Providing
the information and services the community needs regarding
HIV, AIDS and TB
The
prevalence of HIV in Uganda is monitored by the Ministry
of Health, the AIDS Control Programme and on the government's
behalf by UNAIDS, PEPFAR and UNGASS. HIV counselling and
testing services are the main sources of information on
new infections, the socio-economic character of those
being tested and also their other health practices and
conditions. Hope Clinic Lukuli, being a general practice
facility, is better suited than a HIV testing-only site,
or a maternal health site without HIV services, to provide
a broader population from which to determine barriers
to accessing services and the proportion of people tested
who are found as HIV positive. A key message we have learned
from the clients is that the past barriers to accessing
information on HIV, AIDS and TB - distance, stigma-laded
clinics, cost - has meant that many people are visiting
Hope Clinic because of our mobilisation work and style
of services rather than due to a recent 'risk event'.
Our monthly
reporting statistics to the Government show that even
after five years of free to client services, 7-11% of
the people who visit for counselling and testing are identified
as having HIV. In the first few years our prevalence (positive
test results / all clients tested) was regularly in the
11-16% range. Our removal of barriers to counselling and
testing distances and costs PLUS the assurance of reliable
access to information, care, support and necessary treatment
reassured the community.
Hope
Clinic Lukuli is a sustainable provider of services that
works with government and Uganda's development partners
to achieve the national health strategy. Whereas donor
projects open, deliver a specific service and close, we
host their services and manage a continuing comprehensive
package of HIV and TB related services.
TB
in Uganda is widespread. Broadly speaking, TB can be carried
by a person (who is therefore infected) but the TB is
not active (it is latent). Avert.org
describes the various conditions:
"A
person can have active or inactive (sometimes called latent)
tuberculosis. Active tuberculosis or TB disease means
the bacteria are active in the body and the immune system
is unable to stop them from causing illness. People with
active tuberculosis in their lungs can pass the bacteria
on to anyone they come into close contact with. When a
person with active tuberculosis coughs, sneezes or spits,
people nearby may breathe in the tuberculosis bacteria
and become infected. People can also be infected with
tuberculosis bacteria that are not active in their body.
If a person has latent tuberculosis, it means their body
has been able to successfully fight the TB bacteria and
stop them from causing illness. People who have latent
tuberculosis do not feel sick, do not have symptoms and
cannot pass tuberculosis on to other people. In some people
tuberculosis bacteria remain inactive for a lifetime without
becoming active. But in some other people the inactive
tuberculosis may become active tuberculosis if the person's
immune system becomes weakened - for example by HIV"
The
2009 UNGASS report 'Country Status Report' considered
the available surveys from 2005 to 2007 and noted gaps
in the coordination of HIV, general health services and
TB. Hope Clinic Lukuli has sought integration with government
TB programmes and the TB CAP project but the focus has
been on government-staffed facilities. UNGASS noted: "TB
services, diagnostic services were available at 97% of
the hospitals, 98% of HC IV, 50% of HC III, and 9% of
HC II while treatment and follow up was available at 93%
of hospitals, 98% HC IV, 70% of HC III and 11% of HC II."
A challenge facing expanded coverage is that people with
coughs, and people who see others with coughs and might
be able to bring them for screening don't go to hospitals,
or large district-level HC-IV facilities. They do go to
maternity sites, fever management sites and the non-government
facilities near their community.
The
US Government's PEPFAR
response to TB has sought to improve the available
testing for TB among the HIV positive population and then
the commencement and continued DOTS policy. With financial
support to Hope Clinic Lukuli, our community network could
mobilise patients with apparently active TB to be screened
and, with the HIV patients who we already screen, ensure
greater coverage of the population in Makindye Division.
The
thirty years of AIDS has seen great development of policy,
with it being more clearly informed by affected populations.
The partnerships have years of experiences to draw from.
The current challenge is to get the funds to the last
organisations that serve the people. Hope Clinic Lukuli
uses Support, Training, Infrastructure, Community Catalysts
and Knowledge to design and deliver the comprehensive
HIV and AIDS services that Makindye needs. We do it for
and with government, our clients benefit from UNITAID,
Global Fund, CHAI, national taxes and US PEPFAR resources.
As
the world marks #AIDS30 and the UN GA HLM #AIDS2011 meets
in June 2011, the civil society organisations that get
on with the work should be considered. Advocacy has shaped
the Policy, The Global Fund, PEPFAR and innovative financing
like UNITAID are funding the Partnerships. The People
are the clients to be, the patients on the register, the
community they live in and the community-based health
providers that they already rely upon for fever management,
maternal health and childhood healthcare. If you would
like specific examples and statistics, follow the links
on the left above or email
the Director
