Rebecca Akunzirwe

BScN (MuK), MSc. CEB (Muk)
Email: rakunzirwe@musph.ac.ug, akunzirwer@uniph.go.ug
Telephone: +256 752384468/ +256 772229130

Host Site: AIDS Control Program, Ministry of Health.

Host Mentor: Dr. Elena Magongo/Dr. Miriam Nakanwagi

ABOUT THE FELLOW

Now equipped as a certified field epidemiologist, Rebecca holds a master’s degree in Clinical Epidemiology and Biostatistics. Her specific focus lies in enhancing service delivery for children and adolescents living with HIV.

During her training, Rebecca was attached to the pediatric and adolescent HIV care and treatment branch of the AIDS Control Program, Ministry of Health.

Thanks to the in-service training, Rebecca has acquired significant expertise in leadership, mentorship, scientific communication, quality improvement projects, and outbreak investigation and response, encompassing data analysis, interpretation, and utilization. Leading one outbreak and participating in four others, she gained hands-on experience. Additionally, she played a role in organizing both national and international conferences on HIV and AIDS.

  Achievements at the Host Site

• Participated in the production of the quarterly HIV/AIDS reports/ bulletin.
• Participated in the drafting of the new national HIV guidelines on differentiated service delivery for children and adolescents living with HIV.
• She was part of the organizing committee for the paediatric and adolescent HIV learning collaborative for Africa which was aimed at providing an opportunity for HIV program managers from African countries to engage, share best practices and foster south to south evidenced-based learning among countries on the African continent on pediatric and adolescent HIV care and treatment.
• She was a part of the external assessors for health facilities on a baby-friendly health facility initiative in Uganda with a particular focus on the baby-friendliness of health facilities for HIV-exposed infants
• She was a part of the national team that reviewed and revised Family Connect Program health messages and promotional materials.
• She carried out four studies: ‘Adherence to the Early infant diagnosis study among HIV-exposed infants in Uganda, 2017−2019’, ‘Improving HIV index testing among children and adolescents living with HIV at Fort Portal Regional Referral Hospital, 2023’, ‘Performance, challenges, and opportunities to EID testing among facilities using Point of Care technologies in Uganda, 2023’ and ‘impact of Ebola Outbreak on utilization of differentiated service delivery model utilization in Mubende and Kassanda Districts’ and ‘Trends in differentiated service delivery model utilization among children and adolescents living with HIV’.

Fellowship program specific achievements

• Led an outbreak investigation:

• • Outbreak of scabies in a Hoima District, 2022
• Participated in four other outbreak investigations:
  • Malaria deaths among children with severe malaria, Namutumba District
  • EVD outbreak in Kassanda and Mubende District
  • Meningitis in Obongi District
  • Yellow fever in Masaka District
• Analyzed surveillance data from DHIS on trends in differentiated service delivery model utilization in Uganda, 2020-2022.

Local Conferences

• • 2022 PEPFAR HIV science summit
  • 2022 National Field Epidemiology Conference
  • 2023 National Field Epidemiology Conference at the national level

International Conferences

• • International workshop on HIV and Paediatrics
  • 8th Africa Field Epidemiology Conference

• Wrote and published three newspaper articles:

• • What you need to know about cervical cancer screening
  • Get your COVID-19 shot
  • Violence against adolescent girls is a driver of HIV/AIDS
• Editor for the Issue 2 Volume 7 NIPH Epibulletin.
• Designed and implemented a quality improvement study on the improvement of index testing among children and adolescents living with HIV in Fort Portal Regional Referral Hospital.
• Conducted an HIV epidemiological study on the factors associated with adherence to the Early Infant Diagnosis among HIV-exposed infants in Uganda.
• Submitted 2 manuscripts for publication to peer reviewed journals titled ‘Scabies Outbreak Investigation in a Fishing Community in Uganda’ and ‘Time to Care Seeking and Associated Factors among Sudan Virus Disease patients in Uganda, Sep−Nov, 2022’
• Authored 31 manuscripts; first author on 7 manuscripts and co-authored 24 manuscripts including 3 case studies.
• Wrote and submitted a grant to the Royal Society of Hygiene and Tropical Medicine to launch a pilot surveillance system for scabies.

Summary of Epidemiological Study: 

 Title: Adherence to the early infant diagnosis alogarithm among infants exposed to HIV in Uganda, 2017-2019

Background: Early infant diagnosis (EID) facilitates early initiation into HIV care and treatment for identified HIV-positive infants. According to the Uganda Ministry of Health (MOH) EID testing algorithm, testing for HIV-exposed infants (HEI) should occur at <6 weeks, 9 and 18 months of age, and 6 weeks after stopping breastfeeding. Uganda has faced challenges with loss to follow-up (LTFU) for EID. We assessed adherence to the EID algorithm for HEI and associated factors.

Methods: We analyzed data from the ‘Impact of the National Program for Prevention of Mother-to-Child Transmission of HIV in Uganda (2017−2019)’ study. HIV-positive mothers and their infants enrolled in a prospective cohort (2017−2018) were followed until the HEI tested positive, died, was LTFU, or reached 18 months of age. Of the infants who didn’t die before each timepoint, we calculated the proportion that adhered to the EID algorithm (having HIV tests at all four appropriate timepoints, using 15 months of age as a proxy for 6 weeks after cessation of breastfeeding).

We evaluated factors associated with adherence using modified Poisson regression.

Results: Among 1,804 HEI, 912 (51%) were male. At baseline, 1,605 (89%) were HIV-negative, 37 (2%) were HIV-positive, and 162 (9%) had indeterminate or missing results. Among baseline-negative HEI, 1,212 (76%) remained negative at 9 months, 1 (0.06%) tested positive, 18 (1%) died, and 374 (23%) did not test. Of those negative at 9 months, 1,066 (88%) remained negative at 15 months, 2 (0.2%) tested positive, 4 (0.3%) died, and 140 (12%) did not test. Of those negative at 15 months, 793 (74%) were negative at 18 months, 5 (0.5%) died, and 268 (25%) did not test. Overall, 164 (10%) of 1,605 HEI who were HIV-negative at baseline were tested only at baseline. Overall adherence to the complete EID algorithm timeframe was 46% (833/1,777). Perceived discrimination due to HIV status [RR=0.80, 95%CI (0.66-0.97)], having fewer pregnancies [RR=0.96, 95%CI (0.94-0.99)] and reporting sexual violence [RR=0.74, 95%CI (0.65-0.88)] were associated with non-adherence.

Conclusion: Fewer than half of HEI received the recommended HIV tests at the recommended timepoints. Interventions to address stigma may improve adherence to the EID algorithm. Investigations are needed to explore associations between sexual violence, parity, and adherence to the EID algorithm.

Key lessons learnt during the fellowship

During the fellowship, she developed the following skill sets:

• Outbreak Investigation and response including the institution of interventions
• Evaluation of surveillance systems
• Designing and implementing Quality Improvement Projects
• Data management, analysis, and interpretation using such software as STATA, EpiInfo, and QGIS
• Scientific writing (for Abstracts, Manuscripts, case studies)
• Presentation skills and dissemination of findings
• Networking and lobbying skills
• Grant writing

Next Steps

Armed with the acquired skills, Rebecca aspires to contribute further within the Ministry of Health or a related organization, working towards enhanced global health, swift responses to public health emergencies, and the improved delivery of services to children and adolescents living with HIV.

Pictorial