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CAMPAIGN TO END
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TABLE OF CONTENTS
SECTION 1: INTRODUCTION AND OVERVIEW OF COUNTRY CONTEXT........................ 3
Trends of the HIV epidemic in Uganda....................................................................................... 3
Drivers of the Epidemic in Uganda ......................................................................................... 4
Overview of Paediatric HIV&AIDS in Uganda ............................................................................ 5
SECTION 2: .................................................................................................................................... 6
OBJECTIVE 1; FAMILY CENTRED CARE AND NUTRITION; ................................................ 6
Policy and strategy guidelines in Uganda: .................................................................................... 6
Progress and gaps in PMTCT service delivery to mothers and babies....................................... 7
Growth in PMTCT service coverage .......................................................................................... 8
Beneficiary outcome of objective 1:............................................................................................ 9
OBJECTIVE 2: EARLY INFANT DIAGNOSIS AND TREATMENT............................................ 13
Policy and Strategy provisions in Uganda.................................................................................. 13
Beneficiary outcome.................................................................................................................. 14
OBJECTIVE 3; ACCESS TO APPROPRIATE MEDICATIONS..................................................... 18
Policy and strategy provisions in Uganda .................................................................................. 18
OBJECTIVE 4: FULL FUNDING TO ELIMINATE PAEDIATRIC AIDS. ...................................... 23
Policy and strategy provisions. .................................................................................................. 23
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AIDS Acquired Immune Deficiency Syndrome
ART Anti Retroviral Therapy
CEPA Campaign to End Paediatric HIV/AIDS
CSOs Civil Society Organizations
EID Early Infant Diagnosis
EIT Early Infant treatment
HEPS Coalition for Health Promotion and Social
HIV Human Immunodeficiency Virus
MOH Ministry of Health
NAAP National Advocacy Action Plan
PMTCT Prevention of Mother to Child Transmission
TMAP Treatment Monitoring and Advocacy Project
UNAIDS Joint United Nations for AIDS
UNICEF United Nations Children’s Fund
WHO World Health Organizations
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SECTION 1: INTRODUCTION AND OVERVIEW OF COUNTRY CONTEXT.
Trends of the HIV epidemic in Uganda
The approximately 25 year old epidemic in Uganda started in the 1980’s on the shores of Lake
Victoria in Rakai spreading quickly, initially in major urban areas and along major road network
highway 1 with heterosexual contact being the major infection route. The first National AIDS
Control Programme was set-up in Uganda at the Ministry of Health (MoH) to sensitise and
educate the public for prevention of HIV infection using the Abstinence, Be Faithful, Condom
use (ABC) strategy, ensure safe blood for transfusion, surveillance and initiate programmes for
care and treatment. By the early 1990s a large part of the population had succumbed to
opportunistic infections with a higher prevalence in urban relative to rural areas. It is estimated
that the epidemic had its peak during this period with the average antenatal HIV prevalence of
18 %, 25%-30% in major urban areas. It was realised that addressing the epidemic needed a
collective effort from all stakeholders in their different mandates and areas on comparative
advantage and capabilities. Political leadership, political commitment and openness about the
epidemic were identified as key in controlling the epidemic. The second phase of the epidemic
was between 1992 and 2000 reflecting a nationwide decline in prevalence 2 .
The third stage of the epidemic as revealed by the Uganda HIV/AIDS Sero-Behavioural Survey
2004-2005 (UNSBS 04/05) reflects a HIV prevalence of 6.4 % for the age group 15-49 both
sexes; urban 10.1 %, rural 5.7 %, female 7.5 % and male 5.0 %. Prevalence as shown in Figure 1-1
below is highest in the 30 – 34 age groups.
Figure 0-1 : HIV prevalence between age 15-59 years by age and sex
Uganda HIV/AIDS Sero-Behavioural Survey 2004-2005
Uganda UNGASS Progress report of January 2008
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It is estimated that a total of 2.6 million people have been infected by HIV in the last 25 years of
whom 1.6 million 3 have passed on. Most of these were from productive age groups thus
affecting the nation’s productivity. It is also estimated that currently there are about 100,000
new infections 4 every year.
Drivers of the Epidemic in Uganda
Factors driving the epidemic include behavioural factors, social–cultural, socio-behavioural,
economic and geographic factors among others. These include 5 higher risk sex (which include
non-marital, extra-marital, non-consensual, commercial, transactional, intergenerational, sex for
survival), mother to child transmission, HIV discordance and non-disclosure, poverty, early
marriages, glorifying of non-marital sex, multiple sexual partners, stigma, discrimination and STI
New infections are found highest among the cohabiting/married/widowed group at 42% as
shown in figure 1-3 below.
Distribution of new infections by sources
Policy Recommendations Based on the Major Findings of the 2004-05 Uganda HIV/AIDS Sero-Behavioural Study
Ministry of Health records
The Road Map towards Universal Access to HIV Prevention in Uganda August 2006.
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Overview of Paediatric HIV&AIDS in Uganda
Of the 1.I Million HIV infected individuals in Uganda, an estimated 110,000 are children. Of these
children 50,000 are in need of life saving antiretroviral therapy. (ART)Only 16,000(8.8%) of the
180,000 individuals receiving are children. Most of the children who receive ART in Uganda are
located in urban setting 6 . If Uganda attained full coverage and utilization of PMTCT it would save
25, 000 babies born infected each year and approximately 2083 per day. This will would also save
on the cost of lifelong treatment for these babies in addition to reducing their suffering and
allowing them to contribute to national development. Full coverage of PMTCT+ would contribute
to reduction in Infant mortality rate one of the MDG indicators, where Uganda. For example
Uganda has under-5 mortality rate of 130 children out of 1000 and Infant mortality rate (under 1),
of 82 children out of 1000 (UNICEF, 2007). It is against this background that CEPA Uganda will
aim at addressing bottlenecks that lead to the above situation and help reverse the trend and save
25,000+ children that currently get infected annually in Uganda. Like in other countries the four
core CEPA objectives provide ground for developing the NAAP. These are:
1. Family-Centered Care and Nutrition. Expand access to PPTCT+ and pediatric
treatment, care, and support, including nutrition services, and integrate child and family
services with other health services in order to improve survival rates and health
outcomes for children, HIV-positive mothers, and their families.
2. Early Infant Diagnosis and Treatment. Expand access to early infant diagnosis and
earlier and improved pediatric treatment in order to improve survival rates and health
outcomes for children.
3. Access to Appropriate Medications. Reduce distribution barriers and increase the
global supply of high-quality, low-cost lifesaving medicines for children and their families,
including ARVs, drugs to treat opportunistic infections, and first and second-line
regimens to ease dosing and administration.
4. Full Funding to Eliminate Pediatric AIDS. Secure the financial resources needed
to facilitate country-level scale-up of PPTCT+ and pediatric and maternal treatment
National HIV&AIDS Strategic Plan 2007/8- 2011/12. Uganda AIDS Commission
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OBJECTIVE 1; FAMILY CENTRED CARE AND NUTRITION;
Expand access to PMTCT+ and paediatric treatment, care and support including nutrition
services; integrate child and family services with other health services in order to improve
survival rates and health outcomes for children, HIV-positive mothers and their families. This
campaign aims at influencing the government, development partners and implementing
organisations to prioritise family wide prevention, treatment and care. It’s aimed at influencing
service providers and policy makers to adopt WHO guidelines endorsing highly active
antiretroviral therapy (HAART) as best practice for PMTCT.
Policy and strategy guidelines in Uganda:
The 2006 Policy Guidelines for PMTCT in Uganda 7 provide for a comprehensive strategic
approach for preventing HIV infection among infants and children that includes four elements, in
line with global WHO/UNICEF and UNAIDS guidelines:
Primary prevention of HIV infection among women of childbearing age
Preventing unintended pregnancies among women living with HIV
Preventing HIV transmission from women living with HIV to their infants
Providing appropriate treatment, care and support to mothers living with HIV and their
children and families.
The Health Sector Strategic Plan (HSSP) II 2005/06 – 2009/10 8 aims to make PMTCT services
available at all health facilities of HC level III or higher. In addition, the 2006 PMTCT policy
guidelines provide that Health Centre II should provide a basic PMTCT package comprised of:
Counselling the mothers to promote uptake of HIV testing,
Providing support to mothers and their families to make appropriate infant feeding choices,
and where infrastructural and human resources capacities permit,
Providing ARVs for the mother and infant at the time of labour and birth.
The assumptions in the PMTCT Policy guidelines with respect to ARV regimens in PMTCT are
20% of all the HIV+ mothers will be on single dose Nevirapine, primarily those attending
late or at lower health centres.
20% of all the HIV+ mothers will be on AZT+3TC+sdN; in cases of late attendance at
Health Centre IV (HCIV) and hospitals
MOH (2006) Policy Guidelines for Prevention of Mother-to-Child Transmission of HIV in Uganda, Kampala
MOH (2005) Health Sector Strategic Plan II 2005/06 – 2009/10, Kampala
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40% of all the HIV+ mothers will be on AZT+ sdN; those reached before 34 weeks of
20% of all the HIV +mothers will be HAART; 75% on AZT+3TC+NVP
The HIV Control Bill 2007 9 provides for mandatory HIV testing for all pregnant women, and
access to medications for PMTCT by all HIV positive pregnant women as an entitlement.
In contrast to mandatory testing for pregnant women, the bill provides for pre-test
counselling for the spouse, to inform the decision for HIV testing (as a choice).
The bill does not address the entitlement of HIV positive mothers to medications for HIV
treatment, and the right of infants born to HIV positive mothers to access medications for
Family-focused HIV treatment, care and support: The UNAIDS/UNICEF/WHO Progress
Report on Universal Access for 2008 indicates that testing pregnant women for HIV not only
provides an entry point for them to receive interventions to prevent transmission to the child
but also facilitates the enrolment of women, their families and future infants into longitudinal
HIV prevention, care and treatment.
A recent study in Uganda observed an 81% reduction in mortality among uninfected children
over a 31-month period if their HIV-infected parents were receiving antiretroviral therapy
and co-trimoxazole preventive therapy 10 .
Breastfeeding and HIV prevention in infants: The 2006 national PMTCT policy guidelines
provide for the following elements with respect to infant feeding for HIV positive mothers:
Mothers living with HIV and their partners will be counselled on infant feeding, within the
context of HIV infection to enable them make an informed and appropriate choice.
Adequate support will be given to them to facilitate practice of the chosen method.
A mother should opt for replacement feeding if it is Affordable, Feasible, Acceptable,
Sustainable, and Safe
A mother living with HIV will continue to breastfeed the infant who tests HIV positive for as
long as possible
Progress and gaps in PMTCT service delivery to mothers and babies
Knowledge about the risk of MTCT and PMTCT is still low, reported in the 2006 UDHS at
52% among women and 43% among men.
GOU (2007) The Human Immunodeficiency Virus Control Bill, 2007, Kampala
Mermin J et al. Mortality in HIV-infected Ugandan adults receiving antiretroviral treatment and survival of their HIV-uninfected
children: a prospective cohort study. Lancet, 2008, 371:752–759.
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Pregnant women that attend antenatal care receive HIV prevention education as a core
element in group health education sessions, and individual education and counselling
This is reinforced by information provided during the pre and post test counselling that
accompanies HIV testing.
There is limited specific provision for direct and sustained follow up support to HIV negative
mothers identified through PMTCT services, their spouses, or their family members.
Only 6% of the pregnant women receiving PMTCT services attend with their spouses’ 11 .HIV
prevention education emphasized in ante natal clinics receives little or no attention during
delivery and in post natal services; which services reach only a limited section of mothers
and their children.
Only 41% of mothers have health facility deliveries; and only 26% receive post-natal care 12 .
Growth in PMTCT service coverage 13
Proportion of Health Facilities in Uganda with PMTCT services – by facility level
Hospitals HC IV HC III HC II
2005 94% 86% 9% 0%
2006 94% 87% 20% 2%
2007 97% 92% 29% 3%
Source: UNGASS Uganda Report for 2006 and 2007
The Uganda UNGASS Report for 2007 indicates that PMTCT coverage increased from 16% in
2005 to 34% in 2007. This exponential rate of increase can be attributed to the accelerated
PMTCT roll out at HC III level over the same period; which grew from 9% to 29% (a 200%
increase). This underscores the importance of further growth in HC III coverage, if the national
target of 90% PMTCT reach is to be realized.
While PMTCT coverage at Hospitals and HC IV is close to the HSSP II target of 100%, coverage
at HC III is far below this, and seems unlikely to be realized if progress continues at the pace
between 2005 and 2007. The above figures need to be considered in light of the fact that 91%
of all health facilities in the country are HC II and III level. This means that realistic access to
PMTCT services can only be realized if coverage at these HC levels is greatly improved.
Use of a two-drug regimen AZT-3TC (Combivir) started in Uganda in 2007; initially aiming to
reach clients at higher level health facilities (Health Centre IV, District and referral Hospitals),
Uganda PMTCT Report Card, 2007
As reported in the UDHS 2006 report
Uganda UNGASS Progress report of January 2008
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where the process can be directly supervised by the appropriately qualified health worker
(Medical Doctor or Clinical Officer). The reported coverage with a two-drug combination in
2007 at only 9% was much lower than the global average of 32% 14 .
It is encouraging to note that generic ARV production started in Uganda in 2009, including the
2-drug combination for PMTCT. This achievement provides a strong and valid basis for
advocacy to scale up the 2-drug combination to three for PMTCT.
Beneficiary outcome of objective 1:
Increased access to PMTCT+ and paediatric treatment, care, and support, including nutrition
services, and integrate child and family services.
UNAIDS, UNICEF, WHO (2008) Towards Universal Access: Scaling up HIV services for women and children in the health sector
Progress Report 2008
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Family-Centred Care and Nutrition NAAP matrix
Core Objective: Family-Centred Care and Nutrition.
Expand access to PMTCT+ and paediatric treatment, care, and support, including nutrition services, and integrate child and family services with other health
services in order to improve survival rates and health outcomes for children, HIV-positive mothers, and their families.
Bottlenecks Activities Advocacy Output Advocacy Outcome Indicators Target
Limited access to Advocate and support MOH to MOH commitment to Setting of PMTCT National MOH, CSOs,
PMTCT +services produce and disseminate guidelines producing and targets by civil PMTCT+ Development
which do not to civil society organizations on disseminating PMTCT+ society. targets set by Partners,
reach all women guidelines. Dissemination of
PMTCT +and Paediatric HIV stakeholders. UAC
in need. ( 30% in Commitment from civil PMTCT+ guidelines
2007 of all treatment.
society on the to stakeholders. Best practise
expected HIV prioritisation of Development of
Hold a meeting with civil society report.
positive pregnant PMTCT+. FCC protocols for
organisations on PMTCT + and
women receiving Stakeholders understand health facilities.
incorporation in work plans.
ARVs for the Paediatric FCC
Convene a paediatric stakeholders
to review and recommend
paediatric FCC protocols for health
Prepare a best practice report on
national Paediatric FCC models
Inadequate Lobby and support MOH on the MOH support to Guide on the Guide on MOH.
nutritional development of a minimum developing minimum minimal nutritional minimal MOGLSD,
supplementati nutritional package for children nutritional healthcare supplements nutritional UAC, CSOs.
on and exposed to or living with package.
disseminated. Best practice
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children HIV&AIDS. FCC guideline Production and report.
exposed to or developed. distribution of IEC
living with Advocate and support MOH to Best practice report on materials.
develop IEC materials on the FCC. Guidelines
minimum nutritional package for National training incorporating FCC
children exposed to or living with curriculum on FCC in and promote service
HIV&AIDS. place. delivery design
Support MOH on the dissemination changes to address
of minimum nutritional health care continuum of care.
package and FCC guidelines to Sharing of best
CSOs at national and sub national practice report with
levels; district health offices and stakeholders to
health care facilities at all levels. improve
Lobby AIDS Control programming.
Program/MOH as well as health
care worker pre-service training
institutions to incorporate FCC
approaches and delivery of
nutritional minimum package into
their respective in service and pre-
service training curriculum.
Development of media brief on
FCC on CLWHIV.
Convene Uganda Paediatric
meeting to review and recommend
paediatric FCC protocols for health
Widespread Advocate and support MOH on Commitment by Government and Stigma and MOH,
stigma and developing of IEC materials with government and development discriminatio Uganda AIDS
discrimination information on Stigma and development partners to partners roll out n strategy Commission,
discrimination reduction. support the Stigma and adopted. development
against PLWA anti-stigma
Mobilise CSO to lobby for adoption Discrimination strategy. partners.
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has negative and funding of the national stigma campaign.
impact on and discrimination communication
PMTCT and strategy.
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OBJECTIVE 2: EARLY INFANT DIAGNOSIS AND TREATMENT
Aimed at expanding access to early infant diagnosis and earlier improved paediatric treatment in
order to improve survival rates and health outcomes for children. This CEPA objective aims at
persuading national stakeholders to develop and implement policies and guidelines to promote
national level scale up of early infant diagnosis and treatment programs. The government,
development partners and Civil Society will enhance and expand EID and EIT programs and
support paediatric AIDS services within the National Strategic Plan and Ministry of Health
Policy and Strategy provisions in Uganda
Early infant diagnosis of HIV among HIV-exposed children and adequate follow-up are an
essential integral component in PMTCT, to effectively identify infants living with HIV and ensure
the timely initiation of care and treatment. The PMTCT policy guidelines, 2006 state that all
children born to mothers living with HIV should be tested for HIV from 10-14 weeks of age and
offered follow up care and support. It also states that all children born to mother living with HIV
should be started on prophylaxis using Cotrimoxazole, 6-8mg/kg body weight daily from 6
weeks of age until he or she is confirmed to be HIV negative. The global WHO guidelines on
care for infants born to HIV positive mothers, 2008 provide for;
HIV antibody testing at birth, and again at 6, 12 and 18 months of age,
HIV/PCR at 4 weeks and again at 4 months
ART (TMP+SMX) from 4 weeks until there is confirmation of HIV negative status
Vitamin A 100,000 IU at 9 months, 200,000 IU every 6 months until the age of 5 years
The importance of early infant diagnosis in enabling timely access to AIDS care is well illustrated
by the experience from Kenya, which reported a 66% increase in the number of children on
ART between 2006 and 2007, following introduction of PCR for all exposed children at 6 weeks
of age and older, followed by HIV antibody test at 18 months 15 .
The common approach for diagnosis of HIV/AIDS in children is use of a combination of clinical
signs and symptoms among sick children based on WHO guidelines for clinical staging, and HIV
antibody testing. The circumstances mentioned for HIV testing in children were;
When a child is sick and is taken to a health facility, or through child health clinics such as
EPI and growth monitoring
When a child is suspected to have been exposed to HIV (e.g., born to an HIV positive
mother, defiled/raped) and is taken for testing
During HIV counselling and testing sessions for families – as may be done during home-
based, VCT, or family visits to health facilities (outreach that encourages testing for all;
WHO, UNAIDS, UNICEF (2008) Towards Universal access: scaling up priority HIV/AIDS interventions in the health sector
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The WHO guidelines for clinical diagnosis of HIV/AIDS in children are often not available at
some of the health facilities expected to provide this service. It is important that all health
facilities have the necessary guidelines, not only for clinical diagnosis and staging of HIV/AIDS in
children, but also for provider-initiated testing and counselling for children, a strategy already in
use in some African countries 16 . In countries such as Malawi and Zambia, provider-initiated
testing and counselling of sick children has helped to substantially increase the numbers of HIV-
infected infants and children who are detected.
A number of countries in Africa have integrated HIV status information in routine child and
maternal health records (e.g., the Child Health Card) to facilitate the identification of HIV-
exposed infants and provide appropriate diagnostic and follow-up services 17 . However, Uganda
is yet to adopt this important strategy to enhance timely and consistent paediatric AIDS care.
Reduction in early child and maternal mortality due to HIV&AIDS.
Bottlenecks to achieving the above;
Disparity in the 2006 PMTCT policy and the National Guidelines of 2008.
Testing of mothers during pregnancy is not a law, so opt out is encouraged.
Limited awareness of the revised National Infant feeding policy and guidelines of 2009
Inadequate access to ART for children(including specialized formulations and dozing).
Long turnaround time (Upto 3 months in some Centres) to receive HIV DNA PCR results
for infants tested (Yet to come up with activities for this).
UNAIDS, UNICEF, WHO (2008) Towards Universal Access: Scaling up HIV services for women and children in the health sector
Progress Report 2008
Examples include: Cameroon, Malawi, Rwanda, Swaziland, United Republic of Tanzania and Zimbabwe
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Early Infant Diagnosis and Treatment NAAP matrix
Core Objective: Early Infant Diagnosis and Treatment.
Expand access to early infant diagnosis and earlier and improved paediatric treatment in order to improve survival rates and health outcomes for children.
Bottleneck Activities Advocacy Output Advocacy Indicators Target
Limited Develop and produce fact sheets Presentation of Awarenes Briefs on early infant MOH,
awareness of and briefs on infant feeding to factsheets and s creation feeding. Referral
the revised policy makers and CSOs. briefs to policy and more MOH and
National Hold a consultative meeting with makers. children recommendations for district
Infant feeding Members of Parliament of the Civil society and tested for roll-out on EID/EIT in health
policy and HIV&AIDS Committee to government HIV&AIDS health centres. centres,
guidelines of champion EID and EIT. commitment on . IEC materials Parliame
2009 Production and dissemination of the dissemination promoting adherence nt of
IEC materials promoting of the infant linking EID with Uganda.
adherence linking EID with feeding policy. testing. MOES.
testing for all children. Education and
Support and participation in awareness of
national consultative forums like National infant
Paediatric Day, World AIDS Day feeding policy.
promoting EID and Treatment.
Disparity in Government MOH Revised PMTCT MOH,
the 2006 Hold and support stakeholder commitment on impleme comprehensive Uganda AIDS
PMTCT policy meetings with government to harmonizing ntation policy. Commission.
and the lobby for the revision of PMTCT paediatric care Government Uganda Law
National policy in alignment with the policy and hospitals receiving Reform
Guidelines of National Guidelines. guidelines. national Commission,
2008. Hold a meeting among policy EID/EIT guidelines paediatri Media reporting on UNICEF
and stakeholders to agree on the (diagnosing and c EID and EIT.
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dissemination of the PMTCT treatment regimens EID/EIT National paediatric
policy and National Guidelines. shared among standard curriculum in place.
Develop and share a brief to the partners. s.
media on the PMTCT policy and Commitment by
National Guidelines. government and MOH
Dialogue with government and stakeholders on health
development partners to the disseminations
strengthening training for pre- of PMTCT policy.
service and in-service providers. training
Support the government on the program
completion of the National s
Inadequate Hold lobby meetings with Agreement by Increased MOH,
access to ART government and development government and commitme PEPFAR,
for partners to scale up support to development nt UAC, Civil
children(inclu Paediatric ART. partners on towards Society Fund
ding support to ART. Paediatric
Testing of Participate in the development of HIV bill including Compreh Comprehensive HIV Uganda AIDS
mothers the HIV&AIDS prevention bill comprehensive ensive bill. Commission,
during while advocating for mandatory EID/T. HIV&AIDS Uganda Law
pregnancy is and available provider-initiated bill Reform
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not a law, so counselling and testing developed Commission.
opt out is (mandatory HIV testing for every .
encouraged. pregnant woman).
Mobilise the involvement of
treatment organisations in
review of the HIV bill.
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OBJECTIVE 3; ACCESS TO APPROPRIATE MEDICATIONS
Reduce distribution barriers and increase the global supply of high quality, low cost lifesaving
medicines for children and their families including ARVs, drugs to treat opportunistic infections
and first and second line regimens to ease dosing and administration. It’s aimed at influencing the
government, development partners and drug manufacturers to revise policies and procedures to
reduce country level barriers and increase the supply and availability of paediatric medications
including ARVs and drugs to treat opportunistic infections.
Policy and strategy provisions in Uganda
Despite international commitments to achieve universal access to HIV/AIDS services by 2010,
including 80% coverage for PMTCT+ services, progress toward these goals remains too slow,
and paediatric HIV transmission remains high. It is estimated that 17% of new infection in
children occur primarily because pregnant HIV positive women lack access to PMTCT services.
Globally of the nearly 3 million people on treatment globally, only 200,000, or 6.7% are
In Uganda, according to MOH, AIDS Control Program (2008), there are about 150,000
children living with HIV/AIDS. Of these 50,000 are in need of ART but only 26% are
Out of about 1.2 million women who become pregnant each year in Uganda, only about
38% deliver at formal health centres, yet an estimated 78,000 are living with HIV/AIDS,
meaning that many cases go undiagnosed and untreated
Annual paediatric HIV/AIDS infection rate remains unacceptably high at about 25,000
children per year.
Studies carried out by HEPS Uganda on availability of HIV and TB medicines and diagnostics
have shown poor availability of paediatric formulations. Nevirapine for PMTCT was found in
only 41% of surveyed facilities
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Availability of Paediatric Antiretroviral: Essential AIDS and TB Medicines and
Diagnostics in Uganda; an Assessment of Availability and Management (May 2009)
Public Private Mission
Overall Urban Rural Overall Urban Rur Overall Urban Rural (n=5)
(n=15) (n=13) (n=13) al (n=20) (n=15)
(n=32) (n=17) (n=
Didanosine powder for 3% 7% 0 0 0 - 0 0 0
oral solution 2g/100ml
Efavirenz cap 50mg 41% 60% 24% 15% 15% - 45% 53% 20%
Lamivudine oral solution 16% 7% 24 8% 8% - 50% 40% 80%
Lamivudine oral solution 25% 27% 24% 0 0 - 20% 20% 20%
Nevirapine oral suspension 56% 53% 59% 15% 15% - 60% 53% 80%
Ritonavir oral solution 0 0 0 0 0 - 0 0 0
Stavudine cap 15mg 22% 33% 12% 8% 8% - 40% 47% 20%
Stavudine cap 20mg 19% 20% 18% 0 0 - 45% 40% 60%
Zidovudine cap 100mg 19% 275 12% 0 0 - 40% 47% 20%
Zidovudine oral solution 34% 40% 29% 0 0 - 70% 60% 100%
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Increased access to Paediatric HIV treatment
Disparity in the 2006 PMTCT Policy and the National Treatment Guidelines. The Essential
Medicine List does not provide for Pediatric ARVs and the National Pharmaceutical Plan is
Inadequate access to ART for children(including specialized formulations and dozing)
Inefficiencies in the Procurement & supply chain systems: these include the Procurement and
Disposal of Assets Law that is not conducive to assess to medicines, supply challenges at the
National Medical Stores as well as lack of human resource and capacity at health facilities
Registration of new formulations is slow and prohibitive
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Access to Appropriate Medications Nutrition NAAP matrix
Bottlenecks Activities Advocacy Advocacy Key Performance Targets Responsible
Outputs Outcomes Indicators Partners
National Analyze and make 500 copies Relevant PMTCT Policy and Analysis report MOH officials, Consultant/H
PMTCT policy, report of existing gaps in authorities utilize Treatment ACP, AIC, EPS
National policies these findings in Guidelines that Fact-sheets, LRC, All
Treatment Produce 500 copies each of their meetings policy briefs Parliamentaria stakeholders
spell issues of
Guidelines, fact sheets, policy briefs on Parliamentarians ns
EML, NSSP are paediatric ART
gaps and present to the policy and key officials
silent on infant makers understand issues
HIV/AIDS Have 10 lobby meetings with in report
treatment. policy makers and key
Stock out of Conduct bi-annual monitoring Increased MOH, NMS, Monitoring MOH officials, HEPS
drugs at the studies on availability of awareness of Health facility in- reports, media ACP, AIC,
health facilities Paediatric ARVs and availability of charges commit to coverage LRC,
commodities paediatric ARVs stop stock outs Increased Parliamentarian All
Press conferences Improved availability of s stakeholders
delivery of Paediatric ARVs
Inefficiency in Tracking study of lead time of MOH officials, Government Tracking report MOH officials, HEPS/UYP/U
the paediatric ARVs media use commits to Report of ACP, AIC, PA
Procurement & reports in their creating meetings LRC,
supply chain Holding meetings with health Information Parliamentarian
meetings and for
systems workers and NMS to identify management s All
planning system to control
supply chain bottlenecks and stakeholders
forge solutions stock outs
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Registration of Study time it takes to register NDA uses NDA discusses Study report NDA, MOH All
new new formulation report to inform consideration of stakeholders
formulations is its drug improving
slow and registration registration
prohibitive process guidelines for
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OBJECTIVE 4: FULL FUNDING TO ELIMINATE PAEDIATRIC AIDS.
Aimed at securing financial resources needed to facilitate country level scale up of PMTCT+ and
paediatric and maternal treatment programs. It will persuade both government and development
partners commit the increased finical resources needed to effectively scale up PMTCT+ and
paediatric treatment programs and eliminate paediatric AIDS and mortality.
Policy and strategy provisions.
Although public spending on health has increased from about $8 (sh16,000) per person in 2001 to $11
(sh22,000) per person in 2007, the Government still not reached its own target of $28 (sh56,000) per
person needed to cover the Uganda National Minimum Healthcare Package. Neither has it come close to
meeting the $40(sh80, 000) per person recommended by the World Health Organisation as minimum
needed to fund health care in developing countries. Practically, Uganda’s health sector is under-funded,
relying heavily on private sources of financing, especially out-of-pocket spending. The budgetary allocation
stands at 10%, contrary to the Abuja declaration threshold of 15%. Consequently, due to insufficient
funding, the package of health services at public health facilities is inadequate to meet people healthcare
The sector is heavily donor dependant, with donors providing about half of the budget. According to the
Ministry of Finance, donors contribute UGX 253 billion to the sector and off budget, the donors provide
300 billion. The U.S. alone through the President’s Emergency Fund for HIV/AIDS Relief (PEPFAR),
contributes up to US$ 283 million for HIV/AIDS alone. The sector consequently incurs high levels of
inefficiency within “volatile and unpredictable” external funding. Since donors provide around 75% of the
funding, the government is left with little ability to dictate the way in which money for the sector is
Another policy and implementation issue on funding is that decentralization has continued, but has not
resulted in a significant improvement in delivery of services. The vast majority of spending at the
decentralized level has gone toward employee costs and arrears – not toward drugs, equipment, and
other infrastructural costs. Thus, while allocation of money to decentralized facilities was meant to
improve service provision, the transfer of money has not translated into the expected improvement in
services. In such a situation paediatric HIV/AIDS has been one of the victims of funding challenges.
24 | P a g e
Full funding Nutrition NAAP matrix
Full Funding to Eliminate Paediatric AIDS.
Secure the financial resources needed to facilitate country-level scale-up of PMTCT+ and paediatric and maternal treatment programs.
Objective Activities Out put Outcome KPI Target Partners
Under budgetary Advocate for increased budgetary Paediatric Budget Funding levels in -Budget MoFPED, HEPS-Uganda,
allocations for allocations for MoH (I5% Abuja HIV/AIDS and respect to Paediatric Advocacy LGs, MoH ANECCA,
paediatric Declaration ): Specific activities: PMTCT budget HIV/AIDS and PMTCT Development
-Under take national Annual budget
HIV/AIDS by funding briefing revealed to stakeholders increased Research
government reviews to determine the per capita paper for action Centre,
paediatric HIV/AIDS allocations and funding for
develop a CEPA Budget Threshold – Paediatric
briefing paper HIV/AIDS and
-Recommendations to PMTCT
-1 national budget advocacy meeting government for
to demand for budget prioritization of actions on paediatric
Paediatric HIV/AIDS and PMTCT
HIV/AIDS and PMTCT
-4 regional budget advocacy meeting budget prioritization
to demand for budget prioritization of
Paediatric HIV/AIDS and PMTCT
Inadequate funding Advocate for increased support for Briefing paper Recommendations to -Advocacy Global Fund, HEPS-Uganda,
for paediatric paediatric HIV/AIDS and PMTCT on state of donors on how to fill Report on USAID, ANECCA,
HIV/AIDS and from development partners. The development gaps on paediatric Development
levels of WHO,
PMTCT by partners funding HIV/AIDS and PMTCT donors support UNAIDS, Research
-Under take national donor PMTCT
development for HIV/AIDS and meet their Centre,
and Paediatric HIV/AIDS support for paediatric DFID ,
partners and PMTCT obligations GHA……….
analysis and develop a CEPA donor HIV/AIDS and DANIDA
Threshold matrix - Development PMTCT
25 | P a g e
- 1 PMTCT and Paediatric HIV/AIDS PMTCT and
donor funding Appraisal workshop Paediatric
- Media and CSOs advocacy policy funding levels
briefs to use to pressure development matrix
partners to increase funding for
paediatric HIV/AIDS and PMTCT
- Annual press
briefs on funding
Lack of Conduct tracking studies on -1 PET report on Empowered media and Empowered Partners in HEPS-Uganda,
transparency and paediatric HIV/AIDS and PMTCT PMTCT and CSO partners to media and CSO CEPA ANECCA,
accountability funding Paediatric monitor the use of partners to Development
Develop HIV/AIDS funding HIV/AIDS HIV/AIDS Funds monitor the use Research
monitoring matrix for media and media
funding of HIV/AIDS Centre,
CSOs HIV funds