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CURATOR
A pinboard by
Herry Mapesi

Research Officer, Ifakara Health Institute

PINBOARD SUMMARY

Since October 2013 I have been working as a clinician at the Chronic Diseases Clinic of Ifakara which is a clinic for HIV-infected patients in rural Tanzania. The clinic is located in St. Francis Referral Hospital and serves patients from Kilombero and Ulanga districts of Morogoro in southern-west Tanzania. During this time, I have been attending HIV-infected and Tuberculosis patients on both out and in-patient basis. Apart from being involved in patients’ care and treatment I have been involved in several research projects involving HIV-infected patients in our clinic. So far I have managed to be the first author in three publications published in peer reviewed journals as well as a co-authored in other eight publications and there are several manuscripts under preparations. February 2017 I completed a Masters of Science in Epidemiology program at the University of Basel, Switzerland. My thesis was based on a research project to evaluate prevalence, incidence and predictors of renal impairment among HIV-infected patients enrolled in our cohort from January 2013 to June 2016. I performed the statistical analysis using Stata and we assessed predictors of renal impairment at enrolment by using logistic regression model and for the predictors of incidence of renal impairment during follow-up we used Cox proportional hazards model and generalized estimated equations. We only included patients who were using first line antiretroviral treatment. I was the principal investigator of the project and the manuscript is under review at HIV Medicine Journal with an abstract being accepted as a poster presentation at the 16th European Aids Conference from October 25th-27th, 2017 in Milan, Italy. Currently I’m preparing a new protocol to evaluate prevalence, predictors and incidence of renal impairment among HIV-infected patients who have been using second line antiretroviral treatment for at least six months. This is a follow-up study from my previous work and it involves second line patients because the risk of renal impairment increases in this population. In Sub Saharan Africa we are still using antiretroviral regimens containing tenofovir disoproxil fumarate and Protease inhibitors (atazanavir/ritonavir and lopinavir/ritonavir) for the second line antiretroviral treatment and these drugs have been previously reported to be associated with increased risk of renal impairment in HIV-infected patients.

5 ITEMS PINNED

Prevalence,awareness and factors associated with hypertension in North West Tanzania.

Abstract: Hypertension is a public health problem, and yet few people are aware of it and even fewer access effective treatment. With the ongoing demographic transition in many parts of Sub-Saharan Africa, people are changing from rural, manual work to urban lifestyles, hence the risk of hypertension increases.This study aimed at determining the prevalence, awareness and risk factors associated with hypertension in North West Tanzania.A community-based cross-sectional study was conducted among adults in Magu District in 2013. Information on socio-demographic, economic and lifestyle characteristics, medical conditions, and risk factors for hypertension were collected according to the WHO Steps survey tool. Measurements of blood pressure, blood sugar, pulse rate, and anthropometry were taken. Multivariate logistic regression was used to estimate the odds ratios (OR) and 95% confidence intervals (95% CI) for factors associated with hypertension (Blood pressure ≥140/90mm/Hg). Frequencies and percentages were used to determine the awareness, and treatment among hypertensive participants.Among 9678 participants, the prevalence of hypertension was 8.0% and pre-hypertension 36.2%. There was a higher prevalence of hypertension at older ages, among females (8.2%) compared to males (7.7%), and among urban dwellers (10.1%) compared to rural residents (6.8%). Overweight, obese, and diabetic individuals had a higher risk of hypertension while HIV positive participants had a lower risk of hypertension (OR = 0.56; 95% CI 0.39 - 0.79). Among participants with hypertension, awareness was less than 10%.By integrating blood pressure screening into our long-standing community HIV screening program, we were able to identify many previously undiagnosed cases of hypertension and pre-hypertension. Age, residence, overweight and obesity were the major associated factors for hypertension. Awareness and treatment rates are very low indicating the need for programs to improve awareness, and treatment of hypertension.

Pub.: 10 Jun '17, Pinned: 18 Sep '17

Hazardous alcohol consumption is not associated with CD4+ T-cell count decline among PLHIV in Kampala Uganda: A prospective cohort study.

Abstract: There is limited data on the effects of alcohol on immunological response among persons living with HIV (PLHIV) in sub-Saharan Africa. We assessed the relationship between hazardous alcohol use and CD4+ T-cell count, among PLHIV in Uganda.PLHIV aged ≥ 18 years were enrolled in a cohort study at the Infectious diseases clinic Kampala, Uganda. Alcohol consumption was assessed at enrolment (baseline) and 6 monthly thereafter using the alcohol use disorders identification test (AUDIT). The CD4+ T-cell counts, assessed at baseline and over the next 12 months were compared between alcohol use strata, using linear mixed effects regression. Using longitudinal mediation analysis methods, we estimated the effect of alcohol induced ART non-adherence on CD4+ T-cell count.Of the 1566 participants enrolled, 863(44.1%) were non-alcohol users (AUDIT score = 0), 433(27.7%) were non-hazardous (AUDIT score 1-7) alcohol users while 270 (17.2%) were hazardous (AUDIT score ≥ 8) alcohol users. The overall median (IQR) baseline CD4+ T-cell count was 356 (243-516) cells/μl. There were no differences in the median baseline CD4+ T-cell count between hazardous and non-hazardous alcohol users compared to non-alcohol users in both the non-ART (p = 0.43) and ART group (p = 0.77). The mean CD4+ T-cell count over 12 months was not different between hazardous alcohol users and non-alcohol users (non-ART group p = 0.88 and ART group p = 0.62), nor between non-hazardous alcohol users and non-alcohol users (and non-ART group p = 0.66 and ART group p = 0.20). Alcohol use was not associated with a significant natural direct effect on CD4+ T-cell count (1.37 95%CI [-1.78, 4.52] cells/μl, p = 0.39) but had a statistically significant natural indirect effect on reduction of CD4+ T-cell count (-0.91 cells/μl [-1.36, -0.45], p < 0.001) mediated through ART non-adherence.Hazardous alcohol use among PLHIV was not directly associated with lower CD4+ T-cell count but had a significant natural indirect effect on CD4+ T-cell count mediated through ART non-adherence. Among PLHIV with lower than expected CD4+ T-cell count, alcohol consumption should be excluded as an underlying factor for non-adherence to ART and any interventions targeting alcohol use should tackle possible ART non-adherence.

Pub.: 01 Jul '17, Pinned: 18 Sep '17

HIV/HBV co-infection is a significant risk factor for liver fibrosis in Tanzanian HIV-infected adults.

Abstract: In sub-Saharan Africa, the burden of liver disease associated with chronic hepatitis B (HBV) and HIV is unknown. We characterized liver disease using aspartate aminotransferase-to-platelet ratio index (APRI) and FIB-4 in patients with HIV, HBV, and HIV/HBV co-infection in Tanzania.Using a cross sectional design, we compared the prevalence of liver fibrosis in treatment-naive HIV mono-infected, HBV mono-infected, and HIV/HBV co-infected adults enrolled at Management and Development for Health (MDH)-supported HIV treatment clinics in Dar es Salaam, Tanzania. Risk factors associated with significant fibrosis (APRI>0.5 and FIB-4 >1.45) were examined.267 HIV-infected, 165 HBV-infected and 63 HIV/HBV co-infected patients were analyzed [44% male, median age 37 (IQR 14), BMI 23 (7)]. APRI and FIB-4 were strongly correlated (r = 0.78, p = < .001, R2 0.61). Overall median APRI scores were low [HIV/HBV [0.36 (IQR 0.4)], HIV [0.23 (0.17)], HBV [0.29 (0.15)] (p <0.01)]. In multivariate analyses, HIV/HBV co-infection was associated with APRI >0.5 [HIV/HBV vs. HIV: OR 3.78 (95% CI 1.91, 7.50)], [HIV/HBV vs. HBV: OR 2.61 (1.26, 5.44)]. HIV RNA per 1 log10 copies/ml increase [OR 1.53 (95% CI 1.04, 2.26)] and HBV DNA per 1 log10 copies/ml increase [OR 1.36 (1.15, 1.62)] were independently associated with APRI >0.5 in HIV-infected and HBV-infected patients, respectively.HIV/HBV co-infection is an important risk factor for significant fibrosis. Higher levels of circulating HIV and HBV virus may play a direct role in liver fibrogenesis. Prompt diagnosis and aggressive monitoring of liver disease in HIV/HBV co-infection is warranted.

Pub.: 27 Jun '17, Pinned: 18 Sep '17

Prevalence of metabolic syndrome, discrete or comorbid diabetes and hypertension in sub-Saharan Africa among people living with HIV versus HIV-negative populations: a systematic review and meta-analysis protocol.

Abstract: Metabolic disorder and high blood pressure are common complications globally, and specifically among people living with HIV (PLHIV). Diabetes, metabolic syndrome and hypertension are major risk factors for cardiovascular diseases and their related complications. However, the burden of metabolic syndrome, discrete or comorbid diabetes and hypertension in PLHIV compared with HIV-negative population has not been quantified. This review and meta-analysis aims to compare and analyse the prevalence of these trio conditions between HIV-negative and HIV-positive populations in sub-Saharan Africa (SSA).The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement guides the methods for this study. Eligibility criteria will be published original articles (English and French language) from SSA that present the prevalence of metabolic syndrome, discrete and/or comorbid diabetes, and hypertension comparisons between PLHIV and HIV-negative populations. The following databases will be searched from January 1990 to February 2017: PubMed/Medline, EBSCOhost, Web of Science, Google Scholar, Scopus, African Index Medicus and Cochrane Database of Systematic Reviews. Eligibility screening and data extraction will be conducted independently by two reviewers, and disagreements resolved by an independent reviewer. Methodological quality and risk of bias will be assessed for individual included studies, while meta-analysis will be used to estimate study outcomes prevalence according to subgroups. Sensitivity analysis will also be performed to further test the robustness of the findings.This proposed study does not require ethical approval. The results will be published as a scientific article in a peer-reviewed journal, and presented at conferences and to relevant health agencies.PROSPERO registration number (CRD42016045727).

Pub.: 12 Jul '17, Pinned: 18 Sep '17

The impact of antiretroviral therapy on symptom burden among HIV outpatients with low CD4 count in rural Uganda: nested longitudinal cohort study.

Abstract: Individuals with HIV have a high prevalence of physical and psychological symptoms throughout their disease course. Despite the clinical and public health implications of unresolved pain and symptoms, little is known about the effect of anti-retroviral therapy (ART) on these outcomes. This study aimed to assess the impact on symptom burden for the year after ART initiation in individuals with a CD4 count <200 cells/uL in Uganda.HIV-infected, ART-naıve adults referred from voluntary testing and counseling services in rural Uganda for enrollment into a randomized controlled trial to test fluconazole as primary prophylaxis against cryptococcal disease were invited to complete the Memorial Symptom Assessment Scale-Short Form (MSAS-SF) prior to commencing ART and at two subsequent follow up visits. This tool measures self-reported 7-day period prevalence and associated burden of physical and psychological symptoms. Changes in the total number of symptoms and distress indices with time on ART and trial arm were investigated through fitting Linear Mixed Models for repeated measures.During the first year of ART initiation the prevalence of most individual symptoms remained constant. The notable exceptions which improved after commencing ART are as follow; prevalence of pain (prevalence changed from 79% to 60%), weight loss (67% to 31%), lack of appetite (46% to 28%), feeling sad (52% to 25%) and difficulty sleeping (35% to 23%). The total number of symptoms and distress indices reduced after treatment commenced. Of concern was that half or more study participants remained with symptoms of pain (60%), itching (57%), skin changes (53%) and numbness in hands and feet (52%) after starting ART. Sixteen symptoms remained with a burden of 25% or more.Despite the beneficial effect of ART on reducing symptoms, some patients continue to experience a high symptom burden. It is essential that HIV services in sub-Saharan Africa integrate management of symptoms into their programmes.CRYPTOPRO [ISRCTN 76481529 ], November 2004.

Pub.: 15 Jul '17, Pinned: 18 Sep '17