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

1. Capacity building in scaling up Pediatric HIV care: A case of Uganda Geoffrey Taasi, STD/ACP, Ministry of Health, Uganda Uganda STD/ACP, MOH

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

3. Background 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. Uganda STD/ACP, MOH

4. Description • 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 Uganda STD/ACP, MOH

5. Key Interventions & resources 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 Uganda STD/ACP, MOH

6. Evidence of successes and achievements 1 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) Uganda STD/ACP, MOH

7. Evidence of successes and achievements 2 • 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 Uganda STD/ACP, MOH

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

9. Paediatric HIV coverage was 33% by March 2012

10. Challenges and counter strategies 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

11. Lessons learnt 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

12. Conclusions and recommendations • 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

13. Acknowledgements • 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,,,,) Uganda STD/ACP, MOH

14. Thank You Very Much! Uganda STD/ACP, MOH