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Harris JR, Kadobera D, Kwesiga B, Kabwama SN, Bulage L, Kyobe HB, Kagirita AA, Mwebesa HG, Wanyenze RK, Nelson LJ, Boore AL, Ario AR. Improving the effectiveness of Field Epidemiology Training Programs: characteristics that facilitated effective response to the COVID-19 pandemic in Uganda. BMC Health Serv Res 2022; 22:1532. [PMID: 36526999 PMCID: PMC9756722 DOI: 10.1186/s12913-022-08781-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 10/10/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The global need for well-trained field epidemiologists has been underscored in the last decade in multiple pandemics, the most recent being COVID-19. Field Epidemiology Training Programs (FETPs) are in-service training programs that improve country capacities to respond to public health emergencies across different levels of the health system. Best practices for FETP implementation have been described previously. The Uganda Public Health Fellowship Program (PHFP), or Advanced-FETP in Uganda, is a two-year fellowship in field epidemiology funded by the U.S. Centers for Disease Control and situated in the Uganda National Institute of Public Health (UNIPH). We describe how specific attributes of the Uganda PHFP that are aligned with best practices enabled substantial contributions to the COVID-19 response in Uganda. METHODS We describe the PHFP in Uganda and review examples of how specific program characteristics facilitate integration with Ministry of Health needs and foster a strong response, using COVID-19 pandemic response activities as examples. We describe PHFP activities and outputs before and during the COVID-19 response and offer expert opinions about the impact of the program set-up on these outputs. RESULTS Unlike nearly all other Advanced FETPs in Africa, PHFP is delinked from an academic degree-granting program and enrolls only post-Master's-degree fellows. This enables full-time, uninterrupted commitment of academically-trained fellows to public health response. Uganda's PHFP has strong partner support in country, sufficient technical support from program staff, Ministry of Health (MoH), CDC, and partners, and full-time dedicated directorship from a well-respected MoH staff member. The PHFP is physically co-located inside the UNIPH with the emergency operations center (EOC), which provides a direct path for health alerts to be investigated by fellows. It has recognized value within the MoH, which integrates graduates into key MoH and partner positions. During February 2020-September 2021, PHFP fellows and graduates completed 67 major COVID-related projects. PHFP activities during the COVID-19 response were specifically requested by the MoH or by partners, or generated de novo by the program, and were supervised by all partners. CONCLUSION Specific attributes of the PHFP enable effective service to the Ministry of Health in Uganda. Among the most important is the enrollment of post-graduate fellows, which leads to a high level of utilization of the program fellows by the Ministry of Health to fulfill real-time needs. Strong leadership and sufficient technical support permitted meaningful program outputs during COVID-19 pandemic response. Ensuring the inclusion of similar characteristics when implementing FETPs elsewhere may allow them to achieve a high level of impact.
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Affiliation(s)
- Julie R. Harris
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Steven N. Kabwama
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda
| | - Henry B. Kyobe
- grid.4991.50000 0004 1936 8948University of Oxford, Kellogg College, Oxford, UK ,grid.415705.2Ministry of Health, Kampala, Uganda
| | | | | | - Rhoda K. Wanyenze
- grid.11194.3c0000 0004 0620 0548College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Lisa J. Nelson
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Amy L. Boore
- grid.512457.0Centers for Disease Control and Prevention, Kampala, Uganda
| | - Alex Riolexus Ario
- Uganda Public Health Fellowship Program, National Institute of Public Health, Kampala, Uganda ,grid.415705.2Ministry of Health, Kampala, Uganda
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Ario AR, Bulage L, Wibabara Y, Muwereza P, Eurien D, Kabwama SN, Kwesiga B, Kadobera D, Turyahabwe S, Musinguzi JB, Wanyenze RK, Nasirumbi PM, Lukoye D, Harris JR, Mills LA, Nelson LJ. Uganda Public Health Fellowship Program's Contributions to the National HIV and TB Programs, 2015–2020. GLOBAL HEALTH: SCIENCE AND PRACTICE 2022; 10:GHSP-D-21-00574. [PMID: 35487554 PMCID: PMC9053155 DOI: 10.9745/ghsp-d-21-00574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 03/21/2022] [Indexed: 11/15/2022]
Abstract
The Uganda Public Health Fellowship Program has built the capacity of its fellows to address multiple gaps in the Uganda health system as well as to contribute to improving Uganda's ability to prevent, prepare for, and respond to public health emergencies such as HIV and TB. Despite remarkable progress in controlling HIV and TB, Uganda is one of the 30 high-burden TB/HIV countries. Approximately 53,000 Ugandans had a new HIV diagnosis in 2019, and approximately 88,000 Ugandans had a TB diagnosis in 2020. Fellows in the Uganda Public Health Fellowship Program (UPHFP) work directly with the Ministry of Health AIDS and TB Control Programs, the U.S. Centers for Disease Control and Prevention, UPHFP supervisors, and implementing partners to investigate and evaluate HIV-related and TB-related issues. These activities have contributed to the Uganda HIV and TB programs. UPHFP fellows complete projects in 7 competency domains, including outbreak investigations, surveillance evaluations, and data quality improvement. Priority HIV/AIDS/TB information gaps/topics are identified in consultation with key stakeholders, and fellows complete projects to guide program improvements and policy decisions. During 2015–2020, UPHFP fellows implemented 127 HIV and TB projects covering key program areas in AIDS and TB control programs, including care and treatment (16 projects), TB/HIV (18), prevention of mother-to-child HIV transmission (24), key and priority populations (9), pre-exposure and post-exposure prophylaxis (7), adolescent girls and young women (6), service delivery (13), and diagnosis of TB including drug-resistant TB and TB in high-risk groups (32). These projects have helped improve retention, quality of care, and treatment outcomes for people living with HIV, HIV and TB coinfected patients, and TB patients. They have also contributed to the decrease in pediatric TB and infant HIV positivity rates and improved service delivery for key populations. UPHFP results were disseminated to relevant stakeholders such as government departments, implementing partners, districts, and the general community and guided decision making. UPHFP has significantly improved HIV and TB control in Uganda. Other countries with similar programs could benefit from this approach and utilize program fellows to support HIV and TB control.
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Affiliation(s)
- Alex R Ario
- Ministry of Health, Kampala, Uganda.
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Lilian Bulage
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
- African Field Epidemiology Network, Kampala, Uganda
| | - Yvette Wibabara
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Peter Muwereza
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Daniel Eurien
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
| | - Steven N Kabwama
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Benon Kwesiga
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Daniel Kadobera
- Uganda Public Health Fellowship Program, Ministry of Health, Kampala, Uganda
- Uganda National Institute of Public Health, Kampala, Uganda
| | - Stavia Turyahabwe
- Ministry of Health, Kampala, Uganda
- National TB and Leprosy Control Division, Ministry of Health, Kampala, Uganda
| | - Joshua B Musinguzi
- Ministry of Health, Kampala, Uganda
- AIDS Control Programme, Ministry of Health, Kampala, Uganda
| | - Rhoda K Wanyenze
- College of Health Sciences, Makerere University School of Public Health, Kampala, Uganda
| | - Pamela M Nasirumbi
- U.S. Centers for Disease Control and Prevention, Division of Global Health Protection, Centers for Global Health, Kampala, Uganda
| | - Deus Lukoye
- U.S. Centers for Disease Control and Prevention, Division of Global Health Protection, Centers for Global Health, Kampala, Uganda
| | - Julie R Harris
- U.S. Centers for Disease Control and Prevention, Division of Global Health Protection, Centers for Global Health, Kampala, Uganda
| | - Lisa A Mills
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Centers for Global Health, Kampala, Uganda
| | - Lisa J Nelson
- U.S. Centers for Disease Control and Prevention, Division of Global HIV and TB, Centers for Global Health, Kampala, Uganda
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Seffren V, Lowther S, Guerra M, Kinzer MH, Turcios-Ruiz R, Henderson A, Shadomy S, Baggett HC, Harris JR, Njoh E, Salyer SJ. Strengthening the global one health workforce: Veterinarians in CDC-supported field epidemiology training programs. One Health 2022; 14:100382. [PMID: 35686141 PMCID: PMC9171531 DOI: 10.1016/j.onehlt.2022.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Effective prevention, detection, and response to disease threats at the human-animal-environment interface rely on a multisectoral, One Health workforce. Since 2009, the U.S. Centers for Disease Control and Prevention (CDC) has supported Field Epidemiology Training Programs (FETPs) to train veterinarians and veterinary paraprofessionals (VPPs) alongside their human health counterparts in the principles of epidemiology, disease surveillance, and outbreak investigations. We aim to describe and evaluate characteristics of CDC-supported FETPs enrolling veterinarians/VPPs to understand these programs contribution to the strengthening of the global One Health workforce. Methods We surveyed staff from CDC-supported FETPs that enroll veterinarians and VPPs regarding cohort demographics, graduate retention, and veterinary and One Health relevant curriculum inclusion. Descriptive data was analyzed using R Version 3.5.1. Results Forty-seven FETPs reported veterinarian/VPP trainees, 68% responded to our questionnaire, and 64% reported veterinary/VPP graduates in 2017. The veterinary/VPP graduates in 2017 made up 12% of cohorts. Programs reported 74% of graduated veterinarians/VPPs retained employment within national ministries of agriculture. Common veterinary and One Health curriculum topics were specimen collection and submission (93%), zoonotic disease (90%) and biosafety practices (83%); least covered included animal/livestock production and health promotion (23%) and transboundary animal diseases (27%). Less than half (41%) of programs reported the curriculum being sufficient for veterinarians/VPPs to perform animal health specific job functions, despite most programs being linked to the ministry of agriculture (75%) and providing veterinary-specific mentorship (63%). Conclusions Our results indicate that FETPs provide valuable training opportunities for animal health sector professionals, strengthening the epidemiology capacity within the ministries retaining them. While veterinary/VPP trainees could benefit from the inclusion of animal-specific curricula needed to fulfill their job functions, at present, FETPs continue to serve as multisectoral, competency-based, in-service training important in strengthening the global One Health workforce by jointly training the animal and human health sectors. Global health security requires multisectoral epidemiology workforce capacity. FETPs with veterinarians/VPPs were linked to ministries of agriculture and health. Veterinary/VPP FETP trainees jointly train alongside public health epidemiologists. One Health and Zoonotic Diseases curriculum was offered by most FETPs. FETPs train in epidemiology and surveillance at human-animal-environment interface.
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Affiliation(s)
- Victoria Seffren
- PHI/CDC Global Health Fellowship Program, Atlanta, GA, USA
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Corresponding author at: Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention. 1600 Clifton Rd., MS H24-3, Atlanta, GA 30333, USA.
| | - Sara Lowther
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Marta Guerra
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Michael H. Kinzer
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Reina Turcios-Ruiz
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alden Henderson
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sean Shadomy
- One Health Office, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Henry C. Baggett
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Julie R. Harris
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Eni Njoh
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Stephanie J. Salyer
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Kostova DA, Moolenaar RL, Van Vliet G, Lasu A, Mahar M, Richter P. Strengthening Pandemic Preparedness Through Noncommunicable Disease Strategies. Prev Chronic Dis 2021; 18:E93. [PMID: 34672923 PMCID: PMC8588872 DOI: 10.5888/pcd18.210237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Deliana A Kostova
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30322.
| | - Ronald L Moolenaar
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia
| | | | - Ally Lasu
- RTI International, Research Triangle Park, North Carolina
| | - Michael Mahar
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia
| | - Patricia Richter
- Division of Global Health Protection, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, Georgia
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Kostova D, Richter P, Van Vliet G, Mahar M, Moolenaar RL. The Role of Noncommunicable Diseases in the Pursuit of Global Health Security. Health Secur 2021; 19:288-301. [PMID: 33961498 PMCID: PMC8217593 DOI: 10.1089/hs.2020.0121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Noncommunicable diseases and their risk factors are important for all aspects of outbreak preparedness and response, affecting a range of factors including host susceptibility, pathogen virulence, and health system capacity. This conceptual analysis has 2 objectives. First, we use the Haddon matrix paradigm to formulate a framework for assessing the relevance of noncommunicable diseases to health security efforts throughout all phases of the disaster life cycle: before, during, and after an event. Second, we build upon this framework to identify 6 technical action areas in global health security programs that are opportune integration points for global health security and noncommunicable disease objectives: surveillance, workforce development, laboratory systems, immunization, risk communication, and sustainable financing. We discuss approaches to integration with the goal of maximizing the reach of global health security where infectious disease threats and chronic disease burdens overlap.
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Affiliation(s)
- Deliana Kostova
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Patricia Richter
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Gretchen Van Vliet
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Michael Mahar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
| | - Ronald L Moolenaar
- Deliana Kostova, PhD, is a Senior Economist; Patricia Richter, PhD, is Branch Chief, Global Noncommunicable Diseases Branch; Michael Mahar, PhD, is a Public Health Advisor; and Ronald L. Moolenaar, MD, is Associate Director for Science; all in the Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA. Gretchen Van Vliet, MPH, is Senior Public Health Project Director, Global Public Health Impact Center, RTI International, Research Triangle Park, NC
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