DOCSLIB.ORG

The Effect of HIV-1 Subtypes on HIV Transmission and Disease Progression in Rakai District, Uganda

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
The Effect of HIV-1 Subtypes on HIV Transmission and Disease Progression in Rakai District, Uganda THE EFFECT OF HIV-1 SUBTYPES ON HIV TRANSMISSION AND DISEASE PROGRESSION IN RAKAI DISTRICT, UGANDA by NOAH KIWANUKA, MBChB, MPH Submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy Dissertation Advisor: Prof. Christopher C. Whalen, MD, MS Department of Epidemiology and Biostatistics CASE WESTERN RESERVE UNIVERSITY May, 2008 CASE WESTERN RESERVE UNIVERSITY SCHOOL OF GRADUATE STUDIES We hereby approve the thesis/dissertation of _Noah Kiwanuka_______________________________________ candidate for the Ph.D___degree *. (signed)__Christopher Whalen, MD, MS ______________________ (chair of the committee) __Ajah Sethi, PhD_____________________________________ __Jeffery Albert, PhD___________________________________ __Catherine Stein, PhD__________________________________ __Peter Zimmerman, PhD________________________________ ________________________________________________ (date) _March 20, 2008_______________ *We also certify that written approval has been obtained for any proprietary material contained therein. i Copyright © 2008 by Noah Kiwanuka All rights reserved ii DEDICATION I dedicate this work to: My parents; mom Edith Namuwonge Busuulwa, and dad Livingstone Busuulwa (late), Who did a lot to ensure that I got a good education and encouraged me to aspire for greater achievements My wife Josephine Nalusiba Kiwanuka, You stood by me and lovingly cheered me on And my children Faith Nakamatte, Favor Nakalembe, and any yet unborn May God help you replicate the same academic path iii TABLE OF CONTENTS List of Tables ……………………………………………………………………........v List of Figures ……………………………………………………………………….vii Acknowledgements ………………………………………………………………....viii Abstract ……………………………………………………………………………......x Introduction ……………………………………………………………………………1 Chapter 1: Background, Specific aims, and Significance ………………………..8 Chapter 2: Study Methods ………………………………………………………...38 Chapter 3: A synopsis of the three manuscripts …………………………………62 Chapter 4: HIV-1 subtype and heterosexual transmission of HIV among HIV discordant couples in Rakai, Uganda. …………………65 Chapter 5: Rate of CD4+ T cell loss by HIV-1 subtype among HIV-1 infected adults in Rakai, Uganda. ………………………………….....99 Chapter 6: Effect of HIV-1 subtype on disease progression in persons with incident HIV-1 infections, Rakai, Uganda.…………………….125 Chapter 7: Conclusions, Recommendations, Data limitations and Strengths …148 Appendices: Extra tables and figures ………………………………………………173 Curriculum vitae ……………………………………………………………………..183 iv LIST OF TABLES Chapter 4 Table 4.1: Characteristics of monogamous HIV-1 discordant couples …………….......79 Table 4.2: Comparison of selected characteristics by HIV-1 Subtype …………………82 Table 4.3: HIV transmission rates among couples with HIV-1 subtype data ..…………83 Table 4.4: HIV transmission rates regardless of stage of HIV infection ……..…………85 Table 4.5: HIV transmission rates in latent stage of HIV infection …………………….86 Table 4.6: HIV transmission and couple genital ulceration disease status ……………..87 Table 4.7: HIV transmission rate per-coital act ………………………………………...88 Table 4.8: Rate ratios of HIV transmission per-coital act ..……………………………..90 Table 4.9: HIV transmission incidence rate per 100 person years ..…………………...174 Table 4.10: Rate ratios: models with and without HIV load …..………………………175 Table 4.11: Transmission rate by enrolment status of index positive partner .………..176 Table 4.12: HIV transmission incidence rate/100 py by couple GUD status…………..177 Chapter 5 Table 5.1: Descriptive characteristics of the study population ……………………….110 Table 5.2: Comparison of HIV-1 subtype by selected characteristics ………………..111 Table 5.3: Unadjusted rate of CD4+ T cell loss by selected characteristics ………….114 Table 5.4: Adjusted rate of CD4+ T cell loss, overall and by HIV-1 subtype ………..115 v Table 5.5: HIV-1 subtype differences in rate of CD4+ cell loss………………………117 Chapter 6 Table 6.1: Characteristics of Study Participants; overall and by HIV-1 Subtype …….134 Table 6.2: Progression from HIV-1 Seroconversion to AIDS ………………………...137 Table 6.3: Progression from HIV-1 Seroconversion to death.………………………...140 Table 6.4: Characteristics of study population at enrolment ..…………………….…..181 Table 6.5: Hazard ratios of progression to AIDS.………………………………..……182 vi LIST OF FIGURES Chapter 1 Figure 1.1: The natural history of HIV-1 infection ………………………………….12 Chapter 2 Figure 2.1: The Multi-region Hybridization Assay…………………………………..48 Chapter 4 Figure 4.1: Measurement of the at risk exposure period ……………………………75 Chapter 5 Figure 5.1 Matrix-scatter plot of CD4+ T counts ……………………………….…179 Figure 5.2 Trajectories of CD4+ T cells with fitted linear line..…………………...179 Chapter 6 Figure 6.1. Kaplan-Meier curves of time-to-AIDS by HIV-1 Subtype …………....136 Figure 6.2. Kaplan-Meier curves of time-to-death by HIV-1 Subtype …………….139 vii ACKNOWLEDGEMENTS Ebenezer! I give all the glory and honor to the Lord Jesus Christ for thus far He hath brought me. On the path to completing this training, I have been graciously helped by many wonderful persons – to them all, I extend my sincere appreciation. I thank the Fogarty AIDS International Research and Training Program (AITRP) at Case Western Reserve University for funding my studies. Special thanks go to Prof. Christopher Whalen, Alice Cantini, and Grace Svilar for all the support you have accorded me. I thank Prof. Christopher Whalen, my advisor and committee chair for guiding me very well during my pursuit of this degree. I have learnt a lot from his systematic and first principles based approach to epidemiology, statistical analysis, and research. I appreciate the guidance and advice of other committee members Dr. Jeffrey Albert, Dr. Ajay Sethi, Dr. Peter Zimmerman, and Dr. Catherine Stein. I am very grateful to the Management of Rakai Health Sciences Program for mentoring me in my research career and for allowing me to use the Rakai data for my dissertation. Special thanks go to Professors Ronald H. Gray and Maria J. Wawer of Johns Hopkins University, Baltimore, USA, and David Serwadda, Fred Wabwire-Mangen, and Nelson K. Sewankambo of Makerere University, Kampala, Uganda. I am very grateful to Dr. Merlin Robb and the Management of the Makerere University Walter Reed Project for viii allowing me to use their data for my dissertation. My sincere thanks to Mr. Oliver Laeyendecker, Dr. Thomas C. Quinn, and Dr. Steven Reynolds of the National Institute of Allergy and Infectious Diseases, and the laboratory staff of Rakai Health Sciences Program for helping me with the lab work. I am very grateful to Joseph Ssekasanvu and John Baptist Bwanika, Data Managers in Rakai Health Sciences Program, for being there for me all the time I needed help with the datasets. I extend my special thanks to my wife Josephine Nalusiba Kiwanuka for encouraging me and for enduring all the time I was taken away from the family by the academic program. My sincere appreciations go to all my siblings particularly Joseph Mabirizi and Dr. Jackson S. Musuuza for being a great source of encouragement. I also thank Pastor Charles Musisi and all the members of Kalisizo Pentecostal Church, Uganda, and Pastor Abel Oriri and Heights Fellowship Church, Cleveland, USA, for praying with me. I thank Dr. Achilles Katamba, my friend and schoolmate from elementary school to Case Western Reserve University, for encouraging me to pursue this training. I am deeply indebted to the people of Rakai district, Uganda, whose participation in the research activities has given rise to important epidemiological and public health findings on the HIV/AIDS pandemic. ix The Effect of HIV-1 Subtypes on HIV Transmission and Disease Progression in Rakai District, Uganda Abstract by NOAH KIWANUKA Objectives: To determine whether HIV transmission and disease progression differ by HIV-1 subtype. Methods: The effect of HIV-1 subtypes on HIV transmission and disease progression was investigated using data from community-based cohort studies in Rakai district, Uganda. HIV-1 subtype was determined by genomic sequencing of the gag and gp41 viral regions and by the Multi-region Hybridization Assay (MHA). HIV viral loads were determined by Roche Amplicor v1.5, and CD4+ T cell counts by BD Facscalibur system. Adjusted measures of association were estimated using Poisson regression model, linear mixed effects model, and Cox proportional hazards model. Results: Adjusting for age, viral load, and genital ulcers (GUD), HIV transmission was higher for subtype A relative subtype D (Rate ratio, 1.98; 95% CI, 1.17 - 3.34). Age (<30 years) of the positive partner (RR, 3.98; 95%CI, 1.90 - 8.35), GUD (RR, 1.83; 95% CI, x 1.16 - 2.89), and viral load (RR, 2.17; 95% CI, 1.60 - 2.94) were significant risk factors for HIV transmission. Regardless of subtype, the rate of CD4+ T cell loss (cells/μL per year) was -31.6 (95%CI; -44.6, -18.6), adjusted for age, baseline CD4 counts, and viral load. Adjusted rate of CD4+ cell loss was -8.8 (95%CI; -35.1, 17.4) for subtype A, -34.3 (95%CI; -64.0, -4.6) for R, -37.5 (95%CI; -54.1, -20.8) for subtype D, and -77.5 (95%CI; -136.6, -18.4) for M. The median time from seroconversion to AIDS was shorter for subtypes D, R and M (6.5, 5.6, and 5.8 years, respectively), compared with A (8.0 years; p =0.022). Relative to subtype A, adjusted hazard ratios (95% CI) of progression to AIDS were 2.13 (1.10 - 4.11) for subtype D, 2.16 (1.05 - 4.45) for recombinants, and 4.40 (1.71-11.3) for infection with multiple HIV strains. Conclusions: In Rakai, subtype A has a higher rate of HIV transmission than subtype D or inter-subtype recombinants. However, subtype A has a slower rate of progression to AIDS compared to subtype D, recombinants, and multiple HIV strains. Determination of HIV-1 subtype may be important in trials of preventive and therapeutic HIV-1 vaccines and in the management of HIV infected individuals. Key words: HIV-1 subtypes, HIV transmission, disease progression Word count: 347 xi INTRODUCTION The human immunodeficiency virus (HIV) is a genetically diverse virus and its genetic diversity appears to affect its pathogenicity and natural history.
Load more

Recommended publications
  • Download (739Kb)
    VIEWS & REVIEWS Arterial ischemic stroke in HIV Defining and classifying etiology for research studies Laura A. Benjamin, ABSTRACT MRCP, PhD HIV infection, and potentially its treatment, increases the risk of an arterial ischemic stroke. Mul- Alan Bryer, FCN (SA), tiple etiologies and lack of clear case definitions inhibit progress in this field. Several etiologies, PhD many treatable, are relevant to HIV-related stroke. To fully understand the mechanisms and the Sebastian Lucas, FRCP, terminology used, a robust classification algorithm to help ascribe the various etiologies is FRCPath needed. This consensus paper considers the strengths and limitations of current case definitions Alan Stanley, FCN (SA) in the context of HIV infection. The case definitions for the major etiologies in HIV-related strokes Theresa J. Allain, FRCP, were refined (e.g., varicella zoster vasculopathy and antiphospholipid syndrome) and in some in- PhD stances new case definitions were described (e.g., HIV-associated vasculopathy). These case def- Elizabeth Joekes, FRCR initions provided a framework for an algorithm to help assign a final diagnosis, and help classify Hedley Emsley, FRCP, the subtypes of HIV etiology in ischemic stroke. Neurol Neuroimmunol Neuroinflamm 2016;3:e254; PhD doi: 10.1212/NXI.0000000000000254 Ian Turnbull, FRCR Colin Downey, MIBMS GLOSSARY Cheng-Hock Toh, FRCP, ACL 5 anticardiolipin antibodies; anti-b2GP1 5 anti–b2-glycoprotein I; APS 5 antiphospholipid syndrome; HSV 5 herpes PhD simplex virus; IgG 5 immunoglobulin G; LA 5 lupus anticoagulant; RPR 5 rapid plasma reagin; SVD 5 small vessel disease; 5 5 5 Kevin Brown, FRCPath, TB tuberculosis; TOAST Trial of Org 10172 in Acute Stroke Treatment; TTP thrombotic thrombocytopenic purpura; VDRL 5 Venereal Disease Research Laboratory; VZV 5 varicella zoster virus.
    [Show full text]
  • • Current Population Estimated at 43 Million • 70% <30Years
    HIV / AIDS situation in Uganda Lydia Nakiyingi, Ahmed Ddungu and Joel Maena Uganda Participants for EACS HIV Summer Course Location Uganda’s HIV History • 1978- First AIDS patient identified in Rakai district- 150km from Kampala • 1980- HIV was observed as highly fatal disease of mysterious origin. Locals named it ‘slim’ disease read “silimu” due to assoc severe wasting with no cure • 1984: ELISA first HIV test available in Uganda • 1986: F. Castro invites Ug. soldiers go for training - 30% test HIV+ in Cuba • 1987- The AIDS support organization was started to provide palliative care • 1989-Ugandan popular musician (Philly Bongoley Lutaaya) makes a public announcement about his HIV status (Died a year later) • 1990-Uganda first African nation to open a VCT clinic; the “AIDS Information Centre” that continues a dynamic and active anti HIV campaign to date • 1990-1992- Highest HIV prevalence registered (14%) with high rates of mortality which culminated into several mass campaigns (e.g.red ribbon, Demographics media) and a high level political response • Current population estimated at 43 million • 1992- Creation of the Uganda AIDS commission, a government entity tasked • 70% <30years to develop a national HIV/AIDS policy to steer a multi-sectorial and multi- partner response to HIV/AIDS in Uganda HIV Demographics- UPHIA SURVEY Adult HIV Prevalence by region Music Legend: Philly B Lutaaya makes his status public Uganda’s Progress in HIV Epidemic Control • 1990-Abstinence, Behaviour Change, Condom use (ABC)strategy (Presidential HIV Prevalence by Age, Sex initiative) • 1990-Involvement in Clinical trials on Zidovudine in a research setting • 2004-PMTCT (NVP at MUJHU) • 2005-HAART (based on CD4 count and WHO stage) • 2006-2017; Safe Male Circumcision (3.6million as of 2018) PREP MTCT B+ HAART for all key populations (TB, discordant, Sex workers, Hepatitis) • 2018-HAART for all PLWH • 2018: 1.1 million Ugandans are PLHIV Conclusions • Implementing Partners in HIV HIV prevalence in Uganda has significantly declined (>50% decline) .
    [Show full text]
  • Ending CHILD MARRIAGE and TEENAGE PREGNANCY in Uganda
    ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA A FORMATIVE RESEARCH TO GUIDE THE IMPLEMENTATION OF THE NATIONAL STRATEGY ON ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA Final Report - December 2015 ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA 1 A FORMATIVE RESEARCH TO GUIDE THE IMPLEMENTATION OF THE NATIONAL STRATEGY ON ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA A FORMATIVE RESEARCH TO GUIDE THE IMPLEMENTATION OF THE NATIONAL STRATEGY ON ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA Final Report - December 2015 ACKNOWLEDGEMENTS The United Nations Children Fund (UNICEF) gratefully acknowledges the valuable contribution of many individuals whose time, expertise and ideas made this research a success. Gratitude is extended to the Research Team Lead by Dr. Florence Kyoheirwe Muhanguzi with support from Prof. Grace Bantebya Kyomuhendo and all the Research Assistants for the 10 districts for their valuable support to the research process. Lastly, UNICEF would like to acknowledge the invaluable input of all the study respondents; women, men, girls and boys and the Key Informants at national and sub national level who provided insightful information without whom the study would not have been accomplished. I ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA A FORMATIVE RESEARCH TO GUIDE THE IMPLEMENTATION OF THE NATIONAL STRATEGY ON ENDING CHILD MARRIAGE AND TEENAGE PREGNANCY IN UGANDA CONTENTS ACKNOWLEDGEMENTS ..................................................................................I
    [Show full text]
  • HIV/AIDS Treatment and Care in a Long-Term Conflict Setting: Observations from the AIDS Support Organization (TASO) in the Teso Region Emma Smith SIT Study Abroad
    SIT Graduate Institute/SIT Study Abroad SIT Digital Collections Independent Study Project (ISP) Collection SIT Study Abroad Spring 2008 HIV/AIDS Treatment and Care in a Long-Term Conflict Setting: Observations From The AIDS Support Organization (TASO) in the Teso Region Emma Smith SIT Study Abroad Follow this and additional works at: https://digitalcollections.sit.edu/isp_collection Recommended Citation Smith, Emma, "HIV/AIDS Treatment and Care in a Long-Term Conflict Setting: Observations From The AIDS Support Organization (TASO) in the Teso Region" (2008). Independent Study Project (ISP) Collection. 99. https://digitalcollections.sit.edu/isp_collection/99 This Unpublished Paper is brought to you for free and open access by the SIT Study Abroad at SIT Digital Collections. It has been accepted for inclusion in Independent Study Project (ISP) Collection by an authorized administrator of SIT Digital Collections. For more information, please contact [email protected]. HIV/AIDS Treatment and Care in a Long-Term Conflict Setting: Observations from The AIDS Support Organization (TASO) in the Teso Region Emma Smith Advisor: Alutia Samuel Academic Directors: Charlotte Mafumbo and Martha Wandera Location: TASO Soroti SIT Uganda Spring 2008 Dedication To all the people living with HIV/AIDS in Teso, who continue to live strongly despite decades of suffering from continuous war, displacement and neglect. May the world come to recognize the struggles that you live with. Acknowledgements There are so many people to whom thanks is owed, it would not be possible to acknowledge them all even if time and space allowed. Primarily, I would like to thank the clients of TASO Soroti, who so willingly welcomed a stranger into their communities and allowed so many questions to be asked of them.
    [Show full text]
  • Priority Service Provision Under Decentralization: a Case Study of Maternal and Child Health Care in Uganda
    Small Applied Research No. 10 Priority Service Provision under Decentralization: A Case Study of Maternal and Child Health Care in Uganda December 1999 Prepared by: Frederick Mwesigye, M.A Makerere University Abt Associates Inc. n 4800 Montgomery Lane, Suite 600 Bethesda, Maryland 20814 n Tel: 301/913-0500 n Fax: 301/652-3916 In collaboration with: Development Associates, Inc. n Harvard School of Public Health n Howard University International Affairs Center n University Research Co., LLC Funded by: U.S. Agency for International Development Mission The Partnerships for Health Reform (PHR) Project seeks to improve people’s health in low- and middle-income countries by supporting health sector reforms that ensure equitable access to efficient, sustainable, quality health care services. In partnership with local stakeholders, PHR promotes an integrated approach to health reform and builds capacity in the following key areas: > Better informed and more participatory policy processes in health sector reform; > More equitable and sustainable health financing systems; > Improved incentives within health systems to encourage agents to use and deliver efficient and quality health services; and > Enhanced organization and management of health care systems and institutions to support specific health sector reforms. PHR advances knowledge and methodologies to develop, implement, and monitor health reforms and their impact, and promotes the exchange of information on critical health reform issues. December 1999 Recommended Citation Mwesigye, Frederick. 1999. Priority Service Provision Under Decentralization: A Case Study of Maternal and Child Health Care in Uganda. Small Applied Research Paper No. 10. Bethesda, MD: Partnerships for Health Reform Project, Abt Associates Inc. For additional copies of this report, contact the PHR Resource Center at [email protected] or visit our website at www.phrproject.com.
    [Show full text]
  • Herpesviruses
    J Clin Pathol: first published as 10.1136/jcp.32.9.859 on 1 September 1979. Downloaded from Journal of Clinical Pathology, 1979, 32, 859-881 Herpesviruses MORAG C. TIMBURY' AND ELIZABETH EDMOND2 From the 'Department of Bacteriology, Royal Infirmary, Glasgow and the 2Regional Virus Laboratory, City Hospital, Greenbank Drive, Edinburgh, UK Herpesviruses are ubiquitous in both human and tion (Plummer et al., 1970) or microneutralisation animal populations (Plummer, 1967). The four tests (Pauls and Dowdle, 1967) are often used for human herpesviruses are herpes simplex (HSV), this, but differentiating the two types of virus today varicella-zoster (VZ), cytomegalovirus (CMV), and can probably be done more easily by biochemical Epstein-Barr (EBV) viruses, and all exhibit the prop- methods. Thus the DNA of the viruses can be dis- erty, rare among human pathogenic viruses, of tinguished by restriction enzyme analysis (Skare et remaining latent within the body after primary infec- al., 1975). Similarly, many of the virus polypeptides tion. Latent virus persists for many years-probably produced in infected cells by the two types of virus throughout life-and in some patients reactivates to can be distinguished by polyacrylamide gel electro- cause secondary or recurrent infections. Human phoresis (Courtney and Powell, 1975). herpesviruses can almost be regarded as part of the commensal flora, and certainly HSV is present in LABORATORY DIAGNOSIS the saliva of healthy people from time to time HSV-1 infections are most rapidly diagnosed by (Douglas and Couch, 1970). The viruses exhibit a isolation of the virus in cell cultures such as BHK21 remarkably successful parasitism since the upset to or RK1 3 cells (Grist et al., 1979).
    [Show full text]
  • New York Chapter American College of Physicians Annual
    New York Chapter American College of Physicians Annual Scientific Meeting Poster Presentations Saturday, October 12, 2019 Westchester Hilton Hotel 699 Westchester Avenue Rye Brook, NY New York Chapter American College of Physicians Annual Scientific Meeting Medical Student Clinical Vignette 1 Medical Student Clinical Vignette Adina Amin Medical Student Jessy Epstein, Miguel Lacayo, Emmanuel Morakinyo Touro College of Osteopathic Medicine A Series of Unfortunate Events - A Rare Presentation of Thoracic Outlet Syndrome Venous thoracic outlet syndrome, formerly known as Paget-Schroetter Syndrome, is a condition characterized by spontaneous deep vein thrombosis of the upper extremity. It is a very rare syndrome resulting from anatomical abnormalities of the thoracic outlet, causing thrombosis of the deep veins draining the upper extremity. This disease is also called “effort thrombosis― because of increased association with vigorous and repetitive upper extremity activities. Symptoms include severe upper extremity pain and swelling after strenuous activity. A 31-year-old female with a history of vascular thoracic outlet syndrome, two prior thrombectomies, and right first rib resection presented with symptoms of loss of blood sensation, dull pain in the area, and sharp pain when coughing/sneezing. When the patient had her first blood clot, physical exam was notable for swelling, venous distension, and skin discoloration. The patient had her first thrombectomy in her right upper extremity a couple weeks after the first clot was discovered. Thrombolysis with TPA was initiated, and percutaneous mechanical thrombectomy with angioplasty of the axillary and subclavian veins was performed. Almost immediately after the thrombectomy, the patient had a rethrombosis which was confirmed by ultrasound.
    [Show full text]
  • Intimate Partner Violence As a Predictor of Marital Disruption in Rural Rakai, Uganda: a Longitudinal Study
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by eScholarship - University of California UCLA UCLA Previously Published Works Title Intimate partner violence as a predictor of marital disruption in rural Rakai, Uganda: a longitudinal study. Permalink https://escholarship.org/uc/item/2kz5x57n Journal International journal of public health, 61(8) ISSN 1661-8556 Authors Wagman, Jennifer A Charvat, Blake Thoma, Marie E et al. Publication Date 2016-11-01 DOI 10.1007/s00038-016-0891-z Peer reviewed eScholarship.org Powered by the California Digital Library University of California See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/308047420 Intimate partner violence as a predictor of marital disruption in rural Rakai, Uganda: a longitudinal study Article in International Journal of Public Health · September 2016 DOI: 10.1007/s00038-016-0891-z CITATIONS READS 7 161 11 authors, including: Jennifer Wagman Marie Thoma University of California Los Angeles Fielding School of Public Health University of Maryland, College Park 51 PUBLICATIONS 1,343 CITATIONS 49 PUBLICATIONS 1,094 CITATIONS SEE PROFILE SEE PROFILE Anthony Ndyanabo Fredrick Nalugoda Rakai Health Sciences Program Rakai Health Sciences Program 41 PUBLICATIONS 877 CITATIONS 265 PUBLICATIONS 11,819 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Mucosal HIV Susceptibility View project ALPHA Network View project All content following this page was uploaded by Jennifer Wagman on 31 March 2018. The user has requested enhancement of the downloaded file. Int J Public Health DOI 10.1007/s00038-016-0891-z ORIGINAL ARTICLE Intimate partner violence as a predictor of marital disruption in rural Rakai, Uganda: a longitudinal study Jennifer A.
    [Show full text]
  • A Review on Prevention and Treatment of Aids
    Pharmacy & Pharmacology International Journal Review Article Open Access A Review on prevention and treatment of aids Abstract Volume 5 Issue 1 - 2017 Human immunodeficiency virus (HIV) is a retrovirus which causes acquired immune Chinmaya keshari sahoo,1 Nalini kanta deficiency syndrome (AIDS) a condition where CD4+ cell count falls below 200 cells/ Sahoo,2 Surepalli Ram Mohan Rao,3 Muvvala µl and immune system begins to fail in humans leading to life threatening infections. 4 Many factors are associated with the sexual transmission of HIV causing AIDS. HIV Sudhakar 1 is transmitted by three main routes sexual contact, exposure to infected body fluids or Department of Pharmaceutics, Osmania University College of Technology, India tissues and from mother to child during pregnancy, delivery or breast feeding (vertical 2Department of Pharmaceutical Analysis and Quality assurance, transmission). Hence the efforts for prevention and control of HIV have to rely largely MNR College of Pharmacy, India on sexually transmitted disease (STD) control measures and AIDS. In the developing 3Mekelle University, Ethiopia countries both prevalence and incidence of AIDS are very high. The impact of AIDS 4Department of pharmaceutics, Malla Reddy College of on women’s health adversely affected by various reasons such as more susceptibility Pharmacy, India than men, asymptomatic nature of infection etc. The management of AIDS can be controlled by antiretroviral therapy, opportunistic infections and alternative medicine. Correspondence: Chinmaya keshari sahoo, Department of In present study is an update on origins of HIV, stages of HIV infection, transmission, Pharmaceutics, Osmania University College of Technology, India, diagnosis, prevention and management of AIDS. Email [email protected] Keywords: aids, HIV cd4+, vertical transmission, antiretroviral therapy Received: November 18, 2016 | Published: February 08, 2017 Abbreviations: HIV, human immunodeficiency virus; AIDS, bodily fluids such as saliva and tears do not transmit HIV.
    [Show full text]
  • Program of the 4Th Scientific Conference
    Makerere University College of Health Sciences Program for the 7th Annual Scientific Conference 20th – 22nd September 2011; Speke Resort Munyonyo Kampala, Uganda 20th SEPTEMBER 2011 Abstract No. Time Presentation 8.00-8.30 Arrival and registration PLENARY Chair: Dr Rhoda Wanyenze; Co-Chair: Dr. Freddie Bwanga 8.30 - 9.00 Key note address – All for Health – One Health: Dr. Jane Aceng Director General MOH PLENARY Health Systems, Health Policy & Healthcare Chair: Prof Fredrick Wabwire-Mangen; Co-Chair: Prof. David Guwatudde PP1001_20 9.00-9.10 Health Systems, Governance and Health Outcome: Dr. Freddie Ssengoba PP1002_20 9.10-9.20 Challenges and Future Systems in Uganda to Ensure Delivery of Quality Care: Dr. Robert Basaza PP1003_20 9.20-9.30 Transforming Education to Strengthen Health Systems in an Inter-department World: Prof. David Serwadda 9.30-9:40 DISCUSSION PP1004_20 9:40-9:50 Role of Cultural Institutions in Healthcare Delivery, Disease Prevention and Health Promotion: Dr. Nelson Kawalya PP1005_20 9:50-10:00 Impact of Private for Profit Institutions in Healthcare Delivery and Health Systems Strengthening: Dr. Ian Clarke PP1006_20 10:00-10:10 HIV/AIDS programming through District based technical assistance programme: Experience from STAR-EC: Dr. Samson Kironde 10:10-10:20 DISCUSSION 10:20-10:50 TEA BREAK OFFICIAL OPENING CEREMONY: MC – Prof. Harriet Mayanja; Co-MC: Mr. Gerald Makumbi 10:50-10.55 Welcome remarks by Chair, 7ASC Organising Committee MakCHS: Dr. Freddie Bwanga 10.55-11.10 Announcement of the Bill & Melinda Gates Research Grant for Africa: Dr. Wong 11.10-11.10 Remarks on Translating Research into Policy and Healthcare Delivery by Chair, Research College of Health Sciences Makerere University: Prof.
    [Show full text]
  • Equitable Access to Health Professional Training in Uganda: a Cross Sectional Study
    See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/324855149 Equitable Access to Health Professional Training in Uganda: A Cross Sectional Study Article in Annals of Global Health · April 2018 DOI: 10.29024/aogh.7 CITATIONS READS 0 67 10 authors, including: Samuel Maling Jerome Kabakyenga Mbarara University of Science & Technology (MUST) Mbarara University of Science & Technology (MUST) 39 PUBLICATIONS 284 CITATIONS 91 PUBLICATIONS 1,005 CITATIONS SEE PROFILE SEE PROFILE Hannington Muyenje Nelson Sewankambo TEARFUND Makererere University 2 PUBLICATIONS 0 CITATIONS 330 PUBLICATIONS 20,066 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Postpartum sepsis/infection View project Post discharge mortality View project All content following this page was uploaded by Nelson Sewankambo on 28 August 2018. The user has requested enhancement of the downloaded file. Galukande M, et al. Equitable Access to Health Professional Training in Uganda: A Cross Sectional Study. Annals of Global Health. 2018; 84(1), pp. 91–99. DOI: https://doi.org/10.29024/aogh.7 ORIGINAL RESEARCH Equitable Access to Health Professional Training in Uganda: A Cross Sectional Study M. Galukande*, S. Maling†, J. Kabakyenga‡, J. Nshaho§, H. Oboke‖, B. Oonge¶, H. Muyenje**, G. Katumba-Sentongo††, H. Mayanja-Kizza‡‡ and N.K. Sewankambo‡‡ Objective: We set out to assess inequalities to access health professional education, and the impact of an education improvement program supported by MEPI (Medical Education Partnership Initiative). Inequali- ties in the higher education system in sub-Saharan Africa remain despite some transformative policies and affirmative action.
    [Show full text]
  • Rakai Health Sciences Program (Formerly Rakai Project)
    Rakai Health Sciences Program (formerly Rakai Project) 1. Physical Geography Rakai District is one of the 56 administrative districts of Uganda and lies between longitudes 31oE and 32oE, and latitudes 0oS and 1oS. The district is located in the south-west of the country bordering the Republic of Tanzania in the south. The district has a total area of 4,973 Sq. Kms, with 3,889 sq. kms being land with a total population of 467,215. The Rakai Health Sciences program, was initiated as Rakai Project in 1988 to study the magnitude and dynamics of the HIV disease. It represents a collaboration between the Uganda Virus Research Inst. of Uganda’s Ministry of Health, researchers at Makerere University, Kampala, Columbia University, New York and Johns Hopkins University, Baltimore. 2. Procedures The project conducts extensive community epidemiologic and behavioral studies to document the HIV/STD epidemics and risk factors, implements HIV/STD preventive services and undertakes large community randomized intervention trials for HIV prevention, STD control and prevention of adverse outcomes of pregnancy. The Rakai Community Cohort Study (RCCS) conducted by the Rakai Health Sciences Program in Rakai District, provides a unique resource for hypothesis generating and hypothesis testing research on HIV and other infections (including TB, malaria, STDs, HPV) and on maternal and child health (including prevention of mother-to-child HIV transmission and screening for cervical neoplasia). Using the RCCS as the basis for all activities, the Rakai Program has conducted major randomized HIV prevention trials, innovative operations research on prevention strategies; and has made fundamental contributions to knowledge of HIV transmission dynamics, viral molecular epidemiology (in preparation for HIV and HPV vaccine trials), novel findings regarding interactions between HIV and other co-infections (e.g., HSV-2, HHV-8, HCV, malaria, STDs and BV), and on the impact of HIV on fertility, family stability, marital violence and many other behavioral and demographic factors.
    [Show full text]