Infectious Diseases Institute (IDI) Collections

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Browsing Infectious Diseases Institute (IDI) Collections by Subject "Africa"
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    Access to HIV/AIDS care for mothers and children in sub-Saharan Africa: adherence to the postnatal PMTCT program
    (Taylor & Francis (Routledge), 2009-09) 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.
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    Are the best antiretrovirals being used in Africa?
    (Mediscript Limited, 2006) John, Laurence ; Kambugu, Andrew ; Songa, Patricia ; castelnouvo, Barbara ; Colebunders, Robert ; Kamya, Moses
    No Abstract
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    The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project
    (Elsevier, 2024) Kirenga, Bruce J. ; Chakaya, Jeremiah ; Yimer, Getnet ; Nyale, George ; Haile, Tewodros ; Muttamba, Winters ; Mugenyi, Levicatus ; Katagira, Winceslaus ; Worodria, William ; Aanyu-Tukamuhebwa, Hellen ; Lugogo, Njira ; Joloba, Moses ; Mersha, Tesfaye B. ; Bekele, Amsalu ; Fred Makumbi, Fred ; Mekasha, Amha ; Green, Cynthia L. ; de Jong, Corina ; Kamya, Moses ; van der Molen, Thys
    Background: Severe asthma is associated with high morbidity, mortality, and health care utilization, but its burden in Africa is unknown. Objective: We sought to determine the burden (prevalence, mortality, and activity and work impairment) of severe asthma in 3 countries in East Africa: Uganda, Kenya, and Ethiopia. Methods: Using the American Thoracic Society/European Respiratory Society case definition of severe asthma, we analyzed for the prevalence of severe asthma (requiring Global Initiative for Asthma [GINA] steps 4-5 asthma medications for the previous year to achieve control) and severe refractory asthma (remains uncontrolled despite treatment with GINA steps 4-5 asthma medications) in a cohort of 1086 asthma patients who had been in care for 12 months and had received all GINA-recommended medications. Asthma control was assessed by the asthma control questionnaire (ACQ). Results: Overall, the prevalence of severe asthma and severe refractory asthma was 25.6% (95% confidence interval [CI], 23.1-28.3) and 4.6% (95% CI, 3.5-6.0), respectively. Patients with severe asthma were (nonsevere vs severe vs severe refractory) older (39, 42, 45 years, P = .011), had high skin prick test reactivity (67.1%, 76.0%, 76.0%, P = .004), had lower forced expiratory volume in 1 second percentage (81%, 61%, 55.5%, P < .001), had lower quality of life score (129, 127 vs 121, P < .001), and had higher activity impairment (10%, 30%, 50%, P < .001). Factors independently associated with severe asthma were hypertension comorbidity; adjusted odds ratio 2.21 (1.10-4.47), P = .027, high bronchial hyperresponsiveness questionnaire score; adjusted odds ratio 2.16 (1.01-4.61), P = .047 and higher ACQ score at baseline 2.80 (1.55-5.08), P = .001. Conclusion: The prevalence of severe asthma in Africa is high and is associated with high morbidity and poor quality of life.
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    Intimate partner violence and self-reported pre-exposure prophylaxis interruptions among HIV-negative partners in HIV serodiscordant couples in Kenya and Uganda
    (Lippincott, 2018) Cabral, Alejandra ; Baeten, Jared M. ; Ngure, Kenneth ; Velloza, Jennifer ; Odoyo, Josephine ; Haberer, Jessica E. ; Celum, Connie ; Muwonge, Timothy ; Asiimwe, Stephen ; Heffron, Renee
    Background: Oral pre-exposure prophylaxis (PrEP) is effective for HIV prevention, and PrEP delivery studies are investigating ways to deliver PrEP with high adherence. However, in many settings with high HIV burden, intimate partner violence (IPV) is reported often and could be a barrier to the effective PrEP use. We examined the association between IPV and interruptions in PrEP use. Methods: We analyzed data from 1013 serodiscordant heterosexual couples enrolled in a large PrEP demonstration project in Kenya and Uganda, the Partners Demonstration Project. At quarterly study visits, HIV-negative participants receiving PrEP were asked about interruptions in their PrEP use and experiences with IPV. The association between IPV and PrEP interruptions was analyzed using multivariable generalized estimating equations. Results: At baseline and follow-up, there were 53 visits with reports of abuse by 49 HIV-negative partners, including physical, economic, and verbal IPV. Interruptions in PrEP use were reported at 328 visits (7.1% of all visits) by 249 people. The median length of PrEP interruption was 28 days (interquartile range: 7–45). The frequency of PrEP interruptions among those reporting IPV was 23.8% and those without IPV was 6.9%. PrEP interruption was significantly associated with IPV after adjustment for age and frequency of sexual intercourse (adjusted odds ratio = 2.6, 95% confidence interval: 1.2 to 6.0). Conclusions: IPV was more likely to be reported at visits when PrEP interruptions were also reported, which may have implications for sustained adherence to PrEP. Within PrEP delivery programs, there may be opportunities to assess individual safety and well-being to bolster adherence.
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    Prevalence of lipodystrophy and metabolic abnormalities in HIV-infected African children after 3 years on first-line antiretroviral therapy
    (Lippincott, 2015) Bwakura-Dangarembizi, Mutsawashe ; Musiime, Victor ; Szubert, Alexander J. ; Prendergast, Andrew J. ; Gomo, Zvenyika A. ; Thomason, Margaret J. ; Musarurwa, Cuthbert ; Mugyenyi, Peter ; Nahirya, Patricia ; Kekitiinwa, Adeodata ; Gibb, Diana M. ; Walker, Ann S. ; Nathoo, Kusum
    Background: Most pediatric lipodystrophy data come from high-income/ middle-income countries, but most HIV-infected children live in sub-Saharan Africa, where lipodystrophy studies have predominantly investigated stavudine-based regimens. Methods: Three years after antiretroviral therapy (ART) initiation, body circumferences and skinfold thicknesses were measured (n = 590), and fasted lipid profile assayed (n = 325), in children from 2 ARROW trial centres in Uganda/Zimbabwe. Analyses compared randomization to long-term versus short-term versus no zidovudine from ART initiation [unadjusted; latter 2 groups receiving abacavir+lamivudine+non-nucleoside-reversetransciptase-inhibitor (nNRTI) long-term], and nonrandomized (confounder-adjusted) receipt of nevirapine versus efavirenz. Results: Body circumferences and skinfold thicknesses were similar regardless of zidovudine exposure (P > 0.1), except for subscapular and supra-iliac skinfolds-for-age which were greater with long-term zidovudine (0.006 < P < 0.047). Circumferences/skinfolds were also similar with efavirenz and nevirapine (adjusted P > 0.09; 0.02 < P < 0.03 for waist/waist-hip-ratio). Total and high-density lipoprotein (HDL)-cholesterol, HDL/triglycerideratio (P < 0.0001) and triglycerides (P = 0.01) were lower with long-term zidovudine. Low-density lipoprotein (LDL)-cholesterol was higher with efavirenz than nevirapine (P < 0.001). Most lipids remained within normal ranges (75% cholesterol, 85% LDL and 100% triglycerides) but more on long-term zidovudine (3 NRTI) had abnormal HDL-cholesterol (88% vs. 40% short/no-zidovudine, P < 0.0001). Only 8/579(1.4%) children had clinical fat wasting (5 grade 1; 3 grade 2); 2(0.3%) had grade 1 fat accumulation. Conclusions: Long-term zidovudine-based ART is associated with similar body circumferences and skinfold thicknesses to abacavir-based ART with low rates of lipid abnormalities and clinical lipodystrophy, providing reassurance where national programs now recommend long-term zidovudine. Efavirenz and nevirapine were also similar; however, the higher LDL observed with efavirenz and lower HDL observed with zidovudine suggests that zidovudine+lamivudine+efavirenz should be investigated in future.
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    A public health approach to cervical cancer screening in Africa through community-based self-administered HPV testing and mobile treatment provision
    (Wiley, 2020) Nakalembe, Miriam ; Makanga, Philippa ; Kambugu, Andrew ; Laker-Oketta, Miriam ; Huchko, Megan J. ; Martin, Jeffrey
    The World Health Organization (WHO) refers to cervical cancer as a public health problem, and sub-Saharan Africa bears the world's highest incidence. In the realm of screening, simplified WHO recommendations for low-resource countries now present an opportunity for a public health approach to this public health problem. We evaluated the feasibility of such a public health approach to cervical cancer screening that features community-based self-administered HPV testing and mobile treatment provision. In two rural districts of western-central Uganda, Village Health Team members led community mobilization for cervical cancer screening fairs in their communities, which offered self-collection of vaginal samples for high-risk human papillomavirus (hrHPV) testing. High-risk human papillomavirus-positive women were re-contacted and referred for treatment with cryotherapy by a mobile treatment unit in their community. We also determined penetrance of the mobilization campaign message by interviewing a probability sample of adult women in study communities about the fair and their attendance. In 16 communities, 2142 women attended the health fairs; 1902 were eligible for cervical cancer screening of which 1892 (99.5%) provided a self-collected vaginal sample. Among the 393 (21%) women with detectable hrHPV, 89% were successfully contacted about their results, of which 86% returned for treatment by a mobile treatment team. Most of the women in the community (93%) reported hearing about the fair, and among those who had heard of the fair, 68% attended. This public health approach to cervical cancer screening was feasible, effectively penetrated the communities, and was readily accepted by community women. The findings support further optimization and evaluation of this approach as a means of scaling up cervical cancer control in low-resource settings.
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    Severe Renal Dysfunction and Risk Factors Associated with Renal Impairment in HIV-Infected Adults in Africa Initiating Antiretroviral Therapy
    (CID, 2008) Reid, Andrew ; Stohr, Wolfgang ; Walker, Sarah A ; Williams, Ian G. ; Kityo, Cissy ; Hughes, Peter ; Kambugu, Andrew ; Gilks, Charles F. ; Mugyenyi, Peter ; Munderi, Paula ; Hakim, James ; Gibb, Diana M.
    Background. We sought to investigate renal function in previously untreated symptomatic human immunodeficiency virus (HIV)–infected adults with CD4+ cell counts of !200 cells/mm3 who were undergoing antiretroviral therapy (ART) in Africa. Methods. The study was an observational analysis within a randomized trial of ART management strategies that included 3316 participants with baseline serum creatinine levels of 360 mmol/L. Creatinine levels were measured before ART initiation, at weeks 4 and 12 of therapy, and every 12 weeks thereafter. We calculated estimated glomerular filtration rate (eGFR) using the Cockcroft-Gault formula. We analyzed the incidence of severely decreased eGFR (!30 mL/min/1.73 m2) and changes in eGFR to 96 weeks, considering demographic data, type of ART, and baseline biochemical and hematological characteristics as predictors, using random-effects models. Results. Sixty-five percent of the participants were women. Median values at baseline were as follows: age, 37 years; weight, 57 kg; CD4+ cell count, 86 cells/mm3; and eGFR, 89 mL/min/1.73 m2. Of the participants, 1492 (45%) had mild ( 60 but !90 mL/min/1.73 m2) and 237 (7%) had moderate ( 30 but !60 mL/min/1.73 m2) impairments in eGFR. First-line ART regimens included zidovudine-lamivudine plus tenofovir disoproxil fumarate(for 74% of patients), nevirapine (16%), and abacavir (9%) (mostly nonrandomized allocation). After ART initiation, the median eGFR was 89–91 mL/min/1.73 m2 for the period from week 4 through week 96. Fifty-two participants (1.6%) developed severe reductions in eGFR by week 96; there was no statistically significant difference between these patients and others with respect to first-line ART regimen received (Pp.94). Lower baseline eGFR or hemoglobin level, lower body mass index, younger age, higher baseline CD4+ cell count, and female sex were associated with greater increases in eGFR over baseline, with small but statistically significant differences between regimens (P ! .001 for all). Conclusions. Despite screening, mild-to-moderate baseline renal impairment was relatively common, but these participants had greatest increases in eGFR after starting ART. Severe eGFR impairment was infrequent regardless of ART regimen and was generally related to intercurrent disease. Differences between ART regimens with respect to changes in eGFR through 96 weeks were of marginal clinical relevance, but investigating longer-term nephrotoxicity remains important.
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    When to switch for antiretroviral treatment failure in resource-limited settings?
    (Lippincott Williams & Wilkins., 2007) Vekemansa, Marc ; Johnb, Laurence ; Colebunders, Robert
    Thanks to the leadership of the World Health Organisation (WHO), and massive financial support from programmes such as the Global Fund and the US President’s Emergency Plan for AIDS Relief (PEPFAR), the number of HIV-infected individuals accessing antiretroviral therapy (ART) in resource-limited settings has tripled from 2001 to 2005. An estimated 1.3 million HIV-infected individuals were on ART in 2005, representing 20% of those in need of treatment.