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TOPOWA Project: 2023 Highlights

 





This year was very exciting for our TOPOWA project. It will also likely be the busiest of this 5 year project. As we are completing our second year of this NIH-funded project, we thought we should summarize some highlights from 2023.



In the beginning of the year we moved into our new facility in Bugolobi, but we also expanded the Uganda project team, received IRB approvals for our pilot studies, finished 2 pilot studies, received IRB approvals for our cohort study, set up our neuroscience and biomarker laboratories, finalized the data collection process, trained the entire project team, recruited the participants for our cohort study, completed the baseline assessment with 300 women in the cohort study (T1) and completed about half of the first follow-up assessments (T2) in time for the holiday break. As I reflect on all of this, am really in awe of how we made so much progress.

 



And, while we did not publish any new manuscripts using our TOPOWA project data this year, we have several papers under review, and we also had a major team effort disseminating our research at local, national and international conferences (see the list at the end). We are particularly proud of the research dissemination at the Global Alcohol Policy Conference (Cape Town, SA, Oct 24-26), the International Conference on Urban Health (Atlanta, USA, Nov. 6-9) and the American Public Health Association (Atlanta, USA, Nov 12-15).  

 



We also held four outreach sessions at the INTEGHRAL hub about the TOPOWA study, about our translational neuroscience approach, assessing social determinants of health with the study abroad class, and also about using wearables for research in mental health.

 



Additionally, we met with the Youth Advisory Board and the Project Advisory Board. These boards provide us with valuable guidance regarding project implementation and planning. The young women on the Youth Advisory Board have been very engaged and provided important perspectives that have really shaped our protocol and data collection process. We met twice, as planned, this year.





We also had several community visits to meet with local leaders at our three study sites. For this type of community project it is very important that we engage with the communities so that we can stay current on changes and factor in the relevant context in our analysis plans and when interpreting the study findings.




The TOPOWA project also hosted our study abroad program in May with students from Kennesaw State University who took the course that I led with Drs. Seneca Vaught and Kandice Porter (both professors at Kennesaw State University) on “Examining the Social Determinants of Health from a Global Context: The Role of Power, Privilege, Policy and Place in Uganda”.  



We were really fortunate that Dr. Shannon McMorrow (Associate Professor at Western Michigan University) gave us an overview of her PhotoVoice project while serving as a Fulbright Scholar at Makerere University. She is also a collaborator on disseminating our TOPOWA Photovoice project. I also had the opportunity to visit her PhotoVoice exhibit at the American Spaces (hosted by the U.S. Embassy in Kampala) on June 20th.




This past June we also hosted Doctor David Basangwa at Kennesaw State University. He’s a TOPOWA Project Advisory Board Member and the former Executive Director of the Butabika National Referral Hospital in Kampala. Butabika is the only national referral hospital for mental health in the entire country. We took Dr. Basangwa to visit with the wonderful Center for Youth and Young Adult Addiction and Recovery at Kennesaw State University given his expertise in addiction. Dr. Basangwa was also very interested in understanding our translational neuroscience laboratory and research approach and visited with Dr. Ebony Glover and toured her laboratory set-up at Kennesaw State University. We have now set up a similar lab for our data collection at the INTEGHRAL Hub in Kampala. Because we envision this hub to facilitate research and educational projects we set up a separate website (www.integhralhub.com).



While in Kampala in June, we also had the opportunity to celebrate the commemoration of the World Drug Day (June 26) with the theme People First: Stop Stigma and Discrimination, Strengthen Prevention at the UYDEL treatment center in Masooli in partnership with the United Nations Office on Drugs and Crime (UNODC). UYDEL also celebrated their 30th year anniversary as a community organization serving thousands and thousands of young people. I had an opportunity to speak to local reporters about both key events.




 While July 4th is the Independence Day in the U.S., we used that special day for having an outreach event at the INTEGHRAL hub showcasing the approach we use for the translational neuroscience. We were joined by our colleagues and stakeholders. We were so glad that Dr. Hafisa from the Ministry of Health joined us (she is also on our advisory board).

 




Dr. Basangwa also toured our facilities during another visit and brought colleagues from the Uganda National Drug Authority to see how we were planning to collect the biomarkers (urine drug screening as well stress hormones in saliva).





We also had a chance to celebrate Dr. Rogers Kasirye, the Executive Director for the Uganda Youth Development Link (UYDEL), for successfully defending his doctoral dissertation. UYDEL is our long-term research implementation partner and collaborator for the past 10-15 years.  UYDEL is overseeing the recruitment of the TOPOWA participants as well as the implementation of the vocational training program which serves as our intervention. It was also very special that Dr. Paul Bukuluki, could join as he was the Dissertation committee chair.



 As mentioned, our cohort study officially started with hosting our first participants on August 14, 2023.  It took many steps to get to this significant milestone.  We completed and submitted several ethical review board (IRB) approvals to pilot the wearables and mHealth component of the study and then obtain approvals for the main cohort study.  We required approvals from Kennesaw State University, Makerere University and the Uganda National Council for Science and Technology.


We also traveled to Kampala with our neuroscience team in February to set up the translational neuroscience labs at the Hub and then again in June/July to test the labs and train the new study team in survey administration, data management, and biomarker collection and testing.  This was a massive undertaking, finalizing the data collection protocol and process. We were so grateful that both Dr. Tanja Jovanovic and Dr. Anais Stenson joined us to share their expertise in translational neuroscience and assist in setting up the laboratories. Our urine kits for the drug screening were significantly delayed by an international vendor and we had to develop a new plan to keep the study on track. We ended up using a vendor in the U.S. and sending the kits with Rogers Kasirye and Mutaawe Rogers as they were attending a conference in California the U.S. in July. We were so lucky that the timing worked.





In November we went back to Kampala to get the team ready for the follow-up cohort assessment. We had completed the baseline for the cohort study and participants had completed the intervention. So we modified the survey and checked on all data quality issues prior to launching the next data collection phase.




 

What is next? As we now have the formative qualitative data, pilot studies and the cohort baseline data all collected, the project team will prioritize manuscript preparation. We are eager to disseminate the findings on the social drivers of women’s mental health and strategies for mitigate the impact of stressors. We also welcome your ideas and input for how we may expand the study or tackle under researched issues among youth in Uganda. Our TOPOWA project research is integrated across so many disciplines (e.g., urban health, women’s health, vocational training outcomes, implementation research, data science).


Please see the list of presentations below. Follow our work on social media (twitter and LinkedIn) using the hashtag #TOPOWAProject. We also have a TOPOWA Project LinkedIn page. Our study abroad program uses the hashtag #KSUganda and we travel with the students during Maymester (month of May). If you have interest in collaborating in Uganda at the INTEGHRAL hub, send us a note. We are particularly looking to expand mHealth projects, training and outreach, translational neuroscience, as well as adding components to the TOPOWA cohort study. We will be collecting data through 2025.


We are so very grateful for this opportunity and NIH funding to conduct this innovative study that seeks to improve women's mental health in low-resource settings. Thanks to all who were part of our journey or contributed in some way to our success and completion of our milestones this year.

 





Research Presentations


PhotoVoice Project (conducted in 2022 to understand young women’s perceptions of place and mental health and to understand urban stressors).


  • Examining Stressors for Young Women in Urban Uganda through Photovoice: Reflections from the TOPOWA Study in Kampala. Lead Presenter:  Dr. Monica Swahn on behalf of Dr. Shannon McMorrow, The International Conference on Urban Health, Atlanta, GA, November 6-9, 2023.


Focus Groups (conducted in 2022 to understand young women’s perceptions of urban stressors, coping strategies for navigating stressors and perceptions of any benefit and outcomes related to completing vocational training).


  • Social drivers of infectious disease transmission and treatment among socioeconomically disadvantaged young women in Kampala, Uganda: Using qualitative data from a community-based cohort study to conceptualize system dynamics. Lead Presenter, Dr. Matt Lyons (co-authors Palitsky, R., Nabulya, A., Gittner, K., Mobley K., Hall, W., Swahn, M.) Association for Global South Studies, Atlanta, GA October 20, 2023.

  • Exploring the Impact of Urban Stressors on Mental Health in Uganda: Perspectives from Young Women in Kampala's Urban Slums.  Lead Presenter: Kate Mobley (TOPOWA doctoral student), The International Conference on Urban Health, Atlanta, GA, November 6-9.

  • Linking urban stressors to mental health in Uganda: Lived experiences of young women in Kampala’s urban slums. Presenter: Dr. Kevin Gittner (co-authors: Dr. Matthew Lyons, Dr. Monica Swahn, Dr. Jane Palmier, Jacqueline Nassaka, Anna Kavuma), American Public Health Association Meeting, Atlanta, GA November 12-15, 2023.

Neighborhood Mapping (completed in 2022 to identify and obtain GPS location data of key urban stressors as outlined by young women).   


  • Neighborhood Mapping of Alcohol Outlet in 3 Slums in Kampala, Uganda: Findings from the TOPOWA Study.  Lead Presenter: Dr. Monica Swahn (co-authors: Dr. Jane Palmier, Rogers Kasirye), The 48th Annual Alcohol Epidemiology Symposium of the Kettil Bruun Society, Johannesburg, South Africa, June 7, 2023.

  • Using a Container-Based Approach for Mapping Alcohol Outlets in Urban Slums: Results from the TOPOWA Study in Kampala, Uganda. Lead Presenter: Dr. Monica Swahn (co-authors: Dr. Jane Palmier, Rogers Kasirye), The Global Alcohol Policy Conference, Cape Town, South Africa, October 24-26, 2023.

  • Identifying and Mapping Urban Stressors: A Participatory Approach for Understanding Place and Mental Health in 3 Slums in Kampala, Uganda: Lead presenter: Dr. Monica Swahn (co-authors: Dr. Jane Palmier, Rogers Kasirye), The International Conference on Urban Health, Atlanta, GA, November 6-9.

  • Mapping urban stressors across 3 slums in Kampala: Exploring locations and characteristics of the alcohol landscape.  Lead Presenter: Dr. Monica Swahn (co-authors: Dr. Jane Palmier, Rogers Kasirye), American Public Health Association Meeting, Atlanta, GA November 12-15, 2023.

Wearable Pilot Studies (completed in 2023 to test the feasibility of the Garmin sensor protocol for assessing sleep and the overall data collection process which included deploying the sensors in the community with a daily diary, a follow-up survey and three focus groups).


  • Sleep Quality, Food Scarcity, and Mental Health among a Pilot Study of Young Women living in the Slums of Kampala, Uganda.  Lead presenter: Rachel Culbreth (co-authors, Karen Nielsen, Kate Mobley, Jane Palmier, Paul Bukuluki, Monica Swahn). The International Conference on Urban Health, Atlanta, GA, November 6-9.

  • A mixed methods approach for assessing sleep quality and mental health: A pilot study of young women living in the urban slums of Kampala, Uganda. Lead Presenter: Monica Swahn on behalf of Dr. Rachel Culbreth, co-authors:  Dr. Karen Nielsen, Kate Mobley, Jane Palmier). American Public Health Association Meeting, Atlanta, GA November 12-15, 2023. 

 

 

 Publications

Swahn, M. H., Nassaka, J., Nabulya, A., Palmier, J., & Vaught, S. (2022). A Qualitative Assessment of Place and Mental Health: Perspectives of Young Women Ages 18–24 Living in the Urban Slums of Kampala, Uganda. International journal of environmental research and public health19(19), 12935.https://www.mdpi.com/1660-4601/19/19/12935

 

 




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