There is no Conflict of Interest for this presentation

Strengthening TB and HIV&AIDSResponses in East Central Uganda

There is no Conflict of Interest for this presentation


Responding appropriately to the complex health needs of most-at-risk populations in

hard-to-reach areas:

Improving HIV outcomes through integrated service delivery to fishing communities of the

Sigulu Islands in Uganda

20th International AIDS Conference

21st July, 2014

Dr. Samson Kironde


Presentation Layout

Background and Description

Illustrative Results

Lessons learned and Conclusion


The Sigulu Islands are located in Lake Victoria in Uganda

Commercial fishing is the main economic activity on

these islands


Background to the Sigulu Islands

Fishing communities have been noted to be at high risk of acquiring HIV infection in many countries in sub-Saharan Africa

The Sigulu archipelago in Namayingo District, Uganda comprises of 11 inhabited islands (out of 19) with over 42,000 people most of whom are fishing families

The lucrative fishing business attracts many different nationalities to the islands and the migrant nature of commercial fishing makes populations mobile

Daily access to disposable income leads to high risk behaviours such as transactional sex with CSWs, alcoholism and drug usage

A baseline survey done in 2010 showed high STI prevalence with HIV prevalence ranging from 17-30%


Healthcare infrastructure is poor and low level…

Access to healthcare remains a major bottleneck islands are hard-to-reach and up to 8 hours from mainland by motor boat)

Due to their migrant nature, islanders have poor health seeking behaviour

STAR-EC, a USAID funded project managed by JSI Research & Training Institute, Inc., conducts quarterly outreaches to the islands in order to provide integrated service delivery

Due to poor infrastructure, services are provided mainly in outreach mode in tents


A range of services are provided during an outreach

Integrated services provided include: HIV testing and counseling Voluntary medical male circumcision STI management Family Planning Malaria diagnosis and treatment TB diagnosis and treatment HIV care and support, including

opportunistic infection treatment Risk reduction initiatives and

community dialogue to promote structural HIV prevention

Antiretroviral therapy Dissemination of IEC materials

For those diagnosed HIV positive, a ‘continuum of response’ is emphasized to enable them to be linked to relevant services

Integrated Service Delivery Client Flow during a typical outreachTe

nt

Registration• General Population• Pregnant mothers• Mothers with Infants• VMMC Clients etc.

General Health Education• HIV&AIDS• TB• STIs

VMMC service delivery using MOVE

HTC point for VMMC Clients

• VMMC Health Education• Condom distribution• Analgesics provision• Day 2 Review

• ART initiation• Chronic Care• ART Refills

• Antenatal Care• Postnatal Care

Family Planning • Pills• Depo Provera• Implants• Vasectomy

Sputum testing for TB

General Laboratory• HTC• EID• CD4• STIs• Malaria

Supplies Store

‘Mentor mothers’for counseling adherenceand psychosocial support

HTC results distributionand post test counseling• Immunization

• Health Education• Family Planning advice

Data processing

•Ge

nera

l IEC

•Co

ndom

pro

moti

on•

Soci

al m

arke

ting

•Ed

utai

nmen

t

* Couple counseling and other individualized counseling done at secluded spots wherever these are available on the outreach site

Tent

Tent

Tent

Tent

Tent

TentTent

Health Facility (HC II)

Improvised Reed structure


Limited infrastructure calls for improvised service delivery…

Whatever space available is used

by the visiting health teams!


Illustrative Results: April 2011-June 2014

HIV Testing and Counseling (HTC)

• 22,450 individuals received HTC

• 11% (1,950) HIV positive

• 1,096 (45%) enrolled on ART

‘Continuum of response’ emphasized

• 77% of all HIV+ linked to care

• 100% of all HIV+ pregnant women linked to PMTCT

• 100% of all circumcised received HTC

• 100% of all eligible for ART received it

• 100% TB cases put on treatment

Other integrated services provided included:

• 82 patients put on TB treatment

• 1,444 clients received STI treatment

• 1,022 received Family Planning

• 611,077 condom pieces distributed


HIV prevalence has continued to drop in newly tested islanders…

Baseline Q3 2011 Q3 2012 Q3 2013 Q3 2014

30.4%

19.4%

13.7%11.6%

6.8%5.0% 5.4%

4.0% 2.7% 2.2%

HIV Prevalence: Sigulu Islands vs. East Central Uganda2010-2014

Islands East Central Region

Sigulu Islands significantly contribute to HIV prevalence in East Central Uganda


Uptake of most services provided is commendable…

2011 2012 2013 2014 Total

535

1,555

838

2,117

5,045

VMMC uptake 2010-2014

VMMC uptake has steadily risen

~40% of eligible males >10 years have been circumcised for HIV prevention to-date


Lessons learned and conclusion

The integrated outreach model has increased access to and uptake of services in a very hard-to-reach but high HIV prevalence area

Even with poor infrastructure, improvisation does allow delivery of much needed services

Directing resources where new HIV infections are likely to emerge contributes to controlling the spread of the epidemic

Combating HIV in the Sigulu Islands through multiple approaches will contribute to

markedly controlling the HIV epidemic in East Central Uganda


Acknowledgements

I would like to thank the following for their contribution towards service delivery to the highly vulnerable population of the Sigulu Islands:

The Government of the Republic of Uganda notably the Ministry of Health

Namayingo District Local Government and District Health Office

PEPFAR and USAID for providing funding

JSI Research & Training Institute and its consortium partners on STAR-EC

The beneficiaries who reside in the Sigulu archipelago

Documents

There is no Conflict of Interest for this presentation