HIV Care Research Programme / Entebbe Clinical Cohort Project

Lead Research Organisation: MRC/UVRI Uganda Research Unit on AIDS

Abstract

During the era before antiretroviral therapy (ART) became available for the care of patients living with advanced HIV disease, an important challenge was to prevent or to treat effectively the various opportunistic infections that are the main cause of illness and death among HIV infected patients. Examples include bacterial pneumonia, tuberculosis, and infections of the gastrointestinal tract or the brain. A cohort of patients from Entebbe living with HIV infection was first recruited in 1995, as a collaborative project between The AIDS Support Organisation (TASO) and the MRC/UVRI Uganda Research Unit on AIDS. Participants are examined at 6-monthly intervals, when diseased status is documented and blood specimens are investigated. Patients are treated on these occasions and in between whenever ill. The cohort is used to evaluate innovative strategies aiming to prevent opportunistic infections and improve participants health. In the past, studies investigated the effectiveness of a vaccine to prevent pneumonia, of prophylactic treatment to prevent tuberculosis and of cotrimoxazole, a sulphonamide drug given to prevent various bacterial infections. After ART has become available, the cohort is used to investigate additional interventions that may help to simply ART therapy and to make it more cost-effective.

Technical Summary

Purpose: To document morbidity and mortality in a cohort of HIV infected adults and to investigate the interactions between HIV and other infections in order to identify possible interventions. To test innovative interventions that can reduce progression to AIDS or death. Methods: This is a longitudinal urban cohort of HIV-1 infected adults attending six monthly scheduled visits and whenever ill. Follow-up visits involve the application of a questionnaire, a physical examination and specimen collection for full blood count, CD4 count and a blood slide for malaria. Additional laboratory data are collected for diagnostic purposes when patients are ill. Patients are treated and followed-up at the study clinics of the MRC and TASO, but in-patient care is provided at Entebbe Hospital if required. The Entebbe Cohort and the studies conducted herein are mainly supported by the MRC Unit in Uganda from its core funds. Some work has bewn funded by external collaborators. The cohort started in 1995. It has been used to evaluate a variety of innovative interventions, including the effectiveness of a pneumococcal vaccine, the feasibility of isoniazid prophylaxis, and the effect of cotrimoxazole on the morbidity and mortality of HIV infected patients. More recently, the cohort has been one of the major sources for the recruitment of patients into the DART Trial. The cohort also contributes to work funded by the International AIDS Vaccine Initiative, aiming to identiy individuals who produce neutrilazing antibodies. Antiretroviral therapy (ART) became systematically available to HIV patients in the cohort since 2004, partly through the Entebbe Hospital, partly through our partner organization TASO, and partly through the MRC. The Entebbe cohort also facilitates various social science studies e.g. on HIV status disclosure, health related quality of life and sexual behaviour.

Publications

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Brown M (2006) Schistosoma mansoni, nematode infections, and progression to active tuberculosis among HIV-1-infected Ugandans. in The American journal of tropical medicine and hygiene

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Walker AS (2012) Mortality in the year following antiretroviral therapy initiation in HIV-infected adults and children in Uganda and Zimbabwe. in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

 
Description Partnership with The AIDS Support Organisation (TASO) 
Organisation The AIDS Support Organization (TASO)
Country Uganda 
Sector Charity/Non Profit 
PI Contribution MRC funded clinicians supplement patient care of TASO's HIV care clinic in Entebbe.
Collaborator Contribution Source of participants in clinical research. Contribution of ongoing pyschosocial support to people affected by HIV/AIDS who are also MRC research participants. Access to broad community outreach network for dissemination of information on research objectives and research outputs
Impact Overall enhancement of quality of HIV patient care in the Entebbe community as well as developing research capacity
 
Description The Entebbe District Hospital 
Organisation Entebbe District Hospital
Country Uganda 
Sector Hospitals 
PI Contribution Support for training in HIV care and Antiretroviral therapy in particular. Support to hospital in the establishment of their public sector antiretroviral therapy service: through staff training; consulation and refurbishing of suitable clinic space
Collaborator Contribution Provision of inpatient and diagnostic facilities for participants in MRC clinical research. Support of MRC research initiatives with access to communities who utilise the hospital and its satelite referring health centres
Impact Excellent working realtionship which enhances ability to carry out clincial studies and improves overall quality of care for people with HIV infection
 
Description Uganda National Council of Science and Technology 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? Yes
Geographic Reach Local
Primary Audience Policymakers/politicians
Results and Impact National consultative meeting of research and medicines regulators to discuss ethical appropriateness of further trials on cotrimoxazole prophylaxis among HIV infected patients on antiretroviral therapy. We provided data on effect of Cotrimoxazole on haematologic parameters of untreated HIV infected adults.

A call was made for further studies evaluating continued prophylactic treatment with Cotrimoxazole for HIV infected patients on antiretroviral therapy
Year(s) Of Engagement Activity 2008