6 research outputs found
The Association between Asymptomatic and Mild Neurocognitive Impairment and Adherence to Antiretroviral Therapy amongst people living with HIV
No full textBackground: HIV disease is associated with neurocognitive impairment which is one of the neurological complications of the viral infection. The spectrum of HIV Associated neurocognitive impairment has significantly changed since the advent of ART. The inclusion of the asymptomatic but cognitively impaired population of patients has changed the dynamics of this population, and requires further research to identify the impact it has on the progression of the disease as well as on any other aspects. Poor adherence to ART is one of the main causes of treatment failure and studies done previously point towards the milder forms of Neurocognitive Impairment as being a cause of poor adherence, among other aspects. Primary Objective: To assess the association between the milder forms of neurocognitive impairment and adherence to ART. Methods: The study was a cross-sectional survey, with consecutive sampling, with a total sample size of 218 patients. An association was sought between cognitive status and adherence as measured by objective means, self-reported means and last viral load value as a surrogate marker. The study utilised quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by MOCA, instrumental activities of daily living by Lawton score and objective and subjective adherence measures by medication possession ratio (MPR) and simplified medication adherence questionnaire (SMAQ) respectively. Univariate and bivariate analysis was conducted to determine the strengths of association between various predictor and the outcome variables. Results: A final sample size of 218 was selected out of all those eligible (500 patients). All study participants underwent a neurocognitive assessment, which revealed 69% minor neurocognitive impairment while 31% had no neurocognitive impairment. No patient was identified with HIV associated dementia on screening. Secondly, all study participants underwent adherence assessment which revealed optimal adherent rates of 66% and 77% by objective (by MPR) and subjective (SMAQ) measures respectively. There were no statistically significant differences in the baseline characteristics (age, gender, education, marital status, living arrangements, employment status, level of income) between the group of participants with cognitive impairment and those without impairment (p-value \u3e 0.05). Similarly, when the same group were compared on characteristics related to their HIV diagnosis and treatment, no statistically significant differences were observed (p-value \u3e 0.05). Discussion: Even though the rate of cognitive impairment in this study was high, it corresponds to some of the studies earlier carried out (CHARTER study = 53%), the majority of which were asymptomatic and Mild Cognitive Disorders, while only 2% had HIV Associated Dementia. It is however important to note that the MOCA screening tool, initially designed to screen for minor cognitive impairment, has had various cut off scores in different studies. Finally, whereas MOCA is only a screening tool, confirmation of neurocognitive impairment requires a battery of tests administered over a period of time which is not possible in routine clinic care or the settings of this study. Adherence rates observed in this study approximate those observed in other settings for patients on treatment with ART. Conclusions: Cognitive impairment is prevalent in the population studied. However, despite lack of association between adherence to medication and cognitive impairment, the relevance of these finding needs to be assessed. Recommendations: There is need to assess for early forms of cognitive impairment in patients on treatment with ART using culturally sanctioned assessment tools to enable identification. Further studies with participants from diverse settings need to be done to enable validation of the tools used for this purpose as well as to determine the relevance of this finding in HIV positive individuals
The association between asymptomatic and mild neurocognitive impairment and adherence to antiretroviral therapy among people living with human immunodeficiency virus
No full textBackground: Asymptomatic cognitive impairment in human immunodeficiency virus (HIV)-infected patients has recently been recognised as part of HIV-associated neurocognitive disorders. This has been implicated as one of the causes of poor adherence to antiretroviral therapy (ART).
Objective: To assess the association between neurocognitive impairment (asymptomatic and mild forms) and adherence to ART.
Methods: This was a cross-sectional survey involving 218 participants consecutively sampled from those attending the HIV treatment clinic at Aga Khan University Hospital in Nairobi. Data collected included quantitative primary data on pre-defined baseline characteristics, neurocognitive assessment by Montreal Cognitive Assessment (MoCA) tool (Appendix 1), instrumental activities of daily living by Lawton score and objective and subjective adherence measures by medication possession ratio (MPR) and simplified medication adherence questionnaire (SMAQ) (see Appendix 2). Univariate and bivariate analyses were conducted to determine the strengths of association between predictor and the outcome variables.
Results: Among the 218 participants in the study, a total of 69% had asymptomatic to mild neurocognitive impairment as assessed by the MoCA tool, while a total of 66% were determined as being adherent to ART by objective measures (by MPR) compared to subjective rates of 77% as assessed by SMAQ. However, no statistically significant association was observed between the presence of asymptomatic or mild neurocognitive impairment and likelihood of adherence to ART (p > 0.05).
Conclusion: Even though asymptomatic and mild forms of cognitive impairment are prevalent in the population studied, there was no significant association between cognitive impairment and adherence to treatment
Never be silent : publishing & imperialism in Kenya, 1884-1963
No full textSocial communications are central to any social struggle. There is a sizable body of literature from other countries on the use of oral medium, newspapers, books and other forms of communications being used as tools for organising against a powerful enemy, as a training ground for cadres and for clarifying and developing revolutionary theory, ideology, organisation and practice. All this ensures a greater unity among those resisting oppression and exploitation. Thus revolutionary and liberation forces of Bolsheviks in the Soviet Union, the Communist Party of China, and in Vietnam had developed theories and practices of revolutionary publishing as part of their revolutionary work. This has also been the case during anti-colonial and anti-imperialist struggles in Africa, but very little of this has been systematically documented as an aspect of revolutionary communications policy and practice. While the
colonial communications systems have been reasonably well documented, the resistance communication systems remain largely undocumented and ignored. This book is an initial attempt to document this dynamic communications process in Kenya with its external struggles against colonialism and its complex internal struggles with overlaying divisions of race and class, Kenyan and foreign peoples. The main theme emerging from this experience is that people struggling to change their society always find ways of establishing their own system of communicating with the people they lead
and by whom they are led. Their mission of revolution, of change, of peace, of social and economic justice requires that they should never be silent. This was well understood and practised by the liberation forces in Kenya. They
were never silent
The Veterans Aging Cohort Study Index is not associated with HIV-associated neurocognitive disorders in Uganda
No full textThe Veterans Aging Cohort Study (VACS) Index has been associated with HIV-associated neurocognitive disorder (HAND) in some populations but has not been studied in sub-Saharan Africa. We investigated whether the VACS Index is associated with HAND in a rural population in Rakai, Uganda. HIV-infected (HIV+) adults on antiretroviral therapy underwent a neurocognitive battery for determination of HAND stage using Frascati criteria. VACS component scores were recorded for all participants. Out of 156 study participants, HAND stages were 49% normal cognition, 15% asymptomatic neurocognitive impairment, 31% minor neurocognitive disorder, and 7% HIV-associated dementia. There was no significant association between VACS Index and any HAND stage. In this first study of the VACS Index in sub-Saharan Africa, we found no association between VACS Index score and HAND
Distinction between epileptic and non-epileptic arousal by heart rate change
No full textOBJECTIVE: We investigated the difference in heart rate (HR) change between epileptic and non-epileptic arousals in adult patients with epilepsy (PWE).
METHODS: This is a case-control study conducted at the University Hospitals of Cleveland Medical Center. Inclusion criteria are (1) adult (≥18 years old) PWE who had arousal related to a focal aware or impaired awareness automatism seizure with or without focal to bilateral tonic-clonic seizure during an Epilepsy Monitoring Unit (EMU) admission between January 2009 and January 2021 or (2) adult PWE who had a non-epileptic arousal during an EMU admission between July 2020 and January 2021. Outcomes are (1) a percent change in baseline HR within 60 s after arousal and (2) the highest percent change in baseline HR within a 10-s sliding time window within 60 s after arousal.
RESULTS: We included 20 non-epileptic arousals from 20 adult PWE and 29 epileptic arousals with seizures from 29 adult PWE. Within 60 s after arousal, HR increased by a median of 86.7% (interquartile range (IQR), 52.7%-121.3%) in the epileptic arousal group compared to a median of 26.1% (12.9%-43.3%) in the non-epileptic arousal group (p \u3c 0.001). The cut-off value was 48.7%. The area under the curve (AUC), sensitivity, and specificity were 0.85, 0.79, and 0.80, respectively. More than 70.1% was only in the epileptic arousals, with 100% specificity. Within 10 s of the greatest change, HR increased by 36.5 (18.7%-48.4%) in the epileptic arousal group compared to 17.7 (10.9%-23.7%) in the non-epileptic arousal group (p \u3c 0.001). The cut-off value was 36.5%. The AUC, sensitivity, and specificity were 0.79, 0.52, and 0.95, respectively. More than 48.1% was only in the epileptic arousals, with 100% specificity.
SIGNIFICANCE: Tachycardia during epileptic arousals was significantly higher and more robust compared to tachycardia during non-epileptic arousals
Evaluation of the Feasibility and Efficacy of Point-of-Care Antibody Tests for Biomarker-Guided Management of Coronavirus Disease 2019
No full textBackground. Biomarker-guided therapy could improve management of inpatients with coronavirus disease 2019 (COVID-19). Although some results indicate that antibody tests are prognostic, little is known about patient management using point-of-care (POC) antibody tests. Methods. COVID-19 inpatients were recruited to evaluate 2 POC tests: LumiraDx and RightSign. Ease of use data were collected. Blood was also collected for centralized testing using an established antibody assay (GenScript cPass). A nested case-control study assessed if POC tests conducted on stored specimens were predictive of time to sustained recovery, mortality, and a composite safety outcome. Results. While both POC tests exhibited moderate agreement with the GenScript assay (both agreeing with 89% of antibody determinations), they were significantly different from the GenScript assay. Treating the GenScript assay as the gold standard, the LumiraDx assay had 99.5% sensitivity and 58.1% specificity whereas the RightSign assay had 89.5% sensitivity and 84.0% specificity. The LumiraDx assay frequently gave indeterminant results. Both tests were significantly associated with clinical outcomes. Conclusions. Although both POC tests deviated moderately from the GenScript assay, they predicted outcomes of interest. The RightSign test was easier to use and was more likely to detect those lacking antibody compared to the LumiraDx test treating GenScript as the gold standard. © The Author(s) 2024. Published by Oxford University Press on behalf of Infectious Diseases Society of America. All rights reserved
