Dr. Innocent Ssemanda

Dr. Innocent Ssemanda

MBChB (MAK), MPH (MAK) Fellowship in Field Epidemiology (UNIPH)
Email: issemanda@uniph.go.ug
Telephone:256702353037 / 256777531618

Host Site: Ministry of Health, AIDS Control Program (ACP)

Host Mentor: : Dr. Mina Nakawuka

ABOUT THE FELLOW

As a Field Epidemiologist at the Uganda National  Institute of Public Health, I have led numerous  outbreak investigations, including measles,  food poisoning, anthrax, and Mpox. With a  master’s degree in public health and expertise in  epidemiology, I have spearheaded the integration  of non-communicable disease screening into HIV  care. My work has involved capacity-building  for health workers, policy development, and  scientific writing. My exceptional leadership,  operational excellence, and commitment to data driven decision-making have made me a valuable  asset in Uganda’s public health landscape. Prior to  my current role, I served as a Quality Improvement  Specialist at Population Services International,  where I honed my project management skills. My  primary interests include Global Health Security  and Strengthening Health Systems.

During the fellowship, I was attached to the AIDS  Control Program (ACP), a unit within the Ministry  of Health in Uganda. The ACP’s mandate is to  provide leadership for the public health response  to HIV/AIDS in core areas such as:

• HIV/AIDS Surveillance
• Policy Formulation
• Resource Mobilization
• Capacity Development
• Setting Standards and Quality Assurance

Through this in-service training, I have developed strong skills in leadership, outbreak investigation, and response, including data analysis, interpretation, and application. I have led two outbreaks and participated in five others.Additionally, I have been involved in national programs, including the Joint External Evaluation of the Progress of the International Health Regulation Policy Implementation.

  Achievements at the Host Site

At the AIDS Control Program (ACP), I was attached to the Adult Care and Treatment unit, where I participated in and led several key activities,
including:

• Integration Evaluation: Evaluated the  integration of non-communicable diseases  (NCDs) and cervical cancer screening among  people living with HIV into routine HIV clinics  across the country.
• National Dissemination: Participated  in the national dissemination of the 2022  Consolidated HIV and AIDS Guidelines.
• Protocol Drafting: Contributed to drafting the  2024 Uganda Population-Based HIV Impact  Assessment (UPHIA) protocol.
• Mpox Impact Assessment: Led the  assessment of the impact of the Mpox  outbreak on the HIV population.
• Pilot Evaluation: Participated in the evaluation  of data from the first NCD integration pilot  conducted in four health facilities within  Kampala.
• Mortality Reporting Assessment: Led andsupported the assessment of HIV-related mortality reporting at nine regional referral hospitals across the country.
• Data Quality Assessment: Led a team of fellows to assess the impact of the 2022 PMTCT Data Quality Assessment (DQA) on subsequent data quality.
• Research Publication: Authored and published an article on the importance of herbs and other foods in the treatment of HIV and AIDS.
• Data Analysis: Analyzed trends of TB preventive therapy uptake and completion among HIV patients using data from DHIS2, with results disseminated at three conferences and published in a local bulletin.
• Viral Load Study: Conducted a study at Butabika Hospital on the prevalence and factors associated with viral load suppression among mental health patients.

Fellowship program specific achievements

• Health Worker Training: Facilitated training  in enhanced surveillance and reporting for  health workers in Butaleja District.
• Quality Improvement Project: Designed and  implemented a QI project on acute febrile  illness surveillance at Jinja Regional Referral  Hospital.

Outbreak Investigations 

Led Two Outbreak Investigations:

• Cholera Outbreak: Elegu Point of Entry, January  2024.
• Mpox Outbreak: Nakaseke, Adjumani, and  Iganga districts, September 2024.

Participated in Five Other Outbreak  Investigations: 

• Anthrax outbreak investigation in Ibanda  District.
• EVD outbreak in Masaka District.
• Food poisoning outbreak at a school in  Mukono District.
• Food poisoning incident at a funeral in Jinja  District.
• Measles outbreak at Panyadoli refugee settlement in Kiryandongo District.

Additional Contributions 

• Mortality Notification Study: Designed  and implemented a QI study on improving  mortality notification at Mbale Regional  Referral Hospital.
• Training Cohort Support: Supported the  training of a cohort of 23 frontline FETP fellows,  20 of whom graduated on time.
• Lead Author: Served as the lead author for the  Uganda Public Health Bulletin Volume 8, Issue  1.
• Conference Presentations: Presented at six  local conferences, including:
• Joint Scientific Annual Conference
•  25th Uganda Society of Health Scientists  Annual Conference
• National Field Epidemiology Conference
• PEPFAR Summit
• National TB Conference

Publications 

• Published Works:
• Two newspaper articles.
• One manuscript in the BMC Public Health  journal.
• Two bulletin articles in the UNIPH Epi-bulletin.

Summary of Epidemiological Study: 

 Title: Uptake and Completion of Tuberculosis  Preventive Therapy among People Living with  HIV on Antiretroviral Therapy in Uganda, 2020– 2023 

Background: In 2015, Uganda adopted the  World Health Organization (WHO) guidelines for  Tuberculosis Preventive Therapy (TPT) among  people living with HIV (PLHIV). The country has  implemented several initiatives to scale up TPT,  including its integration into HIV care services. The  WHO target for both initiation and completion of  TPT among PLHIV in care is 90% by 2035. This  study describes trends and spatial distribution of  TPT uptake and completion, as well as reasons for  non-completion among PLHIV in Uganda.

Methods: We extracted and analyzed national  and subnational aggregated data on TPT among  PLHIV on Antiretroviral Therapy (ART) as reported  through the District Health Information System  Version 2 (DHIS2) from January 2020 to December  2023. TPT eligibility, initiation, and completion  rates were calculated. Reasons for non completion were categorized as loss to follow up, TB diagnosis, stopping due to side effects, and  death while on TPT. Trends were analyzed using  the Mann-Kendall test, and spatial distribution  was described by region over time. A p-value of  <0.05 was considered statistically significant.

Results: By June 2023, 1,330,693 PLHIV on ART  were eligible for TPT, of which 87% (1,157,703)  had been initiated and 92% (1,065,086) of those  initiated had completed TPT treatment. Between  January 2020 and December 2023, uptake of TPT  increased from 21% of eligible PLHIV to 89%, while  completion increased from 91% to 96%. Of the  92,617 (8%) ART clients who did not complete their  TPT regimen, 29,435 (37%) were lost to follow-up,  2,356 (3%) died, and 1,589 (2%) were diagnosed  with TB.

Conclusion:Uganda is close to achieving the  WHO TPT initiation target and has already met  the target for TPT completion among PLHIV. It is  important for the Ministry of Health to maintain  high initiation rates of TPT among newly enrolled  PLHIV.

Key lessons learnt during the fellowship

Throughout the fellowship, I developed the  following skill sets:

• Outbreak Investigation and Response:  Including the institution of interventions.
• Evaluation of Surveillance Systems.
• Designing and Implementing Quality  Improvement Projects.
• Data Management, Analysis, and Interpretation:  Utilizing software such as STATA, EpiInfo, and  QGIS.
• Scientific Writing: For abstracts, manuscripts,  policy briefs, and short articles.
• Presentation Skills: Effectively disseminating  findings.
• Networking and Lobbying Skills.

Next Steps

With the competencies gained, I aim to join the  Africa CDC and TEPHINET field epidemiologists’  roster, allowing me to apply my hard-earned skills  toward enhancing global health and responding  promptly to public health emergencies and  threats.

Pictorial

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