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
Self-care practices and needs in patients with hypertension, diabetes, or both in rural Uganda: a mixed-methods study
AbstractTusubira, A. K., Nalwadda, C. K., Akiteng, A. R., Armstrong-Hough, M., Hsieh, E., Ngaruiya, C., Rabin, T. L., Hawley, N., Lipska, K. J., Kalyesubula, R., Ssinabulya, I., & Schwartz, J. I. (n.d.).Publication year
2020Journal title
The Lancet Global HealthVolume
8Page(s)
S19AbstractBackground The prevalence of non-communicable diseases (NCDs) is increasing in rural sub-Saharan Africa. Implementation and adaptation of recommended self-care practices is crucial for successful management of NCDs to prevent complications. However, little is known about self-care practices in patients living in rural sub-Saharan Africa. In this study, we aimed to understand patients' adherence to self-care practices for hypertension, diabetes, or both, in rural Uganda and their reasons for non-adherence. Methods We conducted a mixed-methods study in adult patients previously diagnosed with diabetes or hypertension, or both, who attended outpatient NCD clinics at three health facilities in Nakaseke district. We concurrently collected quantitative data from a random sample of patients using pretested, structured questionnaires and held focus group discussions and in-depth interviews with a purposive sample of patients. Descriptive statistics were calculated for the quantitative data. Qualitative analysis was conducted using a thematic approach. Findings Between April and August, 2019, we administered questionnaires and carried out six focus group discussions and 19 in-depth interviews with 385 participants. Mean age was 54·0 years (SD 14·57) and most respondents, 257 (66·8%), were female. Of the 385 participants, 39·2% (151) had diabetes; 36·9% (142) had hypertension, and 23·9% (92) had both conditions. Most respondents reported daily adherence to medication for hypertension (79·5% [186/234]) and diabetes (84·8% [206/243]). Few participants (15·6% [60/385]) reported daily vigorous physical activity, but 63·1% (243/385) reported moderate physical activity at least once per week. Most respondents reported adherence to recommendations for dietary changes (75·6% [291/385]), non-smoking (98·7% [380/385]), alcohol abstinence (90·1% [347/385]), and weight management (75·6% [291/385]). From the interviews and discussions, patients reported that they tried to adhere to recommended medications but were limited by the inability to obtain them. Most patients reported irregular self-monitoring and many reported confusion about recommended practices due to mixed messages, mainly from their peers. Respondents also reported use of herbal remedies, soaking swollen feet in salt water, and coping with stress through prolonged sleep, social isolation, and alcohol use. Interpretation Varied self-care practices exist among rural Ugandan NCD patients. Patients inconsistently engage in recommended practices because of uncertain access to medicines, structural barriers, and inconsistent messaging. Locally adapted educational self-care programmes and consistent access to medicines could help improve self-care in these patients. As low-income countries like Uganda continue to advance their NCD policies, specific attention should be focused on strategies to ensure equitable access to essential NCD medicines. Additionally, the unique circumstances of people living in rural settings should be taken into account when developing programmes for management of NCDs. Funding Yale Institute of Global Health Hecht Global Health Faculty Network AwardSustainability of the streamlined ART (START-ART) implementation intervention strategy among ART-eligible adult patients in HIV clinics in public health centers in Uganda : a mixed methods study
AbstractKaturamu, R., Kamya, M. R., Sanyu, N., Armstrong-Hough, M., & Semitala, F. C. (n.d.).Publication year
2020Journal title
Implementation science communicationsVolume
1Issue
1AbstractBackground: Despite increasing access to antiretroviral therapy (ART), the proportion of eligible patients initiated on treatment remains suboptimal. Only 64.6% of the people living with HIV (PLHIV) globally were initiated on ART by June 2019. The streamlined ART (START-ART) implementation study was based on the PRECEDE model, which suggests that “predisposing, enabling, and reinforcing” factors are needed to create behavior change. START-ART increased ART initiation within 2 weeks of eligibility by 42%. However, the gains from some implementation interventions erode over time. We evaluated facilitators and barriers to sustainability of this streamlined ART initiation in the year following the implementation period. Methods: We designed a mixed-methods explanatory sequential study to examine the sustainability of START-ART implementation. Quantitative component consisted of cross-sectional patient chart reviews of routinely collected data; qualitative component consisted of key informant interviews of health workers in START-ART facilities 2 years after conclusion of the implementation period. We analyzed data from 15 public health centers of Mbarara district, where the START-ART implementation was carried out. We included PLHIV aged > 18 years who initiated ART from June 2013 to July 2016. The START-ART implementation took place from June 2013 to June 2015 while the sustainability period was from August 2015 to July 2016. Results: A total of 863 ART-eligible patients were sampled. The median CD4 count was 348 cells/ml (IQR 215–450). During the intervention, 338 (77.4%) eligible patients initiated on ART within 2 weeks compared with 375 (88.2%) during the sustainability period (risk difference 10.8%; 95% CI 5.9–15.8%). In 14 of the 15 health centers, the intervention was sustained. During key informant interviews, rapid ART initiation sustainability was attributed to counseling skills that were obtained during intervention and availability of point-of-care (POC) CD4 PIMA machine. Failure to sustain the intervention was attributed to three specific barriers: lack of training after the intervention, transfer of trained staff to other health facilities, and shortage of supplies like cartridges for POC CD4 PIMA machine. Conclusion: Rapid ART initiation was sustained in most health centers. Skills acquired during the intervention and functional POC CD4 machine facilitated while staff transfers and irregular laboratory supplies were barriers to sustainability of rapid ART initiation.Sustainability of the streamlined ART (START-ART) implementation intervention strategy among ART-eligible adult patients in HIV clinics in public health centers in Uganda: a mixed methods study
AbstractArmstrong-Hough, M., Katuramu, R., Kamya, M. R., Sanyu, N., Armstrong-Hough, M., & Semitala, F. C. (n.d.).Publication year
2020Journal title
Implementation science communicationsVolume
1Page(s)
37AbstractDespite increasing access to antiretroviral therapy (ART), the proportion of eligible patients initiated on treatment remains suboptimal. Only 64.6% of the people living with HIV (PLHIV) globally were initiated on ART by June 2019. The streamlined ART (START-ART) implementation study was based on the PRECEDE model, which suggests that "predisposing, enabling, and reinforcing" factors are needed to create behavior change. START-ART increased ART initiation within 2 weeks of eligibility by 42%. However, the gains from some implementation interventions erode over time. We evaluated facilitators and barriers to sustainability of this streamlined ART initiation in the year following the implementation period.Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda : A descriptive time series analysis
AbstractArmstrong-Hough, M., Sharma, S., Kishore, S. P., Akiteng, A. R., & Schwartz, J. I. (n.d.).Publication year
2020Journal title
PloS oneVolume
15Issue
12AbstractBackground: Availability of essential medicines for non-communicable diseases (NCDs) is poor in lowand middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. Methods: We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. Results: Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. Conclusions: We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.Variation in the availability and cost of essential medicines for non-communicable diseases in Uganda: A descriptive time series analysis
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Sharma, S., Kishore, S. P., Akiteng, A. R., & Schwartz, J. I. (n.d.).Publication year
2020Journal title
PloS oneVolume
15Issue
12Page(s)
e0241555AbstractAvailability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time.Digital monitoring technologies could enhance tuberculosis medication adherence in Uganda : Mixed methods study
AbstractMusiimenta, A., Tumuhimbise, W., Mugaba, A. T., Muzoora, C., Armstrong-Hough, M., Bangsberg, D., Davis, J. L., & Haberer, J. E. (n.d.).Publication year
2019Journal title
Journal of Clinical Tuberculosis and Other Mycobacterial DiseasesVolume
17AbstractBackground: Effective administration of tuberculosis therapy remains challenging. The recommended strategy of direct observed therapy is challenging and its implementation has been limited in many settings. Digital adherence technologies could be promising patient-centered strategies for monitoring adherence. However, few quality studies have assessed patients' experiences with these technologies.Objective: To explore TB patients' perceptions of a digital adherence intervention composed of a digital adherence monitor and SMS texts.Methods: We purposively sampled TB patients who owned phones, had been taking TB medication for at least a month, and were receiving their treatment from Mbarara Regional Referral Hospital. We interviewed 35 TB patients to elicit information on perceptions of the proposed intervention which electronically monitors how they take their medication, and sends SMS reminders to patients to help them take their medications, as well as send SMS notifications to patients' social supporters to provide the patient with assistance if possible. We inductively analyzed data using content analysis to derive categories describing how participants perceived the intervention.Results: Participants anticipated that the intervention would enhance medication adherence by reminding them to take medication, and helping in the management of complicated regimen. Participants felt that monitoring adherence could enable them to demonstrate their commitment to adherence. Participants expressed concerns about not seeing the SMS on time and unintended TB status disclosure.Conclusion: Digital adherence technologies may provide acceptable alternative approaches to monitoring TB medication, especially in settings where DOT is difficult to implement.Digital monitoring technologies could enhance tuberculosis medication adherence in Uganda: Mixed methods study
AbstractArmstrong-Hough, M., Musiimenta, A., Tumuhimbise, W., Mugaba, A. T., Muzoora, C., Armstrong-Hough, M., Bangsberg, D., Davis, J. L., & Haberer, J. E. (n.d.).Publication year
2019Journal title
Journal of clinical tuberculosis and other mycobacterial diseasesVolume
17Page(s)
100119AbstractEffective administration of tuberculosis therapy remains challenging. The recommended strategy of direct observed therapy is challenging and its implementation has been limited in many settings. Digital adherence technologies could be promising patient-centered strategies for monitoring adherence. However, few quality studies have assessed patients' experiences with these technologies.Home-based tuberculosis contact investigation in uganda : A household randomised trial
AbstractDavis, J. L., Turimumahoro, P., Meyer, A. J., Ayakaka, I., Ochom, E., Ggita, J., Mark, D., Babirye, D., Okello, D. A., Mugabe, F., Fair, E., Vittinghoff, E., Armstrong-Hough, M., Dowdy, D., Cattamanchi, A., Haberer, J. E., & Katamba, A. (n.d.).Publication year
2019Journal title
ERJ Open ResearchVolume
5Issue
3AbstractIntroduction: The World Health Organization (WHO) recommends household tuberculosis (TB) contact investigation in low-income countries, but most contacts do not complete a full clinical and laboratory evaluation. Methods: We performed a randomised trial of home-based, SMS-facilitated, household TB contact investigation in Kampala, Uganda. Community health workers (CHWs) visited homes of index patients with pulmonary TB to screen household contacts for TB. Entire households were randomly allocated to clinic (standard-of-care) or home (intervention) evaluation. In the intervention arm, CHWs offered HIV testing to adults; collected sputum from symptomatic contacts and persons living with HIV (PLWHs) if ≥5 years; and transported sputum for microbiologic testing. CHWs referred PLWHs, children'Something so hard': a mixed-methods study of home sputum collection for tuberculosis contact investigation in Uganda
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Ggita, J., Turimumahoro, P., Meyer, A. J., Ochom, E., Dowdy, D., Cattamanchi, A., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung DiseaseVolume
22Issue
10Page(s)
1152-1159AbstractHome sputum collection could facilitate prompt evaluation and diagnosis of tuberculosis (TB) among contacts of patients with active TB. We analyzed barriers to home-based collection as part of an enhanced intervention for household TB contact investigation in Kampala, Uganda.ADHD in Japan: A sociological perspective
AbstractArmstrong-Hough, M. (n.d.). (M. R. Bergey, A. M. Filipe, P. Conrad, & I. Singh, Eds.).Publication year
2018Page(s)
261-269AbstractJapanese research on ADHD is prolific, and clinical management of this condition in Japan takes place in one of the most accessible and efficient health care delivery systems in the world. It is therefore particularly instructive to examine differences in the identification, management, and social context of ADHD in Japan; these differences can tell us much about the role of 'local' cultural, political, and institutional forces in professional and popular perceptions of a global illness. As this subchapter shows, differences in the sociocultural and institutional context of ADHD in Japan lead not only to different experiences of illness among individuals, but also to different choices about its management and treatment for parents and clinicians. Although rates of medication usage for ADHD are on the rise in Japan, they remain low by international standards. The classic formulation of Ritalin, emblematic of the rise of ADHD in the United States, is eschewed completely, and there is evidence that clinicians and regulators alike have a preference for nonstimulant drug therapy. Medicalized understandings of the origins of ADHD symptoms do not seem to have removed the stigma associated with the diagnosis. These differences in the medicalization of ADHD in Japan are particularly notable in the context of the country’s notoriously competitive, exam-based educational system and high levels of anxiety surrounding child and adolescent behavioral issues. This short subchapter responds to three related sociological questions about the rise of ADHD in Japan. First, and most broadly, how has the medicalization of ADHD progressed in Japan? Second, what is the nature of the stigma associated with ADHD in Japan, what are its origins, and how is it changing? And finally, how has the course of its medicalization and its changing association with deviance influenced the identification and treatment of ADHD in Japan? (PsycINFO Database Record (c) 2018 APA, all rights reserved)Biomedicalization and the practice of culture : globalization and type 2 diabetes in the United States and Japan
AbstractArmstrong-Hough, M. (n.d.).Publication year
2018Abstract~Brief Report: "Give Me Some Time": Facilitators of and Barriers to Uptake of Home-Based HIV Testing During Household Contact Investigation for Tuberculosis in Kampala, Uganda
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Ggita, J., Ayakaka, I., Dowdy, D., Cattamanchi, A., Haberer, J. E., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
Journal of acquired immune deficiency syndromes (1999)Volume
77Issue
4Page(s)
400-404AbstractIntegrating home-based HIV counseling and testing (HCT) with tuberculosis (TB) evaluation could improve the uptake of HIV testing among household contacts of patients with active TB. We sought to identify the facilitators of and barriers to HCT during household contact investigation for TB in Kampala, Uganda.Conformity and communal decision-making: First-tester effects on acceptance of home-based HIV counseling and testing in Uganda
AbstractArmstrong-Hough, M., Meyer, A., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
PeerJ PrePrintsAbstractBackground Individuals' observation of how group members ahead of them behave canDisparities in availability of essential medicines to treat non-communicable diseases in Uganda : A poisson analysis using the service availability and readiness assessment
AbstractArmstrong-Hough, M., Kishore, S. P., Byakika, S., Mutungi, G., Nunez-Smith, M., & Schwartz, J. I. (n.d.).Publication year
2018Journal title
PloS oneVolume
13Issue
2AbstractOBJECTIVE: Although the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD).METHODS: We fit a Poisson regression model using 2013 SARA data from 196 Ugandan health facilities. The outcome was total number of different EM-NCD available. Basic amenities, equipment, region, health facility type, managing authority, NCD diagnostic capacity, and range of HIV services were tested as predictor variables.FINDINGS: In multivariate models, we found significant associations between EM-NCD availability and region, managing authority, facility type, and range of HIV services. For-profit facilities' EM-NCD counts were 98% higher than public facilities (p < .001). General hospitals and referral health centers had 98% (p = .004) and 105% (p = .002) higher counts compared to primary health centers. Facilities in the North and East had significantly lower counts than those in the capital region (p = 0.015; p = 0.003). Offering HIV care was associated with 35% lower EM-NCD counts (p = 0.006). Offering HIV counseling and testing was associated with 57% higher counts (p = 0.048).CONCLUSION: We identified multiple within-country disparities in availability of EM-NCD in Uganda. Our findings can be used to identify gaps and guide distribution of limited resources. While the primary purpose of SARA is to assess and monitor health services readiness, we show that it can also be an important resource for answering complex research and policy questions requiring multivariate analysis.Disparities in availability of essential medicines to treat non-communicable diseases in Uganda: A Poisson analysis using the Service Availability and Readiness Assessment
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Kishore, S. P., Byakika, S., Mutungi, G., Nunez-Smith, M., & Schwartz, J. I. (n.d.).Publication year
2018Journal title
PloS oneVolume
13Issue
2Page(s)
e0192332AbstractAlthough the WHO-developed Service Availability and Readiness Assessment (SARA) tool is a comprehensive and widely applied survey of health facility preparedness, SARA data have not previously been used to model predictors of readiness. We sought to demonstrate that SARA data can be used to model availability of essential medicines for treating non-communicable diseases (EM-NCD).Feasibility, acceptability, and adoption of digital fingerprinting during contact investigation for tuberculosis in Kampala, Uganda : A parallel-convergent mixed-methods analysis
AbstractWhite, E. B., Meyer, A. J., Ggita, J. M., Babirye, D., Mark, D., Ayakaka, I., Haberer, J. E., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2018Journal title
Journal of medical Internet researchVolume
20Issue
11AbstractBACKGROUND: In resource-constrained settings, challenges with unique patient identification may limit continuity of care, monitoring and evaluation, and data integrity. Biometrics offers an appealing but understudied potential solution.OBJECTIVE: The objective of this mixed-methods study was to understand the feasibility, acceptability, and adoption of digital fingerprinting for patient identification in a study of household tuberculosis contact investigation in Kampala, Uganda.METHODS: Digital fingerprinting was performed using multispectral fingerprint scanners. We tested associations between demographic, clinical, and temporal characteristics and failure to capture a digital fingerprint. We used generalized estimating equations and a robust covariance estimator to account for clustering. In addition, we evaluated the clustering of outcomes by household and community health workers (CHWs) by calculating intraclass correlation coefficients (ICCs). To understand the determinants of intended and actual use of fingerprinting technology, we conducted 15 in-depth interviews with CHWs and applied a widely used conceptual framework, the Technology Acceptance Model 2 (TAM2).RESULTS: Digital fingerprints were captured for 75.5% (694/919) of participants, with extensive clustering by household (ICC=.99) arising from software (108/179, 60.3%) and hardware (65/179, 36.3%) failures. Clinical and demographic characteristics were not markedly associated with fingerprint capture. CHWs successfully fingerprinted all contacts in 70.1% (213/304) of households, with modest clustering of outcomes by CHWs (ICC=.18). The proportion of households in which all members were successfully fingerprinted declined over time (ρ=.30, PFeasibility, Acceptability, and Adoption of Digital Fingerprinting During Contact Investigation for Tuberculosis in Kampala, Uganda: A Parallel-Convergent Mixed-Methods Analysis
AbstractArmstrong-Hough, M., White, E. B., Meyer, A. J., Ggita, J. M., Babirye, D., Mark, D., Ayakaka, I., Haberer, J. E., Katamba, A., Armstrong-Hough, M., & Davis, J. L. (n.d.).Publication year
2018Journal title
Journal of medical Internet researchVolume
20Issue
11Page(s)
e11541AbstractIn resource-constrained settings, challenges with unique patient identification may limit continuity of care, monitoring and evaluation, and data integrity. Biometrics offers an appealing but understudied potential solution.Integrating home HIV counselling and testing into household TB contact investigation : a mixed-methods study
AbstractArmstrong-Hough, M., Ochom, E., Meyer, A. J., Armstrong-Hough, M., Kizito, S., Ayakaka, I., Turimumahoro, P., Ggita, J. M., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
Public Health ActionVolume
8Issue
2Page(s)
72-78AbstractSetting: Community health workers (CHWs) increasingly deliver community-based human immunodeficiency virus (HIV) counselling and testing (HCT) services. Less is known about how this strategy performs when integrated with household tuberculosis (TB) contact investigations. Objective: We conducted a prospective mixed-methods study to evaluate the feasibility and quality of CHW-facilitated, home-based HCT among household TB contacts. Design: CHWs visited households of consenting TB patients to screen household contacts for TB and HIV. They performed HIV testing using a serial enzyme-linked immunosorbent assay rapid-antibody testing algorithm. Laboratory technicians at health facilities re-tested the samples and coordinated quarterly HIV panel testing for CHWs. We conducted focus group discussions (FGDs) with CHWs on their experiences in carrying out home-based HCT. Results: Of 114 household contacts who consented to and underwent HIV testing by CHWs, 5 (4%) tested positive, 108 (95%) tested negative, and 1 (1%) had indeterminate results; 110 (96%) samples had adequate volume for re-testing. Overall agreement between CHWs and laboratory technicians was 99.1% (κ = 0.90, 95%CI 0.71-1.00, P < 0.0001). In FGDs, CHWs described context-specific social challenges to performing HCT in a household setting, but said that their confidence grew with experience. Conclusion: Home-based HCT by CHWs was feasible among household TB contacts and produced high-quality results. Strategies to address social challenges are required to optimize yield.Patterns of usage and preferences of users for tuberculosis-related text messages and voice calls in Uganda
AbstractArmstrong-Hough, M., Ggita, J. M., Ojok, C., Meyer, A. J., Farr, K., Shete, P. B., Ochom, E., Turimumahoro, P., Babirye, D., Mark, D., Dowdy, D., Ackerman, S., Armstrong-Hough, M., Nalugwa, T., Ayakaka, I., Moore, D., Haberer, J. E., Cattamanchi, A., Katamba, A., & Davis, J. L. (n.d.).Publication year
2018Journal title
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung DiseaseVolume
22Issue
5Page(s)
530-536AbstractLittle information exists about mobile phone usage or preferences for tuberculosis (TB) related health communications in Uganda.Social determinants of tuberculosis evaluation among household contacts: a secondary analysis
AbstractArmstrong-Hough, M., Shelby, T., Meyer, A. J., Ochom, E., Turimumahoro, P., Babirye, D., Katamba, A., Davis, J. L., & Armstrong-Hough, M. (n.d.).Publication year
2018Journal title
Public health actionVolume
8Issue
3Page(s)
118-123AbstractSeven public sector tuberculosis (TB) units and surrounding communities in Kampala, Uganda. To evaluate the influence of household-level socio-economic characteristics on completion of TB evaluation during household contact investigation. A cross-sectional study nested within the control arm of a randomized, controlled trial evaluating home-based sputum collection and short messaging service communications. We used generalized estimating equations to estimate the association between completion of TB evaluation and socio-economic determinants. Of 116 household contacts referred to clinics for TB evaluation, 32 (28%) completed evaluation. Completing evaluation was strongly clustered by household. Controlling for individual symptoms, contacts from households earning below-median income (adjusted risk ratio [aRR] 0.28, 95%CI 0.09-0.88, 0.029) and contacts from households in which the head of household had no more than primary-level education (aRR 0.40, 95%CI 0.18-0.89, 0.025) were significantly less likely to complete evaluation for TB. Socio-economic factors such as low income and education increase the risk that household contacts of TB patients will experience barriers to completing TB evaluation themselves. Further research is needed to identify specific mechanisms by which these underlying social determinants modify the capability and motivation of contacts to complete contact investigation.Text messages sent to household tuberculosis contacts in Kampala, Uganda : Process evaluation
AbstractMeyer, A. J., Babirye, D., Armstrong-Hough, M., Mark, D., Ayakaka, I., Katamba, A., Haberer, J. E., & Lucian Davis, J. (n.d.).Publication year
2018Journal title
JMIR mHealth and uHealthVolume
6Issue
11AbstractBackground: Previous studies have reported the inconsistent effectiveness of text messaging (short message service, SMS) for improving health outcomes, but few have examined to what degree the quality, or “fidelity,” of implementation may explain study results. Objective: The aim of this study was to determine the fidelity of a one-time text messaging (SMS) intervention to promote the uptake of tuberculosis evaluation services among household contacts of index patients with tuberculosis. Methods: From February to June 2017, we nested a process evaluation of text message (SMS) delivery within the intervention arm of a randomized controlled trial of tuberculosis contact investigation in Kampala, Uganda. Because mobile service providers in Uganda do not provide delivery confirmations, we asked household tuberculosis contacts to confirm the receipt of a one-time tuberculosis-related text message (SMS) by sending a text message (SMS) reply through a toll-free “short code.” Two weeks later, a research officer followed up by telephone to confirm the receipt of the one-time text message (SMS) and administer a survey. We considered participants lost to follow-up after 3 unsuccessful call attempts on 3 separate days over a 1-week period. Results: Of 206 consecutive household contacts, 119 had a text message (SMS) initiated from the server. While 33% (39/119) were children aged 5-14 years, including 20% (24/119) girls and 13% (15/119) boys, 18 % (21/119) were adolescents or young adults, including 12% (14/119) young women and 6% (7/119) young men. 50% (59/119) were adults, including 26% (31/119) women and 24% (28/119) men. Of 107 (90%) participants for whom we could ascertain text message (SMS) receipt status, 67% (72/107) confirmed text message (SMS) receipt, including 22% (24/107) by reply text message (SMS) and 45% (48/107) during the follow-up telephone survey. No significant clinical or demographic differences were observed between those who did and did not report receiving the text message (SMS). Furthermore, 52% (56/107) reported ever reading the SMS. The cumulative likelihood of a text message (SMS) reaching its target and being read and retained by a participant was 19%. Conclusions: The fidelity of a one-time text message (SMS) intervention to increase the uptake of household tuberculosis contact investigation and linkage to care was extremely low, a fact only discoverable through detailed process evaluation. This study suggests the need for systematic process monitoring and reporting of implementation fidelity in both research studies and programmatic interventions using mobile communications to improve health.Text Messages Sent to Household Tuberculosis Contacts in Kampala, Uganda: Process Evaluation
AbstractArmstrong-Hough, M., Meyer, A. J., Babirye, D., Armstrong-Hough, M., Mark, D., Ayakaka, I., Katamba, A., Haberer, J. E., & Davis, J. L. (n.d.).Publication year
2018Journal title
JMIR mHealth and uHealthVolume
6Issue
11Page(s)
e10239AbstractPrevious studies have reported the inconsistent effectiveness of text messaging (short message service, SMS) for improving health outcomes, but few have examined to what degree the quality, or "fidelity," of implementation may explain study results.Disparities in Availability of Essential Medicines to Treat Non-communicable Diseases in Uganda: A Cross-sectional Poisson Analysis Using the 2013 Service Availability and Readiness Assessment
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Kishore, S., & Schwartz, J. (n.d.).Publication year
2017Journal title
Annals of Global HealthVolume
83Issue
1Page(s)
138AbstractBackground: The most widely endorsed methodology used to collect data on health system readiness is the Service Availability and Readiness Assessment (SARA), a comprehensive survey of health facility preparedness, developed by the World Health Organization. SARA data have not previously been used to model and analyze the predictors of readiness indicators measured in the survey. We sought to demonstrate that SARA data can be used in this way by modeling the availability of essential medicines for treating non-communicable diseases (EM-NCD). Methods: We built a Poisson regression model using data collected at 196 Ugandan health facilities in the 2013 SARA survey. Our outcome of interest was the number of different EM-NCD available in each facility. Basic amenities, basic equipment, region, health facility type, managing authority, capacity for diagnosing NCDs, and range of HIV services were used as predictor variables. Findings: Adjusting for basic amenities, basic equipment, and capacity for diagnosing NCDs, our final model indicates significant associations between EM-NCD availability and geographic region, health facility type, managing authority, and range of HIV services. Adjusting for other variables such as facility type and amenities, private for-profit facilities' number of EM-NCD is 124% higher on average than public facilities (pDrop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda : A prospective, multi-center study
AbstractArmstrong-Hough, M., Turimumahoro, P., Meyer, A. J., Ochom, E., Babirye, D., Ayakaka, I., Mark, D., Ggita, J., Cattamanchi, A., Dowdy, D., Mugabe, F., Fair, E., Haberer, J. E., Katamba, A., & Davis, J. L. (n.d.).Publication year
2017Journal title
PloS oneVolume
12Issue
11AbstractSetting: Seven public tuberculosis (TB) units in Kampala, Uganda, where Uganda’s national TB program recently introduced household contact investigation, as recommended by 2012 guidelines from WHO. Objective: To apply a cascade analysis to implementation of household contact investigation in a programmatic setting. Design: Prospective, multi-center observational study. Methods: We constructed a cascade for household contact investigation to describe the proportions of: 1) index patient households recruited; 2) index patient households visited; 3) contacts screened for TB; and 4) contacts completing evaluation for, and diagnosed with, active TB. Results: 338 (33%) of 1022 consecutive index TB patients were eligible for contact investigation. Lay health workers scheduled home visits for 207 (61%) index patients and completed 104 (50%). Among 287 eligible contacts, they screened 256 (89%) for symptoms or risk factors for TB. 131 (51%) had an indication for further TB evaluation. These included 59 (45%) with symptoms alone, 58 (44%) childrenDrop-out from the tuberculosis contact investigation cascade in a routine public health setting in urban Uganda: A prospective, multi-center study
AbstractArmstrong-Hough, M., Armstrong-Hough, M., Turimumahoro, P., Meyer, A. J., Ochom, E., Babirye, D., Ayakaka, I., Mark, D., Ggita, J., Cattamanchi, A., Dowdy, D., Mugabe, F., Fair, E., Haberer, J. E., Katamba, A., & Davis, J. L. (n.d.).Publication year
2017Journal title
PloS oneVolume
12Issue
11Page(s)
e0187145AbstractSeven public tuberculosis (TB) units in Kampala, Uganda, where Uganda's national TB program recently introduced household contact investigation, as recommended by 2012 guidelines from WHO.