Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 The Infectious Diseases Institute Care and Research Initiatives Dr Alex G Coutinho Executive Director IDI-MUCHS

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 IDI’s Contribution to the National HIV/AIDS Care and Treatment Response The Care and Treatment Services at Mulago –9,000 active clients in care –6,500 active clients on antiretroviral therapy (ART) –600 active clients on second-line ART The KCC-IDI Project –HIV/AIDS care capacity established at 6 KCC Health centres –5,000 active clients in care –2,500 active clients on antiretroviral therapy

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 PCT Programme Innovations Internally-focused Innovations (task-shifting) –Nurse visit programme –Pharmacy- refill visit programme –Use of HIV+ friends to support clinic flow –Computerization of medical records (ICEA) Externally-focused Innovations –Development of care capacity in the Kampala city council facilities –Development of care and treatment capacity in 7 districts in North- West Uganda

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 Summary of the Task-shifting Approach: ART REFILLS -Protocol WHO stage 3 or 4 CD4 count less than 200cells/ul On ART Stable At least 4 nurse visits Criteria: Assessed by MO Adherence to ART 100% Disclosure Regular appointments for 6/12 Not pregnant No ART toxicity grade 3/4 Agrees to refill CD4 rising Cohort: undetectable viral load Counseling Reinforce adherence message for refill Prescription by the doctor for Two refills Mo 1 Refill 1 Mo 2 Refill 2 Mo 3 3 monthly routine nurse visits: History and assessment Prescription by Nurse/ Doctor I/c Nurse visit Lab-request for lab-file Mo 4 Refill 1 Mo 5 Refill 2 Blood taking 6 monthly doctors visit with CD4 results and assessment Good adherence & good response to therapy¹ 6 MONTH CYCLE

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 Evolution of the PCT Key Performance Indicators

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 Using ICTs to improve Programme Quality ICEA.net (Clinic Database) On-line prescriptions and lab requisitions fully functional Clinical dashboards for user friendly access to clinical information Automatic downloads of lab results The ICEA Client Interface for Clinicians

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 AIDC Numbers in the National Context

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 IDI Research Programme Summary Programme goal is to cultivate African-led research 97 publications in peer- reviewed journals by June 2010 Over 40 research projects currently active

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 Late Presentation increases mortality in HIV-infected subjects on ART

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 Cumulative probability of death over 36 months on ART according to CD4 cell count stratum with the highest mortality rates realized in those with CD4 T cell counts<25 cells/μL. Probability of death Early Mortality in ART Cohorts is Dependant on Baseline CD4 Count

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 Planned Research Studies to investigate how to reduce early mortality in HIV treatment 1.Prevention of Early Mortality Study in a district setting (Kiboga District Hospital) 2.The PROMPT Study on prevention of early mortality among TB co-infected HIV patients

Press Briefing: Office of the Vice Chancellor MUK 6 th September 2010 Acknowledgements Makerere University The Ministry of Health- Uganda College of Health Sciences –Prof Moses Kamya –Prof Harriet Mayanja –Prof Elly Katabira IDI Management / Staff CDC/PEPFAR IDI Clients