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Profile: Fogarty Fellow Dr Joseph Matovu investigates HIV self-testing in Ugandan fishing community

March / April 2021 | Volume 20 Number 2

Dr. Joseph K.B. Matovu stands in front of a fishing boat on the shoreline in Uganda, many boats in the background. 

By Susan Scutti

Self-test kits can improve rates of HIV testing but distributing them in remote regions can be challenging. When social network leaders were trained to disseminate the test kits within a Ugandan fishing community, more than 95% were properly used and returned, a study by Fogarty Fellow Dr. Joseph Matovu found.

Matovu, a behavioral research scientist with a doctorate in public health, concentrates on HIV testing research because only when patients know their status can they begin treatment and care. HIV prevalence is thought to be as high as 37% in Ugandan fishing communities, explained Matovu. Since workers typically fish at night and sleep during the day, they miss out on health care services, he said. “So, we’ve been looking for something innovative that would reach them when they are awake, self-testing they can do in the convenience of their own homes.”

Matovu had become familiar with social networks while conducting previous research with Dr. Laura Bogart, a behavioral scientist at the Rand Corp. A social network is “any loose grouping of people who live together, work together, know each other in some way and associate in some way,” said Matovu. He explained that it is well known that social bonds can spur the apathetic to action; studies show, for example, that male testing increases when their female partners work with them. “If I went to a fishing community and identified those who can reach others through some form of a social network, then that should give me an opportunity to reach more people,” hypothesized Matovu.

For his Fogarty project, Matovu and his team identified 21 overlapping social networks within the targeted community. They included groups such as boat pushers, motorcycle taxi operators, card players and sex workers. After each group chose a “peer leader,” Matovu’s team vetted and trained these leaders to use the kits and counsel others, making referrals for treatment when necessary. Next, the peer leaders distributed self-testing kits to their networks. “We gave out 298 self-testing kits and of these only two people refused the kits, so we had 99% acceptability,” said Matovu, who added that results also showed “just under 98% confirmation of use.”

About 7% of the test-kit receipt population tested positive for HIV, which is a much lower prevalence than estimated, said Matovu, who believes his team had unknowingly missed some higher risk networks. Ten of the 12 individuals who tested positive for the first time had their results confirmed by laboratory analyses and 9 went on to receive care. The study was co-funded by the Africa Research Excellence Fund.

The fellowship taught Matovu new skills, including how to design interventions and how to write and apply for grants. It also helped him strengthen and expand his network of collaborators. With his travel stipend, he made stops at Yale University, the Rand Corporation and South Carolina University’s School of Medicine in September 2019, delivering presentations on his research at each. “The fellowship connected me with people I’d never have met otherwise,” said Matovu. “My U.S. mentor is Dean Kurth of Yale University’s school of nursing while my local mentors are Professors David Serwadda and Dean Wanyenze from Makerere University School of Public Health.” Matovu also worked closely with Prof. Albert I. Ko at Yale University School of Public Health and Dr. Laura Bogart from the RAND Corporation.

His project also helped to strengthen existing research capacity in Uganda. “I’d worked with this team in the past and this time they not only helped to collect data but also in the analysis of data and writing and publishing papers,” explained Matovu. “Usually you work with people collecting data and when they finish, they disappear. Now they know how data analysis is done and how to write and publish a paper.” In his next study, he plans to include master’s degree students. “I want to build capacity among young scientists who become part of a team I can turn to whenever I do research,” he said.

Since completing his study, Matovu has published two papers with two more underway. He also applied for and won a grant from the European and Developing Countries Clinical Trials Partnership to expand the research to other Ugandan fishing communities. “We have about 4,000 fishing communities in Uganda, so this pilot study was a drop in the ocean,” he said. “I believe the findings will also translate to other countries since fishing communities share similar characteristics and are organized in the same way - fishing done at night, far from medical centers.”

A Fogarty fellowship is a “lifetime experience,” said Matovu, who expects to continue working with his newfound mentors and collaborators for many years. “The opportunities that come mean you actually achieve more in one year than you normally could in 10.”

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