Susan WaakoBSN (MUK), MPH (MUK), Advanced Field Epidemiology Fellow (UPHFP) Host Site: AIDS Control Program, Ministry of HealthHost Mentor: Dr. Kadama Herbert |
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ABOUT THE FELLOWSusan Waako is a field epidemiologist with a Master of Public Health and a background degree in Nursing Science both from Makerere University Kampala. Before the fellowship, I worked with the Uganda Ministry of Health as a regional EPI surveillance officer for Jinja Region in support of human resource surge capacity for the polio response and routine surveillance activities during 2022. During the fellowship, I was attached to the Uganda National AIDS Control Program (ACP), Ministry of Health. The program directs and guides the implementation of the HIV/AIDS control and prevention strategy. Its core mission is to provide the highest possible level of HIV care services to all people in Uganda through the delivery of promotive, preventive, curative, palliative, and rehabilitative health services at all levels. Core responsibilities include coordination of activities geared at the control and prevention of HIV/AIDS, resource mobilization, capacity development, and monitoring and evaluation. Others are coordinating activities of partners in HIV programming in Uganda, including identifying priority areas and guiding operations. Through the two years of in-service training, I have been able to strengthen my competence skills in leadership, outbreak investigations and response, risk communication, scientific writing, partner coordination, and mentorship. Achievements at the Host SiteAt ACP, I was attached to the pre-exposure prophylaxis program and while there I participated in and supported several projects and activities including but not limited to: – Participated in the development of the national demonstration concept and road map for event-driven pre-exposure prophylaxis (PrEP) piloting in Uganda – Analysed PrEP surveillance data in the PrEP tracker, 2017-2022 – Participated in the development of the national Event Driven Pre-Exposure Prophylaxis (ED PrEP) training materials. – Participated in the first-ever national PrEP target setting using the PrEP IT tool. – Coordinated the weekly and bi-weekly ED PrEP performance review meetings during the pilot phase and scale-up phase respectively. – Participated in the development of a Change Package (desktop aid): To Improve Uptake & Continuity of Pre-Exposure Prophylaxis (PrEP) in Uganda. – Participated in the development of the national private pharmacy PrEP distribution point guide and training manual in preparation for its launch. – Participated in evaluating the performance of the ED PrEP piloting sites and implementing partners following scale-up – Participated in the national ToT for PrEP pilot sites during the pilot phase and implementing partners during the scale-up phase. – Participated in updating the national Technical Guidance on Pre-Exposure Prophylaxis (PrEP) for Persons at Substantial Risk of HIV Infection in Uganda Fellowship program specific achievementsLed one outbreak investigation – Blackwater fever cases in Bukomansimbi district, February 2024 Participated in six other outbreak investigations – Anthrax outbreak associated with handling and consuming meat from cows that died suddenly, Ibanda District, February–April 2023 – Anthrax Outbreaks in Western Uganda: the role of illegal meat dealers in spreading the infection, August 2022–April 2024. – Measles outbreak facilitated by suboptimal vaccine coverage and health facility crowding, Bundibugyo District, Western Uganda, February–June 2023 – Cholera outbreak associated with drinking contaminated lake shore water, Namayingo District, Uganda, July–August – Mpox outbreak in Isingiro and Mbarara districts, October 2024 – Mental illness among migrant domestic workers from Uganda in the middle-East, 2019-2023 Analyzed surveillance data from PrEP tracker – Pre-exposure prophylaxis initiation and its associated factors among Adolescent Girls and Young Women in Uganda, 2017–2022 Presented at three local conferences and attended one international workshop – The 9th and 10th National Field Epidemiology Conference and at – The 23rd Annual Uganda Society for Health Scientists Scientific Conference. Participated in a Decision Modeling for Health Economics Evaluation Workshop held in Istanbul, Turkey in which together with my colleague we presented a policy brief on the cost-effectiveness of preventive strategies for human anthrax in Uganda: a health sector perspective Published two newspaper articles in the New Vision – HIV among adolescent girls and young women, a ticking time bomb for Uganda – Cholera outbreaks a continued public health threat to Ugandans Wrote and published one article in the UPHB – Pre-exposure prophylaxis initiation and its associated factors among Adolescent Girls and Young Women in Uganda, 2017–2022 Editor of the Uganda Public Health Bulletin volume 8, issue 1, January to March 2023 Implemented a QI study to Improve Death Notification at Kalisizo Hospital, Uganda using a Quality Improvement Approach, December 2023–May 2024. Other activities – Submitted a manuscript for publication to peer-reviewed as lead author journal titled “Pre-exposure prophylaxis initiation and its associated factors among Adolescent Girls and Young Women in Uganda, 2017–2022 – Conducted an epidemiological study on factors associated with risky sexual behaviors among adolescent girls and young women attending the outpatient clinics at Fort Portal Regional Referral Hospital, June 2024 – Participated in a group HIV study titled: Impact of data quality assessment on PMTCT indicators at selected health facilities, September 2025. – Excess mortality survey in Uganda where I supervised a team of 8 research assistants in data collection in Luuka District. – Uganda cross-sectional mini-national survey to determine immunization coverage and factors associated with immunization uptake in Uganda. – Participated in the multisector Joint External Evaluation for Uganda for International Health Regulation, 2023 Summary of Epidemiological Study:Title: Pre-exposure prophylaxis initiation and its associated factors among Adolescent Girls and Young Women in Uganda, 2017–2022 Background: In Uganda, the HIV incidence among adolescent girls and young women (AGYW) aged 15-24 years has remained high. Despite the several studies done in relation to AGYW and HIV, little is known about their male sexual partners (MSP). We characterized MSP of AGYW in Fort Portal Regional Referral Hospital, located in the South Western Region of Uganda in June 2024. Methods: We conducted a cross-sectional study among AGYW attending the outpatient clinic at Fort Portal Regional Referral Hospital in Fort Portal City. We used systematic sampling and every 5th AGYW at the outpatient unit was approached for enrollment into the study. We collected data on demographic and other characteristics of both AGYW and their MSP (most recent) using a semi-structured researcher-administered questionnaire. We summarized the data on AGYW and their MSP characteristics as frequencies and proportions. Results: A total of 355 AGYW participated in the study. Of these, 214(60%) were aged 20-24 years, 261(74%) were in sexual relationships, and 43(12%) reported being HIV positive. Of the 261 AGYW in male sexual relations, 189(74%) reported having MSP who were older than them with the majority 141(75%) aged 25 years and above. A total of 198(76%) of the AGYW reported having MSP who disclosed their HIV status to them, of whom 27(10.3%) were HIV positive. Of the 27 AGYW with HIV-positive MSPs, 9(3%) reported being in sero-discordant relationships. More than two-thirds 181(69%) of the AGYW reported having circumcised MSP. 72(32%) and 57(22%) of the AGYW reported having MSPs who were businessmen and boda-boda riders respectively; 84(32%) used recreational drugs prior to sexual encounter; and only 13(5%) consistently used condoms. Conclusion: A high number of AGYW reported being HIV positive with some in sero-discordant relationships. AGYW were in sexual relationships with MSPs who were older, most being boda-boda riders with limited use of condoms suggesting the need for the Ministry of Health (MoH) to scale up HIV prevention programs among boda-boda riders as a priority population that is likely to transmit HIV to AGYW. MoH may need to strengthen social behavior change communication programs on correct and consistent condom use among AGYW and other priority populations. Key lessons learnt during the fellowship
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