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1. 72 weeks post-partum follow-up of dolutegravir versus efavirenz initiated in late pregnancy (DolPHIN-2): an open-label, randomised controlled study

Author

Malaba, T.R., Nakatudde, I., Kintu, K., Colbers, A., Chen, T., Reynolds, H., Read, L., Read, J., Stemmet, L.A., Mrubata, M., Byrne, K., Seden, K., Twimukye, A., Theunissen, H., Hodel, E.M., Chiong, J., Hu, N.C., Burger, D.M., Wang, Duolao, Byamugisha, J., Alhassan, Y., Bokako, S., Waitt, C., Taegtmeyer, M., Orrell, C., Lamorde, M., Myer, L., Khoo, S., Malaba, T.R., Nakatudde, I., Kintu, K., Colbers, A., Chen, T., Reynolds, H., Read, L., Read, J., Stemmet, L.A., Mrubata, M., Byrne, K., Seden, K., Twimukye, A., Theunissen, H., Hodel, E.M., Chiong, J., Hu, N.C., Burger, D.M., Wang, Duolao, Byamugisha, J., Alhassan, Y., Bokako, S., Waitt, C., Taegtmeyer, M., Orrell, C., Lamorde, M., Myer, L., and Khoo, S.

Abstract

Item does not contain fulltext, BACKGROUND: Late initiation of antiretrovirals in pregnancy is associated with increased risk of perinatal transmission and higher infant mortality. We report the final 72-week postpartum results for efficacy and safety of dolutegravir-based compared with efavirenz-based regimens in mothers and infants. METHODS: DolPHIN-2 was a randomised, open-label trial. Pregnant women in South Africa and Uganda aged at least 18 years, with untreated but confirmed HIV infection and an estimated gestation of at least 28 weeks, initiating antiretroviral therapy in third trimester were eligible for inclusion. Eligible women were randomly assigned (1:1) to receive either dolutegravir-based (50 mg dolutegravir, 300 mg tenofovir disoproxil fumarate, and either 200 mg emtricitabine in South Africa or 300 mg lamivudine in Uganda) or efavirenz-based (fixed dose combination 600 mg tenofovir disoproxil fumarate plus either emtricitabine in South Africa or lamivudine in Uganda) therapy. The primary efficacy outcome was the time to a viral load of less than 50 copies per mL measured at 6, 12, 24, 48, and 72 weeks postpartum with a Cox model adjusting for viral load and CD4 cell count. Safety endpoints were summarised by the number of women and infants with events. This trial is registered with ClinicalTrials.gov, NCT03249181. FINDINGS: Between Jan 23 and Aug 15, 2018, 280 women were screened for inclusion, of whom 268 (96%) women were randomly assigned: 133 (50%) to the efavirenz group and 135 (50%) to the dolutegravir group. 250 (93%; 125 [50%] in the efavirenz group and 125 [50%] in the dolutegravir group) women were included in the intention-to-treat analysis of efficacy. Median time to viral load of less than 50 copies per mL was 4·1 weeks (IQR 4·0-5·1) in the dolutegravir group compared with 12·1 weeks (10·7-13·3) in the efavirenz group (adjusted hazard ratio [HR] 1·93 [95% CI 1·5-2·5]). At 72 weeks postpartum, 116 (93%) mothers in the dolutegravir group and 114 (91%) in the efavirenz gr

Published
2022

3. A STUDY OF MORPHOLOGICAL PATTERNS OF GLENOID CAVITY OF SCAPULA

Author

Hina B Rajput, Kintu K Vyas, and Bhavesh D Shroff

Subjects
Glenoid cavity, Glenoid notch, Shoulder arthroplasty, Medicine
Abstract

Background: Shoulder arthroplasty offer pain relief and improement in patients of shoulder arthritis. Appropriate fixation of glenoid component of scapula is essential to evade loosening which is the common indication for revision surgery. The glenoid cavity is small and allows only a restricted spot for limited fixation devices. For this reason, knowledge of the morphology of glenoid cavity is important. Methodology: In the current study, 5 diameters of glenoid cavity of 43 right sided and 57 left sided dried unpaired human scapulae have been measured with the aid of digital vernier callipers. Results: Various shapes of glenoid cavity like inverted comma, pear or oval based on the glenoid notch have also been observed. The values of glenoid cavity in the current study are lower than those reported in other studies. Conclusion: These findings suggest that the difference in size of the glenoid cavity in Gujarati population may have to be taken into consideration while deciding the size of the glenoid component in shoulder arthroplasty in this population.

Published
2012

5. Dolutegravir versus efavirenz in women starting HIV therapy in late pregnancy (DolPHIN-2): an open-label, randomised controlled trial

Author

Kintu, K., Malaba, T.R., Nakibuka, J., Papamichael, C., Colbers, A., Byrne, K., Seden, K., Hodel, E.M., Chen, T., Twimukye, A., Byamugisha, J., Reynolds, H., Watson, V., Burger, D.M., Wang, D., Waitt, C., Taegtmeyer, M., Orrell, C., Lamorde, M., Myer, L., Khoo, S., Kintu, K., Malaba, T.R., Nakibuka, J., Papamichael, C., Colbers, A., Byrne, K., Seden, K., Hodel, E.M., Chen, T., Twimukye, A., Byamugisha, J., Reynolds, H., Watson, V., Burger, D.M., Wang, D., Waitt, C., Taegtmeyer, M., Orrell, C., Lamorde, M., Myer, L., and Khoo, S.

Abstract

Contains fulltext : 220640.pdf (Publisher’s version ) (Closed access), BACKGROUND: Late initiation of HIV antiretroviral therapy (ART) in pregnancy is associated with not achieving viral suppression before giving birth and increased mother-to-child transmission of HIV. We aimed to investigate virological suppression before giving birth with dolutegravir compared with efavirenz, when initiated during the third trimester. METHODS: In this randomised, open-label trial, DolPHIN-2, we recruited pregnant women in South Africa and Uganda aged at least 18 years, with untreated but confirmed HIV infection and an estimated gestation of at least 28 weeks, initiating ART in third trimester. Participants were randomly assigned (1:1) to dolutegravir-based or efavirenz-based therapy. HIV viral load was measured 7 days and 28 days after antiretroviral initiation, at 36 weeks' gestation, and at the post-partum visit (0-14 days post partum). The primary efficacy outcome was a viral load of less than 50 copies per mL at the first post-partum visit, and the primary safety outcome was the occurrence of drug-related adverse events in mothers and infants until the post-partum visit. Longer-term follow-up of mothers and infants continues. This study is registered with ClinicalTrials.gov, NCT03249181. FINDINGS: Between Jan 23, and Aug 15, 2018, we randomly assigned 268 mothers to dolutegravir (135) or efavirenz (133). All mothers and their infants were included in the safety analysis, and 250 mothers (125 in the dolutegravir group, 125 in the efavirenz group) and their infants in efficacy analyses, by intention-to-treat analyses. The median duration of maternal therapy at birth was 55 days (IQR 33-77). 89 (74%) of 120 in the dolutegravir group had viral loads less than 50 copies per mL, compared with 50 (43%) of 117 in the efavirenz group (risk ratio 1·64, 95% CI 1·31-2·06). 30 (22%) of 137 mothers in the dolutegravir group reported serious adverse events compared with 14 (11%) of 131 in the efavirenz group (p=0·013), particularly surrounding pregnancy and pue

Published
2020

6. DolPHIN-1: Randomised controlled trial of dolutegravir (DTG)- versus efavirenz (EFV)-based therapy in mothers initiating antiretroviral treatment in late pregnancy

Author

Orrell, C, Kintu, K, Coombs, JA, Amara, A, Myer, L, Kaboggoza, J, Simmons, B, Else, L, Heiberg, C, Waitt, C, Walimbwa, S, Hodel, EM, Hill, A, Khoo, S, and Lamorde, M

Subjects
Science & Technology, Infectious Diseases, Immunology, 1103 Clinical Sciences, Life Sciences & Biomedicine, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
Abstract

Background: ART initiation in the 3rd trimester of pregnancy is associated with failure to achieve viral suppression (VS) by delivery and increased transmission of HIV. We randomised 60 treatment naïve pregnant women at 28-36w gestation in Uganda and South Africa 1:1 to receive EFV or DTG+2NRTIs. The primary endpoint was pharmacokinetics (PK) of DTG in women and breastfed infants; secondary endpoints included VS. Methods: To comply with national guidelines, EFV+2NRTI was initiated on referral, with subjects randomized to DTG switched within 7 days. Viral load (VL) was collected at every visit; intensive maternal PK sampling (0-24h) was performed at 14 days on DTG, and 2 weeks post-partum, with paired sampling between maternal plasma and cord blood, breastmilk and infant plasma. All infants were exclusively breastfed. Results: There was no significant pre-ART differences between DTG (n=29) and EFV (n=31) arms in maternal age, gestation at treatment initiation (30.8w), weight, obstetric history, VL (log 4 copies) and CD4 count (394 cells/mm3). Third trimester DTG exposures were low with Ctrough at or below target (MEC 324ng/mL) in 9/28 (32%) mothers. DTG transfer across the placenta (122%) and in breast milk (3%) coupled with delayed elimination resulted in significant infant exposures potentially persisting during breast-feeding. Both regimens were well-tolerated. A total of 10 SAEs were reported in 5 mothers and 3 infants, with no significant differences between arms. Superior VS was observed with DTG (Table 1) at the 2w post-partum visit (P=0.005). However, VL>1000 copies/mL near delivery was still observed with both DTG (3.7%) and EFV (7.4%). No HIV transmissions were observed Conclusions: HIV RNA suppression < 50 copies/mL was more rapid with DTG (despite low DTG exposures when started in the third trimester) which may translate to improved PMTCT for ART initiation in late pregnancy. The impact of significant infant DTG exposures related to intrauterine transfer, continued breastfeeding and delayed elimination is being evaluated in the DolPHIN-2 study.

Published
2018

7. A thematic analysis of the Uganda lower secondary school curriculum:requirement for inclusion in schools

Author

Kintu, K. (Kassim)

Subjects
Education
Abstract

Uganda has registered profound levels of primary and secondary school attendance since the introduction of Universal Primary Education in 1997 and Universal Secondary Education in 2007. Introducing Universal Secondary Education made Uganda the first country in sub-Saharan Africa to introduce the compulsory secondary level education. While this policy has improved access, there has not been a corresponding increase in quality, and large numbers of children are still missing out on secondary education. This master thesis is analyzing inclusive education at the heart of the reformed lower secondary school curriculum. To reach this goal, the lower secondary school curriculum framework document and two interviews from people familiar with the reform process serves as the data for the analysis. The research is a qualitative study and the data was analyzed using content analysis approach. The theoretical framework consists of theories of inclusive education and aims of Education for All global movement (EFA) as well as Sustainable Development Goal 4. The Uganda lower secondary school framework document is analyzed visa-vis the aims of EFA and SDG 4. The main categories that emerged from the data concerning inclusive education were: Participation as a requirement addressing diversity; inclusive, alternative ways of learning for all; inclusive and safe learning environment; teaching material addressing diversity without stereotypes; and assessment addressing all learners and their achievement. There were also topics that were missing from the data, such as, specific discussions about people or groups that might be in danger of exclusion or concrete methods or pedagogy of including everyone.

Published
2016

8. The Wooden Skull: An Innovation through the Use of Local Materials and Technology to Promote the Teaching and Learning of Human Anatomy.

Author

Mugagga K, Mwarisi MG, and Dare SS

Subjects
Bignoniaceae, Curriculum, Educational Measurement, Humans, Learning, Students, Medical, Teaching, Technology, Uganda, Anatomy education, Education, Medical, Undergraduate, Models, Anatomic, Skull anatomy & histology, Wood
Abstract

Skeleton models are important in facilitating a student's easy retention and recollection of information in the future. These may assist students carry out hands-on practice in order to acquire and practice new skills that are relevant to first aid. The increasing number of medical institutions and medical students attracts the challenge of inadequate facilitation of the teaching and learning processes. This warrants a study and/or an exploration of an alternative solution such as wooden models in order to solve the problem of scarce and ethically restricted human teaching aids. Wooden pieces (50 cm length × 20 cm diameter) from a Jacaranda mimosifolia tree were prepared for the carving process, and wooden replicas of human skulls were made. Two experimental groups of randomly selected medical students (60: active and 60: control) were separately taught using wooden and natural skull models, respectively. The two groups were assessed and evaluated using the natural skull models to compare their understanding of the anatomy of the skull. Additionally, opinion statements were collected from participants in the active group during the oral examination. Six (6) wooden skull models were produced and used for experimental study. Comparisons of academic scores (mean and median) between active (students using the wooden skull) and control (students using natural skull) groups showed no statistically significant difference ( P ≥ 0.05). Concerning the enhancement of learning skills, the wooden model was constructed in a way that would be able to enhance learning as it would be the natural skull. The wooden skull model, with more improvement in structural formation, can adequately facilitate the teaching and learning of anatomy of the human skull. This project and the experimental study about utilization of the wooden skull model provide a good potential of using the wooden models to supplement the use of the natural human skull., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (Copyright © 2020 Kintu Mugagga et al.)

Published
2020
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9. Evaluation of Bilateral Asymmetry in the Humerus of Human Skeletal Specimen.

Author

Dare SS, Masilili G, Mugagga K, and Ekanem PE

Subjects
Burundi epidemiology, Congo epidemiology, Female, Humans, Kenya epidemiology, Male, Rwanda epidemiology, Uganda epidemiology, Body Remains anatomy & histology, Body Weights and Measures, Humerus anatomy & histology, Shoulder Joint anatomy & histology
Abstract

Several studies have established a relationship between morphological and behavioral asymmetry making investigations of bilateral bone asymmetry an attractive and important research area. The purpose of this study was to investigate bilateral asymmetry patterns of skeletal specimen from five geographical locations (Rwanda, Burundi, Congo, Kenya, and Uganda) at Galloway Osteological Collection, Department of Anatomy, School of Biomedical Sciences, Makerere University College of Health Sciences. The angle of torsion and retroversion, mid-shaft circumference, length, and weight of 232 pairs of humeri were determined. A Torsiometer was used to measure the angle of torsion in degrees according to Krahl and Evans 1945, a tape was used to measure the mid-shaft circumference at the level of the apex of the deltoid V, and the length in cm was determined. An osteometric board was used to measure the length of the humerus in centimeters. A weighing balance was used to measure the weight of the humerus in grams. The analysis of humeral asymmetry with respect to parameters of the human skeletal specimen at the Galloway Osteological Collection Mulago revealed bilateral asymmetrical status observed in the angle of torsion, length, weight, and mid-shaft circumference. Our result mostly showed lateralization to the right in all the parameters investigated except the torsion angle which is to the left. Our investigation revealed that humeral torsion is inversely proportional to weight, length, and mid-shaft circumference of the humerus. This study established the existence of bilateral asymmetries in the humeri of all the geographical regions investigated with more asymmetry observed in the male compared with the female., Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this paper

Published
2019
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10. Influence of community-based education on undergraduate health professions students' decision to work in underserved areas in Uganda.

Author

Kizito S, Baingana R, Mugagga K, Akera P, and Sewankambo NK

Subjects
Adult, Female, Humans, Male, Uganda, Workforce, Young Adult, Career Choice, Curriculum, Education, Medical, Undergraduate statistics & numerical data, Medically Underserved Area, Rural Health Services, Schools, Medical statistics & numerical data, Students, Health Occupations statistics & numerical data
Abstract

Background: Uganda is beset by a shortage of health workers and the few available are mal-distributed. Providing rural exposure through community-based education could positively influence students' perspectives towards work in rural areas. We aimed to assess the impact of Community-Based Education and Research (COBERS) on health professions students' attitudes towards working in rural areas. This was a before-and-after study among 525 students of 4 medical universities in Uganda. Data was collected using self-administered paper-based questionnaires. Logistic regression and Poisson regression respectively were used to assess intention and intended number of years of work in rural areas., Results: Before COBERS, 228/518 (44.0%) students indicated that they intended to work in rural areas as compared to 245/506 (48.4%) after the COBERS placement. Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1-0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1-0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0-3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5-35.5). Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3-1.0) and Internet (IRR = 1.5; 95% CI 1.0-2.3), high salary (IRR = 0.4; 95% CI 0.3-0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3-3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3-0.8) and long distance courses (IRR = 2.1; 95% CI 1.4-3.1) were significant motivators after having undergone the COBERS placement., Conclusions: The majority of health professions students do not intend to work in rural areas after they graduate. Improving the welfare of health professionals working in rural areas could attract more health professionals to rural areas thus addressing the maldistribution of health workers in Uganda.

Published
2017
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