Support to MoH TWGs, committees
Using its vast experience in HIV/AIDS care and management PCT staff continued to support the Ministry of Health (MoH) by serving on Technical Working Groups (TWGs) and committees developing policies and guidelines used for the national HIV response. The year the team participated in developing the HIV Issues paper that informed the development of 3rd National Development Plan (NDPIII) for the period 2020/2021-2024/25. The PCT representative chaired and guided the TWG in developing NDP contents for this thematic area and supported national committees with making decisions on switching patients to 3rd line ART in the country.
The team acted as part of the pharmacovigilance committee responsible for the detection, assessment, minimization and communication of the risk of drug adverse reactions. In addition to this, two new clinics, neurology and physiotherapy, got integrated into the HIV/AID services. The clinics aim to cater for patients with problems, which are due to direct effects of HIV or associated opportunistic infections. Plans for commencement of another integrated care model, HIV/Dermatology clinic, have been finalized and expected to open soon
The Dolutegravir (DTG) experience
In October 2016 WHO reviewed ART regimens for HIV and found those including Dolutegravir (DTG) to have more effective, better viral suppression, CD4 count recovery and a lower risk of treatment discontinuation compared with Efavirenz (EFZ). As such, PEPFAR recommended fast introduction of DTG in its priority countries. Due to the high prevalence of primary resistance to EFV, Uganda became one of the early adopters of the recommendation. In June 2018, MoH updated ART guidelines to introduce DTG-based regimens as preferred 1st-line ART for adults and IDI was chosen a pilot site to transition certain treatment experienced patients to DTG based 1st line ART. By March 2019, a number of stable patients were observed to have developed hyperglycemia and for some severe enough to require admission, this was possible because of the excellent pharmacovigilance programme. MoH has since amended national ART guidelines basing on findings of this best practice.
PCT support to GHS establishment and transitioning
The teams participated in assessing facilities for infection, prevention and control (IPC) capabilities and training staff where gaps are identified. These efforts have since contributed to a steady and successful implementation of GHS projects mainly the Global Health Security Partner Engagement Project and Joint Mobile Emerging Diseases Intervention Clinical Capability that eventually led to GHS becoming an autonomous programme. PCT staff provide assistance to various GHS projects as well as ongoing support to teams offering clinical care.
Annual Major Visit introduced
The “Annual Major Visit” is a clinical review where patients receive a comprehensive evaluation and do recommended lab tests so as to optimize compliance to set care guidelines and chances for early detection of developing complications. Since its implementation in July 2018 major visit reviews have led to significant improvement in timeliness of viral load testing, screening for non-communicable diseases (hypertension, diabetes) and cervical cancer.
Thirty-two undergraduate medical students from Islamic University in Uganda and 1 fellowship student from Aga Khan University had clinical training placement in PCT.
Patient safety programme
On 6th September 2018, PCT hosted the first Uganda Patient Safety Symposium.
The event was collaboratively organized by the Ministry of Health (MoH), the Community Health and Information Network (CHAIN), the Human Rights and Peace Centre, Makerere University and Nottingham Law School (Nottingham Trent University, UK) and the aim was to; bring stakeholders together in an inclusive dialogue about patient safety; evaluate past and present patient safety initiatives within Uganda, identify successes and weaknesses and begin to develop a framework for future action.
Differentiated Service Delivery Models
DSDMs have improved efficiency of existing care and treatment approaches by addressing individuals’ needs, informing targeted interventions with better outcomes. The models have also improved access, coverage and quality of services leading to efficient utilization of resources. During the 2018/2019 period, PCT embarked on expedited implementation of DSD models so as to reduce on clinic visits per patient and focus on managing advanced HIV disease and other complicated patients.
Currently, we have clustered 50 patient groups (3-7 members) ready to be enrolled in the Community Client Led ART Delivery (CCLAD) model. With this approach daily clinic, patient numbers have been maintained below 200.