Wetland change detection and inundation north of lake George, western Uganda using landsat data

A remote sensing approach has been adopted to detect seasonal change and inundation in the wetlands north of Lake George, western Uganda that is being impacted by anthropogenic factors. Five Landsat (TM and ETM+) satellite imagery of August 1987, January 1995, September 1999, March 2001 and December 2001 were used. During change detection in the wetland region, three broad classes (water bodies, exposed areas and vegetated zones) were generated in a Geographic Information System (GIS) using the Normalised Difference Water Index (NDWI), Normalised Difference Vegetation Index (NDVI), and unsupervised classification supported with ground data. Inundation mapping was carried out using density slicing on image sets with similar precipitation inputs. Change detection shows a slight decrease in vegetated and exposed wetlands areas from August 1987 through March 2001. Inundation mapping presents an increase in waterlogged expanses from January 1995 to December 2001. There is a likelihood of present anthropogenic factors playing a significant role in denuding the wetland land cover. A similar remote sensing approach could be used for monitoring temporal and spatial aspects of other wetlands in the region.Keywords: Wetland, Change detection, Inundation, Lake George, Remote Sensin

Cost Effectiveness of a Pharmacy-Only Refill Program in a Large Urban HIV/AIDS Clinic in Uganda

HIV/AIDS clinics in Uganda and other low-income countries face increasing numbers of patients and workforce shortages. We performed a cost-effectiveness analysis comparing a Pharmacy-only Refill Program (PRP), a form of task-shifting, to the Standard of Care (SOC) at a large HIV/AIDS clinic in Uganda, the Infectious Diseases Institute (IDI). The PRP was started to reduce workforce shortages and optimize patient care by substituting pharmacy visits for SOC involving monthly physician visits for accessing antiretroviral medicines.We used a retrospective cohort analysis to compare the effectiveness of the PRP compared to SOC. Effectiveness was defined as Favorable Immune Response (FIR), measured as having a CD4 lymphocyte count of over 500 cells/µl at follow-up. We used multivariate logistic regression to assess the difference in FIR between patients in the PRP and SOC. We incorporated estimates of effectiveness into an incremental cost-effectiveness analysis performed from a limited societal perspective. We estimated costs from previous studies at IDI and conducted univariate and probabilistic sensitivity analyses. We identified 829 patients, 578 in the PRP and 251 in SOC. After 12.8 months (PRP) and 15.1 months (SOC) of follow-up, 18.9% of patients had a FIR, 18.6% in the PRP and 19.6% in SOC. There was a non-significant 9% decrease in the odds of having a FIR for PRP compared to SOC after adjusting for other variables (OR 0.93, 95% CI 0.55-1.58). The PRP was less costly than the SOC (US$520 vs. 655 annually, respectively). The incremental cost-effectiveness ratio comparing PRP to SOC was US$ 13,500 per FIR. PRP remained cost-effective at univariate and probabilistic sensitivity analysis.The PRP is more cost-effective than the standard of care. Similar task-shifting programs might help large HIV/AIDS clinics in Uganda and other low-income countries to cope with increasing numbers of patients seeking care

Incident Tuberculosis during Antiretroviral Therapy Contributes to Suboptimal Immune Reconstitution in a Large Urban HIV Clinic in Sub-Saharan Africa

Antiretroviral therapy (ART) effectively decreases tuberculosis (TB) incidence long-term, but is associated with high TB incidence rates in the first 6 months. We sought to determine the incidence and the long-term effects of TB during ART on HIV treatment outcome, and the risk factors for incident TB during ART in a large urban HIV clinic in Uganda.Routinely collected longitudinal clinical data from all patients initiated on first-line ART was retrospectively analysed. 5,982 patients were included with a median baseline CD4+ T cell count (CD4 count) of 117 cells/mm(3) (interquartile range [IQR]; 42, 182). In the first 2 years, there were 336 (5.6%) incident TB events in 10,710 person-years (py) of follow-up (3.14 cases/100 pyar [95% CI 2.82-3.49]); incidence rates at 0-3, 3-6, 6-12 and 12-24 months were 11.25 (9.58-13.21), 6.27 (4.99-7.87), 2.47 (1.87-3.36) and 1.02 (0.80-1.31), respectively. Incident TB during ART was independently associated with baseline CD4 count of <50 cells/mm(3) (hazard ratio [HR] 1.84 [1.25-2.70], P = 0.002) and male gender (HR 1.68 [1.34-2.11], P<0.001). After two years on ART, the patients who had developed TB in the first 12 months had a significantly lower median CD4 count increase (184 cells/mm(3) [IQR; 107, 258, n = 118] vs 209 cells/mm(3) [124, 309, n = 2166], P = 0.01), a larger proportion of suboptimal immune reconstitution according to two definitions (increase in CD4 count <200 cells/mm(3): 57.4% vs 46.9%, P = 0.03, and absolute CD4 count <200 cells/mm(3): 30.4 vs 19.9%, P = 0.006), and a higher percentage of immunological failure according to the WHO criteria (13.6% vs 6.5%, P = 0.003). Incident TB during ART was independently associated with poor CD4 count recovery and fulfilling WHO immunological failure definitions.Incident TB during ART occurs most often within 3 months and in patients with CD4 counts less than 50 cells/mm(3). Incident TB during ART is associated with long-term impairment in immune recovery

Assessing COVID-19 vaccine roll-out in Uganda: a case study of uptake and associated factors among health care workers and older people

Introduction We conducted a survey to investigate the uptake of COVID-19 vaccination among healthcare workers (HCWs) and older persons (≥ 50 years) in Uganda, groups at particular risk of infection and severe disease outcomes respectively. Methods The survey was conducted between May and August 2021, during the early phase of COVID-19 vaccine roll-out. All HCWs at Entebbe and Kisubi hospitals, Wakiso district (urban/peri-urban) and Villa Maria hospital, Kalungu district (rural), and non-healthcare worker (non-HCW) individuals enrolled in an ongoing older persons’ cohort study in Wakiso district, completed an interviewer-administered questionnaire on socio-demographics, pre-existing medical conditions, attitudes regarding COVID-19 vaccines, and vaccination uptake. Logistic regression was performed to investigate factors associated with uptake. Findings A total of 746 individuals, 597 HCWs and 149 non-HCW older persons, participated. Majority were aged ≤50 years (71.6%), female (63.1%), and had secondary school/other higher-level education (77.8%). COVID-19 uptake was 63.7%, overall; 95.2%, Entebbe Hospital; 75.4%, Kisubi Hospital; 49.5%, Villa Maria Hospital; and 20.8%, non-HCW. Among HCWs, health facility [Entebbe hospital (aOR 18.9, 95% CI 8.9-40.2), Kisubi hospital (aOR 5.2, 95% CI 3.0-9.0) all compared with Villa Maria], age &gt;50 years (aOR 3.1, 95% CI 1.2-8.4) and positive attitude towards COVID-19 vaccines (aOR 5.0, 95% CI 2.1-11.8) were associated with high uptake, while female sex (aOR 0.5, 95% CI 0.3-0.9) was associated with low uptake. Among non-HCW older persons, absence of chronic infectious disease (aOR 4.3, 95% CI 1.1-16.3) good attitude towards COVID-19 vaccines (aOR 29.2, 95% CI 4.1-208.8) were associated with high uptake, while advanced age 70-79 years (aOR 0.1, 95% CI 0.01-0.97) was associated with low uptake. Conclusion COVID-19 vaccine uptake was lowest among rural-based HCWs and non-HCW older persons. Vaccination campaigns during a pandemic need to foster positive attitudes towards vaccines and employ strategies specifically designed to improve vaccine uptake among disadvantaged populations

Scatter plot of estimated joint density of incremental costs and incremental effects of Pharmacy-only Refill Program (PRP) versus Standard of Care (SOC) by Monte Carlo simulation.

<p>Scatter plot of estimated joint density of incremental costs and incremental effects of Pharmacy-only Refill Program (PRP) versus Standard of Care (SOC) by Monte Carlo simulation.</p

Mean and incremental costs, probability of CD4 cell count over 500 cell/ul at 1 year and cost-effectiveness comparing PRP and standard care in patients on antiretroviral treatment at the IDI clinic, Kampala, Uganda.

<p>Inc. – Incremental; ICER: Incremental Cost-Effectiveness Ration; FIR – Favorable Immune Response; PRP: Pharmacy-Only Refill Program; SOC – Standard of Care.</p><p>*All costs are per person per year.</p

Tornado diagram of univariate sensitivity analysis showing the impact on incremental costs comparing Pharmacy-only Refill Program (PRP) versus Standard of Care (SOC).

<p>Tornado diagram of univariate sensitivity analysis showing the impact on incremental costs comparing Pharmacy-only Refill Program (PRP) versus Standard of Care (SOC).</p

Cost-effectiveness acceptability curve showing the probability that Pharmacy-only Refill Program (PRP) or Standard of Care (SOC) is cost-effective compared to the other over a range of values of willingness to pay.

<p>Cost-effectiveness acceptability curve showing the probability that Pharmacy-only Refill Program (PRP) or Standard of Care (SOC) is cost-effective compared to the other over a range of values of willingness to pay.</p

Univaraite and multivariate logistic regression analysis of variables associated with follow-up CD4 cell count over 500 cells/ul (n = 807).

<p>OR: odd ratio; SOC: standard of care; PRP: Pharmacy Refill Program; ART: antiretroviral treatment; d4T: stavudine; 3TC: lamivudine; NVP: nevirapine; ZDV: zidovudine; EFV: efavirenz; TDF: tenofovir; FTC: emtricitabine; LPV/r: lopinavir/ritonavir; OI: opportunistic infection.</p