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Namuju OC, Namuwenge PM, Kwizera R, Obuya E, Kirumira P, Naluyima R, Ahimbisibwe C, Ndyetukira J, Nakato H, Kirungi R, Gakuru J, Junju S, Nuwagira E, Rutakagirwa M, Nsibirwa S, Nabitaka V, Nalintya E, Mpoza E, Muzoora CK, Musubire AK, Boulware DR, Meya DB. Adherence of health workers to guidelines for screening and management of cryptococcal meningitis in Uganda. PLoS One 2023; 18:e0284165. [PMID: 37036886 PMCID: PMC10085016 DOI: 10.1371/journal.pone.0284165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION Health workers' failure to adhere to guidelines for screening, diagnosis and management of HIV-associated cryptococcal meningitis (CM) remains a significant public health concern. We aimed to assess adherence to the standards of care and management of HIV patients at risk of CM per the MoH guidelines and assess stock management of CM supplies in the period of January to June 2021 at selected public health facilities (HFs) in Uganda. METHODS The study employed an observational cross-sectional design to assess the level of adherence of health workers to standards of clinical care and management of HIV positive patients at risk of CM as per the clinical guidelines for Uganda, and stock management of CM supplies in the period of January to June 2021in selected public health facilities. The study team used a survey guide designed by MoH to assess and score the screening, diagnosis and management practices of Health Facilities towards CM. Scoring was categorized as red (< 80%), light green (80%-95%), and dark green (˃95%) in the order from worst to best adherence. The data was transcribed into a spread sheet and analysed using STATA-v15. RESULTS The study team visited a total of 15 public health facilities including 5 general hospitals, 9 regional referral hospitals (RRHs) and 1 National Referral hospital (NRH). The mean score for adherence to screening and management of CM for all the combined facilities was 15 (64.7%) classified as red. 10 (66.7%) HFs had not performed a baseline CD4 test for eligible patients within 2 weeks of ART initiation. With regards to treatment, 9 (60%) of the HFs were scored as light green on knowledge of the procedure for reconstituting intravenous Liposomal Amphotericin B. None of the HFs visited had potassium chloride tablets in stock. CONCLUSION Major MoH guidelines are generally not being adhered to by health workers while managing cryptococcal meningitis. It is vital that government and implementing partners regularly support HFs with training, mentorship, and support supervision on CM management to improve adherence to CM screening and treatment guidelines.
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Affiliation(s)
- Olivie C Namuju
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Proscovia M Namuwenge
- Department of Advanced HIV Disease and Treatment, Ministry of Health, Kampala, Uganda
| | - Richard Kwizera
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Emmanuel Obuya
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Paul Kirumira
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rose Naluyima
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Cynthia Ahimbisibwe
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - JaneFrancis Ndyetukira
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Hawa Nakato
- Department of Advanced HIV Disease and Treatment, Ministry of Health, Kampala, Uganda
| | - Robert Kirungi
- HIV Department, Clinton Health Access Initiative (CHAI), Kampala, Uganda
| | - Jane Gakuru
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Samuel Junju
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edwin Nuwagira
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Morris Rutakagirwa
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sara Nsibirwa
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Vennie Nabitaka
- HIV Department, Clinton Health Access Initiative (CHAI), Kampala, Uganda
| | - Elizabeth Nalintya
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Edward Mpoza
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Conrad K Muzoora
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Abdu K Musubire
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - David R Boulware
- Department of Medicine and International Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - David B Meya
- Department of Research, Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Department of Medicine and International Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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Cresswell FV, Kasibante J, Martyn EM, Tugume L, Stead G, Ssembambulidde K, Rutakingirwa MK, Kagimu E, Nsangi L, Namuju C, Ndyetukira JF, Ahimbisibwe C, Kugonza F, Sadiq A, Namudde A, Dobbin J, Srishyla D, Quinn C, Kabahubya M, Muzoora C, Watiti S, Meya DB, Elliott AM. A Journey of Hope: giving research participants a voice to share their experiences and improve community engagement around advanced HIV disease in Uganda. AAS Open Res 2020; 3:33. [PMID: 33274313 PMCID: PMC7682503 DOI: 10.12688/aasopenres.13104.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 11/20/2022] Open
Abstract
Over the last decade excellent progress has been made globally in HIV management thanks to antiretroviral therapy (ART) rollout and international guidelines now recommending immediate initiation of ART in people living with HIV. Despite this, advanced HIV disease (CD4 less than 200 cells/mL) and opportunistic infections remain a persistent challenge and contribute significantly to HIV-associated mortality, which equates to 23,000 deaths in Uganda in 2018 alone. Our Meningitis Research Team based in Uganda is committed to conducting clinical trials to answer important questions regarding diagnostics and management of HIV-associated opportunistic infections, including tuberculosis and cryptococcal meningitis. However, clinical research is impossible without research participants and results are meaningless unless they are translated into benefits for those affected by the disease. Therefore, we held a series of community engagement events with the aims of 1) giving research participants a voice to share their experiences of clinical research and messages of hope around advanced HIV disease with the community, 2) dispelling myths and stigma around HIV, and 3) raising awareness about the complications of advanced HIV disease and local clinical research and recent scientific advances. The purpose of this Open Letter is to describe our community engagement experience in Uganda, where we aimed to give clinical research participants a greater voice to share their experiences. These activities build upon decades of work in HIV community engagement and lays a platform for future research and engagement activities.
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Affiliation(s)
- Fiona V. Cresswell
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- MRC UVRI LSHTM Uganda Research Unit, Entebbe, Uganda
| | - John Kasibante
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Emily M. Martyn
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Lillian Tugume
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Gavin Stead
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | | | | | - Enock Kagimu
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Laura Nsangi
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Carol Namuju
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Jane F. Ndyetukira
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | | | - Florence Kugonza
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Alisat Sadiq
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Alice Namudde
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Joanna Dobbin
- Department of Primary Care & Population Health, University College London, London, UK
| | | | - Carson Quinn
- University of California San Francisco Medical Centre, San Francisco, USA
| | - Mable Kabahubya
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Conrad Muzoora
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David B. Meya
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Alison M. Elliott
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- MRC UVRI LSHTM Uganda Research Unit, Entebbe, Uganda
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Cresswell FV, Kasibante J, Martyn EM, Tugume L, Stead G, Ssembambulidde K, Rutakingirwa MK, Kagimu E, Nsangi L, Namuju C, Ndyetukira JF, Ahimbisibwe C, Kugonza F, Sadiq A, Namudde A, Dobbin J, Srishyla D, Quinn C, Kabahubya M, Muzoora C, Watiti S, Meya DB, Elliott AM. A Journey of Hope: giving research participants a voice to share their experiences and improve community engagement around advanced HIV disease in Uganda. AAS Open Res 2020; 3:33. [PMID: 33274313 PMCID: PMC7682503 DOI: 10.12688/aasopenres.13104.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 09/20/2023] Open
Abstract
Over the last decade excellent progress has been made globally in HIV management thanks to antiretroviral therapy (ART) rollout and international guidelines now recommending immediate initiation of ART in all HIV-positive people. Despite this, advanced HIV disease (CD4 less than 200 cells/mL) and opportunistic infections remain a persistent challenge and contribute significantly to HIV-associated mortality, which equates to 23,000 deaths in Uganda in 2018 alone. Our Meningitis Research Team based in Uganda is committed to conducting clinical trials to answer important questions regarding diagnostics and management of HIV-associated opportunistic infections, including tuberculosis and cryptococcal meningitis. However, clinical research is impossible without research participants and results are meaningless unless they are translated into benefits for those affected by the disease. Therefore, we held a series of community engagement events with the aims of giving clinical research participants a voice in sharing their experiences of clinical research and messages of hope around advanced HIV disease with the community, dispelling myths and stigma around HIV, raising awareness about the complications of advanced HIV disease and local ongoing clinical research and recent scientific advances. The purpose of this Open Letter is to describe our community engagement experience in Uganda, which we hope will lay the foundation for further clinical research public engagement activities, giving research participants a greater voice to share their experiences.
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Affiliation(s)
- Fiona V. Cresswell
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- MRC UVRI LSHTM Uganda Research Unit, Entebbe, Uganda
| | - John Kasibante
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Emily M. Martyn
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Lillian Tugume
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Gavin Stead
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | | | | | - Enock Kagimu
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Laura Nsangi
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Carol Namuju
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Jane F. Ndyetukira
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | | | - Florence Kugonza
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Alisat Sadiq
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Alice Namudde
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Joanna Dobbin
- Department of Primary Care & Population Health, University College London, London, UK
| | | | - Carson Quinn
- University of California San Francisco Medical Centre, San Francisco, USA
| | - Mable Kabahubya
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Conrad Muzoora
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - David B. Meya
- Research Department, Infectious Diseases Institute, Kampala, 22418, Uganda
| | - Alison M. Elliott
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- MRC UVRI LSHTM Uganda Research Unit, Entebbe, Uganda
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Frances Ndyetukira J, Kwizera R, Kugonza F, Ahimbisibwe C, Namujju C, Sadiq A, Namudde A. The conundrum of clinical trials and standard of care in sub-Saharan Africa - the research nurse perspective. J Res Nurs 2019; 24:649-660. [PMID: 34394589 PMCID: PMC7932327 DOI: 10.1177/1744987118824625] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nurses form a very important part of the health workforce in sub-Saharan Africa. Research nurses are critical to the implementation of clinical trials. The duties and responsibilities of a research nurse are complex and continue to evolve as new practices and guidelines are formulated. AIMS In this paper, we have highlighted the major contributions of research nurses in HIV clinical trials in sub-Saharan Africa from the unique perspective of Ugandan nurses. METHODS The requirements and challenges of two multi-site, randomised cryptococcal meningitis clinical trials in Uganda were assessed from the perspective of research nurses conducting complex research in resource-limited settings. RESULTS Over the course of 8 years, approximately 1739 participants were screened and 934 people were enrolled into the two trials. The nurses found that patient education and engagement were among the most important predictors of success in minimising loss to follow-up. CONCLUSIONS Research nurses played a key role in communicating clinical research goals to patients, obtaining informed consent, minimising loss to follow-up, and ensuring that research practices are translated and implemented into standard of care. However, there remains a need to integrate the same level of care provided in clinical research studies to non-study patients.
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Affiliation(s)
| | - Richard Kwizera
- Richard Kwizera, Department of Research, Infectious Diseases Institute College of Health Sciences, Makerere University P.O. BOX 22418, Kampala, Uganda.
| | | | | | | | | | - Alice Namudde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
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Ahimbisibwe C, Kwizera R, Ndyetukira JF, Kugonza F, Sadiq A, Hullsiek KH, Williams DA, Rhein J, Boulware DR, Meya DB. Management of amphotericin-induced phlebitis among HIV patients with cryptococcal meningitis in a resource-limited setting: a prospective cohort study. BMC Infect Dis 2019; 19:558. [PMID: 31242860 PMCID: PMC6595678 DOI: 10.1186/s12879-019-4209-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/19/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Amphotericin-induced phlebitis is a common infusion-related reaction in patients managed for cryptococcal meningitis. High-quality nursing care is critical component to successful cryptococcosis treatment. We highlight the magnitude and main approaches in the management of amphotericin-induced phlebitis and the challenges faced in resource-limited settings. METHODS We prospectively determined the incidence of amphotericin-induced phlebitis during clinical trials in Kampala, Uganda from 2013 to 2018. We relate practical strategies and challenges faced in clinical management of phlebitis. RESULTS Overall, 696 participants were diagnosed with HIV-related cryptococcal meningitis. Participants received 7-14 doses of intravenous (IV) amphotericin B deoxycholate 0.7-1.0 mg/kg/day for induction therapy through peripheral IV lines at a concentration of 0.1 mg/mL in 5% dextrose. Overall, 18% (125/696) developed amphotericin-induced phlebitis. We used four strategies to minimize/prevent the occurrence of phlebitis. First, after every dose of amphotericin, we gave one liter of intravenous normal saline. Second, we rotated IV catheters every three days. Third, we infused IV amphotericin over 4 h. Finally, early ambulation was encouraged to minimize phlebitis. To alleviate phlebitis symptoms, warm compresses were used. In severe cases, treatment included topical diclofenac gel and oral anti-inflammatory medicines. Antibiotics were used only when definite signs of infection developed. Patient/caregivers' education was vital in implementing these management strategies. Major challenges included implementing these interventions in participants with altered mental status and limited access to topical and oral anti-inflammatory medicines in resource-limited settings. CONCLUSIONS Amphotericin-induced phlebitis is common with amphotericin, yet phlebitis is a preventable complication even in resource-limited settings. TRIAL REGISTRATION The ASTRO-CM trial was registered prospectively. ClincalTrials.gov : NCT01802385 ; Registration date: March 1, 2013; Last verified: February 14, 2018.
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Affiliation(s)
- Cynthia Ahimbisibwe
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Richard Kwizera
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jane Frances Ndyetukira
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Florence Kugonza
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Alisat Sadiq
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Kathy Huppler Hullsiek
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Darlisha A. Williams
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - Joshua Rhein
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - David R. Boulware
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA
| | - David B. Meya
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- Division of Infectious Diseases and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN USA
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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