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Article ; Online: Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. Reply.

Okafor, Elizabeth C / Pastick, Katelyn A / Rajasingham, Radha

2020 Volume 383, Issue 11, Page(s) 1089

MeSH term(s)	Betacoronavirus ; Coronavirus Infections/drug therapy ; Coronavirus Infections/epidemiology ; Humans ; Hydroxychloroquine ; Pandemics ; Pneumonia, Viral/epidemiology
Chemical Substances	Hydroxychloroquine (4QWG6N8QKH)
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc2023617
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Article: Rates of refusal of clinical autopsies among HIV-positive decedents and an overview of autopsies in Uganda.

Namuju, Olivie C / Kwizera, Richard / Lukande, Robert / Pastick, Katelyn A / Taylor, Jonee M / Nicol, Melanie R / Boulware, David R / Meya, David B

Wellcome open research

2022 Volume 6, Page(s) 302

Abstract: Background: ...

Abstract	Background:
Language	English
Publishing date	2022-02-01
Publishing country	England
Document type	Journal Article
ISSN	2398-502X
ISSN	2398-502X
DOI	10.12688/wellcomeopenres.17316.2
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. Reply

Okafor, Elizabeth C / Pastick, Katelyn A / Rajasingham, Radha

N Engl J Med

Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #646763
Database	COVID19

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Article: Baseline Cytomegalovirus Viremia at Cryptococcal Meningitis Diagnosis Is Associated With Long-term Increased Incident TB Disease and Mortality in a Prospective Cohort of Ugandan Adults With HIV.

Ellis, Jayne / Bangdiwala, Ananta S / Skipper, Caleb P / Tugume, Lillian / Nsangi, Laura / Matovu, John / Pastick, Katelyn A / Ssebambulidde, Kenneth / Morawski, Bozena M / Musubire, Abdu K / Schleiss, Mark R / Moore, David A J / Jarvis, Joseph N / Boulware, David R / Meya, David B / Castelnuovo, Barbara

Open forum infectious diseases

2023 Volume 10, Issue 9, Page(s) ofad449

Abstract: Background: Adults with HIV-associated cryptococcal meningitis have overlapping burdens of cytomegalovirus (CMV) and tuberculosis (TB) coinfections. CMV infection/reactivation is strongly associated with CMV-specific memory T-cell activation and ... ...

Abstract	Background: Adults with HIV-associated cryptococcal meningitis have overlapping burdens of cytomegalovirus (CMV) and tuberculosis (TB) coinfections. CMV infection/reactivation is strongly associated with CMV-specific memory T-cell activation and upregulation of type 1 interferons, which may lead to increased risk of TB disease and poor outcomes. Methods: We conducted a cohort study of 2-week survivors of cryptococcal meningitis during 2010-2021 to determine TB incidence and all-cause mortality over time stratified by baseline CMV status. Results: We followed 497 Ugandans with HIV-associated cryptococcal meningitis for a median (interquartile range) of 4.6 (2.6-53.9) months. Overall, 42% (210/497) developed incident TB disease or died. One-fifth (98/497, 19.7%) developed incident TB disease, and 29% (142/497) of participants died during follow-up. Of 259 participants with CMV viral load measured at baseline, 37% (96/259) had concurrent CMV viremia (defined as anyone with detectable CMV DNA in plasma/serum by qualitative polymerase chain reaction [PCR] detection). Of 59 with measured CMV immunoglobulin G (IgG), 100% had positive CMV IgG antibody serology (≥10 enzyme-linked immunosorbent assay units/mL). CMV viremia was positively associated with higher HIV viral load (196 667 vs 73 295 copies/mL; Conclusions: CMV viremia >1000 IU/mL at meningitis diagnosis was associated with increased incident TB disease and mortality during long-term follow-up. Future studies to determine the causal relationship and potential for therapeutic intervention are warranted.
Language	English
Publishing date	2023-09-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofad449
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Article: Pregnancy-Related Tuberculous Meningitis and Immune Reconstitution Inflammatory Syndrome: A Case Series and Systematic Review.

Pastick, Katelyn A / Kagimu, Enock / Dobbin, Joanna / Ssebambulidde, Kenneth / Gakuru, Jane / Milln, Jack / Nakabuye, Betty / Meya, David B / Boulware, David R / Cresswell, Fiona V / Bahr, Nathan C

Open forum infectious diseases

2022 Volume 9, Issue 10, Page(s) ofac513

Abstract: Background: Tuberculosis is a leading cause of death among women of reproductive age. However, tuberculous meningitis, the most severe form of extrapulmonary tuberculosis, is rarely discussed in pregnancy despite this being a unique period of immune ... ...

Abstract	Background: Tuberculosis is a leading cause of death among women of reproductive age. However, tuberculous meningitis, the most severe form of extrapulmonary tuberculosis, is rarely discussed in pregnancy despite this being a unique period of immune modulation that may predispose women to active disease. Methods: We identified and described cases of tuberculous meningitis among pregnant or postpartum women screened during meningitis clinical trials in Uganda from 2018 to 2022. We conducted a systematic literature review via PubMed/Medline and Embase for all English-language publications from 1970 to 10 July 2022, to identify additional cases. Results: We identified 8 cases of pregnancy-related tuberculous meningitis in Ugandan women living with human immunodeficiency virus (HIV) and 40 additional cases via systematic literature review (none HIV-positive). Of all combined cases, 50% (24/48) were diagnosed postpartum; 50% (24/48) had initial onset during pregnancy, of which 38% (9/24) had worsening of symptoms or disease relapse following pregnancy cessation. Diagnosis was missed or delayed in 33% (16/48) of cases. For those with known outcomes, maternal mortality was 23% (11/48) and fetal/neonatal mortality was 30% (13/44). Of maternal survivors, 30% (11/37) had residual neurologic deficits. Conclusions: The true incidence of tuberculous meningitis in pregnancy or the postpartum period is unclear but likely underappreciated. To date, nearly all published cases have occurred in HIV-negative or otherwise immunocompetent women. Given the well-described physiological immunosuppression during pregnancy and subsequent reconstitution postpartum, physicians must be aware of tuberculous meningitis and pregnancy-related immune reconstitution inflammatory syndrome, especially in countries with a high burden of tuberculosis and in women living with HIV.
Language	English
Publishing date	2022-10-06
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofac513
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Article ; Online: A post-mortem analysis of tenofovir, lamivudine, efavirenz and fluconazole penetration in female genital tissues.

Wang, Fan / Namuju, Olivie C / Pastick, Katelyn A / Abdusalaamu, Kizito / Mishra, Usha / Collins, Lindsey / Boulware, David R / Lukande, Robert / Meya, David B / Nicol, Melanie R

The Journal of antimicrobial chemotherapy

2022 Volume 77, Issue 11, Page(s) 3180–3186

Abstract: Background: Optimal penetration of anti-infectives in the female genital tract (FGT) is paramount in the treatment and prevention of infectious diseases. While exposure of anti-infectives in lower FGT tissues (e.g. cervix, vagina) has been described, ... ...

Abstract	Background: Optimal penetration of anti-infectives in the female genital tract (FGT) is paramount in the treatment and prevention of infectious diseases. While exposure of anti-infectives in lower FGT tissues (e.g. cervix, vagina) has been described, little data exist on upper genital tissues (e.g. ovary, uterus). Methods: Autopsies were performed and post-mortem tissues were collected within 24 h of death for female participants with advanced HIV in Uganda (n = 27). Tenofovir, lamivudine, efavirenz and fluconazole concentrations were measured using LC-MS/MS in plasma, ovarian, uterine, cervical and vaginal tissues. Tissue penetration was calculated as tissue-to-plasma concentration ratios (TPRs). Results: TPRs of tenofovir, lamivudine and fluconazole were highest in vaginal tissue (medians 1.86, 1.83 and 0.94, respectively), while the TPR of efavirenz was highest in ovarian tissue (median 0.65). With cervix as a reference compartment, vaginal TPRs were significantly higher than cervical for all four drugs; TPRs of efavirenz in uterine and ovarian compartments were also significantly higher than cervical. Most of the post-mortem FGT samples had a TPR of greater than 1 for tenofovir and lamivudine, while less than 50% had a TPR of greater than 1 for both efavirenz and fluconazole. Conclusions: Penetration of anti-infectives was not homogeneous among the FGT compartments. Approximately 70% of FGT tissues had a TPR of greater than 1 for tenofovir and lamivudine, favouring the prevention of local HIV replication and transmission in the FGT.
MeSH term(s)	Female ; Humans ; Tenofovir/therapeutic use ; Lamivudine/therapeutic use ; Fluconazole/pharmacology ; Fluconazole/therapeutic use ; Chromatography, Liquid ; Autopsy ; HIV Infections ; Tandem Mass Spectrometry ; Benzoxazines/therapeutic use ; Genitalia, Female ; Anti-HIV Agents/therapeutic use
Chemical Substances	Tenofovir (99YXE507IL) ; Lamivudine (2T8Q726O95) ; efavirenz (JE6H2O27P8) ; Fluconazole (8VZV102JFY) ; Benzoxazines ; Anti-HIV Agents
Language	English
Publishing date	2022-09-07
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	191709-2
ISSN	1460-2091 ; 0305-7453
ISSN (online)	1460-2091
ISSN	0305-7453
DOI	10.1093/jac/dkac300
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Zs.A 1197: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG)
Zs.MO 124: Show issues

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Article: A Systematic Review of Treatment and Outcomes of Pregnant Women With COVID-19-A Call for Clinical Trials.

Pastick, Katelyn A / Nicol, Melanie R / Smyth, Elizabeth / Zash, Rebecca / Boulware, David R / Rajasingham, Radha / McDonald, Emily G

Open forum infectious diseases

2020 Volume 7, Issue 9, Page(s) ofaa350

Abstract: Background: Data pertaining to COVID-19 in pregnancy are limited; to better inform clinicians, we collated data from COVID-19 cases during pregnancy and summarized clinical trials enrolling this population.: Methods: We performed a systematic ... ...

Abstract	Background: Data pertaining to COVID-19 in pregnancy are limited; to better inform clinicians, we collated data from COVID-19 cases during pregnancy and summarized clinical trials enrolling this population. Methods: We performed a systematic literature review of PubMed/MEDLINE to identify cases of COVID-19 in pregnancy or the postpartum period and associated outcomes. We then evaluated the proportion of COVID-19 clinical trials (from ClinicalTrials.gov) excluding pregnant or breastfeeding persons (both through June 29, 2020). Results: We identified 11 308 published cases of COVID-19 during pregnancy. Of those reporting disease severity, 21% (416/1999) were severe/critical. Maternal and neonatal survival were reassuring (98% [10 437/10 597] and 99% [1155/1163], respectively). Neonatal disease was rare, with only 41 possible cases of infection reported in the literature. Of 2351 ongoing COVID-19 therapeutic clinical trials, 1282 were enrolling persons of reproductive age and 65% (829/1282) excluded pregnant persons. Pregnancy was an exclusion criterion for 69% (75/109) of chloroquine/hydroxychloroquine, 80% (28/35) of lopinavir/ritonavir, and 48% (44/91) of convalescent plasma studies. We identified 48 actively recruiting or completed drug trials reporting inclusion of this population. Conclusions: There are limited published reports of COVID-19 in pregnancy despite more than 14 million cases worldwide. To date, clinical outcomes appear reassuring, but data related to important long-term outcomes are missing or not yet reported. The large number of clinical trials excluding pregnant persons, despite interventions with safety data in pregnancy, is concerning. In addition to observational cohort studies, pregnancy-specific adaptive clinical trials could be designed to identify safe and effective treatments.
Keywords	covid19
Language	English
Publishing date	2020-08-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	2757767-3
ISSN	2328-8957
ISSN	2328-8957
DOI	10.1093/ofid/ofaa350
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Differences in Reasons for Late Presentation to HIV Care in Uganda Among Men and Women.

Lofgren, Sarah M / Tsui, Sharon / Natala, Nakita / Nakasujja, Noeline / Sebuliba, Raymond / Ndyetukira, Jane Francis / Arinda, Anita / Akinyange, Vanessa / Hullsiek, Kathy H / Nalintya, Elizabeth / Sadiq, Alisat / Pastick, Katelyn A / Stadleman, Anna / Meya, David / Boulware, David R

AIDS and behavior

2022 Volume 27, Issue 1, Page(s) 303–313

Abstract: Late presentation to HIV care, i.e., presenting with < 200 CD4 cells/mL, is associated with higher mortality and worse outcomes. Despite that, a quarter of people living with HIV in Uganda still present late to care. We surveyed Ugandans living with HIV ... ...

Abstract	Late presentation to HIV care, i.e., presenting with < 200 CD4 cells/mL, is associated with higher mortality and worse outcomes. Despite that, a quarter of people living with HIV in Uganda still present late to care. We surveyed Ugandans living with HIV who enrolled in clinic ≤ 90 days prior. We compared groups who presented 'late' with CD4 < 200 and 'early' with CD4 > 350, stratifying by sex. We found men who presented late had higher externalized stigma than early presenters. Thirty-six percent of the entire cohort were depressed. Social support was stronger in late presenters versus early, although weak overall. Social support was inversely correlated with depression, with social support dropping as depression increased. Interventions to improve clinic privacy, reduce stigma, improve social support, and help women disclose their HIV status to male partners are needed to reduce late presentation to HIV care.
MeSH term(s)	Humans ; Male ; Female ; HIV Infections/diagnosis ; HIV Infections/epidemiology ; Uganda/epidemiology ; CD4 Lymphocyte Count ; Social Support ; Delayed Diagnosis
Language	English
Publishing date	2022-08-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	1339885-4
ISSN	1573-3254 ; 1090-7165
ISSN (online)	1573-3254
ISSN	1090-7165
DOI	10.1007/s10461-022-03764-9
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Zs.A 6451: Show issues

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Article ; Online: Rates of refusal of clinical autopsies among HIV-positive decedents and an overview of autopsies in Uganda [version 2; peer review

Katelyn A. Pastick / Richard Kwizera / Melanie R. Nicol / Robert Lukande / David B. Meya / David R. Boulware / Olivie C. Namuju / Jonee M. Taylor

Wellcome Open Research, Vol

3 approved]

2022 Volume 6

Abstract: Background: Human immunodeficiency virus (HIV)-related mortality remains high in sub-Saharan Africa. Clinical autopsies can provide invaluable information to help ascertain the cause of death. We aimed to determine the rate and reasons for autopsy ... ...

Abstract	Background: Human immunodeficiency virus (HIV)-related mortality remains high in sub-Saharan Africa. Clinical autopsies can provide invaluable information to help ascertain the cause of death. We aimed to determine the rate and reasons for autopsy refusal amongst families of HIV-positive decedents in Uganda. Methods: We consented the next-of-kin for post-mortem examinations among Ugandan decedents with HIV from 2017-2020 at Kiruddu National Referral Hospital. For those who refused autopsies, reasons were recorded. Results: In this analysis, 165 decedents with HIV were included from three selected wards at Kiruddu National Referral Hospital. Autopsy was not performed in 45% of the deceased patients; the rate of autopsy refusal was 36%. The most common reasons for autopsy refusal were time constraints (30%), family satisfaction with clinical diagnosis (15%), fear of disfigurement of the remains (15%), and lack of perceived benefit (15%). By seeking consent from multiple family members and clearly explaining to them the purpose of performing the autopsy, we found a reduction in the rate of autopsy refusal among relatives of the deceased patients at this hospital compared to previous studies at the same site (36% vs. 60%). Conclusions: We found lower rates of autopsy refusal compared to previous studies at the same site. This underscores the importance of clearly explaining the purpose of autopsies as they increase active sensitization about their relevance and dispel myths related to autopsies among the general population. Good, culturally sensitive, and timely explanations to the family of the benefits of autopsy increase the rate of obtaining permission. Building capacity for performing autopsies by training more pathologists and increasing laboratory resources to decrease the turn-around-time for autopsy reports and extending these services to peripheral health facilities could improve autopsy acceptance rates.
Keywords	Autopsy ; postmortem changes ; autopsy refusal ; mortality ; HIV Seropositivity ; Uganda ; eng ; Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	Wellcome
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Barriers to HIV care in Uganda and implications for universal test-and-treat: a qualitative study.

Lofgren, Sarah M / Tsui, Sharon / Atuyambe, Lynn / Ankunda, Leander / Komuhendo, Robina / Wamala, Nathan / Sadiq, Alisat / Kirumira, Paul / Srishyla, Diksha / Flynn, Andrew / Pastick, Katelyn A / Meya, David B / Nakasujja, Noeline / Porta, Carolyn

AIDS care

2021 Volume 34, Issue 5, Page(s) 597–605

Abstract: Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 ... ...

Abstract	Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) "ART-experienced" or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL "late presenters" or 3) ART naïve CD4 count >350 cells/uL "early presenters". In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors.
MeSH term(s)	Alcoholism ; CD4 Lymphocyte Count ; Female ; HIV Infections/diagnosis ; HIV Infections/drug therapy ; Humans ; Male ; Qualitative Research ; Social Stigma ; Uganda
Language	English
Publishing date	2021-07-27
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1012651-x
ISSN	1360-0451 ; 0954-0121
ISSN (online)	1360-0451
ISSN	0954-0121
DOI	10.1080/09540121.2021.1946000
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Zs.A 2799: Show issues

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