Department of Internal Medicine

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Browsing Department of Internal Medicine by Author "Apiyo, Paska"

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    Challenges associated with the roll-out of HCC surveillance in sub-Saharan Africa - the case of Uganda
    (Journal of Hepatology, 2020) Stijn, Van Hees; Muyindike, Winnie; Erem, Geoffrey; Ocama, Ponsianoo; Seremba, Emmanuel; Apiyo, Paska; Michielsen, Peter; Okwir, Mark; Vanwolleghem, Thomas
    In sub-Saharan Africa, where HBV infections are the main cause of HCC, surveillance programs are mostly not available.2 Nonetheless, with an incidence rate of 8.9 cases per 100,000 inhabitants per year, which is likely to be an underestimate, HCC surveillance is a pressing medical need in this part of the world.2,3 The recent introduction of country-wide vaccination programs in these countries will likely result in a drop in HCC incidence a few decades from now, but this does not apply to patients that are currently infected.4 In a recent African cohort of 1,315 hepatocellular tumors, 84% of the tumors were diagnosed at a late, multifocal disease stage with a mean size of 8 ± 4 cm and a median survival of 2.5 months.2 Given the strong association between early detection and improved survival, these findings highlight the need to set up surveillance programs in sub-Saharan Africa, provided curative treatment options are available.1 We have recently launched such a program in Uganda, where HCC is one of the most common malignancies. Age-standardized incidence rates of 6.5/100,000 in men and 6.0/100,000 in women have been reported. Unfortunately, its mortality rate almost mirrors its incidence.2,5–7 Following a kick-off meeting in Kampala in August 2019 where representatives from the radiology and internal medicine departments of 5 Ugandan, tertiary care hospitals were present, a questionnaire was launched among the participants to identify gaps that needed bridging in order to set up an HCC surveillance program. Participants were asked about the number of patients with HBV and HCC in their centers, the availability of alpha fetoprotein and ultrasound testing, as well as the available manpower to perform ultrasound. A summary of the findings is displayed in Table 1. None of the centers had an HCC surveillance program in place. However, outpatient HBV clinics are available in 3/5 centers and planned in the fourth. The estimated number of patients fre quenting these HBV clinics varies between <100 and 500–1,000. Given a nationwide HBsAg seroprevalence of 10% in Uganda, these varying numbers might point to the regional differences in HBV-infected patients, but they may also point to variations in linkage to care.8 Ultrasound machines are widely available in all centers and except for 2, all were manufactured within the last decade (Table 1). The number of staff trained to perform ultrasound largely varies between centers, ranging between 1 and 39, but corresponds to a coverage of 87% for the total number of medical staff at the radiology departments (radiologists/radiographers). Regular post-graduate training for ultrasound staff is provided in 3/5 centers. AFP testing is avail able in 2 centers; in a third center testing is offered based on reagent availability. A registry of the number of HCC cases is available in 1 center, though survival data are not systematically recorded. Diagnosis of HCC is based on clinical signs, such as a palpable liver mass or liver lesions on ultrasound in patients with clinical deterioration and not identified during screening of patients at risk. Liver surgery for non-advanced HCC is available in 1 center. Our survey highlights the feasibility of rolling out an HCC surveillance program in Uganda, as manpower, US equipment and treatment options are available. Further investment should aim at establishing HBV clinics with optimal linkage to care and broadening HCC treatment capacities. Our findings may guide other groups aiming to roll out surveillance programs in different countries. keywords: Challenges, HCC surveillance, and sub-Saharan Africa
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    Impaired renal function and associated risk factors in newly diagnosed HIV-infected adults in Gulu Hospital, Northern Uganda
    (BMC nephrology, 2015) Odongo, Pancras; Wanyama, Ronald; Obol, James Henry; Apiyo, Paska; Byakika-Kibwika, Pauline
    Background: Screening for renal diseases should be performed at the time of diagnosis of human immunodeficiency virus (HIV) infection. Despite the high prevalence of HIV/AIDS in Northern Uganda, little is known about the status of renal function and its correlates in the newly diagnosed HIV-infected individuals in this resource limited region. We aimed to determine the status of renal function and factors associated with impaired renal function in newly diagnosed HIV-infected adults in Northern Uganda. Methods: This was a seven month cross-sectional hospital-based study, involving newly diagnosed HIV-infected patients, 18 years and older. Patients with history of diabetes mellitus, hypertension and renal disease were excluded. Estimated glomerular filtration rate (eGFR) was calculated using Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula (Table one). Factors associated with impaired renal function (eGFR < 60 ml/min/1.73 m2) were thus sought. Results: We enrolled 361 participants (230, 63.7% female) with Mean ± standard deviation age of 31.4 ± 9.5 years. 52, (14.4%) had impaired renal function (eGFR <60 mL/min/1.73 m2) and of this 37 (71.2%) moderate renal impairment (eGFR 30–59.9 mL/min/1.73 m2) while 15 (28.8%) had severe renal impairment (eGFR <30 mL/min/1.73 m2). Proteinuria was recorded in 189 (52.4%) participants. Of these, 154 (81.5%) had mild (1+) while 8 (4.2%) had severe (3+) proteinuria. Using logistic regression, age, CD4 cell count, and proteinuria were significantly associated with impaired renal function; age >34 years (OR 2.8, 95% CI 1.3 – 5.9; P =0.009), CD4 count <350 cells/μL (OR 2.4, 95% CI 1.0-4.7; P =0.039) and proteinuria (OR 9.6, 95% CI 5.2–17.9; P < 0.001). Conclusion: The prevalence of impaired renal function was high in new HIV-infected individuals in this region with limited resources. So, screening for renal disease in HIV is recommended at the time of HIV diagnosis