Host Mentor: Miss Juliet Cheptoris, Dr Joshua Musinguzi
ABOUT THE FELLOW
Patience holds a Master of Public Health from Makerere University with a background in human medicine. She joined the Public Health Fellowship Program in 2020.
During the fellowship, she was attached to the STI/AIDS Control Program (ACP) where she supported the HIV prevention arm of Adolescent Girls and Young Women (AGYW) Program. During this time, she performed large dataset analyses, scientific writing and presentations, project designing and implementation, participated in high level national meetings, coordination of training and mentorship activities, review and editing national documents, responded to various disease outbreaks to mention but a few. Outside her host site, Patience participated in various outbreak investigations. These engagements have greatly built her capacity and complemented the skills and experience she had achieved from my previous trainings. With this fellowship, she has the ability to serve in any capacity with a spirit of excellence and a great sense of leadership as an epidemiologist.
Achievements at the Host Site
Participated in review and editing of various national documents including the Education Plus Initiative for the AGYW as the chief editor, Gender Based Violence (GBV) treatment guidelines, and consolidated guidelines for prevention and treatment of HIV in Uganda, and the national HIV Health Management Information System (HMIS) tools among others.
Participated in the development of the monitoring and evaluation of GBV/VAC frame work.
Participated in the planning, budgeting, coordination, preparations, concept writing and report writing of the national pre-world AIDS day conferences for adolescents and young people (AYP), 2021 and 2022.
Participated in planning and organisation of national adolescents and young people pre- world AIDS day dialogue meetings, 2022.
Developed concepts and budgets for the AGYW program mentorship and supervision activities.
Led a team to conduct systems mapping and evaluation of SGBV individual tracking and systems mapping for the police stations and health facilities in Kampala and Rwenzori regions and developed a report to guide development of an inter-linked GBV reporting system.
Participated in several mentorship, supervision and training activities of health facilities on group antenatal care (GANC), safe spaces for AGYW, validation of the GBV data, integration of non-communicable disease management into HIV care and treatment, and many others.
Attended various host site meetings, including program meetings and high-level technical meetings with the implementing partners and development partners.
Engaged in the evaluation of the performance and scoring process of the AGYW program in the country using the HIV Prevention Self-Assessment Tool (PSAT) and development of the HIV prevention road map for the AGYW program.
Participated in writing monthly, quarterly and annual performance reports for the AGYW program.
Trained the national trainers on management of SGBV assault kit.
Fellowship program specific achievements
Designed and led an investigation to evaluate the readiness of health facilities to manage the second wave of COVID-19, June 2021, a public health emergency issue.
Co- investigated in various public health emergencies including:
Malaria outbreak in Iganga district,
Malaria deaths in Napak District,
Cholera outbreak in Nakivale refugee settlement
Jiggers infestation in Sheema Districts
Ebola Virus Disease outbreak in Kampala city.
Conducted other investigations of public health importance:
Evaluation of readiness and preparedness to manage Plague in Westnile region,
Readiness of laboratory to manage COVID-19 in Uganda, Assessment of ownership and use of long-lasting insecticidal nets three months after a mass distribution campaign in Uganda
Analyzed program surveillance data to determine the trends of HIV positivity rate among Children 0-14 years diagnose with TB, (2017-2020), a descriptive analysis project. Designed and implemented a quality improvement project to improve PrEP uptake among dolescent girls and young women (15-24) years in selected health facilities, Mbarara District, Uganda, Jan-Jun 2022.
Designed and implemented an epidemiological study to determine factors associated with Sexual Gender-based Violence (SGBV) among adolescent girls and young women during the main COVID-19 period in Eastern Uganda.
Conference presentations
Oral presentation on readiness of health facilities to manage the second wave of COVID-19, June 2021, a public health emergency evaluation study at the National Field Epidemiology Conference, Kampala, 2021.
Oral presentation on readiness of health facilities to manage the second wave of COVID-19, June 2021, a public health emergency evaluation study at the 1st International Conference of Public Health in Africa (CPHIA) 2021.
Oral presentation on sexual and gender-based violence among adolescent girls and young women during the main COVID-19 period in Bukedi Region, Eastern Uganda, at the Joint Annual Scientific Conference (JASH Conference), 2022, Kampala.
Oral presentation on HIV test positivity and testing for recent infections among adolescent girls and young women aged 10-24 years in Uganda, 2017 – 2021, at the National Field Epidemiology Conference, Kampala, 2022.
Written communication
Manuscripts:
Lead author
o “Readiness of Health Facilities to Manage COVID-19, Uganda, June 2021” Submitted to the Health services BMC Journal for peer review and publishing.
o “HIV positivity and recent rates among Adolescent girls and young women aged 10-24 years in Uganda 2017-2021”. Undergoing review by the resident advisor.
o “SGBV among adolescent Girls and young women during the main COVID-19 period in Eastern region ”.Undergoing review by the resident advisor.
Co-authored
o Barriers and facilitators to retention in HIV care for persons on community differentiated service delivery (DSD) models in Uganda, 2021
o Malaria Outbreak in Nabitende Subcounty, Iganga District, Uganda 2021
o Investigation of Jiggers Outbreak, Sheema District, Uganda 2022
o Ownership and use of Long-lasting Insecticide Nets Three months after a Mass Distribution campaign, Uganda 2021 Editor of Volume 7 issue 1 January-March 2022 Uganda National Institute of Public Health (UNIPH) Epi bulletin.
Authored three articles in the UNIPH Epi bulletin
o Readiness of health facilities to manage the second wave of COVID- 19,Uganda, June 2021
o HIV positivity and recency rates among Adolescent Girls and Young Women, 2017-2021, Uganda.
o Sexual Gender-based Violence among adolescent girls and young women during the main COVID-19 period in Bukedi region, Uganda” Policy brief: Injectable Cabotegravir should be part of the PrEP program.
Newspaper articles:
o Stop multidrug-resistant TB and save the future
o The battle of HIV/AIDS and depression amidst COVID-19
o COVID-19 Impact on persons with HIV/AIDS
o What to do when one tests HIV positive
Skills/ Lessons learnt
During the fellowship, I learnt and developed the following skill sets:
Conducting outbreak investigations
Evaluating and strengthening surveillance systems
Project desgning, 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
Summary of Epidemiological Study:
Title: Readiness of Health Facilities to Manage COVID-19 in Uganda, June 2021
Patience Mwine1*, Immaculate Atuhaire1, Benon Kwesiga1, Daniel Kadobera1, Sherry R. Ahirirwe1, Hilda T. Nansikombi1, Shaban Senyange1, Sarah Elayeete1, Veronicah Masanja1, Alice Asio1, Allan Komakech1, Rose Nampeera1, Edirisa J. Nsubuga1, Petranilla Nakamya1 Andrew Kwiringira1, Stella M Migamba1, Lillian Bulage1, Paul E. Okello1, Sandra Nabatanzi2, Fred Monje1, Alex R. Ario1, Julie R. Harris2
1 Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
2 Centers for Disease Control and Prevention, Kampala Uganda
Background: The COVID-19 pandemic has overwhelmed the capacity of health facilities globally, emphasizing the need for readiness. The first wave of COVID-19 in Uganda peaked in late
2020, uncovering challenges with facility readiness. In mid-2021, we assessed the readiness of health facilities in Uganda to manage the second wave of COVID-19.
Methods: We assessed 17 RRH and 71 lower-level health facilities from all subregions of Uganda during June 2021. In each of the facilities, we interviewed the director about challenges faced during the first COVID-19 wave. We inspected COVID-19 treatment units (CTUs) and other facility service delivery points using a WHO observational checklist with infection prevention, equipment, medicines, personal protective equipment (PPE) and CTU surge capacity. We used the “ReadyScore’’ criteria to classify level of preparedness as >80% (‘better prepared’), 40–80% (‘work to do’), and <40% (‘not ready’). Readiness was assessed using facility-level-specific parameters.
Results: All 17 RRH assessed were managing COVID-19 patients at the time of the visit. Of these, 15 (88%) were in the “work to do” category, and two (12%) were “better prepared”. Most 13 (82%) had an inadequate supply of essential medicines, 12 (71%) lacked oxygen, and 11 (65%) lacked space to expand CTUs. Fifty-five (77%) of the 71 lower-level health facilities assessed were “not ready”, and 16 (23%) were in the “work to do” category. Seventy (99%) lacked medicines, 64 (90%) lacked PPE, and 53 (75%) la
Conclusion: Few health facilities were ready to manage a second wave of COVID-19 in Uganda during June 2021. The largest gaps were in essential medicines, PPE, oxygen, and space for CTU expansion. Adequate preparedness for future waves of COVID-19 requires additional support and action in Uganda
Keywords: COVID-19, Preparedness, Second wave, Health facilities, Uganda
Key lessons learnt during the fellowship
Outbreak detection, Investigation, response and control
Editorial skills for scientific articles including weekly, monthly, quarterly e bulletins, and epidemiological bulletins
Data analysis using Epi info, STATA, SPSS, R, and QGIS and interpretation of results
Development of surveillance systems
Leadership and management skills acquired from the various projects led and assignments
Designing and implementation of Quality Improvement Projects
Conducting Data Quality assessment
Evaluating a surveillance system
Communication skills including presentation, written and negotiation skills
Networking skills
Next Steps
I hope to use all the knowledge and skills to contribute to the surveillance and control epidemics in Uganda and beyond. I also want to mentor those after me in this program.
Pictorial
Dr. Patience (standing) with the DREAMS focal persons, AGYW peers, and IP representative revising the PrEP screening tool and discussing the PrEP guidelines in Mbarara, Western Uganda, January 2022
Dr Patience Mwine (bending) scooping malaria larvae in a rice field during malaria outbreak in Iganga district, Uganda, 2021
Dr Patience Mwine (on the left) conducting GBV data validation and on-site mentorship on data reporting to health workers in one of the health facilities Isingiro district, Western Uganda, 2021