According to UNAIDS, Uganda’s HIV epidemic has not changed pattern over the past 30 years and remains generalized, though HIV prevalence has consistently been higher among women than men. During the 1990s, the country achieved impressive success controlling the spread of the virus, reducing the adult prevalence rate from a national average of 18.5 percent in 1992 to just 6.4 percent in 2005.
This success was compromised during the 2000s when the country’s response shifted direction and HIV prevalence rates ticked up. As of 2016, Uganda’s adult HIV prevalence rate is 6.5 percent, the country is home to some 1.4 million PLHIV, and roughly 800,000 children under the age of 17 who have been orphaned or made otherwise vulnerable by HIV/AIDS. An estimated 28,000 Ugandans have died of AIDS-related causes.
With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the American International Health Alliance (AIHA) is currently implementing a partnership to strengthen national capacity in biomedical engineering and technology with support from the U.S. Centers for Disease Control and Prevention (CDC) in Kampala. Our previous work in country focused on palliative care.
Click here for a printable overview of our work in Uganda.
PEPFAR Civil Society Organization Initiative
2016 – 2019
At the request of the Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy (S/GAC), the Health Resources Services Administration (HRSA) and its partners, AIHA and the National Alliance of State and Territorial AIDS Directors (NASTAD), created a project with the goal of improving engagement between country teams for the President’s Emergency Plan for AIDS Relief (PEPFAR) and civil society organizations (CSOs).
The CSO Engagement Initiative is a PEPFAR-wide project to support collaboration between in-country/regional PEPFAR teams and CSOs in the PEPFAR planning and implementation process. It enlists the efforts of staff from HRSA and its partners, AIHA and NASTAD. HRSA, AIHA, and NASTAD provide a wealth of expertise in successfully engaging civil society into HIV service planning, prioritization and service delivery, both domestically and globally.
At the outset of the project, HRSA, AIHA, and NASTAD held multiple calls with PEPFAR country teams to discuss their needs and expected outcomes. The project team then provided a menu of specialized technical assistance options, based on these communications, for PEPFAR country teams and CSOs to choose from, should they be interested in utilizing the project. These options included support for the following: CSO recruitment for participation in COP planning and implementation, meaningful CSO engagement in COP planning, meaningful CSO engagement in PEPFAR implementation, and evaluation of CSO engagement and dissemination of tools.
Ultimately, PEPFAR teams from four countries requested technical assistance (TA) from the CSO Engagement Initiative during the FY 2016-2019 period of performance: Ethiopia, Mozambique, Nigeria, and Uganda. The project encompassed a series of activities customized to each country’s needs and timed to coincide with COP-related activities as appropriate.
- The project team conducted an assessment of the state of civil society and its relationships with PEPFAR country teams prior to additional activities in each country. While every country is unique, common themes included PEPFAR teams finding CSOs lacking in sophistication when it comes to data and unable to provide the type of information that PEPFAR requires from them. In turn, CSOs often described PEPFAR teams as insufficiently engaged with them. Both PEPFAR and CSO respondents agreed on the need for capacity building for CSOs to help them become better partners with PEPFAR in the fight against HIV/AIDS.
- The project team conducted Data Presentation Workshops. The purpose of these workshops was to help PEPFAR better communicate their highly sophisticated data to an audience who may not be as comfortable with technical terms. In some countries, CSO leadership participated in these workshops as well. There was near unanimous agreement that these workshops were helpful to all.
- After the Data Presentation Workshops, the project team conducted CSO Orientation Development Workshops and supported PEPFAR country teams as they in turn conducted CSO Orientation Meetings prior to COP 19 activities in Ethiopia. The CSO Orientation Development Workshops provided PEPFAR teams and CSO Leadership with support to design and Orientation Meeting for CSOs to help orient them to COP processes. Once again, PEPFAR team members and CSO leadership reported that the Development Workshops helped them in designing the Orientation Meetings, and Meeting participants reported that they felt more prepared to meaningfully engage with PEPFAR.
- The project took an explicitly adaptive approach, using data gathered from each activity to improve. This adaptive approach allowed the project team to be as responsive as possible to individual country needs and to change their approach when necessary, contributing to project success.
Strengthening In-country Capacity to Train Biomedical Engineers and Technicians
2015 – 2019
The Uganda Biomedical Engineering Equipment Management Program was launched under AIHA’s Twinning Center Program in 2015, focusing on building the capacity of public sector biomedical engineers and technicians to service, repair and conduct safety testing and calibration on laboratory equipment critical to the HIV/TB clinical cascade.
Like many other low-income countries around the globe, Uganda faces a severe shortage of healthcare workers, including qualified biomedical engineers and technicians who play a crucial role in today’s technology-driven health systems. There is a critical need for biomedical engineers and equipment technicians (biomeds) capable of conducting preventive maintenance and repair on laboratory equipment, including HIV diagnostic equipment.
A recent gap analysis revealed that most current Ugandan biomeds and laboratory technicians lack the skills they need to properly conduct routine preventive maintenance, repair, and safety calibration of lab equipment. As a result, a large percentage of the country’s lab equipment not currently under service contract is either malfunctioning or not working at all.
To address this challenge, in late 2015 AIHA launched a twinning partnership linking the Uganda Ministry of Health’s Health Infrastructure Division (HID) and Central Public Health Laboratories (CPHL) with the Lorma Consortium, a group of technical experts from the United States, Canada, and the Philippines led by Lorma Colleges and Medical Center. In early 2017, AIHA graduated the Lorma Consortium and AIHA started direct implementation of the project.
AIHA biomedical technology project in Uganda currently has four objectives: 1) Training biomeds in the maintenance of laboratory equipment which directly supports HIV and TB service delivery; 2) Building the capacity of biomeds who will directly support the establishment of a national laboratory equipment calibration center; 3) Supporting biomeds in servicing, maintenance, and certification of biosafety cabinets; and 4) Supporting biomeds to achieve knowledge and skills to the level of certification to maintain automated equipment supporting viral load testing and early infant diagnosis used for monitoring the suppression of HIV.
AIHA employs a comprehensive, multi-faceted approach to strengthening the capacity of biomeds through targeted in-service training, starting with non-automated lab equipment and working toward more sophisticated equipment critical to the HIV clinical cascade.
AIHA and our partners developed two training curricula covering both non-automated and automated lab equipment that directly supports HIV and TB diagnosis and treatment, as well as refrigeration and air-conditioning training to better support routine viral load testing. In addition, we’ve trained 30 biomeds on non-automated equipment, identifying seven of these as leaders, who have completed a training-of-trainers course to enable them to step down trainings in their respective regions.
Eight biomeds went through a comprehensive two-week training on refrigeration and air conditioning equipment, which becomes ever more important as Uganda’s labs shift to routine viral load testing. In August 2017, four biomeds completed a year-long, three-phase biosafety cabinet calibration and certification (BSCC) course conducted in partnership with Eagleson Institute in Maine. This trained BSCC team has to date assessed nearly 100 BSCs across the country. AIHA and our partners worked with a local vendor in June and July 2017 to conduct the first GeneXpert training in East Africa, with 24 biomeds completing this initial two-phased course. GeneXpert is currently the main point of care equipment used for TB testing and is expected to become one of the main diagnostics for viral load testing in the future.
The project team also developed national laboratory equipment maintenance guidelines, which are currently under final review, and — in 2017 — established and commissioned a national laboratory equipment calibration center on the UNHLS campus.
To read the final closeout report of AIHA’s Twinning Center Program, click here.
African Palliative Care Association / American International Health Alliance
2005 – 2009
AIHA provided targeted technical assistance to bolster APCA’s capacity as a regional member association by focusing on building organizational management, networking, training, and advocacy skills of APCA staff.
The African Palliative Care Association (APCA) was established in 2004 in Kampala, Uganda. With funding from PEPFAR, AIHA provided technical assistance to APCA from 2005 to 2009, largely in the form of organizational development and staffing support to empower the nascent association as a leading pan-African association capable of helping scale up local and national palliative care associations and programs across the continent.
AIHA supported APCA’s efforts to gather African stakeholders and health providers from 10 countries in April 2005 to develop a strategy that would build donor relations and develop key palliative care policies across Africa. The workshop emphasized priorities set forth by the World Health Organization to advance palliative care, including expanded palliative care drug access, policy development, and training and education.
With this support, African stakeholders and providers were able to more effectively leverage other support and address key policy gaps in their countries. This includes appropriate symptom management for people living with HIV (PLHIV) who are on ART and pain management for PLHIV during the end-of-life stage of the disease.
AIHA provided direct funding to APCA to support palliative care associations in Kenya, Tanzania, and Uganda and, through our HRSA-supported HIV/AIDS Twinning Center Program, established and managed four south-south partnerships involving APCA:
- Botswana Institute of Health Sciences (2007 – Present)
This south-south partnership is strengthening the Institute’s capacity to provide pre- and in-service training on palliative care and helping integrate palliative care concepts into existing pharmacy technology, health education, and dental therapy programs.
- Hope Worldwide (2007 – 2011)
This south-south partnership advocated for increased availability to appropriate palliative care medicines and working to improve the overall provision of palliative care services available in Cote d’Ivoire.
- Mozambican National Nursing Association (2006 – 2008)
This south-south partnership focused on building the institutional capacity of ANEMO, strengthening its capacity as a member organization to help improve HIV-related nursing care throughout Mozambique.
- Palliative Care Alliance of Zambia (2005 – 2010)
This south-south partnership worked to develop institutional and human resource capacity at PCAZ and position the organization as a leading advocate for national palliative care policies and standards throughout Zambia. Based on the success of this twinning partnership, AIHA was able to graduate APCA and provide direct support to PCAZ from 2010 to 2014.
In addition to the partnerships listed above, AIHA provided direct funding to APCA to support three other palliative care associations in Kenya, Tanzania, and Uganda.
The early work of APCA was highlighted in February 2006 as a PEPFAR success story.