Publications by authors named "Mirembe B"

Article Synopsis
  • Product adherence significantly impacts the accurate evaluation of HIV-1 prevention methods like the dapivirine vaginal ring, with varying levels of adherence leading to biased efficacy estimates.* -
  • In the MTN-020/ASPIRE trial, per-protocol analyses indicated a 30.8% efficacy, while those with the highest adherence showed an efficacy of 53.6% when analyzing drug release from the ring.* -
  • Advanced statistical methods, such as principal stratification and marginal structural models, enhance our understanding of HIV-1 prevention effectiveness in clinical trials by adjusting for adherence levels.*
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Article Synopsis
  • * The WHO published the first COVID-19 Weekly Epidemiological Update on August 17, 2020, and continued until the final edition on September 1, 2023, after which updates transitioned to a comprehensive format every 4 weeks.
  • * The article reviews the WEU's data collection and publication process, its global impact, and offers recommendations to improve collaboration and information sharing for future health crises.
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Article Synopsis
  • COVID-19 is caused by a virus with no vaccines or treatments available during the study, necessitating the assessment of knowledge and adherence to public health measures among the Ugandan population.
  • A cross-sectional study in Uganda involved face-to-face interviews and questionnaires to gauge household knowledge, attitudes, and adherence to COVID-19 prevention strategies.
  • Findings showed that while knowledge levels were adequate (72.2%), adherence rates were moderate (63.7%), and positive attitudes (57.8%) were significant; higher knowledge correlated with better attitudes and adherence to prevention measures.
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Article Synopsis
  • The COVID-19 pandemic has seen the emergence of numerous SARS-CoV-2 variants, impacting global health through increased infections and hospitalizations.
  • Early detection and effective surveillance of these variants are crucial for understanding their health risks and guiding public health responses.
  • The article outlines past variants, their genetic evolution, and the importance of integrating genomic data with epidemiological insights for ongoing and future public health initiatives.
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  • The 2022-2023 mpox outbreak mainly impacted adult men, with only 1.3% of cases occurring in children and teens under 18.
  • In the analyzed data, there was only one ICU admission for children and no recorded deaths in that age group.
  • Different age groups experienced various transmission routes and clinical symptoms during the outbreak.
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Article Synopsis
  • * Conducted between March and September 2021, the pilot study involved 30 young women aged 18-24 with low adherence to PrEP, offering them peer-delivered support along with regular clinic visits to evaluate feasibility and acceptability.
  • * Results indicated high acceptance and completion rates of peer visits, with significant improvements in PrEP adherence; qualitative analysis uncovered positive peer experiences, motivating factors from peer support, and various barriers
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We assessed if acceptability of the dapivirine vaginal ring for HIV prevention differed among the subgroup of women who reported engaging in transactional sex prior to enrollment in MTN-020/ASPIRE (phase III trial in Malawi, South Africa, Uganda, and Zimbabwe, 2012-2015;  = 2629). Transactional sex was defined as receipt of money, goods, gifts, drugs, or shelter in exchange for sex in the past year. Dimensions of acceptability included: ease of use and physical sensation in situ, impacts on sex, partner's opinion, and likelihood of future use.

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Article Synopsis
  • COVID-19, caused by SARS-CoV-2, was declared a public health emergency in January 2020, with early studies showing that over 80% of deaths were among individuals aged 60 and older.
  • The World Health Organization developed strategies to prioritize vaccine distribution, emphasizing the importance of vaccinating at-risk populations, particularly older adults, aiming for full vaccination coverage.
  • Data analysis revealed that people aged 60 and above made up more than 80% of COVID-19 deaths globally, with significant mortality impact seen in lower and middle-income countries, highlighting the urgency for effective vaccine rollout.*
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The coronavirus disease (COVID-19) presented a unique opportunity for the World Health Organization (WHO) to utilise public health intelligence (PHI) for pandemic response. WHO systematically captured mainly unstructured information (e.g.

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MTN-025/HOPE was an open-label trial of the dapivirine vaginal ring conducted in four African countries between 2016 and 2018. Women were first offered one ring monthly (at baseline, months 1 and 2), thereafter, transitioned to a more applicable real-world dispensation schedule, - 3 rings quarterly (at months 3, 6 and 9). Logistic regression analysis was used to assess correlates of ring acceptance at baseline and through follow-up.

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Background: Anthrax is a zoonotic infection caused by the bacteria Bacillus anthracis. Humans acquire cutaneous infection through contact with infected animals or animal products. On May 6, 2018, three cows suddenly died on a farm in Kiruhura District.

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Background: Kampala city slums, with one million dwellers living in poor sanitary conditions, frequently experience cholera outbreaks. On 6 January 2019, Rubaga Division notified the Uganda Ministry of Health of a suspected cholera outbreak in Sembule village. We investigated to identify the source and mode of transmission, and recommended evidence-based interventions.

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Article Synopsis
  • Rift Valley fever (RVF) is a viral disease transmitted by mosquitoes, with suspected cases reported in several Ugandan districts, prompting an investigation into the outbreak's scope and exposure factors.
  • Laboratory tests confirmed RVF in humans using polymerase chain reaction, leading to a case definition based on specific symptoms and testing methods for confirmation.
  • The investigation involved collecting blood samples from both humans and animals, conducting interviews to identify exposure risks, and performing environmental assessments to inform control and prevention strategies.
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Objective: Vaccine-preventable human papillomavirus (HPV) infection is common, especially in sub-Saharan Africa where HIV risk is also high. However, unlike other sexually transmitted infections (STIs), HPV's role in HIV acquisition is unclear. We evaluated this relationship using data from MTN-003, a clinical trial of HIV chemoprophylaxis among cisgender women in sub-Saharan Africa.

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Understanding characteristics associated with adherence to pre-exposure prophylaxis (PrEP) methods for HIV-1 prevention may assist with optimizing implementation efforts. The dapivirine vaginal ring is a novel topical PrEP delivery method. Using data from a randomized, double-blind, placebo-controlled, phase III trial of the dapivirine vaginal ring conducted in four African countries, generalized estimating equation models were used to evaluate correlates of ring adherence.

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  • The study investigates the timing of COVID-19 symptom onset in Uganda, analyzing data from confirmed cases between March and September 2020.
  • A total of 420 symptomatic cases were examined, revealing that symptoms commonly appeared within three days post-exposure, with cough, running nose, and fever being the most frequent signs.
  • Findings suggest that younger individuals (≤20 years) are more likely to show symptoms earlier, providing important insights for health monitoring strategies related to COVID-19 exposure.
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  • Crimean-Congo haemorrhagic fever (CCHF) is a viral disease transmitted by ticks, causing severe hemorrhagic symptoms, with multiple outbreaks reported in Uganda, primarily in the 'cattle corridor'.
  • A study conducted from July 2018 to January 2019 identified 14 confirmed cases, all with fever and a high prevalence of unexplained bleeding, resulting in a significant case-fatality rate of 36%.
  • Risk factors included close contact with livestock, living near grazing fields, and a high incidence of tick attachment, highlighting the need for targeted interventions to prevent future outbreaks.
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Article Synopsis
  • * Out of the first 54 confirmed cases by April 12, 2020, a majority were asymptomatic or presented with mild symptoms, primarily among international travelers, with only one symptomatic case detected upon entry.
  • * Overall, the study found low transmission rates among the symptomatic cases, highlighting the importance of targeted testing in identifying asymptomatic carriers and controlling the spread of the virus.
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  • - The Uganda Ministry of Health announced a cholera outbreak in the Kyangwali Refugee Settlement on February 23, 2018, with over 60 individuals affected, leading to an investigative study to assess the outbreak's extent and transmission methods.
  • - Investigators defined cholera cases based on symptoms and conducted a case-control study, finding a case-fatality rate of 2.1% with the highest impact on individuals from the Democratic Republic of Congo.
  • - The outbreak lasted four months and was linked to contaminated stream water resulting from open defecation, with an overall attack rate of 3.2 per 1000 people in Hoima District.
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Gender roles and imbalances in sexual power contribute to the heightened HIV-1 risk faced by women in Sub-Saharan Africa. This has led prevention research to focus on the development of female controlled methods. Despite the design of products such as vaginal rings to be used autonomously by women, male partners and women's perceptions of relationships influence HIV prevention choices.

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Typhoid fever affects 21 million people globally, 1% of whom succumb to the disease. The social, economic and public health consequences of this disease disproportionately affect people in Africa and Asia. In order to design context specific prevention strategies, we need to holistically characterise outbreaks in these settings.

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Background: While antiretroviral therapy (ART) availability for HIV patients has increased dramatically in Uganda, patient linkage to and retention in care remains a challenge. We assessed patterns of engagement in care in 20 Ugandan health facilities with low retention based on national reporting.

Methods: We assessed patient linkage to care (defined as registering for pre-ART or ART care at the facility within 1 month of HIV diagnosis) and 6-month retention in care (having a visit 3-6 months after ART initiation) and associations with patient-/facility-level factors using multivariate logistic regression.

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Background: In 2013, Uganda adopted a test-and-treat policy for HIV patients 15 years or younger. Low retention rates among paediatric and adolescent antiretroviral therapy (ART) initiates could severely limit the impact of this new policy. This evaluation tested the impact of a differentiated care model called Family Clinic Day (FCD), a family-centered appointment scheduling and health education intervention on patient retention and adherence to monthly appointment scheduling.

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Background: Recent HIV prevention trials required use of effective contraceptive methods to fulfill eligibility for enrollment. We compared pregnancy rates in a subset of participants enrolled in the Microbicide Trials Network protocol (MTN-003), a randomized trial of chemoprophylaxis to prevent HIV acquisition among women aged 18-45 years who initiated depot medroxyprogesterone acetate (DMPA) or combined oral contraceptives (COCs) at enrollment, relative to those already using DMPA or COCs.

Methods: Data were analyzed from MTN-003 participants from Uganda.

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