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1. The burden of severe asthma in sub-Saharan Africa: Findings from the African Severe Asthma Project

Author

Kirenga, Bruce J., Chakaya, Jeremiah, Yimer, Getnet, Nyale, George, Haile, Tewodros, Muttamba, Winters, Mugenyi, Levicatus, Katagira, Winceslaus, Worodria, William, Aanyu-Tukamuhebwa, Hellen, Lugogo, Njira, Joloba, Moses, Mersha, Tesfaye B., Bekele, Amsalu, Makumbi, Fred, Mekasha, Amha, Green, Cynthia L., de Jong, Corina, Kamya, Moses, and van der Molen, Thys

Published
2024
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2. HIV combination prevention and declining orphanhood among adolescents, Rakai, Uganda, 2001–18: an observational community cohort study

Author

Santelli, John S, Chen, Ivy S, Nabukalu, Dorean, Lutalo, Tom, Spindler, Esther J, Chang, Larry W, Grabowski, Mary Kate, Grilo, Stephanie A, Kreniske, Philip, Wei, Ying, Nalugoda, Fred, Hoffman, Susie, Maru, Mahlet, Chu, Sofia, Ssewamala, Fred M, Byansi, William, Kagaayi, Joseph, Wawer, Maria J, Gray, Ronald H, Serwadda, David, and Makumbi, Fred

Published
2022
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4. Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

Author

Ayles, Helen, Bowden, Rory, Calvez, Vincent, Cohen, Myron, Dennis, Anne, Essex, Max, Fidler, Sarah, Frampton, Dan, Hayes, Richard, Herbeck, Josh, Kaleebu, Pontiano, Kityo, Cissy, Lingappa, Jairam, Novitsky, Vladimir, Paton, Nick, Rambaut, Andrew, Seeley, Janet, Ssemwanga, Deogratius, Tanser, Frank, Lutalo, Tom, Galiwango, Ronald, Makumbi, Fred, Sewankambo, Nelson K., Nabukalu, Dorean, Ndyanabo, Anthony, Ssekasanvu, Joseph, Nakawooya, Hadijja, Nakukumba, Jessica, Kigozi, Grace N., Nantume, Betty S., Resty, Nampijja, Kambasu, Jedidah, Nalugemwa, Margaret, Nakabuye, Regina, Ssebanobe, Lawrence, Nankinga, Justine, Kayiira, Adrian, Nanfuka, Gorreth, Ahimbisibwe, Ruth, Tomusange, Stephen, Galiwango, Ronald M., Nakalanzi, Margaret, Otobi, Joseph O., Ankunda, Denis, Ssembatya, Joseph L., Ssemanda, John B., Kato, Emmanuel, Kairania, Robert, Kisakye, Alice, Batte, James, Ludigo, James, Nampijja, Abisagi, Watya, Steven, Nehemia, Kighoma, Anyokot, Sr. Margaret, Mwinike, Joshua, Kibumba, George, Ssebowa, Paschal, Mondo, George, Wasswa, Francis, Nantongo, Agnes, Kakembo, Rebecca, Galiwango, Josephine, Ssemango, Geoffrey, Redd, Andrew D., Santelli, John, Kennedy, Caitlin E., Wagman, Jennifer, Tobian, Aaron, Ratmann, Oliver, Kagaayi, Joseph, Hall, Matthew, Golubchick, Tanya, Kigozi, Godfrey, Xi, Xiaoyue, Wymant, Chris, Nakigozi, Gertrude, Abeler-Dörner, Lucie, Bonsall, David, Gall, Astrid, Hoppe, Anne, Kellam, Paul, Bazaale, Jeremiah, Kalibbala, Sarah, Laeyendecker, Oliver, Lessler, Justin, Nalugoda, Fred, Chang, Larry W, de Oliveira, Tulio, Pillay, Deenan, Quinn, Thomas C, Reynolds, Steven J, Spencer, Simon E F, Ssekubugu, Robert, Serwadda, David, Wawer, Maria J, Gray, Ronald H, Fraser, Christophe, and Grabowski, M Kate

Published
2020
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8. HIV Prevention Efforts and Incidence of HIV in Uganda

Author

Grabowski, Kate M., Serwadda, David M., Gray, Ronald H., Nakigozi, Gertrude, Kigozi, Godfrey, Kagaayi, Joseph, Ssekubugu, Robert, Nalugoda, Fred, Lessler, Justin, Lutalo, Thomas, Galiwango, Ronald M., Makumbi, Fred, Kong, Xiangrong, Kabatesi, Donna, Alamo, Stella T., Wiersma, Steven, Sewankambo, Nelson K., Tobian, Aaron A.R., Laeyendecker, Oliver, Quinn, Thomas C., Reynolds, Steven J., Wawer, Maria J., and Chang, Larry W.

Published
2017
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11. Household wealth and HIV incidence over time, rural Uganda, 1994–2018

Author

Santelli, John S., primary, Chen, Ivy, additional, Makumbi, Fred, additional, Wei, Ying, additional, Nalugoda, Fred, additional, Lutalo, Tom, additional, Spindler, Esther, additional, Grilo, Stephanie A., additional, Deisher, Andrea, additional, Grabowski, Katherine, additional, Hoffman, Susie, additional, Kagaayi, Joseph, additional, Chang, Larry W., additional, Gray, Ronald, additional, Wawer, Maria, additional, and Serwadda, David, additional

Published
2021
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12. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

Author

Serwadda David, Nalwadda Gorette, Mutebi Aloysius, Bua John, Rutebemberwa Elizeus, Okui Olico, Kiwanuka Noah, Makumbi Fred, Rahman M, Waiswa Peter, Ekirapa-Kiracho Elizabeth, Pariyo George W, and Peters David H

Subjects
Public aspects of medicine, RA1-1270
Abstract

Abstract Background Geographical inaccessibility, lack of transport, and financial burdens are some of the demand side constraints to maternal health services in Uganda, while supply side problems include poor quality services related to unmotivated health workers and inadequate supplies. Most public health interventions in Uganda have addressed only selected supply side issues, and universities have focused their efforts on providing maternal services at tertiary hospitals. To demonstrate how reforms at Makerere University College of Health Sciences (MakCHS) can lead to making systemic changes that can improve maternal health services, a demand and supply side strategy was developed by working with local communities and national stakeholders. Methods This quasi-experimental trial is conducted in two districts in Eastern Uganda. The supply side component includes health worker refresher training and additions of minimal drugs and supplies, whereas the demand side component involves vouchers given to pregnant women for motorcycle transport and the payment to service providers for antenatal, delivery, and postnatal care. The trial is ongoing, but early analysis from routine health information systems on the number of services used is presented. Results Motorcyclists in the community organized themselves to accept vouchers in exchange for transport for antenatal care, deliveries and postnatal care, and have become actively involved in ensuring that women obtain care. Increases in antenatal, delivery, and postnatal care were demonstrated, with the number of safe deliveries in the intervention area immediately jumping from Conclusions Transport and service vouchers appear to be a viable strategy for rapidly increasing maternal care. MakCHS can design strategies together with stakeholders using a learning-by-doing approach to take advantage of community resources.

Published
2011
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14. The Impact of HIV Combination Prevention on Declining Orphanhood Among Adolescents, Rakai, Uganda, 2001-2018 (Updated 16 April 2021)

Author

Santelli, John S., primary, Chen, I, additional, Nabukalu, Doreen, additional, Lutalo, Tom, additional, Spindler, Esther, additional, Larry, C, additional, Grabowski, M.K., additional, Grilo, Stephanie, additional, Kreniske, Philip, additional, Wei, Y, additional, Nalugoda, Fred, additional, Hoffman, Susie, additional, Maru, Mahlet, additional, Chu, Sofia, additional, Ssewamala, Fred, additional, Byansi, William, additional, Kagaayi, Joseph, additional, Wawer, Maria, additional, Gray, Ronald, additional, Serwadda, David, additional, and Makumbi, Fred, additional

Published
2021
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15. Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

Author

Ratmann, Oliver, primary, Kagaayi, Joseph, additional, Hall, Matthew, additional, Golubchick, Tanya, additional, Kigozi, Godfrey, additional, Xi, Xiaoyue, additional, Wymant, Chris, additional, Nakigozi, Gertrude, additional, Abeler-Dörner, Lucie, additional, Bonsall, David, additional, Gall, Astrid, additional, Hoppe, Anne, additional, Kellam, Paul, additional, Bazaale, Jeremiah, additional, Kalibbala, Sarah, additional, Laeyendecker, Oliver, additional, Lessler, Justin, additional, Nalugoda, Fred, additional, Chang, Larry W, additional, de Oliveira, Tulio, additional, Pillay, Deenan, additional, Quinn, Thomas C, additional, Reynolds, Steven J, additional, Spencer, Simon E F, additional, Ssekubugu, Robert, additional, Serwadda, David, additional, Wawer, Maria J, additional, Gray, Ronald H, additional, Fraser, Christophe, additional, Grabowski, M Kate, additional, Ayles, Helen, additional, Bowden, Rory, additional, Calvez, Vincent, additional, Cohen, Myron, additional, Dennis, Anne, additional, Essex, Max, additional, Fidler, Sarah, additional, Frampton, Dan, additional, Hayes, Richard, additional, Herbeck, Josh, additional, Kaleebu, Pontiano, additional, Kityo, Cissy, additional, Lingappa, Jairam, additional, Novitsky, Vladimir, additional, Paton, Nick, additional, Rambaut, Andrew, additional, Seeley, Janet, additional, Ssemwanga, Deogratius, additional, Tanser, Frank, additional, Lutalo, Tom, additional, Galiwango, Ronald, additional, Makumbi, Fred, additional, Sewankambo, Nelson K., additional, Nabukalu, Dorean, additional, Ndyanabo, Anthony, additional, Ssekasanvu, Joseph, additional, Nakawooya, Hadijja, additional, Nakukumba, Jessica, additional, Kigozi, Grace N., additional, Nantume, Betty S., additional, Resty, Nampijja, additional, Kambasu, Jedidah, additional, Nalugemwa, Margaret, additional, Nakabuye, Regina, additional, Ssebanobe, Lawrence, additional, Nankinga, Justine, additional, Kayiira, Adrian, additional, Nanfuka, Gorreth, additional, Ahimbisibwe, Ruth, additional, Tomusange, Stephen, additional, Galiwango, Ronald M., additional, Nakalanzi, Margaret, additional, Otobi, Joseph O., additional, Ankunda, Denis, additional, Ssembatya, Joseph L., additional, Ssemanda, John B., additional, Kato, Emmanuel, additional, Kairania, Robert, additional, Kisakye, Alice, additional, Batte, James, additional, Ludigo, James, additional, Nampijja, Abisagi, additional, Watya, Steven, additional, Nehemia, Kighoma, additional, Anyokot, Sr. Margaret, additional, Mwinike, Joshua, additional, Kibumba, George, additional, Ssebowa, Paschal, additional, Mondo, George, additional, Wasswa, Francis, additional, Nantongo, Agnes, additional, Kakembo, Rebecca, additional, Galiwango, Josephine, additional, Ssemango, Geoffrey, additional, Redd, Andrew D., additional, Santelli, John, additional, Kennedy, Caitlin E., additional, Wagman, Jennifer, additional, and Tobian, Aaron, additional

Published
2020
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17. Inferring HIV-1 transmission networks and sources of epidemic spread in Africa with deep-sequence phylogenetic analysis

Author

Ratmann, Oliver, Grabowski, M. Kate, Hall, Matthew, Golubchik, Tanya, Wymant, Chris, Abeler-Dörner, Lucie, Bonsall, David, Hoppe, Anne, Brown, Andrew Leigh, de Oliveira, Tulio, Gall, Astrid, Kellam, Paul, Pillay, Deenan, Kagaayi, Joseph, Kigozi, Godfrey, Quinn, Thomas C., Wawer, Maria J., Laeyendecker, Oliver, Serwadda, David, Gray, Ronald H., Fraser, Christophe, Ayles, Helen, Bowden, Rory, Calvez, Vincent, Cohen, Myron, Dennis, Ann, Essex, Max, Fidler, Sarah, Frampton, Daniel, Hayes, Richard, Herbeck, Joshua T., Kaleebu, Pontiano, Kityo, Cissy, Lingappa, Jairam, Novitsky, Vladimir, Paton, Nick, Rambaut, Andrew, Seeley, Janet, Ssemwanga, Deogratius, Tanser, Frank, Nakigozi, Gertrude, Ssekubugu, Robert, Nalugoda, Fred, Lutalo, Tom, Galiwango, Ronald, Makumbi, Fred, Sewankambo, Nelson K., R. Tobian, Aaron A., Reynolds, Steven J., Mondo, George, Santelli, John, Kennedy, Caitlin E., Wagman, Jennifer, Global Health, Graduate School, AII - Infectious diseases, APH - Personalized Medicine, and APH - Quality of Care

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

21. Phenotypic characteristics and asthma severity in an East African cohort of adults and adolescents with asthma: findings from the African severe asthma project

Author

Kirenga, Bruce, primary, Chakaya, Jeremiah, additional, Yimer, Getnet, additional, Nyale, George, additional, Haile, Tewodros, additional, Muttamba, Winters, additional, Mugenyi, Levicatus, additional, Katagira, Winceslaus, additional, Worodria, William, additional, Aanyu-Tukamuhebwa, Hellen, additional, Lugogo, Njira, additional, Joloba, Moses, additional, Bekele, Amsalu, additional, Makumbi, Fred, additional, Green, Cindy, additional, de Jong, Corina, additional, Kamya, Moses, additional, and van der Molen, Thys, additional

Published
2020
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22. Population-level adult mortality following the expansion of antiretroviral therapy in Rakai, Uganda

Author

Nabukalu, Dorean, primary, Reniers, Georges, additional, Risher, Kathryn A., additional, Blom, Sylvia, additional, Slaymaker, Emma, additional, Kabudula, Chodziwadziwa, additional, Zaba, Basia, additional, Nalugoda, Fred, additional, Kigozi, Godfrey, additional, Makumbi, Fred, additional, Serwadda, David, additional, Reynolds, Steven J., additional, Marston, Milly, additional, Eaton, Jeffrey W., additional, Gray, Ron, additional, Wawer, Maria, additional, Sewankambo, Nelson, additional, and Lutalo, Tom, additional

Published
2019
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25. Combination HIV Prevention and HIV Incidence in Uganda

Author

Grabowski, Mary K, Serwadda, David M, Gray, Ronald H, Nakigozi, Gertrude, Kigozi, Godfrey, Kagaayi, Joseph, Ssekubugu, Robert, Nalugoda, Fred, Lessler, Justin, Lutalo, Thomas, Galiwango, Ronald, Makumbi, Fred, Kong, Xiangrong, Kabatesi, Donna, Alamo, Stella T, Wiersma, Steven, Sewankambo, Nelson K, Tobian, Aaron A R, Laeyendecker, Oliver, Quinn, Thomas C, Reynolds, Steven J, Wawer, Maria J, and Chang, Larry W

Subjects
Adult, Male, Adolescent, Incidence, Sexual Behavior, HIV Infections, Middle Aged, Viral Load, Young Adult, Anti-Retroviral Agents, Circumcision, Male, Multivariate Analysis, Humans, Female, Uganda, Longitudinal Studies, Poisson Distribution, Research Article
Abstract

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.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.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, P0.001). HIV viral-load suppression among all HIV-positive persons increased from 42% in 2009 to 75% by 2016 (P0.001). Male circumcision coverage increased from 15% in 1999 to 59% by 2016 (P0.001). 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 (P0.001). 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).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.).

Published
2017

27. Maternal and neonatal implementation for equitable systems. A study design paper

Author

Ekirapa-Kiracho, Elizabeth, primary, Tetui, Moses, additional, Bua, John, additional, Muhumuza Kananura, Rornald, additional, Waiswa, Peter, additional, Makumbi, Fred, additional, Atuyambe, Lynn, additional, Ajeani, Judith, additional, George, Asha, additional, Mutebi, Aloysuis, additional, Kakaire, Ayub, additional, Namazzi, Gertrude, additional, Paina, Ligia, additional, and Namusoke Kiwanuka, Suzanne, additional

Published
2017
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28. Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices: a quasi-experimental study in three rural Ugandan districts

Author

Ekirapa-Kiracho, Elizabeth, primary, Muhumuza Kananura, Rornald, additional, Tetui, Moses, additional, Namazzi, Gertrude, additional, Mutebi, Aloysius, additional, George, Asha, additional, Paina, Ligia, additional, Waiswa, Peter, additional, Bumba, Ahmed, additional, Mulekwa, Godfrey, additional, Nakiganda-Busiku, Dinah, additional, Lyagoba, Moses, additional, Naiga, Harriet, additional, Putan, Mary, additional, Kulwenza, Agatha, additional, Ajeani, Judith, additional, Kakaire-Kirunda, Ayub, additional, Makumbi, Fred, additional, Atuyambe, Lynn, additional, Okui, Olico, additional, and Namusoke Kiwanuka, Suzanne, additional

Published
2017
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30. Maternal and neonatal implementation for equitable systems : a study design paper

Author

Ekirapa-Kiracho, Elizabeth, Tetui, Moses, Bua, John, Kananura, Rornald Muhumuza, Waiswa, Peter, Makumbi, Fred, Atuyambe, Lynn, Ajeani, Judith, George, Asha, Mutebi, Aloysuis, Kakaire, Ayub, Namazzi, Gertrude, Paina, Ligia, Kiwanuka, Suzanne Namusoke, Ekirapa-Kiracho, Elizabeth, Tetui, Moses, Bua, John, Kananura, Rornald Muhumuza, Waiswa, Peter, Makumbi, Fred, Atuyambe, Lynn, Ajeani, Judith, George, Asha, Mutebi, Aloysuis, Kakaire, Ayub, Namazzi, Gertrude, Paina, Ligia, and Kiwanuka, Suzanne Namusoke

Abstract

Background: Evidence on effective ways of improving maternal and neonatal health outcomes is widely available. The challenge that most low-income countries grapple with is implementation at scale and sustainability. Objectives: The study aimed at improving access to quality maternal and neonatal health services in a sustainable manner by using a participatory action research approach. Methods: The study consisted of a quasi-experimental design, with a participatory action research approach to implementation in three rural districts (Pallisa, Kibuku and Kamuli) in Eastern Uganda. The intervention had two main components; namely, community empowerment for comprehensive birth preparedness, and health provider and management capacity-building. We collected data using both quantitative and qualitative methods using household and facility-level structured surveys, record reviews, key informant interviews and focus group discussions. We purposively selected the participants for the qualitative data collection, while for the surveys we interviewed all eligible participants in the sampled households and health facilities. Descriptive statistics were used to describe the data, while the difference in difference analysis was used to measure the effect of the intervention. Qualitative data were analysed using thematic analysis. Conclusions: This study was implemented to generate evidence on how to increase access to quality maternal and newborn health services in a sustainable manner using a multisectoral participatory approach., Supplement: 4Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)

Published
2017
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31. Effect of a participatory multisectoral maternal and newborn intervention on maternal health service utilization and newborn care practices : a quasi-experimental study in three rural Ugandan districts

Author

Ekirapa-Kiracho, Elizabeth, Kananura, Rornald Muhumuza, Tetui, Moses, Namazzi, Gertrude, Mutebi, Aloysius, George, Asha, Paina, Ligia, Waiswa, Peter, Bumba, Ahmed, Mulekwa, Godfrey, Nakiganda-Busiku, Dinah, Lyagoba, Moses, Naiga, Harriet, Putan, Mary, Kulwenza, Agatha, Ajeani, Judith, Kakaire-Kirunda, Ayub, Makumbi, Fred, Atuyambe, Lynn, Okui, Olico, Kiwanuka, Suzanne Namusoke, Ekirapa-Kiracho, Elizabeth, Kananura, Rornald Muhumuza, Tetui, Moses, Namazzi, Gertrude, Mutebi, Aloysius, George, Asha, Paina, Ligia, Waiswa, Peter, Bumba, Ahmed, Mulekwa, Godfrey, Nakiganda-Busiku, Dinah, Lyagoba, Moses, Naiga, Harriet, Putan, Mary, Kulwenza, Agatha, Ajeani, Judith, Kakaire-Kirunda, Ayub, Makumbi, Fred, Atuyambe, Lynn, Okui, Olico, and Kiwanuka, Suzanne Namusoke

Abstract

Background: The MANIFEST study in eastern Uganda employed a participatory multisectoral approach to reduce barriers to access to maternal and newborn care services. Objectives: This study analyses the effect of the intervention on the utilization of maternal and newborn services and care practices. Methods: The quasi-experimental pre- and post-comparison design had two main components: community mobilization and empowerment, and health provider capacity building. The primary outcomes were utilization of antenatal care (ANC), delivery and postnatal care, and newborn care practices. Baseline (n = 2237) and endline (n = 1946) data were collected from women of reproductive age. The data was analysed using difference in differences (DiD) analysis and logistic regression. Results: The DiD results revealed an 8% difference in early ANC attendance (p < 0.01) and facility delivery (p < 0.01). Facility delivery increased from 66% to 73% in the intervention area, but remained unchanged in the comparison area (64% vs 63%, p < 0.01). The DiD results also demonstrated a 20% difference in clean cord care (p < 0.001) and an 8% difference in delayed bathing (p < 0.001). The intervention elements that predicted facility delivery were attending ANC four times [adjusted odds ratio (aOR) 1.42, 95% confidence interval (CI) 1.171.74] and saving for maternal health (aOR 2.11, 95% CI 1.39-3.21). Facility delivery and village health team (VHT) home visits were key predictors for clean cord care and skin-to-skin care. Conclusions: The multisectoral approach had positive effects on early ANC attendance, facility deliveries and newborn care practices. Community resources such as VHTs and savings are crucial to maternal and newborn outcomes and should be supported. VHT-led health education should incorporate practical measures that enable families to save and access transport services to enhance adequate preparation for birth., Supplement: 4Special Issue: MANIFEST (Maternal and Neonatal Implementation for Equitable Systems Study)

Published
2017
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34. Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans

Author

Nanzigu,Sarah, Kiguba,Ronald, Kabanda,Joseph, Mukonzo,Jackson K, Waako,Paul, Kityo,Cissy, Makumbi,Fred, Nanzigu,Sarah, Kiguba,Ronald, Kabanda,Joseph, Mukonzo,Jackson K, Waako,Paul, Kityo,Cissy, and Makumbi,Fred

Abstract

Sarah Nanzigu,1,2 Ronald Kiguba,1 Joseph Kabanda,3 Jackson K Mukonzo,1 Paul Waako,1 Cissy Kityo,4 Fred Makumbi31Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda; 2Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; 3Institute of Public Health, Makerere University College of Health Sciences, Kampala, Uganda; 4Joint Clinic Research Centre, Kampala, UgandaIntroduction: CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented.Objective: This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts.Methods: Patients' records at two HIV/ART sites – the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda – were reviewed. Records of 426 patients – 68.3% female and 63.2% from JCRC – who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/µL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ≥50, <100 with ≥100, <200 with ≥200, and ≥200 with ≥250 cells/µL.Results: The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ≥ 200 cells/µL re

Published
2013

35. High Prevalence of Malaria Parasitemia and Anemia among Hospitalized Children in Rakai, Uganda

Author

Kiggundu, Valerian L., primary, O'Meara, Wendy P., additional, Musoke, Richard, additional, Nalugoda, Fred K., additional, Kigozi, Godfrey, additional, Baghendaghe, Enos, additional, Lutalo, Tom, additional, Achienge, Marion K., additional, Reynolds, Steven J., additional, Makumbi, Fred, additional, Serwadda, David, additional, Gray, Ronald H., additional, and Wools-Kaloustian, Kara K., additional

Published
2013
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37. Increasing access to institutional deliveries using demand and supply side incentives: early results from a quasi-experimental study

Author

Ekirapa-Kiracho, Elizabeth, primary, Waiswa, Peter, additional, Rahman, M Hafizur, additional, Makumbi, Fred, additional, Kiwanuka, Noah, additional, Okui, Olico, additional, Rutebemberwa, Elizeus, additional, Bua, John, additional, Mutebi, Aloysius, additional, Nalwadda, Gorette, additional, Serwadda, David, additional, Pariyo, George W, additional, and Peters, David H, additional

Published
2011
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40. Frequency of Long-Term Nonprogressors in HIV-1 Seroconverters From Rakai Uganda

Author

Laeyendecker, Oliver, primary, Redd, Andrew D, additional, Lutalo, Tom, additional, Gray, Ronald H, additional, Wawer, Maria, additional, Ssempijja, Victor, additional, Gamiel, Jordyn, additional, Bwanika, John Baptist, additional, Makumbi, Fred, additional, Nalugoda, Fred, additional, Opendi, Pius, additional, Kigozi, Godfrey, additional, Ndyanabo, Anthony, additional, Iga, Boaz, additional, Kiwanuka, Noah, additional, Sewankambo, Nelson, additional, Reynolds, Steven J, additional, Serwadda, David, additional, and Quinn, Thomas C, additional

Published
2009
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42. Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans.

Author

Nanzigu, Sarah, Kiguba, Ronald, Kabanda, Joseph, Mukonzo, Jackson K., Waako, Paul, Kityo, Cissy, and Makumbi, Fred

Subjects
IMMUNOCOMPROMISED patients, ANTIRETROVIRAL agents, HIGHLY active antiretroviral therapy, ETHNOLOGY, HIV, HIV-positive persons
Abstract

Introduction: CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented. Objective: This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts. Methods: Patients' records at two HIV/ART sites - the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda - were reviewed. Records of 426 patients - 68.3% female and 63.2% from JCRC - who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/μL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ⩾50, <100 with ⩾100, <200 with ⩾200, and ⩾200 with ⩾250 cells/μL. Results: The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ⩾ 200 cells/μL reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/μL. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara. Conclusion: Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses. [ABSTRACT FROM AUTHOR]

Published
2013
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43. Effect of changing antiretroviral treatment eligibility criteria on patient load in Kampala, Uganda.

Author

Konde-Lule, Joseph, Makumbi, Fred, Pakker, Nadine, Muyinda, Asad, Mubiru, Mesach, and Cobelens, FrankG.J.

Subjects
*ANTIVIRAL agents, *AGE distribution, *ANALYSIS of variance, *BLOOD cell count, *CONFIDENCE intervals, *HIV infections, *DIAGNOSIS of HIV infections, *MEDICAL care, *PROBABILITY theory, *SERODIAGNOSIS, *T cells, *RELATIVE medical risk, *DISEASE prevalence, *DISEASE progression
Abstract

In many resource-poor countries, CD4 count thresholds of eligibility for antiretroviral treatment (ART) were initially low (<200 cells/mm3) but are now being increased to improve patient survival and to reduce HIV transmission. There are few quantitative data on the effect of such increases on the demand for ART. The objective of this study was to measure HIV prevalence and the proportion of HIV-positives eligible for antiretroviral therapy at different CD4 cut-off levels among users of public health care services in Kampala, Uganda. We recruited 1200 adults from three primary care clinics in Kampala, including equal numbers of family planning (FP) clients, pregnant women, adult patients with any complaint, and persons seeking HIV counseling and testing. All participants were screened for HIV and those positive had a CD4 count done. HIV prevalence in all patients was 16.9% (203/1200). ART eligibility based on CD4 counts significantly increased from 36% at a 200 cells/mm3 cut-off to 44% at 250 cells and to 57% at 350 cells cut-off (p for χ2 trend<0.001). We concluded that changing cut-off levels to higher CD4 counts will significantly increase patient load in Kampala's primary care clinics, but a phased implementation should minimize negative effects on quality of care. [ABSTRACT FROM AUTHOR]

Published
2011
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44. Quantifying HIV transmission flow between high-prevalence hotspots and surrounding communities: a population-based study in Rakai, Uganda

Author

Ratmann, Oliver, Kagaayi, Joseph, Hall, Matthew, Golubchick, Tanya, Kigozi, Godfrey, Xi, Xiaoyue, Wymant, Chris, Nakigozi, Gertrude, Abeler-Dörner, Lucie, Bonsall, David, Gall, Astrid, Hoppe, Anne, Kellam, Paul, Bazaale, Jeremiah, Kalibbala, Sarah, Laeyendecker, Oliver, Lessler, Justin, Nalugoda, Fred, Chang, Larry W, de Oliveira, Tulio, Pillay, Deenan, Quinn, Thomas C, Reynolds, Steven J, Spencer, Simon E F, Ssekubugu, Robert, Serwadda, David, Wawer, Maria J, Gray, Ronald H, Fraser, Christophe, Grabowski, M Kate, Ayles, Helen, Bowden, Rory, Calvez, Vincent, Cohen, Myron, Dennis, Anne, Essex, Max, Fidler, Sarah, Frampton, Dan, Hayes, Richard, Herbeck, Josh, Kaleebu, Pontiano, Kityo, Cissy, Lingappa, Jairam, Novitsky, Vladimir, Paton, Nick, Rambaut, Andrew, Seeley, Janet, Ssemwanga, Deogratius, Tanser, Frank, Lutalo, Tom, Galiwango, Ronald, Makumbi, Fred, Sewankambo, Nelson K., Nabukalu, Dorean, Ndyanabo, Anthony, Ssekasanvu, Joseph, Nakawooya, Hadijja, Nakukumba, Jessica, Kigozi, Grace N., Nantume, Betty S., Resty, Nampijja, Kambasu, Jedidah, Nalugemwa, Margaret, Nakabuye, Regina, Ssebanobe, Lawrence, Nankinga, Justine, Kayiira, Adrian, Nanfuka, Gorreth, Ahimbisibwe, Ruth, Tomusange, Stephen, Galiwango, Ronald M., Nakalanzi, Margaret, Otobi, Joseph O., Ankunda, Denis, Ssembatya, Joseph L., Ssemanda, John B., Kato, Emmanuel, Kairania, Robert, Kisakye, Alice, Batte, James, Ludigo, James, Nampijja, Abisagi, Watya, Steven, Nehemia, Kighoma, Anyokot, Sr. Margaret, Mwinike, Joshua, Kibumba, George, Ssebowa, Paschal, Mondo, George, Wasswa, Francis, Nantongo, Agnes, Kakembo, Rebecca, Galiwango, Josephine, Ssemango, Geoffrey, Redd, Andrew D., Santelli, John, Kennedy, Caitlin E., Wagman, Jennifer, Tobian, Aaron, Ratmann, Oliver, Kagaayi, Joseph, Hall, Matthew, Golubchick, Tanya, Kigozi, Godfrey, Xi, Xiaoyue, Wymant, Chris, Nakigozi, Gertrude, Abeler-Dörner, Lucie, Bonsall, David, Gall, Astrid, Hoppe, Anne, Kellam, Paul, Bazaale, Jeremiah, Kalibbala, Sarah, Laeyendecker, Oliver, Lessler, Justin, Nalugoda, Fred, Chang, Larry W, de Oliveira, Tulio, Pillay, Deenan, Quinn, Thomas C, Reynolds, Steven J, Spencer, Simon E F, Ssekubugu, Robert, Serwadda, David, Wawer, Maria J, Gray, Ronald H, Fraser, Christophe, Grabowski, M Kate, Ayles, Helen, Bowden, Rory, Calvez, Vincent, Cohen, Myron, Dennis, Anne, Essex, Max, Fidler, Sarah, Frampton, Dan, Hayes, Richard, Herbeck, Josh, Kaleebu, Pontiano, Kityo, Cissy, Lingappa, Jairam, Novitsky, Vladimir, Paton, Nick, Rambaut, Andrew, Seeley, Janet, Ssemwanga, Deogratius, Tanser, Frank, Lutalo, Tom, Galiwango, Ronald, Makumbi, Fred, Sewankambo, Nelson K., Nabukalu, Dorean, Ndyanabo, Anthony, Ssekasanvu, Joseph, Nakawooya, Hadijja, Nakukumba, Jessica, Kigozi, Grace N., Nantume, Betty S., Resty, Nampijja, Kambasu, Jedidah, Nalugemwa, Margaret, Nakabuye, Regina, Ssebanobe, Lawrence, Nankinga, Justine, Kayiira, Adrian, Nanfuka, Gorreth, Ahimbisibwe, Ruth, Tomusange, Stephen, Galiwango, Ronald M., Nakalanzi, Margaret, Otobi, Joseph O., Ankunda, Denis, Ssembatya, Joseph L., Ssemanda, John B., Kato, Emmanuel, Kairania, Robert, Kisakye, Alice, Batte, James, Ludigo, James, Nampijja, Abisagi, Watya, Steven, Nehemia, Kighoma, Anyokot, Sr. Margaret, Mwinike, Joshua, Kibumba, George, Ssebowa, Paschal, Mondo, George, Wasswa, Francis, Nantongo, Agnes, Kakembo, Rebecca, Galiwango, Josephine, Ssemango, Geoffrey, Redd, Andrew D., Santelli, John, Kennedy, Caitlin E., Wagman, Jennifer, and Tobian, Aaron

Abstract

Background International and global organisations advocate targeting interventions to areas of high HIV prevalence (ie, hotspots). To better understand the potential benefits of geo-targeted control, we assessed the extent to which HIV hotspots along Lake Victoria sustain transmission in neighbouring populations in south-central Uganda. Methods We did a population-based survey in Rakai, Uganda, using data from the Rakai Community Cohort Study. The study surveyed all individuals aged 15–49 years in four high-prevalence Lake Victoria fishing communities and 36 neighbouring inland communities. Viral RNA was deep sequenced from participants infected with HIV who were antiretroviral therapy-naive during the observation period. Phylogenetic analysis was used to infer partial HIV transmission networks, including direction of transmission. Reconstructed networks were interpreted through data for current residence and migration history. HIV transmission flows within and between high-prevalence and low-prevalence areas were quantified adjusting for incomplete sampling of the population. Findings Between Aug 10, 2011, and Jan 30, 2015, data were collected for the Rakai Community Cohort Study. 25 882 individuals participated, including an estimated 75·7% of the lakeside population and 16·2% of the inland population in the Rakai region of Uganda. 5142 participants were HIV-positive (2703 [13·7%] in inland and 2439 [40·1%] in fishing communities). 3878 (75·4%) people who were HIV-positive did not report antiretroviral therapy use, of whom 2652 (68·4%) had virus deep-sequenced at sufficient quality for phylogenetic analysis. 446 transmission networks were reconstructed, including 293 linked pairs with inferred direction of transmission. Adjusting for incomplete sampling, an estimated 5·7% (95% credibility interval 4·4–7·3) of transmissions occurred within lakeside areas, 89·2% (86·0–91·8) within inland areas, 1·3% (0·6–2·6) from lakeside to inland areas, and 3·7% (2·3–5·8) from in

45. Poor immunological recovery among severely immunosuppressed antiretroviral therapy-naïve Ugandans.

Author

Nanzigu S, Kiguba R, Kabanda J, Mukonzo JK, Waako P, Kityo C, and Makumbi F

Abstract

Introduction: CD4 T lymphocytes remain the surrogate measure for monitoring HIV progress in resource-limited settings. The absolute CD4 cell counts form the basis for antiretroviral therapy (ART) initiation and monitoring among HIV-infected adults. However, the rate of CD4 cell change differs among patients, and the factors responsible are inadequately documented., Objective: This study investigated the relationship between HIV severity and ART outcomes among ART-naïve Ugandans, with the primary outcome of complete immunological recovery among patients of different baseline CD4 counts., Methods: Patients' records at two HIV/ART sites - the Joint Clinic Research Centre (JCRC) in the Kampala region and Mbarara Hospital in Western Uganda - were reviewed. Records of 426 patients - 68.3% female and 63.2% from JCRC - who initiated ART between 2002 and 2007 were included. HIV severity was based on baseline CD4 cell counts, with low counts considered as severe immunosuppression, while attaining 418 CD4 cells/μL signified complete immunological recovery. Incidence rates of complete immunological recovery were calculated for, and compared between baseline CD4 cell categories: <50 with ≥50, <100 with ≥100, <200 with ≥200, and ≥200 with ≥250 cells/μL., Results: The incidence of complete immunological recovery was 158 during 791.9 person-years of observation, and patients with baseline CD4 ≥ 200 cells/μL reached the end point of immunological recovery 1.89 times faster than the patients with baseline CD4 < 200 cells/μL. CD4 cell change also differed by time, sex, and site, with a faster increase observed during the first year of treatment. CD4 cell increase was faster among females, and among patients from Mbarara., Conclusion: Initiating ART at an advanced HIV stage was the main reason for poor immunological recovery among Ugandans. Earlier ART initiation might lead to better immunological responses.

Published
2013
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46. Frequency of long-term nonprogressors in HIV-1 seroconverters From Rakai Uganda.

Author

Laeyendecker O, Redd AD, Lutalo T, Gray RH, Wawer M, Ssempijja V, Gamiel J, Bwanika JB, Makumbi F, Nalugoda F, Opendi P, Kigozi G, Ndyanabo A, Iga B, Kiwanuka N, Sewankambo N, Reynolds SJ, Serwadda D, and Quinn TC

Subjects
Adult, Female, HIV Infections epidemiology, Humans, Male, Time Factors, Uganda epidemiology, Young Adult, HIV Infections pathology, HIV-1 classification, HIV-1 immunology
Abstract

Objective: Studies on long-term nonprogressors (LTNP) have been conducted in the USA and Europe. This study examined the frequency of LTNPs and HIV controllers among 637 HIV-1 seroconverters in rural Uganda., Design and Methods: LTNPs were defined as being infected for more than 7 years with a CD4 T-cell count above 600 cells per microliter, and HIV controllers as having undetectable viral loads on 3 separate occasions without antiretroviral treatment. HIV-1 viral load and subtype distribution between LTNP and non-LTNP populations were determined., Results: Of the HIV seroconverters, 9.1% (58/637) were LTNPs and 1.4% (9/637) were HIV controllers. LTNPs had a significantly lower viral load at set point than non-LTNP participants (P < 0.001). The Kaplan-Meier joint probability of surviving to 7 years with a CD4 count >600 was 19.2%. Individuals who survived 7 years had a significantly higher frequency of HIV-1 subtype A (P < 0.05), but seroconverters infected with HIV-1A did not have a significantly higher probability of becoming an LTNP., Conclusions: The frequency of LTNPs appears to be relatively high in Uganda and it may be important to take this into account when designing studies of viral pathogenesis and performing HIV vaccine trials in sub-Saharan Africa.

Published
2009
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