Research Project Diaries: evaluative strategies in STI global indicators

Lauren who studied the MSc Control of Infectious Diseases, took on a research project with LSHTM’s STIRIG (Sexually Transmitted Infections Research Interest Group) at the MRC/UVRI & LSHTM Uganda Research Unit, focusing on evaluating syphilis control and surveillance programming. Lauren took part in primary data collection, where she gained some of the key skills needed for conducting primary research: key elements of critical analysis and reasoning, quick thinking and adaptation.
Lauren at one of the research health facilities

Summer Studies

“My interest in STI research was cultivated prior to my joining the Master’s at LSHTM. By attending the Control of STI module and meetings of the STIRIG group, I learned of current field research opportunities at LSHTM, and of the MRC/UVRI & LSTHM Uganda Research Unit. After the whirlwind of final exams, the rush of participating in primary data collection was the highlight that concluded my Masters’ experience and gave me the chance to apply skills developed during my module courses. My time in Uganda gave me hands-on experience in research and an in-depth understanding of surveillance research and evaluative strategies in STI global indicators.

After initially meeting with the research team, I settled in at the UVRI (Uganda Virus Research Unit) research centre headquarters in Entebbe where the MRC/UVRI & LSHTM Unit is located. After a few short weeks, we headed into rural areas for surveying corresponding health facilities, and I was able to contribute to the field collection activities for the remainder of my two months. Study data collection used Open Data Kit (ODK) software on tablets provided by the Open Research Kits group, and I gained valuable coding experience outside of the analysis for my final project.

STI Surveillance

Surveillance is a critical component of effective disease control programmes, and during my summer research project, I was able to participate in a study evaluating syphilis control and surveillance programming in South-Western Uganda. Undiagnosed and untreated Treponema pallidum infection (the cause of syphilis) during pregnancy can be transmitted from mother to baby, and result in fetal loss, stillbirth and other adverse pregnancy outcomes, such as organ abnormalities in the child, known as congenital syphilis. Syphilis is the second leading cause of preventable infant mortality worldwide, despite global recommendations for universal screening programs during pregnancy.

Syphilis is the second leading cause of preventable infant mortality worldwide, despite global recommendations for universal screening programs during pregnancy.

Under the stewardship of the World Health Organization (WHO), effective elimination of mother to child transmission (eMTCT) of syphilis, HIV and hepatitis B programmes include achieving indicators of 95% syphilis testing at first antenatal visit and 95% of women with positive tests effectively treated with penicillin, which brings down the rate of congenital syphilis to less than 50 cases/100,000 live births. The primary aim of the research project that I joined (at the MRC/UVRI & LSHTM Uganda Research Unit) was to evaluate the effectiveness of the introduction of a novel dual HIV and syphilis point-of-care test rolled out at antenatal clinics in achieving the first two indicators of the eMTCT programme.

Using a before-and-after evaluation design, I helped collect and analyse data from antenatal clinic patient records of health facilities selected through a two-stage cluster random sampling in two districts in South Western Uganda. We compared the rates of testing, positive reactions and treatment among antenatal clinic attenders (N=2000) in the 9-months prior to (January 2018-September 2018) and 9-months after (January 2019 – present) the introduction of a dual HIV/syphilis test kit instead of separate test kits. We also tracked the possible effect of syphilis screening by looking at maternity records of the same health facilities, documenting potential syphilis-attributable birth outcomes and HIV infection rates. Finally, we collected data on the management of sexually transmitted infections (STIs), particularly from patients with genital ulcer disease seen at the clinics. This was done to make some inferences about the community burden attributable to syphilis, and the adequacy of treatment offered.

Learning the Research Ropes

Data Collectors Allan (left) and Damalie (right)

Collecting primary research data during the course may not suit all MSc students, but it constitutes an invaluable experience for those contemplating starting a research career overseas. As a fledgeling researcher, I experienced personal nadir points – for example, when data collection wasn’t going to schedule, and the visible health inequity that I witnessed daily. I developed an inquisitive approach in Uganda, and the project taught me key elements of critical analysis and independent reasoning, as well as quick thinking and adaptation – all very useful to help develop or adapt a research protocol to answer unexplored questions in the field. It also allowed me the opportunity to participate in a cohesive research group at the MRC/UVRI & LSHTM Uganda unit, which will help me in the future.

Highlights of my summer project included exploring Uganda on my free weekends, and getting to know the people of Uganda – I developed lasting friendships with researchers and health facility workers.”