Mwebesa Bwana | Mbarara University of Science and Technology (MUST) (original) (raw)

Papers by Mwebesa Bwana

Research paper thumbnail of Failure to Initiate Antiretroviral Therapy, Loss to Follow-up and Mortality Among HIV-Infected Patients During the Pre-ART Period in Uganda

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Delays and failures in initiation of antiretroviral therapy (ART) among treatment eligible patien... more Delays and failures in initiation of antiretroviral therapy (ART) among treatment eligible patients may compromise the effectiveness of HIV care in Africa. An accurate understanding, however, of the pace and completeness of ART initiation and mortality during the waiting period is obscured by frequent losses to follow-up. We evaluated newly ART-eligible HIV-infected adults from 2007 to 2011 in a prototypical clinic in Mbarara, Uganda. A random sample of patients lost to follow-up was tracked in the community to determine vital status and ART initiation after leaving the original clinic. Outcomes among the tracked patients were incorporated using probability weights, and a competing risks approach was used in analyses. Among 2633 ART-eligible patients, 490 were lost to follow-up, of whom a random sample of 132 was tracked and 111 (84.0%) had outcomes ascertained. After incorporating the outcomes among the lost, the cumulative incidence of ART initiation at 30, 90, and 365 days after eligibility was 16.0% [95% confidence interval (CI): 14.2 to 17.7], 64.5% (95% CI: 60.9 to 68.1), and 81.7% (95% CI: 77.7 to 85.6). Death before ART was 7.7% at 1 year. Male sex, higher CD4 count, and no education were associated with delayed ART initiation. Lower CD4 level, malnourishment, and travel time to clinic were associated with mortality. Using a sampling-based approach to account for losses to follow-up revealed that both the speed and the completeness of ART initiation were suboptimal in a prototypical large clinic in Uganda. Improving the kinetics of ART initiation in Africa is needed to make ART more in real-world populations.

Research paper thumbnail of Diagnosing Kaposi’s Sarcoma (KS) in East Africa: how accurate are clinicians and pathologists?

Research paper thumbnail of Task Shifting and Skin Punch for the Histologic Diagnosis of Kaposi's Sarcoma in Sub-Saharan Africa: A Public Health Solution to a Public Health Problem

Research paper thumbnail of Estimation of mortality among HIV-infected people on antiretroviral treatment in east Africa: a sampling based approach in an observational, multisite, cohort study

The Lancet HIV, 2015

Background Mortality in HIV-infected people after initiation of antiretroviral treatment (ART) in... more Background Mortality in HIV-infected people after initiation of antiretroviral treatment (ART) in resource-limited settings is an important measure of the eff ectiveness and comparative eff ectiveness of the global public health response. Substantial loss to follow-up precludes accurate accounting of deaths and limits our understanding of eff ectiveness. We aimed to provide a better understanding of mortality at scale and, by extension, the eff ectiveness and comparative eff ectiveness of public health ART treatment in east Africa.

Research paper thumbnail of Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy

PLoS Neglected Tropical Diseases, 2014

Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infe... more Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (''deworming'') in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naïve individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.

Research paper thumbnail of How to Take HIV Antiretroviral Medications on Time without a Watch in Rural Uganda

Research paper thumbnail of Sampling-Based Approach to Determining Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Scale-Up Programs in Africa

Research paper thumbnail of Understanding Reasons for and Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Programs in Africa Through a Sampling-Based Approach

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010

Objectives-Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Afr... more Objectives-Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up.

Research paper thumbnail of Creation and evaluation of EMR-based paper clinical summaries to support HIV-care in Uganda, Africa

International Journal of Medical Informatics, 2010

Purpose-Getting the right information to providers can improve quality of care. We set out to pro... more Purpose-Getting the right information to providers can improve quality of care. We set out to provide patient-specific Electronic Medical Record (EMR)-based clinical summaries for providers taking care of HIV-positive adult patients in the resource-limited setting of Mbarara, Uganda.

Research paper thumbnail of Biomarker Testing to Estimate Under-Reported Heavy Alcohol Consumption by Persons with HIV Initiating ART in Uganda

AIDS and Behavior, 2010

Alcohol affects the transmission and treatment of HIV, yet may be under-reported in resource-limi... more Alcohol affects the transmission and treatment of HIV, yet may be under-reported in resource-limited settings. We compared self-reported alcohol consumption with levels of plasma carbohydrate-deficient transferrin (%CDT), a biomarker of heavy alcohol consumption, in persons initiating antiretroviral therapy in Uganda. Almost seven percent (6.7%) of persons reporting abstaining and 10% reporting consuming 1-40 drinks in the prior month tested positive for %CDT, and actual under-report may be higher due to low sensitivity of %CDT. These results suggest likely under-report in those reporting abstaining and current drinking. Improved identification of heavy alcohol consumption is needed for research and clinical purposes.

Research paper thumbnail of Diminishing Availability of Publicly Funded Slots for Antiretroviral Initiation among HIV-Infected ART-Eligible Patients in Uganda

Background: The impact of flat-line funding in the global scale up of antiretroviral therapy (ART... more Background: The impact of flat-line funding in the global scale up of antiretroviral therapy (ART) for HIV-infected patients in Africa has not yet been well described.

Research paper thumbnail of Estimation of Mortality among HIV-infected people on antiretroviral therapy treatment in east Africa: a sampling based approach in an observational, multisite, cohort study

The lancet HIV, 2015

Mortality after initiation of antiretroviral treatment (ART) among HIV-infected patients in resou... more Mortality after initiation of antiretroviral treatment (ART) among HIV-infected patients in resource limited settings is a critical measure of the effectiveness and comparative effectiveness of the global public health response. Unknown outcomes due to high loss to follow-up (LTFU) preclude accurate accounting of deaths and limit our understanding of effectiveness. We evaluated in HIV-infected adults on ART in 14 clinics in five settings in Kenya, Uganda and Tanzania using a sampling-based approach in which we intensively traced a random sample of lost patients (> 90 days late for last scheduled visit) and incorporated their vital status outcomes into analyses of the entire clinic population through probability-weighted survival analyses. We followed 34,277 adults on ART from Mbarara and Kampala, Uganda; Eldoret and Kisumu, Kenya; and Morogoro, Tanzania. The median age was 35 years, 34% were men, and median pre-therapy CD4 count was 154 cells/μl. Overall 5,780 (17%) were LTFU, 99...

Research paper thumbnail of Failure to Initiate Antiretroviral Therapy, Loss to Follow-up and Mortality Among HIV-Infected Patients During the Pre-ART Period in Uganda

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2013

Delays and failures in initiation of antiretroviral therapy (ART) among treatment eligible patien... more Delays and failures in initiation of antiretroviral therapy (ART) among treatment eligible patients may compromise the effectiveness of HIV care in Africa. An accurate understanding, however, of the pace and completeness of ART initiation and mortality during the waiting period is obscured by frequent losses to follow-up. We evaluated newly ART-eligible HIV-infected adults from 2007 to 2011 in a prototypical clinic in Mbarara, Uganda. A random sample of patients lost to follow-up was tracked in the community to determine vital status and ART initiation after leaving the original clinic. Outcomes among the tracked patients were incorporated using probability weights, and a competing risks approach was used in analyses. Among 2633 ART-eligible patients, 490 were lost to follow-up, of whom a random sample of 132 was tracked and 111 (84.0%) had outcomes ascertained. After incorporating the outcomes among the lost, the cumulative incidence of ART initiation at 30, 90, and 365 days after eligibility was 16.0% [95% confidence interval (CI): 14.2 to 17.7], 64.5% (95% CI: 60.9 to 68.1), and 81.7% (95% CI: 77.7 to 85.6). Death before ART was 7.7% at 1 year. Male sex, higher CD4 count, and no education were associated with delayed ART initiation. Lower CD4 level, malnourishment, and travel time to clinic were associated with mortality. Using a sampling-based approach to account for losses to follow-up revealed that both the speed and the completeness of ART initiation were suboptimal in a prototypical large clinic in Uganda. Improving the kinetics of ART initiation in Africa is needed to make ART more in real-world populations.

Research paper thumbnail of Diagnosing Kaposi’s Sarcoma (KS) in East Africa: how accurate are clinicians and pathologists?

Research paper thumbnail of Task Shifting and Skin Punch for the Histologic Diagnosis of Kaposi's Sarcoma in Sub-Saharan Africa: A Public Health Solution to a Public Health Problem

Research paper thumbnail of Estimation of mortality among HIV-infected people on antiretroviral treatment in east Africa: a sampling based approach in an observational, multisite, cohort study

The Lancet HIV, 2015

Background Mortality in HIV-infected people after initiation of antiretroviral treatment (ART) in... more Background Mortality in HIV-infected people after initiation of antiretroviral treatment (ART) in resource-limited settings is an important measure of the eff ectiveness and comparative eff ectiveness of the global public health response. Substantial loss to follow-up precludes accurate accounting of deaths and limits our understanding of eff ectiveness. We aimed to provide a better understanding of mortality at scale and, by extension, the eff ectiveness and comparative eff ectiveness of public health ART treatment in east Africa.

Research paper thumbnail of Empiric Deworming and CD4 Count Recovery in HIV-Infected Ugandans Initiating Antiretroviral Therapy

PLoS Neglected Tropical Diseases, 2014

Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infe... more Background: There is conflicting evidence on the immunologic benefit of treating helminth co-infections (''deworming'') in HIV-infected individuals. Several studies have documented reduced viral load and increased CD4 count in antiretroviral therapy (ART) naïve individuals after deworming. However, there are a lack of data on the effect of deworming therapy on CD4 count recovery among HIV-infected persons taking ART.

Research paper thumbnail of How to Take HIV Antiretroviral Medications on Time without a Watch in Rural Uganda

Research paper thumbnail of Sampling-Based Approach to Determining Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Scale-Up Programs in Africa

Research paper thumbnail of Understanding Reasons for and Outcomes of Patients Lost to Follow-Up in Antiretroviral Therapy Programs in Africa Through a Sampling-Based Approach

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2010

Objectives-Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Afr... more Objectives-Losses to follow-up after initiation of antiretroviral therapy (ART) are common in Africa and are a considerable obstacle to understanding the effectiveness of nascent treatment programs. We sought to characterize, through a sampling-based approach, reasons for and outcomes of patients who become lost to follow-up.

Research paper thumbnail of Creation and evaluation of EMR-based paper clinical summaries to support HIV-care in Uganda, Africa

International Journal of Medical Informatics, 2010

Purpose-Getting the right information to providers can improve quality of care. We set out to pro... more Purpose-Getting the right information to providers can improve quality of care. We set out to provide patient-specific Electronic Medical Record (EMR)-based clinical summaries for providers taking care of HIV-positive adult patients in the resource-limited setting of Mbarara, Uganda.

Research paper thumbnail of Biomarker Testing to Estimate Under-Reported Heavy Alcohol Consumption by Persons with HIV Initiating ART in Uganda

AIDS and Behavior, 2010

Alcohol affects the transmission and treatment of HIV, yet may be under-reported in resource-limi... more Alcohol affects the transmission and treatment of HIV, yet may be under-reported in resource-limited settings. We compared self-reported alcohol consumption with levels of plasma carbohydrate-deficient transferrin (%CDT), a biomarker of heavy alcohol consumption, in persons initiating antiretroviral therapy in Uganda. Almost seven percent (6.7%) of persons reporting abstaining and 10% reporting consuming 1-40 drinks in the prior month tested positive for %CDT, and actual under-report may be higher due to low sensitivity of %CDT. These results suggest likely under-report in those reporting abstaining and current drinking. Improved identification of heavy alcohol consumption is needed for research and clinical purposes.

Research paper thumbnail of Diminishing Availability of Publicly Funded Slots for Antiretroviral Initiation among HIV-Infected ART-Eligible Patients in Uganda

Background: The impact of flat-line funding in the global scale up of antiretroviral therapy (ART... more Background: The impact of flat-line funding in the global scale up of antiretroviral therapy (ART) for HIV-infected patients in Africa has not yet been well described.

Research paper thumbnail of Estimation of Mortality among HIV-infected people on antiretroviral therapy treatment in east Africa: a sampling based approach in an observational, multisite, cohort study

The lancet HIV, 2015

Mortality after initiation of antiretroviral treatment (ART) among HIV-infected patients in resou... more Mortality after initiation of antiretroviral treatment (ART) among HIV-infected patients in resource limited settings is a critical measure of the effectiveness and comparative effectiveness of the global public health response. Unknown outcomes due to high loss to follow-up (LTFU) preclude accurate accounting of deaths and limit our understanding of effectiveness. We evaluated in HIV-infected adults on ART in 14 clinics in five settings in Kenya, Uganda and Tanzania using a sampling-based approach in which we intensively traced a random sample of lost patients (> 90 days late for last scheduled visit) and incorporated their vital status outcomes into analyses of the entire clinic population through probability-weighted survival analyses. We followed 34,277 adults on ART from Mbarara and Kampala, Uganda; Eldoret and Kisumu, Kenya; and Morogoro, Tanzania. The median age was 35 years, 34% were men, and median pre-therapy CD4 count was 154 cells/μl. Overall 5,780 (17%) were LTFU, 99...