Phoebe Nabunya

BSc. BLT (MAk),MSc. International Infectious Disease.Management (MAK), Uganda Public Health, Fellowship Programme, Field Epidemiology Fellow
Email:demong@musph.ac.ug
Telephone: 0774558101 / 0756 558101

Host Site: The National TB and Leprosy Program (NTLP)

Host Mentor: Dr.Dr Deus Lukoye, Dr Simon Muchuro, Dr Stavia Turyahabwe

ABOUT THE FELLOW

Daniel Jacob Emong is a cohort 2020 advanced field epidemiology fellow with a background in Biomedical Laboratory Technology. I hold a Master of International infectious Disease Management from Makerere University. I have over time gained interest in Tuberculosis (TB) and HIV/AIDS. During my time as a public health fellow, I was hosted at The National TB and Leprosy Program (NTLP), Ministry of Health for a two-year apprenticeship. I have conceptualised, designed and implemented studies in Tuberculosis including TB treatment outcomes among adult TB/HIV co-infected patients in Kampala Metropolitan, Uganda 2018-2020. At NTLP, I was able to carry out investigations to guide programme decisions. I have extensive knowledge in Tuberculosis and HIV/AIDS patient care, capacity building and health systems strengthening. Through this experience, I have built my confidence and extensive competence in designing study protocols and, implementing them, writing reports, abstracts, PowerPoint presentations, manuscript writing, data analysis, publication skills and investigating outbreaks including Rift Valley Fever and COVID-19 response. I have led two outbreak investigations and participated in 4 others. I have also been part of the COVID-19 response and control activities. I have undertaken several short courses and improved my skills in using data to develop policies, data analysis using statistical and spatial packages like STATA, SPSS, EPI Info and QGIS; Event-based surveillance and case-based surveillance.

  Achievements at the Host Site

• The fellow supported the monitoring and evaluation team at the program with TB performance reviews and mentorships in the country
• A conducted training and support supervision of health facilities implementing electronic Case Bases Surveillance System (eCBSS) in Kampala and Wakiso at the host site
• Conducted training of regional trainers on TB catch-up campaign in Lango subregion to find all missing people with TB during 2021 and sustain the activities to reach all the people who require TB prevention, diagnosis and treatment in line with the national strategic direction of reducing TB incidences towards ending the TB epidemic by 2030 at the host site
• I actively participated in editing radio and television scripts for TB drama awareness on stigma and discrimination while at the host site.
• I supported the Social and Behaviour Change Communication team in developing a concept for the “Community-Based Media catch up campaign To END TB”
• I led in the development of the information, Education and Communication (IEC) materials for “Community-Based Media catch up campaign To END TB”
• Conducted assessments why there was low uptake of Tuberculosis preventive treatment in Mulago national referral hospital and Hoima district
• Conducted quality improvement projects to optimise uptake of Tuberculosis preventive treatment in Mulago national referral hospital and Hoima district.
• Conducted two epidemiological studies “Effect of community differentiated service delivery models on retention and viral suppression among
• stable HIV clients in Wakiso districts, Uganda, 2021 and TB treatment outcomes among TB/HIV coinfected patients being treated in Kampala Metropolitan region, Uganda, 2018-2020 ”
• Actively participated in the development of Tuberculosis and leprosy data management and analysis guidelines 2020/2021
• onducted Verification of the alleged T.B outbreak in Tororo district, 2020

Fellowship program specific achievements

• The fellow has been an editor on one issue of the Uganda National institute of public health
• Led investigator/principal in the effect of COVID-19 pandemic on seeking for HIV/AIDS, tuberculosis, malaria, and maternal and child health services, Uganda, 2020
• Led investigator/principal in an investigation of Malaria Insecticide-treated bed net ownership and utilisation in Kaliro district following a mass distribution
• Led investigator/principal in Rift Valley Fever outbreak investigation in kyegegwa district between 6th and 9th September 2021
• Led investigator/principal in Epidemiological Investigation of a Rift Valley Fever Outbreak in Humans and Livestock in Moyo district, March 2021
• Co-investigator in the investigation of Brucellosis outbreak in Moyo district, March 2021
• Co-investigator in the investigation of Outbreak of foodborne disease linked to contaminated anyoya (snack) prepared by a food vendor, Obongi district, Uganda, August 2021
• Co-investigator in the investigation of transmission of COVID-19 associated with clustering during Church activities, Omoro District, Northern Uganda, October 2020.
• Co-investigator in the investigation of Measles outbreak in Nakivale Refugee Camp in Isingiro This investigation was led by Immaculate Akusekera, a PHFP cohort 2020
• Co-investigator in an investigation of COVID-19 among truck drivers in Uganda. (The Truckers Protection Project)
• Co-investigating a suspected community case transmission of COVID -19 in Rakai district• Co-investigator in Epidemiological investigation of risk factors associated with Malaria death in Kitgum district

Conference Presentations

• Oral presentation on the TB treatment outcomes and associated factors among TB/HIV co-treated patients aged ≥ 15 years in Kampala Metropolitan, Uganda 2018-2020
• Oral presentation on the Effects of COVID 19 pandemic on essential health service delivery in Uganda, 2020

Publications and Manuscripts

• Effect of community differentiated service delivery models on retention and viral suppression among stable HIV clients in Wakiso districts, Uganda, 2021
• TB treatment outcomes among TB/HIV coinfected patients being treated in Kampala Metropolitan region, Uganda, 2018-2020
• Factors affecting uptake and completion of Isoniazid Preventive Treatment (IPT) among contacts under the age of five years at Mulago national referral hospital, Uganda 2021.
• Effect of COVID-19 pandemic on seeking for HIV/AIDS, tuberculosis, malaria, and maternal and child health services, Uganda, 2020
• Rift Valley Fever Outbreak in Humans and Livestock in Moyo district, March 2021
• Rift Valley Fever outbreak investigation in kyegegwa district, September 2021

Summary of Epidemiological Study: 

 Title: TB treatment outcomes among TB/HIV coinfected patients being treated in Kampala Metropolitan region, Uganda, 2018-2020

Background: There are 1.4 million persons infected with HIV in Uganda and 40% of those are coinfected with TB. WHO targets ≥90% TB/HIV treatment success by 2025. However, the TB treatment outcomes of TB/HIV co-infected patients need to be optimized. We described the epidemiological characteristics and treatment outcomes of co-infected patients during 2018-2020.

Methods: We conducted a retrospective cross-sectional study in all TB-infected patients ≥15 years of age who tested positive for HIV and were initiated on TB/HIV co-treatment between 2018-2020 in six districts of Kampala metropolitan in Uganda. We considered at least one hospital with the highest volume of HIV patients. We abstracted demographics and treatment outcomes from TB and HIV registers. TB treatment success was defined as patients who were cured orthose who completed 6 months’ treatment as per the WHO guidelines. We described the patients’ characteristics and treatment outcomes.

Results: Of the 317 TB/HIV patients on co-treatment during the study period, 202 (64%) were male and 136 (43%) were aged 25-34 years. In total, 265 (84%) had treatment success between 2018-2020, including 44% who completed treatment and 40% who were cured. Among the 44 (14%) who had unsuccessful treatment, 29 (65%) died, 9 (3%) were lost to follow-up, 7 (2%) failed treatment and 7 (2%) were not evaluated.

Conclusion: The TB treatment success rate was very close to the national TB treatment success target of 85%. We recommended continued evaluation to identify factors associated with TB treatment failure.

Key lessons learnt during the fellowship

PHFP has presented an opportunity for hands-on learning experience in field epidemiology and public health leadership with the skills and competencies acquired from this practical experience and mentorship with supervision from technical experts in the ministry and fellowship program are priceless. During the fellowship, I leant and developed the following skills:

• National disease outbreak investigations to establish sources of the outbreak, the causes and inform early prevention and control interventions
• Leadership skills of managing studies and responding to disease outbreaks
• Assessments of sub-optimal health and behaviour outcomes
• Scientific writing of manuscripts, abstracts, Policy briefs, and newspaper articles
• Designing and implementing quality improvement projects
• Evaluating surveillance system
• Presentation skills
• Networking

Next Steps

Leveraging on my knowledge, experience and skills obtained before and during the public health fellowship period, I hope to further my career in the field of epidemiology through service at national and international levels. I plan on publishing all the work done during the fellowship period in peer review journals.

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