Lilian Bulage has a biological science background from Kyambogo University and a Master of Health Services Research from Makerere University. Prior to joining PHFP-FET, Lilian worked at the National Tuberculosis and Leprosy Program (NTLP) specifically at the National Tuberculosis Reference Laboratory (NTRL); a South African National Accreditation System (SANAS) accredited and WHO Supra-National Reference Laboratory. At NTRL, Lilian worked as a Laboratory Scientist in-charge of External Quality Assurance (EQA) activities for the South Eastern TB Zone.

In-addition, she worked as a secretary in-charge of the NTLP Tuberculosis Research and Innovations Forum. She had publications about Tuberculosis, titled, “The Quality of Tuberculosis Services in Health Care Centres in a Rural District in Uganda: The Providers’ and Clients’ Perspective, and Quality of Sputum Specimen Samples Submitted for Culture and Drug Susceptibility Testing at the National Tuberculosis Reference Laboratory-Uganda, July-October 2013” as lead author.

Outside NTLP, Lilian was a member of the WHO National Stop transmission of Polio (NSTOP) where she actively participated in conducting active surveillance activities. She joined the PHFP-FET in January 2015 and was based at the Central Public Health Laboratories (CPHL), Ministry of Health for her field placement.

Introduction: Viral load (VL) testing improves monitoring of patients’ response to HIV therapy. According to the World Health Organization (WHO), more than 70% of non-suppressed clients should re-suppress after 6 months intensified adherence support (IAS). However, only 50% re-suppressed on 2nd time testing at 6 months of follow up.

We established whether virologically non-suppressed patients underwent IAS for 6months, identified structural and process issues affecting service delivery for non-suppressed clients, estimated outcomes at end of 6 months period of IAS, and assessed patient and provider perspectives on what else is needed for effective provision of IAS.

Methods: Data collection was based on Donabedian model of quality of health care that evaluates structures, processes and outcomes of
health care. We extracted data from clients’ files, ART card and, CD4 and VL daily activity register. We interviewed clients who had received their 1st VL result between Aug 2014 and Dec 2015 (427) at 10 health facilities. We interviewed ART clinic in-charges, expert clients and laboratory staff (33).

In-addition, we used a checklist and an observation guide to obtain additional data. Primary outcome in the study was % virological suppression status at 6months. The secondary outcomes were % that underwent IAS (monthly visits to health facility), % that submitted 6months follow up sample and % of eligible clients switched to 2nd line ART.

Results: Of the 282 clients interviewed, 20% (57/282) had high, 28% (79/282) had moderate, and 48% (139/282) had low knowledge about VL and VL testing services. of the 378 clients, only 39% (137/378) underwent IAS for the recommended 6months, 28% (106/378) 4-5 times, 17% (63/378) 1-3 times and 16% (59/378) not conducted, and 1% (3/378) LTFU/Died. 42% (162/379) did not submit FU sample at 6months, 43% (90/207 tested successfully) non-suppressed on 2nd time testing, 62% (56/90 non suppressed) not switched to 2nd line, 38% (13/34) switched immediately after 1st VL result, and 56% (65/117) of suppressed clients had been switched immediately after 1st VL result. 14/31 health workers (HW) did not know standard results turnaround time (TAT).  Clients, dislikes about VL testing services were, that knowing VL results causes; stress, worry, scares, discourages and increases stigma. Health workers disliked IAS being recommended without counselors at health facilities, IAS period is short, mis-allocation of results and VL testing services being very far from clients. Some of the reasons for not switching clients were, client given second chance on IAS, patient feels well, patient unreliably adherent to 1st line therapy and patient is concerned about 2nd line therapy side effects.

Conclusion: Non-adherence to guidelines for monitoring response to ART using VL and limited knowledge about VL among both non-suppressed clients and health workers was observed. We recommended that the AIDS Control Programme and CPHL come up with performance indicators for monitoring response using VL. The info gathered in this study could guide formulation of clients’ IEC materials.

Lilian says, the fellowship program has re-emphasized the importance of team work, leadership, good managerial skills and the uniqueness of each health problem that are key in results achievement. As evidenced by the achievements listed above, Lilian gained/strengthened her skills in field outbreak investigations, field outbreak investigations report writing, data analysis including analysis of public health surveillance data, manuscript writing, communication and leadership. “My decision to join the PHFP-FETP has made me a disease detective competent in surveillance, outbreak detection, investigation and response in all kinds of situations including in emergency and complex settings, CPHL has greatly improved my knowledge and skills in laboratory based health systems” she says. Lilian intends to focus on Health Laboratory Surveillance/Epidemiology and Infectious diseases Surveillance/Epidemiology including HIV and Tuberculosis.