Daniel Eurien

BEHS, MPH, PgdHSM, FGLM
Email: euriend56@gmail.com
Telephone: +256788370059

Host Site: AIDS Control Program (ACP)

Host Mentors: Dr. Joshua Musinguzi and Dr. Shaban Mugerwa

ABOUT THE FELLOW

Daniel Eurien holds a Bachelor of Environmental Health Science from Makerere University; a Masters in Public Health from The Peoples-Uni,  United Kingdom and a Post graduate Diploma in Health Services Management from the Indian Institute of Public Health, India. Daniel is also an alumnus of the Frontline Field Epidemiology Training Program and a Fellowship in Governance, Leadership and Management of Health Services from Makerere University. Before joining the Fellowship Program, he served as a Health Educator in Amuria District Local Government. He also served as HIV Focal Person and acted as Assistant District Health Officer. While at the District Local Government, he oversaw the coordination of implementation of all HIV programs and also provided technical assistance in disease surveillance and immunization activities. He has undertaken a number of short courses, including data analysis using statistical and spatial packages like STATA, SPSS, EPI Info and QGIS; TB Operations Research and Monitoring and Evaluation.

Achievements at the Host Site

• Participated in the review of Health Management Information System data capture tools used in HIV/AIDS care and treatment. This ensured that the data captured at service point levels are robust enough and aligned to measure the core indicators outlined in the Health Sector HIV/AIDS Strategic Plan 2018-2022.
• Participated in development of the Health Sector HIV/AIDS Strategic Plan 2018/2022 as Team Lead for the Strategic Information working group. The new strategic plan seeks to provide a strategic direction to accelerate achievement of 2030 goal of zero new infections through incorporating new strategies like pre exposure prophylaxis among others.
• Was principal investigator in the investigation of IPT completion rates among People Living with HIV in North Eastern Uganda, 2015 to 2017. This study provided evidence of the challenges of roll-out of IPT including IPT stock outs to the National TB and Leprosy Control Program.
• Participated in the Training of Trainers on New HIV Prevention Guidelines that was followed by training of district level trainers. This led to capacity building of frontline health workers on new strategies like pre exposure prophylaxis with the aim of implementing combination HIV prevention in order to contain the epidemic.

Fellowship program specific achievements

Emergency response and outbreak investigation

Lead Investigator;

• Cholera outbreak investigation in Kampala, January 2019. This investigation revealed that drinking water from an unprotected well caused the outbreak, the unprotected well was closed; consequently, the cholera outbreak was contained.
• IPT completion rates among People Living with HIV in North Eastern Uganda, 2015 to 2017. This study provided evidence to the National TB and Leprosy Control Program about the challenges of roll-out of IPT including IPT stock outs.
• Suspected Typhoid fever outbreak in Kabarole District in May 2018. It was found that the reported outbreak was as a result of over-diagnosis of Typhoid fever cases as result of not confirming cases by culture. A quality improvement project was implemented at Fort Portal Regional Referral hospital in which clinical diagnosis of Typhoid fever cases reduced by 80%.
• HIV Care Cascades among Key Populations in Uganda, 2015 to 2019. HIV cascade among key populations in Uganda showed very poor rates of retention in treatment and very low viral load test coverage; suggesting an urgent need to develop and implement effective interventions to support patients in care and increase viral load coverage among all people with HIV.
• Investigation of a Mysterious Illness in Mubende District, 2018. In this investigation, the cause of death was not established because all the reported cases had been buried by the time of investigation. However, capacity of the District Health Teams and the community on early reporting of unusual health events for speedy response was developed.

Co-Investigator;

• A cholera outbreak in Hoima District associated with drinking unsafe water from the lake  Investigation of Anthrax among domestic ruminants in the affected districts of Arua, Kween and Kiruhura
• Investigation of Black Water Fever in Mbale Region in 2018  Investigation of anthrax among humans in Arua District  Investigation of food borne outbreak as a result of consumption of relief food in Karamoja Region.

Scientific communication and writing

Conference Presentations

• Presented a paper on IPT completion among People living with HIV in North Eastern Uganda, 2015 to 2017 at both the Uganda Society for Health Scientists 19th Annual Conference and at the 5th Uganda National Field Epidemiology Conference.
• Presented a paper on Cholera outbreak associated with drinking contaminated unprotected well water in Kampala, 2019 at both the Uganda Society for Health Scientists 19th Annual Conference and at the 5th Uganda National Field Epidemiology Conference. This paper was voted as the oral presentation at the Uganda Society for Health Scientists 19th annual conference.

Written communication

Bulletin articles

He published three bulletin articles in the Quarterly Epidemiological Bulletin of the Uganda National Institute of Public Health, Ministry of Health including:

• Need for increase of coverage of portable water in slum dwellings in Kampala slums to reduce frequent cholera outbreaks, 2019
• IPT completion among People living with HIV in North Eastern Uganda, 2015 to 2017.
• Cholera outbreak associated with drinking contaminated unprotected well water in Kampala, 201

Policy Brief

• The need to increase access to portable water in slum dwellings in Kampala to prevent cholera outbreaks. This policy brief highlighted the role played by flooding of storm water drainages in cholera outbreaks; consequently, Kampala Capital City Authority used this evidence to prioritize construction of storm water drainages to prevent future flooding.

Manuscripts

• IPT completion among People living with HIV in North Eastern Uganda, 2015 to 2017.
• Cholera outbreak associated with drinking contaminated unprotected well water in Kampala, 2019.

Summary of Epidemiological Study: 

 Title: IPT completion among People living with HIV in North Eastern Uganda, 2015 – 2017

Background: Isoniazid preventive therapy (IPT) is highly effective at preventing tuberculosis among Persons Living with HIV (PLHIV). However, IPT completion rates in Uganda have not been studied. We examined completion rates for the 6-month course of IPT and factors associated with
non-completion among PLHIV in northeastern Uganda.

Methods:  We conducted a retrospective cohort study using routinely-collected program data in nine Anti-retroviral Treatment (ART) sites in northeastern Uganda. The study period covered January 2015-December 2017. Non-completion was defined as failure to pick up any of the six
IPT refills over a 6-month period. We abstracted data on IPT treatment site, IPT completion, and demographic and clinical characteristics from the IPT register and patient HIV care card. We used logistic regression to identify factors associated with non-completion.

Results: Among 543 patients who startedIPT, 175 (32%) completed the full 6-month course. Among those who did not complete, 163 (44%) did not have a documented reason for stopping; 193 (52%) had to stop due to drug stock outs at their treatment site, and 12 (3.3%) were lost to follow-up.
Being at World Health Organization (WHO) HIV clinical stages three and four at initiation were associated with a higher risk of IPT non-completion compared to those who were at WHO clinical staging one and two (aRR 1.35, 95%CI 1.23-1.48).

Conclusion: IPT completion rate among PLHIV in northeastern Uganda were suboptimal, largely due to IPT drug stock outs. The National TB and Leprosy Program should streamline the IPT supply chain to address drug stock outs and improve completion rates.

Key Skills and Competencies acquired.

During the fellowship, I learnt and developed the following skill sets:

• Data analysis skills
• Designing an epidemiological study
• Evaluating a surveillance system
• Presentation skills
• Outbreak investigation
• Writing skills
• Networking skills

Next Steps

• I hope to apply the skills of field of Epidemiology to build capacity of my fellow health workers in the district in the medium term. I am also open to taking up a more challenging role of an Epidemiologist at the national level where I will fully apply the knowledge and skills I have learned in past last two years.