Discordant responses to antiretroviral treatment: prevalence, risk factors and associated mortality in Rwanda

Mexico AIDS Conference 200

Risk factors for hepatotoxicity of nevirapine-containing antiretroviral drug regimens in a large antiretroviral treatment program in Rwanda

Mexico AIDS Conference 200

Principal Response Curve Analysis of Arthropod Community Abundance Data with Sparse Subsets

Principal response curve (PRC) analysis was applied to an assessment of the ecological impact of the genetically-modified (GM), insect-resistant, cotton MON 88702 on predatory Hemiptera communities in the field. The field community was represented by ten taxa collected ten times across the season at six sites, in which individual taxa were not observed in at least 25% of the time (unique site x collection combinations). These complete absences and those nearly so, called sparse subsets of the data in this investigation, were the result of geoclimatic and seasonal variations, which are both independent of the treatment effect for which the PRC analysis is intended. If the sparse subsets were included in the analysis, the treatment effect would be underestimated. Here, a modified analysis is proposed to remove those sparse subsets and to be performed on the incomplete data. In the application to MON 88702, four components (PRC1-4) were significant at the 5% level by the modified method, when more than 50% of the data were excluded due to no- or low responses, and five (PRC1-5) by the classical method. While PRC1-2 was highly consistent between two methods, PRC3-5 was largely different because of sparse subsets of the data. Differences in results between two methods demonstrate that excluding sparse subsets prevented the bias in the estimation of the treatment effect and the relationship with the community from confounding with the environmental variation that caused the sparse data. In this regard, the modification should be considered as a supplement of the classical PRC analysis and recommended when abundance data have sparse subsets

Determination of circulating Mycobacterium tuberculosis strains and transmission patterns among pulmonary TB patients in Kawempe municipality, Uganda, using MIRU-VNTR

<p>Abstract</p> <p>Background</p> <p>Mycobacterial interspersed repetitive units - variable number of tandem repeats (MIRU-VNTR) genotyping is a powerful tool for unraveling clonally complex <it>Mycobacterium tuberculosis </it>(MTB) strains and detection of transmission patterns. Using MIRU-VNTR, MTB genotypes and their transmission patterns among patients with new and active pulmonary tuberculosis (PTB) in Kawempe municipality in Kampala, Uganda was determined.</p> <p>Results</p> <p>MIRU-VNTR genotyping was performed by PCR-amplification of 15 MTB-MIRU loci from 113 cultured specimens from 113 PTB patients (one culture sample per patient). To determine lineages, the genotypes were entered into the MIRU-VNTR<it>plus </it>database [<url>http://www.miru-vntrplus.org/</url>] as numerical codes corresponding to the number of alleles at each locus. Ten different lineages were obtained: Uganda II (40% of specimens), Uganda I (14%), LAM (6%), Delhi/CAS (3%), Haarlem (3%), Beijing (3%), Cameroon (3%), EAI (2%), TUR (2%) and S (1%). Uganda I and Uganda II were the most predominant genotypes. Genotypes for 29 isolates (26%) did not match any strain in the database and were considered unique. There was high diversity of MIRU-VNTR genotypes, with a total of 94 distinct patterns. Thirty four isolates grouped into 15 distinct clusters each with two to four isolates. Eight households had similar MTB strains for both index and contact cases, indicating possible transmission.</p> <p>Conclusion</p> <p>MIRU-VNTR genotyping revealed high MTB strain diversity with low clustering in Kawempe municipality. The technique has a high discriminatory power for genotyping MTB strains in Uganda.</p

Patient Enrolment into HIV Care and Treatment within 90 Days of HIV Diagnosis in Eight Rwandan Health Facilities: A Review of Facility-Based Registers

INTRODUCTION: Access to antiretroviral therapy (ART) has increased greatly in sub-Saharan Africa. However many patients do not enrol timely into HIV care and treatment after HIV diagnosis. We studied enrolment into care and treatment and determinants of non-enrolment in Rwanda. METHODS: Data were obtained from routine clinic registers from eight health facilities in Rwanda on patients who were diagnosed with HIV at the antenatal care, voluntary counselling-and-testing, outpatient or tuberculosis departments between March and May 2009. The proportion of patients enrolled into HIV care and treatment was calculated as the number of HIV infected patients registered in ART clinics for follow-up care and treatment within 90 days of HIV diagnosis divided by the total number of persons diagnosed with HIV in the study period. RESULTS: Out of 482 patients diagnosed with HIV in the study period, 339 (70%) were females, and the median age was 29 years (interquartile range [IQR] 24-37). 201 (42%) enrolled into care and treatment within 90 days of HIV diagnosis. The median time between testing and enrolment was six days (IQR 2-14). Enrolment in care and treatment was not significantly associated with age, sex, or department of testing, but was associated with study site. None of those enrolled were in WHO stage 4. The median CD4 cell count among adult patients was 387 cells/mm(3) (IQR: 242-533 cells/mm(3)); 81 of 170 adult patients (48%) were eligible to start ART (CD4 count<350 cells/mm(3) or WHO stage 4). Among those eligible, 45 (56%) started treatment within 90 days of HIV diagnosis. CONCLUSION: Less than 50% of diagnosed HIV patients from eight Rwandan health facilities had enrolled into care and treatment within 90 days of diagnosis. Improving linkage to care and treatment after HIV diagnosis is needed to harness the full potential of ART

ANALYSIS OF ADAPTATION DIVERSITY TO CLIMATE VARIABILITY AND CHANGE AMONG PASTORAL COMMUNITIES IN NORTH-EASTERN UGANDA

Adaptation framing remains one of the major challenges to achieving greater implementation of adaptation initiatives in Sub-Saharan Africa (SSA). Using an integrated analytical framework that frames adaptation indicators into three dimensions; adaptive, absorptive and transformative capacities, we analysed the adaptation diversity in Karamoja sub-region, Uganda. We found a strong perception of the existence of climate variability and change manifested through the occurrence of droughts, floods, hailstorms, late onset and early rainfall onset. Absorptive capacity revealed varied status of asset ownership, custodianships, and access to these assets, presence of informal social safety nets, and social cohesion. Adaptive capacity revealed the presence of a diversity of livelihood sources, livelihood assets and associated income, but its human capital indicator revealed considerably high illiteracy levels among respondents. Meanwhile, transformative capacity revealed existence of network structures, governance and institutions, facilitated access to early warning information on pests, diseases and rainfall onset. Traditional institutions and the justice system played a key role in conflict resolution, mediation and negotiation for kraals establishment, grazing, and watering rights. We conclude that pastoral communities in Karamoja have a high inclination to maintenance of stability while their flexibility and ability to change decreases with the intensity of change pro-rata.Le cadrage de l\u2019adaptation reste l\u2019un des d\ue9fis majeurs pour parvenir \ue0 une plus grande mise en \u153uvre des initiatives d\u2019adaptation en Afrique subsaharienne (ASS). En utilisant un cadre analytique int\ue9gr\ue9 qui encadre les indicateurs d\u2019adaptation en trois dimensions; capacit\ue9s d\u2019adaptation, d\u2019absorption et de transformation, nous avons analys\ue9 la diversit\ue9 de l\u2019adaptation dans la sous-r\ue9gion de Karamoja, en Ouganda. Nous avons trouv\ue9 une forte perception de l\u2019existence de la variabilit\ue9 et des changements climatiques qui se manifestent par la survenue de s\ue9cheresses, d\u2019inondations, de temp\ueates de gr\ueale, d\u2019apparition tardive et pr\ue9coce des pr\ue9cipitations. La capacit\ue9 d\u2019absorption a r\ue9v\ue9l\ue9 des statuts vari\ue9s d\u2018\ua0actifs\ua0de\ua0propri\ue9t\ue9, de la protection de ses actifs et d\u2019acc\ue8s \ue0 ces actifs, la pr\ue9sence des r\ue9seaux de la s\ue9curit\ue9 sociale informels et la coh\ue9sion sociale. La capacit\ue9 d\u2019adaptation a r\ue9v\ue9l\ue9 la pr\ue9sence d\u2019une diversit\ue9 de sources de subsistance, d\u2019actifs de subsistance et de revenus associ\ue9s, mais son indicateur de capital humain a r\ue9v\ue9l\ue9 des niveaux d\u2019analphab\ue9tisme consid\ue9rablement \ue9lev\ue9s parmi les r\ue9pondants. Pendant ce temps, la capacit\ue9 de la transformation a r\ue9v\ue9l\ue9 l\u2019existence de structures de r\ue9seau, de gouvernance et d\u2019institutions, a facilit\ue9 l\u2019acc\ue8s aux informations d\u2019alerte pr\ue9coce sur les ravageurs, les maladies et l\u2019apparition des pluies. Les institutions traditionnelles et le syst\ue8me judiciaire ont jou\ue9 un r\uf4le cl\ue9 dans la r\ue9solution des conflits, la m\ue9diation et la n\ue9gociation pour l\u2019\ue9tablissement des \ue9tables et les droits de p\ue2turage et d\u2019abreuvement. Nous concluons que les communaut\ue9s pastorales du Karamoja ont une forte tendance au maintien de la stabilit\ue9 tandis que leur flexibilit\ue9 et leur capacit\ue9 \ue0 changer diminuent avec l\u2019intensit\ue9 du changement au prorata

Linkage to HIV care before and after the introduction of provider-initiated testing and counselling in six Rwandan health facilities.

HIV testing and counselling forms the gateway to the HIV care and treatment continuum. Therefore, the World Health Organization recommends provider-initiated testing and counselling (PITC) in countries with a generalized HIV epidemic. Few studies have investigated linkage-to-HIV-care among out-patients after PITC. Our objective was to study timely linkage-to-HIV-care in six Rwandan health facilities (HFs) before and after the introduction of PITC in the out-patient departments (OPDs). Information from patients diagnosed with HIV was abstracted from voluntary counselling and testing, OPD and laboratory registers of six Rwandan HFs during three-month periods before (March-May 2009) and after (December 2009-February 2010) the introduction of PITC in the OPDs of these facilities. Information on patients' subsequent linkage-to-pre-antiretroviral therapy (ART) care and ART was abstracted from ART clinic registers of each HF. To triangulate the findings from HF routine, a survey was held among patients to assess reasons for non-enrolment. Of 635 patients with an HIV diagnosis, 232 (36.5%) enrolled at the ART clinic within 90 days of diagnosis. Enrolment among out-patients decreased after the introduction of PITC (adjusted odds ratio, 2.0; 95% confidence interval, 1.0-4.2; p = .051). Survey findings showed that retesting for HIV among patients already diagnosed and enrolled into care was not uncommon. Patients reported non-acceptance of disease status, stigma and problems with healthcare services as main barriers for enrolment. Timely linkage-to-HIV-care was suboptimal in this Rwandan study before and after the introduction of PITC; the introduction of PITC in the OPD may have had a negative impact on linkage-to-HIV-care. Healthier patients tested through PITC might be less ready to engage in HIV care. Fear of HIV stigma and mistrust of test results appear to be at the root of these problems

FACTORS DETERMINING INTENSITY OF CAMEL ADOPTION IN SEMI-ARID NORTH-EASTERN UGANDA

Integration of camel ( Camelus dromedarius ) production in the traditional livestock systems is increasingly gaining significance as a strategy for household adaptation to prolonged and recurrent droughts in African arid and semi-arid lands. There is increasing interest in promoting camels as a strategy to mitigate the effects of prolonged droughts in communities where camels have not been reared before. However, the intensity of camel adoption and the factors that drive camel adoption process in semi-arid Uganda are not clear. The objective of this study was to determine the level of intensity and socio-economic factors influencing the intensity of camel adoption in Karamoja sub-region in Uganda. Econometric results show that age the of a household head was significantly associated with the intensity of camel adoption; whereas household size, credit access and crop area cultivated significantly decreased with the intensity of camel adoption in the region. Increasing camel adoption was possible with increasing access to capital; as well as carefully balancing the competition for labour with crop cultivation.L\u2019int\ue9gration de la production de chameaux (Camelus dromedarius) dans les syst\ue8mes d\u2019\ue9levage traditionnels prend de plus en plus d\u2019importance en tant que strat\ue9gie d\u2019adaptation des m\ue9nages aux s\ue9cheresses prolong\ue9es et r\ue9currentes dans les regions arides et semi-arides d\u2019Afrique. Il y a un int\ue9r\ueat croissant pour la promotion des chameaux comme strat\ue9gie pour att\ue9nuer les effets des s\ue9cheresses prolong\ue9es dans les communaut\ue9s o\uf9 les chameaux n\u2019ont pas \ue9t\ue9 \ue9lev\ue9s auparavant. Cependant, l\u2019intensit\ue9 de l\u2019adoption des chameaux et les facteurs qui motivent le processus d\u2019adoption des chameaux dans la r\ue9gion semi-aride de l\u2019Ouganda ne sont pas clairs. L\u2019objectif de cette \ue9tude \ue9tait de d\ue9terminer le niveau d\u2019intensit\ue9 et les facteurs socio-\ue9conomiques influen\ue7ant l\u2019intensit\ue9 de l\u2019adoption de chameaux dans la sous-r\ue9gion de Karamoja en Ouganda. Les r\ue9sultats \ue9conom\ue9triques ont montr\ue9 que l\u2019\ue2ge du chef de m\ue9nage \ue9tait significativement associ\ue9 \ue0 l\u2019intensit\ue9 de l\u2019adoption de chameaux ; tandis que la taille des m\ue9nages, l\u2019acc\ue8s au cr\ue9dit et la superficie cultiv\ue9e ont consid\ue9rablement diminu\ue9 avec l\u2019intensit\ue9 de l\u2019adoption de chameaux dans la r\ue9gion. L\u2019augmentation de l\u2019adoption de chameaux \ue9tait possible avec un acc\ue8s accru au capital; ainsi que d\u2019\ue9quilibrer soigneusement la concurrence pour la main-d\u2019\u153uvre avec la culture des plantes