Autologous adipose-derived stromal vascular fraction (SVF) is described as a therapeutic alternat... more Autologous adipose-derived stromal vascular fraction (SVF) is described as a therapeutic alternative in keloid treatment. However, most conclusions are based on observational with the majority conducted in high-income countries and yet the highest-burden of keloids is in Low-and middle-income countries (LMICs). In order to explore the therapeutic benefits of SVF in keloids, the safety and feasibility of their use in LMICs need to be evaluated.Methods: In this phase 1 randomized controlled pilot clinical trial conducted in the Plastic Surgery Unit of Kirruddu National Referral Hospital Kampala, 8 patients were assigned 1:1 ratio into either SVF or Triamcinolone Acetonide (TAC) arms. In the SVF arm, a median (IQR) number of stromal cell infiltration of 2.7x106 (11x106) was administered while the controls received 10mg/ml TAC in a ratio of 1:1 TAC into keloid volume. Primary end-points were adverse events development based on the Common Terminology Criteria for Adverse Events (CTCAE) v...
Background Globally, tuberculosis disease (TB) is more common among males than females. Recent re... more 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 ...
RationaleDetailed data on the characteristics and outcomes of patients with COVID-19 in sub-Sahar... more RationaleDetailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited.ObjectiveWe determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda.MeasurementsAs of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation.Main resultsThe median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm ...
Phylogenetic inference is useful in characterising HIV transmission networks and assessing where ... more Phylogenetic inference is useful in characterising HIV transmission networks and assessing where prevention is likely to have the greatest impact. However, estimating parameters that influence the network structure is still scarce, but important in evaluating determinants of HIV spread. We analyzed 2017 HIV pol sequences (728 Lake Victoria fisherfolk communities (FFCs), 592 female sex workers (FSWs) and 697 general population (GP)) to identify transmission networks on Maximum Likelihood (ML) phylogenetic trees and refined them using time-resolved phylogenies. Network generative models were fitted to the observed degree distributions and network parameters, and corrected Akaike Information Criteria and Bayesian Information Criteria values were estimated. 347 (17.2%) HIV sequences were linked on ML trees (maximum genetic distance ≤4.5%, ≥95% bootstrap support) and, of these, 303 (86.7%) that consisted of pure A1 (n = 168) and D (n = 135) subtypes were analyzed in BEAST v1.8.4. The maj...
Background: Uganda has one of the highest maternal deaths at a ratio of 336 per 100,000 live birt... more Background: Uganda has one of the highest maternal deaths at a ratio of 336 per 100,000 live births. As Uganda strives to achieve sustainable development goals, appropriate antenatal care is key to reduction of maternal mortality. We explored women’s reported receipt of seven of the Uganda guidelines components of antenatal care, and associated factors in hard to reach Lake Victoria island fishing communities of Kalangala district. Methods: A cross sectional survey among 486 consenting women aged 15-49 years, who were pregnant at any time in the past 6 months was conducted in 6 island fishing communities of Kalangala district, Uganda, during January-May 2018. Interviewer administered questionnaires, were used to collect data on socio-demographics and receipt of seven of the Uganda guidelines components of antenatal care. Regression modeling was used to determine factors associated with receipt of all seven components. Results: Over three fifths (65.0%) had at least one ANC visit dur...
We report on the implementation experience of carrying out data collection and other activities f... more We report on the implementation experience of carrying out data collection and other activities for a public health evaluation study on whether U.S. President's Emergency Plan for AIDS Relief (PEPFAR) investment improved utilization of health services and health system strengthening in Uganda. The retrospective study period focused on the PEPFAR scale-up, from mid-2005 through mid-2011, a period of expansion of PEPFAR programing and health services. We visited 315 health care facilities in Uganda in 2011 and 2012 to collect routine health management information system data forms, as well as to conduct interviews with health system leaders. An earlier phase of this research project collected data from all 112 health district headquarters, reported elsewhere. This article describes the lessons learned from collecting data from health care facilities, project management, useful technologies, and mistakes. We used several new technologies to facilitate data collection, including por...
Severe malaria is a medical emergency associated with high mortality. Adequate treatment requires... more Severe malaria is a medical emergency associated with high mortality. Adequate treatment requires initial parenteral therapy for fast parasite clearance followed by longer acting oral antimalarial drugs for cure and prevention of recrudescence. In a randomized controlled clinical trial, we evaluated the 42-day parasitological outcomes of severe malaria treatment with intravenous artesunate (AS) or intravenous quinine (QNN) followed by oral artemisinin based combination therapy (ACT) in children living in a high malaria transmission setting in Eastern Uganda. We enrolled 300 participants and all were included in the intention to treat analysis. Baseline characteristics were similar across treatment arms. The median and interquartile range for number of days from baseline to parasite clearance was significantly lower among participants who received intravenous AS (2 (1-2) vs 3 (2-3), P < 0.001). Overall, 63.3% (178/281) of the participants had unadjusted parasitological treatment f...
The gastrointestinal (GI) mucosa is central to HIV pathogenesis, and the integrin αβpromotes the ... more The gastrointestinal (GI) mucosa is central to HIV pathogenesis, and the integrin αβpromotes the homing of immune cells to this site, including those that serve as viral targets. Data from simian immunodeficiency virus (SIV) animal models suggest that αβblockade provides prophylactic and therapeutic benefits. We show that pre-HIV infection frequencies of αβperipheral blood CD4T cells, independent of other T cell phenotypes and genital inflammation, were associated with increased rates of HIV acquisition in South African women. A similar acquisition effect was observed in a Kenyan cohort and in nonhuman primates (NHPs) after intravaginal SIV challenge. This association was stronger when infection was caused by HIV strains containing V2 envelope motifs with a preference for αβbinding. In addition, pre-HIV αβCD4T cells predicted a higher set-point viral load and a greater than twofold increased rate of CD4T cell decline. These results were confirmed in SIV-infected NHPs. Increased freq...
The American journal of tropical medicine and hygiene, Feb 8, 2018
Boosted tuberculin skin test (TST) reactions can be misclassified as new latent tuberculosis (TB)... more Boosted tuberculin skin test (TST) reactions can be misclassified as new latent tuberculosis (TB) infection. To our knowledge, no study has evaluated the prevalence of TST boosting in a population-based sample in high TB burden settings. We determined the prevalence of TST boosting among urban residents in Uganda. We evaluated 99 participants with initial TST < 5 mm and repeated a skin test after 2 weeks. We found that only 2% had boosted TST reactions suggesting that most TST conversions could represent new TB infections in this high-burden setting.
Waterborne viruses are a significant cause of human disease, especially in developing countries s... more Waterborne viruses are a significant cause of human disease, especially in developing countries such as Uganda. A total of 15 virus-selective samples were collected at five sites (Bugolobi Wastewater Treatment Plant (WWTP) influent and effluent, Nakivubo Channel upstream and downstream of the WWTP, and Nakivubo Swamp) in July and August 2016. Quantitative PCR and quantitative RT-PCR was performed to determine the concentrations of four human viruses (adenovirus, enterovirus, rotavirus, and hepatitis A virus) in the samples. Adenovirus (1.53*105-1.98*107 copies/L) and enterovirus (3.17*105-8.13*107 copies/L) were found to have the highest concentrations in the samples compared to rotavirus (5.79*101-3.77*103 copies/L) and hepatitis A virus (9.93*102-1.11*104 copies/L). In addition, next-generation sequencing and metagenomic analyses were performed to assess viral diversity, and several human and vertebrate viruses were detected, including Herpesvirales, Iridoviridae, Poxviridae, Circ...
Jaids Journal of Acquired Immune Deficiency Syndromes, Jun 1, 2004
The purpose of the study was to assess knowledge and beliefs regarding vaccines and willingness t... more The purpose of the study was to assess knowledge and beliefs regarding vaccines and willingness to participate in HIV vaccine trials. A baseline survey assessed knowledge and attitudes toward vaccination and potential HIV vaccines among 14,177 participants aged 15-49 years, in a population cohort. Willingness to participate in HIV-preventive vaccine trials was assessed during a follow-up survey 10 months later after providing community education on HIV vaccines. Knowledge of the preventive utility of vaccines was high (71%), but higher in men than women (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), and increased with education levels (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Vaccines were considered appropriate for children and women (99 and 88%, respectively), but not for adult men (28%). Participants felt that adolescents were the most appropriate subjects for HIV preventive vaccine trials (93.7%) but also thought that HIV-positive persons were eligible for trials (60.2%), and only 20% thought a preventive vaccine could help control HIV. HIV vaccine awareness increased from 68% at baseline to 81% at follow-up (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Willingness to participate in HIV-preventive vaccine trials was 77%. Vaccine knowledge and willingness to participate in trials are high in this population. However, there still is need for education on the potential role of preventive HIV vaccines in the control of the epidemic and the importance of vaccination for men, especially in the context of an HIV vaccine.
... Id: 19554819. Autor: Nalugoda F; Wagman J; Kiddugavu M; Kiwanuka N; Garrett E; Gray RH; Serwa... more ... Id: 19554819. Autor: Nalugoda F; Wagman J; Kiddugavu M; Kiwanuka N; Garrett E; Gray RH; Serwadda D; Wawer MJ; Emanuel EJ. Título: Is there coercion or undue inducement to participate in health research in developing countries? An example from Rakai, Uganda. ...
Autologous adipose-derived stromal vascular fraction (SVF) is described as a therapeutic alternat... more Autologous adipose-derived stromal vascular fraction (SVF) is described as a therapeutic alternative in keloid treatment. However, most conclusions are based on observational with the majority conducted in high-income countries and yet the highest-burden of keloids is in Low-and middle-income countries (LMICs). In order to explore the therapeutic benefits of SVF in keloids, the safety and feasibility of their use in LMICs need to be evaluated.Methods: In this phase 1 randomized controlled pilot clinical trial conducted in the Plastic Surgery Unit of Kirruddu National Referral Hospital Kampala, 8 patients were assigned 1:1 ratio into either SVF or Triamcinolone Acetonide (TAC) arms. In the SVF arm, a median (IQR) number of stromal cell infiltration of 2.7x106 (11x106) was administered while the controls received 10mg/ml TAC in a ratio of 1:1 TAC into keloid volume. Primary end-points were adverse events development based on the Common Terminology Criteria for Adverse Events (CTCAE) v...
Background Globally, tuberculosis disease (TB) is more common among males than females. Recent re... more 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 ...
RationaleDetailed data on the characteristics and outcomes of patients with COVID-19 in sub-Sahar... more RationaleDetailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited.ObjectiveWe determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda.MeasurementsAs of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation.Main resultsThe median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm ...
Phylogenetic inference is useful in characterising HIV transmission networks and assessing where ... more Phylogenetic inference is useful in characterising HIV transmission networks and assessing where prevention is likely to have the greatest impact. However, estimating parameters that influence the network structure is still scarce, but important in evaluating determinants of HIV spread. We analyzed 2017 HIV pol sequences (728 Lake Victoria fisherfolk communities (FFCs), 592 female sex workers (FSWs) and 697 general population (GP)) to identify transmission networks on Maximum Likelihood (ML) phylogenetic trees and refined them using time-resolved phylogenies. Network generative models were fitted to the observed degree distributions and network parameters, and corrected Akaike Information Criteria and Bayesian Information Criteria values were estimated. 347 (17.2%) HIV sequences were linked on ML trees (maximum genetic distance ≤4.5%, ≥95% bootstrap support) and, of these, 303 (86.7%) that consisted of pure A1 (n = 168) and D (n = 135) subtypes were analyzed in BEAST v1.8.4. The maj...
Background: Uganda has one of the highest maternal deaths at a ratio of 336 per 100,000 live birt... more Background: Uganda has one of the highest maternal deaths at a ratio of 336 per 100,000 live births. As Uganda strives to achieve sustainable development goals, appropriate antenatal care is key to reduction of maternal mortality. We explored women’s reported receipt of seven of the Uganda guidelines components of antenatal care, and associated factors in hard to reach Lake Victoria island fishing communities of Kalangala district. Methods: A cross sectional survey among 486 consenting women aged 15-49 years, who were pregnant at any time in the past 6 months was conducted in 6 island fishing communities of Kalangala district, Uganda, during January-May 2018. Interviewer administered questionnaires, were used to collect data on socio-demographics and receipt of seven of the Uganda guidelines components of antenatal care. Regression modeling was used to determine factors associated with receipt of all seven components. Results: Over three fifths (65.0%) had at least one ANC visit dur...
We report on the implementation experience of carrying out data collection and other activities f... more We report on the implementation experience of carrying out data collection and other activities for a public health evaluation study on whether U.S. President's Emergency Plan for AIDS Relief (PEPFAR) investment improved utilization of health services and health system strengthening in Uganda. The retrospective study period focused on the PEPFAR scale-up, from mid-2005 through mid-2011, a period of expansion of PEPFAR programing and health services. We visited 315 health care facilities in Uganda in 2011 and 2012 to collect routine health management information system data forms, as well as to conduct interviews with health system leaders. An earlier phase of this research project collected data from all 112 health district headquarters, reported elsewhere. This article describes the lessons learned from collecting data from health care facilities, project management, useful technologies, and mistakes. We used several new technologies to facilitate data collection, including por...
Severe malaria is a medical emergency associated with high mortality. Adequate treatment requires... more Severe malaria is a medical emergency associated with high mortality. Adequate treatment requires initial parenteral therapy for fast parasite clearance followed by longer acting oral antimalarial drugs for cure and prevention of recrudescence. In a randomized controlled clinical trial, we evaluated the 42-day parasitological outcomes of severe malaria treatment with intravenous artesunate (AS) or intravenous quinine (QNN) followed by oral artemisinin based combination therapy (ACT) in children living in a high malaria transmission setting in Eastern Uganda. We enrolled 300 participants and all were included in the intention to treat analysis. Baseline characteristics were similar across treatment arms. The median and interquartile range for number of days from baseline to parasite clearance was significantly lower among participants who received intravenous AS (2 (1-2) vs 3 (2-3), P < 0.001). Overall, 63.3% (178/281) of the participants had unadjusted parasitological treatment f...
The gastrointestinal (GI) mucosa is central to HIV pathogenesis, and the integrin αβpromotes the ... more The gastrointestinal (GI) mucosa is central to HIV pathogenesis, and the integrin αβpromotes the homing of immune cells to this site, including those that serve as viral targets. Data from simian immunodeficiency virus (SIV) animal models suggest that αβblockade provides prophylactic and therapeutic benefits. We show that pre-HIV infection frequencies of αβperipheral blood CD4T cells, independent of other T cell phenotypes and genital inflammation, were associated with increased rates of HIV acquisition in South African women. A similar acquisition effect was observed in a Kenyan cohort and in nonhuman primates (NHPs) after intravaginal SIV challenge. This association was stronger when infection was caused by HIV strains containing V2 envelope motifs with a preference for αβbinding. In addition, pre-HIV αβCD4T cells predicted a higher set-point viral load and a greater than twofold increased rate of CD4T cell decline. These results were confirmed in SIV-infected NHPs. Increased freq...
The American journal of tropical medicine and hygiene, Feb 8, 2018
Boosted tuberculin skin test (TST) reactions can be misclassified as new latent tuberculosis (TB)... more Boosted tuberculin skin test (TST) reactions can be misclassified as new latent tuberculosis (TB) infection. To our knowledge, no study has evaluated the prevalence of TST boosting in a population-based sample in high TB burden settings. We determined the prevalence of TST boosting among urban residents in Uganda. We evaluated 99 participants with initial TST < 5 mm and repeated a skin test after 2 weeks. We found that only 2% had boosted TST reactions suggesting that most TST conversions could represent new TB infections in this high-burden setting.
Waterborne viruses are a significant cause of human disease, especially in developing countries s... more Waterborne viruses are a significant cause of human disease, especially in developing countries such as Uganda. A total of 15 virus-selective samples were collected at five sites (Bugolobi Wastewater Treatment Plant (WWTP) influent and effluent, Nakivubo Channel upstream and downstream of the WWTP, and Nakivubo Swamp) in July and August 2016. Quantitative PCR and quantitative RT-PCR was performed to determine the concentrations of four human viruses (adenovirus, enterovirus, rotavirus, and hepatitis A virus) in the samples. Adenovirus (1.53*105-1.98*107 copies/L) and enterovirus (3.17*105-8.13*107 copies/L) were found to have the highest concentrations in the samples compared to rotavirus (5.79*101-3.77*103 copies/L) and hepatitis A virus (9.93*102-1.11*104 copies/L). In addition, next-generation sequencing and metagenomic analyses were performed to assess viral diversity, and several human and vertebrate viruses were detected, including Herpesvirales, Iridoviridae, Poxviridae, Circ...
Jaids Journal of Acquired Immune Deficiency Syndromes, Jun 1, 2004
The purpose of the study was to assess knowledge and beliefs regarding vaccines and willingness t... more The purpose of the study was to assess knowledge and beliefs regarding vaccines and willingness to participate in HIV vaccine trials. A baseline survey assessed knowledge and attitudes toward vaccination and potential HIV vaccines among 14,177 participants aged 15-49 years, in a population cohort. Willingness to participate in HIV-preventive vaccine trials was assessed during a follow-up survey 10 months later after providing community education on HIV vaccines. Knowledge of the preventive utility of vaccines was high (71%), but higher in men than women (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001), and increased with education levels (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Vaccines were considered appropriate for children and women (99 and 88%, respectively), but not for adult men (28%). Participants felt that adolescents were the most appropriate subjects for HIV preventive vaccine trials (93.7%) but also thought that HIV-positive persons were eligible for trials (60.2%), and only 20% thought a preventive vaccine could help control HIV. HIV vaccine awareness increased from 68% at baseline to 81% at follow-up (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.001). Willingness to participate in HIV-preventive vaccine trials was 77%. Vaccine knowledge and willingness to participate in trials are high in this population. However, there still is need for education on the potential role of preventive HIV vaccines in the control of the epidemic and the importance of vaccination for men, especially in the context of an HIV vaccine.
... Id: 19554819. Autor: Nalugoda F; Wagman J; Kiddugavu M; Kiwanuka N; Garrett E; Gray RH; Serwa... more ... Id: 19554819. Autor: Nalugoda F; Wagman J; Kiddugavu M; Kiwanuka N; Garrett E; Gray RH; Serwadda D; Wawer MJ; Emanuel EJ. Título: Is there coercion or undue inducement to participate in health research in developing countries? An example from Rakai, Uganda. ...
Uploads