This proposal aims to sustain gains made over the last six years, and further accelerate epidemic control through scale up of evidence based and high impact interventions towards achievement of UNAIDS 90:90:90 targets; and strengthening national, regional, district, health facilities and community health structures in Kampala region of Uganda.
Despite IDI and MUg’s scale up of HIV/AIDS programs in Kampala and Wakiso over the last six years and increasing HIV+ clients in care from 28,308 [15,477 (55%) on ART] in 2010; to 95,034 patients in care [87,568 (92%) on ART] by June 2016, key challenges to achieving epidemic control remain. These include: inadequate access to friendly/suitable HIV/AIDS services for KP/PP and other vulnerable populations (AGYW, OVC etc.); suboptimal VL coverage at 65% overall, with <75% suppression among children tested; high rates of attrition from care due to unique challenges in the region; supply chain constraints; and inadequate human resources, infrastructure and diagnostic services especially in the private sector, leading to overcrowding of public facilities.
The proposed project will focus on strategies to achieve and sustain epidemic control; and strengthen the six WHO health systems strengthening building blocks.
The projects’ implementation strategy will include: 1) Sustaining gains made to ensure continuity of care for the existing 205,821 HIV+ patients in care, 2) Scale up of evidence based HIV care and treatment strategies; and high impact combination prevention interventions with special focus on KP/PP and vulnerable populations, 3) Strengthening of health structures with additional focus on community structures and the private sector.
In the short term, the project will increase HIV positivity yield from HTS among adults, adolescents and pediatric clients; with timely linkage into care, and early initiation on ART including test and treat. There will be increased coverage of VL tests for PLHIV on ART. Identification and management of TB-HIV patients will be improved. Facilities (including PFP, PNFP, and Faith based organisations) with satisfactory proficiency test (PT) performance; and linkage to sample transportation and results transmission systems will be increased. High impact combination prevention services among KP/PP will be strengthened including access to ART (test and treat) and VMMC among age group 15- 49. There will also be a functional OVC program with increased linkage of OVC to core services. DHTs’ competencies in reviewing, analysing and utilizing HIV Program data including performance review and coordination of CQI projects will be strengthened.
In the intermediate term, there will be increased ART coverage (including HIV care differentiation) with routine test and start; improved adherence to ART, community support and retention; increased viral load suppression rates for PLHIV on ART; and therefore reduced HIV transmission including MTCT. TB treatment success rates for TB/HIV clients will be improved. The number of labs implementing LQMS, and achieving improved standards towards accreditation will be increased; with increased access to quality lab services. The proportion of OVC graduating from core services will be increased over time. As a result of focused interventions, there will be reduced high-risk behaviors among PLHIV and VMMC clients; including increased condom use. ART facilities will have functional electronic medical records, accuracy and completeness of health data will be increased, and districts will demonstrate increased oversight of HIV programs and improved data use for planning.
Over the five years, the HIV incidence will be reduced leading to sustained epidemic control. HIV and TB related mortality will be reduced. Kampala region district leadership will be able to effectively plan, coordinate, and monitor their HIV epidemic.