The first week of Uganda APPE 2019 is already over! Granted, it was a quick week since the first two days were spent travelling and much of our time here was spent settling in and getting oriented to our housing and the different parts of Makerere and Mulago where the students will be spending their time. Despite the short week, the students have already been exposed to so much. Issues such as drug availability and antibiotic resistance have been topics of recurring discussion among our group. The students have been enjoying the weekend with some excursions in Kampala- yesterday they visited the Uganda National Mosque and this afternoon we plan to visit one of the craft markets!
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| Melanie M, An, and Joe inside the Uganda National Mosque |
I keep needing to remind myself that it's been 12 months since I was last in Kampala. I've been here enough times now that everything seems familiar yet it is very obvious that when I am a half a world away, things here are constantly changing. The first significant change- the expressway from Entebbe to Kampala has been completed! Everytime I have asked about this road for the last 3 years the response was always "it will be done in 3 months". Guess the inability to predict how long road construction projects will take is a universal one. To put in perspective the impact of this, this expressway took what used to be between a 2-4 hour drive to the airport down to about 45-60 minutes, something we were very grateful for when landing at 11pm after 24 hours of traveling.
A second difference I've already observed is the effect of the rollout of dolutegravir in Uganda. When I was last here in May 2018, the country was just beginning the rollout and it was only available in a limited capacity at a few locations. Since that time, the country has had to deal with the Botswana study report which had the unexpected finding of increased neural tube defects when women were on dolutegravir at the time of conception. The low prevalence of these birth defects (0.09% of pregnancies in the HIV-negative population) makes it very difficult to determine whether the increased prevalence observed in this study (just 4 births out of 496 pregnancies) was truly a drug effect, due to some other unidentified factor, or just random. This has been carefully followed in the months since the report but updates at CROI earlier this year seem promising as there have been no new cases reported. This is all particularly relevant in Uganda as women of child-bearing age make a significant portion of the population living with HIV and dolutegravir is really a game-changer in HIV treatment in regards to efficacy and tolerability. Despite the struggles in rollout with how to manage this uncertain risk, dolutegravir has continued to roll out and uptake is significantly higher now than when I was here last. This opens the door for many research questions. What is the frequency of adverse effects from dolutegravir in this population? Given dolutegravir's potency, will this affect the incidence of IRIS (a question the meningitis team is particularly interested in)? Will we see changes in prevalence of antiretroviral resistance since dolutegravir has a particularly high barrier to resistance?
Many changes have been going on with my research projects as well. One of my projects in Uganda has been a collaborative project with MUJHU research that I have previously posted about (Preventing HIV infection in women). This study had just wrapped on when I was last year and we've spent the last year running lots of assays and analyzing our results. We presented our findings at CROI earlier this year and I'm excited to say these results will soon by published in Clinical Infectious Disease (link to abstract/paper here) . We found some interesting and unexpected interactions between the use of DMPA injection and the vaginal microbiome and the effects on drug concentrations in cervical tissues. Overall, our findings were encouraging in that they provide reassurance that DMPA does not negatively effect drug concentrations and women should be able to use DMPA and oral PrEP safely. Here is a link to a video interview I did with Contagion Live that summarize our findings: Contagion Live Interview.
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| Me with collaborator Flavia Matovu Kiweewa presenting our results at CROI in March 2019 |
Watch for updates in future blogs regarding some other Kampala-based projects!
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