Objective: To evaluate the performance of QuantiFERON-TB GOLD (QFTG) in a resource-poor setting a... more Objective: To evaluate the performance of QuantiFERON-TB GOLD (QFTG) in a resource-poor setting among patients with and without HIV infection. Design: Cross-sectional study. Setting: Two hospitals in Northern Tanzania. Subjects: Eighty three adult male and female inpatients. Intervention: All patients were screened for HIV infection and underwent tuberculin skin test (TST) and QFTG. Results: Eighty-three subjects were enrolled, and 29 (35%) of 83 were HIV-infected. QFTG yielded indeterminate results in 12 (22%; 95%CI 12%-34%) of 54 HIV-uninfected and 13 (45%; 95%CI 26%-64%) of 29 HIV-infected subjects (p=0.0323). Among those with smear-positive pulmonary tuberculosis, TST was positive in 40 (100%; 95%CI 91%-100%) of 40 HIV-uninfected subjects compared with seven (54%; 95%CI 25%-81%) of 13 HIV-infected subjects (p<0.0001), and QFTG was positive in 28(70%; 95%CI 53%-83%) of 40 HIV-uninfected subjects compared with three (23%; 95%CI 5%-54%) of 13 HIV-infected subjects (p=0.0029). Among medical inpatients at risk for latent tuberculosis infection, TST was positive in seven (50%) of 14 HIV-uninfected patients and three (19%) of 16 HIV-infected patients (p=0.0701) and QFTG was positive among two (14%) of 14 HIV-uninfected patients and three (19%) of 16 HIV-infected patients (p=0.7437). Conclusions: The presence of HIV co-infection was associated with a significant reduction in sensitivity of both the TST (p<0.0001) and QFTG (p=0.0029) for the diagnosis of active M.tuberculosis infection. The high proportion of indeterminate QFTG and lack of sensitivity, particularly among HIV-infected patients, may limit its applicability in settings like Tanzania. Larger studies in resource-poor settings are required.
Journal of the International Association of Physicians in AIDS Care (JIAPAC), 2007
Antiretroviral treatment literacy leads to greater HIV testing and treatment and antiretroviral t... more Antiretroviral treatment literacy leads to greater HIV testing and treatment and antiretroviral treatment adherence. Among northern Tanzanian subjects, antiretroviral treatment awareness was only 17%. Factors associated with low antiretroviral treatment literacy included having exchanged money or gifts for sex, living in rural areas, having more than 2 children, and having a primary education only. Previous HIV testing was protective against low antiretroviral treatment literacy. These results support refocusing HIV education efforts and increasing synergy between HIV prevention and treatment programs.
HIV/AIDS is one of the major public health problems affecting people worldwide. Counselling and t... more HIV/AIDS is one of the major public health problems affecting people worldwide. Counselling and testing is a process by which an individual undergoes confidential counselling to enable him/her to make an informed choice about his or her HIV status and to take appropriate actions. The objective of this study was to assess factors affecting HIV counselling and testing (HCT) among adults in Muheza district in northeastern Tanzania. A total of 394 adults were interviewed using a standardized questionnaire. The majority of the study participants were females (N=213; 54.1%). Most of the respondents were either in or have completed secondary education. Almost two thirds of the study population (262) was not married. Seventy one percent of all participants viewed HCT positively. A significant proportion of married (17.7%) and unmarried (16.5%) participants judged HCT as not essential as it would not change the test result. Sixty-eight percent of the respondents did not consider themselves at risk and most of them (71%) were married. Importantly, 26% reported being scared of discrimination. In conclusion our study results demonstrate that only half of the study population had adequate knowledge of HCT. Being married was considered as a 'protective' factor in terms HIV risk which indicates a misconception. These findings underscore the importance of proper HIV counselling and testing in this community so as to bridge the knowledge gap. It further demonstrates the need to address in detail misconceptions during HIV counselling and testing.
Background. Access to antiretroviral therapy is rapidly expanding in sub-Saharan Africa. Identify... more Background. Access to antiretroviral therapy is rapidly expanding in sub-Saharan Africa. Identifying the predictors of incomplete adherence, virologic failure, and antiviral drug resistance is essential to achieving long-term success. Methods. A total of 150 subjects who had received antiretroviral therapy for at least 6 months completed a structured questionnaire and adherence assessment, and plasma human immunodeficiency virus (HIV) RNA levels were measured. Virologic failure was defined as an HIV RNA level 1400 copies/mL; for patients with an HIV RNA level 11000 copies/mL, genotypic antiviral drug resistance testing was performed. Predictors were analyzed using bivariable and multivariable logistic regression models. Results. A total of 23 (16%) of 150 subjects reported incomplete adherence. Sacrificing health care for other necessities (adjusted odds ratio [AOR], 19.8;) and the proportion of months receiving self-funded treatment (AOR, 23.5;) P ! .01 P p .04 were associated with incomplete adherence. Virologic failure was identified in 48 (32%) of 150 subjects and was associated with incomplete adherence (AOR, 3.6;) and the proportion of months receiving self-funded antiretroviral therapy (AOR, 13.0; P p .03). Disclosure of HIV infection status to family members or others was protective against virologic failure (AOR, 0.10; P p .02). P p .04 Conclusions. Self-funded treatment was associated with incomplete adherence and virologic failure, and disclosure of HIV infection status was protective against virologic failure. Efforts to provide free antiretroviral therapy and to promote social coping may enhance adherence and reduce rates of virologic failure. Access to antiretroviral drugs for all HIV-infected persons in need is a global health priority; currently, 12 million individuals are receiving antiretroviral therapy (ART), and a rapid scaleup in the number of individuals receiving ART is in progress [1, 2]. ART regimens in resource-limited areas commonly contain the nonnucleoside reverse-transcriptase inhibitor (NNRTI) nevirapine, which is frequently coformulated in a fixed-dose, 3-drug combination with 2 nucleoside reverse-transcriptase inhibitors (NRTIs). Several reports document suppression of plasma HIV RNA levels to below detectable limits, increases in CD4 + cell counts, and improved clinical outcomes and survival
This chapter explores how adolescents diagnosed with Attention Deficit Hyperactivity Disorder (AD... more This chapter explores how adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) make sense of their condition, how they feel about their difficulties and how they perceive themselves and their reality within the South African context. This chapter is presented against the backdrop of more than thirty years of well-established research that has largely focused on assessment, diagnosis, management and treatment of the condition. The intention of this chapter is to examine how adolescents perceive ADHD as it relate to their lives. The accounts contained in the research provide insights into the lives and minds of young people who have been diagnosed as having ADHD. Qualitative approach was employed and data was collected via semi-structured interviews. The sample comprised five adolescents, all outpatients of Chris Hani Baragwanath's Child and Adolescent Psychiatric Unit. Through a process of thematic content analysis the data was analyzed and major themes were identified and interpreted. 2. Rationale Attention Deficit Hyperactivity Disorder is currently the most commonly diagnosed behavioral childhood disorder and the diagnosis is without doubt controversial. ADHD continues to receive ongoing attention from parents, members of education systems, health professionals and researchers. In the United States of America, between 30 percent and 40 percent of all children who are referred to child clinics and centers have been diagnosed
Fixed dose combination abacavir=lamivudine=zidovudine (ABC=3TC=ZDV) among HIV-1 and tuberculosis ... more Fixed dose combination abacavir=lamivudine=zidovudine (ABC=3TC=ZDV) among HIV-1 and tuberculosis (TB)-coinfected patients was evaluated and outcomes between early vs. delayed initiation were compared. In a randomized, pilot study conducted in the Kilimanjaro Region of Tanzania, HIV-infected inpatients with smearpositive TB and total lymphocyte count <1200=mm 3 were randomized to initiate ABC=3TC=ZDV either 2 (early) or 8 (delayed) weeks after commencing antituberculosis therapy and were followed for 104 weeks. Of 94 patients screened, 70 enrolled (41% female, median CD4 count 103 cells=mm 3), and 33 in each group completed 104 weeks. Two deaths and 12 serious adverse events (SAEs) were observed in the early arm vs. one death, one clinical failure, and seven SAEs in the delayed arm (p ¼ 0.6012 for time to first grade 3=4 event, SAE, or death). CD4 cell increases were þ331 and þ328 cells=mm 3 , respectively. TB-immune reconstitution inflammatory syndromes (TB-IRIS) were not observed in any subject. Using intent-to-treat (ITT), missing ¼ failure analyses, 74% (26=35) vs. 89% (31=35) randomized to early vs. delayed therapy had HIV RNA levels <400 copies=ml at 104 weeks (p ¼ 0.2182) and 66% (23=35) vs. 74% (26=35), respectively, had HIV RNA levels <50 copies=ml (p ¼ 0.6026). In an analysis in which switches from ABC=3TC=ZDV ¼ failure, those receiving early therapy were less likely to be suppressed to <400 copies=ml [60% (21=35) vs. 86% (30=35), p ¼ 0.030]. TB-IRIS was not observed among the 70 coinfected subjects beginning antiretroviral treatment. ABC=3TC=ZDV was well tolerated and resulted in steady immunologic improvement. Rates of virologic suppression were similar between early and delayed treatment strategies with triple nucleoside regimens when substitutions were allowed.
Background. Public health programs have focused on abstinence and faithfulness with a single part... more Background. Public health programs have focused on abstinence and faithfulness with a single partner as HIV protective behaviors. To examine the association between numbers of sexual partners and seropositivity, we studied clients presenting for HIV voluntary counseling and testing (VCT) at a community-based HIV/AIDS organization in Moshi, Tanzania. Methods. Clients presenting between November 2003 and December 2004 reported numbers of lifetime sexual partners. The association between HIV infection and numbers of sexual partners, trichotomized by lifetime abstinence (0 partners), faithfulness (1 partner), and multiple partners (>1 partner), was calculated by gender. Results: Of 1,974 clients studied, 1,070 (54%) were female and the median age was 30 (range 18-83) years. Of clients, 72 (3.6%) reported abstinence; 585 (29.6%), one partner, and 1,317 (66.7%), multiple partners. As the number of lifetime sexual partners increased from 0 to 1 to >1, among males the absolute risk of...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2008
Background-Trimethoprim-sulfamethoxazole (SXT) reduces morbidity and mortality among HIV-infected... more Background-Trimethoprim-sulfamethoxazole (SXT) reduces morbidity and mortality among HIV-infected persons in Africa, but its impact on antimicrobial resistance is of concern.
Clinical criteria are recommended to select HIV-infected patients for initiation of antiretrovira... more Clinical criteria are recommended to select HIV-infected patients for initiation of antiretroviral therapy when CD4 lymphocyte testing is unavailable. We evaluated the performance characteristics of WHO staging criteria, anthropometrics, and simple laboratory measurements for predicting CD4 lymphocyte count (CD4 count) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3) among HIV-infected patients in Tanzania. A total of 202 adults, diagnosed with HIV infection through community-based testing, underwent a detailed evaluation including staging history and examination, anthropometry, complete blood count, erythrocyte sedimentation rate (ESR), and CD4 count. Univariable analysis and recursive partitioning were used to identify characteristics associated with CD4 count 200 cells/mm(3). Of 202 participants 109 (54%) had a CD4 count &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3). Characteristics most strongly associated with CD4 count &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3) (p-value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) were the presence of mucocutaneous manifestations (72% vs. 28%), lower total lymphocyte count (TLC) (median 1,450 vs. 2,200 cells/mm(3)), lower total white blood cell count (median 4,200 vs. 5,500 cells/mm(3)), and higher ESR (median 95 vs. 53 mm/h). In a partition tree model, TLC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1,200 cells/mm(3), ESR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=120 mm/h, or the presence of mucocutaneous manifestations yielded a sensitivity of 0.85 and specificity of 0.63 for predicting CD4 count &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3). The sensitivity of the 2006 WHO Staging system improved from 0.75 to 0.93 with inclusion of these parameters, at the expense of specificity (0.36 to 0.26). The presence of mucocutaneous manifestations, TLC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1,200 cells/mm(3), or ESR…
Objective: To evaluate the performance of QuantiFERON-TB GOLD (QFTG) in a resource-poor setting a... more Objective: To evaluate the performance of QuantiFERON-TB GOLD (QFTG) in a resource-poor setting among patients with and without HIV infection. Design: Cross-sectional study. Setting: Two hospitals in Northern Tanzania. Subjects: Eighty three adult male and female inpatients. Intervention: All patients were screened for HIV infection and underwent tuberculin skin test (TST) and QFTG. Results: Eighty-three subjects were enrolled, and 29 (35%) of 83 were HIV-infected. QFTG yielded indeterminate results in 12 (22%; 95%CI 12%-34%) of 54 HIV-uninfected and 13 (45%; 95%CI 26%-64%) of 29 HIV-infected subjects (p=0.0323). Among those with smear-positive pulmonary tuberculosis, TST was positive in 40 (100%; 95%CI 91%-100%) of 40 HIV-uninfected subjects compared with seven (54%; 95%CI 25%-81%) of 13 HIV-infected subjects (p<0.0001), and QFTG was positive in 28(70%; 95%CI 53%-83%) of 40 HIV-uninfected subjects compared with three (23%; 95%CI 5%-54%) of 13 HIV-infected subjects (p=0.0029). Among medical inpatients at risk for latent tuberculosis infection, TST was positive in seven (50%) of 14 HIV-uninfected patients and three (19%) of 16 HIV-infected patients (p=0.0701) and QFTG was positive among two (14%) of 14 HIV-uninfected patients and three (19%) of 16 HIV-infected patients (p=0.7437). Conclusions: The presence of HIV co-infection was associated with a significant reduction in sensitivity of both the TST (p<0.0001) and QFTG (p=0.0029) for the diagnosis of active M.tuberculosis infection. The high proportion of indeterminate QFTG and lack of sensitivity, particularly among HIV-infected patients, may limit its applicability in settings like Tanzania. Larger studies in resource-poor settings are required.
Journal of the International Association of Physicians in AIDS Care (JIAPAC), 2007
Antiretroviral treatment literacy leads to greater HIV testing and treatment and antiretroviral t... more Antiretroviral treatment literacy leads to greater HIV testing and treatment and antiretroviral treatment adherence. Among northern Tanzanian subjects, antiretroviral treatment awareness was only 17%. Factors associated with low antiretroviral treatment literacy included having exchanged money or gifts for sex, living in rural areas, having more than 2 children, and having a primary education only. Previous HIV testing was protective against low antiretroviral treatment literacy. These results support refocusing HIV education efforts and increasing synergy between HIV prevention and treatment programs.
HIV/AIDS is one of the major public health problems affecting people worldwide. Counselling and t... more HIV/AIDS is one of the major public health problems affecting people worldwide. Counselling and testing is a process by which an individual undergoes confidential counselling to enable him/her to make an informed choice about his or her HIV status and to take appropriate actions. The objective of this study was to assess factors affecting HIV counselling and testing (HCT) among adults in Muheza district in northeastern Tanzania. A total of 394 adults were interviewed using a standardized questionnaire. The majority of the study participants were females (N=213; 54.1%). Most of the respondents were either in or have completed secondary education. Almost two thirds of the study population (262) was not married. Seventy one percent of all participants viewed HCT positively. A significant proportion of married (17.7%) and unmarried (16.5%) participants judged HCT as not essential as it would not change the test result. Sixty-eight percent of the respondents did not consider themselves at risk and most of them (71%) were married. Importantly, 26% reported being scared of discrimination. In conclusion our study results demonstrate that only half of the study population had adequate knowledge of HCT. Being married was considered as a 'protective' factor in terms HIV risk which indicates a misconception. These findings underscore the importance of proper HIV counselling and testing in this community so as to bridge the knowledge gap. It further demonstrates the need to address in detail misconceptions during HIV counselling and testing.
Background. Access to antiretroviral therapy is rapidly expanding in sub-Saharan Africa. Identify... more Background. Access to antiretroviral therapy is rapidly expanding in sub-Saharan Africa. Identifying the predictors of incomplete adherence, virologic failure, and antiviral drug resistance is essential to achieving long-term success. Methods. A total of 150 subjects who had received antiretroviral therapy for at least 6 months completed a structured questionnaire and adherence assessment, and plasma human immunodeficiency virus (HIV) RNA levels were measured. Virologic failure was defined as an HIV RNA level 1400 copies/mL; for patients with an HIV RNA level 11000 copies/mL, genotypic antiviral drug resistance testing was performed. Predictors were analyzed using bivariable and multivariable logistic regression models. Results. A total of 23 (16%) of 150 subjects reported incomplete adherence. Sacrificing health care for other necessities (adjusted odds ratio [AOR], 19.8;) and the proportion of months receiving self-funded treatment (AOR, 23.5;) P ! .01 P p .04 were associated with incomplete adherence. Virologic failure was identified in 48 (32%) of 150 subjects and was associated with incomplete adherence (AOR, 3.6;) and the proportion of months receiving self-funded antiretroviral therapy (AOR, 13.0; P p .03). Disclosure of HIV infection status to family members or others was protective against virologic failure (AOR, 0.10; P p .02). P p .04 Conclusions. Self-funded treatment was associated with incomplete adherence and virologic failure, and disclosure of HIV infection status was protective against virologic failure. Efforts to provide free antiretroviral therapy and to promote social coping may enhance adherence and reduce rates of virologic failure. Access to antiretroviral drugs for all HIV-infected persons in need is a global health priority; currently, 12 million individuals are receiving antiretroviral therapy (ART), and a rapid scaleup in the number of individuals receiving ART is in progress [1, 2]. ART regimens in resource-limited areas commonly contain the nonnucleoside reverse-transcriptase inhibitor (NNRTI) nevirapine, which is frequently coformulated in a fixed-dose, 3-drug combination with 2 nucleoside reverse-transcriptase inhibitors (NRTIs). Several reports document suppression of plasma HIV RNA levels to below detectable limits, increases in CD4 + cell counts, and improved clinical outcomes and survival
This chapter explores how adolescents diagnosed with Attention Deficit Hyperactivity Disorder (AD... more This chapter explores how adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) make sense of their condition, how they feel about their difficulties and how they perceive themselves and their reality within the South African context. This chapter is presented against the backdrop of more than thirty years of well-established research that has largely focused on assessment, diagnosis, management and treatment of the condition. The intention of this chapter is to examine how adolescents perceive ADHD as it relate to their lives. The accounts contained in the research provide insights into the lives and minds of young people who have been diagnosed as having ADHD. Qualitative approach was employed and data was collected via semi-structured interviews. The sample comprised five adolescents, all outpatients of Chris Hani Baragwanath's Child and Adolescent Psychiatric Unit. Through a process of thematic content analysis the data was analyzed and major themes were identified and interpreted. 2. Rationale Attention Deficit Hyperactivity Disorder is currently the most commonly diagnosed behavioral childhood disorder and the diagnosis is without doubt controversial. ADHD continues to receive ongoing attention from parents, members of education systems, health professionals and researchers. In the United States of America, between 30 percent and 40 percent of all children who are referred to child clinics and centers have been diagnosed
Fixed dose combination abacavir=lamivudine=zidovudine (ABC=3TC=ZDV) among HIV-1 and tuberculosis ... more Fixed dose combination abacavir=lamivudine=zidovudine (ABC=3TC=ZDV) among HIV-1 and tuberculosis (TB)-coinfected patients was evaluated and outcomes between early vs. delayed initiation were compared. In a randomized, pilot study conducted in the Kilimanjaro Region of Tanzania, HIV-infected inpatients with smearpositive TB and total lymphocyte count <1200=mm 3 were randomized to initiate ABC=3TC=ZDV either 2 (early) or 8 (delayed) weeks after commencing antituberculosis therapy and were followed for 104 weeks. Of 94 patients screened, 70 enrolled (41% female, median CD4 count 103 cells=mm 3), and 33 in each group completed 104 weeks. Two deaths and 12 serious adverse events (SAEs) were observed in the early arm vs. one death, one clinical failure, and seven SAEs in the delayed arm (p ¼ 0.6012 for time to first grade 3=4 event, SAE, or death). CD4 cell increases were þ331 and þ328 cells=mm 3 , respectively. TB-immune reconstitution inflammatory syndromes (TB-IRIS) were not observed in any subject. Using intent-to-treat (ITT), missing ¼ failure analyses, 74% (26=35) vs. 89% (31=35) randomized to early vs. delayed therapy had HIV RNA levels <400 copies=ml at 104 weeks (p ¼ 0.2182) and 66% (23=35) vs. 74% (26=35), respectively, had HIV RNA levels <50 copies=ml (p ¼ 0.6026). In an analysis in which switches from ABC=3TC=ZDV ¼ failure, those receiving early therapy were less likely to be suppressed to <400 copies=ml [60% (21=35) vs. 86% (30=35), p ¼ 0.030]. TB-IRIS was not observed among the 70 coinfected subjects beginning antiretroviral treatment. ABC=3TC=ZDV was well tolerated and resulted in steady immunologic improvement. Rates of virologic suppression were similar between early and delayed treatment strategies with triple nucleoside regimens when substitutions were allowed.
Background. Public health programs have focused on abstinence and faithfulness with a single part... more Background. Public health programs have focused on abstinence and faithfulness with a single partner as HIV protective behaviors. To examine the association between numbers of sexual partners and seropositivity, we studied clients presenting for HIV voluntary counseling and testing (VCT) at a community-based HIV/AIDS organization in Moshi, Tanzania. Methods. Clients presenting between November 2003 and December 2004 reported numbers of lifetime sexual partners. The association between HIV infection and numbers of sexual partners, trichotomized by lifetime abstinence (0 partners), faithfulness (1 partner), and multiple partners (>1 partner), was calculated by gender. Results: Of 1,974 clients studied, 1,070 (54%) were female and the median age was 30 (range 18-83) years. Of clients, 72 (3.6%) reported abstinence; 585 (29.6%), one partner, and 1,317 (66.7%), multiple partners. As the number of lifetime sexual partners increased from 0 to 1 to >1, among males the absolute risk of...
JAIDS Journal of Acquired Immune Deficiency Syndromes, 2008
Background-Trimethoprim-sulfamethoxazole (SXT) reduces morbidity and mortality among HIV-infected... more Background-Trimethoprim-sulfamethoxazole (SXT) reduces morbidity and mortality among HIV-infected persons in Africa, but its impact on antimicrobial resistance is of concern.
Clinical criteria are recommended to select HIV-infected patients for initiation of antiretrovira... more Clinical criteria are recommended to select HIV-infected patients for initiation of antiretroviral therapy when CD4 lymphocyte testing is unavailable. We evaluated the performance characteristics of WHO staging criteria, anthropometrics, and simple laboratory measurements for predicting CD4 lymphocyte count (CD4 count) &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3) among HIV-infected patients in Tanzania. A total of 202 adults, diagnosed with HIV infection through community-based testing, underwent a detailed evaluation including staging history and examination, anthropometry, complete blood count, erythrocyte sedimentation rate (ESR), and CD4 count. Univariable analysis and recursive partitioning were used to identify characteristics associated with CD4 count 200 cells/mm(3). Of 202 participants 109 (54%) had a CD4 count &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3). Characteristics most strongly associated with CD4 count &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3) (p-value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.0001) were the presence of mucocutaneous manifestations (72% vs. 28%), lower total lymphocyte count (TLC) (median 1,450 vs. 2,200 cells/mm(3)), lower total white blood cell count (median 4,200 vs. 5,500 cells/mm(3)), and higher ESR (median 95 vs. 53 mm/h). In a partition tree model, TLC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1,200 cells/mm(3), ESR &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;or=120 mm/h, or the presence of mucocutaneous manifestations yielded a sensitivity of 0.85 and specificity of 0.63 for predicting CD4 count &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;200 cells/mm(3). The sensitivity of the 2006 WHO Staging system improved from 0.75 to 0.93 with inclusion of these parameters, at the expense of specificity (0.36 to 0.26). The presence of mucocutaneous manifestations, TLC &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;1,200 cells/mm(3), or ESR…
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