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Baluku JB, Namiiro S, Namanda B, Nabwana M, Andia-Biraro I, Worodria W, Salata R, Mfinanga S, Gerson S, Kirenga B. Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios in Distinguishing Lung Cancer in People with HIV. Dis Markers 2024; 2024:8822024. [PMID: 38292339 PMCID: PMC10827363 DOI: 10.1155/2024/8822024] [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] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 01/03/2024] [Accepted: 01/10/2024] [Indexed: 02/01/2024]
Abstract
Objective The neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) demonstrate good diagnostic accuracy in distinguishing lung cancer patients from healthy individuals, primarily in HIV-negative populations. We determined the sensitivity (Se), specificity (Sp), and area under the curve (AUC) of the NLR and PLR in discriminating between people living with HIV (PLWH) with and without lung cancer. Methods This is a comparative analysis of secondary data. Cases were PLWH with lung cancer from a retrospective cohort treated at the Uganda Cancer Institute. Controls were unmatched PLWH without lung cancer who were randomly selected from three HIV clinics in Uganda. Se, Sp, and AUC analysis and determination of optimal cutoffs were performed using receiver operating characteristic (ROC) curves. Results Of 115 PLWH (18 cases and 97 controls), 83 (72.2%) were female, 110 (95.7) were on ART, and the median (IQR) age was 46 (38-51) years. The median (IQR) NLR was higher among cases than controls (3.53 (3.14-7.71) vs. 0.92 (0.67-1.09), p < 0.001). Similarly, the PLR was higher among cases than controls (237.5 (177.8-361.6) vs. 123.6 (100.6-155.4), p=0.001). At a cutoff of 2.44, the respective Se, Sp, and AUC of the NLR were 87.5% (95% CI: 61.7%-98.4%), 100% (95% CI: 96.2%-100%), and 0.94 (95% CI: 0.85-1.00, p < 0.001). Similarly, the respective Se, Sp, and AUC for the PLR were 75% (95% CI: 47.6%-92.7%), 87.2% (95% CI: 78.8%-93.2%), and 0.81 (95% CI: 0.70-0.93, p < 0.001) at a cutoff of 196.3. Conclusion The NLR and PLR discriminated PLWH with and without lung cancer and could be useful in PLWH with respiratory symptoms in whom lung cancer can easily be misdiagnosed as other lung pathology.
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Affiliation(s)
- Joseph Baruch Baluku
- Makerere University Lung Institute, Kampala, Uganda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Sharon Namiiro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Brenda Namanda
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Martin Nabwana
- Makerere University–Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Makerere University Lung Institute, Kampala, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Salata
- Department of Medicine, UH Cleveland Medical Center, Cleveland, USA
| | - Sayoki Mfinanga
- Muhimbili Center, National Institute for Medical Research, Dar es Salaam, Tanzania
| | - Stanton Gerson
- School of Medicine, Case Western Reserve University, Cleveland, USA
| | - Bruce Kirenga
- Makerere University Lung Institute, Kampala, Uganda
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Mulindwa F, Castelnuovo B, Brusselaers N, Nabwana M, Bollinger R, Buzibye A, Agnes Odongpiny EL, Kiguba R, Schwarz JM. Dolutegravir use over 48 weeks is not associated with worsening insulin resistance and pancreatic beta cell function in a cohort of HIV-infected Ugandan adults. AIDS Res Ther 2023; 20:65. [PMID: 37689695 PMCID: PMC10492310 DOI: 10.1186/s12981-023-00564-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND The Uganda Ministry of Health issued restrictive guidelines on the use of dolutegravir (DTG) in persons stratified to have a heightened risk of diabetes mellitus. This followed multiple reports of persons with HIV (PWH) presenting with accelerated hyperglycemia after a few weeks to months of exposure to DTG. Having demonstrated a low incidence of diabetes mellitus and improving blood glucose trajectories in a cohort of ART naïve Ugandan PWH on DTG, we sought to determine whether the observed improvement in blood glucose did not mask background compensated insulin resistance. METHODS In this analysis, 63 patients underwent serial oral glucose tolerance tests over 48 weeks. Using fasting serum insulin and glucose, we calculated insulin resistance and pancreatic beta cell function by homeostatic modelling (HOMA IR and HOMA%β respectively). Absolute mean changes between baseline and post-baseline blood glucose, pancreatic beta cell function and insulin resistance were computed by subtracting each post-baseline value from the baseline value and compared using student t-test. Multiple linear regression models were used to determine the factors associated with changes in pancreatic beta cell function and insulin resistance. RESULTS Of the 63 participants, 37 (58%) were female. Median age was 31 (IQR: 28-37). Despite a trend towards an initial increase in both HOMA IR and HOMA%β at 12 weeks followed by a decline through 36 weeks to 48 weeks, the HOMA IR and HOMA%β at 48 weeks were not significantly different from baseline i.e. (difference in mean HOMA IR from baseline: 0.14, 95%CI: -0.46, 0.733, p = 0.648) and (difference in mean HOMA %β from baseline: 6.7, 95%CI: -13.4, 26.8, p = 0.506) respectively. CONCLUSION We demonstrated insignificant changes in both insulin resistance and pancreatic beta cell function in clinically stable young adult Ugandan PWH on dolutegravir for 48 weeks. We add to the body of evidence demonstrating glucose metabolic safety of dolutegravir in ART naïve patients. Ugandan guidelines should reconsider restricting DTG initiation in ART naive adults at high risk for diabetes.
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Affiliation(s)
- Frank Mulindwa
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Barbara Castelnuovo
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska University, Stockholm, Sweden
| | - Martin Nabwana
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Allan Buzibye
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, USA
- Department of Basic Sciences, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
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Mulindwa F, Schwarz JM, Brusselaers N, Nabwana M, Bollinger R, Buzibye A, Amutuhaire W, Yendewa G, Laker E, Kiguba R, Castelnuovo B. Blood glucose outcomes of anti-retroviral therapy naïve Ugandan people with HIV with pre-diabetes mellitus initiated on dolutegravir for 48 weeks. Res Sq 2023:rs.3.rs-3154716. [PMID: 37577475 PMCID: PMC10418540 DOI: 10.21203/rs.3.rs-3154716/v1] [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] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Background The Uganda ministry of Health recommends frequent blood glucose monitoring for the first six months on dolutegravir, in people with HIV (PWH) having pre-diabetes mellitus (pre-DM). We sought to determine if indeed PWH with pre-diabetes started on dolutegravir had worse blood glucose outcomes at 48 weeks compared to those with normal blood glucose. Methods In this matched cohort study, we compared 44 PWH with pre-DM and 88 PWH with normal blood glucose at baseline. The primary outcome was change in mean fasting blood glucose (FBG) from baseline to week 48 and 2-hour blood glucose (2hBG) from baseline to week 36 compared between the two groups. Results There was significant increase in FBG in PWH with normal blood glucose (mean change in FBG(FBG): 3.9mg/dl, 95% confidence interval (95% CI): (2.2, 5.7), p value (p) = < 0.0001) and decrease in those with pre-DM (FBG: -6.1mg/dl, 95%CI (-9.1, -3.2), p = < 0.0001) at 48 weeks. 2hBG at 36 weeks was significantly lower than at baseline in both groups with the magnitude of reduction larger in those with pre-DM at 12 weeks (adjusted differences in mean drop in 2hBG (a2hBG): -19.69mg/dl, 95%CI (-30.19, -9.19), p = < 0.0001) and 36 weeks (a2hBG: -19.97mg/dl, 95%CI (-30.56, -9.39), p = < 0.0001). Conclusion We demonstrated that Ugandan ART naïve PWH with pre-diabetes at enrollment have consistent improvement in both fasting blood glucose and glucose tolerance over 48 weeks on dolutegravir. Intensified blood glucose monitoring of these patients in the first six months of dolutegravir may be unnecessary.
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Affiliation(s)
| | | | | | - Martin Nabwana
- Makerere University Johns Hopkins University Research Collaboration
| | | | | | | | | | - Eva Laker
- Makerere University Infectious Diseases Institute
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Mulindwa F, Castelnuovo B, Brusselaers N, Nabwana M, Bollinger R, Laker E, Kiguba R, Schwarz JM. Dolutegravir use over 48 weeks is not associated with worsening insulin resistance and pancreatic beta cell function in a cohort of HIV-infected Ugandan adults. Res Sq 2023:rs.3.rs-3175598. [PMID: 37502917 PMCID: PMC10371155 DOI: 10.21203/rs.3.rs-3175598/v1] [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] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Background The Uganda Ministry of Health issued restrictive guidelines on the use of dolutegravir (DTG) in persons stratified to have a heightened risk of diabetes mellitus. This followed multiple reports of persons with HIV (PWH) presenting with accelerated hyperglycemia after a few weeks to months of exposure to DTG. Having demonstrated a low incidence of diabetes mellitus and improving blood glucose trajectories in a cohort of ART naïve Ugandan PWH on DTG, we sought to determine whether the observed improvement in blood glucose did not mask background compensated insulin resistance. Methods In this analysis, 63 patients underwent serial oral glucose tolerance tests over 48 weeks. Using fasting serum insulin and glucose, we calculated insulin resistance and pancreatic beta cell function by homeostatic modelling (HOMA IR and HOMA%β respectively). Absolute mean changes between baseline and post-baseline blood glucose, pancreatic beta cell function and insulin resistance were computed by subtracting each post-baseline value from the baseline value and compared using student t-test. Multiple linear regression models were used to determine the factors associated with changes in pancreatic beta cell function and insulin resistance. Results Of the 63 participants, 37 (58%) were female. Median age was 31 (IQR: 28-37). Despite a trend towards an initial increase in both HOMA IR and HOMA%β at 12 weeks followed by a decline through 36 weeks to 48 weeks, the HOMA IR and HOMA%β at 48 weeks were not significantly different from baseline i.e. (difference in mean HOMA IR from baseline: 0.14, 95%CI: -0.46, 0.733, p = 0.648) and (difference in mean HOMA %β from baseline: 6.7, 95%CI: -13.4, 26.8, p = 0.506) respectively.
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Affiliation(s)
| | | | | | - Martin Nabwana
- Makerere University - Johns Hopkins University Research Collaboration
| | | | - Eva Laker
- Makerere University Infectious Diseases Institute
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Baluku JB, Namiiro S, Namanda B, Katusabe S, Namusoke D, Nkonge R, Okecha T, Nassaazi C, Niyonzima N, Bogere N, Nuwagira E, Nabwana M, Ssekamatte P, Andia-Biraro I, Worodria W, Salata R, Mfinanga S, Gerson S, Kirenga B. Mycobacterium tuberculosis infection and cytogenetic abnormalities among people with HIV. Mutat Res Genet Toxicol Environ Mutagen 2023; 888:503640. [PMID: 37188437 DOI: 10.1016/j.mrgentox.2023.503640] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To compare cytogenetic abnormalities among people living with HIV (PLWH) with and without previous exposure to Mycobacterium tuberculosis (Mtb) (both latent tuberculosis infection [LTBI] and active tuberculosis [TB]). METHODS Adult PLWH (≥18 years) were randomly selected at three HIV clinics in Uganda. Previous active TB was confirmed in the clinics' TB records. LTBI was defined as a positive QuantiFERON-TB Gold Plus assay. Participants' buccal mucosal exfoliated cells were examined (per 2000 cells) using the buccal micronucleus assay for chromosomal aberrations (micronuclei and/or nuclear buds), cytokinetic defects (binucleated cells), proliferative potential (normal differentiated cells and basal cell frequency) and/or cell death (condensed chromatin, karyorrhexis, pyknotic and karyolytic cells). RESULTS Among 97 PLWH, 42 (43.3%) had exposure to Mtb;16 had previous successfully treated active TB and 26 had LTBI. PLWH with exposure to Mtb had a higher median number of normal differentiated cells (1806.5 [1757.0 - 1842.0] vs. 1784.0 [1732.0 - 1843.0], p = 0.031) and fewer karyorrhectic cells (12.0 [9.0 - 29.0] vs. 18.0 [11.0 - 30.0], p = 0.048) than those without. PLWH with LTBI had fewer karyorrhectic cells than those without (11.5 [8.0 - 29.0] vs. 18.0 [11 - 30], p = 0.006). CONCLUSION We hypothesized that previous exposure to Mtb is associated with cytogenetic damage among PLWH. We found that exposure to Mtb is associated with more normal differentiated cells and less frequent karyorrhexis (a feature of apoptosis). It is unclear whether this increases the propensity for tumorigenesis.
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Affiliation(s)
- Joseph Baruch Baluku
- Makerere University Lung Institute, Kampala, Uganda; Division of pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
| | - Sharon Namiiro
- Department of internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Brenda Namanda
- Division of pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
| | - Shamim Katusabe
- Division of pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
| | | | - Reagan Nkonge
- Division of pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
| | | | | | | | | | - Edwin Nuwagira
- Department of Internal Medicine, Mbarara University of Science and Technology, Uganda
| | - Martin Nabwana
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Phillip Ssekamatte
- Department of Immunology and Molecular Biology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - William Worodria
- Makerere University Lung Institute, Kampala, Uganda; Department of internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Salata
- Department of Medicine, UH Cleveland Medical Center, USA
| | - Sayoki Mfinanga
- National Institute for Medical Research, Muhimbili Center, Tanzania
| | - Stanton Gerson
- School of Medicine, Case Western Reserve University, USA
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Mulindwa F, Castelnuovo B, Brusselaers N, Bollinger R, Rhein J, Edrisa M, Buzibye A, Amutuhaire W, Yendewa G, Nabaggala S, Odongpiny ELA, Kiguba R, Nakawooza A, Dujanga S, Nabwana M, Schwarz JM. Blood glucose trajectories and incidence of diabetes mellitus in Ugandan people living with HIV initiated on dolutegravir. AIDS Res Ther 2023; 20:15. [PMID: 36915103 PMCID: PMC10009965 DOI: 10.1186/s12981-023-00510-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/07/2023] [Indexed: 03/14/2023] Open
Abstract
BACKGROUND Following reports of anti-retroviral therapy (ART) experienced Ugandan people living with HIV (PLHIV) presenting with diabetic ketoacidosis weeks to months following a switch to dolutegravir (DTG), the Uganda Ministry of Health recommended withholding DTG in both ART naïve and experienced PLHIV with diabetes mellitus (T2DM), as well as 3-monthly blood glucose monitoring for patients with T2DM risk factors. We sought to determine if the risk of T2DM is indeed heightened in nondiabetic ART naïve Ugandan PLHIV over the first 48 weeks on DTG. METHODS Between January and October 2021, 243 PLHIV without T2DM were initiated on DTG based ART for 48 weeks. Two-hour oral glucose tolerance tests (2-h OGTT) were performed at baseline, 12, and 36 weeks; fasting blood glucose (FBG) was measured at 24 and 48 weeks. The primary outcome was the incidence of T2DM. Secondary outcomes included: incidence of pre-Diabetes Mellitus (pre-DM), median change in FBG from baseline to week 48 and 2-h blood glucose (2hBG) from baseline to week 36. Linear regression models were used to determine adjusted differences in FBG and 2hBG from baseline to weeks 48 and 36 respectively. RESULTS The incidence of T2DM was 4 cases per 1000 PY (1/243) and pre-DM, 240 cases per 1000 person years (PY) (54/243). There was a significant increase in FBG from baseline to week 48 [median change from baseline (FBG): 3.6 mg/dl, interquartile range (IQR): - 3.6, 7.2, p-value (p) = 0.005] and significant reduction in 2hBG (2hBG: - 7.26 mg/dl, IQR: - 21.6, 14.4, p = 0.024) at week 36. A high CD4 count and increased waist circumference were associated with 2hBG increase at week 36. CONCLUSION We demonstrated a low incidence of T2DM in Ugandan ART-naïve patients receiving DTG. We also demonstrated that longitudinal changes in BG were independent of conventional risk factors of T2DM in the first 48 weeks of therapy. Restricting the use of dolutegravir in Ugandan ART naïve patients perceived to be high risk for diabetes mellitus may be unwarranted.
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Affiliation(s)
- Frank Mulindwa
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Barbara Castelnuovo
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska University, Stockholm, Sweden
| | | | - Joshua Rhein
- School of Medicine, Division of Infectious Diseases, University of Minnesota, Minneapolis, MN, USA
| | - Mutebi Edrisa
- Internal Medicine Department, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Allan Buzibye
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | - George Yendewa
- Department of Internal Medicine, Case Western Reserve University, Cleveland, USA
| | - Sarah Nabaggala
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | | | - Ronald Kiguba
- Department of Pharmacology and Therapeutics, College of Health Sciences Makerere University, Kampala, Uganda
| | - Aisha Nakawooza
- Capacity Building Program, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Simon Dujanga
- Internal Medicine Department, Makerere University, College of Health Sciences, Kampala, Uganda
| | - Martin Nabwana
- Makerere University Johns Hopkins Collaboration HIV Clinic, Kampala, Uganda
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, USA
- Department of Basic Sciences, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
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Baluku JB, Nabwana M, Mwanahamisi SB, Kansiime G, Nuwagira E, Turyahabwe S, Kirenga B. Early culture conversion is a poor marker of treatment outcome among people with HIV and drug-resistant TB. HIV Med 2023; 24:335-343. [PMID: 36054688 DOI: 10.1111/hiv.13392] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our objective was to determine associations between early (≤2 months) culture conversion (ECC) among people with HIV and drug-resistant tuberculosis (DRTB) in Uganda. METHODS This was a countrywide retrospective cohort of people with bacteriologically confirmed DRTB and a positive baseline culture at 16 centres in Uganda between 2013 and 2019. Data were abstracted from treatment files and unit DRTB registers. Monthly sputum cultures were performed using the Lowenstein-Jensen solid medium. RESULTS We included 664 people with DRTB and a positive baseline culture, of whom 353 (53.4%) also had HIV. Among those living with HIV, 225 (63.7%) were male and 331 (94.3%) were on antiretroviral therapy. The median month of culture conversion was 2 (interquartile range [IQR] 1-3). ECC was observed among 226 people living with HIV (64.0%; 95% confidence interval [CI] 58.9-68.9). A DRTB treatment regimen of six or more drugs was associated with ECC among people living with HIV (adjusted odds ratio [aOR] 3.82; 95% CI 1.06-13.82; p = 0.041). Cure and overall treatment success was observed among 232 (65.7%) and 269 (76.2%) people living with HIV, respectively. However, ECC was not associated with cure (crude odds ratio [OR] 0.97; 95% CI 0.61-1.54; p = 0.901), death (OR 1.12; 95% CI 0.61-2.29; p = 0.610), or overall treatment success (OR 1.29; 95% CI 0.78-2.13; p = 0.326). CONCLUSION The majority of people living with HIV and DRTB achieve ECC. However, ECC does not predict cure, death, or treatment success. Moreover, it may require six or more drugs to achieve ECC. ECC is not an excellent indicator of the effectiveness of DRTB regimens among people living with HIV.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Martin Nabwana
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Grace Kansiime
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edwin Nuwagira
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Stavia Turyahabwe
- National TB and Leprosy Program, Ministry of Health, Kampala, Uganda
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Baluku JB, Nabwana M, Nalunjogi J, Muttamba W, Mubangizi I, Nakiyingi L, Ssengooba W, Olum R, Bongomin F, Andia-Biraro I, Worodria W. Cardiovascular risk factors among people with drug-resistant tuberculosis in Uganda. BMC Cardiovasc Disord 2022; 22:464. [PMID: 36333654 PMCID: PMC9636825 DOI: 10.1186/s12872-022-02889-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
Background Tuberculosis (TB) and its risk factors are independently associated with cardiovascular disease (CVD). We determined the prevalence and associations of CVD risk factors among people with drug-resistant tuberculosis (DRTB) in Uganda. Methods In this cross-sectional study, we enrolled people with microbiologically confirmed DRTB at four treatment sites in Uganda between July to December 2021. The studied CVD risk factors were any history of cigarette smoking, diabetes mellitus (DM) hypertension, high body mass index (BMI), central obesity and dyslipidaemia. We used modified Poisson regression models with robust standard errors to determine factors independently associated with each of dyslipidaemia, hypertension, and central obesity. Results Among 212 participants, 118 (55.7%) had HIV. Overall, 196 (92.5%, 95% confidence interval (CI) 88.0-95.3) had ≥ 1 CVD risk factor. The prevalence; 95% CI of individual CVD risk factors was: dyslipidaemia (62.5%; 55.4–69.1), hypertension (40.6%; 33.8–47.9), central obesity (39.3%; 32.9–46.1), smoking (36.3%; 30.1–43.1), high BMI (8.0%; 5.0–12.8) and DM (6.5%; 3.7–11.1). Dyslipidaemia was associated with an increase in glycated haemoglobin (adjusted prevalence ratio (aPR) 1.14, 95%CI 1.06–1.22). Hypertension was associated with rural residence (aPR 1.89, 95% CI 1.14–3.14) and previous history of smoking (aPR 0.46, 95% CI 0.21–0.98). Central obesity was associated with increasing age (aPR 1.02, 95%CI 1.00–1.03), and elevated diastolic blood pressure (aPR 1.03 95%CI 1.00–1.06). Conclusion There is a high prevalence of CVD risk factors among people with DRTB in Uganda, of which dyslipidaemia is the commonest. We recommend integrated services for identification and management of CVD risk factors in DRTB.
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Baluku JB, Nakazibwe B, Wasswa A, Naloka J, Ntambi S, Waiswa D, Okwir M, Nabwana M, Bongomin F, Katuramu R, Nuwagira E, Ntabadde K, Katongole P, Senyimba C, Andia-Biraro I. Prevalence of intestinal helminth co-infection in drug resistant tuberculosis in Uganda. Open Forum Infect Dis 2022; 9:ofac541. [PMID: 36324329 PMCID: PMC9620429 DOI: 10.1093/ofid/ofac541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Although a third of people with tuberculosis (TB) are estimated to be coinfected with helminths, the prevalence is largely unknown among people with drug-resistant TB (DR-TB). We determined the prevalence of helminth coinfection among people with DR-TB in Uganda. Methods In a multicenter, cross-sectional study, eligible Ugandan adults with confirmed DR-TB were consecutively enrolled between July to December 2021 at 4 treatment centers. Sociodemographic data were collected using a questionnaire. Participants underwent anthropometric and blood pressure measurements, and blood samples were evaluated for random blood glucose, glycated hemoglobin, nonfasting lipid profile, human immunodeficiency virus (HIV) infection, and a complete blood count. Fresh stool samples were evaluated for adult worms, eggs, and larvae using direct microscopy after Kato-Katz concentration techniques. Results Of 212 participants, 156 (73.6%) were male, 118 (55.7%) had HIV, and 3 (2.8%) had malaria coinfection. The prevalence of intestinal helminth coinfection was 4.7% (10/212) (95% confidence interval, 2.6%–8.6%). The frequency of helminth infections was Ancylostoma duodenale (n = 4), Schistosoma mansoni (n = 2), Enterobius vermicularis (n = 2), Ascaris lumbricoides (n = 1), and Trichuris trichiura (n = 1). Conclusions The prevalence of helminth coinfection was low among people with DR-TB. More studies are needed to determine the clinical relevance of helminth/DR-TB coinfection.
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Affiliation(s)
- Joseph Baruch Baluku
- Mildmay Uganda , Kampala , Uganda
- Kiruddu National Referral Hospital , Kampala , Uganda
- Makerere University Lung Institute , Kampala , Uganda
| | | | - Amir Wasswa
- Mulago National Referral Hospital , Kampala , Uganda
| | - Joshua Naloka
- Mulago National Referral Hospital , Kampala , Uganda
| | - Samuel Ntambi
- Mulago National Referral Hospital , Kampala , Uganda
| | | | - Mark Okwir
- Faculty of Medicine, Lira University , Lira , Uganda
| | - Martin Nabwana
- Makerere University - Johns Hopkins University Research Collaboration , Kampala , Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine , Gulu , Uganda
| | | | - Edwin Nuwagira
- Mbarara University of Science and Technology , Mbarara , Uganda
| | | | - Paul Katongole
- School of Medicine, Makerere University College of Health Sciences , Kampala , Uganda
| | | | - Irene Andia-Biraro
- School of Medicine, Makerere University College of Health Sciences , Kampala , Uganda
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Baluku JB, Nabwana M, Kansiime G, Nuwagira E. Cigarette smoking is associated with an increase in blood monocytes in people with tuberculosis: A cross-sectional study. Medicine (Baltimore) 2022; 101:e30737. [PMID: 36123871 PMCID: PMC9478250 DOI: 10.1097/md.0000000000030737] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
The effect of smoking on immune responses in people with tuberculosis (TB) is not well elucidated. We aimed to compare peripheral blood counts of CD4+ and CD87 + T-lymphocytes, monocytes, and neutrophils and the CD4:CD8 ratio in TB patients with and without history of cigarette smoking. We further determined factors associated with current smoking. Participants with TB were consecutively enrolled in a cross-sectional study at a national TB treatment center in Uganda in 2018. We compared cell counts and the CD4:CD8 ratio using the median test among never smokers, past smokers (>6 months ago) and current smokers (≤6 months). Factors associated with current smoking were determined using logistic regression. A post hoc analysis for factors associated with an increase in the monocytes was also performed. Of 363 participants, there were 258 (71.1%) never smokers, 50 (13.8%) past smokers, and 55 (15.2%) current smokers. Most current smokers (49.1%) had a high sputum mycobacterial load. They also had the lowest body mass index and the highest axillary temperature. The median (interquartile range [IQR]) monocyte count among current smokers was 815 (540-1425) cells/mm3 and was significantly higher than that among past smokers (610 (350-900) cells/mm3, P = .017) and never smokers (560 [400-800] cells/mm3, P = .001). The monocyte counts positively correlated with the number of cigarettes smoked per day among current smokers (R = 0.43, P = .006). Current smokers also had higher neutrophil and CD4+ T-cell counts than never smokers. In a multivariable logistic regression model, an increase in the monocyte count was associated with current cigarette smoking (adjusted odds ratio [aOR] = 4.82, 95% confidence interval 1.61-14.39, P = .005). Similarly, current cigarette smoking was independently associated with an increase in the monocyte count (aOR = 1.80, 95% CI 1.39-2.32, P < .001). Cigarette smoking is associated with an increase in the blood monocytes in people with TB in a dose- and time-dependent manner. Further, current smoking is associated with an increase in neutrophils and CD4+ T-lymphocytes. The findings suggest that current smokers have systemic inflammation that is not necessarily beneficial to TB control in TB patients.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Martin Nabwana
- Makerere University-John Hopkins University Research Collaboration, Kampala, Uganda
| | - Grace Kansiime
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Edwin Nuwagira
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
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Kiweewa Matovu F, Kiwanuka N, Nabwana M, Scholes D, Musoke P, Glenn Fowler M, Beksinska ME, Pettifor JM, Brown TT, Kiweewa FM, Nakabiito C, Nawagi F, Kamira B, Isingel E, Bule S, Kukundakwe V, Kateregga A, Musisi M(M, Namayanja PM, Mirembe D, Mbabali MS, Mulebeke S, Nabisere J, Nakakande J, Matovu N, Nakaye D, Wynne J, Mulumba F, Mukasa R, Ssewanyana M, Nabunya HK, Biira FA, Kyomukama E, Nampiira S, Zalwago A, Namuganga ML, Mwebaza D, Namuli PE, Tulina C, Kikonyogo FS, Nabatanzi RB, Muwawu R, Musisi JN, Saava MN, Najjemba MMK, Kaahwa W, Mukalazi RN, Takhuli MM, Sawsan O, Mugenyi M, Mugagga MA, Sserugo F, Namuddu A, Kemigisha D, Nakyeyune J, Nassozi CK, Asello J, Nakawungu ZZ, Kaboggoza OH, Ssebabi SB, Birungi B, Ssentogo RL, Mubiru MC, Nansamba W, Kalungi SN, Bukenya LE, Asiimwe P, Bazira JA, Katongole S, Nabwana M, Twinomujuni W, Nakacwa S, Baddokwaya JN, Elwana AM, Nanyonjo J, Adikini S, Nalwoga J, Rwanzogyera G, Okello F, Kiiza DK, Mayanja E, Katongole F, Kiwewa M, Onen F, Mutebo J, Mukasa D, Tamale J, Kibirige I, Nabwana M. Intramuscular depot medroxyprogesterone acetate accentuates bone loss associated with tenofovir disoproxil fumarate-containing antiretroviral therapy initiation in young women living with HIV (the BONE: CARE study): a prospective cohort study in Uganda. The Lancet Global Health 2022; 10:e694-e704. [PMID: 35427526 PMCID: PMC9449816 DOI: 10.1016/s2214-109x(22)00080-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/25/2022] [Accepted: 02/17/2022] [Indexed: 01/01/2023] Open
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12
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Kibudde S, Namisango E, Nakaganda A, Atieno M, Bbaale J, Nabwana M, Kiyange F, O'brien M, Luyirika EBK, Orem J. Turnaround time and barriers to treatment of newly diagnosed cancer in Uganda: a mixed-methods longitudinal study. Afr Health Sci 2022; 22:327-337. [PMID: 36032470 PMCID: PMC9382503 DOI: 10.4314/ahs.v22i1.40] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Cancer represents a growing public health concern. Late-stage at diagnosis, limited access to effective treatment, and loss to follow-up are responsible for dismal outcomes. Objective To describe care pathways, turnaround times, and identify barriers to timely initiation of cancer treatment Methods Using a sequential mixed-methods design involving focus group discussions, we followed up 50 participants between January, and June 2018. We computed the median observed turnaround time to treatment (TTT) at each care step and reported delay as deviations from the proposed ideal turnaround times. Results The ideal TTT with either chemotherapy, or radiotherapy, or surgery was 8, 14, and 21 days respectively. At a median follow-up time of 35.5 days (IQR 17–66), only 29 of the 50 study participants had completed all steps between registration and initiation of treatment, and the observed median TTT was 16 days (9 – 22 days) for chemotherapy, and 30 days (17 – 49 days) for radiotherapy, reflecting a significant delay (p-value = 0.017). Reported barriers were; shortage of specialists, patients required visits to outside facilities for staging investigations, prohibitive costs, poor navigation system and time wastage. Conclusions When compared to the recommended ideal turnaround time, there was significant institutional delay in access to chemotherapy and radiotherapy attributed to multiple external and internal healthcare system barriers.
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Affiliation(s)
| | - Eve Namisango
- African Palliative Care Association, Entebbe, Uganda
- Cicely Saunders Institute, King's College London
| | | | | | - Joy Bbaale
- School of Public Health, Makerere University College of Health Sciences
| | | | - Fatia Kiyange
- African Palliative Care Association, Entebbe, Uganda
| | - Meg O'brien
- African Palliative Care Association, Entebbe, Uganda
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Baluku JB, Nabwana M, Winters M, Bongomin F. Tuberculosis contact tracing yield and associated factors in Uganda. BMC Pulm Med 2022; 22:64. [PMID: 35172788 PMCID: PMC8848908 DOI: 10.1186/s12890-022-01860-z] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The yield of tuberculosis (TB) contact tracing is historically low in Uganda. We determined factors associated with a positive contact tracing yield at an urban public TB clinic in Kampala, Uganda. METHODS We reviewed contact tracing registers of index TB cases registered between 2015 and 2020 at Kitebi Health Center, a primary level facility. Contacts who had symptoms of TB were designated as having presumptive TB. A contact investigation that yielded a new TB case was designated as a positive yield. We used logistic regression to determine factors associated with a positive yield of contact tracing. RESULTS Of 778 index TB cases, 455 (58.5%) had a contact investigation conducted. Index cases with a telephone contact in the unit TB register (adjusted odds ratio (aOR) 1.66, 95% CI 1.02-1.97, p = 0.036) were more likely to have a contact investigation conducted than those who did not. Of 1350 contacts, 105 (7.8%) had presumptive TB. Of these, 73 (69.5%) were further evaluated for active TB and 29 contacts had active TB. The contact tracing yield for active TB was therefore 2.1% (29/1,350). The odds of a positive yield increased tenfold with each additional presumptive contact evaluated for active TB (aOR 10.1, 95% CI 2.95-34.66, p < 0.001). Also, retreatment index TB cases were more likely to yield a positive contact (aOR 7.69 95% CI 2.08-25.00, p = 0.002) than to new cases. CONCLUSION TB contact tracing should aim to evaluate all contacts with presumptive TB and contacts of retreatment cases to maximise the yield of contact tracing.
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Affiliation(s)
- Joseph Baruch Baluku
- Makerere University Lung Institute, Kampala, Uganda. .,Kiruddu National Referral Hospital, Kampala, Uganda.
| | - Martin Nabwana
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Felix Bongomin
- Department Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Kibudde S, Kirenga BJ, Nabwana M, Okuku F, Walusansa V, Orem J. Clinical profile and initial treatment of non-small cell lung cancer: a retrospective cohort study at the Uganda Cancer Institute. Afr Health Sci 2021; 21:1739-1745. [PMID: 35283966 PMCID: PMC8889841 DOI: 10.4314/ahs.v21i4.30] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction Lung cancer is a major global public health burden constituting 11.6% of all new cancer diagnoses and 18.4% of all cancer-related mortality. Purpose To describe the clinical profile and initial treatment of non-small cell lung cancer in Uganda. Methods We reviewed charts of a cohort of patients with a histologically confirmed diagnosis of non-small cell lung cancer, treated between January 2013 and November 2015 at the Uganda Cancer Institute. Results A total of 74 patients met the inclusion criteria. The median age was 56 years (IQR 47-70), with 16.2% below the age 45 years, and 51% were female. Only 10 percent were active smokers and the most frequent histological subtype was adenocarcinoma (71%). The majority (91.9%) had stage IV disease at diagnosis and frequent metastases to contralateral lung, liver, and bones. Twenty-seven (27) patients received platinum-based chemotherapy, while 27 patients received erlotinib, and only 4 patients received palliative thoracic radiotherapy. The median survival time was 12.4 months, and the overall response rate was 32.7%. There was no survival difference by type of systemic treatment, and on multivariate analysis, poor performance status was predictive of adverse outcomes (p < 0.001). Conclusions Patients with non-small cell lung cancer in Uganda frequently presented with late-stage disease at diagnosis. The majority of patients were female, never-smokers, and had predominantly adenocarcinoma subtype.
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Affiliation(s)
| | - Bruce James Kirenga
- College of Health Sciences, Makerere University
- Makerere University Lung Institute
| | | | - Fred Okuku
- Uganda Cancer Institute, Department of Medical Oncology
| | | | - Jackson Orem
- Uganda Cancer Institute, Department of Medical Oncology
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Baluku JB, Namiiro S, Nabwana M, Muttamba W, Kirenga B. Undernutrition and Treatment Success in Drug-Resistant Tuberculosis in Uganda. Infect Drug Resist 2021; 14:3673-3681. [PMID: 34526787 PMCID: PMC8437412 DOI: 10.2147/idr.s332148] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 08/01/2021] [Accepted: 09/02/2021] [Indexed: 12/21/2022] Open
Abstract
Background Undernutrition is associated with unfavourable treatment outcomes among people with drug-resistant tuberculosis (DRTB). Factors influencing the treatment outcomes among undernourished people with DRTB are not well characterised. The aim of this study was to determine factors associated with treatment success among undernourished people with DRTB in Uganda. Methods We analysed data from a retrospective cohort of people with DRTB from 16 treatment sites in Uganda. We included participants with a pre-treatment body mass index (BMI) of <18.5 kilograms/meters2 (kg/m2). Participants were categorised as having mild (BMI of 18.5–17 kg/m2), moderate (BMI of 16.9–16.0 kg/m2) or severe (BMI of <16.0 kg/m2) undernutrition. We performed logistic regression analysis to determine factors associated with treatment success. Results Among 473 people with DRTB, 276 (58.4%) were undernourished (BMI < 18.5 Kg/m2) and were included in the study. Of these, 92 (33.3%) had mild, 69 (25.0%) had moderate and 115 (41.7%) had severe undernutrition. The overall treatment success rate (TSR) for the undernourished was 71.4% (n = 197). Although the TSR was similar among participants with mild (71.7%), moderate (78.3%) and severe (67.0%) undernutrition (p = 0.258), all treatment failure cases (n =6) were among participants with severe undernutrition (p = 0.010). Cigarette smoking (odds ratio (OR) = 0.19, 95% CI 0.07–0.47, p < 0.001), urban residence (OR = 0.31, 95% CI 0.14–0.70, p = 0.005) and moderate (OR = 0.14, 95% CI 0.06–0.35, p < 0.001) and severe anaemia (OR = 0.06, 95% CI 0.01–0.29, p = 0.001) were associated with lower odds of treatment success. Conclusion Most undernourished people with DRTB have severe undernutrition. Smoking and anaemia are modifiable factors which upon appropriate intervention could improve treatment success. The effect of urban residence on the TSR needs to be evaluated further.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.,Research and Innovation Department, Makerere University Lung Institute, Kampala, Uganda
| | - Sharon Namiiro
- Research and Innovation Department, Makerere University Lung Institute, Kampala, Uganda
| | - Martin Nabwana
- Quality Management Division, Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Winters Muttamba
- Research and Innovation Department, Makerere University Lung Institute, Kampala, Uganda
| | - Bruce Kirenga
- Research and Innovation Department, Makerere University Lung Institute, Kampala, Uganda
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Baluku JB, Katuramu R, Naloka J, Kizito E, Nabwana M, Bongomin F. Multidisciplinary management of difficult-to-treat drug resistant tuberculosis: a review of cases presented to the national consilium in Uganda. BMC Pulm Med 2021; 21:220. [PMID: 34246234 PMCID: PMC8272325 DOI: 10.1186/s12890-021-01597-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 06/03/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Patients with drug resistant tuberculosis (DR-TB) with comorbidities and drug toxicities are difficult to treat. Guidelines recommend such patients to be managed in consultation with a multidisciplinary team of experts (the "TB consilium") to optimise treatment regimens. We describe characteristics and treatment outcomes of DR-TB cases presented to the national DR-TB consilium in Uganda between 2013 and 2019. METHODS We performed a secondary analysis of data from a nation-wide retrospective cohort of DR-TB patients with poor prognostic indicators in Uganda. Patients had a treatment outcome documented between 2013 and 2019. Characteristics and treatment outcomes were compared between cases reviewed by the consilium with those that were not reviewed. RESULTS Of 1,122 DR-TB cases, 189 (16.8%) cases from 16 treatment sites were reviewed by the consilium, of whom 86 (45.5%) were reviewed more than once. The most frequent inquiries (N = 308) from DR-TB treatment sites were construction of a treatment regimen (38.6%) and management of side effects (24.0%) while the most frequent consilium recommendations (N = 408) were a DR-TB regimen (21.7%) and "observation while on current regimen" (16.6%). Among the cases reviewed, 152 (80.4%) were from facilities other than the national referral hospital, 113 (61.1%) were aged ≥ 35 years, 72 (40.9%) were unemployed, and 26 (31.0%) had defaulted antiretroviral therapy. Additionally, 141 (90.4%) had hepatic injury, 55 (91.7%) had bilateral hearing loss, 20 (4.8%) had psychiatric symptoms and 14 (17.7%) had abnormal baseline systolic blood pressure. Resistance to second-line drugs (SLDs) was observed among 9 (4.8%) cases while 13 (6.9%) cases had previous exposure to SLDs. Bedaquiline (13.2%, n = 25), clofazimine (28.6%, n = 54), high-dose isoniazid (22.8%, n = 43) and linezolid (6.7%, n = 13) were more frequently prescribed among cases reviewed by the consilium than those not reviewed. Treatment success was observed among 126 (66.7%) cases reviewed. CONCLUSION Cases reviewed by the consilium had several comorbidities, drug toxicities and a low treatment success rate. Consilia are important "gatekeepers" for new and repurposed drugs. There is need to build capacity of lower health facilities to construct DR-TB regimens and manage adverse effects.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Kiruddu National Referral Hospital, Kampala, Uganda.
- Makerere University Lung Institute, Kampala, Uganda.
| | | | | | - Enock Kizito
- USAID/Defeat TB, University Research Co LLC, Kampala, Uganda
| | - Martin Nabwana
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
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Baluku JB, Kabamooli RA, Kajumba N, Nabwana M, Kateete D, Kiguli S, Andia-Biraro I. Contact tracing is associated with treatment success of index tuberculosis cases in Uganda. Int J Infect Dis 2021; 109:129-136. [PMID: 34174434 PMCID: PMC9395259 DOI: 10.1016/j.ijid.2021.06.049] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/15/2021] [Accepted: 06/21/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE: To determine the effect of contact tracing on the treatment outcomes of index tuberculosis (TB) cases in Uganda. METHODS: We evaluated TB cases registered at an urban public health facility in Uganda in 2015–2020. We extracted data from the unit’s TB and contact tracing registers. Treatment outcomes were classified as cure, loss to follow-up, death and treatment failure. Treatment success was the sum of cure and treatment completion. RESULTS: Among 778 TB cases, contact tracing was conducted for 455 (58.5%). Compared with cases without contract tracing (n=323), cases with contract tracing (n=455) had higher treatment success (92.5% vs 79.3%) and cure rates (57.1% vs 39.9%) and lower loss to follow-up (3.5% vs 9.3%), treatment failure (0.4% vs 1.6%) and death (3.5% vs 9.9%) (P<0.001). Contact tracing was associated with higher odds of treatment success (adjusted odds ratio (aOR) 3.00, 95% CI 1.92–4.70, P<0.001) and cure (aOR 3.11, 95% CI 1.97–4.90, P<0.001), and lower odds of loss to follow-up (aOR 0.33, (0.13–0.83), P=0.018) and death (aOR 0.38, (0.20–0.72), P=0.003). CONCLUSION: TB contact tracing should be conducted consistently not only for the benefit of identifying new TB cases but also to promote treatment success of index cases.
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Affiliation(s)
- Joseph Baruch Baluku
- Kiruddu National Referral Hospital, Kampala, Uganda; Makerere University Lung Institute, Kampala, Uganda.
| | | | | | - Martin Nabwana
- Makerere University - Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - David Kateete
- Department of Microbiology and Immunology, Makerere University College of Health Sciences
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences
| | - Irene Andia-Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences
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Baluku JB, Nakazibwe B, Naloka J, Nabwana M, Mwanja S, Mulwana R, Sempiira M, Nassozi S, Babirye F, Namugenyi C, Ntambi S, Namiiro S, Bongomin F, Katuramu R, Andia-Biraro I, Worodria W. Treatment outcomes of drug resistant tuberculosis patients with multiple poor prognostic indicators in Uganda: A countrywide 5-year retrospective study. J Clin Tuberc Other Mycobact Dis 2021; 23:100221. [PMID: 33553682 PMCID: PMC7856462 DOI: 10.1016/j.jctube.2021.100221] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Comorbid conditions and adverse drug events are associated with poor treatment outcomes among patients with drug resistant tuberculosis (DR - TB). This study aimed at determining the treatment outcomes of DR - TB patients with poor prognostic indicators in Uganda. METHODS We reviewed treatment records of DR - TB patients from 16 treatment sites in Uganda. Eligible patients had confirmed DR - TB, a treatment outcome in 2014-2019 and at least one of 15 pre-defined poor prognostic indicators at treatment initiation or during therapy. The pre-defined poor prognostic indicators were HIV co-infection, diabetes, heart failure, malignancy, psychiatric illness/symptoms, severe anaemia, alcohol use, cigarette smoking, low body mass index, elevated creatinine, hepatic dysfunction, hearing loss, resistance to fluoroquinolones and/or second-line aminoglycosides, previous exposure to second-line drugs (SLDs), and pregnancy. Tuberculosis treatment outcomes were treatment success, mortality, loss to follow up, and treatment failure as defined by the World Health Organisation. We used logistic and cox proportional hazards regression analysis to determine predictors of treatment success and mortality, respectively. RESULTS Of 1122 DR - TB patients, 709 (63.2%) were male and the median (interquartile range, IQR) age was 36.0 (28.0-45.0) years. A total of 925 (82.4%) had ≥2 poor prognostic indicators. Treatment success and mortality occurred among 806 (71.8%) and 207 (18.4%) patients whereas treatment loss-to-follow-up and failure were observed among 96 (8.6%) and 13 (1.2%) patients, respectively. Mild (OR: 0.57, 95% CI 0.39-0.84, p = 0.004), moderate (OR: 0.18, 95% CI 0.12-0.26, p < 0.001) and severe anaemia (OR: 0.09, 95% CI 0.05-0.17, p < 0.001) and previous exposure to SLDs (OR: 0.19, 95% CI 0.08-0.48, p < 0.001) predicted lower odds of treatment success while the number of poor prognostic indicators (HR: 1.62, 95% CI 1.30-2.01, p < 0.001), for every additional poor prognostic indicator) predicted mortality. CONCLUSION Among DR - TB patients with multiple poor prognostic indicators, mortality was the most frequent unsuccessful outcomes. Every additional poor prognostic indicator increased the risk of mortality while anaemia and previous exposure to SLDs were associated with lower odds of treatment success. The management of anaemia among DR - TB patients needs to be evaluated by prospective studies. DR - TB programs should also optimise DR - TB treatment the first time it is initiated.
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Affiliation(s)
- Joseph Baruch Baluku
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
- Mildmay Uganda, Wakiso, Uganda
- Makerere University Lung Institute, Kampala, Uganda
| | - Bridget Nakazibwe
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Joshua Naloka
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Martin Nabwana
- Makerere University – Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Sarah Mwanja
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Rose Mulwana
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Mike Sempiira
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Febronius Babirye
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Carol Namugenyi
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | - Samuel Ntambi
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
| | | | - Felix Bongomin
- Department of Medical Microbiology & Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Richard Katuramu
- National Tuberculosis and Leprosy Control Program, Ministry of Health, Kampala, Uganda
| | - Irene Andia-Biraro
- Department of Internal Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- MRC/UVRI & LSHTM Uganda Research Unit, Uganda
| | - William Worodria
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda
- Makerere University Lung Institute, Kampala, Uganda
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Atuhaire P, Matovu F, Nakalega R, Kataike H, Nabwana M, Lukyamuzi Z, Guwattude D. Time to first viral load testing among pregnant women living with HIV initiated on option B+ at 5 government clinics in Kampala city, Uganda: Retrospective cohort study. Int J Infect Dis 2021; 104:526-531. [PMID: 33434664 DOI: 10.1016/j.ijid.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 01/01/2021] [Accepted: 01/04/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Timely viral load (VL) testing is critical in the care of pregnant women living with HIV and receiving anti-retroviral therapy (ART). There is paucity of data regarding the Time to First Viral Load (TFVL) testing in resource-limited settings. METHODS We extracted clinical and VL test data from records of a cohort of ART-naïve pregnant women living with HIV who initiated Option B + and were retained in care between 01 Jan 2015 and 31 Dec 2015. The data were verified against laboratory VL registers. TFVL (in months) was calculated based on the time difference between the date of ART initiation and FVL test. Descriptive and Cox regression analyses of data up to 30 Sep 2017 (33 months later) were done. RESULTS Of the 622 records retrieved, 424 women were retained in care. Of 424 women retained in care, 182/424 (43%) had at least one VL result post ART initiation while 242/424 (57%) had no VL performed. Only 30/182 (16.5%) had a second VL. At six, nine, and twelve months, only 8/424 (1.9%), 47/424 (11.1%), and 94/424 (22.2%) had VL testing performed respectively post ART initiation. The median TFVL testing was 12.7 months (95 CI 11.6-13.7) post ART initiation. Across the five clinics, patient factors (age, gravidity, gestational age, marital status, and adherence at 12 months) were not significant predictors. CONCLUSION A dismal 1.9% rate of achieving WHO-recommended TFVL testing and a median TFVL testing of twelve months post ART initiation were observed. The non-association of patient factors to these observations may suggest a serious need to review health system factors likely associated with these observations and their effective interventions.
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Affiliation(s)
- Patience Atuhaire
- Makerere University-Johns Hopkins University Research Collaboration; Makerere University College of Health Sciences - School of Public Health
| | - Flavia Matovu
- Makerere University-Johns Hopkins University Research Collaboration; Makerere University College of Health Sciences - School of Public Health
| | - Rita Nakalega
- Makerere University-Johns Hopkins University Research Collaboration
| | - Hajira Kataike
- Makerere University-Johns Hopkins University Research Collaboration
| | - Martin Nabwana
- Makerere University-Johns Hopkins University Research Collaboration
| | - Zubair Lukyamuzi
- Makerere University-Johns Hopkins University Research Collaboration
| | - David Guwattude
- Makerere University College of Health Sciences - School of Public Health
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20
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Matovu FK, Nabwana M, Kiwanuka N, Scholes D, Isingel E, Nolan ML, Fowler MG, Musoke P, Pettifor JM, Brown TT, Beksinska ME. Bone Mineral Density in Antiretroviral Therapy-Naïve HIV-1-Infected Young Adult -Women Using Depot Medroxyprogesterone Acetate or Nonhormonal Contraceptives in Uganda. JBMR Plus 2020; 5:e10446. [PMID: 33615111 PMCID: PMC7872338 DOI: 10.1002/jbm4.10446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/10/2020] [Accepted: 10/27/2020] [Indexed: 12/15/2022] Open
Abstract
Most studies evaluating BMD in human immunodeficiency virus (HIV)‐infected populations have focused on antiretroviral therapy (ART)‐experienced patients. In this study, the association between HIV‐1 and/or depot medroxyprogesterone acetate (DMPA) and BMD among untreated HIV‐1–infected women in a resource‐limited setting was assessed before long‐term exposure to ART. The data were then compared with that of the 2005–2008 United States National Health and Nutrition Examination Survey data for non‐Hispanic White and Black women. Women aged 18–35 years, recruited from health facilities in Kampala, Uganda, were classified based on their combination of HIV‐1 status and DMPA use: (i) HIV‐1–infected current DMPA users, (ii) HIV‐1–infected previous DMPA users, (iii) HIV‐1–infected nonhormonal‐contraceptive users, and (iv) HIV‐uninfected nonhormonal‐contraceptive users. All HIV‐1–infected women reported being ART‐naïve at baseline. BMD was measured at the lumbar spine, total hip, and femoral neck using DXA. Multivariate linear regression was used to assess the association between HIV‐1 and/or DMPA and BMD Z‐scores. Baseline data were analyzed for 452 HIV‐1–infected (220 nonhormonal users, and 177 current and 55 previous DMPA users) and 69 HIV‐1–uninfected nonhormonal‐contraceptive users. The mean age was 26.1 years (SD, 4.2) with a median duration of DMPA use among current users of 24.0 months [medians (interquartile range), 12‐48]. A higher proportion of HIV‐1–infected previous (12.7%) or current DMPA users (20.3%) and nonhormonal users (15.0%) had low BMD (Z‐score ≤−2 at any of the three sites) compared with age‐matched HIV‐1–uninfected women (2.9%). HIV‐1 infection and DMPA use were independently associated with significantly lower mean BMD Z‐scores at all sites, with the greatest difference being among HIV‐1–infected current DMPA users (5.6%–8.0%) versus uninfected nonhormonal users. Compared with non‐Hispanic White and Black women, the Ugandan local reference population had generally lower mean BMD at all sites. Newer treatment interventions are needed to mitigate BMD loss in HIV‐1–infected women in resource‐limited settings. © 2020 The Authors. JBMR Plus published by Wiley Periodicals LLC. on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Flavia Kiweewa Matovu
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala Uganda.,Makerere University College of Health Sciences Kampala Uganda
| | - Martin Nabwana
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala Uganda
| | - Noah Kiwanuka
- Makerere University College of Health Sciences Kampala Uganda
| | - Delia Scholes
- Kaiser Permanente Washington Health Research Institute Seattle WA USA
| | - Esther Isingel
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala Uganda
| | - Monica L Nolan
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala Uganda
| | - Mary G Fowler
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Philippa Musoke
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration Kampala Uganda.,Makerere University College of Health Sciences Kampala Uganda
| | - John M Pettifor
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
| | - Todd T Brown
- Johns Hopkins University School of Medicine Baltimore MD USA
| | - Mags E Beksinska
- Maternal Adolescent & Child Health Research Unit, Faculty of Health Sciences University of the Witwatersrand Johannesburg South Africa
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21
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McGoldrick SM, Mutyaba I, Adams SV, Larsen A, Krantz EM, Namirembe C, Mooka P, Nabakooza S, Ndagire M, Mubiru K, Nabwana M, Nankinga R, Gerdts S, Gordon-Maclean C, Geriga F, Omoding A, Sessle E, Kambugu J, Uldrick TS, Orem J, Casper C. Survival of children with endemic Burkitt lymphoma in a prospective clinical care project in Uganda. Pediatr Blood Cancer 2019; 66:e27813. [PMID: 31157502 DOI: 10.1002/pbc.27813] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 04/10/2019] [Accepted: 04/26/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE "Endemic" Burkitt lymphoma (BL) is a common childhood cancer in Africa. Social and treatment factors may contribute to poor survival. With the aim of improving BL outcomes in Uganda, we undertook a comprehensive project (BL Project) that provided diagnostic support, access to standard chemotherapy, nutritional evaluations, and case management. We evaluated survival of children with BL in the context of the project. PATIENTS AND METHODS Patients followed by the BL Project who consented to research were enrolled in this study. Children with a pathology diagnosis consistent with BL were eligible. Data were collected prospectively. First-line chemotherapy generally consisted of six cycles of cyclophosphamide, vincristine, low-dose methotrexate (COM). We used Kaplan-Meier and Cox regression analyses to evaluate factors associated with overall survival (OS). RESULTS Between July 2012 and June 2017, 341 patients with suspected BL presented to the BL Project. One hundred eighty patients with a pathology-based diagnosis were included in this study. The median age was seven years (interquartile range, 5-9), 74% lived ≥100 km from the Uganda Cancer Institute, 61% had late-stage disease, 84% had ECOG performance status < 3, 63% reported B-symptoms, and 22% showed neurologic symptoms. Fewer than 10% abandoned therapy. The four-year OS rate was 44% (95% CI, 36%-53%). In a multivariate model, ECOG status was significantly associated with mortality. CONCLUSION The BL Project reduced effects of lacking supportive care and oncology resources, and allowed patients from Uganda to receive curative intent therapy with minimal loss to follow-up. Nonetheless, OS remains unacceptably low. Improved therapeutic approaches to endemic BL are urgently needed in Africa.
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Affiliation(s)
| | | | - Scott V Adams
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Anna Larsen
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | - Peter Mooka
- Hutchinson Centre Research Institute, Kampala, Uganda
| | | | | | - Kelvin Mubiru
- Hutchinson Centre Research Institute, Kampala, Uganda
| | | | - Rose Nankinga
- Hutchinson Centre Research Institute, Kampala, Uganda
| | - Sarah Gerdts
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | | | | | | | | | | | | | - Corey Casper
- Departments of Medicine and Global Health, Infectious Disease Research Institute and the University of Washington, Seattle, Washington
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22
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Angucia B, Nabwana M, Asasira J, Mulumba Y, Mutyaba I, Jackson O. Spectrum of Primary Cancer Diagnoses Among Patients at Uganda Cancer Institute in 2015 and 2016. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.48700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Most recent cancer registry data suggests a change in cancer occurrence in Uganda with a decrease in incidence of Kaposi sarcoma (KS) but an increase in cervical, prostate and breast cancer. Anecdotal data suggest that KS, non-Hodgkin's lymphoma and breast cancer were the most common cancers among patients at Uganda Cancer Institute (UCI) by 2006. Aim: To describe the spectrum of cancer diagnoses among new patients that presented for care at UCI over the past 2-years. Methods: We conducted a cross sectional study of patients admitted into care at UCI with a histologic or clinical diagnosis of cancer from January 2015 to December 2016. Cancer diagnoses were reported as proportions by gender and age - children (0-14 years) and adults (above 14 years). Results: Overall, 8279 new patients were registered during the study period but only 7588 (92%) were recorded in the electronic database and had information on cancer diagnosis. Of these, 53% were admitted in 2015, and 55% were females. Median age was 48 years (IQR: 34-62). Among 2997 female adults, 30% had cervical, 17% breast, 5% Kaposi sarcoma (KS), 4% leukemia and 3.9% esophageal cancer. Among 2136 male adults, 17% had KS, 12% prostate, 10% esophageal, 6% leukemia and 4% colorectal cancer. Among the 486 children, 17% had leukemia, 16.7% nephroblastoma (Wilms tumor), 15.9% Burkitt lymphoma (BL), 8% rhabdomyosarcoma, and 6% Kaposi sarcoma. Conclusion: The distribution of cancer diagnoses among patients seen at UCI reflects the population level cancer incidence with cervical, breast, KS, prostate, esophageal, and colorectal cancer in adults, and nephroblastoma in children as the leading cause of cancer related morbidity. The overrepresentation of leukemia may be due to referral bias but warrants further study. The correlation of our findings with incidence data suggests that missing information did not significantly skew our findings. However more investments are needed to improve the quality of data captured electronically.
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Affiliation(s)
| | - M. Nabwana
- Uganda Cancer Institute, Kampala, Uganda
| | - J. Asasira
- Uganda Cancer Institute, Kampala, Uganda
| | - Y. Mulumba
- Uganda Cancer Institute, Kampala, Uganda
| | - I. Mutyaba
- Uganda Cancer Institute, Kampala, Uganda
| | - O. Jackson
- Uganda Cancer Institute, Kampala, Uganda
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