Uganda

Fellowship Site: Makerere University, UgandaUs Institution: Yale UniversityProject Title: Oral swab testing using GeneXpert Ultra for TB screening among PLHIV Background: Tuberculosis (TB) is the leading cause of death among people living with HIV (PLHIV) worldwide (WHO report, 2019). PLHIV are at an increased risk of TB, and in some African countries, on average 60% of persons with TB have HIV (Dye, 2019). However, identifying active TB in PLHIV poses a diagnostic challenge with the traditional approaches (Candice, 2011). We aim to evaluate the performance of oral swabs to rule-out active TB disease and to facilitate early initiation of TB preventive therapy (TPT).Rationale: Early confirmation and treatment of active TB is lifesaving for PLHIV while exclusion of active TB is a critical first step in prescribing preventive therapy. This reduces mortality in PLHIV, but has low rates of uptake in most of Sub-Saharan Africa (WHO report, 2020).Study objectives:1. To compare the yield of Xpert Ultra testing of material collected from repeated (up to 10 based on prior studies) Copan FLOQswabs among PLHIV with confirmed TB (i.e., positive sputum Xpert Ultra result)2. To evaluate the sensitivity and specificity of oral swab-based Xpert Ultra testing using the optimal number of Copan FLOQswabs among PLHIV initiating (antiretroviral therapy) ART.Methods: Leveraging infrastructure from my mentors ongoing NHLBI-funded studies of TB diagnostics in Uganda, we will collect up to 10 oral Copan FLOQswabs from PLHIV initiating ART. We will compare the yield (Aim 1) and accuracy (Aim 2) of Xpert Ultra testing of material from one vs. two Copan FLOQswabs.Importance of the study: The proposed study will establish a novel method that utilizes the widely available GeneXpert platform and an alternative, simple to collect sample for TB screening to overcome challenges with the current approach to systematic screening for TB among PLHIV. The data will either support larger evaluations of the optimal protocol for oral swab analysis using Xpert Ultra or inform efforts to further refine oral swab analysis using alternative molecular assays. A rapid and sensitive screening tool of this type could result in earlier diagnosis and treatment of TB, facilitate early initiation of TPT, and pave a way for rapid MDR-TB detection in this vulnerable patient population

Ms. Block Ngaybe will spend her fellowship year at Makerere University in Kampala, Uganda under the mentorship of Agnes Kiragga, PhD, Purnima Madhivanan, MBBS, MPH, PhD, John Ehiri, PhD, MPH, MSc, and Maia Ingram, MPH. Her research will focus on determinants of prospective uptake of a preventative HIV vaccine among the most at-risk populations in Uganda. Ms. Block Ngaybe is a PhD Candidate at the University of Arizona. She enjoys conducting research and teaching and would love to be a professor at a university at some point in her career. She also hopes to have a career practicing health promotion, perhaps within the university where she works, or with the US government or a non-governmental organization. Her main career and personal influences have been her parents, a doctor and nutritionist, who inspire her in their work helping serve a rural border town in Arizona. She has also been highly influenced by her mentor and advisor, Purnima Madhivanan, a leader in global health and health advocacy and justice.

Dr. Ssuna spent his fellowship year at Makerere University College of Health Sciences in Kampala under the mentorship of Achilles Katamba, PhD, Mari Armstrong-Hough, PhD and Luke Davis, MD, MAS. His research focused on improving screening and management of diabetes mellitus and post-TB lung disease among HIV/TB patients public health facilities in Uganda. Dr. Ssuna is a medical doctor and an epidemiologist with interests in HIV-TB coinfection, the impact of diabetes on patient outcomes for HTV-TB, and implementation science. He completed his first medical degree at Mbarara University of Science and Technology, and completed a dual Masters of Science degree in Clinical Epidemiology and Biostatistics from Makerere University. Dr. Ssuna holds a certificate in Implementation Science at University of California San Francisco (UCSF), where he gained profound knowledge, in theory, study designs for intervention research, translating evidence into policy, designing interventions to change organizational behavior, and community engagement.

Dr. Turimumahoro will spend her fellowship year at Makerere University College of Health Sciences in Kampala, Uganda under the mentorship of Achilles Katamba, MBChB, MSC, PHD and Luke Davis, MD, MAS. Her research will focus on the uptake of tuberculosis preventive therapy in resource limited settings. Dr. Turimumahoro is a medical doctor at Makerere University College of Health Sciences. She is an early career researcher with interests in the economics of population health and she has four years of experience doing implementation research to optimize community-based active case finding strategies. She aspires to become an independent researcher optimizing primary care strategies of public health importance. She was born and educated in Uganda, which is a resource-limited setting, and as a teenager she was a caregiver attending to her late father, who was being managed for chronic kidney failure. These personal experiences and the opportunity to work with passionate researchers such as Dr. Davis at Yale University and Dr. Katamba at Makerere University have shaped her decisions to participate, advocate and promote research that leads to incremental gains that can shape a more sustainable and equitable healthcare system.

Dr. Wandji will spend his fellowship year at the Atutur General Hospital located in Kumi District, Uganda, under the mentorship of Isaac Ssinabulya, MBChB, MMed and Jeremy Schwartz, MD, MPH. His research will focus on mental illness among caregivers of young children with sickle cell disease in rural Uganda. Dr. Wandji is a RN. His long-term goal is to become an independent global health scientist committed to developing and testing culturally-responsive intervention models to effectively prevent and treat non-communicable diseases, including mental health and substance use disorders, among rural and resource-limited populations in sub-Saharan Africa. His career has focused on population health programs among highly at risk and underserved minority populations, guided by the concepts of 'common good,’ ‘social justice,’ and ‘healthcare equity.’