Vivian Ntono

BScN (MUK), MPH (MUK), Field Epidemiology Fellow -PHFP
Tel: +256-776-607229
Email: ntonovivian@musph.ac.ug, ntonovivian@gmail.com

Host Site: Mental Health, Substance Abuse and Neurological Disorders, Ministry of Health & Butabika National Referral Hospital (Alcohol & Drug Unit)

Host Mentors: Dr. Hafsa Lukwata and  Dr. Brian Mutamba

ABOUT THE FELLOW

Vivian Ntono holds a Master of Public Health and a Bachelor of Science in Nursing from Makerere University Kampala, Uganda. Vivian has worked in a number of research projects, the most recent being the Makerere University John Hopkins University (MUJHU) as a Study Nurse. Vivian was hosted at Mental Health, Substance Abuse and Neurological Disorders, Ministry of Health & Butabika National Referral Hospital (Alcohol & Drug Unit). Vivian has developed skills in applied Epidemiology, effective communication and emergency public response and has interest in using epidemiologic methods in solving global health challenges.

  Achievements at the Host Site

• Analyzed Surveillance Data to determine Distribution of Attempted Suicide: Uganda, January 2016 – December 2017. This led to drafting of policy brief which was presented at the NCD technical working group and published in the NCD quarterly bulletin. It recommended Integration of Suicide prevention strategy into the Mental Health Policy in Uganda.
• Participated in writing a concept on psychosocial support during Ebola response and participated in planning meetings for psychosocial support during the Ebola outbreak in Kasese.
• Lead editor in the NCD quarterly bulletin which is a platform to showcase research and current news on NCDs. The NCD bulletin also fosters interaction among the various stakeholders and reflects upon progress made by key players and policy makers.
• Conducted Quality Improvement project on Improving screening, assessment and reporting of Depression among People Living with HIV at the HIV Clinic in Naguru Hospital, Kampala District, Uganda-2019. This provided the first steps of integration of mental health care in HIV care and promotion of key indicators like adherence to ART and improved Viral load suppression.
• Conducted an epidemiological study on Distribution of Childhood Mental Health Disorders among children receiving care in Butabika National Referral Hospital, Kampala, Uganda, 2018 following a dissemination workshop on Childhood Mental Health Policy guidelines that
  indicated gaps as far as burden and drivers of childhood mental health disorders.

Fellowship program specific achievements

Descriptive analysis

• Analysis of Surveillance Data to Determine Distribution of attempted Suicide: Uganda, January 2016 – December 2017. This led to drafting of policy brief which was presented at the NCD technical working group and published in the NCD quarterly bulletin. It recommended Integration of Suicide prevention strategy into the Mental Health Policy in Uganda.

Field investigations
Lead investigator:

• Cutaneous Anthrax outbreak associated with handling meat of dead animals in Rhino Camp, Arua District, Uganda-2018
• Verification of Anthrax outbreak in Nebbi, Zombo and Arua Districts
• Ebola preparedness and risk mapping activity in Kasese District from 14th August- 19th August, 2018.

Co-Investigator:

• Cholera outbreak investigation in Hoima District, 2018
• Animal Anthrax outbreak investigation Arua District Rhino-camp, Rigbo and Pawor sub-county
• TB outbreak investigation in Butabika National Referral Hospital from 14th to 25th of January.
• Malaria Outbreak investigation in Gomba District 24th February to 21st March
• Malaria outbreak in Kole District from 1st July, 2019 to 19th July, 2019

Bulletin Articles

• Integration of Suicide prevention strategy into the Mental Health Policy in Uganda
• Distribution of Attempted Suicide in Uganda, 2016-2017
• 7th AFENET Conference, Maputo, Mozambique, 11th – 16th November 2018

Quality Improvement project

• Improving screening, assessment and reporting of Depression among People Living with HIV using a Quality Improvement Approach in Naguru China Friendship Hospital, Kampala District, Uganda-2019.
• Overall, by October, that is 6 months of implementing the Quality Improvement Project, 99% of the HIV patients had been screened for depression in the ISS clinic. Out of HIV patients that had been screened, a total of 91 (96%) of HIV patients were assessed for depression on the ISS clinic over the QI Project Period. Among those that had been assessed 38 (7%) were referred to the Psychiatrist for further review.
• There was an increasing trend of the proportion of screening and assessment for depression in HIV on the ISS clinic and had exceeded the target by the third month of the project. Overall this was a successful QI project and we recommended HIV service providers to step up assessment and screening of depression to improve on adherence to ART regimens and promote Viral load suppression.

Conference Presentations

• Cutaneous Anthrax Outbreak associated with contact with dead animals in Rhino-camp Sub-county, Arua District, Uganda(TEPHINET Conference 2019)
• Assessment And Characterization Of Extra-Pulmonary TB In Uganda, 2014 Conference 2019)

Policy Brief

• Integration of Suicide prevention strategy into the Mental Health Policy in Uganda, 2018

HIV project

• Prevalence and distribution of HIV among people that have experienced childhood abuse in Uganda TB Operational Research
• Assessment And Characterization of Extra-Pulmonary TB in Uganda, 2014 to 2017 Prevalence of EPTB was 1.5/100,000 in 2013, 1.9/100,000 in 2014, 1.3/100,000 in 2015, 2.6/100,000 in 2016, and 1.9/100,000 in 2017.
• There was annual average increase of 8% in EPTB in Uganda over the study period (p<0.0001). EPTB was 7-fold higher among HIV-positive patients compared with HIV-negative patients (AOR: 7.3, CI:3.6-17). EPTB is increasing in Uganda.
• HIV infection was associated with EPTB. We recommend intensified screening for PTB, especially among HIV-positive individuals, early diagnosis, and prompt treatment of EPTB.

Newspaper Articles

• What can we do to prevent Suicide in Uganda was submitted to the New Vision on 8th April, 2019

Manuscripts

• Cutaneous Anthrax Outbreak associated with contact with dead animals in Rhino-camp Sub-county, Arua District, Uganda, 2018 (under peer review)
• Assessment And Characterization Of Extra-Pulmonary TB In Uganda, 2014 to 2017 (under peer review)

Summary of Epidemiological Study: 

 Title: Assessment and Characterization of Extra-Pulmonary Tuberculosis among Patients Receiving Care in Public Health Facilities in Kampala, Uganda, 2013 – 2017

Background:  Despite recent advances in diagnosis, treatment, and management, tuberculosis (TB) remains a major public health problem. Uganda is one of the highburden TB countries, and extra-pulmonary (EPTB) is a common presentation. We assessed and characterized EPTB among patients receiving care in public health facilities in Kampala to inform treatment strategies at the point of care.

Methods: We conducted a retrospective cross-sectional data analysis of all TB cases in the Track-TB database from 2013-2017. We abstracted data on presumptive, bacteriologically-confirmed and clinically diagnosed TB patients enrolled during the period. We conducted descriptive epidemiology and used chi-square test for trends to test association. Multivariable logistic regression was used to determine predictors of EPTB.

Results: Data for a total of 4,025 EPTB patients were obtained. Of these, 58% (2,348/4,025) were female. The mean age was 33 years (SD=13) and 32% (1,285/4,025) were aged 30-39 yrs. Thirty-seven percent (1,502/4,025) were new TB patients and66% (2,666/4,025) were HIV-positive. Forty-eight percent (1,922/4,025) completed TB treatment. Prevalence of EPTB was 1.5/100,000 in 2013, 1.9/100,000 in 2014, 1.3/100,000 in 2015, 2.6/100,000 in 2016, and 1.9/100,000 in 2017. There was annual average increase of 8% in EPTB in Uganda over the study period (p<0.0001). EPTB was 7-fold higher among HIV-positive patients compared with HIV-negative patients (AOR: 7.3, CI: 3.6-17).

Conclusion and Recomendations: EPTB is increasing in Uganda. HIV infection was associated with EPTB. We recommend intensified screening for EPTB, especially among HIV-positive individuals, early diagnosis, and prompt treatment of EPTB.

Key Skills learnt during the fellowship

• 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 Naguru China Friendship Hospital.

Next Steps

• With the knowledge and skills I have acquired in field epidemiology, I intend to build a career in epidemiology and mainly Non-Communicable Diseases.
• I also intend to pass on the knowledge and skills I have acquired to field epidemiology professionals and stakeholders.

Pictorial