Journal Articles

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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.
Emotional and relationship dynamics between HIV sero discordance and concordance couples: a narrative literature review and theoretical framework
(ARC Publications Private Limited, 2017) Mwakalapuka, Amani; Mwampagatwa, Ipyana; Bali, Theodora; Mwashambwa, Masumbuko; Kibusi, Stephen
Tanzania is among the countries with high prevalence of HIV prevalence in the World. Despite the fact that the epidemic has been, and still is a threat to persons of all ages, recent studies have suggested that most new infections occur among couples in stable relationships. Infected couples are categorised into two: the positive concordant, where both the partners are HIV positive; and sero-discordant couples, where one partner is HIV positive while the other is negative. Recently, researchers and many other stake-holders working on the HIV/AIDS epidemic have given a remarkable attention to this astonishing reality. For instance one study in East and Southern Africa indicates that there are great variations of discordancy varying from 36% to 85%, with an overall rate of 49%. HIV couple sero-discordancy is responsible for varied levels of psychological distress including heightened levels of anxiety, poor emotional adaptation and increased or excessive substance use, most often coupled with exclusion and social isolation within family and in the neighbourhood. However, to date the influence of sero-discordancy on family and couple relationship functioning and how it differs from that among concordant couples remains elusive. Discordancy have been associated with more difficulties as compared to the seroconverted couples, these include relationship and emotional disturbances, sexual contact distancing, marital separation and disruptions. The Lazarus and Folkmans (1984)s Transactional Model can be helpful in understanding individuals with HIV discordancy on their emotional response, coping strategies and the ultimate decisions towards their marital relationships fate. Couple sero-discordancy, HIV/AIDS, Theory, Emotional problems, psychosocial problems, Literature review.
Factors associated with HIV status disclosure and its effect on treatment adherence and quality of life among children 6–17 years on Antiretroviral therapy in southern highlands zone, Tanzania: unmatched case control study
(Hindawi, 2018) Bulali, Regina Edward; Kibusi, Stephen Matthew; Mpondo, Bonaventura C. T.
The World Health Organization (WHO) recommends that children should be informed of their HIV status at ages 6 to 12 years and full disclosure of HIV and AIDS be offered in a caring and supportive manner at about 8 to 10 years. The objective of this study was to determine factors associated with HIV status disclosure and its effect on treatment adherence and health-related quality of life among children between 6 and 17 years of age living with HIV/AIDS in the Southern Highlands Zone, Tanzania, 2017. Methods. A hospital based unmatched case control study was conducted between April and September 2017. A total of 309 children between 6 and 17 years on ART for at least six months were enrolled in this study. Simple random sampling was employed in selecting the children from existing treatment registers. Data were collected using a structured questionnaire which included the WHO Quality of Life standard tool (WHOQOL-BREF 2012 tool) and treatment adherence manual. Multiple logistic regression was used to test for the independent effect of HIV status disclosure on treatment adherence and quality of life at p value less than 0.05. Results. Out of 309 children, only 102 (33%) had their HIV status disclosed to them. The mean age at HIV status disclosure was 12.39 (SD=3.015). HIV status disclosure was high among girls (51%), children aged 10-13 years (48.3%), and those living with their biological parents (59.8%). After adjusting for confounders, being aged between 10-13 and 14-17 years was associated with HIV status disclosure (AOR 19.178, p<0.05 and AOR=65.755, p<0.001, respectively). HIV status disclosure was associated with ART adherence (AOR=8.173, p<0.05) and increased the odds of having good quality of life (AOR=3.283, p<0.001). HIV status disclosure significantly improved adherence to treatment and quality of life among children living with HIV/AIDS.
HIV infection in the elderly: arising challenges
(Hindawi, 2016) Mpondo, Bonaventura C. T.
Globally there is an increase in the number of people living with HIV at an advanced age (50 years and above). This is mainly due to prolonged survival following the use of highly active antiretroviral therapy. Living with HIV at an advanced age has been shown to be associated with a number of challenges, both clinical and immunological. This minireview aims at discussing the challenges encountered by elderly HIV-infected patients.
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.
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.
Prevalence and risk factors of mortality among adult HIV patients initiating ART in rural setting of HIV care and treatment services in North western Tanzania: a retrospective cohort study
(Hindawi, 2017) Gunda, Daniel Wilfred; Nkandala, Igembe; Kilonzo, Semvua Bukheti; Kilangi, Boniface Bartholomew; Mpondo, Bonaventura Cornel
Introduction. HIV still causes high mortality despite use of ART. This study was designed to determine the prevalence and risk factors of mortality among HIV patients receiving ART in north western rural Tanzania. A retrospective study of HIV patients on ART was done at Sengerema in Mwanza, Tanzania. The data on demography, date of HIV diagnosis, WHO stage, opportunistic infections, CD4, hemoglobin, ART regimen,and time and outcome on treatment as dead or alive were collected and analyzed using STATA version 11. In total, 740 patients were studied. The median age was 35 (27–42) years with female predominance of 465 (62.8%). Of the participants, 261 (35.3%) had WHO stages 3 and 4 diseases. Most participants, 258 (34.9%), had baseline CD4 counts <200 cells/𝜇l. Deaths occurred in 86 (11.6%) patients which were independently associated with male gender (16.0% versus 9.0%, 𝑝 = 0.015), being divorced (OR=2.7,𝑝 < 0.001), WHO stages 3 and 4 (OR=2.3,𝑝 = 0.05), CD4<200 cells/𝜇l (OR=3.4, 𝑝 < 0.001), and severe anemia (OR=6.6, 𝑝 < 0.001). The mortality is high among HIV patients receiving ART in north western rural Tanzania. Universal testing could increase early diagnosis and treatment. A close follow-up ofat-risk patients within the first year of ART could reduce the mortality of this sub group of patients.
Trends in hospitalisation for human immunodeficiency virus in a tertiary hospital in Dar es Salaam, Tanzania: a case study
(East African Health Research Commission, 2020) Shayo, Grace A; Nagu, Tumaini; Msele, Lilian; Munseri, Patricia; Mbekenga, Columba; Kibusi, Steven; Pallangyo, Kisali; Mugusi, Ferdinand
Background: Reports on a systematic evaluation of the impact of antiretroviral therapy(ART) on patients’ hospitalisation in Sub Saharan Africa (SSA) and Tanzania, in particular, are scarce. We aimed at documenting the trends of hospital admissions at Muhimbili National Hospital (MNH) following scale-up of free access to ART in Tanzania. Methods: Records for all admissions at MNH from June 2005 to June 2015 were reviewed. We extracted data from the Hospital Information Management System as well as from patients’ charts. Data extracted included diagnosis at discharge, the reason for admission and thereafter assessed admission trends over the decade. We summarised the data as frequency and percentages. We compared proportions using the Chi-squared test, P<0.05 was deemed significant. Results: Overall there were 209,101 admissions during the study period (June 2005 to June 2015) and 7864/209,101 (3.8%) were due to HIV infection. Whereas 598/4,519 (13.2%) of all admissions in 2005 were due to HIV, only 345/13,119 (2.6%) of admissions in 2015 were HIV-related; showing a significant drop over time (P-value for trend < .001). Generally, females 3887/6679 (58.2%) were more likely to be admitted than males (41.8%). Median CD4 count for admitted HIV patients was 143 cells/μl. Majority of admissions occurred in the medical wards 3643/5310 (68.6%). Discharge diagnoses were Tuberculosis 1396/6482 (21.5%), anaemias 1016/6482 (15.6 %), malignancies 789/6482(12.2%), CNS infections 541/6482 (8.3%) and chronic kidney disease 308/6482 (4.8%). Three leading AIDS defining malignancies among hospitalised patients included Kaposi’s sarcoma 380/789 (48.2%), carcinoma of the cervix 77/789 (9.8%), and Non-Hodgkin’s lymphoma 44/789 (5.6%). Conclusion: Despite a drastic drop of HIV related admissions at Muhimbili National Hospital over the years, the infection remains a problem of the adults, largely females suffering from medical conditions and presenting with severe immunosuppression. Tuberculosis remained the most common opportunistic infection among hospitalized HIV infected patients. Anaemia and cancers became more important causes of admission than was diarrhoea which had been the most common among HIV infected patients in pre- ART.

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