Kasese District is nestled in the far western corner of Uganda, surrounded by mountainous national parks, and bordering the Democratic Republic of Congo (DRC). Building on existing collaborations with Kagando hospital, a team from the MRC-University of Glasgow Centre for Virus Research (CVR) is investigating the prevalence of exposure to viral hemorrhagic fever viruses (VHF viruses) and SARS-CoV-2 in health care workers and surrounding communities. VHF viruses are regularly seen in this part of Uganda and cause a variety of diseases: Rift Valley Fever (RVF), Ebola and Crimean congo haemorrhagic fever (CCHF). This study seeks to understand the epidemiological spread of disease in healthcare workers and abattoir workers in order to strengthen prevention strategies.
After successfully running several studies in Uganda, international travel was suspended and team members from the UK were unable to visit the research sites. However, with the leadership of Dr Mary Munyagwa, medical director at Kagando hospital and Stella Atim, a veterinarian and PhD fellow at Makerere University who is investigating CCHF in Uganda and remote assistance from members of the CVR team, the study went ahead. Laheri Kabugho was appointed as team leader with Mercy Musoki, Joshua Muhindo, Esther Atolere and Mercy Kabugho as study nurses, Bettress Happy and Robinah Aliganyira as HIV counselor, Robert Muhindo as community mobilizer and Edson Masereka as laboratory technologist. Alongside the need to train staff in sample collection and research, the UK team also ensured that equipment was delivered in a timely and safe manner – with items such as blood tubes and needles, a heat block, and the relevant trial documentation i.e. consent forms.
What did they do about it?
Zoom provided the platform to carry out remote training with powerpoint slides and videos shared online. WhatsApp daily communication was also an essential tool.
Marina Kugler, Project Coordinator, made sure that the equipment and necessary items for the study arrived, carefully boxed and labelled from Glasgow.
‘We organised kits and lab equipment, printed out consent forms and packed boxes with needles, phones, face masks and much more. Everything was labelled so the participants could be easily recruited and to reduce administrative errors in the very important documentation of the study’.
The minutiae required in planning a remote study was not underestimated and enabled the successful implementation of the research. Participants were recruited at a rate of ~30 per day, blood samples were heat inactivated and stored in the delivered freezer, before transported to Entebbe for testing at the UVRI.
Study questionnaires were filled out via mobile phones and REDCap, rather than by paper, to allow quick collection and safe storage. Data is available in real time online, which allowed Marina to check for missing values and any queries were resolved on Whatsapp – the fastest and most reliable way to communicate with the study site. Laheri and the team also commented on the ease they felt in getting help and support from the remote team.
‘The care and the support you gave us was the best part of the study. It was not as we were alone, we were always with you during the whole study.’ - Laheri
One of the key elements of any study is the mobilisation of communities and this was carried out very effectively by the study team. Stella, Laheri and Robert would meet with a member of the village health team and the village leader to explain the study. Through these contacts, they would organise mobilisation in the villages to recruit participants.
What can we learn?
Clear expectation setting with stakeholders is important, especially in regard to the availability of data for analysis. Depth is paramount with many qualitative or mixed-methodological studies, and when timing is disrupted, staying open, positive, and accommodating goes a long way toward ensuring high-quality data. It’s advisable to build in padding for each and every stage of the research process, from recruitment through to analysis. Staying flexible will help ensure maximum number of participants are recruited and it will also reinforce a collaborative research ethos, which is important now more than ever.
What is next?
Right now, the team is working on the data analysis of all 300 health care workers with their sex/age/geographically matched 450 community members. The results will provide information about the epidemiological spread of viral infections in the expected special risk group of health care workers. Results will be communicated to the study groups and solutions for risk reduction will be developed together.
Kagando Mission Hospital, Bwera General Hospital, Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine Uganda Research Unit (MRC/UVRI and LSHTM Uganda Research Unit), Glasgow University, and the UK Public Health Rapid Support Team (UK-PHRST).
When not responding to disease outbreaks, the UK-PHRST conducts rigorous operational research to improve epidemic preparedness and enhance our understanding of how best to tackle these threats in the future.