(The Late) Doreen Nsiimire Gonahasa

BSc FST (Mak), MPH (IHSU), Advanced Field Epidemiology Fellow (UPHFP)
Email:dorynegona@musph.ac.ug/ doryengona@gmail.com
Telephone: +256 779 398990/ +256 701 400786

Host Site: Infectious Diseases Institute (IDI)

Host Mentors: Ms Lydia Nakiire and Dr. Larmode Mohammed

ABOUT THE FELLOW

Now a fully-fledged field epidemiologist, I hold a Master‟s degree in Public health with a background in Food Science and Technology. I have taken particular interest in implementation of One Health approach to public health.
During the Public Health Fellowship Program, I was attached to the Infectious Diseases Institute, a Ministry of Health implementing partner that has done tremendous work across the country in the areas of HIV care, Global Health Security, AMR surveillance, and training and mentorship of health care staff among other things.
Through the in-service training I have attained excellent skills in leadership, outbreak investigation, and public health response including data analysis, interpretation, and use. I have led two outbreaks and participated in seven others including the COVID-19 pandemic. I have also been involved in a number of national document formulations including the One Health strategic documents, the National Action Plan for Health Security (NAPHS) and the Integrated Disease Surveillance and Response Guidelines – 3rd Edition (IDSR).

  Achievements at the Host Site

At IDI I was attached to the Global Health Security Project in which I participated in and led activities. A subset of these is listed below:

• Participated in capacity building for EVD Preparedness and response at POEs in Arua District (25th -29th March)
• Participated in the National Simulation Exercise to assess Uganda‟s readiness for EVD
• Participated in review of Uganda‟s EVD Contingency Plan
• Participated in drafting of SOPs for Border Health
• Led Anthrax outbreak response and risk communication in Kween District
• Took part in review of the National Action Plan for Health Security in preparation for its launch due July 2019
• Participated in review of Pandemic Influenza Plan linkage to NAPHS and EVD Plan
• Participated in organizing for and launch of National Action Plan for Health Security
• Supported EVD Risk Assessment readiness in Health Facilities and Population Connectivity Across Borders assessment in South Western Uganda
• Participated in the EVD outbreak After Action Review and report writing
• Took part in a ToT on One Health implementation at District level
• Trained Nakasongola District Local Government staff on One Health implementation
• Participated in development of the National Pandemic Influenza Preparedness Plan
• Took part in data collection and report writing for the national Food Safety Situation Analysis
• Undertook a COVID-19 ToT for District support in preparation for training in Soroti region
• Facilitated a District COVID-19 Orientation on identification, reporting and response in Soroti region
• Supported COVID-19 response through regional support in Busoga Sub region
• Trained Health Workers at Mulago Hospital on COVID-19 surveillance and Infection Prevention and Control
• Participated in follow up of returnees (Ugandan‟s that returned home from abroad following different measures for containment of the outbreak) under institutional quarantine
• Participated in an M&E exercise for the National Action Plan for Health Security (NAPHS) one year after its launch
• Supported National Inter-Action Review for COVID-19 Response
• Facilitated health worker training in Butaleja District in enhanced surveillance and reporting
• Designed and implemented a QI Project on Acute Febrile Illness surveillance at Jinja Regional Referral Hospital

Fellowship program specific achievements

• Led two outbreak investigations:
  – Fatal cross-border outbreak of plague in Zombo District, March 2019
  – Cluster of strange deaths in Katabi Town Council, Wakiso District
• Participated in several other outbreak investigations:
  – Leprosy investigation in Lira District, March 2019
  – EVD outbreak in Kasese District, June 2019
  – CCHF outbreak in Kagadi District, 2019
  – Food poisoning in Lamwo District, 2019
  – COVID-19 pandemic, 2020
• Analyzed surveillance data from DHIS on the incidence and trend of bacterial meningitis in Uganda for the period between 2014 to 2018
• Presentations at conferences
  – Fatal cross-border outbreak of plague in Zombo District at the 5th and 6th National Field Epidemiology Conference and the 4th Joint Annual Scientific and Health Conference
  – International Airport screening for COVID-19 at Entebbe International Airport at the 6th National Field Epidemiology Conference
• Wrote and published four newspaper articles
  – Why it is important to conduct a postmortem especially for people who die from unknown cause published in the New Vision of 17th August 2019
  – Boots on the Ground for Uganda‟s Ebola Preparedness and Response Efforts published in the Tephinet bulletin for the period of July-September 2019
  – One Health Day Celebrations published in the New Vision on 1st November 2019
  – Healthy practices to maintain during and after the COVID-19 pandemic published on 29th August 2020 by New Vision
• Was lead author for the Issue 2 Volume 4 National Institute of Public Health (NIPH) bulletin
• Wrote and published four articles in the National Institute of Public Health bulletin
  – Fatal cross border outbreak of plague in Zombo District, March 2019
  – EVD spill over into Uganda, June 2019
  – Highlights of Cohort 2018 graduation in January 2020
  – Cohort 2020 recruitment as they start the two-year in-service training
• Designed and implemented a Quality Improvement study on improvement of Acute Febrile Illness (AFI) surveillance at Jinja Regional Referral Hospital
• Conducted an HIV epi study on the factors associated with delay in 1st DNA PCR testing for HIV-exposed infants in Kyenjojo and Kyegegwa Districts for the period of July to December 2019.
• Submitted a manuscript for publication to peer reviewed journal titled „Fatal cross border outbreak of plague in Zombo District, March 2019‟ and have another under internal review titled „Factors associated with late 1st DNA PCR test among HIV exposed infants in Fort Portal Region, Uganda, July-December 2019‟.

Summary of Epidemiological Study: 

 Title: Factors associated with delay in 1st DNA PCR testing for HIV-exposed infants in Kyenjojo and Kyegegwa Districts for the period of July to December 2019.

Background: Despite high access to ART among HIV infected pregnant women (>90%), early 1st PCR testing (within 2 months of birth) for HIV-exposed infants (HEI) born to these mothers remains low. There is limited understanding of factors associated with late 1st PCR testing of these infants in Uganda. Understanding these factors is important for guiding programmatic interventions to improve early infant testing and improving survival of HIV-infected infants. We determined the prevalence of and factors associated with late 1st PCR testing.

Methods: We conducted a facility-based cross-sectional study using routine clinic data from eleven health care facilities in Kyenjojo and Kyegegwa Districts in Fort Portal Region in Uganda. The selected health facilities contributed 30% (132/420) of all HIV-exposed infants (HEI) who tested late, that is beyond 8 weeks of age in the Fort Portal region during July to September 2020. We included caregiver-infant pairs for infants who received a 1st DNA PCR test between July – December 2019 at the study sites. Our outcome was HEI who had a late DNA PCR test. We computed the proportion of infants who tested late and used logistic regressions to determine significance of association.

Results: Three hundred sixty-two mother-infant pairs were recruited for the study. Most of the mothers were married/cohabiting, were farmers, and had attained only a primary or lower level of education. Most had attended ANC and delivered at a facility for most recent pregnancy. The prevalence of late PCR testing was 9.9% (36/362). In univariate analysis, late 1st DNA PCR was associated with delivery at home (OR 5.0; 95% CI 2.6-12.13); ANC non-attendance for that pregnancy (OR 78.4; 95% CI 9.32-659.8) and feeding method being mixed or replacement (MF/RF) (OR 64.4; 95% CI 19.69-210.6). In multivariate analysis, it was associated with delivery at home (OR 3.54; 95% CI 1.24-9.99), ANC non-attendance (OR 11.0; 95% CI 0.70-173.25), and feeding method being MF/RF (OR 47.8; 95% CI 13.26-172.16)

Conclusion: One in ten infants exposed to HIV were tested late in Kyenjojo and Kyegegwa Districts during the second half of 2019. Late testing was associated with home delivery, failure to attend ANC, and non-exclusive breastfeeding. Not attending ANC and delivering at home could imply that mothers are not aware of the need to have their children tested and started on treatment when need be. There is therefore need for the Ministry of Health and its relevant implementing partners to use some community focused interventions such sensitization to supplement efforts so far instituted to realize the goal of eMTCT of HIV/AIDS.

Key Skills Lessons Learnt

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

• Outbreak Investigation and response including institution of interventions
• Evaluation of surveillance systems
• Designing and implementing Quality Improvement Projects
• Data management, analysis and interpretation using such sofware as STATA, Epi Info and QGIS
• Scientific writing (for Abstracts, Manuscripts, Policy Briefs and short articles)
• Presentation skills and dissemination of findings
• Networking and lobbying skills
• Leadership and team management skills

Next Steps

With the competencies gained, I hope to be able to continue to serve within the Ministry of Health or related organization in realization of improved global health and prompt response to public health emergencies and threats.