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
Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda
AbstractDavis, J. L., Ayakaka, I., Ggita, J. M., Ochom, E., Babirye, D., Turimumahoro, P., Gupta, A. J., Mugabe, F. R., Armstrong-Hough, M., Cattamanchi, A., & Katamba, A. (n.d.).Publication year
2022Journal title
Frontiers in Public HealthVolume
10AbstractSince 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation—home-based TB-HIV evaluation and follow-up text messaging—returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users.Theory-Informed Design of a Tailored Strategy for Implementing Household TB Contact Investigation in Uganda
AbstractArmstrong-Hough, M., Davis, J. L., Ayakaka, I., Ggita, J. M., Ochom, E., Babirye, D., Turimumahoro, P., Gupta, A. J., Mugabe, F. R., Armstrong-Hough, M., Cattamanchi, A., & Katamba, A. (n.d.).Publication year
2022Journal title
Frontiers in public healthVolume
10Page(s)
837211AbstractSince 2012, the World Health Organization has recommended household contact investigation as an evidence-based intervention to find and treat individuals with active tuberculosis (TB), the most common infectious cause of death worldwide after COVID-19. Unfortunately, uptake of this recommendation has been suboptimal in low- and middle-income countries, where the majority of affected individuals reside, and little is known about how to effectively deliver this service. Therefore, we undertook a systematic process to design a novel, theory-informed implementation strategy to promote uptake of contact investigation in Uganda, using the COM-B (Capability-Opportunity-Motivation-Behavior) model and the Behavior Change Wheel (BCW) framework. We systematically engaged national, clinic-, and community-based stakeholders and collectively re-examined the results of our own formative, parallel mixed-methods studies. We identified three core behaviors within contact investigation that we wished to change, and multiple antecedents (i.e., barriers and facilitators) of those behaviors. The BCW framework helped identify multiple intervention functions targeted to these antecedents, as well as several policies that could potentially enhance the effectiveness of those interventions. Finally, we identified multiple behavior change techniques and policies that we incorporated into a multi-component implementation strategy, which we compared to usual care in a household cluster-randomized trial. We introduced some components in both arms, including those designed to facilitate initial uptake of contact investigation, with improvement relative to historical controls. Other components that we introduced to facilitate completion of TB evaluation-home-based TB-HIV evaluation and follow-up text messaging-returned negative results due to implementation failures. In summary, the Behavior Change Wheel framework provided a feasible and transparent approach to designing a theory-informed implementation strategy. Future studies should explore the use of experimental methods such as micro-randomized trials to identify the most active components of implementation strategies, as well as more creative and entrepreneurial methods such as human-centered design to better adapt the forms and fit of implementation strategies to end users.An emerging syndemic of smoking and cardiopulmonary diseases in people living with HIV in Africa
AbstractPeprah, E., Armstrong-Hough, M., Cook, S. H., Mukasa, B., Taylor, J. Y., Xu, H., Chang, L., Gyamfi, J., Ryan, N., Ojo, T., Snyder, A., Iwelunmor, J., Ezechi, O., Iyegbe, C., O’reilly, P., & Kengne, A. P. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
6Page(s)
1-12AbstractBackground: African countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2–4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke. Conclusion: We call for a parallel program of implementation research to promote the adoption of evidence-based interventions, which could improve health outcomes for PWH with cardiopulmonary diseases and address the health inequities experienced by PWH in African countries.An Emerging Syndemic of Smoking and Cardiopulmonary Diseases in People Living with HIV in Africa
AbstractArmstrong-Hough, M., Peprah, E., Armstrong-Hough, M., Cook, S. H., Mukasa, B., Taylor, J. Y., Xu, H., Chang, L., Gyamfi, J., Ryan, N., Ojo, T., Snyder, A., Iwelunmor, J., Ezechi, O., Iyegbe, C., O’Reilly, P., & Pascal Kengne, A. (n.d.).Publication year
2021Journal title
International journal of environmental research and public healthVolume
18Issue
6AbstractAfrican countries have the highest number of people living with HIV (PWH). The continent is home to 12% of the global population, but accounts for 71% of PWH globally. Antiretroviral therapy has played an important role in the reduction of the morbidity and mortality rates for HIV, which necessitates increased surveillance of the threats from pernicious risks to which PWH who live longer remain exposed. This includes cardiopulmonary comorbidities, which pose significant public health and economic challenges. A significant contributor to the cardiopulmonary comorbidities is tobacco smoking. Indeed, globally, PWH have a 2-4-fold higher utilization of tobacco compared to the general population, leading to endothelial dysfunction and atherogenesis that result in cardiopulmonary diseases, such as chronic obstructive pulmonary disease and coronary artery disease. In the context of PWH, we discuss (1) the current trends in cigarette smoking and (2) the lack of geographically relevant data on the cardiopulmonary conditions associated with smoking; we then review (3) the current evidence on chronic inflammation induced by smoking and the potential pathways for cardiopulmonary disease and (4) the multifactorial nature of the syndemic of smoking, HIV, and cardiopulmonary diseases. This commentary calls for a major, multi-setting cohort study using a syndemics framework to assess cardiopulmonary disease outcomes among PWH who smoke.Associations Among Patient Race, Sedation Practices, and Mortality in a Large Multi-Center Registry of COVID-19 Patients
AbstractArmstrong-Hough, M., Valley, T. S., Iwashyna, T. J., Cook, S., Hough, C. L., & Armstrong-Hough, M. (n.d.).Publication year
2021Journal title
American Journal of Respiratory and Critical Care MedicineVolume
203Issue
9Abstract~Availability, functionality and access of blood pressure machines at the points of care in public primary care facilities in Tororo district, Uganda
AbstractArmstrong-Hough, M., Besigye, I. K., Okuuny, V., Armstrong-Hough, M., Katahoire, A. R., Sewankambo, N. K., Mash, R., & Katamba, A. (n.d.).Publication year
2021Journal title
South African family practice : official journal of the South African Academy of Family Practice/Primary CareVolume
63Issue
1Page(s)
e1-e6AbstractEarly diagnosis of hypertension prevents a significant number of complications and premature deaths. In resource-variable settings, diagnosis may be limited by inadequate access to blood pressure (BP) machines. We sought to understand the availability, functionality and access of BP machines at the points of care within primary care facilities in Tororo district, Uganda.Efficacy of a Peer-Led Intervention to Deliver Tuberculosis Education and Counseling in Kampala, Uganda: A Prospective Cohort Study
AbstractArmstrong-Hough, M., Baker, A., Meyer, A., Nanziri, L., Ggita, J., Ayakaka, I., Armstrong-Hough, M., Katamba, A., & Davis, J. (n.d.).Publication year
2021Journal title
American Journal of Respiratory and Critical Care MedicineVolume
203Issue
9Abstract~Gaps in TB preventive therapy for persons initiating antiretroviral therapy in Uganda: an explanatory sequential cascade analysis
AbstractArmstrong-Hough, M., Kalema, N., Semeere, A., Banturaki, G., Kyamugabwa, A., Ssozi, S., Ggita, J., Kabajaasi, O., Kambugu, A., Kigozi, J., Muganzi, A., Castelnuovo, B., Cattamanchi, A., & Armstrong-Hough, M. (n.d.).Publication year
2021Journal title
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung DiseaseVolume
25Issue
5Page(s)
388-394AbstractThe WHO recommends TB symptom screening and TB preventive therapy (TPT) for latent TB infection (LTBI) in persons living with HIV (PLWH). However, TPT uptake remains limited. We aimed to characterize and contextualize gaps in the TPT care cascade among persons enrolling for antiretroviral therapy (ART). Four PEPFAR-supported facilities in Uganda. We studied a proportionate stratified random sample of persons registering for ART when TPT was available. Patient-level data on eligibility, initiation, and completion were obtained from registers to determine proportion of eligible patients completing each cascade step. We interviewed providers and administrators and used content analysis to identify barriers to guideline-concordant TPT practices. Of 399 study persons, 309 (77%) were women. Median age was 29 (IQR 25-34), CD4 count 405 cells/µL (IQR 222-573), and body mass 23 kg/m² (IQR 21-25). Of 390 (98%) screened, 372 (93%) were TPT-eligible. Only 62 (17%) eligible PLWH initiated and 36 (58%) of 62 completed TPT. Providers reported hesitating to prescribe TPT because they lacked confidence excluding TB by symptom screening alone and feared promoting drug resistance. Although isoniazid was available, past experience of irregular supply discouraged TPT initiation. Providers pointed to insufficient TB-dedicated staff, speculated that patients discounted TB risk, and worried TPT pill burden and side effects depressed ART adherence. While screening was nearly universal, most eligible PLWH did not initiate TPT. Only about half of those who initiated completed treatment. Providers feared promoting drug resistance, harbored uncertainty about continued availability, and worried TPT could antagonize ART adherence. Our findings suggest urgent need for stakeholder engagement in TPT provision.Identifying the Functional Components of a Community of Practice to Improve Tuberculosis Contact Investigation in Uganda
AbstractArmstrong-Hough, M., Hennein, R., Ggita, J., Turimumahoro, P., Ochom, E., Meyer, A., Armstrong-Hough, M., Katamba, A., & Davis, J. (n.d.).Publication year
2021Journal title
American Journal of Respiratory and Critical Care MedicineVolume
203Issue
9Abstract~Organizational Readiness to Deliver Household TB Contact Investigation in Uganda: A Survey of Health Facilities
AbstractArmstrong-Hough, M., Johnson, A., Turimumahoro, P., Ochom, E., Meyer, A., Ggita, J., Armstrong-Hough, M., Katamba, A., & Davis, J. (n.d.).Publication year
2021Journal title
American Journal of Respiratory and Critical Care MedicineVolume
203Issue
9Abstract~Patient experiences of switching from Efavirenz- to Dolutegravir-based antiretroviral therapy : a qualitative study in Uganda
AbstractTwimukye, A., Laker, M., Odongpiny, E. A., Ajok, F., Onen, H., Kalule, I., Kajubi, P., Seden, K., Owarwo, N., Kiragga, A., Armstrong-Hough, M., Katahoire, A., Mujugira, A., Lamorde, M., & Castelnuovo, B. (n.d.).Publication year
2021Journal title
BMC Infectious DiseasesVolume
21Issue
1AbstractBackground: In 2019, the World Health Organisation (WHO) recommended Dolutegravir (DTG) as the preferred first-line antiretroviral treatment (ART) for all persons with HIV. ART regimen switches may affect HIV treatment adherence. We sought to describe patient experiences switching from EFV to DTG-based ART in Kampala, Uganda. Methods: Between July and September 2019, we purposively sampled adults living with HIV who had switched to DTG at the Infectious Diseases Institute HIV clinic. We conducted in-depth interviews with adults who switched to DTG, to explore their preparation to switch and experiences on DTG. Interviews were audio-recorded, transcribed and analysed thematically using Atlas ti version 8 software. Results: We interviewed 25 adults: 18 (72%) were women, and the median age was 35 years (interquartile range [IQR] 30–40). Median length on ART before switching to DTG was 67 months (IQR 51–125). Duration on DTG after switching was 16 months (IQR 10–18). Participants reported accepting provider recommendations to switch to DTG mainly because they anticipated that swallowing a smaller pill once a day would be more convenient. While most participants initially felt uncertain about drug switching, their providers offer of frequent appointments and a toll-free number to call in the event of side effects allayed their anxiety. At the same time, participants said they felt rushed to switch to the new ART regimen considering that they had been on their previous regimen(s) for several years and the switch to DTG happened during a routine visit when they had expected their regular prescription. Some participants felt unprepared for new adverse events associated with DTG and for the abrupt change in treatment schedule. Most participants said they needed additional support from their health providers before and after switching to DTG. Conclusion and recommendations: Adults living with HIV stable on an EFV-based regimen but were switched to DTG in a program-wide policy change found the duration between counselling and drug switching inadequate. DTG was nonetheless largely preferred because of the small pill size, once daily dosing, and absence of EFV-like side effects. Community-engaged research is needed to devise acceptable ways to prepare participants for switching ART at scale.Patient experiences of switching from Efavirenz- to Dolutegravir-based antiretroviral therapy: a qualitative study in Uganda
AbstractArmstrong-Hough, M., Twimukye, A., Laker, M., Odongpiny, E. A. L., Ajok, F., Onen, H., Kalule, I., Kajubi, P., Seden, K., Owarwo, N., Kiragga, A., Armstrong-Hough, M., Katahoire, A., Mujugira, A., Lamorde, M., & Castelnuovo, B. (n.d.).Publication year
2021Journal title
BMC infectious diseasesVolume
21Issue
1Page(s)
1154AbstractIn 2019, the World Health Organisation (WHO) recommended Dolutegravir (DTG) as the preferred first-line antiretroviral treatment (ART) for all persons with HIV. ART regimen switches may affect HIV treatment adherence. We sought to describe patient experiences switching from EFV to DTG-based ART in Kampala, Uganda.Risk, Race, and Structural Racism
AbstractArmstrong-Hough, M., Valley, T. S., Armstrong-Hough, M., & Adegunsoye, A. (n.d.).Publication year
2021Journal title
Annals of the American Thoracic SocietyVolume
18Issue
8Page(s)
1289-1290Abstract~Saliva as a gold-standard sample for SARS-CoV-2 detection
AbstractArmstrong-Hough, M., Tan, S. H., Allicock, O., Armstrong-Hough, M., & Wyllie, A. L. (n.d.).Publication year
2021Journal title
The Lancet. Respiratory medicineVolume
9Issue
6Page(s)
562-564Abstract~Social support for self-care : Patient strategies for managing diabetes and hypertension in rural uganda
AbstractTusubira, A. K., Nalwadda, C. K., Akiteng, A. R., Hsieh, E., Ngaruiya, C., Rabin, T. L., Katahoire, A., Hawley, N. L., Kalyesubula, R., Ssinabulya, I., Schwartz, J. I., & Armstrong-Hough, M. (n.d.).Publication year
2021Journal title
Annals of Global HealthVolume
87Issue
1Page(s)
1-13AbstractBackground: Low-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings. Objective: We sought to understand self-care efforts and their facilitators among patients with diabetes and hypertension in rural Uganda. Methods: Between April and June 2019, we conducted a cross-sectional qualitative study among adult patients from outpatient NCD clinics at three health facilities in Uganda. We conducted in-depth interviews exploring self-care practices for hypertension and/or diabetes and used content analysis to identify emergent themes. Results: Nineteen patients participated. Patients said they preferred conventional medicines as their first resort, but often used traditional medicines to mitigate the impact of inconsistent access to prescribed medicines or as a supplement to those medicines. Patients adopted a wide range of vernacular practices to supplement treatment or replace unavailable diagnostic tests, such as tasting urine to gauge blood-sugar level. Finally, patients sought and received both instrumental and emotional support for self-care activities from networks of family and peers. Patients saw their children as their most reliable source of support facilitating self-care, especially as a source of money for medicines, transport and home necessities. Conclusion: Patients valued conventional medicines but engaged in varied self-care practices. They depended upon networks of social support from family and peers to facilitate self-care. Interventions to improve self-care may be more effective if they improve access to prescribed medicines and engage or enhance patients’ social support networks.Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda
AbstractArmstrong-Hough, M., Tusubira, A. K., Nalwadda, C. K., Akiteng, A. R., Hsieh, E., Ngaruiya, C., Rabin, T. L., Katahoire, A., Hawley, N. L., Kalyesubula, R., Ssinabulya, I., Schwartz, J. I., & Armstrong-Hough, M. (n.d.).Publication year
2021Journal title
Annals of global healthVolume
87Issue
1Page(s)
86AbstractLow-income countries suffer a growing burden of non-communicable diseases (NCDs). Self-care practices are crucial for successfully managing NCDs to prevent complications. However, little is known about how patients practice self-care in resource-limited settings.Development of a discrete choice experiment to understand patient preferences for diabetes and hypertension management in rural Uganda
AbstractMoor, S. E., Tusubira, A. K., Akiteng, A. R., Hsieh, E., Ngaruiya, C., Rabin, T. L., Hawley, N. L., Lipska, K. J., Armstrong-Hough, M., Nalwadda, C. K., Nugent, R., Kalyesubula, R., Ssinabulya, I., & Schwartz, J. I. (n.d.).Publication year
2020Journal title
The Lancet Global HealthVolume
8Page(s)
S22AbstractBackground: In 2020, non-communicable diseases (NCDs) currently account for 40% of deaths in east Africa and are expected to surpass communicable diseases as the leading causes of death in sub-Saharan Africa by 2030. However, there remain many gaps in the provision of high quality, patient-centred NCD service delivery in low-income countries such as Uganda, especially in rural settings. We developed a discrete choice experiment (DCE) to understand how patients with common NCDs, such as hypertension and diabetes, make health-care-seeking decisions. A DCE is a quantitative tool that measures the weight of different factors that affect a decision. Participants are presented with two hypothetical scenarios to choose between. Here we report on the formative, qualitative phase of DCE development. Methods: For this DCE, choice sets consist of two health facilities described in terms of various attributes (factors) that affect decision-making. To develop a locally relevant DCE, we conducted formative qualitative research consisting of 18 in-depth interviews with patients seeking care for hypertension or diabetes, or both, at three health facilities in rural Nakaseke District, Uganda. We purposively selected participants so that each disease and facility were represented. Interviews explored how participants choose which facility to visit and challenges that she or he faces in accessing care or medicines, or both. A team of three researchers coded the interviews using a directed approach to reveal 11 potential attributes on which patients make decisions. After review of the data and analysis with local and international content experts, we narrowed this list to six attributes to be included in the DCE. Findings: The six selected attributes included: provision of education; availability of medicines; transport to the facility; costs associated with treatment; interactions with health-care providers; and presence of peer support groups. Attribute levels encompassed the range of experiences for each attribute as emerged from qualitative analysis. We then developed a full profile, fractional factorial DCE with three surveys. Interpretation: The process of developing this NCD-focused DCE relied on reference to the literature, primary qualitative data collection, and expert consensus to create a tool that would yield actionable data to improve NCD health service delivery in rural Uganda. Little is known about how rural patients in low-income and middle-income countries navigate the health-care system, nor is there much description of how to develop DCEs to investigate patient preferences in these countries. This work will guide public health officials in developing NCD service delivery options and inform investigators on DCE development. Funding: Yale Institute of Global Health Hecht Global Health Faculty Network Award Downs International Health Student Travel FellowshipExperiences and intentions of Ugandan household tuberculosis contacts receiving test results via text message : An exploratory study
AbstractGgita, J. M., Katahoire, A., Meyer, A. J., Nansubuga, E., Nalugwa, T., Turimumahoro, P., Ochom, E., Ayakaka, I., Haberer, J. E., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2020Journal title
BMC public healthVolume
20Issue
1AbstractBackground: The World Health Organization (WHO) recommends household contact investigation for tuberculosis (TB) in high-burden countries. However, household contacts who complete evaluation for TB during contact investigation may have difficulty accessing their test results. Use of automated short-messaging services (SMS) to deliver test results could improve TB status awareness and linkage to care. We sought to explore how household contacts experience test results delivered via SMS, and how these experiences influence follow-up intentions. Methods: We conducted semi-structured interviews with household contacts who participated in a randomized controlled trial evaluating home sputum collection and delivery of TB results via SMS (Pan-African Clinical Trials Registry #201509000877140). We asked about feelings, beliefs, decisions, and behaviors in response to the SMS results. We analyzed the content and emerging themes in relation to the Theory of Planned Behavior. Results: We interviewed and achieved thematic saturation with ten household contacts. Nine received TB-negative results and one a TB-positive result. Household contacts reported relief upon receiving SMS confirming their TB status, but also said they lacked confidence in the results delivered by SMS. Some worried that negative results were incorrect until they spoke to a lay health worker (LHW). Household contacts said their long-term intentions to request help or seek care were influenced by perceived consequences of not observing the LHW's instructions related to the SMS and follow-up procedures; beliefs about the curability of TB; anticipated support from LHWs; and perceived barriers to responding to an SMS request for further evaluation. Conclusion: Household contacts experienced relief when they received results. However, they were less confident about results delivered via SMS than results delivered by LHWs. Delivery of results by SMS should complement continued interaction with LHWs, not replace them.Experiences and intentions of Ugandan household tuberculosis contacts receiving test results via text message: an exploratory study
AbstractArmstrong-Hough, M., Ggita, J. M., Katahoire, A., Meyer, A. J., Nansubuga, E., Nalugwa, T., Turimumahoro, P., Ochom, E., Ayakaka, I., Haberer, J. E., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2020Journal title
BMC public healthVolume
20Issue
1Page(s)
310AbstractThe World Health Organization (WHO) recommends household contact investigation for tuberculosis (TB) in high-burden countries. However, household contacts who complete evaluation for TB during contact investigation may have difficulty accessing their test results. Use of automated short-messaging services (SMS) to deliver test results could improve TB status awareness and linkage to care. We sought to explore how household contacts experience test results delivered via SMS, and how these experiences influence follow-up intentions.Implementing mhealth interventions in a resource-constrained setting : Case study from Uganda
AbstractMeyer, A. J., Armstrong-Hough, M., Babirye, D., Mark, D., Turimumahoro, P., Ayakaka, I., Haberer, J. E., Katamba, A., & Davis, J. L. (n.d.).Publication year
2020Journal title
JMIR mHealth and uHealthVolume
8Issue
7AbstractBackground: Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. Objective: We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. Methods: We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). Results: We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. Conclusions: mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures.Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda
AbstractArmstrong-Hough, M., Meyer, A. J., Armstrong-Hough, M., Babirye, D., Mark, D., Turimumahoro, P., Ayakaka, I., Haberer, J. E., Katamba, A., & Davis, J. L. (n.d.).Publication year
2020Journal title
JMIR mHealth and uHealthVolume
8Issue
7Page(s)
e19552AbstractMobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions.Mobile Health Technologies May Be Acceptable Tools for Providing Social Support to Tuberculosis Patients in Rural Uganda : A Parallel Mixed-Method Study
AbstractMusiimenta, A., Tumuhimbise, W., Atukunda, E. C., Mugaba, A. T., Muzoora, C., Armstrong-Hough, M., Bangsberg, D., Davis, J. L., & Haberer, J. E. (n.d.).Publication year
2020Journal title
Tuberculosis research and treatmentVolume
2020Page(s)
7401045AbstractBackground: Social support has been shown to mitigate social barriers to medication adherence and improve tuberculosis (TB) treatment success rates. The use of mobile technology to activate social support systems among TB patients, however, has not been well explored. Moreover, studies that tie supportive SMS (Short Message Service) texts to electronic monitoring of TB medication adherence are lacking.Objective: To explore TB patients' current access to social support and perceptions of utilizing real-time adherence monitoring interventions to support medication adherence.Methods: We purposively selected TB patients who owned phones, had been taking TB medications for ≥1 month, were receiving their treatment from Mbarara Regional Referral Hospital, and reported having ≥1 social supporter. We interviewed these patients and their social supporters about their access to and perceptions of social support. We used STATA 13 to describe participants' sociodemographic and social support characteristics. Qualitative data were analyzed using content analysis to derive categories describing accessibility and perceptions.Results: TB patients report requesting and receiving a variety of different forms of social support, including instrumental (e.g., money for transport and other needs and medication reminders), emotional (e.g., adherence counselling), and informational (e.g., medication side effects) support through mobile phones. Participants felt that SMS notifications may motivate medication adherence by creating a personal sense of obligation to take medications regularly. Participants anticipated that limited financial resources and relationship dynamics could constrain the provision of social support especially when patients and social supporters are not oriented about their expectations.Conclusion: Mobile telephones could provide alternative approaches to providing social support for TB medication adherence especially where patients do not stay close to their social supporters. Further efforts should focus on optimized designs of mobile phone-based applications for providing social support to TB patients and training of TB patients and social supporters to match their expectations.Predictors of evaluation in child contacts of TB patients
AbstractArmstrong-Hough, M., Lee, G., Meyer, A. J., Kizito, S., Katamba, A., Davis, J. L., & Armstrong-Hough, M. (n.d.).Publication year
2020Journal title
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung DiseaseVolume
24Issue
8Page(s)
847-849Abstract~Prevalence, associated factors and perspectives of HIV testing among men in Uganda
AbstractNangendo, J., Katahoire, A. R., Armstrong-Hough, M., Kabami, J., Obeng-Amoako, G. O., Muwema, M., Semitala, F. C., Karamagi, C. A., Wanyenze, R. K., Kamya, M. R., & Kalyango, J. N. (n.d.).Publication year
2020Journal title
PloS oneVolume
15Issue
8AbstractBackground: Despite overall increase in HIV testing, more men than women remain untested. In 2018, 92% of Ugandan women but only 67% of men had tested for HIV. Understanding men's needs and concerns for testing could guide delivery of HIV testing services (HTS) to them. We assessed the prevalence of testing, associated factors and men's perspectives on HIV testing in urban and peri-urban communities in Central Uganda. Methods and findings: We conducted a parallel-convergent mixed-methods study among men in Kampala and Mpigi districts from August to September 2018. Using two-stage sampling, we selected 1340 men from Mpigi. We administered a structured questionnaire to collect data on HIV testing history, socio-demographics, self-reported HIV risk-related behaviors, barriers and facilitators to HIV testing. We also conducted 10 focus-groups with men from both districts to learn their perspectives on HIV testing. We used modified Poisson regression to assess factors associated with HIV testing and inductive thematic analysis to identify barriers and facilitators. Though 84.0% of men reported having tested for HIV, only 65.7% had tested in the past 12-months despite nearly all (96.7%) engaging in at least one HIV risk-related behavior. Men were more likely to have tested if aged 25-49 years, Catholic, with secondary or higher education and circumcised. Being married was associated with ever-testing while being widowed or divorced was associated with testing in past 12-months. Men who engaged in HIV risk-related behavior were less likely to have tested in the past 12-months. Qualitative findings showed that men varied in their perspectives about the need for testing, access to HTS and were uncertain of HIV testing and its outcomes. Conclusions: Recent HIV testing among men remains low. Modifying testing strategies to attract men in all age groups could improve testing uptake, reduce gender disparity and initiate risk reduction interventions.Prevalence, associated factors and perspectives of HIV testing among men in Uganda
AbstractArmstrong-Hough, M., Nangendo, J., Katahoire, A. R., Armstrong-Hough, M., Kabami, J., Obeng-Amoako, G. O., Muwema, M., Semitala, F. C., Karamagi, C. A., Wanyenze, R. K., Kamya, M. R., & Kalyango, J. N. (n.d.).Publication year
2020Journal title
PloS oneVolume
15Issue
8Page(s)
e0237402AbstractDespite overall increase in HIV testing, more men than women remain untested. In 2018, 92% of Ugandan women but only 67% of men had tested for HIV. Understanding men's needs and concerns for testing could guide delivery of HIV testing services (HTS) to them. We assessed the prevalence of testing, associated factors and men's perspectives on HIV testing in urban and peri-urban communities in Central Uganda.