| 1. |
- Gusdal, Annelie K, 1963-, et al.
(författare)
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Peer counselors' role in supporting patients' adherence to ART in Ethiopia and Uganda
- 2011
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 23:6, s. 657-662
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Tidskriftsartikel (refereegranskat)abstract
- Our aim was to explore peer counselors' work and their role in supporting patients' adherence to antiretroviral treatment (ART) in resource-limited settings in Ethiopia and Uganda. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Two main categories with related subcategories emerged from the analysis. The first main category, peer counselors as facilitators of adherence, describes how peer counselors played an important role by acting as role models, raising awareness, and being visible in the community. They were also recognized for being close to the patients while acting as a bridge to the health system. They provided patients with an opportunity to individually talk to someone who was also living with HIV, who had a positive and life-affirming attitude about their situation, and were willing to share personal stories of hope when educating and counseling their patients. The second main category, benefits and challenges of peer counseling, deals with how peer counselors found reward in helping others while at the same time acknowledging their limitations and need of support and remuneration. Their role and function were not clearly defined within the health system and they received negligible financial and organizational support. While peer counseling is acknowledged as an essential vehicle for treatment success in ART support in sub-Saharan Africa, a formal recognition and regulation of their role should be defined. The issue of strategies for disclosure to support adherence, while avoiding or reducing stigma, also requires specific attention. We argue that the development and implementation of support to peer counselors are crucial in existing and future ART programs, but more research is needed to further explore factors that are important to sustain and strengthen the work of peer counselors.
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| 2. |
- Gusdal, Annelie K, 1963-, et al.
(författare)
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Voices on adherence to ART in Ethiopia and Uganda : a matter of choice or simply not an option?
- 2009
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Ingår i: AIDS Care. - : Informa UK Limited. - 0954-0121 .- 1360-0451. ; 21:11, s. 1381-1387
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Tidskriftsartikel (refereegranskat)abstract
- This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: "Patients' competing costs and systems' resource constraints'' and "Patients' trust in ART and quality of the patient-provider encounters.'' The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling.
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| 3. |
- Malm, Mikaela, et al.
(författare)
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Determination of lamivudine, zidovudine and nevirapine, in capillary blood sampled on filter paper, by liquid chromatography
- 2009
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Ingår i: Journal of Chromatographic Science. - : Oxford University Press (OUP). - 0021-9665 .- 1945-239X. ; 47:10, s. 855-862
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Tidskriftsartikel (refereegranskat)abstract
- A bioanalytical method for determination of lamivudine (3TC), zidovudine (AZT), and nevirapine (NVP) in 100 μL capillary blood applied onto sampling paper has been developed and validated. The antiretroviral drugs (ARV) were analyzed by reversed phase gradient liquid chromatography with UV detection. Separation was performed on a Zorbax SB C8 (250 × 4.6 mm) column with a twostep gradient: (i) methanol.0.05 mol/L acetic acid-sodium acetate buffer (pH 3.95, 15:85 v/v) and (ii) methanol.0.05 mol/L acetic acid-sodium acetate buffer (pH 3.95, 50:50 v/v) with a flow rate of 1.0 mL/min. UV detection was performed at 260 nm. Total assay precisions were 6.3, 4.7, and 4.9% for 3TC at 0.34, 0.69, and 3.9 μg/mL, and 5.1, 5.5, and 3.2% for AZT at 0.40, 0.80, and 4.5 μg/mL. For NVP, total assay precisions were 5.2, 8.3, and 3.5% at 2.6, 4.5, and 8.8 μg/mL. Lower limit of quantifications (LLOQ) were 0.11 and 0.13 μg/mL for 3TC and AZT where the precisions were 2.0% for both the analytes. For NVP, LLOQ was 1.3 μg/mL where precision was 2.6%. Concentrations were determined for 10 h for two subjects receiving standard twice daily antiretroviral therapy containing 3TC, AZT, and NVP. Maximum 3TC concentrations were 2.5 and 2.8 μg/mL for subject 1 and 2, respectively. For AZT, maximum concentrations were 1.8 and 1.1 μg/mL while being 15 and 9.6 μg/mL for NVP. Pre-dose trough concentration of NVP was 11 μg/mL for subject 1 and 9.6 μg/mL for subject 2.
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| 4. |
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| 5. |
- Obua, Celestino
(författare)
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Fixed-dose chloroquine and sulfadoxine/pyrimethamine treatment of malaria : outcome and pharmacokinetic aspects
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: A pre-packaged fixed-dose formulation of chloroquine (CQ) and sulfadoxine/pyrimethamine (SIP) combination (Homapak) is widely used for the treatment of falciparum malaria in the Home Based Management of Fevers program for Ugandan children. Until the present study, the efficacy, pharmacokinetics and drug interactions of the dose regimen of the product were not known. Aims: To explore treatment outcome and the pharmacokinetics with fixed-dose CQ+SP combination in uncomplicated falciparum malaria in Uganda. Materials and methods: In a classical pharmacokinetic study, possible pharmacokinetic interactions between CQ and SIP during co-administration as Homapak were explored and the bioequivalence was determined in healthy volunteers (n=32). Multiple blood samples were obtained on day 0 and up to day 21. Plasma drug levels were assayed using HPLC and classical pharmacokinetic calculations were pursued (I). The efficacy of the fixed-dose CQ+SP (Homapak) compared with AQ+SP combination was determined during a clinical trial in children with uncomplicated falciparum malaria (n= 18 3) (II). The effects of nutritional status and other host factors at recruitment together with the attained CQ and S concentrations on the treatment outcomes in the children were determined by statistical predictions using regression analyses (III). Blood samples collected on filter paper in children (n=83) treated with the fixeddose CQ+SP were modeled in a population approach using the NONMEM software to determine the exposure (AUC) that predicts cure, from which a proposal for dose modification was made for the treatment of uncomplicated falciparum malaria (IV). Results: Sulfadoxine absorption was more rapid in Homapak (ka = 0.55 h-1) than when given as Fansidar + CQ (ka = 0.27 h-, p=0.004), but similar when Fansidar was given alone (ka = 0.32 h-1, p=0.03). Other pharmacokinetic parameters of S, P and CQ were similar when given together or separately, demonstrating bioequivalence of Homapak to reference formulations (I). Efficacy of Homapak was tested, and based on the day 14 adequate clinical and parasitological response, CQ+SP (Homapak) had poorer efficacy at 70.9% compared to 97.4% for AQ+SP (p<0.001). In those given Homapak, treatment failure rates were much higher (48.2%) for the younger age group given halfstrength (HS), than in the older children (18.2%, p=0.004) given the fullstrength (FS) Homapak. (II). Among the children given Homapak, stunting was more common (27.7%) compared to underweight (19.3%) and wasting (9.6%), with the mean given doses of CQ and S (mg/kg) and concentrations higher in the FS than HS dose groups. Overall the significant explanatory covariates for cure were day 1 S concentration (p=0.004), day 3 CQ concentration (p=0.037), and stunting (p=0.046) (III). By applying a population approach to the response and pharmacokinetics in these children using twocompartmental models the drug exposure (especially AUC0-336) was found to be predictive of response, with the HS dose group having lower AUCO-336 values, the majority being below the level predicted for cure. A simulated modified dose, with all children in the age range 6 - 60 months given the same higher fixed-dose CQ+SP would greatly improve the possibility of achieving AUC necessary for cure in at least 95% of the children (IV). Conclusions: The fixed-dose CQ+SP formulation (Homapak) is of good quality. It is however inferior in efficacy compared with AQ+SP combination. AQ could therefore be used as a replacement in combination with SP in the treatment of falciparum malaria where sensitivity patterns permit. To improve response with the fixed-dose CQ+SP a dose modification is proposed by giving all children 6 - 60 months the same higher dose of the formulation.
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| 6. |
- Obua, Celestino, et al.
(författare)
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Multiple ART Programs Create a Dilemma for Providers to Monitor ARV Adherence in Uganda
- 2011
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Ingår i: Open AIDS Journal. - : Bentham Science Publishers Ltd.. - 1874-6136. ; 5, s. 17-24
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Tidskriftsartikel (refereegranskat)abstract
- Background: Increased availability and accessibility of antiretroviral therapy (ART) has improved the length and quality of life amongst people living with HIV/AIDS. This has changed the landscape for care from episodic to longterm care that requires more monitoring of adherence. This has led to increased demand on human resources, a major problem for most ART programs. This paper presents experiences and perspectives of providersin ART facilities, exploring the organizational factors affecting their capacity to monitor adherence to ARVs. Methods: From an earlier survey to test adherence indicators and rank facilities as good, medium or poor adherence performances, six facilities were randomly selected, two from each rank. Observations on facility set-up, provider-patient interactions and key informant interviews were carried out. The strengths, weaknesses, opportunities and threats identified by health workers as facilitators or barriers to their capacity to monitor adherence to ARVs were explored during group discussions. Results: Findings show that the performance levels of the facilities were characterized by four different organizational ARTprograms operating in Uganda, with apparent lack of integration and coordination at the facilities. Of the six facilities studied, the two highadherence performing facilities were Non-Governmental Organization (NGO) programs, while facilities with dual organizational programs(Governmental/NGO) performed poorly. Working conditions, record keeping and the duality of programs underscored the providers' capacity tomonitor adherence. Overall 70% of the observed provider-patient interactions were conducted in environments that ensured privacy of the patient. The mean performance for record keeping was 79% and 50% in the high and low performing facilities respectively. Providers often found it difficult to monitor adherence due to the conflicting demands from the different organizational ART programs. Conclusion: Organizational duality at facilities is a major factor in poor adherence monitoring. The different ART programs in Uganda need to be coordinated and integrated into a single well resourced program to improve ART services and adherence monitoring. The focus on long-term care of patients on ART requires that the limitations to providers' capacity for monitoring adherence become central during the planning and implementation of ART programs.
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| 7. |
- Ocheng, Francis, et al.
(författare)
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Antibacterial activities of extracts from Ugandan medicinal plants used for oral care
- 2014
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Ingår i: Journal of Ethnopharmacology. - : Elsevier BV. - 0378-8741 .- 1872-7573. ; 155:1, s. 852-855
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Tidskriftsartikel (refereegranskat)abstract
- Ethnopharmacological relevance: Medicinal plants are widely used for treatment of oral/dental diseases in Uganda. Aim of the study: To investigate antibacterial activities of 16 commonly used medicinal plants on microorganisms associated with periodontal diseases (PD) and dental caries (DC). Materials and methods: Pulp juice and solvent extracts (hexane, methanol and water) from the plants were tested against Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia associated with PD and Streptococcus mutans, Streptococcus sobrinus, Lactobacillus acidophilus associated with DC. Tests were done using agar well-diffusion (pulp juice) and agar-dilution (Solvent extracts) assays. Results: Pulp juice from Zanthoxylum chalybeum and Euclea latidens showed activity against all the bacteria, Zanthoxylum chalybeum being most active. Hexane extract from aerial part of Helichrysum odoratissimum was most active (MIC: 0.125-0.5 mg/ml). Methanol extract from leaves of Lantana trifolia showed activity against all bacteria (MIC: 0.25-1 mg/ml). Conclusion: Several of the tested plants showed antibacterial activities against bacteria associated with PD and DC, meriting further investigations.
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| 8. |
- Ocheng, Francis, et al.
(författare)
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Essential Oils from Ugandan Aromatic Medicinal Plants : Chemical Composition and Growth Inhibitory Effects on Oral Pathogens
- 2015
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Ingår i: Evidence-based Complementary and Alternative Medicine. - : Hindawi Limited. - 1741-427X .- 1741-4288.
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Tidskriftsartikel (refereegranskat)abstract
- The study assessed the growth inhibitory effects of essential oils extracted from ten Ugandan medicinal plants (Bidens pilosa, Helichrysum odoratissimum, Vernonia amygdalina, Hoslundia opposita, Ocimum gratissimum, Cymbopogon citratus, Cymbopogon nardus, Teclea nobilis, Zanthoxylum chalybeum, and Lantana trifolia) used traditionally in the management of oral diseases against oral pathogens. Chemical compositions of the oils were explored by GC-MS. Inhibitory effects of the oils were assessed on periodontopathic Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans and cariogenic Streptococcus mutans and Lactobacillus acidophilus using broth dilution methods at concentrations of 1%, 0.1%, and 0.01%. The most sensitive organism was A. actinomycetemcomitans. Its growth was markedly inhibited by six of the oils at all the concentrations tested. Essential oil from C. nardus exhibited the highest activity with complete growth inhibition of A. actinomycetemcomitans and P. gingivalis at all the three concentrations tested, the major constituents in the oil being mainly oxygenated sesquiterpenes. Most of the oils exhibited limited effects on L. acidophilus. We conclude that essential oils from the studied plants show marked growth inhibitory effects on periodontopathic A. actinomycetemcomitans and P. gingivalis, moderate effects on cariogenic S. mutans, and the least effect on L. acidophilus. The present study constitutes a basis for further investigations and development of certain oils into alternative antiplaque agents.
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| 9. |
- Ocheng, Francis, et al.
(författare)
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Essential Oils from Ugandan Medicinal Plants : In Vitro Cytotoxicity and Effects on IL-1 beta-Induced Proinflammatory Mediators by Human Gingival Fibroblasts
- 2016
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Ingår i: Evidence-based Complementary and Alternative Medicine. - : Hindawi Publishing Corporation. - 1741-427X .- 1741-4288.
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Tidskriftsartikel (refereegranskat)abstract
- The study investigated cytotoxicity of essential oils from four medicinal plants (Bidens pilosa, Ocimum gratissimum, Cymbopogon nardus, and Zanthoxylum chalybeum) on human gingival fibroblasts and their effects on proinflammatory mediators' secretion. Cytotoxicity of essential oils was investigated using 3-(4, 5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide assay. Effects of essential oils at subcytotoxicity concentrations on interleukin-(IL-) 6, IL-8, and prostaglandin E-2 (PGE(2)) secretions by gingival fibroblasts treated with IL-1 beta (300 pg/mL) were evaluated by ELISA and EIA. IC50 values of the essential oils ranged from 26 mu g/mL to 50 mu g/mL. Baseline and IL-1 beta-induced secretion of PGE(2) was inhibited by treatment with essential oil from O. gratissimum. Essential oils from B. pilosa and C. nardus had synergistic effects with IL-1 beta on PGE(2) seceretion. In conclusion, the study suggests that essential oil from O. gratissimum decreases gingival fibroblasts secretion of PGE(2), while essential oils from B. pilosa and C. nardus increase PGE(2) secretion. Essential oil from Z. chalybeum was the most cytotoxic, while oil from C. nardus was the least cytotoxic. Although the clinical significance of these findings remains to be determined, it may be suggested that essential oil from O. gratissimum, applied at subcytotoxicity concentrations, could reduce the participation of gingival fibroblasts in the gingival inflammation and tissue destruction associated with periodontitis.
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| 10. |
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