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Kamali A.,Uganda Virus Research Institute
Tropical Medicine and International Health | Year: 2010

Summary HIV epidemic has had greatest impact in sub-Saharan Africa (SSA) and mainly in East and Southern Africa with HIV prevalence in some parts going up to 30%. In the recent years, considerable HIV research on prevention, treatment and care, and vaccine has been conducted in many developing countries and provided evidence-based knowledge to control the epidemic. However, there have also been disappointing results in HIV prevention trials such as in HIV vaccine and microbicide trials. Despite these outcomes, important lessons have been learnt that help in designing future trials. This article examines the recent advances in HIV research in developing countries. The most recent HIV prevention research has demonstrated the effect of male circumcision on HIV acquisition, and lack of impact of HSV-2 treatment on HIV transmission and acquisition. Use of HIV antiretroviral drugs (ARVs) for HIV prevention is a new area that has attracted interest and a number of trials are examining the effect of oral Pre-Exposure Prophylaxis on HIV acquisition and also looking at the potential of ARVs in reducing infectiousness. Progress has been made in HIV treatment, monitoring treatment efficacy and toxicity as well as evaluation of different models of ART delivery. HIV vaccine research has, however, faced most challenges despite many efforts that have been put in. Looking into the future, there are ongoing trials that will hopefully generate important information to strengthen HIV policies in the next few years. There are, however, many other gaps in HIV research that need to be urgently addressed. © 2010 Blackwell Publishing Ltd.

Munderi P.,Uganda Virus Research Institute
Current Opinion in HIV and AIDS | Year: 2010

Purpose of review: To review data related to the outcomes of antiretroviral therapy (ART) and the current operational experiences of ART programmes in low-income and middle-income countries (LMICs), concentrating on the implications and feasibility of changing ART initiation practice. Recent findings: ART initiation practice inhigh-income country settings has been modified in favour of starting ART earlier, basing on early evidence that HIV-associated morbidity and mortality are significantly reduced, and because there are increasingly more potent less toxic antiretroviral drug options available.In LMICs, ART initiation continues to follow conservative practice. At the same time, reports from ART programmes in low-income settings continue to demonstrate great benefits in terms of survival for people with HIV. However, compared with high-income country settings, the clinical outcomes of ART in LMICs are less favourable. The enormous HIV disease burden coupled with weaker health service capability is a key challenge to expanding ART effectively, although, as ART programmes mature, there are early indications that patient outcomes may be improving. Summary: In the immediate term, whether it is feasible to move to wide-scale earlier initiation of ART in LMICs remains in question; the priority for many countries is still equity and meeting the unmet needs for treatment. However, the possibility that early ART could reduce the risk of HIV transmission presents a particularly compelling incentive for earlier treatment in the high-burden settings of LMICs and further evidence on this rationale is anticipated from ongoing and planned studies. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Shott J.P.,SAIC | Galiwango R.M.,Uganda Virus Research Institute | Reynolds S.J.,National Institute of Allergy and Infectious Diseases
Journal of Tropical Medicine | Year: 2012

Technology advances in rapid diagnosis and clinical monitoring of human immunodeficiency virus (HIV) infection have been made in recent years, greatly benefiting those at risk of HIV infection, those needing care and treatment, and those on antiretroviral (ART) therapy in sub-Saharan Africa. However, resource-limited, geographically remote, and harsh climate regions lack uniform access to these technologies. HIV rapid diagnostic tests (RDTs) and monitoring tools, such as those for CD4 counts, as well as tests for coinfections, are being developed and have great promise in these settings to aid in patient care. Here we explore the advances in point-of-care (POC) technology in the era where portable devices are bringing the laboratory to the patient. Quality management approaches will be imperative for the successful implementation of POC testing in endemic settings to improve patient care. Copyright © 2012 Joseph P. Shott et al.

Farine D.R.,University of Oxford | Downing C.P.,Uganda Virus Research Institute | Downing P.A.,University of Oxford
Behavioral Ecology | Year: 2014

Despite widespread research on the interaction rules that drive group-living behavior in animals, little is known about the spatial self-organization of individuals in heterospecific groups. This has led to significant challenges in teasing apart the various mechanisms thought to underpin multispecies groups. One potentially useful approach for gaining an understanding of this process is to identify the rules that best predict the observed distribution of individuals across these groups. In order to gain an insight into the decision-making process that might generate patterns of heterospecific associations, we collected data on the number and distribution of nests in breeding colonies that contained 3 species of weaverbird. We found no evidence of segregation by species, either within or between colonies. Using agent-based simulations of males applying different rules of attraction and repulsion to conspecifics or heterospecifics, we found that the best-fitting rule contained no heterospecific attraction. In this rule, individuals picked colonies based on an optimal distribution of conspecific nests. Given that nests are an important sexual signal in weavers, our findings suggest that this rule is biologically relevant: Males are seeking an optimal trade-off between attracting females via lekking and competing for mates if too many conspecific nests are present. © The Author 2014.

Dye T.V.,New York University | Apondi R.,Uganda Virus Research Institute | Lugada E.,CHF International
PLoS ONE | Year: 2011

Background: Many countries face severe scale-up barriers toward achievement of MDGs. We ascertained motivational and experiential dimensions of participation in a novel, rapid, ''diagonal'' Integrated Prevention Campaign (IPC) in rural Kenya that provided prevention goods and services to 47,000 people within one week, aimed at rapidly moving the region toward MDG achievement. Specifically, the IPC provided interventions and commodities targeting disease burden reduction in HIV/ AIDS, malaria, and water-borne illness. Methods: Qualitative in-depth interviews (IDI) were conducted with 34 people (18 living with HIV/AIDS and 16 not HIVinfected) randomly selected from IPC attendees consenting to participate. Interviews were examined for themes and patterns to elucidate participant experience and motivation with IPC. Findings: Participants report being primarily motivated to attend IPC to learn of their HIV status (through voluntary counseling and testing), and with receipt of prevention commodities (bednets, water filters, and condoms) providing further incentive. Participants reported that they were satisfied with the IPC experience and offered suggestions to improve future campaigns. Interpretation: Learning their HIV status motivated participants along with the incentive of a wider set of commodities that were rapidly deployed through IPC in this challenging region. The critical role of wanting to know their HIV status combined with commodity incentives may offer a new model for rapid scaled-up of prevention strategies that are wider in scope in rural Africa. © 2011 Dye et al.

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