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Anti-Retroviral Therapy

The Uganda Population-Based HIV Impact Assessment (UPHIA), a household-based national survey, was conducted from August 2016 to March 2017 to assess the progress of Uganda’s national HIV response.  According to UPHIA, the prevalence of HIV among adults aged 15 to 64 in Uganda is 6.2%: 7.6% among females and 4.7% among males. This corresponds to approximately 1.2 million people aged 15 to 64 living with HIV in Uganda. HIV prevalence is higher among women living in urban areas (9.8%) than those in rural areas (6.7%).

The prevalence of HIV among children aged 0-14 is 0.5% which corresponds to approximately 95,000 children living with HIV in Uganda. In Uganda in 2018, 1.4 million people were living with HIV. Women are disproportionately affected by HIV in Uganda:

Of the 1,300,000 adults living with HIV, 770 000 (59.23%) were women. New HIV infections among young women aged 15–24 years were more than double those among young men: 14 000 new infections among young women, compared to 5000 among young men (MOH-Uganda/UNAIDS, 2018).

The 90–90–90 targets envision that, by 2020, 90% of people living with HIV will know their HIV status, 90% of people who know their HIV-positive status will be accessing treatment and 90% of people on treatment will have suppressed viral loads. In terms of all people living with HIV, reaching the 90–90–90 targets means that 81% of all people living with HIV are on treatment and 73% of all people living with HIV are virally suppressed. In 2018 in Uganda:

84% of people living with HIV knew their status.

72% of people living with HIV were on treatment.

64% of people living with HIV were virally suppressed.

Of all adults aged 15 years and over living with HIV, 73% were on treatment, while 66% of children aged 0–14 years living with HIV were on treatment. The 90-90-90 strategy has been revised to 95-95-95 strategy.

The revised Uganda National HIV Prevention and treatment Guidelines were rolled out in 2018. The 2016 version of the “Consolidated Guidelines for Prevention and Treatment of HIV in Uganda” expanded the HIV “test and treat” policy to all people diagnosed with HIV.

The “test and treat” policy involves providing lifelong Ante Retroviral Therapy (ART) to people living with HIV irrespective of CD4 or WHO HIV clinical staging. In the 2018 version of the “Consolidated Guidelines for Prevention and Treatment of HIV in Uganda, a recommendation was made for optimizing treatment by using Dolutegravir, a newer drug, in combination with Tenofovir and Lamuvudine (TLD) as preferred first-line for eligible people living with HIV.  The guideline has also provided guidance on HIV self-testing to increase access to testing. There is a renewed focus on screening and treating for syphilis in pregnant women and their partners.Baylor College of Medicine Children’s Foundation – Uganda (Baylor-Uganda) in partnership with the Inter-Bureau Coalition (IBC) and Women’s Organisation Network for Human Rights Advocacy   (WONETHA) is implementing a PEPFAR funded project through CDC named “Accelerating Epidemic Control in Fort Portal Region (ACE-Fort) in the Republic of Uganda under the President’s Emergency Plan for AIDS Relief (PEPFAR)”. The project goal is to contribute to MOH efforts to reduce the incidence of HIV infection and HIV/AIDS related morbidity and mortality among children and adults in Uganda in line with UNAIDS 95-95-95 targets for epidemic control.

The project supports 145 Health Facilities in nine (9) districts of Fort portal region; Bundibugyo, Kabarole, Bunyangabu, Kamwenge, Kitagwenda, Kasese, Kyegegwa, Kyenjojo and Ntoroko as well as the Fort Portal Regional Referral Hospital.

In line with the 95-95-95 strategy, by the end of the quarter one (December, 2019) of the 2nd year of ACE-Fort Project, 85,149 HIV positive clients were receiving ART treatment; 2,171 newly identified HIV positive clients had been initiated on ART within the quarter, 98% patients on ART had accessed viral load test and 90% were virally suppressed. Viral load access was more among adults than children and adolescents. Moreover, viral load suppression rates were better among adults than children and adolescents. Among children (0-9years) and adults (20-24 years), more females accessed viral load tests compared to their male counterparts. However, for adolescents and adults aged 25+years, more males than females accessed viral load tests. Female children and female adolescents achieved better viral suppression rates compared to their male counterparts.

However, among adults, better viral suppression rates were achieved in males than females. Holiday viral load campaigns will continue to be held, to address challenges of school going children.

The project will continue to strengthen interventions to improve viral load suppression among children and adolescents, support health facilities in the management of non-suppressed clients and ART optimization for children and adolescents. Among adolescents and young people, the Young People and Adolescent Peer Supporters (YAPS) which has been rolled out in the region will support fellow adolescents to improve their adherence to treatment.

 

 

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