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Dr. Muwereza Peter
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ABOUT THE FELLOWI am a Field Epidemiologist with a Master of Public Health from Makerere University, School of Public Health and a Bachelor of Medicine and Surgery from Makerere University, College of Health Sciences. During my time as a Public Health Fellow, I was hosted at the Aids Control Program, Ministry of Health. Achievements at the Host Site
Fellowship program specific achievements
Conference presentations
Descriptive Analysis of Dolutegravir (DTG) Adverse Events Surveillance data in Uganda, 2017-2019 – NFEC 2019 Publications and manuscripts written
Manuscripts being prepared:
Summary of Epidemiological Study: Title: Effects of transition to Dolutegravir based ART regimen on adherence, viral suppression and incidence of Opportunistic Infections among ART clients, Bugweri District, 2020 Background: In 2017, the world health organization recommended transitioning to dolutegravir-based first-line ART regimens (DTG), particularly in regions where pre-treatment drug resistance to non-nucleoside reverse transcriptase inhibitor first-line regimens reaches 10%, such as Southern and Eastern Africa. DTG has better side effects profile than Efavirenz (EFV) and is associated with a lower risk of virologic failure and resistance compared to EFV. Studies from predominantly high-income settings found that dolutegravir-based regimens have superior efficacy, tolerability and durability compared with existing first-line regimens. However, after the national wide roll out of DTG initiation on HIV patient care in 2019 in Uganda, reports on adverse events following initiation of DTG were received by National Drug Authority from mainly Kampala and Wakiso Districts and a few other regions. A case series from the Infectious Diseases Institute (IDI) raised initial concern that patients receiving DTG for HIV treatment were developing clinically significant hyperglycaemia/Diabetes Mellitus and/or other clinical adverse events at a higher-than-expected frequency. This study aimed at establishing the effects of transition to Dolutegravir based ART regimen on; adherence, viral suppression, retention in care, incidence of Opportunistic Infections and adverse events among ART clients in Bugweri District, Uganda, 2020. Methods: We collected data from all the six ART clinics in Bugweri District. Patients‟ files who had been transitioned to the Dolutegravir-based first-line ART regimens were reviewed for age, sex, regimen type, adherence, side effects, VL suppression, retention in care, Opportunistic infections, CD4 counts. T-tests, univariate, and bivariate analyses to make comparisons of characteristics before and after DTG transitioning were conducted. Results: A total of 663 records were reviewed; 51% (337) were female and 49% (326) were male. The mean age was 48 years, ranging from 12 to 97 years. All the 663 were transitioned to Tenofovir/Lamivudine/Dolutegravir (TLD). Of the 663 patients, 93% (618) were virally suppressed while 7% (45) were not suppressed before transitioning to DTG, 96% (529) of those on DTG were virally suppressed while 4% (24) were not suppressed. The difference in suppression rate between regimens not statically significant, 95%CI -3580-2444, p-value 0.36. The adherence level for patients on other regimens before DTG was: 98% (650) had good adherence, 1.5% (10) had poor adherence, and 0.45% (3) had fair adherence. While on DTG-based regimens, 99% (659) had good adherence, while 0.3% (2) had fair and 0.3% (2) had poor adherence. The WHO staging was the same before and after the start of DTG-based regimens. While on non-DTG based regimens of the 663 patients, 34% (227) patients reported at least a side effect and 0.45% (3) patients reported side effects while on DTG. While on non-DTG based regimens, 5.1% (34) patients were at some point lost to follow up, but and 2.9% (19) of those on DTG-based regimens were lost to follow-up. Of the 663 patients on non-DTG based regimens 1.7% (11) had an OI before transitioning them to DTG while 0.45% (3) patients had at least an OI on DTG for at least 6 months. Conclusion and Recomendations: DTG showed better side effects profile compared to other regimens. This is contrary to initial reports from earlier case studies in Uganda. We also observed that adherence, retention in care, and viral load suppression were better than that of other regimens. Whereas transitioning of patients from other regimens to DTG was supposed to be for stable virally suppressed clients on first line ART, non-suppressed patients were also transitioned in some health centres. No reports were sent to NDA on adverse events. Training of health workers to ensure appropriate implementation of ART guidelines as well as pharmacovigilance is recommended. Key Skills Lessons Learnt
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