Browsing by Author "Namisi, Charles"

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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.
Mentorship Needs at Academic Institutions in Resource-Limited Settings: A Survey at Makerere University College of Health Sciences
(BMC , CAMPUS, 4 CRINAN ST, LONDON, ENGLAND, N1 9XW, 2011-07-29) Nakanjako, Damalie; Byakika-Kibwika, Pauline; Kintu, Kenneth; Aizire, Jim; Nakwagala, Fred; Luzige, Simon; Namisi, Charles; Mayanja-Kizza, Harriet; Kamya, R Moses
Background: Mentoring is a core component of medical education and career success. There is increasing global emphasis on mentorship of young scientists in order to train and develop the next leaders in global health. However, mentoring efforts are challenged by the high clinical, research and administrative demands. We evaluated the status and nature of mentoring practices at Makerere University College of Health Sciences (MAKCHS). Methods: Pre-tested, self-administered questionnaires were sent by email to all Fogarty alumni at the MAKCHS (mentors) and each of them was requested to complete and email back the questionnaire. In addition to training level and number of mentors, the questionnaires had open-ended questions covering themes such as; status of mentorship, challenges faced by mentors and strategies to improve and sustain mentorship within MAKCHS. Similarly, open-ended questionnaires were sent and received by email from all graduate students (mentees) registered with the Uganda Society for Health Scientists (USHS). Qualitative data from mentors and mentees was analyzed manually according to the pre-determined themes. Results: Twenty- two out of 100 mentors responded (14 email and 8 hard copy responses). Up to 77% (17/22) of mentors had Master’s-level training and only 18% (4/22) had doctorate-level training. About 40% of the mentors had ≥ two mentees while 27% had none. Qualitative results showed that mentors needed support in terms of training in mentoring skills and logistical/financial support to carry out successful mentorship. Junior scientists and students reported that mentorship is not yet institutionalized and it is currently occurring in an adhoc manner. There was lack of awareness of roles of mentors and mentees. The mentors mentioned the limited number of practicing mentors at the college and thus the need for training courses and guidelines for faculty members in regard to mentorship at academic institutions. Conclusions: Both mentors and mentees were willing to improve mentorship practices at MAKCHS. There is need for institutional commitment to uphold and sustain the mentorship best practices. We recommend a collaborative approach by the stakeholders in global health promotion to build local capacity in mentoring African health professionals.
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.
Prevalence, Factors Associated and Treatment Outcome of Hyperbilirubinaemia in Neonates Admitted to St Francis Hospital, Nsambya, Uganda: A Descriptive Study
(African Health Sciences Makerere University Medical School, 2020-04-20) Nyangabyaki-Twesigye, Catherine; Mworozi, Edison; Namisi, Charles; Nakibuuka, Victoria; Kayiwa, Joshua; Ssebunya, Robert; Mukose, Aggrey David
Background: With targeted management of neonatal hyperbilirubinaemia in high-income countries, there has been a drastic drop in both the prevalence and mortality. On the contrary, over two-thirds of the global burden of neonatal hyperbilirubinaemia is in Sub-saharan Africa and South East Asia with a high mortality risk of 16-35%. Neonatal hyperbilirubinaemia is not a leading global cause of neonatal mortality, however leads to irreversible neurological damage and death when managed poorly. Three-quarters of the babies admitted to the national referral hospital in Uganda had significant hyperbilirubinaremia; 16.6% of these babies died. We aimed at determining the prevalence, treatment outcome and describing factors associated with hyperbilirubinaemia in neonates admitted to St Francis hospital, Nsambya. Methods: A cross sectional study was carried out. A total of 242 files of babies with a preliminary diagnosis of hyperbilirubinaemia were retrieved retrospectively. Relevant data was extracted from the files and analysed using STATA version 14.0. Results: The prevalence of significant hyperbillirubinaemia was 22.7% (55/242). Seventy-seven percent of the babies admitted did not require treatment for hyperbilirubinaemia. No factors were found to be significantly associated with significant hyperbilirubinaemia. The case fatality for severe hyperbilirubinaemia was 20% (6/30); half of these babies had haemolytic disease of the newborn. Conclusion: Establishment of local guidelines will prevent unnecessary admissions and ensure timely treatment is admin istered. Longitudinal studies are required to discover factors associated with neonatal hyperbilirubinaemia in this region.
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.