Opportunities for improving the efficiency of paediatric HIV treatment programmes

Objectives: To conduct two economic analyses addressing whether to: routinely monitor HIV-infected children on antiretroviral therapy (ART) clinically or with laboratory tests; continue or stop cotrimoxazole prophylaxis when children become stabilized on ART. Design and methods: The ARROW randomized trial investigated alternative strategies to deliver paediatric ART and cotrimoxazole prophylaxis in 1206 Ugandan/Zimbabwean children. Incremental cost-effectiveness and value of implementation analyses were undertaken. Scenario analyses investigated whether laboratory monitoring (CD4 tests for efficacy monitoring; haematology/biochemistry for toxicity) could be tailored and targeted to be delivered cost-effectively. Cotrimoxazole use was examined in malaria-endemic and non-endemic settings. Results: Using all trial data, clinical monitoring delivered similar health outcomes to routine laboratory monitoring, but at a reduced cost, so was cost-effective. Continuing cotrimoxazole improved health outcomes at reduced costs. Restricting routine CD4+ monitoring to after 52 weeks following ART initiation and removing toxicity testing was associated with an incremental cost-effectiveness ratio of $6084 per quality-adjusted life-year (QALY) across all age groups, but was much lower for older children (12+ years at initiation; incremental cost-effectiveness ratio =$769/QALY). Committing resources to improve cotrimoxazole implementation appears cost-effective. A healthcare system that could pay $600/QALY should be willing to spend up to$12.0 per patient-year to ensure continued provision of cotrimoxazole. Conclusion: Clinically driven monitoring of ART is cost-effective in most circumstances. Routine laboratory monitoring is generally not cost-effective at current prices, except possibly CD4 testing amongst adolescents initiating ART. Committing resources to ensure continued provision of cotrimoxazole in health facilities is more likely to represent an efficient use of resources

Molecular characterization of new tools for blocking integrin α11β1 function

Master's Thesis in Biomedical SciencesBMED395MAMD-MEDB

The Case Method and Students’ Performance at Makerere University Business School

The purpose of this study was to examine the relationship between the case method of teaching and students’ performance in a university setting. The study describes the nature of student involvement and engagement in the process of study, especially as stimulated by the use of the case method. The findings indicate a positive relationship between application of the method and students’ performance. It is noted that using the method promotes in-depth understanding because students are exposed to ‘wrapped-around’ and holistic learning, which enables them to compare and contrast concepts; relate these concepts to other subjects and experiences; and to generate questions and hypotheses that lead to further inquiry and new knowledge. Therefore, it is recommended that universities promote utilisation of the method and facilitate further research into its effectiveness.Keywords: Curriculum innovation; Student-centred learning; MUB

HIV-associated anemia after 96 weeks on therapy: determinants across age ranges in Uganda and Zimbabwe.

Given the detrimental effects of HIV-associated anemia on morbidity, we determined factors associated with anemia after 96 weeks of antiretroviral therapy (ART) across age groups. An HIV-positive cohort (n=3,580) of children age 5-14, reproductive age adults 18-49, and older adults ≥50 from two randomized trials in Uganda and Zimbabwe were evaluated from initiation of therapy through 96 weeks. We conducted logistic and multinomial regression to evaluate common and differential determinants for anemia at 96 weeks on therapy. Prior to initiation of ART, the prevalence of anemia (age 5-11 <10.5 g/dl, 12-14 <11 g/dl, adult females <11 g/dl, adult males <12 g/dl) was 43%, which decreased to 13% at week 96 (p<0.001). Older adults had a significantly higher likelihood of anemia compared to reproductive age adults (OR 2.60, 95% CI 1.44-4.70, p=0.002). Reproductive age females had a significantly higher odds of anemia compared to men at week 96 (OR 2.56, 95% CI 1.92-3.40, p<0.001), and particularly a greater odds for microcytic anemia compared to males in the same age group (p=0.001). Other common factors associated with anemia included low body mass index (BMI) and microcytosis; greater increases in CD4 count to week 96 were protective. Thus, while ART significantly reduced the prevalence of anemia at 96 weeks, 13% of the population continued to be anemic. Specific groups, such as reproductive age females and older adults, have a greater odds of anemia and may guide clinicians to pursue further evaluation and management

HOPE IN THE VALLEY OF PHD STUDY IN SOUTHWESTERN UGANDA: A PHENOMENOLOGICAL STUDY.

Background This phenomenological study investigates the pivotal role of hope in shaping the lived experiences of PhD students in Southwestern Uganda, with particular attention to the challenges they face, their aspirations, and the perceived effectiveness of available support systems throughout their academic journey.  Methods Employing a qualitative research design, the study draws insights from in-depth interviews conducted with 20 PhD candidates, 7 female and 13 male, aged bracket 35-55 years of age, enrolled across multiple universities in the region. Participants were selected through purposive sampling to ensure a rich diversity of perspectives. Thematic analysis was used to interpret the data, revealing a complex interplay between personal determination and external barriers.  Results Findings highlight a range of emotional, financial, academic, and institutional challenges, including limited access to research funding, inadequate supervision, prolonged timelines, and family pressures.  Conclusion Despite these obstacles, hope emerged as a central psychological and motivational resource that sustained the students’ commitment to completing their studies and making meaningful contributions to their communities and the broader society. The study further uncovered the significance of informal peer networks, mentorship, and occasional institutional support in nurturing this hope.  Recommendation The research underscores the need for higher education institutions to develop more robust and responsive support systems tailored to the needs of doctoral students. It calls for policies that address mental health, financial aid, supervision quality, and career development. By recognizing and fostering hope as a critical component of academic resilience, universities can enhance the overall doctoral experience and improve completion rates

In Vitro studies of immune mechanisms in bovine Theileriosis

This thesis describes studies that were undertaken to evaluate in vitro cell-mediated and humoral immune mechanisms in bovine tropical theileriosis caused by Theileria annulata, and to identify target cells infected by Theileria annulata and Theileria parva sporozoites.Bovine peripheral blood leucocytes (EBL) were fractionated into B-enriched and T-enriched cell populations by nylon wool adherence, plastic surface adherence or E-rosette sedimentation. Evaluation of the infectibility of fractionated cell populations and EBL by Theileria annulata sporozoites in vitro showed that T. annulata selectively infects and establishes in adherent cells, a significant proportion of which exhibit Fc receptors, but these infected cells did not appear to secrete immunoglobulin. Identification of the cell types in T. parva and T. annulata cell lines using immunofluorescence and rosette assays showed that T. parva cell lines exhibited T cell sur¬ face markers whereas T. annulata cell lines did not. Moreover, a significant percentage of cells in T. annulata cell lines had Fc receptors indicating that these parasites infect different lymphocyte subpopulations.Optimal conditions for the production of bovine T cell growth factor (TCGP) were established. A combination of Concanavalin A (Con A) and bovine spleen cells yielded more potent TCGP than a combination of Con A and EBL. The TCGP thus produced was used to maintain T cell blasts in culture for about two months.Cell-mediated immune responses in bovine tropical theileriosis were studied using a cell culture technique. This technique allowed for evaluation of cell-mediated responses in an autologous system, in that cultures were initiated in vitro using EBL from an animal before infection and these were later used as targets for effectors from the same individual following infection. Results of this preliminary study showed that cells whose cytotoxicity was restricted to autologous cell lines were generated only in calves that had been successfully infected and immunized against the parasite thus suggesting a role for geneticallyrestricted cytotoxicity in recovery from and immunity to theileriosis.Non-genetically restricted cytotoxic cells were irregularly generated in vitro following initiation and maintenance of an autologous mixed lymphocyte reaction for five days in growth medium. Addition of crude bovine TCGF to this culture system did not enhance the generation of cytotoxic cells.Sporozoite infectivity for bovine lymphocytes in vitro was specifically inhibited by serum taken from cattle hyperimmunized with stabilates of T. annulata sporozoites. There was no synergistic inhibitory effect when sporozoites were exposed to both antisera and PBL from immune calves.It was suggested that immunity against bovine theileriosis is an interplay between humoral and cell-mediated .immune mechanisms. Antibodies may inhibit entry of sporozoites into the host's target cells and their subsequent transformation and cytotoxic cells kill schizont-infected cells

Tuberculosis incidence is high in HIV-infected African children but is reduced by co-trimoxazole and time on antiretroviral therapy

BACKGROUND: There are few data on tuberculosis (TB) incidence in HIV-infected children on antiretroviral therapy (ART). Observational studies suggest co-trimoxazole prophylaxis may prevent TB, but there are no randomized data supporting this. The ARROW trial, which enrolled HIV-infected children initiating ART in Uganda and Zimbabwe and included randomized cessation of co-trimoxazole prophylaxis, provided an opportunity to estimate the incidence of TB over time, to explore potential risk factors for TB, and to evaluate the effect of stopping co-trimoxazole prophylaxis. METHODS: Of 1,206 children enrolled in ARROW, there were 969 children with no previous TB history. After 96 weeks on ART, children older than 3 years were randomized to stop or continue co-trimoxazole prophylaxis; 622 were eligible and included in the co-trimoxazole analysis. Endpoints, including TB, were adjudicated blind to randomization by an independent endpoint review committee (ERC). Crude incidence rates of TB were estimated and potential risk factors, including age, sex, center, CD4, weight, height, and initial ART strategy, were explored in multivariable Cox proportional hazards models. RESULTS: After a median of 4 years follow-up (3,632 child-years), 69 children had an ERC-confirmed TB diagnosis. The overall TB incidence was 1.9/100 child-years (95 % CI, 1.5-2.4), and was highest in the first 12 weeks following ART initiation (8.8/100 child-years (5.2-13.4) versus 1.2/100 child-years (0.8-1.6) after 52 weeks). A higher TB risk was independently associated with younger age (<3 years), female sex, lower pre-ART weight-for-age Z-score, and current CD4 percent; fewer TB diagnoses were observed in children on maintenance triple nucleoside reverse transcriptase inhibitor (NRTI) ART compared to standard non-NRTI + 2NRTI. Over the median 2 years of follow-up, there were 20 ERC-adjudicated TB cases among 622 children in the co-trimoxazole analysis: 5 in the continue arm and 15 in the stop arm (hazard ratio (stop: continue) = 3.0 (95 % CI, 1.1-8.3), P = 0.028). TB risk was also independently associated with lower current CD4 percent (P <0.001). CONCLUSIONS: TB incidence varies over time following ART initiation, and is particularly high during the first 3 months post-ART, reinforcing the importance of TB screening prior to starting ART and use of isoniazid preventive therapy once active TB is excluded. HIV-infected children continuing co-trimoxazole prophylaxis after 96 weeks of ART were diagnosed with TB less frequently, highlighting a potentially important role of co-trimoxazole in preventing TB

EFFECTS OF RESULTS BASED FINANCING ON PERFORMANCE OF THE INCENTIVIZED INDICATORS. A QUASI-EXPERIMENTAL STUDY DESIGN.

Background Despite the nationwide roll-out of RBF, the National performance of several key incentivized indicators showed a decline in performance in the year 2019/2020 compared to the previous year.  Method The study took on a quasi-experimental study design. Data from HFs that were part of phase one of the RBF rollout (exposed group) was analyzed and compared to data from HFs in phase three of RBF implementation (Nonexposed group) a time before the rollout of RBF phase three in Uganda. All data analysis was done in Stata using version 16. Results:  The study results show that in the exposed group of health facilities, Incentivised indicators changed significantly after the project implementation as regards the average number (mean) of clients served by the health facilities; p&lt; 0.01, p&lt;0.05, or p&lt;0.1 for the difference coefficients Similar, though relatively slower effects were observable in the same indicators for an unexposed group of health facilities. IPT2 coverage declined by 6%, health facility deliveries were 59% achieved (89% national target) and declined by 3%, and under-five Vitamin A coverage declined by 9% to 21.4% far below the target of 66%. Essential drug stock declined by 7%, to 46% below the national target of 75% maternal deaths increased by 7.6%, reporting timeliness declined by 12.5% from 97.5% public health facility staffing declined by 3% to 73% against the targeted 80%. Conclusion RBF contributes to improved health service utilization as evidenced by the improved performance of incentivized indicators and improved data quality over time.  Recommendation There is a need to continuously review which indicators are incentivized to achieve quality of care in all health services if it is to be mainstreamed

Population level usage of health services, and HIV testing and care, prior to decentralization of antiretroviral therapy in Agago District in rural Northern Uganda: Additional Files

A study protocol developed to investigate health service usage, particularly HIV testing and care, in 2/6 parishes of the Lapono sub-county of northern Uganda, prior to introduction of AntiRetroviral Therapy (ART) services in Lira Kato Health Centre (a local lower-level health centre III). The protocol consists of household and individual questionnaires which were administered to members of each household. These captured individual demographic and health-related information on adults (aged 15–59 years) and socioeconomic data on children living in each household. The protocol was approved by the Joint Clinical Research Centre/Research Ethical Committee (JCRC/REC), Uganda National Council for Science and Technology (UNCST) and Office of the President of the Republic of Uganda

Board Independence and Company Performance in East Africa

Purpose: The main aim of this study was to examine influence of board independence on financial performance of listed companies in the East African Community (EAC) by examining the influence of board independence on performance of EAC’s listed companies and compare the influence of board independence on company’s financial performance before and after the operationalisation of the EAC- Common Market in 2010 to make recommendations on how board independence can enhance of hinder a company’s financial performance Design/Methodology/Approach: We adopted a positivist paradigm in a quantitative analysis using non-probability sampling to select forty-two EAC listed companies. We developed hypothesises basing on secondary data from databases (DataStream, Eikon, Mint Global Bureau Van Dijk) and company’s annual reports. SPSS was used to carry out regression diagnostic test and generate descriptive statistics, correlation, and regression results. Findings and Recommendation: Our findings indicated that to some extent board independence had a statistically significant influence on company financial performance measured by RoA, RoE, TbQ but not PeR. Secondly; we also discovered some negligible changes in board independence for most listed companies for the period before and after operationalisation of the EAC - Common Market. Based on our inconclusive statistical results and the extant literature review, we recommend that EAC listed companies adopt a code of best practice that emphasises an increase in board independence. Keywords: Board Independence, Regional Economic Integration, Financial Performance. DOI: 10.7176/RJFA/12-12-01 Publication date:June 30th 202