regression analysis was used to determine associations between abnormal OSI and independent variables. Results We enrolled 427 women with a mean age of 25.66 ± 5.30 years. Of these, 83 (19.44%), 95% CI (15.79– 23.52) had an abnormal obstetric shock index. Being referred [aOR 2.34, 95% CI (1.41–3.89), p = 0.001], having had an episiotomy/perineal laceration [aOR 1.90, 95% CI (1.15–3.13), p = 0.012] and having a visually estimated blood loss > 200 mls [aOR 1.78, 95% CI (1.06–3.01), p = 0.028] were significantly associated with abnormal OSI. Conclusion Approximately one in every five women who delivered vaginally at MRRH during the study period had an abnormal OSI. We recommend that clinicians have a high index of suspicion for haemodynamic instability among women in the immediate postpartum period. Mothers who are referred in from other facilities, those that get episiotomies/perineal lacerations and those with estimated blood loss > 200mls should be prioritized for close monitoring.
Absolute eosinophil count correlates with temperature and CD4 count independently of HIV infection among tuberculosis patients
(Tropical Medicine & International Health, 2020) Baluku, Joseph Baruch; Anguzu, Godwin Tukumbo; Bongomin, Felix; Byonanebye, Dathan Mirembe
To determine clinical correlates of the peripheral absolute eosinophil count (AEC) among bacteriologically confirmed TB patients in Uganda. We evaluated data of bacteriologically confirmed adult TB patients who had a peripheral blood AEC measurement at the National TB Treatment Center in Uganda during a cross-sectional study. We performed linear regression analysis for correlates of log-transformed AEC. We included 235 patients in this analysis with a median (interquartile range, IQR) age of 31 (24–39) years. 60.4% were male, and 33.6% had TB/HIV co-infection. In a multivariable linear regression model that controlled for age, residence type, HIV status, weight loss, anorexia, body mass index, CD8+ T-cell count, haemoglobin level and TB bacillary load, males had a 47.0% higher AEC than females (adjusted coefficient (R2) = 0.385, 95% confidence interval (CI) 0.012–0.759 P = 0.043). Also, a 1 °C raise in temperature resulted in an 11.5% decrease in the AEC (R2 = −0.122 95% CI (−0.233 to −0.011) P = 0.031) while a 1 cell/mm3 increase in the CD4+ T-cell count resulted in a 0.10% increase in the AEC (R2 = 0.001 95% CI (0.000–0.001) P = 0.032). The AEC was higher among males than females, consistent with the normal population distribution of AEC among Ugandans. The AEC was weakly but positively correlated with the CD4 count and negatively correlated with temperature.

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