Host Site: The AIDS control program (ACP), Ministry of Health
Host Mentor: Dr. Peter Mudiope
ABOUT THE FELLOW
Now an accomplished field epidemiologist, Peter Chris holds a Master’s degree in Public health and a Bachelors degree in Human Medicine and Surgery. Peter has interest in HIV, maternal, and child health, global security and One Health.
During the fellowship, he was attached to the AIDS control program (ACP) under the department of National disease control, Ministry of Health. Through the in-service training he has attained skills in programming, monitoring and evaluation, support supervision and mentorship, reporting performance against targets, media reporting, outbreak investigation, and response, conducting quality improvement projects, budgeting and accountability, financial lobbying skills, surveillance data analysis, interpretation, and utilization.
Achievements at the Host Site
Participated in the national evaluation of the uptake and effectiveness of the PMTCT retention strategies for mother-baby pairs in North Acholi region
Participated in the national rollout of Viral load testing of pregnant and breastfeeding mothers at Point of Care (POC)
Participated in the national dissemination of 2017-2019 Uganda’s national PMTCT Impact evaluation findings.
Analysed data from the PMTCT impact evaluation to assess predictors of exclusive breastfeeding among HIV-exposed infants in Uganda, 2017–2019.
Participated in developing a protocol for maternal HIV retesting in late pregnancy and during postnatal care.
Participated in peer learning sessions that guided implementation, and scale-up of the group antenatal/postnatal (GANC-PNC) intervention.
Designed and implemented a continuous quality improvement (CQI) project to improve pre-exposure prophylaxis (PrEP) screening and initiation among AGYW enrolled in G-ANC/ PNC in Mubende regional referral hospital.
Participated in the development of national maternal HIV retesting tools to be used during late ANC, labor & delivery, and PNC.
Supported the PMTCT monitoring and evaluation (M&E) team
Participated in the rollout, national mentorship, and support supervision of point of care (POC) testing for viral load and early infant diagnosis (EID) using gene xpert and m-pima machines to ensure same-day sampling, testing, and provision of results.
Participated in the national rollout of maternal HIV retesting tools
Participated in support supervision and mentorship for multi-disease testing in the Ankole region in order to scale up TB, EID, Viral Load, COVID-19, HPV, and other diagnostic services to ensure optimization of laboratory testing through increasing access to POC integrated testing.
Participated in planning, resource mobilization, publicity, coordination, and implementation of the pioneer 2023 pre-world AIDS Day activities, especially 2023 Adolescent and Young People (AYP) conference, 2023 interuniversity HIV awareness conference, 2023 HIV awareness run, HIV bodaboda street ride.
Developed, and administered HIV-related questions, and judged responses of the contestants at the 2023 interuniversity HIV Awareness Quiz (was a QUIZ master)
Participated in the launch of the condom strategic initiative ‘get it on, stay safe’
Fellowship program specific achievements
Surveillance Data Analysis
Analyzed DHIS 2 surveillance data on trend and spatial distribution of HIV yield from partners ≥ 15 years from Assisted Partner Notification (APN), Uganda, 2020–2022.
Epidemiological Study
Secondary data analysis from the national PMTCT impact evaluation to assess predictors of exclusive breastfeeding among HIV-exposed infants in Uganda, 2017–2019.
HIV-Study
Conducted an HIV study to assess the impact of integrated HIV, diabetes, and hypertension management in Uganda: a time-use study using before and after approach, 2023
Quality Improvement Project
Designed and implemented a continuous quality improvement (CQI) project to improve pre-exposure prophylaxis (PrEP) eligibility screening and initiation among pregnant and breastfeeding mothers aged <25 years enrolled in group antenatal/postnatal care (G-ANC/PNC) in Mubende regional referral hospital, May–October 2023.
Newspaper Articles (03)
In addition to HIV, pay attention to Hepatitis, and syphilis infections during ANC. It was aimed at awareness and demand creation to contribute towards the global triple elimination agenda of the three diseases
Invest to End Tuberculosis (TB): What Is Your Role? It was aimed at mobilizing resources towards the fight against Tuberculosis during the 2022 World TB day
Together we can kick polio out of Uganda. It was aimed at increasing the acceptability of the oral polio vaccine during the national mass campaign
Response to Public Health Emergencies
Led four investigations of public health events
COVID-19 outbreak among refugees in Nyakabande Transit Centre, Kisoro district, Southwestern Uganda, June–July, 2022
Monkeypox (MPX) alert verification in Tororo District, Eastern Uganda, February 2023
Tracing traditional healer linked to an Ebola case in Luweero District, November 2022
Contact tracing for SUDV in Nakasongola District, November 2022
Participated in six other outbreak investigations:
Risk factors for death among children with severe malaria in Namutumba District, April 2022
Rapid health assessment in the refugee host communities in Kisoro District, South Western Uganda, June–July 2022
Gastrointestinal Anthrax outbreak, Ibanda District, August 2022
SUDV outbreak in Mubende, Jinja Districts, September–December 2022. Following this outbreak, I conducted a study to assess the impact of the outbreak on access to HIV/care services among known HIV clients in Mubende and Kassanda Districts
Conference Presentations
Presented at five local conferences and four international conferences
8th National Field Epidemiology Conference (NFEC), 2022- 1 oral
2nd International Pediatric HIV Symposium in Africa (IPHASA), Zimbabwe, Virtually, 2023
– 1 poster
Workshop facilitator
Facilitator of a pre-conference workshop on Early Action Reviews: Planning and Implementation of the 7-1-7 Target for Timely Detection, Notification, and Response to Outbreaks, 8th AFENET Scientific Conference, Mombasa, Kenya
Bulletin Articles
Was part of the editorial team for Volume 7, issue 2 of the Uganda Public Health Bulletin (UPHB)Quarterly Epidemiological Bulletin, April-June 2022
Wrote and published three articles in the UNIHP bulletin
COVID-19 outbreak among refugees, Nyakabande transit center, June–July 2022
HIV yield from assisted partner notification (APN) in Uganda, 2020-2022
Predictors of EBF among HIV-exposed infants, 2017–2019
Mentorship of FETP-Frontline Tier Trainees
Mentored six Frontline FETP trainees in Eastern Uganda: Mbale District (03), Mbale City (01), and Sironko District (02).
Publication in Peer-Reviewed Journals
Lead author on 3 manuscripts:
One is submitted to a peer-reviewed journal titled ‘Investigation of COVID-19 Outbreak at a Refugee Transit Centre, Kisoro District, Uganda, June–July 2022’
One to CDC clearance titled ‘predictors of exclusive breastfeeding among HIV-exposed infants in Uganda, 2017–2019’.
One under internal review titled ‘HIV testing yield from assisted partner notification (APN) in Uganda: 2020-2022’
Co-Author on More than 20 Manuscripts
Ebola Handbook Writing
Lead in risk communication and community engagement (RCCE) and psychosocial support. This enables real-time exchange of information, opinions, and advice between frontline responders and affected communities. During an EBOD outbreak, RCCE must be integrated in nearly all pillars of the response
Summary of Epidemiological Study:
Title: Predictors of exclusive breastfeeding for six months among HIV-exposed infants in Uganda: Insights from a prospective cohort study, 2017–2019
Background: Exclusive breastfeeding is recommended for HIV-exposed infants (HEIs) for six months to lower the risk of mother-to-child HIV transmission and enhance HIV-free survival. We estimated the predictors of exclusive breastfeeding (EBF) for 6 months in mothers receiving routine prevention of mother-to-child HIV transmission (PMTCT) care in Uganda.
Methods:We analyzed secondary data from a prospective cohort study of Uganda’s PMTCT impact evaluation, conducted at 152 randomly-selected public and private facilities during 2017-2019. Health facilities offering PMTCT services are stratified into higher-level (Level IV centers and hospitals, which deliver comprehensive health care), and lower-level (Level I to III centers, which offer more limited services). HEIs were defined as infants born to HIV-positive mothers who tested HIV-negative at baseline. Mother-HEI pairs were recruited ≤3 months postpartum and followed at 6, 9, 12, 15, and 18 months. Baseline data included the HEIs’ and mothers’ HIV status; follow-up data included infant feeding practices. We excluded HEIs with missing feeding data at 6 months. Multivariate modified Poison regression was used to determine predictors of EBF for six months.
Results: Among 1,527 eligible HEIs, 767 (50%, 95%CI 48-53%) were male, 464 (30%, 95%CI 28- 32%) were exclusively breastfed for six months, and 310 (20%, 95%CI 18-22%) of their mothers received PMTCT services at a higher-level facility. Among 1,013 mothers with data, 890 (88%, 95%CI 86-90%) were virally suppressed at baseline. Of 1,278 mothers with data, 205 (16%, 95%CI 14-18%) disclosed their HIV status to their spouses. Having a mother who was virally suppressed (aRR=2.1, 95%CI 1.2-3.8), disclosed her HIV status to her spouse (aRR=1.4, 95%CI 1.0-2.0), and received PMTCT at a higher-level health facility (aRR=1.4, 95%CI 1.1- 1.9) were associated with increased likelihood of receiving EBF for 6 months among HEIs.
Conclusion: HEI six-month EBF rates were low. Factors that have been previously associated with adherence to ART (viral suppression, disclosing status to spouses) were also associated with EBF for 6 months. Further investigation is needed to understand the reasons for the higher likelihood of EBF among mothers who are virally suppressed, disclose HIV status to spouses, as well as attend PMTCT at higher-level facilities.
Key lessons learnt during the fellowship
Outbreak Investigation and response.
Utilization of surveillance data.
Evaluation of surveillance systems.
Designing and implementing Quality Improvement Projects
Data management, analysis, and interpretation using data management software such as STATA, and EpiInfo.
Generating informative maps using a quantum geographic information system (QGIS)to guide, decisions on action, planning, and policy.
Scientific writing and presentation skills.
Grant management skills
Financial accountability skills
Networking and lobbying skills
Coordination skills and teamwork.
Multisectoral collaboration.
Media communication skills
Next Steps
With the competencies gained, I hope to continue serving within the Ministry of Health or related organizations and programs in the realization of improved global health security and prompt response to public health emergencies and threats.
Pictorial
PPeter Chris (wearing mask) interviewing a mother by the garden side during his first field experience in Namutumba District, April 2022.
Peter Chris (grey jacket) reviewing registers during the Anthrax outbreak investigation in the Ibanda District, in August 2022.
Peter Chris making a presentation at the 2nd national HIV and AIDS symposium.
Peter Chris (with microphone) giving his verdict as a judge at the 2023 inter-university HIV awareness quiz.