Capacity building in scaling up pediatric HIV care: A case of Uganda

1. Geoffrey Taasi,
STD/ACP, Ministry of Health,
Uganda
1
April 8, 2013 Uganda STD/ACP, MOH

2. •Geoffrey Taasi
•Dr. Elyanu Peter
•Cotty Nabatanzi
April 8, 2013
Uganda STD/ACP, MOH 2

3. • Of the 146,000 children living with HIV, 76,750
urgently need ART
• Only 24% had access to ART by 2009. Without ART,
75% die by age five.
• In 2009 the Uganda National coverage was at 33%.
• Early diagnosis & treatment can prevent these deaths
• Coverage remain low at 68% and 58% at hospital
and HC IV
• 100% and 82% adult ART respectively
• Most health workers lack the skills to manage
paediatric HIV.
April 8, 2013 Uganda STD/ACP, MOH 3

4. • Between 2009 and 2011, the MOH
implemented the Pediatric HIV training and
communication project
• To strengthen capacity of care providers to
identify and test children at risk of HIV,
• To provide quality pediatric and adolescent
HIV and AIDS care
April 8, 2013 Uganda STD/ACP, MOH 4

5. • A harmonized National curriculum
• A five day training and a two day mentorship
• Job aids, mentorship guides and an M&E system
were developed.
• Retrospective data collection and analysis of
service statistics -early 2012.
• Client exit interviews -10 sites in 2011, 40 care
givers of children (35F, 5M) and 10 adolescents
were interviewed and data analyzed
April 8, 2013 Uganda STD/ACP, MOH 5

6. • Coverage increased to 68% in 2012 up from
33% in 2009
• 36.6% on ART by March 2012 from 24% in
2009
• 462 health trained on pediatric psychosocial
support and
• 1,082 trained on clinical care
• 202 mentors (regional and National)
April 8, 2013 Uganda STD/ACP, MOH 6

7. • Mean period between eligibility and initiation
on ART reduced from six to one month.
• Care providers can provide quality pediatric
ART services.
• 100% of the care givers interviewed knew
correct dosing and frequency of medication
• 95% knew their appointment dates and 80%
kept them
April 8, 2013 Uganda STD/ACP, MOH 7

8. Have we made any
progress?
In 2011 – only 49% of
Infants were initiated on
ART
In 2012 – 56% of Infants
were initiated on ART

10. • Delay in consensus building
• Late identification of children,
• late initiation, losses to follow up,
• Poor adherence, Paed formulations
• Strengthened central coordination by
MOH,
• Role distribution among partners,
improved supply chain, mentorship, use
of job aids
Uganda STD/ACP, MOH
April 8, 2013
10

11. • Proper needs assessment ensures demand
driven CB,
• ownership, sustainability and SS
• Ownership of interventions by stakeholders
requires interventions by them, for them and to
them and not at them.
• Scaling up of pediatric HIV is best done
simultaneously with the Adult ART.
Uganda STD/ACP, MOH
April 8, 2013
11

12. • The model can be replicated to effectively save costs
and develop capacity without much disruption of
other services
• Pediatric HIV care does not require separate clinics
and long training but harmonized, standardized
curricula & mentorship
• Country ownership is possible when efforts are
coordinated by government and implementation
provided for by a public framework
Uganda STD/ACP, MOH
April 8, 2013
12

13. • STD/ACP, Uganda Ministry of Health
• USAID
• Health Communications Partnership (HCP)
• Regional Centre for Quality of health care,
Miserere University
• All HIV USAID partners in Uganda (STARs,
Baylor, SUSTAIN, RTI,,,,)
April 8, 2013 Uganda STD/ACP, MOH
13

14. April 8, 2013 Uganda STD/ACP, MOH 14