Showing papers by "Makerere University published in 2005"

Rates of HIV-1 Transmission per Coital Act, by Stage of HIV-1 Infection, in Rakai, Uganda

Abstract: Background. We estimated rates of human immunodeficiency virus (HIV)‐1 transmission per coital act in HIV-discordant couples by stage of infection in the index partner. Methods. We retrospectively identified 235 monogamous, HIV-discordant couples in a Ugandan populationbased cohort. HIV transmission within pairs was confirmed by sequence analysis. Rates of transmission per coital act were estimated by the index partner’s stage of infection (recent seroconversion or prevalent or late-stage infection). The adjusted rate ratio of transmission per coital act was estimated by multivariate Poisson regression. Results. The average rate of HIV transmission was 0.0082/coital act (95% confidence interval [CI], 0.0039‐ 0.0150) within ∼2.5 months after seroconversion of the index partner; 0.0015/coital act within 6‐15 months after seroconversion of the index partner (95% CI, 0.0002‐0.0055); 0.0007/coital act (95% CI, 0.0005‐0.0010) among HIV-prevalent index partners; and 0.0028/coital act (95% CI, 0.0015‐0.0041) 6‐25 months before the death of the index partner. In adjusted models, early- and late-stage infection, higher HIV load, genital ulcer disease, and younger age of the index partner were significantly associated with higher rates of transmission. Conclusions. The rate of HIV transmission per coital act was highest during early-stage infection. This has implications for HIV prevention and for projecting the effects of antiretroviral treatment on HIV transmission. Model estimates suggest that the rate of heterosexual HIV-1 transmission per coital act follows a U-shaped curve, being highest during the postseroconversion period, lower during latency, and increasing with advancing disease [1‐4]. This is supported by findings that blood HIV load, which is higher during the postseroconversion period and during advanced disease, is the principal predictor of heterosexual transmission [5‐

Pathogenesis, clinical features, and neurological outcome of cerebral malaria.

Abstract: Cerebral malaria is the most severe neurological complication of Plasmodium falciparum malaria. Even though this type of malaria is most common in children living in sub-Saharan Africa, it should be considered in anybody with impaired consciousness that has recently travelled in a malaria-endemic area. Cerebral malaria has few specific features, but there are differences in clinical presentation between African children and non-immune adults. Subsequent neurological impairments are also most common and severe in children. Sequestration of infected erythrocytes within cerebral blood vessels seems to be an essential component of the pathogenesis. However, other factors such as convulsions, acidosis, or hypoglycaemia can impair consciousness. In this review, we describe the clinical features and epidemiology of cerebral malaria. We highlight recent insights provided by ex-vivo work on sequestration and examination of pathological specimens. We also summarise recent studies of persisting neurocognitive impairments in children who survive cerebral malaria and suggest areas for further research.

The International HIV Dementia Scale: a new rapid screening test for HIV dementia.

Abstract: Objective: HIV dementia is an important neurological complication of advanced HIV infection. The use of a cross-cultural screening test to detect HIV dementia within the international community is critical for diagnosing this condition. The objective of this study was to evaluate the sensitivity and specificity of a new screening test for HIV dementia the International HIV Dementia Scale (IHDS) in cohorts from the US and Uganda. Design: Two cross-sectional cohort studies designed to evaluate for the presence of HIV dementia. Methods: Sixty-six HIV-positive individuals in the US and 81 HIV-positive individuals in Uganda received the IHDS and full standardized neurological and neuropsychological assessments. The sensitivity and specificity of varying cut-off scores of the IHDS were evaluated in the two cohorts. Results: In the US cohort the mean IHDS score for HIV-positive individuals without dementia and with dementia were 10.6 and 9.3 respectively (P < 0.001). Using the cut-off of = 10 the sensitivity and specificity for HIV dementia with the IHDS were 80% and 57% respectively in the US cohort and 80% and 55% respectively in the Uganda cohort. Conclusions: The IHDS may be a useful screening test to identify individuals at risk for HIV dementia in both the industrialized world and the developing world. Full neuropsychological testing should then be performed to confirm a diagnosis of HIV dementia. (authors)

National character does not reflect mean personality trait levels in 49 cultures

Abstract: Most people hold beliefs about personality characteristics typical of members of their own and others' cultures. These perceptions of national character may be generalizations from personal experience, stereotypes with a "kernel of truth," or inaccurate stereotypes. We obtained national character ratings of 3989 people from 49 cultures and compared them with the average personality scores of culture members assessed by observer ratings and self-reports. National character ratings were reliable but did not converge with assessed traits. Perceptions of national character thus appear to be unfounded stereotypes that may serve the function of maintaining a national identity.

Adherence to HIV antiretroviral therapy in HIV+ ugandan patients purchasing therapy

Abstract: Our objective was to determine the level of adherence and reasons for non-adherence to antiretroviral therapy (ART) among HIV-positive (HIV+) people on ART in a resource-limited setting. Patients receiving ART were recruited into the cross-sectional study from three treatment centres in Kampala, Uganda. The number of missed doses over the last three days was assessed by structured patient interviews and dichotomized at +/-95% adherence. Reasons for non-adherence were assessed with both structured patient interviews and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression. In all, 304 HIV-infected persons on ART were enrolled into the study. Factors associated with non-adherence were marital status (odds ratio (OR) = 2.93, 95% confidence interval (CI) 1.32-6.50) and low monthly income <50 US$ [OR = 2.77, 95% CI 1.64-4.67]. We concluded that levels of self-reported adherence in patients receiving ART in Kampala are comparable to levels in resource-rich settings with inability to purchase and secure a stable supply as a major barrier to adherence.

Sensitive Drug-Resistance Assays Reveal Long-Term Persistence of HIV-1 Variants with the K103N Nevirapine (NVP) Resistance Mutation in Some Women and Infants after the Administration of Single-Dose NVP: HIVNET 012

Abstract: Background. The HIV Network for Prevention Trials (HIVNET) 012 trial showed that NVP resistance (NVPR) emerged in some women and children after the administration of single-dose nevirapine (SD-NVP). We tested whether K103N-containing human immunodeficiency virus (HIV)-1 variants persisted in women and infants 1 year or more after the administration of SD-NVP. Methods. We analyzed samples from 9 women and 5 infants in HIVNET 012 who had NVPR 6-8 weeks after the administration of SD-NVP. Samples were analyzed with the ViroSeq system and with 2 sensitive resistance assays, LigAmp and TyHRT. Results. ViroSeq detected the K103N mutation in 8 of 9 women and in 2 of 5 infants. LigAmp detected the K103N mutation at low levels in 8 of 9 women and in 4 of 5 infants. K103N was not detected by ViroSeq 12-24 months after the administration of SD-NVP but was detected by LigAmp in 3 of 9 women and in 1 of 5 infants. K103N was also detected in those samples by use of the TyHRT assay. Conclusions. K103N-containing variants persist in some women and infants for 1 year or more after the administration of SD-NVP. Sensitive resistance assays may provide new insight into the impact of antiretroviral drug exposure on HIV-1 evolution.

Cryptosporidiosis and microsporidiosis in ugandan children with persistent diarrhea with and without concurrent infection with the human immunodeficiency virus

Abstract: Cryptosporidium spp. and Enterocytozoon bieneusi are enteric pathogens that have emerged as significant causes of persistent diarrhea (PD) in immunologically compromised individuals particularly in association with HIV/AIDS. We conducted a cross-sectional study on the clinical epidemiology of E. bieneusi and Cryptosporidium in children with PD, with and without HIV/AIDS, attending Uganda's Mulago National Referral Hospital. Two hundred forty-three children aged 14 days), were analyzed for HIV status and CD4 lymphocyte counts, and stools were screened for the presence of E. bieneusi and Cryptosporidium by microscopy and positive samples genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis. Eighty (32.9%) of the children were excreting E. bieneusi, and 76 (31.3%) were excreting Cryptosporidium. Ninety-one of the 243 children had HIV, of who 70 (76.9%) had E. bieneusi, versus 10 (6.6%) of the 152 without (odds ratio = 47.33; 95% CI = 19.88 to 115.97), while 67 (73.6%) had Cryptosporidium, versus 9 (5.9%) without (odds ratio = 44.36; 95% CI = 18.39 to 110.40). Children with counts < 25% CD4 cells were more likely to have either E. bieneusi (odds ratio = 7.42; 95% CI = 3.77 to 14.69) or Cryptosporidium (odds ratio = 6.45; 95% CI = 3.28 to 12.76) than those with higher CD4 percentages. However, only HIV status was independently associated with either Cryptosporidium or E. bieneusi. Among the 243 children with PD, 67 (27.8%) were infected with both enteric pathogens, with HIV being the only independent predictor of coinfection. Finally, some 81% of HIV-infected children with PD excreted one or both organisms, compared with only 10% of children with PD testing negative for HIV. Seventy-four percent of isolates were C. hominis, the anthroponotic species, 17% were C. parvum, the zoonotic species, and 8% were a mixture of the two or others.

Voluntary HIV counseling and testing acceptance, sexual risk behavior and HIV incidence in Rakai, Uganda

Abstract: Objective: To assess the acceptance of voluntary HIV counseling and testing (VCT) and the effects of VCT on sexual risk behavior and HIV acquisition in Rakai, Uganda. Methods: In a ruralcohort, 10 694consenting adults were interviewed,provided blood for HIV testing and were offered free VCT by community resident counselors. The proportions receiving VCT and the adjusted risk ratio (adj. RR) of VCT acceptance were estimated by log binomial regression. Risk behaviors and HIV incidence per 100 person-years (PY) in HIV-negative acceptors and non-acceptors of VCT were assessed prospectively. Results: Although 93% initially requested HIV results, 62.2% subsequently accepted VCT. VCT acceptance was lower among persons with no prior VCT [Adj. RR = 0.88; 95% confidence interval (CI), 0.85‐0.90], individuals with primary education (adj. RR = 0.94; 95% CI, 0.90‐0.99) or higher (adj. RR = 0.91; 95% CI, 0.87‐0.97), individuals who were HIV-positive (adj. RR = 0.72; 95% CI, 0.68‐0.76), and persons reporting condom use in the past 6 months (inconsistent users, adj. RR = 0.95; 95% CI, 0.90‐ 0.99; consistent users, adj. RR = 0.88; 95% CI, 0.82‐0.95). VCT acceptance was higher among the currently married (adj. RR = 1.14; 95% CI, 1.08‐1.20) and previously married (adj. RR = 1.11; 95% CI, 1.04‐1.18). Receipt of results was not significantly associated with age, gender, and self-perception of HIV risk. There were no significant differences in sexual risk behaviors, or in HIV incidence between acceptors (1.6/100 PY) and non-acceptors (1.4/100 PY) of VCT. Conclusion: In this rural cohort where VCT services are free and accessible, there is self-selection of individuals accepting VCT, and no impact of VCT on subsequent risk behaviors or HIV incidence.

Nevirapine (NVP) Resistance in Women with HIV-1 Subtype C, Compared with Subtypes A and D, after the Administration of Single-Dose NVP

Abstract: Objective. In the Human Immunodeficiency Virus (HIV) Network for Prevention Trials (HIVNET) 012 trial in Uganda, 6-8 weeks after single-dose nevirapine (SD-NVP), NVP resistance mutations were detected at a higher rate in women with HIV-1 subtype D than in women with subtype A. Here, we evaluate the rate of NVP resistance mutations in women with subtype C. Methods. NVP resistance mutations were detected using the ViroSeq HIV-1 Genotyping System. Results. The portion of women with any NVP resistance mutation was higher in those with subtype C (45/ 65 [69.2%] in the NVP and zidovudine trial, Malawi) than in those in the HIVNET 012 trial with either subtype A (28/144 [19.4%]; P<.0001) or subtype D (35/97 [36.1%]; P<.0001). In a multivariate model, subtype (C vs. A: odds ratio [OR], 8.73 [95% confidence interval {CI}, 4.29-17.76]; C vs. D: OR, 3.38 [95% CI, 1.65-6.93]) and viral load at delivery (OR, 2.35 [95% CI, 1.62-3.40]) independently predicted NVP resistance mutations, but maternal age, parity, and time between SD-NVP and the 6-8-week visit did not. Conclusions. The rate of NVP resistance mutations after SD-NVP was significantly higher in women with HIV-1 subtype C than in women with subtype A or D. Studies are needed to assess the clinical significance of this finding.

Patient and health service delay in pulmonary tuberculosis patients attending a referral hospital: a cross-sectional study.

Abstract: Background Delays in diagnosis and initiation of effective treatment increase morbidity and mortality from tuberculosis as well as the risk of transmission in the community. The aim of this study was to determine the time taken for patients later confirmed as having TB to present with symptoms to the first health provider (patient delay) and the time taken between the first health care visit and initiation of tuberculosis treatment (health service delay). Factors relating to these 'delays' were analyzed.

Improving facility-based care for sick children in Uganda: training is not enough

Abstract: This study assessed the effects of scaling-up Integrated Management of Childhood Illness (IMCI) on the quality of care received by sick children in 10 districts in Uganda Health workers trained in IMCI were found to deliver significantly better care than health workers who had not yet been trained, but absolute levels of service quality remained low Achieving training coverage alone is not sufficient as a strategy to improve and sustain care quality Other factors including training quality, effective supervision, availability of essential drugs, vaccines and equipment, and the policy context are also important and must be included in child survival policies and plans

Determinants of the Impact of Sexually Transmitted Infection Treatment on Prevention of HIV Infection: A Synthesis of Evidence from the Mwanza, Rakai, and Masaka Intervention Trials

Abstract: Community-randomized trials in Mwanza, Tanzania, and Rakai and Masaka, Uganda, suggested that population characteristics were an important determinant of the impact of sexually transmitted infection (STI) treatment interventions on incidence of human immunodeficiency virus (HIV) infection. We performed simulation modeling of HIV and STI transmission, which confirmed that the low trial impact in Rakai and Masaka could be explained by low prevalences of curable STI resulting from lower-risk sexual behavior in Uganda. The mature HIV epidemics in Uganda, with most HIV transmission occurring outside core groups with high STI rates, also contributed to the low impact on HIV incidence. Simulated impact on HIV was much greater in Mwanza, although the observed impact was larger than predicted from STI reductions, suggesting that random error also may have played some role. Of proposed alternative explanations, increasing herpetic ulceration due to HIV-related immunosuppression contributed little to the diminishing impact of antibiotic treatment during the Ugandan epidemics. The strategy of STI treatment also was unimportant, since syndromic treatment and annual mass treatment showed similar effectiveness in simulations of each trial population. In conclusion, lower-risk behavior and the mature HIV epidemic explain the limited impact of STI treatment on HIV incidence in Uganda in the 1990s. In populations with high-risk sexual behavior and high STI rates, STIs treatment interventions may contribute substantially to prevention of HIV infection.

Cancer survival in Kampala, Uganda.

Abstract: Epidemiological data on the occurrence of cancer in sub-Saharan Africa are sparse, and population-based cancer survival data are even more difficult to obtain due to various logistic difficulties The population-based Cancer Registry of Kampala, Uganda, has followed up the vital status of all registered cancer patients with one of the 14 most common forms of cancer, who were diagnosed and registered between 1993 and 1997 in the study area We report 5-year absolute and relative survival estimates of the Ugandan patients and compare them with those of black American patients diagnosed in the same years and included in the SEER Program of the United States In general, the prognosis of cancer patients in Uganda was very poor Differences in survival between the two patient populations were particularly dramatic for those cancer types for which early diagnosis and effective treatment is possible For example, 5-year relative survival was as low as 83% for colorectal cancer and 177% for cervical cancer in Uganda, compared with 542 and 639%, respectively, for black American patients The collection of good-quality follow-up data was possible in the African environment The very poor prognosis of Ugandan patients is most likely explained by the lack of access to early diagnosis and treatment options in the country On the policy level, the results underscore the importance of the consistent application of the national cancer control programme guidelines as outlined by the World Health Organization

Traditional herbal remedies used in the management of sexual impotence and erectile dysfunction in western Uganda

Abstract: Background: The utilisation of ethnobotanical indigenous knowledge is vital in male sexual reproductive health care delivery in western Uganda. Reproductive health care is the second most prevalent health care problem in Africa. However, this concept of reproductive health care has been focusing mainly on women disregarding men. Thus, some diseases such as sexual impotence and erectile dysfunction that deserve mention are regarded as petty though important in economic productivity, family stability and sexually transmitted diseases control including HIV/AIDS. Objective: This study was carried out mainly to document medicinal plants used in the treatment of sexual impotence and erectile dysfunction disorders in western Uganda. Methods: The medical ethnobotanical indigenous knowledge were collected by visiting traditional healers and documenting the medicinal plants used and other socio-cultural aspects allied with sexual impotence and erectile dysfunction. The methods used to collect the relevant information regarding the medicinal plants used included informal and formal discussions, field visits and focused semi-structured interviews. Results: Thirty-three medicinal plants used in the management of sexual impotence and erectile dysfunction were documented and Citropsis articulata and Cola acuminata were among the highly utilized medicinal plants. Conclusion: From the researchers’ point of view, the usage of herbal remedies in managing male sexual disorders is useful because of long cultural history of utilisation and the current renewed interest in natural products to sustain health globally. As a way recognising the values and roles of traditional medical knowledge in health care provision, further research into the efficacy and safety of herbal remedies in male sexual disorders is precious in Uganda and beyond. More so, the establishment of rapport between relevant government department in Ministry of Health, modern health workers through collaborative and networking ventures with traditional healers under close supervision and monitoring of herbal treatments is noble.

Artemisinin versus Nonartemisinin Combination Therapy for Uncomplicated Malaria: Randomized Clinical Trials from Four Sites in Uganda

Abstract: BACKGROUND: Drug resistance in Plasmodium falciparum poses a major threat to malaria control. Combination antimalarial therapy including artemisinins has been advocated recently to improve efficacy and limit the spread of resistance, but artemisinins are expensive and relatively untested in highly endemic areas. We compared artemisinin-based and other combination therapies in four districts in Uganda with varying transmission intensity. METHODS AND FINDINGS: We enrolled 2,160 patients aged 6 mo or greater with uncomplicated falciparum malaria. Patients were randomized to receive chloroquine (CQ) + sulfadoxine-pyrimethamine (SP); amodiaquine (AQ) + SP; or AQ + artesunate (AS). Primary endpoints were the 28-d risks of parasitological failure either unadjusted or adjusted by genotyping to distinguish recrudescence from new infections. A total of 2,081 patients completed follow-up, of which 1,749 (84%) were under the age of 5 y. The risk of recrudescence after treatment with CQ + SP was high, ranging from 22% to 46% at the four sites. This risk was significantly lower (p < 0.01) after AQ + SP or AQ + AS (7%-18% and 4%-12%, respectively). Compared to AQ + SP, AQ + AS was associated with a lower risk of recrudescence but a higher risk of new infection. The overall risk of repeat therapy due to any recurrent infection (recrudescence or new infection) was similar at two sites and significantly higher for AQ + AS at the two highest transmission sites (risk differences = 15% and 16%, p < 0.003). CONCLUSION: AQ + AS was the most efficacious regimen for preventing recrudescence, but this benefit was outweighed by an increased risk of new infection. Considering all recurrent infections, the efficacy of AQ + SP was at least as efficacious at all sites and superior to AQ + AS at the highest transmission sites. The high endemicity of malaria in Africa may impact on the efficacy of artemisinin-based combination therapy. The registration number for this trial is ISRCTN67520427 (http://www.controlled-trials.com/isrctn/trial/|/0/67520427.html).

Unravelling the genetic diversity of the three main viruses involved in Sweet Potato Virus Disease (SPVD), and its practical implications.

Abstract: SUMMARY Sweetpotato (Ipomoea batatas) is a widely grown food crop, in which the most important diseases are caused by viruses. Genetic variability of three widely distributed sweetpotato viruses was analysed using data from 46 isolates of Sweet potato feathery mottle virus (SPFMV), 16 isolates of Sweet potato mild mottle virus (SPMMV) and 25 isolates of Sweet potato chlorotic stunt virus (SPCSV), of which 19, seven and six isolates, respectively, are newly characterized. Division of SPFMV into four genetic groups (strains) according to phylogenetic analysis of coat protein (CP) encoding sequences revealed that strain EA contained the East African isolates of SPFMV but none from elsewhere. In contrast, strain RC contained ten isolates from Australia, Africa, Asia and North America. Strain O contained six heterogeneous isolates from Africa, Asia and South America. The seven strain C isolates from Australia, Africa, Asia, and North and South America formed a group that was genetically distant from the other SPFMV strains. SPMMV isolates showed a high level of variability with no discrete strain groupings. SPCSV isolates from East Africa were phylogenetically distant to SPCSV isolates from elsewhere. Only from East Africa were adequate data available for different isolates of the three viruses to estimate the genetic variability of their local populations. The implications of the current sequence information and the need for more such information from most sweetpotato-growing regions of the world are discussed in relation to virus diagnostics and breeding for virus resistance.

Temporal patterns of crop raiding by elephants: a response to changes in forage quality or crop availability?

Abstract: Temporal patterns of crop raiding by elephants were studied for 13 months in 1996/1997 at Kibale Forest National Park, Uganda. To determine the influence of environmental factors on the timing of raiding, we tested for correlations between crop raiding patterns and the quality of natural forage within the forest as well as crop availability beyond park boundaries. Crop raiding occurred throughout the year with peaks in dry seasons when crop availability was high. Bananas and maize were the main crops raided. Variations in forage quality were moderate with small seasonal fluctuations and peaks in dry seasons. Monthly crop raiding incidences were not influenced by forage quality but by ripening of maize. Comparison of forage quality and temporal distribution of crop raiding between savanna and forest habitats suggests that crop availability is more important in forest habitats, whereas in savanna habitats large seasonal fluctuations in forage quality have a greater influence on temporal patterns of crop raiding. Resume Les modeles temporels de l'incursion des cultures par elephants etaient etudies pendant 13 mois en 1996/97 au parc national de Kibale Forest au Uganda. Afin de determiner l'influence d’elements liea l'environnement sur le timing des incursions, nous avons essaye de trouver les correlations entre les modeles d'incursion et la qualite du fourrage naturel dans la foret ainsi que la disponibilite de cultures au-dela des frontieres du parc. L'incursion des cultures s'est produite a travers l'annee et culminait pendant les periodes seches quand la disponibilite des cultures etaient au plus eleve. Les cultures ciblees le plus souvent etaient les bananes et le mais. Des variations dans la qualite de fourrage etait moderees, avec les petites fluctuations saisonnieres et les points culminants pendant les periodes seches. Les survenances mensuelles d'incursion des cultures n’etaient pas influencees par la qualite de fourrage mais par le murissement du mais. Une comparaison de qualite de fourrage et la distribution temporale des incursions entre les habitats forestiers et savanes suggere que la question de disponibilite est plus important dans les habitats forestiers, tandis que dans les habitats savanes des grandes fluctuations saisonnieres au niveau de la qualite de fourrage exercent un influence plus marquee sur les modeles temporels de l'incursion des cultures.

Immunoadjuvant Prednisolone Therapy for HIV-Associated Tuberculosis: A Phase 2 Clinical Trial in Uganda

Abstract: Tuberculosis (TB) is a common and serious complication of HIV-1 infection in the developing world, especially in sub-Saharan Africa [1]. Since the emergence of the HIV epidemic in Africa, the incidence rates of TB have increased dramatically, overwhelming national TB control programs across Africa. More than one-half of patients with TB presenting to TB clinics are infected with HIV, and these patients often present at early stages of HIV infection. Although HIV-infected patients with TB respond to effective antituberculous therapy [2–4], their prognosis remains poor [3, 5–8]. Deaths early during treatment are often attributable to TB [3, 6], whereas deaths late during treatment are attributable to complications of HIV infections other than TB. Epidemiologic observations indicate that TB may increase the rate of opportunistic infections in HIV-infected patients [9, 10] and may reduce survival [9, 11, 12], especially among patients with CD4+ T cell counts ≥200 cells/μL [13, 14]. Mounting evidence from immunologic and virologic studies supports the concept of copathogenesis in which TB triggers cellular immune activation [15, 16], mediated by cytokines such as tumor necrosis factor (TNF)–α, which, in turn, stimulates HIV replication, leading to higher viral load and accelerating HIV infection. One point of attack in efforts to stop this cascade is to attenuate expression of cytokines and thereby reduce the stimulus for HIV replication in latently infected cells [17]. Phase 1 and 2 clinical trials of selective TNF-α inhibitors—such as thalidomide, pentoxifylline, and etanercept—in HIV-associated TB have shown that these inhibitors offer short-term clinical benefits and reduce viral load despite only partial inhibition of TNF-α [18–20]. Since the immune activation of TB is mediated through a network of cytokines, less selective and more potent agents, such as glucocorticoids, may be more effective at interrupting the effects of TB on HIV than are selective cytokine inhibitors. In an observational study of HIV-infected patients without AIDS, the use of corticosteroids was associated with sustained increases in CD4+ T cell counts, with a minimum of adverse events [21, 22]. Prednisolone is an attractive choice for immunoadjuvant therapy in HIV-associated TB because it reduces expression of cytokines [23, 24], is effective in managing inflammatory complications of extrapulmonary TB [25], and is an inexpensive and widely available glucocorticoid agent. Like all corticosteroids, however, prednisolone can produce serious adverse events that may limit its use, even if shown to be effective. The balance of benefit and risk for prednisolone therapy has not been established for patients with HIV-associated TB. The aim of the present study was to assess the safety and biological effect of oral, self-administered prednisolone therapy as an immunoadjuvant treatment for HIV-associated TB among patients with CD4+ T cell counts ≥200 cells/μL.

Context matters: interpreting impact findings in child survival evaluations

Abstract: Appropriate consideration of contextual factors is essential for ensuring internal and external validity of randomized and non-randomized evaluations. Contextual factors may confound the association between delivery of the intervention and its potential health impact. They may also modify the effect of the intervention or programme, thus affecting the generalizability of results. This is particularly true for large-scale health programmes, for which impact may vary substantially from one context to another. Understanding the nature and role of contextual factors may improve the validity of study results, as well as help predict programme impact across sites. This paper describes the experience acquired in measuring and accounting for contextual factors in the Multi-Country Evaluation of the IMCI (Integrated Management of Childhood Illness) strategy in five countries: Bangladesh, Brazil, Peru, Uganda and Tanzania. Two main types of contextual factors were identified. Implementation-related factors include the characteristics of the health systems where IMCI was implemented, such as utilization rates, basic skills of health workers, and availability of drugs, supervision and referral. Impact-related factors include baseline levels and patterns of child mortality and nutritional status, which affect the scope for programme impact. We describe the strategies used in the IMCI evaluation in order to obtain data on relevant contextual factors and to incorporate them in the analyses. Two case studies - from Tanzania and Peru - show how appropriate consideration of contextual factors may help explain apparently conflicting evaluation results.

Experiences of pregnant adolescents--voices from Wakiso district, Uganda.

Abstract: Background: In Uganda, morbidity and mortality among adolescent mothers and their children are high. Social factors behind this problem need to be better understood. Objective: To explore problems that pregnant adolescents face in order to design appropriate policies and interventions. Methods: This was a descriptive study that utilized qualitative methods for data collection. The study population comprised of pregnant adolescents, adolescent mothers, opinion leaders, In-charge of health unit, and Traditional Birth Attendants (TBAs) in Wakiso district, Uganda. Six Focus Group Discussions (FGDs) with adolescent mothers and pregnant adolescents, and six key informant interviews were conducted with leaders in-charge of health units and TBAs. A moderator and a note taker facilitated the FGDs, which were tape recorded with consent from participants. Qualitative content analysis was done. Results: Discussions revealed that pregnant adolescents faced domestic physical violence. Furthermore, they were psychologically violated by parents and partners, and the community within which they lived. Pregnant adolescents were treated inhumanely and overworked with household chores and had inadequate food to eat. Adolescents experienced stigma and as a result some had carried out unsafe abortions. Key informant interviews and FGDs revealed that health workers were rude and unsympathetic to pregnant adolescents. This significantly contributed to delayed health care seeking when adolescents were ill. Conclusion: Pregnant adolescents lack basic needs like shelter, food and security. They also face relational problems with families, partners and the community. There is, therefore, a need to sensitize the community and school personnel about adolescent reproductive health issues. In addition, adolescent friendly services need to be established/strengthened. Continuous in-service training for health workers with emphasis on counseling skills for young people is urgently needed. African Health Sciences Vol. 5 (4) 2005: pp. 304-309

Patterns of crop raiding by primates around the Budongo Forest Reserve, Uganda

Abstract: Crop raiding by primates in particular and wild animals in general is a significant source of people-forest conflict around the Budongo Forest Reserve, Uganda. Crop loss to wild animals undermines local support for conservation efforts in this area. Patterns of primate crop raiding were studied over a period of 14 months in six villages (five adjacent to the Budongo Forest Reserve and one that is approximately 3,500 m from the forest edge). Data were collected via a questionnaire survey. Additional information was obtained from the relevant local government offices. Chimpanzees Pan troglodytes, baboons Papio anubis, other monkeys, bush pigs Potamochoeus procus and porcupines Hystrix cristata were reported by farmers to be the major causes of crop losses by wildlife. Of farmers, 73% reported suffering crop damage caused by primates, and 79% considered baboons to be the most destructive of all crop raiding species. Drought, insect pests, poor sowing, plant diseases and accidental fires were other s...

Resistance after single-dose nevirapine prophylaxis emerges in a high proportion of Malawian newborns.

Abstract: The administration of single-dose nevirapine to women in labor and their infants can prevent HIV-1 mother-to-child transmission. We examined nevirapine resistance in infants who were HIV-1 infected despite single-dose nevirapine prophylaxis, including 18 Ugandan infants (HIVNET 012 trial, nine subtype A and nine subtype D) and 23 Malawian infants (NVAZ trial, all subtype C). Nevirapine resistance was more frequent in infants with subtype C than with subtypes A and D (87 versus 50%, P = 0.016).

Antiretroviral therapy and sexual behavior: A comparative study between antiretroviral-naive and -experienced patients at an urban HIV/AIDS care and research center in Kampala, Uganda

Abstract: We examined whether use of antiretroviral (ARV) therapy is associated with increased sexual risk behavior in a cross-sectional study of patients undergoing ARV therapy (ARV experienced) compared to patients not undergoing ARV therapy (ARV-naive) attending an urban HIV clinic in Kampala, Uganda. Sexual behavior during the prior 6 months and sexually transmitted disease (STD) treatment was determined by face-to-face structured interviews. Multiple logistic regression was used to identify independent correlates of sexual activity, multiple sexual partners, inconsistent condom use, and STD treatment during the prior 6 months. Three hundred forty-seven (48%) of the 723 respondents reported a history of sexual intercourse in the 6 months prior to the interview (sexually active). Receipt of ARV therapy was not associated with a significantly higher likelihood of being sexually active (adjusted odds ratio [AOR], 2.0 95% confidence interval [CI], 0.3-9.9). Among both ARV-experienced and ARV-naive persons who were sexually active, 35% (120) reported one or more casual sexual partners in addition to a main partner (no difference by ARV status). Consistent condom use with spouse, regular, casual, and commercial partners was reported by 57%, 65%, 85%, and 85% of the sexually active respondents, respectively. The ARV-experienced respondents were more likely to report consistent condom use with their spouses than were ARV-naive respondents (OR 2.82 95% CI 1.74-4.6). ARV-experienced respondents were more likely than ARV-naive respondents to have disclosed their HIV status to their spouses (OR 1.57 95% CI 1.07-2.30).The ARV-experienced group was more likely to report STD treatment in the prior 6 months (AOR 2.62 95% CI 1.8-3.83) than the ARV-naive group. The findings suggest that in this population, use of ARV therapy was not associated with risky sexual behavior in the prior 6 months. Still, recall and social desirability biases remain important limitations in interpreting these conclusions.

The prevalence of depression in two districts of Uganda.

Abstract: Little information is available on the prevalence of depression in Uganda Given the recent political history of Uganda, depression may be common The aim was to estimate the point prevalence of probable clinical depressive disorder among the general population in two contrasting districts of Uganda Translated versions (in Madi and Lusoga) of the 13-item Beck Depression Inventory (BDI) were administered to a systematic sample of adult residents in the Adjumani and Bugiri districts of Uganda The overall prevalence of probably clinically significant depression (BDI score of 20–39) was 174% Significantly higher rates were found in women and in Adjumani District Depression is common in Uganda and particularly in the more troubled and less socially cohesive district of Adjumani

Persistence of nevirapine exposure during the postpartum period after intrapartum single-dose nevirapine in addition to zidovudine prophylaxis for the prevention of mother-to-child transmission of HIV-1.

Abstract: Objective: To determine nevirapine (NVP) plasma levels during the postpartum period after a single intrapartum NVP dose for the prevention of mother-to-child transmission Methods: Plasma samples at delivery and during days 8 to 45 postpartum were obtained from HIV-infected Thai women who received an intrapartum NVP dose in the Perinatal HIV Prevention Clinical Trial-2 (PHPT-2) for the prevention of perinatal HIV transmission These data were combined with NVP concentration data from 2 phase 1 studies of NVP for a population analysis Results: The median NVP level fell to 68 ng/mL (range: <50-228, n = 43) 8 to 14 days after dosing and to 51 ng/mL (range: <50-166, n = 25) between 15 and 21 days During the second and third weeks postpartum, NVP levels were below the limit of quantitation in 23% and 44% of samples, respectively Between 21 and 45 days, no sample had a quantifiable NVP concentration A simulation derived from the population analysis predicts that NVP concentration falls to less than 10 ng/mL in 5% of women by 11 days, in 50% of women by 175 days, and in 95% of women by 28 days Conclusions: Significant NVP concentrations remained for up to 20 days in these Thai women To ensure that coverage is maintained until NVP concentrations fall to nonsuppressive levels, 1 month of additional antiretroviral treatment after delivery should be considered to prevent the emergence of resistant viruses

Nitrogen and phosphorus removal in substrate-free pilot constructed wetlands with horizontal surface flow in uganda

Abstract: In constructed wetlands (CWs) with horizontal sub-surface flow, nutrient removal, especially phosphorus, is limited because the root biomass fills the pore spaces of the substrate (usually gravel), ...