IntraHealth International’s newest project in Uganda—the USAID Regional Health Integration to Enhance Services in Eastern Uganda Activity (or USAID RHITES-E)—developed a 60-day strategy to help the Eastern Uganda region achieve and surpass some of its annual HIV service goals.

Some 1.4 million adults and children are living with HIV in Uganda. The adult prevalence rate is 6.4%, and 28,000 Ugandans died due to AIDS-related causes in 2016. But the government has fast-tracked the country’s fight toward an AIDS-free generation and is making significant progress. New HIV infections in adults dropped from 135,000 in 2010 to about 60,000 in 2016.

Expanding voluntary medical male circumcision (VMMC) services and viral load monitoring are two of the country’s key prevention and treatment strategies. VMMC can reduce a man’s risk of acquiring HIV through heterosexual intercourse by 60%.

But at the end of July, with just two months before the end of the fiscal year, the Eastern Uganda region had reached only 77% of its 2016-2017 year-end goal of providing 9,362 men with VMMC services, and only 40% of eligible HIV-positive clients had received viral load tests.

USAID RHITES-E—which began on May 22, 2017—developed a plan focused on the power of community health teams and data to help the region get back on track.

By the end of September, more than 11,000 men had opted for VMMC services, and 98% of eligible clients in the 160 antiretroviral therapy sites served by the project had tested their viral loads.

Voluntary Medical Male Circumcision

When it became clear that the region was struggling to meet its VMMC target, the project set to work.

First, project staff met with health facility teams of trained surgeons and assistants, nurses, vaccinators, counsellors, laboratory assistants, village health team leaders, and data clerks to understand their views on how to best ramp up VMMC services without negatively affecting other health services. The project incorporated their feedback and ideas into a plan.

The project helped officials assign each health facility a new 60-day VMMC target and assess facilities for compliance to VMMC guidelines and for the availability of supplies and equipment. After addressing any gaps, the facilities sent village health teams out to mobilize communities and inform the public about the benefits and availability of VMMC services.

The village health team members—already known and trusted by their communities—were critical to increasing demand for VMMC in the region.

The approach included both facility-based and mobile VMMC sites. Two pairs of surgeons worked at each site from Friday to Sunday. The sites also offered HIV tests and tetanus vaccinations. Younger boys aged 10-14 were given priority in the waiting line. Men aged 20-35 received counseling on HIV prevention, including condom use, and were given postoperative care guidance. The postoperative follow-up rate at 48 hours was 98%.

By the end of September, the project had helped Eastern Uganda surpass its goal by providing VMMC to more than 11,000 men.

Viral Load Suppression

Suppressing viral load is crucial to the health of HIV-positive clients as well as a strategy for curbing the spread of HIV. Uganda’s national goal is to achieve 73% viral load suppression among adults living with HIV between the ages of 15 and 49 by 2020, and the country is on track to achieve it.

But to know whether a client’s viral load is suppressed, he or she must first get a test, and only 40% of eligible clients at the 140 antiretroviral therapy sites covered by the project were getting tested.

To address this gap, the project employed a phased approach over two months.

In the first phase, the project:

• Generated lists of eligible clients that included client IDs, phone numbers, and/or locations, and flagged client files using colored viral load stickers.
• Provided key facility staff members with airtime to reach out to clients via mobile phones.
• Developed a dashboard for tracking facility-level progress on achieving viral load monitoring targets.

The project then instituted monthly viral load reviews—which included the district health teams, facility staff who provided antiretroviral therapy services, and the heads of health facilities—held at the district level to review progress and improve data use. Then project staff shifted their focus based on the dashboard data, identifying and reaching the remaining clients eligible for viral load monitoring, including those without telephone numbers, as well as providing facility-based mentorship to health facility staff.

Case managers and mentor mothers, alongside the national viral load campaign team, went out into the communities to find and talk with eligible clients. After this intervention, 98% of eligible clients had received a viral load test. 

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