Laura Guay
Uganda
School of Medicine, MD program
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In 2005, approximately 1 million people were living with HIV in Uganda. A pregnant woman who is HIV-positive can transfer the virus to her baby in the womb, during childbirth, or through breastfeeding. Without any intervention, the risk of mother-to-child transmission of HIV is around 15-30% if the mother does not breastfeed the child, and 30-45% with prolonged breastfeeding. Current prevalence of HIV among pregnant women in Kampala, Uganda is around 10%. The Prevention of Mother-to-Child HIV Transmission (PMTCT) program at Mulago Hospital in Kampala has been effective in screening for HIV and providing HIV care for pregnant women. As the PMTCT program expands, new practices are implemented based on current research findings in hopes to further decrease the number of HIV-positive infants and incorporate comprehensive HIV care for women and families. Currently, there has been only limited evaluation of the PMTCT program at Mulago Hospital in terms of impact and effectiveness. Specifically, three new aspects of the program have yet to be evaluated—1) scaling up access to antiretroviral therapy (ART), 2) the introduction of multi-drug PMTCT treatment options, and 3) the distribution of prepackaged syringes with infant doses of nevirapine (NVP) to mothers during antenatal visits. We propose to analyze the existing PMTCT database to evaluate program performance: to identify areas of improvement that can help increase the number of eligible women to start on ART and increase uptake of new PMTCT interventions, and to determine the outcome of dispensing NVP syringes on the rate of return delivery.
My summer in Kampala was amazingly defined by the individuals I met each day—in the office, in the hospitals, in my neighborhood, and on the roads walking home after work. From my previous experience working in East Africa, I was nervous about how much work I could accomplish in eight short weeks. I was lucky to have been working with a spectacular group of Ugandans and mentors from Hopkins, who were not only enthusiastic about pushing forward with the project, but also eager to share with me the culture and natural wonders of Uganda.
During my time at Mulago Hospital, I had the chance to talk to and observed doctors, nurses, and patients in this national referral hospital. It was hard to believe the paucity of supplies, equipment, beds, and most obvious—the complete lack of space. As one of the countries with the world’s highest fertility rates, hundreds of pregnant women arrived at the hospital each morning. The unfortunate truth is that Mulago is not built, nor equipped, to serve all these patients. I witnessed rows of laboring women enduring contractions as they sprawled along the hallway floors of the labor and delivery wards, waiting for an open bed. I also met nurses and doctors who regularly work in these settings and have the motivation to continue each day to help the endless stream of women coming through the doors. Everyone hopes things will improve with time, and I hope to find some way to help that time come quicker.
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