Publications by authors named "Mujuru H"

Background: Vertical HIV-1 transmission despite antiretroviral therapy may be mitigated by use of long-acting, broadly neutralizing, monoclonal antibodies (bNAb) such as VRC07523LS. The present study was designed to determine the safety and pharmacokinetics of VRC07523LS.

Methods: VRC07523LS, 80 mg/dose, was administered subcutaneously after birth to non-breastfed (Cohort 1; N=11, enrolled in USA) and breastfed (Cohort 2; N=11, enrolled in South Africa and Zimbabwe) infants exposed to HIV-1.

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Background: Rotavirus vaccines are moderately protective against illness in high mortality settings compared with low mortality settings. Vaccine effectiveness (VE) evaluations may clarify our understanding of these disparities, but estimates among key subpopulations and against rare outcomes are not available in many analyses due to sample size. We combined 25 datasets from test-negative design case-control evaluations in 24 countries that enrolled children with medically-attended diarrhea, laboratory-confirmed rotavirus stool testing, and documented vaccination status.

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  • Rapid urbanization in sub-Saharan Africa is linked to a rise in asthma cases among children and teens, particularly due to challenges in obtaining clinical diagnoses for those exhibiting symptoms.* -
  • A two-phase study was conducted across multiple countries involving adolescents aged 12-14, where asthma symptoms were assessed through a questionnaire, and further evaluations were carried out on those with symptoms, including tests for lung function and environmental risk factors.* -
  • The study aimed to gather data on the prevalence and severity of asthma in symptomatic adolescents, alongside objective testing methods like spirometry and fractional exhaled nitric oxide (FeNO) to better understand asthma's impact on daily life.*
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Treatment options for children living with HIV have historically been less effective, less practical and more difficult to implement compared with those for adults, as the research and development of new drugs for children has lagged behind. Significant progress has been achieved in response to the paediatric HIV epidemic over the last decade. Several optimised paediatric antiretroviral formulations are currently available or in development, including fixed-dose combination tablets containing a complete World Health Organization-recommended regimen.

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Objective: To systematically review literature from randomised controlled trials (RCTs) investigating the effectiveness of electronic monitoring device informed interventions on adherence and clinical outcomes in children and adolescents with chronic conditions.

Study Design: A systematic review was conducted. An electronic literature search covering studies, with no pre-specified starting date up to June 2024, was performed in Medline, EMBASE, Web of Science, Cochrane and Trials databases was conducted.

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  • Adolescents living with HIV often experience stunting and delayed puberty, leading to issues with bone density and muscle function.
  • The VITALITY trial included 842 adolescents from Zambia and Zimbabwe, examining the impact of vitamin D and calcium supplementation on their musculoskeletal health while using various measurement techniques.
  • The study found that lower bone density scores were linked to factors like older age at ART initiation, low physical activity, and poor dietary intake of vitamin D and calcium, suggesting supplementation and exercise could benefit these adolescents.
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  • Dolutegravir (DTG) is metabolized in the body, producing an inactive form called DTG glucuronide (DTG-gluc), and the study focused on its metabolic ratio (DTG-MR) among 85 HIV-positive children aged 3 months to 18 years.
  • The research found that the overall DTG-MR in children was similar to that in adults and was primarily influenced by the use of rifampicin, which significantly increased the DTG-MR.
  • These results suggest that factors like age, body weight, and type of NRTI treatment do not affect the DTG-MR in children, paving the way for better pharmacokinetic modeling for pediatric patients based on adult data
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Background: Of the 2 million children living with HIV globally, 90% live in sub-Saharan Africa. Despite antiretroviral therapy, longstanding HIV infection is associated with several chronic complications in children including growth failure, particularly stunting and delayed puberty. Vitamin D deficiency, which is highly prevalent among children living with HIV in sub-Saharan Africa, has further adverse impact on bone health.

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Preterm birth (PTB) is the leading cause of morbidity and mortality in children globally, yet its prevalence has been difficult to accurately estimate due to unreliable methods of gestational age dating, heterogeneity in counting, and insufficient data. The estimated global PTB rate in 2020 was 9.9% (95% confidence interval: 9.

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Background: Preterm birth (birth before 37 completed weeks of pregnancy) is the leading cause of neonatal and child under-five mortality globally, both of which are highest regionally in sub-Saharan Africa. The skin barrier plays a critical role in neonatal health and increasing evidence supports the use of topical emollient therapy to promote postnatal growth and reduce hospital-acquired infections in preterm infants. The World Health Organization (WHO) currently recommends emollient therapy in preterm or low birthweight infants globally but calls for further research on impacts of emollient use, especially in Africa.

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  • The study highlights the rising burden of non-communicable diseases (NCDs) among healthcare workers in Zimbabwe, set against a backdrop of high HIV prevalence and limited healthcare resources.
  • A cross-sectional health-check involving 6,598 healthcare workers revealed that around 50% had at least one chronic condition, with a notable prevalence of multimorbidity (15%), particularly among those aged 50 and older.
  • Many chronic conditions, apart from HIV, were often undiagnosed or untreated, indicating a need for improved chronic disease management strategies in the healthcare sector of southern Africa.
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Health workers are essential for a functioning healthcare system, and their own health is often not addressed. During the COVID-19 pandemic health workers were at high risk of SARS-CoV-2 infection whilst coping with increased healthcare demand. Here we report the development, implementation, and uptake of an integrated health check combining SARS-CoV-2 testing with screening for other communicable and non-communicable diseases for health workers in Zimbabwe during the COVID-19 pandemic.

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With COVID-19 no longer categorized as a public health emergency of international concern, vaccination strategies and priority groups for vaccination have evolved. Africa Centres for Diseases Prevention and Control proposed the '100-100-70%' strategy which aims to vaccinate all healthcare workers, all vulnerable groups, and 70% of the general population. Understanding whether healthcare workers were reached during previous vaccination campaigns and what can be done to address concerns, anxieties, and other influences on vaccine uptake, will be important to optimally plan how to achieve these ambitious targets.

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Background: Air pollution is the second largest risk to health in Africa, and children with asthma are particularly susceptible to its effects. Yet, there is a scarcity of air pollution exposure data from cities in sub-Saharan Africa. We aimed to identify potential exposure reduction strategies for school children with asthma living in urban areas in sub-Saharan Africa.

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Objectives: To determine how muscle strength, power, mass, and density (i.e. quality) differ between children living with HIV (CWH) and those uninfected, and whether antiretroviral therapy (ART) regime is associated with muscle quality.

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Background: We evaluated dolutegravir pharmacokinetics in infants with human immunodeficiency virus (HIV) receiving dolutegravir twice daily (BID) with rifampicin-based tuberculosis (TB) treatment compared with once daily (OD) without rifampicin.

Methods: Infants with HIV aged 1-12 months, weighing ≥3 kg, and receiving dolutegravir BID with rifampicin or OD without rifampicin were eligible. Six blood samples were taken over 12 (BID) or 24 hours (OD).

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  • Optimal antituberculosis therapy is crucial for achieving good health outcomes in patients.
  • Research shows that infants with HIV receiving standard doses of first-line TB drugs have significantly lower peak plasma concentrations than adults.
  • This suggests that increasing the dosage of these TB drugs in infants may be necessary for better treatment effectiveness.
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Asthma is the most common chronic respiratory disease among school-going adolescents worldwide. However, the burden of severe asthma is highest in Sub-Saharan Africa. This study aimed to explore teachers' perceptions of asthma care across six African countries.

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Objectives: This study identifies barriers and provides recommendations to improve asthma care in children across sub-Saharan Africa, where qualitative data is lacking despite high rates.

Design: One of the aims of our National Institute for Health Research global health research group 'Achieving Control of Asthma in Children in Africa' was to use qualitative thematic analysis of transcribed audio recordings from focus group discussions (FGDs) to describe barriers to achieving good asthma control.

Setting: Schools in Blantyre (Malawi), Lagos (Nigeria), Durban (South Africa), Kampala (Uganda) and Harare (Zimbabwe).

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  • Dolutegravir is an effective, once-daily HIV treatment for children aged 4 weeks and older, with a population pharmacokinetic model created to assess its dosing based on clinical trial data.
  • The model, involving 239 pediatric participants, accounts for variables like weight, age, and formulation, allowing for accurate predictions of drug concentration across different patient profiles.
  • Findings indicate that the dolutegravir levels in children are comparable to those in adults, and no significant safety issues were linked to drug exposure in this population.
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Background: Cohort studies in adults with HIV showed that dolutegravir was associated with neuropsychiatric adverse events and sleep problems, yet data are scarce in children and adolescents. We aimed to evaluate neuropsychiatric manifestations in children and adolescents treated with dolutegravir-based treatment versus alternative antiretroviral therapy.

Methods: This is a secondary analysis of ODYSSEY, an open-label, multicentre, randomised, non-inferiority trial, in which adolescents and children initiating first-line or second-line antiretroviral therapy were randomly assigned 1:1 to dolutegravir-based treatment or standard-of-care treatment.

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Background: The pattern of paediatric kidney diseases across different regions is influenced by genetic, racial, and environmental differences.

Objectives: The aim of this study was to review the current spectrum and outcome of childhood kidney diseases at Parirenyatwa Group of Hospitals and highlight the challenges of care.

Design: Retrospective observational study.

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With COVID-19 no longer categorized as a public health emergency of international concern, vaccination strategies and priority groups for vaccination have evolved. Africa Centers for Diseases Prevention and Control proposed the '100-100-70%' strategy which aims to vaccinate all healthcare workers, all vulnerable groups, and 70% of the general population. Understanding whether healthcare workers were reached during previous vaccination campaigns and what can be done to address concerns, anxieties, and other influences on vaccine uptake, will be important to optimally plan how to achieve these ambitious targets.

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Objectives: HIV infection impairs bone density in children living with HIV (CLWH). We aimed to determine the prevalence of self-reported fracture (past or current), associated risk factors and disability, by HIV status in Zimbabwean children.

Design: Cross-sectional study.

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  • Super-boosted lopinavir/ritonavir (LPV/r) dosing strategies vary among infants with HIV due to limited access to pediatric ritonavir formulations, impacting treatment effectiveness.
  • A pharmacokinetic study involved infants aged 1-12 months in sub-Saharan Africa receiving LPV/r in conjunction with or without rifampicin-based TB treatment, assessing drug levels through blood samples.
  • Results indicated that infants on rifampicin often had subtherapeutic LPV levels, highlighting the need for alternative antiretroviral options for those with co-infection, such as dolutegravir.
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