Browsing by Author "Kasaro M"

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Depression, pregnancy, and HIV: the case to strengthen mental health services for pregnant and post-partum women in sub-Saharan Africa.
(2014-Jul) Stringer EM; Meltzer-Brody S; Kasaro M; Stuebe AM; Wiegand S; Paul R; Stringer JS; Department of Psychiatry, University of North Carolina School of Medicine, Chapel Hill, NC, USA.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA. Electronic address: elizabeth_stringer@med.unc.edu.; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.; Department of Psychiatry, University Teaching Hospital, Lusaka, Zambia.
Hybrid versus vaccine immunity of mRNA-1273 among people living with HIV in East and Southern Africa: a prospective cohort analysis from the multicentre CoVPN 3008 (Ubuntu) study.
(2025-Feb) Garrett N; Tapley A; Hudson A; Dadabhai S; Zhang B; Mgodi NM; Andriesen J; Takalani A; Fisher LH; Kee JJ; Magaret CA; Villaran M; Hural J; Andersen-Nissen E; Ferarri G; Miner MD; Le Roux B; Wilkinson E; Lessells R; de Oliveira T; Odhiambo J; Shah P; Polakowski L; Yacovone M; Samandari T; Chirenje Z; Elyanu PJ; Makhema J; Kamuti E; Nuwagaba-Biribonwoha H; Badal-Faesen S; Brumskine W; Coetzer S; Dawson R; Delany-Moretlwe S; Diacon AH; Fry S; Gill KM; Ebrahim Hoosain ZA; Hosseinipour MC; Inambao M; Innes C; Innes S; Kalonji D; Kasaro M; Kassim P; Kayange N; Kilembe W; Laher F; Malahleha M; Maluleke VL; Mboya G; McHarry K; Mitha E; Mngadi K; Mda P; Moloantoa T; Mutuluuza CK; Naicker N; Naicker V; Nana A; Nanvubya A; Nchabeleng M; Otieno W; Potgieter EL; Potloane D; Punt Z; Said J; Singh Y; Tayob MS; Vahed Y; Wabwire DO; McElrath MJ; Kublin JG; Bekker LG; Gilbert PB; Corey L; Gray GE; Huang Y; Kotze P; ICAP at Columbia University, Eswatini Prevention Center, Mbabane, Eswatini.; Nelson Mandela Academic Clinical Research Unit Clinical Research Site, Mthatha, South Africa.; Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, USA.; University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, USA.; South African Medical Research Council, Isipingo Clinical Research Site, KwaZulu-Natal, South Africa.; Soweto - Kliptown Clinical Research Site, Soweto, South Africa.; Synergy Biomed Research Institute, East London, South Africa.; Qhakaza Mbokodo Research Clinic, Ladysmith, South Africa.; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, Seattle, USA.; COVID-19 Prevention Network, Seattle, USA.; Wits RHI University of the Witwatersrand, Johannesburg, South Africa.; TASK Eden, Western Cape, South Africa.; Synexus Stanza Clinical Research Centre Clinical Research Site, Pretoria, South Africa.; TASK Central, Cape Town, South Africa.; Department of Global Health, University of Washington, Seattle, USA.; KwaZulu-Natal Research Innovation & Sequencing Platform, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban, South Africa.; Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.; Moi University Clinical Research Centre, Eldoret, Kenya.; Centre for the AIDS Programme of Research in South Africa, University of KwaZulu-Natal, Durban, South Africa.; Baylor College of Medicine Children's Foundation-Uganda, Kampala, Uganda.; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.; PHOENIX Pharma (Pty) Ltd, Port Elizabeth, South Africa.; Kisumu Clinical Research Site, Kisumu, Kenya.; South African Medical Research Council, Pretoria, South Africa.; Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, South Africa.; FAMCRU Family Clinical Research Unit, Cape Town, South Africa.; Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa.; Joint Clinical Research Centre, Lubowa, Uganda.; MU-JHU Research Collaboration Clinical Research Site, Kampala, Uganda.; Johns Hopkins Research Project, Blantyre, Malawi.; Center for HIV/AIDS Vaccine Immunology, Duke University School of Medicine, Durham, NC, USA.; National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, USA.; Duke University Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA.; The Aurum Institute, Rustenburg Clinical Research Site, Rustenburg, South Africa.; Synexus Helderberg, Cape Town, South Africa.; The Aurum Institute, Klerksdorp Clinical Research Site, Klerksdorp, South Africa.; MERC Kempton, Kempton, South Africa.; Malawi Clinical Research Site, Lilongwe, Malawi.; MERC Welkom, Welkom, South Africa.; Cape Town HVTN Immunology Laboratory, Hutchinson Centre Research Institute of South Africa, Cape Town, South Africa.; Hutchinson Centre Research Institute of South Africa, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa.; CFHRZ - Ndola Clinical Research Site, Ndola, Zambia.; Department of Medicine, University of Cape Town, Cape Town, South Africa.; University of Cape Town Lung Institute Clinical Research Site, Cape Town, South Africa.; Josha Research Clinical Research Site, Bloemfontein, South Africa.; MERC Middelburg, Middelburg, South Africa.; Centre for Epidemic Response & Innovation, Stellenbosch, South Africa.; Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe.; Kombewa Clinical Research Site, Kisumu, Kenya.; Maseno University School of Medicine, Kenya.; UNC Global Projects/Kamwala District Health Centre, Lusaka, Zambia.; UVRI-IAVI HIV Vaccine Program Ltd. Clinical Research Site, Entebbe, Uganda.; Botswana Harvard AIDS Institute, Gaborone, Botswana.; PHRU Matlosana Clinical Research Site, Klerksdorp, South Africa.; MeCRU Clinical Research Site, Pretoria, South Africa.; Public Health Sciences Division, Fred Hutchinson Cancer Center, Seattle, USA.; Tembisa Clinic 4, Gauteng, South Africa.; Blantyre Clinical Research Site, Blantyre, Malawi.; CFHRZ Clinical Research Site, Lusaka, Zambia.; Newtown Clinical Research, Johannesburg, South Africa.; Clinical HIV Research Unit/Helen Joseph Clinical Research Site, Johannesburg, South Africa.; Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.; Tongaat Clinical Research Site, KwaZulu-Natal, South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: With limited access to mRNA COVID-19 vaccines in lower income countries, and people living with HIV (PLWH) largely excluded from clinical trials, Part A of the multicentre CoVPN 3008 (Ubuntu) study aimed to assess the safety of mRNA-1273, the relative effectiveness of hybrid versus vaccine immunity, and SARS-CoV-2 viral persistence among PLWH in East and Southern Africa during the omicron outbreak. METHODS: Previously unvaccinated adults with HIV and/or other comorbidities associated with severe COVID-19 received either one (hybrid immunity) or two (vaccine immunity) 100-mcg doses of ancestral strain mRNA-1273 in the first month, depending on baseline evidence of prior SARS-CoV-2 infection. In a prospective cohort study design, we used covariate-adjusted Cox regression and counterfactual cumulative incidence methods to determine the hazard ratio and relative risk of COVID-19 and severe COVID-19 with hybrid versus vaccine immunity within six months. The ongoing Ubuntu study is registered on ClinicalTrials.gov (NCT05168813) and this work was conducted from December 2021 to March 2023. FINDINGS: Between December 2021 and September 2022, 14,237 participants enrolled, and 14,002 (83% PLWH, 69% SARS-CoV-2 seropositive) were included in the analyses. Vaccinations were safe and well tolerated. Common adverse events were pain or tenderness at the injection site (26.7%), headache (20.4%), and malaise (20.3%). Severe adverse events were rare (0.8% of participants after the first and 1.1% after the second vaccination), and none were life-threatening or fatal. Among PLWH, the median CD4 count was 635 cells/μl and 18.5% had HIV viraemia. The six-month cumulative incidences in the hybrid immunity and vaccine immunity groups were 2.02% (95% confidence interval [CI] 1.61-2.44) and 3.40% (95% CI 2.30-4.49) for COVID-19, and 0.048% (95% CI 0.00-0.10) and 0.32% (95% CI 0.59-0.63) for severe COVID-19. Among all PLWH the hybrid immunity group had a 42% lower hazard rate of COVID-19 (hazard ratio [HR] 0.58; 95% CI 0.44-0.77; p < 0.001) and a 73% lower hazard rate of severe COVID-19 (HR 0.27; 95% CI 0.07-1.04; p = 0.056) than the vaccine immunity group, but this effect was not seen among PLWH with CD4 counts <350 cells/μl or HIV viraemia. Twenty PLWH had persistent SARS-CoV-2 virus at least 50 days. INTERPRETATION: Hybrid immunity was associated with superior protection from COVID-19 compared to vaccine immunity with the ancestral mRNA-1273 vaccine. Persistent infections among immunocompromised PLWH may provide reservoirs for emerging variants. FUNDING: National Institute of Allergy and Infectious Diseases.
Long-term follow-up of HIV seroconverters in microbicide trials - rationale, study design, and challenges in MTN-015.
(2016-Sep) Riddler SA; Husnik M; Gorbach PM; Levy L; Parikh U; Livant E; Pather A; Makanani B; Muhlanga F; Kasaro M; Martinson F; Elharrar V; Balkus JE; g College of Medicine-John Hopkins University Research Project , Queen Elizabeth Central Hospital , Blantyre , Malawi.; k Division of AIDS , National Institutes of Health , Bethesda , MD , USA.; i Centre for Infectious Disease Research in Zambia , Lusaka , Zambia.; j UNC Project - Tidziwe Centre , Kamuzu Central Hospital , Lilongwe , Malawi.; e Microbicide Trials Network , Magee-Womens Research Institute , Pittsburgh , PA , USA.; h UZ-UCSF Collaborative Research Programme , University of Zimbabwe , Harare , Zimbabwe.; c Department of Epidemiology , University of California , Los Angeles , CA , USA.; b MTN Statistical and Data Management Center , Fred Hutchinson Cancer Research Center , Seattle , WA , USA.; d FHI360 , Durham, NC , USA.; a Division of Infectious Diseases , University of Pittsburgh , Pittsburgh , PA , USA.; f HIV Prevention Research Unit , South African Medical Research Council , Durban , South Africa.; CIDRZ; Centre for Infectious Disease Research in Zambia (CIDRZ)
BACKGROUND: As the effect of biomedical prevention interventions on the natural history of HIV-1 infection in participants who seroconvert is unknown, the Microbicide Trials Network (MTN) established a longitudinal study (MTN-015) to monitor virologic, immunological, and clinical outcomes, as well as behavioral changes among women who become HIV-infected during MTN trials. We describe the rationale, study design, implementation, and enrollment of the initial group of participants in the MTN seroconverter cohort. METHODS: Initiated in 2008, MTN-015 is an ongoing observational cohort study enrolling participants who acquire HIV-1 infection during effectiveness studies of candidate microbicides. Eligible participants from recently completed and ongoing MTN trials are enrolled after seroconversion and return for regular follow-up visits with clinical and behavioral data collection. Biologic samples including blood and genital fluids are stored for future testing. RESULTS: MTN-015 was implemented initially at six African sites and enrolled 100/139 (72%) of eligible women who seroconverted in HIV Prevention Trials Network protocol 035 (HPTN 035, conducted by the MTN). The median time from seroconversion in HPTN 035 to enrollment in MTN-015 was 18 months. Retention was good with >70% of visits completed. Implementation challenges included regulatory reviews, translation, and testing of questionnaires, and site readiness. CONCLUSIONS: Enrollment of HIV-seroconverters into a longitudinal observational follow-up study is feasible and acceptable to participants. Data and samples collected in this protocol will be used to assess safety of investigational HIV microbicides and answer other important public health questions for HIV infected women.
Treatment and outcome of AIDS-related Kaposi sarcoma in South Africa, Malawi and Zambia: an international comparison.
(2017) Rohner E; Kasaro M; Msadabwe-Chikuni SC; Stinson K; Mohamed Z; Tweya H; Egger M; Bohlius J; Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.; Khayelitsha ART Program, Médecins Sans Frontières, Cape Town, South Africa.; Radiation Oncology, Groote Schuur Hospital, Cape Town, South Africa.; Cancer Diseases Hospital, Lusaka, Zambia.; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.; Lighthouse Trust at Kamuzu Central Hospital, Lilongwe, Malawi.; Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland.
HIV-related Kaposi sarcoma (KS) is common in sub-Saharan Africa, but optimal treatment strategies in resource-limited settings remain unclear. We did a retrospective cohort study of adults diagnosed with KS before initiating antiretroviral therapy (ART) at three ART programs in South Africa, Malawi and Zambia. We extracted data from medical charts at HIV clinics and oncological referral centers and used electronic data from the International epidemiology Databases to Evaluate AIDS Southern Africa. We used descriptive statistics to assess tumor (T) and systemic illness (S) stage and treatment of AIDS-KS patients. Kaplan-Meier analyses were used to assess survival after KS diagnosis. We analyzed data from 57 patients in total (20 from South Africa, 20 from Zambia, 17 from Malawi). Median age at KS diagnosis was 35 years and similar across sites. The percentage of patients with poor risk AIDS-KS (T1S1) was similar in South Africa (25%) and Malawi (24%) and higher in Zambia (45%). All AIDS-KS patients initiated ART at the HIV clinic. For KS care, in South Africa 18 patients (90%) were referred to an oncology department; in Malawi and Zambia most patients were managed by the HIV clinics. In Malawi and South Africa, most AIDS-KS patients received systemic chemotherapy, in Zambia one patient received chemotherapy at the HIV clinic. A year after KS diagnosis, 15 patients (75%) in South Africa, 10 patients (50%) in Zambia, and 8 patients (47%) in Malawi were still alive; another 3 patients (15%) in South Africa, 8 patients (40%) in Zambia and 4 patients (24%) in Malawi were lost to follow-up. Management of AIDS-KS patients varied considerably across sites in Malawi, South Africa and Zambia. We need more reliable survival data for AIDS-KS patients in sub-Saharan Africa before we can assess which treatments and clinical pathways should be adopted in a specific setting.