D. Saylor

G. Nakigozi

K. Robertson

M.J. Wawer

N. Nakasujja

N. Sacktor

R.H. Gray

X. Kong

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212 Non -Commun i c a b l e D i s e a s e s & In j u r i e sFindings: Analysis of the data from the training on diabetes revealedthat at almost every visit: 96% worked with a person with diabetes,92% counseled a patient on diabetes, 94% talked with a diabeticpatient about taking their medications, 63% inspected a patient’s feet,83% made a referral to a hospital/clinic, and 96% used the diabetesaction plan. The knowledge retention and application scores werehigh for the hypertension content as well. On almost every visit,100% worked with someone who had hypertension, 96% counseleda person on improving their diet, 96% talked with patients aboutrefilling medications or taking BP meds, 75% referred a patient tohospital or clinic, and 96% used the hypertension action plan.However, only 30.4% measured BP on almost every visit.Interpretation: One year after completion of a training program theCHWS retained knowledge and applied it in the care of their patientswith hypertension and diabetes. The 100% retention rate after 12months affirms the commitment of the participants and increases thelikelihood of project sustainability. Challenges: Lack of equipment totake blood pressures did not give the CHWS the chance to practice orgather important data for the medical team. Going Forward: Futureresearch studies will be expanded to include home visits to observethe CHWS interacting with their clients as they apply knowledgefrom the training, funding for BP monitors, and the collection ofpatient level data to directly link education and training to outcomesfor individuals and communities.Funding: No funding listed.Abstract #: 02NCD022Prevalence of and risk factors for peripheral neuropathyin Rakai, UgandaD. Saylor1, G. Nakigozi2, N. Nakasujja3, X. Kong4, K. Robertson5,R.H. Gray4, M.J. Wawer4, N. Sacktor1; 1Johns Hopkins UniversitySchool of Medicine, Baltimore, MD/US, 2Rakai Health Sciences Pro-gram, Rakai, UG, 3Makerere University, Kampala, UG, 4Johns HopkinsUniversity Bloomberg School of Public Health, Baltimore, MD/US,5University of North Carolina - Chapel Hill, Chapel Hill, NC/USBackground: Peripheral neuropathy (PN) is a common and poten-tially debilitating neurologic complication of HIV infection. System-atic studies of PN in sub-Saharan Africa are lacking. This study aimedto identify the prevalence of and risk factors for PN in rural Uganda.Methods: A sample of participants in the Rakai Community CohortStudy were selected for this study. Eligible participants were >18years old, HIV-positive (HIV+), antiretroviral (ARV) naïve, and hadCD4 counts either between 351 and 500 cells/mm3 or 3. Age- andgender-matched HIV-negative (HIV-) participants were also selected.Written informed consent was obtained from all participants whothen underwent a detailed neurological evaluation including assess-ment of demographic characteristics, subjective PN symptoms, and aneurological examination by a trained medical officer. PN was definedas > 1 sign on examination (e.g. decreased pinprick or vibration inthe fingers or toes, distal weakness, or reduced/ absent ankle reflexes)and > 1 subjective symptom (e.g. paresthesias, numbness, or pain inthe hands or feet). PN risk factors were determined by comparingcharacteristics of participants with and without neuropathy using t-tests for continuous variables and chi-squared tests for categoricalvariables. This study was approved by the Johns Hopkins Universityand Uganda Virus Research Institute Institutional Review Boards.Findings: 538 participants were enrolled: 200HIV+ participants withmoderate immunosuppression (CD4 count 351-500), 107HIV+ARV-naïve participants with advanced immunosuppression (CD4 count <0.001) than those with moderate immunosuppression. PN was moreprevalent among HIV+ than HIV- participants (24% vs. 8%, p <0.001) and showed a trend toward statistical significance among HIV+participants with advanced immunosuppression versus those withmoderate immunosuppression (30% vs. 20%, p¼0.05). In addition toHIV status and level of immunosuppression, older age (mean: 38 yearsvs. 35 years, p¼0.03) was also a significant predictor of PN, but BMI(p¼0.45), alcohol use (p¼0.78), and prior isoniazid use (p¼0.06) werenot. PN severity was worse in HIV+ than HIV- participants as assessedby the Modified Total Neuropathy Scale (p¼0.003).Interpretation: PN is prevalent in rural Uganda and is more com-mon in HIV+ individuals, with a trend toward increased prevalencein those with advanced disease. PN prevalence also increases withage. This highlights the need for early diagnosis and treatment of HIVto prevent this potentially debilitating complication and the necessityof close monitoring for PN as the HIV+ population ages.Funding: NIMH RO1 MH099733 (Sacktor, Wawer) and NINDSR25 NS065729-05S2 (Saylor)Abstract #: 02NCD023Effect of parity on the epidemiologic profile of Malawianwomen presenting for obstetric fistula repair: A crosssectional studyA.M. Sih1, D.M. Kopp2, J.H. Tang2, N.E. Rosenberg3, E. Chipungu4,J.P. Wilkinson3; 1SUNY Downstate Medical Center, Brooklyn, NY/US,2UNC Department of OB-GYN, Lilongwe, MW, 3UNC Project-Malawi,Lilongwe, MW, 4Fistula Care Centre, Bwaila Maternity Hospital,Lilongwe, MWBackground: Obstetric fistula remains a debilitating condition inlow-income countries. Previous descriptive studies of fistula patientsreport a majority as being young and primiparous at the time offistula formation. The population of women who are multiparous atthe time of fistula formation has rarely been described. Our objec-tive is to describe the patient population presenting for obstetricfistula repair at the Fistula Care Centre at Bwaila Maternity Hospitalin Lilongwe, Malawi and to identify potential risk factors that maycontribute to fistula formation, particularly among multiparouswomen.Methods: We completed a cross-sectional analysis of baseline datafrom women who presented for obstetric fistula repair betweenSeptember 2011 and September 2014. After providing informedconsent, these women completed an admission form that includedquestions about their demographics, obstetric history, and physicalexam findings. Women with non-obstetric fistula and those whodid not know their number of deliveries were excluded from theanalysis. The primary outcome of the study was to compare thedemographic characteristics of women who had obstetric fistulaform during their first pregnancy versus during a subsequentpregnancy. Chi-square, Fischer exact, and Mann-Whitney testswere used. IRB approval was obtained from the Malawi NationalHealth Sciences Research Committee and the University of NorthCarolina IRB.Findings: During the study period, 513 women presented to theFistula Care Centre, of which 459 (89.5%) had obstetric fistula andwere included in the analysis. Of these, 195 patients (42.5%) wereprimiparous and 258 (56.2%) were multiparous at the time of fistulaformation. The median parity for multiparous patients at the time offistula formation was 3 (IQR 2-4). Multiparous patients were morelikely to be currently married (68.9% vs 53.4%, p¼0.001), to have aliveborn infant at that delivery (29.7% vs 15.9%, p¼0.001), to labor lessthan 24 hours (55.8% vs 40.0%, p¼0.001), and to have a Caesarean

Prevalence of and risk factors for peripheral neuropathy in Rakai, Uganda

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Prevalence of and risk factors for peripheral neuropathy in Rakai, Uganda

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