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Gregson CL, Rehman AM, Rukuni R, Mukwasi-Kahari C, Madanhire T, Kowo-Nyakoko F, Breasail MÓ, Jeena L, Mchugh G, Filteau S, Chipanga J, Simms V, Mujuru H, Ward KA, Ferrand RA. Perinatal HIV infection is associated with deficits in muscle function in children and adolescents in Zimbabwe. AIDS 2024; 38:853-863. [PMID: 37991523 DOI: 10.1097/qad.0000000000003795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To determine how muscle strength, power, mass, and density (i.e. quality) differ between children living with HIV (CWH) and those uninfected, and whether antiretroviral therapy (ART) regime is associated with muscle quality. DESIGN A cross-sectional study in Harare, Zimbabwe. METHODS The study recruited CWH aged 8-16 years, taking ART for at least 2 years, from HIV clinics, and HIV-uninfected children from local schools. Muscle outcomes comprised grip strength measured by hand-held Jamar dynamometer, lower limb power measured by standing long-jump distance, lean mass measured by dual-energy X-ray absorptiometry, and muscle density (reflecting intramuscular fat) by peripheral quantitative computed tomography. Linear regression calculated adjusted mean differences (aMD) by HIV status. RESULTS Overall, 303 CWH and 306 without HIV, had mean (SD) age 12.5 (2.5) years, BMI 17.5 (2.8), with 50% girls. Height and fat mass were lower in CWH, mean differences (SE) 7.4 (1.1) cm and 2.7 (0.4)kgs, respectively. Male CWH had lower grip strength [aMD 2.5 (1.1-3.9) kg, P < 0.001], long-jump distance [7.1 (1.8-12.5) cm, P = 0.006], muscle density [0.58 (0.12-1.05) mg/cm 3 , P = 0.018, but not lean mass 0.06 (-1.08 to 1.21) kg, P = 0.891) versus boys without HIV; differences were consistent but smaller in girls. Mediation analysis suggested the negative effect of HIV on jumping power in boys was partially mediated by muscle density ( P = 0.032). CWH taking tenofovir disoproxil fumarate (TDF) had lower muscle density [0.56 (0.00-1.13)mg/cm 3 , P = 0.049] independent of fat mass, than CWH on other ART. CONCLUSION Perinatally acquired HIV is associated, particularly in male individuals, with reduced upper and lower limb muscle function, not mass. Intra-muscular fat (poorer muscle quality) partially explained reductions in lower limb function. TDF is a novel risk factor for impaired muscle quality.
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Affiliation(s)
- Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Andrea M Rehman
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health
| | - Ruramayi Rukuni
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases
| | - Cynthia Mukwasi-Kahari
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
- Department of Radiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - Tafadzwa Madanhire
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health
| | - Farirayi Kowo-Nyakoko
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC Lifecourse Epidemiology Centre, Human Development and Health, University of Southampton, Southampton, UK
| | - Mícheál Ó Breasail
- Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Monash Medical Centre, Nursing and Health Sciences, Monash University, Clayton, VIC, Australia
| | - Lisha Jeena
- Nuffield Department of Medicine, University of Oxford, Oxford
| | - Grace Mchugh
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Suzanne Filteau
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph Chipanga
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
| | - Victoria Simms
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health
| | - Hilda Mujuru
- Department of Paediatrics, University of Zimbabwe, Harare, Zimbabwe
| | - Kate A Ward
- Department of Radiology, College of Health Sciences, University of Zimbabwe, Harare, Zimbabwe
- MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Banjul, The Gambia
| | - Rashida A Ferrand
- The Health Research Unit Zimbabwe, Biomedical Research and Training Institute, Harare, Zimbabwe
- Clinical Research Department, Faculty of Infectious and Tropical Diseases
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Hinga A, Jeena L, Awuor E, Kahindi J, Munene M, Kinyanjui S, Molyneux S, Marsh V, Kamuya D. Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya. Wellcome Open Res 2022; 7:75. [PMID: 35855072 PMCID: PMC9257264 DOI: 10.12688/wellcomeopenres.17533.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 12/04/2022] Open
Abstract
Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the KEMRI Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees. Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12. Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process where one protocol was submitted to multiple review committees simultaneously . The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee’s target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic. Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews.
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Affiliation(s)
- Alex Hinga
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Lisha Jeena
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Esther Awuor
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Jane Kahindi
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Marianne Munene
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Samson Kinyanjui
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Strathmore Business School, Strathmore University, Nairobi, Ole Sangare Road, P.O. Box 59857 – 00200, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Vicki Marsh
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Hinga A, Jeena L, Awuor E, Kahindi J, Munene M, Kinyanjui S, Molyneux S, Marsh V, Kamuya D. Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya. Wellcome Open Res 2022; 7:75. [PMID: 35855072 PMCID: PMC9257264 DOI: 10.12688/wellcomeopenres.17533.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 08/31/2023] Open
Abstract
Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the KEMRI Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees. Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12. Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process where one protocol was submitted to multiple review committees simultaneously . The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee's target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic. Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews.
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Affiliation(s)
- Alex Hinga
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Lisha Jeena
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Esther Awuor
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Jane Kahindi
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Marianne Munene
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
| | - Samson Kinyanjui
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
- Strathmore Business School, Strathmore University, Nairobi, Ole Sangare Road, P.O. Box 59857 – 00200, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Vicki Marsh
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
| | - Dorcas Kamuya
- Kenya Medical Research Institute (KEMRI) - Wellcome Trust Research Programme, Kilifi, P.O. Box 230-80108, Kenya
- Centre for Tropical Medicine, Nuffield Department of Medicine, Oxford University, Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, UK
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Abstract
OBJECTIVE To determine the optimal tuberculosis (TB) management strategy for children living in peri-urban, resource-limited settings. DESIGN We compared TB treatment outcomes among children aged 0-15 years receiving doorstep care (n = 82) with those of a historical group (n = 97) receiving clinic-based care. RESULTS The doorstep care and clinic-based groups had similar age and sex profiles; treatment default rates were 3.7% (3/82) vs. 38.1% (37/97, P < 0.0001), treatment completion rates were 65.9% (54/82) vs. 51.6% (50/97, P = 0.01), and cure rates were 13.4% (11/82) vs. 2.1% (2/97), respectively (P < 0.0001). CONCLUSION Children living in peri-urban communities had improved TB treatment outcomes with doorstep care.
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Affiliation(s)
- L Jeena
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), South Africa
| | - K Naidoo
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), South Africa; Medical Research Council CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
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