Implementing Uganda’s HIV Test & Treat policy

Dec 07, 2021

Four years after Uganda adopted the policy, we have had remarkable successes as the country has seen a gradual increase of people living with HIV on treatment

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Admin .
@New Vision

By Winifred Ikilai

Orphaned at the age of six years, Winifred Ikilai lost her dear mother to AIDS in the late 90s when the HIV pandemic ravaged the country.

By then, HIV treatment did not exist and was a mystery for many. Only those who could afford millions for the monthly dose survived. But her mother was among the unlucky left only to die in her ancestral home.

The journey to treatment for all was one that many did not live to witness. Following scientific research, the effectiveness of treatment (ARVs) as prevention was demonstrated in the 2011 landmark study HPTN052. The study demonstrated that early ARV treatment for newly diagnosed individuals helped those living with HIV reduce their viral load to undetectable levels, thereby reducing the likelihood of transmission to HIV negative partners by nearly 100 per cent. This was the inception of the U=U (Undetectable = Transmittable) campaign that we know of today. U=U maintains that viral suppression helps keep those living with HIV healthy while also preventing transmission to HIV-negative sex partners. Put plainly, it means that someone who is living with HIV and is using ART to maintain an undetectable viral load cannot transmit the virus to their partner.  

Uganda then took on this Test and Treat policy in November 2016, following the World Health recommendation that all people newly diagnosed with HIV start ART as soon as possible in order to preserve their health and decrease community viral load, which subsequently reduces the rate of new HIV infections in Uganda.

Four years after Uganda adopted the policy, we have had remarkable successes as the country has seen a gradual increase of people living with HIV on treatment. Of the 1.4 million people living with HIV in Uganda, 89% are aware of their HIV status, of those that are aware of their status, 94% are on HIV treatment and 90% of which are virally suppressed.  

However, despite this success, there remain key concerns among people living with HIV from the community. These concerns were raised during a recent national dialogue on Test & Treat in Kampala. Networks of people living with HIV, including civil society organizations, have reported that there are gaps in the way the Test and Treat policy is being implemented and that these discrepancies may negatively impact the gains we have made in combatting HIV in Uganda.  

On paper Test & Treat sounds great, but how prepared are those living with HIV to engage in lifelong treatment? In many cases, people are not adequately prepared to do so.  One of the greatest challenges is that most of our healthcare settings do not have qualified, trained professional counsellors. There are very few counsellors in Government aided health facilities as the Ministry of Health staffing structure does not incorporate them. The burden falls on HIV positive clients commonly known as expert clients and linkage facilitators to provide psycho-social support. You will find a few in Organizational model facilities supported by implementing partners such as TASO, Uganda Cares, Mild May and Joint clinical research centre, states a recipient of care. This is enormously consequential as mental and emotional health play a critical role in drug adherence and reducing stigma among those living with and at high risk for HIV. 

Mr Omoding Tom from Kumi district PLHIV Forum puts it plainly:

“We have very few or even no social workers best suited to offer quality counselling services. What usually happens is that when someone walks into a facility, they are given the routine counselling and given a Start pack (ARVs to start with) before they even accept their status because the “Test & Treat policy” is all about same-day initiation. What people do not understand is difficult to come to terms with being HIV positive.”

 

The question is how immediate is immediate? I believe that a human rights component and patient-centred approach beyond looking at clients as mere recipients of care, should be implemented in HIV-related policies. For the Test and Treat policy to work best, the following must be considered.

  1. We must shift from Test & Treat to Test, Treat & Retain. The Ministry of Health should offer new guidance to the health service providers (including implementing partners) to ensure that clients are prepared to adhere to their daily ART regimen by providing them with the support of counsellors. If someone is not yet ready to be initiated let us work with the person by preparing them well enough to initiated on treatment.
  2. In addition to counsellors, we should have treatment and retention facilitators. For example, when HIV treatment was first introduced in Uganda, a person was asked to come with a treatment buddy and both could undergo thorough counselling. Treatment literacy was also prioritized and included home-based care and follow up. This worked efficiently before and should be re-introduced.
  3. If someone is tested and they are found to be positive, they should be offered a counsellor immediately. They should be supported emotionally and mentally and introduced to the benefits and side effects of ART. They should be supported to take the time they need to be ready to start treatment. 
  4. We need to ensure uninterrupted access to HIV treatment. The 6 multi-months drug refills have worked well for most clients and should be functionalized through the differentiated service delivery model.
  5. Treatment literacy materials should be disseminated at both the health facility and household level.

If we are to achieve our 95-95-95 and attain our goal of ending HIV by 2030, we must work together to ensure that psychosocial support services are provided to people living with HIV Personally, the support I have received has helped me maintain adherence to my HIV medication. All Ugandans should be offered this support, says Dr Watiti Stephen the Chairperson of the National Forum of PLHA networks in Uganda. Sometimes people give up! Sometimes they develop side effects like some of our friends who have developed diabetes. They need to be counselled and supported emotionally for them to sustain this treatment.

HIV treatment comes with a lot of benefits including reduced risk of transmission from mother to child, partners in discordant relationships and generally community prevention.

Therefore, the Ministry of Health, Uganda AIDS Commission, Development partners and HIV service providers should take into consideration community voices seeking policy reform if our target of ending AIDS is to be achieved soon.

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