Durham, NC, United States
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Apps R.,Frederick National Laboratory for Cancer Research | Apps R.,Massachusetts General Hospital | Qi Y.,Frederick National Laboratory for Cancer Research | Qi Y.,Massachusetts General Hospital | And 44 more authors.
Science | Year: 2013

A variant upstream of human leukocyte antigen C (HLA-C) shows the most significant genome-wide effect on HIV control in European Americans and is also associated with the level of HLA-C expression. We characterized the differential cell surface expression levels of all common HLA-C allotypes and tested directly for effects of HLA-C expression on outcomes of HIV infection in 5243 individuals. Increasing HLA-C expression was associated with protection against multiple outcomes independently of individual HLA allelic effects in both African and European Americans, regardless of their distinct HLA-C frequencies and linkage relationships with HLA-B and HLA-A. Higher HLA-C expression was correlated with increased likelihood of cytotoxic T lymphocyte responses and frequency of viral escape mutation. In contrast, high HLA-C expression had a deleterious effect in Crohn's disease, suggesting a broader influence of HLA expression levels in human disease.


Hughes J.P.,University of Washington | Hughes J.P.,Fred Hutchinson Cancer Research Center | Haley D.F.,Emory University | Haley D.F.,Family Health International FHI360 | And 8 more authors.
Annals of Epidemiology | Year: 2015

Purpose: Reductions in risk behaviors are common following enrollment in human immunodeficiency virus (HIV) prevention studies. We develop methods to quantify the proportion of change in risk behaviors that can be attributed to regression to the mean versus study participation and other factors. Methods: A novel model that incorporates both regression to the mean and study participation effects is developed for binary measures. The model is used to estimate the proportion of change in the prevalence of "unprotected sex in the past 6months" that can be attributed to study participation versus regression to the mean in a longitudinal cohort of women at risk for HIV infection who were recruited from ten U.S. communities with high rates of HIV and poverty. HIV risk behaviors were evaluated using audio computer-assisted self-interviews at baseline and every 6months for up to 12months. Results: The prevalence of "unprotected sex in the past 6months" declined from 96% at baseline to 77% at 12months. However, this change could be almost completely explained by regression to the mean. Conclusions: Analyses that examine changes over time in cohorts selected for high- or low- risk behaviors should account for regression to the mean effects. © 2015 Elsevier Inc.


PubMed | Family Health International FHI360, Ministry of Health and German Leprosy and TB Relief Association
Type: Journal Article | Journal: International journal of mycobacteriology | Year: 2016

Tuberculosis (TB) remains one of the deadliest infectious diseases worldwide, with a disproportionate number of those affected living in slum areas. We assessed the magnitude of pulmonary cases among tuberculosis patients in an urban slum in southeast Nigeria, their demographic and clinical characteristics and any associations with treatment outcomes.A retrospective cohort study of patients registered under the National TB Programme (NTP) from 1 January to 31 December 2012 was carried out. Data were extracted from TB treatment cards and registers.Of 647 new TB patients registered, 555 (85.8%) were pulmonary TB (PTB) with a mean age of 34.5years, and a male/female ratio of 1.3. Among these, 468 (84.3%) were smear-positive, while 87 (15.7%) were smear-negative cases. Twenty-one (3.8%) were children younger than 15years old. TB/HIV co-infection rate was 16.9%; 57.4% received antiretroviral therapy (ART) and 88.3% received cotrimoxazole preventive therapy (CPT). Female patients were significantly younger compared to male patients (p=0.003), had higher proportions of smear-negative TB (p=0.001) and HIV-positive status (p0.001). Treatment success rate was 88.5% among smear-positive patients and 79.3% among smear-negative patients. More patients with smear-negative TB were lost to follow up compared with smear-positive TB patients (p<0.02). HIV co-infection was associated with unfavourable treatment outcomes (OR 0.2, CI 0.1-0.4, p0.001). Among them, those who received ART had better outcomes.The study revealed high proportion of PTB, mostly smear-positive TB with HIV-associated outcomes and underlines the need to ensure early TB diagnosis and improved access to HIV care for HIV co-infected patients in this setting.


Mbah H.,Family Health International FHI360 | Ojo E.,Family Health International FHI360 | Ameh J.,Family Health International FHI360 | Musuluma H.,Family Health International FHI360 | And 9 more authors.
PLoS ONE | Year: 2014

Background: Achieving accreditation in laboratories is a challenge in Nigeria like in most African countries. Nigeria adopted the World Health Organization Regional Office for Africa Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (WHO/AFRO-SLIPTA) in 2010. We report on FHI360 effort and progress in piloting WHO-AFRO recognition and accreditation preparedness in six health facility laboratories in five different states of Nigeria. Method: Laboratory assessments were conducted at baseline, follow up and exit using the WHO/AFRO-SLIPTA checklist. From the total percentage score obtained, the quality status of laboratories were classified using a zero to five star rating, based on the WHO/AFRO quality improvement stepwise approach. Major interventions include advocacy, capacity building, mentorship and quality improvement projects. Results: At baseline audit, two of the laboratories attained 1- star while the remaining four were at 0- star. At follow up audit one lab was at 1- star, two at 3-star and three at 4-star. At exit audit, four labs were at 4- star, one at 3-star and one at 2-star rating. One laboratory dropped a 'star' at exit audit, while others consistently improved. The two weakest elements at baseline; internal audit (4%) and occurrence/incidence management (15%) improved significantly, with an exit score of 76% and 81% respectively. The elements facility and safety was the major strength across board throughout the audit exercise. Conclusion: This effort resulted in measurable and positive impact on the laboratories. We recommend further improvement towards a formal international accreditation status and scale up of WHO/AFRO-SLIPTA implementation in Nigeria. © 2014 Mbah et al.

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