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1.
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
2.
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
3.
Emerg Infect Dis ; 23(3)2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28125398

RESUMO

The US Food and Drug Administration recently approved ciprofloxacin for treatment of plague (Yersina pestis infection) based on animal studies. Published evidence of efficacy in humans is sparse. We report 5 cases of culture-confirmed human plague treated successfully with oral ciprofloxacin, including 1 case of pneumonic plague.


Assuntos
Antibacterianos/uso terapêutico , Ciprofloxacino/uso terapêutico , Peste/tratamento farmacológico , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peste/epidemiologia , Uganda/epidemiologia
5.
Trans R Soc Trop Med Hyg ; 105(12): 717-26, 2011 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-22047912

RESUMO

Burkitt's lymphoma (BL) is a major cause of death among Ugandan children. We studied clinical characteristics and outcomes of childhood BL over time at the Uganda Cancer Institute (UCI). A total of 1217 children (766 boys, 451 girls, mean age 6.69 years) diagnosed with BL between 1985 and 2005 were included. There were no significant changes in the proportion of boys and girls diagnosed, or in mean age at diagnosis. Facial tumor (n=945, 77.65%) and abdominal disease (n=842, 69.19%) were the most common presentations. The proportion of children presenting with hepatic mass, malignant pleocytosis, and advanced-stage (stage C and D) BL increased during the study period (P<0.01). A total of 1085 children out of 1206 (89.97%) received at least one cycle of chemotherapy, and 832 of 1099 (75.71%) demonstrated objective response (i.e. complete or partial remission). The most common symptoms at BL diagnosis were fever (n=621, 51.03%), anemia (n=593, 48.73%), and weight loss (n=588, 48.32%). Significant increases in the proportion of children with fever, and significant changes in the proportion of children with anemia, night sweats and severe infection were observed. HIV positivity was 3.87%, but no substantial differences in the proportion of HIV-positive children were observed. Mortality was not significantly different over time: it was similar in boys and girls, higher in older children (compared with younger ones), in those with advanced-stage BL, and HIV-positive children, but lower in children with facial tumors compared with other tumor presentations, and among those who received chemotherapy.


Assuntos
Linfoma de Burkitt/diagnóstico , Linfoma de Burkitt/tratamento farmacológico , Adolescente , Anemia/etiologia , Linfoma de Burkitt/complicações , Linfoma de Burkitt/epidemiologia , Criança , Pré-Escolar , Feminino , Febre/etiologia , Acesso aos Serviços de Saúde , Humanos , Leucocitose/etiologia , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores Socioeconômicos , Resultado do Tratamento , Uganda/epidemiologia , Perda de Peso
6.
Scand J Infect Dis ; 42(6-7): 522-6, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20180681

RESUMO

Although infections with multiple human papillomavirus (HPV) types have been reported widely, more information is needed on the occurrence of the different types. We determined the distribution of seroprevalences to multiple HPV types in Finland and Uganda to compare the epidemiology of the different HPV types in the 2 populations. Serum samples were obtained from 2784 Finnish and 1964 Ugandan women (mean ages 22 y and 25 y, respectively) of whom 44% and 57%, respectively, had antibodies to at least 1 of the 7 HPV types (6, 11, 16, 18, 31, 33, 45) tested (p < 0.001). Multiple HPV antibody positivity was common. HPV45-seropositive Finns had a higher risk of having antibodies to other high-risk HPV types: HPV18 (odds ratio (OR) = 10.9), HPV31 (OR 6.1), HPV33 (OR 12.2), than their Ugandan counterparts: HPV18 (OR 3.4), HPV31 (OR 2.2), HPV33 (OR 3.3). Increased estimates for being double antibody-positive were also noted among HPV18- and HPV16-seropositive women, but there were no major differences between HPV16-seropositive Finns and Ugandans. In addition to biological and behavioural factors, iatrogenic and societal factors (screening vs no screening) may also result in the different occurrence of infections with the high-risk HPV types in Finland and Uganda.


Assuntos
Alphapapillomavirus/classificação , Infecções por Papillomavirus/epidemiologia , Adolescente , Adulto , Alphapapillomavirus/isolamento & purificação , Anticorpos Antivirais/sangue , Feminino , Finlândia/epidemiologia , Soropositividade para HIV , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Infecções por Papillomavirus/virologia , Fatores de Risco , Estudos Soroepidemiológicos , Uganda/epidemiologia
7.
Pediatr Blood Cancer ; 52(4): 455-8, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-18802952

RESUMO

BACKGROUND: Characteristics of children with Burkitt lymphoma (BL) and HIV infection have not been described in Uganda before. PROCEDURE: We reviewed records at Uganda Cancer Institute (UCI) for years 1994-2004, to compare clinical features and outcome of BL in children who are HIV positive and negative (HIV+, HIV-). As statistical methods we used Student's t-test, Chi-square and Kaplan-Meier's to compare both groups. RESULTS: Of 1,462 records of children retrieved, 228 met the eligibility criteria and were reviewed (158 HIV-, 70 HIV+). There were 139 (61%) males and 89 (39%) females. The mean age was 6.9 years (HIV+ 6.7, HIV- 7.1). One hundred seventy-one cases (75%) had facial tumor (HIV+ 71.4%, HIV- 76.6%). HIV positive children presented significantly with extrafacial disease (lymphadenopathy 67%, hepatic masses 51%, and thoracic masses 10%). Presentation with advanced stage disease occurred more frequently in HIV positive patients compared to HIV negative patients. Treatment response rates to chemotherapy were similar irrespective of HIV status. However, overall survival was poorer in HIV positive patients with a median survival of 11.79 months (P-value < 0.000, 95% CI 8.65-14.92). CONCLUSIONS: BL in Uganda presents frequently with facial disease irrespective of HIV status. However HIV+ BL also presents commonly with extra facial sites, mainly lymphadenopathy. There is no difference in response to treatment with chemotherapy, but HIV+ BL patients have poorer survival. There is need for further characterization of BL in Uganda to understand the role of HIV in disease process and outcome.


Assuntos
Linfoma de Burkitt/complicações , Linfoma de Burkitt/patologia , Infecções por HIV/complicações , Infecções por HIV/patologia , Adolescente , Linfoma de Burkitt/mortalidade , Criança , Pré-Escolar , Feminino , Infecções por HIV/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Uganda
8.
Trop Doct ; 38(1): 7-11, 2008 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-18302850

RESUMO

We reviewed the scientific literature on Burkitt's lymphoma (BL) in Africa in order to provide information on the current status of clinical care and the existing research challenges. BL epidemiology led to the discovery of the Epstein Barr virus, an important cause of several viral illnesses and malignancies. The incidence of BL has increased in the endemic areas of Africa, overlapping with the epidemic of HIV and increase of malaria. The impact of this on the clinical care of BL in the region is therefore of interest, especially in HIV-infected children. Rapid methods must be developed which enable the correct diagnosis to be made. It is important to improve supportive care to allow fairly aggressive treatment, to research into salvage therapy for those who fail first-line treatment, and to develop less toxic drug combinations for HIV-infected patients. Documentation of HIV status through counselling should be offered to all patients.


Assuntos
Linfoma de Burkitt/diagnóstico , Linfoma de Burkitt/terapia , África , Antineoplásicos/uso terapêutico , Humanos , Estadiamento de Neoplasias
9.
Afr Health Sci ; 7(3): 166-75, 2007 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18052871

RESUMO

Burkitt's lymphoma (BL) was first described in Eastern Africa, initially thought to be a sarcoma of the jaw. Shortly it became well known that this was a distinct form of Non Hodgkin's lymphoma. The disease has given insight in all aspects of cancer research and care. Its peculiar epidemiology has led to the discovery of Epstein Barr virus (EBV) and its importance in the cause of several viral illnesses and malignancies. The highest incidence and mortality rates of BL are seen in Eastern Africa. BL affects mainly children, and boys are more susceptible than girls. Evidence for a causal relationship between EBV and BL in the endemic form is fairly strong. Frequency of association between EBV and BL varies between different patient groups and different parts of the world. EBV may play a role in the pathogenesis of BL by deregulation of the oncogene c-MYC by chromosomal translocation. Although several studies suggest an association between malaria and BL, there has never been a conclusive population study in support of a direct role of malaria in causation of BL. The emergence of HIV and a distinct subtype of BL in HIV infected have brought a new dimension to the disease particularly in areas where both HIV and BL are endemic. BL has been reported as a common neoplasmin HIV infected patients, but not in other forms of immuno-depression, and the occurrence of BL seems to be higher amongst HIV positive adults, while the evidence of an association amongst children is still disputed. The role of other possible risk factors such as low socio-economical status, exposure to a plant species common in Africa called Euphorbiaceae, exposure to pesticies and to other infections such as schistosomiasis and arbovirus (an RNA virus transmitted by insect vectors) remain to be elucidated.


Assuntos
Linfoma de Burkitt/epidemiologia , Linfoma de Burkitt/etiologia , Adolescente , Adulto , África/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade
10.
J Infect Dis ; 193(7): 971-7, 2006 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-16518759

RESUMO

Children living in malaria-endemic regions have a high incidence of Burkitt lymphoma (BL), the etiology of which involves Plasmodium falciparum malaria and Epstein-Barr virus (EBV) infections. In the present study, we compared EBV DNA loads in plasma and saliva samples from Ugandan children with acute malaria (M+) at the time of diagnosis and 14 days after antimalaria treatment, children without malaria (M-), and children with BL. EBV DNA was detected, by real-time polymerase chain reaction, in 31% of the plasma and in 79% of the saliva samples from children in the M+ group. Antimalaria treatment led to clearance of plasma viral load in 85% of the cases but did not affect the levels in saliva. There was a significant difference in plasma EBV loads across the groups. The lowest levels were detected in samples from the M- group, increased levels were detected in samples from the M+ group, and levels reached the highest values in samples from children with BL. The same trend was evident in the frequency and levels of anti-BZLF1 antibodies, which is indicative of viral reactivation. In the M+ group, the positive plasma samples clustered around 7-9 years of age, the peak incidence of BL. The clearance of circulating EBV after antimalaria treatment suggests a direct relationship between active malaria infection and viral reactivation.


Assuntos
Antimaláricos/uso terapêutico , DNA Viral/análise , Infecções por Vírus Epstein-Barr/virologia , Herpesvirus Humano 4/fisiologia , Malária Falciparum/tratamento farmacológico , Carga Viral , Adolescente , Envelhecimento , Anticorpos Antivirais/sangue , Linfoma de Burkitt/virologia , Criança , Pré-Escolar , Proteínas de Ligação a DNA/imunologia , Herpesvirus Humano 4/efeitos dos fármacos , Herpesvirus Humano 4/genética , Herpesvirus Humano 4/isolamento & purificação , Humanos , Malária Falciparum/complicações , Malária Falciparum/virologia , Reação em Cadeia da Polimerase , Saliva/virologia , Transativadores/imunologia , Uganda , Proteínas Virais/imunologia
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