Best practice and innovations by PHAs in accessing and

supporting rural HIV/AIDS programmes in Uganda

Dr Joanita KigoziCollege of Health Sciences, Makerere University, Kampala, Uganda.

IDI Outreach Program I Strategic General nature:

– Focuses on development of Infectious Diseases services through systematic and longer term linkages with partners.

– Partners: national/government institutions, districts, reputable NGOs, FBOs, private sector and training institutions.

– Use of the health systems approach.

IDI Outreach Program II

• Goal: To build capacity for the scale up of quality comprehensive HIV/AIDS services

• Over 40,000 Individuals in care at facilities supported by outreach programmes in Uganda

• Numerous challenges to E²S

• PHAs are critical in addressing these challenges

E²S Challenges -Programmatic• Critical shortage of HRH

• Poor management of logistics & supplies

• Manual data management systems

• Inadequate infrastructure

• Increasing patient numbers/demand for services

• Low rates of retention in care

E²S Challenges –PHA Perspective

• Access; Distance, Terrain

• Long waiting times

• Quality of service delivery

• Opportunity cost of seeking care

• Limited availability of other HIV related services; OI drugs, Family planning etc

Determinants of Loss to follow up (LTFU)

• Long distance to facility

• Long waiting time at the facility

• Large household size

• ½ of respondents could not be reached by phone or physical tracing.

Determinants of LTFU

“My greatest challenge was distance. I used to travel from far and always arrive very late hence ending up being among the last people to be served. I found it hard to get a boda boda (cycle taxi) in the late hours of the day to return home. The situation became even worse when I was transferred to school further away making it difficult to keep on coming”

PHA response• Bridging the HR

gap;– Pre- packing drugs

– Patient registration

– Completion of manual registers

– Phone calls and physical tracing for clients LTFU

PHA response II

• Health education;– Drug adherence

– Positive living

– Positive prevention

– Appointment keeping

PHA response III

• Mobilisation;– HCT– Care Outreaches

• Sensitisation– HIV/AIDS services– Positive living– Positive prevention– Anti stigma

campaigns through drama and testimonies

Tirwomwe Association “The AIDS scourge is not just for one person”

• 50 PHAs with a Chairman & working committee

• Origin;– Chairman facilitated to access ARVs for group

from facility 35 KM away

– Support positive living, ART adherence and retention in care and advocacy for services

Progress Tirwomwe association

• Advocacy for ART services

• Meals during ART outreach clinics– <0.5 USD/mth,

food & firewood in kind

– Members cook on clinic days.

Tirwomwe association today

• Nearby facility accredited to provide ART services

• Association supports over 200PHAs– Drama group; health education, community

sensitization– Village visits, home visits. – Low rates of LTFU.– Good adherence to ART.– Reduction in stigma

Summary• PLHIV critical to E²S of rural HIV/AIDS programmes

• Recognition and support for PHA innovations should be a major objective for national HIV/AIDS programmes

• It also recognizes the GIPA (Greater Involvement of People with HIV/AIDS) principle which is critical for sustainability and social responsibility of HIV/AIDS programmes

• The common phrase by PHAs- “There is nothing for us without us” – makes their involvement in E2S initiatives more necessary

Thank you