30 results on '"Kanyesigye, Michael"'
Search Results
2. Association between metabolic syndrome and cervical cancer among women in Southwestern Uganda: A case-control study
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Kajabwangu, Rogers, Ngonzi, Joseph, Izudi, Jonathan, Bazira, Joel, Ssedyabane, Frank, Kanyesigye, Michael, Atwine, Raymond, Kayondo, Musa, Ankunda, Rogers, Lugobe, Henry Mark, Turanzomwe, Stuart, Randall, Thomas C., and Bajunirwe, Francis
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- 2024
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3. Feasibility of Rapid Case Ascertainment for Cancer in East Africa: An Investigation of Community-Representative Kaposi Sarcoma in the Era of Antiretroviral Therapy
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Semeere, Aggrey, Byakwaga, Helen, Laker-Oketta, Miriam, Freeman, Esther, Busakhala, Naftali, Wenger, Megan, Kasozi, Charles, Ssemakadde, Matthew, Bwana, Mwebesa, Kanyesigye, Michael, Kadama-Makanga, Philippa, Rotich, Elyne, Kisuya, Job, Sang, Edwin, Maurer, Toby, Wools-Kaloustian, Kara, Kambugu, Andrew, and Martin, Jeffrey
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Biomedical and Clinical Sciences ,Clinical Sciences ,Health Sciences ,Sexually Transmitted Infections ,Clinical Research ,Rare Diseases ,Infectious Diseases ,Emerging Infectious Diseases ,HIV/AIDS ,Cancer ,Infection ,Adult ,Feasibility Studies ,HIV Infections ,Humans ,Kenya ,Sarcoma ,Kaposi ,Uganda ,Kaposi sarcoma ,HIV infection ,Rapid case ascertainment ,Feasibility ,Community ,Sub-Saharan Africa ,East Africa ,Oncology and Carcinogenesis ,Public Health and Health Services ,Oncology & Carcinogenesis ,Oncology and carcinogenesis ,Epidemiology - Abstract
BackgroundRapid case ascertainment (RCA) refers to the expeditious and detailed examination of patients with a potentially rapidly fatal disease shortly after diagnosis. RCA is frequently performed in resource-rich settings to facilitate cancer research. Despite its utility, RCA is rarely implemented in resource-limited settings and has not been performed for malignancies. One cancer and context that would benefit from RCA in a resource-limited setting is HIV-related Kaposi sarcoma (KS) in sub-Saharan Africa.MethodsTo determine the feasibility of RCA for KS, we searched for all potential newly diagnosed KS among HIV-infected adults attending three community-based facilities in Uganda and Kenya. Searching involved querying of electronic medical records, pathology record review, and notification by clinicians. Upon identification, a team verified eligibility and attempted to locate patients to perform RCA, which included epidemiologic, clinical and laboratory measurements.ResultsWe identified 593 patients with suspected new KS. Of the 593, 171 were ineligible, mainly because biopsy failed to confirm KS (65%) or KS was not new (30%). Among the 422 remaining, RCA was performed within 1 month for 56% of patients and within 3 months for 65% (95% confidence interval: 59 to 70%). Reasons for not performing RCA included intervening death (47%), inability to contact (44%), refusal/unsuitable to consent (8.3%), and patient re-location (0.7%).ConclusionsWe found that RCA - an important tool for cancer research in resource-rich settings - is feasible for the investigation of community-representative KS in East Africa. Feasibility of RCA for KS suggests feasibility for other cancers in Africa.
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- 2021
4. Beyond T Staging in the “Treat-All” Era: Severity and Heterogeneity of Kaposi Sarcoma in East Africa
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Freeman, Esther E, Semeere, Aggrey, McMahon, Devon E, Byakwaga, Helen, Laker-Oketta, Miriam, Regan, Susan, Wenger, Megan, Kasozi, Charles, Ssemakadde, Matthew, Bwana, Mwebesa, Kanyesigye, Michael, Kadama-Makanga, Philippa, Rotich, Elyne, Kisuya, Job, Wools-Kaloustian, Kara, Bassett, Ingrid V, Busakhala, Naftali, and Martin, Jeffrey
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Biomedical and Clinical Sciences ,Clinical Sciences ,Sexually Transmitted Infections ,Digestive Diseases ,Emerging Infectious Diseases ,Rare Diseases ,Infectious Diseases ,HIV/AIDS ,Cancer ,Infection ,Adult ,Female ,HIV Infections ,Humans ,Kenya ,Male ,Neoplasm Staging ,Sarcoma ,Kaposi ,Severity of Illness Index ,Uganda ,HIV ,AIDS ,Kaposi sarcoma ,sub-Saharan Africa ,delayed diagnosis ,global health ,biopsy ,cancer ,staging ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundAlthough many patients with Kaposi sarcoma (KS) in sub-Saharan Africa are diagnosed with AIDS Clinical Trials Group (ACTG) T1 disease, T1 staging insufficiently captures clinical heterogeneity of advanced KS. Using a representative community-based sample, we detailed disease severity at diagnosis to inform KS staging and treatment in sub-Saharan Africa.MethodsWe performed rapid case ascertainment on people living with HIV, aged 18 years or older, newly diagnosed with KS from 2016 to 2019 at 3 clinic sites in Kenya and Uganda to ascertain disease stage as close as possible to diagnosis. We reported KS severity using ACTG and WHO staging criteria and detailed measurements that are not captured in the current staging systems.ResultsWe performed rapid case ascertainment within 1 month for 241 adults newly diagnosed with KS out of 389 adult patients with suspected KS. The study was 68% men with median age 35 years and median CD4 count 239. Most of the patients had advanced disease, with 82% qualifying as ACTG T1 and 64% as WHO severe/symptomatic KS. The most common ACTG T1 qualifiers were edema (79%), tumor-associated ulceration (24%), extensive oral KS (9%), pulmonary KS (7%), and gastrointestinal KS (4%). There was marked heterogeneity within T1 KS, with 25% of patients having 2 T1 qualifying symptoms and 3% having 3 or more.ConclusionMost of the patients newly diagnosed with KS had advanced stage disease, even in the current antiretroviral therapy "treat-all" era. We observed great clinical heterogeneity among advanced stage patients, leading to questions about whether all patients with advanced KS require the same treatment strategy.
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- 2021
5. Prevalence, correlates and treatment needs of dental caries among people on antiretroviral therapy in Uganda: a cross sectional study
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Arubaku, Wilfred, Kwizera, Godfrey, Tusubira, Deusdedit, Kanyesigye, Michael, Chamut, Steffany, Seymour, Brittany Anne, Siedner, Mark J., Niyonzima, Vallence, Najjuma, Josephine N., and Maling, Samuel
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- 2022
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6. Adaptation of the Client Diagnostic Questionnaire for East Africa
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Kwobah, Edith Kamaru, primary, Goodrich, Suzanne, additional, Kulzer, Jayne Lewis, additional, Kanyesigye, Michael, additional, Obatsa, Sarah, additional, Cheruiyot, Julius, additional, Kiprono, Lorna, additional, Kibet, Colma, additional, Ochieng, Felix, additional, Bukusi, Elizabeth A., additional, Ofner, Susan, additional, Brown, Steven A., additional, Yiannoutsos, Constantin T., additional, Atwoli, Lukoye, additional, and Wools-Kaloustian, Kara, additional
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- 2024
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7. D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda
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Okello, Samson, Asiimwe, Stephen B, Kanyesigye, Michael, Muyindike, Winnie R, Boum, Yap, Mwebesa, Bosco B, Haberer, Jessica E, Huang, Yong, Williams, Kenneth, Burdo, Tricia H, Tracy, Russell P, Bangsberg, David R, Mocello, A Rain, Martin, Jeffrey N, Hunt, Peter W, and Siedner, Mark J
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Biomedical and Clinical Sciences ,Public Health ,Health Sciences ,Clinical Research ,Prevention ,Hypertension ,HIV/AIDS ,Sexually Transmitted Infections ,Aging ,Infectious Diseases ,Cardiovascular ,2.1 Biological and endogenous factors ,Aetiology ,Adult ,Anti-HIV Agents ,Antihypertensive Agents ,Female ,Fibrin Fibrinogen Degradation Products ,HIV Infections ,Humans ,Male ,Risk Factors ,D-dimer ,immune activation ,hypertension ,antiretroviral therapy ,Africa ,Clinical Sciences ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
ObjectivesWe sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda.MethodsWe used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension.ResultsIn the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count
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- 2016
8. Implementation and Operational Research
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Roy, Monika, Muyindike, Winnie, Vijayan, Tara, Kanyesigye, Michael, Bwana, Mwebesa, Wenger, Megan, Martin, Jeffrey, and Geng, Elvin
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Medical Microbiology ,Biomedical and Clinical Sciences ,Clinical Sciences ,Sexually Transmitted Infections ,Clinical Research ,HIV/AIDS ,Emerging Infectious Diseases ,Infectious Diseases ,Rare Diseases ,Tuberculosis ,4.2 Evaluation of markers and technologies ,Detection ,screening and diagnosis ,4.4 Population screening ,Infection ,Good Health and Well Being ,Adult ,Ambulatory Care Facilities ,Coinfection ,HIV Infections ,Humans ,Mass Screening ,Microscopy ,Operations Research ,Patient Acceptance of Health Care ,Prevalence ,Sputum ,Uganda ,HIV ,tuberculosis ,screening ,implementation ,Public Health and Health Services ,Virology ,Clinical sciences ,Epidemiology ,Public health - Abstract
BackgroundThe uptake of intensified active TB case-finding among HIV-infected patients using symptom screening is not well understood. We evaluated the rate and completeness of each interim step in the TB pulmonary "diagnostic cascade" to understand real-world barriers to active TB case detection.MethodsWe conducted a cohort analysis of new, antiretroviral therapy-naive, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012-September 30, 2013). We used medical records to extract date of completion of each step in the diagnostic cascade: symptom screen, order, collection, processing, and result. Factors associated with lack of sputum order were evaluated using multivariate Poisson regression and chart review of 50 screen-positive patients.ResultsOf 2613 patients, 2439 (93%) were screened for TB and 682 (28%) screened positive. Only 90 (13.2%) had a sputum order. Of this group, 83% completed the diagnostic cascade, 13% were diagnosed with TB, and 50% had a sputum result within 1 day of their visit. Sputum ordering was associated with WHO stage 3 or 4 HIV disease and greater number of symptoms. The main identifiable reasons for lack of sputum order in chart review were treatment of presumed malaria (51%) or bacterial infection (43%).ConclusionsThe majority of newly enrolled HIV-infected patients who screened positive for suspected TB did not have a sputum order, and those who did were more likely to have more symptoms and advanced HIV disease. Further evaluation of provider behavior in the management of screen-positive patients could improve active TB case detection rates.
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- 2016
9. Incidence and predictors of hypertension in adults with HIV-initiating antiretroviral therapy in south-western Uganda
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Okello, Samson, Kanyesigye, Michael, Muyindike, Winnie R, Annex, Brian Herb, Hunt, Peter W, Haneuse, Sebastien, and Siedner, Mark Jacob
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Biomedical and Clinical Sciences ,Clinical Sciences ,Hypertension ,Infectious Diseases ,HIV/AIDS ,Prevention ,Cardiovascular ,Clinical Research ,Evaluation of treatments and therapeutic interventions ,6.1 Pharmaceuticals ,Infection ,Good Health and Well Being ,Adult ,Anti-Retroviral Agents ,Female ,HIV Infections ,Humans ,Incidence ,Male ,Risk Factors ,Uganda ,aging ,antiretroviral therapy ,HIV ,AIDS ,hypertension ,noncommunicable disease ,sub-Saharan Africa ,Cardiorespiratory Medicine and Haematology ,Medical Physiology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences - Abstract
ObjectiveThe successful scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has led to increasing life expectancy, and thus increased risk of hypertension. We aimed to describe the incidence and predictors of hypertension in HIV patients receiving ART at a publicly funded clinic in rural Uganda.MethodsWe abstracted data from medical records of adult patients who initiated ART at an HIV clinic in south-western Uganda during 2010-2012. We defined hypertension as at least two consecutive clinical visits, with a SBP at least 140 mmHg and/or SBP of at least 90 mmHg, or prescription for an antihypertensive medication. We calculated the incidence of hypertension and fit multivariable Cox proportional-hazards models to identify predictors of hypertension.ResultsA total of 3389 patients initiated ART without a prior diagnosis of hypertension during the observation period. Over 3990 person-years of follow-up, 445 patients developed hypertension, for a crude incidence of 111.5/1000 (95% confidence interval 101.9-121.7) person-years. Rates were highest among men aged at least 40 years (158.8 per/1000 person-years) and lowest in women aged 30-39 years (80/1000 person-years). Lower CD4 cell count at ART initiation, as well as traditional risk factors including male sex, increasing age, and obesity, were independently associated with hypertension.ConclusionWe observed a high incidence of hypertension in HIV-infected persons on ART in rural Uganda, and increased risk with lower nadir CD4 cell counts. Our findings call for increased attention to screening of and treatment for hypertension, along with continued prioritization of early ART initiation.
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- 2015
10. Incidence and predictors of early loss to follow up among patients initiated on protease inhibitor-based second-line antiretroviral therapy in southwestern Uganda
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Nuwagira, Edwin, Lumori, Boniface A. E., Muhindo, Rose, Kanyesigye, Michael, Amir, Abdallah, Muyindike, Winnie, and Muzoora, Conrad
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- 2021
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11. Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study
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Campbell, Jeffrey I, primary, Aturinda, Isaac, additional, Mwesigwa, Evans, additional, Habinka, Annabella, additional, Kanyesigye, Michael, additional, Holden, Richard J, additional, Siedner, Mark J, additional, and Kraemer, John D, additional
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- 2023
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12. Behavioral Predictors of Intention to Use a Text Messaging Reminder System Among People Living With HIV in Rural Uganda: Survey Study (Preprint)
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Campbell, Jeffrey I, primary, Aturinda, Isaac, additional, Mwesigwa, Evans, additional, Habinka, Annabella, additional, Kanyesigye, Michael, additional, Holden, Richard J, additional, Siedner, Mark J, additional, and Kraemer, John D, additional
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- 2022
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13. Implementation of 'Treat‐all' at adult HIV care and treatment sites in the Global IeDEA Consortium: results from the Site Assessment Survey
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Brazier, Ellen, Maruri, Fernanda, Duda, Stephany N., Tymejczyk, Olga, Wester, C William, Somi, Geoffrey, Ross, Jeremy, Freeman, Aimee, Cornell, Morna, Poda, Armel, Musick, Beverly S., Zhang, Fujie, Althoff, Keri N., Mugglin, Catrina, Kimmel, April D., Yotebieng, Marcel, Nash, Denis, Karminia, Azar, Sohn, Annette H., Allen, Debbie, Bloch, Mark, Boyd, Susan, Brown, Katherine, Costa, Jess, Donohue, William, Gunathilake, Manoji, Hoy, Jennifer, Macrae, Karen, Moore, Richard, Roth, Norman, Rowling, Diane, Silvers, Julie, Smith, David J., Sowden, David, Templeton, David, Varma, Rick, Woolley, Ian, Youds, David, Meng, Somanithd Chhay, Vannary, Bun, Chan, Yun Ting, Lam, Wilson, Lee, Man Po, Ning, Han, Pansy, Yu Po Chu, Kumarasamy, N., Pujari, Sanjay, Kurniati, Nia, Merati, Tuti Parwati, Muktiarti, Dina, Parwata, Wayan Sandhi, Ratni, Made, Sukmawati, Ni Made Dewi Dian, Vedaswari, Dian Sulistya Putu Diah, Wati, Ketut Dewi Kumara, Yunihastuty, Evy, Tanuma, Junko, Mills, Graham, Raymond, Nigel, Ditangco, Rossana, Papa, Ohnmar Seinn, Tek, Ng Oon, Azwa, Raja, Daud, Fauziah, Juin, Wong Ke, Kamarulzaman, Adeeba Binti, Khairulddin, Nik, Li, Chong Meng, Moy, Fong Siew, Shah, Raja Iskandar, Shyan, Wong Peng, Sim, Benedict, Thahira, Jamal Mohamed, Tuang, Koh Mia, Yusoff, Nik, Choi, Jun Yong, Chan, Yu?Jiun, Huang, Chih?Sheng, Wing?Wai, Wong, Avihingsanon, Anchalee, Chokephaibulkit, Kulkanya, Hansudewechakul, Rawiwan, Khumcha, Benjhawan, Khusuwan, Suwimon, Kiertiburanakul, Sasisopin, Lumbiganon, Pagakrong, Maleesatharn, Alan, Praparattanapan, Jutarat, Puthanakit, Thanyawee, Sricharoenchai, Sirintip, Sudjaritruk, Tavitiya, Watanaporn, Suporn, An, Vu Thien, Cuong, Do Duy, H?ng, Bùi Thu, Huy, Bùi V?, Quy, Du Tuan, Van, Lam Nguyen, Baragunzwa, Agathomfue, Gakima, Dévote, Ingabire, Gloria, Kankinoi, Floride, Manyundo, Risase Scholastique, Misago, Celestin, Nahimana, Thierry, Nimbona, Pélagie, Ntirampeba, Felicite, Twizere, Christella, Ajeh, Rogers, Djenabou, Amadou, Dzudie, Anastase, Ewanoge, Alice Ndelle, Tchassem, Edmond, Bampapa, Therese, Lelo, Patricia, Kitetele, Faustin, Paul, Marie, Tytyna, Amida, Akolbout, Maryse, Bitsindou, Parfait, Diafouka, Merlin, Mafoua, Adolphe, Mahinga, Nadine, Moudila, Ella, Moutoula, Antoinette, Ndala, Ulrich, Nsonde, Dominique Mahambou, Ayinkamiye, Josephine, Dusabe, Chantal, Hakizimana, Theogene, Mbaraga, Gilbert, Mukamana, Joyce, Mukantwali, Sandrine, Munyaneza, Athanase, Murangwa, Anthere, Musenguwera, J. Claude, Ngutegure, Marie Immanculee, Ntarambirwa, Fidele, Nyiransabimana, Diane, Sinayobye, Jean D'Amour, Tuyishimire, Yvonne, Uwamahoro, Olive, Viateur, Habumuremyi, Vincent, Sugira, Kuhn, Yee Yee, Musick, Beverly, Rodriguez, Israel, Wools?Kaloustian, Kara, Yiannoutsos, Constantin, Akajoroit, Esinasi, Ariya, Peter, Atsimale, Meshack, Barua, Zeruya, Busaka, Oscar, Bukusi, Elizabeth, Chebor, Valentine, Chemweno, Timothy, Chirchir, John, Esendi, Lameck Diero Sagida, Fwamba, Aisha, Mmella, Anne, Githumbi, Eunice, Hussein, Marcia Nasimiyu, Kandie, Xavier, Kemunto, Martha, Khaemba, Elizabeth, Kipchumba, Mary, Koech, Emily, Kosgei, Caroline, Laundrick, Barasa, Merongo, Ruth, Mochotto, Patricia, Munyisi, Consolata, Ndakalu, Lilian, Ochieng, William Okoth, Odalo, Paul, Okumu, Wicklife, Omari, Lilian, Omondi, Alphoce, Osia, Lydia, Owino, Magret, Oyoo, Maureen, Pepela, Doris, Rono, Millicent, Simon, Omar, Tenge, Angie, Too, Mary, Toto, Modesta, Towett, Cathrine, Wawire, Kennedy, Kimambo, Mensaria, Kinyota, Ester, Lyamuya, Rita, Mathias, Julia, Mfuko, Athuman Ramadhan, Michael, Denna, Ngonyani, Kapella Zacharia, Nyaga, Charles, Somi, G.R., Urassa, Mark S., Batte, James, Bwana, Mwebesa Bosco, Castelnuovo, Barbara, Kanyesigye, Michael, Kisakye, Alice, Nalugoda, Fred, Semuwemba, Haruna, Ssali, John, Ssemakadde, Matthew, Castilho, Jessica, Cesar, Carina, De Alencastro, Paulo Ricardo, Barbosa, Eduardo Luiz, Brites, Carlos, Caricol, Renata, Carmo, Fabiana Bononi Do, Coelho, Lara Esteves, Escuder, Maria Mercedes, Estevam, Denize Lotufo, Ferreira, Flavia Gomes Faleiro, Gonçalves, Alexandre, Gouvêa, Aída Barbosa, Ikeda, Maria Leticia Rodrigues, Kalichman, Artur O., Machado, Daisy Maria, Queiroz, Simone, Souza, Rosa, Succi, Regina Célia, Trindade, Kátia Valeska, Tupinambás, Unai, Wolff, Marcelo, Rouzier, Vanessa, Padgett, Denis, Crabtree, Brenda, Martin, Carlos Eduardo Verne, Mejia, Fernando, Chang, Benny, Done, Brenda, Gabe, Larry, Gill, John, Gough, Kevin, Howlett, Gail, Klein, Marin, Latendre?Paquette, Judy, Leung, Victor, Macphee, Paul, Macpherson, P., Maharaj, Raj, Medina, Lorna Carrasco, Page, Suzanne, Pexos, Costas, Rachlis, Anita, Salters, Kate, Sterling, Sherine, Boswell, Stephen, Burkholder, Greer, Cesteros, Gisela, Chagaris, Kalliope, Franklin, Rosa, Fuhrer, Jack, Gilbert, Cynthia L., Goetz, Matthew, Grasso, Chris, Horberg, Michael, Hunter?Mellado, Robert F., Kell, Rita, Kitahata, Mari, Klein, Daniel, Levine, Ken, Marconi, Vincent, Mathews, Christopher, Mayor, Angel M., Mcgowan, Catherine, Napravnik, Sonia, Novak, Richard, Oursler, Kris Ann, Ramos, Shellier, Rodriguez, Benigno, Rodriguez, Maria C., Silverberg, Michael, Simberkoff, Michael S., Varshney, Mohit, Ward, Douglas, Widick, Barb, Yangco, Bienvenido G., Davies, Mary?Ann, Smith, Lilian, Von Groote, Per Maximilian, Muhairwe, Josephine, Balakasi, Steve, Banda, Quietus, Kalepa, Getrude, Bello, Andrew, Bulla, J.W., Chigeda, Maria, Chikaphupha, Joyce, Chikwekwere, Flora, Kachoka, Jack, Kapito, Allan, Katondo, Alinafe Nathan, Kumwenda, Molly, Labein, Felix Phewa, Magombo, Ronald, Malumbe, Bridget, Makuwira, I., Marico, Patricia, Masangale, Betha, Mchiela, Angella, Midian, Dan, Phiri, Kezia, Tambe, Mary, Thomas, Baid, Thomson, Charles, Hector, Jonas, Cross, Anna, Dlamini, Siphephelo, Eley, Brian, Euvrard, Jonathan, Fatti, Geoffrey, Hilderbrand, Katherine, Hsiao, Marvin, Mpye, Michael, Prozesky, Hans, Reubenson, Gary, Rose, Lesley, Sawry, Shobna, Sibambo, Nosisa, Technau, Karl, Vinikoor, Michael, Chimbetete, Cleophas, Kamenova, Kamelia, Balestre, Eric, Leroy, Valeriane, Malasteste, Karen, Djimon, Marcel Zannou, D' Almeida, Marcelline, Hounhoui, Ghislaine, Assogba, Michee, Zoungrana, Jacques, Yaméogo, Issouf, Tapsoba, Achille, Abdelh, Sidibé, Bosse, Clarisse Amani, Diabaté, Mamoudou, Eboua, Tanoh Kassi François, Folquet, Madeleine Amorissani, Hawelander, Denise, Konaté, Mamadou, Kouakou, Kouadio, Lambert, Dohoun, Minga, Albert Kla, N'Gbeche, Marie Sylvie, Tanon, Aristophane, Yao, Abo, Renner, Lorna, N'Diaye, Clémentine, Berthé, Mme Alima, Seydi, Moussa, Tine, Judicaël, Elom, Takassi Ounoo, Kariylare, Benjamin, and Patassi, Akessiwe
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Public health administration -- Evaluation ,HIV infection -- Diagnosis -- Drug therapy ,Health - Abstract
: Introduction: Since 2015, the World Health Organization (WHO) has recommended that all people living with HIV (PLHIV) initiate antiretroviral treatment (ART), irrespective of CD4+ count or clinical stage. National adoption of universal treatment has accelerated since WHO's 2015 “Treat All” recommendation; however, little is known about the translation of this guidance into practice. This study aimed to assess the status of Treat All implementation across regions, countries, and levels of the health care delivery system. Methods: Between June and December 2017, 201/221 (91%) adult HIV treatment sites that participate in the global IeDEA research consortium completed a survey on capacity and practices related to HIV care. Located in 41 countries across seven geographic regions, sites provided information on the status and timing of site‐level introduction of Treat All, as well as site‐level practices related to ART initiation. Results: Almost all sites (93%) reported that they had begun implementing Treat All, and there were no statistically significant differences in site‐level Treat All introduction by health facility type, urban/rural location, sector (public/private) or country income level. The median time between national policy adoption and site‐level introduction was one month. In countries where Treat All was not yet adopted in national guidelines, 69% of sites reported initiating all patients on ART, regardless of clinical criteria, and these sites had been implementing Treat All for a median period of seven months at the time of the survey. The majority of sites (77%) reported typically initiating patients on ART within 14 days of confirming diagnosis, with 60% to 62% of sites implementing Treat All in East, Southern and West Africa reporting same‐day ART initiation for most patients. Conclusions: By mid‐ to late‐2017, the Treat All strategy was the standard of care at almost all IeDEA sites, including rural, primary‐level health facilities in low‐resource settings. While further assessments of site‐level capacity to provide high‐quality HIV care under Treat All and to support sustained viral suppression after ART initiation are needed, the widespread introduction of Treat All at the service delivery level is a critical step towards global targets for ending the HIV epidemic as a public health threat., Introduction WHO's 2015 recommendation for immediate treatment of all PLHIV, regardless of CD4+ cell count, represented a paradigm shift in HIV care and treatment. By preventing morbidity and mortality among [...]
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- 2019
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14. Prevalence, Correlates and Treatment Needs of Dental Caries Among People on Antiretroviral Therapy in Uganda: A Cross Sectional Study
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Arubaku, Wilfred, primary, Kwizera, Godfrey, additional, Tusubira, Deusdedit, additional, Kanyesigye, Michael, additional, Chamut, Steffany, additional, Seymour, Brittany Anne, additional, Siedner, Mark J., additional, Niyonzima, Vallence, additional, Najjuma, Josephine N., additional, and Maling, Samuel, additional
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- 2022
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15. Renal Tubular Dysfunction Among People Living with HIV on Tenofovir Disoproxil Fumarate in Uganda: A Hospital-Based Cross-Sectional Study
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Ng'umbi, John Phillip, primary, Nuwagira, Edwin, additional, Kanyesigye, Michael, additional, Muyindike, Winnie, additional, and Muhindo, Rose, additional
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- 2022
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16. Feasibility of Rapid Case Ascertainment for Cancer in East Africa: An Investigation of Community-Representative Kaposi Sarcoma in the Era of Antiretroviral Therapy
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Semeere, Aggrey, primary, Byakwaga, Helen, additional, Laker-Oketta, Miriam, additional, Freeman, Esther, additional, Busakhala, Naftali, additional, Wenger, Megan, additional, Kasozi, Charles, additional, Ssemakadde, Matthew, additional, Bwana, Mwebesa, additional, Kanyesigye, Michael, additional, Kadama-Makanga, Philippa, additional, Rotich, Elyne, additional, Kisuya, Job, additional, Sang, Edwin, additional, Maurer, Toby, additional, Wools-Kaloustian, Kara, additional, Kambugu, Andrew, additional, and Martin, Jeffrey, additional
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- 2021
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17. Beyond T Staging in the Treat All Era: Capturing the Severity and Heterogeneity of Kaposi’s Sarcoma in East Africa
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Freeman, Esther E., primary, McMahon, Devon E., additional, Semeere, Aggrey, additional, Byakwaga, Helen, additional, Laker-Oketta, Miriam, additional, Wenger, Megan, additional, Kasozi, Charles, additional, Semakadde, Matthew, additional, Bwana, Mwebesa, additional, Kanyesigye, Michael, additional, Kadama-Makanga, Philippa, additional, Rotich, Elyne, additional, Kisuya, Job, additional, Wools-Kaloustian, Kara, additional, Bassett, Ingrid, additional, Busakhala, Naftali, additional, and Martin, Jeffrey, additional
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- 2020
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18. Implementation of electronic medical records requires more than new software: Lessons on integrating and managing health technologies from Mbarara, Uganda
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Madore, Amy, Rosenberg, Julie, Muyindike, Winnie R, Bangsberg, David R, Bwana, Mwebesa B, Martin, Jeffrey N, Kanyesigye, Michael, and Weintraub, Rebecca
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- 2015
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19. Association between HIV and blood pressure in adults and role of body weight as a mediator: Cross-sectional study in Uganda
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Okello, Samson, primary, Ueda, Peter, additional, Kanyesigye, Michael, additional, Byaruhanga, Emmanuel, additional, Kiyimba, Achilles, additional, Amanyire, Gideon, additional, Kintu, Alex, additional, Fawzi, Wafaie W., additional, Muyindike, Winnie R., additional, and Danaei, Goodarz, additional
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- 2017
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20. Program Implementation of Option B+ at a President's Emergency Plan for AIDS Relief-Supported HIV Clinic Improves Clinical Indicators But Not Retention in Care in Mbarara, Uganda
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Miller, Kathleen, primary, Muyindike, Winnie, additional, Matthews, Lynn T., additional, Kanyesigye, Michael, additional, and Siedner, Mark J., additional
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- 2017
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21. Predictors of dropout from care among HIV-infected patients initiating antiretroviral therapy at a public sector HIV treatment clinic in sub-Saharan Africa
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Asiimwe, Stephen B., primary, Kanyesigye, Michael, additional, Bwana, Bosco, additional, Okello, Samson, additional, and Muyindike, Winnie, additional
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- 2015
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22. A combination SMS and transportation reimbursement intervention to improve HIV care following abnormal CD4 test results in rural Uganda: a prospective observational cohort study
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Siedner, Mark J., primary, Santorino, Data, additional, Lankowski, Alexander J., additional, Kanyesigye, Michael, additional, Bwana, Mwebesa B., additional, Haberer, Jessica E., additional, and Bangsberg, David R., additional
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- 2015
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23. Immune Activation and Risk of Hypertension in HIV-Infected Adults Initiating Antiretroviral Therapy in Uganda: A Nested Case-Control Study
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Okello, Samson, primary, Asiimwe, Stephen, additional, Kanyesigye, Michael, additional, Muyindike, Winnie R., additional, Boum, Yap, additional, Haberer, Jessica, additional, Bangsberg, David, additional, Mocello, A. Rain, additional, Martin, Jeffery N., additional, Hunt, Peter, additional, and Siedner, Mark, additional
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- 2015
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24. Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy
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Lankowski, Alexander J., primary, Tsai, Alexander C., additional, Kanyesigye, Michael, additional, Bwana, Mwebesa, additional, Haberer, Jessica E., additional, Wenger, Megan, additional, Martin, Jeffrey N., additional, Bangsberg, David R., additional, Hunt, Peter W., additional, and Siedner, Mark J., additional
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- 2014
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25. Use of Symptom Screening and Sputum Microscopy Testing for Active Tuberculosis Case Detection Among HIV-Infected Patients in Real-World Clinical Practice in Uganda.
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Roy, Monika, Muyindike, Winnie, Vijayan, Tara, Kanyesigye, Michael, Bwana, Mwebesa, Wenger, Megan, Martin, Jeffrey, and Geng, Elvin
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- 2016
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26. Predictors of dropout from care among HIV-infected patients initiating antiretroviral therapy at a public sector HIV treatment clinic in sub-Saharan Africa.
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Asiimwe, Stephen B., Kanyesigye, Michael, Bwana, Bosco, Okello, Samson, and Muyindike, Winnie
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- *
HIV-positive persons , *HIV infections , *THERAPEUTICS , *ANTIRETROVIRAL agents , *PUBLIC sector , *PUBLIC health , *ANTI-HIV agents , *HIV infection epidemiology , *LONGITUDINAL method , *RESEARCH funding , *T cells , *HUMAN research subjects , *PROPORTIONAL hazards models , *PATIENT dropouts - Abstract
Background: In sub-Saharan Africa (SSA), antiretroviral therapy (ART) can prolong life for HIV-infected patients. However, patients initiating ART, especially in routine treatment programs, commonly dropout from care either due to death or loss to follow-up.Methods: In a cohort of HIV-infected patients initiating ART at a public sector clinic in Uganda, we assessed predictors of dropout from care (a composite outcome combining death and loss to follow-up). From a large set of socio-demographic, clinical, and laboratory variables routinely collected at ART initiation, we selected those predicting dropout at P <0.1 in unadjusted analyses for inclusion into a multivariable proportional hazards regression model. We then used a stepwise backward selection procedure to identify variables which independently predicted dropout at P <0.05.Results: Data from 5,057 patients were analyzed. The median age was 33 years (IQR 28 to 40) and 27.4% had CD4+ T-cell counts <100 cells/μL at ART initiation. The median duration of follow-up was 24 months (IQR = 14 to 42, maximum follow-up = 64 months). Overall dropout was 26.9% (established cumulative mortality = 2.3%, loss to follow-up = 24.6%), 5.6% were transferred to other service providers, and 67.5% were retained in care. A diagnosis of Kaposi's sarcoma (hazard ratio (HR) = 3.3, 95% CI 2.5 to 4.5); HIV-associated dementia (HR = 2.6, 95% CI 1.5 to 4.6); history of cryptococcosis (HR = 2.2, 95% CI 1.4 to 3.3); and reduced hemoglobin concentration (<11 g/dl versus ≥13.8 g/dl (HR = 1.9, 95% CI 1.6 to 2.2) were strong predictors of dropout. Other independent predictors of dropout were: year of ART initiation; weight loss ≥10%; reduced total lymphocyte count; chronic diarrhea; male sex; young age (≤28 years); and marital status.Conclusions: Among HIV-infected patients initiating ART at a public sector clinic in SSA, biological factors that usually predict death were especially predictive of dropout. As most of the dropouts were lost to follow-up, this observation suggests that many losses to follow-up may have died. Future studies are needed to identify appropriate interventions that may improve both individual-level patient outcomes and outcome ascertainment among HIV-infected ART initiators in this setting. [ABSTRACT FROM AUTHOR]- Published
- 2016
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27. Incidence of Acute Kidney Injury and Associated Mortality among Individuals with Drug-Susceptible Tuberculosis in Uganda.
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Kansiime G, Aklilu AM, Baluku JB, Yasmin F, Kanyesigye M, Muzoora CK, Wilson FP, Bajunirwe F, Brewster U, and Kalyesubula R
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Background: Although tuberculosis (TB) is associated with significant mortality and morbidity, its impact on kidney function is not well understood and is often attributed to anti-TB drugs. We aimed to assess the incidence of acute kidney injury (AKI) in the immediate post-TB diagnosis period in Uganda, a TB/HIV-endemic country in sub-Saharan Africa., Methods: We included patients enrolled in an observational cohort study of adults diagnosed with drug-susceptible TB followed longitudinally. Adults (≥ 18years) without known kidney disease were enrolled between 8/2022-7/2023 at three regional hospitals serving 12.5% of the Ugandan population. Our primary outcome was incidence of KDIGO-defined AKI within two weeks of TB diagnosis. Other outcomes included predictors of AKI and its association with 30-day survival., Results: A total of 156 adults were included. The median (IQR) age was 39 (28-53) years, most were male (68.6%) and 49.4% had HIV. People with HIV had shorter time to TB diagnosis from symptom onset (21[7-30] days) compared to HIV-negative participants (60[23-90] days), p<0.001. The incidence of AKI was 33.3% (52/156), and was similar between people with and without HIV. Proteinuria or hematuria at enrollment was associated with higher odds of AKI (OR-2.68, 95%CI 1.09-6.70, p∼0.033). AKI was associated with significant risk of mortality (aHR-8.22, 95% CI, 1.94-34.72, p ∼0.004) independent of HIV status., Conclusion: The overall incidence of AKI in the immediate post-TB diagnosis period is high and associated with increased mortality risk. Our findings suggest monitoring kidney function should be routine for patients with TB, including prior to treatment initiation., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Nephrology.)
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- 2024
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28. Beyond T Staging in the "Treat-All" Era: Severity and Heterogeneity of Kaposi Sarcoma in East Africa.
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Freeman EE, Semeere A, McMahon DE, Byakwaga H, Laker-Oketta M, Regan S, Wenger M, Kasozi C, Ssemakadde M, Bwana M, Kanyesigye M, Kadama-Makanga P, Rotich E, Kisuya J, Wools-Kaloustian K, Bassett IV, Busakhala N, and Martin J
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- Adult, Female, HIV Infections complications, Humans, Kenya, Male, Neoplasm Staging, Sarcoma, Kaposi complications, Severity of Illness Index, Uganda, Sarcoma, Kaposi pathology
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Background: Although many patients with Kaposi sarcoma (KS) in sub-Saharan Africa are diagnosed with AIDS Clinical Trials Group (ACTG) T1 disease, T1 staging insufficiently captures clinical heterogeneity of advanced KS. Using a representative community-based sample, we detailed disease severity at diagnosis to inform KS staging and treatment in sub-Saharan Africa., Methods: We performed rapid case ascertainment on people living with HIV, aged 18 years or older, newly diagnosed with KS from 2016 to 2019 at 3 clinic sites in Kenya and Uganda to ascertain disease stage as close as possible to diagnosis. We reported KS severity using ACTG and WHO staging criteria and detailed measurements that are not captured in the current staging systems., Results: We performed rapid case ascertainment within 1 month for 241 adults newly diagnosed with KS out of 389 adult patients with suspected KS. The study was 68% men with median age 35 years and median CD4 count 239. Most of the patients had advanced disease, with 82% qualifying as ACTG T1 and 64% as WHO severe/symptomatic KS. The most common ACTG T1 qualifiers were edema (79%), tumor-associated ulceration (24%), extensive oral KS (9%), pulmonary KS (7%), and gastrointestinal KS (4%). There was marked heterogeneity within T1 KS, with 25% of patients having 2 T1 qualifying symptoms and 3% having 3 or more., Conclusion: Most of the patients newly diagnosed with KS had advanced stage disease, even in the current antiretroviral therapy "treat-all" era. We observed great clinical heterogeneity among advanced stage patients, leading to questions about whether all patients with advanced KS require the same treatment strategy., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
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- 2021
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29. D-Dimer Levels and Traditional Risk Factors Are Associated With Incident Hypertension Among HIV-Infected Individuals Initiating Antiretroviral Therapy in Uganda.
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Okello S, Asiimwe SB, Kanyesigye M, Muyindike WR, Boum Y 2nd, Mwebesa BB, Haberer JE, Huang Y, Williams K, Burdo TH, Tracy RP, Bangsberg DR, Mocello AR, Martin JN, Hunt PW, and Siedner MJ
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- Adult, Antihypertensive Agents administration & dosage, Antihypertensive Agents therapeutic use, Female, Humans, Hypertension drug therapy, Male, Risk Factors, Anti-HIV Agents therapeutic use, Fibrin Fibrinogen Degradation Products metabolism, HIV Infections complications, HIV Infections drug therapy, Hypertension etiology
- Abstract
Objectives: We sought to describe blood pressure (BP) changes after antiretroviral therapy (ART) initiation and evaluate the association of markers of inflammation with incident hypertension in a cohort of HIV-infected individuals in Uganda., Methods: We used mixed effects linear regression to model changes in systolic BP over time among a cohort of HIV-infected individuals initiating ART in Uganda. After exclusion of participants with preexisting hypertension, we identified participants with normal BP throughout follow-up (controls) and those with elevated BP on ≥3 consecutive visits (cases). Before ART initiation, participants had testing for interleukin 6, kynurenine/tryptophan ratio, lipopolysaccharide, soluble CD14, soluble CD163, and D-dimer and those with viral suppression at 6 months during ART had repeat tests. We fit logistic regression models to estimate associations between biomarkers and risk of incident hypertension., Results: In the entire cohort, systolic BP increased by 9.6 mm Hg/yr (95% CI: 7.3 to 11.8) in the first 6 months of ART, then plateaued. Traditional factors: male gender (adjusted odds ratio (AOR) 2.76, 95% CI: 1.34 to 5.68), age (AOR 1.09, 95% CI: 1.04 to 1.13), overweight (AOR 4.48, 95% CI: 1.83 to 10.97), and a CD4 count <100 cells (AOR 3.08, 95% CI: 1.07 to 8.89) were associated with incident hypertension. After adjusting for these, D-dimer levels at month 6 were inversely associated with incident hypertension (AOR 0.61, 95% CI: 0.37 to 0.99). Although not significant, similar associations were seen with sCD14 and kynurenine/tryptophan ratio., Conclusion: BP increases early after ART initiation in Ugandans. Traditional risk factors, rather than immune activation, were associated with incident hypertension in this population., Competing Interests: All authors report no conflicts of interest.
- Published
- 2016
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30. Implementation and Operational Research: Use of Symptom Screening and Sputum Microscopy Testing for Active Tuberculosis Case Detection Among HIV-Infected Patients in Real-World Clinical Practice in Uganda.
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Roy M, Muyindike W, Vijayan T, Kanyesigye M, Bwana M, Wenger M, Martin J, and Geng E
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- Adult, Ambulatory Care Facilities, Coinfection microbiology, HIV Infections microbiology, Humans, Operations Research, Patient Acceptance of Health Care statistics & numerical data, Prevalence, Tuberculosis microbiology, Uganda epidemiology, Coinfection epidemiology, HIV Infections epidemiology, Mass Screening, Microscopy, Sputum microbiology, Tuberculosis diagnosis, Tuberculosis epidemiology
- Abstract
Background: The uptake of intensified active TB case-finding among HIV-infected patients using symptom screening is not well understood. We evaluated the rate and completeness of each interim step in the TB pulmonary "diagnostic cascade" to understand real-world barriers to active TB case detection., Methods: We conducted a cohort analysis of new, antiretroviral therapy-naive, HIV-infected patients who attended a large HIV clinic in Mbarara, Uganda (March 1, 2012-September 30, 2013). We used medical records to extract date of completion of each step in the diagnostic cascade: symptom screen, order, collection, processing, and result. Factors associated with lack of sputum order were evaluated using multivariate Poisson regression and chart review of 50 screen-positive patients., Results: Of 2613 patients, 2439 (93%) were screened for TB and 682 (28%) screened positive. Only 90 (13.2%) had a sputum order. Of this group, 83% completed the diagnostic cascade, 13% were diagnosed with TB, and 50% had a sputum result within 1 day of their visit. Sputum ordering was associated with WHO stage 3 or 4 HIV disease and greater number of symptoms. The main identifiable reasons for lack of sputum order in chart review were treatment of presumed malaria (51%) or bacterial infection (43%)., Conclusions: The majority of newly enrolled HIV-infected patients who screened positive for suspected TB did not have a sputum order, and those who did were more likely to have more symptoms and advanced HIV disease. Further evaluation of provider behavior in the management of screen-positive patients could improve active TB case detection rates.
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- 2016
- Full Text
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