Situation of HIV/AIDS services in Karamoja

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.

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)

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

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.

Hospital HC IV HC III Total

Abim 1 0 3 4

Kotido 0 1 4 5

Moroto 2 0 8 10

Kaabong 1 1 0 2

Nakapiripirit 1 2 6 9

District performance

0

20

40

60

80

100

120

Abim Kabong Kotido Moroto Nakapiripirit

% of ANC sites providng PMTCT services %of pregnant women tested for HIV

% of HIV+ pregnant women given ARVs for prevention % of HIV exposed babies given ARVs for prophylaxis

• 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

Comprehensive HIV care and support

• Service delivery facilities• Matany hospital• Moroto hospital• Abim hospital• Kaabong hospital• Kotido HC III• Tokora HC IV

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.

HCT/ART uptake < 5 years Children

Moroto Nakapiripirit

Kotido Abim Kaabong

Children tested

50 10 170 1 4

Tested positive

34 1 30 0 1

Given ARVs 5 0 0 0 0

DBS PerformanceMoroto

Nakaps

Kotido Abim Kaabong

Total

Children born to HIV+ mothers tested for HIV

22 24 21 28 0 95

Children born to HIV+ mothers tested HIV+

5 2 9 No results

0 16

HCT/ART adult females

Moroto Nakapiripirit Kotido Abim Kaabong

Tested 2776 1638 2041 573 399

Positive 295 109 158 86 19

Given ARVs 131 20 0 11 4

HCT/ART Adult male

Moroto Nakapiripirit

Kotido Abim Kaabong

Tested 1849 911 1482 245 269

Tested positive

279 84 106 38 37

Given ARVs 114 12 0 2 6

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.

Key concern

Training

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

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

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

Discussion