Prevalence and Factors Associated With Liver Fibrosis Among Adult HIV-Infected Patients Attending Urban and Rural Care Clinics in Uganda.

BACKGROUND: Liver fibrosis is common among HIV-infected patients. Risk factors vary by location. Understanding this variation may inform prevention strategies. We compared the prevalence and correlates of liver fibrosis among HIV-infected patients attending care clinics in Uganda. METHODS: This was a cross-sectional study involving 2030 HIV-infected patients attending care clinics in urban and rural Uganda. Liver fibrosis was defined as liver stiffness measurement (LSM) >7.1 KPa. Proportions and correlates of liver fibrosis were assessed and compared using logistic regression stratified by gender and site. RESULTS: Prevalence of liver fibrosis was higher among participants in the rural clinic (15% vs 11%; P = .017). History of tobacco use (urban P = .022; rural P = .035) and serologic evidence of hepatitis C infection (HCV; urban P = .028; rural P = .03) was associated with liver fibrosis in all men. Elevated liver transaminases (urban P = .002; rural P = .028) and increasing age (urban P = .008; rural P = .052) were risk factors among all women. Tobacco use among women was only a risk factor in those attending the rural clinic (P = .003), and detectable HIV viral load (P = .002) for men in the urban clinic. CONCLUSIONS: Liver fibrosis is prevalent among HIV-infected persons in Uganda. HIV viral suppression and avoiding tobacco may be strategies to prevent liver fibrosis and cancer risk

Mentorship needs at academic institutions in resource-limited settings: a survey at makerere university college of health sciences

<p>Abstract</p> <p>Background</p> <p>Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS).</p> <p>Methods</p> <p>Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors) and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees) registered with the Uganda Society for Health Scientists (USHS). Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes.</p> <p>Results</p> <p>Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses). Up to 77% (17/22) of mentors had Master's-level training and only 18% (4/22) had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions.</p> <p>Conclusions</p> <p>Both mentors and mentees were willing to improve mentorship practices at MAKCHS. There is need for institutional commitment to uphold and sustain the mentorship best practices. We recommend a collaborative approach by the stakeholders in global health promotion to build local capacity in mentoring African health professionals.</p

The multi-country PROMOTE HIV antiretroviral treatment observational cohort in Sub-Saharan Africa: objectives, design, and baseline findings.

CAPRISA, 2018.Abstract available in pdf

Efficacy and safety of an extended nevirapine regimen in infants of breastfeeding mothers with HIV-1 infection for prevention of HIV-1 transmission (HPTN 046): 18-month results of a randomized, double-blind, placebo-controlled trial.

CAPRISA, 2013.Abstract available in PDF file

MORBIDITY AND MORTALITY OF HIV EXPOSED UNINFECTED CHILDREN IN SUB-SAHARAN AFRICA

Background: Several sub-Saharan Africa countries are on a fast-track to elimination of mother-to-child transmission of HIV through rapid scale-up of antiretroviral therapy (ART) programs. Peripartum-ART exposures have been associated with increased childhood morbidity. Objectives: To compare anthropometric, and clinical outcomes among exposed (maternal-HIV and ART), versus unexposed children. Methods: Prospective cohort of exposed children enrolled from the PROMISE randomized-clinical-trial (combination-ART (cART) versus non-cART), and age-and-gender-matched controls separately enrolled from child-well clinics, in Malawi, and Uganda. WHO growth-standards (2006) were used to derive weight-for-age (WAZ); length-for-age (LAZ); weight-for-length (WLZ); and head-circumference-for-age (HCAZ) z-scores; and the DAIDS toxicity tables (version 1.0, 2004/2009), to classify hematological parameters. Wilcoxan Rank-Sum/Fischer’s exact tests were used to compare variables, and Generalized-Estimating-Equations, and Cox proportional hazards models to measure associations. Results: Overall, 471(50.5%) exposed and 462(49.5%) control-children were enrolled. Ugandan exposed verses controls had lower mean-Z-scores: LAZ (p0.05). Adjusted relative-risk (RR), 95% confidence interval (CI) of stunting was higher among exposed versus control-children: 2.11 (1.14, 3.90), p=0.017, at 12-months, and 1.83 (1.03, 3.24), p=0.039, at 24-months-of-age, in Uganda; and 1.57 (1.18, 2.10), p=0.002, at 24-months-of-age, in Malawi. Relative-risk of HCAZ below WHO median was higher among exposed versus controls at 24-months-of-age, RR (95 CI) = 1.78 (1.10, 2.90), p=0.019, in Malawi; and 1.28 (0.82, 2.01), p=0.279, in Uganda. Hematological parameters, and hospitalization risks, were similar (p>0.05) across exposure groups, or more favorable among exposed versus controls. Grade 2 or higher anemia risk was lower among exposed versus control-children: adjusted RR (95% CI) = 0.33 (0.17, 0.64), p=0.001 in Uganda, and RR (95% CI) = 0.56 (0.26, 1.16), p=0.119, in Malawi. Similar trends were observed with grade 3 or higher risk. Risk-estimates were homogeneous across cART and non-cART exposure-groups (p>0.05); and in-utero versus cumulative (in-utero and postpartum)) models. Conclusions: In-utero, but not postpartum, exposures to maternal-HIV and ART, are associated with lower LAZ (including stunting), WAZ and HCAZ at 24 months-of-age. Hematological patterns and hospitalization risk were homogeneous across exposure groups

Indirect serum biomarkers perform sub optimally in screening for significant liver fibrosis among HIV-infected and uninfected adults in Uganda.

INTRODUCTION: Indirect serum bio-markers present an acceptable noninvasive and cheap alternative for screening of significant liver fibrosis (SLF). Evaluation of their use in resource limited settings is important to determine their utility. METHODS: We conducted a cross sectional study among 520 HIV infected and HIV uninfected adults attending care clinics in Kampala Uganda. Presence of SLF was determined using Fibroscan® liver stiffness measurement of ≥7.2KPa. The diagostic value of indirect serum bio-markers for diagnosis of SLF was evaluated using the area under the receiver operating characteristics curve (AUROC) using Fibroscan® as gold standard. RESULTS: Overall AUROC values for Age Platelet Index (API), Aspartate to Alanine Ratio (AAR), AST-to-Platelet Ratio Index (APRI), Fibrosis Index based on 4 Factors (FIB-4) and Gamma glutamyl transferase to Platelet Ratio Index (GPR) were 0.52, 0.49, 0.55, 0.55 and 0.54 respectively. Among HIV-infected participants AUROC values were slightly improved at predicting presence of SLF but still under 70%. CONCLUSION: Despite APRI and FIB-4 being more likely to identify participants with SLF, the overall diagnostic value of all serum bio-markers was poor with and without stratification by HIV status. We recommend the use of Fibroscan® technology as more accurate non-invasive diagnostic method for screening of SLF

Use of effective family planning methods and frequency of sex among HIV-infected and HIV-uninfected African women

Abstract Background Frequency of sex, contraceptive use and HIV infection are key determinants of fertility. Use of an effective family planning (EFP) method (injectable, oral, intra-uterine contraceptive device (IUCD), or Norplant) potentially eliminates women’s concerns of unintended pregnancy. We report the association between EFP and frequency of sex among HIV-infected and HIV-uninfected non-pregnant African women. Methods Prospective fertility intentions study nested within a phase 3 randomized double-masked placebo-controlled trial (2003-2005) to treat genital tract infections in HIV-infected and HIV-uninfected non-pregnant women. Enrollment of study participants was stratified by HIV infection status. Data on demographics, family planning and sexual history were obtained at baseline and at 3, 6, 9 and 12 months. Chi square and Wilcoxon Rank-Sum tests were used to compare categorical and continuous variables, respectively. Generalized Estimating Equations method was used to estimate relative risk (RR) of frequent sex (≥ 2 acts/week) among users of different EFP methods (injectable, oral, implant or intra-uterine contraceptive device). Results After adjusting for age, current health status, and fertility intentions, EFP use was significantly associated with frequent sex among HIV-infected women (RR 1.32; 95% Confidence Interval [CI] 1.14-1.52); this association was not statistically significant among HIV-uninfected women (RR 1.10; 95% CI 0.96-1.24). Fertility intentions among HIV-infected, and education among HIV-uninfected womenwere independent predictors of sex frequency. Conclusion These data suggest that the association between EFP use and frequency of sex among women varies by HIV infection status. Service-delivery of diverse EFP methods should be integrated within HIV counseling, testing and treatment facilities. Trial registration Registration number NCT00140764 under the clinicaltrials.gov, first Posted: September 1, 2005, last Update Posted: August 10, 2011