Kenneth Bainomugisha:

BEHS (MUK), MPH (MUK), Field Epidemiology Fellow (PHFP)
Tel: +256787992834, +256753154844
Email: kbainomugisha@musph.ac.ug and
kbainomugisha@gmail.com

Host Site:

Uganda Prisons Service

Host Mentor:

Dr. James Kisambu

ABOUT THE FELLOW

Kenneth Bainomugisha holds a Master of Public Health and a Bachelor of Environmental Health Science from Makerere University Kampala, Uganda. Kenneth has received training in Disaster Risk Leadership and Public Health in Complex Emergencies from Makerere University School of Public Health. He has worked at the Epidemiology and Surveillance Division of the Ministry of Health and developed passion for International Health Regulations (2005) and subsequently conducted a study, “Surveillance for Public Health Emergencies of International Concern at Points of Entry for Uganda, a case of Entebbe International Airport” for his master‟s thesis. His attachment to the Uganda Prisons Service exposed him to unique health needs of prisoners as a key population. He developed skills in Applied Epidemiology, effective communication and emergency public response and has interest in using epidemiologic methods in solving cross-border public health problems.

Achievements at the Host Site

Engaged in support supervision and mentorship activities in different prison health facilities around the country. This contributed to improved HIV/TB care in prison health facilities.

Participated in workshops and conferences at the host site such as the Electronic Medical Records (EMR). These engagements led to harmonization of the National EMR and the Prison EMR and strengthened reporting on indicators such as care transferred prisoners and linkage of released prisoners.

Reviewed and disseminated updated HIV/AIDS guidelines among Prison Health Workers such as Assisted Partner Notification (APN) and
Differentiated Service Delivery Model (DSDM) among others.

Studied key indicators of prisoners‟ health such as HIV/TB/Mental Illness prevalence and determinants and recommended evidence-based
practices to improve on prisoners‟ health.

Fellowship program specific achievements

Emergency response and outbreak investigation

Descriptive analysis:

• Analysis of Surveillance Data to determine mental and neurological disorders among prisoners who sought care at Murchison Bay prison
  Hospital in Uganda, 2015 – 2017.
• The results from this study generated evidence of the need to strengthen care of prisoners with these disorders with special recommendation to increase metal health workers in prison health facilities.

Outbreak Investigations

Lead Investigator:

• Anthrax Outbreak investigation, Makutano Village, Kween District, May 2018.
• Suspected Food Poisoning Outbreak Caused by Drinking Porridge Prepared with Fermented Maize Flour, Katuulo Village, Lwengo District, Oct 2018
  Co- Investigator:
• Anthrax Outbreak Caused by Handling and or Consumption of Meat from a Dead Cow in Kaplobotwo Village, Kween District, Uganda April, 2018
• Prolonged Cholera Outbreak in Kyangwali Refugee Settlement caused by drinking contaminated water from the stream, Hoima, Uganda, 2018
• Uganda Ebola Virus Disease Preparedness Assessment and Risk Mapping, Aug – Sept, 2018

Bulletin Articles;

• Mental and neurological disorders among prisoners who sought care at Murchison Bay Prison Hospital in Uganda, 2015 – 2017
• Risk factors for active TB among HIVPositive prisoners on ART at Murchison Bay Hospital in Luzira Maximum Security Prison in Uganda; 2013-2017

Quality Improvement project;

• Improving Quality of HIV/TB and Related Data at Murchison Bay Hospital in Luzira Maximum Prison in Uganda, 2019. The QI project was able to make an impact on the knowledge levels of health workers on data quality and percentage of patients with missing records in the
  ART clinic in Luzira Prisons Health facilities reduced.

Conference Presentations

• Mental and Neurological Disorders Among Prisoners Who Sought Care at Murchison Bay Prison Hospital in Uganda, 2015 – 2017 (USHS 19th
  Annual Scientific Conference 23 -24 May 2019)
• Risk factors for active Tuberculosis among HIV-Positive prisoners on Antiretroviral Therapy at a Maximum-Security Prison in Uganda;
  2013-2017 (USHS 19th Annualc Scientific Conference 23 -24 May 2019 & The 5th Uganda National Field Epidemiology Conference
  2019)
• Anthrax Outbreak Associated with Handling Anthrax Infected Dead Cows, Makutano Village, Kween District, Uganda, May 2018 (USHS
  19th Annual Scientific Conference 23 -24 May 2019)

Policy Brief

• Democratic Republic of Congo Ebola Outbreak Should Constitute a Public Health Emergency of International Concern, 2017
• Improve Screening of Prisoners for Mental Illnesses in Prison Health Facilities in Uganda

HIV project

• Risk factors for active Tuberculosis among HIV-Positive prisoners on Antiretroviral Therapy (ART) at a Maximum-Security Prison in Uganda;
  2013-2017. Our study found that the incidence of active TB among HIV prisoners on ART was >20 times higher than that in the general population. Prisoners who had stayed in prison for >5 years and those who had a WHO stage of IV at enrolment on ART had a higher risk of developing active TB while in prison.

TB Operations Research

• Risk factors for active Tuberculosis among HIV-Positive prisoners on Antiretroviral Therapy at a Maximum-Security Prison in Uganda;
  2013-2017. Staying longer in prisons and having WHO Stage IV on ART enrolment were key risk factors for developing of TB.

Newspaper Articles

• Can Current HIV/AIDS Interventions by Uganda Prisons Service curb the worrying Prevalence? (Published in The New Vision Jul 17, 2018)
• Entebbe Airport and Ebola Viral Disease preparedness (Aviation Bulletin, 2019)

Manuscripts

• Short Communication Manuscript – Cutaneous Anthrax Outbreak Caused by Handling Meat from Infected Carcass, Makutano Village, Kween
  District, Uganda, May 2018 (under review)
• Risk factors for active Tuberculosis among HIV-Positive prisoners on Antiretroviral Therapy at a Maximum-Security Prison in Uganda;
  2013-2017 (under review)

Summary of Epidemiological Study: 

 Title: Risk factors for Active Tuberculosis among HIV-Positive Male Prisoners onAntiretroviral Therapy, at Luzira Maximum
Security Prison, Uganda, 2013-2017

Introduction: Tuberculosis (TB) prevalence in Uganda Prisons Service (UPS) is estimated at 654/100,000, more than double that in the general population (253/100,000). We documented the incidence of and risk factors for active TB among HIV positive male prisoners on Antiretroviral Therapy (ART) in Luzira Maximum Security Prison  (LMSP) in Uganda, 2013-2017.

Methods:  We conducted a retrospective cross-sectional analysis of data for HIV-infected male prisoners on ART diagnosed with TB from January 2013-December 2017 at LMSP. Routinely collected program data were obtained from medical registers at LMSP. We considered prisoners who had
been detained for ≥1 year before data collection. We computed the proportion of prisoners on ART who developed TB and used logistic regression to identify risk factors for active TB among male HIV+ prisoners.

Results: Of the 108 HIV+ male prisoners on ART, 69 (63%) were aged 18-34 years, 61  (57%) had stayed in prison for a period of 1 to 3 years, 81 (75%) were at HIV WHO clinical stage 1 or 2, and 61 (57%) had a normal body mass index 18.5-24.9. 24 (22%) prisoners on ART developed active TB. HIV+ prisoners enrolled on ART with HIV WHO clinical stage 3 had increased odds to acquire TB from prison compared to those in stage 1 (AOR=141; 95% CI=2.1-9795). Among HIV+ prisoners, unemployment before prison, was associated with anincreased odds of acquiring TB in prison (AOR=0.015; 95% CI=0.000-0.73), and 62 (57%) of HIV+ prisoners enrolled with BMI of 18.5-24.9 had lower odds of acquiring TB from prison compared to 10 (44%) who had a BMI of <18.5 at enrolment (AOR=0.032; 95% CI=0.0021-0.51).

Conclusion; Persons presenting late for ART initiation, and those with low BMI had increased odds of developing TB. We recommended on entry screening of all new prisoners and early ART initiation for all HIV+ prisoners.

Key Skills and Competencies acquired.

• Practical skills in disease outbreak investigation, response and control.
• Scientific writing and presentation skills to various audiences.
• Analysis, interpretation and evaluation of surveillance data to improve health.
• Leadership and management skills attained from the different assignments at the host site and the Quality Improvement project conducted in Uganda Prisons Service.

Next Steps

• With the knowledge and skills I have acquired in field epidemiology, I desire to build a career in infectious disease epidemiology and
  International Health Regulations.
• I also intend to transfer the knowledge and skills I have gained to persons with interest in field epidemiology.