Cohort profile: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) - A prospective HIV cohort in rural Tanzania

Letang, Emílio; Kalinjuma, Aneth Vedastus; Glass, Tracy R.; Gamell, Anna; Mapesi, Herry; Sikalengo, George; Luwanda, Lameck; Mnzava, Dorcas; Ntamatungiro, Alex J; Ndaki, Regina; Francis, Gideon; Vanobberghen, Fiona; Furrer, Hansjakob; Klimkait, Thomas; Felger, Ingrid; Tanner, Marcel; Hatz, Christoph; Weisser, Maja; Battegay, Manuel

doi:10.4414/smw.2017.14485

Cited by 25 publications

(23 citation statements)

References 30 publications

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“…The hospital serves a rural population of approximately 1 million people living in the Kilombero, Ulang, and Malinyi districts as a referral center. The hospital has 360 beds, runs an emergency department, and includes the Chronic Diseases Clinic Ifakara, which specializes in HIV and tuberculosis management [16, 17].…”

Section: Methodsmentioning

confidence: 99%

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study

Ndege

Weisser

Elzi

et al. 2019

Open Forum Infectious Diseases

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Background Patients with suspected tuberculosis are often overtreated with antituberculosis drugs. We evaluated the diagnostic value of the focused assessment with sonography for HIV-associated tuberculosis (FASH) in rural Tanzania. Methods In a prospective cohort study, the frequency of FASH signs was compared between patients with confirmed tuberculosis and those without tuberculosis. Clinical and laboratory examination, chest x-ray, Xpert MTB/RIF assay, and culture from sputum, sterile body fluids, lymph node aspirates, and Xpert MTB/RIF urine assay was done. Results Of 191 analyzed patients with a 6-month follow-up, 52.4% tested positive for human immunodeficiency virus, 21.5% had clinically suspected pulmonary tuberculosis, 3.7% had extrapulmonary tuberculosis, and 74.9% had extrapulmonary and pulmonary tuberculosis. Tuberculosis was microbiologically confirmed in 57.6%, probable in 13.1%, and excluded in 29.3%. Ten of eleven patients with splenic or hepatic hypoechogenic lesions had confirmed tuberculosis. In a univariate model, abdominal lymphadenopathy was significantly associated with confirmed tuberculosis. Pleural- and pericardial effusion, ascites, and thickened ileum wall lacked significant association. In a multiple regression model, abnormal chest x-ray (odds ratio [OR] = 6.19; 95% confidence interval [CI], 1.96–19.6; P < .002), ≥1 FASH-sign (OR = 3.33; 95% CI, 1.21–9.12; P = .019), and body temperature (OR = 2.48; 95% CI, 1.52–5.03; P = .001 per °C increase) remained associated with tuberculosis. A combination of ≥1 FASH sign, abnormal chest x-ray, and temperature ≥37.5°C had 99.1% sensitivity (95% CI, 94.9–99.9), 35.2% specificity (95% CI, 22.7–49.4), and a positive and negative predictive value of 75.2% (95% CI, 71.3–78.7) and 95.0% (95% CI, 72.3–99.3). Conclusions The absence of FASH signs combined with a normal chest x-ray and body temperature <37.5°C might exclude tuberculosis.

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Section: Methodsmentioning

confidence: 99%

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study

Ndege

Weisser

Elzi

et al. 2019

Open Forum Infectious Diseases

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“…We conducted a prospective cohort study among HIV-infected patients attending the Chronic Diseases Clinic of Ifakara (CDCI) at the Saint Francis Referral Hospital in Ifakara. All patients attending the CDCI were invited to participate in the Kilombero and Ulanga Antiretroviral Cohort (KIULARCO), a cohort established 2005 comprising almost 9000 enrolled patients and around 3500 patients on active follow-up [ 16 , 17 ]. The CDCI serves the population from 2 different districts in southwestern Tanzania, namely the Kilombero and Ulanga districts in the Morogoro region.…”

Section: Methodsmentioning

confidence: 99%

“…Data on kidney function in PLWHIV from rural SSA regions are scarce, and almost no data in longitudinal cohorts are available. The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) offers a perfect setting to study prevalence rates and predictors of renal impairment among newly diagnosed PLWHIV and incidence rates of renal impairment during follow-up in a rural SSA setting [ 16 , 17 ].…”

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confidence: 99%

Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania

Mapesi

Kalinjuma

Ngerecha

et al. 2018

Open Forum Infectious Diseases

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BackgroundWe assessed the prevalence, incidence, and predictors of renal impairment among people living with HIV (PLWHIV) in rural Tanzania.MethodsIn a cohort of PLWHIV aged ≥15 years enrolled from January 2013 to June 2016, we assessed the association between renal impairment (estimated glomerural filtration rate < 90 mL/min/1.73 m2) at enrollment and during follow-up with demographic and clinical characteristcis using logistic regression and Cox proportional hazards models.ResultsOf 1093 PLWHIV, 172 (15.7%) had renal impairment at enrollment. Of 921 patients with normal renal function at baseline, 117 (12.7%) developed renal impairment during a median follow-up (interquartile range) of 6.2 (0.4–14.7) months. The incidence of renal impairment was 110 cases per 1000 person-years (95% confidence interval [CI], 92–132). At enrollment, logistic regression identified older age (adjusted odds ratio [aOR], 1.79; 95% CI, 1.52–2.11), hypertension (aOR, 1.84; 95% CI, 1.08–3.15), CD4 count <200 cells/mm3 (aOR, 1.80; 95% CI, 1.23–2.65), and World Health Organization (WHO) stage III/IV (aOR, 3.00; 95% CI, 1.96–4.58) as risk factors for renal impairment. Cox regression model confirmed older age (adjusted hazard ratio [aHR], 1.85; 95% CI, 1.56–2.20) and CD4 count <200 cells/mm3 (aHR, 2.05; 95% CI, 1.36–3.09) to be associated with the development of renal impairment.ConclusionsOur study found a low prevalence of renal impairment among PLWHIV despite high usage of tenofovir and its association with age, hypertension, low CD4 count, and advanced WHO stage. These important and reassuring safety data stress the significance of noncommunicable disease surveillance in aging HIV populations in sub-Saharan Africa.

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“…Within routine care, stable patients are assessed by a clinician 4 times per year. During clinical visits, information on demographics, clinical parameters, co-morbidities, prescription of cART and co-medications, adherence and laboratory monitoring are entered into a customized electronic clinical record system designed for subsequent scientific analysis (OpenMRS, http://openmrs.org) [19,20]. In 2012, the clinic integrated TB services and implemented systematic screening for TB with the World Health Organization (WHO) symptom screening tool and Xpert 1 MTB/RIF for patients with suspected TB (Cepheid, USA) [21][22][23][24].…”

Section: Study Site and Patient Populationmentioning

confidence: 99%

Extrapulmonary tuberculosis in HIV-infected patients in rural Tanzania: The prospective Kilombero and Ulanga antiretroviral cohort

et al. 2020

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BackgroundIn sub-Saharan Africa, diagnosis and management of extrapulmonary tuberculosis (EPTB) in people living with HIV (PLHIV) remains a major challenge. This study aimed to characterize the epidemiology and risk factors for poor outcome of extrapulmonary tuberculosis in people living with HIV (PLHIV) in a rural setting in Tanzania. MethodsWe included PLHIV >18 years of age enrolled into the Kilombero and Ulanga antiretroviral cohort (KIULARCO) from 2013 to 2017. We assessed the diagnosis of tuberculosis by integrating prospectively collected clinical and microbiological data. We calculated prevalenceand incidence rates and used Cox regression analysis to evaluate the association of risk factors in extrapulmonary tuberculosis (EPTB) with a combined endpoint of lost to follow-up (LTFU) and death. ResultsWe included 3,129 subjects (64.5% female) with a median age of 38 years (interquartile range [IQR] 31-46) and a median CD4+ cell count of 229/μl (IQR 94-421) at baseline. During the median follow-up of 1.25 years (IQR 0.46-2.85), 574 (18.4%) subjects were diagnosed with tuberculosis, whereof 175 (30.5%) had an extrapulmonary manifestation. Microbiological evidence by Acid-Fast-Bacillus stain (AFB-stain) or Xpert ® MTB/RIF was present in 178/483 (36.9%) patients with pulmonary and in 28/175 (16.0%) of patients with extrapulmonary manifestations, respectively. Incidence density rates for pulmonary Tuberculosis (PTB and EPTB were 17.9/1000person-years (py) (95% CI 14.2-22.6) and 5.8/1000 PLOS ONEPLOS ONE | https://doi.org/10.

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Cohort profile: The Kilombero and Ulanga Antiretroviral Cohort (KIULARCO) - A prospective HIV cohort in rural Tanzania

Cited by 25 publications

References 30 publications

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study

Sonography to Rule Out Tuberculosis in Sub-Saharan Africa: A Prospective Observational Study

Prevalence and Evolution of Renal Impairment in People Living With HIV in Rural Tanzania

Extrapulmonary tuberculosis in HIV-infected patients in rural Tanzania: The prospective Kilombero and Ulanga antiretroviral cohort

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