Infectious Diseases Institute (IDI) Collections
http://hdl.handle.net/10570/186
2024-03-28T23:30:40ZThe academic alliance for AIDS care and prevention in Africa
http://hdl.handle.net/10570/223
The academic alliance for AIDS care and prevention in Africa
Quinn, Thomas C.
In the continent of Africa, AIDS is the leading cause of death, responsible for over 20% of all fatalities. To date, over 16 million people in Africa have died from AIDS, and approximately 26 million or 70% of the world’s total of HIV infected people reside in sub-Saharan Africa. Howe ve r, little or no treatment, either for HIV infection itself or for its complications, is available to HIV infected Africans. This inequity in care between Africa and western countries has been attributed to lack of infrastructure, poverty, lack of financial support from developed countries, insufficient health care delivery systems, lack of knowledge by African physicians on the use of these drugs, insufficient laboratory support,political inaction, and many other factors. Although increasing attention has been focused on the problem, particularly in the lay press, and although pharmaceutical companies have reduced the cost of their drugs, most Africans still cannot afford these medicines, and little has been done to bring good clinical care to the millions of HIV infected Africans. To address this problem, a new organization was formed in June 2001 called "The Academic Alliance for AIDS Care and Prevention in Africa," led by a group of Ugandan physicians from Makerere University and the Infectious Diseases Society of America with HIV/AIDS care experts from North America.
2001-11-01T00:00:00ZAccess to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program
http://hdl.handle.net/10570/272
Access to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program
Nassali, Mercy; Nakanjako, Damalie; Kyabayinze, Daniel; Beyeza, Jolly; Okoth, Anthony; Mutyaba, Twaha
Despite scale up of perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions,postnatal continuity of comprehensive HIV/AIDS care, for both the mother and baby, remains a challenge in developing countries. We determined adherence to the postnatal PMTCT program (PN-PMTCT) and the associated factors among mothers at a public urban hospital in Uganda. We interviewed HIV-positive postnatal mothers on discharge and we determined adherence to PN-PMTCT by the proportion of mothers that honored their return appointments by the end of eight weeks postpartum. We had focus group discussions to assess factors that influence adherence to PN-PMTCT. Of 289 mothers, only 110 (38%) adhered to PN-PMTCT. Previous attendance of a routine postnatal review and having access to a phone were significantly associated with adherence to PMTCT among mothers older than 25 years (odds ratio (OR) 3.6 (95% confidence interval (CI); 1.2 10.4)) and (OR 3.1 (95% CI; 1.3 7.1)), respectively. On the other hand, Christianity (OR 3.2 (95% CI; 1.1 9.0)) was significantly associated with adherence to PN-PMTCT among mothers below 25 years of age. Mothers’ perceived benefits of the PN-PMTCT program, easy access to the program, and presence of social support from a spouse were important motivators for mothers to adhere to PN-PMTCT. Even with improved antenatal and intra-partum PMTCT services, only a third of the HIV-infected mothers adhered to the PNPMTCT program. Mothers who previously attended a routine postnatal care were 3.6 fold more likely to adhere to PN-PMTCT. We recommend strategies to increase mothers’ adherence to PN-PMTCT interventions in order to increase access to HIV/AIDS care for mothers and children in sub-Saharan Africa.
2009-09-01T00:00:00ZAdherence to anti-retroviral ttherapy among HIV infected mothers on option B plus aattending the Upper Mulago post natal clinic
http://hdl.handle.net/10570/5524
Adherence to anti-retroviral ttherapy among HIV infected mothers on option B plus aattending the Upper Mulago post natal clinic
Naiwumbwe, Halima K
Background: Over 90% of the children living with HIV in Sub-Saharan Africa acquire the infection through mother-to-child transmission (MTCT). Elimination of MTCT (eMTCT) of HIV could be realized by country wide rollout of Option B+ because of further simplification of the ART regimen, harmonization of PMTCT and HIV treatment programmes as well as reduction in transmission to serodiscordant partners. Studies have shown good adherence among people taking ART for their own health. However, in Option B+ where mothers are started on lifelong ART even when healthy for the sake of eMTCT, adherence remains questionable. Adherence to ART by mothers on Option B+ is very critical for eMTCT and long term maternal health benefits with improved infant survival by delaying emergence of resistant strains of the virus and ensuring durability of the present regimens.
The study aim was to determine the level of and factors associated with adherence to ART by mothers on Option B+ attending the post natal clinic of Mulago hospital and the infant HIV prevalence at six weeks.
Methods: HIV infected post natal mothers on option B+ attending the Upper Mulago post natal clinic with their infants were consecutively enrolled between August 2014 and January 2015. Questionnaires were administered to these mothers to gather information on adherence through the self-report and visual analogue scale (VAS) methods.
The infants’ HIV DNA PCR test results routinely done by Baylor-Uganda (a pediatric HIV care center) were retrieved and recorded in the respective questionnaires.
The mean adherence by self report over a three day and seven day recall periods as well as VAS were calculated separately. The three day self report adherence and that of VAS were used to assess for factors associated with optimal adherence. Multivariate logistic regression analysis was done to determine factors independently associated with adherence to ART.
Results: A total of 228 postnatal women and their infants were enrolled. Their mean age was 26.5years (SD 5.2) and mean duration on ART was 5.8 months (SD 5.8). Their infants were seen at a mean age of 7.5weeks (SD 2.1).
The mean adherence level by self report for the three day and one week recall period was 92.3% and 93.8% respectively. Mean adherence level by VAS was 84.6%.
The proportion of mothers with optimal adherence by self report was 196/228 [86.0%, 95% CI 81.9% - 90.9%] and 181/228 [79.4%, 95% CI 74.1% - 84.7%] using three day and one week recall period respectively.
Only 69/228 [30.3%, 95% CI 24.3% - 36.3%] of the mothers had optimal adherence to option B+ ART by the VAS.
The factors that were independently associated with optimal adherence to ART by SR and VAS respectively included; duration on ART of at least six months [AOR=3.6, 95% CI 1.1- 11.6], not requiring food before taking ART [AOR= 2.9, 95% CI 1.2- 6.9] and being on an alternative ART regimen other than TDF/3TC/EFV [AOR= 2.1, 95% CI 1.1- 3.9].
The barriers to optimal adherence were; stigma within and outside the home (22.4% and 15.4%) respectively, lack of support from the partner (20.4%) and forgetfulness (11.9%).
Eight of the 228 infants (3.5%) had a positive HIV DNA PCR result.
Conclusion:
The level of adherence to option B+ ART among the HIV-positive post natal mothers in Mulago Hospital was reasonably good with majority (84.6% by SR) having optimal adherence.
The factors independently associated with adherence to ART in mothers on Option B+ were; duration on ART of at least six months, not requiring food before taking ART and being on an ART drug combination other than TDF/3TC/EFV. However, barriers to optimal adherence reported among the mothers were stigma within and outside the home, lack of support from the male partners and forgetfulness.
The prevalence of HIV at six weeks among infants born to mothers on Option B+ at Mulago hospital was low at 3.5%.
A thesis submitted in partial fulfillment of the requirements for the award of the Masters of Medicine Degree in Paediatrics and Child Health of Makerere University
2014-06-01T00:00:00ZAdherence to antiretroviral therapy in HIV-positive adolescents in Uganda assessed by multiple methods a prospective cohort study
http://hdl.handle.net/10570/949
Adherence to antiretroviral therapy in HIV-positive adolescents in Uganda assessed by multiple methods a prospective cohort study
Wiens, Matthew O.; MacLeod, Stuart; Musiime, Victor; Ssenyonga, Mark; Kizza, Ruth; Bakeera-Kitaka, Sabrina; Odoi-Adome, Richard; Ssali, Francis
Background: The effectiveness of traditional adherence measurements used in adolescent populations isdifficult to assess. Antiretroviral (ARV) adherence research among adolescents living with HIV in resourceconstrained countries is particularly challenging and little evidence is available.
Objectives: The primary objective of this study was to determine the feasibility of a large-scale, long-term study using electronic adherence monitoring in Uganda. The secondary objective was to compare accuracy of pill count (PC) and self-report (SR) adherence with electronic medication vials (eCAPs ).
Methods: Adolescents receiving ARV therapy at the Joint Clinical Research Centre in Kampala, Uganda, were recruited. ARVs were dispensed in eCAPs for 1 year. Person-pill-days (PPDs) [1 day where adherence was measured for one medication in one patient] were calculated and a weighted paired t-test was used to compare the levels of adherence among subjects for three different adherence measurement methods.
Results: Fifteen patients were included: 40% were female, mean age was 14 years, mean baseline CD4+ cell count was 244 cells/mL, and average treatment duration was 9 months at study entry. Overall, 4721 PPDs were observed. Some eCAPs required replacement during the study resulting in some data loss. Consent rate was high (94%) but was slow due to age limit cut-points.
Overall adherence for SR was 99%, PC was 97% and eCAP was 88% (p < 0.05 for all comparisons).
93%, 67% and 23% of patients had an adherence of greater than 95% as measured by SR, PC and eCAP
methods, respectively.
Conclusions: A large-scale adherence study in Uganda would be feasible using a more robust electronic
monitoring system. Adherence measurements produced by PCs and self-reporting methods appear to
overestimate adherence measured electronically.
2012-10-01T00:00:00Z