Soroti University
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2024-03-29T02:42:44Z
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Isoniazid preventive therapy completion between July-September 2019: A comparison across HIV differentiated service delivery models in Uganda
https://ir.sun.ac.ug//handle/123456789/93
Isoniazid preventive therapy completion between July-September 2019: A comparison across HIV differentiated service delivery models in Uganda
Levicatus, Mugenyi; Proscovia, Mukonzo Namuwenge; Simple, Ouma; Baker, Bakashaba; Mastula, Nanfuka; Jennifer, Zech; Collins, Agaba; Andrew, Mijumbi Ojok; Fedress, Kaliba; John, Bossa Kato; Ronald, Opito; Yunus, Miya; Cordelia, Katureebe; Yael, Hirsch-Moverman
Background
Tuberculosis (TB) remains the leading cause of death among people living with HIV
(PLHIV). To prevent TB among PLHIV, the Ugandan national guidelines recommend Isoniazid
Preventive Therapy (IPT) across differentiated service delivery (DSD) models, an effective
way of delivering ART. DSD models include Community Drug Distribution Point
(CDDP), Community Client-led ART Delivery (CCLAD), Facility-Based Individual Management
(FBIM), Facility-Based Group (FBG), and Fast Track Drug Refill (FTDR). Little is
known about the impact of delivering IPT through DSD.
Methods
We reviewed medical records of PLHIV who initiated IPT between June-September 2019 at
TASO Soroti (TS), Katakwi Hospital (KH) and Soroti Regional Referral Hospital (SRRH).
We defined IPT completion as completing a course of isoniazid within 6–9 months. We utilized
a modified Poisson regression to compare IPT completion across DSD models and
determine factors associated with IPT completion in each DSD model.
Results
Data from 2968 PLHIV were reviewed (SRRH: 50.2%, TS: 25.8%, KH: 24.0%); females:
60.7%; first-line ART: 91.7%; and Integrase Strand Transfer Inhibitor (INSTI)-based regimen:
61.9%. At IPT initiation, the median age and duration on ART were 41.5 (interquartile
range [IQR]; 32.3–50.2) and 6.0 (IQR: 3.7–8.6) years, respectively. IPT completion overall was 92.8% (95%CI: 91.8–93.7%); highest in CDDP (98.1%, 95%CI: 95.0–99.3%) and lowest
in FBG (85.8%, 95%CI: 79.0–90.7%). Compared to FBIM, IPT completion was significantly
higher in CDDP (adjusted rate ratio [aRR] = 1.15, 95%CI: 1.09–1.22) and CCLAD
(aRR = 1.09, 95% CI 1.02–1.16). In facility-based models, IPT completion differed between
sites (p<0.001). IPT completion increased with age for FBIM and CCLAD and was lower
among female participants in the CCLAD (aRR = 0.82, 95%CI 0.67–0.97).
Conclusion
IPT completion was high overall but highest in community-based models. Our findings provide
evidence that supports integration of IPT within DSD models for ART delivery in
Uganda and similar settings.
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https://doi.org/10.1371/journal.pone.0296239
2024-01-02T00:00:00Z
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Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study
https://ir.sun.ac.ug//handle/123456789/92
Diagnostic and pre-treatment intervals among patients with cervical cancer attending care at the Uganda Cancer Institute: a cross-sectional study
Jackie, Lalam Lacika; Henry, Wabinga; Joseph, Kagaayi; Ronald, Opito; Christopher, Garimoi Orach; Amos Deogratius, Mwaka
Abstract
Background Majority of patients with cervical cancer in the low- and middle-income countries experience long
diagnostic and pre-treatment intervals. This study sought to determine the factors associated with the diagnostic and
pre-treatment intervals among patients with cervical cancer.
Methods This was a cross-sectional study conducted at the Uganda Cancer Institute (UCI) during October 2019 to
January 2020. Patients aged ≥ 18 years with histological diagnosis of cervical cancer were consecutively sampled. Data
were collected using a pre-tested semi-structured questionnaire and a data abstraction form. Diagnostic intervals,
defined as the time between first visit of a patient to a primary healthcare provider to time of getting confirmed
diagnosis, of ≤ 3 months was defined as early & >3 months as late. Pre-treatment intervals, which is the time from
histological diagnosis to starting cancer chemo-radiotherapy of ≤ 1 month was defined as early and > 1 month as late.
Data were analysed using STATA version 14.0. We used modified Poisson regression models with robust variance to
determine socio-demographic and clinical factors associated with the intervals.
Results The mean age of the participants was 50.0 ± 11.7 years. The median diagnostic and pre-treatment intervals
were 3.1 (IQR: 1.4–8.2) months and 2.4 (IQR: 1.2–4.1) months respectively. Half of the participants, 49.6% (200/403)
were diagnosed early; one in 5 patients, 20.1% (81/403) promptly (within one month) initiated cancer chemoradiotherapy.
Participants more likely to be diagnosed early included those referred from district hospitals (level 5)
(aPR = 2.29; 95%CI: 1.60–3.26) and with squamous cell carcinomas (aPR = 1.55; 95%CI: 1.07–2.23). Participants more
likely to be diagnosed late included those who first discussed their symptoms with relatives, (aPR = 0.77; 95%CI:
(0.60–0.98), had > 2 pre-referral visits (aPR = 0.75; 95%CI (0.61–0.92), and had advanced stage (stages 3 or 4) (aPR = 0.68;
95%CI: 0.55–0.85). Participants more likely to initiate cancer chemo-radiotherapy early included older patients (≥ 60
years) (aPR = 2.44; 95%CI: 1.18–5.03). Patients likely to start treatment late were those who had ≥2 pre-referral visits (aPR = 0.63; 95%CI: 0.41–0.98) and those that took 3 - 6 months with symptoms before seeking healthcare (aPR =
0.52;95%CI: 0.29 - 0.95).
Conclusion
Interventions to promote prompt health-seeking and early diagnosis of cervical cancer need to target
primary healthcare facilities and aim to enhance capacity of primary healthcare professionals to promptly initiate
diagnostic investigations. Patients aged < 60 years require targeted interventions to promote prompt initiation of
chemo-radiation therapy.
Acknowledgements
The authors are grateful to the study participants for accepting to provide the
necessary data, and the research assistants who diligently interviewed the
participants and collected data. The authors are also grateful to the nursing officer at the CI who coordinated the study and helped identified patients’ files. We also appreciate the CI director and administrators from allowing
use access the patients. JLL is profoundly grateful to the African Breast and
Cervical Cancer Awareness research collaborations for supporting her in this
research project.
2023-11-27T00:00:00Z
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Severe malaria burden, clinical spectrum and outcomes at Apac district hospital, Uganda
https://ir.sun.ac.ug//handle/123456789/91
Severe malaria burden, clinical spectrum and outcomes at Apac district hospital, Uganda
Emmanuel, Ocen; Ronald, Opito; Crispus, Tegu; Alex, Oula; Peter, Olupot‑Olupot
Abstract
Background Most data describing severe malaria (SM) in sub‑Saharan Africa (SSA) are from research settings out
side disease endemic areas. Using routinely collected data from Apac District Hospital, this study aimed at determin
ing the burden and clinical spectrum of severe malaria.
Methods This was a retrospective study that reviewed all paediatric admission records for malaria in the 24 months
period from Jan 2019 to Dec 2020 at Apac District Hospital. Data on children aged 60 days to 12 years who at admis
sion tested positive for malaria and fulfilled the World Health Organization clinical criteria for surveillance of severe
malaria were abstracted using a customized proforma designed to capture variables on social demographic, clinical
presentation, treatment, and outcomes. In addition, the tool included laboratory variables for complete blood counts,
haemoglobin, and glucose levels. Data were analysed using STATA V15.0. The study had ethical approval from Mbale
Regional Referral Hospital REC, Approval No. MRRH‑REC 053/2019.
Results A total of 5631 admission records were retrieved for this study period. Of these, 3649 (64.8%) were malaria
admissions and 3422/3649 were children below 12years, with only 1864 (54.5%) of children having complete data.
Of the 1864 children, 745 (40.0%) fulfilled the severe malaria inclusion criteria. Of the 745 children, 51.4% (n = 381)
were males. The median age at admission was 31 months (IQR = 17–60). The most common clinical presentations
among children with severe malaria were fever 722 (97.3%), cough 478 (64.2%), and difficulty in breathing 122 (17.9%).
The median length of hospital stay was 2 (IQR; 2–4) days and 133 (17.9%) had prolonged hospital stay (> 4 days).
Factors independently associated with prolonged hospital stay were, presenting with difficulty in breathing, aOR 1.83
(95% CI 1.02–3.27, P = 0.042) and prostration aOR 8.47 (95% CI 1.94–36.99, P = 0.004). A majority of admitted children,
735 (98.7%) survived, while 10 (1.3%) died of SM.
Conclusion A high proportion (40.0%) of malaria admissions were due to SM. Prolonged Hospital stay was associ
ated with prostration and difficulty in breathing. Overall mortality was low, 1.3% compared to mortality in the previ
ously reported series. This study was able to use routinely collected data to describe the burden and clinical spectrum
of SM. Improvement in the quality of data from such settings would improve disease descriptions for policy, monitor
ing of epidemics, response to interventions and to inform research
2023-01-01T00:00:00Z
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Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute
https://ir.sun.ac.ug//handle/123456789/90
Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute
Jennifer, Achan; Francis Xavier, Kasujja; Ronald, Opito; Henry, Wabinga; Christopher Garimoi, Orach; Amos Deogratius, Mwaka
Abstract
Background: Most breast cancer (BC) patients in Uganda are diagnosed with
advanced-stage
disease and experience poor outcomes. This study examined the
diagnostic and pre-treatment
intervals and factors associated with these intervals
among BC patients attending care at the Uganda Cancer Institute (UCI).
Methods: This was a cross-sectional,
facility-based
study. Data were collected
using structured questionnaire administered by trained research assistants and
analyzed using STATA version 14.0. Modified Poisson regressions models were
used to determine the strength of associations between independent variables
and diagnostic and pre-treatment
intervals.
Results: The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four
in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140)
stage IV cancers. The median interval from first consultation to diagnosis diagnostic
interval (DI) was 5.6 months (IQR: 1.5–17.0),
while the median interval
from histological diagnosis to start of chemotherapy pre-treatment
interval (PTI)
was 1.7 months (IQR: 0.7–4.5).
Majority (85%, n = 341) of participants were diagnosed
at ≥3 months from first consultation with clinicians. Participants with
tertiary education and those who lived within 100–199
km from the UCI were
about four times and twice more likely to be diagnosed early (DI <3 months from
first consultation) ([aPR = 3.88; 95% CI: 1.15–13.0]
and [aPR = 2.19; 95% CI: 1.06–4.55]),
respectively. About half (48.3%; n = 176) of participants started chemotherapy
within 1 month of cancer diagnosis. Patients who lived more than 300 km
from the UCI were less likely to start chemotherapy within 1 month of histology
diagnosis of cancer.
Conclusion: Majority of breast cancer patients are diagnosed late and in advanced
stages. There is need to promote all efforts toward timely diagnosis when
cancers are still in early stages by identifying factors responsible for prolonged
diagnostic intervals among breast cancer patients.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided
the original work is properly cited.
© 2023 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.
2023-01-01T00:00:00Z