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Chishinga N.,Zambia AIDS Related TB Project | Chishinga N.,London School of Hygiene and Tropical Medicine | Kinyanda E.,Medical Research Council Uganda Virus Research Institute | Weiss H.A.,London School of Hygiene and Tropical Medicine | And 4 more authors.
BMC Psychiatry | Year: 2011

Background: This study was conducted to evaluate the diagnostic accuracy and determine the optimum cut-off scores for clinical use of the Center for Epidemiological Studies Depression scale (CES-D) and Alcohol Use Disorders Identification Test (AUDIT) against a reference psychiatric diagnostic interview, in TB and anti-retroviral therapy (ART) patients in primary care in Zambia.Methods: This was a cross-sectional study in 16 primary level care clinics. Consecutive sampling was used to select 649 participants who started TB treatment or ART in the preceding month. Participants were first interviewed using the CES-D and AUDIT, and subsequently with a psychiatric diagnostic interview for current major depressive disorder (MDD) and alcohol use disorders (AUDs) using the Mini-International Neuropsychiatric Interview (MINI). The diagnostic accuracy was calculated using the Area Under the Receiver Operating Characteristic curve (AUROC). The optimum cut-off scores for clinical use were calculated using sensitivity and positive predictive value (PPV).Results: The CES-D and AUDIT had high internal consistency (Cronbach's alpha = 0.84; 0.98 respectively). Confirmatory factor analysis showed that the four-factor CES-D model was not a good fit for the data (Tucker-Lewis Fit Index (TLI) = 0.86; standardized root-mean square residual (SRMR) = 0.06) while the two-factor AUDIT model fitted the data well (TFI = 0.99; SRMR = 0.04). Both the CES-D and AUDIT demonstrated good discriminatory ability in detecting MINI-defined current MDDs and AUDs (AUROC for CES-D = 0.78; AUDIT = 0.98 for women and 0.75 for men). The optimum CES-D cut-off score in screening for current MDD was 22 (sensitivity 73%, PPV 76%) while that of the AUDIT in screening for AUD was 24 for women (sensitivity 60%, PPV 60%), and 20 for men (sensitivity 55%, PPV 50%).Conclusions: The CES-D and AUDIT showed high discriminatory ability in measuring MINI-defined current MDD and AUD respectively. They are suitable mental health screening tools for use among TB and ART patients in primary care in Zambia. © 2011 Chishinga et al; licensee BioMed Central Ltd.


Hoskins S.,Medical Research Council Clinical Trials Unit | Weller I.,University College London | Jahn A.,Ministry of Health | Jahn A.,International Training and Education Center on | And 5 more authors.
AIDS | Year: 2010

Monitoring the progress of HIV programmes is vital, as services are scaled up to include increasing numbers in need of care. Globally, the presence of multiple donors at all levels of HIV care has produced vast monitoring systems. Within HIV-treatment programmes in low and middle-income countries, directly assessing long-term outcomes such as survival is problematic, so indicators are used to monitor the progress of the treated population. However, the internal, external, construct validity and predictive value of current indicators have never been evaluated. Although the burden on facility staff compiling routine monitoring reports is vast, there is uncertainty as to which indicators best monitor patient progress. This burden will grow as increasing numbers of life-cohorts are created for monitoring purposes leading to data inaccuracies and compromising the internal validity of reported indicators. Furthermore, a number of fundamental indicators, including survival and retention, may not capture the construct they intend to measure, compromising the ability of programme managers to obtain reliable estimates regarding the welfare of their population in care. It is not known which indicators can predict the longer-term outcome of the patient population, and as such, can enable managers to respond to predictors of failure early. An evaluation of current indicators is urgently needed to ensure that reported facility-level data accurately reflect the welfare of the treated population and comparisons of programme performance are meaningful. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Maher D.,Medical Research Council Uganda Virus Research Institute | Smeeth L.,London School of Hygiene and Tropical Medicine | Sekajugo J.,Ministry of Health
Bulletin of the World Health Organization | Year: 2010

Sub-Saharan Africa is undergoing health transition as increased globalization and accompanying urbanization are causing a double burden of communicable and noncommunicable diseases. Rates of communicable diseases such as HIV/AIDS, tuberculosis and malaria in Africa are the highest in the world. The impact of noncommunicable diseases is also increasing. For example, age-standardized mortality from cardiovascular disease may be up to three times higher in some African than in some European countries. As the entry point into the health service for most people, primary care plays a key role in delivering communicable disease prevention and care interventions. This role could be extended to focus on noncommunicable diseases as well, within the context of efforts to strengthen health systems by improving primary-care delivery. We put forward practical policy proposals to improve the primary-care response to the problems posed by health transition: (i) improving data on communicable and noncommunicable diseases; (ii) implementing a structured approach to the improved delivery of primary care; (iii) putting the spotlight on quality of clinical care; (iv) aligning the response to health transition with health system strengthening; and (v) capitalizing on a favourable global policy environment. Although these proposals are aimed at primary care in sub-Saharan Africa, they may well be relevant to other regions also facing the challenges of health transition. Implementing these proposals requires action by national and international alliances in mobilizing the necessary investments for improved health of people in developing countries in Africa undergoing health transition.


Settumba S.N.,Medical Research Council Uganda Virus Research Institute | Sweeney S.,London School of Hygiene and Tropical Medicine | Seeley J.,Medical Research Council Uganda Virus Research Institute | Seeley J.,London School of Hygiene and Tropical Medicine | And 6 more authors.
Tropical Medicine and International Health | Year: 2015

Objective: To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit. Methods: Full financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients-based and step-down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers. Results: Provision of chronic care services was concentrated at higher-level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices. Conclusion: Most patients reported directly to higher-level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.


Kinyanda E.,Medical Research Council Uganda Virus Research Institute | Hoskins S.,Medical Research Council | Nakku J.,Butabika National Psychiatric Referral Hospital | Nawaz S.,Dartmouth College | And 2 more authors.
BMC Psychiatry | Year: 2011

Background: Not much is known about the risk factors of major depressive disorder (MDD) in HIV/AIDS in the African socio-cultural context. Therefore a study was undertaken to examine the prevalence and risk factors of MDD in HIV/AIDS in semi-urban Uganda.Methods: A cross-sectional study was undertaken among 618 respondents attending two HIV clinics in Uganda.Results: Prevalence of MDD was 8.1%. Factors associated with MDD at univariate analysis only were female gender, family history of mental illness, negative coping style, alcohol dependency disorder, food insecurity and stress; not associated with MDD were social support, neurocognitive impairment, CD4 counts and BMI. Factors independently associated with MDD were psychosocial impairment, adverse life events, post traumatic stress disorder, generalised anxiety disorder and life-time attempted suicide.Conclusion: Psychological and social factors were the main risk factors of MDD among ambulatory HIV positive persons with no evidence for the role of the neurotoxic effects of HIV. Treatment approaches for MDD in this patient group should be modeled on those used among non-HIV groups. © 2011 Kinyanda et al; licensee BioMed Central Ltd.


Kenny J.,Clinical Trials Unit | Kenny J.,University College London | Mulenga V.,University of Lusaka | Hoskins S.,Clinical Trials Unit | And 2 more authors.
AIDS | Year: 2012

OBJECTIVE: Success in diagnosing and treating HIV-infected adults has, where HIV care and treatment is available, turned HIV into a chronic, rather than life-limiting disease. Progress meeting the needs of HIV-infected children, perinatally and horizontally infected adolescents, pregnant women and older people has lagged behind. We review the special needs and barriers to scaling up care and antiretroviral therapy (ART) coverage in these populations. DESIGN AND METHODS: A literature review combined with personal views and operational experience specifically from countries covered by the Evidence for Action programme. RESULTS: Challenges include logistics of diagnosis and treatment in pregnancy, difficulties in early infant diagnosis, availability of appropriate paediatric formulations, management of adolescents, and comorbidities in older people. CONCLUSION: Priorities for development need to focus upon the simplification of HIV care to allow provision for all ages at the primary healthcare level. Specific priorities include focused use of virological testing in infants, ongoing development of dispersible and scored fixed-dose ART combinations suitable for use across ages, development of 'adolescent-friendly' HIV services catering for perinatally and horizontally infected adolescents to improve adherence and reduce onward transmissions, simplification of referral pathways to ensure all pregnant women are tested for HIV and commenced on ART, and education of healthcare workers on the specific needs of HIV care in older patients. Each priority will be reviewed and potential solutions discussed. © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Sigaloff K.C.E.,University of Amsterdam | Mandaliya K.,Coast Province General Hospital | Hamers R.L.,University of Amsterdam | Otieno F.,Coast Province General Hospital | And 6 more authors.
AIDS Research and Human Retroviruses | Year: 2012

In view of the recent antiretroviral therapy (ART) scale-up in Kenya, surveillance of transmitted HIV drug resistance (TDR) is important. A cross-sectional survey was conducted among newly HIV-1 diagnosed, antiretroviral-naive adults in Mombasa, Kenya. Surveillance drug resistance mutations (SDRMs) were identified according to the 2009 WHO list. HIV-1 subtypes were determined using REGA and SCUEAL subtyping tools. Genotypic test results were obtained for 68 of 81 participants, and SDRMs were identified in 9 samples. Resistance to nonnucleoside reverse transcriptase inhibitors (K103N) occurred in five participants, yielding a TDR prevalence of 7.4% (95% confidence interval 2.4-16.3%). Frequencies of HIV-1 subtypes were A (70.6%), C (5.9%), D (2.9%), and unique recombinant forms (20.6%). The TDR prevalence found in this survey is higher than previously reported in different regions in Kenya. These findings justify increased vigilance with respect to TDR surveillance in African regions where ART programs are scaled-up in order to inform treatment guidelines. © Copyright 2012, Mary Ann Liebert, Inc. 2012.


PubMed | Anglia, Keele University, Medical Research Council Uganda Virus Research Institute, Aberdeen Group and Khon Kaen University
Type: | Journal: Epidemiology and infection | Year: 2017

The co-existence of stroke and HIV has increased in recent years, but the impact of HIV on post-stroke outcomes is poorly understood. We examined the impact of HIV on inpatient mortality, length of acute hospital stay and complications (pneumonia, respiratory failure, sepsis and convulsions), in hospitalized strokes in Thailand. All hospitalized strokes between 1 October 2004 and 31 January 2013 were included. Data were obtained from a National Insurance Database. Characteristics and outcomes for non-HIV and HIV patients were compared and multivariate logistic and linear regression models were constructed to assess the above outcomes. Of 610 688 patients (mean age 634 years, 454% female), 014% (866) had HIV infection. HIV patients were younger, a higher proportion were male and had higher prevalence of anaemia (P < 0001) compared to non-HIV patients. Traditional cardiovascular risk factors, hypertension and diabetes, were more common in the non-HIV group (P < 0001). After adjusting for age, sex, stroke type and co-morbidities, HIV infection was significantly associated with higher odds of sepsis [odds ratio (OR) 175, 95% confidence interval (CI) 129-24], and inpatient mortality (OR 215, 95% CI 18-256) compared to patients without HIV infection. The latter did not attenuate after controlling for complications (OR 220, 95% CI 183-264). HIV infection is associated with increased odds of sepsis and inpatient mortality after acute stroke.


Wekesa C.,Medical Research Council Uganda Virus Research Institute | Kirenga B.J.,Makerere University | Joloba M.L.,Makerere University | Bwanga F.,Makerere University | And 2 more authors.
International Journal of Tuberculosis and Lung Disease | Year: 2014

SETTING: An out-patient clinic in a country with high rates of tuberculosis-human immunodeficiency virus (TBHIV) co-infection. DESIGN: Cross-sectional analytical study of 123 adults with chronic cough and no previous anti-tuberculosis treatment. Demographic, clinical, chest X-ray (CXR) and GeneXpert® MTB/RIF data were collected. Proportions of TB diagnoses using both tests were calculated and compared using an unpaired t-test. RESULTS: Sixty-six patients (53.7%) were female and 35 (28.5%) tested positive for HIV; 21 (17.1%) were Xpert-positive, while 51 (42.5%) had CXR suggestive of TB (P = 0.0018), of whom only 15 (29.4%) were Xpertpositive. CXR was suggestive of pulmonary TB in 15 (71.4%) of the 21 patients with a positive Xpert test. CONCLUSIONS: The majority of the sputum smearnegative patients did not have TB on single Xpert testing.CXR gave an overestimate of sputum smear-negative TB cases. © 2014 The Union.


PubMed | Medical Research Council Uganda Virus Research Institute
Type: Journal Article | Journal: AIDS research and human retroviruses | Year: 2016

Control of HIV replication through CD4(+) and CD8(+) T cells might be possible, but the functional and phenotypic characteristics of such cells are not defined. Among cytokines produced by T cells, CCR5 ligands, including macrophage inflammatory protein-1 beta (MIP-1), compete for the CCR5 coreceptor with HIV, promoting CCR5 internalization and decreasing its availability for virus binding. Interferon (IFN)- also has some antiviral activity and has been used as a read-out for T cell immunogenicity. We used cultured ELISpot assays to compare the relative contribution of MIP-1 and IFN- to HIV-specific responses. The magnitude of responses was 1.36 times higher for MIP-1 compared to IFN-. The breadth of the MIP-1 response (45.41%) was significantly higher than IFN- (36.88%), with considerable overlap between the peptide pools that stimulated both MIP-1 and IFN- production. Subtype A and D cross-reactive responses were observed both at stimulation and test level, but MIP-1 and IFN- responses displayed different effect patterns. We conclude that the MIP-1 ELISpot would be a useful complement to the evaluation of the immunogenicity of HIV vaccines and the activity of adjuvants.

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