Browsing by Author "Lundin, Rebecca"

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Implementation of the WHO 2011 Recommendations for Isoniazid Preventive Therapy (IPT) in Children Living With HIV/AIDS: A Ugandan Experience
(LIPPINCOTT WILLIAMS & WILKINS , TWO COMMERCE SQ, 2001 MARKET ST, PHILADELPHIA, USA, PA, 19103, 2016) Costenaro, Paola; Massavon, William; Lundin, Rebecca; Nabachwa, M. Sandra; Fregonese, Federica; Morelli, Erika; Alowo, Agnes; Musoke, Nannyonga Maria; Namisi, Charles; Kizito, Susan; Bilardi, Davide; Mazza, Antonio; Cotton, F. Mark; Giaquinto, Carlo; Penazzato, Martina
Background: Intensified tuberculosis (TB) case finding and isoniazid preventive therapy (IPT) are strongly recommended for children who are HIV infected. Data are needed to assess the feasibility of the WHO 2011 intensified tuberculosis case finding/ IPT clinical algorithm. Methods: Children who are HIV infected and attending Nsambya Home Care at Nsambya Hospital, Uganda, were screened for TB following WHO recommendations. IPT was given for 6 months after excluding TB. Factors associated with time to IPT initiation were investigated by multivariate Cox proportional hazard regression. Health care workers were interviewed on reasons for delay in IPT initiation. Results: Among the 899 (49% male) children with HIV, 529 (58.8%) were screened for TB from January 2011 to February 2013. Children with active TB were 36/529 (6.8%), 24 (4.5%) were lost to follow-ups and 280 (52.9%) started IPT, 86/280 (30.7%) within 3 months of TB screening and 194/280 (69.3%) thereafter. Among the 529 children screened for TB, longer time to IPT initiation was independently associated with cough at TB screening (hazard ratio 0.62, P = 0.02, 95% confidence interval: 0.41 to 0.94). Four children (1% of those starting treatments) interrupted IPT because of a 5-fold increase in liver function measurements. In the survey, Health care workers reported poor adherence to antiretroviral therapy, poor attendance to periodic HIV follow-ups, and pill burden as the 3 main reasons to delay IPT. Conclusion: In resource-constrained settings, considerable delays in IPT initiation may occur, particularly in children with HIV who are presenting with cough at TB screening. The good safety profile of isoniazid in antiretroviral–therapy-experienced children provides further support to IPT implementation in this population.
Nsambya Community Home-Based Care Complements National HIV and TB Management Efforts and Contributes to Health Systems Strengthening in Uganda: An Observational Study
(HINDAWI LTD , ADAM HOUSE, 3RD FLR, 1 FITZROY SQ, LONDON, ENGLAND, W1T 5HF, 2014-03-06) Massavon, William; Mugenyi, Levi; Nsubuga, Martin; Lundin, Rebecca; Penazzato, Martina; Nannyonga, Maria; Namisi, Charles; Ingabire, Resty; Kalibbala, Daniel; Kironde, Susan; Costenaro, Paola; Bilardi, Davide; Mazza, Antonio; Criel, Bart; Tumwine, K. James; Seeley, Janet; Giaquinto, Carlo
Community Home-Based Care (CHBC) has evolved in resource-limited settings to fill the unmet needs of people living with HIV/AIDS (PLHA). We compare HIV and tuberculosis (TB) outcomes from the Nsambya CHBC with national averages in Kampala, Uganda. This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC to national averages from 2007 to 2011. Outcomes included numbers of HIV and TB patients enrolled into care, retention, loss to follow-up (LTFU), and mortality among patients on antiretroviral therapy (ART) at 12 months from initiation; new smear positive TB cure and defaulter rates; and proportion of TB patients tested for HIV. Chi-square test and trends analyses were used to compare outcomes from Nsambya CHBC with national averages. By 2011, approximately 14,000 PLHA had been enrolled in the Nsambya CHBC, and about 4,000 new cases of TB were detected and managed over the study period. Overall, retention and LTFU of ART patients 12 months after initiation, proportion of TB patients tested for HIV, and cure rates for new smear-positive TB scored higher in the Nsambya CHBC compared to national averages. The findings show that Nsambya CHBC complements national HIV and TB management and results in more positive outcomes.
Viral Load Detection Using Dried Blood Spots in a Cohort of HIV-1- Infected Children in Uganda: Correlations with Clinical and Immunological Criteria for Treatment Failure
(AMER SOC MICROBIOLOGY , 1752 N ST NW, WASHINGTON, USA, DC, 20036-2904, 2014-07) Costenaro, Paola; Lundin, Rebecca; Petrara, Raffaella Maria; Penazzato, Martina; Massavon, William; Kizito, Susan; Nabachwa, Monica Sandra; Musoke, Nannyonga Maria; Namisi, Charles; Morelli, Erika; Bilardi, Davide; Mazza, Antonio; Zanchetta, Marisa; Giaquinto, Carlo; Rossi, De Anita
Correlations between clinical/immunological treatment failure and viral load (VL) detected by dried blood spot (DBS) sampling were explored in HIV-1-infected children in Uganda. Of 104 children on combined antiretroviral treatment (cART), 12.5% experienced clinical and/or immunological failure, while 28.8%, 44.2%, and 26.9% had VLs of <1,000, 1,000 to 5,000, and >5,000 copies/ml, respectively. Clinical/immunological failure poorly predicted virological failure.
Viral Load Detection Using Dried Blood Spots in a Cohort of HIV-1- Infected Children in Uganda: Correlations with Clinical and Immunological Criteria for Treatment Failure
(American Society for Microbiology, 2014-04-22) Costenaro, Paola; Lundin, Rebecca; Petrara, Maria Raffaella; Penazzato, Martina; Massavon, William; Kizito, Susan; Nabachwa, Sandra Monica; Nannyonga Musoke, Maria; Namisi, Charles; Morelli, Erika; Bilardi, Davide; Mazza, Mazza; Zanchetta, Marisa; Giaquinto, Carlo; De Rossi, Anita
High rates of virological suppression were reported among HIV-1-infected children of low- and middle-income countries (LMIC) up to 5 to 6 years after receiving combined antiretroviral treatment (cART) (1). In 2013, the World Health Organization (WHO) recommended viral load (VL) monitoring as the preferred approach to detecting treatment failure (TF) among HIV-1-infected children. High costs, a lack of adequate facilities, and inappropriate handling of specimens still limit the implementation of VL monitoring in LMIC, leading to delays in detecting treatment failure when immunological and/or clinical criteria are used instead.