Uganda has made tremendous progress in combating the HIV and AIDS epidemic with a decline in the prevalence from 18% in the early 1980s to 7.3% in 2011; and further decline to 6.0% according to the last AIDS Indicator Survey. This has been as a result of the implementation of the National HIV and AIDS Strategic Plan (NSP 2015/16 – 2019/20).
There has been a change in policy in HIV testing and enrolment into care; Uganda adopted the WHO guidelines on testing and treating where all individuals testing HIV positive are started on ART irrespective of their CD4 status clinical stage and age. A number of policy reviews have been undertaken and improvement in the implementation guidelines in the HIV response achieved.
There are 17 Sustainable Development Goals (SDGs), and SDG 3 focuses on health. It emphasizes achievement of “Good health and well-being”, i.e. end the AIDS epidemic by 2030, end tuberculosis, malaria and neglected tropical diseases as well as combating hepatitis, water-borne diseases and other communicable diseases.
The United Nations General Assembly of 2016 reaffirmed the commitment to end the AIDS epidemic by 2030. Similarly, at Country level, Uganda in June last year launched the Presidential Fast track Initiative to end AIDS as a Public Health Threat in Uganda by 2030. This is a legacy to present to future generations; to accelerate and scale up the fight against HIV, and end AIDS.
Overall there was scale up of Prevention of Mother to Child Transmission services with 95% of mothers accessing PMTCT services and as a result there has been reduction in child infections and lowering the Mother-To-Child Transmission (MTCT) rate to below 5%. This implies that Uganda is on track towards elimination of Mother to child Transmission of HIV. There was intensified scale up of SMC services with an increase in coverage from 26% in 2011 to 43% by end of 2016.
There has been an increase in uptake of HIV Testing Services though there still gaps in linkage of those who test HIV positive for care and Treatment services. The positive trend in PMTCT with 86% coverage has a hiccup the lost to follow up of the mother-baby pairs with 57% at first PCR and 36% at second PCR. This means that only 32% of the HIV Exposed Infants complete the cascade.
Under the care, treatment and support, Uganda adopted and launched the WHO 2016 ART guidelines that have in part contributed to scale up of ART services. By end of June 2017 over 1 Million people were receiving Ant-Retroviro Therapy (ART) giving coverage of 67%.
Under Social support government has taken lead through the Operation Wealth Creation (OWC) targeting Orphans and other vulnerable children (OVC) and vulnerable persons, Social Assistance Grants for Empowerment (SAGE) targeting the elderly and the Youth Livelihood Program (YLP) targeting the youth, this support is complimented by support from the CSOs.
Under systems strengthening there are 69% of public-sector positions are currently filled. 45% of the private sector has HIV work place policies and the HIV financing has been over and above the estimated cost with USD 651,661,433 in 2016/17 against the estimated cost of USD 632,600,000.
The Goal of HIV prevention is to reduce the number of new youth and adult infections by 70% and the number of new pediatric HIV infections by 95% by 2020. Through implementation of the combination prevention strategies that focus on adoption of safer sexual behaviors, scaling up bio medical interventions and HCT as well as addressing the underlying social-cultural drivers of the epidemic. The activities carried out to achieve the objectives include Behavior Change Communication (BCC), HIV Testing and Counseling (HTC), Prevention of Mother to Child HIV Transmission (PMTCT), Safe Male Circumcision (SMC), condom promotion and provision, activities for key population.
HIV prevention aims at: Reducing the number of new HIV infections, increased coverage and utilization of prevention services, increased adoption of safer sexual behavior and reduction of risky behaviors
There have been several achievements under the prevention thematic area. 1188 teachers trained on PIASCY which is a BCC program in primary and secondary schools, MoH has been able to disseminate guidelines for mitigation and prevention of teenage pregnancy and HIV in school setting.
There active post-test clubs in the communities: Community dialogues conducted in the community 10,756,247 including PMTCT mothers HIV tests conducted of whom 37% first time testers and 31% tested as couples. HIV positivity rate 3% HTS linkage to care out of 256,529 HIV positive 220,431 (78%) linked to care 44 districts (37%) achieved the recommended 90% link to care new districts doing very well in linkage to care.
The cultural institutions are using different avenues to ensure that all people get the HIV information. 3241 facilities with PMTCT services 95% mothers testing in ANC and 31% male partner testing 1% MTCT transmission at 6 weeks 72% of facilities have active FSG PrEP Guidelines completed and data collection tools in development. To be continued.
Namayanja Rose Nsereko