33 results on '"Galiwango R"'
Search Results
2. PP 7.7 – 00055 Temporary increase in circulating replication-competent latent HIV-infected resting CD4+ T cells after switch to a Dolutegravir-based antiretroviral regiment
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Ferreira, R.-C., primary, Reynolds, S.J., additional, Capoferri, Adam A., additional, Gowanlock, S.N., additional, Baker, O.R., additional, Miller, J., additional, Brown, E.E., additional, Saraf, S., additional, Kirby, C., additional, Lynch, B., additional, Hackman, J., additional, Lai, J., additional, Tomusange, S., additional, Kityamuweesi, T., additional, Jamiru, S., additional, Anok, A., additional, Buule, P., additional, Bruno, D., additional, Martens, C., additional, Rose, R., additional, Lamers, S.L., additional, Galiwango, R., additional, Poon, A., additional, Quinn, T.C., additional, Prodger, J.L., additional, and Redd, A.D., additional
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- 2022
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3. Inferring HIV-1 transmission networks and sources of epidemic spread in Africa with deep-sequence phylogenetic analysis
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Ratmann, O., Grabowski, M.K., Hall, M., Golubchik, T., Wymant, C., Abeler-Dörner, L., Bonsall, D., Hoppe, A., Brown, A.L., de Oliveira, T., Gall, A., Kellam, P., Pillay, D., Kagaayi, J., Kigozi, G., Quinn, T.C., Wawer, M.J., Laeyendecker, O., Serwadda, D., Gray, R.H., Fraser, C., Ayles, H., Bowden, R., Calvez, V., Cohen, M., Dennis, A., Essex, M., Fidler, S., Frampton, D., Hayes, R., Herbeck, J.T., Kaleebu, P., Kityo, C., Lingappa, J., Novitsky, V., Paton, N., Rambaut, A., Seeley, J., Ssemwanga, D., Tanser, F., Nakigozi, G., Ssekubugu, R., Nalugoda, F., Lutalo, T., Galiwango, R., Makumbi, F., Sewankambo, N.K., R. Tobian, A.A., Reynolds, S.J., Chang, L.W., Nabukalu, D., Ndyanabo, A., Ssekasanvu, J., Nakawooya, H., Nakukumba, J., Kigozi, G.N., Nantume, B.S., Resty, N., Kambasu, J., Nalugemwa, M., Nakabuye, R., Ssebanobe, L., Nankinga, J., Kayiira, A., Nanfuka, G., Ahimbisibwe, R., Tomusange, S., Galiwango, R.M., Kalibbali, S., Nakalanzi, M., Otobi, J.O., Ankunda, D., Ssembatya, J.L., Ssemanda, J.B., Kairania, R., Kato, E., Kisakye, A., Batte, J., Ludigo, J., Nampijja, A., Watya, S., Nehemia, K., Anyokot, M., Mwinike, J., Kibumba, G., Ssebowa, P., Mondo, G., Wasswa, F., Nantongo, A., Kakembo, R., Galiwango, J., Ssemango, G., Redd, A.D., Santelli, J., Kennedy, C.E., and Wagman, J.
- Abstract
To prevent new infections with human immunodeficiency virus type 1 (HIV-1) in sub-Saharan Africa, UNAIDS recommends targeting interventions to populations that are at high risk of acquiring and passing on the virus. Yet it is often unclear who and where these ‘source’ populations are. Here we demonstrate how viral deep-sequencing can be used to reconstruct HIV-1 transmission networks and to infer the direction of transmission in these networks. We are able to deep-sequence virus from a large population-based sample of infected individuals in Rakai District, Uganda, reconstruct partial transmission networks, and infer the direction of transmission within them at an estimated error rate of 16.3% [8.8–28.3%]. With this error rate, deep-sequence phylogenetics cannot be used against individuals in legal contexts, but is sufficiently low for population-level inferences into the sources of epidemic spread. The technique presents new opportunities for characterizing source populations and for targeting of HIV-1 prevention interventions in Africa.
- Published
- 2019
4. The effect of current Schistosoma mansoni infection on the immunogenicity of a candidate TB vaccine, MVA85A, in BCG-vaccinated adolescents: An open-label trial
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Wajja, A, Kizito, D, Nassanga, B, Nalwoga, A, Kabagenyi, J, Kimuda, S, Galiwango, R, Mutonyi, G, Vermaak, S, Satti, I, Verweij, J, Tukahebwa, E, Cose, S, Levin, J, Kaleebu, P, Elliott, AM, McShane, H, and Diemert, DJ
- Subjects
0301 basic medicine ,Bacterial Diseases ,Male ,Physiology ,T-Lymphocytes ,Biochemistry ,0302 clinical medicine ,Immunogenicity, Vaccine ,Immune Physiology ,Medicine and Health Sciences ,Vaccines, DNA ,Uganda ,Enzyme-Linked Immunoassays ,Child ,Tuberculosis Vaccines ,Immune Response ,education.field_of_study ,Vaccines ,Immunity, Cellular ,Immune System Proteins ,ELISPOT ,Immunogenicity ,lcsh:Public aspects of medicine ,Vaccination ,Schistosoma mansoni ,Antibodies, Bacterial ,3. Good health ,Infectious Diseases ,Helminth Infections ,Research Design ,BCG Vaccine ,Female ,Tuberculosis vaccines ,Research Article ,Tuberculosis ,lcsh:Arctic medicine. Tropical medicine ,Infectious Disease Control ,Adolescent ,Clinical Research Design ,lcsh:RC955-962 ,030231 tropical medicine ,Population ,Immunology ,Biology ,Research and Analysis Methods ,03 medical and health sciences ,Helminths ,parasitic diseases ,medicine ,Parasitic Diseases ,Animals ,Humans ,Antigens ,education ,Immunoassays ,Antigens, Bacterial ,Reactogenicity ,Public Health, Environmental and Occupational Health ,Organisms ,Biology and Life Sciences ,Proteins ,lcsh:RA1-1270 ,medicine.disease ,Tropical Diseases ,Virology ,Invertebrates ,Schistosomiasis mansoni ,030104 developmental biology ,Immunoglobulin G ,Immunologic Techniques ,Linear Models ,Adverse Events ,BCG vaccine ,Acyltransferases - Abstract
Introduction Helminth infection may affect vaccine immunogenicity and efficacy. Adolescents, a target population for tuberculosis booster vaccines, often have a high helminth burden. We investigated effects of Schistosoma mansoni (Sm) on the immunogenicity and safety of MVA85A, a model candidate tuberculosis vaccine, in BCG-vaccinated Ugandan adolescents. Methods In this phase II open label trial we enrolled 36 healthy, previously BCG-vaccinated adolescents, 18 with no helminth infection detected, 18 with Sm only. The primary outcome was immunogenicity measured by Ag85A-specific interferon gamma ELISpot assay. Tuberculosis and schistosome-specific responses were also assessed by whole-blood stimulation and multiplex cytokine assay, and by antibody ELISAs. Results Ag85A-specific cellular responses increased significantly following immunisation but with no differences between the two groups. Sm infection was associated with higher pre-immunisation Ag85A-specific IgG4 but with no change in antibody levels following immunisation. There were no serious adverse events. Most reactogenicity events were of mild or moderate severity and resolved quickly. Conclusions The significant Ag85A-specific T cell responses and lack of difference between Sm-infected and uninfected participants is encouraging for tuberculosis vaccine development. The implications of pre-existing Ag85A-specific IgG4 antibodies for protective immunity against tuberculosis among those infected with Sm are not known. MVA85A was safe in this population. Trial registration ClinicalTrials.gov NCT02178748, Author summary There is an urgent global need for an improved TB vaccine strategy. Adolescents are an important target population for a TB vaccine. In field settings where the need for a vaccine is greatest, co-infection with other pathogens including malaria, HIV and helminths, may interfere with the impact of such strategies. In this study, we used a model TB vaccine candidate based on a genetically engineered viral vector, and with an excellent safety profile, to determine whether there was any immunological interference when this vaccine was used in adolescents who were co-infected with S. mansoni. Our data shows comparable immunogenicity in adolescents infected and uninfected with S. mansoni, suggesting that co-infection with this helminth species may not have an adverse impact on candidate TB vaccines of this type. The vaccine was safe and induced robust cellular responses in both the infected and uninfected adolescents following immunisation. These findings are important and encouraging for tuberculosis vaccine development.
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- 2017
5. Analysis of pig trading networks and practices in Uganda
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Atherstone, C., primary, Galiwango, R. G., additional, Grace, D., additional, Alonso, S., additional, Dhand, N. K., additional, Ward, M. P., additional, and Mor, S. M., additional
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- 2018
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6. Foreskin T-cell subsets differ substantially from blood with respect to HIV co-receptor expression, inflammatory profile, and memory status
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Prodger, J L, primary, Gray, R, additional, Kigozi, G, additional, Nalugoda, F, additional, Galiwango, R, additional, Hirbod, T, additional, Wawer, M, additional, Hofer, S O P, additional, Sewankambo, N, additional, Serwadda, D, additional, and Kaul, R, additional
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- 2012
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7. Immune correlates of HIV exposure without infection in foreskins of men from Rakai, Uganda.
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Prodger, J L, Hirbod, T, Kigozi, G, Nalugoda, F, Reynolds, S J, Galiwango, R, Shahabi, K, Serwadda, D, Wawer, M J, Gray, R H, and Kaul, R
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- 2014
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8. Inferring HIV-1 transmission networks and sources of epidemic spread in Africa with deep-sequence phylogenetic analysis
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Ratmann, O., Grabowski, M.K., Hall, M., Golubchik, T., Wymant, C., Abeler-Dörner, L., Bonsall, D., Hoppe, A., Brown, A.L., de Oliveira, T., Gall, A., Kellam, P., Pillay, D., Kagaayi, J., Kigozi, G., Quinn, T.C., Wawer, M.J., Laeyendecker, O., Serwadda, D., Gray, R.H., Fraser, C., Ayles, H., Bowden, R., Calvez, V., Cohen, M., Dennis, A., Essex, M., Fidler, S., Frampton, D., Hayes, R., Herbeck, J.T., Kaleebu, P., Kityo, C., Lingappa, J., Novitsky, V., Paton, N., Rambaut, A., Seeley, J., Ssemwanga, D., Tanser, F., Nakigozi, G., Ssekubugu, R., Nalugoda, F., Lutalo, T., Galiwango, R., Makumbi, F., Sewankambo, N.K., R. Tobian, A.A., Reynolds, S.J., Chang, L.W., Nabukalu, D., Ndyanabo, A., Ssekasanvu, J., Nakawooya, H., Nakukumba, J., Kigozi, G.N., Nantume, B.S., Resty, N., Kambasu, J., Nalugemwa, M., Nakabuye, R., Ssebanobe, L., Nankinga, J., Kayiira, A., Nanfuka, G., Ahimbisibwe, R., Tomusange, S., Galiwango, R.M., Kalibbali, S., Nakalanzi, M., Otobi, J.O., Ankunda, D., Ssembatya, J.L., Ssemanda, J.B., Kairania, R., Kato, E., Kisakye, A., Batte, J., Ludigo, J., Nampijja, A., Watya, S., Nehemia, K., Anyokot, M., Mwinike, J., Kibumba, G., Ssebowa, P., Mondo, G., Wasswa, F., Nantongo, A., Kakembo, R., Galiwango, J., Ssemango, G., Redd, A.D., Santelli, J., Kennedy, C.E., Wagman, J., Ratmann, O., Grabowski, M.K., Hall, M., Golubchik, T., Wymant, C., Abeler-Dörner, L., Bonsall, D., Hoppe, A., Brown, A.L., de Oliveira, T., Gall, A., Kellam, P., Pillay, D., Kagaayi, J., Kigozi, G., Quinn, T.C., Wawer, M.J., Laeyendecker, O., Serwadda, D., Gray, R.H., Fraser, C., Ayles, H., Bowden, R., Calvez, V., Cohen, M., Dennis, A., Essex, M., Fidler, S., Frampton, D., Hayes, R., Herbeck, J.T., Kaleebu, P., Kityo, C., Lingappa, J., Novitsky, V., Paton, N., Rambaut, A., Seeley, J., Ssemwanga, D., Tanser, F., Nakigozi, G., Ssekubugu, R., Nalugoda, F., Lutalo, T., Galiwango, R., Makumbi, F., Sewankambo, N.K., R. Tobian, A.A., Reynolds, S.J., Chang, L.W., Nabukalu, D., Ndyanabo, A., Ssekasanvu, J., Nakawooya, H., Nakukumba, J., Kigozi, G.N., Nantume, B.S., Resty, N., Kambasu, J., Nalugemwa, M., Nakabuye, R., Ssebanobe, L., Nankinga, J., Kayiira, A., Nanfuka, G., Ahimbisibwe, R., Tomusange, S., Galiwango, R.M., Kalibbali, S., Nakalanzi, M., Otobi, J.O., Ankunda, D., Ssembatya, J.L., Ssemanda, J.B., Kairania, R., Kato, E., Kisakye, A., Batte, J., Ludigo, J., Nampijja, A., Watya, S., Nehemia, K., Anyokot, M., Mwinike, J., Kibumba, G., Ssebowa, P., Mondo, G., Wasswa, F., Nantongo, A., Kakembo, R., Galiwango, J., Ssemango, G., Redd, A.D., Santelli, J., Kennedy, C.E., and Wagman, J.
- Abstract
To prevent new infections with human immunodeficiency virus type 1 (HIV-1) in sub-Saharan Africa, UNAIDS recommends targeting interventions to populations that are at high risk of acquiring and passing on the virus. Yet it is often unclear who and where these ‘source’ populations are. Here we demonstrate how viral deep-sequencing can be used to reconstruct HIV-1 transmission networks and to infer the direction of transmission in these networks. We are able to deep-sequence virus from a large population-based sample of infected individuals in Rakai District, Uganda, reconstruct partial transmission networks, and infer the direction of transmission within them at an estimated error rate of 16.3% [8.8–28.3%]. With this error rate, deep-sequence phylogenetics cannot be used against individuals in legal contexts, but is sufficiently low for population-level inferences into the sources of epidemic spread. The technique presents new opportunities for characterizing source populations and for targeting of HIV-1 prevention interventions in Africa.
9. High retention and appropriate use of insecticide-treated nets distributed to HIV-affected households in Rakai, Uganda: results from interviews and home visits
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Ludigo James, Galiwango Ronald, Jacobs Ilana, Kagaayi Joseph, Mills Lisa A, Cohee Lauren, Ssekasanvu Joseph, and Reynolds Steven J
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Arctic medicine. Tropical medicine ,RC955-962 ,Infectious and parasitic diseases ,RC109-216 - Abstract
Abstract Background Distribution of insecticide-treated nets (ITNs) has recently been incorporated into comprehensive care strategies for HIV-positive people in malaria-endemic areas. WHO now recommends free or low-cost distribution of ITNs to all persons in malaria-endemic areas, regardless of age, pregnancy and HIV status. Knowledge about and appropriate use of ITNs among HIV-positive ITN recipients and their household members has not been well characterized. Methods 142 randomly selected adults were interviewed in July–August 2006 to assess knowledge, retention, and appropriate use of ITNs they had received through a PEPFAR-funded comprehensive HIV care programme in rural Uganda. Results Among all participants, 102 (72%, CI: 65%–79%) reported they had no ITNs except those provided by the programme. Of 131 participants who stated they were given ≥ 1 ITN, 128 (98%, CI: 96%–100%) stated they still possessed at least one programme-provided ITN. Reported programme-ITN (pITN) use by participants was high: 119 participants (91%, CI: 86%–96%) reported having slept under pITN the night prior to the survey and 115 (88%, CI: 82%–94%) reported sleeping under pITN seven days per week. Being away from home and heat were the most common reasons given for not sleeping under an ITN. A sub-study of thirteen random home visits demonstrated concordance between participants' survey reports and actual use of ITNs in homes. Conclusion There was excellent self-reported retention and appropriate use of ITNs distributed as a part of a community-based outpatient HIV care programme. Participants perceived ITNs as useful and were unlikely to have received ITNs from other sources.
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- 2009
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10. HIV Prevention Efforts and Incidence of HIV in Uganda.
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Grabowski, M. K., Serwadda, D. M., Gray, R. H., Nakigozi, G., Kigozi, G., Kagaayi, J., Ssekubugu, R., Nalugoda, F., Lessler, J., Lutalo, T., Galiwango, R. M., Makumbi, F., Kong, X., Kabatesi, D., Alamo, S. T., Wiersma, S., Sewankambo, N. K., Tobian, A. A. R., Laeyendecker, O., and Quinn, T. C.
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HIV prevention , *ANTIRETROVIRAL agents , *AIDS , *CIRCUMCISION , *VIRAL load , *SEROCONVERSION , *PUBLIC health - Abstract
Background: To assess the effect of a combination strategy for prevention of human immunodeficiency virus (HIV) on the incidence of HIV infection, we analyzed the association between the incidence of HIV and the scale-up of antiretroviral therapy (ART) and medical male circumcision in Rakai, Uganda. Changes in population-level viral-load suppression and sexual behaviors were also examined.Methods: Between 1999 and 2016, data were collected from 30 communities with the use of 12 surveys in the Rakai Community Cohort Study, an open, population-based cohort of persons 15 to 49 years of age. We assessed trends in the incidence of HIV on the basis of observed seroconversion data, participant-reported use of ART, participant-reported male circumcision, viral-load suppression, and sexual behaviors.Results: In total, 33,937 study participants contributed 103,011 person-visits. A total of 17,870 persons who were initially HIV-negative were followed for 94,427 person-years; among these persons, 931 seroconversions were observed. ART was introduced in 2004, and by 2016, ART coverage was 69% (72% among women vs. 61% among men, P<0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P<0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P<0.001). The percentage of adolescents 15 to 19 years of age who reported never having initiated sex (i.e., delayed sexual debut) increased from 30% in 1999 to 55% in 2016 (P<0.001). By 2016, the mean incidence of HIV infection had declined by 42% relative to the period before 2006 (i.e., before the scale-up of the combination strategy for HIV prevention) - from 1.17 cases per 100 person-years to 0.66 cases per 100 person-years (adjusted incidence rate ratio, 0.58; 95% confidence interval [CI], 0.45 to 0.76); declines were greater among men (adjusted incidence rate ratio, 0.46; 95% CI, 0.29 to 0.73) than among women (adjusted incidence rate ratio, 0.68; 95% CI, 0.50 to 0.94).Conclusions: In this longitudinal study, the incidence of HIV infection declined significantly with the scale-up of a combination strategy for HIV prevention, which provides empirical evidence that interventions for HIV prevention can have a population-level effect. However, additional efforts are needed to overcome disparities according to sex and to achieve greater reductions in the incidence of HIV infection. (Funded by the National Institute of Allergy and Infectious Diseases and others.). [ABSTRACT FROM AUTHOR]- Published
- 2017
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11. Enhancing genomics and bioinformatics access in Africa: an imperative leap.
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Aruhomukama D, Galiwango R, Meehan CJ, and Asiimwe B
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- Africa, Humans, Genomics, Computational Biology
- Abstract
Competing Interests: We declare no competing interests.
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- 2024
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12. Generalizability of machine learning in predicting antimicrobial resistance in E. coli: a multi-country case study in Africa.
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Nsubuga M, Galiwango R, Jjingo D, and Mboowa G
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- Drug Resistance, Bacterial genetics, Ciprofloxacin pharmacology, Ciprofloxacin therapeutic use, Ampicillin, Cefotaxime, Machine Learning, Nigeria, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Escherichia coli genetics
- Abstract
Background: Antimicrobial resistance (AMR) remains a significant global health threat particularly impacting low- and middle-income countries (LMICs). These regions often grapple with limited healthcare resources and access to advanced diagnostic tools. Consequently, there is a pressing need for innovative approaches that can enhance AMR surveillance and management. Machine learning (ML) though underutilized in these settings, presents a promising avenue. This study leverages ML models trained on whole-genome sequencing data from England, where such data is more readily available, to predict AMR in E. coli, targeting key antibiotics such as ciprofloxacin, ampicillin, and cefotaxime. A crucial part of our work involved the validation of these models using an independent dataset from Africa, specifically from Uganda, Nigeria, and Tanzania, to ascertain their applicability and effectiveness in LMICs., Results: Model performance varied across antibiotics. The Support Vector Machine excelled in predicting ciprofloxacin resistance (87% accuracy, F1 Score: 0.57), Light Gradient Boosting Machine for cefotaxime (92% accuracy, F1 Score: 0.42), and Gradient Boosting for ampicillin (58% accuracy, F1 Score: 0.66). In validation with data from Africa, Logistic Regression showed high accuracy for ampicillin (94%, F1 Score: 0.97), while Random Forest and Light Gradient Boosting Machine were effective for ciprofloxacin (50% accuracy, F1 Score: 0.56) and cefotaxime (45% accuracy, F1 Score:0.54), respectively. Key mutations associated with AMR were identified for these antibiotics., Conclusion: As the threat of AMR continues to rise, the successful application of these models, particularly on genomic datasets from LMICs, signals a promising avenue for improving AMR prediction to support large AMR surveillance programs. This work thus not only expands our current understanding of the genetic underpinnings of AMR but also provides a robust methodological framework that can guide future research and applications in the fight against AMR., (© 2024. The Author(s).)
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- 2024
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13. Alcohol Consumption Modifies Susceptibility to HIV-1 Entry in Cervical Mucosa-Derived CD4+ T cells of Women Resident in a Fishing Community of Lake Victoria, Uganda.
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Bernard Ssentalo B, Driciru E, Fahad M, Nantongo M, Namuleme M, Kitandwe PK, Ssekayita EM, Galiwango R, Mirembe V, Muwenda BK, Muwanga M, Kayongo A, and Lutwama F
- Abstract
Background: A significant overlap exists in the burden of Alcohol Use Disorders (AUDs) and the HIV epidemic in Sub-Saharan Africa. Over 60% of HIV infections occur in women, mostly through the cervical mucosa. Absorption and systemic circulation of alcohol induces global physiological and immune effects, including at the genital mucosa. Alcohol alters expression of cell surface receptors, mucosal barrier permeability, inflammatory responses, and lymphocyte trafficking and homing. However, a substantial knowledge gap exists on whether these cellular and or immunological effects of alcohol modify the consumers' CD4+ T cell susceptibility to HIV-1 entry at the cervical mucosa. HIV seronegative women, aged 18-49 years were recruited from Kasenyi and Kigungu fish landing sites of Lake Victoria. They were categorized as Alcohol Consumers (n=27) or non-Alcohol Consumers (n=26) based on the World Health Organization Alcohol-Use-Disorder-Test (WHO-AUDIT) at a cut-off score of >=8/40 and <8/40, respectively. Cytobrush-collected Cervical Mononuclear Cells [CMCs] and Peripheral Blood Mononuclear Cells [PBMCs] from heparinized whole-blood were surface stained for CD4+ T cell immunophenotyping. To measure susceptibility to HIV entry, CMCs and PBMCs were co-cultured overnight with equal amount of GFP-tagged HIV-1 pseudo-virus particles. Both immunophenotyping and HIV entry were measured on a BD LSR II flow cytometer., Results: There was no significant difference in the frequency of CD4+ T cells in blood (p=0.451) or mucosa (p=0.838) compartments across study groups. However, we observed a combined four-fold higher HIV entry (p=0.0001) into cervical versus blood-derived CD4+ T cells regardless of alcohol consumption status. More so, cervical-derived CD4+ T cells of alcohol-consumers showed a two-fold increase in susceptibility to HIV entry (P=0.0185) compared to the non-alcohol consumer group. Double positive α4β7+CD4+T cells of alcohol consumers exhibited a higher HIV entry compared to those from alcohol non-consumers(p=0.0069)., Conclusion: This study demonstrates that cervical CD4+ T cells are more susceptible to HIV entry than those from blood. Also, cervical CD4+ T cells of alcohol consumers are more susceptible than those of non-consumers. Differences in frequencies of α4β7+ CD4+ T between alcohol consumers and non-consumers' cells may account for the increased susceptibility to HIV entry., Competing Interests: Competing interests; The authors declare that they have no competing interests.
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- 2023
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14. Nearly half of adults with symptoms of sexually transmitted infections (STIs) did not seek clinical care: A population-based study of treatment-seeking behavior among adults in Rakai, Uganda.
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Ogale YP, Kennedy CE, Nalugoda F, Mpagazi J, Jackson JC, Galiwango R, Ssekubugu R, Kigozi G, Denison JA, Gaydos CA, Kagaayi J, and Grabowski MK
- Abstract
Understanding treatment-seeking behavior is critical to the treatment and control of sexually transmitted infections (STIs), yet current data on STI treatment seeking in low-resource settings is rare. This population-based study aimed to describe STI treatment-seeking behavior and identify factors associated with seeking treatment at a clinic among adults with STI-related symptoms in rural Uganda. The STI prevalence study (STIPS) conducted a survey and STI testing among all consenting adults aged 18-49 in two communities in rural south-central Uganda. Of 1,825 participants, 962 individuals self-reported STI symptoms in the past six months; we present descriptive data on treatment seeking and STI prevalence among these individuals. We used multivariable Poisson regressions with robust variance to determine the sociodemographic and symptom-related factors independently associated with seeking STI treatment at a clinic and assessed the association with previous clinic treatment seeking and current STI diagnosis. Forty-three percent of adults who reported STI-related symptoms in the past six months said they did not seek any treatment. Among those who did, 58% sought treatment at a private clinic, 28% at a government clinic, 9% at a pharmacy/drug store, 3% at a traditional healer, 2% at a market/shop, and 5% at another location. Among both males and females, having multiple STI related symptoms was positively associated with clinic treatment seeking (males = PRR: 1.73, 95%CI: 1.36-2.21; females = PR: 1.41, 95%CI: 1.12-1.78). Approximately one-third of males and females who reported previously seeking clinic treatment for their symptoms were diagnosed with a curable STI at the time of the survey. In this setting, nearly half of adults with STI-related symptoms are not seeking clinical care and many who report having sought treatment for recent STI symptoms have curable STIs. Future studies should explore barriers to care-seeking and strategies to improve STI services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ogale et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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15. Phylogenomic analysis uncovers a 9-year variation of Uganda influenza type-A strains from the WHO-recommended vaccines and other Africa strains.
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Nabakooza G, Owuor DC, de Laurent ZR, Galiwango R, Owor N, Kayiwa JT, Jjingo D, Agoti CN, Nokes DJ, Kateete DP, Kitayimbwa JM, Frost SDW, and Lutwama JJ
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- Humans, Hemagglutinins, Influenza A Virus, H3N2 Subtype, Uganda epidemiology, Phylogeny, Hemagglutinin Glycoproteins, Influenza Virus genetics, World Health Organization, Influenza, Human epidemiology, Influenza, Human prevention & control, Influenza A Virus, H1N1 Subtype genetics, Influenza A virus, Influenza Vaccines genetics
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Genetic characterisation of circulating influenza viruses directs annual vaccine strain selection and mitigation of infection spread. We used next-generation sequencing to locally generate whole genomes from 116 A(H1N1)pdm09 and 118 A(H3N2) positive patient swabs collected across Uganda between 2010 and 2018. We recovered sequences from 92% (215/234) of the swabs, 90% (193/215) of which were whole genomes. The newly-generated sequences were genetically and phylogenetically compared to the WHO-recommended vaccines and other Africa strains sampled since 1994. Uganda strain hemagglutinin (n = 206), neuraminidase (n = 207), and matrix protein (MP, n = 213) sequences had 95.23-99.65%, 95.31-99.79%, and 95.46-100% amino acid similarity to the 2010-2020 season vaccines, respectively, with several mutated hemagglutinin antigenic, receptor binding, and N-linked glycosylation sites. Uganda influenza type-A virus strains sequenced before 2016 clustered uniquely while later strains mixed with other Africa and global strains. We are the first to report novel A(H1N1)pdm09 subclades 6B.1A.3, 6B.1A.5(a,b), and 6B.1A.6 (± T120A) that circulated in Eastern, Western, and Southern Africa in 2017-2019. Africa forms part of the global influenza ecology with high viral genetic diversity, progressive antigenic drift, and local transmissions. For a continent with inadequate health resources and where social distancing is unsustainable, vaccination is the best option. Hence, African stakeholders should prioritise routine genome sequencing and analysis to direct vaccine selection and virus control., (© 2023. The Author(s).)
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- 2023
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16. Air pollution and mobility patterns in two Ugandan cities during COVID-19 mobility restrictions suggest the validity of air quality data as a measure for human mobility.
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Galiwango R, Bainomugisha E, Kivunike F, Kateete DP, and Jjingo D
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- Humans, Uganda, Cities, Particulate Matter analysis, Environmental Monitoring, Communicable Disease Control, COVID-19, Air Pollutants analysis, Air Pollution analysis
- Abstract
We explored the viability of using air quality as an alternative to aggregated location data from mobile phones in the two most populated cities in Uganda. We accessed air quality and Google mobility data collected from 15
th February 2020 to 10th June 2021 and augmented them with mobility restrictions implemented during the COVID-19 lockdown. We determined whether air quality data depicted similar patterns to mobility data before, during, and after the lockdown and determined associations between air quality and mobility by computing Pearson correlation coefficients ([Formula: see text]), conducting multivariable regression with associated confidence intervals (CIs), and visualized the relationships using scatter plots. Residential mobility increased with the stringency of restrictions while both non-residential mobility and air pollution decreased with the stringency of restrictions. In Kampala, PM2.5 was positively correlated with non-residential mobility and negatively correlated with residential mobility. Only correlations between PM2.5 and movement in work and residential places were statistically significant in Wakiso. After controlling for stringency in restrictions, air quality in Kampala was independently correlated with movement in retail and recreation (- 0.55; 95% CI = - 1.01- - 0.10), parks (0.29; 95% CI = 0.03-0.54), transit stations (0.29; 95% CI = 0.16-0.42), work (- 0.25; 95% CI = - 0.43- - 0.08), and residential places (- 1.02; 95% CI = - 1.4- - 0.64). For Wakiso, only the correlation between air quality and residential mobility was statistically significant (- 0.99; 95% CI = - 1.34- - 0.65). These findings suggest that air quality is linked to mobility and thus could be used by public health programs in monitoring movement patterns and the spread of infectious diseases without compromising on individuals' privacy., (© 2022. The Author(s).)- Published
- 2023
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17. Community purchases of antimicrobials during the COVID-19 pandemic in Uganda: An increased risk for antimicrobial resistance.
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Kiragga AN, Najjemba L, Galiwango R, Banturaki G, Munyiwra G, Iwumbwe I, Atwine J, Ssendiwala C, Natif A, and Nakanjako D
- Abstract
Self-Medication (SM) involves the utilization of medicines to treat self-recognized symptoms or diseases without consultation and the irrational use of over-the-counter drugs. During the COVID-19 pandemic, the lack of definitive treatment led to increased SM. We aimed to estimate the extent of SM for drugs used to treat COVID-19 symptoms by collecting data from pharmacy sale records. The study was conducted in Kampala, Uganda, where we extracted data from community pharmacies with functional Electronic Health Records between January 2018 and October 2021 to enable a comparison of pre-and post-COVID-19. The data included the number of clients purchasing the following drugs used to treat COVID-19 and its symptoms: Antibiotics included Azithromycin, Erythromycin, and Ciprofloxacin; Supplements included Zinc and vitamin C, while Corticosteroids included dexamethasone. A negative binomial model was used to estimate the incident rate ratios for each drug to compare the effect of COVID-19 on SM. In the pre- COVID-19 period (1st January 2018 to 11th March 2020), 19,285 customers purchased antibiotics which included; Azithromycin (n = 6077), Ciprofloxacin (n = 6066) and Erythromycin (n = 997); health supplements including Vitamin C (430) and Zinc (n = 138); and Corticosteroid including Dexamethasone (n = 5577). During the COVID-19 pandemic (from 15th March 2020 to the data extraction date in October 2021), we observed a 99% increase in clients purchasing the same drugs. The number of clients purchasing Azithromycin increased by 19.7% to 279, Ciprofloxacin reduced by 58.8% to 96 clients, and those buying Erythromycin similarly reduced by 35.8% to 492 clients. In comparison, there were increases of 170%, 181%, and 377% for Vitamin C, Zinc, and Dexamethasone, respectively. The COVID-19 pandemic underscored the extent of SM in Uganda. We recommend future studies with a representation of data from pharmacies located in rural and urban areas to further study pandemics' effect on antimicrobials prescriptions, including obtaining pharmacists' perspectives using mixed methods approaches., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Kiragga et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
- Published
- 2023
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18. Molecular Epidemiology and Evolutionary Dynamics of Human Influenza Type-A Viruses in Africa: A Systematic Review.
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Nabakooza G, Galiwango R, Frost SDW, Kateete DP, and Kitayimbwa JM
- Abstract
Genomic characterization of circulating influenza type-A viruses (IAVs) directs the selection of appropriate vaccine formulations and early detection of potentially pandemic virus strains. However, longitudinal data on the genomic evolution and transmission of IAVs in Africa are scarce, limiting Africa's benefits from potential influenza control strategies. We searched seven databases: African Journals Online, Embase, Global Health, Google Scholar, PubMed, Scopus, and Web of Science according to the PRISMA guidelines for studies that sequenced and/or genomically characterized Africa IAVs. Our review highlights the emergence and diversification of IAVs in Africa since 1993. Circulating strains continuously acquired new amino acid substitutions at the major antigenic and potential N-linked glycosylation sites in their hemagglutinin proteins, which dramatically affected vaccine protectiveness. Africa IAVs phylogenetically mixed with global strains forming strong temporal and geographical evolution structures. Phylogeographic analyses confirmed that viral migration into Africa from abroad, especially South Asia, Europe, and North America, and extensive local viral mixing sustained the genomic diversity, antigenic drift, and persistence of IAVs in Africa. However, the role of reassortment and zoonosis remains unknown. Interestingly, we observed substitutions and clades and persistent viral lineages unique to Africa. Therefore, Africa's contribution to the global influenza ecology may be understated. Our results were geographically biased, with data from 63% (34/54) of African countries. Thus, there is a need to expand influenza surveillance across Africa and prioritize routine whole-genome sequencing and genomic analysis to detect new strains early for effective viral control.
- Published
- 2022
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19. Bioinformatics mentorship in a resource limited setting.
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Jjingo D, Mboowa G, Sserwadda I, Kakaire R, Kiberu D, Amujal M, Galiwango R, Kateete D, Joloba M, and Whalen CC
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- Computational Biology education, High-Throughput Nucleotide Sequencing, Humans, Universities, Biomedical Research education, Mentors
- Abstract
Background: The two recent simultaneous developments of high-throughput sequencing and increased computational power have brought bioinformatics to the forefront as an important tool for effective and efficient biomedical research. Consequently, there have been multiple approaches to developing bioinformatics skills. In resource rich environments, it has been possible to develop and implement formal fully accredited graduate degree training programs in bioinformatics. In resource limited settings with a paucity of expert bioinformaticians, infrastructure and financial resources, the task has been approached by delivering short courses on bioinformatics-lasting only a few days to a couple of weeks. Alternatively, courses are offered online, usually over a period of a few months. These approaches are limited by both the lack of sustained in-person trainer-trainee interactions, which is a key part of quality mentorships and short durations which constrain the amount of learning that can be achieved., Methods: Here, we pioneered and tested a bioinformatics training/mentorship model that effectively uses the available expertise and computational infrastructure to deliver an in-person hands-on skills training experience. This is done through a few physical lecture hours each week, guided personal coursework over the rest of the week, group discussions and continuous close mentorship and assessment of trainees over a period of 1 year., Results: This model has now completed its third iteration at Makerere University and has successfully mentored trainees, who have progressed to a variety of viable career paths., Conclusions: One-year (intermediate) skills based in-person bioinformatics training and mentorships are viable, effective and particularly appropriate for resource limited settings., (© The Author(s) 2021. Published by Oxford University Press.)
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- 2022
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20. Employing phylogenetic tree shape statistics to resolve the underlying host population structure.
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Kayondo HW, Ssekagiri A, Nabakooza G, Bbosa N, Ssemwanga D, Kaleebu P, Mwalili S, Mango JM, Leigh Brown AJ, Saenz RA, Galiwango R, and Kitayimbwa JM
- Subjects
- Algorithms, Phylogeny, ROC Curve, Machine Learning, Support Vector Machine
- Abstract
Background: Host population structure is a key determinant of pathogen and infectious disease transmission patterns. Pathogen phylogenetic trees are useful tools to reveal the population structure underlying an epidemic. Determining whether a population is structured or not is useful in informing the type of phylogenetic methods to be used in a given study. We employ tree statistics derived from phylogenetic trees and machine learning classification techniques to reveal an underlying population structure., Results: In this paper, we simulate phylogenetic trees from both structured and non-structured host populations. We compute eight statistics for the simulated trees, which are: the number of cherries; Sackin, Colless and total cophenetic indices; ladder length; maximum depth; maximum width, and width-to-depth ratio. Based on the estimated tree statistics, we classify the simulated trees as from either a non-structured or a structured population using the decision tree (DT), K-nearest neighbor (KNN) and support vector machine (SVM). We incorporate the basic reproductive number ([Formula: see text]) in our tree simulation procedure. Sensitivity analysis is done to investigate whether the classifiers are robust to different choice of model parameters and to size of trees. Cross-validated results for area under the curve (AUC) for receiver operating characteristic (ROC) curves yield mean values of over 0.9 for most of the classification models., Conclusions: Our classification procedure distinguishes well between trees from structured and non-structured populations using the classifiers, the two-sample Kolmogorov-Smirnov, Cucconi and Podgor-Gastwirth tests and the box plots. SVM models were more robust to changes in model parameters and tree size compared to KNN and DT classifiers. Our classification procedure was applied to real -world data and the structured population was revealed with high accuracy of [Formula: see text] using SVM-polynomial classifier., (© 2021. The Author(s).)
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- 2021
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21. Association between tuberculosis in men and social network structure in Kampala, Uganda.
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Miller PB, Zalwango S, Galiwango R, Kakaire R, Sekandi J, Steinbaum L, Drake JM, Whalen CC, and Kiwanuka N
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- Adult, Child, Family Characteristics, Female, Humans, Male, Social Networking, Uganda epidemiology, Tuberculosis epidemiology
- Abstract
Background: Globally, tuberculosis disease (TB) is more common among males than females. Recent research proposes that differences in social mixing by sex could alter infection patterns in TB. We examine evidence for two mechanisms by which social-mixing could increase men's contact rates with TB cases. First, men could be positioned in social networks such that they contact more people or social groups. Second, preferential mixing by sex could prime men to have more exposure to TB cases., Methods: We compared the networks of male and female TB cases and healthy matched controls living in Kampala, Uganda. Specifically, we estimated their positions in social networks (network distance to TB cases, degree, betweenness, and closeness) and assortativity patterns (mixing with adult men, women, and children inside and outside the household)., Results: The observed network consisted of 11,840 individuals. There were few differences in estimates of node position by sex. We found distinct mixing patterns by sex and TB disease status including that TB cases have proportionally more adult male contacts and fewer contacts with children., Conclusions: This analysis used a network approach to study how social mixing patterns are associated with TB disease. Understanding these mechanisms may have implications for designing targeted intervention strategies in high-burden populations., (© 2021. The Author(s).)
- Published
- 2021
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22. Assessing a transmission network of Mycobacterium tuberculosis in an African city using single nucleotide polymorphism threshold analysis.
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Yassine E, Galiwango R, Ssengooba W, Ashaba F, Joloba ML, Zalwango S, Whalen CC, and Quinn F
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- Bacterial Proteins genetics, Cities statistics & numerical data, Cross-Sectional Studies, Genome, Bacterial, Genotype, Humans, Mycobacterium tuberculosis classification, Mycobacterium tuberculosis physiology, Phylogeny, Tuberculosis epidemiology, Tuberculosis transmission, Uganda epidemiology, Virulence Factors genetics, Whole Genome Sequencing, Mycobacterium tuberculosis genetics, Mycobacterium tuberculosis isolation & purification, Polymorphism, Single Nucleotide, Tuberculosis microbiology
- Abstract
Tuberculosis (TB) is the leading cause of death in humans by a single infectious agent worldwide with approximately two billion humans latently infected with the bacterium Mycobacterium tuberculosis. Currently, the accepted method for controlling the disease is Tuberculosis Directly Observed Treatment Shortcourse (TB-DOTS). This program is not preventative and individuals may transmit disease before diagnosis, thus better understanding of disease transmission is essential. Using whole-genome sequencing and single nucleotide polymorphism analysis, we analyzed genomes of 145 M. tuberculosis clinical isolates from active TB cases from the Rubaga Division of Kampala, Uganda. We established that these isolates grouped into M. tuberculosis complex (MTBC) lineages 1, 2, 3, and 4, with the most isolates grouping into lineage 4. Possible transmission pairs containing ≤12 SNPs were identified in lineages 1, 3, and 4 with the prevailing transmission in lineages 3 and 4. Furthermore, investigating DNA codon changes as a result of specific SNPs in prominent virulence genes including plcA and plcB could indicate potentially important modifications in protein function. Incorporating this analysis with corresponding epidemiological data may provide a blueprint for the integration of public health interventions to decrease TB transmission in a region., (© 2021 The Authors. MicrobiologyOpen published by John Wiley & Sons Ltd.)
- Published
- 2021
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23. HIV-1 Subtype Distribution and Diversity Over 18 Years in Rakai, Uganda.
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Lamers SL, Rose R, Cross S, Rodriguez CW, Redd AD, Quinn TC, Serwadda D, Kagaayi J, Kigozi G, Galiwango R, Gray RH, Grabowski MK, and Laeyendecker O
- Subjects
- Adolescent, Adult, HIV Core Protein p24 genetics, HIV Envelope Protein gp41 genetics, HIV Infections virology, Humans, Middle Aged, Prospective Studies, Uganda epidemiology, Young Adult, Genetic Variation, HIV Infections epidemiology, HIV-1 classification
- Abstract
The Rakai Community Cohort Study in south central Uganda has surveyed people aged 15-49 since 1994. Antiretroviral therapy (ART) was introduced in 2004. HIV p24 and gp41 subtype distribution and viral diversity were studied from blood samples collected at three surveys in 1994-1995, 2002-2003, and 2008-2009, which were compared with a new survey round from 2011 to 2012. These included 1364 HIV+ individuals. For both p24 and gp41 domains, the genetic diversity within subtypes A and D was significantly increasing in the pre-ART era and decreased between the last two survey rounds in the ART era ( p < .01). This study suggests that despite ongoing mixing of viral subtypes, an association with the introduction of ART to a reduction of intra-subtype viral genomic diversity may be occurring, which can be explored in ongoing studies.
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- 2020
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24. The effect of current Schistosoma mansoni infection on the immunogenicity of a candidate TB vaccine, MVA85A, in BCG-vaccinated adolescents: An open-label trial.
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Wajja A, Kizito D, Nassanga B, Nalwoga A, Kabagenyi J, Kimuda S, Galiwango R, Mutonyi G, Vermaak S, Satti I, Verweij J, Tukahebwa E, Cose S, Levin J, Kaleebu P, Elliott AM, and McShane H
- Subjects
- Adolescent, Animals, Antibodies, Bacterial blood, BCG Vaccine administration & dosage, Child, Female, Humans, Immunity, Cellular, Immunoglobulin G blood, Linear Models, Male, Schistosoma mansoni, Tuberculosis immunology, Uganda, Vaccination adverse effects, Vaccines, DNA, Acyltransferases immunology, Antigens, Bacterial immunology, Immunogenicity, Vaccine, Schistosomiasis mansoni immunology, T-Lymphocytes immunology, Tuberculosis prevention & control, Tuberculosis Vaccines immunology
- Abstract
Introduction: Helminth infection may affect vaccine immunogenicity and efficacy. Adolescents, a target population for tuberculosis booster vaccines, often have a high helminth burden. We investigated effects of Schistosoma mansoni (Sm) on the immunogenicity and safety of MVA85A, a model candidate tuberculosis vaccine, in BCG-vaccinated Ugandan adolescents., Methods: In this phase II open label trial we enrolled 36 healthy, previously BCG-vaccinated adolescents, 18 with no helminth infection detected, 18 with Sm only. The primary outcome was immunogenicity measured by Ag85A-specific interferon gamma ELISpot assay. Tuberculosis and schistosome-specific responses were also assessed by whole-blood stimulation and multiplex cytokine assay, and by antibody ELISAs., Results: Ag85A-specific cellular responses increased significantly following immunisation but with no differences between the two groups. Sm infection was associated with higher pre-immunisation Ag85A-specific IgG4 but with no change in antibody levels following immunisation. There were no serious adverse events. Most reactogenicity events were of mild or moderate severity and resolved quickly., Conclusions: The significant Ag85A-specific T cell responses and lack of difference between Sm-infected and uninfected participants is encouraging for tuberculosis vaccine development. The implications of pre-existing Ag85A-specific IgG4 antibodies for protective immunity against tuberculosis among those infected with Sm are not known. MVA85A was safe in this population., Trial Registration: ClinicalTrials.gov NCT02178748.
- Published
- 2017
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25. Low Rates of Transmitted Drug Resistance Among Newly Identified HIV-1 Seroconverters in Rural Rakai, Uganda.
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Reynolds SJ, Ssempijja V, Galiwango R, Ndyanabo A, Nakigozi G, Lyagoba F, Nazziwa J, Redd A, Lamers SL, Gray R, Wawer M, Serwadda D, and Quinn TC
- Subjects
- Adolescent, Adult, Cohort Studies, Female, Genotyping Techniques, HIV Infections epidemiology, HIV Protease genetics, HIV Reverse Transcriptase genetics, HIV-1 isolation & purification, Humans, Male, Middle Aged, Prevalence, Rural Population, Uganda epidemiology, Young Adult, Drug Resistance, Viral, HIV Infections transmission, HIV Infections virology, HIV-1 genetics
- Abstract
We investigated the rate of transmitted drug resistance (TDR) among HIV-1 seroconverters identified from the Rakai Community Cohort Study (RCCS) survey, a population-based cohort in Rakai District, Uganda. Participants aged 15-49 are interviewed at study visits approximately every 12-18 months and provided a serological sample. Antiretroviral therapy (ART) has been provided free of charge since 2004. RCCS participants with documented negative HIV-1 serology between January 2011 and August 2012 and confirmed seroconversion between November 2012 and October 2013 were included in this analysis. Serum was genotyped for HIV drug resistance mutations in reverse transcriptase and protease genes. Mutations were classified according to the 2009 World Health Organization surveillance of transmitted HIV-1 drug resistance update. Seventy-five (75) seroconverters were identified and genotyped. The mean age was 28 years (range 18-49) and the majority were male, n = 44 (58%). The HIV-1 subtype frequencies were A = 19 (25%), D = 44 (59%), C = 4 (5%), A/D recombinant = 5 (7%), and C/D recombinant = 3 (4%). The majority (72/75, 96%) of individuals were infected with wild-type virus with no evidence of TDR. Two individuals had a single non-nucleoside reverse transcriptase inhibitor mutation each, K101E and K103N, and one had a single protease inhibitor mutation, M46I. No mutations were identified involving nucleoside reverse transcriptase inhibitors. In conclusion, almost 10 years after the introduction of ART in rural Uganda, rates of TDR remain low. Ongoing surveillance for TDR remains an important public health priority and should be conducted among known seroconverters to estimate TDR.
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- 2017
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26. Inflammation and HIV Transmission in Sub-Saharan Africa.
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Kaul R, Prodger J, Joag V, Shannon B, Yegorov S, Galiwango R, and McKinnon L
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- Africa South of the Sahara epidemiology, CD4-Positive T-Lymphocytes immunology, Female, Genitalia, Female immunology, Genitalia, Male immunology, HIV isolation & purification, HIV Infections immunology, Humans, Immunity, Mucosal immunology, Male, Disease Transmission, Infectious, HIV Infections transmission, Inflammation immunology, Sexually Transmitted Diseases immunology
- Abstract
While the per-contact risk of sexual HIV transmission is relatively low, it is fourfold higher in sub-Saharan Africa, and this may partly explain the major global disparities that exist in HIV prevalence. Genital immune parameters are key determinants of HIV transmission risk, including epithelial integrity and the presence of highly HIV-susceptible intraepithelial or submucosal CD4+ T cell target cells. Biological parameters that may enhance mucosal HIV susceptibility in highly HIV-affected regions of sub-Saharan Africa include increased levels of mucosal inflammation, which can affect both epithelial integrity and target cell availability, as well as the increased mucosal surface area that is afforded by an intact foreskin, contraceptive choices, and intravaginal practices. There are multifactorial causes for increased mucosal inflammation, with the prevalence and nature of common co-infections being particularly relevant.
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- 2015
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27. Durable Suppression of HIV-1 after Virologic Monitoring-Based Antiretroviral Adherence Counseling in Rakai, Uganda.
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Billioux A, Nakigozi G, Newell K, Chang LW, Quinn TC, Gray RH, Ndyanabo A, Galiwango R, Kiggundu V, Serwadda D, and Reynolds SJ
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- Adult, Counseling, Female, Humans, Male, Uganda, Antiretroviral Therapy, Highly Active, HIV Infections drug therapy, HIV Infections virology, HIV-1 physiology, Patient Compliance, Viral Load physiology
- Abstract
Objectives: HIV viral load is recommended for monitoring antiretroviral treatment and identifying treatment failure. We assessed the durability of viral suppression after viral load-triggered adherence counseling among patients with HIV viremia 6 months after ART initiation., Design: Observational cohort enrolled in an antiretroviral treatment program in rural Uganda., Methods: Participants who underwent routine viral load determination every 24 weeks and had at least 48 weeks of follow-up were included in this analysis. Patients with viral loads >400 copies/ml at 24 weeks of treatment were given additional adherence counseling, and all patients were followed to assess the duration of viral suppression and development of virologic failure., Results: 1,841 participants initiating antiretroviral therapy were enrolled in the Rakai Health Sciences Program between June 2005 and June 2011 and were followed with viral load monitoring every 24 weeks. 148 (8%) of patients did not achieve viral suppression at 24 weeks and were given additional adherence counseling. 85 (60%) of these patients had undetectable viral loads at 48 weeks, with a median duration of viral suppression of 240 weeks (IQR 193-288 weeks). Failure to achieve an undetectable viral load at 48 weeks was associated with age <30 years and 24 week viral load >2,000 copies/ml in multivariate logistic regression analysis., Conclusions: The majority of patients with persistent viremia who were provided adherence counseling achieved robust viral suppression for a median 4.6 years. Access to virologic monitoring and adherence counseling is a priority in resource-limited settings.
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- 2015
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28. Is CD4 monitoring needed among ugandan clients achieving a virologic and immunologic response to treatment?
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Reynolds SJ, Sempa JB, Kiragga AN, Newell K, Nakigozi G, Galiwango R, Gray R, Quinn TC, Serwadda D, and Chang L
- Subjects
- Adult, CD4 Lymphocyte Count, Female, HIV Infections virology, HIV-1, Health Services Needs and Demand, Humans, Male, Multivariate Analysis, Treatment Outcome, Uganda, Viral Load, Anti-Retroviral Agents therapeutic use, CD4-Positive T-Lymphocytes immunology, HIV Infections drug therapy, HIV Infections immunology
- Abstract
It is unclear whether ongoing CD4 monitoring is needed following immunologic and virologic response to antiretroviral therapy (ART). We investigated the proportion of clients who achieved a virologic and immunologic response and then had a subsequent CD4 count <200 cells/μL despite continued virologic suppression. Included in this analysis were clients receiving ART through the Rakai Health Sciences Program between June 2004-May 2013 who achieved a CD4 ≥200 cells/μL and VL ≤400 copies/mL and who had three sets of CD4 and VL measurements (defined as a sequence) within a 390 day period. A CD4 decline was defined as any drop in CD4 count to <200 cells/μL during a period of viral suppression. A total of 1553 clients were included, 68% females, mean age of 35.5 years (SD 8.3), median baseline CD4 count 183 cells/μL (IQR 106-224). 43 (2.8%) clients developed CD4 declines, the majority, 32/43 (74%), among individuals whose initial CD4 was <300 cells/μL. Of the 43 clients with CD4 declines, 24 had an additional CD4 measurement and 20/24 (83%) achieved a CD4 ≥200 cell/μL on their next measurement (median 285 cells/μL; IQR 220-365). CD4 declines were significantly greater among those with lower CD4 at sequence initiation [adjusted hazard ratio (AHR) 4.3 (95% CI 2.1, 9.0) CD4 200-249 versus ≥350 cells/μL]. Clients who achieved an immunologic and virologic response to ART were unlikely to experience a subsequent CD4 count decline to <200 cells/μL, and among those experiencing a decline, the majority were transient in nature. Thus, ongoing CD4 monitoring could be omitted.
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- 2014
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29. HIV Infection in Uncircumcised Men Is Associated With Altered CD8 T-cell Function But Normal CD4 T-cell Numbers in the Foreskin.
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Prodger JL, Hirbod T, Gray R, Kigozi G, Nalugoda F, Galiwango R, Reynolds SJ, Huibner S, Wawer MJ, Serwadda D, and Kaul R
- Subjects
- Adult, CD4 Lymphocyte Count, Flow Cytometry, Humans, Immunohistochemistry, Male, Middle Aged, Polymerase Chain Reaction, Young Adult, CD4-Positive T-Lymphocytes immunology, CD8-Positive T-Lymphocytes immunology, Circumcision, Male, Cytokines metabolism, Foreskin immunology, HIV Infections immunology
- Abstract
Background: Human immunodeficiency virus (HIV)-infected (HIV+) men are more susceptible to sexually transmitted infections, and may be superinfected by HIV. We hypothesized that HIV induces immune alterations in the foreskin that may impact the subsequent acquisition/clearance of genital coinfections., Methods: Foreskin tissue and blood were obtained from 70 HIV-uninfected and 20 HIV+ men undergoing circumcision. T cells were characterized by flow cytometry, immunohistochemistry, and polymerase chain reaction., Results: There was substantial influx of CD8 T-cells into the foreskins of HIV+ men (108.8 vs 23.1 cells/mm(2); P < .001); but foreskin CD4 T-cell density was unchanged (43.0 vs 33.7/mm(2); P = .67), despite substantial blood depletion (409.0 vs 877.8 cells/µL; P < .001). While frequencies of foreskin C-C chemokine receptor type 5(+) (CCR5(+)) T cells, T regulatory cells, and T-helper 17 cells were unaltered in HIV+ men, CD8 T-cell production of tumor necrosis factor α (TNFα) was decreased. HIV-specific CD8 T cells were present in the foreskins of HIV+ men, although their frequency and function was reduced compared to the blood., Conclusions: Foreskin CD4 T-cell density and CCR5 expression were not reduced during HIV infection, perhaps explaining susceptibility to HIV superinfection. Foreskin CD8 T-cell density was increased, but decreased production of TNFα may enhance susceptibility to genital coinfections in HIV+ men.
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- 2014
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30. Impact of asymptomatic Herpes simplex virus-2 infection on T cell phenotype and function in the foreskin.
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Prodger JL, Gray R, Kigozi G, Nalugoda F, Galiwango R, Nehemiah K, Kakanga M, Hirbod T, Wawer MJ, Sewankambo N, Serwadda D, and Kaul R
- Subjects
- Adult, CD4-Positive T-Lymphocytes immunology, Circumcision, Male, Humans, Male, Receptors, CCR5 metabolism, Viral Load, CD4-Positive T-Lymphocytes virology, Foreskin virology, Herpesvirus 2, Human immunology
- Abstract
Herpes simplex virus type 2 (HSV-2) increases the risk of HIV acquisition in men and overall CD4 T cell density in the foreskin. Using tissues obtained during routine male circumcision, we examined the impact of HSV-2 on the function and phenotype of foreskin T cells in Ugandan men. HSV-2 infection was predominantly associated with a compartmentalized increase in CCR5 expression by foreskin CD4 T cells, which may contribute to HIV susceptibility.
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- 2012
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31. Non-enrollment for free community HIV care: findings from a population-based study in Rakai, Uganda.
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Nakigozi G, Makumbi F, Reynolds S, Galiwango R, Kagaayi J, Nalugoda F, Ssettuba A, Sekasanvu J, Musuuza J, Serwada D, Gray R, and Wawer M
- Subjects
- Adult, Attitude to Health ethnology, Female, HIV Infections epidemiology, Humans, Male, Patient Acceptance of Health Care ethnology, Patient Acceptance of Health Care statistics & numerical data, Risk-Taking, Rural Health, Socioeconomic Factors, Uganda epidemiology, HIV Infections psychology, Patient Acceptance of Health Care psychology, Uncompensated Care statistics & numerical data
- Abstract
Improved understanding of HIV-related health-seeking behavior at a population level is important in informing the design of more effective HIV prevention and care strategies. We assessed the frequency and determinants of failure to seek free HIV care in Rakai, Uganda. HIV-positive participants in a community cohort who accepted VCT were referred for free HIV care (cotrimoxazole prophylaxis, CD4 monitoring, treatment of opportunistic infections, and, when indicated, antiretroviral therapy). We estimated proportion and adjusted Prevalence Risk Ratios (adj. PRR) of non-enrollment into care six months after receipt of VCT using log-binomial regression. About 1145 HIV-positive participants in the Rakai Community Cohort Study accepted VCT and were referred for care. However, 31.5% (361/1145) did not enroll into HIV care six months after referral. Non-enrollment was significantly higher among men (38%) compared to women (29%, p=0.005). Other factors associated with non-enrollment included: younger age (15-24 years, adj. PRR = 2.22; 95% CI: 1.64, 3.00), living alone (adj. PRR = 2.22; 95% CI: 1.57, 3.15); or in households with 1-2 co-residents (adj. PRR = 1.63; 95% CI: 1.31, 2.03) compared to three or more co-residents, or a CD4 count >250 cells/ul (adj. PRR = 1.81; 95% CI: 1.38, 2.46). Median (IQR) CD4 count was lower among enrolled 388 cells/ul (IQR: 211,589) compared to those not enrolled 509 cells/ul (IQR: 321,754). About one-third of HIV-positive persons failed to utilize community-based free services. Non-use of services was greatest among men, the young, persons with higher CD4 counts and the more socially isolated, suggesting a need for targeted strategies to enhance service uptake.
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- 2011
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32. High retention and appropriate use of insecticide-treated nets distributed to HIV-affected households in Rakai, Uganda: results from interviews and home visits.
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Cohee L, Mills LA, Kagaayi J, Jacobs I, Galiwango R, Ludigo J, Ssekasanvu J, and Reynolds SJ
- Subjects
- Cohort Studies, Confidence Intervals, Family Characteristics, Female, HIV Infections complications, House Calls, Humans, Male, Rural Population, Social Marketing, Surveys and Questionnaires, Uganda, Bedding and Linens statistics & numerical data, Health Knowledge, Attitudes, Practice, Insecticides, Malaria prevention & control, Mosquito Control instrumentation, Patient Acceptance of Health Care, Program Evaluation
- Abstract
Background: Distribution of insecticide-treated nets (ITNs) has recently been incorporated into comprehensive care strategies for HIV-positive people in malaria-endemic areas. WHO now recommends free or low-cost distribution of ITNs to all persons in malaria-endemic areas, regardless of age, pregnancy and HIV status. Knowledge about and appropriate use of ITNs among HIV-positive ITN recipients and their household members has not been well characterized., Methods: 142 randomly selected adults were interviewed in July-August 2006 to assess knowledge, retention, and appropriate use of ITNs they had received through a PEPFAR-funded comprehensive HIV care programme in rural Uganda., Results: Among all participants, 102 (72%, CI: 65%-79%) reported they had no ITNs except those provided by the programme. Of 131 participants who stated they were given >or= 1 ITN, 128 (98%, CI: 96%-100%) stated they still possessed at least one programme-provided ITN. Reported programme-ITN (pITN) use by participants was high: 119 participants (91%, CI: 86%-96%) reported having slept under pITN the night prior to the survey and 115 (88%, CI: 82%-94%) reported sleeping under pITN seven days per week. Being away from home and heat were the most common reasons given for not sleeping under an ITN. A sub-study of thirteen random home visits demonstrated concordance between participants' survey reports and actual use of ITNs in homes., Conclusion: There was excellent self-reported retention and appropriate use of ITNs distributed as a part of a community-based outpatient HIV care programme. Participants perceived ITNs as useful and were unlikely to have received ITNs from other sources.
- Published
- 2009
- Full Text
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33. Telecommunications and health Care: an HIV/AIDS warmline for communication and consultation in Rakai, Uganda.
- Author
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Chang LW, Kagaayi J, Nakigozi G, Galiwango R, Mulamba J, Ludigo J, Ruwangula A, Gray RH, Quinn TC, Bollinger RC, and Reynolds SJ
- Subjects
- Anti-HIV Agents adverse effects, Anti-HIV Agents therapeutic use, Humans, Program Evaluation, Uganda, Delivery of Health Care, HIV Infections drug therapy, HIV Infections physiopathology, HIV Infections prevention & control, Hotlines economics, Hotlines statistics & numerical data, Telecommunications economics, Telecommunications statistics & numerical data
- Abstract
Hotlines and warmlines have been successfully used in the developed world to provide clinical advice; however, reports on their replicability in resource-limited settings are limited. A warmline was established in Rakai, Uganda, to support an antiretroviral therapy program. Over a 17-month period, a database was kept of who called, why they called, and the result of the call. A program evaluation was also administered to clinical staff. A total of 1303 calls (3.5 calls per weekday) were logged. The warmline was used mostly by field staff and peripherally based peer health workers. Calls addressed important clinical issues, including the need for urgent care, medication side effects, and follow-up needs. Most clinical staff felt that the warmline made their jobs easier and improved the health of patients. An HIV/AIDS warmline leveraged the skills of a limited workforce to provide increased access to HIV/AIDS care, advice, and education.
- Published
- 2008
- Full Text
- View/download PDF
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