Sustaining gains made in the HIV response as we fight Ebola
Nov 11, 2022
The COVID-19 pandemic has shown that diverted attention, funds and lockdowns have had a dire impact on our fight to end AIDS.

Sustaining gains made in the HIV response as we fight Ebola
Admin .
@New Vision
By Jackie Makokha and Nelson Musoba
History has taught us that pandemics and world crises often weigh heavily on health systems. Now, as African countries recover from COVID-19, we find Ebola threatens to interrupt essential HIV services.
While the evolving Ebola epidemic in Uganda calls for continued and sustained intervention, it is imperative to integrate the fight against HIV into the Ebola response fully. Lessons from the HIV response can also help to inform the response to Ebola.
The COVID-19 pandemic has shown that diverted attention, funds and lockdowns have had a dire impact on our fight to end AIDS.
A UNAIDS report titled A Pandemic Triad shows COVID-19, the debt crisis and the Ukraine war deepened the fiscal crisis of developing countries, severely undermining their capacity to invest in health.
UNAIDS research further shows that domestic funding for the HIV response, which had been growing significantly in low and middle-income countries, has fallen now for two consecutive years (by 2% in 2021 compared to 2020).
In Eastern and Southern Africa, clinic visits decreased by more than 50% and the risk of patients running out of antiretroviral therapy on a given day increased from 5% before the COVID-19 lockdown to 25% in countries such as Uganda and many others across the region.
Key populations, women, children and people living with chronic diseases, such as HIV, bear the brunt of crises.
The COVID-19 pandemic exacerbated shadow pandemics–resulting in a 30-60% jump in unwanted teenage pregnancies in many countries on the continent. UNPFA data shows that over 35400 teenage pregnancies in Uganda were registered in 2020, and almost 197000 in the first six months of 2021.
Apart from COVID-19, the Ebola outbreak in Uganda is unfolding against a backdrop of other public health emergencies including a nutrition crisis in the Karamoja region, the impact of recent floods and mudslides, Rift Valley Fever, yellow fever, malaria and measles outbreaks and a recent confirmed case of Crimean Congo Hemorrhagic Fever (CCHF) that is also burdening further community health systems and other social coping mechanisms.
These crises could adversely impact HIV treatment, viral load tests, mother-to-child transmission of HIV, and early infant diagnosis of HIV among other essential and basic health care for the approximately 1,400,000 people in Uganda living with HIV, if not mitigated.
Therefore, it is vital that the Ugandan Government, policymakers and development partners support communities of people living with HIV and at risk of HIV to ensure that gains in the HIV response are sustained at this critical moment.
Communities are the backbone of responding to pandemics and epidemics at every level. It is imperative that multi-sectoral partners put communities first to ensure that prevention and treatment continuity work is ongoing, particularly for key populations, girls, and children.
Community-led monitoring, women-led and key population-led organizations need to be premised and equipped to monitor the continuity of HIV services and act swiftly when required. Community leaders also play a pivotal role in our fight against HIV and in containing the Ebola outbreak in the affected and at-risk districts.
The unfortunate and fatal occurrence of a man succumbing to Ebola in Kampala after consulting a traditional healer provides a sobering lesson about the importance of collaborating with community leaders. Lessons learned from addressing HIV where traditional, religious and cultural leaders together with people living with HIV were at the frontline of a community-driven response. Traditional and faith leaders play influential roles in our communities and it is important that we integrate them into any planned activities.
It is important that we continue mobilizing and sensitizing religious and faith leaders to promote evidence-based medical interventions for HIV and Ebola.
Furthermore, dangerous practices such as the exhumation of bodies even for the purposes of carrying out religious rights show the communication gaps between communities and health workers. This allows us to simplify and enhance our communication with communities.
While the onset of COVID-19 exposed inequalities and gaps in our health system, it also provided innovative interventions that we can model today. COVID-19 also tested Uganda’s service delivery models and refined them.
The Fast Track Anti-Retroviral Refill approach and the home-based ARV refill approach were conventional approaches that enabled many of those who were on treatment to continue without worrying about stock-outs during the COVID-19 lockdowns.
Through the Fast Track Anti-Retroviral Refill approach, people living with HIV on treatment were allowed to stock up to three months' rations of the required dosage, limiting frequent interactions with health workers.
]On the other hand, with the home-based ARV strategy, people on treatment would receive their drugs at home through a network of peers who worked on a voluntary basis. This peer network is currently active in the Ebola-restricted districts of Mubende and Kassanda.
A non-pharmaceutical intervention included leveraging the use of mobile phone technology for HIV care and peer-driven ARV refill strategies were some of the innovations that helped to sustain people on treatment during the COVID-19-related lockdowns.
Mobile phone technology is a powerful tool in Uganda, a country where about 65% have mobile phone subscriptions, according to the Uganda Communications Commission.
Mobile phone technology proved successful in HIV care, treatment and support during the COVID-19 restrictions and is still being relied upon during the Ebola outbreak.
Notably during COVID-19, those already on treatment and who needed adherence support were encouraged to use mobile phone counselling. The counseling was also extended to individuals who needed general counseling. Health workers can continue to leverage mobile phones to offer counseling, call and remind clients about specific appointment dates and offer health care advice.
As we fight the Ebola outbreak, we need to keep our promise of ending AIDS for all by 2030. To do this, we need to learn from recent crises, collaborate to maximise our efforts and most importantly, put people at the centre of all we envisage to achieve.
The writers: Jackie Makokha is the UNAIDS Country Director for Uganda and Nelson Musoba is the Director General of the Uganda AIDS Commission