Presentation on theme: "Dr. Ario Alex Riolexus, STD/ACP – Ministry of Health, Uganda 24 th July 2014 TASO Satellite Meeting, 20 th International AIDS Conference, Melbourne – Australia."— Presentation transcript:
Dr. Ario Alex Riolexus, STD/ACP – Ministry of Health, Uganda 24 th July 2014 TASO Satellite Meeting, 20 th International AIDS Conference, Melbourne – Australia
After over a quarter century, HIV epidemic in Uganda is still severe and generalized. Current estimates of HIV prevalence is at 7.3% in adults but with marked geographical, socio-demographic and socio-economic heterogeneity. Burden: About 1.5 million adults and children in a population of 35 million. New infections:124,000 in 2009, 130,000 in 2010, 145,000 in 2011, 130,000 in 2013 60,000 annual mortality
Scale up of ART using a public health approach in 2004 Number in need of ART at 500 CD4 – 1,405,000 (1,207,000 adults and 193,000 children) Current No. on treatment – 600,000 Retention after 12 months of ART initiation – 86% Adherence to ART at 95% and above - 91%, LTFU – 18.5% 96.8% are on 1 st line ARV regimen; 3% are on 2 nd line; a small percentage is on 3 rd line
Appropriate policies Multi-sectoral response with broad based stakeholder involvement NSP Decentralisation policy MoH Sectoral Policies and Guidelines National Health policy HSSIP The Client Charter Public Private Partnership Policy ART, eMTCT, HCT, HBC Policies, Adherence Strategy etc National Prevention Policy
National Development Policy Financing ARV procurement Decentralisation of ART to lower level HF Political commitment eMTCT campaign – 1 st Lady is Champion The President and 1 st Lady openly undergoing HIV Testing HIV Trust Fund
An approach that promotes the development and sustainability of communities and community organizations and actors, and enables them to contribute to the long term sustainability of health and other interventions at community level.
Experience from community based organisations and lessons learnt The rapid scale up of ART using a public health approach posed health systems challenges The medical paradigm for control of the HIV epidemic was stretched to the limit in Uganda, where institutional and human resources were inadequate for the large numbers seeking care. This called for task sharing and skills transfer
NHP and HSSIP recognises the role community plays in health delivery but notes its current weaknesses Understanding the cause of weakness in a system is the first step towards recognising the solution HSR of the HIV national response revealed serious gaps in all health systems building blocks
Recognition of the role of community systems in the whole HIV treatment cascade Strengthening the community system and using PLHIV as part of the solution to the workforce needs to bridge the gap for a better national response Grant proposal funding requirements
Infectious Diseases Institute (IDI) The AIDS Support Organization (TASO) Joint Clinical Research Centre (JCRC) Mildmay Uganda Reach Out Mbuya Northern Uganda Health Integration to Enhance Services (NUHITES) and STARs EGPAF SUSTAIN Uganda Cares, Mama’s Club, M2M etc VHTs in Public and PNFP Facilities
A- Family-Centered Care: offering care and support to meet the needs of the entire family Using the Chronic Care Model Using Mother Baby Care Point Using the Male Involvement Strategy
The Chronic Care Model, depicted above emphasizes a patient-centred approach to handling chronic conditions, with the Community, Family, Health System and favourable policies all contributing to a patent’s wellbeing and health. The core triad of Patients and Families, Community Partners, and the Health Care Team is the cornerstone of chronic care.
The three-tiered Uganda Chronic Care Model encompasses Patients and Family, Community Partners and Health Care Teams and focuses on a patient-centred approach helps programs control costs by enabling appropriate use of self-care and low-cost services based in the family and community. The model also emphasizes a proactive approach to anticipated care needs.
The mother baby care point is an improved service delivery model to optimize retention and adherence, EID uptake, and appropriate transitions for mothers and exposed infants Keeps mother-infant pairs together at one "care point" through 18 months post-partum and beyond Minimizes the number of transfers for the pair
Negative infant discharged Positive infant and mother referred to treatment clinic Mother referred to treatment clinic Antenatal Care for Mother Mother - Baby Care point (post natal) MCH Service Point Routine ANC care HTC, risk reduction counseling, condoms, & couples HTC ART initiation & management for HIV+ pregnant women HIV Treatment Clinic ART for already enrolled HIV+ Postnatal mothers ART for newly diagnosed HIV+ postnatal mothers Family planning Routine PNC including Immunization, well child services, EID & care for HEI up to 18 months ART for all HIV+ infants through 18 months PregnancyPostpartum / Breastfeeding Period Ongoing care & support 18 months postpartum HIV Negative Infants at 18 months HIV Infected infants at 18 months Community Systems: FSG, Peer Mothers, Community Follow up
B- Comprehensive Care: providing holistic care for people living with HIV/AIDS, TB, sexually transmitted infections, and other opportunistic infections. National Adherence Strategy Treatment Supporters Expert Clients
C- Service Linkages: leveraging locally available existing resources, training health workers and improved reporting. Linkage Facilitators Peer Mothers/Fathers PLHIV Networks Village Health Teams (VHT) Family Support Groups (FSG) Home Visiting by Health workers Effective referral system mTRAC, DHIS2 MARPs strategy
D- Sustainable Approaches: strengthening existing CSOs and increasing their capacity to mobilize and manage resources. Civil Society Fund Enhanced planning capacity of CSOs Local generation of revenue by CSOs Increased support to CSOs by government Encouragement of formation of indigenous NGOs – TASO, Baylor Uganda, IDI, Mildmay, Mama’s Club etc
E- Fostering Partnerships: promoting partnerships at all levels—local, regional, national, and international. Representation of CSO and ADP in TWGs, PC, HPAC Partnership Committee East African Community Partnership Frameworks with International Agencies JRM, JAR, NHA GIPA MoU with Implementing Partners
1- Demand Creation and Advocacy: promoting uptake of services and improved lobbying for service provision and allocation of resources and accountability. Consumer advocates – CHAIN, PLHIV Networks CSOs – ICWEA, UGANET, NAFOPHANU, UDN etc Parliamentary Committee on HIV/AIDS Tailored campaigns – eMTCT, HTC, WAD etc
2- Improved Communication: promoting uptake of services, linkage and referral. Mobile phone text messaging as a reminder tool for promoting adherence to ART Availability of many telecommunication companies – MTN, Airtel, Orange, etc Booklets on HIV for political and cultural leaders Use of local FM radios
3- Capacity Building: improving the capacity of the community to respond and participate meaningfully in HIV care. Mentorship programs for service providers at all levels Leadership and technical training of CSOs and service providers Fellowship Program at MUSPH CSS Activity funding – GF, PEPFAR, Irish AID etc
4- Quality Improvement: improving the quality of HIV care using simple proven quality improvement models. National Quality Improvement Framework Formation of Quality Improvement Teams in all health facilities Inclusion of Expert Clients and CSO representatives at Health Facility Quality Improvement Teams