Appropriate second-line antiretroviral therapy for HIV infection is needed in resource-limited settings. In a comparison of three protease-inhibitor–based regimens in sub-Saharan Africa, the one that ...included nucleoside reverse-transcriptase inhibitors performed favorably.
The public health approach of the World Health Organization (WHO),
1
together with large-scale donor funding, has enabled millions of adults and children in sub-Saharan Africa who are infected with the human immunodeficiency virus (HIV) to have access to lifesaving antiretroviral therapy.
2
The key principle is the use of simplified, standardized approaches that are feasible on a large scale in resource-limited settings,
1
,
3
including a first-line regimen of two nucleoside reverse-transcriptase inhibitors (NRTIs) plus one non-NRTI (NNRTI). In most settings, treatment is monitored clinically and with the use of CD4+ counts, with typically late detection of treatment failure, accompanied by substantial . . .
HIV is transmitted primarily through sexual intercourse, and the objective of this study was therefore to assess whether there is occult viral replication and resistance in genital secretions in ...patients on protease inhibitor (PI)-based second-line therapy.
HIV-infected adults taking ritonavir-boosted lopinavir with either two nucleoside reverse transcriptase inhibitors (NRTIs), raltegravir or as monotherapy for 96 weeks, were enrolled at seven clinical sites in Uganda. Viral load (VL) was measured in cervico-vaginal secretions or semen and in a corresponding plasma sample. Genotypic resistance was assessed in genital secretion samples and plasma samples. Results were compared between compartments and with the plasma resistance profile at first-line failure.
Of the 111 participants enrolled (91 female, 20 male), 16 (14%) and 30 (27%) had VL >1,000 and >40 copies/ml, respectively, in plasma; 3 (3%) and 23 (21%) had VL >1,000 copies/ml and >40 copies/ml, respectively, in genital secretions. There was 74% agreement between plasma and genital secretion VL classification above/below 40 copies/ml threshold (kappa-statistic =0.29; P=0.001). RT mutations (both NRTI and non-nucleoside reverse transcriptase inhibitor) were detected in genital secretions in four patients (similar profile to corresponding plasma sample at first-line failure) and PI mutations were detected in two (one polymorphism with no impact on resistance; one with high-level PI resistance).
High level (>1,000 copies/ml) viral replication and development of new RT or PI resistance in the genital compartment were rare. The risks of transmission arising from resistance evolution in the genital compartment are likely to be low on PI-based second-line therapy.
Since mid 1990s, Uganda has had an estimated 1.6 million internally displaced persons (IDPs) in the northern and eastern districts. A major cause of morbidity and mortality amongst children in ...displaced settings is protein energy malnutrition.
To estimate the prevalence of and describe the risk factors for protein energy malnutrition among under five years old children living in internally displaced persons camps in Omoro county Gulu district.
This was a cross sectional study undertaken among internally displaced people's in Omoro county, Gulu district during 13 - 23(rd) September 2006. Anthropometric measurements of 672 children aged 3 - 59 months were undertaken and all their caretakers interviewed. The anthropometric measurements were analyzed using z-scores of height-for-age (H/A) and weight-for-height (W/H) indices. Qualitative data were collected through 6 focus group discussions, key informant interviews and observation. Data were captured using Epi Data version 3.0 and analyzed using EPI-INFO version 3.3.2 and SPSS version 12.0 computer packages respectively. ResultsThe prevalence of global stunting was found to be 52.4% and of global acute malnutrition 6.0%. Male children are at risk of being stunted Adjusted OR 1.57 95% CI 1.15-2.13; p value=0.004. Children in the age group 3 - 24 months were at risk of acute malnutrition Adjusted OR 2.78 95% CI 1.26-6.15; p value=0.012 while de-worming was protective Adjusted OR 0.44 95% CI 0.22-0.88; p value=0.018. The main sources of foodstuff for IDPs include food rations distributed by WFP, cultivation and purchase.
There is high prevalence of protein energy malnutrition (stunting) among children in the internally displaced people's camps in Gulu district. Male children are at an increased risk of stunting while children aged between 3 - 24 months are at an increased risk of suffering from acute malnutrition. Stakeholders including local government and relief organizations should intensify efforts to improve the nutritional status of IDPs especially children in the camp settings. The quantity of and access to household food supplies, health education on infant and child feeding and integrated management of childhood illnesses (IMCI) activities in the camps should be strengthened.
From 2006 to 2011, a cohort study was conducted among 1000 children resident in urban and rural settings of Uganda to ascertain and compare the response to antiretroviral therapy (ART) among urban ...versus rural children and the factors associated with this response. Clinical, immunological, and virological parameters were ascertained at baseline and weeks 24, 48, 96, and 144 after ART initiation. Adherence to ART was assessed at enrollment by self-report (SR) and pill counts (PC). Overall, 499/948 (52.6%) children were resident in rural areas, 504/948 (53.1%) were male, and their mean age was 11.9±4.4 years (urban children) and 11.4±4.1 years (rural children). The urban children were more likely to switch to second-line ART at a rate of 39.9 per 1000 person-years (95% CI: 28.2-56.4) versus 14.9 per 1000 person-years (95% CI: 8.7-25.7), p=0.0038, develop any new WHO 3/4 events at 127/414 (30.7%) versus 108/466 (23.2%), p=0.012, and have a higher cumulative incidence of hospitalization of 54/449 (12.0%) versus 32/499 (6.4%), p=0.003, when compared to rural children. No differences were observed in mean changes in weight, height, CD4 count and percentage, and hemoglobin and viral load between urban and rural children. Adherence of ≥95% was observed in 88.2% of urban versus 91.3% of rural children by SR (p=0.130), and in 78.8% of urban versus 88.8% of rural children by PC (p<0.0001). In this study rural children had more favorable clinical outcomes and were more likely to adhere optimally to ART than urban children.
Background: Uganda has made progress in reducing its HIV prevalence from 7.3% in 2011 to 6% in 2017, however, more needs to be done to meet the World Health Organization (WHO) target of 95% of the ...population knowing their HIV status, 95% enrolled on treatment and 95% achieving viral suppression. This study aimed to assess the bottlenecks and opportunities towards achieving the 95 95 95 targeted HIV services in the Bukedea district.
Methods: A mixed-methods cross-sectional study was conducted in the Bukedea district covering males and females aged 18-65 years who had consented to participate in the study. We used a purposive sampling procedure to select our study participants. Qualitative data was collected through focus group discussions, key informant interviews, and document reviews for quantitative data. Quantitative data were analyzed using STATA v 14 whereas qualitative data were analyzed using the thematic analysis approach.
Results: The challenges were grouped as patient-related, medication-related, and facility-related. The patient-related challenges were stigma, fear of taking the medication, poor nutrition, long distances, alcoholism, busy working schedules, and domestic violence. The medication-related challenges were side effects and pill burden. The facility-related challenges were inadequate pretest counseling and stock-outs. The use of anti-retroviral drugs (ART) was common in piggery and poultry and the sources of these drugs were reported to be the people on ART and the health workers.
The opportunities included home-based counseling, organizing more outreaches, counseling and health education, targeted testing, and strengthening the Village Health Teams (VHT) networks.
Conclusions: The study revealed that the major challenges towards achieving the targeted 95-95-95 HIV services were stigma, inadequate pre-test counseling, fear of disclosure, and poor adherence due to alcoholism, sharing of drugs with animals and partners. The use of anti-retroviral drugs in animal husbandry was common in the Bukedea District.
Introduction Since mid 1990s, Uganda has had an estimated 1.6 million
internally displaced persons (IDPs) in the northern and eastern
districts. A major cause of morbidity and mortality amongst ...children in
displaced settings is protein energy malnutrition. Objective To
estimate the prevalence of and describe the risk factors for protein
energy malnutrition among under five years old children living in
internally displaced persons camps in Omoro county Gulu district.
Methods This was a cross sectional study undertaken among internally
displaced people's in Omoro county, Gulu district during 13 - 23rd
September 2006. Anthropometric measurements of 672 children aged 3 59
months were undertaken and all their caretakers interviewed. The
anthropometric measurements were analyzed using z- scores of
height-for-age (H/A) and weight-for-height (W/H) indices. Qualitative
data were collected through 6 focus group discussions, key informant
interviews and observation. Data were captured using Epi Data version
3.0 and analyzed using EPI-INFO version 3.3.2 and SPSS version 12.0
computer packages respectively. Results The prevalence of global
stunting was found to be 52.4% and of global acute malnutrition 6.0%.
Male children are at risk of being stunted Adjusted OR 1.57 95% CI
1.15-2.13; p value=0.004. Children in the age group 3 24 months were at
risk of acute malnutrition Adjusted OR 2.78 95% CI 1.26-6.15; p
value=0.012 while de-worming was protective Adjusted OR 0.44 95% CI
0.22-0.88; p value=0.018. The main sources of foodstuff for IDPs
include food rations distributed by WFP, cultivation and purchase.
Conclusion and Recommendations There is high prevalence of protein
energy malnutrition (stunting) among children in the internally
displaced people's camps in Gulu district. Male children are at an
increased risk of stunting while children aged between 3 24 months are
at an increased risk of suffering from acute malnutrition. Stakeholders
including local government and relief organizations should intensify
efforts to improve the nutritional status of IDPs especially children
in the camp settings. The quantity of and access to household food
supplies, health education on infant and child feeding and integrated
management of childhood illnesses (IMCI) activities in the camps should
be strengthened.
PDF
