ABOUT THE FELLOW
I am a Field Epidemiologist with a Master of Public Health from Makerere University, School of Public Health and a Bachelor of Medicine and Surgery from Makerere University, College of Health Sciences. During my time as a Public Health Fellow, I was hosted at the Aids Control Program, Ministry of Health.
My roles included analysis of program generated data on key indicators to monitor trends in the HIV response and preparing reports for dissemination to stakeholders, participating in operational research and dissemination of key findings, participation in Quality Improvement Projects to address service gaps identified, participation in the development of Program specific workplans and their implementation, participation in field-based activities including training, supervision and mentoring of district staff, and participation in formation of guidelines for HIV care and treatment and dissemination.
I implemented several projects on HIV care and treatment and participated in other research activities at the program. They include analysis of trends of Viral load non-suppression among children and adolescents from 2017-2019, Analysis of pharmacovigilance practices in Uganda, rapid assessment of Dolutegravir toxicity in Kampala and Wakiso. I participated in the generation of the 2020 HIV care and treatment guidelines, dissemination of the Health Information Management System (HMIS) tools, national annual integrated support supervision, Pediatric antiretroviral (ART) regimen optimization and national Electronic Medical (EMR) records review.
These activities built my capacity to conceptualize, design and implement program activities including research.
I lead five outbreak investigations and participated in six others. I published articles in local newspapers and epi-bulletins.
Achievements at the Host Site
- Team lead; annual support supervision – Kampala-Wakiso Sub-region
- Team lead Pharmacovigilance assessment for DTG rollout in Uganda
- Rapid assessment for DTG adverse events in Kampala and Wakiso
- Participated in the National EMR functionality Assessment
- Participated in the National Pediatric and adolescent ART regimen optimization guidelines revision
- Participated the National roll out of 2019 ACP-HMIS tools
Fellowship program specific achievements
- I was an editor on one issue of the Uganda National Institute of Public Health (UNIPH) bulletin.
- Conducted analysis of routine data on Viral load – Viral Load non suppression among Children and adolescents in Uganda, 2017-2019.
- Team lead – Ebola Viral Disease Outbreak investigation in Kasese District, 2019.
- Team lead – Yellow fever Outbreak investigation in Moyo, Buliisa and Maracha Districts, 2020.
- Team lead – Dolutegravir Adverse events in Uganda, 2020
- Team lead – Anthrax Outbreak Investigation in Rubirizi District, 2020.
- I participated in the following outbreaks:
- Leprosy in Lira District, 2019
- Relief Food Poisoning in Karamoja, 2019
- Covid-19 (Entebbe, Kabale), 2020
- Mysterious deaths in Katabi, 2019.
- INH (isoniazid) Adverse Events, 2020
- Ebola Viral Disease surveillance, Namugongo, 2020
- Led a quality improvement project “Improvement Viral Load coverage in Namayingo District, 2020.
- HIV study: “The Impact of the Strengthening Laboratory Management towards Accreditation Program in Implementing Quality Assured Laboratory Services, Uganda, 2010-2019”
- Conducted a study on Effects of transition to Dolutegravir based ART regimen on adherence, viral suppression and incidence of Opportunistic Infections among ART clients, Bugweri District, 2020.
Conference presentations
- Poster presentation – The Impact of the Strengthening Laboratory Management towards Accreditation Program in Implementing Quality Assured Laboratory Services, Uganda, 2010-2019 – Science summit 2020
- Oral presentation – Anthrax Outbreak Investigation in Rubirizi District, 2020 – NFEC 2020
Descriptive Analysis of Dolutegravir (DTG) Adverse Events Surveillance data in Uganda, 2017-2019 – NFEC 2019
Publications and manuscripts written
- Yellow fever Outbreak in Moyo, Maracha and Buliisa – published in the National Institute of Public Health quarterly bulletin
- The 5th National Epidemiology Conference: Epibulletin article in the National Institute of Public Health quarterly bulletin
- Co-authored articles in the Uganda National Institute of Public Health (UNIPH) bulletin,
- Leprosy – Investigation in Lira District 2019
- Namugongo Episcopal Ebola Viral Disease Surveillance. 2019
- Ebola Outbreak in Kasese District, 2019
- Policy brief: Counselors in Public sector for HIV care and treatment – under review
- Newspaper article in the New Vision: “Use social media to promote good public health practices”
- Newspaper article in Daily monitor: “It is time to take care of your health”
- Manuscript on “The Impact of the Strengthening Laboratory Management towards Accreditation Program in Implementing Quality Assured Laboratory Services, Uganda, 2010-2019” in clearance
Manuscripts being prepared:
- Yellow fever Outbreak in Moyo, Bullisa and Maracha
- Viral load Non suppression among children and adolescents in Uganda 2017 – 2019
- Anthrax Outbreak in Rubirizi
- Effects of transition to DTG from NVP/EFV-based regimens
Summary of Epidemiological Study:
Title: Effects of transition to Dolutegravir based ART regimen on adherence, viral suppression and incidence of Opportunistic Infections among ART clients, Bugweri District, 2020
Background: In 2017, the world health organization recommended transitioning to dolutegravir-based first-line ART regimens (DTG), particularly in regions where pre-treatment drug resistance to non-nucleoside reverse transcriptase inhibitor first-line regimens reaches 10%, such as Southern and Eastern Africa. DTG has better side effects profile than Efavirenz (EFV) and is associated with a lower risk of virologic failure and resistance compared to EFV. Studies from predominantly high-income settings found that dolutegravir-based regimens have superior efficacy, tolerability and durability compared with existing first-line regimens. However, after the national wide roll out of DTG initiation on HIV patient care in 2019 in Uganda, reports on adverse events following initiation of DTG were received by National Drug Authority from mainly Kampala and Wakiso Districts and a few other regions. A case series from the Infectious Diseases Institute (IDI) raised initial concern that patients receiving DTG for HIV treatment were developing clinically significant hyperglycaemia/Diabetes Mellitus and/or other clinical adverse events at a higher-than-expected frequency. This study aimed at establishing the effects of transition to Dolutegravir based ART regimen on; adherence, viral suppression, retention in care, incidence of Opportunistic Infections and adverse events among ART clients in Bugweri District, Uganda, 2020.
Methods: We collected data from all the six ART clinics in Bugweri District. Patients‟ files who had been transitioned to the Dolutegravir-based first-line ART regimens were reviewed for age, sex, regimen type, adherence, side effects, VL suppression, retention in care, Opportunistic infections, CD4 counts. T-tests, univariate, and bivariate analyses to make comparisons of characteristics before and after DTG transitioning were conducted.
Results: A total of 663 records were reviewed; 51% (337) were female and 49% (326) were male. The mean age was 48 years, ranging from 12 to 97 years. All the 663 were transitioned to Tenofovir/Lamivudine/Dolutegravir (TLD). Of the 663 patients, 93% (618) were virally suppressed while 7% (45) were not suppressed before transitioning to DTG, 96% (529) of those on DTG were virally suppressed while 4% (24) were not suppressed. The difference in suppression rate between regimens not statically significant, 95%CI -3580-2444, p-value 0.36. The adherence level for patients on other regimens before DTG was: 98% (650) had good adherence, 1.5% (10) had poor adherence, and 0.45% (3) had fair adherence. While on DTG-based regimens, 99% (659) had good adherence, while 0.3% (2) had fair and 0.3% (2) had poor adherence. The WHO staging was the same before and after the start of DTG-based regimens. While on non-DTG based regimens of the 663 patients, 34% (227) patients reported at least a side effect and 0.45% (3) patients reported side effects while on DTG. While on non-DTG based regimens, 5.1% (34) patients were at some point lost to follow up, but and 2.9% (19) of those on DTG-based regimens were lost to follow-up. Of the 663 patients on non-DTG based regimens 1.7% (11) had an OI before transitioning them to DTG while 0.45% (3) patients had at least an OI on DTG for at least 6 months.
Conclusion and Recomendations: DTG showed better side effects profile compared to other regimens. This is contrary to initial reports from earlier case studies in Uganda. We also observed that adherence, retention in care, and viral load suppression were better than that of other regimens. Whereas transitioning of patients from other regimens to DTG was supposed to be for stable virally suppressed clients on first line ART, non-suppressed patients were also transitioned in some health centres. No reports were sent to NDA on adverse events. Training of health workers to ensure appropriate implementation of ART guidelines as well as pharmacovigilance is recommended.
Key Skills Lessons Learnt
During the fellowship, I learnt and developed the following Uganda Public Health Fellowship Program – Field Epidemiology Track Cohort 2019 Graduation skills/competencies:
- Designing and implementing Quality Improvement Projects
- Evaluating a surveillance system
- Presentation skills
- Writing skills
- Networking skills
- Outbreak Investigation
- Scientific writing; Manuscripts, Abstracts, Policy Briefs and Newspaper article
- Editorial skills for scientific articles
- Data analysis skills
Next Steps
I will work towards ensuring that all the work that I have worked on during the fellowship is published in peer reviewed journals. I hope to use the skills gained to provide strong leadership to the health care sector in Uganda for improved health systems.
Pictorial
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