Dr. Miriam Nakanwagi

MPH (University of Manchester), MBCHB (Mak), Field Epidemiology Fellow (UPHFP)
Email: nakanwagi.miriam@gmail.com, mnakanwagi@musph.ac.ug
Contacts: +256 782 414 114,

Host Site: AIDS Control Program (ACP) MOH

Host Mentors: Dr Shaban Mugerwa, Dr Joshua Musinguzi

ABOUT THE FELLOW

Motivation for joining the program
I joined the Public Health Fellowship Program in January 2017. I had previously worked as a program officer in a CDC supported health systems strengthening project on Prevention of Mother to Child Transmission of HIV/AIDS. Having always been passionate about numbers, I knew that I would thrive and shine when the medicine and mathematics in me met. And to this end, epidemiology was the answer.

I henceforth embarked on the program with a deep seated desire to sharpen my skills in epidemiology. The two years on the program gave me a platform to achieve this and so much more.
During the Fellowship Program, I was placed at the STI/AIDS Control Program (ACP) for the hands on training. I joined the team at ACP and contributed to the national efforts towards HIV/AIDS epidemic control.

  Achievements at the host site

1. A National mentor in HIV Prevention and Care and treatment services
2. Led teams for various ACP trainings, support supervision and mentorships such as the revised National consolidated guidelines for HIV/AIDS treatment, National PMTCT Evaluation Exercise and the National eMTCT validation exercise.
3. Led the eMTCT National Validation Report writing exercise.
4. Chaired weekly Option B+ meetings with implementing partners.
5. Assessed eMTCT service provision in hard to reach areas such as Buvuma islands.
6. Participated in various technical working groups in ACP and these included: workshop on preparation of tools, Standard Operating Procedures and implementation guidelines for Pre-Exposure Prophylaxis (PrEP), curriculum development for training of health workers on the Differentiated Service Delivery Model (DSDM), Optimization of HIV treatment access in South Western Uganda, HIV self-testing, the development of the Health Sector HIV/AIDS Strategic Plan (2018 – 2022/3), national review of the DREAMS project for adolescent girls and Young women and review of HIV/AIDS related HMIS tools
7. Participated in different high level meetings including: Implementing partner coordination meeting with MoH on review of HIV care and treatment services in Uganda, monthly viral load performance and data review meetings, WHO-AFRO meeting on optimising HIV diagnosis and treatment for children living with HIV/AIDS, improving early infant diagnosis performance meeting, National Stakeholder Meeting on HIV Testing Services, Integration of adolescent services into routine HIV care
8. Facilitated a Focus Group Discussion with health workers during piloting of Dolutegravir, a new first line antiretroviral drug.

Key deliverables on the Fellowship Program

Outbreak investigations and other projects

• Led a rapid HIV service delivery assessment of Bidibidi Refugee settlement
• Co-investigated the rapid health assessment of service provision in Bidibidi refugee settlement
• Led an investigation of a suspected anthrax outbreak in Isingiro District
• Participated in the investigation of outbreaks including: An outbreak of cholera in Nebbi district, Poisoning due to adulteration of alcohol with Methanol in Kampala, Meningitis Outbreak in Bunyangabo, and an investigation of skin burns among people harvesting grasshoppers in Uganda
• Analyzed District Health Information Software 2 (DHIS2) data on women that come with known HIV status at their first antenatal care visit and also data to compare TB treatment outcomes in children that are HIV positive with those that are HIV negative
• Designed and implemented two projects: “Addressing low proportions of repeat HIV testing in Maternity in Kayunga Hospital: A Quality Improvement Project” and “Assessing conversion to HIV-positivity among babies on Option B+ Program for Prevention of Mother To Child Transmission of HIV: Kampala and Wakiso Districts, 2013-2017”

Scientific communication and writing

• Suboptimal HIV Service Delivery in Bidibidi Refugee Settlement, Yumbe district, March 2017, presented at the 13th Joint Annual Scientific and Health Conference, 27th – 29th September 2017
• Outbreak of Gastrointestinal Anthrax Following Consumption of Beef of Suspicious Origin – Isingiro District, Uganda, 2017 presented at the 3rd Uganda National Field Epidemiology Conference, November 2017 and presented on my behalf at the 2018 Field Epidemiology Training Program International Night, 16th- 19th April 2018
• Low Proportions of Women Coming with Known HIV status at First Antenatal Visit, Uganda, 2012-2016, Uganda, presented at the 4th Uganda National Field Epidemiology Conference, 2nd November 2017 and at the 7th AFENET Conference, 12th -16th November 2018
• Low HIV Seroconversion Proportions on Repeat Testing in Maternity in Kayunga Hospital, Uganda, 2018, accepted for the 9th International Workshop on HIV and Women, 2nd- 3rd March 2019

Written Communication

• Editor of Issue 2, Volume 4, September 2017 of the Uganda National Institute of Public Health (UNIPH) Epibulletin
• Elimination of Mother to Child Transmission of HIV – We all have a role to play; Newspaper article, published in The New Vision, Tuesday 4th July as a commentary
• Rapid Health Assessment of HIV Service Delivery: Epibulletin article, published in the UNIPH Epibulletin, Issue 2, Vol 3, April – June 2017
• Highlights of the Uganda Population HIV Impact Assessment, published in the UNIPH Epibulletin, Issue 2, Volume 4, September 2017
• Policy brief: Increase Vaccination Against Meningococcal Meningitis to areas outside the Meningitis Belt: Lessons from a cluster of Meningitis in Bunyangabo, Published in the UNIPH
• Epibulletin, Issue 1, Volume 3, January-March 2018
• Outbreak of Gastrointestinal Anthrax Following Eating Beef of Suspicious Origin – Isingiro District, Uganda, 2017: Manuscript submitted for review and publication
• Low Proportions of Women Coming with Known HIV status at First Antenatal Visit, Uganda, 2012-2016, Uganda: Manuscript submitted for review and publication.

Summary of Epidemiological Study: 

 Title:  Low HIV Seroconversion Proportions on Repeat Testing in Maternity in Kayunga Hospital, Uganda, 2018

Authors: Miriam Nakanwagi1*, Mathias Kigozi2, Suzan Nakazibwe2, Benon Kwesiga1, Lilian Bulage1, Daniel Kadobera1, Steven Ndugwa Kabwama1, Alex Riolexus Ario1, 1Uganda Public Health Fellowship Program, 2Kayunga Hospital

Abstract

Introduction:  A previously HIV-negative woman during antenatal care can seroconvert to an HIV-positive status later during pregnancy which necessitates HIV re-testing in maternity. An HIV re-test is done three months after the previous test. Generally, HIV re-tests are hardly done in maternity. We used Quality Improvement (QI) approaches and aimed to increase the proportion of HIV re-testing in maternity in Kayunga hospital to 95% and to determine the proportion of women that seroconverted to HIV positive status on a re-test.

Methods:   We established the baseline metric by ascertaining the proportion of women that had had an HIV re-test in maternity in Kayunga hospital from January to June 2018. We trained the maternity staff on the correct eligibility for an HIV retest and the correct Prevention of Mother to Child Transmission of HIV (PMTCT) codes. We also created a column for eligibility for re-test in the integrated maternity register. We analyzed the proportions of women that had an HIV re-test done in maternity during July to October 2018 and compared with the baseline proportions. We also analyzed the proportions of women that seroconverted on a re-test in maternity.

Results:  At baseline, of 447 women attending maternity from January to June, 324 (72%) were eligible for a retest. Of these, 61 (19%) had had a retest done in maternity. The re-testing proportions increased from 31 of the 35 eligible (87.5%) at the start of the intervention to 70 of the 71 eligible (98%) at the end of the intervention. Overall, 206 (93%) of the 221 eligible women had had an HIV re-test in maternity during this period. Of 206 women that re-tested in maternity, two women (1%) seroconverted to an HIV positive status.

Conclusion and Recommendations:   From 2012-2016, the fatal RTI rate decreased by 29% in KD. However, the fatal RTI rate in KD is still almost twice as high as the global rate (17.4). There is a need to establish interventions to curb RTIs and reduce reckless driving. RTI prevention strategies in KD should emphasize vulnerable road users (pedestrians/motorcyclists) and young adult males, who bore the highest proportional burden of RTIs.
Key terms: Road traffic Injuries, traffic accidents, Uganda

Key skills/competences acquired

• Outbreak investigation and response
• Emergency public health surveillance
• National level HIV/AIDS programming and coordination
• Program/project design, implementation and monitoring and evaluation
• Scientific writing and communication: Newspaper articles, policy briefs, manuscripts, bulletin articles, power point presentation
• Leadership
• Innovation

Next steps

I will use my expertise in epidemiology to contribute towards improving the health indicators in Uganda and elsewhere in the world in the field of Public health emergencies and/or HIV/AIDS.