2.0. PROGRESS REPORT
Implementation Science (ImS) is key to addressing the persistent challenges to HIV elimination in Uganda, but research capacity is still limited. In 2015, with funding from the Fogarty HIV Research Training Program (HIVRT) (D43TW010037), we established a training program at MU focused on Building ImS Capacity to Strengthen the Response to the HIV/AIDS Epidemic in Uganda. Over the last five years, this program has been very successful in establishing a strong foundation for the ImS field in Uganda. We have trained a total of 31 trainees on different tracks of ImS including 15 master’s degrees, 14 non-degree fellowships and two ongoing PhDs. Through the research conducted by our trainees, we have contributed local evidence to improve policy and practice in HIV testing, treatment and care, and integration of HIV and NCD care. We have progressively integrated ImS programs at MU and adapted the UCSF curriculum to develop a well contextualized Post Graduate diploma in ImS research and quality improvement (PGD ImS-QI). We have brought together a multidisciplinary (Biomedical, Behavioral, Public Health) team of faculty based at MU, for research training in ImS. These teams co-facilitate ImS trainings and have successfully applied for ImS grants (see section 2.1.6.) Through our alumni, we have extended application of ImS principles to HIV programs and some of our trainees have been absorbed to support HIV/TB programs at the Ministry of Health. Our program has increasingly become the go-to place for capacity building in ImS. In summary, we have built institutional ImS research capacity at MU through integrating ImS as a field of study and supported trainees to write successful grants and assume leadership positions (Table 10 and 11). We are extremely proud of the positive impact of our HIVRT program on HIV research and HIV care in Uganda. Our specific achievements are detailed below in line with our completed project (D43TW010037) objectives.
2.1. To build scientific leadership and expertise for ImS research at MU and to strengthen research in Uganda by helping trainees to integrate into Ugandan institutions and pursue independently supported research careers. (Objectives 1&6).
We have enrolled and successfully trained 31 trainees (1-Masters in Advanced Science in ImS at UCSF, 14-masters in different programs at MU, 13 trainees completed the one-year UCSF Online Certificate in ImS program, 1 trainee completed a non-degree research training, and two are pursuing PhD in Health Sciences with a concentration in ImS at MU. All trainees on the different tracks have received training in ImS research methods through either the introductory course, UCSF online ImS program, seminars or journal clubs. Each of the trainees received training in Responsible Conduct of Research, conducted a mentored ImS research project and were individually supported to identify a research gap, write the proposal, collect and analyze data, and prepare manuscript(s). This has strengthened their research capacity and scientific writing which has resulted into several publications and successful grant applications as detailed below.
2.1.1. Trainee publications
Our trainees have been mentored in scientific writing and as a result 14 papers have been published, as summarized in Box 1, with 7 additional manuscripts submitted and 11 in final stages of preparation. All our publications are in the HIV research priority areas and are compliant with the NIH public access policy.
2.1.2. Presentation at international research meetings
We have supported our trainees to disseminate their research findings at local & International meetings. A total of 28 (oral and poster) presentations on a range of HIV topics a have been presented at these meetings. Some of the topics presented include; Assessing retention in HIV care, HIV oral testing among adult men in Uganda, High virological suppression and retention among HIV key population patients, Feasibility of utilizing short messaging service (SMS) technology to deliver Tuberculosis testing results in Uganda, Viral suppression among pregnant & post-partum women, Evaluating the sustainability of ART Interventions, HIV testing among young people (15-24 years), Use of oral pre-exposure (PrEP) prophylaxis in fishing communities among others. Some of the trainees were awarded travel grants to present at international conferences such as the Conference on Retroviruses and Opportunistic Infections (Nangendo-CROI 2020), International AIDS Society (Semitala & Byonanebye-IAS 2017), American Thoracic Society (Kalema-ATS 2017), International Conference on AIDS and STIs in AFRICA (Ssuuna ICASA, 2019). Others presented at local meetings such as the Joint Annual Scientific Health (JASH), MU International Symposium on NCDs and MU/UCSF/IDRC Young Investigators Research Scientist. During the local meetings, some of our trainees also received awards such as: best oral abstract presentation Kalibbala-JASH), (Up-coming young scientist (Nangendo –YIRS, 2020) and Best young Scientist (Kabami-YIRS, 2020).
Box 1: Selected publications of program trainees (numbering based on all trainee publications; trainees bold)
Kalema N, Lindan C, Glidden D, Yoo SD, Katamba A, Alfred A, Katagira W, Byanyima P, Musisi E, Kaswabuli S, Ingvar S, Zawedde J, Yoon C, Ayakaka I, Davis JL, Huang L, Worodria W, Cattamanchi A., 2017. Predictors and short-term outcomes of recurrent pulmonary tuberculosis, Uganda: a cohort study.. S Afr Respir J. 2017; 23 (4):106-112. PMID: 29368752, PMCID: PMC5777612
Semitala FC, Camlin CS, Wallenta J, Kampiire L, Katuramu R, Amanyire G, Namusobya J, Chang W, Kahn JG, Charlebois ED, Havlir DV, Kamya MR, Geng EH 2017. Understanding uptake of an intervention to accelerate antiretroviral therapy initiation in Uganda via qualitative inquiry, Journal of the International AIDS Society 2017, 20:e25033, PMID: 29206357 PMCID: PMC5810312
Katuramu, Jeanna Wallenta Law, Fred C Semitala, 2019. Closing the gap: A novel metric of change in performance, East African Journal of Applied Health Monitoring and Evaluation.
Dathan M Byonanebye, Fred C Semitala Jackson Katende, Alex Bakenga, Irene Arinaitwe, Peter Kyambadde, Patrick Musinguzi, Irene Andia Biraro, Pauline Byakika-Kibwika, Moses R Kamya, 2019, High viral suppression and low attrition in healthy HIV-infected patients initiated on ART with CD4 above 500 cells/μL in a program setting in Uganda, African Health Sciences Journal, Vol 20 No 1 (2020)
Dalsone Kwarisiima , Mucunguzi Atukunda , Asiphas Owaraganise , Gabriel Chamie , Tamara Clark , Jane Kabami , Vivek Jain , Dathan Byonanebye , Florence Mwangwa1 , Laura B. Balzer , Edwin Charlebois , Moses R. Kamya, Maya Petersen , Diane V. Havlir and Lillian B. Brown, 2019, Hypertension control in integrated HIV and chronic disease clinics in Uganda in the SEARCH study BMC Public Health volume 19, Article number: 511 (2019), PMID: 31060545
Semitala FC, Cattamanchi A, Andama A, Atuhumuza E, Katende J, Mwebe S, Asege L, Nakaye M, Kamya MR, Yoon C, 2019, Brief Report: Yield and Efficiency of Intensified Tuberculosis Case-Finding Algorithms in 2 High-Risk HIV Subgroups in Uganda J Acquir Immune Defic Syndr. 2019 Dec 1;82(4):416-420. doi: 10.1097/QAI.0000000000002162; PMID: 31658185 PMCID: PMC6822376.
Nakku-Joloba E, Kiguli J, Kayemba CN, Twimukye A, Mbazira JK, Parkes-Ratanshi R5, Birungi M, Kyenkya J, Byamugisha J, Gaydos C, Manabe YC, 2019, Perspectives on male partner notification and treatment for syphilis among antenatal women and their partners in Kampala and Wakiso districts, Uganda, BMC Infectious Diseases, 2019 Feb 6;19(1):124. doi: 10.1186/s12879-019-3695-y. PMID: 30727950, PMCID: PMC6366113
Birungi J, Cui Z, Okoboi S, Kapaata A, Munderi P, Mukajjanga C, Nanfuka M, Nyonyintono MS, Kim J, Zhu J6, Kaleebu P2, Moore DM3,6, 2019, Lack of effectiveness of adherence counselling in reversing virological failure among patients on long-term antiretroviral therapy in rural Uganda, HIV Medicine 2020 Jan; 21(1): 21–29.PMID: 31432614, PMCID: PMC6916407
Tugume L, Muwonge TR, Joloba EN, Isunju JB, Kiweewa FM., 2019, Perceived Risk Versus Objectively Measured Risk of HIV Acquisition: A Cross-Sectional Study among HIV-negative Individuals in Serodiscordant Partnerships with Clients Attending an Urban Clinic in Uganda, BMC Public Health. 2019 Nov 29;19 (1):1591. doi: 10.1186/s12889-019-7929-0. PMID: 31783826, PMCID: PMC6884744
Richard Katuramu, Moses R. Kamya, Naome Sanyu, Mari Armstrong-Hough and Fred C. Semitala*, 2020, Sustainability of the streamlined ART (START-ART) implementation intervention strategy among ART-eligible adult patients in HIV clinics in public health centers in Uganda: a mixed methods study, Implementation Science Communications (2020) 1:37
Martin Muddu*, Andrew K. Tusubira, Brenda Nakirya, Rita Nalwoga, Fred C. Semitala, Ann R. Akiteng,Jeremy I. Schwartz and Isaac Ssinabulya, 2020, Exploring barriers and facilitators to integrated hypertension-HIV management in Ugandan HIV clinics using the Consolidated Framework for Implementation Research (CFIR)”, Implementation Science Communications (2020) 1:45
Jane Kabami , Laura B Balzer , Hachem Saddiki , James Ayieko , Dalsone Kwarisiima , Mucunguzi Atukunda , Edwin D Charlebois , Tamara D Clark , Catherine A Koss , Theodore Ruel , Elizabeth A Bukusi , Craig R Cohen , Phillipa Musoke , Maya L Petersen , Diane V Havlir , Moses R Kamya , Gabriel Chamie Population-level Viral Suppression among Pregnant and Post-partum Women in a Universal Test and Treat Trial, AIDS Journal, 2020 Jul 15;34(9):1407-1415, PMID: 32472768, DOI: 10.1097/QAD.0000000000002564
Joanita Nangendo ,Anne R. Katahoire,Mari Armstrong-Hough,Jane Kabami,Gloria Odei Obeng-Amoako,Mercy Muwema,Fred C. Semitala,Charles A. Karamagi,Rhoda K. Wanyenze,Moses R. Kamya,Joan N. Kalyango. Prevalence, associated factors and perspectives of HIV testing among men in Uganda, 2020 Aug 7;15(8):e0237402. doi: 10.1371/journal.pone.0237402. eCollection 2020. PMID: 32764820.
Trainee led Grants
Our trainees have successfully written and won 13 ImS grants as Principal Investigators and Co-Investigators. An additional five submitted proposals are under review as detailed in (Table 10) below.
Table 10: Successfully Awarded Grants and Submitted Proposals by our Trainees
No. | Trainee | Grant title | Grant number | Role on the project | Funding source |
Successfully awarded grants | |||||
1. | Nelson Kalema | Map and Understand Gaps in the latent TB cascade of care for persons registering for HIV care in the Kampala-Wakiso IDI Outreach Program Uganda | UCSF 10823sc | Principal Investigator | NIH |
2. | Dalsone Kwarisima | Interventions to reduce alcohol use and increase adherence to TB preventive therapy among HIV/TB co-infected drinkers (DIPT 2/2) | U01AA026221 | Co- Investigator | NIH |
3. | Dalsone Kwarisima | Strategic antiretroviral therapy and HIV testing for youth in rural Africa (SATURN) | UG3HD96915 | Co- Investigator | NIH |
4. | Jane Kabami | Transforming Ugandan Institutions Training Against HIV/AIDS (HEPI-TUITAH) | R25TW011210 | Co-Investigator | NIH |
5. | Jane Kabami | Integrated HIV/HTN Project: Leveraging the HIV platform for Hypertension Control in Uganda | CSA2018H5-2518 | Principal Investigator /Coordinator | EDTCP |
6. | Fred Semitala; Eleanor Namusoke; | Uganda Adolescent HIV prevention and Treatment Implementation Science Alliance (U – AHISA) | OICE – 19- 65 659-1 | Co-Investigators | NIH |
7. | Fred Semitala and Muddu Martin | HIV/NCD integration: Integrating Hypertension (HTN) and HIV care within Mulago ISS clinic in Uganda using the Behavior Change Wheel (BCW) and WHO HEARTS strategy | MJAP/VITAL 2019/001 |
Principal investigator and Co-Principal investigator |
NIH |
8. | Edith Nakku | Center for Point-of-Care Technologies Research for Sexually Transmitted Diseases | U54 EB007958-11 | Sub-recipient PI | NIH |
9. | Edith Nakku | Targeted Intervention for improvement of Oral PrEP uptake and adherence in Uganda | – | Principal Investigator | MoH-Uganda |
10. | Fred Semitala | Education for Inter-professional HIV care in Uganda EIPHIV –Uganda | Sub Award No.11479 SC | Principal Investigator | NIH |
11. | Fred Semitala | Options for delivering Isoniazid-Rifapentine (3HP) for TB Prevention (3HP Options Trial | 1R01HL144406 | Site Principal Investigator | NIH |
12. | Fred Semitala and Martin Muddu | PULESA Uganda -Strengthening the Blood Pressure Care and Treatment Cascade for Ugandans Living with HIV—Implementation Strategies to Save Lives |
1 UG3 HL154501-01 Pending |
Principal Investigator and Co-Investigator |
NIH |
13. | Dathan Byonanebye | Program for Accelerated Control of TB in Karamoja (PACT-Karamoja) | 72061720CA00003 | Co-Investigator | |
Submitted grant applications | |||||
No. | Trainee | Title | Status | Role | Funding source |
1. | Dathan Byonanebye | A Digital Patient Management System to Deliver Differentiated HIV Care Services: The ART Access Project | BEL1707111-AP-03 | Principal Investigator | Enable wehubit, Belgian Technical Corporation |
2. | Dathan Byonanebye | Combination mHealth interventions for health systems strengthening to ensure sustainable HIV response in Uganda: “Digital District 4 HIV (DD4HIV) (Health Systems Research Initiative | Under review | Principal Investigator | |
3. | Dathan Byonanebye | HealthCall-Interactive Response | Under review | Principal Investigator | Ministry of Sci, Tech and Innovation |
4. | Joanita Nangendo | Optimizing HIV testing and linkage to care among men using a community health worker-driven model of HIV self-testing in Uganda | Not successful | Co-Principal Investigator | NIH |
Abbreviations: IDI, Infectious Diseases Institute; DIPT, Drinkers’ Intervention to prevent Tuberculosis.
2.1.3. Post training placements
We are proud that alumni of our training program have were recruited as faculty, Program Officers at MoH and other HIV institutions while others have enrolled for PhD studies as detailed in Table 11.
Table 11: Post-training Transition of Selected Graduates on our Training Program
Name |
Training received |
Previous position |
Current portfolio/ Institution |
Nelson Kalema |
Master of advanced Science and ImS at UCSF |
Internist |
Program Impact Specialist for the HIV Outreach program at the IDI, MU |
Dalsone Kwarisiima |
UCSF online ImS certificate program |
HIV prevention Manager, MJAP |
Senior Prevention Specialist for HIV USAID, Uganda |
Richard Katuramu |
Master of Medicine |
Research Coordinator, Streamlined Antiretroviral Therapy (START ART) Trial, Infectious Diseases Research Collaboration |
Senior program officer Multi drug resistant TB, National TB and Leprosy program, Uganda Ministry of Health |
Dathan Byonanebye |
Master of Medicine |
Research Coordinator
The SEARCH Trial Infectious Diseases Research Collaboration (IDRC) |
1. Lecturer, Makerere School of Public Health, MU 2.Principal Investigator, “Impact of Mobile Health Interactive Software on Tuberculosis Treatment Outcomes: 3. PhD Candidate Topic: Long-term cardiovascular complications in HIV positive patients treated with contemporary ART. University of New South Wales (UNSW), Sydney, Australia. |
Josephine Birungi |
UCSF online ImS certificate program |
Head of Research, The AIDS Support organization |
PhD fellow; Implementation of integrated HIV/NCD care, Medical Research council, Uganda |
Joan Nangendo |
Master of Science, Clinical Epi and Bio statistics |
Laboratory technologist |
PhD candidate, MU, Topic: HIV Self-Testing as a strategy to increase HIV testing uptake and linkage to prevention and care among men in Mpigi district. |
Jane Kabami |
UCSF online ImS certificate program |
Project Coordinator– SEARCH Trial, IDRC |
PhD candidate, MU, Topic: Optimizing Virologic outcomes among pregnant women in South western Uganda |
Martin Muddu |
UCSF online ImS certificate program |
Program Advisor- HIV care and treatment, Makerere University Joint AIDs Program |
Principal Investigator Project title: Integrating Hypertension and HIV care within Mulago ISS clinic in Uganda using the Behavior Change Wheel and WHO HEARTS strategy |
2.2. Establishment of a sustainable ImS research training program and creation of a Centre of Excellence for the ImS at MU (objectives 2&7)
Our program made strides at integrating ImS as a field of study at MU by introducing a one-week elective course at the Clinical Epidemiology Unit (CEU), providing a modular course largely delivered by Ugandan faculty. We also developed a curriculum for ImS training which is currently under review for accreditation by the university. An introductory ImS course was introduced to first-year masters’ students at the CEU. The course is facilitated by both faculty and alumni who completed ImS training. The course has been embedded in the teaching schedule at CEU as an elective and runs once every year. Since its introduction at CEU, over 10 students developed ImS projects and have been competitively selected by our program and other FIC programs with ImS component for training research support. This course has created awareness of ImS research and students are encouraged at their respective departments to take on ImS projects. This has resulted in an ever-increasing number of applications that we receive every year for masters’ support from the different courses at the College of Health Sciences.
We also introduced a modular ImS course which was co-funded with the International Research Training on TB and Other Pulmonary Complications of HIV (D43TW009607), and University of California San Francisco. The goal of this course is to provide a platform for mentored implementation research training for individuals engaged in HIV and or TB research /programing in Uganda. The course was largely modelled after the UCSF online ImS Certificate program. It was structured into four taught modules spread-out over 18 months, interlaced with monthly works-in-progress meetings in which trainees present their research projects to peers and faculty for constructive feedback. Each year up to 15 students are introduced to various concepts and frameworks in ImS which they have applied to their research projects. The course was initially conducted as short courses mainly facilitated by our UCSF collaborators who built the local capacity for trainees and faculty. Currently, it is largely facilitated by Ugandan faculty from MU.
Support to other training and research programs. Several programs at MU and the surrounding institutions are leveraging on the established ImS platform to build capacity building of their trainees and staff. These programs include; 1) Training in Malaria Surveillance, Epidemiology and Implementation Science Research to Strengthen Malaria Policy and Control in Uganda, D43TW010526; 2) Strengthening behavioral and social science research capacity to address evolving challenges in HIV care and prevention in Uganda, D43TW011304. Trainees supported by these programs attend the monthly ImS journal clubs, modular course, and the introductory ImS course at CEU. They are also co-mentored and supervised by our program faculty; 3) PULESA-UGANDA: Strengthening the Blood Pressure Care and Treatment Cascade for Ugandans, Living with HIV – Implementation Strategies to Save Lives (1 UG3 HL154501-01); 4) Integrated HIV/HTN Project: Leveraging the HIV platform for Hypertension Control in Uganda (EDTCP Grant number: CSA2018H5-2518)
2.3. To promote collaborations between academic research institutions and faculty in Uganda and those in the US (Objective 3)
We have promoted collaborations across institutions in Uganda and the US by involving interdisciplinary teams in ImS training.
Through the ImS program, we brought together a multidisciplinary team of 10 faculty from the Colleges of Humanities and Social Sciences and Health sciences for research training in Behavioral and Social Science Research (BSSR). Led by Drs. Kamya, Katahoire and Camlin, the BSSR group won a five-year training grant (D43TW011304) titled “Strengthening Behavioral and Social Science Research capacity to address evolving challenges in HIV care and prevention in Uganda”.
Our collaborators at UCSF have also co-mentored, co-authored papers and written grant proposals with trainees. Four of our trainees have co-authored papers with UCSF faculty. (See Box 1 and Section 6.1.1) Some of our trainees and Ugandan program faculty (Drs. Achilles Katamba, Irene Ayakaka, Aggrey Semeere, Fred Semitala and Nelson Kalema) are co-facilitators on the UCSF Online Certificate in ImS program. Drs. Semitala and Semeere teach the introduction to implementation science while Drs. Katamba and Ayakaka teach community engagement.
2.4. To strengthen trainee contributions to evidence–based decision making related to HIV prevention, care and treatment services through regular interactions with policy makers and HIV program implementers (Objective 4)
From the inception of the program, we have engaged policymakers and HIV implementing partners in setting the research agenda for ImS in Uganda and as a result, our trainees’ research findings have been used to address key gaps on the HIV care cascade. Research conducted and published by our trainees has contributed to development of policy and implementation guidelines for HIV prevention, care and treatment. For example, research findings on rapid HIV oral testing among adults and adherence to the viral load algorithm by trainees Nangendo and Ms. Kyomuhendo contributed to the local evidence in the revision of the national guidelines for HIV self-testing and ART switching. Drs. Muddu and Kwarisiima’s studies also contributed to the integration of non-communicable diseases management in HIV care. Our trainees have extended the knowledge acquired from ImS training to HIV programs and are influencing HIV practices. For example, Drs. Namusoke-Magongo, Katuramu have been recruited to support key projects in the Ministry of Health (MoH) under the AIDS control and TB programs. Similarly, Drs. Kwarisiima and Kalema are actively engaged in programmatic research at USAID and the Infectious Diseases Institute (IDI) respectively. Six trainees are members of the TWG at MoH and have used such opportunities to promote the use of ImS methods in programming, policy formulation and stakeholder engagement at MoH before rolling out guidelines.
Table 12: Trainee participation in MoH HIV/TB Technical Working Groups and programs
Name |
Position/Membership |
Eleanor Namusoke |
Pediatric & Adolescent HIV Care and Treatment |
Dalsone Kwarisiima |
TWG on the most-at-risk populations and has participated in developing data collection tools for key population programming. |
Richard Katuramu |
TB/HIV committee Multi-drug resistant TB program at MoH |
Martin Ssuuna |
TWG for differentiated service care delivery |
Martin Muddu |
TWG for HIV Care and Treatment for Uganda AIDS commission |
Fred Semitala |
MoH-National committee for ART, HIV drug resistance and the National Tuberculosis and Leprosy Program (NTLP) Research forum |
2.5. To optimize training through utilization of additional available resources in Uganda (including projects funded by the NIH, PEPFAR and other international agencies) (Objective 5)
In conclusion, our program has been very successful and has laid a strong foundation for ImS research training in Uganda. There is, however, a great need to consolidate these efforts in the next phase of the program to create a sustained growth of ImS research environment at MU and the application of ImS to bear on HIV research and service delivery on a larger scale.