Factors affecting virological non-suppression amongst HIV-positive patients on antiretroviral therapy: Uganda, August 2014 - July 2015

Introduction: virological suppression is a critical indicator for HIV treatment success and reduction in HIV transmission risk. However, despite the increasing number of people on antiretroviral therapy (ART), there is limited information about non-suppression and its determinants among HIV-positive (HIV+) individuals enrolled in care in many resource-limited settings. This study estimated the virological non-suppression rates amongst HIV+ patients who had been on ART for at least 6 months and the factors associated with non-suppression. Methods: a descriptive cross-sectional study was conducted using routinely collected data from viral load testing samples from 100,678 HIV+ patients enrolled in HIV care across the country between August 2014 and July 2015. Viral load testing was conducted at the Central Public Health Laboratories in Kampala, Uganda. We extracted data on socio-demographic, clinical and viral load testing results. We defined virological non-suppression as having ≥ 1000 copies of viral RNA/ml of blood for plasma or ≥ 5000 copies of viral RNA/ml of blood for dry blood spots. We used logistic regression to identify factors associated with virological non-suppression. Results: majority of the patients (68%) were females. The overall non-suppression rate was 11%. Second-time testers had a higher non-suppression rate than first-time testers (50% vs. 10%, OR = 7.0, 95%CI = 6.2-7.9); and children aged < 5 years (29%, OR = 5.3, 95%CI = 4.8-6.0) and adolescents aged 15-19 (27%, OR = 4.1, 95%CI = 3.7-4.5) had higher non-suppression rates than persons of other age groups. Non-suppression rates were also higher among suspected treatment failures (29%, OR = 4.0, 95%CI = 3.7-4.4), patients with reported adherence levels < 85% (35%, OR = 3.4, 95%CI = 3.0-3.9), and patients with active TB (20%, OR = 2.0, 95%CI = 1.5-2.3) than those without these conditions. Breastfeeding (6%, OR = 0.61, 95%CI = 0.54-0.69) and pregnant women (8%, OR = 0.77, 95%CI = 0.65-0.91) had lower non-suppression rates than non-breastfeeding and non-pregnant women (10%). Conclusion: virological non-suppression was associated with second time testers, young age, poor adherence, and TB co-infection. To maximize the benefits of the expanded ART, we recommend close follow-up and intensified targeted adherence support for second time testers, children and adolescents. Adherence to standard guidelines for managing TB/HIV co-infections should be emphasized by all ART clinics

Risk factors for Podoconiosis: Kamwenge District, Western Uganda, 2015

Introduction: Podoconiosis, a form of non-infectious elephantiasis, is a disabling Neglected Tropical Disease. In August 2015, a non-government organization reported an increase in elephantiasis cases in Kamwenge District. We conducted an investigation to confirm the diagnosis, identify causes and risk factors, and guide control efforts. Methods: we defined a suspect case-person as a Kamwenge resident with bilateral asymmetrical swelling of lower limbs lasting ≥ 1month, plus ≥ 1 of the following: skin itching; burning sensation; plantar oedema; lymph-ooze; prominent skin markings; rigid toes; mossy papillomata. A probable case was a suspect case with negative microfilaria antigen immunological-card test results. We conducted active case-finding in affected communities. In a case-control study we compared shoe-use and feet-washing practices before disease onset among 40 probable case-persons and 75 asymptomatic village control-persons, matched by age (± 5y) and sex. We collected soil samples to characterize soil-irritant composition. Results: our active case-finding identified 52 suspect cases in two affected sub-counties during 1980-2015 (incidence = 2.9/100,000/year), including 40 probable cases (mean age = 47y; range: 13-80y). The annual case counts did not increase significantly over time. All case-persons had negative immunological-card test. In the case-control study, 93% (37/40) of probable case-persons and 31% (23/75) of controls-persons never wore shoes at work (ORM-H = 6.7; 95%CI = 1.7-26); 80% (32/40) of probable case-persons and 55% (39/75) of control-persons never wore shoes at home (ORM-H = 4.4, 95%CI = 1.5-13); 70% (27/39) of probable case-persons and 47% (34/72) of control-persons washed feet at day-end rather than immediately after work (OR = 11, 95%CI = 2.1-57). Soils samples were characterized as being rich black-red volcanic clay. Conclusion: the reported elephantiasis was podoconiosis, which was associated with prolonged foot exposure to volcanic soil. We recommended health education on foot protection and washing, and universal use of protective shoes