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MakImS-Mak BSSR Newsletter December 2023

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Strengthening Implementation and Behavioural Social Sciences in HIV research

Local healthcare providers see the impact of HIV/AIDS, its associated comorbidities and stigma across different age spectrums daily. As research into the development of an HIV cure continues to advance globally, the field has expanded to include implementation science and behavioral social sciences research.

We know that HIV/AIDS is intricately interwoven with an individual’s behavior and social context. Therefore, addressing it solely through biomedical interventions such as drugs and vaccines would be falling short of bringing the epidemic under control. Involving aspects of behavioral and social sciences is critical in helping us to understand how health attitudes, social cognitions and personal habits shape one’s decisions and practices as regards HIV prevention and treatment.

Under the Makerere University Behavioral Social Sciences Research (BSSR) program, we are training a number of early career researchers in order to leverage on the benefits of BSSR to lower HIV incidence and increase treatment coverage rates. As reflected in the various stories shared in this newsletter, fellows research on issues such as the interplay between alcohol use and HIV care is helping to integrate evidence based social behavioral approaches into biomedical care.

Similarly, implementation science is an expanding field within HIV/AIDS research and public health practice. Through it, researchers aim to close the gap between theory and practice by addressing barriers that delay uptake of proven health interventions. Through the Makerere University Implementation Science (ImS) Program, more than 50 young scientists are being trained to optimize the public health impact of efficacious interventions such as test-and-treat and pre-exposure prophylaxis (PrEP) for eligible populations. In this newsletter, you’ll acquaint yourself with the ImS program aims, activities and fellows’ research.

As our fellows on the BSSR and ImS program continue to excel, we envision enhancing capacity for HIV research and care in Uganda and Africa at large. I am pleased to present to you the novel ImS/BSSR newsletter that brings you exhilarating insights into the programs’ activities and achievements. Enjoy your reading!

Highlights

  • Prof. Moses Kamya Awarded the Elise and Walter A. Haas International Award
    • Prof. Kamya was awarded for his outstanding contribution in the field of research and teaching infectious diseases with a particular interest in malaria and HIV. He is past chair of the Department of Medicine and past Dean of the Makerere University School of Medicine in Kampala, Uganda. He is a founding member of the Makerere University Joint AIDS Program (MJAP), the Infectious Diseases Institute (IDI), and the Infectious Diseases Research Collaboration (IDRC) in Uganda.
  • Building Implementation Science Capacity to Strengthen the Response to the HIV/AIDS Epidemic in Uganda
    • The Makerere University School of Medicine Implementation Science (Mak-ImS) Training program, funded by the United States National Institutes of Health-Fogarty International Center is a collaboration between Makerere University College of Health Sciences (MakCHS) and University of California San Francisco (UCSF)-USA. This program focuses and integrating ImS as a field of study at Makerere University; influencing HIV practices and enhancing the cascade of HIV care in Uganda.
  • ImS Program staff hold two-day training for Walter Reed Staff
    • On November 14 and 15 2022, Directors, Heads of Department and departmental staff of Makerere University Walter Reed Program (MUWRP) underwent an intense training in implementation science (ImS), a field of study that enables research uptake into practice. The training purposed to equip MUWRP staff with knowledge on various concepts of implementation science such as its principles, study designs and evaluation frameworks.
  • Dr. Geetha Bansal visits ImS fellows in Uganda
    • On Thursday 18 May 2023, fellows, mentors and mentees on the Implementation Science Program met and interacted with Dr. Geetha Bansal, Program Director, HIV Research and Training Programs at the National Institutes of Health.
  • Emerging researchers share exciting study projects
    • On Friday the 13th of October 2023, the Makerere-Implementation Science (MakImS) program conducted a trainees’ progress review meeting to track advancement of trainees’ PhD, masters and fellowship research projects. The review meeting attracted over 40 participants including trainees, principal investigators, university faculty and mentors.
  • Dr. Amadriyo presents abstract @ the 18th AOGU Conference
    • Dr. Emma Amadriyo, a master’s trainee on the ImS program presented her abstract titled, titled “Missed opportunities for eMTCT among mothers living with HIV whose infants seroconverted in Masaka Regional Referral Hospital – A retrospective cohort analysis” at the 18th annual scientific conference of the Association of Obstetricians and Gynaecologists of Uganda (AOGU)
  • Testimonials from ImS -Alumni
    • SSUNA BASHIR, postdoctoral fellow at Yale University and Makerere University
    • AHMED KATUMBA, Supply Chain Specialist in QED Group LLC.
    • SUSAN NAKUBULWA, applying ImS Frameworks in research and the utilization of Community Engaged Research to enable smoother translation of evidence into practice
    • JOAN NANGENDO, Training Coordinator, Mak-ImS program
    • DR. NELSON KALEMA, mentoring and supporting scientists towards the application of implementation science approaches
    • DR. LILLIAN TUGUME, used knowledge and skills to complete Mmed dissertation that explored the willingness of serodiscordant couples to accept pre-exposure prophylaxis
  • Strengthening Behavioral and Social science Research capacity to address evolving challenges in HIV care and prevention in Uganda
    • Spearheaded by Professors Moses Kamya, Anne Ruhweza Katahoire and Carol Suzanne Camlin, MakBSSR leverages on existing collaborations among social, behavioral, and biomedical scientists at Makerere University and its HIV programs, and the University of California, San Francisco (UCSF). Currently, five PhD candidates, 14 masters’ fellows and eight fellowship candidates are being supported by the project.
  • Q&A With Dr. Namisi Charles Patrick
    • Dr. Namisi’s PhD study, funded by the Behavioral Social Science Research (BSSR) Program of Makerere University, seeks to develop and validate a stigma mastery model for PLHIV. He is the acting Dean of the Mother Kevin Post Graduate Medical School of Uganda Martyrs University, Nkozi.
  • Musanje aims to develop a customized mindfulness intervention for adolescents living with HIV
    • This research aims to culturally adapt a mindfulness and acceptance therapy in Uganda; explore acceptability of a Mindfulness and Acceptance Based Interventions (MABI) among adolescents (15-19 years) in Uganda; evaluate the effectiveness of a MABI on improving mental health among ALHIV and evaluate the effectiveness of a MABI on improving adherence to antiretroviral treatment among ALHIV. The research was conducted at Kisenyi Health Centre IV and Kitebi Health Centre III.
  • Regina Ndagire credits the BSSR Program for equipping her for the working world
    • She is applying the research skills obtained on the program in her current role as a research officer at Clarke International University. Here, she supports students and faculty in research; conducts research training; supervises research and engages in the writing of research policy documents and grants.
  • Using virtual support groups to improve ART adherence among adolescents – Kiirya’s Journey
    • Her study seeks to explore the acceptability, feasibility and effectiveness of online peer support groups to improve adherence among YLHIVA in Kampala. It is being conducted among 402 youths attached to Kisenyi and Kawaala Health Centre IVs and Kiswa and Komamboga Health Centre IIIs.
  • Lived experiences, perceptions & HIV care outcomes among young people living with HIV in South Western Uganda
    • Dr. Raymond Felix Odokonyero is psychiatrist at Mulago National Referral Hospital and lecturer at Makerere University’s College of Health Sciences. His research interests lie in understanding the interplay between alcohol use and HIV care among young people living with HIV (YPLHIV).
  • Nante Rachel Wangi
    • Wangi interested herself in studying Assisted Partner Notification (APN) among people who have severe mental illness (SMI), who are living with HIV (PLHIV) at Butabika National Referral Mental Hospital. She conducted a mixed methods study, quantitatively examining 125 medical files of PLHIV with a diagnosis of SMI between 2018 and 2021. Additionally, ten in-depth interviews with patients and six key informant interviews with health workers were conducted to determine socio-cultural barriers to APN uptake.

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METS Newsletter March 2024

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A team documenting the background and other governance structure requirements in the EMR Implementation Guidelines during the stakeholder workshop held from 26th February to 1st March 2024. Makerere University School of Public Health (MakSPH), METS Program, Kampala Uganda, East Africa.

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 March 2024 Newsletter

  • Development of National Electronic Medical Records (EMR) Implementation Guidelines
    • To date, multiple Electronic Medical Records (EMR) systems have been rolled out to health facilities without implementation guidelines to inform the standard EMR process/clinical workflows within a typical health facility, minimum requirements for various EMRs to integrate and exchange patient information, insurance and billing workflows, human resources management, among others.
    • METS Program and USAID/SITES organized a five-day stakeholder workshop on 26th February to 1st March 2024, to develop and validate the EMR Implementation Guidelines for Uganda.
  • Improving the Quality of Voluntary Medical Male Circumcision
    • In February 2024, the METS Program, in collaboration with the Ministry of Health (MoH), Centers for Disease Control and Prevention (CDC), and Implementing Partners (IMs), conducted targeted onsite mentorship across 56 safe male circumcision sites in CDC-supported regions of Uganda.
    • Key findings highlighted the overall facility performance score of 78%, with 5 out of 8 thematic areas scoring above 80%. Notably, 99% of circumcised males had received Tetanus vaccines.
  • Innovation To Strengthen National Health Care Quality Improvement
    • The 10th National Health Care Quality Improvement (QI) conference brought together health service providers from various parts of the country to share experiences and what they are doing to improve service delivery to patients.
    • The Minister of Health, Hon. Dr. Jane Ruth Aceng, called for solutions that will provide answers especially in areas of governance and leadership, health workforce, information systems, service delivery, financing, special groups, and health products.
    • METS made a presentation on improved service delivery models focusing on empowering young women to stay HIV-free with the help of the Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) initiative.
  • Gallery
    • Makerere University School of Public Health (MakSPH) launches state-of-the-art auditorium
    • Deploying latest EMR Version at Hoima RRH
    • Training of KCCA staff on use of Point of Care (POC) EMR
    • Stakeholder Workshop on Development of EMR Implementation Guidelines

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New Study Reveals Breastfeeding Mothers Embrace Nutrient-Rich Dish for Health Benefits

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Climbing beans on stakes in one of the gardens visited during the Efd-Mak Kabale District Sensitization in November 2021. Makerere University, Kampala Uganda, East Africa.

A study whose results were recently published in Food Science Nutrition, a peer-reviewed journal for rapid dissemination of research in all areas of food science and nutrition has revealed that there is a growing preference for wholesome meals, highlighting its numerous health benefits.

Titled; Lactating mothers’ perceptions and sensory acceptability of a provitamin A carotenoid–iron-rich composite dish prepared from iron-biofortified common bean and orange-fleshed sweet potato in rural western Uganda,” this study was conducted among pregnant and breastfeeding mothers seeking care at Bwera General Hospital, in Kasese district, western Uganda, between 4th and 15th of August 2023.

Researchers in a 2019 study published in BMC Pregnancy and Childbirth among pregnant and breastfeeding women in Northwest Ethiopia discovered that pregnant and breastfeeding women bear the highest burden of this deficiency due to heightened physiological demands for iron and vitamin A. These demands increase significantly during pregnancy to meet fetal needs and continue during lactation to support breastfeeding.

The 2020 report on Developments in Nutrition among 204 countries and territories for 30 years since 1990 highlights the substantial impact of dietary iron deficiency and vitamin A deficiency on women of reproductive age in low- and middle-income countries across Africa and Asia. These micronutrient deficiencies are of paramount concern in public health nutrition due to their adverse effects.

A 2022 study published in The Lancet Global Health reveals that progress in addressing anemia among women of reproductive age (15–49 years) is inadequate to achieve the World Health Assembly’s global nutrition target of reducing anemia prevalence by 50% by 2030 in low- and middle-income countries, including Uganda.

Breastfeeding mothers require a higher intake of iron, ranging from 10–30 mg/day, compared to 8 mg/day for adult males. To help meet this increased need, the World Health Organization (WHO) recommends iron supplementation programs during the postpartum period, starting immediately after delivery and continuing for the first 6 weeks.

On the other hand, the WHO advises against vitamin A supplementation during the postpartum period, as it offers no noticeable health benefits to either the mother or the infant. Instead, it encourages breastfeeding mothers to maintain a diversified diet that includes vitamin A-rich foods. However, it’s important to highlight that supplementing with vitamin A and iron during this time could enhance the content of these nutrients in breast milk.

In rural Uganda, breastfeeding mothers often face deficiencies in vital nutrients particularly vitamin A and iron. This is as a result of over reliance on plant-based local foods, like sweet potato and non-iron biofortified common bean like Nambale, which lack sufficient amounts of provitamin A and iron, respectively.

To improve vitamin A and iron intake among breastfeeding mothers, Uganda’s government, in collaboration with HarvestPlus, a global program dedicated to ending hunger through providing nutrient-rich foods launched biofortification programs. These initiatives introduced orange-fleshed sweet potato rich in provitamin A and iron-biofortified common bean as staple food in Uganda.

As part of his postdoctoral study, Dr. Edward Buzigi, a Nutritionist and Food security expert, at University of Kwa-Zulu Natal, South Africa, evaluated the perceptions and sensory acceptability of a dish made from a combination of orange-fleshed sweet potato and iron-biofortified common bean, known for their high levels of provitamin A carotenoids and iron.

The aim was to determine whether the test food could replace the traditional white-fleshed sweet potato and non-iron biofortified common beans, which lacks these essential nutrients.

Ninety-four breastfeeding mothers took part in the study comparing two foods. Participants assessed the taste, color, aroma, texture, and overall acceptability of both the test and control foods using a five-point scale. Ratings ranged from “dislike very much” to “like very much,” with attributes deemed acceptable if participants rated them as “like” or “like very much.”

Also, focus group discussions were held to explore participants’ thoughts on future consumption of the test food alongside statistical analysis done using the chi-square test to compare sensory attributes between the two food options, while the qualitative data from focus group discussions were analyzed using thematic analysis.

Findings revealed that taste, color, and aroma were satisfactory to the mothers and showed no significant difference between test food and control food. Mothers had favorable views of the taste, aroma, and color of orange-fleshed sweet potato and iron-biofortified common bean but expressed concerns about the soft texture of orange-fleshed sweet potato. Despite this, breastfeeding mothers expressed positive attitudes towards consuming orange-fleshed sweet potato and iron-biofortified common bean, as long as it was accessible, affordable, and easy to prepare.

Dr. Buzigi lecturers at the Department of Community Health and Behavioural Sciences at Makerere University School of Public Health in Uganda.

Read the scientific article here;  https://onlinelibrary.wiley.com/doi/full/10.1002/fsn3.4053

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Call for Applications: AWE Change Masters fellowship programme support

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L-R: The Departments of Family Medicine (School of Medicine) and Human Anatomy (School of Biomedical Sciences) Buildings, College of Health Sciences (CHS), Mulago Hill, Makerere University, Kampala Uganda, East Africa.

Makerere University College of Health Sciences in collaboration with Duke University, USA are conducting a national collaborative research study on Epilepsy with local leading researchers in the fields of neurology and psychology in Uganda and international experts in the field of neurology and neurosurgery in the USA. The study aims to investigate the panorama of epilepsy in Uganda across the life span by clinically characterizing its features, comorbidities, and risk factors among the general population, with a focus on stigma among adolescents.

Applications are invited for the AWE Change Masters fellowship programme support from postgraduate students of:

  • Makerere University College of Health Sciences
  • Mbarara University of Science and Technology
  • Gulu University

The closing date for the receipt of applications is 22nd May 2024.

Submit all Enquiries and Applications to awechangeproject@gmail.com

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