This proposal aims to achieve and sustain HIV epidemic control and 95-95-95 UNAIDS targets through scale up of innovative evidence-based interventions; reducing TB incidence and HIV/TB-related morbidity and mortality; and strengthening GOU capacity to lead the epidemic response and other public health threats in Kampala region of Uganda.
Problem statement: With funding from CDC/PEFAR since April 2017, the IDI has piloted and scaled up innovative cost-efficient HCI strategies like APN and SNS; set up the pioneer MAT centre for PWIDs in Uganda at the Butabika NRH; and strengthened KP programming. The regional VL suppression is 97%; and VL suppression rates among children and adolescents are the highest in Uganda at 92%. However, some gaps remain. HTS coverage is still low at 86% against the UNAIDS 95% target with sub populations including young people and males significantly behind. Among KP and PPs, the stigmatizing and restrictive environment limits access to services. The region has high rates of treatment interruption with 4,941PLHIV interrupting treatment in Q1, COP 22 and TB is a significant cause of morbidity. Data use to inform impactful interventions and monitoring at district level is suboptimal, and the District Health Teams have competing priorities which affect their ability to effectively lead the response.
Overall strategy: The proposed project will focus on implementing evidence based and high impact people-centered interventions geared towards achieving and sustaining the UNAIDS 95:95:95 targets in line with the National HIV/AIDS strategic plan 2020/21 to 2024/25, and Reimagining PEPFAR's Strategic Direction for controlling the epidemic. Throughout the project life, IDI will utilize data/evidence to identify all populations with unmet need; implement cost efficient and high-impact interventions; and monitor program performance. Innovation will remain a core theme and innovative approaches will be used to ensure service continuity during public health emergencies. IDI will collaborate with key stakeholders and leverage transformative partnerships for efficient use of available resources. Government of Uganda (GoU) and community structures (including KP, PP and PWD) will be actively engaged in program planning and implementation for a sustained response. The region will be clustered, and facilities tiered to tailor support given for timely mitigation of emerging issues.
In the short term, there will be increased access to comprehensive, high-quality, person-centered services for HIV and TB. In line with national guidelines, there will be increased HCI, linkage to ART, ART coverage, continuity on treatment (CoT) and VLS for better health outcomes. There will be review, analysis, and use of aggregate data from individual-level and EMR, surveillance, HIV, TB, mortality, and other public health programs to inform strategies.
In the intermediate term, there will be increased VL suppression rates among all PLHIV resulting into reduced incidence of HIV infection; reduced vertical transmission of HIV, syphilis, hepatitis and malaria; improved TB treatment success rates for TB/HIV co infected individuals; increased number of labs implementing LQMS and achieving improved standards towards accreditation; and increased detection and management of NCDs, AHD, TB, CaCx and other OIs. Absorption of HRH staff will increase, and effective district decentralization will be led by RRH in line with PEPFAR and MoH sustainability plans.
Long term Outcomes: Over the 5 years, HIV and TB incidence will reduce leading to sustained epidemic control. HIV, TB, NCD and AHD related mortality and morbidity will reduce. Kampala region will have local capacity for early detection, prevention, and control of public health threats. There will be sustained capacity of RRH and districts (GOU) to plan, implement, and monitor high quality programs resulting into an improved and resilient health care system with better health outcomes.
