CARE AND TREATMENT
Since 2005, Makerere University Walter Reed Project (MUWRP) through the PEPFAR project has been providing care and treatment to HIV positive clients in the four districts of Kayunga, Buikwe, Buvuma and Mukono. PEPFAR’s overall goal is to improve the quality of life among HIV positive clients. To achieve this, MUWRP runs a comprehensive, robust, data driven program that prioritises initiation on antiretroviral therapy (ART), adherence to treatment and retention of its clients under care and treatment in 88 facilities across the four districts.
MUWRP strives to achieve 100% linkage of all its positive clients. A package of interventions including; screening, treatment and/or prophylaxis for major opportunistic infections, rapid ART initiation and intensified adherence support interventions are offered across all populations and age groups. Some of the major tests done at the ART facility include:
- Screening and detection of all forms of tuberculosis in infants, children, adolescents, and adults,
- Initiating all patients diagnosed with all forms of TB on treatment and complete the treatment,
- Strengthening facility and community systems for TB prevention, diagnosis, care, and treatment
- Strengthening the leadership and technical capacity of TB program at subnational levels to effectively guide and manage implementation of TB control activities.
Integration of TB services delivery with community activities like community DSDM implementation, VMMC camps, OVC programming, immunisation outreaches etc.
For female clients, screening of Cervical Cancer is also done at the ART Clinic. Women living with Human Immunodeficiency Virus (HIV) are at a high risk for early development of cervical cancer. Adherence to cervical cancer prevention strategies in this population is vital for the early detection and treatment of cervical cancer.
Since 2012 MUWRP has supported PMTCT services in the 4 districts of Kayunga, Buikwe, Buvuma and Mukono. Two of these districts are island districts with high prevalence of HIV.
PMTCT implementation focuses on elimination of Mother to Child Transmission (eMTCT) of HIV. Initiation of life-long ART for Newly identified HIV positive pregnant and lactating mothers are initiated on ART; pregnant mothers are supported to achieve safe delivery in health facilities; and continued postnatal follow up for the Mother Baby Pairs (MBPs). HIV Exposed Infants (HEI) are followed up at 4-6 weeks (1st DNA PCR), 9months (2nd DNA PCR), after stopping breastfeeding (3rd DNA PCR) and a final rapid test.
HEI indicators have improved over time with exposed infants accessing timely 1st DNA PCR from 88% to 91%
Several innovations have been implemented to achieve 100% adherence and retention of MBPs along the cascade achieve 95% viral load suppression
Implementation of community-based approaches; like community treatment support groups, mother to mother model has improved retention, treatment outcome, treatment support and social economic welfare among mothers attending the eMTCT program within MUWRP supported sites.
CQI (CONTINUOUS QUALITY IMPROVEMENT)
Continuous Quality Improvement (QI) focuses on using program data to identify gaps in performance and use of systematic methods to close the gaps between current and expected standards.
Since 2015, MUWRP has actively implemented national and regional quality improvement collaboratives. The region currently has a total of 15 active district QI coaches that take lead to support; facility based coaching sessions, identification of gaps through root cause analysis and opening up of QI journals on the several identified areas for improvement. Data on ongoing quality improvement projects is reviewed and reported in the National QI database on a monthly basis.
A total of 40 facilities have at least participated in the 16 national/ regional collaboratives since 2015. Currently in FY22, MUWRP region is participating in 10 running QI collaboratives.
District based and regional learning sessions are conducted on a quarterly/ bi-annually basis on all collaboratives to share promising & best practices.
Annually, the MoH organises harvest meetings where best implementing facilities are invited to share best practices for scale up. The MUWRP region has participated in three national harvest meetings.
Young Adolescents Peer Support model (YAPS) was scaled up in MUWRP region in September 2019 starting with Kayunga district and finally to all the 4 districts. The goal of YAPS is to reduce HIV related morbidity and mortality among adolescents and young people by 50% in 2023.
It’s a peer led program and facilities selected different AYP who were trained as YAPS to support the program in activities like, Peer counselling, support disclosure and adherence, physical follow up of missed appointments and lost Adolescent Youth Peer (AYP). Currently we have a total number of 63 trained YAPS in 4 districts attached to 18 facilities. The Young people are empowered with hands-on skills, like making Books, bags, shoes, necklace and forming facility saving groups which helps them earn money for their basic needs and saving in a group.
HSS (HEALTH SYSTEM STRENGTHENING)
The MUWRP Health Systems Strengthening (HSS) program is built on the pillars of the WHO HSS building blocks namely; service delivery, Health Workforce, Health Information systems, Access to essential medicines, Financing and leadership and governance.
MUWRP ensures equity and accessibility of services to the clients in the four districts of Kayunga, Mukono, Buikwe and Buvuma through closely working with all stakeholders including Local Governments, PNFPs, CBOs, Lower level facilities among others.
MUWRP also works to support Health care workforce/ Human Resources for Health (HRH) by filling gaps where there is need for quality service delivery. Continuous monitoring driven by data is also done to ensure HRH support key deliverables for the PEPFAR program and support HRH needs for collaborative stakeholders under the MUWRP/PEPFAR supported districts.
MUWRP currently supports 26 CBOs through providing technical leadership and advisory services on Health Systems Strengthening. This is done through a broad range of approaches such as training, mentorship and coaching, supportive supervision, etc. Continuous assessment of subgrantees is done through performance management including providing regular feedback and relevant support is given to achieve the project’s objectives.
For efficiency and stability, impromptu and scheduled performance audits for all sub grantees to inform the program are conducted, check adherence to contract provisions and provide guidance for contract renewals.
MUWRP also closely works with Local Government (LG) structures responsible for HSS to increase their engagement in program supervision and support.