Lydia Nakiire

  BBLT (Mak), MPH (Mak), Field Epidemiology Fellow (PHFP)
+256-779-251-023/ +256-704-935-467, lnakiire@musph.ac.ug

Host Site: Emergency Operations Center, Ministry of Health

Host Mentor: Dr Issa Makumbi

Secondary Mentor: Obua Thomas 

Academic Mentor : Dr. Joan Kalyango MakCHS

ABOUT THE FELLOW

Lydia Nakiire holds a master’s degree in Public Health and Bachelor of Biomedical Laboratory Technology from Makerere University, Uganda. Lydia started her career as a Laboratory Technologist at the Joint Clinical Research Centre and also worked in other capacities as a deputy head of immunology laboratory and a laboratory mentor.

As a laboratory technologist she worked at Pfizer Malaria Research Project (Protocol A0661134) and other projects in collaboration with MRC-UK clinical trials unit. Lydia mentored Nsambya hospital laboratory personnel under the JCRC-THALAS project in collaboration with MOH-SUSTAIN project.

She saw the laboratory performance improve steadily from star one to star three of WHO SLIPTA program in two years. Lydia joined the PHFP in 2016 and was attached to the Uganda Ministry of Health (MOH)-Public Health Emergency Operation Centre (PHEOC). The Public Health Emergency Operation Centre is among the Global Health Security Agenda (GSHA) pilot demo projects implemented in March-September 2013.

The PHEOC was set up to enhance the countries capacity to detect, prevent and coordinate response to disease outbreaks, natural disasters, bioterrorism and other public health emergencies.

  Achievements at the host site

• Member of the MOH National rapid response team in PH emergency and response
• Incident manager responsible for coordinating response to measles outbreaks in Kampala, Wakiso, Lyantonde, Kayunga, Lwengo and Kibuku Districts.
• Trained the Kampala District rapid response teams on surveillance
• Participated in weekly analysis of data for preparation of the Ministry of Health weekly epidemiological bulletin
• Spearheaded the AMR technical area during the Joint external evaluation June 2017
• Participated in AMR technical working group meetings and contributed to designing the National Action Plan for Antimicrobial resistance 2016-2017.
• Participated in the design and implementation of the Uganda Integrated Disease Surveillance and Response (IDSR) evaluation in 2016.
• Supervised ten research assistants in Eastern Uganda during data collection for IDSR evaluation in 2016.
• Participated in Event-Based Surveillance activities at the PHEOC for situation awareness.
• Spearheaded development of the national inventory of dangerous pathogens in Uganda National Council for Science and Technology in 2016.

Program-specific achievements

Surveillance and Evaluation

• Lydia conducted analysis of the national cholera data from Health Management Information System: 2013-2016 and described epidemiology of cholera.
• Participated in evaluation of the IDSR evaluation in 2016.

Quality improvement project

• Lydia set up a data quality improvement project in Jinja Regional Referral Hospital, one of the AMR sentinel surveillance sites. This is in line with GHSA project of Infectious diseases Institute objectives of improvement of laboratory capacity to test for AMR and quality capacity.

Outbreak investigations

• Led two outbreak investigations
  • Measles outbreak investigation in Kamuli, 2016
  • Acute haemorrhagic conjunctivitis in Gulu District, 2017
• Participated 3 outbreak investigations
  • Measles outbreak propagated by congregation of children at water collection sites: Mayuge District, Uganda, July-October 2016
  • Marburg outbreak investigation in Kween and Kapchorwa Districts,2017
  • Investigation of a suspected Hereditary Spastic Paraparesis in Ibanda District, 2016

HIV Projects

• Lydia analysed Kyoga HIV data set for couple HIV counselling and associated factors.
• Lydia analysed BASIIN data set for HIV/Hepatitis B co-infections and associated factors.

Communication: Presentations and Publications

• Lydia wrote 3 bulletin articles: Measles outbreak in Kamuli District; Acute haemorrhagic conjunctivitis in Gulu, and Enhanced yellow fever surveillance.
• Published an article in Uganda’s New vision “Quality improvement training is crucial for improved laboratory standards”
• Lydia made the following presentations:
  • Measles outbreak propagated by congregation of children at water collection sites: Mayuge District, Uganda, July-October 2016.” Presented at the 65th Epidemic intelligence Conference in Georgia Atlanta, USA.
  • HIV couple counseling and associated factors among HIV infected patients in the Lake Kyoga fishing community.” Presented at Joint Annual Scientific Health conference September 2017; submitted and accepted at ICASA conference and it was submitted to the International AIDS Conference 2018.

• • Descriptive epidemiology of acute haemorrhagic conjunctivitis cases in Gulu district, 2017” Presented at the Joint Annual Scientific Health conference September 2017
  • Descriptive analysis of Cholera cases: HMIS data 2013-2016” Presentedat the Joint Annual Scientific Health conference September 2017

Manuscripts:

• HIV couple counseling and associated factors among HIV infected patients in the Lake Kyoga fishing community.” Manuscript submitted to BMC infectious Diseases
• Measles outbreak propagated by congregation of children at water collection sites: Mayuge District, Uganda, July-October 2016.” Manuscript submitted BMC Infectious Diseases Journal.

Leadership and management:

• Team lead for stakeholders in the AMR technical area
• Incident manager for measles outbreaks in 6 districts.
• Led 2 outbreak investigations

Summary of Epidemiologic Study: 

 Title: HIV couple counseling and associated factors among HIV infected patients in the Lake Kyoga fishing community

Introduction:  Couple HIV Counseling and Testing (CHCT) is a key intervention in the prevention of heterosexual HIV transmission and achievement of the 90-90-90 UNAIDS targets for reducing HIV by 2020. This study assessed utilization of CHCT and associated factors among HIV-infected residents of Kyoga fishing community, a lakeside community of persons considered high-risk for HIV infection.

Methods:  We conducted secondary data analysis of the Makerere University School of Public Health HIV behavioural survey data collected in 2013 among residents of the Lake Kyoga fishing community. We used logistic regression to identify factors independently associated with utilization of CHCT.

Results: The analysis included 118 records.The mean age of participants was 38 (SD: 8.7) years; 61 (53%) were women, 98 (78%) attained primary education, and 63 (53%) were in monogamous marriages. Among 118 persons surveyed, 57 (48%) had ever utilized CHCT. Previous discussion of individual HIV results with partner [adjusted odds ratio (aOR) =12; 95% CI: (3.1-46)] and living at a lake landing site (dock where fishing commerce often takes place) for >5 years [aOR=3.8; 95% CI (1.3-12)] increased the odds of ever utilizing CHCT. Traveling away from the landing site within one month before the survey [aOR=0.31; 95% CI: (0.1-0.93)] reduced the odds of ever utilizing CHCT.

Conclusion:  Previous discussion of HIV results with a partner and living on the landing site for five or more years increased the odds of utilization of CHCT; recent travel away from the site reduced the odds of CHCT in this Ugandan fishing community. To increase CHCT uptake in this community, we recommended the rollout of interventions that encourage discussion of individual HIV results among couples, and interventions targeting mobile populations who have resided in the area for a shorter time.

Lessons Learned

• Analysis and interpretation of surveillance data using Epi info and QGIS. This was particularly informative at the time when reporting during measles outbreak in Kampala and Wakiso was challenging. We used HMIS data to monitor trends of the outbreak
• Outbreak investigation and evidence based decision-making.
• Scientific writing and communication skills.
• Networking with PHEOC/ MOH partners and scientists in other field epidemiology training programmes at the EIS conference and through the TEPHIConnect application. TEPHIConnect was particularly useful when I connected to TEPHINET conference 2017 in Thailand.
• Setting up a quality improvement project