Medicine and Health Sciences Commons^™

Catching Chances: The Movement To Be On The Ground And Research Ready Before An Outbreak, David Brett-Major, James V. Lawler

Journal Articles: Epidemiology

After more than 28,000 Ebola virus disease cases and at least 11,000 deaths in West Africa during the 2014⁻2016 epidemic, the world remains without a licensed vaccine or therapeutic broadly available and demonstrated to alleviate suffering. This deficiency has been felt acutely in the two, short, following years with two Ebola virus outbreaks in the Democratic Republic of Congo (DRC), and a Marburg virus outbreak in Uganda. Despite billions of U.S. dollars invested in developing medical countermeasures for filoviruses in the antecedent decades, resulting in an array of preventative, diagnostic, and therapeutic products, none are available on commercial shelves. This …

Community And District Empowerment For Scale-Up (Codes): A Complex District-Level Management Intervention To Improve Child Survival In Uganda: Study Protocol For A Randomized Controlled Trial., Peter Waiswa, Thomas O'Connell, Danstan Bagenda, Pricila Mullachery, Flavia Mpanga, Dorcus Kiwanuka Henriksson, Anne Ruhweza Katahoire, Eric Ssegujja, Anthony K. Mbonye, Stefan Swartling Peterson

Journal Articles: Epidemiology

BACKGROUND: Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably.

METHODS: The CODES strategy combines management, diagnostic, and evaluation tools to identify …

Community And District Empowerment For Scale-Up (Codes): A Complex District-Level Management Intervention To Improve Child Survival In Uganda: Study Protocol For A Randomized Controlled Trial., Peter Waiswa, Thomas O'Connell, Danstan Bagenda, Pricila Mullachery, Flavia Mpanga, Dorcus K. Henriksson, Anne R. Katahoire, Eric Ssegujja, Anthony K. Mbonye, Stefan S. Peterson

Journal Articles: Epidemiology

BACKGROUND: Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably.

METHODS: The CODES strategy combines management, diagnostic, and evaluation tools to identify …

Depressive And Anxiety Symptoms Predict Sustained Quality Of Life Deficits In Hiv-Positive Ugandan Adults Despite Antiretroviral Therapy: A Prospective Cohort Study., Amara E. Ezeamama, Makhabele N. Woolfork, David Guwatudde, Danstan Bagenda, Yukari C. Manabe, Wafaie W. Fawzi, Mary C. Smith Fawzi

Journal Articles: Epidemiology

The impact of psychosocial status at onset of antiretroviral therapy on changes in quality of life (QOL) and subjectively rated health (SRH) among adults on highly active antiretroviral therapy (HAART) in resource-limited settings is poorly understood. Therefore, we evaluate the association between stigma, anxiety, depression, and social support and change in QOL and SRH in HIV-infected Ugandan adults during an 18-month period.Psychosocial indicators were assessed at enrollment using structured questionnaires. QOL and SRH measures were assessed at months 0, 6, 12, and 18 using the Medical Outcomes Survey-HIV. Linear mixed models determined risk estimated differences in QOL and SRH in …

The Effect Of Standard Dose Multivitamin Supplementation On Disease Progression In Hiv-Infected Adults Initiating Haart: A Randomized Double Blind Placebo-Controlled Trial In Uganda., David Guwatudde, Molin Wang, Amara E. Ezeamama, Danstan Bagenda, Rachel Kyeyune, Henry Wamani, Yukari C. Manabe, Wafaie W. Fawzi

Journal Articles: Epidemiology

BACKGROUND: Efficacy trials investigating the effect of multivitamin (MV) supplementations among patients on Highly Active Antiretroviral Therapy (HAART) have so far been inconclusive. We conducted a randomized, double blind, placebo controlled trial to determine the effect of one recommended daily allowance (RDA) of MV supplementation on disease progression in patients initiating HAART.

METHODS: Eligible subjects were randomized to receive placebo or MV supplementation including vitamins B-complex, C and E. Participants were followed for up to 18 months. Primary endpoints were: change in CD4 cell count, weight and quality of life (QoL). Secondary endpoints were: i) development of a new or …

Improving Child Survival Through A District Management Strengthening And Community Empowerment Intervention: Early Implementation Experiences From Uganda., Anne R. Katahoire, Dorcus K. Henriksson, Eric Ssegujja, Peter Waiswa, Florence Ayebare, Danstan Bagenda, Anthony K. Mbonye, Stefan S. Peterson

Journal Articles: Epidemiology

BACKGROUND: The Community and District Empowerment for Scale-up (CODES) project pioneered the implementation of a comprehensive district management and community empowerment intervention in five districts in Uganda. In order to improve effective coverage and quality of child survival interventions CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. This paper presents early implementation experiences in five pilot districts and lessons learnt during the first 2 years of …

University Students And The Risk Of Hiv And Other Sexually Transmitted Infections In Uganda: The Crane Survey., George W. Rutherford, Andrew Anglemyer, Danstan Bagenda, Michael Muyonga, Christina P. Lindan, Joseph L. Barker, Lisa Johnston, Wolfgang Hladik

Journal Articles: Epidemiology

Adolescents and young adults are at high risk of human immunodeficiency virus (HIV) infection in sub-Saharan Africa. Previous reports have found that university students in Africa comprise a sexually active population, although the prevalence of HIV or sexually transmitted infections (STI) has not been measured. We conducted a cross-sectional survey of students from five large universities in Kampala, Uganda, using respondent-driven sampling. We asked students to complete behavioral questionnaires and provide biological samples to test for HIV, Chlamydia trachomatis, Neisseria gonorrhoeae, Treponema pallidum, Trichomonas vaginalis, and bacterial vaginosis. We enrolled 649 students and obtained interpretable data from 640. Around 50% …

Patterns And Predictors Of Self-Medication In Northern Uganda., Moses Ocan, Freddie Bwanga, Godfrey S. Bbosa, Danstan Bagenda, Paul Waako, Jasper Ogwal-Okeng, Celestino Obua

Journal Articles: Epidemiology

Self-medication with antimicrobial agents is a common form of self-care among patients globally with the prevalence and nature differing from country to country. Here we assessed the prevalence and predictors of antimicrobial self-medication in post-conflict northern Uganda. A cross-sectional study was carried out using structured interviews on 892 adult (≥18 years) participants. Information on drug name, prescriber, source, cost, quantity of drug obtained, and drug use was collected. Households were randomly selected using multistage cluster sampling method. One respondent who reported having an illness within three months in each household was recruited. In each household, information was obtained from only …

Men At Risk; A Qualitative Study On Hiv Risk, Gender Identity And Violence Among Men Who Have Sex With Men Who Report High Risk Behavior In Kampala, Uganda., Rachel King, Joseph Barker, Sylvia Nakayiwa, David Katuntu, George Lubwama, Danstan Bagenda, Tim Lane, Alex Opio, Wolfgang Hladik

Journal Articles: Epidemiology

In Uganda, men who have sex with men (MSM) are at high risk for HIV. Between May 2008 and February 2009 in Kampala, Uganda, we used respondent driven sampling (RDS) to recruit 295 MSM≥18 years who reported having had sex with another man in the preceding three months. The parent study conducted HIV and STI testing and collected demographic and HIV-related behavioral data through audio computer-assisted self-administered interviews. We conducted a nested qualitative sub-study with 16 men purposively sampled from among the survey participants based on responses to behavioral variables indicating higher risk for HIV infection. Sub-study participants were interviewed …

The Good, The Bad, And The Unknown: Quality Of Clinical Laboratories In Kampala, Uganda., Ali M. Elbireer, J. B. Jackson, Hakim Sendagire, Alex Opio, Danstan Bagenda, Timothy K. Amukele

Journal Articles: Epidemiology

BACKGROUND: Clinical laboratories are crucial in addressing the high rates of communicable and non-communicable diseases seen in sub-Saharan Africa (SSA). However, the most basic information, such as the number and quality of clinical laboratories in SSA, is not available. The objective of this study was to create a practical method for obtaining this information in SSA towns and cities using an initial survey in Kampala, Uganda.

METHODS: Kampala city was divided into 5 partially-overlapping regions. Each region was assigned to 2-3 surveyors who identified and surveyed laboratories in their respective regions; in person and on foot. A modified version of …

Multivitamin Supplementation In Hiv Infected Adults Initiating Antiretroviral Therapy In Uganda: The Protocol For A Randomized Double Blinded Placebo Controlled Efficacy Trial., David Guwatudde, Amara E. Ezeamama, Danstan Bagenda, Rachel Kyeyune, Fred Wabwire-Mangen, Henry Wamani, Ferdinand Mugusi, Donna Spiegelman, Molin Wang, Yukari C. Manabe, Wafaie W. Fawzi

Journal Articles: Epidemiology

BACKGROUND: Use of multivitamin supplements during the pre-HAART era has been found to reduce viral load, enhance immune response, and generally improve clinical outcomes among HIV-infected adults. However, immune reconstitution is incomplete and significant mortality and opportunistic infections occur in spite of HAART. There is insufficient research information on whether multivitamin supplementation may be beneficial as adjunct therapy for HIV-infected individuals taking HAART. We propose to evaluate the efficacy of a single recommended daily allowance (RDA) of micronutrients (including vitamins B-complex, C, and E) in slowing disease progression among HIV-infected adults receiving HAART in Uganda.

METHODS/DESIGN: We are using a …

Growth, Immune And Viral Responses In Hiv Infected African Children Receiving Highly Active Antiretroviral Therapy: A Prospective Cohort Study., Philippa M. Musoke, Peter Mudiope, Linda N. Barlow-Mosha, Patrick Ajuna, Danstan Bagenda, Michael M. Mubiru, Thorkild Tylleskar, Mary G. Fowler

Journal Articles: Epidemiology

BACKGROUND: Scale up of paediatric antiretroviral therapy in resource limited settings continues despite limited access to routine laboratory monitoring. We documented the weight and height responses in HIV infected Ugandan children on highly active antiretroviral therapy and determined clinical factors associated with successful treatment outcomes.

METHODS: A prospective cohort of HIV infected children were initiated on HAART and followed for 48 weeks. Body mass index for age z scores(BAZ), weight and height-for-age z scores (WAZ & HAZ) were calculated: CD4 cell % and HIV-1 RNA were measured at baseline and every 12 weeks. Treatment outcomes were classified according to; both …