Dr Yvette Wibabara

MBChB (Mak), MSc (Mak), Field Epidemiology Fellow (UPHFP)
Email: yvettewibabara@musph.ac.ug
Telephone: +256-773523815

Host Site: STI/AIDS Control Program

Host Mentor: Dr Peter Mudiope and Dr Joshua Musinguzi

ABOUT THE FELLOW

Yvette holds a Master of Science in Clinical Epidemiology and Biostatistics from Makerere University with a background in human medicine. I joined this program in 2019 and what captured my mind is the training through service in applied epidemiology and public health leadership. I have been equipped with knowledge and skills through a hands-on experience.

The program has complemented my previous training by engaging me in large dataset analyses, scientific writing, national level meetings, scientific presentations, trainings to mention but a few, hence building my capacity. I have attained a spirit of excellence and problem-solving skills in my practice as an epidemiologist. During my time as a Fellow, I was attached to the STI/AIDS Control Program (ACP). While there, I led various national level trainings and supervisions, supporting mainly the strategic information and the prevention arms of the program.

  Achievements at the Host Site

• National trainer HIV Recency Surveillance project.
• Trained health workers on the implementation of Recency in the regions of Rwenzori, greater Masaka, Hoima, South western, Mubende, Kampala and Wakiso regions.
• Led site activation teams for Recency testing in the same regions.
• Member of the writing team for the PMTCT impact evaluation report (both base line and follow up reports)
• Participated in COAG baseline assessment in Busoga region in the districts of Bugiri, Bugweri, Namutumba, Kaliro, Mayuge and Jinja Districts.
• Participated in validating new DHIS data tools for ACP
• National trainer for Covid-19 surveillance: Conducted various trainings in KCCA facilities, prisons and Mulago Women‟s specialized Hospital. I also supported 5 districts of Mubende region as an epidemiologist
• Participated in various technical working groups at ACP
• Participated in the ACP M&E strategic plan writing
• Part of the writing team for the HIV epidemiologic status Report Participated in SWOT analysis and results framework development of the EMTCT plan.

Fellowship program specific achievements

Outbreak investigations and other projects

• I led an investigation of Leprosy in Lira District March 2019. This involved all cohort fellows.
  I also led an investigation of TB diagnostic discrepancy in the prisons on Jinja, Mbale, Soroti and Moroto, Feb 2020
• I coordinated Ebola Virus Disease (EVD) Surveillance at the Symposium of Episcopal Conferences of Africa and Madagascar (SECAM) at Namugongo Catholic Shrine, Sep 2019
• I did preliminary investigation of an unknown, acute and fatal disease in one family in Kagadi District as well as investigation of neonatal deaths in Bukooba village Sekanyonyi subcounty Mityana district. These two investigations were resolved with the support of district surveillance focal persons on ground without necessitating travel to the field
• I Co- investigated the food poisoning outbreak caused by consumption of contaminated corn-soy blend meal in Napak and Amudat Districts March 2019, Evaluation of Isoniazid (INH) adverse events in Kampala, COVID-19 screening of travelers at Entebbe International Airport, as well as Malaria Data Quality Assessment conducted in selected health facilities in 15 districts, Uganda, March 2020
• I analyzed program data on HIV testing yield during pregnancy and postnatal periods, a descriptive analysis of surveillance data (2015-2018)
• I designed and implemented two projects, one on Factors influencing Turnaround Time of GeneXpert Test Results at Lower-Level Health Facilities, Kampala City, Uganda, January-December 2018, the second on Improving Recency Testing in Rwenzori Region Using Continuous Quality Improvement Approaches, Uganda 2020.

Conference presentations

• Oral presentation on HIV testing yield during pregnancy and postnatal periods, a descriptive analysis of surveillance data (2015-2018) at the National Field Epidemiology Conference, Kampala, 2019
• Oral presentation on Recency Testing Initiative: the Ugandan Case study at the National Field Epidemiology Conference, Kampala, 2019
• Oral presentation on investigation of TB diagnostic discrepancy in the prisons on Jinja, Mbale, Soroti and Moroto, Feb 2020 at the National Field Epidemiology Conference, Kampala, 2020
• Poster presentation on Factors influencing Turnaround Time of GeneXpert Test Results at Lower-Level Health Facilities, Kampala City at the PEPFAR summit 2020 Kampala
• Poster presentation on HIV testing yield during pregnancy and postnatal periods, a descriptive analysis of surveillance data (2015-2018) in Uganda, at the Joint Annual Scientific Conference (JASH Conference), 2019, Kampala

Written communication

• Editor of Volume 4 issue 2 April-June Uganda National Institute of Public Health (UNIPH) epi bulletin
• Authored three articles in the UNIPH epi bulletin
  o An investigation of Leprosy in Lira district, Uganda, Feb- March 2019
  o The Uganda Public Health Fellowship Program Bids Farewell to Their Resident Advisor
  o Uganda Holds the First African Hepatitis Summit
• Policy brief: The Hepatitis B vaccine birth dose should be part of Uganda‟s routine immunization Schedule
• Newspaper article: Why you need to check for Hepatitis B, just like HIV during pregnancy, published in the New Vision dated 11. July 2019

Manuscripts written

• Manuscript on HIV testing yield during pregnancy and postnatal periods, a descriptive analysis of surveillance data (2015-2018). Submitted to AIDS research Therapy BMC Journal for peer review and publishing. Responded to the comments from the journal reviewers.
• Manuscript on Factors influencing Turnaround Time of GeneXpert Test Results at Lower-Level Health Facilities, Kampala City. Undergoing review by the resident advisor.

Summary of Epidemiological Study: 

 Title: Improving Recency Testing in Rwenzori Region Using Continuous Quality Improvement Approaches, Uganda 2020

Background: a bid to achieve HIV epidemic control, Uganda has initiated point-of-care recency testing using the Asanté™ HIV-1 Rapid Recency™ Assay test kit, which distinguishes between recent (acquired within 12 months) and longstanding infections. Results are to be used for surveillance to identify hot spots for new infections through geo-mapping and guide targeted interventions in the affected regions.
The phased implementation of this project started with trainings in selected districts, on competency to conduct the test, quality assurance and data management, followed by site activation. The project implementation involved shipping samples to Uganda Virus Research Institute (UVRI) for verification of the recency test results. However, four months into the implementation which started in Rwenzori region, some facilities had not implemented recency, as evidenced by no samples received at UVRI in Jan 2020. This hindered the realization of the set targets in terms of numbers. We utilized quality improvement approaches in selected sites in Rwenzori region to improve recency testing.

Methods: We implemented the Quality Improvement Project in Nyabbani and Mahyoro HC III‟s in Kitagwenda district, Rwenzori region. We identified the root causes of the gap in Recency testing. We collected data from the HIV testing register, Recency Testing logbook, and consent forms to serve as our baseline. The data characterized a gap in enrollment to Recency. Using the fish bone analysis, we identified the problem. We conducted continuous medical education sessions on Recency testing for the testers, provided tools for proper documentation (consent forms) and trained the testers on how to fill the documents. There was monthly data collection, analysis and interpretation of results.

Results: There was an increase in the proportion of HIV patients enrolled for Recency in both facilities. For Mahyoro the percentage of patients enrolled for recency increased from 0 % in the three months from site activation to 80% in May-June 2020 in while in Nyabbani HCIII the percentage enrollment rose from 0% to 90% during the same period. By September 2020 when the project ended, all facilities had reached 100% enrollment into Recency

Conclusion: The project achieved an improvement in Recency enrollment in Mahyoro and Nyabbani HC III‟s from 0% to 100%. This was attributed continuous mentoring and monitoring visits. The implementing teams need regular refresher trainings to improve on their confidence and knowledge in conducting recency testing. We recommend continued mentorship and support supervisions for healthcare workers involved in recency training.
Key words: Recency, testing, HIV

Key Skills/lessons learnt during the fellowship

During the fellowship, I learnt and developed the following skill sets:

• Conducting outbreak investigations
• Evaluating and strengthening surveillance systems
• Project desining, implementation monitoring and evaluation
• Scientific writing and presentation; Manuscripts, Abstracts and Policy Briefs
• Editorial skills for scientific articles
• Public speaking
• Data collection and analysis with different soft ware
• Networking skills
• Balancing work and family and multitasking
• Time management duri project implementation

Next Steps

I hope to use all the knowledge and skills acquired to impact my community through expert service where need arises or an opportunity presents. I also hope to mentor those after me in this program if given a chance.

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