The PCT programme has evolved over the years into a specialist clinic which supports other clinics around Kampala and around the country. HIV positive patients (called Friends at IDI) are supported with a number of services including free antiretroviral therapy, specialist consultation and a supportive clinical environment. The clinic also serves as a platform for IDI’s research and training activities. PCT has developed several models of care which have allowed IDI to provide an excellent standard of care to close to 10,000 clients and the Adult Infectious Disease Clinic (AIDC) and an additional 60,000 through IDI supported outreach sites. (Including Kampala Capital City Authority Clinics, Expanded Kibaale Kiboga Project and Civil Society Fund/Regional Referral Hospital Project)
There is an increasing emphasis on developing models of care for infections that are closely related with HIV—for example TB and Kaposi ’s sarcoma.

Key Components of the Programme:

  • HIV Prevention Open or Close

    HIV Prevention

    HIV prevention is central to all clinical activities, and mainly targets people living with HIV (PLHIV) (using the concept of “prevention through positives”). The underlying strategy is to increase the number of individuals who are aware of their HIV sero-status; therefore, opportunities to do HIV testing are offered to the families of IDI patients. This strategy is based on the observation that most HIV infections occur in settings where the majority (over 80%) of HIV-infected individuals are unaware of their status. At IDI, we target individuals who are HIV-positive as well as their partners, with interventions that effectively reduce their likelihood to transmit the virus. Many HIV infections in Uganda occur between people in discordant relationships. Some of the special prevention-related activities that IDI carries out include:

    • Identifying HIV discordant couples, and helping them to maintain their discordant status through dedicated clinical and counselling services;
    • Integrating sexual and reproductive health services into all clinical care—including prevention of mother -to-child transmission (PMTCT), providing more contraceptive choices, prevention and treatment of sexually transmitted infections (STIs);
    • Preventing the onset of opportunistic infections (secondary prevention) among those already living with HIV, through the provision of basic care kits (including cotrimoxazole) and careful management of detected opportunistic infections;
    • Starting patients eligible for ART on HIV treatment as quickly as possible, and having them adhere to treatment, reduces their chances of passing on the virus to their partners. This is known as ‘treatment as prevention’;
    • Training and enabling PLHIV to support HIV prevention through behaviour change communication and provision of peer support and peer counselling;
    • Focusing particular attention on young adults, as a particularly high risk group for acquiring or transmitting the virus; and
    • Improving and maintaining HIV/AIDS skills, including those related to prevention, in the health work force including sexual reproductive health and HIV/opportunistic infections prevention as research focal areas.
  • Clinical Services Open or Close

    Clinical Services

    IDI aims to provide quality HIV care that meets both national and international standards, in a setting which facilitates research that can generate information on better approaches to HIV care in low resource settings. Details of the services are:

    Comprehensive Care Package

    All patients, referred to as ‘Friends’ at IDI, receive access to counselling, a safe water vessel, mosquito nets, condoms and screening for opportunistic infections. They are offered preventative treatment e.g. septrin for some illnesses. They also have their CD4 counts monitored, to determine if they need to start HIV medication/ antiretroviral therapy.

    First Line Treatment

    About 7500 (95%) ‘Friends’ are receiving antiretroviral therapy (ART) at the IDI clinic with 6000(80%) on first-line regimen. Patients’ response to treatment is monitored using routine CD4 count and viral load testing.  ‘Friends’ who are clinically stable on their treatment and have a good treatment adherence record are reviewed by nurses (nurse-only visits) or simply walk to the pharmacy (pharmacy refill visit) to refill their drugs. This arrangement reduces the amount of time such patients spend in the clinic, and allows clinicians to concentrate on reviewing patients who need their attention.

    Second Line Treatment

    Over 1000 ‘Friends’ are currently receiving second-line ART (drugs taken after the HIV virus develops resistance to first-line ART therapy) at the clinic. IDI has one of Africa’s largest cohorts of patients receiving second-line therapy, and IDI is carefully monitoring their progress in an effort to develop more effective and replicable approaches to managing such complicated cases. Experience gathered in this area is becoming increasingly important in informing clinical management approaches, for this increasing patient population. 

    Complex Regimen

    Over 300 ‘Friends’ receive more complex ART drug regimens, either due to co-current opportunistic infections other medical problems (such as kidney disease) or failure of second-line ART treatment. This specialised clinic is manned by a multidisciplinary team of physicians, doctors, nurses, counsellors and pharmacists, with vast experience in caring for such complex patients.

    Services available at IDI

    The following services are available:

    • General clinic for HIV patients
    • Integrated TB-HIV clinic
    • Sexual and reproductive health services
    • Adolescents’ clinic
    • Discordant couples clinic
    • Senior citizens clinic
    • Mental health clinic
    • Non communicable diseases clinic
    • Kaposi’s sarcoma clinic
    • Co-Pay clinic services

    For more details about these services click here.

  • Services for Specialized Populations Open or Close

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  • Safe Male Circumcision (SMC) Operational Centre Open or Close

    The SMC Operational Centre, located within IDI, was established by the CDC in June 2012 with the following main objectives:

    • To register all facilities in Uganda carrying out Medical Male Circumcision.
    • To register all implementing partners and their funders in the circumcision scale up.
    • To record the number of men circumcised within a 24 hour period.
    • To record the number of adverse events related to circumcision within 24 hours.
    • To record any serious challenges experienced during the circumcision scale up.

    The project started collecting circumcision data on 22 June 2012. A total of 90 health facilities were registered and have since been routinely contacted for data collection depending on how many days of the week they perform circumcision.
    Currently, the daily data collection is achieved through telephone calls made to all participating facilities by an officer at the Operational Centre. Every day, the data is for the previous day is collected. While making the telephone call, the officer concurrently enters the data being reported into a web-based system that was specifically developed for managing the data.
    At the end of every working day, the Operational Centre officer runs an automated reporting system that automatically generates reports and sends them as email attachment to the stakeholders. The reports consist of charts, worksheets, tables and maps. At the end of every month, an additional monthly summary report for the just completed month is included in the report package.
    The charts provide an excellent way of assessing temporal trends in numbers of men circumcised, while the maps easily reveal the spatial patterns/distributions of the circumcision process. In addition, the MS Excel files that are part of the report package can be further analyzed by users in any way that they may require.
    The Operational Centre has been successful in meeting the objectives of the circumcision project. In spite of this success, the Operational Centre continues to look for ways of improving the system by exploring new techniques and technologies to use for the data management system.

  • Clinics for Special Conditions: Open or Close

    IntegratedTB/HIV Clinic

    TB is the most common infectious cause of death in HIV/TB co-infected patients world over. Internationally, there are recommendations to integrate HIV care with other routine health care services. At IDI, one of the services successfully integrated in HIV care is TB treatment.
    Until late 2008, most IDI TB patients were referred to the TB ward in old Mulago, with a few accessing TB treatment from IDI. A quick review of TB care services initially by a small team of members in 2007 sighted a number of problems:

    • High proportion of HIV/TB co-infected patients defaulted on TB treatment (29%)
    • 1/5 of patients with pulmonary TB were missing a diagnostic sputum smear
    • The effectiveness of TB treatment through sputum results was being monitored just for a low proportion of patients
    • Patients with TB were spending the same or longer time in the IDI premises as non-TB patients

    Interventions
    A) TB working group formation
    The goals of the working group were:

    • Decrease TB treatment default rate
    • Standardise TB diagnosis, treatment and follow-up
    • Improve onTB infection prevention

    Achivements:

    • Development of TB forms for diagnosis, treatment initiation and follow-up
    • New Standard Operating Procedures
    • An outdoor TB/HIV clinic was established in December 2008

    Integration of TB services has led to reduced mortality and results have been published in the international scientific press.

  • Kaposi’s Sarcoma (KS) Open or Close

    KS is the most common cancer in the world, among people that are HIV positive. In Uganda, it accounts for six out of every ten cancer diagnoses made in the Cancer Institute. All patients who come to the IDI clinic are given a skin examination, and biopsies are conducted in cases of suspected KS. Persons who are found to have KS are put on ART immediately, if they are not already on it.

  • Information for Patients Open or Close

    Information for Patients

    The clinic is open Mondays, Tuesdays, Thursdays and Fridays for adult patients. For young adult patients (16-24 years), the clinic is open on Wednesdays.

    People who have tested HIV positive and would like to register at IDI are requested to attend the clinic in Mulago before 9:00 a.m. from Monday to Friday. They will then be given an appointment to come back to the clinic for registration.

    Those requesting to visit the co-pay clinic should contact This email address is being protected from spambots. You need JavaScript enabled to view it. .

    For more details on the services we provide, please see: Clinical Services.

    Health Care Workers

    Those who have a patient that they would like to refer or discuss should email This email address is being protected from spambots. You need JavaScript enabled to view it. .

     

     

  • Sexual Reproductive Health (SRH) Services Open or Close

    The SRH clinic was established in 2008 after obtaining a grant from TIDES Africa to integrate reproductive health services into HIV care at the institute. This was preceded by a needs assessment survey conducted in 2007 whose key findings among the 493 female respondents showed that: 44% were sexually active, 52% agreed not using condoms consistently, Utilization of Family Planning services was at 40% among respondents, 16% were pregnant and ½ of the number had not registered for ANC services, 66% pregnancies were reported as un-intended

    A team from the PCT department was constituted and trained in provision of the various components of SRH services. These components include; family planning, PMTCT, Sexually Transmitted Infection (STI) management, cervical cancer screening and referral.
    Some of the Family planning methods offered include: Depo-Provera (70%), Pills (20%), Implant (08%), IUDs (02%) and Condoms
    Prevent of Mother to Child Transmission (PMTCT)
    Over 1,000 mothers are benefiting from this service. The IDI clinic is implementing option B+ to all pregnant mothers in the clinic in line with the Uganda Ministry of Health guidelines. This involves providing HAART to every HIV positive pregnant woman to prevent HIV transmission from the mother to the child with the view that they continue on HAART for life. A total of 98.6% of the babies born to mothers benefiting from the program have tested HIV negative by 18 months.
    Cervical Cancer Screening
    Every woman in the clinic is screened for cancer of the cervix using the Visual Inspection with Acetic acid (VIA) technique and those found positive are referred for further management in the appropriate units. Those found negative are encouraged to have yearly repeat screening.
    Sexually Transmitted Infection Diagnosis and Treatment

    This is offered to all symptomatic patients both male and female.

  • Training and Mentoring of Clinicians and Nurses Open or Close

    The IDI clinic places emphasis on mentoring of its clinicians and Makerere University Post-graduate students. A time table for senior clinician cover was instituted in the clinic to ensure more structured mentoring of clinicians at the IDI clinic. Under this arrangement, a senior clinician is assigned to be available in person in the urgent care room with specific roles including the review of difficult cases, review of second-line ART patients and handling other consultations that arise from junior clinicians. This has been enhanced by the presence of visiting professors-in-residence. (PIRs)

  • Innovations Open or Close

    Innovations

    Task-Shifting to Address HIV Care Needs: The Nurse-Visit Programme

    Task-shifting is the process of delegation where tasks are moved, where appropriate, to other cadres of health workers. Following the WHO Conference in 2008, global recommendations and guidelines on task-sifting were developed as an international call for urgent improvement of health systems and particularly strengthening of human resources for health. Although task- shifting gained international prominence in 2008, task-shifting had already started taking place at IDI as early as 2006, to address the overwhelming numbers of patients during antiretroviral therapy (ART) rollout in the clinic.

    Nurses are empowered to review patients, so that medical officers can concentrate on treatment and clinical care. To ensure quality of care, the nurses are trained on clinical assessment of patients, identification of drug toxicities, management of opportunistic infections and drug interactions. The nurses have been able to keep abreast with developments in clinical care through continuous nursing education (CNE), a weekly nurse training programme at IDI. Through the weekly CNEs, nurses are updated on various areas such as: general health care, HIV/AIDS, case sharing and clinical skills of patient management. IDI has established standard operating procedures (SOPs)/ guidelines on how patients should be channelled and be reviewed by nurses or doctors.

    The team of nurses at IDI has confidently taken on clinical roles that enable them to review patients, through the ‘Nurse Visit' Programme. Nurses are now able to prescribe treatment for opportunistic infections; identify toxicities such as lipodystrophy and peripheral neuropathy; and identify treatment failure with the help of routine lab tests among other things. At IDI, nurses have been able to shift some of their own tasks to the ‘Expert Friends’, who have taken on tasks that were originally meant for nurses, on a voluntary basis, to enable nurses to concentrate on offering quality care to the ‘Friends’ who attend the clinic. Some of these tasks include measuring weight and height of the patients and transferring of files. The ‘Friends’ are trained in basic patient care management and counselling to provide quality care to other patients.

    The Pharmacy Refill Programme

    The pharmacy refill programme was originally conceived as an efficient and cost effective way of decongesting the IDI Clinic. At the time, it was observed that not all the patients that visited the clinic each day, needed to see a clinician. The clinician workload was too high for both the doctors and nurses because of the high demand for HIV Care. The Pharmacy Refill Programme was then created to cater for this group of ‘Friends’ that were deemed clinically stable. This group includes ‘Friends’ on antiretroviral therapy (ART) and those on cotrimoxazole prophylaxis.

    In order to ease implementation of the programme and identification of potential clients, it was necessary to create a separate pharmacy window to serve patients- “The Pharmacy Refill Window”. ‘Friends’ on ART pick up their medicines on a monthly basis, and see a clinician only once in three months. Patients on cotrimoxazole prophylaxis only see the clinician once in six months, and pick up their medicine once every three months, at the Refill Window. The Refill Window was first opened in 2006, and currently serves about a third of the general clinic population.

  • Greater Involvement of People Living with HIV/AIDS (GIPA) Open or Close

    Greater Involvement of People Living with HIV/AIDS (GIPA)

    The Greater Involvement of People Living with HIV/AIDS (GIPA) programme is a patient-led initiative designed to build a network of care supporters and volunteers who promote adherence to HIV treatment, and also helps ‘Friends’ gain entrepreneurial skills to become self-sufficient. The GIPA philosophy of inclusivity is part of a growing understanding that everyone, including ‘Friends,’ has a role in the care and support of people living with HIV/AIDS.

    The introduction of the GIPA programme (with its array of activities) has been a cornerstone in their lives, as they live positively with HIV/AIDS. IDI impacts ‘Friends’ through the Resource Centre Governance Council for ‘Friends’- a patient’s advocacy group that acts as a formal link between ‘Friends’ and IDI’s administration constituting of thirteen, all elected by their peers at IDI and the KCCA clinics; the IDI music, dance and drama (MD&D) group; Peer educators/Expert 'Friends'; Market Place/skills development and Art and Crafts.

  • Services available Open or Close

    General clinic for HIV patients
    This clinic looks after patients from the time that they are diagnosed HIV positive until they need drug treatment for their HIV and beyond.

    We can see any patient that has received an HIV test at another centre and would wish to access care. We can also see patients who have been accessing care from another centre, but whose doctor thinks that they need to come to a specialist referral centre.

    In this clinic we provide doctor consultations, meetings with counsellors, blood tests for monitoring HIV, anti HIV medication (called anti-retrovirals (ARVs) or anti-retroviral treatment (ART)) and a treatment which helps to prevent other infections (Septrin). We provide these drugs and services free of charge.

    TB-HIV clinic
    This clinic provides services for people who might have Tuberculosis (TB) and who are known to have TB. The clinic provides a “one stop shop” that allows patients to see the same doctor for their HIV and TB, and also to get their medication from the same clinic.

    Sexual and reproductive health services
    This clinic is for men and women who need help with HIV in pregnancy, family planning or sexually transmitted infections. This clinic is available for all patients registered in the clinic, and runs daily. We offer ARVs to prevent babies from getting HIV from their mothers. We offer contraceptive pills, injections, male and female condoms and intrauterine devices (IUD- or coils). We also do tests for sexually transmitted infections such as gonorrhoea, syphilis and hepatitis B.

    Adolescent- Young Adult clinic – the Transition clinic
    This clinic is for young people aged 15 to 25, who have either been accessing care at a children’s HIV centre, or who have just been diagnosed with HIV. This is the largest clinic for young people in the country. The clinic runs on a Wednesday morning, which provides a special time for young people, which is separate from the adult clinic. The doctors and counsellors are used to working with young people in a non-judgemental way. We also organise peer support meetings for the young people to get together in a safe environment. Some of the young people are able to get scholarships for vocational training programmes.

    Discordant couples clinic
    This clinic is for people where one partner in the couple is HIV positive and the other is HIV negative. This can be an HIV negative man and HIV positive woman, or an HIV positive man and an HIV negative woman. We can offer couple counselling, HIV testing for the negative partner and advice on having children safely. We also offer ARVs for the HIV positive partner at any CD4 count, which reduces the risk of their partner getting HIV. We offer peer support meetings, so that couples can meet with other couples who are in the same situation, so they can share advice and experiences with each other. This clinic happens on a Wednesday morning

    Senior Citizens Clinic
    This clinic happens on a Thursday morning. All patients in the clinic over 60 years old are welcome to come to this clinic, and it is run by one of our senior physicians – Dr Isaac Lwanga. This clinic specializes in offering a service for people who may have other problems related to age as well as their HIV, such as strokes, movement problems or memory issues.

    Mental Health Clinic
    On a Thursday morning, Dr Noeline Nakasujja, a consultant from the Department of psychiatry runs a joint clinic, with Sr Faridah Mayanja our clinical psychologist. In this clinic we treat patients who have HIV and mental health problems, such as severe depression and schizophrenia.

    Non communicable diseases
    Dr Noela Owaro is a physician with a special interest in non-communicable diseases such as hypertension, and diabetes in HIV. She sees patients with these problems every day in the clinic, and can offer advice on how to manage these problems jointly with HIV.

    Kaposi Sarcoma
    Kaposi Sarcoma is a type of cancer that causes black patches on the skin of patients with HIV.  Dr Barbara Castlenuovo is a physician with a special interest in Kaposi Sarcoma, and she runs a clinic for patients with this on a Wednesday morning. Patients in this clinic also sometimes get advice and treatment from Uganda Cancer Institute.

    Out of hours clinic
    All of these services are offered free within working hours. However, we know that some people find it hard to reach the clinic during the day due to their work and family commitments. This clinic can also offer extra tests such as tests to see if drugs are resistant to HIV, and some non-communicable disease tests. We offer an out of hours service at a small cost.

  • Frequently Asked Questions about HIV Care and the IDI Clinics Open or Close

    Frequently Asked Questions about HIV Care and the IDI Clinics

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