Oesophageal cancer management guidelines for Uganda

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Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment - 10 Countries, 2004-2015.

Monitoring prevalence of advanced human immunodeficiency virus (HIV) disease (i.e., CD4+ T-cell count <200 cells/μL) among persons starting antiretroviral therapy (ART) is important to understand ART program outcomes, inform HIV prevention strategy, and forecast need for adjunctive therapies.*,†,§ To assess trends in prevalence of advanced disease at ART initiation in 10 high-burden countries during 2004-2015, records of 694,138 ART enrollees aged ≥15 years from 797 ART facilities were analyzed. Availability of national electronic medical record systems allowed up-to-date evaluation of trends in Haiti (2004-2015), Mozambique (2004-2014), and Namibia (2004-2012), where prevalence of advanced disease at ART initiation declined from 75% to 34% (p<0.001), 73% to 37% (p<0.001), and 80% to 41% (p<0.001), respectively. Significant declines in prevalence of advanced disease during 2004-2011 were observed in Nigeria, Swaziland, Uganda, Vietnam, and Zimbabwe. The encouraging declines in prevalence of advanced disease at ART enrollment are likely due to scale-up of testing and treatment services and ART-eligibility guidelines encouraging earlier ART initiation. However, in 2015, approximately a third of new ART patients still initiated ART with advanced HIV disease. To reduce prevalence of advanced disease at ART initiation, adoption of World Health Organization (WHO)-recommended "treat-all" guidelines and strategies to facilitate earlier HIV testing and treatment are needed to reduce HIV-related mortality and HIV incidence

Evaluating Antiretroviral Therapy Service Delivery Models Through Lot Quality Assurance Sampling in Central Uganda

Semei Christopher Mukama,1 Jane Senyondo Nakawesi,1 Dedrix Stephenson Bindeeba,1 Simon Ezajobo,1 Andrew Mugisa,1 Catherine Senyimba,1 Eve Namitala,1 Robert Onzima DDM Anguyo,2 Simon Peter Katongole,3 Barbara Mukasa1 1Mildmay Uganda, Kampala, Uganda; 2Department of International Public Health, Liverpool School of Tropical Medicine (LSTM), Kampala, Uganda; 3Department of Public Health, Gudie University Project, Kampala, UgandaCorrespondence: Simon Peter Katongole, Email [email protected]: This study evaluated the effectiveness and responsiveness of differentiated Human Immunodeficiency Virus (HIV)/Acquired Immuno-Deficiency Syndrome (AIDS) service delivery models (DSDMs) implemented to enhance antiretroviral therapy (ART) access and outcomes for patients while addressing Tuberculosis (TB)-HIV integration, focusing on four of the five DSDMs currently implemented in Uganda.Methodology: A descriptive cross-sectional survey was conducted in eight districts of central Uganda using Lot Quality Assurance Sampling approach from 7th to 23rd March 2023. We randomly sampled 2668 patients who have been on ART for at least 1 year in a Facility-Based Individual Management (FBIM) model or in a non-FBIM DSDM for at least one year. Data were collected through patient interviews and review of records in ART and DSDM registers as well as ART cards. We analyzed the data in proportions, comparing the selected ART outcome and responsiveness indicators between Community Client Led ART Distribution (CCLAD), Community Drugs Distribution Point (CDDP) and Fast-Track Drug Refill (FTDR) DSDMs with the standard care (FBIM) model. The ART outcome variables include patients retained in the 1st line of the ART regimen, patients in World Health Organization clinical stage 1 during the last facility visit, patients who had no CD4 request during the past 12 months, viral load suppression, ART adherence, and patients who reported that they did not experience HIV/AIDS-related symptoms in the past 6 months. The variables on TB care include screening for TB using the intensified case finding form and patients tested positive for TB. Responsiveness variables include the perceived; travel time for ART refill, travel distance for ART refill, convenience and flexibility during ART refill, cost of travel for ART refill, fear of being seen at ART refill point, waiting time before service, adequacy of service time, crowding and risk of infections, social support, ability to address ART treatment challenges, HIV status disclosure and barriers to access. Non-overlap in 95% confidence interval in indicator proportion between non-FBIM DSDM and FBIM means a statistically significant difference in proportion, or otherwise non-significant.Results: Higher proportions of ART patients in the CCLAD and CDDP DSDMs adhered to ART, had suppressed viral load, and a lower TB prevalence than those in FBIM model. Additionally, more CCLAD and CDDP clients reported shorter travel time and distance to access ART than their counterparts in the FBIM model. Compared to FBIM model, higher proportions of those in CCLAD and CDDP also reported flexibility in ART refill scheduling, reduced transport costs, fewer privacy concerns, less HIV/AIDS-related stigma, shorter waiting times, more efficient services, decreased congestion at ART pickup sites, enhanced peer support, improved problem-solving assistance, and increased HIV status disclosure. The FTDR model outperformed FBIM in proportions with fewer requests for CD4 testing, viral load suppression, as well as proportions of clients who reported; shorter travel time, lower transportation cost, decreased privacy concerns, shorter waiting time, and efficient service provision. Compared to both CDDP and FTDR, the FBIM had a higher proportion of clients remain on the first-line ART regimen.Conclusion: Community-based DSDMs show responsiveness to clients’ needs without compromising the effectiveness of ART care for patients. Although FTDR also demonstrates high effectiveness and responsiveness for clients on ART, there is potential for further improvement. Planners and implementers of ART programs should consider both demand- and supply-side innovations to sustain the continuation of DSDMs.Keywords: HIV/AIDS, TB-HIV, DSDM, LQA

A Controlled Trial of Three Methods for Neonatal Circumcision in Lusaka, Zambia

Neonatal male circumcision (NMC) is not routinely practiced in Zambia, but it promising long-term HIV prevention strategy. We studied the feasibility and safety of three different NMC method

Knowledge of Tuberculosis Prevention Across Eight Districts in Central Uganda: An Analysis of Lot Quality Assurance Sampling Survey Data

Robert Onzima DDM Anguyo,1 Semei Christopher Mukama,2 Dedrix Stephenson Bindeeba,2 Catherine Senyimba,2 Simons Ezajobo,2 Jane Senyondo Nakawesi,2 Andrew Mugisa,2 Susan Kiwanuka Nakubulwa,2 Eve Namitala,2 Ronald Mulebeke,2 Yvonne Karamagi,2 Simon Peter Katongole3 1Department of International Public Health, Liverpool School of Tropical Medicine, Uganda (LSTM-Uganda), Kampala, Uganda; 2Mildmay Uganda, Kampala, Uganda; 3Department of Public Health, Gudie University Project, Kampala, UgandaCorrespondence: Robert Onzima DDM Anguyo, Email [email protected]: This study assessed tuberculosis (TB)-related knowledge among people of different demographic groups that is essential for effective TB program planning and implementation.Materials and Methods: We conducted a cross-sectional study using the lot quality assurance sampling (LQAS) methodology in 8 districts, stratifying each district into five supervision areas (SAs). We randomly sampled 19 villages from each SA using probability proportional to size (PPS). We interviewed 2280 respondents, including 760 each of youth 15– 24 years, women 15– 49 years and men 15+ years. The data were analyzed in proportions and SA-level classifications using the LQAS-based decision rules.Results: The findings underscore variations in TB knowledge across demographic groups. Among youths, knowledge of at least two TB symptoms stood at 48.6%, while among women and men, it was 55.3% and 57.0%, respectively. Awareness of TB curability was 75.6% among youths, 80.2% among women, and 84.6% among men. A notable proportion of youths (83.4%), women (89.5%), and men (91.4%) were aware of the potential coexistence of HIV and TB. Concerning actions to take if a family member is suspected of having TB, 89.4% of youth, 92.4% of women, and 57.5% of men were knowledgeable. Knowledge of the risks of incomplete TB treatment was noted among 30.9% of youth, 33.0% of women, and 35.0% of men.Conclusion: There is variation in the level of knowledge across different TB thematic areas between demographic groups, districts and sub-districts (SAs). Planners and implementers of TB programs should be cognizant of such variations and make deliberate efforts to develop tailored interventions in order to address the information and/or education needs of specific contexts in order to improve TB outcomes. The findings highlight the need to particularly target the youth with education programs on TB.Plain Language summary: This study assessed how much different groups of people know about tuberculosis (TB).Why was the study done?: The goal was to find out how well people from different age groups and genders understand TB. Understanding this is important for planning and improving TB health programs.What methods did we employ?: We selected 2280 people across eight districts. We divided each district into five sub-divisions and selected 19 villages from each sub-division. From each village, we interviewed one each of youth aged 15– 24, women aged 15– 49, and men aged 15 years or older.What did we find?: Young people who knew about at least two TB symptoms were 48.6%, compared to 55.3% of women and 57.0% of men.Awareness that TB can be cured was 75.6% among youths, 80.2% among women, and 84.6% among men.Most people knew that TB and HIV can occur together: 83.4% of youths, 89.5% of women, and 91.4% of men.About actions to take if someone in their family might have TB, 89.4% of youths, 92.4% of women, and 57.5% of men were aware.Knowledge about the dangers of not finishing TB treatment was lower, with only 30.9% of youths, 33.0% of women, and 35.0% of men aware.Districts have differences in the amount of people who know about the different areas concerning TB.What do these results mean?: People’s knowledge about TB varies by age, gender, and location. TB programs need to consider these differences and create targeted education to improve understanding and control of TB. Planners and implementers of TB programs need to particularly target the youth with education programs on TB.Keywords: tuberculosis knowledge, central Uganda, youth 15– 24 years, women 15– 49 years, men 15+ year

High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda

<p>Abstract</p> <p>Background</p> <p>There is limited data on Methicillin resistant <it>Staphylococcus aureus </it>(MRSA) in Uganda where, as in most low income countries, the routine use of chromogenic agar for MRSA detection is not affordable. We aimed to determine MRSA prevalence among patients, healthcare workers (HCW) and the environment in the burns units at Mulago hospital, and compare the performance of CHROMagar with oxacillin for detection of MRSA.</p> <p>Results</p> <p>One hundred samples (from 25 patients; 36 HCW; and 39 from the environment, one sample per person/item) were cultured for the isolation of <it>Staphylococcus aureus</it>. Forty one <it>S. aureus </it>isolates were recovered from 13 patients, 13 HCW and 15 from the environment, all of which were oxacillin resistant and <it>mecA/femA/nuc</it>-positive. MRSA prevalence was 46% (41/89) among patients, HCW and the environment, and 100% (41/41) among the isolates. For CHROMagar, MRSA prevalence was 29% (26/89) among patients, HCW and the environment, and 63% (26/41) among the isolates. There was high prevalence of multidrug resistant isolates, which concomitantly possessed virulence and antimicrobial resistance determinants, notably biofilms, hemolysins, toxin and <it>ica </it>genes. One isolate positive for all determinants possessed the <it>bhp </it>homologue which encodes the biofilm associated protein (BAP), a rare finding in human isolates. SCC<it>mec </it>type I was the most common at 54% prevalence (22/41), followed by <it>SCCmec </it>type V (15%, 6/41) and <it>SCCmec </it>type IV (7%, 3/41). <it>SCCmec </it>types II and III were not detected and 10 isolates (24%) were non-typeable.</p> <p>Conclusions</p> <p>Hyper-virulent methicillin resistant <it>Staphylococcus aureus </it>is prevalent in the burns unit of Mulago hospital.</p

Early Diagnosis of HIV Infection in Infants - One Caribbean and Six Sub-Saharan African Countries, 2011-2015.

Pediatric human immunodeficiency virus (HIV) infection remains an important public health issue in resource-limited settings. In 2015, 1.4 million children aged 50% decline. The most common challenges for access to testing for early infant diagnosis included difficulties in specimen transport, long turnaround time between specimen collection and receipt of results, and limitations in supply chain management. Further reductions in HIV mortality in children can be achieved through continued expansion and improvement of services for early infant diagnosis in PEPFAR-supported countries, including initiatives targeted to reach HIV-exposed infants, ensure access to programs for early infant diagnosis of HIV, and facilitate prompt linkage to treatment for children diagnosed with HIV infection