Mari Armstrong-Hough
Mari Armstrong-Hough
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Associate Professor of Social & Behavioral Sciences and Epidemiology
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Professional overview
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Dr. Mari Armstrong-Hough is Associate Professor in the Department of Social & Behavioral Sciences and in the Department of Epidemiology. She is a medical sociologist and epidemiologist of respiratory disease.
Dr. Armstrong-Hough’s global health research examines the epidemiologic interfaces among tuberculosis (TB), HIV, and non-communicable diseases. Combining training in epidemiology and sociology, her work develops and evaluates interventions to increase early case-finding, status awareness, and linkage to care in high-burden settings like Uganda and South Africa. She has published on predictors of evaluation for TB among high-risk groups, novel approaches to active case-finding for TB and HIV, the ways that providers and patients imagine and communicate risk for respiratory infection, and the availability of essential medicines in settings with double burdens of infectious and non-communicable disease. Her first book, Biomedicalization and the Practice of Culture: Globalization and Type 2 Diabetes in the United States and Japan (University of North Carolina Press, 2018), examined how the practice and experience of global evidence-based medicine is shaped by local cultural repertoires. Her recent work has appeared in the Journal of AIDS, International Journal of Tuberculosis and Lung Disease, and the The Lancet Respiratory Medicine. She also co-directs the NIH-funded Mixed-Methods Fellowship of the Pulmonary Complications of AIDS Research Training Program at Makerere University in Kampala, Uganda. She is PI of a prospective cohort study of patients initiating treatment for pulmonary TB in Uganda and a co-investigator on NIH-funded studies of contact tracing for TB.
Dr. Armstrong-Hough’s US-based research examines racial and ethnic disparities in survival of respiratory failure and seeks to develop interventions to ensure that all patients with respiratory failure receive evidence-based care. Approximately 750,000 Americans die each year from respiratory failure, and its 2.5 million survivors experience poor physical function and quality of life persisting five years after discharge. Minority patients are significantly less likely to survive respiratory failure, with up to twice the odds of death as non-Hispanic White patients. Dr. Armstrong-Hough co-PIs the Promoting Equity via Changes In Practice for Respiratory Failure (PRECIPICE) studies, which use large-scale, multicenter data from US ICUs to identify care processes associated with inequities in survival and long-term outcomes. Early work related to these studies has been accepted to Annals of the American Thoracic Society.
Before coming to NYU, Dr. Armstrong-Hough was an Associate Research Scientist in Epidemiology in the Department of Epidemiology of Microbial Diseases at Yale School of Public Health. She previously taught at Davidson College, Meiji University in Tokyo, and Duke University. She has conducted fieldwork in the United States, Japan, Uganda, Ethiopia, and Nepal and is a recipient of the Robert E. Leet and Clara Guthrie Patterson Trust Mentored Research Award in Clinical, Health Services and Policy Research.
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Education
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BA, Sociology, History, and Political Science, University of Wisconsin–MadisonMA, East Asian Studies, Duke UniversityPhD, Sociology, Duke UniversityPostdoctoral MPH, Applied Biostatistics and Epidemiology, Yale
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Publications
Publications
Racial and ethnic disparities in recovery of everyday activities among survivors of respiratory failure
AbstractParrotte, K., Mercado, L., Chen, Y., Liang, N., Wu, S., & Armstrong-Hough, M. (n.d.).Publication year
2023Abstract~Racial Differences in Quality of Life Among Survivors of Respiratory Failure
AbstractParrotte, K., Wu, S., Liang, N., Chen, Y., Mercado, L., & Armstrong-Hough, M. (n.d.).Publication year
2023Abstract~Self-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda
AbstractTusubira, A. K., Ssinabulya, I., Kalyesubula, R., Nalwadda, C. K., Akiteng, A. R., Ngaruiya, C., Rabin, T. L., Katahoire, A., Armstrong-Hough, M., Hsieh, E., Hawley, N. L., & Schwartz, J. I. (n.d.).Publication year
2023Journal title
PLOS global public healthVolume
3Issue
12AbstractBackground Implementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda. Methods Between April and August 2019, we executed a cross-sectional investigation involving 385 adult patients diagnosed with HTN and/or DM. These participants were systematically randomly selected from three outpatient NCD clinics in the Nakaseke district. Data collection was facilitated using a structured survey that inquired about participants’ healthcare-seeking patterns, access to self-care services, education on self-care, medication compliance, and overall health-related quality of life. We utilized Chi-square tests and logistic regression analyses to discern disparities in self-care practices, education, and healthcare-seeking actions based on the patient’s conditions. Results Of the 385 participants, 39.2% had only DM, 36.9% had only HTN, and 23.9% had both conditions (HTN/DM). Participants with DM or both conditions reported more clinic visits in the past year than those with only HTN (P = 0.005). Similarly, most DM-only and HTN/DM participants monitored their weight monthly, unlike those with only HTN (PSelf-care and healthcare seeking practices among patients with hypertension and diabetes in rural Uganda
AbstractArmstrong-Hough, M., Tusubira, A. K., Ssinabulya, I., Kalyesubula, R., Nalwadda, C. K., Akiteng, A. R., Ngaruiya, C., Rabin, T. L., Katahoire, A., Armstrong-Hough, M., Hsieh, E., Hawley, N. L., & Schwartz, J. I. (n.d.).Publication year
2023Journal title
PLOS global public healthVolume
3Issue
12Page(s)
e0001777AbstractImplementing effective self-care practices for non-communicable diseases (NCD) prevents complications and morbidity. However, scanty evidence exists among patients in rural sub-Saharan Africa (SSA). We sought to describe and compare existing self-care practices among patients with hypertension (HTN) and diabetes (DM) in rural Uganda.“Re-norming of HIV testing in TB contact investigation: a randomized controlled trial”
AbstractArmstrong-Hough, M. (n.d.).Publication year
2023Abstract~Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam : a case study
AbstractShelley, D., Alvarez, G. G., Nguyen, T., Nguyen, N., Goldsamt, L. A., Cleland, C. M., Tozan, Y., Shuter, J., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1AbstractBackground: Smoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial. Methods: Data collection and analyses were guided by two implementation science frameworks and the socio-ecological model. Qualitative interviews were conducted with 13 health care providers and 24 patients in three OPCs. Workflow analyses were conducted in each OPC. Qualitative data were analyzed using rapid qualitative analysis procedures. Based on findings, components of the intervention and implementation strategies were adapted, followed by a 3-month pilot study in one OPC with 16 patients randomized to one of two intervention arms. Results: The primary adaptations included modifying the TDT intervention counseling content to address barriers to quitting among PLWH and Vietnamese sociocultural norms that support smoking cessation. Implementation strategies (i.e., training and system changes) were adapted to respond to provider- and clinic-level determinants of implementation effectiveness (e.g., knowledge gaps, OPC resource constraints, staffing structure, compatibility). Conclusions: Adaptations were facilitated through a mixed method, stakeholder (patient and health care provider, district health leader)-engaged evaluation of context-specific influences on intervention and implementation effectiveness. This data-driven approach to refining and adapting components aimed to optimize intervention effectiveness and implementation in the context of HIV care. Balancing pragmatism with rigor through the use of rapid analysis procedures and multiple methods increased the feasibility of the adaptation process. Trial registration: ClinicalTrials.gov NCT05162911 . Registered on December 16, 2021.Adapting a tobacco cessation treatment intervention and implementation strategies to enhance implementation effectiveness and clinical outcomes in the context of HIV care in Vietnam: a case study
AbstractArmstrong-Hough, M., Shelley, D., Alvarez, G. G. G., Nguyen, T., Nguyen, N., Goldsamt, L., Cleland, C., Tozan, Y., Shuter, J., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1Page(s)
112AbstractSmoking rates remain high in Vietnam, particularly among people living with HIV/AIDS (PLWH), but tobacco cessation services are not available in outpatient HIV clinics (OPCs). The research team is conducting a type II hybrid randomized controlled trial (RCT) comparing the cost-effectiveness of three tobacco cessation interventions among PLWH receiving care in HIV clinics in Vietnam. The study is simultaneously evaluating the implementation processes and outcomes of strategies aimed at increasing the implementation of tobacco dependence treatment (TDT) in the context of HIV care. This paper describes the systematic, theory-driven process of adapting intervention components and implementation strategies with demonstrated effectiveness in high-income countries, and more recently in Vietnam, to a new population (i.e., PLWH) and new clinical setting, prior to launching the trial.Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation : Protocol for a cluster-randomised trial
AbstractArmstrong-Hough, M., Ggita, J., Gupta, A. J., Shelby, T., Nangendo, J., Ayen, D. O., Davis, J. L., & Katamba, A. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
5AbstractIntroduction HIV status awareness is important for household contacts of patients with tuberculosis (TB). Home HIV testing during TB contact investigation increases HIV status awareness. Social interactions during home visits may influence perceived stigma and uptake of HIV testing. We designed an intervention to normalise and facilitate uptake of home HIV testing with five components: guided selection of first tester; prosocial invitation scripts; opt-out framing; optional sharing of decisions to test; and masking of decisions not to test. Methods and analysis We will evaluate the intervention effect in a household-randomised controlled trial. The primary aim is to assess whether contacts offered HIV testing using the norming strategy will accept HIV testing more often than those offered testing using standard strategies. Approximately 198 households will be enrolled through three public health facilities in Kampala, Uganda. Households will be randomised to receive the norming or standard strategy and visited by a community health worker (CHW) assigned to that strategy. Eligible contacts ≥15 years will be offered optional, free, home HIV testing. The primary outcome, proportion of contacts accepting HIV testing, will be assessed by CHWs and analysed using an intention-to-treat approach. Secondary outcomes will be changes in perceived HIV stigma, changes in perceived TB stigma, effects of perceived HIV stigma on HIV test uptake, effects of perceived TB stigma on HIV test uptake and proportions of first-invited contacts who accept HIV testing. Results will inform new, scalable strategies for delivering HIV testing. Ethics and dissemination This study was approved by the Yale Human Investigation Committee (2000024852), Makerere University School of Public Health Institutional Review Board (661) and Uganda National Council on Science and Technology (HS2567). All participants, including patients and their household contacts, will provide verbal informed consent. Results will be submitted to a peer-reviewed journal and disseminated to national stakeholders, including policy-makers and representatives of affected communities. Trial registration number ClinicalTrials.gov Identifier: NCT05124665.Assessing a norming intervention to promote acceptance of HIV testing and reduce stigma during household tuberculosis contact investigation: protocol for a cluster-randomised trial
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Ggita, J., Gupta, A. J., Shelby, T., Nangendo, J., Ayen, D. O., Davis, J. L., & Katamba, A. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
5Page(s)
e061508AbstractHIV status awareness is important for household contacts of patients with tuberculosis (TB). Home HIV testing during TB contact investigation increases HIV status awareness. Social interactions during home visits may influence perceived stigma and uptake of HIV testing. We designed an intervention to normalise and facilitate uptake of home HIV testing with five components: guided selection of first tester; prosocial invitation scripts; opt-out framing; optional sharing of decisions to test; and masking of decisions not to test.Associations among past trauma, post-displacement stressors, and mental health outcomes in Rohingya refugees in Bangladesh: A secondary cross-sectional analysis
AbstractArmstrong-Hough, M., Ritsema, H., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Frontiers in public healthVolume
10Page(s)
1048649AbstractThe Rohingya endured intense trauma in Myanmar and continue to experience trauma related to displacement in Bangladesh. We aimed to evaluate the association of post-displacement stressors with mental health outcomes, adjusting for previously experienced trauma, in the Rohingya refugee population in Cox's Bazar, Bangladesh.Core components of a Community of Practice to improve community health worker performance : a qualitative study
AbstractHennein, R., Ggita, J. M., Turimumahoro, P., Ochom, E., Gupta, A. J., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1AbstractBackground: Communities of Practice (CoPs) offer an accessible strategy for healthcare workers to improve the quality of care through knowledge sharing. However, not enough is known about which components of CoPs are core to facilitating behavior change. Therefore, we carried out a qualitative study to address these important gaps in the literature on CoPs and inform planning for an interventional study of CoPs. Methods: We organized community health workers (CHWs) from two tuberculosis (TB) clinics in Kampala, Uganda, into a CoP from February to June 2018. We conducted interviews with CoP members to understand their perceptions of how the CoP influenced delivery of TB contact investigation. Using an abductive approach, we first applied inductive codes characterizing CHWs’ perceptions of how the CoP activities affected their delivery of contact investigation. We then systematically mapped these codes into their functional categories using the Behavior Change Technique (BCT) Taxonomy and the Behavior Change Wheel framework. We triangulated all interview findings with detailed field notes. Results: All eight members of the CoP agreed to participate in the interviews. CHWs identified five CoP activities as core to improving the quality of their work: (1) individual review of feedback reports, (2) collaborative improvement meetings, (3) real-time communications among members, (4) didactic education sessions, and (5) clinic-wide staff meetings. These activities incorporated nine different BCTs and five distinct intervention functions. CHWs reported that these activities provided a venue for them to share challenges, exchange knowledge, engage in group problem solving, and benefit from social support. CHWs also explained that they felt a shared sense of ownership of the CoP, which motivated them to propose and carry out innovations. CHWs described that the CoP strengthened their social and professional identities within and outside the group, and improved their self-efficacy. Conclusions: We identified the core components and several mechanisms through which CoPs may improve CHW performance. Future studies should evaluate the importance of these mechanisms in mediating the effects of CoPs on program effectiveness.Core components of a Community of Practice to improve community health worker performance: a qualitative study
AbstractArmstrong-Hough, M., Hennein, R., Ggita, J. M., Turimumahoro, P., Ochom, E., Gupta, A. J., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2022Journal title
Implementation science communicationsVolume
3Issue
1Page(s)
27AbstractCommunities of Practice (CoPs) offer an accessible strategy for healthcare workers to improve the quality of care through knowledge sharing. However, not enough is known about which components of CoPs are core to facilitating behavior change. Therefore, we carried out a qualitative study to address these important gaps in the literature on CoPs and inform planning for an interventional study of CoPs.Cultural Adaptation and Validation of the General Self-Efficacy Scale in Ugandan Community Health Workers
AbstractArmstrong-Hough, M., Hennein, R., Nanziri, L. M., Musinguzi, J., Ggita, J. M., Turimumahoro, P., Ochom, E., Gupta, A. J., Halder, A., Katamba, A., White, M. A., Pietrzak, R. H., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2022Journal title
Global implementation research and applicationsVolume
2Issue
4Page(s)
371-383AbstractSelf-efficacy is central to community health workers' capacity and motivation to deliver evidence-based care; thus, validated measures of self-efficacy are needed to assess the effectiveness of community health worker programs. In this study, we culturally adapted and evaluated the General Self-Efficacy Scale among community health workers in Uganda using multiple methods. We adapted the ten-item General Self-Efficacy Scale through cross-cultural discussions within our multidisciplinary research team, translation from English into Luganda and back-translation into English, and six cognitive interviews with community health workers. We administered the adapted scale in a staged, two-part cross-sectional study, including a total of 147 community health workers. Exploratory factor analysis yielded three factors, which we labeled problem-solving, persistence, and resourcefulness. This three-factor solution had good model fit (standardized root mean square residual = 0.07) and explained 53.4% of the variance. We found evidence of convergent validity, as scores for the total scale were positively correlated with years of experience ( = 0.48; < .001) and perceived social support ( = 0.39, < .001). Scores were also higher among those with higher educational attainment in one-way analysis of variance and Bonferroni-corrected post hoc tests [ (2,72) = 9.16, < .001]. We also found evidence of discriminant validity, as scores for the total scale were not correlated with age ( = - 0.07, = .55), in agreement with literature showing that general self-efficacy is an age-independent construct. The internal consistency of the adapted scale was within the acceptable range for a pilot study (Cronbach's = 0.61). This evaluation of a Uganda-adapted General Self-Efficacy Scale demonstrated promising psychometric properties; however, larger studies with repeated measures are warranted to further assess the adapted scale's factor structure, validity, reliability, and stability over time.Determinants of testing for HIV among young people in Uganda. A nested, explanatory-sequential study
AbstractKalibbala, D., Mpungu, S. K., Ssuna, B., Muzeyi, W., Mberesero, H., Semitala, F. C., Katahoire, A., Armstrong-Hough, M., Kalyango, J. N., & Musiime, V. (n.d.).Publication year
2022Journal title
PLOS global public healthVolume
2Issue
12AbstractAwareness of HIV serostatus helps individuals calibrate behaviour or link to care. Globally, young people (15-24years) contribute over 30% of new HIV infections. Despite progress in enhancing access to HIV services, HIV testing among young people in Uganda is below target. We determined the prevalence and factors influencing HIV testing among young people in a peri-urban district with the highest proportion of young people. We conducted a nested explanatory sequential mixed-methods study from March to May 2019 in Wakiso district. We used stratified cluster random sampling to select 397 rural and 253 urban young people from eight parishes. We collected data using questionnaires and subsequently conducted in-depth interviews with 16 purposively selected survey participants. The prevalence of testing for HIV was 80.2%. Young people related their decisions about HIV testing to self-evaluation of their risk and perceived ability to manage the consequences of a positive result. Participants reported high levels of support for HIV testing from peers, partners, and family members. They perceived health facilities as confusing, distant, expensive, and staffed by judgmental, older health workers as barriers. They felt that mobile testing points solved some of these problems, but introduced less privacy and greater confidentiality concerns. The prevalence of HIV testing among young people in Wakiso district was low compared to the UNAIDS 2030 target but among the highest in sub-Saharan Africa. Community-based programs resolve many concerns about testing at health facilities. However, there is a need to make these programs more comfortable and private.Determinants of testing for HIV among young people in Uganda. A nested, explanatory-sequential study
AbstractArmstrong-Hough, M., Kalibbala, D., Mpungu, S. K., Ssuna, B., Muzeyi, W., Mberesero, H., Semitala, F. C., Katahoire, A., Armstrong-Hough, M., Kalyango, J. N., & Musiime, V. (n.d.).Publication year
2022Journal title
PLOS global public healthVolume
2Issue
12Page(s)
e0000870AbstractAwareness of HIV serostatus helps individuals calibrate behaviour or link to care. Globally, young people (15-24years) contribute over 30% of new HIV infections. Despite progress in enhancing access to HIV services, HIV testing among young people in Uganda is below target. We determined the prevalence and factors influencing HIV testing among young people in a peri-urban district with the highest proportion of young people. We conducted a nested explanatory sequential mixed-methods study from March to May 2019 in Wakiso district. We used stratified cluster random sampling to select 397 rural and 253 urban young people from eight parishes. We collected data using questionnaires and subsequently conducted in-depth interviews with 16 purposively selected survey participants. The prevalence of testing for HIV was 80.2%. Young people related their decisions about HIV testing to self-evaluation of their risk and perceived ability to manage the consequences of a positive result. Participants reported high levels of support for HIV testing from peers, partners, and family members. They perceived health facilities as confusing, distant, expensive, and staffed by judgmental, older health workers as barriers. They felt that mobile testing points solved some of these problems, but introduced less privacy and greater confidentiality concerns. The prevalence of HIV testing among young people in Wakiso district was low compared to the UNAIDS 2030 target but among the highest in sub-Saharan Africa. Community-based programs resolve many concerns about testing at health facilities. However, there is a need to make these programs more comfortable and private.Factors associated with willingness to use oral pre-exposure prophylaxis (PrEP) in a fisher-folk community in peri-urban Kampala, Uganda
AbstractSsuna, B., Katahoire, A., Armstrong-Hough, M., Kalibbala, D., Kalyango, J. N., & Kiweewa, F. M. (n.d.).Publication year
2022Journal title
BMC public healthVolume
22Issue
1AbstractBackground: The World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence. Objective: To examine the perceptions and factors associated with willingness to use oral PrEP among members of fishing communities in Uganda, a key population at risk of HIV. Methods: We conducted an explanatory sequential mixed-methods study at Ggaba fishing community from February to June 2019. Survey data were collected from a systematic random sample of 283 community members in which PrEP had not been rolled out yet by the time of we conducted the study. We carried out bivariate tests of association of willingness to use PrEP with demographic characteristics, HIV risk perception, HIV testing history. We estimated prevalence ratios for willingness to use PrEP. We used backward elimination to build a multivariable modified Poisson regression model to describe factors associated with willingness to use PrEP. We purposively selected 16 participants for focus group discussions to contextualize survey findings, analysing data inductively and identifying emergent themes related to perceptions of PrEP. Key results: We enrolled 283 participants with a mean age of 31 ± 8 years. Most (80.9%) were male. The majority of participants had tested for HIV in their lifetime, but 64% had not tested in the past 6 months. Self-reported HIV prevalence was 6.4%. Most (80.6, 95%CI 75.5–85.0) were willing in principle to use PrEP. Willingness to use PrEP was associated with perceiving oneself to be at high risk of HIV (aPR 1.99, 95%CI 1.31–3.02, P = 0.001), having tested for HIV in the past 6-months (aPR 1.13, 95%CI 1.03–1.24, P = 0.007), and completion of tertiary education (aPR 1.97, 95%CI 1.39–2.81, P < 0.001). In focus group discussions, participants described pill burden, side-effects and drug safety as potential barriers to PrEP use. Conclusions and recommendations: Oral PrEP was widely acceptable among members of fishing communities in peri-urban Kampala. Programs for scaling-up PrEP for fisherfolk should merge HIV testing services with sensitization about PrEP and also increase means of awareness of PrEP as an HIV preventive strategy.Factors associated with willingness to use oral pre-exposure prophylaxis (PrEP) in a fisher-folk community in peri-urban Kampala, Uganda
AbstractArmstrong-Hough, M., Ssuna, B., Katahoire, A., Armstrong-Hough, M., Kalibbala, D., Kalyango, J. N., & Kiweewa, F. M. (n.d.).Publication year
2022Journal title
BMC public healthVolume
22Issue
1Page(s)
468AbstractThe World Health Organization (WHO) recommends the use of pre-exposure prophylaxis (PrEP) in key populations at elevated risk for exposure to HIV. If used effectively, PrEP can reduce annual HIV incidence to below 0.05%. However, PrEP is not acceptable among all communities that might benefit from it. There is, therefore, a need to understand perceptions of PrEP and factors associated with willingness to use PrEP among key populations at risk of HIV, such as members of communities with exceptionally high HIV prevalence.Implementation, interrupted : Identifying and leveraging factors that sustain after a programme interruption
AbstractHennein, R., Ggita, J., Ssuna, B., Shelley, D., Akiteng, A. R., Davis, J. L., Katamba, A., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Global Public HealthVolume
17Issue
9Page(s)
1868-1882AbstractMany implementation efforts experience interruptions, especially in settings with developing health systems. Approaches for evaluating interruptions are needed to inform re-implementation strategies. We sought to devise an approach for evaluating interruptions by exploring the sustainability of a programme that implemented diabetes mellitus (DM) screening within tuberculosis clinics in Uganda in 2017. In 2019, we conducted nine interviews with clinic staff and observed clinic visits to determine their views and practices on providing integrated care. We mapped themes to a social ecological model with three levels derived from the Consolidated Framework for Implementation Research (CFIR): outer setting (i.e. community), inner setting (i.e. clinic), and individuals (i.e. clinicians). Respondents explained that DM screening ceased due to disruptions in the national supply chain for glucose test strips, which had cascading effects on clinics and clinicians. Lack of screening supplies in clinics limited clinicians’ opportunities to perform DM screening, which contributed to diminished self-efficacy. However, culture, compatibility and clinicians’ beliefs about DM screening sustained throughout the interruption. We propose an approach for evaluating interruptions using the CFIR and social ecological model; other programmes can adapt this approach to identify cascading effects of interruptions and target them for re-implementation.Métodos de diagnóstico salival para determinar la infección por el SARS-CoV-2 en países de ingresos bajos y medios
AbstractTan, S. H., Allicock, O. M., Katamba, A., Carrington, C. V., Wyllie, A. L., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Bulletin of the World Health OrganizationVolume
100Issue
12Page(s)
808-814AbstractAs the coronavirus disease 2019 (COVID-19) continues to disproportionately affect low-and middle-income countries, the need for simple, accessible and frequent diagnostic testing grows. In lower-resource settings, case detection is often limited by a lack of available testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To address global inequities in testing, alternative sample types could be used to increase access to testing by reducing the associated costs. Saliva is a sensitive, minimally invasive and inexpensive diagnostic sample for SARS-CoV-2 detection that is appropriate for asymptomatic surveillance, symptomatic testing and at-home collection. Saliva testing can lessen two major challenges faced by lower-and middle-income countries: constrained resources and overburdened health workers. Saliva sampling enables convenient self-collection and requires fewer resources than swab-based methods. However, saliva testing for SARS-CoV-2 diagnostics has not been implemented on a large scale in low-and middle-income countries. While numerous studies based in these settings have demonstrated the usefulness of saliva sampling, there has been insufficient attention on optimizing its implementation in practice. We argue that implementation science research is needed to bridge this gap between evidence and practice. Low-and middle-income countries face many barriers as they continue their efforts to provide mass COVID-19 testing in the face of substantial inequities in global access to vaccines. Laboratories should look to replicate successful approaches for sensitive detection of SARS-CoV-2 in saliva, while governments should act to facilitate mass testing by lifting restrictions that limit implementation of saliva-based methods.Patient preferences for facility-based management of hypertension and diabetes in rural Uganda : A discrete choice experiment
AbstractMoor, S. E., Tusubira, A. K., Wood, D., Akiteng, A. R., Galusha, D., Tessier-Sherman, B., Donroe, E. H., Ngaruiya, C., Rabin, T. L., Hawley, N. L., Armstrong-Hough, M., Nakirya, B. D., Nugent, R., Kalyesubula, R., Nalwadda, C., Ssinabulya, I., & Schwartz, J. I. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
7AbstractObjective To explore how respondents with common chronic conditions - hypertension (HTN) and diabetes mellitus (DM) - make healthcare-seeking decisions. Setting Three health facilities in Nakaseke District, Uganda. Design Discrete choice experiment (DCE). Participants 496 adults with HTN and/or DM. Main outcome measures Willingness to pay for changes in DCE attributes: getting to the facility, interactions with healthcare providers, availability of medicines for condition, patient peer-support groups; and education at the facility. Results Respondents were willing to pay more to attend facilities that offer peer-support groups, friendly healthcare providers with low staff turnover and greater availabilities of medicines. Specifically, we found the average respondent was willing to pay an additional 77 121 Ugandan shillings (UGX) for facilities with peer-support groups over facilities with none; and 49 282 UGX for 1 month of medicine over none, all other things being equal. However, respondents would have to compensated to accept facilities that were further away or offered health education. Specifically, the average respondent would have to be paid 3929 UGX to be willing to accept each additional kilometre they would have to travel to the facilities, all other things being equal. Similarly, the average respondent would have to be paid 60 402 UGX to accept facilities with some health education, all other things being equal. Conclusions Our findings revealed significant preferences for health facilities based on the availability of medicines, costs of treatment and interactions with healthcare providers. Understanding patient preferences can inform intervention design to optimise healthcare service delivery for patients with HTN and DM in rural Uganda and other low-resource settings.Patient preferences for facility-based management of hypertension and diabetes in rural Uganda: a discrete choice experiment
AbstractArmstrong-Hough, M., Moor, S. E., Tusubira, A. K., Wood, D., Akiteng, A. R., Galusha, D., Tessier-Sherman, B., Donroe, E. H., Ngaruiya, C., Rabin, T. L., Hawley, N. L., Armstrong-Hough, M., Nakirya, B. D., Nugent, R., Kalyesubula, R., Nalwadda, C., Ssinabulya, I., & Schwartz, J. I. (n.d.).Publication year
2022Journal title
BMJ openVolume
12Issue
7Page(s)
e059949AbstractTo explore how respondents with common chronic conditions-hypertension (HTN) and diabetes mellitus (DM)-make healthcare-seeking decisions.Perceptions, preferences, and experiences of tuberculosis education and counselling among patients and providers in Kampala, Uganda : A qualitative study
AbstractAyakaka, I., Armstrong-Hough, M., Hannaford, A., Ggita, J. M., Turimumahoro, P., Katamba, A., Katahoire, A., Cattamanchi, A., Shenoi, S. V., & Lucian Davis, J. (n.d.).Publication year
2022Journal title
Global Public HealthAbstractTuberculosis (TB) education seeks to increase patient knowledge about TB, while TB counselling seeks to offer tailored advice and support for medication adherence. While universally recommended, little is known about how to provide effective, efficient, patient-centred TB education and counselling (TEC) in low-income, high HIV-TB burden settings. We sought to characterise stakeholder perceptions of TEC in a public, primary care facility in Kampala, Uganda, by conducting focus group discussions with health workers and TB patients in the TB and HIV clinics. Participants valued TEC but reported that high-quality TEC is rarely provided, because of a lack of time, space, staff, planning, and prioritisation given to TEC. To improve TEC, they recommended adopting practices that have proven effective in the HIV clinic, including better specifying educational content, and employing peer educators focused on TEC. Patients and health workers suggested that TEC should not only improve TB patient knowledge and adherence, but should also empower and assist all those undergoing evaluation for TB, whether confirmed or not, to educate their households and communities about TB. Community-engaged research with patients and front-line providers identified opportunities to streamline and standardise the delivery of TEC using a patient-centred, peer-educator model.Perceptions, preferences, and experiences of tuberculosis education and counselling among patients and providers in Kampala, Uganda: A qualitative study
AbstractArmstrong-Hough, M., Ayakaka, I., Armstrong-Hough, M., Hannaford, A., Ggita, J. M., Turimumahoro, P., Katamba, A., Katahoire, A., Cattamanchi, A., Shenoi, S. V., & Davis, J. L. (n.d.).Publication year
2022Journal title
Global public healthVolume
17Issue
11Page(s)
2911-2928AbstractTuberculosis (TB) education seeks to increase patient knowledge about TB, while TB counselling seeks to offer tailored advice and support for medication adherence. While universally recommended, little is known about how to provide effective, efficient, patient-centred TB education and counselling (TEC) in low-income, high HIV-TB burden settings. We sought to characterise stakeholder perceptions of TEC in a public, primary care facility in Kampala, Uganda, by conducting focus group discussions with health workers and TB patients in the TB and HIV clinics. Participants valued TEC but reported that high-quality TEC is rarely provided, because of a lack of time, space, staff, planning, and prioritisation given to TEC. To improve TEC, they recommended adopting practices that have proven effective in the HIV clinic, including better specifying educational content, and employing peer educators focused on TEC. Patients and health workers suggested that TEC should not only improve TB patient knowledge and adherence, but should also empower and assist all those undergoing evaluation for TB, whether confirmed or not, to educate their households and communities about TB. Community-engaged research with patients and front-line providers identified opportunities to streamline and standardise the delivery of TEC using a patient-centred, peer-educator model.Saliva-based methods for SARS-CoV-2 testing in low- and middle-income countries
AbstractTan, S. H., Allicock, O. M., Katamba, A., Carrington, C. V., Wyllie, A. L., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Bulletin of the World Health OrganizationVolume
100Issue
12Page(s)
808-814AbstractAs the coronavirus disease 2019 (COVID-19) continues to disproportionately affect low- and middle-income countries, the need for simple, accessible and frequent diagnostic testing grows. In lower-resource settings, case detection is often limited by a lack of available testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To address global inequities in testing, alternative sample types could be used to increase access to testing by reducing the associated costs. Saliva is a sensitive, minimally invasive and inexpensive diagnostic sample for SARS-CoV-2 detection that is appropriate for asymptomatic surveillance, symptomatic testing and at-home collection. Saliva testing can lessen two major challenges faced by lower- and middle-income countries: constrained resources and overburdened health workers. Saliva sampling enables convenient self-collection and requires fewer resources than swab-based methods. However, saliva testing for SARS-CoV-2 diagnostics has not been implemented on a large scale in low- and middle-income countries. While numerous studies based in these settings have demonstrated the usefulness of saliva sampling, there has been insufficient attention on optimizing its implementation in practice. We argue that implementation science research is needed to bridge this gap between evidence and practice. Low- and middle-income countries face many barriers as they continue their efforts to provide mass COVID-19 testing in the face of substantial inequities in global access to vaccines. Laboratories should look to replicate successful approaches for sensitive detection of SARS-CoV-2 in saliva, while governments should act to facilitate mass testing by lifting restrictions that limit implementation of saliva-based methods.Saliva-based methods for SARS-CoV-2 testing in low- and middle-income countries
AbstractArmstrong-Hough, M., Tan, S. H., Allicock, O. M., Katamba, A., Carrington, C. V. F., Wyllie, A. L., & Armstrong-Hough, M. (n.d.).Publication year
2022Journal title
Bulletin of the World Health OrganizationVolume
100Issue
12Page(s)
808-814AbstractAs the coronavirus disease 2019 (COVID-19) continues to disproportionately affect low- and middle-income countries, the need for simple, accessible and frequent diagnostic testing grows. In lower-resource settings, case detection is often limited by a lack of available testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To address global inequities in testing, alternative sample types could be used to increase access to testing by reducing the associated costs. Saliva is a sensitive, minimally invasive and inexpensive diagnostic sample for SARS-CoV-2 detection that is appropriate for asymptomatic surveillance, symptomatic testing and at-home collection. Saliva testing can lessen two major challenges faced by lower- and middle-income countries: constrained resources and overburdened health workers. Saliva sampling enables convenient self-collection and requires fewer resources than swab-based methods. However, saliva testing for SARS-CoV-2 diagnostics has not been implemented on a large scale in low- and middle-income countries. While numerous studies based in these settings have demonstrated the usefulness of saliva sampling, there has been insufficient attention on optimizing its implementation in practice. We argue that implementation science research is needed to bridge this gap between evidence and practice. Low- and middle-income countries face many barriers as they continue their efforts to provide mass COVID-19 testing in the face of substantial inequities in global access to vaccines. Laboratories should look to replicate successful approaches for sensitive detection of SARS-CoV-2 in saliva, while governments should act to facilitate mass testing by lifting restrictions that limit implementation of saliva-based methods.