Pick Topic
Review Topic
List Experts
Examine Expert
Save Expert
  Site Guide ··   
HIV Seropositivity: HELP
Articles from Uganda
Based on 131 articles published since 2008
||||

These are the 131 published articles about HIV Seropositivity that originated from Uganda during 2008-2019.
 
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6
1 Review The dual impact of antiretroviral therapy and sexual behaviour changes on HIV epidemiologic trends in Uganda: a modelling study. 2014

Shafer, Leigh Anne / Nsubuga, Rebecca N / Chapman, Ruth / O'Brien, Katie / Mayanja, Billy N / White, Richard G. ·Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada Medical Research Council Unit on AIDS/Uganda Virus Research Institute, Entebbe, Uganda. · Medical Research Council Unit on AIDS/Uganda Virus Research Institute, Entebbe, Uganda. · London School of Hygiene and Tropical Medicine, London, UK. ·Sex Transm Infect · Pubmed #24567521.

ABSTRACT: OBJECTIVES: Antiretroviral therapy (ART) availability in a population may influence risky sexual behaviour. We examine the potential impact of ART on the HIV epidemic, incorporating evidence for the impact that ART may have on risky sexual behaviour. METHODS: A mathematical model, parameterised using site-specific data from Uganda and worldwide literature review, was used to examine the likely impact of ART on HIV epidemiologic trends. We varied assumptions about rates of initiating ART, and changes in sexual partner turnover rates. RESULTS: Modelling suggests that ART will reduce HIV incidence over 20 years, and increase prevalence. Even in the optimistic scenario of ART enrollment beginning after just five months of infection (in HIV stage 2), prevalence is estimated to rise from a baseline of 10.5% and 8.3% among women and men, respectively, to at least 12.1% and 10.2%, respectively. It will rise further if sexual disinhibition occurs or infectiousness while on ART is slightly higher (2% female to male, rather than 0.5%). The conditions required for ART to reduce prevalence over this period are likely too extreme to be achievable. For example, if ART enrolment begins in HIV stage 1 (within the first 5 months of infection), and if risky sexual behaviour does not increase, then 3 of our 11 top fitting results estimate a potential drop in HIV prevalence by 2025. If sexual risk taking rises, it will have a large additional impact on expected HIV prevalence. Prevalence will rise despite incidence falling, because ART extends life expectancy. CONCLUSIONS: HIV prevalence will rise. Even small increases in partner turnover rates will lead to an additional substantial increase in HIV prevalence. Policy makers are urged to continue HIV prevention activities, including promoting sex education, and to be prepared for a higher than previously suggested number of HIV infected people in need of treatment.

2 Review What are the essential components of HIV treatment and care services in low and middle-income countries: an overview by settings and levels of the health system? 2012

Munderi, Paula / Grosskurth, Heiner / Droti, Benson / Ross, David A. ·MRC/UVRI Research Unit on AIDS in Uganda, Uganda Virus Research Institute, Entebbe, Uganda. Paula.Munderi@mrcuganda.org ·AIDS · Pubmed #23303438.

ABSTRACT: OBJECTIVES: To review and summarize the essential components of HIV treatment and care services in low and middle-income countries (LMICs). METHODS: Literature review and reflection on programmatic experience. FINDINGS: There is increasing recognition that the essential 'package' of HIV care must include early identification of HIV-positive people in need of care, appropriate initial and continued counselling, assessment of HIV disease stage, treatment with HAART for those who need it, monitoring while on treatment for efficacy, adherence and side-effects, detection and management of other complications of HIV infection, provision of sexual and reproductive health services as well as careful record-keeping. The impressive scale-up of HIV treatment and care services has required decentralization of service provision linked to task-shifting. But the future holds even greater challenges, as the number of people in need of HIV care continues to rise at a time when many traditional donors and governments in the most-affected regions have reduced budgets. CONCLUSION: In the long-term, the increased demand for HIV-care services can only be satisfied through increased decentralisation to peripheral health units, with the role of each type of unit being appropriate to the human and material resources available to it.HIV-care services can also naturally integrate with the care of chronic noncommunicable diseases and with closely related services like mother and child health, and thus should promote a shift from vertical to integrated programming. Staff training and support around a set of evidence-based policies and guidelines and a reliable supply of essential medicines and supplies are further essential components for a successful programme.

3 Review Clinical characteristics associated with Mycoplasma genitalium infection among women at high risk of HIV and other STI in Uganda. 2012

Vandepitte, Judith / Bukenya, Justine / Hughes, Peter / Muller, Etienne / Buvé, Anne / Hayes, Richard / Weiss, Helen A / Grosskurth, Heiner. ·MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. Judith.vandepitte@mrcuganda.org ·Sex Transm Dis · Pubmed #22592838.

ABSTRACT: BACKGROUND: Mycoplasma genitalium is a common infection of the genitourinary tract, but its pathogenic effects have not been well described, especially in women. The increasing evidence that M. genitalium is associated with HIV infection calls for an urgent consensus on how best to control this infection. The aim of this study was to describe symptoms and signs associated with M. genitalium infection among high-risk women in Uganda. METHODS: A cohort of 1027 female sex workers was recruited in Kampala in 2008. At enrollment, HIV testing was performed, genital specimens were tested for other sexually transmitted infection, and urogenital symptoms and signs were recorded. Endocervical swabs were tested for M. genitalium using a commercial Real-TM PCR assay (Sacace Biotechnologies, Como, Italy). The associations of clinical signs and symptoms with prevalent M. genitalium were investigated using multivariable logistic regression models. RESULTS: Reported dysuria and presence of mucopurulent vaginal discharge were significantly associated with M. genitalium infection (OR: 1.85, 95% confidence interval: 1.13-3.03 and OR: 1.55, 95% confidence interval: 1.06-2.29, respectively). There was little evidence for an association with cervicitis or with pelvic inflammatory disease. CONCLUSIONS: In this specific population, we found evidence that symptoms of urethritis and mucopurulent vaginal discharge were associated with M. genitalium infection. This supports earlier studies showing that M. genitalium may lead to clinically relevant genitourinary disorders and should be treated. In the absence of sensitive screening tests, further work is needed to validate clinical findings as possible indicators of M. genitalium infection to guide a possible syndromic approach for its control.

4 Review Burkitt lymphoma in Uganda, the legacy of Denis Burkitt and an update on the disease status. 2012

Walusansa, Victoria / Okuku, Fred / Orem, Jackson. ·Uganda Cancer Institute, Kampala, Uganda. ·Br J Haematol · Pubmed #22313244.

ABSTRACT: Burkitt lymphoma (BL) was first described in Uganda in 1958 as a sarcoma of the jaw but later confirmed to be a distinct form of Non Hodgkin lymphoma (NHL). This discovery was the defining moment of cancer research in Uganda, which eventually led to the establishment of a dedicated cancer research institute, the Uganda Cancer Institute (UCI) in 1967. The centre was dedicated to Denis Burkitt in recognition of his contribution to cancer research in East Africa. BL is still the commonest NHL in childhood in Uganda. Its incidence has significantly increased recently due to yet unknown factors. Although the human immunodeficiency virus (HIV) was considered a possible reason for the increase, there is no evidence that it has substantially impacted on the epidemiology of the disease. However, for those patients with BL who are co infected with HIV there is a clear impact of the disease on clinical presentation and outcome. HIV-infected patients commonly present with extra facial sites and tend to have poor overall survival (median survival of 11·79 months). In summary, BL, as a disease entity in Uganda, has maintained the same clinical characteristics since its discovery, despite the emergence of HIV during the intervening period.

5 Review Preventing HIV transmission in married and cohabiting HIV-discordant couples in sub-Saharan Africa through combination prevention. 2010

Matovu, Joseph K B. ·Makerere University School of Public Health, Kampala, Uganda. jmatovu@jhsph.edu ·Curr HIV Res · Pubmed #20636280.

ABSTRACT: Most new HIV infections in sub-Saharan Africa now occur in married and cohabiting couples, many of whom do not realize that only one of them may be infected with HIV. HIV-negative individuals living in stable HIV-discordant partnerships (in which one partner is HIV-infected while the other one is not) are twice as likely to get infected with HIV as those living in concordant HIV-negative relationships. Since HIV transmission occurs mainly from HIV-infected persons who are unaware of their status, a combination of interventions including behavioral and biomedical interventions is urgently needed to increase knowledge of HIV status as well as reduce the risk of HIV transmission within married and cohabiting couples. Behavioral interventions include promotion of couples' counseling, testing and disclosure; condom promotion as well as alcohol risk-reduction, while biomedical interventions include provision of antiretroviral treatment to the HIV-infected partner, medical male circumcision and treatment of sexually transmitted infections. Since no single intervention can turn around the current HIV tide in married and cohabiting couples, we argue for the inclusion of these interventions in a combination prevention package for married and cohabiting HIV-discordant couples in sub-Saharan Africa.

6 Clinical Trial Penile Anaerobic Dysbiosis as a Risk Factor for HIV Infection. 2017

Liu, Cindy M / Prodger, Jessica L / Tobian, Aaron A R / Abraham, Alison G / Kigozi, Godfrey / Hungate, Bruce A / Aziz, Maliha / Nalugoda, Fred / Sariya, Sanjeev / Serwadda, David / Kaul, Rupert / Gray, Ronald H / Price, Lance B. ·Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA cindyliu@gwu.edu. · Center for Microbiomics and Human Health, Division of Pathogen Genomics, Translational Genomics Research Institute, Flagstaff, Arizona, USA. · National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland, USA. · Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA. · Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Rakai Health Sciences Program, Entebbe, Uganda. · Department of Ophthalmology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA. · Department of Biological Sciences, Center for Ecosystem Science and Society, Northern Arizona University, Flagstaff, Arizona, USA. · Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, USA. · Department of Medicine, University of Toronto, Toronto, Canada. ·MBio · Pubmed #28743816.

ABSTRACT: Sexual transmission of HIV requires exposure to the virus and infection of activated mucosal immune cells, specifically CD4

7 Clinical Trial Brief Report: Medication Sharing Is Rare Among African HIV-1 Serodiscordant Couples Enrolled in an Efficacy Trial of Oral Pre-exposure Prophylaxis (PrEP) for HIV-1 Prevention. 2017

Thomson, Kerry A / Haberer, Jessica E / Marzinke, Mark A / Mujugira, Andrew / Hendrix, Craig W / Celum, Connie / Ndase, Patrick / Ronald, Allan / Bangsberg, David R / Baeten, Jared M / Anonymous4680899. ·*Department of Epidemiology, University of Washington, Seattle, WA; †Center for Global Health and Department of Medicine, Massachusetts General Hospital, Boston, MA; ‡Departments of Pathology and Medicine, Johns Hopkins University, Baltimore, MD; §Department of Epidemiology and Biostatistics, Makerere University, Kampala, Uganda; ‖Division of Clinical Pharmacology and Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD; ¶Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA; #Department of Global Health, University of Washington, Seattle, WA; **Department of Medicine, University of Manitoba, Winnipeg, Canada; ††Oregon Health and Sciences University and Portland State University School of Public Health, Portland, OR; and ‡‡Departments of Global Health, Medicine, and Epidemiology, University of Washington, Seattle, WA. ·J Acquir Immune Defic Syndr · Pubmed #28291050.

ABSTRACT: Sharing of pre-exposure prophylaxis (PrEP) medications is a concern for PrEP implementation. For HIV-1 serodiscordant couples, sharing may undermine the HIV-1 prevention benefit and also cause antiretroviral resistance if taken by HIV-1 infected partners. Within a PrEP efficacy trial among HIV-1 serodiscordant couples, we assessed the occurrence of PrEP sharing by self-report and plasma tenofovir concentrations in HIV-1 infected partners. PrEP sharing was self-reported at <0.01% of visits, and 0%-1.6% of randomly selected and 0% of purposively selected specimens from HIV-1 infected participants had detectable tenofovir concentrations (median: 66.5 ng/mL, range: 1.3-292 ng/mL). PrEP sharing within HIV-1 serodiscordant couples was extremely rare.

8 Clinical Trial Safety and Efficacy of a Dapivirine Vaginal Ring for HIV Prevention in Women. 2016

Nel, Annalene / van Niekerk, Neliëtte / Kapiga, Saidi / Bekker, Linda-Gail / Gama, Cynthia / Gill, Katherine / Kamali, Anatoli / Kotze, Philip / Louw, Cheryl / Mabude, Zonke / Miti, Nokuthula / Kusemererwa, Sylvia / Tempelman, Hugo / Carstens, Hannelie / Devlin, Brid / Isaacs, Michelle / Malherbe, Mariëtte / Mans, Winel / Nuttall, Jeremy / Russell, Marisa / Ntshele, Smangaliso / Smit, Marlie / Solai, Leonard / Spence, Patrick / Steytler, John / Windle, Kathleen / Borremans, Maarten / Resseler, Sophie / Van Roey, Jens / Parys, Wim / Vangeneugden, Tony / Van Baelen, Ben / Rosenberg, Zeda / Anonymous3890890. ·From International Partnership for Microbicides, Silver Spring, MD (A.N., N.N., H.C., B.D., M.I., M.M., W.M., J.N., M.R., S.N., M.S., L.S., P.S., J.S., K.W., Z.R.) · London School of Hygiene and Tropical Medicine, London (S. Kapiga) · Mwanza Intervention Trials Unit, Mwanza, Tanzania (S. Kapiga) · Desmond Tutu HIV Centre, University of Cape Town, Cape Town (L.-G.B., K.G.), Maternal, Adolescent, and Child Health Research, Edendale (C.G., Z.M.), Qhakaza Mbokodo Research Clinic, Ladysmith (P.K.), Prevention for HIV and AIDS Project, Pinetown (N.M.), Madibeng Centre for Research, Brits, the Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria (C.L.), and Ndlovu Care Group, Elandsdoorn (H.T.) - all in South Africa · Medical Research Council-Uganda Virus Research Institute Research Unit on AIDS, Entebbe, Uganda (A.K., S. Kusemererwa) · and SGS Life Science Services-Biometrics, Mechelen (M.B., S.R.), and Janssen Research and Development, Beerse (J.V.R., W.P., T.V., B.V.B.) - both in Belgium. ·N Engl J Med · Pubmed #27959766.

ABSTRACT: BACKGROUND: The incidence of human immunodeficiency virus (HIV) infection remains high among women in sub-Saharan Africa. We evaluated the safety and efficacy of extended use of a vaginal ring containing dapivirine for the prevention of HIV infection in 1959 healthy, sexually active women, 18 to 45 years of age, from seven communities in South Africa and Uganda. METHODS: In this randomized, double-blind, placebo-controlled, phase 3 trial, we randomly assigned participants in a 2:1 ratio to receive vaginal rings containing either 25 mg of dapivirine or placebo. Participants inserted the rings themselves every 4 weeks for up to 24 months. The primary efficacy end point was the rate of HIV type 1 (HIV-1) seroconversion. RESULTS: A total of 77 participants in the dapivirine group underwent HIV-1 seroconversion during 1888 person-years of follow-up (4.1 seroconversions per 100 person-years), as compared with 56 in the placebo group who underwent HIV-1 seroconversion during 917 person-years of follow-up (6.1 seroconversions per 100 person-years). The incidence of HIV-1 infection was 31% lower in the dapivirine group than in the placebo group (hazard ratio, 0.69; 95% confidence interval [CI], 0.49 to 0.99; P=0.04). There was no significant difference in efficacy of the dapivirine ring among women older than 21 years of age (hazard ratio for infection, 0.63; 95% CI, 0.41 to 0.97) and those 21 years of age or younger (hazard ratio, 0.85; 95% CI, 0.45 to 1.60; P=0.43 for treatment-by-age interaction). Among participants with HIV-1 infection, nonnucleoside reverse-transcriptase inhibitor resistance mutations were detected in 14 of 77 participants in the dapivirine group (18.2%) and in 9 of 56 (16.1%) in the placebo group. Serious adverse events occurred more often in the dapivirine group (in 38 participants [2.9%]) than in the placebo group (in 6 [0.9%]). However, no clear pattern was identified. CONCLUSIONS: Among women in sub-Saharan Africa, the dapivirine ring was not associated with any safety concerns and was associated with a rate of acquisition of HIV-1 infection that was lower than the rate with placebo. (Funded by the International Partnership for Microbicides; ClinicalTrials.gov number, NCT01539226 .).

9 Clinical Trial Intimate Partner Violence and Adherence to HIV Pre-exposure Prophylaxis (PrEP) in African Women in HIV Serodiscordant Relationships: A Prospective Cohort Study. 2016

Roberts, Sarah T / Haberer, Jessica / Celum, Connie / Mugo, Nelly / Ware, Norma C / Cohen, Craig R / Tappero, Jordan W / Kiarie, James / Ronald, Allan / Mujugira, Andrew / Tumwesigye, Elioda / Were, Edwin / Irungu, Elizabeth / Baeten, Jared M / Anonymous18030869. ·*Department of Epidemiology, University of Washington, Seattle, WA; †Department of Medicine and Center for Global Health, Massachusetts General Hospital, Boston, MA; ‡Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA; Departments of §Global Health; ‖Medicine, University of Washington, Seattle, WA; ¶Kenya Medical Research Institute, Nairobi, Kenya; #Division of Global Health Equity, Department of Medicine, Brigham and Women's Hospital, Boston, MA; **Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, CA; ††Centers for Disease Control and Prevention, Atlanta, GA; ‡‡Department of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya; §§Department of Medicine, University of Manitoba, Winnipeg, Canada; ‖‖Kabwohe Clinical Research Center, Kabwohe, Uganda; ¶¶Department of Reproductive Health, Moi University, Eldoret, Kenya; and ##Kenyatta National Hospital, Nairobi, Kenya. ·J Acquir Immune Defic Syndr · Pubmed #27243900.

ABSTRACT: BACKGROUND: Intimate partner violence (IPV) is associated with higher HIV incidence, reduced condom use, and poor adherence to antiretroviral therapy and other medications. IPV may also affect adherence to pre-exposure prophylaxis (PrEP). METHODS: We analyzed data from 1785 HIV-uninfected women enrolled in a clinical trial of PrEP among African HIV serodiscordant couples. Experience of verbal, physical, or economic IPV was assessed at monthly visits by face-to-face interviews. Low PrEP adherence was defined as clinic-based pill count coverage <80% or plasma tenofovir levels <40 ng/mL. The association between IPV and low adherence was analyzed using generalized estimating equations, adjusting for potential confounders. In-depth interview transcripts were examined to explain how IPV could impact adherence. RESULTS: Sixteen percent of women reported IPV during a median of 34.8 months of follow-up (interquartile range 27.0-35.0). Overall, 7% of visits had pill count coverage <80%, and 32% had plasma tenofovir <40 ng/mL. Women reporting IPV in the past 3 months had increased risk of low adherence by pill count (adjusted risk ratio 1.49, 95% confidence interval: 1.17 to 1.89) and by plasma tenofovir (adjusted risk ratio 1.51, 95% confidence interval: 1.06 to 2.15). Verbal, economic, and physical IPV were all associated with low adherence. However, the impact of IPV diminished and was not statistically significant 3 months after the reported exposure. In qualitative interviews, women identified several ways in which IPV affected adherence, including stress and forgetting, leaving home without pills, and partners throwing pills away. CONCLUSIONS: Women who reported recent IPV in the Partners PrEP Study were at increased risk of low PrEP adherence. Strategies to mitigate PrEP nonadherence in the context of IPV should be evaluated.

10 Clinical Trial HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. 2014

Donnell, Deborah / Baeten, Jared M / Bumpus, Namandjé N / Brantley, Justin / Bangsberg, David R / Haberer, Jessica E / Mujugira, Andrew / Mugo, Nelly / Ndase, Patrick / Hendrix, Craig / Celum, Connie. ·*Department of Global Health University of Washington and Vaccine and Infectious Disease Institute Fred Hutchinson Cancer Research Center, Seattle, WA; Departments of †Global Health; ‡Medicine; §Epidemiology, University of Washington, Seattle, WA; Departments of ‖Pharmacology and Molecular Sciences; ¶Medicine, Johns Hopkins University, Baltimore, MD; #Center for Global Health, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, Boston, MA; **Department of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda; ††Department of Obstetrics and Gynecology, University of Nairobi and Kenyatta National Hospital, Nairobi; and ‡‡Department of Epidemiology, Johns Hopkins University, Baltimore, MD. ·J Acquir Immune Defic Syndr · Pubmed #24784763.

ABSTRACT: BACKGROUND: Antiretroviral pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy for which adherence is a known determinant of efficacy. Blood concentrations of PrEP medications are one objective marker of adherence. METHODS: In a placebo-controlled PrEP efficacy trial of tenofovir disoproxil fumarate (TDF) and TDF with emtricitabine (FTC/TDF) among 4747 African women and men with an HIV-infected partner, we measured plasma tenofovir concentrations from participants in the active PrEP arms: 29 HIV seroconverters (cases) and 196 randomly selected controls who remained uninfected. RESULTS: Among controls, 71% of visits had tenofovir concentrations >40 ng/mL, consistent with steady-state daily dosing, compared with 21% of cases at the visit HIV was first detected. Pill count data indicated that 96% of controls and 66% of cases had >80% adherence for these same visits. The estimated protective effect of PrEP against HIV, based on concentrations >40 ng/mL, was 88% (95% confidence interval: 60 to 96, P < 0.001) for individuals receiving TDF and 91% (95% confidence interval: 47 to 98, P = 0.008) for individuals receiving FTC/TDF. Controls had consistent patterns of PrEP concentrations during follow-up; among the 81% with concentrations >40 ng/mL at month 1, 75% maintained this concentration at month 12. Only 5 of 29 seroconverters seemed to be consistently adherent to PrEP. Tenofovir concentrations >40 ng/mL were associated with older age and shorter time on study; concentrations ≤40 ng/mL occurred more commonly when participants reported no sex with their HIV-infected partner. CONCLUSIONS: Plasma concentrations of tenofovir consistent with daily dosing were highly predictive of protection from HIV acquisition. Most of those who took PrEP seemed to have high and consistent adherence.

11 Clinical Trial Long-term consistent use of a vaginal microbicide gel among HIV-1 sero-discordant couples in a phase III clinical trial (MDP 301) in rural south-west Uganda. 2013

Abaasa, Andrew / Crook, Angela / Gafos, Mitzy / Anywaine, Zacchaeus / Levin, Jonathan / Wandiembe, Symon / Nanoo, Ananta / Nunn, Andrew / McCormack, Sheena / Hayes, Richard / Kamali, Anatoli. ·MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. Andrew.Abaasa@mrcuganda.org ·Trials · Pubmed #23374729.

ABSTRACT: BACKGROUND: A safe and effective vaginal microbicide could substantially reduce HIV acquisition for women. Consistent gel use is, however, of great importance to ensure continued protection against HIV infection, even with a safe and effective microbicide. We assessed the long-term correlates of consistent gel use in the MDP 301 clinical trial among HIV-negative women in sero-discordant couples in south-west Uganda. METHODS: HIV-negative women living with an HIV-infected partner were enrolled between 2005 and 2008, in a three-arm phase III microbicide trial and randomized to 2% PRO2000, 0.5% PRO2000 or placebo gel arms. Follow-up visits continued up to September 2009. The 2% arm was stopped early due to futility and the 229 women enrolled in this arm were excluded from this analysis. Data were analyzed on 544 women on the 0.5% and placebo arms who completed at least 52 weeks of follow-up, sero-converted or became pregnant before 52 weeks. Consistent gel use was defined as satisfying all of the following three conditions: (i) reported gel use at the last sex act for at least 92% of the 26 scheduled visits or at least 92% of the visits attended if fewer than 26; (ii) at least one used applicator returned for each visit for which gel use was reported at the last sex act; (iii) attended at least 13 visits (unless the woman sero-converted or became pregnant during follow-up). Logistic regression models were fitted to investigate factors associated with consistent gel use. RESULTS: Of the 544 women, 473 (86.9%) were followed for at least 52 weeks, 29 (5.3%) sero-converted and 42 (7.7%) became pregnant before their week 52 visit. Consistent gel use was reported by 67.8%. Women aged 25 to 34 years and those aged 35 years or older were both more than twice as likely to have reported consistently using gel compared to women aged 17 to 24 years. Living in a household with three or more rooms used for sleeping compared to one room was associated with a twofold increase in consistent gel use. CONCLUSION: In rural Uganda younger women and women in houses with less space are likely to require additional support to achieve consistent microbicide gel use. TRIAL REGISTRATION: Protocol Number ISRCTN64716212.

12 Clinical Trial Sub-optimal vitamin B-12 levels among ART-naïve HIV-positive individuals in an urban cohort in Uganda. 2012

Semeere, Aggrey S / Nakanjako, Damalie / Ddungu, Henry / Kambugu, Andrew / Manabe, Yukari C / Colebunders, Robert. ·Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda. asemeere@gmail.com ·PLoS One · Pubmed #22768330.

ABSTRACT: 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) naïve 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/µl) 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/µl/year, P=0.01 respectively. The prevalence of a sub-optimal vitamin B-12 was high in this HIV-infected, ART-naïve 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.

13 Clinical Trial Extended prophylaxis with nevirapine and cotrimoxazole among HIV-exposed uninfected infants is well tolerated. 2012

Aizire, Jim / Fowler, Mary Glenn / Wang, Jing / Shetty, Avinash K / Stranix-Chibanda, Lynda / Kamateeka, Moreen / Brown, Elizabeth R / Bolton, Steve G / Musoke, Philippa M / Coovadia, Hoosen. ·Makerere University, Johns Hopkins University Research Collaboration, Kampala, Uganda. ·AIDS · Pubmed #22112598.

ABSTRACT: OBJECTIVE: Nevirapine and cotrimoxazole are associated with hematologic toxicities and skin-rash. Safety of their concurrent use for prophylaxis over extended periods among HIV-exposed uninfected infants has not been previously assessed. DESIGN: Secondary data analysis of the 'HIV Prevention Trials Network-046 protocol' (version 2.0), a phase-III, randomized, placebo-controlled trial that assessed efficacy and safety of nevirapine prophylaxis against breast milk transmission of HIV-1. METHODS: Trial infants received 6-month study nevirapine/placebo, and standard-of-care peripartum single-dose nevirapine+/- zidovudine 'tail', and cotrimoxazole prophylaxis from 6 weeks through breastfeeding cessation. Adverse events were monitored using United States Division of AIDS Toxicity Tables (2004). Risk of neutropenia, anemia and skin-rash in the cotrimoxazole + nevirapine and the cotrimoxazole + placebo groups were compared using negative-binomial regression. RESULTS: Incidence of neutropenia and/or anemia, and skin-rash was highest during the first 6 weeks of life and declined, thereafter, regardless of study group. Time to first adverse event after 6 weeks was similar in cotrimoxazole + nevirapine and cotrimoxazole + placebo groups: hazard ratio (95% confidence interval) was 1.26 (0.96-1.66) for neutropenia and/or anemia (all grades), 1.27 (0.80-2.03) for neutropenia and/or anemia (grade ≥3) and 1.16 (0.46-2.90) for skin-rash (grade ≥2). There were no statistically significant differences in immediate (6 weeks-6 months) and long-term (6-12 months) adverse event risk among infants on cotrimoxazole + nevirapine versus cotrimoxazole + placebo. CONCLUSION: Extended nevirapine and cotrimoxazole prophylaxis through 6 months of age among HIV-exposed uninfected infants did not appear to increase the immediate or long-term risk of neutropenia, anemia or skin-rash. Concurrent use beyond 6 months, however, needs to be evaluated.

14 Article Polypharmacy among HIV positive older adults on anti-retroviral therapy attending an urban clinic in Uganda. 2018

Ssonko, Michael / Stanaway, Fiona / Mayanja, Harriet K / Namuleme, Tabitha / Cumming, Robert / Kyalimpa, John L / Karamagi, Yvonne / Mukasa, Barbara / Naganathan, Vasi. ·Mildmay Uganda, 12 Km Entebbe Road, Naziba Hill Lweza, P.O. Box 24985, Kampala, Uganda. mikssonko@gmail.com. · Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia. · Makerere University College of Health Sciences, Kampala, Uganda. · Mildmay Uganda, 12 Km Entebbe Road, Naziba Hill Lweza, P.O. Box 24985, Kampala, Uganda. · Centre for Education and Research on Ageing, Sydney Medical School, Concord Clinical School, University of Sydney, Sydney, Australia. · Ageing and Alzheimers Institute, Concord Hospital, Sydney, Australia. ·BMC Geriatr · Pubmed #29843635.

ABSTRACT: BACKGROUND: Polypharmacy has not been investigated in patients living with HIV in developing countries. The aims of this study were to determine the prevalence of polypharmacy, the factors associated with polypharmacy and whether polypharmacy was associated with adverse effects among older adults on anti-retroviral therapy (ART). METHODS: Cross-sectional study in older adults aged 50 and over on ART attending an outpatient HIV/AIDS care centre in Uganda. Demographic and clinical data collected on number and type of medications plus supplements, possible medication related side-effects, comorbidity, frailty, cognitive impairment, current CD4 count and viral load. RESULTS: Of 411 participants, 63 (15.3, 95% C.I. 11.9, 18.8) had polypharmacy (≥ 4 non- HIV medications). In multivariate analyses, polypharmacy was associated with one or more hospitalisations in the last year (Prevalence Ratio PR = 1.8, 95% C.I. 1.1, 3.1, p = 0.02), prescription by an internist (PR = 3.6, 95% C.I. 1.3, 10.5, p = 0.02) and frailty index scores of 5 to 6 (PR = 10.6, 95% C.I. 1.4, 78, p = 0.02), and 7 or more (PR = 17.4, 95% C.I. 2.4, 126.5, p = 0.005). Polypharmacy was not associated with frequency and severity of possible medication related side effects and falls. CONCLUSION: Polypharmacy is common among older HIV infected patients in sub-Saharan Africa. It's more prevalent among frail people, who have been in hospital in the last year and who have been seen by an internist. We found no evidence that polypharmacy results in any harm but this is worth exploring further.

15 Article Facing HIV infection and unintended pregnancy: Rakai, Uganda, 2001-2013. 2018

Grilo, Stephanie Ann / Song, Xiaoyu / Lutalo, Tom / Mullinax, Margo / Mathur, Sanyukta / Santelli, John. ·Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY, 10032, USA. sag2179@cumc.columbia.edu. · Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA. · Icahn School of Medicine at Mount Sinai andThe Tisch Cancer Institute, Icahn School of Medicine at Mount Sinail, New York, USA. · Rakai Health Sciences Program, Kalisizo, Uganda. · American Jewish World Service, New York, NY, USA. · Population Council, Washington, DC, USA. ·BMC Womens Health · Pubmed #29486752.

ABSTRACT: BACKGROUND: Unintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. The aim of this paper is to examine unintended pregnancy over time in the context of substantial human immunodeficiency virus (HIV) prevalence and increasing access to anti-retro viral therapy (ART). METHOD: Data are from the Rakai Community Cohort Study (RCCS) - a cohort of communities with 10,000-12,000 adults, ages 15-49, in Rakai District, Uganda. We examined prevalence of current pregnancies over time, intended pregnancy, and unintended pregnancies (unwanted, mistimed, ambivalent). We then examined risk factors for the different categories of unintended pregnancy among women who were currently pregnant. The full sample included 32,205 observations over 13 years. RESULTS: The prevalence of mistimed pregnancy and unwanted pregnancy both decreased significantly over time (p < .001). The prevalence of current pregnancies and intended pregnancy showed no significant changes over the thirteen year period. The same overall pattern was found when only examining HIV positive women in the sample; however, the trends were not significant. Out of the 2820 current pregnancies reported, 54.4% were intended, 29.8% were mistimed, 13.2% were unwanted, and 2.5% were ambivalent. After controlling for other predictors, HIV status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy (RRR = 2.44, 95% CI = 1.65-3.61, p < .001] and ambivalent pregnancy [RRR = 2.07; CI: 1.03 to 4.18, p = 0.041]. In 2004, after the introduction of ART, there was a decreased risk in unintended pregnancy [RR = 0.75; CI: 0.66 to 0.84, p < .001]. Women with a secondary education or higher also had a decreased risk in unintended pregnancy [RR = 0.70; CI: 0.70 to 0.92, p = 0.002]. DISCUSSION: HIV was an important predictor of unwanted pregnancy. Unintended pregnancy decreased in the sample over time which may be due to an increase in ART availability and rising levels of education.

16 Article False-positive HIV diagnoses: lessons from Ugandan and Russian research cohorts. 2018

Coleman, Sharon M / Gnatienko, Natalia / Lloyd-Travaglini, Christine A / Winter, Michael R / Bridden, Carly / Blokhina, Elena / Lioznov, Dmitry / Adong, Julian / Samet, Jeffrey H / Liegler, Teri / Hahn, Judith A. ·a Boston University School of Public Health , Boston , MA , USA. · b Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston Medical Center , Boston , MA , USA. · c Laboratory of Clinical Pharmacology of Addictions , First Pavlov State Medical University , St. Petersburg , Russia. · d Immune Suppression Syndrome Clinic , Mbarara University of Science and Technology , Mbarara , Uganda. · e Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA. · f Department of Medicine , University of California , San Francisco , CA , USA. ·HIV Clin Trials · Pubmed #29384717.

ABSTRACT: BACKGROUND: Research studies rely on accurate assessment of entry criteria in order to maintain study integrity and participant safety, however, challenges can exist with HIV studies in international settings. OBJECTIVE: Examine the unexpectedly high proportion of study participants with an undetectable HIV viral load found in Ugandan and Russian research cohorts meeting antiretroviral therapy (ART)-naïve entry criteria. METHODS: Russian participants with documented HIV and ART-naïve status were recruited between 2012 and 2015 from clinical and non-clinical sites in St. Petersburg. Participants in Uganda were recruited from Mbarara Regional Referral Hospital from 2011 to 2014 with documented HIV infection via rapid diagnostic testing and recorded ART-naïve in the clinic database. HIV viral load testing of baseline samples was performed; the lower limit of detection was 500 copies/mL in Russia and 40 in Uganda. Due to an unexpectedly high proportion of participants with undetectable viremia, additional tests were performed: enzyme-linked immunosorbent assay HIV testing and testing for ART. RESULTS: In Russia, 16% (58/360) had undetectable viremia; 3% (9/360) re-tested HIV-seronegative and 4% (13/360) tested positive for ART. In Uganda 11% (55/482) had undetectable viremia; 5% (26/482) re-tested HIV-seronegative, while <1% (4/482) tested positive for ART. CONCLUSIONS: In both Russia & Uganda, undetectable viremia was much higher than would be expected for an HIV-infected ART-naïve cohort. Misclassification of study participants was due to misdiagnosis of HIV with rapid diagnostic testing and inaccurate accounting of ART use. Confirmatory HIV testing could improve accuracy of participants meeting entry criteria for HIV infection as might increased scrutiny of medication use in an ART-naïve cohort.

17 Article Higher sequence diversity in the vaginal tract than in blood at early HIV-1 infection. 2018

Klein, Katja / Nickel, Gabrielle / Nankya, Immaculate / Kyeyune, Fred / Demers, Korey / Ndashimye, Emmanuel / Kwok, Cynthia / Chen, Pai-Lien / Rwambuya, Sandra / Poon, Art / Munjoma, Marshall / Chipato, Tsungai / Byamugisha, Josaphat / Mugyenyi, Peter / Salata, Robert A / Morrison, Charles S / Arts, Eric J. ·Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada. · Department of Medicine, Case Western Reserve University, Cleveland, Ohio, United States of America. · Joint Clinical Research Centre, Kampala, Uganda. · FHI 360, Durham, North Carolina, United States of America. · Department of Pathology and Laboratory Medicine, University of Western Ontario, London, Ontario, Canada. · Department of Obstetrics and Gynaecology, University of Zimbabwe, Harare, Zimbabwe. · Faculty of Medicine, Makerere University, Kampala, Uganda. ·PLoS Pathog · Pubmed #29346424.

ABSTRACT: In the majority of cases, human immunodeficiency virus type 1 (HIV-1) infection is transmitted through sexual intercourse. A single founder virus in the blood of the newly infected donor emerges from a genetic bottleneck, while in rarer instances multiple viruses are responsible for systemic infection. We sought to characterize the sequence diversity at early infection, between two distinct anatomical sites; the female reproductive tract vs. systemic compartment. We recruited 72 women from Uganda and Zimbabwe within seven months of HIV-1 infection. Using next generation deep sequencing, we analyzed the total genetic diversity within the C2-V3-C3 envelope region of HIV-1 isolated from the female genital tract at early infection and compared this to the diversity of HIV-1 in plasma. We then compared intra-patient viral diversity in matched cervical and blood samples with three or seven months post infection. Genetic analysis of the C2-V3-C3 region of HIV-1 env revealed that early HIV-1 isolates within blood displayed a more homogeneous genotype (mean 1.67 clones, range 1-5 clones) than clones in the female genital tract (mean 5.7 clones, range 3-10 clones) (p<0.0001). The higher env diversity observed within the genital tract compared to plasma was independent of HIV-1 subtype (A, C and D). Our analysis of early mucosal infections in women revealed high HIV-1 diversity in the vaginal tract but few transmitted clones in the blood. These novel in vivo finding suggest a possible mucosal sieve effect, leading to the establishment of a homogenous systemic infection.

18 Article Factors associated with HIV positive sero-status among exposed infants attending care at health facilities: a cross sectional study in rural Uganda. 2018

Kahungu, Methuselah Muhindo / Kiwanuka, Julius / Kaharuza, Frank / Wanyenze, Rhoda K. ·Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda. mmkahungu@gmail.com. · Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda. ·BMC Public Health · Pubmed #29338730.

ABSTRACT: BACKGROUND: East and South Africa contributes 59% of all pediatric HIV infections globally. In Uganda, HIV prevalence among HIV exposed infants was estimated at 5.3% in 2014. Understanding the remaining bottlenecks to elimination of mother-to-child transmission (eMTCT) is critical to accelerating efforts towards eMTCT. This study determined factors associated with HIV positive sero-status among exposed infants attending mother-baby care clinics in rural Kasese so as to inform enhancement of interventions to further reduce MTCT. METHODS: This was a cross-sectional mixed methods study. Quantitative data was derived from routine service data from the mother's HIV care card and exposed infant clinical chart. Key informant interviews were conducted with health workers and in-depth interviews with HIV infected mothers. Quantitative data was analyzed using Stata version 12. Logistic regression was used to determine factors associated with HIV sero-status. Latent content analysis was used to analyse qualitative data. RESULTS: Overall, 32 of the 493 exposed infants (6.5%) were HIV infected. Infants who did not receive ART prophylaxis at birth (AOR = 4.9, 95% CI: 1.901-13.051, p=0.001) and those delivered outside of a health facility (AOR = 5.1, 95% CI: 1.038 - 24.742, p = 0.045) were five times more likely to be HIV infected than those who received prophylaxis and those delivered in health facilities, respectively. Based on the qualitative findings, health system factors affecting eMTCT were long waiting time, understaffing, weak community follow up system, stock outs of Neverapine syrup and lack of HIV testing kits. CONCLUSION: Increasing facility based deliveries and addressing underlying health system challenges related to staffing and availability of the required commodities may further accelerate eMTCT.

19 Article Effectiveness of WHO's pragmatic screening algorithm for child contacts of tuberculosis cases in resource-constrained settings: a prospective cohort study in Uganda. 2018

Martinez, Leonardo / Shen, Ye / Handel, Andreas / Chakraburty, Srijita / Stein, Catherine M / Malone, LaShaunda L / Boom, W Henry / Quinn, Frederick D / Joloba, Moses L / Whalen, Christopher C / Zalwango, Sarah. ·Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA; Institute of Global Health, University of Georgia, Athens, GA, USA; Division of Infectious Diseases and Geographic Medicine, School of Medicine, Stanford University, Stanford, CA, USA. Electronic address: leomarti@stanford.edu. · Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA. · Department of Computer Sciences, University of Georgia, Athens, GA, USA. · Department of Population and Quantitative Health Sciences, Tuberculosis Research Unit & Department of Medicine, Case Western Reserve University, Cleveland, OH, USA; Uganda-CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda. · Division of Infectious Disease, Department of Medicine and Tuberculosis Research Unit, Case Western Reserve University, Cleveland, OH, USA; Uganda-CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda. · University of Georgia, Department of Veterinary Medicine, Athens, GA, USA. · Department of Immunology/Molecular Biology and Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda. · Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA; Institute of Global Health, University of Georgia, Athens, GA, USA. · Uganda-CWRU Research Collaboration, Makerere University and Mulago Hospital, Kampala, Uganda. ·Lancet Respir Med · Pubmed #29273539.

ABSTRACT: BACKGROUND: Tuberculosis is a leading cause of global childhood mortality; however, interventions to detect undiagnosed tuberculosis in children are underused. Child contact tracing has been widely recommended but poorly implemented in resource-constrained settings. WHO has proposed a pragmatic screening approach for managing child contacts. We assessed the effectiveness of this screening approach and alternative symptom-based algorithms in identifying secondary tuberculosis in a prospectively followed cohort of Ugandan child contacts. METHODS: We identified index patients aged at least 18 years with microbiologically confirmed pulmonary tuberculosis at Old Mulago Hospital (Kampala, Uganda) between Oct 1, 1995, and Dec 31, 2008. Households of index patients were visited by fieldworkers within 2 weeks of diagnosis. Coprevalent and incident tuberculosis were assessed in household contacts through clinical, radiographical, and microbiological examinations for 2 years. Disease rates were compared among children younger than 16 years with and without symptoms included in the WHO pragmatic guideline (presence of haemoptysis, fever, chronic cough, weight loss, night sweats, and poor appetite). Symptoms could be of any duration, except cough (>21 days) and fever (>14 days). A modified WHO decision-tree designed to detect high-risk asymptomatic child contacts was also assessed, in which all asymptomatic contacts were classified as high risk (children younger than 3 years or immunocompromised [HIV-infected]) or low risk (aged 3 years or older and immunocompetent [HIV-negative]). We also assessed a more restrictive algorithm (ie, assessing only children with presence of chronic cough and one other tuberculosis-related symptom). FINDINGS: Of 1718 household child contacts, 126 (7%) had coprevalent tuberculosis and 24 (1%) developed incident tuberculosis, diagnosed over the 2-year study period. Of these 150 cases of tuberculosis, 95 (63%) were microbiologically confirmed with a positive sputum culture. Using the WHO approach, 364 (21%) of 1718 child contacts had at least one tuberculosis-related symptom and 85 (23%) were identified as having coprevalent tuberculosis, 67% of all coprevalent cases detected (diagnostic odds ratio 9·8, 95% CI 6·8-14·5; p<0·0001). 1354 (79%) of 1718 child contacts had no symptoms, of whom 41 (3%) had coprevalent tuberculosis. The WHO approach was effective in contacts younger than 5 years: 70 (33%) of 211 symptomatic contacts had coprevalent disease compared with 23 (6%) of 367 asymptomatic contacts (p<0·0001). This approach was also effective in contacts aged 5 years and older: 15 (10%) of 153 symptomatic contacts had coprevalent disease compared with 18 (2%) of 987 asymptomatic contacts (p<0·0001). More coprevalent disease was detected in child contacts recommended for screening when the study population was restricted by HIV-serostatus (11 [48%] of 23 symptomatic HIV-seropositive child contacts vs two [7%] of 31 asymptomatic HIV-seropositive child contacts) or to only culture-confirmed cases (47 [13%] culture confirmed cases of 364 symptomatic child contacts vs 29 [2%] culture confirmed cases of 1354 asymptomatic child contacts). In the modified algorithm, high-risk asymptomatic child contacts were at increased risk for coprevalent disease versus low-risk asymptomatic contacts (14 [6%] of 224 vs 27 [2%] of 1130; p=0·0021). The presence of tuberculosis infection did not predict incident disease in either symptomatic or asymptomatic child contacts: in symptomatic contacts, eight (5%) of 169 infected contacts and six (5%) of 111 uninfected contacts developed incident tuberculosis (p=0·80). Among asymptomatic contacts, incident tuberculosis occurred in six (<1%) of 795 contacts infected at baseline versus four (<1%) of 518 contacts uninfected at baseline, respectively (p=1·00). INTERPRETATION: WHO's pragmatic, symptom-based algorithm was an effective case-finding tool, especially in children younger than 5 years. A modified decision-tree identified 6% of asymptomatic child contacts at high risk for subclinical disease. Increasing the feasibility of child-contact tracing using these approaches should be encouraged to decrease tuberculosis-related paediatric mortality in high-burden settings, but this should be partnered with increasing access to microbiological point-of-care testing. FUNDING: National Institutes of Health, Tuberculosis Research Unit, AIDS International Training and Research Program of the Fogarty International Center, and the Center for AIDS Research.

20 Article The intersection of intimate partner violence and HIV risk among women engaging in transactional sex in Ugandan fishing villages. 2018

Sileo, Katelyn M / Kintu, Michael / Kiene, Susan M. ·a Division of Epidemiology and Biostatistics, Graduate School of Public Health , San Diego State University , San Diego , USA. · b Wakiso Integrated Rural Development Association , Entebbe , Uganda. · c Alcohol Research Center on HIV , Brown University School of Public Health , Providence , USA. ·AIDS Care · Pubmed #29063817.

ABSTRACT: Intimate partner violence (IPV) may increase risk for HIV/AIDS among women engaging in transactional sex in Ugandan fishing communities. In this cross-sectional study, 115 women reporting engaging in transactional sex in Lake Victoria fishing communities completed a computerized interview. We tested associations between IPV and other HIV risk factors, with unprotected sex and HIV status, and tested moderators of the IPV-HIV risk relationship. Women reporting recent sexual IPV reported 3.36 times more unprotected sex acts (AdjExp[B] = 3.36, 95% CI = 1.29-8.69, p = 0.07). The effect of sexual IPV on sexual risk was significantly greater among alcohol and fish sellers compared to sex workers (interaction: Exp[B] = 12.29, 95% CI = 5.06-29.85, p < 0.001). Women reporting any sexual IPV were nearly four times more likely to report being HIV positive than women reporting no sexual IPV (AOR = 3.94, 95% CI = 1.22-12.66, p = 0.02). Integrated IPV and HIV interventions are needed in this context, especially among alcohol and fish sellers engaging in transactional sex.

21 Article Prevalence and predictors of unknown HIV status among women delivering in Mulago National Referral Hospital, Kampala, Uganda. 2017

Namara-Lugolobi, Emily C / Nakigozi, Gertrude / Namukwaya, Zikulah / Kaye, Dan K / Nakku-Joloba, Edith. ·Makerere University - Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda. · Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda. · Makerere University College of Health Sciences, Department of Obstetrics and Gynecology, Kampala, Uganda. ·Afr Health Sci · Pubmed #29937866.

ABSTRACT: Introduction: Knowledge of a person's HIV status during pregnancy is critical for prevention of mother to child transmission of HIV. Objectives: To determine the prevalence and factors associated with unknown HIV status among women delivering in Mulago Hospital. Methods: This was a cross-sectional study of women that had just delivered. The women's demographic characteristics, health seeking behaviour, health system-related factors and knowledge on PMTCT were collected. Fisher's exact test, Wilcoxon rank sum test and logistic regression were used to test associations. Results: The prevalence of unknown HIV status was 2.6% (10/382). Attending ANC at higher level facilities (OR =0.1 95% CI 0.0 - 0.4) and having been counselled for HIV testing during ANC (OR=0.1, 95% CI 0.0 - 0.4) were associated with likelihood of having a known HIV status. Out of the ten women with unknown HIV status, 4/6 who attended ANC in public/government accredited health facilities "opted out" of HIV testing due to personal reasons. Among the four who attended ANC in private clinics, two were not offered HIV testing and one "opted out". Conclusion: Most participants had a known HIV status at labour (97%). Private clinics need to be supported to provide free quality HCT services in ANC.

22 Article Text Messaging for Improving Antiretroviral Therapy Adherence: No Effects After 1 Year in a Randomized Controlled Trial Among Adolescents and Young Adults. 2017

Linnemayr, Sebastian / Huang, Haijing / Luoto, Jill / Kambugu, Andrew / Thirumurthy, Harsha / Haberer, Jessica E / Wagner, Glenn / Mukasa, Barbara. ·Sebastian Linnemayr, Jill Luoto, and Glenn Wagner are with the RAND Corporation, Santa Monica, CA. Haijing Huang is with the Pardee RAND Graduate School, Santa Monica. Andrew Kambugu is with Infectious Diseases Institute and Makerere University, Kampala, Uganda. Harsha Thirumurthy is with Department of Health Policy and Management and Gillings School of Global Public Health at the University of North Carolina at Chapel Hill. Jessica E. Haberer is with Massachusetts General Hospital Center for Global Health and Harvard Medical School, Boston, MA. Barbara Mukasa is with Mildmay Uganda, Kampala. ·Am J Public Health · Pubmed #29048966.

ABSTRACT: OBJECTIVES: To assess the effectiveness of Short Message Service (SMS) reminder messages on antiretroviral and cotrimoxazole prophylaxis adherence among HIV-positive youths as well as the relative effectiveness of SMS with and without a response option. METHODS: Eligible HIV-positive patients aged 15 to 22 years at 2 HIV clinics in Kampala, Uganda, participated in a year-long parallel individual-randomized controlled trial and were assigned in a 1-to-1-to-1 ratio to a weekly SMS message group, weekly SMS message with response option group, or a usual-care control group. RESULTS: We enrolled 332 participants. Electronically measured mean adherence was 67% in the control group, 64% in the 1-way SMS group (95% confidence interval [CI] = 0.77, 1.14), and 61% in the 2-way SMS group (95% CI = 0.75, 1.12) in an intent-to-treat analysis. Results for secondary outcomes and complete-case analysis were similarly statistically insignificant across groups. CONCLUSIONS: Despite previous evidence that interventions using SMS reminders can promote antiretroviral therapy adherence, this study shows that they are not always effective in achieving behavior change. More research is needed to find out for whom, and under what conditions, they can be beneficial. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00830622.

23 Article Beyond HIV-serodiscordance: Partnership communication dynamics that affect engagement in safer conception care. 2017

Matthews, Lynn T / Burns, Bridget F / Bajunirwe, Francis / Kabakyenga, Jerome / Bwana, Mwebesa / Ng, Courtney / Kastner, Jasmine / Kembabazi, Annet / Sanyu, Naomi / Kusasira, Adrine / Haberer, Jessica E / Bangsberg, David R / Kaida, Angela. ·Center for Global Health, Massachusetts General Hospital, Boston, MA, United States of America. · Division of Infectious Disease, Massachusetts General Hospital, Boston, MA, United States of America. · Mbarara University of Science and Technology, Mbarara, Uganda. · Harvard T.H. Chan School of Public Health, Boston, MA, United States of America. · Research Institute McGill University Health Centre, Montreal, Canada. · Division of General Medicine, Massachusetts General Hospital, Boston, MA, United States of America. · OHSU-PSU School of Public Health, Portland, OR, United States of America. · Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. ·PLoS One · Pubmed #28880892.

ABSTRACT: INTRODUCTION: We explored acceptability and feasibility of safer conception methods among HIV-affected couples in Uganda. METHODS: We recruited HIV-positive men and women on antiretroviral therapy (ART) ('index') from the Uganda Antiretroviral Rural Treatment Outcomes cohort who reported an HIV-negative or unknown-serostatus partner ('partner'), HIV-serostatus disclosure to partner, and personal or partner desire for a child within two years. We conducted in-depth interviews with 40 individuals from 20 couples, using a narrative approach with tailored images to assess acceptability of five safer conception strategies: ART for the infected partner, pre-exposure prophylaxis (PrEP) for the uninfected partner, condomless sex timed to peak fertility, manual insemination, and male circumcision. Translated and transcribed data were analyzed using thematic analysis. RESULTS: 11/20 index participants were women, median age of 32.5 years, median of 2 living children, and 80% had HIV-RNA <400 copies/mL. Awareness of HIV prevention strategies beyond condoms and abstinence was limited and precluded opportunity to explore or validly assess acceptability or feasibility of safer conception methods. Four key partnership communication challenges emerged as primary barriers to engagement in safer conception care, including: (1) HIV-serostatus disclosure: Although disclosure was an inclusion criterion, partners commonly reported not knowing the index partner's HIV status. Similarly, the partner's HIV-serostatus, as reported by the index, was frequently inaccurate. (2) Childbearing intention: Many couples had divergent childbearing intentions and made incorrect assumptions about their partner's desires. (3) HIV risk perception: Participants had disparate understandings of HIV transmission and disagreed on the acceptable level of HIV risk to meet reproductive goals. (4) Partnership commitment: Participants revealed significant discord in perceptions of partnership commitment. All four types of partnership miscommunication introduced constraints to autonomous reproductive decision-making, particularly for women. Such miscommunication was common, as only 2 of 20 partnerships in our sample were mutually-disclosed with agreement across all four communication themes. CONCLUSIONS: Enthusiasm for safer conception programming is growing. Our findings highlight the importance of addressing gendered partnership communication regarding HIV disclosure, reproductive goals, acceptable HIV risk, and commitment, alongside technical safer conception advice. Failing to consider partnership dynamics across these domains risks limiting reach, uptake, adherence to, and retention in safer conception programming.

24 Article High rates of viral suppression in adults and children with high CD4+ counts using a streamlined ART delivery model in the SEARCH trial in rural Uganda and Kenya. 2017

Kwarisiima, Dalsone / Kamya, Moses R / Owaraganise, Asiphas / Mwangwa, Florence / Byonanebye, Dathan M / Ayieko, James / Plenty, Albert / Black, Doug / Clark, Tamara D / Nzarubara, Bridget / Snyman, Katherine / Brown, Lillian / Bukusi, Elizabeth / Cohen, Craig R / Geng, Elvin H / Charlebois, Edwin D / Ruel, Theodore D / Petersen, Maya L / Havlir, Diane / Jain, Vivek. ·Infectious Diseases Research Collaboration, Kampala, Uganda. · School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda. · Kenya Medical Research Institute, Nairobi, Kenya. · Division of HIV, Infectious Diseases & Global Medicine, University of California, San Francisco, CA, USA. · Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA. · Division of Infectious Diseases, Department of Pediatrics, University of California, San Francisco, CA, USA. · Department of Biostatistics and Epidemiology, Berkeley School of Public Health, Berkeley, CA, USA. ·J Int AIDS Soc · Pubmed #28770596.

ABSTRACT: INTRODUCTION: The 2015 WHO recommendation of antiretroviral therapy (ART) for all HIV-positive persons calls for treatment initiation in millions of persons newly eligible with high CD4+ counts. Efficient and effective care models are urgently needed for this population. We evaluated clinical outcomes of asymptomatic HIV-positive adults and children starting ART with high CD4+ counts using a novel streamlined care model in rural Uganda and Kenya. METHODS: In the 16 intervention communities of the HIV test-and-treat Sustainable East Africa Research for Community Health Study (NCT01864603), all HIV-positive individuals irrespective of CD4 were offered ART (efavirenz [EFV]/tenofovir disoproxil fumarate + emtricitabine (FTC) or lamivudine (3TC). We studied adults (≥fifteen years) with CD4 ≥ 350/μL and children (two to fourteen years) with CD4 > 500/μL otherwise ineligible for ART by country guidelines. Clinics implemented a patient-centred streamlined care model designed to reduce patient-level barriers and maximize health system efficiency. It included (1) nurse-conducted visits with physician referral of complex cases, (2) multi-disease chronic care (including for hypertension/diabetes), (3) patient-centred, friendly staff, (4) viral load (VL) testing and counselling, (5) three-month return visits and ART refills, (6) appointment reminders, (7) tiered tracking for missed appointments, (8) flexible clinic hours (outside routine schedule) and (9) telephone access to clinicians. Primary outcomes were 48-week retention in care, viral suppression (% with measured week 48 VL ≤ 500 copies/mL) and adverse events. CONCLUSIONS: Using a streamlined care model, viral suppression, retention and ART safety were high among asymptomatic East African adults and children with high CD4+ counts initiating treatment. CLINICAL TRIAL NUMBER: NCT01864603.

25 Article Efficacy of an enhanced linkage to HIV care intervention at improving linkage to HIV care and achieving viral suppression following home-based HIV testing in rural Uganda: study protocol for the Ekkubo/PATH cluster randomized controlled trial. 2017

Kiene, Susan M / Kalichman, Seth C / Sileo, Katelyn M / Menzies, Nicolas A / Naigino, Rose / Lin, Chii-Dean / Bateganya, Moses H / Lule, Haruna / Wanyenze, Rhoda K. ·Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, 5500 Campanile Drive (MC-4162), San Diego, CA, 92182, USA. skiene@mail.sdsu.edu. · Department of Psychology, University of Connecticut, Storrs, CT, USA. · Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, CA, USA. · Department of Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, MA, USA. · Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda. · Department of Mathematics and Statistics, San Diego State University, San Diego, CA, USA. · Formerly: Department of Global Health, University of Washington, Seattle, WA, USA. · Gombe Hospital, Gombe, Uganda. ·BMC Infect Dis · Pubmed #28673251.

ABSTRACT: BACKGROUND: Though home-based human immunodeficiency virus (HIV) counseling and testing (HBHCT) is implemented in many sub-Saharan African countries as part of their HIV programs, linkage to HIV care remains a challenge. The purpose of this study is to test an intervention to enhance linkage to HIV care and improve HIV viral suppression among individuals testing HIV positive during HBHCT in rural Uganda. METHODS: The PATH (Providing Access To HIV Care)/Ekkubo Study is a cluster-randomized controlled trial which compares the efficacy of an enhanced linkage to HIV care intervention vs. standard-of-care (paper-based referrals) at achieving individual and population-level HIV viral suppression, and intermediate outcomes of linkage to care, receipt of opportunistic infection prophylaxis, and antiretroviral therapy initiation following HBHCT. Approximately 600 men and women aged 18-59 who test HIV positive during district-wide HBHCT in rural Uganda will be enrolled in this study. Villages (clusters) are pair matched by population size and then randomly assigned to the intervention or standard-of-care arm. Study teams visit households and participants complete a baseline questionnaire, receive HIV counseling and testing, and have blood drawn for HIV viral load and CD4 testing. At baseline, standard-of-care arm participants receive referrals to HIV care including a paper-based referral and then receive their CD4 results via home visit 2 weeks later. Intervention arm participants receive an intervention counseling session at baseline, up to three follow-up counseling sessions at home, and a booster session at the HIV clinic if they present for care. These sessions each last approximately 30 min and consist of counseling to help clients: identify and reduce barriers to HIV care engagement, disclose their HIV status, identify a treatment supporter, and overcome HIV-related stigma through links to social support resources in the community. Participants in both arms complete interviewer-administered questionnaires at six and 12 months follow-up, HIV viral load and CD4 testing at 12 months follow-up, and allow access to their medical records. DISCUSSION: The findings of this study can inform the integration of a potentially cost-effective approach to improving rates of linkage to care and HIV viral suppression in HBHCT. If effective, this intervention can improve treatment outcomes, reduce mortality, and through its effect on individual and population-level HIV viral load, and decrease HIV incidence. TRIAL REGISTRATION: NCT02545673.

Next