Thomas, Kristin

School of Public Health

MSPH

Uganda

Interim Evaluation of Randomized Trial on the Impact of CHWs

The Rakai Health Sciences Program (RHSP) is a large and well established program focused on HIV-related research in southwestern Uganda. We have an ongoing HIV implementation science project focused on improving HIV care and prevention service delivery in a very high HIV prevalence fishing community using a peer community health worker approach that also leverages mHealth.  This cluster-randomized study began recruitment September 2015 and is now in need of interim mixed methods evaluations to better understand intervention fidelity, processes, and interim impact.

Global Health Mentor/PI: Larry Chang, MD

To say that I was nervous before my trip to Uganda would largely be an unnecessary use of poetic license – I was excited to see a new place and have a new experience! And even better, two of my peers from the Social and Behavioral Interventions concentration would be joining me for the summer.

We were extremely lucky: we were working at the Rakai Health Sciences Program, one of the premier research centers in the country and probably in East Africa more generally, and our research teams were exceptionally well-trained and enthusiastic about the work. I was working on a mixed-methods evaluation of the mLAKE study, a HIV counseling intervention leveraging mHealth. My work was highly qualitative, and I was reminded of just how much I love delving into the [health-related] stories of people’s lived experiences. I worked closely with the Qualitative Research Team as we took the two-hour drive along a bumpy dirt road out to the Kasensero fishing community twice a week during the month of July. Once there, I learned the hard way about the difficulties of reaching members of such a mobile and transient shantytown community. I experienced first-hand the necessity to think on my feet and implement quick changes once in the field. Those weren’t always the easiest days, and some days I left the guesthouse for the office at 8:30AM and returned at 7PM after an exhausting day!

This practicum experience in Uganda’s Rakai District colored in the picture of international health that I had gained from the first year of my Masters of Science in Public Health program. Although the Kasensero community has received several educational interventions aimed at dispelling myths about HIV/AIDS, I was surprised to learn that misconceptions about HIV and a fervent sense of stigma still pervade the community, where nearly 40% of residents have the virus! While reading ~40 transcripts detailing people’s stories about where they obtained some of the knowledge, not only were they influenced by their social networks, as was to be expected, but they also learned some sexual health delusions in school, where teachers were likely trying to encourage abstinence through fear. My work on this research study helped to add context for the behavior change challenges that our Community Health Workers are experiencing, and for the modified approach that we can take to deepen our impact in the community.

I should note that while I was largely tasked with writing this narrative on my reflections about joining a research project in a developing country, navigating a new culture and cultural differences in the work environment, and life in a rural East African town – which were all important factors of my experience – the GHEFP was much more than that, and much more than I could have imagined. I established new friendships not only with my Hopkins peers and other public health students, but expatriates from around the world, and my Ugandan colleagues and other Ugandans that I met at the places that I frequented. Further, I had an amazing time at music festivals in Kampala, on vacation on the beaches of Zanzibar, and on safaris and hikes at Queen Elizabeth National Park and Sipi Falls. The GHEFP allowed me to have an enriching educational experience not just academically, but socially and culturally as well.

I am grateful to the Center for Global Health and my project’s Primary Investigator, Dr. Larry Chang, for giving me this opportunity to shine as a mixed-methods researcher ready to take on the (global public health) world when May rolls around in a few months. But most importantly, I’m grateful for all that I have learned about myself and my ambitions for the future through this truly inspiring experience in Uganda.

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September 2020

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