High Rate of HIV Re-suppression After Viral Failure on First Line Antiretroviral Therapy in the Absence of Switch to Second Line.

In a randomised comparison of nevirapine or abacavir with zidovudine + lamivudine, routine viral load monitoring was not performed yet 27% of individuals with viral failure at w48 re-suppressed by w96 without switching. This supports WHO recommendations that suspected viral failure should trigger adherence counselling and repeat measurement before considering treatment switch

The Social Network: How People with Visual Impairment use Mobile Phones in Kibera, Kenya

Living in an informal settlement with a visual impairment can be very challenging resulting in social exclusion. Mobile phones have been shown to be hugely beneficial to people with sight loss in formal and high-income settings. However, little is known about whether these results hold true for people with visual impairment (VIPs) in informal settlements. We present the findings of a case study of mobile technology use by VIPs in Kibera, an informal settlement in Nairobi. We used contextual interviews, ethnographic observations and a co-design workshop to explore how VIPs use mobile phones in their daily lives, and how this use influences the social infrastructure of VIPs. Our findings suggest that mobile technology supports and shapes the creation of social infrastructure. However, this is only made possible through the existing support networks of the VIPs, which are mediated through four types of interaction: direct, supported, dependent and restricted

Rapid accumulation of HIV-1 thymidine analogue mutations and phenotypic impact following prolonged viral failure on zidovudine-based first-line ART in sub-Saharan Africa.

Background: Lack of viral load monitoring of ART is known to be associated with slower switch from a failing regimen and thereby higher prevalence of MDR HIV-1. Many countries have continued to use thymidine analogue drugs despite recommendations to use tenofovir in combination with a cytosine analogue and NNRTI as first-line ART. The effect of accumulated thymidine analogue mutations (TAMs) on phenotypic resistance over time has been poorly characterized in the African setting. Patients and methods: A retrospective analysis of individuals with ongoing viral failure between weeks 48 and 96 in the NORA (Nevirapine OR Abacavir) study was conducted. We analysed 36 genotype pairs from weeks 48 and 96 of first-line ART (14 treated with zidovudine/lamivudine/nevirapine and 22 treated with zidovudine/lamivudine/abacavir). Phenotypic drug resistance was assessed using the Antivirogram assay (v. 2.5.01, Janssen Diagnostics). Results: At 96 weeks, extensive TAMs (≥3 mutations) were present in 50% and 73% of nevirapine- and abacavir-treated patients, respectively. The mean (SE) number of TAMs accumulating between week 48 and week 96 was 1.50 (0.37) in nevirapine-treated participants and 1.82 (0.26) in abacavir-treated participants. Overall, zidovudine susceptibility of viruses was reduced between week 48 [geometric mean fold change (FC) 1.3] and week 96 (3.4, P  =   0.01). There was a small reduction in tenofovir susceptibility (FC 0.7 and 1.0, respectively, P  =   0.18). Conclusions: Ongoing viral failure with zidovudine-containing first-line ART is associated with rapidly increasing drug resistance that could be mitigated with effective viral load monitoring

Phenotypic and genotypic analyses to guide selection of reverse transcriptase inhibitors in second-line HIV therapy following extended virological failure in Uganda

Objectives We investigated phenotypic and genotypic resistance after 2 years of first-line therapy with two HIV treatment regimens in the absence of virological monitoring. Methods NORA [Nevirapine OR Abacavir study, a sub-study of the Development of AntiRetroviral Therapy in Africa (DART) trial] randomized 600 symptomatic HIV-infected Ugandan adults (CD4 cell count <200 cells/mm3) to receive zidovudine/lamivudine plus abacavir (cABC arm) or nevirapine (cNVP arm). All virological tests were performed retrospectively, including resistance tests on week 96 plasma samples with HIV RNA levels ≥1000 copies/mL. Phenotypic resistance was expressed as fold-change in IC50 (FC) relative to wild-type virus. Results HIV-1 RNA viral load ≥1000 copies/mL at week 96 was seen in 58/204 (28.4%) cABC participants and 21/159 (13.2%) cNVP participants. Resistance results were available in 35 cABC and 17 cNVP participants; 31 (89%) cABC and 16 (94%) cNVP isolates had a week 96 FC below the biological cut-off for tenofovir (2.2). In the cNVP arm, 16/17 participants had resistance mutations synonymous with high-level resistance to nevirapine and efavirenz; FC values for etravirine were above the biological cut-off in 9 (53%) isolates. In multivariate regression models, K65R, Y115F and the presence of thymidine analogue-associated mutations were associated with increased susceptibility to etravirine in the cABC arm. Conclusions Our data support the use of tenofovir following failure of a first-line zidovudine-containing regimen and shed further light on non-nucleoside reverse transcriptase inhibitor hypersusceptibility

Mapping the medical outcomes study HIV health survey (MOS-HIV) to the EuroQoL 5 Dimension (EQ-5D-3L) utility index

10.1186/s12955-019-1135-8Health and Quality of Life Outcomes1718

High rate of HIV resuppression after viral failure on first-line antiretroviral therapy in the absence of switch to second-line therapy.

In a randomized comparison of nevirapine or abacavir with zidovudine plus lamivudine, routine viral load monitoring was not performed, yet 27% of individuals with viral failure at week 48 experienced resuppression by week 96 without switching. This supports World Health Organization recommendations that suspected viral failure should trigger adherence counseling and repeat measurement before a treatment switch is considered

Identification of research activities for the dairy sector development in Uganda: systemic and participatory approaches

No Abstract

The Effect of Public Health Spending on Under-five Mortality Rate in Uganda

Previous studies indicate that under-five mortality rates have remained stagnant and Uganda failed to meet the Millennium Development Goals target and hence unlikely to achieve Sustainable Development Goals. Although effective health reforms and programs such as the Immunization Integrated Management of Childhood Illness (IMCI), and Home Based Management of Fever (HBMF) and increasing health expenditure were undertaken since1990s, health outcomes especially under-five mortality rates have remained poor. Uganda’s under-five mortality rate has remained high that is 68 per 1000 live birth in relation to MDGs target 56 per 1000 live birth in 2014 .The MDGs assessment report by United Nation Development Programme (UNDP) shows that the low level of public health expenditure is a major factor determining poor child health outcomes in Uganda. However empirical evidence on the health expenditure and its effect on under-five mortality rate have remained inconclusive. Simple Ordinary least squares (OLS) method was used to investigate the relationship between public health spending and under-five mortality rate. The results revealed that recurrent health expenditure, capital health expenditure, women literacy rate and percentage of population living in urban areas are strongly associated with under-five mortality rate. The study therefore recommends that the government should increase health spending per capita in relation to the increase in population and increase accessibility to education for the girl child

Who knows, Who Cares?: Determinants of Enactment, Awareness and Compliance With Community Natural Resource Management Bylaws in Uganda

Community-based Natural Resource Management (NRM) is increasingly becoming an important approach for addressing natural resource degradation in low income countries. This study analyzes the determinants of enactment, awareness of and compliance with by-laws related to Natural Resource Management (NRM) in order to draw policy implications that could be used to increase the effectiveness of by-laws in managing natural resources sustainably. We found a strong association between awareness and compliance with NRM bylaws. This suggests the need to promote environmental education as part of the strategy to increase compliance with NRM bylaws. Econometric analysis of the survey data indicates factors that are associated with enactment of local NRM bylaws, and awareness of and compliance with NRM requirements: • Local NRM bylaws are more likely to be enacted in communities where there are programs and organizations focusing on agriculture and environment, but less likely where the land tenure system is customary than where other land tenure systems are predominant. • People are more aware of requirements related to bush burning in communities that are closer to an all-weather road and have better access to credit. People are more aware of requirements related to tree planting and protection closer to roads, and where there are more programs and organizations with focus on agriculture and the environment • People are more likely to comply with a bylaw enacted by the local council than otherwise. People are more likely to comply with requirements related to tree planting and protection in communities where agricultural potential is high, where income poverty is lower, where adults are more educated and where there are more credit organizations. These findings imply that improving awareness of NRM requirements is critical to increase compliance with such requirements. Awareness is greater in areas closer to all-weather roads, probably due to better access to information in such areas. Development of roads and communication can thus facilitate better community NRM. Other low cost options to increase awareness could include use of radio programs, environmental education in schools, resource user seminars, brochures, and district level training workshops. Devolution of responsibility contributes to greater compliance with NRM requirements, given that compliance is greater with bylaws enacted by local councils than with laws enacted at a higher level. Involvement of locally accountable and representative authorities in enacting and enforcing NRM requirements appears critical for the legitimacy and success of such regulation. Involvement of external programs and organizations focusing on agriculture and environment issues can help to promote such local enactment. Several dimensions of poverty, including greater income poverty, poor education, and poor access to credit are associated with lower compliance with tree planting and protection requirements. This supports the hypothesis of a poverty-natural resource degradation trap, and suggests that measures to reduce poverty can have “win-win” benefits helping to improve NRM as well