Situation of HIV/AIDS services in Karamoja

1. Situation of HIV/AIDS services in Karamoja

2. Introduction • 1M people infected with HIV. • 110,000 children <15 years • Estimated 135,000 new infections in 2007 (25% were due to MTCT) • Estimated 153,000 people on ART. (Less than 10% of patient on ART are children). • Other than the low prevalence, HIV/AIDS indicators in Karamoja are poor.

3. Introduction cont Prevalence of HIV • Estimated regional prevalence stands at 3.5% • Variation from 1.9 in Nakapiripirit to 5.6 in Abim district. • Projected PLWHA in Karamoja is 35,000.(at 3.5% prevalence rate)

4. Situation of HIV/AIDS PMTCT • MTCT contributes to 15% of all HIV infection • PMTCT is an entry point of treatment care and support • There has been an increase in geographical coverage of PMTCT/EID services in Karamoja

5. PMTCT Coverage by level • HSSP II, the national PMTCT programme aims at scaling up services to 50% of HC IIIs by 2010 and improving quality of services with particular focus on postnatal care. • By Dec 2008, health facilities providing PMTCT was as shown in the table below.

6. District performance • The widening gap between ARV prophylaxis coverage for mothers and infants is a real concern. • In all the districts the gap is higher than 50%. • Impact of PMTCT is maximal when both mothers and infants receive ARV prophylaxis. Key question is • r

7. Comprehensive HIV care and support • Service delivery facilities • Matany hospital • Moroto hospital • Abim hospital • Kaabong hospital • Kotido HC III • Tokora HC IV

8. Comprehensive HIV care and support Cotimoxazole uptake. • 43% reduction in mortality with Cotrimoxazole • 23% reduction in hospital admissions with Cotrimoxazole • With antiretroviral therapy, survival out comes are good (but we are treating older children ‘survivor bias’) • 75% reduction in mortality if treatment started on diagnosis in first year of life (South Africa) • Resource-poor setting also reporting survival into adulthood of children infected perinatally • Co-trimoxazole prophylaxis (CPT) uptake among HIV exposed children - remains low.

9. HCT/ART uptake < 5 years Children

10. DBS Performance

11. HCT/ART adult females

12. HCT/ART Adult male

13. Key concern • Quality of services • Very few health workers have been trained • Single dose vs Combined dose. The Programme is still largely using single dose nevirapine for PMTCT due to lack of trained health workers. • Logistic management • Limited support that is provided to HIV positive clients including mothers who would have otherwise opted not to breastfeed.

14. Key concern Training • There is an overwhelming need for refresher trainings and training new staff in line with the revised PMTCT policy guidelines

15. Key concern Monitoring and Evaluation • Whereas timely reporting has improved, it is still unacceptably low. • Submission of monthly reports to the MoH • Many districts are still using the HMIS other than the monthly PMTCT reporting format

16. Recommendations / Way Forward • Strengthening planning, implement and monitor HIV/AIDS care services, PMTCT and infant feeding counseling services. • Capacity building. • Invest in information management • Update and streamline the logistics management system

17. Discussion