More research needed in child health, HIV - experts

The Minister of Health has highlighted a need to build research capacity to address the health disparities affecting children, adolescents and their families.

Dr. Jane Ruth Aceng made the remarks at the 2023 Forum on Child and Adolescent Global Health Research and Capacity Building. The Forum attracted over 60 researchers and research trainees representing universities from across the globe.

“As a region, we face multiple health challenges affecting children, adolescents and their families, and these include existing endemic diseases, such as, HIV, tuberculosis and malaria; emerging and reemerging infectious diseases, such as Ebola, and non-communicable diseases. It is, therefore, critical to train the next generation of researchers who are well versed with working with multi-disciplinary teams to optimize health outcomes for populations,’ Dr. Aceng said.  

She added that the government greatly values evidence-based research as it feeds into policies and programs to improve the well-being of children and communities.

“A 2017 Lancet Report found that only 35 percent of scientific publications addressing research interventions in low and middle income countries include authors who work in low and middle income settings. Moreover, few African scholars on the continent are able to find funding for their research programs, primarily due to lack of infrastructure to develop research projects, and most research interventions for sub-Saharan Africa are still guided by theoretical models originated in the global north, which lack contextual relevance,” Dr. Aceng says.

According to Prof. Fred Ssewamala, an Associate Dean for Transdisciplinary Faculty Research at Washington University in St Louis, and the founder of the International Centre for Child Health and Development (ICHAD), children and adolescents in sub-Saharan Africa, and in Uganda in particular, face multiple obstacles which prohibit their healthy development and adherence to HIV treatment.

“The Suubi+Adherence Round 2 study that we are conducting in Greater Masaka examines the longitudinal impact of an economic empowerment intervention on HIV treatment adherence and care outcomes. The background to the initial Suubi+Adherence Round 1 study was that children were increasingly not adhering to their ARV medication because they forget, wanted to be like other children who do not take the drugs, and because of poverty. When people are poor, they will not have the transport to pick up ARVs from health centers or the food required to eat before taking the medication,” he says. 

Prof. Ssewamala added that results from the Suubi+Adherence Round 1 were promising, with data showing that participants who received the intervention consistently reported improved adherence to antiretroviral medications, viral suppression increased significantly, as well as improvement in their mental health functioning. 

The Suubi+Adherence Round 2 study, which is working with over 39 clinics and health centers in Greater Masaka, is trying to figure out whether the positive outcomes reported in Round 1 of the study are sustained over time, providing a longer-term follow-up to establish impact across years as participants transition into young adulthood. 

Another study called M-Suubi is being implemented in health clinics with participants attending over 100 schools, is focused on reducing the impact of stigma. “Stigma is pronounced in controlled places, such as boarding schools. Once children leave the dormitories in the morning, they are not allowed back until 6pm. So, taking ARVs is a problem. Should the children take them under cover, or should they disclose their status to the matron?” Prof. Ssewamala asks.

Dr Proscovia Nabunya, an assistant professor at Washington University in St. Louis, who leads one of the studies addressing stigma known as Suubi4Stigma, says that group-based interventions, such as those involving multiple families and group cognitive behavioral therapy, have the potential to address stigma. 

“Preliminary findings from this study indicate that participating in group-based interventions is associated with reduction in mental health challenges, specifically depression, which is one of the major barriers to treatment adherence. These interventions are also associated with an increase in treatment adherence among children living with HIV. Group-based therapies are critically important in because individual therapies are too expensive and besides, we do not have many therapists in Uganda,” she says.

The funding and mentorship support, through grants, extended by ICHAD to researchers and people interested in research in Uganda, gives them an opportunity to connect with people in the field of child health, mental health and HIV treatment.

[email protected]