ABOUT THE FELLOW
Gloria Bahizi is a Field epidemiologist and holds a Master of Public Health from Makerere University, School of Public Health. During my time as a Public health Fellow, I was attached at the National Tuberculosis and Leprosy Division (NTLD), Ministry of Health. I conceptualized, designed and implemented Tuberculosis research projects like Epidemiology of Rifampicin resistant TB patients in Uganda. I was able to carry out investigations to guide programme decisions. I have extensive knowledge in HIV/AIDS and Tuberculosis patient care capacity building and health systems strengthening. Through this experience, I developed planning, budgeting, mentorship, report writing and leadership skills. I have built competence in designing research protocols, investigating disease outbreaks including Ebola and the COVID-19 response, data management and analysis, report, abstract, presentation, manuscript writing and publishing skills for articles in the local newspapers, national bulletins and international journals.
I have been able to lead three outbreak investigations and participate in three more outbreak investigations. I have undertaken several short courses and improved my skills data analysis using statistical and spatial packages like STATA, SPSS, EPI Info and QGIS; Event-Based Surveillance, and Case based surveillance.
Achievements at the Host Site
- The fellow supported the monitoring and evaluation team at the program with TB performance reviews and mentorships in the country
- Conducted a descriptive analysis and presented a report on the profile of Rifampicin resistant TB in Uganda to NTLP and submitted a manuscript. This created awareness on the burden of resistant TB in Uganda since the last drug resistant survey was done in 2013.
- It also highlighted the importance of using existing data.
- Participated in the revision of the Tuberculosis Health Information and Management Systems (TB- HIMS) tools which led to the incorporation of new indicators for in the national surveillance and reporting system
- Produced two National Tuberculosis and Leprosy Program quarterly bulletins of the Tuberculosis activities and highlights which were published widely thus improving awareness and sharing evidence-based knowledge on the investigations of drug resistant TB in Nakapiripirit and the burden of rifampicin resistance in the country
- The fellow was participated in the programme review of TB services with support from the World Health Organization
- Conducted support supervision in Gulu district to enhance TB case finding and better TB treatment outcomes and mentored health workers on TB performance in different indicators as analyzed from DHIS2.
- Conducted a data quality assessment and led the team in Kotido district which led to improved accuracy of reporting in Karamoja region.
- Participated in writing of the National Strategic Plan (Host site) and the patient centred approach for TB which was successfully launched.
Fellowship program specific achievements
The fellow has also been an editor on one issue of the Uganda National Institute of Public Health (UNIPH) bulletin
- Conducted analysis on data from NTLP on the profile of rifampicin resistant Tuberculosis in Uganda
- Team lead/Principal Investigator in the investigation of a malaria outbreak in Mbale District
- Team lead/Principal Investigator in the investigation of drug resistant Tuberculosis in Nakapiripirit district in Karamoja region
- Team lead on the evaluation of Isoniazid adverse event reports in Kampala, Uganda
- Attended a 1week course on event-based surveillance
- Participated in the following outbreaks:
– A yellow fever outbreak in Bukakata, Masaka District associated with sylvatic transmission to a susceptible population
– Assessment of Tuberculosis diagnostic test discordance in selected prisons of Uganda, 2020
– Leprosy investigation in Lira district, 2019
- Conducted an HIV study with CDC mentorship on the Progress towards 90-90-90 for prisoners in prisons providing direct HIV services versus services via referral, Uganda: A cascade analysis for 2017-2018
- Led a quality improvement project “Improving TB Case Detection Rates in Bumanya HC IV and Nawaikoke HC III in Kaliro District”
Conference presentations
- Oral presentation on the Malaria Outbreak in Mbale district June 2019 at the National Field Epidemiology Conference, Kampala, 2019
- Oral presentation on the Epidemiological profile of Rifampicin-Resistant TB Patients in Uganda 2014–2018: Analysis of laboratory at the National Field Epidemiology Conference, Kampala, 2020
- Poster presentation on the Malaria Outbreak in Mbale district June 2019 at the Joint Annual Scientific Conference (JASH Conference), 2019, Kampala Uganda
- Poster presentation on the Progress towards 90-90-90 for prisoners in prisons providing direct HIV services versus services via referral, Uganda: A cascade analysis for 2017-2018 at the AIDS 2020 Virtual conference
Publications and manuscripts written
- Epidemiological profile of Rifampicin-Resistant TB Patients in Uganda 2014–2018: Analysis of laboratory data, submitted to journal
- Progress towards 90-90-90 for prisoners in prisons providing direct HIV services versus services via referral, Uganda: A cascade analysis for 2017-2018, still under review
- Malaria Outbreak Facilitated by Increased Vector-Breeding Sites sustained by Intermittent Rainfall: Mbale District, Uganda, June 2019, published in the National Institute of Public Health quarterly bulletin
- Drug resistant Tuberculosis assessment in Nakapiripirit district in Karamoja region, published in the National Tuberculosis and Leprosy Division bulletin
- Newspaper articles published in New Vision about a TB Free Uganda-Missed cases and Not all cough is COVID-19, don‟t forget Tuberculosis
Summary of Epidemiological Study:
Title: Progress towards 90-90-90 for prisoners in prisons providing direct HIV services versus services via referral, Uganda: A cascade analysis for 2017-2018
Background: Ugandan prisoners have higher-than-national HIV prevalence (14% v. 6.2%) and are a key population for epidemic control efforts. Uganda‟s prisons provide HIV testing and Antiretroviral Therapy (ART) through in-house models (testing and ART directly provided within prisons by prison health staff) or referral models (services from external providers entering the prison or at nearby public health facilities with or without prisoners). We characterized the cascade of HIV care among prisoners for the two models and described barriers to favorable outcomes at key cascade steps.
Methods: We conducted a retrospective cohort analysis from January 2017 to December 2018. Data were collected from four prisons, two with referral services and two with in-house services. Prisoners were identified in HIV testing registers and ART registers. Viral loads (VL) were obtained from patient files and the Uganda national VL database. HIV cascade achievements measured at year-end were: Testing completeness (proportion of all inmates who knew their HIV status), Treatment initiation completeness (proportion of HIV-positive inmates who had initiated ART), and VL suppression (proportion of HIV-positive inmates on ART with ≥1 VL result who were virologically suppressed (<1000 copies/mL)). Structured interviews were conducted in the 4 facilities with health workers charged with HIV service provision to identify barriers to HIV care for prisoners.
Results:
| Cascade step |
All prisoners
N=6803 |
In-House Testing & Treatment
N=5922 |
Referral Testing & Treatment
N=881 |
| HIV Testing Completeness |
87% (5924) |
91% (5380) |
62% (544) |
| HIV-Positive |
12% (717/5924) |
10% (546/5380) |
31% (171/544) |
| Treatment Initiation Completeness |
70% (503/717) |
79% (429/546) |
43% (74/171) |
| Viral Load Testing Completeness |
30% (151/503) |
32% (137/429) |
10% (8/74) |
| Viral Load Suppression |
92% (139/151) |
98% (135/137) |
50% (4/8) |
Barriers in prisons operating both models included inadequate clinic space, staffing, and staff training, and uncoordinated prisoner releases and transfers (often before ART initiation or VL testing; limited paper records inaccessible to future providers). For referral-model prisons, limited outside organization funding and staffing, security challenges in transporting prisoners to outside clinics, and limited opportunities for outside organization staff to enter prisons were also identified.
Conclusion: In-house services yielded better performance than referral. Both had gaps in VL testing. Limited human resources and uncoordinated prisoner transfers and releases were barriers to comprehensive HIV services. We recommend in-house testing and ART in all prisons where possible, and electronic medical records to improve continuity of care.
Key Skills Lessons Learnt
The PHFP has presented an opportunity for hands on learning experience in field epidemiology and public health leadership. The skills and competencies acquired from this practical experience and mentorship with supervision from technical experts in the Ministry of Health and the fellowship program are invaluable. During the fellowship, I learnt and developed the following skills:
- Outbreak Investigation; National disease outbreak investigations and response as part of the MOH National rapid Response Team (NRRT) and the National Task Force (NTF) to establish causes of outbreaks and inform early prevention and control interventions. With this we were able to participate in the COVID-19 response supporting different regions
- Scientific writing; Manuscripts, Abstracts, Policy Briefs and Newspaper article which created avenues to share information with the public and National stakeholders building presentation and networking skills
- Leadership skills in rapid response and control of disease outbreaks, analysis and evaluation of national surveillance systems, quality improvement and program implementation
- Evaluation and analysis of data from surveillance systems to generate information for action to improve program implementation strategies
Next Steps
- I hope to further my career in the field of Epidemiology through service with the Ministry of Health, National and international agencies that will allow me to leverage my knowledge, experiences and skills obtained.
- international agencies that will allow me to leverage my knowledge, experiences and skills obtained.
|