The Estimated Burden of HIV Disease in Uganda, 20052010

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Testing Couples and families in the context of
home-based CT in Uganda Approaches and challenges

Nafuna Wamai Technical Advisor HCT GAP-CDC
Uganda International CT Workshop Lusaka,
Zambia 23 January 2008
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Outline

• Rationale
• Strategies
• Activities
• Lessons learned
• Challenges
• Conclusion

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Rationale

• Increased access to CT for couples and families
• Overcome disclosure challenges
• Opportunity for
• HIV Prevention
• Improved adherence
• Stigma reduction

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Strategies

• Targeted
• Family members of clients in care
• Adult
• Pediatric
• General population
• District
• Region

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Implementation

• Piloted in research settings in 2003
• Recognized approach within revised national HCT
  policy
• Programmatic expansion started 2004
• Implemented by MoH, NGOs, PEPFAR partners

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Activities - 1

• Mobilization
• Households, via index client
• Communities and health units, via CORPS
• Household Education
• Couples mobilized first
• Eligible and consenting clients receive pre-test
  counseling

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Activities -2

• VCT provided by trained lay counselor
• Finger stick testing with 3 test algorithm
• Quality assurance using filter papers

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Activities - 3

• Parental consent for children and adolescents
• Assent for adolescents
• Eligible children identified and provided CT

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Services for HIV-positive clients

• Referral to health facilities for
• Basic Care Package
• Opportunistic infections management
• TB Screening
• ART Assessment
• PMTCT
• Post-test and Discordant couple clubs

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General Population100 door-to-door VCT access
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Implementation

• Trough local NGO
• Implementation team
• 30 counselor/lab tech teams
• 175 part time Resident Parish Mobilizers
• Local health center staff

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Program Objectives

• Goal Reach 250,000 people within two years and
  provide care to those who test HIV-positive
• Target groups Household members gt12 years and
  children at risk of HIV
• Mother HIV-positive or deceased

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Coverage and uptake
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HBVCT Clients Demographics
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Couple HIV- test Results
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Lessons learned

• Feasible and highly acceptable
• Demand for HIV testing is high
• Increased awareness of program eases counseling
  process
• Infected family members identified early and
  benefit from Care/ART
• Discordant couples supported

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Challenges

• Finding eligible clients at home
• Accessing couples in polygamous situations
• Addressing community needs beyond CT and basic
  care
• Counselor skills in counseling couples and
  children
• Access to pediatric client families

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Conclusions

• Unmet need for couples and family CT
• scale-up of approaches
• Opportunity for integrating prevention into care
• Family based approach

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