Department of Medicine

Prevalence and factors associated with cryptoccocal antigenemia among patients with advanced HIV in Mbale regional referral hospital.

2022-05-03T10:58:31Z

Prevalence and factors associated with cryptoccocal antigenemia among patients with advanced HIV in Mbale regional referral hospital. Ebonu, Eric Background Cryptococcal infection is an opportunistic infection caused by a fungal infection with Cryptococcus neoformans. It is found majorly among severely immunocompromised people, especially those living with advanced HIV. It is associated with a high rate of morbidity and mortality. A positive serum test for cryptococcal antigen (CrAg) is the current clinical practice gold standard for diagnosis of cryptococcal infection. This antigen-based test is the basis for categorizing patient’s antigenemia status. Cryptococcal infection is an independent predictor for cryptococcal meningitis which is the most severe form of Cryptococcal infection and the second commonest cause of morbidity and death among People Living with HIV (PLHIV) with Advanced HIV disease (AHD). AHD is defined as having a CD4 cell count of less than 200cells/mm World Health Organization (WHO) clinical stage 3 or 4 event at presentation in adults. In Uganda, Cryptococcal antigenemia and AHD have been described specially in central Uganda, but there are no formal studies describing the condition in Eastern Uganda. This study, therefore, assessed the prevalence and the factors associated with cryptococcal antigenemia among PLHIV with advanced HIV disease in Mbale Regional Referral Hospital (Mbale RRH). Aims/Rationale The main objective of this study was to determine the prevalence and factors associated with cryptococcal antigenemia among PLHIV with advanced HIV disease. Materials and Methods In this cross-sectional study, we recruited participants of 18 years of age and above who were HIV positive with advanced disease in Mbale RRH medical ward. Eligible participants were; all patients with AHD aged 18 years and above, voluntarily willing to participate in the study and able to give informed consent. They were recruited consecutively until a sample size of 228 was achieved. We collected data on social, demographic and clinical characteristics using a pre-tested customized data collection tool administered to study participants. Cryptococcal antigenemia was determined using Lateral flow assay (Immuno-Mycologics IMMYR) test. Besides the consent to participate in this study, additional mandatory clinical care consent was obtained as part of the hospital protocol from all CrAg positive patients to do a lumbar puncture (LP) and obtained Cerebral spinal fluid (CSF). The CSF was tested using the Lateral flow assay and if found positive was cultured using Sabouraud Dextrose agar culture media. All the positive cultures were subjected with a drug sensitivity testing (DST) for fluconazole and Amphotericin B sensitivity. The collected data were entered into an excel based databased, exported and were analyzed using STATA version 14.0. proportions of socio demographic factors were reported and prevalence of cryptococcal antigenemia was reported as proportion of those patients with positive serum CrAg compared to the total number of patients enrolled in the study. Factors associated with cryptococcal antigenemia were reported first as proportion and further analyses to determine the associations were conducted using multiple logistic regression models. Results Between May to June 2019, we enrolled 228 participants, 152 (66.7%) females, mean age (SD) 42 (12.4) years and median CD4 count of 194 cells/mm3 (IQR 129-370). Of the total 228 patients, only 10/228 (4.4%; 95% CI, 0.024 - 0.080) had cryptococcal antigenemia. Although the factors associated with cryptococcal antigenemia were significant at bivariate analysis, they were found to lack significance at multivariate analysis, these factors included; CD4 cell count of less than 100cells/mm3 (AOR=3.70), keeping poultry at home, taking ART was protective (AOR=0.240). Clinical features associated with a positive serum CrAg; headaches (AOR=1), neck and back pains (AOR=8.817), altered vision (18.061), recent confusion (AOR=6.323) and neck stiffness (AOR=676.217). 30% of those with positive serum CrAg had a suppressed viral load. Conclusions Cryptococcal antigenemia is common among the people living with AHD with a CD4 of <100cells/mm3, independent predictors associated with were CD4cell count <100cells/mm clinical symptoms & signs of meningeal irritation and poultry keeping. We recommend regular screening for CD4 counts, prophylaxis for those found with CD4 counts <100cells/mm prophylaxis for those who have AHD and also keep poultry at home, early & effective ART initiation and education of people living with HIV/AIDS (PLWHA) as a means of early detection of patients at risk, prevention and reduction of risks respectively. Dissertation

Prevalence of three cardiometabolic diseases and their associated factors among patients on art at the HIV clinic in Mbale regional referral hospital.

2022-07-07T06:44:47Z

Prevalence of three cardiometabolic diseases and their associated factors among patients on art at the HIV clinic in Mbale regional referral hospital. Asio, Sarah There are currently 1.4 million people living with HIV (PLHIV) on ART in Uganda. PLHIV are currently living longer as a result of use of antiretroviral therapy (ART). The prevalence of cardiometabolic diseases (CMDs) is increasing among this population. These diseases increase risk of development of cardiovascular disease (CVO) which is now emerging as one of the causes of morbidity and mortality ~ong PLHIV. The increased CMOs and increased GVO risk among PLHIV has been attributed to HIV infection itself, the of ARVs and shared lifestyle risk factors among others. Studies on CMOs among PLHIV in Uganda are few and those done generally been done in other parts of the country other than Mbale Regional Referral Hospital (MRRH). There is need to know the magnitude of CMDs among patients on ART in MRRH HIV clinic. The aim of this study was to determine the prevalence of CMOs and associated factors among patients on ART in MRRH. Methods This was a cross-sectional study conducted among PLHIV in MRRH. Data was obtained from chart reviews, participant interviews and analyzed blood samples collected from the participants. Participants were systematically sampled from the ART clinic in MRRH. Odd's ratios (OR) were used as a measure of association and adjusted odds ratios (AOR) were calculated using logistic regression to explore the factors associated with CMOs. Ethical clearance was obtained from Mbale Regional Referral Hospital Research Ethics Committee. Results A total of 324 PLHIV were included in the study, two patients had incomplete data and were excluded from analysis. Majority (63.7%) were aged between 40-59 years with mean age 45 years. There were more females (64.5%) participants than the men. Cardiometabolic diseases were prevalent in this population of PLHIV on ART with hypertension at 32.4%, dyslipidemia 50% and diabetes at 1.8%. The majority of these PLHIV were not aware of these disorders. Known traditional risk factors were associated with cardiometabolic diseases such as age above 60 years was associated with hypertension adjusted odds ratio (AOR) =9.07 (95% CL, 0.5-15), overweight (AOR = 3.59, 95% CL: 1.31- 9.88). Surprisingly patients with low salty diet were paradoxically more likely to have hypertension however most of these patients were among the 104 patients who knew their status (AOR=0.42, 95% CL: 0.2-0.90). Dyslipidemia was strongly associated with being overweight, abnormal waist circumference, salty foods and viral load. Those with high viral load> 1000 copies had threefold increased of dyslipidemia with odds ratio (OR) = 3.46, 95% CL: 1.14-10.54). Overweight had 1.3 increased odds of being diagnosed with dyslipidemia (OR=2.26, 95% CL: 1.12- 4.59) while abnormal waist circumference had 0.7 increased odds of having dyslipidemia (OR=1.7 95% CL: 2.67). Patients who rarely added salt in their diet had increased odds of developing idernia with odds ratio (1.83, 95% CL: 1.18-2.85). Diabetes did not have any significant associations Conclusion There is higher prevalence of cardiometabolic diseases among the patients on ART in Mbale compared to the prevalence noted among the general population. A majority of the patients were not aware about their disease status. Dyslipidemia is the most prevalent followed by hypertension with diabetes the least prevalent. The traditional risk factors are associated with these diseases. The higher prevalence than in the general population suggests possible contribution of HIV to these diseases. Therefore, screening for these diseases should be emphasized among patients on ART. Dissertation.

A Descriptive-multivariate analysis of community knowledge, confidence, and trust in COVID-19 clinical trials among healthcare workers in Uganda

2022-04-13T08:45:24Z

A Descriptive-multivariate analysis of community knowledge, confidence, and trust in COVID-19 clinical trials among healthcare workers in Uganda Kasozi, Keneth Iceland; Laudisoit, Anne; Osuwat, Lawrence Obado; Batiha, Gaber El-Saber; Omairi, Naif E. Al; Aigbogun, Eric; Ninsiima, Herbert Izo; Usman, Ibe Michael; DeTora, Lisa M.; MacLeod, Ewan Thomas Background—misinformation and mistrust often undermines community vaccine uptake, yet information in rural communities, especially of developing countries, is scarce. This study aimed to identify major challenges associated with coronavirus disease 2019 (COVID-19) vaccine clinical trials among healthcare workers and staff in Uganda. Methods—a rapid exploratory survey was conducted over 5 weeks among 260 respondents (66% male) from healthcare centers across the country using an online questionnaire. Twenty-seven questions assessed knowledge, confidence, and trust scores on COVID-19 vaccine clinical trials from participants in 46 districts in Uganda. Results—we found low levels of knowledge (i.e., confusing COVID-19 with Ebola) with males being more informed than females (OR = 1.5, 95% CI: 0.7–3.0), and mistrust associated with policy decisions to promote herbal treatments in Uganda and the rushed international clinical trials, highlighting challenges for the upcoming Oxford–AstraZeneca vaccinations. Knowledge, confidence and trust scores were higher among the least educated (certificate vs. bachelor degree holders). We also found a high level of skepticism and possible community resistance to DNA recombinant vaccines, such as the Oxford–AstraZeneca vaccine. Preference for herbal treatments (38/260; 14.6%, 95% CI: 10.7–19.3) currently being promoted by the Ugandan government raises major policy concerns. High fear and mistrust for COVID-19 vaccine clinical trials was more common among wealthier participants and more affluent regions of the country. Conclusion—our study found that knowledge, confidence, and trust in COVID-19 vaccines was low among healthcare workers in Uganda, especially those with higher wealth and educational status. There is a need to increase transparency and inclusive participation to address these issues before new trials of COVID-19 vaccines are initiated. Keywords: COVID-19 clinical trials in resource poor countries; COVID-19; clinical trials in Africa; COVID-19 and medical workers; vaccines; COVAX Article

Retirement—a time to dread or to cherish?

2021-05-04T06:43:58Z

Retirement—a time to dread or to cherish? Taylor-Robinson, Simon D Retirement is often a taboo subject amongst medical professionals. Many have dedicated a major part of their lives to the practice of medicine to the exclusion of anything else. The thought of empty days or lack of externally driven purpose is something that unsettles many who are approaching pensionable age. In reality, such fears rarely materialize. The challenge of transition to a new phase of life is all the more poignant if ill health intervenes early, causing premature cessation of work. Article