Fogarty Fellow Ivan Segawa investigates nurse-led PrEP delivery in Uganda
March/ April 2022 | Volume 21 Number 2
One in four new HIV infections in sub-Saharan Africa occurs among adolescent girls and young women (AGYW) ages 15 to 24. In Uganda, 270 new infections occur every week within this age group. Researcher Ivan Segawa observed the increased vulnerability to HIV for AGYM. “They have limited access to HIV services plus they are young, their partners are older, and so often it is their partners who decide whether to use HIV prevention methods or not."
In Uganda, pre-exposure prophylaxis (PrEP)is generally delivered through HIV clinics, which many people find unappealing due to stigma surrounding the virus. Segawa's pilot study evaluates a health delivery model that integrates oral PrEP into family planning clinics, where nurses can take the lead in offering effective HIV prevention to AGYW. Unlike HIV clinics, family planning clinics are frequent stops for women seeking birth control. Their staff of experienced sexual and reproductive health nurse providers are familiar faces to many AGYW patients and thus strategically positioned to identify those who may be at high risk for HIV.
“This study, which is co-funded by the National Institute of Nursing Research, can inform task-shifting initiatives that have already seen nurses successfully run HIV clinics in our settings," said Segawa, whose education spans pharmaceutical science, clinical epidemiology, and biostatistics. “Yet other health professionals also have a role to play in increasing access to HIV services." In the U.S., for example, pharmacies provide vaccinations and other services, he noted. Pharmacies in Uganda might conduct HIV testing or deliver PrEP helping to alleviate the burden on physicians who might then focus on severe cases. “But the challenges we faced were with privacy and we are still navigating this landscape," explained Segawa. Research is also needed to evaluate the value of new delivery methods for HIV services outside traditional HIV clinics, he said.
Courtesy of Ivan SegawaThe photo shows a nurse interacting with a young woman at a family planning clinic within a government health care center in Uganda.
Segawa and his team have completed enrolling patients for his fellowship project. The nurses, who trained for four weeks with Segawa's team, are now delivering PrEP while fulfilling their traditional responsibilities at the clinic. “Initially, of course, the nurses had no prior training in PrEP , so we explored many topics, including counselling. Sometimes we felt like this was too much for them. But we told them 'pick up what you can, and we will keep coming back,' said Segawa. He hopes his research will provide enough evidence to make this model of HIV prevention care sustainable.
Throughout his fellowship, Segawa has acquired new skills, like manuscript writing and constructing quantitative methodologies. “I used to think manuscript writing is for the end. But now I know you can work on drafts even while collecting data." He also believed science was about clinics, labs, writing, and computers until he discovered project management. “If you are not up to speed on managing human resources and finances that's something that can set you back," said Segawa.
Another important aspect of his training has been the weekly competency meetings, where he learns about mentorship and K grants. “I hope to apply for a K43 grant within the next two years using the data I will have generated from my Fogarty study and master's degree. In the meantime, I am seeking small grants to answer more research questions in the field of HIV prevention." A Ph.D. and academic career feel “inevitable" to Segawa, steps along the road to becoming an independent researcher. To those hoping to apply for a Fogarty grant, he advises: “Read a lot of literature in your area to identify gaps that will increase the novelty of your idea. Anything is possible, just believe in yourself."
Updated April 19, 2022
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