The MUWRP Key and priority population (KP/PP) programme aims at reaching and providing the populations with individual and/or small group-level HIV prevention interventions. The key and priority population categories include; Key Populations, the Female/ and incarcerated populations (prisoners), Men who have sex with men, People who inject drugs and transgender women.
Priority Populations (PP) include: long distance truck drivers, Commercial Sex Workers Fisher folks (FF), discordant couples, PLHIV Adults, PLHIV Adolescents, and uniformed service men (Police, Prisons warders, and army officers), Adolescent girls and young women (AGYW).
The populations are served with a range of services including;
• Offering or referral to HIV Testing Service (HTS).
• Information, education, and communication (IEC)
• STI screening, prevention, and treatment
• Linkage or referral to ART
• Prevention, diagnosis, treatment of TB
• Screening and vaccination for viral hepatitis
• Reproductive Health (Family Planning)
• Referral to medication-assisted therapy (MAT).
Currently MUWRP has served over 16,000 KPs and 11,000 PPs and attained a yield of 4% among the KPs and 3% among the PPs with a VL suppression rate of 97%. The KP and PP populations are provided services through hotspot day and moonlight outreaches, Drop in centres (DICs), social networks, social media and peer referrals. The programme conducts work through sub-grantee engagement and facilities to reach the populations in the mapped out hotspots and facility, DIC walk-ins.
In 2015, MUWRP implemented the DREAMS program with a package of interventions in Mukono (In the 13 sub counties and one municipality) with an aim of reducing HIV incidence among HIV negative pregnant girls and young women (15-24) by 25% in year 1 and up to 40% by year 2nd year (Sept 2017).
MUWRP prevention services target 95,834 priority sub populations. These populations of AGYW at risk and vulnerable to HIV infection include; those involved in transactional sex, engaged in sexual debut, having STIs, engaged in commercial sex, experienced GBV, orphans 10-17, teen mothers, out of school among others. Other beneficiaries include Uncircumcised men 15+, and Eligible men 15+ not on
ART. The ultimate goal of reducing HIV infection among the sub population is through; engagement of 6 locally selected community-based organisations (CBOs) within Mukono district, DREAMS peers, engagement of facility teams, identification of community safe spaces together with the peers, local leaders and CBOs.
Through the implementation period, MUWRP has supported 65,777 AGYW with a complete age appropriate primary, secondary and contextual intervention of services; both biomedical and behavioural services including; access to HTS, contraceptive mix, PrEP and post care GBV services. Other services include; community and school-based HIV and violence prevention, socio-economic empowerment including vocational skilling, financial and saving literacy. MUWRP linked AGYW to formal examination bodies for informal skills like the Directorate of Industrial Training (DIT) to certify the AGYW skills learned.
MUWRP has also supported AGYW who would like to continue with education and currently, 5 AGYW are enrolled for university education with different professional skills. These set of interventions have led to reduction of HIV and early pregnancies, achieved continuity of education for vulnerable AGYW, AGYW have started small scale and these also continue to mentor and refer other AGYW to enrol for the DREAMS programme in their communities. MUWRP has attained the saturation for the ages of 20-24 through ensuring AGYWs in that age category received a complete primary and relevant secondary package.
OVC (ORPHANS AND VULNERABLE CHILDREN)
The Orphans and Vulnerable Children (OVC) program is implemented in the three districts of Buikwe, Kayunga and Mukono by six Community-Based Organisations supported by the MUWRP- PEPFAR project.
The program targets HIV exposed infants between 0-17 years (especially adolescent mothers and newly diagnosed women), children of Key Populations (KPs), and all infants, children and adolescents exposed to harm/violence.
The four core program areas include: interventions that support the achievement of health outcomes,
build health and nutrition knowledge and skills in care givers, facilitate access to key health services especially HIV testing, care and treatment to enable vulnerable children especially girls stay HIV free. It also includes interventions that reduce economic vulnerabilities and increase resilience in adolescents and families affected by and vulnerable to HIV, interventions that prevent and mitigate violence, abuse, exploitation and neglect of children and adolescents including sex and gender-based violence.
The fourth core program area entails supporting children and adolescents affected by and vulnerable to HIV to overcome barriers to accessing education including enrolment, attendance, retention, progress and /or transition and provide vocational training for some adolescents.
Implementation of the program is done in partnership with stakeholders like Facility health workers, clients, VHTs, Police, District (DCDO, PO/SW, CDO), faith-based organisations, Local councils and Child help line. These are engaged through Community dialogues, Screening, identifying and referring VAC/GBV cases identified at HH level, Enrolment of survivors of VAC, Follow up VAC/GBV cases, Coordination with the facility teams, Networking with the other support networks, Proper and continuous documentation, Timely reporting and review of performance which informs you of the areas of improvement, Participating in the non-suppressors clinic days for C/ALHIV and communication follow between the facility and community.
Upon confirmation that the household is stable in all the core domains of OVC, they graduate off the program. Stability is when the household HIV status is known, virally suppressed, not undernourished, improved financial stability, violence free, not child led and all children are in school.
VMMC- Voluntary Medical Male Circumcision is pronounced as an effective HIV prevention tool following completion of 3 RCTs in 2000.The government of Uganda adopted as one of the bio-medical strategies as an effort to contribute to the reduction of HIV in the country. MUWRP since 2009 through funding from PEPFAR has been implementing a VMMC service program in 4 districts of central Uganda namely: Kayunga, Mukono, Buvuma and Buikwe. The health departments of the four districts together with CBOs have been partners to the implementation of this activity at the different government and non-government facilities.
Generally, boys and men from the age of 15 are targeted in this program to receive a holistic reproductive health package including HIV Care referral, STI treatment referral for correction of congenital deformities. Over 40 MUWRP supervised both government and private facilities in the region offer free VMMC services to communities.
The VMMC department has overtime developed capacity to offer technical assistance and training to other Implementing partners that offer VMMC services in the country as well as taking lead with the Ugandan Ministry of Health to develop VMMC policies that guide a safe and improved implementation of VMMC services in the country.
PREP AND MSM MANAGEMENT
HIV prevention needs to change during a person’s lifetime. Combination prevention is a mix of biomedical, behavioural, and structural interventions that decrease risk of HIV acquisition. Combining approaches may result in greater impact than using single interventions alone. Antiretroviral drugs (ARVs) used as PrEP provide an important additional prevention tool.
PrEP is the use of ARV drugs by HIV-uninfected persons to prevent the acquisition of HIV before exposure to HIV. It is a one daily pill taken during periods of risk exposure, with a preferred regimen of TDF/FTC and alternate regimen of TDF/3TC given.
Before initiation, clients need to go through screening using the eligibility screening criteria. This includes; prior HIV testing to confirm HIV negative status, clients should not have any suspicion of acute HIV infection, clients should be at substantial risk for HIV acquisition, creatinine clearance >60ml/min and they should be willing to take PrEP as prescribed.
Substantial risk populations for HIV acquisition include: Key Populations e.g. Female sex workers, Men who have sex with men (MSM), Transgender (TG), persons in prisons and persons who inject drugs and Priority Populations e.g. discordant couples, migrant populations, fisherfolk communities, long distance truck drivers, clients of sex workers, Adolescent girls and young women, pregnant and breastfeeding women etc.
These populations are penetrated for PrEP initiation using peer mobilisers to link the service providers to them, conducting community outreaches. MUWRP supports the program through ensuring availability of supplies, conducting training of HCWs and peers, printing IEC materials and M&E tools as well as supporting MOH to develop and revise PrEP implementation and technical guidelines.
As part of the Key Populations served under prevention; MUWRP identifies MSM from her region to offer them HIV prevention services including HTS, health education and messaging, screening for TB, STIs and GBV, offering PrEP, ART for the HIV positive and ST I& TB management.
The MSM community is a hard-to-penetrate community that needs a range of strategies to penetrate in order to provide them with prevention services. This is because of the legal barriers surrounding them, stigma and discrimination, poor health seeking behaviours etc.
MSM peers are instrumental in the identification of this population. These mobilise and inform their peers about the availability of prevention services at the different points including safe spaces. The snow-ball or seed referral mechanism is pivotal in the identification of this sub-population where one MSM identified may refer to a number of other MSM he knows. Social media (SM) mobilisation is also used, where different SM platforms like WhatsApp groups are used to offer prevention messaging and alert them about the different services. Overtime, the drop-in-centres (DICs) have been established at 3 hospitals i.e. Mukono General Hospital, Kawolo Hospital and Kayunga Regional Referral Hospital; these are one-stop points where this sub-population can get all the services they need at one attempt.