Browsing by Author "Gunda, Daniel W."
Now showing 1 - 9 of 9
Results Per Page
Sort Options
Item Accuracy of WHO immunological criteria in identifying virological failure among HIV-infected adults on first line antiretroviral therapy in Mwanza, North-western Tanzania(BioMed Central, 2017) Gunda, Daniel W.; Kidenya, Benson R.; Mshana, Stephen E.; Kilonzo, Semvua B.; Mpondo, Bonaventura C. T.Optimal HIV treatment monitoring remains a big challenge in resource limited settings. Guidelines recommend the use of clinical and immunological criteria in resource limited settings due to unavailability of viral load monitoring; however their utility is questionable. This study aimed at assessing the accuracy of immunological criteria in detecting treatment failure among HIV infected Tanzanian adults receiving first line ART. A clinic based cross sectional study was conducted between February and July 2011 at Bugando Medical centre (BMC) HIV care and treatment clinic (CTC) involving HIV infected patients aged 18 years and above, receiving first line ART; followed up for at least 1 year. Viral load was tested for every enrolled patient. Standard WHO criteria were used to define immunological failure. Virological failure was defined as one viral load measurement of >5000 copies/ml and was used as a gold standard. A 2 × 2 table was used to assess the accuracy of immunological criteria in detecting treatment failure. A total of 274 HIV-infected adults were enrolled into the study. Out of these, 65.7% were females, the median age was 39 years (IQR 33–45), the median BMI 21.9 kg/m2 (IQR 19.7–24.0). Out of the 274 study participants 156 (56.9%) had immunological failure. Only 60 of the study participants (21.9%) had viral load >5000. Only 42 patients (70%) were found to have both immunological failure and virological failure. The sensitivity of immunological criteria in detecting treatment failure was 70%, specificity 46.7%, positive predictive and negative predictive values of 26.9 and 84.7% respectively. WHO immunological criteria have low sensitivity and positive predictive value for detecting treatment failure. Relying on CD4 counts for treatment monitoring would therefore lead to misclassifications of treatment failure that could result into unnecessary or delayed switch to second line ART. Access to viral load monitoring is important to avoid these misclassifications.Item Client satisfaction with family planning services in the area of high unmet need:evidence from Tanzania service provision assessment survey, 2014-2015(BMC, 2018) Bintabara, Deogratius; Ntwenya, Julius; Maro, Isaac I.; Kibusi, Stephen; Gunda, Daniel W.; Mpondo, Bonaventura C. T.Client satisfaction has been found to be an important factor for the uptake and continuation of family planning services. This study aimed to examine the current status of and factors associated with clients satisfaction with family planning services in Tanzania, which has a high unmet need for family planning. Methods: The study used data from the Tanzania Service Provision Assessment survey of 2014–2015. A facility was classified as having high service readiness for FP if it scored at least 67.7% on a composite score based on three domains (staff training and guidelines, basic diagnostic equipment, and basic medicines), following criteria developed by the World Health Organization. The exit interview questionnaire was used to collect information from women about their level of satisfaction, whether very satisfied more or less satisfied, or not satisfied with the services received. The response was dichotomized into Yes if the woman reported being very satisfied with services received otherwise coded as No. Unadjusted and adjusted logistic regression models were used to assess the association between the client satisfaction and covariate variables; service readiness, facility type, managing authority, location, management meetings, supervision, providers sex, and working experience, clients age and education. All analyses were weighted to correct for non-response, disproportionate and complex sampling by using the SVY command in Stata 14. Out of the 1188 facilities included in the survey, 427 (35.9%) provided family planning services. A total of 1746 women participated in observations and exit interviews. Few (22%) facilities had a high readiness to provide family planning services. While most facilities had the recommended equipment available, only 42% stocked contraceptives (e.g. oral pills, injectable contraceptives and/or condoms). Further, trained staff and clinical guidelines were present in only 30% of services. Nevertheless, the majority (91%) of clients reported that they were satisfied with services. In the multivariate analysis, a high service readiness score [AOR=2.5, 95% CI; 1.1–6.0], receiving services from private facilities [AOR=2.3, 95% CI; 1.1–5.0], and being in the age group 20 to 29 years [AOR=0.3, 95% CI; 0.1–0.7] were all significantly associated with clients’ satisfaction with family planning services.Item Cytopenias among ART-naive patients with advanced HIV disease on enrolment to care and treatment services at a tertiary hospital in Tanzania: a cross-sectional study(Montfort Press, 2017) Gunda, Daniel W.; Godfrey, Kahamba G.; Kilonzo, Semvua B.; Mpondo, Bonaventura C.HIV/AIDS causes high morbidity and mortality through both immunosuppression and complications not directly related to immunosuppression. Haematological abnormalities, including various cytopenias, occur commonly in HIV through immune and non-immune pathways. Though these complications could potentially cause serious clinical implications, published literature on the magnitude of this problem and its associated factors in Tanzania is scarce. This study aimed at determining the prevalence and risk factors of HIV-associated cytopenias among ART-naive patients enrolling for care and treatment services at Bugando Care and Treatment Centre (CTC) in Mwanza, Tanzania. This was a cross-sectional clinic-based study done between March 2015 and February 2016, involving all antiretroviral therapy (ART)-naive adult HIV positive patients enrolling for care and treatment services at Bugando CTC. Patients younger than 18 years and those with missing data were excluded. Data were analysed using Stata version 11 to determine the prevalence and risk factors of cytopenias. A total of 1205 ART-naive patients were included. Median age was 41 years (interquartile range [IQR] 32 to 48). Most participants were female (n = 789; 65.6%), with a female-to-male ratio of 2:1. The median baseline CD4 count was 200 cells/μL (IQR 113 to 439). About half (49%) of the study participants had baseline CD4 counts less than 200 cells/μL. Anaemia, leucopenia, and thrombocytopenia were found in 704 (58.4%), 285 (23.6%), and 174 (14.4%) participants, respectively, and these were strongly associated with advanced HIV infection. The magnitude of cytopenias is high among ART-naive HIV-positive adults, and cytopenias are more marked with advanced HIV infection. Early diagnosis of HIV and timely initiation of ART could potentially reduce the number of people living with advanced HIV disease and its associated complications, including the cytopenias investigated in this study. Patients with cytopenias should undergo thorough screening for tuberculosis, which is an important and treatable correlate of cytopenia, in addition to close follow-up for any potential negative outcomes.Item Hepatitis B virus infection in Tanzania: current status and challenges(Hindawi, 2018) Kilonzo, Semvua B.; Gunda, Daniel W.; Mpondo, Bonaventura C. T.; Bakshi, Fatma A.; Jaka, HyasintaHepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.Item HIV Epidemic in Tanzania: the possible role of the key populations(Hindawi, 2017) Mpondo, Bonaventura C. T.; Gunda, Daniel W.; Kilonzo, Semvua B.HIV remains a public health concern in Tanzania and other Eastern and Southern African countries. Estimates show that there were about 1.4 million people living with HIV in Tanzania in the year 2013. HIV is a generalized epidemic in Tanzania with heterosexual transmission being the main route of transmission. Recently, however, there has been growing concern on the potential role of the key populations in HIV epidemic in the country. Studies done have shown significantly higher HIV prevalence in these populations compared to the general population. These studies have also reported high risky behaviors among members of these populations. This review aims at discussing the possible role of the key populations in the HIV epidemic in Tanzania.Item HIV epidemic in Tanzania: the possible role of the key populations(Hindawi, 2017) Mpondo, Bonaventura C. T.; Gunda, Daniel W.; Kilonzo, Semvua B.HIV remains a public health concern in Tanzania and other Eastern and Southern African countries. Estimates show that there were about 1.4 million people living with HIV in Tanzania in the year 2013. HIV is a generalized epidemic in Tanzania with heterosexual transmission being the main route of transmission. Recently, however, there has been growing concern on the potential role of the key populations in HIV epidemic in the country. Studies done have shown significantly higher HIV prevalence in these populations compared to the general population. These studies have also reported high risky behaviors among members of these populations. This review aims at discussing the possible role of the key populations in the HIV epidemic in Tanzania.Item Liver fibrosis and hepatitis B coinfection among ART Na\ve HIV-infected patients at a tertiary level hospital in Northwestern Tanzania: a cross-sectional study(Hindawi, 2017) Kilonzo, Semvua B.; Gunda, Daniel W.; Kashasha, Flora; Mpondo, Bonaventura C.Liver fibrosis which is a common complication of chronic hepatitis B infection is rarely diagnosed in low-resource countries due to limited capacity to perform biopsy studies. Data on the utilization of noninvasive techniques which are feasible for diagnosis of liver fibrosis in these settings among HIV-infected patients is scarce. The objective of this study was to establish the magnitude of liver fibrosis by using both aspartate-aminotransferase-to-platelets ratio and fibrosis-4 scores with associated hepatitis B coinfection among antiretroviral therapy naïve HIV-infected patients. We reviewed data of 743 adult patients attending HIV clinic with available hepatitis B surface antigen test results. Baseline clinical information was recorded and aspartate-aminotransferase-to-platelet ratio and fibrosis-4 scores were calculated. The cut-off values of 1.5 and 3.25 were used for diagnosis of significant fibrosis by aspartate-aminotransferase-to-platelets ratio and fibrosis-4 scores, respectively. Results. The prevalence of liver fibrosis was 3.5% when aspartate-aminotransferase-to-platelet score was used and 4.6% with fibrosis-4 score and they were both significantly higher among patients with hepatitis B coinfection. Younger patients with HIV advanced disease and elevated liver transaminases had increased risk of having hepatitis B coinfection. A remarkable number of HIV-infected patients present with liver fibrosis, predominantly those with hepatitis B infection.Item Prevalence and associated factors of late HIV diagnosis in north-western rural Tanzania: a cross sectional study(Health Research User's Trust Fund, 2017) Gunda, Daniel W.; Kaganda, Rashid A.; Bakshi, Fatma A.; Kilonzo, Semvua B.; Mpondo, Bonaventura C.Despite scaling up of HIV and treatment services to improve the outcome of people living with HIV, still a high proportion of patients seek out medical attention at late stages of the disease. This contributes to late initiation of ART and poor clinical outcome especially in sub Saharan Africa. The literature on magnitude of this problem in Tanzania is still scarce. This study aimed to determine the prevalence and associated factors of delayed HIV diagnosis in rural Tanzania. This was a cross sectional study, involving newly diagnosed adult HIV patients sent in for care and treatment linkage. Information regarding age, sex, WHO stage, type of opportunistic condition, HIV testing service and on diagnosis CD4 counts were all collected. On diagnosis CD4 counts <200cells/µl was coded as Late HIV diagnosis. The proportion of with Late HIV diagnosis was calculated and logistic regression modal was used to determine the degree of association of different variables at 95%CI. In total 649 patients were included in this study. The median age of the study participants was 45.5 years most of them being females 396 (61.02%). The median CD4 count was 168 cells/µl and majority of our study participants 468 (72.11%) were in WHO clinical stage 3&4. Overall 385 (59.32%) were found to have Late HIV diagnosis where 303 (78.70%) had stage 3&4 AIDS defining illness (OR=2.2, p<0.001). Male patients were predominantly affected (OR=1.4, p=0.035), who were more likely to be tested following PITC service (OR=30, p<0.001). Late HIV diagnosis is prevalent in our setting with high prevalence of most of the stage 3&4 AIDS defining illnesses. Male patients are predominantly affected as late presenters. There is a need to strengthen and extend the available Provider Initiated Testing and Counselling activities to primary health care level.Item Prevalence and risk factors of active TB among adult HIV patients receiving ART in Northwestern Tanzania: a retrospective cohort study(Hindawi, 2018) Gunda, Daniel W.; Maganga, Simon C.; Nkandala, Igembe; Kilonzo, Semvua B.; Mpondo, Bonaventura C.; Shao, Elichilia R.; Kalluvya, Samwel E.Although ART has improved the outcome of people living with HIV/AIDS, still some patients develop TB while receiving ART. The literature on the magnitude of this problem is still scarce in our setting especially northwestern Tanzania. This study was designed to determine the prevalence of active TB among HIV patients on ART and assess its potential risk factors. A retrospective cohort study was done among adult HIV-positive patients initiated on ART at Bugando Medical Centre. Patients who were TB positive before ART initiation were excluded. Data regarding demographic, clinical, and laboratory information, TB status on receipt of ART, and time on ART were collected and analyzed using STATA 11 to determine the prevalence of TB and its associated factors. In total, 391 patients were enrolled in this study. The median age was 39 (32–46) years, and a total of 129 (32.99%) participants had CD4 counts <200 cells/µl and 179 (45.78%) had WHO stage 3 and 4 illnesses. A total of 43 (11.0%) participants developed TB while receiving ART which was independently associated with male gender (OR = 2.9;p=0.007 ), WHO clinical stage 3 and 4 (OR = 1.4; p=0.029), baseline CD4 count <200 cells/µl (OR = 9.1; pp<), and having not used IPT (OR = 3.1; p=0.05). Active TB is prevalent among HIV patients while receiving ART in northwestern Tanzania which is independently associated with male gender, advanced HIV disease, and nonuse of IPT. Universal HIV testing could reduce late HIV diagnosis and hence reduce the risk of developing TB while receiving ART in our setting. Also IPT should be widely used for those who are negative for TB on screening.