Towards an AIDS Free Generation in Uganda Programme - Summary Progress Report July-December 2015

With an estimated 193,500 children under the age of 14 years living with HIV and more than half not yet into care in Uganda, ICCO Cooperation is implementing a two year project towards reducing the number of new HIV infections among infants in Uganda.

This report provides a summary of achievements, challenges, and lessons learnt in the first year of the Towards an AIDS Free Generation in Uganda (TAFU) programme. The programme aims to reduce the number of new HIV infections among infants and to increase the number of HIV-positive children on treatment in 5 districts in Uganda. It seeks to achieve this by mobilising communities to address barriers to testing, treatment, and adherence, and by creating awareness around paediatric HIV treatment and the specific needs of children living with HIV. The programme is being implemented by ICCO Cooperation together with a range of local and international partners: Community Health Alliance Uganda (CHAU), Health Need Uganda (HNU), Deliverance Church Uganda-The AIDS Intervention Program (DCU-TAIP), The National Forum of People Living with HIV Network in Uganda (NAFOPHANU), Pentecostal Assemblies of God - Karamoja Integrated Development Program (PAG-KIDEP), and STOP AIDS NOW!.

The programme focuses on how best to link the community-based health promotion and mobilisation activities with the health facility-based services using the following 3-fold approach:

• Empowering 3,500 HIV-affected families socially and economically to retain mothers and children into care, and mobilising support for families with children living with HIV.
• Mobilising communities in 5 districts to address barriers to testing, treatment, and adherence, and creating awareness around paediatric HIV treatment and the specific needs of children living with HIV.
• Strengthening tracing and referral and follow-up systems for HIV-positive women and children especially at lower level health systems, and improving coordination between village health teams and health centres.

The report highlights the progress of the project related to specific outcomes and outputs identified for each of these approaches. The following are just a selection of achievements of the programme with a special focus on communication:

In relation to the first approach to get mothers and children into care, the programme sought to support and strengthen open dialogue and support between spouses in households caring for HIV-positive children. The project trained 99 local leaders, health workers, and people living with HIV (PLHIV) to enable them to effectively communicate with couples. The purpose of this training was to enable them to promote healthy relationships among couples and their children, as well as promote HIV/AIDS status disclosure and couple HIV testing.

Related to the second approach, in order to mobilise communities and address barriers to testing, treatment, and adherence, the programme sought to sensitise the community about the importance of paediatric care/prevention of mother to child transmission (PMTCT) through public awareness activities. A total of 19 community dialogue meetings were held with village health teams (VHTs) and local leaders, and these mainly focused on paediatric HIV, eliminating mother-to-child transmission (EMTCT), and the importance of antenatal care (ANC).

In addition, community leaders (local and religious leaders) were trained on effective communication with couples and were made aware of the important role they play in: mobilising families and children to go for HIV testing and treatment; addressing, through community dialogues, HIV stigma and discrimination in their communities; and encouraging HIV status disclosure among couples. So far, 54 community leaders are actively involved in mobilising their communities for testing and treatment referrals.

In relation to strengthening tracing and referral systems, one of the programme partners, CHAU, developed a manual for VHTs on paediatric treatment guidelines, and shared it with all TAFU implementing partners. Using the manual, 174 VHTs were identified and trained on peadiatric HIV/AIDS treatment and care, referral mechanisms, follow-up and home visits, and data management, among other topics.

The following are some of the lessons learned outlined in the report:

• There is still a big knowledge gap between HIV and tuberculosis (TB) among health workers. As orientation and mentorship for health workers is carried out, this should be emphasised, as there is a big correlation between HIV and TB.
• Community schools, churches, public health facilities, VHTs, and retired health workers (village clinics) play a significant role in the health care and treatment in communities. Working with these structures has helped the programme reach out to the community.
• With technical support, village health groups (VHGs) can be developed into village/community schemes that can provide social and economic protection to HIV-positive mothers and children.
• Greater involvement of women living with HIV/AIDS helps in mobilisation and to increase the number of people turning up for health services.
• Involvement of senior men and women teachers in caring for children living positively reduces stigma in schools.
• Schools are one of the best avenues to approach and follow up on children living with HIV, since they spend most of their time at school.
• Resource persons like the religious and local leaders within the community are the best persons to address barriers within communities since they have a lot of credibility in the community.

The report also outlines some of the promising practices emerging from the programme. These include, amongst others, teasing out issues that stand out at programmatic and advocacy levels to inform programming. For example, the following was raised by CHAU: Most health workers lack specific paediatric HIV information; there is the need for a sensitisation campaign on male involvement in ANC in health centres; and there is the need for a sensitisation campaign on status disclosure, since it helps increase the number of positive pregnant mothers and child enrolment into EMTCT and paediatric care. In addition, community mapping and a thorough understanding of the community, as was done by HNU, helps to understand the community better and makes mobilisation for services easier.

One of the challenges encountered by the project was the fact that there is still a lot of stigma and discrimination of people living with HIV within the community. The project addressed this by conducting community dialogue meetings to address HIV stigma and discrimination.

The report ends with a number of recommendations which are mainly around logical and service-related issues such as staff support and transport.