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Involve Stakeholders in COVID-19 Vaccine Priority Setting, Mak Bioethicists urge Government

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By Joseph Odoi

As Uganda rolls out vaccines in an effort to kick out coronavirus, Bioethicists from Makerere University have urged Government to involve all stakeholders in priority setting for COVID-19 vaccination.

This call follows a latest study which sought to establish ethical and social issues for COVID-19 vaccination in the country.

While disseminating preliminary findings of the study titled ‘Ethical And Social issues for COVID-19 vaccine priority setting and access in Uganda’, Associate Professor Joseph Ochieng from the Department of Anatomy, College of Health Sciences (CHS), Makerere University said one of the most effective ways for public buy-in for new interventions is effective stakeholder engagement using the down-up model so that all stakeholders feel they have a say and their input is valued.

“When people are adequately involved in the decision making, they tend to adequately accept the results and take them up because they feel they own them. So we set out to access the different stakeholders whether they’re aware of the ethical issues associated with priority setting and how they’re going to handle priority of vaccine access in Uganda,” he explained while at Anatomy Department Building on 19th March, 2021. 

Prof. Ochieng further noted that there should a proactive, open (to the public) and evidence-based engagement of as many stakeholders as possible in these and related processes.

’This is important to build and sustain public support to and trust in health systems, all of which are critical in ensuring an equitable and efficient health system’’ he added

With regard to priorities, the Bioethicists state that since the quantities for the COVID-19 vaccine coming in are small, there should be a pre-determined evidence-based criterion for deciding who gets what first, and who should lose out or wait for the next opportunity

“Setting those priorities of who is vaccinated when has a number of ethical and social issues with questions.

We came up with this study to see how we can contribute to this issue of priority setting and vaccine access so that everyone feels it’s a fair process. If people believe it’s fair, then it’s ethical and acceptable and likely to be taken up,” Prof. Ochieng explained.

Findings

As Part of the preliminary findings, Dr. John Barugahare, Co-investigator and Senior Lecturer at Department of Philosophy, Makerere University said COVID-19 could be controlled by first attending to people who are likely to spread the disease like travelers; including truck drivers who have been associated with this disease whenever they traverse the country.

“We’ve heard from taxi drivers and conductors saying that they’re exposed to the risk of infections from passengers everyday by virtue of their work and they increase the risk of transmission to other passengers. However, they don’t understand why the elderly in rural areas are having priority over them,” he said.

Dr. Baruhagare further says that there is need to harmonize WHO immunization guidelines by setting priorities which fit into the local context as each country has its unique challenges.

Moving forward, the researchers recommend public engagement to create awareness on vaccination guidelines

“If the guidelines are developed, they should be freely available and well publicized. There should also be a continuous process of priority setting,” Prof. Ochieng noted.

“In future, such processes of setting priorities should be more open and transparent. There should be sufficient efforts to involve the public and seek opinions on what they think as opposed to having a few individuals to guide in the decision making process,” added Dr. Barugahare.

Funded by the World Health Organization (WHO), the study involved key informant interviews and in-depth interviews with a number of key stakeholders in COVID-19 intervention like bioethicists, clinicians, public health experts, policy makers, lawyers, human rights activists and scientists.

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Researchers call for interventions to support HIV/AIDS prevention among University Students

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Group photo of Study team and Participants at the Dissemination meeting.

Researchers at Makerere University College of Health Sciences have given recommendations on how the education and health sectors can support HIV/AIDS prevention among students.

The researchers advised that the health sector should develop communication strategies and materials specific to university students and increase support to provide youth-friendly HIV prevention services at universities. The education sector working with University management should include: life skill programs during orientation of new students; HIVST delivery through peers and freshman orientations; Increase sensitization & access to PEP/PrEP by high-risk students; and update and disseminate institutional HIV policies.

The recommendations were made at a dissemination meeting for a study titled ‘HIV risk and factors associated with use of novel prevention interventions among female students at Makerere Universityheld on the 30th September 2022 at the Food Science & Technology Hall, Makerere University Campus.The study funded by Government of Uganda through the Makerere University Research & Innovations Fund (MakRIF) was conducted by Dr. Lorraine Oriokot (Principal Investigator), Dr. Ivan Segawa, Dr. Sabrina Bakeera-Kitaka, Dr. Andrew Mujugira and Ms. Sharon Okello.

The objectives of the study were: to know the percentage of female students at risk of HIV; and to know the characteristics of students that have used the newer HIV prevention methods, which are HIV self-testing; Pre-exposure prophylaxis; and Post-exposure prophylaxis.

A total of 534 female students with an average age of 22years completed the survey. The results and findings of the study were:

  • Behavioural characteristics (12% of the respondents were in multiple sexual relationships; 21% of the respondents had a partner ≥ 10 years from their age; 29% of the respondents used emergency contraceptive (in the past 6 months); 21% of the respondents had never tested for HIV; and 10% of the respondents believed that they were at high risk for HIV)
  • The study considered a person was high risk if they: Had a partner who was HIV positive; Had multiple sexual relationships, anal or transactional sex; Used drugs especially injectable drugs; Had 2 or more sexually transmitted episodes in one year; Were pregnant or breast feeding; Were or had partners who sex workers, fishermen, long-distance truck driver, boda-boda rider, or army officers
  • Overall, 21% students were deemed high risk for HIV; 19% of students had ever used HIV self-test kits; 64% had ever heard of oral HIVST; 93% were willing to use HIVST; HIVST was more likely to be used by older students; HIVST can bridge the HIV testing gaps among students
  • 80% had ever tested for HIV far below the global targets of 95%; Self-test kits are freely available at the University Hospital; Test kits can be purchased over-the-counter in pharmacies
  • For PEP it was found that:3% of students had ever used PEP; 9% among those eligible for PEP; 70% had ever heard of PEP; 65% were willing to use PEP; PEP use was linked to having a partner and high-self risk perception; PEP is currently the only way to reduce the risk of HIV infection in an individual who has been exposed to HIV; PEP is available at Makerere University Hospital at no cost
  • For PreP it was found that:1% of students had ever used PrEP; 2% among high-risk students; 45% had ever heard of PrEP; 52% were willing to use PrEP; PrEP has been linked with decreased new infections of HIV; PreP is currently available as oral tablets. Vaginal rings and injectable forms are being tested for wide roll out; and PrEP is available at KCCA health facilities and facilities offering HIV care.

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Research findings show that Iron levels of blood donors in Uganda are low

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Members of the research team at the dissemination on 15th November 2022.

Makerere University researchers have released research findings showing that some blood donors in Uganda have low iron levels,low iron stores are common in blood donors, and that the donors who are deferred for low blood levels have limited insight into their situation. The findings were presented at a research dissemination workshop held on the 15th November 2022 at Makerere University College of Health Sciences.

In his remarks, Dr. Aggrey Dhabangi, Principal Investigator (PI) of the study explained that lack of iron may result in anaemia, which in turn makes blood donors ineligible to donate. ‘Other complications arising from low iron include, fatigue, low energy, and depression’, he added.

Statistics show that Uganda collects about 300,000 blood donations per year which is below the WHO recommended target of one donation per 100 population per year. As such, more donations are needed to increase blood supply. However, 10% of potential donors are turned away (deferred), 25% of these are due to low blood levels (anaemia); these missed donations may further exacerbate blood shortages in the country. Thresholds for eligibility to donate are 12.5g/dL and 13.5 g/dL for women and men respectively.

A total of 500 donors were involved in the cross-sectional study conducted within the central region blood collection sites of the Uganda Blood Transfusion Services (UBTS). The key findings of the study included:

  • The results showed that, of all potential donors screened to donate, 20.6 % had low iron stores. Among donors with blood levels acceptable to donate, 11.5% had low iron stores, while among those already turned away from donating for low blood levels, 61.5% also had had low iron.
  • The prevalence of low iron stores was higher among females (33.0%) compared to males (2.5%), but even higher among younger females i.e., 24 years and below (35.4%).
  • Further analysis revealed that, NOT eating an“iron-rich” diet was a major factor linked to low storesamong blood donors.
  • Interviews with donors turned away from donating for low blood levels revealed that many did not receive sufficient explanations as to why they were turned away, and what they were told was sometimes confusing to them.
  • Although the majority were surprised to be found with low blood levels and seemed frustrated for being turned away; deferral for low blood levels was generally poorly understood. Some interpreted it to mean, they had just ‘enough blood for themselves, but not enough to donate’. Others took the issue very lightly, yet their iron measurements have shown that 61.5% of these individuals besides being low on blood, they also had low iron.

The researchers gave the following recommendations:

  • Dietary (Iron-rich diet):Action – The population should be encouraged to adopt healthy eating lifestyle/diet which is iron-rich.Foods like leafy greens (bbugga, dodo, nakati), liver, beef, beans among others should be included in diets.
  • Behavioural change communicationon nutrition should be instituted to get the populations to change their diets and eating habits.
  • Consider Iron supplements for the population to repleteiron stores. The UBTS/Ministry of Health can offer iron pills to the affected donors. In the past this was done.
  • Identify donors at risk of Iron Deficiency through screening to identify affected persons early enough for interventions.
  • Improved communication is necessary for better handling of blood donors; the capacity of UBTS staff should be built; produce IEC materials for deferred donors: anaemia treatment, and prevention
  • Referral – to physicians for work-up and further management of anaemia

This study was made possible through collaboration between Makerere University College of Health Sciences and Uganda Blood Transfusion Services. Funding support was provided by the Government of the Republic of Uganda, through the Makerere University Research and Innovations Fund (Mak-RIF) – Round 3, financial year 2021/22.

Research Team: Dr. Aggrey Dhabangi (Principal Investigator (PI) and Co-PIs Dr. Godfrey Siu, Dr. Ronald Ssenyonga, Dr. Susan Acan, Mrs. Dorothy Kyeyune, and Dr. Imelda Bates.

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METS Newsletter October 2022

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Mabel from METS takes Biostatisticians through eCBSS during the DHIS2 training. Photo: MakSPH METS.

The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).

Highlights of the METS August 2022 Newsletter

  • Advancing health information security, privacy and confidentially
    • With support from the Makerere University School of Public Health (MakSPH) – METS Program and other partners, the MoH has developed the national Health Information Exchange (HIE) and Interoperability guidelines that will guide the implementation of HIE initiatives within the health sector.
  • Inaugural HIV Recency Testing Data Quality Assessment
    • The inaugural HIV Recency Testing Data Quality Assessment (DQA) was conducted from 28th August – 10th September 2022, with an aim of designing interventions for improving data quality for public health action.
    • The DQA was carried out in a representative sample of 170 facilities geographically distributed across the country by 15 teams of members from MoH, METS, UCSF, implementing partners (IPs) and districts health teams.
  • Case Based Surveillance Learning Exchange in Kenya
    • The main objective of the learning visit was to benchmark the Kenyan CBS program with the aim of harnessing the implementation modalities, lessons learned, and best practices that will guide program improvements in Uganda.
    • The key lessons learnt for implementation of the CBS program in Uganda will require key steps including; strong leadership, coordination and involvement by MoH and partners, alignment of funding priorities with national needs; clear documentation of policies and guidelines; adoption of a unique identifier to manage de-duplication of patients across the health sector; strengthening communities of practice within the workforce capable of maintaining and extending the CBS implementation and development of a national data warehouse for surveillance.
  • Milestones in equipping health facilities to track commodities
    • UgandaEMR is an electronic medical records system that is currently in use in over 1,400 health facilities in Uganda. UgandaEMR currently supports the following service areas such as HIV, TB, MCH, Laboratory, SMC, and Cervical Cancer, among others. Since 2015, the MakSPH-METS program has been supporting the Ministry of Health in the design and development of UgandaEMR.
    • One of the latest modules added to UgandaEMR by MaKSPH-METS is the stock management and dispensing (SMD) module that supports the documentation of essential medical supplies distributed and/or received at health facilities from the national medical warehouses.

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