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Nakireka S, Mukunya D, Tumuhaise C, Olum R, Namulema E, Napyo A, Serwanja Q, Ingabire PM, Muyinda A, Bongomin F, Musaba M, Mutaki V, Nantale R, Akunguru P, Ainembabazi R, Nomujuni D, Olwit W, Nakawunde A, Nyiramugisha S, Aol PM, Rujumba J, Munabi I, Kiguli S. "I thought I was going to die": Experiences of COVID-19 patients managed at home in Uganda. PLoS One 2023; 18:e0295113. [PMID: 38085728 PMCID: PMC10715664 DOI: 10.1371/journal.pone.0295113] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND In Uganda, approximately 170,000 confirmed COVID-19 cases and 3,630 deaths have been reported as of January 2023. At the start of the second COVID-19 wave, the Ugandan health system was overwhelmed with a sudden increase in the number of COVID-19 patients who needed care, and the Ministry of Health resorted to home-based isolation and care for patients with mild to moderate disease. Before its rollout, the COVID-19 home-based care strategy had neither been piloted nor tested in Uganda. OBJECTIVE To explore the experiences of COVID-19 patients managed at home in Uganda. METHODS This was a qualitative study that was conducted to explore the lived experiences of COVID-19 patients managed at home. The study was carried out among patients who presented to three hospitals that were designated for treating COVID-19 patients in Uganda. COVID-19 patients diagnosed at these hospitals and managed at home were followed up and contacted for in-depth telephone interviews. The data were analysed using thematic content analysis with the aid of NVIVO 12.0.0 (QRS International, Cambridge, MA). RESULTS Participants experienced feelings of fear and anxiety: fear of death, fear of losing jobs, fear of infecting loved ones and fear of adverse events such as loss of libido. Participants also reported feelings of loneliness, hopelessness and depression on top of the debilitating and sometimes worsening symptoms. In addition to conventional medicines, participants took various kinds of home remedies and herbal concoctions to alleviate their symptoms. Furthermore, COVID-19 care resulted in a high economic burden, which persisted after the COVID-19 illness. Stigma was a major theme reported by participants. Participants recommended that COVID-19 care should include counselling before testing and during and after the illness to combat the fear and stigma associated with the diagnosis. Another recommendation was that health workers should carry out home visits to patients undergoing home-based care and that COVID-19 treatment should be free of charge. CONCLUSION COVID-19 home-based care was associated with fear, anxiety, loneliness, depression, economic loss and stigma. Policymakers should consider various home-based follow-up strategies and strengthen counselling of COVID-19 patients at all stages of care.
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Affiliation(s)
- Susan Nakireka
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
- Department of Internal Medicine, Uganda Christian University, School of Medicine, Mukono, Uganda
| | - David Mukunya
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Research, Nikao Medical Center, Kampala, Uganda
| | - Crescent Tumuhaise
- Department of Medicine, Our Lady Health of the Sick, Nkozi Hospital, Mpigi, Uganda
| | - Ronald Olum
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
- School of Public Health, Makerere University, Kampala, Uganda
| | - Edith Namulema
- Department of Internal Medicine, Mengo Hospital, Kampala, Uganda
- Department of Internal Medicine, Uganda Christian University, School of Medicine, Mukono, Uganda
| | - Agnes Napyo
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Public Health, Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda
| | | | | | - Asad Muyinda
- Department of Medicine, Jinja Regional Referral Hospital, Jinja, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Milton Musaba
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Vivian Mutaki
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Ritah Nantale
- Department of Community and Public Health, Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | | | | | | | - William Olwit
- Department of Radiology, Uganda Cancer Institute, Kampala, Uganda
| | - Aisha Nakawunde
- Department of Medicine, St. Francis Hospital Nsambya, Kampala, Uganda
| | | | | | - Joseph Rujumba
- Department of Pediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
| | - Ian Munabi
- Department of Anatomy, School of Medicine, Makerere University, Kampala, Uganda
| | - Sarah Kiguli
- Department of Pediatrics and Child Health, School of Medicine, Makerere University, Kampala, Uganda
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Ojji DB, Cornelius V, Partington G, Francis V, Pandie S, Smythe W, Hickman N, Barasa F, Damasceno A, Dzudie A, Jones E, Ingabire PM, Mondo C, Ogah O, Ogola E, Sani MU, Shedul GL, Shedul G, Rayner B, Sliwa K, Poulter N. Effect of 3, 2-Drug Combinations of Antihypertensive Therapies on Blood Pressure Variability in Black African Patients: Secondary Analyses of the CREOLE Trial. Hypertension 2022; 79:2593-2600. [DOI: 10.1161/hypertensionaha.121.18333] [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: 11/16/2022]
Abstract
Background:
The effect of 3 commonly recommended combinations of anti-hypertensive agents—amlodipine plus hydrochlorothiazide (calcium channel blocker [CCB]+thiazide), amlodipine plus perindopril (CCB+ACE [angiotensin-converting enzyme]-inhibitor), and perindopril plus hydrochlorothiazide (ACE-inhibitor+thiazide) on blood pressure variability (V) are unknown.
Methods:
We calculated the blood pressure variability (BPV) in 405 patients (130, 146, and 129 randomized to ACE-inhibitor+thiazide, CCB+thiazide, and CCB+ACE-inhibitor, respectively) who underwent ambulatory blood pressure monitoring after 6 months of treatment in the Comparisons of Three Combinations Therapies in Lowering Blood Pressure in Black Africans trial (CREOLE) of Black African patients. BPV was calculated using the SD of 30-minute interval values for 24-hour ambulatory BPs and for confirmation using the coefficient of variation. Linear mixed model regression was used to calculate mean differences in BPV between treatment arms. Within-clinic BPV was also calculated from the mean SD and coefficient of variation of 3 readings at clinic visits.
Results:
Baseline distributions of age, sex, and blood pressure parameters were similar across treatment groups. Participants were predominately male (62.2%) with mean age 50.4 years. Those taking CCB+thiazide had significantly reduced ambulatory systolic and diastolic BPV compared with those taking ACE-inhibitor+thiazide. The CCB+thiazide and CCB+ACE-inhibitor groups showed similar BPV. Similar patterns of BPV were apparent among groups using within-clinic blood pressures and when assessed by coefficient of variation.
Conclusions:
Compared with CCB-containing combinations, ACE-inhibitor plus thiazide was associated with higher levels, generally significant, of ambulatory and within-clinic systolic and diastolic BPV. These results supplement the differential ambulatory blood pressure–lowering effects of these therapies in the CREOLE trial.
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Affiliation(s)
- Dike B. Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja/University of Abuja Teaching Hospital, Gwagwalada, Nigeria (D.B.O.)
| | - Victoria Cornelius
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, United Kingdom (V.C., G.P., N.P.)
| | - Giles Partington
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, United Kingdom (V.C., G.P., N.P.)
| | - Veronica Francis
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | - Shahiemah Pandie
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | - Wynand Smythe
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | - Nicky Hickman
- Clinical Research Center, Faculty of Health Sciences, University of Cape Town, South Africa (V.F., S.P., W.S., N.H.)
| | | | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique (A. Damasceno)
| | | | - Erika Jones
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (E.J., B.R.)
| | | | - Charles Mondo
- St Francis Hospital, Nsambya, Kampala, Uganda (P.M.I., C.M.)
| | - Okechukwu Ogah
- Cardiology Unit, Department of Medicine, University College Hospital, Ibadan, Nigeria (O.O.)
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Kenya (E.O.)
| | - Mahmoud U. Sani
- Department of Medicine, Bayero University, Kano and Aminu Kano Teaching Hospital, Nigeria (M.U.S.)
| | - Gabriel Lamkur Shedul
- Department of Family Medicine, University of Abuja Teaching Hospital, Gwagwalada (G.L.S.)
| | - Grace Shedul
- Department of Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Nigeria (G.S.)
| | - Brian Rayner
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa (E.J., B.R.)
| | - Karen Sliwa
- Hatter Institute of Cardiovascular Research in Africa, Cape Town, South Africa (K.S.)
| | - Neil Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, United Kingdom (V.C., G.P., N.P.)
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Ingabire PM, Ojji DB, Rayner B, Ogola E, Damasceno A, Erika J, Dzudie A, Ogah O, Poulter N, Sani MU, Barasa F, Shedul G, Mukisa J, Mukunya D, Mondo CK. High prevalence of non-dipping patterns among black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2360] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of anti-hypertensive therapy, and intensifying salt restriction.
Objectives
To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of three 6-months anti-hypertensive regimens on the dipping pattern among Black African hypertensive patients.
Methods
This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-hour ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures.
Results
The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium >140mmol/l (OR=1.72, 95% CI: 1.17–2.51, p-value 0.005), a higher office systolic BP (OR=1.03, 95% CI: 1.01–1.05, p-value 0.003) and a lower office diastolic BP (OR=0.97, 95% CI: 0.95–0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's χ2 0.71, p-value 0.40).
Conclusion
There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Fogarty International Center and the National Institutes of Health of the United States of America Figure 1
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Affiliation(s)
| | - D B Ojji
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - B Rayner
- University of Cape Town, Division of Nephrology and Hypertension, Department of Medicine, Faculty of Clinical Sciences,, Cape Town, South Africa
| | - E Ogola
- University of Nairobi, Department of Clinical Medicine and Therapeutics, Nairobi, Kenya
| | - A Damasceno
- Eduardo Mondlane University, Maputo, Mozambique
| | - J Erika
- University of Cape Town, Division of Nephrology and Hypertension, Department of Medicine, Faculty of Clinical Sciences,, Cape Town, South Africa
| | - A Dzudie
- University Hospital of Douala, Douala, Cameroon
| | - O Ogah
- Ibadan University College Hospital, Cardiology Unit, Department of Medicine, Ibadan, Nigeria
| | - N Poulter
- Imperial College London, Imperial Clinical Trials Unit, School of Public Health, London, United Kingdom
| | - M U Sani
- Aminu Kano Teaching Hospital, Kano, Nigeria
| | - F Barasa
- Moi Teaching and referral Hospital, Eldoret, Kenya
| | - G Shedul
- University of Abuja Teaching Hospital, Abuja, Nigeria
| | - J Mukisa
- Makerere University College of Health Sciences, Department of Medicine, MakNCD D43 project, Kampala, Uganda
| | - D Mukunya
- Makerere University College of Health Sciences, Department of Medicine, MakNCD D43 project, Kampala, Uganda
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Ingabire PM, Ojji DB, Rayner B, Ogola E, Damasceno A, Jones E, Dzudie A, Ogah OS, Poulter N, Sani MU, Barasa FA, Shedul G, Mukisa J, Mukunya D, Wandera B, Batte C, Kayima J, Pandie S, Mondo CK. High prevalence of non-dipping patterns among Black Africans with uncontrolled hypertension: a secondary analysis of the CREOLE trial. BMC Cardiovasc Disord 2021; 21:254. [PMID: 34022790 PMCID: PMC8141234 DOI: 10.1186/s12872-021-02074-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dipping of blood pressure (BP) at night is a normal physiological phenomenon. However, a non-dipping pattern is associated with hypertension mediated organ damage, secondary forms of hypertension and poorer long-term outcome. Identifying a non-dipping pattern may be useful in assessing risk, aiding the decision to investigate for secondary causes, initiating treatment, assisting decisions on choice and timing of antihypertensive therapy, and intensifying salt restriction. OBJECTIVES To estimate the prevalence and factors associated with non-dipping pattern and determine the effect of 6 months of three antihypertensive regimens on the dipping pattern among Black African hypertensive patients. METHODS This was a secondary analysis of the CREOLE Study which was a randomized, single blind, three-group trial conducted in 10 sites in 6 Sub-Saharan African countries. The participants were 721 Black African patients, aged between 30 and 79 years, with uncontrolled hypertension and a baseline 24-h ambulatory blood pressure monitoring (ABPM). Dipping was calculated from the average day and average night systolic blood pressure measures. RESULTS The prevalence of non-dipping pattern was 78% (564 of 721). Factors that were independently associated with non-dipping were: serum sodium > 140 mmol/l (OR = 1.72, 95% CI 1.17-2.51, p-value 0.005), a higher office systolic BP (OR = 1.03, 95% CI 1.01-1.05, p-value 0.003) and a lower office diastolic BP (OR = 0.97, 95% CI 0.95-0.99, p-value 0.03). Treatment allocation did not change dipping status at 6 months (McNemar's Chi2 0.71, p-value 0.40). CONCLUSION There was a high prevalence of non-dipping among Black Africans with uncontrolled hypertension. ABPM should be considered more routinely in Black Africans with uncontrolled hypertension, if resources permit, to help personalise therapy. Further research is needed to understand the mechanisms and causes of non-dipping pattern and if targeting night-time BP improves clinical outcomes. Trial registration ClinicalTrials.gov (NCT02742467).
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Affiliation(s)
- Prossie Merab Ingabire
- St. Francis Hospital, Nsambya, Kampala, Uganda
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - Dike B. Ojji
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
| | - Brian Rayner
- Division of Nephrology and Hypertension, Cape Town, South Africa
| | - Elijah Ogola
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
| | | | - Erika Jones
- Division of Nephrology and Hypertension, Cape Town, South Africa
| | | | - Okechukwu S. Ogah
- Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
| | - Neil Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
| | - Mahmoud U. Sani
- Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Felix Ayub Barasa
- Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Grace Shedul
- Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - John Mukisa
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Mukunya
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
| | - Bonnie Wandera
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - Charles Batte
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
| | - Shahiemah Pandie
- Hatter Institute of Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | | | - CREOLE Study Investigators
- St. Francis Hospital, Nsambya, Kampala, Uganda
- MakNCD D43 Project, Makerere University College of Health Sciences, Kampala, Uganda
- Faculty of Health Sciences, Busitema University, Mbale, Uganda
- Department of Medicine, Faculty of Clinical Sciences, University of Abuja, Abuja, Nigeria
- University of Abuja Teaching Hospital, Gwagwalada, Nigeria
- Pharmacy, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
- Cardiology Unit, Department of Medicine, University of Ibadan/University College Hospital, Ibadan, Nigeria
- Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
- Division of Nephrology and Hypertension, Cape Town, South Africa
- Hatter Institute of Cardiovascular Research in Africa, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London, UK
- Department of Cardiology, Moi Teaching and Referral Hospital, Eldoret, Kenya
- Department of Clinical Medicine and Therapeutics, University of Nairobi, Nairobi, Kenya
- Eduardo Mondlane University Hospital, Maputo, Mozambique
- Douala General Hospital, Douala, Cameroon
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Ingabire PM, Semitala F, Kamya MR, Nakanjako D. Delayed Antiretroviral Therapy (ART) Initiation among Hospitalized Adults in a Resource-Limited Settings: A Challenge to the Global Target of ART for 90% of HIV-Infected Individuals. AIDS Res Treat 2019; 2019:1832152. [PMID: 31057959 PMCID: PMC6463639 DOI: 10.1155/2019/1832152] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 01/02/2019] [Accepted: 02/26/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Combination antiretroviral therapy (cART) initiation in hospital settings, where individuals often present with undiagnosed, untreated, advanced HIV disease, is not well understood. METHODS A cross-sectional study was conducted to determine a period prevalence of cART initiation within two weeks of eligibility, as determined at hospitalization. Using a pretested and precoded data extraction tool, data on cART initiation status and reason for not initiating cART was collected. Phone calls were made to patients that had left the hospital by the end of the two-week period. Delayed cART initiation was defined as failure to initiate cART within two weeks. Sociodemographic characteristics, WHO clinical stage, CD4 count, cART initiation status, and reasons for delayed cART initiation were extracted and analyzed. RESULTS Overall, 386 HIV-infected adults were enrolled, of whom 289/386 (74.9%) had delayed cART initiation, 77/386 (19.9%) initiated cART, and 20/386 (5.2%) were lost-to-follow-up, within two weeks of cART eligibility. Of 289 with delayed ART initiation, 94 (32.5%) died within two weeks of cART eligibility. Patients with a CD4 cell count≥ 50 cells/μl and who resided in ≥8 kilometers from the hospital were more likely to have delayed cART initiation [adjusted odds ratio (AOR) 2.34, 95% CI: 1.33-4.10, p value 0.003; and AOR 1.92, 95% CI: 1.09-3.40, p value 0.025; respectively]. CONCLUSION Up to 75% of hospitalized HIV-infected, cART-naïve, cART-eligible patients did not initiate cART and had a 33% pre-ART mortality rate within two weeks of eligibility for cART. Hospital based strategies to hasten cART initiation during hospitalization and electronic patient tracking systems could promote active linkage to HIV treatment programs, to prevent HIV/AIDS-associated mortality in resource-limited settings.
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Affiliation(s)
- Prossie Merab Ingabire
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- St. Francis Hospital, Nsambya, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
| | - Fred Semitala
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses R. Kamya
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda
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