Managing timely access to Nevirapine syrup for exposed HIV infants at non-maternity art clinics

World Health Organisation (WHO) and Uganda Ministry of Health (MOH) recommend Nevirapine (NVP) Prophylaxis at birth for all HIV Exposed Infants (HEIs).  However, at TASO-Mbale, only 50% (5/10) of the HEIs had received the NVP within 72 hours of birth. A follow up revealed that whereas mothers were receiving antenatal care services at TASO Mbale, when it came to delivery, they went to public or private health facilities that lacked NVP supplies. This is common for most health facilities that provide antiretroviral therapy but lack maternal and child health care services like delivery.

With a new initiative from TASO Mbale, one of the UPMB USAID-Local Service Delivery for HIV and AIDS Activity (LSDA) supported facilities, the team came up with an innovation to prepare mothers with NVP for their new born babies. “We looked at several interventions which included; cohorting mothers by age of pregnancy and Expected Delivery Date for tracking purposes; routine health talks about benefits of elimination of Mother to Child Transmission (eMTCT). The team at the clinic started updating mothers’ physical addresses and phone contacts regularly”, says the ART clinic in charge. Expectant clients were scheduled for a clinic appointment and given NVP at last antenatal care (ANC) visit and advised to pack it with the ‘Mama-Kit’ (a set of materials given to a pregnant woman to for use during the delivery process). It is a requirement that all expectant mothers are supposed to have in preparation for delivery).  A reminder phone call was made around the expected date of delivery to confirm delivery and initiation of the NVP. Through these interventions:

“We managed to increase NVP uptake at birth from the initial 50% to 100%.  We have also learnt that regular phone follow-ups create a good ‘doctor-client’ relationship, and also help us book the HEIs for the timely 1st PCR and consequent Viral Load and PCRs tests”, says the clinic in-charge.

Namono Rose is one of our clients who has been through the eMTCT four times.  We interacted with her to explore her experience.

“I am called Namono Rose, 33 years old from Mbale district. I am a mother of four and I separated with the father of my children in 2021.

I have been a client at TASO-Mbale since 2010. Before I found out that I was HIV positive, I was sickly but I thought it were signs of early pregnancy since I had just got married to my ex-husband. I went to the nearest clinic, where I took an HIV test which turned out negative. But I continued feeling unwell. Because of the HIV awareness campaigns by TASO over the radios and community drama exhibitions, I convinced myself to go to the AIDs Information Center to take a second test since it was near home. Unfortunately, the results showed that I was HIV positive. I was referred to TASO-Mbale, where I was counseled, and initiated on co-trimoxazole therapy since my CD4 was still very good. I convinced my husband to test too, and he was also positive. We were counseled and educated about safe parenthood since we were both still young and had never had children.

I had a child in 2012, I decided not to breastfeed her due to the fear of passing on the virus to her despite all the counselling I had received. I went on to have other three children whom I breastfeed till one year. I had now proved that I can have HIV negative children after the first child.

My fourth baby is nine months old. Before the birth of this baby, I was enrolled into a special project by my “musawo” clinician and counselor who told me that they were monitoring my pregnancy till birth. I went through routine counseling and other PMTCT programmes. But this time, I was given the NVP syrup at my last Clinic visit. I was showed how it should be given, how I should pack it in my antenatal bag, together with the ‘mama-kit’. After delivery, I called the ‘musawo’, and I informed her that I had given birth, and she was happy for me. She asked me to come to the hospital when the baby is one month old, which I did. A test was done and she was negative. I continued coming to the hospital to monitor my baby’s health and growth. At nine months, another test was done and she is still negative.

I have learnt that attending ANCs, delivering at the health facility, not sharing sharp instruments, are very important if you want to have HIV negative babies.”

Preparing expectant mothers with NVP syrup for their newborns is vital in reducing the risk of exposure since they are able to administer the drug within time regardless of where they have delivered from. This intervention is helpful for ART clinics that provide antenatal care services for pregnant mothers on ART but do not support delivery.


Tapping into hidden network groups for vmmc -the use of satisfied clients to mobilise adult males 30 years

The fight against HIV/AIDS takes a multiprong approach for both prevention and treatment. Voluntary medical male circumcision (VMMC) is one of the biomedical HIV prevention interventions that are being emphasized. Uganda is among the 15 priority countries in which WHO/UNAIDS recommended VMMC. According to Uganda AIDS Commission report for 2020, 516,000 eligible males were circumcised.

Although strides have been made to reach males with VMMC, there is an age band disparity especially in getting males that are 30+ years to access VMMC. Boroboro Health Centre III, a UPMB-LSDA supported facility is among the sites where VMMC services are being provided in Lango sub region. Despite efforts to mobilize the 30+ years males for circumcision, turn up for services remained low. A root cause analysis conducted at the facility revealed that; the 30+ years males think that VMMC is for young boys. They also felt that their privacy was being violated during the VMMC camps when older men were mixed with young boys. The timing of the VMMC activity was also not favourable for them since it happens during working hours.

The facility team sought for solutions that could help them reach the 30+ years target group. The use of satisfied VMMC clients as “champions” to mobilize their peers and flexing working hours to accommodate the working class were selected as solutions to fix the problem. At the time of assessment, the facility had only managed to reach 30 males of 30+ years in a space of three months. This number was small compared to the monthly target of about 52 clients 30+ years.

“We realized that most of the males 30+ years preferred to come to the facility beyond 5 o’clock given their working schedules and also not wanting to be mixed with the other age categories consequently we had to adjust the working hours to accommodate this category and avail them the services”, says the VMMC Focal Person at the facility.

The satisfied client strategy was very instrumental in mobilizing and driving the client numbers high at Boroboro HC III. These satisfied clients are VMMC beneficiaries who are enlisted from within the Health Centers catchment area. They are briefly trained by the health information officers and are given a modest facilitation of transport refund and airtime. This facilitation is performance based and they have to meet certain targets in the month before being refunded, says the lead VMMC champion for mobilization.

In a space of six months, Boroboro HC III had managed to reach 80% of the expected target of male 30+ years. The efforts and strategies used enabled them to tap into an age band that is seemingly hard to reach with VMMC services. The facility continues to engage the satisfied clients with whom they hold regular planning meetings.
“VMMC services for this age band needs to be tailored to the needs of the clients other than operating in a business-as-usual mode of VMMC camps where these categories will not show up”, says the VMMC FP of Boroboro.

The UPMB regional team in the North have picked up lessons from the use of these strategies. They plan to scale them up to sites that have similar challenges like that of Boroboro to reach out to males 30+ years with HIV prevention services.

Graduation from Vulnerability – A testimony on the impact of AGYW Services

In the hustle and bustle of Kampala, you will find a small overpopulated township called Nakulabye, and that’s where I hail from. Born and bred. My name is Agatha. I am 21 years old and I am a single parent of two wonderful children, Hope (2 years old) and Brilliant (1-year-old).

As I became a young woman, I discovered dating and sex early and by the age of 19 I had my son. My mother helped me raise him, and two years later I had my daughter. This time round It was tough for me to expect my mom to help me as well as my children.

In 2020 at the outbreak of COVID-19 in Uganda, I lost my small job and couldn’t afford to take care of my children and my mother too who had turned vulnerable. We largely lacked food in the house and I couldn’t do anything about it. So, I made a choice. The worst choice of my life. I decided to turn to sex work. I thought I would only do it once, but when the money ran out and I was in the same situation again, I went back.  I got a boyfriend who promised to take care of me. I stayed with him for 6months while doing sex work secretly since he was not providing anything. He started acting rude and sometimes he could beat me and force me to have sex whenever he was drunk.  I hated myself since I couldn’t find a proper job. I started becoming aggressive, moody and angry. I did not like the person I had become. In August 2021, a friend told me about the AGYW program at Alliance of Women Advocating for change (AWAC). She knew it would be a great opportunity for me. In was enrolled onto the AGYW program and I was happy to turn away from the negative life I was living because I knew it was only a matter of time before it destroyed me.

I was so happy when I was called to join my fellow Youths for Stepping stone and hair dressing in the AGYW program. Since then, I have started focusing on my goal of establishing my own Saloon. AGYW program has given me a new lease on life, and being part of a project that focuses on changing the lives of young girls makes me feel so proud.

AGYW program through Chosen Generation

“I never knew the potentials in me until the AGYW program through Chosen Generation reached me; I have acquired lots of life and livelihood skills which will not leave my life again, I can now make right choices for my life and avoid activities that would put my life in trouble”  from AGYW beneficiary!

All this was made possible with funds from CDC through UPMB

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