Fogarty Fellowship Research Focuses on Substance Use Intervention
“In the process of collecting data, we were actually able to change the lives of some youth. For me that was really profound. It wasn't just about collecting data, it was about making someone’s life better than it was,” said Florence Jaguga, MBChB, MMed, as she reflected on the impact of her research.
Dr. Jaguga received a prestigious Fogarty Global Health Fellowship through the Northern/Pacific Global Health (NPGH) Research Training Consortium. Her year-long research project trains peer counselors to deliver a brief substance use intervention for youth living with HIV and then assesses how feasible and acceptable the intervention is. The first part of the intervention asks the youth a broad set of questions about the pattern of substance use and then assigns a score based on the level of substance use. “Then the peers deliver a counselling session using motivational interviewing techniques to get the youth to weigh the pros and cons of using substances, see how interested they are in changing and how important it is for them to change,” said Dr. Jaguga. “They elicit change talk from the youth rather than giving really direct advice. In the end, they give them a menu of options of ways they can actually change their behavior and an educational booklet," she continued.
Florence Jaguga, MBChB, MMed
The intervention was adapted from a World Health Organization brief intervention and has been delivered by the trained peers to 100 youth. Qualitative and quantitative feedback from the youth, peers, and clinic staff is currently being analyzed, but the impact of the implementation science research is already being felt. “We see is that 38 percent of youth had moderate to high-risk cues, which I think is just really high, so that caught my eye,” said Dr. Jaguga.
“From the focus group discussion transcripts, you can see that there's a lot of positivity. The youth learned a lot from the sessions and have the perception that the intervention was useful. They were eager to have more youth learn about substance use,” Dr. Jaguga continued.
Two peers were selected through a systematic formal process including a quiz, an assessment of their counseling skills, and an assessment of accurate delivery of the different components of the intervention. The intervention sessions were recorded and the peers also received weekly supervision to ensure the intervention was given as intended. Focus group discussions also showed comfort and confidence in the peers.
The focus groups also provided some critical feedback that the intervention was brief, scripted and very structured. Some participants expressed a desire to have more communication and discussion.
As the Fogarty year research wraps up later this year, Dr. Jaguga reports that plans are already moving forward to potentially integrate the brief intervention into clinical practice at Moi Teaching and Referral Hospital. “We had in-depth interviews with the leadership and with the clinic staff and there's a lot of interest and support for it. We are going to work together to see that this doesn't die. We see a lot of promise for sustainability,” she said.
Dr. Jaguga said the Fogarty Fellowship has been invaluable, not only in analyzing this intervention, but in providing her experience and education as well. “It's really massive in terms of helping me progress my research career. Being a Fogarty Fellow gives you credibility. I've also learned a lot of implementation science skills through writing the proposal, trainings provided by NPGH and also implementing the project,” she continued. Project management skills such as obtaining IRB approval, hiring and managing personnel, budgeting, data collection and time management are other areas where Dr. Jaguga feels she has benefited from the Fogarty Fellowship experience. The Global Health Fellowship Program is a 12-month clinical research training sponsored by the National Institutes of Health’s Fogarty International Center (FIC) in partnership with several NIH Institutes and Offices. Fellows represent academic institutions from the U.S. as well as partners in low and middle-income countries. Applications are due each year in November for the next year’s cohort.
Each Fogarty Fellow is guided by a team of mentors. “My mentorship team was rich in the sense that I had people along on board with that diverse set of skills,” she added. Her team included Drs. Mary Ott (IU), Eve Puffer (Duke) Edith Opondi (Moi) and Edith Kwobah (Moi). “I've been able to tap into all of that experience and expertise. We've had the monthly meetings and I've learned a lot from the entire team.”
In addition to this Fogarty research project, Dr. Jaguga leads the alcohol and drug unit at MTRH and sees patients clinically with a variety of substance abuse and mental health issues. She said that adding the Fogarty research to her busy clinical and administrative schedule was challenging, but worth it. “It's a launching pad into future research work,” she said, noting that the application was not too detailed and something that early career researchers can attempt and even learn from the process. “Actually this Fogarty Fellowship has helped me think about a career in public health and moving from treating individual patients to ensuring access to treatment for populations as well,” she added.
Looking toward the future, Dr. Jaguga is stiving to connect and collaborate with people working in substance use fields in the U.S and other places to learn more about how others are managing substance use disorders in other parts of the world. She also plans to apply for additional funding from the NIH as her research career grows.
“I’m thankful for the opportunity to conduct this work and extremely grateful that someone else in another part of the world gives money for this kind of work to be done in less well-resourced parts of the world. I am very grateful for the opportunity to be a Fogarty Fellow,” she concluded.
