Overview Narrative

It is estimated that 1,200,000 Ugandans are living with HIV/AIDS and about 38% (456,000) have tested and know their HIV status. At least 135,000 new HIV infections occur in Uganda each year of these 80% are adults. Currently, the number of PHA accessing care and antiretroviral treatment (ART) nationally is estimated at 357,108 and 193,746 (60% of eligible) respectively; with adults comprising 91.5 % of recipients at 350 facilities countrywide. However, the number of people in need of ART is approximately 358,000 implying an unmet need of more than 50% (UNAIDS). Access to PMTCT services is estimated at 48% among pregnant women, and only 21% of the pregnant women eligible for HAART received treatment in the year ending June 2009. Every year an estimated 149,000 new HIV infections occur in Uganda. With the introduction of various models to scale up HIV counseling and testing; the number of PHA identified and therefore need to access HIV care and treatment services continues to increase. Although efforts have been made by the Ministry of Health (MOH), PEPFAR and other stakeholders to scale up HIV/AIDS care and treatment services nationally, only about 60% of the need is being met. There are several challenges encountered in the delivery of HIV/AIDS services. These include high demand for services, weak health infrastructure (human resource, monitoring and evaluation, laboratory systems, logistics management systems) and poor coordination and linkages among providers, with resultant duplication in reporting, and inequitable access to services.

The basic care package (BCP) was developed and standardized by CDC Uganda and the MOH in 2004. BCP interventions prolong and improve the quality of life of PHA by preventing opportunistic infections (OI); and preventing transmission of HIV through Prevention with Positives interventions (PWP). In addition, the BCP is affordable, easy to use, readily available, beneficial to family members and complementary to ART. It currently comprises: identification of PHA through couple and family based counseling and testing; daily cotrimoxazole prophylaxis, safe water system (household water treatment chlorine solution, a filter cloth, and water vessel for safe water storage) for prevention of diarrheal diseases, long lasting insecticide-treated mosquito nets for malaria prevention, and condoms supplies. PWP strives to avert HIV transmission to sexual partners and unborn children through: partner testing and supported disclosure, partner discordance counseling; management of sexually transmitted infections; family planning, prevention of mother to child transmission of HIV (PMTCT); safer sex practices including abstinence; fidelity with correct and consistent use of condoms. Recent BCP components being addressed through training and information education and communication (IEC) materials are TB/HIV, nutrition, pain and symptom management. Documented research related to the BCP show it improves the quality of life of persons with HIV/AIDS (PHA), delays progression to AIDS and the need to initiate ART overall prolonging survival. Studies showed use of the BCP results in 35% reduction in diarrhea among HIV-infected persons and their household members; 15-70% reduction in malaria, clinic visits and hospitalizations; and a 46% reduction in death. Additionally, it has been observed that BCP helps decrease stigma, increase the retention of PHA in pre-ART in care; increases adherence to cotrimoxazole prophylaxis and ART.

Under PEPFAR I, the BCP served as the minimum HIV/AIDS care service provided to about 250,000 PHA through 198 PEPFAR supported sites [(public and private hospitals, community based organizations (CBO), faith based organizations (FBO), and non-governmental organizations (NGO)] in 68 of the 82 districts of Uganda. Provision of the BCP did not involve direct service provision to PHA, but was done through the existing health system; using 17 PEPFAR supported HIV/AIDS prevention, care and treatment programs. Key program activities included: distribution of health commodities [(BCP starter kit containing two long lasting insecticide treated bed nets, safe water system, condoms (optional) and important health information on PWP, nutrition, TB/HIV integration, pain and symptom relief; distribution of commodity refills; and support for improved cotrimoxazole supply chain between National and Joint Medical Stores and facilities to ensure sustained availability of cotrimoxazole for prophylaxis. BCP training curricula was developed, and used training and capacity building of HIV/AIDS health care providers and peer educators in the implementation of the BCP services. Additionally a national print and electronic media behavior change communications campaign was developed and implemented to complement BCP activities.

This mechanism will continue to support the implementation of a multi-faceted program aimed at educating PHA on how to prevent OI and HIV transmission, while living longer and healthier lives. Systems for the manufacture, packaging and distribution of the BCP have been established but need to be strengthened for a sustainable basic care program to ensure that BCP commodities are available and accessible to all identified persons with HIV/AIDS. Partnerships will be fostered with the local manufacturers and other relevant partners to ensure availability of BCP commodities in the public and commercial sectors. It is intended that all these commodities will be available nationwide through sustainable channels. In PEPFAR II, the focus will be to build on the achievements of the basic care activities, with emphasis on better integration with the public health systems and coverage of services particularly in the public and private health sectors (especially in hard to reach areas); strengthening systems for the supply chain of BCP commodities, and evaluation of the current and potential BCP components.

It is estimated that 1,200,000 Ugandans are living with HIV/AIDS and about 38% (456,000) have tested and know their HIV status. At least 135,000 new HIV infections occur in Uganda each year of these 80% are adults. Currently, the number of PHA accessing care and antiretroviral treatment nationally is estimated at 357,108 and 193,746 (60% of eligible) respectively; with adults comprising 91.5 % of recipients at 350 facilities countrywide. However, the number of people in need of ART is approximately 358,000 implying an unmet need of more than 50% (UNAIDS). Access to PMTCT services is estimated at 48% among pregnant women, and only 21% of the pregnant women eligible for HAART received treatment in the year ending June 2009. Every year an estimated 149,000 new HIV infections occur in Uganda. With the introduction of various models to scale up HIV counseling and testing; the number of PHA identified and therefore need to access HIV care and treatment services continues to increase. Although efforts have been made by the Ministry of Health (MOH), PEPFAR and other stakeholders to scale up HIV/AIDS care and treatment services nationally, only about 40% of the need is being met. There are several challenges encountered in the delivery of HIV/AIDS services. These include high demand for services, weak health infrastructure (human resource, monitoring and evaluation, laboratory systems, logistics management systems) and poor coordination and linkages among providers, with resultant duplication in reporting, and inequitable access to services.

Under PEPFAR I, the BCP served as the minimum HIV/AIDS care service provided to about 250,000 PHA through 198 PEPFAR supported sites [(public and private hospitals, community based organizations (CBO), faith based organizations (FBO), and non-governmental organizations (NGO)] in 68 of the 82 districts of Uganda. Provision of the BCP was done through the 17 existing PEPFAR supported HIV/AIDS prevention, care and treatment programs. Key program activities included: distribution of health commodities- a BCP starter kit containing two long lasting insecticide treated bed nets, safe water system, condoms (optional) and important health information on PWP, nutrition, TB/HIV integration, pain and symptom relief; distribution of commodity refills; and support for improved cotrimoxazole supply chain between National and Joint Medical Stores and facilities to ensure sustained availability of cotrimoxazole for prophylaxis. BCP training curricula was developed and used for training and capacity building of HIV/AIDS health care providers and peer educators in the implementation of the BCP services. Additionally a national print and electronic media behavior change communications campaign was developed and implemented to complement BCP activities.

In PEPFAR II, this mechanism will provide for continued support for the existing 250,000 PHA through 198 PEPFAR supported sites in 68 of the 82 districts of Uganda. It is expected that a total of 60,000 new BCP starter kits will be distributed, with 85% (51,000) targeting adult PHA in HIV prevention, PMTCT, care and treatment programs. There will be continued implementation of a multi-faceted program aimed at educating PHA on how to prevent OI and HIV transmission, while living longer and healthier lives. Systems for the manufacture, packaging and distribution of the BCP have been established but need to be strengthened for a sustainable basic care program to ensure that BCP commodities are available and accessible to all identified persons with HIV/AIDS. The focus will be to build on the achievements of the basic care activities, with emphasis on better integration with the public health systems and coverage of services particularly in the and private health sectors public (especially in hard to reach areas); strengthening systems for the supply chain of BCP commodities, and evaluation of the current and potential BCP components. Program monitoring will include support supervision and use of program data to track program implementation and evaluate program activities.

It is estimated that 1,200,000 Ugandans are living with HIV/AIDS and about 38% (456,000) have tested and know their HIV status. At least 135,000 new HIV infections occur in Uganda each year of these 80% are adults. Currently, the number of PHA accessing care and antiretroviral treatment (ART) nationally is estimated at 357,108 and 193,746 (60% of eligible) respectively at 350 facilities countrywide. Children in HIV/AIDS care and treatment currently comprise approximately 15 % and 10 % respectively. Only 39% of the estimated 42,140 children in urgent need of ART are receiving it, compared to 63% of eligible adults. Access to PMTCT services remains low, about 48% of pregnant women, and only 21% of these eligible for HAART received treatment in the year ending June 2009. It is estimated that only 17% of infants were able to access early infant diagnosis in the past year and yet the national guidelines recommend ART of all infants below 12 months. Every year an estimated 149,000 new HIV infections occur in Uganda. Although efforts have been made by the Ministry of Health (MOH), PEPFAR and other stakeholders to scale up HIV/AIDS care and treatment services nationally, only about 40% of the need is being met. There are several challenges encountered in the delivery of HIV/AIDS services. These include high demand for services, weak health infrastructure (human resource, monitoring and evaluation, laboratory systems, logistics management systems) and poor coordination and linkages among providers, with resultant duplication in reporting, and inequitable access to services.

Under PEPFAR I, the BCP served as the minimum HIV/AIDS care service provided to about 250,000 PHA including children, through 198 PEPFAR supported sites [(public and private hospitals, community based organizations (CBO), faith based organizations (FBO), and non-governmental organizations (NGO)] in 68 of the 82 districts of Uganda. Provision of the BCP was done through the 17 existing PEPFAR supported HIV/AIDS prevention, care and treatment programs. Key program activities included: distribution of health commodities- a BCP starter kit containing two long lasting insecticide treated bed nets, safe water system, and important health information on PWP, nutrition, TB/HIV integration, pain and symptom relief for children infected with HIV/ADS; and support for improved cotrimoxazole supply chain between National and Joint Medical stores and facilities to ensure sustained availability of cotrimoxazole for prophylaxis. BCP training curricula was developed and used for training and capacity building of HIV/AIDS health care providers, care takers and peer educators in the implementation of the BCP services with a focus on pediatric HIV/AIDS. Additionally, a national print and electronic media behavior change communications campaign was developed and implemented to complement BCP activities. PHA including parents, care takers of the children and adolescents have been actively involved in interpersonal communication activities at sites including giving health talks and participating in community sensitization on HIV/AIDS prevention, care and treatment.

In PEPFAR II, this mechanism will provide for continued support for the existing estimated 53,566 children in care (16,833 on ART) and their families through 198 PEPFAR supported sites (public and private hospitals, CBO, FBO, and NGO facilities) in 68 of the 82 districts of Uganda. There are increased efforts to identify and enroll children with HIV/AIDS into care and treatment under the national Early Infant Diagnosis program and other initiatives. It is expected that a total of 60,000 new BCP starter kits will be distributed, through HIV prevention, PMTCT, care and treatment programs, about 15% (9,000) of the new BCP starter kits will be target children living with HIV/AIDS and their families, those in rural and hard to reach areas will be prioritized. There will be continued implementation of a multi-faceted program aimed at educating PHA on how to prevent OI and HIV transmission, while living longer and healthier lives. Systems for the manufacture, packaging and distribution of the BCP have been established but need to be strengthened for a sustainable basic care program to ensure that BCP commodities are available and accessible to all identified persons with HIV/AIDS. The focus will be to build on the achievements of the basic care activities, with emphasis on better integration with the public health systems and coverage of services particularly in the public and private health sectors (especially hard to reach areas) to achieve universal access to basic care for all PHA identified nationally; strengthening systems for the supply chain of BCP commodities, and evaluation of the current and potential BCP components. Program monitoring will include support supervision and use of program data to track program implementation and evaluate program activities In addition to distribution of the BCP kits and commodity refills, the mechanism will review and revise related training and IEC materials, to better cater for pediatric issues; as well as the BCC media campaign in collaboration with the MOH and other stakeholders as necessary. To improve access to BCP, the mechanism will train HIV/AIDS health care providers, care takers and peer educators in the implementation of the BCP services with a focus on the unique needs of children. Through communication campaigns and interpersonal communication, awareness will be created among the general public about the BCP and its use will be promoted in both the public and private health sectors to address sustainability issues.

It is estimated that 1,200,000 Ugandans are living with HIV/AIDS and about 38% (456,000) have tested and know their HIV status. At least 135,000 new HIV infections occur in Uganda each year of these 80% are adults. Currently, the number of PHA accessing care and antiretroviral treatment nationally is estimated at 357,108 and 193,746 (60% of eligible) respectively; with adults comprising 91.5 % of recipients at 350 facilities countrywide. However, the number of people in need of ART is approximately 358,000 implying an unmet need of more than 50% (UNAIDS). Access to PMTCT services is estimated at 48% among pregnant women, and only 21% of the pregnant women eligible for HAART received treatment in the year ending June 2009. Every year an estimated 149,000 new HIV infections occur in Uganda, mainly through sexually transmission. With the introduction of various models to scale up HIV counseling and testing; the number of PHA identified and therefore need to access HIV care and treatment services continues to increase. Although efforts have been made by the Ministry of Health (MOH), PEPFAR and other stakeholders to scale up HIV/AIDS care and treatment services nationally, only about 60% of the need is being met. There are several challenges encountered in the delivery of HIV/AIDS services. These include high demand for services, weak health infrastructure (human resource, monitoring and evaluation, laboratory systems, logistics management systems) and poor coordination and linkages among providers, with resultant duplication in reporting, and inequitable access to services.

Under PEPFAR I, the BCP served as the minimum HIV/AIDS care service provided to over 250,000 PHA through 198 PEPFAR supported sites [(public and private hospitals, community based organizations (CBO), faith based organizations (FBO), and non-governmental organizations (NGO)] in 68 of the 82 districts of Uganda. Provision of the BCP was done through the 17 existing PEPFAR supported HIV/AIDS prevention, care and treatment programs. Key program activities included: distribution of health commodities- a BCP starter kit containing two long lasting insecticide treated bed nets, safe water system, condoms (optional) and important health information on PWP, nutrition, TB/HIV integration, pain and symptom relief; distribution of commodity refills; and support for improved cotrimoxazole supply chain between National and Joint Medical Stores and facilities to ensure sustained availability of cotrimoxazole for prophylaxis. Distribution of condoms to sexually active PHA occurred through provision the BCP starter kits and condom supplies at facilities and in the communities.

BCP training curricula was developed and used for training and capacity building of HIV/AIDS health care providers and peer educators in the implementation of the BCP services. The training aimed to promote HIV/AIDS prevention beyond abstinence and being faithful, to include correct and consistent use of condoms. PHA have been actively involved in interpersonal communication activities at facilities, which comprised health talks and community sensitization on HIV/AIDS prevention. Additionally a national print and electronic media behavior change communications campaign was developed and implemented to complement BCP activities.

In PEPFAR II, this mechanism will provide for continued support for the existing 250,000 PHA through 198 PEPFAR supported sites in 68 of the 82 districts of Uganda. It is expected that a total of 60,000 new BCP starter kits will be distributed to PHA in HIV prevention, PMTCT, care and treatment programs. This mechanism will work through the already identified sites and scale up to other underserved areas to achieve universal access to basic care for all PHA identified nationally. The sexual and other behavioral prevention activity will continue to ensure regular and constant availability of condoms supplies to sexually active PHA, and to promote proper and consistent condom use through condom distribution outlets. Regular and constant supply of condoms will be achieved through the distribution of the BCP starter kit and regular replenishment of condom supplies as required. The Ministry of Health regularly maintains national condom supplies through funding from AIDS Development partners and other sources. This mechanism will allocate funds to supplement the MOH supplies. Specifically this funding will enable the procurement, shipping and handling of commodities; conduct post shipment testing, packaging, and distribution of condoms. This will ensure continued access to condoms by PHA, as MOH supply may be unpredictable and may fall short of the national requirements, resulting in disruption of condom supplies.