112 research outputs found
Survival and predictors of mortality after completion of TB treatment among people living with HIV: a 5-year analytical cohort
No full textAbstract Background After completion of TB treatment patients may remain at risk of co-morbidity and mortality. We determined the survival and predictors of all-cause mortality after completing TB treatment among ART-experienced patients. Methods This was a retrospective cohort analysis of all ART experienced patients who completed TB treatment at a specialist HIV clinic in Uganda, between 2009 and 2014. The patients were followed for five years after TB treatment. We determined the cumulative probability of death, and predictors of mortality using Kaplan-Meier methods and Cox proportional hazard models, respectively. Results A total 1,287 patients completed TB treatment between 2009 and 2014, of which 1,111 were included in the analysis. At TB treatment completion, the median age was 36 years (IQR: 31–42), 563 (50.7%) were males, and median CD4 cell count was 235 cells/mL (IQR: 139–366). The person-time at risk was 4410.60 person-years. The all-cause mortality rate was 15.42 (95% CI: 12.14–19.59) per 1000 person-years. The probability of death at five years was 6.9% (95%CI: 5.5- 8.8). In the multivariable analysis, CD4 count < 200 cells/mL was a predictor of all-cause mortality (aHR = 1.81, 95%CI:1.06–3.11, p = 0.03) alongside history of retreatment (aHR = 2.12, 95%CI: 1.16–3.85, p = 0.01). Conclusion Survival post TB treatment in ART experienced PLHIV is reasonably good. Most deaths occur within two years after TB treatment completion. Patients with a low CD4 count and those with a history of retreatment have an increased risk of mortality which underscores the need for TB prophylaxis, detailed assessment, and close monitoring after completion of TB treatment
Hypertension and associated risk factors in individuals infected with HIV on antiretroviral therapy at an urban HIV clinic in Uganda
No full textAbstractBackgroundScale-up of antiretroviral therapy (ART) might precipitate an increase in non-communicable diseases (NCDs) in adults infected with HIV in sub-Saharan Africa based on data from resource-rich settings. Hypertension is a major modifiable risk factor for cerebrovascular and cardiovascular NCDs. We estimated prevalence, incidence, and risk factors for incident hypertension in adults infected with HIV on ART at an urban clinic in Uganda.MethodsFrom a cohort of adults infected with HIV (>18 years) who initiated ART between Jan 1, 2005, and Jan 3, 2012, at the Infectious Diseases Institute clinic in Kampala, we report the prevalence, incidence, and cumulative incidence (with death as a competing risk) of hypertension (≥140/90 mm Hg). Risk factors for hypertension were evaluated with Cox proportional hazards regression.FindingsOf 9806 individuals who initiated ART, 6351 (64·8%) were women, median age was 36 years (IQR 31–42), and median follow-up was 3·9 years (2·2–5·9). Overall prevalence of hypertension was 15·1% (1472 individuals); older individuals (>50 years) had higher prevalence (299, 38·6%). By year 1, cumulative incidence was 1% and by year 5, it was 3·6%. Overall incidence was 19 cases per 1000 person-years. Multivariate regression showed male sex, older age, increasing body-mass index, and use of stavudine at initiation was associated with an increased rate of hypertension.InterpretationOf our patients, we noted a prevalence of hypertension between 14·6% and 28·5%, similar to the general Ugandan population. Besides traditional risk factors for hypertension, use of stavudine was also identified. Awareness of NCD comorbidity and AIDS-associated risk factors are increasingly important for clinicians caring for adults on ART in sub-Saharan Africa.FundingUniversity of California Global Health Institute (UCGHI) supported GloCal Fellowship funded by the Fogarty International Center (FIC) at the National Institutes of Health (NIH) R25TW009343
Impact of antiretroviral therapy on the incidence of Kaposi's sarcoma in resource-rich and resource-limited settings
No full textImpact of antiretroviral therapy on the incidence of Kaposi's sarcoma in resource-rich and resource-limited settings
No full textPURPOSE OF REVIEW: Given the recent availability of antiretroviral therapy (ART) in resource-limited settings and the significant burden exacted by Kaposi's sarcoma in these areas, we reviewed data regarding the impact of ART on Kaposi's sarcoma incidence. We summarized the sizeable literature in resource-rich settings as well as emerging data from resource-limited regions. Importantly, we delineated ways impact can be defined, including individual patient-level effectiveness; population-level effectiveness; change in population-level incidence; and residual risk of Kaposi's sarcoma.
RECENT FINDINGS: In resource-rich settings, there are now ample data demonstrating beneficial individual patient-level and population-level effects of ART on Kaposi's sarcoma incidence. There is, however, considerable variability between studies and important methodologic shortcomings. Data from resource-limited settings are much more limited; although they preliminarily indicate individual patient-level effectiveness, they do not yet provide insight on population-level effects.
SUMMARY: ART has had a substantial impact on Kaposi's sarcoma incidence in resource-rich settings, but more attention is needed on validly quantifying this effect in order to determine whether additional interventions are needed. Emerging data from resource-limited regions also suggest beneficial impact of ART on Kaposi's sarcoma incidence, but - given the scope of Kaposi's sarcoma in these settings - more data are needed to understand the breadth and magnitude of the effect
A cross-sectional mixed methods protocol to describe correlates and explanations for a long duration of untreated psychosis among patients with first episode psychosis in Uganda
No full textINTRODUCTION: Among patients with psychotic disorders, the 'duration of untreated psychosis' (DUP) is a predictor of key outcomes such as symptom remission and quality of life. In sub-Saharan Africa, DUP is up to five times longer than in high-income countries, with many patients going without antipsychotic medication for 5 years or longer. One contributor to this high DUP may relate to cultural norms that drive use of alternative and complementary therapies (ACTs) as first-line treatment strategies, rather than biomedical care with antipsychotic medicine. We aim to1 determine the prevalence and factors associated with DUP and ACT use in Uganda, and2 Identify factors that drive patient and family choices to use ACT as a first-line treatment strategy.
METHODS AND ANALYSIS: We will leverage on an ongoing cohort study at the national psychiatric and teaching hospital in Uganda. The parent study is an observational cohort design following antipsychotic naïve adults with a first episode of psychosis without substance use, HIV/AIDS or syphilis. The embedded study will use a mixed methods design including quantitative assessment of parent study participants with the Nottingham Onset Schedule-DUP to determine the DUP. Qualitative assessment will focus on patient and caregiver perceptions and use of ACT and its impact on DUP among patients with psychosis using in-depth interviews.
ETHICS AND DISSEMINATION: The study has received ethical approval from the school of medicine research and ethics committee of the college of health sciences at Makerere University. It has also received institutional support to perform the study from the Infectious Diseases Institute and Butabika hospital. Besides publication of the work in reputable peer-reviewed journals, we hope that this work will lead to evidence-based discussions on the need for early interventions to reduce DUP in Uganda
Sub-optimal vitamin B-12 levels among ART-na\uefve HIV-positive individuals in an urban cohort in Uganda
No full textAbstract: Malnutrition is common among HIV-infected individuals and is often accompanied by low serum levels of micronutrients. Vitamin B-12 deficiency has been associated with various factors including faster HIV disease progression and CD4 depletion in resource-rich settings. To describe prevalence and factors associated with sub-optimal vitamin B-12 levels among HIV-infected antiretroviral therapy (ART) naive adults in a resource-poor setting, we performed a cross-sectional study with a retrospective chart review among individuals attending either the Mulago-Mbarara teaching hospitals' Joint AIDS Program (MJAP) or the Infectious Diseases Institute (IDI) clinics, in Kampala, Uganda. Logistic regression was used to determine factors associated with sub-optimal vitamin B-12. The mean vitamin B-12 level was 384 pg/ml, normal range (200-900). Sub-optimal vitamin B-12 levels (<300 pg/ml) were found in 75/204 (36.8%). Twenty-one of 204 (10.3%) had vitamin B-12 deficiency (<200 pg/ml) while 54/204 (26.5%) had marginal depletion (200-300 pg/ml). Irritable mood was observed more among individuals with sub-optimal vitamin B-12 levels (OR 2.5, 95% CI; 1.1-5.6, P = 0.03). Increasing MCV was associated with decreasing serum B-12 category; 86.9 fl (+/- 5.1) vs. 83 fl (+/- 8.4) vs. 82 fl (+/- 8.4) for B-12 deficiency, marginal and normal B-12 categories respectively (test for trend, P = 0.017). Compared to normal B-12, individuals with vitamin B-12 deficiency had a longer known duration of HIV infection: 42.2 months (+/- 27.1) vs. 29.4 months (+/- 23.8; P = 0.02). Participants eligible for ART (CD4,350 cells/mu l) with sub-optimal B-12 had a higher mean rate of CD4 decline compared to counterparts with normal B-12; 118 (+/- 145) vs. 22 (+/- 115) cells/mu l/year, P = 0.01 respectively. The prevalence of a sub-optimal vitamin B-12 was high in this HIV-infected, ART-naive adult clinic population in urban Uganda. We recommend prospective studies to further clarify the causal relationships of sub-optimal vitamin B-12, and explore the role of vitamin B-12 supplementation in immune recovery
Additional file 1 of Survival and predictors of mortality after completion of TB treatment among people living with HIV: a 5-year analytical cohort
No full textSupplementary Material
Implementing screening for hypertension in archetypal HIV primary care: a mixed-methods assessment
No full textBACKGROUND: High prevalence of HIV and hypertension in sub-Saharan Africa puts adults living with HIV (ALWH) at high risk of end-organ complications. Both World Health Organization (WHO) and national guidelines recommend screening and treatment of hypertension among ALWH on antiretroviral therapy (ART). We evaluated the implementation of hypertension screening among adults on ART at three Uganda Cares Primary care facilities. METHODS: Using a sequential explanatory mixed-methods approach, we reviewed patient records, and interviewed both patients and providers during 2018 and 2019. We obtained demographics, clinical and blood pressure (BP) measurements via records review. We estimate the period prevalence of screening and use adjusted modified Poisson regression models to evaluate predictors of screening. In-depth interviews were analysed using a thematic approach to explain the observed prevalence and predictors of BP screening. RESULTS: Records for 1426 ALWH were reviewed. Patients had a median age of 35 years and 65% of them were female. Most were on ART (89% on first-line) with a median duration of 4 years. Only 262 (18%) were overweight or obese with a body mass index (BMI) > 25 Kg/M(2). In 2017 or 2018 patients made a median of 3 visits and 783 patients had a BP recorded, hence a period prevalence 55%. Older age, male sex, more clinic visits, and clinic site were associated with screening in the adjusted analyses. Erratic BP screening was corroborated by patients’ and providers’ interviews. Challenges included; high patient numbers, low staffing, provider apathy, no access to treatment, and lack of functioning of BP equipment. CONCLUSION: Almost half of regular HIV clinic attendees at these prototypical primary care HIV clinics were not screened for hypertension for a whole year. Improving BP screening requires attention to address modifiable challenges and ensure local buy-in beyond just providing equipment
Low-cost chromatic confocal endomicroscope for the diagnosis of cervical precancer
No full textWe have developed a low-cost (material cost < $2,000) chromatic confocal endomicroscope capable of cross-sectional imaging of the tissue at lateral and axial resolution of 1.55µm and 9.5µm, respectively.Open access articleThis item from the UA Faculty Publications collection is made available by the University of Arizona with support from the University of Arizona Libraries. If you have questions, please contact us at [email protected]
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