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Programs

The HIV Prevention, Care and Treatment Program

The HIV Prevention, Care and Treatment Program provides comprehensive HIV/AIDS care and prevention services to clients at the MU-JHU ART clinic, Kawempe National Referral Hospital and the surrounding community. It was launched in the year 2000 as the PMTCT Program and extended in 2017 as the HIV Program. It is currently funded by the CDC/PEPFAR grant through the Infectious Disease Institute (IDI) under the Kampala HIV project.

Operations

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The main goal of the program is to contribute to the national effort of attaining epidemic control by achieving the UNAIDS target of 95:95:95 by 2030; that is, to achieve 95% of people living with HIV knowing their HIV status; 95% of people who know their status to be on treatment; and 95% of people on treatment with suppressed viral loads. Our approach is to get there through the implementation of evidence-based and high-impact interventions.
Our daily activities are made possible by a team of dedicated staff concentrated in four main sections.

  • Clinical: This section is comprised of doctors, nurses, lab technologists and a health visitor. We provide clinical evaluation, treatment and follow-up of patients at the facility and in the community.
  • Counselling: A team of counsellors and peer educators, routinely provide one-on-one and group counselling sessions to support our clients overcome personal challenges and promote adherence to program interventions.
  • Monitoring and Evaluation: This comprises a biostatistician, a data manager, data entrants and data clerks who transcribe data, manage records and monitor and evaluate the progress of the program.
  • Support staff: A driver and runners support the program to smoothly and efficiently conduct the above services.

Services

HIV Care and Prevention

PMTCT: Provision of Prevention of Mother to Child Transmission (PMTCT) services remains core to our program implementation given that Kawempe National Referral Hospital only provides specialised obstetric, gynaecological and paediatric services and is also among the busiest Maternal and Child Health (MCH) units in Uganda. The program aims at eliminating mother-to-child transmission.

Annually, over 15,000 pregnant women attend Antenatal Care (ANC) for the first time and of these women, more than 99.9% receive same-day HIV results. 7.3%  of these are HIV positive and receive lifesaving Antiretroviral (ARVs) drugs. An additional 21,000 pregnant women are screened for HIV at labour, at delivery and in the post-natal period.

Male partner engagement is critical to the uptake and retention of women in the PMTCT cascade. The program provides male-friendly services that include:

  • Invitation letters to partners of women attending ANC
  • Expediting services for couples attending ANC and Antiretroviral Therapy (ART) clinics
  • Provision of male-friendly clinics beyond the working hours in ANC and at the maternity unit

With these interventions, our program has recorded a significant increase in male partner attendance and reduced Mother-to-Child-Transmission rates. Lost to follow-up, new HIV infections during pregnancy and the breastfeeding period remain key challenges to achieving the elimination of mother-to-child transmission of HIV.

HIV testing: The program implements high-yield approaches for HIV case-finding, both at the facility and in the community. These include index testing, social network testing, and targeted testing for high-risk populations. Over 45,000 clients are tested annually and those identified with the HIV infection are linked to our care program

Care and Treatment

Care and Treatment: The program provides comprehensive HIV/AIDS care to about 4,000 clients at our ART clinics located at MU-JHU Research house and Kawempe National Referral Hospital. The complementary services that come with this care include:

  • Routine counselling,
  • Monthly psychosocial meetings to improve on patient adherence, support disclosure and fight stigma,
  • Monthly nutritional demonstrations for mothers of HIV-exposed and HIV-infected infants
  • Community follow-up.

The Care and Treatment services are offered through a Differentiated Services Delivery model, as streamlined by the Uganda Ministry of Health. Through these interventions, the program has been able to reduce patient overload at the clinic, reduce patient waiting time and improve retention in care and viral-load suppression among adults. Achieving viral-load suppression among children and adolescents remains a challenge.

Services for Victims of Sexual and Gender-Based Violence (SGBV)

The program provides staff training, HIV testing, counselling, Post Exposure Prophylaxis and referral for additional supportive care to victims of SGBV.

Health Systems Strengthening

The program supports the use of Electronic Medical Records (EMR) using the UgandaEMR system for integrated Maternal Child Health (MCH) and HIV services at Kawempe NRH. This was first implemented as a pilot project in 2016 and later scaled up in 2020. The program was the first to use the UgandaEMR for MCH services at a high-volume public health facility improving MCH services through the provision of consistent, real-time, accurate, longitudinal data that is easily available to support patient care, monitoring and evaluation and for planning. It’s currently funded by EDCTP through the PREPARE Project and the CDC/PEPFAR grant through the HIV Program.

MU-JHU onsite staff in 2016

Past Programs

Academic Community Partnership (ACP) Grant

MU-JHU established Community Advisory Boards (CABs) in order to involve the community in the Prevention of Mother to Child transmission of HIV (PMTCT) programs and obtain in-put to HIV prevention and care research. The 3 year Academic – Community Partnership (ACP) grant was awarded to MU-JHU in 2009 by the National Institutes of Health (NIH) through the Eunice Kennedy Shriver Institute of Child Health and Human Development (NICHD).

The grant engaged the academic (post doctoral students, researchers, senior scientists and policy makers from the Ministry of health and Ministry of gender, labor and social development and local community (mothers, fathers, disabled, refugees, teachers, VHTS) in HIV/AIDS, maternal and paediatric health research, development and implementation with an objective of obtaining community perspectives for health disparities, gaps and research priorities. It was the only ACP grant outside the United States of America. All other ACP grants were based at US Institutions. It was awarded under the NIH “Limited Competition for Academic – Community Partnership Conference Series” mechanism. The Principal Investigator of the award was Henry Tumwijukye and the Co – Investigator is Teopista Nakyanzi. The Program Specialist from NIH/NICHD was Dr. Regina James and the study coordinator Isabella Birungi-Byarugaba.

The ACP award offered MU-JHU yet another opportunity to further involve the academic and local communities in working together in the processes for designing the research agenda as well as raising the level of community participation and appreciation of biomedical or behavioral research and research outputs.

The ACP grant aimed at bridging the gap between the academia/scientific researchers’ and the local communities in which research is conducted. In particular, the project intended to enrich and diversify the research development processes through:

  • Raising the level of community participation in and appreciation of biomedical and/or behavioral research focus, process and outputs
  • Enhancing participation at all levels (community, district and national) in the setting of research agenda in pediatric and maternal HIV prevention interventions
  • Increasing innovation and effectiveness in dissemination of research results and their implications; to inform and influence necessary action at all levels (national, district, community, household/family and individual.

This conference series grant had a series of meetings, seminars and workshops involving with the Academic and local partners independently and later a joint meeting to synthesis ideas on what the health disparities were. It was from these meetings that consensus was reached to obtain information about health disparities and gaps from the grass root communities. A community survey was then carried out in Mpigi and Kampala district using CBPR techniques to obtain information. As we come to the end of the grant period, we have been able to;

  • Better understand the communities, their research needs, health disparities, priorities and interest areas in Research and Development
  • Identify appropriate techniques for dissemination of research information to the different community stratum
  • Documented the process of involving the different facets of the communities in research using CBPR techniques
IEARDA

The IEARDA program was one of the programs at National Institutions of Health (NIH), administered through Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) with an aim of exposing Universities Research institutions  to the internal Grant application processes at NIH. The idea was that these Institutions can then be able to successfully manage NIH grant application processes, funding mechanisms and awards.
This IEARDA program awarded to MU-JHU was designed to benefit 5 Offices of Research Development (ORDs) within the Makerere University School of Medicine, the Joint Clinical Research Center (JCRC), the Infectious Diseases Institutes (IDI), Makerere University Case Western Reserve University Research Collaboration (MU- CWRU)  and MU-JHU Care Ltd. Other partners have since developed working collaborations. These include Mbarara University of Science and Technology, Baylor College of Medicine Children’s Foundation, Uganda, Nsambya Hospital, Gulu University and UCSF among others.

Aim:

The IEARDA program was coordinated at MU-JHU Research Collaboration and aims at developing a cadre of Grant Administrators and upcoming Scientists that can facilitate/incite faculty staff and Investigators to actively engage more in biomedical and behavioral research.

Major Activities of the IEARDA Program:

  1. Training and capacity building focusing on grantsmanship training and development for upcoming scientists
  2. Creation of a Grant Resource Center hub providing grants materials and training tools.
  3. Providing other grant support services for several other grant offices and Institutions affiliated to the Medical School
  4. Technical support in the development of appropriate IT infrastructure at the core stakeholder ORD offices  that can be used as a focal point for accessing and dissemination of grants information to other ORDs
  5. Supportive capacity enhancement for appropriate finance and accounting IT system across the ORDs that can facilitate management of awards, generate receipts or financial statements in a consistent manner, and handle the requisite financial and compliance reports

The IEARDA Program Planned design:

  • Turned the ORD office at MU-JHU into an ORD Secretariat and coordinating centre for grants support
  • Developed a core team of highly knowledgeable grant managers, trainers and support staff from the affiliate ORDs
  • Used this core team to manage all aspects of grant application processes and awards
  • This plan was constructed on a foundation of a uniquely collaborative, highly successful but decentralized system which exists within the Makerere University School of Medicine and other Research Institutions

Operational Structure of the IEARDA

There was an Advisory Board that provides general guidance to the Secretariat especially in shaping the directing the training program as well as management aspects of grant;

  • The Advisory Board comprised of CEOs or designates of the 5 Affiliate Institutions
  • Provided logistical & infrastructural support to the ORDs i.e. space, personnel, IT support & software, etc,
  • Approved/allowed sufficient time to the members of the Secretariat for the IEARDA functions
  • Identified personnel from the institutions that would  be involved in the training
  • There was a Secretariat that provided day to day and operational support to the IEARDA training program;
    1. Comprised of Grant Administrators from the 5 affiliate Institutions of Makerere University Medical School
    2. Acted as focal persons for the respective affiliate Institutions regarding IEARDA activities
    3. Participated in all the grants’ training programs under the IEARDA
    4. Chaired by the Principal Investigator
MTCT Plus

All eligible women (and their infected partners and children) from the PMTCT program at Mulago Hospital were provided with a range of healthcare benefits, including diagnostic HIV testing for the families, ART, prophylaxis of important infections, such as septrin, TB, and cryptococcal meningitis, and treatment of acute opportunistic infections.  Family members not on ART visited the clinic every 3-6 months, and those on ART had monthly clinic visits. 

In recognition of the fact that HIV is not simply a medical problem, MTCT-Plus offered nutritional support in partnership with the World Food Program and provided patient education, counseling and psychosocial support to the entire family.  In these efforts to provide great emotional support, our Peer Psychosocial Support Group provided support through income generating activities, a music, dance and drama group, a children’s peer support group, and the training of peer educators to provide support and help in the clinic.

Call To Action: PMTCT and PMTCT Follow-Up Clinic

In 2000, the Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) granted Mulago Hospital a five-year Call to Action PMTCT Grant to provide funds to test 30,000 women per year for HIV.  Pregnant women attending Mulago antenatal clinics for HIV/AIDS are screened and given to test 30,000 women per year for HIV.  Pregnant women attending Mulago antenatal clinics for HIV/AIDS are screened and given appropriate counseling as well as access to nevirapine to reduce the risk of mother to child transmission of HIV (MTCT).  The initial PMTCT grant was renewed for an additional two years, with the recognition that women who tested positive through the antenatal clinics should be given an avenue for treatment, leading to the opening of the new PMTCT Follow-Up Clinic on July 6, 2006, run jointly by MU-JHU and Mulago Hospital and with USAID funding through EGPAF.

Objectives

  • To provide all women attending Mulago antenatal clinics with the opportunity for HIV testing and counseling.
  • To prevent mother to child transmission of HIV by providing mothers who test positive at Mulago antenatal clinics with a single dose of nevirapine for PMTCT.
  • To provide comprehensive health care, including ART, at the PMTCT Follow-Up Clinic for the entire family of mothers who test positive at the PMTCT Clinic.

For more information, contact us at  partnerships@mujhu.org