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Kampala, Uganda

Kanters S.,University of Ottawa | Kanters S.,University of British Columbia | Nachega J.,University of Cape Town | Nachega J.,University of Pittsburgh | And 7 more authors.
Antiviral Therapy

Background: CD4+ T-cell count recovery after antiretroviral therapy (ART) initiation is associated with improved health outcomes. It is unknown how the CD4+ T-cell counts of African HIV patients recover following ART initiation. Methods: We examined CD4+ T-cell count recovery in a large cohort of HIV-positive patients initiating ART in Uganda between 2004 and 2011. We categorized patients according to their CD4 + T-cell count at ART initiation. All patients received CD4 + T-cell count evaluations on a biannual basis. We used quantile regression to model the recovery of CD4+ T-cells during ART. Results: A total of 5,271 patients aged ≥14 years at baseline were included. The median number of CD4+ T-cell count measurements was 6 (IQR 4-8), and vital status at censoring was known in 97.2% of individuals. Most CD4 + T-cell count recovery occurred within the first 12 months, with marginal increases beyond 18 months and stabilization after 5 years. The strongest predictor of CD4+ T-cell count recovery was baseline CD4+ T-cell count. After 5 years on treatment, the median CD4 + T-cell count was 334 cells/mm3 for patients initiating ART with <100 cells/mm3. Only those initiating ART with >200 cells/mm3 reached a 5-year median >500 cells/mm3. Adolescents had the most robust CD4+ T-cell count recovery with a median increase after 12 months that was 109 cells/mm3 greater than those initiating ART at age ≥50 years. Conclusions: In individuals from a resource-limited setting, baseline CD4+ T-cell count was highly predictive of the maximum CD4+ T-cell count level achieved while on ART. ©2014 International Medical Press. Source

Ridley I.,RMIT University | Bere J.,Mildmay Center | Clarke A.,Alan Clarke Consultants | Schwartz Y.,Mildmay Center | Farr A.,Green Building Store
Energy and Buildings

The performance, monitored over 2 years, of side by side detached Welsh Passive is presented. The houses which differ in terms of glazed area, the use of thermal stores, area of installed PV and occupant behaviour provide a valuable insight into different strategies to achieve low and near zero low carbon performance in social housing. Dwelling 1 and Dwelling 2 achieved average net annual carbon emissions of 9.4 kg/m2, 24.0 kg/m2, approximately 13%, 33% of a typical "building stock" UK house. The risk of summer time overheating in the dwellings which different glazed areas is analysed in depth. Dwelling 1 certified to Code for Sustainable Homes Level 6 did not achieve true onsite zero carbon performance, the installed PV systems in each dwelling would need to be approximately 6 kW peak to meet this target. Occupant electricity consumption behaviour and appliance choices have a great impact on the energy performance of the houses. With current carbon intensities electricity consumption in UK passive houses needs to be limited to approximately 30% that of the current UK average household if primary energy and zero energy targets are to be achieved while limiting PV size to below 5 kW peak. © 2014 Elsevier B.V. Source

Ridley I.,RMIT University | Clarke A.,Alan Clarke Consultants | Bere J.,Mildmay Center | Altamirano H.,University College London | And 3 more authors.
Energy and Buildings

The monitored performance of the first new London dwelling certified to the Passive House standard is presented. The first detailed analysis of the energy consumption of the heating, ventilation and domestic hot water systems are given. The annual space heating demand of the 2 bedroom, 101 m2 dwelling was 12.1 kWh/m2, achieving the 15 kWh/m2 Passive House target. The annual primary energy demand was 125kWh/m2, marginally above the 120 kWh/m2 target. The measured internal heat gains of 3.65 W/m2 are much greater than the 2.1 W/m2 suggested as standard for dwellings. The Passive House Planning Package, PHPP, is found to be a good predictor of space heating demand and the risk of summer time over heating. Winter space heating demand is sensitive to occupant blind use. With a total metered energy consumption of 65 kWh/m2, the Camden Passive House is one of the lowest energy, small family dwellings, monitored in the UK. © 2013 Elsevier B.V. All rights reserved. Source

Batamwita R.,Mildmay Center | Moore D.M.,British Columbia Center for Excellence in | King R.,Karolinska Institutet | Mills E.,University of Ottawa | Stangl A.L.,International Center for Research on Women
Patient Preference and Adherence

Background: Access to care and treatment services for human immunodeficiency virus (HIV)/ acquired immunodeficiency syndrome (AIDS) are hampered by human resource constraints and knowledge gaps about antiretroviral therapy. Training people with HIV/AIDS (PWA) as educators on antiretroviral therapy may help in the expansion of antiretroviral therapy-related knowledge in Africa. The aim of this study was to assess the antiretroviral therapy-specific knowledge, beliefs, and attitudes of PWA as well as their proactive communication with community members and to explore their willingness to serve as support personnel. Methods: Data were obtained from a large randomized trial of PWA. We analyzed qualitative and quantitative data from 524 PWA aged 18 years and over who initiated home-based antiretroviral therapy in 2003. We assessed knowledge and communication of HIV prevention and treatment messages by PWA to communities using structured messages complemented with other knowledge questions and the willingness of PWA to serve as support persons. Descriptive bivariate associations and logistic regression statistical methods were performed. In addition, qualitative data analysis was used. Results: The level of knowledge about antiretroviral therapy was high among all PWA on several technical attributes. Overall, 90% of PWA reported that they had been consulted by community members for informed opinions on antiretroviral therapy, 70% felt they were opinion leaders on aspects of antiretroviral therapy within the communities, and approximately 70% were willing to be engaged as community support persons. Those who were classified as opinion leaders reported being approached more regularly by community members for expert advice about antiretroviral therapy compared with nonopinion leaders (odds ratio [OR] 11.7; 95% confidence interval [CI] 7.3-18.6), and opinion leaders were significantly more informed on most technical attributes of antiretroviral therapy, such as "who qualifies for antiretroviral therapy based on CD4 count" (OR 1.6, 95% CI 1.1-2.0) and "the need to be evaluated for antiretroviral therapy" (OR 1.8, 95% CI 1.2-2.0). Conclusion: Opinion leaders demonstrated correct knowledge and willingness to provide information on antiretroviral therapy care and treatment issues and were, in turn, consulted more frequently for antiretroviral therapy advice compared with nonopinion leaders. Training opinion leaders to work as community support personnel may increase knowledge about antiretroviral therapy in underserved communities. © 2011 Batamwita et al, publisher and licensee Dove Medical Press Ltd. Source

Parry C.M.,Uganda Virus Research Institute | Parry C.M.,University College London | Parkin N.,Data First Consulting | Diallo K.,CGH | And 12 more authors.
Journal of Clinical Microbiology

Dried blood spots (DBS) are an alternative specimen type for HIV drug resistance genotyping in resource-limited settings. Data relating to the impact of DBS storage and shipment conditions on genotyping efficiency under field conditions are limited. We compared the genotyping efficiencies and resistance profiles of DBS stored and shipped at different temperatures to those of plasma specimens collected in parallel from patients receiving antiretroviral therapy in Uganda. Plasma and four DBS cards from anti-coagulated venous blood and a fifth card from finger-prick blood were prepared from 103 HIV patients with a median viral load (VL) of 57,062 copies/ml (range, 1,081 to 2,964,191). DBS were stored at ambient temperature for 2 or 4 weeks or frozen at -80°C and shipped from Uganda to the United States at ambient temperature or frozen on dry ice for genotyping using a broadly sensitive in-house method. Plasma (97.1%) and DBS (98.1%) stored and shipped frozen had similar genotyping efficiencies. DBS stored frozen (97.1%) or at ambient temperature for 2 weeks (93.2%) and shipped at ambient temperature also had similar genotyping efficiencies. Genotyping efficiency was reduced for DBS stored at ambient temperature for 4 weeks (89.3%, P = 0.03) or prepared from finger-prick blood and stored at ambient temperature for 2 weeks (77.7%, P < 0.001) compared to DBS prepared from venous blood and handled similarly. Resistance profiles were similar between plasma and DBS specimens. This report delineates the optimal DBS collection, storage, and shipping conditions and opens a new avenue for cost-saving ambient-temperature DBS specimen shipments for HIV drug resistance (HIVDR) surveillances in resource-limited settings. Copyright © 2014, American Society for Microbiology. All Rights Reserved. Source

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