Susan Nakubulwa

Susan Nakubulwa

BSc (Econ & Stat), MSc (Epidemiology), Field Epidemiology Fellow (PHFP) +256 772 658252 / +256 704 551752 snakubulwa@musph.ac.ug / nakubulwas@yahoo.com

Host Site: Mildmay Uganda

Host Mentors: Ms Mary Odiit, Dr. Barbara Mukasa

Academic Mentor : Dr. Joan Mutyoba, MakSPH

ABOUT THE FELLOW

Susan Nakubulwa holds a Master of Science degree and a post graduate diploma in Epidemiology from the University London, United Kingdom. She also holds a Bachelor of Science degree in Economics and Statistics from Makerere University, Uganda. From January 2016 to December 2017, Susan was an Epidemiology Fellow with the Uganda Public Health Fellowship Program and she was hosted by Mildmay Uganda.

Before joining the fellowship program, Susan was a Data Manager in the statistics section at Medical Research Council (MRC)/ Uganda Virus Research Institute (UVRI), Uganda Research Unit on AIDS where she contributed to the conduct of HIV research studies for over seven years. Currently, she is a member of the Mildmay Uganda Research Ethics Committee where she contributes to the protection of rights, safety and welfare of human research subjects. She also contributes to Quality Improvement in health service delivery.

From July to December 2017, she was the team leader of a Quality Improvement project to improve the recording of data for the weekly Short Message System (SMS) Option B+ reporting at Entebbe hospital, Wakiso District. Susan has excellent communication skills and contributes to the dissemination of program and research findings through oral presentations at conferences and writing of manuscripts for publication in peer reviewed journals. She is a member of the Next Generation Global Health Security Network East Africa Working Group and the National Rapid Response Team, Ministry of Health, Uganda.

She has contributed to public health in Uganda through investigation of outbreaks for illnesses associated with poisonings, guinea worm and cholera, in order to identify control and prevention measures. In 2016, she led the Rapid Health Assessment of South Sudan Refugees in Uganda. Susan would like to conduct research and contribute to Global Health Security in her future career. She also has interest in contributing to the application of Implementation Science in HIV/AIDS program settings.

Achievements at the host site

Appointed as a member of the Mildmay Uganda Research Ethics Committee (MUREC) to contribute to the protection of rights, safety and welfare of human research subjects. Contributed to the review of MUREC Standard Operating Procedures, reviewed twenty-seven research protocols, led and participated in two site monitoring visits. With the support of Mildmay Uganda, obtained trainings in Research Ethics, Responsible conduct of Research, Good Clinical Practice and participated in two Annual National Research Ethics Conferences.
Took lead in writing the protocol to document the best practices of Mildmay Uganda in service for key populations. The protocol was entitled “Evaluation of the strategies for referral, linkage to- and retention in HIV care for key populations at Mildmay Uganda and supported districts of Central Uganda.”
Analyzed data for a project on the Evaluation of the integration of Isoniazid Preventive Therapy (IPT) and Intensified Case Finding (ICF) into comprehensive routine HIV Care at Mildmay Uganda. Contributed as a co-author of a manuscript entitled “Outcomes of Isoniazid Preventive Therapy (IPT) and incidence of TB among persons attending care at Mildmay Uganda, 2010-2014.”
Analyzed data and wrote a manuscript entitled “Factors associated with couple HIV counseling and testing among adults receiving HIV Voluntary Counseling and Testing Services at Mildmay Uganda, 2011 -2013.”
Implemented a Quality Improvement project in order to improve the recording of Option B+ indicators for Short Message Service (SMS) reporting at Entebbe hospital, Wakiso District where Mildmay Uganda is the implementing partner for the elimination of Mother to Child Transmission of HIV program. Wrote the manuscript entitled “Quality Improvement in the recording of Option B+ indicators for SMS reporting, Wakiso District, July – December 2017.”
Contributed to training and education at Mildmay Uganda Institute of Health Sciences by lecturing on the fundamentals of Epidemiology to students undertaking the Bachelor of Science in Health and Social Systems Management and Bachelor of Science in Human Nutrition and Clinical Dietetics degree studies.

Program-specific achievements

Leadership

Sub-editor of the Quarterly Epidemiological Bulletin of the Uganda National Institute of Public Health, Ministry of Health, from January to September, 2016

Field outbreak investigations

Led in the Rapid Health Assessment of South Sudan Refugees in Adjumani District
Led in the investigation of suspected poisoning of workers at a flower farm in Wakiso District
Led in the investigation of the cholera outbreak in Kasese District
Participated in the investigation on suspected Guinea worm disease in Isingiro District

Surveillance

Conducted descriptive data analysis on the topic entitled “Trends of weekly Short Message Service (SMS) reporting on Option B+ indicators for Mildmay Uganda supported districts of central Uganda, October 2016 to March 2017.”
Evaluated the surveillance system on Option B+ indicators.

Quality Improvement

Conducted a Quality Improvement project at Entebbe hospital, Wakiso District to improve the recording of Option B+ indicators for SMS reporting, July – December 2017.

Communication

Manuscripts
- Submitted a manuscript entitled “Acute Metam Sodium (Sodium N-Methyldithiocarbamate) poisoning caused by occupational exposure at a Flower Farm – Uganda, October 2016” for publication in the Morbidity and Mortality Weekly Report (MMWR) series.
Conference presentations
- Presented at the 9th Training Programs in Epidemiology and Public Health Interventions (TEPHINET) Global conference at Chiang Mai, Thailand, August 2017 and the 3rd National Field Epidemiology conference, November, 2017 on the topic entitled “Acute Poisoning due to Occupational Exposure to Metam Sodium at a Flower farm: Uganda, October 2016”
- Presented at the 2nd National Field Epidemiology conference in 2016 on the topics entitled “Health Assessment for South Sudan Refugees in Adjumani District and the need for Community workers, August 2016” and “Tracking Missed antenatal (ANC) appointments using Option B+ Weekly SMS reporting in central Uganda, January – June 2016”
- Presented at the 12th Joint Annual Scientific Health Conference (JASH) in September 2016 on the topic entitled “Utilization of Comprehensive Health Promotion Packages Targeted for Refugees in Northern Uganda”

Policy briefs

Wrote two policy briefs entitled “Strengthening the monitoring of Flower Farm activities in Uganda to protect the health of workers” and “Utilization of Comprehensive Health Promotion Packages Targeted for Refugees in Northern Uganda.”

Newspaper articles

Published an article entitled “Lessons from the recently launched Violence against Children study for Gender Based Violence (GBV) and HIV” in the New Vision newspaper on 22^nd December, 2017.
Submitted a newspaper article entitled “Infant agony in the era of elimination of mother-to-child HIV transmission” to the New Vision.

Summary of Epidemiological Study:

Title: Report on “Factors associated with couple HIV counseling and testing among adults receiving HIV Voluntary Counseling and Testing Services at Mildmay Uganda, 2011 -2013”

Introduction: Couple HIV Counseling and Testing (CHCT) is an approach that contributes to reducing the spread of HIV. In 2012, the World Health Organization rolled out guidelines for CHCT which highlighted some of the potential benefits of the approach as increased strength of the relationship, emotional support, better quality of life and increased uptake and adherence to antiretroviral therapy.In a systematic review on the effect of HIV testing and counselling on HIV acquisition in Sub-Saharan Africa, one of the findings was that testing with a partner was significantly protective for HIV acquisition and the trend was stronger among females than males, Incidence Rate Ratio, IRR 0.31 (95% CI: 0.19-0.48). Past studies have shown that the uptake of CHCT among health facilities in rural Uganda is at 34% and there is need to scale up the approach of CHCT in the country, given its potential benefits. Therefore, the objective of this study is to identify factors that are associated with CHCT in a routine Voluntary and Testing (VCT) semi-urban setting so that there is a contribution to the body of knowledge that can inform policy on the approaches to focus on in order enhance CHCT during VCT programming.

Methods: The study design was a cross-sectional survey. We conducted secondary data analysis based on data for an earlier study for VCT surveillance for HIV – acquisition. We conducted descriptive data analysis to obtain the socio-demographic characteristics of the study participants and univariable data analyses to investigate the crude associations between CHCT and selected variables of interest. We used the likelihood ratio test for hypotheses testing and adjusted for confounding using logistic regression.

Results: From 2011 to 2013, 12,233 individuals who accessed HIV VCT services at Mildmay Uganda were included in the VCT surveillance database. Of these, 98% (11,930/12,233) were aged 18 years and above and were included in this CHCT study, 43% (5,119/11,929) males and 57% (6,810/11,929) were females. Data on gender was missing for one participant. The CHCT data showed that, 90% (10,792/11,930) came alone and 9.5% (1,138/11,930) came as a couple. After adjusting for both age and education level which were considered as potential confounders, the factors which were associated with CHCT were living with sexual partner, adjusted Odds Ratio (aOR) 2.5, 95%CI 2.2-2.7,(p<0.001), having ever tested for HIV in the past, aOR 1.5, 95% CI 1.3- 1.7, (p<0.001). Participants who disclosed their HIV status to their sexual partners when they had their last HIV test were two times more likely to have come to the VCT site as a couple compared to those who had not disclosed the HIV status to their partners in the past, aOR 2.1(95%CI 1.8- 2.5), p<0.001.

Conclusion and Recommendations: The study findings revealed that the main factors associated with CHCT were those which enhanced communication on VCT among couples. However, the uptake of CHCT was low thus there was the possibility of the lack of awareness of the benefits. There is need to scale up approaches that create awareness of the benefits of CHCT among clients attending routine VCT services in the country. Since there is evidence that communication on VCT among couples is a strong motivator for CHCT, the counselling approaches should be well utilized to emphasize the most appropriate approaches that can increase communication on HIV VCT among couples. There is need for further research in order to identify the barriers of CHCT.

Lessons Learned

I learnt that having a good working relationship with colleagues and seniors is a key component that contributes to career growth. Through proper planning, it is possible to achieve high levels of productivity from work activities amidst challenging circumstances. I also learnt the techniques for timeliness and multi –tasking mainly through the mentorship I received from my academic mentor. I will always treasure the collaboration with MakSPH.

Key skills/competencies acquired

Communication: Acquired through the PHFP mentorship during preparation for scientific conferences and the trainings in scientific writing and report writing.

Collaboration: Acquired during the implementation of the Quality Improvement project since the fellow needed to collaborate with Mildmay Uganda, the eMTCT implementing partner in Wakiso District and the Entebbe hospital leadership to ensure success of the project.

Teamwork: Gained while working with colleagues (fellows), district teams and staff at the host institution.

Innovation and creativity: Acquired during writing of protocols, manuscripts and articles for newspapers.

Leadership: Acquired through leading teams during the implementation of the Quality Improvement project and outbreak investigations.

Problem solving:Learnt during the decision making processes during outbreak investigations.

Next steps (career path)

– Since I am part of the team of trained Field Epidemiologists I will provide insights for responding to public health threats within the country.

– I plan to write grants for the generation of research funds and conduct research in the area of HIV/AIDS and other communicable and non-communicable diseases.