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Hematological abnormalities in HIV-antiretroviral therapy naïve clients as seen at an immune suppression syndrome clinic at Mbarara Regional Referral Hospital, southwestern Uganda
(Dove Press, 2018-06-27) Katemba, Crispus; Muzoora, Conrad; Muwanguzi, Enoch; Mwambi, Bashir; Atuhairwe, Christine; Taremwa, Ivan Mugisha
Aim/objective: To assess the common hematological abnormalities among HIV-antiretroviral therapy (ART) naïve clients attending an immune suppression syndrome (ISS) clinic at Mbarara Regional Referral Hospital (MRRH), southwestern Uganda. Patients and methods: This was a cross-sectional study carried out during the months of March to August 2016 at the ISS clinic of MRRH. We collected approximately 4.0 mL of EDTA anticoagulated blood samples, which were assayed for complete blood count, CD4+ cell count and thin-film examination. Correlation of the hematological abnormalities with CD4+ cell counts was done using correlation coefficient (r) and analysis of variance (F ), and the p-value was set at ≤0.05. Results: A total of 141 clients were enrolled. Of these, 67.38% (95/141) were anemic, 26.24% (40/141) had thrombocytopenia while 26.95% (38/141) had leucopenia. Of the 95 participants with anemia, 89.47% (85/95) presented with normocytic-normochromic anemia, 8.42% (8/95) with microcytic-hypochromic anemia and 2.11% (2/95) with macrocytic-hypochromic anemia. Anemia was not different across the several World Health Organization (WHO) stages of HIV infection disease progression (p>0.05). Statistically significant differences were present among participants with leucopenia (p<0.05). Also, leucopenia was more prevalent (11/38) among participants in WHO stage 4 of HIV infection. CD4+ cell counts correlated with thrombocytopenia (r=0.24, p<0.05) and leucopenia (r=0.15, p<0.05). Conclusion: People living with HIV/AIDS (PLWHIV/AIDS) ought to be routinely monitored and treated for the occurrence of hematological abnormalities. Early initiation of ART can help to prevent some hematological abnormalities.
Unsuppressed viral load after intensive adherence counselling in rural eastern Uganda;
(BMC Health Services Research, 2021-12-18) Ndikabona, Geoffrey; Alege, John Bosco; Kirirabwa, Nicholas Sebuliba; Kimuli, Derrick
Background:The East Central (EC) region of Uganda has the least viral suppression rate despite having a relatively low prevalence of human immunodeficiency virus (HIV ). Although the viral suppression rate in Kamuli district is higher than that observed in some of the districts in the region, the district has one of the largest populations of people living with HIV (PLHIV ). We sought to examine the factors associated with viral suppression after the provision of intensive adherence counselling (IAC) among PLHIV in the district. Methods: We reviewed records of PLHIV and used them to construct a retrospective cohort of patients that started and completed IAC during January – December 2019 at three high volume HIV treatment facilities in Kamuli district. We also conducted key informant interviews of focal persons at the study sites. We summarized the data descriptively, tested differences in the outcome (viral suppression after IAC) using chi-square and t-tests, and established indepen-dently associated factors using log-binomial regression analysis with robust standard errors at 5% statistical signifi-cance level using STATA version 15. Results: We reviewed 283 records of PLHIV. The mean age of the participants was 35.06 (SD 18.36) years. The major-ity of the participants were female (56.89%, 161/283). The viral suppression rate after IAC was 74.20% (210/283). The most frequent barriers to ART adherence reported were forgetfulness 166 (58.66%) and changes in the daily routine 130 (45.94). At multivariable analysis, participants that had a pre-IAC viral load that was greater than 2000 copies/ml [adjusted Prevalence Risk Ratio (aPRR)= 0.81 (0.70 - 0.93), p=0.002] and those that had a previous history of viral load un-suppression [aPRR= 0.79 (0.66 - 0.94), p=0.007] were less likely to achieve a suppressed viral load after IAC. ART drug shortages were rare, ART clinic working hours were convenient for clients and ART clinic staff received training in IAC. Conclusion: Despite the consistency in drug availability, counselling training, flexible and frequent ART clinic days, the viral suppression rate after IAC did not meet recommended targets. A high viral load before IAC and a viral rebound were independently associated with having an unsuppressed viral load after IAC. IAC alone may not be enough to achieve viral suppression among PLHIV. To improve viral suppression rates after IAC, other complementary services should be paired with IAC
Virologic failure in HIV-positive adolescents with perfect adherence in Uganda:
(BMC Palliative care, 2019-01-17) Natukunda, Julian; Kirabira, Peter; Ong, Ken Ing Cherng; Shibanuma, Akira; Jimba, Masamine
Background: Adolescents living with human immunodeficiency virus (HIV) die owing to acquired immune deficiency syndrome (AIDS)-related causes more than adults. Although viral suppression protects people living with HIV from AIDS-related illnesses, little is known about viral outcomes of adolescents in sub-Saharan Africa where the biggest burden of deaths is experienced. This study aimed to identify the factors associated with viral load suppression among HIV-positive adolescents (10–19 years) receiving antiretroviral therapy (ART) in Uganda. Methods: We conducted a cross-sectional study among school-going, HIV-positive adolescents on ART from August to September 2016. We recruited 238 adolescents who underwent ART at a public health facility and had at least one viral load result recorded in their medical records since 2015. We collected the data of patients’ demographics and treatment- and clinic-related factors using existing medical records and questionnaire-guided face-to-face interviews. For outcome variables, we defined viral suppression as < 1000 copies/mL. We used multivariate logistic regression to determine factors associated with viral suppression. Results: We analyzed the data of 200 adolescents meeting the inclusion criteria. Viral suppression was high among adolescents with good adherence > 95% (adjusted odds ratio [AOR] 2.73, 95% confidence interval [95% CI, 1.09 to 6.82). However, 71% of all adolescents who did not achieve viral suppression were also sufficiently adherent (adherence > 95%). Regardless of adherence status, other risk factors for viral suppression at the multivariate level included having a history of treatment failure (AOR 0.26, 95% CI, 0.09 to 0.77), religion (being Anglican [AOR 0.19, 95% CI, 0.06 to 0.62] or Muslim [AOR 0.17, 95% CI, 0.05 to 0.55]), and having been prayed for (AOR 0.38, 95% CI, 0.15 to 0.96). Conclusion: More than 70% of adolescents who experienced virologic failure were sufficiently adherent (adherence > 95). Adolescents who had unsuppressed viral loads in their initial viral load were more likely to experience virologic failure upon a repeat viral load regardless of their adherence level or change of regimen. The study also shows that strong religious beliefs exist among adolescents. Healthcare provider training in psychological counseling, regular and strict monitoring of adolescent outcomes should be prioritized to facilitate early identification and management of drug resistance through timely switching of treatment regimens to more robust combinations.
Virologic response of treatmentexperienced HIV-infected Ugandan childrenand adolescents on NNRTI based first-lineregimen, previously monitored withoutviral load
(BMC Pediatrics, 2021) Kibalama, Ssemambo Phionah; Nalubega-Mboowa, Mary Gorrethy; Owora, Arthur; Serunjogi, Robert; Kironde, Susan; Nakabuye, Sarah; Ssozi, Francis; Nannyonga, Maria; Musoke, Philippa; Barlow-Mosha, Linda
Background:Many HIV-infected African children gained access to antiretroviral treatment (ART) through expansionof PEPFAR programs since 2004 and introduction of“Test and Treat”WHO guidelines in 2015. As ART accessincreases and children transition from adolescence to adulthood, treatment failure is inevitable. Viral load (VL)monitoring in Uganda was introduced in 2016 replacing clinical monitoring. However, there’s limited data on thecomparative effectiveness of these two strategies among HIV-infected children in resource-limited settings (RLS). Methods:HIV-infected Ugandan children aged 1–12 years from HIV-care programs with> 1 year of first-line ARTusing only immunologic and clinical criteria to monitor response to treatment were screened in 2010. Eligiblechildren were stratified by VL≤400 and > 400 copies/ml randomized to clinical and immunological (control) versusclinical, immunological and VL monitoring to determine treatment failure with follow-up at 12, 24, 36, and 48weeks. Plasma VL was analyzed retrospectively for controls. Mixed-effects logistic regression models were used tocompare the prevalence of viral suppression between study arms and identify factors associated with viralsuppression. Results:At baseline all children (n= 142) were on NNRTI based ART (75% Nevirapine, 25% efavirenz). One third ofART-experienced children had detectable VL at baseline despite high CD4%. Median age was 6 years (interquartilerange [IQR]: 5–9) and 43% were female. Overall, the odds of viral suppression were not different between studyarms: (arm by week interaction,p= 0.63), adjusted odds ratio [aOR]: 1.07; 95%CI: 0.53, 2.17,p= 0.57) and did notchange over time (aOR: 0 vs 24 week: 1.15; 95% CI: 0.91, 1.46,p= 0.24 and 0 vs 48 weeks: 1.26; 95%CI: 0.92, 1.74,p= 0.15). Longer duration of a child’s ART exposure was associated with lower odds of viral suppression (aOR: 0.61;95% CI: 0.42, 0.87,p< .01). Only 13% (9/71) of children with virologic failure were switched to second-line ART, in spite of access to real-time VL. Conclusion:With increasing ART exposure, viral load monitoring is critical for early detection of treatment failure inRLS. Clinicians need to make timely informed decisions to switch failing children to second-line ART. Trial registration:ClinicalTrials.govNCT04489953, 28 Jul 2020. Retrospectively registered. (https://register.clinicaltrials.gov).

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