Prevention of Mother-to-ChildTransmission of HIV: Scale-up ofCritical Services in Uganda (District-based Approach)
Edward Bitarakwate, MD, MPH
Technical Director
EGPAF Uganda
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National Context
•About 2 million people infected; 1 million have died& 1 million are living with the infection.
•Six percent of Ugandan adults aged 15-49 areinfected with HIV and prevalence among women ishigher (8 percent, {PMTCT now 6%}) than amongmen (5 percent)
National Context
•1.2 million pregnancies occur annually in Uganda,without intervention, about 30% of HIV positivepregnant women transmit the virus to theirbabies which translates into up to 23,400 newHIV infections resulting from verticaltransmission (MTCT)
•About 120,000 people on HAART, 10,000 ofwhom are children
EGPAF International Family AIDSInitiatives
•The EGPAF program in Uganda started in 2000 after results of theHIVNET 012 trial.
•Using private funds EGPAF Uganda embarked on the design,development, management, monitoring and technical support of theUganda Ministry of Health PMTCT program.
•Since 2003 USAID (PEPFAR) has supported the Uganda EGPAF program.This support enabled the strengthening of the Foundation’s role as akey organization working with the MOH.
•EGPAF works closely with other partners in Uganda to coordinatePMTCT & C/T expansion in Uganda.
Background
•EGPAF strategy in Uganda has been tocomplement Uganda Ministry of Health andprivate partners to cover human resource,infrastructure and commodity gaps in healthdistricts
•EGPAF Uganda helps with the design,development, management, monitoring andtechnical support of the Uganda Ministry ofHealth PMTCT program
EGPAF Uganda Program
EGPAF Uganda Program
•Geographical coverage: 27 districts (Total 86);stretching from western to eastern borders of thecountry
•PMTCT services at 350 (MOH Total 507) sites rangingfrom regional and district hospitals to health centersat sub county level
•Integrated affordable, family-based quality HIV/AIDScare and ART services at 15 health care facilities
Objectives of District-BasedSupport
•To build district capacity in HIV counseling, testing andprovision of other HIV/AIDS services.
•To implement comprehensive PMTCT services. PMTCTfunctions as a key entry point for families intolongitudinal HIV/AIDS care and treatment.
•To integrate the PMTCT program into Maternal & ChildHealth services and into other district health servicesincluding community programs like VCT and HomeBased Care
•To generate sustainable capacity for district ledprogram scale up
Design & Development
•MOH assigns districts to be supported
•Participatory proposal development process-based on national guidelines
•Sub grant development process
- pre-award assessment
- integration with district health budget
•District stakeholders meeting: civil society,technical, political/community leaders
Systems Support
•Identifying key resource persons from within DistrictHealth Team to serve as focal person for HIV/AIDSprogram activities
•Foundation TAs embark on a process of mentoringthese focal persons
–work plan development, integration of all HIV programs
–support supervision
–program monitoring
–logistics management
–training, inter-site coordination meetings
Technical support
•Sub district program support/coordinationteams (based at sub district level)
- support supervision
- lead CMEs: based on performance &identified knowledge gaps, informationupdates provided by the Foundation
- training
Program Performance
•Over 1,000,000 women have accessed PMTCTservices in over 350 sites in 27 districts.
•64,000 HIV+ mothers have been identified
•50,000 pregnant mothers have accessedAntiretroviral Prophylaxis
•28,000 babies have accessed AntiretroviralProphylaxis
Program Performance
Program Performance
PMTCT DataApril 1, 2007 – March 31, 2008
Indicator
Total
Number of eligible pregnant women
385,784
Number of pregnant women receiving HIV counseling
375,257
Total number of pregnant women who were HIV tested
328,243
Total number of pregnant women who received test results
321,906
Number of pregnant women with an HIV-positive test
20,281
Total number of mothers receiving ARV prophylaxis
19,032
Total number of infants receiving ARV prophylaxis
11,375
Number of PMTCT sites/Population coverage
348/64%
“Every Child Deserves A Lifetime”
Acknowledgements
•International Family AIDS Initiatives Staff: Uganda, Regional and USA
•Uganda Ministry of Health
•Partner Organizations incl. but not limited to JCRC, SCMS, AHF/Uganda Cares
•This presentation was made possible through support provided by the Officeof HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of theUnited States Agency for International Development (USAID), through thePresident’s Emergency Plan for AIDS Relief (PEPFAR), as part of the ElizabethGlaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“CallTo Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Theopinions expressed herein are those of the authors and do not necessarilyreflect the views of USAID.
