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1. Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda

Author

Mills, Edward J., Bakanda, Celestin, Birungi, Josephine, Chan, Keith, Hogg, Robert S., Ford, Nathan, Nachega, Jean B., and Cooper, Curtis L.

Subjects
Antiviral agents -- Dosage and administration -- Patient outcomes, HIV infection -- Drug therapy -- Patient outcomes -- Demographic aspects, Health
Abstract

Background: Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine if men have differing outcomes from women across a nationally representative sample of adult patients receiving combination antiretroviral therapy in Uganda. Methods: We estimated survival distributions for adult male and female patients using Kaplan‐Meier, and constructed multivariable regressions to model associations of baseline variables with mortality. We assessed person‐years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted 30% mortality rate among those lost to follow up. Results: We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older, had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received less treatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p < 0.001). Over the period of study, men had a significantly increased risk of death compared with female patients (adjusted hazard ratio 1.43, 95% CI 1.31‐1.57, p < 0.001). The crude mortality rate for males differed importantly from females (43.9, 95% CI 40.7‐47.0/1000 person‐years versus 26.9, 95% CI 25.4‐28.5/1000 person years, p < 0.001). The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person‐years of life lost was lower for females than males (689.7 versus 995.9 per 1000 person‐years, respectively). Conclusions: In order to maximize the benefits of antiretroviral therapy, treatment programmes need to be gender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlier into care., Background Although the global prevalence of HIV among women has remained stable at 50%, in sub‐Saharan Africa, it is markedly higher in females than in males [1]. Similarly in Africa, [...]

Published
2011
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7. Factors associated with long-term antiretroviral therapy attrition among adolescents in rural Uganda: a retrospective study

Author

Okoboi, Stephen, Ssali, Livingstone, Yansaneh, Aisha I., Bakanda, Celestin, Birungi, Josephine, Nantume, Sophie, Okullu, Joanne Lyavala, Sharp, Alana R., Moore, David M., and Kalibala, Samuel

Subjects
AIDS treatment -- Analysis -- Health aspects, HIV infections -- Care and treatment -- Analysis, Highly active antiretroviral therapy -- Analysis -- Health aspects, Health
Abstract

Introduction: As access to antiretroviral therapy (ART) increases, the success of treatment programmes depends on ensuring high patient retention in HIV care. We examined retention and attrition among adolescents in ART programmes across clinics operated by The AIDS Support Organization (TASO) in Uganda, which has operated both facility- and community-based distribution models of ART delivery since 2004. Methods: Using a retrospective cohort analysis of patient-level clinical data, we examined attrition and retention in HIV care and factors associated with attrition among HIV-positive adolescents aged 10-19 years who initiated ART at 10 TASO clinics between January 2006 and December 2011. Retention in care was defined as the proportion of adolescents who had had at least one facility visit within the six months prior to 1 June 2013, and attrition was defined as the proportion of adolescents who died, were lost to follow-up, or stopped treatment. Descriptive statistics and Cox proportional hazards regression models were used to determine the levels of retention in HIV care and the factors associated with attrition following ART initiation. Results: A total of 1228 adolescents began ART between 2006 and 2011, of whom 57% were female. The median duration in HIV care was four years (IQR = 3-6 years). A total of 792 (65%) adolescents were retained in care over the five-year period; 36 (3%) had died or transferred out and 400 (32%) were classified as loss to follow-up. Factors associated with attrition included being older (adjusted hazard ratio (AHR) = 1.38, 95% confidence interval (CI) 1.02- 1.86), having a higher CD4 count (250+ cells/[mm.sup.3]) at treatment initiation (AHR =0.49, 95% CI 0.34-0.69) and HIV care site with a higher risk of attrition among adolescents in Gulu (AHR = 2.26; 95% CI 1.27-4.02) and Masindi (AHR =3.30, 95% CI 1.87-5.84) and a lower risk of attrition in Jinja (AHR =0.24, 95% CI 0.08-0.70). Having an advanced WHO clinical stage at initiation was not associated with attrition. Conclusions: We found an overall retention rate of 65%, which is comparable to rates achieved by TASO's adult patients and adolescents in other studies in Africa. Variations in the risk of attrition by TASO treatment site and by clinical and demographic characteristics suggest the need for early diagnosis of HIV infection, use of innovative approaches to reach and retain adolescents living with HIV in treatment and identifying specific groups, such as older adolescents, that are at high risk of dropping out of treatment for targeted care and support. Keywords: adolescents; HIV treatment; antiretroviral therapy; retention; attrition; community-based delivery; Uganda., Introduction The burden of HIV in Africa is increasingly on adolescents and young adults. Worldwide, adolescents represent 41% of new HIV infections and are the only age group with increasing [...]

Published
2016
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9. No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project

Author

Okoboi, Stephen, primary, Ekwaru, Paul John, additional, Campbell, James D., additional, Egessa, Aggrey, additional, King, Racheal, additional, Bakanda, Celestin, additional, Muramuzi, Emmy, additional, Kaharuza, Frank, additional, Malamba, Samuel, additional, and Moore, David M., additional

Published
2015
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10. Community-based ART distribution system can effectively facilitate long-term program retention and low-rates of death and virologic failure in rural Uganda

Author

Okoboi, Stephen, primary, Ding, Erin, additional, Persuad, Steven, additional, Wangisi, Jonathan, additional, Birungi, Josephine, additional, Shurgold, Susan, additional, Kato, Darius, additional, Nyonyintono, Maureen, additional, Egessa, Aggrey, additional, Bakanda, Celestin, additional, Munderi, Paula, additional, Kaleebu, Pontiano, additional, and Moore, David M., additional

Published
2015
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11. Predictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Uganda

Author

Bray,Sarah, Gedeon,Jillian, Hadi,Ahsan, Kotb,Ahmed, Rahman,Tarun, Sarwar,Elaha, Savelyeva,Anna, Sévigny,Marika, Bakanda,Celestin, Birungi,Josephine, Chan,Keith, Yaya,Sanni, Deonandan,Raywat, Mills,Edward J, Bray,Sarah, Gedeon,Jillian, Hadi,Ahsan, Kotb,Ahmed, Rahman,Tarun, Sarwar,Elaha, Savelyeva,Anna, Sévigny,Marika, Bakanda,Celestin, Birungi,Josephine, Chan,Keith, Yaya,Sanni, Deonandan,Raywat, and Mills,Edward J

Abstract

Sarah Bray,1 Jillian Gedeon,1 Ahsan Hadi,1 Ahmed Kotb, Tarun Rahman,1 Elaha Sarwar,1 Anna Savelyeva,1 Marika Sévigny,1 Celestin Bakanda,2 Josephine Birungi,2 Keith Chan,3 Sanni Yaya,1 Raywat Deonandan,1 Edward J Mills1,21Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada; 2The AIDS Support Organization (TASO), Headquarters, Kampala, Uganda; 3British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, CanadaObjective: Although international guidelines recommend initiating antiretroviral therapy (ART) when a patient’s CD4 cell count is ≤350 cells/μL, most patients in resource-limited settings present with much lower CD4 cell counts. The lowest level that their CD4 cell count reaches, the nadir, may have long-term consequences in terms of mortality. We examined this health state in a large cohort of HIV+ patients in Uganda.Design: This was an observational study of HIV patients in Uganda aged 14 years or older, who were enrolled in 10 major clinics across Uganda.Methods: We assessed the CD4 nadir of patients, using their CD4 cell count at initiation of ART, stratified into categories (<50, 50–99, 100–149, 150–249, 250+ cells/μL). We constructed Kaplan–Meier curves to assess the differences in survivorship for patients left-censored at 1 year and 2 years after treatment initiation. We used Cox proportional hazards regression to model the associations between CD4 nadir and mortality. We adjusted mortality for loss-to-follow-up.Results: Of 22,315 patients, 20,129 patients had greater than 1 year of treatment follow-up. Among these patients, 327 (1.6%) died and 444 (2.2%) were lost to follow-up. After left-censoring at one year, relative to lowest CD4 strata, patients with higher CD4 counts had significantly lower rates of mortality (CD4 150–249, hazard ratio [HR] 0.60, 95% confidence interval [CI

Published
2012

13. No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project.

Author

Okoboi, Stephen, Ekwaru, Paul John, Campbell, James D., Egessa, Aggrey, King, Racheal, Bakanda, Celestin, Muramuzi, Emmy, Kaharuza, Frank, Malamba, Samuel, and Moore, David M.

Subjects
HIV-positive persons, VIRAL load, CD4 lymphocyte count, PATIENT monitoring, HEALTH outcome assessment, AIDS patients, HOME care services
Abstract

Background: We compared clinical outcomes among HIV-infected participants receiving ART who were randomized to viral load (VL) and CD4 cell count monitoring in comparison to CD4 cell count monitoring alone in Tororo, Uganda.Methods: Beginning in May 2003, participants with CD4 cell counts <250 cells/μL or WHO stage 3 or 4 disease were randomized to clinical monitoring alone, clinical monitoring plus quarterly CD4 cell counts (CD4-only); or clinical monitoring, quarterly CD4 cell counts and quarterly VL testing (CD4-VL). In 2007, individuals in clinical monitoring arm were re-randomized to the other two arms and all participants were followed until March 31, 2009. We used Cox Proportional Hazard models to determine if study arm was independently associated with the development of opportunistic infections (OIs) or death.Results: We randomized 1211 participants to the three original study arms and 331 surviving participants in the clinical monitoring arm were re-randomized to the CD4-VL and CD4 only arms. At enrolment the median age was 38 years and the median CD4 cell count was 134 cells/μL. Over a median of 5.2 years of follow-up, 37 deaths and 35 new OIs occurred in the VL-CD4 arm patients, 39 deaths and 42 new OIs occurred in CD4-only patients. We did not observe an association between monitoring arm and new OIs or death (AHR =1.19 for CD4-only vs. CD4-VL; 95 % CI 0.82-1.73).Conclusion: We found no differences in clinical outcomes associated with the addition of quarterly VL monitoring to quarterly CD4 cell count monitoring. [ABSTRACT FROM AUTHOR]

Published
2016
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16. Impact of tuberculosis on mortality among HIV-infected patients receiving antiretroviral therapy in Uganda: a prospective cohort analysis.

Author

Rong Chu, Mills, Edward J., Beyene, Joseph, Pullenayegum, Eleanor, Bakanda, Celestin, Nachega, Jean B., Devereaux, P. J., and Thabane, Lehana

Subjects
TUBERCULOSIS risk factors, CONFIDENCE intervals, HIV-positive persons, LONGITUDINAL method, MORTALITY, RESEARCH funding, DATA analysis, HIGHLY active antiretroviral therapy, PROPORTIONAL hazards models, DATA analysis software, DESCRIPTIVE statistics, KAPLAN-Meier estimator
Abstract

Background: Tuberculosis (TB) disease affects survival among HIV co-infected patients on antiretroviral therapy (ART). Yet, the magnitude of TB disease on mortality is poorly understood. Methods: Using a prospective cohort of 22,477 adult patients who initiated ART between August 2000 and June 2009 in Uganda, we assessed the effect of active pulmonary TB disease at the initiation of ART on all-cause mortality using a Cox proportional hazards model. Propensity score (PS) matching was used to control for potential confounding. Stratification and covariate adjustment for PS and not PS-based multivariable Cox models were also performed. Results: A total of 1,609 (7.52%) patients had active pulmonary TB at the start of ART. TB patients had higher proportions of being male, suffering from AIDS-defining illnesses, having World Health Organization (WHO) disease stage III or IV, and having lower CD4 cell counts at baseline (p < 0.001). The percentages of death during follow-up were 10.47% and 6.38% for patients with and without TB, respectively. The hazard ratio (HR) for mortality comparing TB to non-TB patients using 1,686 PS-matched pairs was 1.37 (95% confidence interval [CI]: 1.08--1.75), less marked than the crude estimate (HR = 1.74, 95% CI: 1.49--2.04). The other PS-based methods and not PS-based multivariable Cox model produced similar results. Conclusions: After controlling for important confounding variables, HIV patients who had TB at the initiation of ART in Uganda had an approximate 37% increased hazard of overall mortality relative to non-TB patients. [ABSTRACT FROM AUTHOR]

Published
2013
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18. Predictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Uganda.

Author

Bray, Sarah, Gedeon, Jillian, Hadi, Ahsan, Kotb, Ahmed, Rahman, Tarun, Sarwar, Elaha, Savelyeva, Anna, Sévigny, Marika, Bakanda, Celestin, Birungi, Josephine, Chan, Keith, Yaya, Sanni, Deonandan, Raywat, and Mills, Edward J.

Subjects
CD4 antigen, HIV-positive persons, HIV infections, HIV, MORTALITY
Abstract

Objective: Although international guidelines recommend initiating antiretroviral therapy (ART) when a patient's CD4 cell count is ≤350 cells/μL, most patients in resource-limited settings present with much lower CD4 cell counts. The lowest level that their CD4 cell count reaches, the nadir, may have long-term consequences in terms of mortality. We examined this health state in a large cohort of HIV+ patients in Uganda. Design: This was an observational study of HIV patients in Uganda aged 14 years or older, who were enrolled in 10 major clinics across Uganda. Methods: We assessed the CD4 nadir of patients, using their CD4 cell count at initiation of ART, stratified into categories (<50, 50-99, 100-149, 150-249, 250+ cells/μL). We constructed Kaplan-Meier curves to assess the differences in survivorship for patients left-censored at 1 year and 2 years after treatment initiation. We used Cox proportional hazards regression to model the associations between CD4 nadir and mortality. We adjusted mortality for loss-to-follow-up. Results: Of 22,315 patients, 20,129 patients had greater than 1 year of treatment follow-up. Among these patients, 327 (1.6%) died and 444 (2.2%) were lost to follow-up. After left-censoring at one year, relative to lowest CD4 strata, patients with higher CD4 counts had significantly lower rates of mortality (CD4 150-249, hazard ratio [HR] 0.60, 95% confidence interval [CI]: 0.45-0.82, P = 0.001; 250+, HR 0.66, 95% CI, 0.44-1.00, P = -0.05). Male sex, older age, and duration of time on ART were independently associated with mortality. When left-censoring at 2 years, CD4 nadir was no longer statistically significantly associated with mortality. Conclusion: After surviving for 1 year on ART, a CD4 nadir was strongly predictive of longer-term mortality among patients in Uganda. This should argue for efforts to increase engagement with patients to ensure a higher CD4 nadir at initiation of treatment. [ABSTRACT FROM AUTHOR]

Published
2012

19. The prognostic value of baseline CD4cell count beyond 6 months of antiretroviral therapy in HIV-positive patients in a resource-limited setting

Author

Mills, Edward J., Bakanda, Celestin, Birungi, Josephine, Yaya, Sanni, and Ford, Nathan

Abstract

The risk of death is highest in the first few months after initiation of antiretroviral therapy (ART). We examined whether initial CD4cell count maintains a strong prognostic value among patients with at least 6 months follow-up after the initiation of ART.

Published
2012
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20. No differences in clinical outcomes with the addition of viral load testing to CD4 cell count monitoring among HIV infected participants receiving ART in rural Uganda: Long-term results from the Home Based AIDS Care Project

Author

Okoboi, Stephen, Ekwaru, Paul J, Campbell, James D, Egessa, Aggrey, King, Racheal, Bakanda, Celestin, Muramuzi, Emmy, Kaharuza, Frank, Malamba, Samuel, and Moore, David M

Subjects
3. Good health
Abstract

Background: We compared clinical outcomes among HIV-infected participants receiving ART who were randomized to viral load (VL) and CD4 cell count monitoring in comparison to CD4 cell count monitoring alone in Tororo, Uganda. Methods Beginning in May 2003, participants with CD4 cell counts

21. Afri-Can Forum 2

Author

Mukudu, Hillary, Martinson, Neil, Sartorius, Benn, Coetzee, Jenny, Dietrich, Janan, Mokgatswana, Kgaugelo, Jewkes, Rachel, Gray, Glenda E, Dugas, Marylène, Béhanzin, Luc, Guédou, Fernand A, Gagnon, Marie-Pierre, Alary, Michel, Rutakumwa, Rwamahe, Mbonye, Martin, Kiwanuka, Thadeus, Nakamanya, Sarah, Muhumuza, Richard, Nalukenge, Winfred, Seeley, Janet, Atujuna, Millicent, Wallace, Melissa, Brown, Ben, Bekker, Linda G, Newman, Peter A, Harryparsad, Rushil, Olivier, Abraham J, Jaspan, Heather B, Wilson, Douglas, Mkhize, Nonhlanhla, Morris, Lynn, Cianci, Gianguido, Dinh, Minh, Hope, Thomas, Passmore, Jo-Ann S, Gray, Clive M, Henrick, Bethany M, Yao, Xiao-Dan, Rosenthal, Kenneth L, Drannik, Anna G, Abimiku, Alash’le, Chanzu, Nadia, Mwanda, Walter, Oyugi, Julius, Anzala, Omu, Mbow, Moustapha, Jallow, Sabelle, Thiam, Moussa, Davis, Alberta, Diouf, Assane, Ndour, Cheikh T, Seydi, Moussa, Dieye, Tandakha N, Mboup, Souleymane, Goodier, Martin, Rilley, Eleanor, Jaye, Assan, Omange, RW., Lester, Richard T, Kimani, Joshua, Ball, T. B, Plummer, Francis A, Geraldo, Nassirou, Mastétsé, Ella G, Sossa, Jerôme C, Zannou, Marcel D, Osawe, Sophia, Okpokoro, Evaezi, Okolo, Felicia, Umaru, Stephen, Abimiku, Rebecca, Audu, Sam, Datong, Pam, Nyange, Jacquelyn, Olenja, Joyce, Mutua, Gaudensia, Jaoko, Walter, Omosa-Manyonyi, Gloria, Farah, Bashir, Khaniri, Maureen, Cockcroft, Anne, Tonkin, Kendra, Girish, Indu, Mhati, Puna, Cunningham, Ashley, Andersson, Neil, Indangasi, Jackton, Diphoko, Thabo, Gaseitsiwe, Simani, Maiswe, Victoria, Iketleng, Thato, Maruapula, Dorcas, Bedi, Keabetswe, Moyo, Sikhulile, Musonda, Rosemary, Wainberg, Mark, Makhema, Joseph, Novitsky, Vladimir, Marlink, Richard, Essex, Max, Okoboi, Stephen, Ssali, Livingstone, Kalibala, Sam, Birungi, Josephine, Egessa, Aggrey, Wangisi, Jonathan, Okullu, Lyavala J, Bakanda, Celestin, Obare, Francis, Boer, I. M S, Semvua, Hadija H, Van Den Boogaard, Jossy, Kiwango, Krisanta W, Ngowi, Kennedy M, Nieuwkerk, Pythia T, Aarnoutse, Rob E, Kiwelu, Ireen, Muro, Eva, Kibiki, Gibson S, Datiri, Ruth, Choji, Grace, Audu, Samuel, Fomsgaard, A., Karlsson, I., Jensen, K. J, Jensen, S. S, Leo-Hansen, C., Jespersen, S., Da Silva Té, D., Rodrigues, C. M, Da Silva, Z. J, Janitzek, C. M, Gerstoft, J., Kronborg, G., Daitiri, Ruth, Emily, Nyariki, Joyce, Olenja, Robert, Lorway R, Anzala, Anzala, Viljoen, Katie, Wendoh, Jerome, Kidzeru, Elvis, Karaoz, Ulas, Brodie, Eoin, Botha, Gerrit, Mulder, Nicola, Gray, Clive, Cameron, William, Stintzi, Alain, Jaspan, Heather, Levett, Paul N, Alexander, David, Gulzar, Naveed, Grewal, Prabvir S, Poon, Art F Y, Brumme, Zabrina, Harrigan, P. R, Brooks, James I, Sandstrom, Paul A, Calvez, Stryker, Sanche, Stephen E, Scott, Jamie K, Swartz, Leslie, Kagee, Ashraf, Lesch, Anthea, Kafaar, Zuhayr, De Wet, Anneliese, Smith, Tricia, Cotton, Laura, Hornschuh, Stefanie, Van Der Watt, Martin, Miller, Cari L, Gray, Glenda, Smit, Jenni, Jaggernath, Manjeetha, Ndung’u, Thumbi, Brockman, Mark, Kaida, Angela, Akolo, Maureen, Gelmon, Larry, Chitwa, Michael, Osero, Justus, Marokoane, Nobantu, Kgakole, Leagajang, Maswabi, Boikhutso, Mpofu, Neo, Ansari, Umaira, Nakinobe, Elizabeth, Miiro, George M, Zalwango, Flavia, Nakiyingi-Miiro, Jessica, Kaleebu, Potiano, Semwanga, John R, Nyanzi, Emily, Musoke, Saidat N, Miiro, George, Mbidde, Edward K, Lutalo, Tom, Kaleebu, Pontiano, Handema, Ray, Chianzu, Graham P, Diagne-Gueye, Diabou, Ndiaye, Mame K, Ndiaye, Birahim P, Traore, Ibrahima, Dia, Mamadou C, Thomas, Gilleh, Tour-Kane, Coumba, Mpendo, Juliet, Muyindike, Winnie, Kambugu, Andrew, Sebastian, Hachizovu, Ray, Handema, Mike, Chaponda, Bertin, Kabuya J, Modest, Mulenga, Janha, Omar, Amambua-Ngwa, Alfred, Nwakanma, Davis C, Jespersen, Sanne, Hønge, Bo L, Esbjörnsson, Joakim, Medina, Candida, Da Silva TÉ, David, Correira, Faustino G, Laursen, Alex L, Østergaard, Lars, Andersen, Andreas, Aaby, Peter, Erikstrup, Christian, Wejse, Christian, Dieye, Siry, Sarr, Moussa, Sy, Haby, Mbodj, Helene D, Ndiaye, Marianne, Ndiaye, Amy, Moussa, Seydi, Nyombi, Balthazar M, Shao, Elichilia R, Chilumba, Innocent B, Inyang, Bucky, Izang, Abel, Cole, Chundung, Cameron, Bill, Rosenthal, Kenneth, Seraise, Boitumelo, and Andrea-Marobela, Kerstin

Subjects
Infectious Diseases
Abstract

Table of contents A1 Introduction to the 2nd synchronicity forum of GHRI/CHVI-funded Canadian and African HIV prevention and vaccine teams O1 Voluntary medical male circumcision for prevention of heterosexual transmission of HIV in adult males in Soweto: What do indicators and incidence rate show? Hillary Mukudu, Neil Martinson, Benn Sartorius O2 Developing a peer-led community mobilization program for sex workers in Soweto: HIV risk and demographics Jenny Coetzee, Janan Dietrich, Kgaugelo Mokgatswana, Rachel Jewkes, Glenda E. Gray O3 Salient beliefs about adherence: A qualitative survey conducted as part of the demonstration study on "treatment as prevention" (TasP) and "pre-exposure prophylaxis" (PrEP) among female sex workers (FSWS) in Cotonou, Benin Marylène Dugas, Luc Béhanzin, Fernand A. Guédou, Marie-Pierre Gagnon, Michel Alary O4 Relative perception of risk as a driver of unsafe sexual practices among key populations: Cases of fisherfolk and women and their partners involved in multiple sexual partnerships in Uganda Rwamahe Rutakumwa, Martin Mbonye, Thadeus Kiwanuka, Sarah Nakamanya, Richard Muhumuza, Winfred Nalukenge, Janet Seeley O5 Exploring the acceptability of new biomedical HIV prevention technologies among MSM, adolescents and heterosexual adults in South Africa Millicent Atujuna, Melissa Wallace, Ben Brown, Linda Gail Bekker, Peter A. Newman O6 HIV-susceptible target cells in foreskins after voluntary medical male circumcision in South Africa Rushil Harryparsad, Abraham J. Olivier, Heather B. Jaspan, Douglas Wilson, Janan Dietrich, Neil Martinson, Hillary Mukudu, Nonhlanhla Mkhize, Lynn Morris, Gianguido Cianci, Minh Dinh, Thomas Hope, Jo-Ann S. Passmore, Clive M. Gray O7 HIV-1 proteins activate innate immune responses via TLR2 heterodimers Bethany M. Henrick, Xiao-Dan Yao, Kenneth L. Rosenthal, the INFANT Study Team O8 Characterization of an innate factor in human milk and mechanisms of action against HIV-1 Bethany M. Henrick, Xiao-Dan Yao, Anna G. Drannik, Alash’le Abimiku, Kenneth L. Rosenthal, the INFANT Study Team O9 Secretor status and susceptibility to HIV infections among female sex workers in Nairobi, Kenya Nadia Chanzu, Walter Mwanda, Julius Oyugi, Omu Anzala O10 Natural Killer cell recall responsiveness to Gag-HIV-1 peptides of HIV-1 exposed but uninfected subjects are associated with peripheral CXCR6+ NK cell subsets Moustapha Mbow, Sabelle Jallow, Moussa Thiam, Alberta Davis, Assane Diouf, Cheikh T. Ndour, Moussa Seydi, Tandakha N. Dieye, Souleymane Mboup, Martin Goodier, Eleanor Rilley, Assan Jaye O11 Profiles of resistance: Local innate mucosal immunity to HIV-1 in commercial sex workers Xiao-Dan Yao, RW. Omange, Bethany M. Henrick, Richard T. Lester, Joshua Kimani, T. Blake Ball, Francis A. Plummer, Kenneth L. Rosenthal O12 Early antiretroviral therapy and pre-exposure prophylaxis for HIV prevention among female sex workers in Cotonou, Benin: A demonstration project Luc Béhanzin, Fernand A. Guédou, Nassirou Geraldo, Ella Goma Mastétsé, Jerôme Charles Sossa, Marcel Djimon Zannou, Michel Alary O13 Building capacity for HIV prevention trials: Preliminary data from a Nigerian cohort of HIV exposed sero-negatives (HESN) Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Sam Audu, Pam Datong, Alash’le Abimiku O14 Equipping healthcare professionals with skills required for the conduct of clinical trials in an effort to build capacity. Lessons learned Jacquelyn Nyange, Joyce Olenja, Gaudensia Mutua, Walter Jaoko, Gloria Omosa-Manyonyi, Bashir Farah, Maureen Khaniri, Omu Anzala O15 Educational technology to support active learning for HIV researchers and planners Anne Cockcroft, Kendra Tonkin, Indu Girish, Puna Mhati, Ashley Cunningham, Neil Andersson O16 From Lake Kivu (Rwanda) and Lake Malawi (Tanzania) to the shores of Lake Victoria (Uganda): Strengthening laboratory capacity through Good Clinical Laboratory Practice training Bashir Farah, Jackton Indangasi, Walter Jaoko, Gaudensia Mutua, Maureen Khaniri, Jacquelyn Nyange, Omu Anzala O17 Rilpivirine and etravirine resistance mutations in HIV-1 subtype C infected patients on a non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy in Botswana Thabo Diphoko, Simani Gaseitsiwe, Victoria Maiswe, Thato Iketleng, Dorcas Maruapula, Keabetswe Bedi, Sikhulile Moyo, Rosemary Musonda, Mark Wainberg, Joseph Makhema, Vladimir Novitsky, Richard Marlink, Max Essex O18 From home-based HIV testing to initiation of treatment: The AIDS Support Organization (TASO) Experience with Home-based HIV Counselling and Testing (HBHCT) among Adolescents in Uganda, 2005-2011 Stephen Okoboi, Livingstone Ssali, Sam Kalibala, Josephine Birungi, Aggrey Egessa, Jonathan Wangisi, Lyavala Joanne Okullu, Celestin Bakanda, Francis Obare41 O19 Feasibility study on using real time medication monitoring among HIV infected and Tuberculosis patients in Kilimanjaro, Tanzania I. Marion Sumari-de Boer, Hadija H. Semvua, Jossy van den Boogaard, Krisanta W. Kiwango, Kennedy M. Ngowi, Pythia T. Nieuwkerk, Rob E. Aarnoutse, Ireen Kiwelu, Eva Muro, Gibson S. Kibiki O20 Deaths still among sero-discordant cohort in Nigeria despite Access to treatment Ruth Datiri, Grace Choji, Sophia Osawe, Evaezi Okpokoro, Felicia Okolo, Stephen Umaru, Rebecca Abimiku, Samuel Audu, Pam Datong, Alash’le Abimiku O21 Therapeutic HIV-1 vaccine trials in Denmark and Guinea-Bissau Fomsgaard A, Karlsson I, Jensen KJ, Jensen SS, Leo-Hansen C, Jespersen S, Da Silva Té D, Rodrigues CM, da Silva ZJ, Janitzek CM, Gerstoft J, Kronborg G, the WAPHIR Group O22 Willingness to participate in a HIV vaccine Trial among HIV exposed sero-negative (HESN) persons in Jos, Nigeria Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku O23 Clinical research volunteers’ perceptions and experiences of screening for enrolment at KAVI-Institute of Clinical Research, Kenya Nyariki Emily, Olenja Joyce, Lorway R. Robert, Anzala Anzala O24 Gut microbiome, HIV-exposure, and vaccine responses in South African infants Katie Viljoen, Jerome Wendoh, Elvis Kidzeru, Ulas Karaoz, Eoin Brodie, Gerrit Botha, Nicola Mulder, Clive Gray, William Cameron, Alain Stintzi, Heather Jaspan, for the INFANT study team O25 Analysis of HIV pol diversity in the concentrated HIV epidemic in Saskatchewan Paul N. Levett, David Alexander, Naveed Gulzar, Prabvir S. Grewal, Art F. Y. Poon, Zabrina Brumme, P. Richard Harrigan, James I. Brooks, Paul A. Sandstrom, Stryker Calvez, Stephen E. Sanche, Jamie K. Scott P1 Evaluating a HIV vaccine research community engagement programme at two HIV prevention research centres in the Western Cape Leslie Swartz, Ashraf Kagee, Anthea Lesch, Zuhayr Kafaar, Anneliese De Wet P2 Validating HIV acquisition risk score using a cohort HIV exposed sero-negative persons in a discordant relationship in Jos, Nigeria, West Africa Evaezi Okpokoro, Sophia Osawe, Ruth Daitiri, Grace Choji, Stephen Umaru, Felicia Okolo, Pam Datong, Alash'le Abimiku P3 Bridging the gap between adults and adolescents and youth adults (AYA) – Employing a youth-centred approach to investigate HIV risk among AYA in Soweto and Durban, South Africa Janan Dietrich, Tricia Smith, Laura Cotton, Stefanie Hornschuh, Martin van der Watt, Cari L. 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Chianzu P9 The Development of HIV Bio-bank resource management to support clinical trial and Intervention research: WAPHIR experience Moussa Thiam, Diabou Diagne-Gueye, Mame K. Ndiaye, Moustapha Mbow, Birahim P. Ndiaye, Ibrahima Traore, Mamadou C. Dia, Gilleh Thomas, Coumba Tour-Kane, Souleymane Mboup, Assan Jaye P10 Capacity building for clinical trials as a novel approach for scaling up HIV prevention research initiatives in East Africa: achievements and challenges Emily Nyanzi, Edward Katongole Mbidde, Pontiano Kaleebu, Juliet Mpendo, Joshua Kimani, Josephine Birungi, Winnie Muyindike, Andrew Kambugu P11 Community and media perspective of research; an advocacy workshop on HIV prevention research Hachizovu Sebastian, Handema Ray, Chaponda Mike, Kabuya Jean Bertin, Mulenga Modest P12 Development of a quantitative HIV-1 and HIV-2 real time PCR (qRT-PCR) viral load assay Moussa Thiam, Omar Janha, Alberta Davis, Alfred Amambua-Ngwa, Davis C. 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Chilumba, Sikhulile Moyo, Simani Gaseitsiwe, Rosemary Musonda P16 Breast-fed HIV-1 exposed infants play catch up. A preliminary report Pam Datong, Bucky Inyang, Sophia Osawe, Abel Izang, Chundung Cole, Felicia Okolo, Bill Cameron, Kenneth Rosenthal, Clive Gray, Heather Jaspan, Alash’le Abimiku, the INFANT study team P17 The frequency of N348I mutation in patient failing combination antiretroviral treatment In Botswana Boitumelo Seraise, Kerstin Andrea-Marobela, Sikhulile Moyo, Rosemary Musonda, Joseph Makhema, Max Essex, Simani Gaseitsiwe

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22. Male gender predicts mortality in a large cohort of patients receiving antiretroviral therapy in Uganda

Author

Mills, Edward J, Bakanda, Celestin, Birungi, Josephine, Chan, Keith, Hogg, Robert S, Ford, Nathan, Nachega, Jean B, and Cooper, Curtis L

Subjects
3. Good health
Abstract

Background: Because men in Africa are less likely to access HIV/AIDS care than women, we aimed to determine if men have differing outcomes from women across a nationally representative sample of adult patients receiving combination antiretroviral therapy in Uganda. Methods: We estimated survival distributions for adult male and female patients using Kaplan-Meier, and constructed multivariable regressions to model associations of baseline variables with mortality. We assessed person-years of life lost up to age 55 by sex. To minimize the impact of patient attrition, we assumed a weighted 30% mortality rate among those lost to follow up. Results: We included data from 22,315 adults receiving antiretroviral therapy. At baseline, men tended to be older, had lower CD4 baseline values, more advanced disease, had pulmonary tuberculosis and had received less treatment follow up (all at p < 0.001). Loss to follow up differed between men and women (7.5 versus 5.9%, p < 0.001). Over the period of study, men had a significantly increased risk of death compared with female patients (adjusted hazard ratio 1.43, 95% CI 1.31-1.57, p < 0.001). The crude mortality rate for males differed importantly from females (43.9, 95% CI 40.7-47.0/1000 person-years versus 26.9, 95% CI 25.4-28.5/1000 person years, p < 0.001). The probability of survival was 91.2% among males and 94.1% among females at 12 months. Person-years of life lost was lower for females than males (689.7 versus 995.9 per 1000 person-years, respectively). Conclusions: In order to maximize the benefits of antiretroviral therapy, treatment programmes need to be gender sensitive to the specific needs of both women and men. Particular efforts are needed to enroll men earlier into care.

23. Predictive value of CD4 cell count nadir on long-term mortality in HIV-positive patients in Uganda.

Author

Bray S, Gedeon J, Hadi A, Kotb A, Rahman T, Sarwar E, Savelyeva A, Sévigny M, Bakanda C, Birungi J, Chan K, Yaya S, Deonandan R, and Mills EJ

Abstract

Objective: Although international guidelines recommend initiating antiretroviral therapy (ART) when a patient's CD4 cell count is ≤350 cells/μL, most patients in resource-limited settings present with much lower CD4 cell counts. The lowest level that their CD4 cell count reaches, the nadir, may have long-term consequences in terms of mortality. We examined this health state in a large cohort of HIV+ patients in Uganda., Design: This was an observational study of HIV patients in Uganda aged 14 years or older, who were enrolled in 10 major clinics across Uganda., Methods: We assessed the CD4 nadir of patients, using their CD4 cell count at initiation of ART, stratified into categories (,50, 50-99, 100-149, 150-249, 250+ cells/μL). We constructed Kaplan-Meier curves to assess the differences in survivorship for patients left-censored at 1 year and 2 years after treatment initiation. We used Cox proportional hazards regression to model the associations between CD4 nadir and mortality. We adjusted mortality for loss-to-follow-up., Results: Of 22,315 patients, 20,129 patients had greater than 1 year of treatment follow-up. Among these patients, 327 (1.6%) died and 444 (2.2%) were lost to follow-up. After left-censoring at one year, relative to lowest CD4 strata, patients with higher CD4 counts had significantly lower rates of mortality (CD4 150-249, hazard ratio [HR] 0.60, 95% confidence interval [CI]: 0.45-0.82, P = 0.001; 250+, HR 0.66, 95% CI, 0.44-1.00, P = -0.05). Male sex, older age, and duration of time on ART were independently associated with mortality. When left-censoring at 2 years, CD4 nadir was no longer statistically significantly associated with mortality., Conclusion: After surviving for 1 year on ART, a CD4 nadir was strongly predictive of longer-term mortality among patients in Uganda. This should argue for efforts to increase engagement with patients to ensure a higher CD4 nadir at initiation of treatment.

Published
2012
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