Browsing by Author "Mugisha, Emmanuel"

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    Feasibility of delivering HPV vaccine to girls aged 10 to 15 years in Uganda
    (African health sciences, 2015) Mugisha, Emmanuel; LaMontagne, Scott; Katahoire, Anne R; Murokora, Daniel; Kumakech, Edward; Seruyange, Rachel; Tsu, Vivien Davis
    Background: Cervical cancer is a leading cause of mortality among women in Uganda. The availability of the human papillomavirus (HPV) vaccine presents an opportunity to prevent cervical cancer. The Government of Uganda conducted a demonstration project exploring the feasibility of two delivery strategies. Objective: To explore the feasibility of two HPV vaccine delivery strategies: 1) a stand-alone school-based strategy that selected girls based on their enrolment in grade 5 (known as the “grade-based” strategy; and 2) an age-based strategy that delivered the HPV vaccine based on the girls’ age (10-year-olds). This strategy combined the delivery of the vaccine with the distribution of deworming medication and vitamin A through an existing Child Days Plus program. Methods: A qualitative study that explored the feasibility of the two delivery strategies from the perspective of health workers, district leaders, and staff of the Uganda National Expanded Programme on Immunization, utilizing in-depth interviews and focus group discussions. Results: Coverage data showed that more girls (88%) were vaccinated using the grade-based strategy and completed all three doses compared to those (73%) vaccinated using the age-based strategy. Health workers and teachers indicated that determining vaccination eligibility was easier by grade than by age and there were minor disruptions to health services and school programs during vaccinations, as reported by health workers and teachers using the grade-based strategy. Conclusion: HPV vaccine delivery at schools using grade eligibility was more feasible than selecting girls by age. Lessons learned in Uganda could be relevant for countries considering implementing HPV vaccinations.
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    Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries
    (Bull World Health Organ, 2011) LaMontagne, D Scott; Barge, Sandhya; Le, Nga Thi; Mugisha, Emmanuel; Penny, Mary E; Gandhi, Sanjay; Janmohamed, Amynah; Kumakech, Edward; Mosqueira, N Rocio; Nguyen, Nghi Quy; Paul, Proma; Tang, Yuxiao; Minh, Tran Hung; Uttekar, Bella Patel; Jumaan, Aisha O
    Objective To assess human papillomavirus (HPV) vaccination coverage after demonstration projects conducted in India, Peru, Uganda and Viet Nam by PATH and national governments and to explore the reasons for vaccine acceptance or refusal. Methods Vaccines were delivered through schools or health centres or in combination with other health interventions, and either monthly or through campaigns at fixed time points. Using a two-stage cluster sample design, the authors selected households in demonstration project areas and interviewed over 7000 parents or guardians of adolescent girls to assess coverage and acceptability. They defined full vaccination as the receipt of all three vaccine doses and used an open-ended question to explore acceptability. Findings Vaccination coverage in school-based programmes was 82.6% (95% confidence interval, CI: 79.3–85.6) in Peru, 88.9% (95% CI: 84.7–92.4) in 2009 in Uganda and 96.1% (95% CI: 93.0–97.8) in 2009 in Viet Nam. In India, a campaign approach achieved 77.2% (95% CI: 72.4–81.6) to 87.8% (95% CI: 84.3–91.3) coverage, whereas monthly delivery achieved 68.4% (95% CI: 63.4–73.4) to 83.3% (95% CI: 79.3–87.3) coverage. More than two thirds of respondents gave as reasons for accepting the HPV vaccine that: (i) it protects against cervical cancer; (ii) it prevents disease, or (iii) vaccines are good. Refusal was more often driven by programmatic considerations (e.g. school absenteeism) than by opposition to the vaccine. Conclusion High coverage with HPV vaccine among young adolescent girls was achieved through various delivery strategies in the developing countries studied. Reinforcing positive motivators for vaccine acceptance is likely to facilitate uptake.
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    Immunogenicity of bivalent HPV vaccine among partially vaccinatedyoung adolescent girls in Uganda
    (Elsevier Ltd., 2014) LaMontagne, D. Scott; Mugisha, Emmanuel; Pan, Yuanji; Kumakech, Edward; Ssemaganda, Aloysius; Kemp, Troy J.; Cover, Jane; Pinto, Ligia A.; Safaeian, Mahboobeh
    Background: Investigations of vaccine efficacy and immunogenicity for adult females receiving fewerthan three doses of human papillomavirus (HPV) vaccine have suggested protection against infection andprecancerous lesions. We investigated the immunogenicity of bivalent HPV vaccines among adolescentgirls from Uganda who received one, two, or three vaccine doses.Methods: Young girls vaccinated through a government program in Uganda were invited to participate.HPV16- and HPV18-specific antibodies were measured at ≥24 months after the last vaccine dose usingan enzyme linked immunoassay in girls who received one (n = 36), two (n = 145), or three (n = 195) doses.Results: Nearly all subjects (99%) were HPV16 and HPV18 seropositive at the time of blood-draw.Geometric mean antibody levels (GMTs) were: HPV161-dose= 230 EU/mL, HPV162-dose= 808 EU/mL,and HPV163-dose= 1607 EU/mL; HPV181-dose= 87 EU/mL, HPV182-dose= 270 EU/mL, andHPV183-dose= 296 EU/mL. The GMT ratio for 2:3 doses was 0.50 (HPV16) and 0.68 (HPV18) anddid not meet the non-inferiority criteria (i.e., lower bound of 97.5% confidence interval of the GMT ratiogreater than 0.50). The GMT ratio for 1:3 doses for HPV16 and HPV18 was inferior, but absolute GMTs forone dose were higher than adult women who received one dose (HPV16 = 124 EU/mL, HPV18 = 69 EU/mL)where efficacy has been demonstrated.Conclusions: Even though immunogenicity with less than three doses did not meet a priori non-inferioritythresholds, antibody levels measured ≥24 months after last dose were similar to those of adult womenwho have been followed for more than eight years for efficacy.
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    Screen-and-Treat Approach to Cervical Cancer Prevention Using Visual Inspection With Acetic Acid and Cryotherapy: Experiences, Perceptions, and Beliefs From Demonstration Projects in Peru, Uganda, and Vietnam
    (The oncologist, 2013) Proma, Paul; Winkler, Jennifer L.; Bartolini, Rosario M.; Penny, Mary E.; Huong, Trinh Thu; Nga, Le Thi; Kumakech, Edward; Mugisha, Emmanuel; Jeronimo, Jose
    Cervical cancer is preventable but continues to cause the deaths of more than 270,000 women worldwide each year, most of them in developing countries where programs to detect and treat precancerous lesions are not affordable or available. Studies have demonstrated that screening by visual inspection of the cervix using acetic acid (VIA) is a simple, affordable, and sensitive test that can identify precancerous changes of the cervix so that treatment such as cryotherapy can be provided. Government partners implemented screening and treatment using VIA and cryotherapy at demonstration sites in Peru, Uganda, and Vietnam. Evaluations were conducted in the three countries to explore the barriers and facilitating factors for the use of services and for incorporation of screen-and-treat programs using VIA andcryotherapyintoroutineservices.Resultsshowedthatuseof VIA and cryotherapy in these settings is a feasible approach to providing cervical cancer prevention services. Activities that can help ensure successful programs include mobilizing and educating communities, organizing services to meet women’s schedules and needs, and strengthening systems to track clients for follow-up. Sustainability also depends on having an adequate number of trained providers and reducing staff turnover. Althoughsomechallengeswerefoundacrossallsites, othersvaried fromcountryto country, suggesting that carefulassessmentsbefore beginning new secondary prevention programs will optimize the probability of success. The Oncologist 2013;18: 1278–1284
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    Using Formative Research to Design a Behavior Change Strategy to Increase the Use of Improved Cookstoves in Peri-Urban Kampala, Uganda
    (International journal of environmental research and public health, 2013) Martin, Stephanie L.; Arney, Jennifer K.; Mueller, Lisa M.; Kumakech, Edward; Walugembe, Fiona; Mugisha, Emmanuel
    Household air pollution from cooking with biomass fuels negatively impacts maternal and child health and the environment, and contributes to the global burden of disease. In Uganda, nearly 20,000 young children die of household air pollution-related pneumonia every year. Qualitative research was used to identify behavioral determinants related to the acquisition and use of improved cookstoves in peri-urban Uganda. Results were used to design a behavior change strategy for the introduction of a locally-fabricated top-lit updraft gasifier (TLUD) stove in Wakiso district. A theoretical framework—opportunity, ability, and motivation—was used to guide the research and behavior change strategy development. Participants consistently cited financial considerations as the most influential factor related to improved cookstove acquisition and use. In contrast, participants did not prioritize the potential health benefits of improved cookstoves. The theoretical framework, research methodology, and behavior change strategy design process can be useful for program planners and 6921 researchers interested in identifying behavioral determinants and designing and evaluating improved cookstove interventions.