Hepatitis C in Uganda: Identification of infected blood donors for micro-elimination

Nankya-Mutyoba, Joan; Apica, Betty; Otekat, Grace; Kyeyune, Dorothy; Nakyagaba, Lourita; Nabunje, Joletta; Nakafeero, Mary; Seremba, Emmanuel; Ocama, Ponsiano

doi:10.1016/j.jve.2021.100041

Cited by 5 publications

(7 citation statements)

References 20 publications

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“…Our study tested for HBsAg, but not hepatitis C virus (HCV), based on our prior finding of zero prevalence in 81 PWH starting ART in Uganda, but 4% (3/76) prevalence of HBsAg. Although low HCV prevalence was confirmed in one study [29], others have found higher prevalence [30,31], thus we may have failed to identify this possible source of ALT or AST elevations.…”

Section: Discussionmentioning

confidence: 74%

Safety and tolerability of isoniazid preventive therapy for tuberculosis for persons with HIV with and without alcohol use: a single arm trial

Hahn,

Ngabirano,

Fatch

et al. 2023

Aids

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Objective: Isoniazid (INH) preventive therapy is recommended to prevent tuberculosis (TB) disease for persons with HIV (PWH), except for those with regular and heavy alcohol consumption, due to hepatotoxicity concerns. We aimed to quantify the incidence of severe INH-related toxicity among PWH with and without recent alcohol consumption. Design: A prospective study of PWH receiving INH. Methods: We included PWH in southwest Uganda with recent (prior 3 months) (n = 200) or no (prior year) self-reported alcohol consumption (n = 101), on antiretroviral therapy, TB infected (≥5 mm on tuberculin skin test), and alanine aminotransferase (ALT) and aspartate aminotransferase (AST) 2× or less the upper limit of normal (ULN). Grade 3+ INH-related toxicity was ALT or AST at least 5× the ULN or severe symptoms; we stopped IPT upon detection. Grade 2 INH-related toxicity was ALT or AST 2–5× the ULN or moderate symptoms. Results: The cumulative incidence of Grade 3+ INH-related toxicity was 8.3% [95% confidence interval (95% CI) 5.4–12.0]; all resolved after INH cessation. Incidence was 6.0% (95% CI 3.1–10.2) among those reporting recent alcohol use and 12.9% (95% CI 7.0–21.0) among those reporting no prior year alcohol use. We found no differences by baseline phosphatidylethanol-confirmed alcohol severity. The cumulative incidence of Grade 2 toxicities (without Grade 3+) was 21.7% (95% CI 17.0–27.1); 25.0% (95% CI 19.0–31.8) among those with recent alcohol use and 14.8% (95% CI 8.1–23.9) among those with no prior year alcohol use. Conclusion: Alcohol use does not appear to increase risk for serious INH-related toxicity among PWH without significant liver enzyme elevations at baseline (≤2x ULN).

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Section: Discussionmentioning

confidence: 74%

Safety and tolerability of isoniazid preventive therapy for tuberculosis for persons with HIV with and without alcohol use: a single arm trial

Hahn,

Ngabirano,

Fatch

et al. 2023

Aids

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“…3 Based on other studies, the prevalence of HbsAg positivity amongst pregnant women in Northern Uganda is close to 10%, 35 with active Hepatitis C infection present in 2%–8% of the population. 36,37 Of note, the Niamey Protocol helps to distinguish patterns of liver morbidity due to schistosomiasis from other etiologies, ameliorating this concern somewhat. Further, relatively few children had abnormal ultrasound findings, limiting the power of the study to detect associations, as evidenced by the wide confidence intervals.…”

Section: Discussionmentioning

confidence: 99%

Baseline Liver Ultrasound Findings in Preschool Children From the Praziquantel in Preschoolers Trial in Lake Albert, Uganda

Pach,

Webb,

Edielu

et al. 2023

Pediatric Infectious Disease Journal

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Background: Periportal fibrosis is a late-stage manifestation of chronic infection with Schistosoma mansoni. Praziquantel (PZQ), the only drug available for the treatment of schistosomiasis, has limited effect in treating established morbidity. Preschool-aged children (PSAC) are not considered to be an at-risk population for severe morbidity. However, the prevalence of periportal fibrosis in PSAC in S. mansoni endemic settings is unknown. Methods: As part of a phase II clinical trial comparing different dosing regimens of PZQ in children age 12–47 months infected with S. mansoni in Uganda (“praziquantel in preschoolers” trial), we present baseline results assessing liver ultrasound (US) findings as per the WHO Niamey Protocol. Results: A total of 7/347 (2%) PSAC had Image Pattern C with pipe stems and echogenic rings suggestive of periportal fibrosis, 29/347 (8%) had Image Pattern B and 58 (17%) had evidence of periportal thickening There were higher adjusted odds of periportal thickening with older age [odds ratio (OR): 1.04; 95% confidence interval (CI): 1.00–1.07], primary maternal education (OR: 1.04; 95% CI: 1.00–1.07) and being taken to the lake weekly (OR: 3.02; 95% CI: 1.19–7.63). A further 44/347 children (13%) had a rounded caudal liver edge which was associated with high S. mansoni infection intensity (adjusted OR: 3.31; 95% CI: 1.46–7.51). Conclusions: Incipient schistosomiasis-related liver morbidity was detected in young children enrolled in the praziquantel in preschoolers trial. Adequate age-adjusted reference measurements for liver ultrasound findings in very small children are lacking but urgently needed. Schistosomiasis-related fibrosis may be delayed or averted with early and repeated PZQ treatment.

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“…Uganda like any other sub-Saharan African country has a functional infrastructure and service delivery system for HIV care except for HBV [ 16 ]. As of now, both HIV and HBV patients are managed in separate clinics with separate staff teams even though they all receive antiretroviral treatment.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators of integrated hepatitis B, C, and HIV screening among pregnant mothers and their newborns attending maternal and newborn clinics in Koboko District, Uganda: A qualitative inquiry of providers’ perspective

Alege,

Oyore,

Nanyonga

et al. 2023

Preprint

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Background HIV and HBV remain significant public health challenges characterized by high prevalence, morbidity, and mortality, especially among women of reproductive age in Uganda. However, both HIV and HBV patients are managed in separate clinics with separate staff even though they all receive ART. Patients with HBV do not receive routine counselling and education, and there are limited resources for laboratory investigation coupled with a high loss to follow-up. This study set out to “assess barriers and facilitators of integrated viral hepatitis B C and HIV care model to optimize screening uptake among mothers and newborns at health facilities in Koboko District, west Nile sub-region, Uganda”. Methods A cross-sectional grounded theory qualitative approach was employed in an institutional setting (HC IIIs). Data was audio recorded using a recording device during the key informant interviews and was transcribed after all interviews were conducted. Data was then analyzed using framework analysis. Results The following facilitated integration: High prevalence, and therefore burden of hepatitis B infection in West Nile region, team spirit by the health workers, reduced long waiting time, availability of medical products such as HBV and HCV test kits, integration of HBV and HIV into HMIS2 form and availability of support from implementing partners such as Infectious Dease Institute which offered mentorship and training on integration and support supervision. Conclusion Barriers to integration included; knowledge gap among health care workers, lack of transport for patients, language barriers during health education, inadequate human resources for health, stock-out of testing kits for HBV and HCV, lack of HMIS 2 column to capture HCV data, lack of funds to facilitate follow up of patients after referral for further investigation upon suspected cases of HBV and HCV. The study participants recommended; Promoting the integration of HBV, HCV, and HIV into routine health services; ensuring a constant supply of HBV, and HCV test kits to avoid stock-out; Engaging VHTs/Community health volunteers to support follow-up of patients and conducting health care workers performance reviews; addressing the issue of inadequate human resource; and finally dealing with misconceptions at community level about HBV and HCV diseases which hinder access to services.

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Hepatitis C in Uganda: Identification of infected blood donors for micro-elimination

Cited by 5 publications

References 20 publications

Safety and tolerability of isoniazid preventive therapy for tuberculosis for persons with HIV with and without alcohol use: a single arm trial

Safety and tolerability of isoniazid preventive therapy for tuberculosis for persons with HIV with and without alcohol use: a single arm trial

Baseline Liver Ultrasound Findings in Preschool Children From the Praziquantel in Preschoolers Trial in Lake Albert, Uganda

Barriers and facilitators of integrated hepatitis B, C, and HIV screening among pregnant mothers and their newborns attending maternal and newborn clinics in Koboko District, Uganda: A qualitative inquiry of providers’ perspective

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