Mildmay Uganda (MUg), an HIV treatment centre near Kampala, the capital of Uganda, has entered into a memorandum of understanding to collaborate with Canadian researchers at the University of Ottawa to develop their research programme and develop an observational cohort database (the MUg observational cohort). The primary objectives of the MUg observational cohort are to monitor clinical care and outcomes of HIV among patients on treatment and to bring awareness to trends that are functional and dysfunctional in HIV care in Uganda. The MUg observational cohort comprises 8835 individuals who initiated combination antiretroviral therapy at MUg between January 2004 and October 2011. There are considerably more women (63.2%) than men in the cohort, and age spans from newborn to 92 years old. The low median age of 31 years (interquartile range: 18-38 years) can be explained by the 24.9% of the cohort aged <18 years. The median baseline CD4 cell count among the entire cohort is 172 cells/mm(3) (interquartile range: 73-249 cells/mm(3)). Data are routinely completed at treatment initiation, and follow-up data are collected routinely through physician visits and laboratory results. Data comprise demographic, behavioural and clinical variables. Collaborations and enquiries relating to the MUg observational cohort are encouraged, and can be addressed to Dr Edward Mills at edward.mills@uottowa.ca.

Background: Gastro-Duodenal Perforations are one of the commonest causes of mortality and morbidity in conditions that require emergency surgery. The main objective of this study was to determine the clinico-pathological pattern and evaluate factors for early postoperative complications of Gastro-duodenal perforations in Mulago. Methods: This was a prospective cohort study of patients with gastro-duodenal perforations managed by simple repair between September 2014 and April 2015 in Mulago was studied. Primary/ secondary outcomes were mortality and complications respectively. Data was managed using stata-12 and multivariate analysis using log-binomial regression model. Results: A total of 65 patients were operated for Gastro-duodenal perforations in the study period. 86.2% were male (M: F 6.2:1). Median age was 35 years (range 16-80 years). 93.9% had gastric perforations. Clinical diagnosis was predicted in 89.3%. H. pylori was present in 7.9%. Mortality was 18.5% and complications developed in 58.5%. Age above 35 and presence of co morbidity predicted mortality (CI 1.22-21.12, p= 0.009) (CI 1.26-8.82, p= 0.024) and early post-operative complications (CI 1.03-2.44, p= 0.031) (CI 1.23-2.44, p= 0.011) respectively. Conclusion: Gastroduodenal perforations remain a common surgical emergency in Mulago hospital affecting mainly young men below 35 years. Majority are gastric perforations. Mortality and early post-operative complications are high, and increase with age and presence of co morbidity.

BackgroundWe aimed to assess the relationship between gender and survival among adult patients newly enrolled on antiretroviral therapy (ART) in Uganda. We also specifically examined the role of antenatal services in favoring women’s access to HIV care.MethodsFrom an observational cohort study, we assessed survival and used logistic regression and differences in means to compare men and women who did not access care through antenatal services. Differences were assessed on measures of disease progression (WHO stage and CD4 count) and demographic (age, marital status, and education), behavioral (sexual activity, disclosure to partner, and testing), and clinical variables (hepatitis B and C, syphilis, malaria, and anemia). A mediational analysis that considered gender as the initial variable, time to death as the outcome, initial CD4 count as the mediator, and age as a covariate was performed using an accelerated failure time model with a Weibull distribution.ResultsBetween 2004 and 2011, a total of 4775 patients initiated ART, and after exclusions 4537 (93.2%) were included in analysis. Men initiating ART were more likely to have a WHO disease stage III or IV (odds ratio: 1.46, 95% confidence interval [CI]: 1.29–1.66), and lower CD4 cell counts compared to women (median baseline CD4 124 cells/mm3, interquartile range [IQR]: 43–205 versus 147 cells/mm3, IQR: 68–212, P-value < 0.0001). Men were at an increased risk of death compared to women (hazard ratio: 1.38, 95% CI: 1.03–1.83). Baseline CD4 cell counts accounted for 43% of the increased risk of death in men (95% CI: 22%–113%). Access to care via antenatal services did not explain differences in outcomes.ConclusionIn this cohort there is a marked increase in risk of mortality for men and approximately half of it can be attributed to their later engagement in care. More effort is required to engage men in care in a timely manner.