Best practice and innovations by PHAs in accessing and supporting rural HIV/AIDS programmes in Uganda Dr Joanita Kigozi College of Health Sciences, Makerere University, Kampala, Uganda.

IDI Outreach Program I Strategic General nature: –Focuses on development of Infectious Diseases services through systematic and longer term linkages with partners. –Partners: national/government institutions, districts, reputable NGOs, FBOs, private sector and training institutions. –Use of the health systems approach.

IDI Outreach Program II Goal: To build capacity for the scale up of quality comprehensive HIV/AIDS services Over 40,000 Individuals in care at facilities supported by outreach programmes in Uganda Numerous challenges to E²S PHAs are critical in addressing these challenges

E²S Challenges -Programmatic Critical shortage of HRH Poor management of logistics & supplies Manual data management systems Inadequate infrastructure Increasing patient numbers/demand for services Low rates of retention in care

E²S Challenges –PHA Perspective Access; Distance, Terrain Long waiting times Quality of service delivery Opportunity cost of seeking care Limited availability of other HIV related services; OI drugs, Family planning etc

Determinants of Loss to follow up (LTFU) Long distance to facility Long waiting time at the facility Large household size ½ of respondents could not be reached by phone or physical tracing.

Determinants of LTFU “ My greatest challenge was distance. I used to travel from far and always arrive very late hence ending up being among the last people to be served. I found it hard to get a boda boda (cycle taxi) in the late hours of the day to return home. The situation became even worse when I was transferred to school further away making it difficult to keep on coming”

PHA response Bridging the HR gap; –Pre- packing drugs –Patient registration –Completion of manual registers –Phone calls and physical tracing for clients LTFU

PHA response II Health education; –Drug adherence –Positive living –Positive prevention –Appointment keeping

PHA response III Mobilisation; –HCT –Care Outreaches Sensitisation –HIV/AIDS services –Positive living –Positive prevention –Anti stigma campaigns through drama and testimonies

Tirwomwe Association “The AIDS scourge is not just for one person” 50 PHAs with a Chairman & working committee Origin; –Chairman facilitated to access ARVs for group from facility 35 KM away –Support positive living, ART adherence and retention in care and advocacy for services

Progress Tirwomwe association Advocacy for ART services Meals during ART outreach clinics –<0.5 USD/mth, food & firewood in kind –Members cook on clinic days.

Tirwomwe association today Nearby facility accredited to provide ART services Association supports over 200PHAs –Drama group; health education, community sensitization –Village visits, home visits. –Low rates of LTFU. –Good adherence to ART. –Reduction in stigma

Summary PLHIV critical to E²S of rural HIV/AIDS programmes Recognition and support for PHA innovations should be a major objective for national HIV/AIDS programmes It also recognizes the GIPA (Greater Involvement of People with HIV/AIDS) principle which is critical for sustainability and social responsibility of HIV/AIDS programmes The common phrase by PHAs- “There is nothing for us without us” – makes their involvement in E2S initiatives more necessary

Thank you