The effect of AIDS defining conditions on immunological recovery among patients initiating antiretroviral therapy at Joint Clinical Research Centre, Uganda

Background While the proportion of HIV-positive children (under 15 years) enrolled on antiretroviral therapy (ART) has increased in recent years, up to 60% of children started on ART do not achieve virological suppression. We set out to determine the factors associated with virological non-suppression among children living with HIV receiving ART at a peri-urban HIV care clinic in Kampala, Uganda. Method This was a retrospective cohort study conducted at the pediatric HIV/AIDS clinic at the Joint Clinical Research Centre (JCRC) in Kampala, Uganda. Three hundred (300) HIV-positive children (0–14 years) were randomly selected from existing medical records and data on children’s socio-demographic and clinical characteristics (age at ART initiation, WHO clinical staging, and ART-induced side effects) were abstracted using a data abstraction form. Virological non-suppression was defined as a viral load ≥1000 copies/Ml of blood after six months of ART initiation. Incident rate ratios (IRRs) were determined as a measure of association between virological non-suppression and child/patient characteristics. The IRRs were obtained via a modified Poisson regression with corresponding 95% confidence intervals (95%CI). All analyses were done using statistical package, Stata version 15. Results The overall non-suppression rate among HIV-positive children on ART was 23%. Being at WHO clinical stage 4 at ART initiation [adj. IRR 2.74; 95%CI: 1.63, 4.61] and ART-induced side effects [adj. IRR 1.77; 95%CI: 1.06, 2.97] were significantly associated with non-suppression. Older age at ART initiation (age 5–9 years: [adj. IRR 0.42; 95%CI: 0.28, 0.65]; age 10–14 years: [adj. IRR 0.34; 95%CI: 0.18, 0.64] was less likely to be associated with virological non-suppression. Conclusion Nearly a quarter of HIV-positive children on ART had a non-suppressed viral load after six months of treatment. Being at WHO clinical stage 4 at ART initiation and ART-induced side effects were significantly associated with virological non-suppression while older age at ART initiation was protective. Our findings suggest a need for age-specific interventions, particularly those targeting children below five years of age, to improve virological suppression among HIV-positive children receiving ART in this setting.

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Prevalence of non-communicable diseases among HIV positive patients on antiretroviral therapy at joint clinical research centre, Lubowa, Uganda

PLoS ONE ◽

10.1371/journal.pone.0221022 ◽

2019 ◽

Vol 14 (8) ◽

pp. e0221022 ◽

Cited By ~ 2

Author(s):

Sheila Kansiime ◽

Doris Mwesigire ◽

Henry Mugerwa

Keyword(s):

Antiretroviral Therapy ◽

Clinical Research ◽

Communicable Diseases ◽

Research Centre ◽

Hiv Positive ◽

Non Communicable Diseases

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Pioneering work on HIV/AIDS in Uganda

10.1093/med/9780198703327.003.0004 ◽

2015 ◽

Author(s):

Peter Mugyenyi

Keyword(s):

Antiretroviral Therapy ◽

Health Education ◽

Research And Development ◽

Clinical Research ◽

Collaborative Research ◽

Research Centre ◽

Hiv Aids

Chapter 4 describes how the author and his colleagues set about trying to tackle HIV/AIDS in Uganda through health education and prevention campaigns, collaborative research, and, ultimately, treatment. It covers how, through the work of the Joint Clinical Research Centre and active support from the country’s President, Uganda took the lead in many aspects of research and development, and how it became clear that the biggest challenges were securing access to treatments and confronting attitudes that the use of antiretroviral therapy (ART) in Africa was simply unfeasible. It also describes how ART became available and successful services were established throughout the country, how Uganda served as a model for many other countries in Africa, and explains the continuing need for investment and development to maintain and build on these successes.

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Prognostic model for nephrotoxicity among HIV-positive Zambian adults receiving tenofovir disoproxil fumarate-based antiretroviral therapy

PLoS ONE ◽

10.1371/journal.pone.0252768 ◽

2021 ◽

Vol 16 (7) ◽

pp. e0252768

Author(s):

Freeman W. Chabala ◽

Edward D. Siew ◽

Wilbroad Mutale ◽

Lloyd Mulenga ◽

Aggrey Mweemba ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Kidney Disease ◽

Serum Creatinine ◽

Tenofovir Disoproxil Fumarate ◽

Research Centre ◽

Hiv Positive ◽

Baseline Serum ◽

Persons Living With Hiv ◽

Acute Kidney Disease ◽

End Stage

Persons living with HIV (PLWH) receiving tenofovir disoproxil fumarate (TDF)-based antiretroviral therapy (ART) risk suffering TDF-associated nephrotoxicity (TDFAN). TDFAN can result in short- and long-term morbidity, including permanent loss of kidney function, chronic kidney disease (CKD), and end-stage kidney disease (ESKD) requiring dialysis. Currently, there is no model to predict this risk or discern which patients to initiate TDF-based therapy. Consequently, some patients suffer TDFAN within the first few months of initiating therapy before switching to another suitable antiretroviral or a lower dose of TDF. In a prospective observational cohort study of adult Zambian PLWH, we modelled the risk for TDFAN before initiating therapy to identify individuals at high risk for experiencing AKI after initiating TDF-based therapy. We enrolled 205 HIV-positive, ART-naïve adults initiating TDF-based therapy followed for a median of 3.4 months for TDFAN at the Adult Infectious Disease Research Centre (AIDC) in Lusaka, Zambia. We defined TDFAN as meeting any of these acute kidney disease (AKD) criteria: 1) An episode of estimated glomerular filtration rate (eGFR)< 60ml/ min/1.73m2 within 3 months, 2) reduced eGFR by> 35% within 3 months or 3) increased serum creatinine by> 50% within 3 months. A total of 45 participants (22%) developed acute kidney disease (AKD) after TDF-based therapy. The development of AKD within the first 3 months of commencing TDF-based therapy was associated with an increase in baseline serum creatinine, age, baseline eGFR and female sex. We concluded that baseline characteristics and baseline renal function biomarkers predicted the risk for AKD within the first 3-months of TDF-based therapy.

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Abstracts of the meeting of the Clinical Genetics Society held at the Clinical Research Centre, Northwick Park Hospital, London on 8 and 9 November 1985

Journal of Medical Genetics ◽

10.1136/jmg.23.2.165 ◽

1986 ◽

Vol 23 (2) ◽

pp. 165-170

Keyword(s):

Clinical Research ◽

Research Centre ◽

Clinical Genetics ◽

Northwick Park Hospital ◽

Park Hospital

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Proposed siting of the new national clinical research centre

BMJ ◽

10.1136/bmj.295.6610.1414-a ◽

1987 ◽

Vol 295 (6610) ◽

pp. 1414-1414

Author(s):

E Kohner

Keyword(s):

Clinical Research ◽

Research Centre

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Implementation of a strategic planning process oriented towards promoting business process management (BPM) at a clinical research centre (CRC)

Business Process Management Journal ◽

10.1108/bpmj-08-2016-0169 ◽

2019 ◽

Vol 25 (4) ◽

pp. 707-737

Author(s):

Victor Cattani Rentes ◽

Silvia Inês Dallavalle de Pádua ◽

Eduardo Barbosa Coelho ◽

Monica Akissue de Camargo Teixeira Cintra ◽

Gabriela Gimenez Faustino Ilana ◽

...

Keyword(s):

Action Research ◽

Strategic Planning ◽

Clinical Research ◽

Management Practices ◽

Planning Process ◽

Lessons Learned ◽

Research Centre ◽

Content Type ◽

Strategic Planning Process ◽

Process Oriented

Purpose This work explores the potential benefits of aligning the strategic planning process with a BPM program in a clinical research center (CRC). The purpose of this paper is to define a process for executing strategic planning oriented towards the promotion of a BPM program. Design/methodology/approach The method applied is action research. This allowed the solution of a practical problem and at the same time the proposition of a new approach to promote BPM in alignment with strategy, which was synthesized in the model presented. Findings The analysis and structuring of the strategic planning process, with the assessment of the as-is situation, were adequate as a preparation step for the first cycle of a BPM program in the CRC. Based on lessons learned along the research project, a model was proposed for the strategic planning process oriented towards promoting BPM. Research limitations/implications The model was conceived from a single application at a CRC, through a cycle of action research. This is one of the limitations of this work. The model was not yet sufficiently tested in other contexts. This represents opportunities for future research. Practical implications The evaluation step in the action research cycle revealed that the organization in focus was satisfied with the results. New management practices in the organizations in focus were implemented as a result of this work. Originality/value Process improvement initiatives are a novelty in the CRC context, and this work may serve as a reference for CRC managers seeking to improve overall performance. The proposed model in this work indicates that a BPM program should start with strategic planning. An initial assessment of the as-is situation of the organization in focus was performed based on the analysis of the undesirable effects in the organization’s management practices, using a technique of the Theory of Constraints. The use of this technique facilitated the identification of solutions to the root causes identified in the assessment. The level of the assessment was deeper in comparison to results obtained with traditional tools used in strategic planning processes. The assessment supports the definition of actions oriented to solving the majority of the management dysfunctions of the organization in focus.

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Opportunistic infection at the start of antiretroviral therapy and baseline CD4+ count less than 50 cells/mm3 are associated with poor immunological recovery

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2018-0105 ◽

2019 ◽

Vol 30 (2) ◽

pp. 163-171

Author(s):

Amod Tilak ◽

Smita Shenoy ◽

Muralidhar Varma ◽

Asha Kamath ◽

Amruta Tripathy ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Opportunistic Infection ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Hiv Positive ◽

P Value ◽

Care Hospital ◽

Long Term Treatment ◽

Immunological Recovery

AbstractIntroductionThere is a dearth of studies assessing the efficacy and immunological improvement in patients started on antiretroviral therapy (ART) in India. This study was undertaken to assess the 2-year treatment outcomes in HIV-positive patients initiated on ART in a tertiary-care hospital.MethodsAfter approval from the Institutional Ethics Committee, adult HIV-positive patients from a tertiary-care hospital, initiated on ART between January 2013 and February 2015, were included in the study. Data on clinical and immunological parameters were obtained from medical case records over a period of 2 years after initiation of therapy. Intention-to-treat analysis was done using a descriptive approach, using SPSS version 15 (SPSS Inc. Released 2006. SPSS for Windows, Version 15.0. Chicago, SPSS Inc.). A logistic regression analysis was done to assess the predictors for poor outcomes. A p-value <0.05 was considered statistically significant.ResultsART was initiated in 299 adult patients. At 1 and 2 years, the median (interquartile range) change in CD4+cell count was 65 (39, 98) cells/mm3and 160 (95, 245) cells/mm3. The change observed after 2 years of treatment initiation was statistically significant compared with that after 1 year. Three deaths occurred during the study period and 28 were lost to follow-up. Male sex, presence of at least one opportunistic infection at the start of therapy, and baseline CD4+count <50 cells/mm3were associated with poor immunological recovery.ConclusionsWith long-term treatment and regular follow-up, sustained clinical and immunological outcomes can be obtained in resource-limited settings.

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