Ugandan Researchers Research Articles

Equity in Global Health Research.

Equity in Global Health Research.

An assessment of implementation science research capacity in Uganda

BackgroundIn Uganda and other resource-poor countries, relevant research findings face a tortuous path to translation into policy and routine practice. Implementation science (ImSc) research could facilitate faster translation. Presently it is unclear what ImSc research capacity and possible training needs exist among Ugandan researchers. To assess both components, we interviewed potential trainees in Kampala, Uganda.MethodsWe used a cross-sectional design to survey potential ImSc trainees who had some research training and involvement in generating or utilizing research. Using a questionnaire, we documented eligibility for ImSc training, knowledge and interest in training, existing self-assessed confidence in initiating clinical research (SCICR) and self-assessed confidence in initiating ImSc research (SCIIR), availability for training and preferred modes of training. We developed scores from the Likert scales and used descriptive statistics, logistic regression and ordinal logistic regression to evaluate predictors of SCIIR.ResultsBetween November 2016 and April 2017, we interviewed 190 participants; 60% were men, with a median age of 37 years. Among participants, 33% comprised faculty, 37% were graduate students and 30% were project staff. The majority of respondents knew about ImSc (73%) and were research-trained (80%). Only 9% reported any ImSc-related training. Previous ImSc training was associated with higher odds of a SCIIR score ≥ 75th percentile. Previous ImSc training compared to not having any training was associated with higher odds of reporting abilities in behaviour change theory integration (OR: 3.3, 95% CI: 1.3–8.5, p = 0.01) and framework use in intervention design and implementation (OR: 2.9, 95% CI: 1.1–7.4, p = 0.03), accounting for age, sex and current employment. In addition, 53% of participants preferred in-person (face-to-face) short ImSc courses compared to a year-long training, while 33% preferred online courses. Participants reported median availability of 6 hours per week (IQR: 4, 10) for training.ConclusionMost participants had some understanding of ImSc research, had research training and were interested in ImSc training. Those with previous ImSc training had better skills and SCIIR, compared to those without previous training. A hybrid approach with modular face-to-face training and online sessions would suit the preferences of most potential trainees.

Dreaming partnership, enabling inequality: administrative infrastructure in global health science

AbstractThis article examines the fiscal and administrative infrastructures underpinning global health research partnerships between the US and Uganda, and the power dynamics they entail. Science studies scholars and anthropologists have argued for the importance of studying so-called ‘boring things’ – standards, bureaucracies, routinization, codes and databases, for example – as a way to bring to the surface the assumptions and power relations that often lie embedded within them. This article focuses on fiscal administration as an understudied ethnographic object within the anthropology of global health. The first part of the article is a case study of the fiscal administration of a US–Uganda research partnership. The second part describes the institutionalization of some of the administrative norms and practices used by this partnership within the ‘global health enabling systems’ employed by US universities working in Uganda and elsewhere in Africa. I analyse a case study and ‘enabling systems’ to show how these administrative strategies create parallel infrastructures that avoid direct partnership with Ugandan public institutions and may facilitate the outsourcing of legal and financial risks inherent in international partnerships to Ugandan collaborators. In this way, these strategies act todisablerather thanenable(or build) Ugandan research and institutional capacity, and have profound implications for African institutions as well as for the dream of ‘real partnership’ in global health.

Beyond HIV prevention: everyday life priorities and demand for PrEP among Ugandan HIV serodiscordant couples.

IntroductionPre‐exposure prophylaxis (PrEP) to prevent HIV infection is being rolled out in Africa. The uptake of PrEP to date has varied across populations and locations. We seek to understand the drivers of demand for PrEP through analysis of qualitative data collected in conjunction with a PrEP demonstration project involving East African HIV serodiscordant couples. Our goal was to inform demand creation by understanding what PrEP means – beyond HIV prevention – for the lives of users.MethodsThe Partners Demonstration Project evaluated an integrated strategy of PrEP and antiretroviral therapy (ART) delivery in which time‐limited PrEP served as a “bridge” to long‐term ART. Uninfected partners in HIV serodiscordant couples were offered PrEP at baseline and encouraged to discontinue once infected partners had taken ART for six months. We conducted 274 open‐ended interviews with 93 couples at two Ugandan research sites. Interviews took place one month after enrolment and at later points in the follow‐up period. Topics included are as follows: (1) discovery of serodiscordance; (2) decisions to accept/decline PrEP and/or ART; (3) PrEP and ART initiation; (4) experiences of using PrEP and ART; (5) PrEP discontinuation; (6) impact of PrEP and ART on the partnered relationship. Interviews were audio‐recorded and transcribed. We used an inductive, content analytic approach to characterize meanings of PrEP stemming from its effectiveness for HIV prevention. Relevant content was represented as descriptive categories.ResultsDiscovery of HIV serodiscordance resulted in fear of HIV transmission for couples, which led to loss of sexual intimacy in committed relationships, and to abandonment of plans for children. As a result, partners became alienated from each other. PrEP countered the threat to the relationship by reducing fear and reinstating hopes of having children together. Condom use worked against the re‐establishment of intimacy and closeness. By increasing couples’ sense of protection against HIV infection and raising the prospect of a return to “live sex” (sex without condoms), PrEP was perceived by couples as solving the problem of serodiscordance and preserving committed relationships.ConclusionsThe most effective demand creation strategies for PrEP may be those that address the everyday life priorities of potential users in addition to HIV prevention.Clinical Trial NumberNCT02775929

Responsible conduct of research: enhancing local opportunities.

Research integrity is the foundation of credible research and a pre-requisite for a successful academic research environment. Lately, a lot of revelations of fraud and other unacceptable behaviour in research have been highly publicized in scientific journals and mass media. Whereas institutions in developed countries have developed guidelines and regulations to ensure responsible conduct of research and appropriately deal with cases of research misconduct, low- and middle-income countries seem to be lagging behind. In Uganda, there seems to be lack of coordinated efforts to address the problem of research misconduct both at the national and institutional level. To propose a framework for fostering scientific integrity and deterring misconduct in research in Ugandan research and academic institutions. A review of literature on scientific integrity, scientific misconduct, responsible conduct of research, and international ethical guidelines was done. Basing on the 2012 Inter-Academy Council policy report, initiatives to promote responsible conduct of research in Ugandan research and academic institutions are proposed. With the proposed framework, an honest and trustworthy research enterprise in Uganda based on principles of scientific integrity is envisioned.

Secondary distress in violence researchers: a randomised trial of the effectiveness of group debriefings

BackgroundSecondary distress including emotional distress, vicarious trauma (VT) and secondary traumatic stress (STS) due to exposure to primary trauma victims have been described in helping professionals and in violence researchers. To our knowledge, there are few prevalence studies, and no tailored interventions have been tested to reduce secondary distress in violence researchers. The study aims to (1) describe the epidemiology of secondary distress experienced by violence researchers; to (2) assess the effectiveness of group debriefings in mitigating secondary distress; to (3) assess risk and protective factors.MethodsWe conducted an un-blinded, individually randomised trial with parallel assignment. Eligible participants were 59 Ugandan researchers employed by the Good Schools Study to interview children who experienced violence in a district of Uganda. Fifty-three researchers agreed to participate and were randomly allocated. The intervention group (n = 26) participated in three group debriefings and the control group (n = 27) in three leisure sessions (film viewings). The primary outcome was change in levels of emotional distress (SRQ-20); secondary outcomes were levels of VT and STS at end-line. A paired t-test assessed the difference in mean baseline and end-line emotional distress. Un-paired t-tests compared the change in mean emotional distress (baseline vs. end-line), and compared levels of VT and STS at end-line. Separate logistic regression models tested the association between end-line emotional distress and a-priori risk or protective factors.ResultsBaseline and end-line levels of emotional distress were similar in control (p = 0.47) and intervention (p = 0.59) groups. The superiority of group debriefing over leisure activities in lowering levels of emotional distress in the intervention group (n = 26; difference in SRQ-20 = 0.23 [SD = 2.18]) compared to the control group (n = 26; difference in SRQ-20 = 0.23 [SD = 1.63]) could not be detected (p = 1). In regression analysis (n = 48), baseline distress increased the odds of end-line distress (OR = 16.1, 95%CI 2.82 to 92.7, p = 0.002). Perceived organisational support (OR = 0.09, 95%CI 0.01 to 0.69, p = 0.02) and belief in God (OR = 0.21, 95%CI 0.03 to 1.26, p = 09) was protective against end-line distress.ConclusionWe found no evidence that violence researchers experienced elevated emotional distress after doing violence research. There was no difference between group debriefings and leisure activities in reducing distress in our sample. However, the hypotheses presented should not be ruled out in other violence research settings. Our findings suggest that organisational support is a significant protective factor and belief in God may be an important coping mechanism.Trial registrationClinical Trials NCT02390778. Retrospectively registered 19 March 2015. The Good Schools Trial was registered at (NCT01678846), on August 24, 2012.

What is the Difference between Cross-National Comparisons and Semi-Comparative Work? Example of Swedish-Ugandan Climate Change Communication Research

This methodological article presents the research approach of semi-comparisons and describes how it could be applied in the field of media and communication studies. The point of departure is that cross-national collaborations do not necessarily always have to result in full-fledged comparative studies, but can “go halfway”, i.e. stay at the semi-comparative level. This is exemplified in terms of an ongoing long-term collaboration between Swedish and Ugandan researchers, focusing on sustainable communication involving the role of media as a provider of relevant information in the case of the climate change issue. The semi-comparative approach – here characterized by: 1) cross-national research connectivity, 2) activities in which one “puts one’s own nation in a wider context” and 3) spontaneous, cross-national research influences – enables the generation of knowledge about the universalism and particularism within the dimensions of mediated climate communication, which would not have been possible with a regular cross-national comparative study. Keywords : climate change, media, cross-national comparative research, semi-comparative approach, sustainable communication, universalism, particularism.

Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science by Johanna Tayloe Crane (review)

Reviewed by: Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science by Johanna Tayloe Crane Mari K. Webel Johanna Tayloe Crane. Scrambling for Africa: AIDS, Expertise, and the Rise of American Global Health Science. Ithaca, N.Y.: Cornell University Press, 2013. xiii + 208 pp. $27.95 (978-0-8014-7917-5). Johanna Tayloe Crane’s multisited ethnographic study of HIV research and treatment makes a conscientious and provocative contribution to a growing body of literature that seeks to locate global health work in diverse historical, social, political, or economic contexts. Here, that context is primarily present-day Mbarara, Uganda. Crane follows American and Ugandan researchers, physicians, and administrators, and occasionally Ugandan patients, as each navigates a world dominated by HIV at Mbarara’s Immune Wellness Clinic. In a crisply written and evocatively told story of research, treatment, and expertise, Crane narrates a history of HIV research and treatment in Africa in the era of PEPFAR, and explores the singular role of HIV/AIDS in the broader development of global health in the past two decades. Scrambling for Africa examines the arrival of antiretroviral (ARV) drugs and American HIV researchers in rural Uganda between roughly 2004 and 2012, highlighting these changes as generative moments in global health science through which particular tensions become visible. Crane, as an inside woman of sorts, is uniquely positioned to pose a sensitive and probing critique of global health at a moment of profound change. At the core of her study is the problem of “valuable inequalities” in global health, and specifically HIV treatment, that emerged as ARVs were rolled out in Africa in the early 2000s. At the time, American doctors grappled with the intense suffering and misfortune of patients without access to life-prolonging drugs, while also recognizing, and desiring, the extraordinarily rich research potential that such patients embodied. This “uncomfortable mix of preventable suffering and scientific productivity” posed a paradox central to the origins and ethos of global health science, Crane successfully argues, and the persistence of these inequalities presents practitioners with the field’s most serious and durable ethical and logistical challenges (p. 7). Crane has achieved a difficult balance in grounding her work in local circumstances in rural Uganda while also insisting upon the “in-between space” of international scientific networks as her “field site” (p. 17). The book offers a series of deftly crafted separate pieces that explore these transnational, interstitial spaces of global health, each chapter building upon the last but also lending itself to independent reading. Chapter 1, Crane’s most wide-ranging chapter, details how new ideas about patient adherence to drug therapies and HIV resistance meshed with older thinking about race, poverty, and who deserves treatment to shape early debates on the ethics of introducing ARVs into Africa. Chapter 2 ventures into laboratories worldwide in pursuit of the “molecular politics” of HIV, artfully exploring how the strain of the virus common to North America and Europe became the standard research entity for HIV research. Crane’s work on the problematic biases that this selection has generated is excellent, and captures the dizzying intellectual and practical challenges that arise out of a research decision effectively made by default. Chapter 3 pivots to consider the laboratory and [End Page 366] clinic together, documenting the “turn toward Africa” in American HIV research of the early 2000s and exploring the consequences of the necessary translation of HIV from the “qualitative and clinical” common to Uganda to the “quantitative, molecular terms” of U.S.-based researchers, funding bodies, and journals (p. 82). Chapter 4 focuses on the changing work of the Immune Wellness Clinic, specifically on a register of HIV patients that spawned a research collaboration between Ugandan and American institutions. Crane uses the register, which ultimately became a computerized database, to explore collaborators’ divergent perspectives on donation, compensation, ownership, and collaboration itself. Chapter 5 returns to the United States, leading the reader into well-appointed conference rooms where global health research agendas are awkwardly but persistently being hammered out into the present day. Here and elsewhere, Crane does excellent work in exploring the nature of “partnership” and suggests several key critical, reflective questions that those wishing...

MUSLIM EDUCATION IN AFRICA: TRENDS AND ATTITUDES TOWARD FAITH-BASED SCHOOLS

Click to increase image sizeClick to decrease image size Additional informationNotes on contributorsMelina Platas Izama is a PhD candidate in political science at Stanford University, specializing in Comparative Politics. She has conducted fieldwork in Uganda, Ghana, Nigeria, and Malawi for her dissertation, and has experience in South Africa, Rwanda, Kenya, and Burkina Faso. She is currently an affiliate at the Makerere Institute of Social Research (MISR), based in Kampala, Uganda, and is a consultant for Ugandan research institutes and non-governmental organizations working in the health and education sectors.

Jerome Kabakyenga: prioritising rural health research in Uganda

Jerome Kabakyenga: prioritising rural health research in Uganda

Ronald Gray: collaborating with Ugandan researchers on HIV trials

Ronald Gray and his Ugandan have accomplished something remarkable in proving that circumcision can help reduce the infection rate of HIV in Africa. They together with the investigators in Kenya and earlier trialists in South Africa have given us a new weapon against the spread of the virus that will undoubtedly save lives. But public health epidemiologist Gray the last man to talk up their achievements. His concern that nobody should think circumcision more than a part of the answer. Its great to have done a trial that has a beneficial because sadly some of our earlier trials have had a negative outcome he says. On the one hand all our team feel very thrilled that we may have contributed to something that going to make a real difference in the world but they are daunted by the challenge of how do you scale this up and provide it safely and guard against an increase in sexual risk behaviours. Gray who Robertson Professor of Reproductive Epidemiology at Johns Hopkins Bloomberg School of Public Health Baltimore MD USA insists that we understand that the work coming out of Rakai Uganda Ugandanled. Gray and his wife the epidemiologist Maria Wawer visit two or three times a year but it is a Ugandan project. There not a single expatriate running the show. It run by our Ugandan colleagues he asserts. (excerpt)

Mothers' Malaria Appears to Enhance Spread of AIDS Virus

EPIDEMIOLOGY For the first time, a study of HIV-infected pregnant women has found that coinfection with malaria significantly increased a mother's risk of transmitting the AIDS virus to her baby before or during birth. According to a report in the November issue of the journal AIDS , HIV-infected pregnant women in the Rakai district of Uganda had nearly three times the risk of transmitting the AIDS virus to their babies if they concurrently had malaria and if the parasite that causes the disease had infected their placentas. “I was startled by the findings,” says the paper's first author, epidemiologist Heena Brahmbhatt of Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. In January 2002, Brahmbhatt, then a Ph.D. candidate at Hopkins studying mother-to-child transmission (MTCT) of HIV, read a report that an antimalarial drug might reduce HIV transmission to infants through their infected mother's breast milk. Intrigued by the possible impact of the drug, Brahmbhatt asked her adviser, Hopkins epidemiologist Ronald Gray, if she could look for the effect of malaria in data from Gray's well-known Rakai study. The study, conducted in collaboration with several Ugandan research groups, evaluated MTCT in 746 HIV-infected pregnant women and their babies in Uganda's Rakai district from 1994 to 1999. Brahmbhatt found 93 cases in which the researchers had ascertained the baby's HIV status and also had preserved the placenta. Of the 15 babies whose mothers had placental malaria, she found that six (40%) became infected. In contrast, HIV spread to only 12 of 78 infants (15%) whose mothers did not have malaria in their placentas. Brahmbhatt emphasizes that the sample size is small, and the findings are not conclusive. Still, the results were statistically significant, leading the authors to conclude that trials are “urgently needed” to evaluate whether giving HIV-infected pregnant women malaria prophylaxis can also reduce the transmission of HIV. “If our observations pan out, there may be a case for much more aggressive malaria suppression in HIV-infected women during pregnancy,” says Gray. ![Figure][1] Net gain. Protecting pregnant women from malaria may help thwart the spread of HIV from mother to child. CREDIT: ORC MACRO/CSTS+PROJECT Few studies have been done on the relationship of placental malaria and the maternal transmission of HIV. In 1998 a preliminary report on HIV-infected women in Kisumu, Kenya, hinted at a similar effect. But a lead investigator in that work, Richard Steketee of the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, says a more thorough analysis showed that, overall, placental malaria did not increase a woman's risk of transmitting HIV to her baby. “The [Rakai and Kisumu] studies don't match up, but that doesn't mean either one is wrong, because the methodology is different,” says Steketee, who heads CDC's malaria epidemiology branch. Steketee's results, in press at Emerging Infectious Diseases , offer a clue to the complex interaction of the two diseases in a pregnant woman. In Kisumu, the researchers assessed the parasitic burden in the placentas. Curiously, they found some protection from HIV when a placenta had a low level of parasites, but the risk of MTCT increased when the parasite density rose to high levels. Hopkins's Gray says he and his co-workers now plan to conduct a similar analysis in the placentas they collected. Steketee suspects that the intensity of the malaria infection modifies the mother's immunity in different ways, affecting HIV's ability to transmit in utero. “It would be important for someone to look at this again,” says Steketee. “These are not easy studies and they are not cheap, but the impact could be substantial.” [1]: pending:yes