With the assistance of PEPFAR, Baylor-Uganda runs a historic clinical centre of excellence (COE) within the National Referral Hospital, Mulago. Without the current effective elimination of Mother to Child Transmission (eMTCT) programs, several children contracted the virus from their mothers. These children and later teenagers, began with the COE as a paediatric HIV clinic 18 years ago.

The centre boasts one of the oldest cohorts of people born with HIV, demonstrating the value of collaboration and the life-saving potential of anti-retroviral therapy (ART) for young patients. For more than 15 years, Baylor-Uganda has been caring for 1,163 adults 25 years old or older born with HIV and their families. The oldest HIV patient at the centre is 38 years old, while 373 other patients are adults who were perinatally infected and are 30 years of age or older. These 373 individuals born with HIV lead happy lives, making valuable contributions to their society—one of them is a PhD student.

The clinic offers a wide range of high-quality, family-focused paediatrics and adolescent services. It provides HIV counseling, testing, treatment, and peer-to-peer counseling. The Centre also manages opportunistic illnesses like cryptococcal disease and tuberculosis.

A multidisciplinary team consisting of nurses, doctors, community health linkage officers, nutritionists, social workers, pharmacy technicians, and a laboratory team keeps the clinic afloat.

The clinic is open every week Monday to Friday from 7 a.m. until 7 p.m. and it serves an average of 200 clients per day. It has structured visits, with children below 10 years coming in on Mondays and Wednesdays, adolescents aged 10 to 17 years on Tuesdays, large families on Thursdays, and young people 18 years and older on Fridays.

Poor adherence to treatment among adolescents and young people is partially attributed to a lack of knowledge of their disease and poor economic situations in their homes. The clinic boasts of youth- and adolescent-friendly services with a robust team of 10 adolescent peer educators living with HIV supporting the clinic each day. The Clinic has designated an arts and crafts corner to equip the youth with income-generating skills, and board games. These activities are aimed at engaging the youth by providing knowledge on their disease as well as building their skills for economic empowerment to improve their adherence to HIV treatment. Trained peers give health talks before the engaging sessions.

Some of the COE’s services and programs include a drama group that shares health education messages with fellow clients. As clients wait for services, they can access an internet corner that offers computer skills training and entertainment.

The COE also operates a laboratory accredited by the College of American Pathologists. With funding from PEPFAR through the US Centers for Disease Control and Prevention (CDC), the Centre runs a call centre that offers toll-free telephone services. The Call Centre offers clinical consulting and counseling assistance to healthcare professionals across the nation. The objective of the Call Centre is to maximize the quality of services provided to children and adolescents.

Given the rigorous medical care that children and adolescents with HIV/AIDS require, this support is essential. In the future, Baylor-Uganda will transfer this service to the Ministry of Health.

COE Milestones

• To date, 98% of both first-line and second-line clients were optimized to Dolutegravir-based ART. Only patients who had contraindications to DTG, such as hyperglycaemia or its risk factors, continued on protease inhibitor-based ART.
• 97% viral load access was achieved at the location due to the delinking of VL test dates from ART refill days and the use of the four-month blood draw window period.