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1.
J Clin Microbiol ; 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33903166

RESUMO

Background: We assessed the performance of CoronaCHEK lateral flow assay on samples from Uganda and Baltimore to determine the impact of geographic origin on assay performance.Methods: Plasma samples from SARS-CoV-2 PCR+ individuals (Uganda: 78 samples from 78 individuals and Baltimore: 266 samples from 38 individuals) and from pre-pandemic individuals (Uganda 1077 and Baltimore 532) were evaluated. Prevalence ratios (PR) were calculated to identify factors associated with a false-positive test.Results: After first positive PCR in Ugandan samples the sensitivity was: 45% (95% CI 24,68) at 0-7 days; 79% (95%CI 64,91) 8-14 days; and 76% (95%CI 50,93) >15 days. In samples from Baltimore, sensitivity was: 39% (95% CI 30, 49) 0-7 days; 86% (95% CI 79,92) 8-14 days; and 100% (95% CI 89,100) 15 days post positive PCR. The specificity of 96.5% (95% CI 97.5,95.2) in Ugandan samples was significantly lower than samples from Baltimore 99.3% (95% CI 98.1,99.8), p<0.01. In Ugandan samples, individuals with a false positive result were more likely to be male (PR 2.04, 95% CI 1.03,3.69) or individuals who had a fever more than a month prior to sample acquisition (PR 2.87, 95% CI 1.12,7.35).Conclusions: Sensitivity of the CoronaCHEK was similar in samples from Uganda and Baltimore. The specificity was significantly lower in Ugandan samples than in Baltimore samples. False positive results in Ugandan samples appear to correlate with a recent history of a febrile illness, potentially indicative of a cross-reactive immune response in individuals from East Africa.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33499732

RESUMO

Point of care rapid recency testing for HIV-1 may be a cost-effective tool to identify recently infected individuals for incidence estimation, and focused HIV prevention through intensified contact tracing. We validated the Asante™ HIV-1 rapid recency® assay for use in Uganda. Archived specimens (serum/plasma), collected from longitudinally observed HIV-1 recently and long-term infected participants, were tested with the Asante HIV-1 rapid recency assay per manufacturer's instructions. Previously identified antiretroviral therapy (ART)-naive samples with known seroconversions within 6 months of follow-up were tested in independent laboratories: the Rakai Health Sciences Program (RHSP) and the Uganda Virus Research Institute HIV Reference Laboratory (UVRI-HRL). In addition, samples from participants who seroconverted within 6-18 months and samples from individuals with chronic HIV-1 infection of at least 18 months duration were classified into three categories: ART naive, ART exposed with suppressed viral loads, and ART exposed with detectable viremia. Of the 85 samples seroconverting in ≤6 months, 27 and 42 samples were identified as "recent" by the Asante HIV-1 rapid recency test at the RHSP laboratory and UVRI-HRL, corresponding to sensitivities of 32% and 49%, respectively. There was 72% agreement between the laboratories (Cohen's kappa = 0.481, 95% CI = 0.317-0.646, p < .0001). Specificity was 100% (200/200) among chronically infected ART-naive samples. The Asante HIV-1 rapid recency assay had low sensitivity for detection of recent HIV-1 infections in Uganda, with substantial interlaboratory variability due to differential interpretation of the test strip bands. Specificity was excellent. Assessment of assay performance in other settings is needed to guide decisions on test utility.

3.
Int J Infect Dis ; 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33130198

RESUMO

OBJECTIVES: There is a high demand for SARS-CoV-2 testing to identify COVID-19 cases. Real-time, quantitative PCR (qRT-PCR) is the recommended diagnostic test but a number of constraints, including cost prevent its widespread implementation. The aim of this study was to evaluate a low cost, easy-to-use rapid antigen test for diagnosing COVID-19 at the point-of-care. METHODS: Nasopharyngeal swabs from suspect COVID-19 cases and from low-risk volunteers were tested on the STANDARD Q COVID-19 Ag Test and results compared with the qRT-PCR results. RESULTS: 262 samples were collected including 90 qRT-PCR positives. The majority were from males (89%) with a mean age of 34 years and only 13 (14%) of the positives were mildly symptomatic. Sensitivity and specificity of the antigen test were 70.0% (95% CI: 60 - 79) and 92% (95% CI: 87 - 96) respectively; diagnostic accuracy was 84% (95% CI: 79 - 88). The antigen test was more likely to be positive in samples with qRT-PCR Ct values ≤29 reaching a sensitivity of 92%. CONCLUSIONS: The STANDARD Q COVID-19 Ag Test performed less than optimally in this evaluation. However, the test may still have an important role to play early in infection when timely access to molecular testing is not available but results should be confirmed by qRT-PCR.

4.
PLoS One ; 15(4): e0230451, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32287264

RESUMO

INTRODUCTION: With the scale-up of antiretroviral therapy (ART) there is a need to monitor programme performance to maximize ART efficacy and to prevent emergence of HIV drug resistance (HIVDR). In keeping with the elements of the World Health Organisation (WHO) guidance we carried out a nationally representative assessment of early warning indicators (EWI) at 304 randomly selected ART service outlets in Uganda. METHODS: Retrospective patient data was extracted for the six EWIs for HIVDR including; on-time antiretroviral (ARV) drug pick-up, patient retention on ART at 12 months, ART dispensing practices, ARV drug stock-outs, viral load suppression (VLS) and viral load (VL) testing completion. Point prevalence for each clinic and national aggregate prevalence with 95% confidence intervals (CI) for all clinics were estimated and facility performances were computed and association between EWIs and programmatic factors assessed using Fisher's Exact Test. RESULTS: Facilities meeting the EWI targets: on-time pill pick-up was 9.5%, more facilities in the north met this target (p = 0.040). Retention on ART at 12 months was 24.1%, facilities in Kampala region (p<0.001) and Specialized ART clinics (p = 0.01) performed better in this indicator. Pharmacy stock-outs was 33.6%, with more facilities in Kampala (p<0.001), specialized ART clinics (p<0.001) and private-for-profit (p<0.001) meeting this target. Dispensing practices was met by 100% of the facilities. VLS was met by 49.2% and 50.8% of facilities met VL completion target with facilities in central region performing better (p<0.001). National prevalence for the EWIs was: on-time pill pick-up 63.3% (CI: 58.9-67.8); retention on ART at 12 months 69.9% (CI: 63.8-76.0); dispensing practices 100.0%; VLS 85.2% (CI: 81.8-88.5) and VL completion, 60.7% (CI: 56.9-64.6). CONCLUSION: Dispensing practices in all facilities were in line with the national guidelines however, there still remains a challenge to long-term ART programmatic success in monitoring patient response to treatment, and maintaining patients on ART without interruptions arising due to poor patient adherence and as a consequence of ARV supply interruption. It is therefore of high importance that the national ART program ensures intensified follow-up for patients, ensuring uninterrupted supply of ARV drugs and increasing VL monitoring at treatment centres, in order to improve patient outcomes and avert preventable HIVDR.


Assuntos
Antirretrovirais/provisão & distribução , Infecções por HIV/tratamento farmacológico , Cooperação do Paciente/estatística & dados numéricos , Adulto , Antirretrovirais/uso terapêutico , Farmacorresistência Viral , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Uganda , Carga Viral , Organização Mundial da Saúde
5.
J Antimicrob Chemother ; 75(5): 1280-1289, 2020 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-32025714

RESUMO

OBJECTIVES: We implemented the WHO cross-sectional survey protocol to determine rates of HIV viral load (VL) suppression (VLS), and weighted prevalence, predictors and patterns of acquired drug resistance (ADR) in individuals with virological failure (VF) defined as VL ≥1000 copies/mL. METHODS: We enrolled 547 and 1064 adult participants on first-line ART for 12 (±3) months (ADR12) and ≥48 months (ADR48), respectively. Dried blood spots and plasma specimens were collected for VL testing and genotyping among the VFs. RESULTS: VLS was 95.0% (95% CI 93.4%-96.5%) in the ADR12 group and 87.9% (95% CI 85.0%-90.9%) in the ADR48 group. The weighted prevalence of ADR was 96.1% (95% CI 72.9%-99.6%) in the ADR12 and 90.4% (95% CI 73.6-96.8%) in the ADR48 group, out of the 30 and 95 successful genotypes in the respective groups. Initiation on a zidovudine-based regimen compared with a tenofovir-based regimen was significantly associated with VF in the ADR48 group; adjusted OR (AOR) 1.96 (95% CI 1.13-3.39). Independent predictors of ADR in the ADR48 group were initiation on a zidovudine-based regimen compared with tenofovir-based regimens, AOR 3.16 (95% CI 1.34-7.46) and ART duration of ≥82 months compared with <82 months, AOR 1.92 (95% CI 1.03-3.59). CONCLUSIONS: While good VLS was observed, the high prevalence of ADR among the VFs before they underwent the recommended three intensive adherence counselling (IAC) sessions followed by repeat VL testing implies that IAC prior to treatment switching may be of limited benefit in improving VLS.

6.
AIDS Behav ; 24(5): 1574-1584, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31520238

RESUMO

Cell phones have increased communication and connection across the globe and particularly in sub-Saharan Africa-with potential consequences for the HIV epidemic. We examined the association among ownership of cell phones, sexual behaviors (number of sexual partners, alcohol use before sex, inconsistent condom use), and HIV prevalence. Data were from four rounds (2010-2016) of the Rakai Community Cohort Study (N = 58,275). Sexual behaviors and HIV prevalence were compared between people who owned a cell phone to people who did not own a cell phone. We stratified analysis by younger (15-24 years) and older (25+ years) age groups and by gender. Using logistic regression and after adjusting for sociodemographic characteristics, we found cell phone ownership was independently associated with increased odds of having two or more sexual partners in the past 12 months across age and gender groups (young men AOR 1.67, 95% CI 1.47-1.90; young women AOR 1.28 95% CI 1.08-1.53; older men AOR 1.54 95% CI 1.41-1.69; older women AOR 1.44 95% CI 1.26-1.65). Interestingly, young men who owned cell phones had decreased odds of using condoms inconsistently (AOR 0.66, 95% CI 0.57-0.75). For young women, cell phone ownership was associated with increased odds of using alcohol before sex (AOR 1.38 95% CI 1.17-1.63) and increased odds of inconsistent condom use (AOR 1.40, 95% 1.17-1.67). After adjusting for sociodemographic characteristics, only young women who owned cell phones had increased odds of being HIV positive (AOR 1.27 95% CI 1.07-1.50). This association was not mediated by sexual behaviors (Adjusted for sociodemographic characteristics and sexual behaviors AOR 1.24, 95% CI 1.05-1.46). While cell phone ownership appears to be associated with increased HIV risk for young women, we also see a potential opportunity for future cell phone-based health interventions.


Assuntos
Telefone Celular , Infecções por HIV , Comportamento Sexual , Adolescente , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Prevalência , Parceiros Sexuais , Uganda/epidemiologia , Adulto Jovem
7.
Popul Stud (Camb) ; 74(1): 93-102, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31117928

RESUMO

There are limited data on the impact of antiretroviral therapy (ART) on population-level adult mortality in sub-Saharan Africa. We analysed data for 2000-14 from the Rakai Community Cohort Study (RCCS) in Uganda, where free ART was scaled up after 2004. Using non-parametric and parametric (Weibull) survival analysis, we estimated trends in average person-years lived between exact ages 15 and 50, per capita life-years lost to HIV, and the mortality hazards of people living with HIV (PLHIV). Between 2000 and 2014, average adult life-years lived before age 50 increased significantly, from 26.4 to 33.5 years for all women and from 28.6 to 33.8 years for all men. As of 2014, life-years lost to HIV had declined significantly, to 1.3 years among women and 0.4 years among men. Following the roll-out of ART, mortality reductions among PLHIV were initially larger in women than men, but this is no longer the case.

8.
J Acquir Immune Defic Syndr ; 80(5): 494-502, 2019 04 15.
Artigo em Inglês | MEDLINE | ID: mdl-30664614

RESUMO

BACKGROUND: The desire for more children and pregnancy rates are influenced by many relationship dynamics and HIV serostatus of couples. SETTING: Rakai Community Cohort Study in Uganda. METHODS: Couple data were retrospectively linked from survey rounds between 2007 and 2015 to assess drivers of fertility desire and pregnancy incidence by HIV status (M-F-; M+F+; M-F+; and M+F-). Multivariable modified Poisson regression was used to estimate prevalence ratios of fertility desire, whereas multivariable Poisson regression was used to estimate incidence rate ratios of pregnancy associated with couple characteristics. RESULTS: Six thousand six hundred forty-seven couples contributed to 7656 person-years. Approximately 40% of couples (where at least 1 HIV+) desired more children. Unmet need for family planning was evident; couples of medium or low Socioeconomic status and with coresident children had lower fertility desires but higher pregnancy rates. Older age, being in a polygamous union, and having a HIV+ spouse in care were associated with lower fertility desire while having an older male partner was associated with higher fertility desire. Pregnancy incidence was lower with older age, among women using hormonal contraception and condoms, HIV+ concordant couples and couples where the HIV+ spouse was in care while pregnancy incidence were higher among women who desired more children, and serodiscordant couples (M-F+). CONCLUSIONS: There are many drivers of fertility desires and pregnancy rates, and HIV does not diminish the desire for more children. Unmet need for family planning was evident and highlighted the need to understand and meet the contraceptive needs of couples.


Assuntos
Infecções por HIV/psicologia , Complicações Infecciosas na Gravidez/epidemiologia , Adolescente , Adulto , Fatores Etários , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Gravidez , Complicações Infecciosas na Gravidez/psicologia , Fatores Sexuais , Inquéritos e Questionários , Uganda , Adulto Jovem
9.
PLoS One ; 14(1): e0210935, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30677068

RESUMO

BACKGROUND: Fertility desires of female and male partners in current relationships are often correlated. We examined the influence of HIV seropositive status of female and male partners on short-term fertility desires in Rakai, Uganda, a setting with high fertility and HIV infection rates. METHODS: Participants were couples (15-49 years old) enrolled in the Rakai Community Cohort Study, from 2011 to 2013 (n = 2,291). Cohen's kappa coefficient was used to measure the correlation of female and male partners' short-term fertility desires (measured as 'wanting a child in the next 12 months'), in both total sample and stratified serostatus groups. HIV serostatus and additional characteristics of female and male partners were included in Poisson regression models to estimate the rate ratios (RR) for each partner's short-term fertility desires. Individual and partner characteristics included HIV status, partner HIV status, age in years, partner age in years, educational attainment, number of living children, community of residence, and socioeconomic status (SES). RESULTS: Short-term fertility desires among female and male partners were moderately associated (Kappa = 0.37, p-value<0.001). The association was weakest among female sero-positive and male sero-negative couples (Kappa = 0.29, p-value<0.001). When adjusting for parity and other covariates in the model, women's short-term fertility desires were significantly associated with their positive sero-status regardless of male partners' sero-status (adjRR = 1.58, p<0.001 for F+M-; adjRR = 1.33, p = 0.001 for F+M+; in comparison with F-M-). Men's short-term fertility desires were significantly associated with their positive sero-status, in addition to their female partners' positive sero-status (adjRR = 1.23 with p-value = 0.022 for F-M+; adjRR = 1.42 with p-value<0.001 for F+M-; adjRR = 1.26 with p-value<0.001 for F+M+; in comparison with F-M-). When the differential effect of parity was included in the model, similar associations remained for both female and male partners when the number of living children was small, but largely reduced when the number of living children was large (3 or more). CONCLUSION: Female and male partners in couple dyads demonstrated moderate agreements about short-term fertility desires. The HIV seropositive status of female partners was most strongly associated with short-term fertility desires of both genders, and this association was even stronger for women who had few or no living children.


Assuntos
Fertilidade , Infecções por HIV/epidemiologia , Infecções por HIV/fisiopatologia , Adolescente , Adulto , Estudos de Coortes , Serviços de Planejamento Familiar , Feminino , Infecções por HIV/complicações , Soronegatividade para HIV , Soropositividade para HIV/epidemiologia , Soropositividade para HIV/fisiopatologia , Soroprevalência de HIV , Humanos , Masculino , Pessoa de Meia-Idade , Paridade , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/fisiopatologia , Parceiros Sexuais , Classe Social , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem
10.
BMC Womens Health ; 18(1): 60, 2018 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-29699548

RESUMO

BACKGROUND: Longitudinal data from a rural Ugandan cohort was used to estimate rates of unfulfilled need for contraception, defined as having unmet need and intent to use contraception at baseline but having an unintended pregnancy or with persistent unmet need for contraception at follow up. METHODS: Between 2002 and 2009 (5 survey rounds), a total of 2610 sexually active non-pregnant women with unmet need for contraception at the start of an inter-survey period were asked whether they intended to use any method of contraception until they desired a child. Modified Poisson multivariate regression was used to estimate unadjusted and adjusted prevalence ratios (PR) and 95% CI of unfulfilled need for contraception. RESULTS: The proportion of women with unmet need at the start of an interval who intended to use contraception significantly increased from 61 to 69.1% (p < 0.05). However the majority of women who said they intended to use contraception had unfulfilled need for contraception at the subsequent survey (64.8 to 56.8%). In the adjusted analysis, significant predictors of unfulfilled need for contraception included age 40-49 years (PR = 1.34; 95% CI 1.04-1.74) and those with unknown HIV status (PR = 1.16; 95% CI 1.06-1.26). CONCLUSIONS: There is a significant discrepancy between women's intent to use contraception (> 60%) and subsequent initiation of use (< 30%) with many having unintended pregnancies which might explain the persistent high fertility in Uganda. Future research needs to address unfulfilled need for contraception among women at risk of unintended pregnancies.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Intenção , Adolescente , Adulto , Anticoncepção/psicologia , Comportamento Contraceptivo/psicologia , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Gravidez , Gravidez não Planejada/psicologia , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Uganda/epidemiologia , Adulto Jovem
11.
Contraception ; 98(1): 41-46, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514043

RESUMO

OBJECTIVES: Covert contraceptive use (CCU) is the use of family planning without a partner's knowledge. This study sought to examine CCU prevalence among women living in Rakai, Uganda, predictors of CCU, and why women resort to CCU. STUDY DESIGN: We used data from women (15-49years) currently using contraceptives (oral contraceptives, Depo Provera, implants, intrauterine devices, and periodic abstinence) during Round 15 (2011-2013) of the Rakai Community Cohort Survey (n=2206). We utilized logistic regressions to analyze the association between self-reported CCU and current contraceptive method, sexual activity, experience of violence, and demographic data. We also used data from in-depth interviews (IDI) on HIV and reproductive health conducted in 2013-2016. RESULTS: CCU prevalence was 26%. In the multivariable model, being previously married (aOR=2.2 [1.7-2.9]), having no formal education (aOR=2.1 [1.1-3.9]), and experiencing physical violence (aOR=1.7 [1.3-2.2]) or having more than 1 sex partner (aOR=1.6 [1.2-2.2]) in the past 12months were CCU predictors. Advancing past primary school decreased the odds of CCU (aOR=0.7 [0.6-0.9]). HIV was positively associated with CCU in the unadjusted model, but not the adjusted. In the IDIs, women primarily resorted to CCU because of discordant fertility desires-coupled with financial insecurity, negative stereotypes towards contraceptives use, deteriorating health, and familial pressure to reproduce. One woman employed CCU because she feared being ostracized from her community. CONCLUSIONS: CCU is common amongst users of contraception and is used to hide family planning from partners and communities. Women that diverge from Uganda's cultural norms had higher odds of CCU. IMPLICATIONS: Clinicians and practitioners should be aware of CCU among their patients and should educate women on the wide variety of contraceptive methods to help them decide if their current covert method is best for their health and safety.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Anticoncepção/psicologia , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Feminino , Humanos , Pessoa de Meia-Idade , Uganda , Adulto Jovem
12.
BMC Womens Health ; 18(1): 46, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29486752

RESUMO

BACKGROUND: Unintended pregnancy is a persistent and global issue with consequences for the health and well-being of mothers and babies. The aim of this paper is to examine unintended pregnancy over time in the context of substantial human immunodeficiency virus (HIV) prevalence and increasing access to anti-retro viral therapy (ART). METHOD: Data are from the Rakai Community Cohort Study (RCCS) - a cohort of communities with 10,000-12,000 adults, ages 15-49, in Rakai District, Uganda. We examined prevalence of current pregnancies over time, intended pregnancy, and unintended pregnancies (unwanted, mistimed, ambivalent). We then examined risk factors for the different categories of unintended pregnancy among women who were currently pregnant. The full sample included 32,205 observations over 13 years. RESULTS: The prevalence of mistimed pregnancy and unwanted pregnancy both decreased significantly over time (p < .001). The prevalence of current pregnancies and intended pregnancy showed no significant changes over the thirteen year period. The same overall pattern was found when only examining HIV positive women in the sample; however, the trends were not significant. Out of the 2820 current pregnancies reported, 54.4% were intended, 29.8% were mistimed, 13.2% were unwanted, and 2.5% were ambivalent. After controlling for other predictors, HIV status had no independent effect on mistimed pregnancy but had a significant effect on unwanted pregnancy (RRR = 2.44, 95% CI = 1.65-3.61, p < .001] and ambivalent pregnancy [RRR = 2.07; CI: 1.03 to 4.18, p = 0.041]. In 2004, after the introduction of ART, there was a decreased risk in unintended pregnancy [RR = 0.75; CI: 0.66 to 0.84, p < .001]. Women with a secondary education or higher also had a decreased risk in unintended pregnancy [RR = 0.70; CI: 0.70 to 0.92, p = 0.002]. DISCUSSION: HIV was an important predictor of unwanted pregnancy. Unintended pregnancy decreased in the sample over time which may be due to an increase in ART availability and rising levels of education.


Assuntos
Infecções por HIV/psicologia , Soropositividade para HIV/psicologia , Mães/psicologia , Gravidez não Planejada/psicologia , Adolescente , Adulto , Estudos de Coortes , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Humanos , Comportamento Materno/psicologia , Pessoa de Meia-Idade , Gravidez , Gravidez não Desejada/psicologia , Fatores de Risco , Uganda , Adulto Jovem
13.
BMC Infect Dis ; 18(1): 93, 2018 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-29482500

RESUMO

INTRODUCTION: The World Health Organization recommends that countries conduct two phase evaluations of HIV rapid tests (RTs) in order to come up with the best algorithms. In this report, we present the first ever such evaluation in Uganda, involving both blood and oral based RTs. The role of weak positive (WP) bands on the accuracy of the individual RT and on the algorithms was also investigated. METHODS: In total 11 blood based and 3 oral transudate kits were evaluated. All together 2746 participants from seven sites, covering the four different regions of Uganda participated. Two enzyme immunoassays (EIAs) run in parallel were used as the gold standard. The performance and cost of the different algorithms was calculated, with a pre-determined price cut-off of either cheaper or within 20% price of the current algorithm of Determine + Statpak + Unigold. In the second phase, the three best algorithms selected in phase I were used at the point of care for purposes of quality control using finger stick whole blood. RESULTS: We identified three algorithms; Determine + SD Bioline + Statpak; Determine + Statpak + SD Bioline, both with the same sensitivity and specificity of 99.2% and 99.1% respectively and Determine + Statpak + Insti, with sensitivity and specificity of 99.1% and 99% respectively as having performed better and met the cost requirements. There were 15 other algorithms that performed better than the current one but rated more than the 20% price. None of the 3 oral mucosal transudate kits were suitable for inclusion in an algorithm because of their low sensitivities. Band intensity affected the performance of individual RTs but not the final algorithms. CONCLUSION: We have come up with three algorithms we recommend for public or Government procurement based on accuracy and cost. In case one algorithm is preferred, we recommend to replace Unigold, the current tie breaker with SD Bioline. We further recommend that all the 18 algorithms that have shown better performance than the current one are made available to the private sector where cost may not be a limiting factor.


Assuntos
Infecções por HIV/diagnóstico , HIV-1/isolamento & purificação , Programas de Rastreamento/métodos , Kit de Reagentes para Diagnóstico , Adulto , Algoritmos , Feminino , Infecções por HIV/virologia , Humanos , Técnicas Imunoenzimáticas/métodos , Técnicas Imunoenzimáticas/normas , Masculino , Programas de Rastreamento/normas , Sistemas Automatizados de Assistência Junto ao Leito , Valor Preditivo dos Testes , Kit de Reagentes para Diagnóstico/normas , Sensibilidade e Especificidade , Uganda
14.
AAS Open Res ; 1: 2, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30714021

RESUMO

Controlled human infection (CHI) models are gaining recognition as an approach to accelerating vaccine development, for use in both non-endemic and endemic populations: they can facilitate identification of the most promising candidate vaccines for further trials and advance understanding of protective immunity. Helminths present a continuing health burden in sub-Saharan Africa. Vaccine development for these complex organisms is particularly challenging, partly because protective responses are akin to mechanisms of allergy. A CHI model for Schistosoma mansoni (CHI-S) has been developed at Leiden University Medical Centre, the Netherlands. However, responses to schistosome infections, and candidate vaccines, are likely to be different among people from endemic settings compared to schistosome-naïve Dutch volunteers. Furthermore, among volunteers from endemic regions who have acquired immune responses through prior exposure, schistosome challenge can be used to define responses associated with clinical protection, and thus to guide vaccine development.  To explore the possibility of establishing the CHI-S in Uganda, a Stakeholders' Meeting was held in Entebbe in 2017. Regulators, community members, researchers and policy-makers discussed implementation challenges and recommended preparatory steps: risk assessment; development of infrastructure and technical capacity to produce the infectious challenge material in Uganda; community engagement from Parliamentary to grass-roots level; pilot studies to establish approaches to assuring fully informed consent and true voluntariness, and strategies for selection of volunteers who can avoid natural infection during the 12-week CHI-S; the building of regulatory capacity; and the development of study protocols and a product dossier in close consultation with ethical and regulatory partners. It was recommended that, on completion, the protocol and product dossier be reviewed for approval in a joint meeting combining ethical, regulatory and environment management authorities. Most importantly, representatives of schistosomiasis-affected communities emphasised the urgent need for an effective vaccine and urged the research community not to delay in the development process.

15.
AIDS Educ Prev ; 29(6): 527-539, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-29283273

RESUMO

Little is known about men who perpetrate IPV in communities also at risk for HIV infection. Using data from the Rakai Community Cohort Study (RCCS), five survey rounds were used (n = 21,157, observation from n = 10,618 men) to examine HIV risk and prevention behaviors among men who reported acts of violence against their wife/primary partner in the past 12 months. Overall, 10.4% men reported perpetrating physical violence and 17.3% perpetrating verbal violence, 3.1% reported sexual violence, 3.1% used violence to have sex with their wife/partner, and 1.1% used verbal coercion. Factors associated with IPV were: age 20-24 years, lower socio-economic status, being married, no male circumcision, drinking alcohol before sex, no consistent condom use, multiple sex partners in the past 12 months, multiple partners ever, and working in a bar. Protective HIV behaviors predicted fewer reports of perpetration and HIV-risk behaviors predicted more reports of perpetrating IPV.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Infecções por HIV/prevenção & controle , Violência por Parceiro Íntimo/psicologia , Assunção de Riscos , Comportamento Sexual , Parceiros Sexuais/psicologia , Maus-Tratos Conjugais/estatística & dados numéricos , Adulto , Consumo de Bebidas Alcoólicas/etnologia , Estudos de Coortes , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/etnologia , Infecções por HIV/psicologia , Humanos , Violência por Parceiro Íntimo/etnologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Comportamento Sexual/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Uganda , Adulto Jovem
16.
BMC Health Serv Res ; 17(1): 758, 2017 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-29162065

RESUMO

BACKGROUND: Understanding the implementation of 2013 World Health Organization (WHO) consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection at the facility level provides important lessons for the roll-out of future HIV policies. METHODS: A national policy review was conducted in six sub-Saharan African countries to map the inclusion of the 2013 WHO HIV treatment recommendations. Twenty indicators of policy adoption were selected to measure ART access (n = 12) and retention (n = 8). Two sequential cross-sectional surveys were conducted in facilities between 2013/2015 (round 1) and 2015/2016 (round 2) from ten health and demographic surveillance sites in Kenya, Malawi, South Africa, Tanzania, Uganda and Zimbabwe. Using standardised questionnaires, facility managers were interviewed. Descriptive analyses were used to assess the change in the proportion of facilities that implemented these policy indicators between rounds. RESULTS: Although, expansion of ART access was explicitly stated in all countries' policies, most lacked policies that enhanced retention. Overall, 145 facilities were included in both rounds. The proportion of facilities that initiated ART at CD4 counts of 500 or less cells/µL increased between round 1 and 2 from 12 to 68%, and facilities initiating patients on 2013 WHO recommended ART regimen increased from 42 to 87%. There were no changes in the proportion of facilities reporting stock-outs of first-line ART in the past year (18 to 11%) nor in the provision of three-month supply of ART (43 to 38%). None of the facilities provided community-based ART delivery. CONCLUSION: The increase in ART initiation CD4 threshold in most countries, and substantial improvements made in the provision of WHO recommended first-line ART regimens demonstrates that rapid adoption of WHO recommendations is possible. However, improved logistics and resources and/or changes in policy are required to further minimise ART stock-outs and allow lay cadres to dispense ART in the community. Increased efforts are needed to offer longer durations between clinic visits, a strategy purported to improve retention. These changes will be important as countries move to implement the revised 2015 WHO guidelines to initiate all HIV positive people onto ART regardless of their immune status.


Assuntos
Antirretrovirais/uso terapêutico , Infecções por HIV/tratamento farmacológico , Política de Saúde , Adulto , África ao Sul do Saara , Assistência Ambulatorial , Antirretrovirais/provisão & distribução , Contagem de Linfócito CD4 , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Instalações de Saúde , Humanos , Masculino , Guias de Prática Clínica como Assunto , Inquéritos e Questionários
17.
BMC Public Health ; 17(1): 792, 2017 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-29017539

RESUMO

BACKGROUND: Low contraceptive uptake and high unmet need for contraception remain significant issues in Uganda compared to neighboring countries such as Kenya, Ethiopia, and Rwanda. Although prior research on contraceptive uptake has indicated that male partners strongly influence women's decisions around contraceptive use, there is limited in-depth qualitative research on knowledge and concerns regarding modern contraceptive methods among Ugandan men. METHODS: Using in-depth interviews (N = 41), this qualitative study investigated major sources of knowledge about contraception and perceptions of contraceptive side effects among married Ugandan men. RESULTS: Men primarily reported knowledge of contraceptives based on partner's experience of side effects, partner's knowledge from health providers and mass media campaigns, and partner's knowledge from her peers. Men were less likely to report contraceptive knowledge from health care providers, mass media campaigns, or peers. Men's concerns about various contraceptive methods were broadly associated with failure of the method to work properly, adverse health effects on women, and severe adverse health effects on children. Own or partner's human immunodeficiency virus (HIV) status did not impact on contraceptive knowledge. CONCLUSIONS: Overall, we found limited accurate knowledge about contraceptive methods among men in Uganda. Moreover, fears about the side effects of modern contraceptive methods appeared to be common among men. Family planning services in Uganda could be significantly strengthened by renewed efforts to focus on men's knowledge, fears, and misconceptions.


Assuntos
Anticoncepcionais , Conhecimentos, Atitudes e Prática em Saúde , Adulto , Anticoncepção/efeitos adversos , Anticoncepção/métodos , Comportamento Contraceptivo/psicologia , Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Uganda , Adulto Jovem
18.
Implement Sci ; 12(1): 47, 2017 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-28381264

RESUMO

BACKGROUND: Successful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this. METHODS: We assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26-74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis. RESULTS: Most policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major barriers to effective implementation. CONCLUSIONS: Most HIV policies were widely implemented in the two settings; however, gaps in implementation coverage prevail and the value of ensuring complete coverage of existing policies should be considered against the adoption of new policies in regard to resource needs and health benefits.


Assuntos
Infecções por HIV/prevenção & controle , Política de Saúde , Adulto , Fármacos Anti-HIV/uso terapêutico , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Assistência à Saúde/organização & administração , Assistência à Saúde/normas , Difusão de Inovações , Feminino , Infecções por HIV/epidemiologia , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prática Profissional , Indicadores de Qualidade em Assistência à Saúde , Uganda/epidemiologia , Adulto Jovem
19.
Gates Open Res ; 1: 4, 2017 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-29528045

RESUMO

Timely progression of people living with HIV (PLHIV) from the point of infection through the pathway from diagnosis to treatment is important in ensuring effective care and treatment of HIV and preventing HIV-related deaths and onwards transmission of infection.  Reliable, population-based estimates of new infections are difficult to obtain for the generalised epidemics in sub-Saharan Africa.  Mortality data indicate disease burden and, if disaggregated along the continuum from diagnosis to treatment, can also reflect the coverage and quality of different HIV services.  Neither routine statistics nor observational clinical studies can estimate mortality prior to linkage to care nor following disengagement from care.  For this, population-based data are required. The Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa brings together studies in Kenya, Malawi, South Africa, Tanzania, Uganda, and Zimbabwe.  Eight studies have the necessary data to estimate mortality by HIV status, and seven can estimate mortality at different stages of the HIV care continuum.  This data note describes a harmonised dataset containing anonymised individual-level information on survival by HIV status for adults aged 15 and above. Among PLHIV, the dataset provides information on survival during different periods: prior to diagnosis of infection; following diagnosis but before linkage to care; in pre-antiretroviral treatment (ART) care; in the first six months after ART initiation; among people continuously on ART for 6+ months; and among people who have ever interrupted ART.

20.
Clin Infect Dis ; 63(suppl 5): S312-S321, 2016 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-27941110

RESUMO

BACKGROUND: If malaria patients who cannot be treated orally are several hours from facilities for injections, rectal artesunate prior to hospital referral can prevent death and disability. The goal is to reduce death from malaria by having rectal artesunate treatment available and used. How best to do this remains unknown. METHODS: Villages remote from a health facility were randomized to different community-based treatment providers trained to provide rectal artesunate in Ghana, Guinea-Bissau, Tanzania, and Uganda. Prereferral rectal artesunate treatment was provided in 272 villages: 109 through community-based health workers (CHWs), 112 via trained mothers (MUMs), 25 via trained traditional healers (THs), and 26 through trained community-chosen personnel (COMs); episodes eligible for rectal artesunate were established through regular household surveys of febrile illnesses recording symptoms eligible for prereferral treatment. Differences in treatment coverage with rectal artesunate in children aged <5 years in MUM vs CHW (standard-of-care) villages were assessed using the odds ratio (OR); the predictive probability of treatment was derived from a logistic regression analysis, adjusting for heterogeneity between clusters (villages) using random effects. RESULTS: Over 19 months, 54 013 children had 102 504 febrile episodes, of which 32% (31 817 episodes) had symptoms eligible for prereferral therapy; 14% (4460) children received treatment. Episodes with altered consciousness, coma, or convulsions constituted 36.6% of all episodes in treated children. The overall OR of treatment between MUM vs CHW villages, adjusting for country, was 1.84 (95% confidence interval [CI], 1.20-2.83; P = .005). Adjusting for heterogeneity, this translated into a 1.67 higher average probability of a child being treated in MUM vs CHW villages. Referral compliance was 81% and significantly higher with CHWs vs MUMs: 87% vs 82% (risk ratio [RR], 1.1 [95% CI, 1.0-1.1]; P < .0001). There were more deaths in the TH cluster than elsewhere (RR, 2.7 [95% CI, 1.4-5.6]; P = .0040). CONCLUSIONS: Prereferral episodes were almost one-third of all febrile episodes. More than one-third of patients treated had convulsions, altered consciousness, or coma. Mothers were effective in treating patients, and achieved higher coverage than other providers. Treatment access was low. CLINICAL TRIALS REGISTRATION: ISRCTN58046240.


Assuntos
Antimaláricos/administração & dosagem , Antimaláricos/uso terapêutico , Malária/tratamento farmacológico , Administração Retal , Artemisininas/administração & dosagem , Artemisininas/uso terapêutico , Artesunato , Pré-Escolar , Agentes Comunitários de Saúde , Feminino , Gana/epidemiologia , Guiné-Bissau/epidemiologia , Humanos , Lactente , Malária/epidemiologia , Masculino , Encaminhamento e Consulta , Tanzânia/epidemiologia , Uganda/epidemiologia
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