1. Prevention of Mother-to-Child Transmission of HIV: Scale-up of Critical Services in Uganda (District- based Approach) Edward Bitarakwate, MD, MPH Technical Director EGPAF Uganda

2. National Context About 2 million people infected; 1 million have died & 1 million are living with the infection. Six percent of Ugandan adults aged 15-49 are infected with HIV and prevalence among women is higher (8 percent, {PMTCT now 6%}) than among men (5 percent)

3. National Context 1.2 million pregnancies occur annually in Uganda, without intervention, about 30% of HIV positive pregnant women transmit the virus to their babies which translates into up to 23,400 new HIV infections resulting from vertical transmission (MTCT) About 120,000 people on HAART, 10,000 of whom are children

4. EGPAF International Family AIDS Initiatives The EGPAF program in Uganda started in 2000 after results of the HIVNET 012 trial. Using private funds EGPAF Uganda embarked on the design, development, management, monitoring and technical support of the Uganda Ministry of Health PMTCT program. Since 2003 USAID (PEPFAR) has supported the Uganda EGPAF program. This support enabled the strengthening of the Foundation’s role as a key organization working with the MOH. EGPAF works closely with other partners in Uganda to coordinate PMTCT & C/T expansion in Uganda.

5. Background EGPAF strategy in Uganda has been to complement Uganda Ministry of Health and private partners to cover human resource, infrastructure and commodity gaps in health districts EGPAF Uganda helps with the design, development, management, monitoring and technical support of the Uganda Ministry of Health PMTCT program

6. EGPAF Uganda Program

7. Geographical coverage: 27 districts (Total 86); stretching from western to eastern borders of the country PMTCT services at 350 (MOH Total 507) sites ranging from regional and district hospitals to health centers at sub county level Integrated affordable, family-based quality HIV/AIDS care and ART services at 15 health care facilities

8. Objectives of District-Based Support To build district capacity in HIV counseling, testing and provision of other HIV/AIDS services. To implement comprehensive PMTCT services. PMTCT functions as a key entry point for families into longitudinal HIV/AIDS care and treatment. To integrate the PMTCT program into Maternal & Child Health services and into other district health services including community programs like VCT and Home Based Care To generate sustainable capacity for district led program scale up

9. Design & Development MOH assigns districts to be supported Participatory proposal development process- based on national guidelines Sub grant development process - pre-award assessment - integration with district health budget District stakeholders meeting: civil society, technical, political/community leaders

10. Systems Support Identifying key resource persons from within District Health Team to serve as focal person for HIV/AIDS program activities Foundation TAs embark on a process of mentoring these focal persons –work plan development, integration of all HIV programs –support supervision –program monitoring –logistics management –training, inter-site coordination meetings

11. Technical support Sub district program support/coordination teams (based at sub district level) - support supervision - lead CMEs: based on performance & identified knowledge gaps, information updates provided by the Foundation - training

12. Program Performance Over 1,000,000 women have accessed PMTCT services in over 350 sites in 27 districts. 64,000 HIV+ mothers have been identified 50,000 pregnant mothers have accessed Antiretroviral Prophylaxis 28,000 babies have accessed Antiretroviral Prophylaxis

13. Program Performance

15. PMTCT Data April 1, 2007 – March 31, 2008 IndicatorTotal Number of eligible pregnant women385,784 Number of pregnant women receiving HIV counseling375,257 Total number of pregnant women who were HIV tested328,243 Total number of pregnant women who received test results321,906 Number of pregnant women with an HIV-positive test20,281 Total number of mothers receiving ARV prophylaxis19,032 Total number of infants receiving ARV prophylaxis11,375 Number of PMTCT sites/Population coverage348/64%

16. “Every Child Deserves A Lifetime”

17. Acknowledgements International Family AIDS Initiatives Staff: Uganda, Regional and USA Uganda Ministry of Health Partner Organizations incl. but not limited to JCRC, SCMS, AHF/Uganda Cares This presentation was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief (PEPFAR), as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.