Browsing by Author "Kitenge, Marcel"

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    Dzherelo (Immunoxel) as adjunctive therapy to standard antituberculosis treatment in patients with pulmonary tuberculosis : a systematic review and meta-analysis of clinical trials
    (BMC (part of Springer Nature), 2021-05-26) Kitenge, Marcel; Phiri, Bessie; Pheeha, Sara M.; Ogunrombi, Modupe; Nyasulu, Peter S.
    Background: Dzherelo (Immunoxel) is one of the few approved immunomodulators that has been shown to produce positive treatment outcomes in patients with tuberculosis (TB). The aim of this review was to assess the effectiveness of Immunoxel used as adjunct therapy with conventional anti-TB therapy for the treatment of pulmonary TB. Methods: Comprehensive search was conducted in different major databases: PubMed (MEDLINE), EMBASE (OVID), Cochrane Central Register of Controlled Trials (CENTRAL), Scopus (Elsevier). We also searched Google Scholar along with trial registries and hand-searched the reference list of identified original research as well as review articles. Conference proceedings of relevant TB and lung disease annual conferences were also screened. Two independent authors extracted outcome data using a standardised extraction form. Relative risk (RR), mean difference (MD) and standardised mean difference (SMD) with a 95% confidence interval (CI) were used as measures of effect. We assessed certainty of evidence using GRADE. Results: Six clinical trials, which met the criteria for the review, were identified, and these provided data for the review. Overall results from the six trials that compared antituberculosis treatment (ATT) alone versus ATT and Immunoxel, and ATT and placebo versus ATT and Immunoxel showed an increased number of patients becoming sputum-negative in the Immunoxel group (RR 3.19; 95% CI 2.44 to 4.17; 488 participants). There was also reduction in body temperature among patients receiving Immunoxel compared to ATT alone (MD −0.20, 95% CI −0.22 to −0.18, 345 participants). However, there were no differences in body weight changes across all the studies (MD 5.65; 95% CI −0.80 to 12.11; 382 participants). Conclusion: Current evidence indicates that the use of Immunoxel as an adjunctive treatment in patients with pulmonary tuberculosis has the potential to enhance the efficacy of antituberculosis treatment. However, welldesigned, conducted and adequately powered clinical trials are needed to establish the effectiveness of this adjunctive treatment.
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    Effects of antiretroviral therapy in HIV-positive adults on new HIV infections among young women : a systematic review protocol
    (BMC, 2019-03-05) Chibawara, Trust; Mbuagbaw, Lawrence; Kitenge, Marcel; Nyasulu, Peter S.
    Background: The HIV/AIDS pandemic has struck regions, countries, and populations in different ways. With the introduction of antiretroviral drugs, people living with HIV (PLHIV) have a much better prognosis, even though there are still many new infections in young women. The role of widespread antiretroviral therapy (ART) on the incidence of HIV in young women is unknown. Methods: We will conduct a comprehensive search of MEDLINE (PubMed), Excerpta Medica database (EMBASE), Scopus, Google Scholar, Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, Latin American and Caribbean Health Sciences Literature (LILACS), conference abstracts, and gray literature sources to identify any relevant literature. We will include randomized and non-randomized clinical trials and cohort studies in which ART was offered to adults aged 18 and above reporting outcomes in females aged 15 to 24 years. The outcomes of interest are HIV incidence, ART initiation, adherence, retention, and viral load suppression. We will screen titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements will be resolved by consensus. We will extract data on the risk of HIV infection in younger females after the use of ART in the adult population. Discussion: To our knowledge, this is the first systematic review to look at the impact of ART use among adults on HIV incidence in young women. The results of this review will be used in a modeling study to simulate the effects of using ART as an effective tool to prevent sexual transmission of HIV to young women. Our findings will inform the treatment-as-prevention (TasP) strategy to reduce new HIV infections among young women.
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    Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings : a systematic review and meta analysis
    (BMC (part of Springer Nature), 2020) Lailulo, Yishak; Kitenge, Marcel; Jaffer, Shahista; Aluko, Omololu; Nyasulu, Peter S.
    Background: Despite the increase in the number of people accessing antiretroviral therapy (ART), there is limited data regarding treatment failure and its related factors among HIV-positive individuals enrolled in HIV care in resource-poor settings. This review aimed to identify factors associated with antiretroviral treatment failure among individuals living with HIV on ART in resource-poor settings. Methods: We conducted a comprehensive search on MEDLINE (PubMed), Excerpta Medica Database (EMBASE), Cochrane Central Register of Controlled Trials (CENTRAL), World Health Organization’s (WHO’s) library database, and Latin American and Caribbean Health Sciences Literature (LILACS). We included observational studies (cohort, casecontrol, and cross-sectional studies) where adolescents and adults living with HIV were on antiretroviral treatment regardless of the ART regimen. The primary outcomes of interest were immunological, virological, and clinical failure. Some of the secondary outcomes were mm3 opportunistic infections, WHO clinical stage, and sociodemographic factors. We screened titles, abstracts, and the full texts of relevant articles in duplicate. Disagreements Results: Antiretroviral failure was nearly 6 times higher among patients who had poor adherence to treatment as compared to patients with a good treatment adherence (OR = 5.90, 95% CI 3.50, 9.94, moderate strength of evidence). The likelihood of the treatment failure was almost 5 times higher among patients with CD4 < 200 cells/ mm3 compared to those with CD4 ≥ 200 CD4 cells/mm3 (OR = 4.82, 95% CI 2.44, 9.52, low strength of evidence). This result shows that poor adherence and CD4 count below < 200 cells/mm3 are significantly associated with treatment failure among HIV-positive patients on ART in a resource-limited setting. Conclusion: This review highlights that low CD4 counts and poor adherence to ART were associated to ART treatment failure. There is a need for healthcare workers and HIV program implementers to focus on patients who have these characteristics in order to prevent ART treatment failure. were resolved by consensus. We analyzed the data by doing a meta-analysis to pool the results for each outcome of interest.