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Kirenga B, Byakika-Kibwika P, Muttamba W, Kayongo A, Loryndah NO, Mugenyi L, Kiwanuka N, Lusiba J, Atukunda A, Mugume R, Ssali F, Ddungu H, Katagira W, Sekibira R, Kityo C, Kyeyune D, Acana S, Aanyu-Tukamuhebwa H, Kabweru W, Nakwagala F, Bagaya BS, Kimuli I, Nantanda R, Buregyeya E, Byarugaba B, Olaro C, Mwebesa H, Joloba ML, Siddharthan T, Bazeyo W. Efficacy of convalescent plasma for treatment of COVID-19 in Uganda. BMJ Open Respir Res 2021; 8:e001017. [PMID: 34376401 PMCID: PMC8354811 DOI: 10.1136/bmjresp-2021-001017] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 07/23/2021] [Indexed: 01/15/2023] Open
Abstract
RATIONALE Convalescent plasma (CCP) has been studied as a potential therapy for COVID-19, but data on its efficacy in Africa are limited. OBJECTIVE In this trial we set out to determine the efficacy of CCP for treatment of COVID-19 in Uganda. MEASUREMENTS Patients with a positive SARS-CoV-2 reverse transcriptase (RT)-PCR test irrespective of disease severity were hospitalised and randomised to receive either COVID-19 CCP plus standard of care (SOC) or SOC alone. The primary outcome was time to viral clearance, defined as having two consecutive RT-PCR-negative tests by day 28. Secondary outcomes included time to symptom resolution, clinical status on the modified WHO Ordinal Clinical Scale (≥1-point increase), progression to severe/critical condition (defined as oxygen saturation <93% or needing oxygen), mortality and safety. MAIN RESULTS A total of 136 patients were randomised, 69 to CCP+SOC and 67 to SOC only. The median age was 50 years (IQR: 38.5-62.0), 71.3% were male and the median duration of symptom was 7 days (IQR=4-8). Time to viral clearance was not different between the CCP+SOC and SOC arms (median of 6 days (IQR=4-11) vs 4 (IQR=4-6), p=0.196). There were no statistically significant differences in secondary outcomes in CCP+SOC versus SOC: time to symptom resolution (median=7 (IQR=5-7) vs 7 (IQR=5-10) days, p=0.450), disease progression (9 (22.0%) vs 7 (24.0%) patients, p=0.830) and mortality (10 (14.5%) vs 8 (11.9%) deaths, p=0.476). CONCLUSION In this African trial, CCP therapy did not result in beneficial virological or clinical improvements. Further trials are needed to determine subgroups of patients who may benefit from CCP in Africa.Trial registration number NCT04542941.
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Affiliation(s)
- Bruce Kirenga
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Pauline Byakika-Kibwika
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Winters Muttamba
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Kayongo
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Namakula Olive Loryndah
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Levicatus Mugenyi
- Biostatistics Department, The AIDS Support Organisation (TASO), Kampala, Uganda, Uganda
| | - Noah Kiwanuka
- Department of research, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda, Uganda
| | - John Lusiba
- Clinical services, Uganda Peoples Defense Forces Medical Services, Kampala, Uganda, Uganda
- Clinical services, Uganda Heart Institute, Kampala, Uganda, Uganda
| | - Angella Atukunda
- Clinical services, Mulago National Referral Hospital, Kampala, Uganda, Kampala, Uganda, Uganda
| | - Raymond Mugume
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Henry Ddungu
- Research Department, Uganda Cancer Institute, Kampala, Uganda, Uganda
| | - Winceslaus Katagira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Rogers Sekibira
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | - Dorothy Kyeyune
- Clinical services, Uganda Blood Transfusion Services, Kampala, Uganda, Uganda
| | - Susan Acana
- Clinical services, Uganda Blood Transfusion Services, Kampala, Uganda, Uganda
| | | | | | - Fred Nakwagala
- Clinical services, Mulago National Referral Hospital, Kampala, Uganda, Kampala, Uganda, Uganda
| | - Bernard Sentalo Bagaya
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Rebecca Nantanda
- Makerere University Lung Institute, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Esther Buregyeya
- Department of research, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda, Uganda
| | - Baterana Byarugaba
- Clinical services, Mulago National Referral Hospital, Kampala, Uganda, Kampala, Uganda, Uganda
| | - Charles Olaro
- Clinical services, Ministry of Health, Kampala, Uganda, Uganda
| | - Henry Mwebesa
- Clinical services, Ministry of Health, Kampala, Uganda, Uganda
| | - Moses Lutaakome Joloba
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda, Uganda
| | - Trishul Siddharthan
- Division of Respiratory and Critical Care Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - William Bazeyo
- Department of research, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda, Uganda
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Muttamba W, Lusiba J, Namakula LO, Byakika-Kibwika P, Ssali F, Ddungu H, Mugenyi L, Kiwanuka N, Sekibira R, Kityo C, Keyune D, Acana S, Musinguzi A, Masasi A, Byamugisha J, Mpanju D, Musoki WJ, Tukamuhebwa HA, Nakwagala F, Bagaya BS, Kayongo A, Kimuli I, Nantanda R, Katagira W, Buregyeya E, Byanyima R, Byarugaba B, Siddharthan T, Mwebesa H, Charles O, Joloba ML, Bazeyo W, Kirenga B. Feasibility of collecting and processing of COVID-19 convalescent plasma for treatment of COVID-19 in Uganda. PLoS One 2021; 16:e0252306. [PMID: 34138909 PMCID: PMC8211202 DOI: 10.1371/journal.pone.0252306] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 03/06/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Evidence that supports the use of COVID-19 convalescent plasma (CCP) for treatment of COVID-19 is increasingly emerging. However, very few African countries have undertaken the collection and processing of CCP. The aim of this study was to assess the feasibility of collecting and processing of CCP, in preparation for a randomized clinical trial of CCP for treatment of COVID-19 in Uganda. Methods In a cross-sectional study, persons with documented evidence of recovery from COVID-19 in Uganda were contacted and screened for blood donation via telephone calls. Those found eligible were asked to come to the blood donation centre for further screening and consent. Whole blood collection was undertaken from which plasma was processed. Plasma was tested for transfusion transmissible infections (TTIs) and anti-SARS CoV-2 antibody titers. SARS-CoV-2 testing was also done on nasopharyngeal swabs from the donors. Results 192 participants were contacted of whom 179 (93.2%) were eligible to donate. Of the 179 eligible, 23 (12.8%) were not willing to donate and reasons given included: having no time 7(30.4%), fear of being retained at the COVID-19 treatment center 10 (43.5%), fear of stigma in the community 1 (4.3%), phobia for donating blood 1 (4.3%), religious issues 1 (4.4%), lack of interest 2 (8.7%) and transport challenges 1 (4.3%). The median age was 30 years and females accounted for 3.7% of the donors. A total of 30 (18.5%) donors tested positive for different TTIs. Antibody titer testing demonstrated titers of more than 1:320 for all the 72 samples tested. Age greater than 46 years and female gender were associated with higher titers though not statistically significant. Conclusion CCP collection and processing is possible in Uganda. However, concerns about stigma and lack of time, interest or transport need to be addressed in order to maximize donations.
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Affiliation(s)
| | - John Lusiba
- Uganda Peoples Defense Forces Medical Services, Kampala, Uganda
- Uganda Heart Institute, Kampala, Uganda
| | | | | | | | | | | | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Cissy Kityo
- Joint Clinical Research Centre, Kampala, Uganda
| | | | - Susan Acana
- Uganda Blood Transfusion Services, Kampala, Uganda
| | | | - Ayub Masasi
- Mulago National Referral Hospital, Kampala, Uganda
| | - Joseph Byamugisha
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mpanju
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Walter Jack Musoki
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Bernard Sentalo Bagaya
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alex Kayongo
- Makerere University Lung Institute, Kampala, Uganda
| | - Ivan Kimuli
- Makerere University Lung Institute, Kampala, Uganda
| | | | | | - Esther Buregyeya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | | | - Trishul Siddharthan
- Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Henry Mwebesa
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Olaro Charles
- Ministry of Health, Republic of Uganda, Kampala, Uganda
| | - Moses Lutaakome Joloba
- Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Bruce Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
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Kirenga B, Muttamba W, Kayongo A, Nsereko C, Siddharthan T, Lusiba J, Mugenyi L, Byanyima RK, Worodria W, Nakwagala F, Nantanda R, Kimuli I, Katagira W, Bagaya BS, Nasinghe E, Aanyu-Tukamuhebwa H, Amuge B, Sekibira R, Buregyeya E, Kiwanuka N, Muwanga M, Kalungi S, Joloba ML, Kateete DP, Byarugaba B, Kamya MR, Mwebesa H, Bazeyo W. Characteristics and outcomes of admitted patients infected with SARS-CoV-2 in Uganda. BMJ Open Respir Res 2020; 7:7/1/e000646. [PMID: 32900781 PMCID: PMC7477797 DOI: 10.1136/bmjresp-2020-000646] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 01/08/2023] Open
Abstract
Rationale Detailed data on the characteristics and outcomes of patients with COVID-19 in sub-Saharan Africa are limited. Objective We determined the clinical characteristics and treatment outcomes of patients diagnosed with COVID-19 in Uganda. Measurements As of the 16 May 2020, a total of 203 cases had been confirmed. We report on the first 56 patients; 29 received hydroxychloroquine (HCQ) and 27 did not. Endpoints included admission to intensive care, mechanical ventilation or death during hospitalisation. Main results The median age was 34.2 years; 67.9% were male; and 14.6% were <18 years. Up 57.1% of the patients were asymptomatic. The most common symptoms were fever (21.4%), cough (19.6%), rhinorrhea (16.1%), headache (12.5%), muscle ache (7.1%) and fatigue (7.1%). Rates of comorbidities were 10.7% (pre-existing hypertension), 10.7% (diabetes) and 7.1% (HIV), Body Mass Index (BMI) of ≥30 36.6%. 37.0% had a blood pressure (BP) of >130/90 mm Hg, and 27.8% had BP of >140/90 mm Hg. Laboratory derangements were leucopenia (10.6%), lymphopenia (11.1%) and thrombocytopenia (26.3%). Abnormal chest X-ray was observed in 14.3%. No patients reached the primary endpoint. Time to clinical recovery was shorter among patients who received HCQ, but this difference did not reach statistical significance. Conclusion Most of the patients with COVID-19 presented with mild disease and exhibited a clinical trajectory not similar to other countries. Outcomes did not differ by HCQ treatment status in line with other concluded studies on the benefit of using HCQ in the treatment of COVID-19.
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Affiliation(s)
- Bruce Kirenga
- Lung Institute, Makerere University, Kampala, Uganda
| | | | - Alex Kayongo
- Lung Institute, Makerere University, Kampala, Uganda
| | | | - Trishul Siddharthan
- Pulmonary and Critical Care, Johns Hopkins University, Baltimore, Maryland, USA
| | - John Lusiba
- Uganda Peoples Defense Forces, Uganda Heart Institute Ltd, Kampala, Uganda
| | | | - Rosemary K Byanyima
- Department of Radiology, Mulago National Specialised Hospital, Kampala, Uganda
| | | | - Fred Nakwagala
- Department of Medicine, Mulago National Specialised Hospital, Kampala, Uganda
| | | | - Ivan Kimuli
- Lung Institute, Makerere University, Kampala, Uganda
| | | | - Bernard Sentalo Bagaya
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Emmanuel Nasinghe
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Beatrice Amuge
- Department of Nursing, Mulago National Specialised Hospital, Kampala, Uganda
| | | | - Esther Buregyeya
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noah Kiwanuka
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Muwanga
- Department of Medicine, Entebbe Regional Referral Hospital, Entebbe, Uganda
| | - Samuel Kalungi
- Pathology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Lutaakome Joloba
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Patrick Kateete
- Department of Immunology and Molecular Biology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Baterana Byarugaba
- Department of Medicine, Mulago National Specialised Hospital, Kampala, Uganda
| | - Moses R Kamya
- Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Henry Mwebesa
- Republic of Uganda Ministry of Health, Kampala, Uganda
| | - William Bazeyo
- Entebbe Regional Refferal Hospital, Makerere University, Kampala, Uganda
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