1. Situation of HIV/AIDS services in Karamoja

2. Introduction 1M people infected with HIV. 110,000 children <15 years Estimated 135,000 new infections in 2007 (25% were due to MTCT) Estimated 153,000 people on ART. (Less than 10% of patient on ART are children). Other than the low prevalence, HIV/AIDS indicators in Karamoja are poor.

3. Introduction cont Prevalence of HIV Estimated regional prevalence stands at 3.5% Variation from 1.9 in Nakapiripirit to 5.6 in Abim district. Projected PLWHA in Karamoja is 35,000.(at 3.5% prevalence rate)

4. Situation of HIV/AIDS PMTCT MTCT contributes to 15% of all HIV infection PMTCT is an entry point of treatment care and support There has been an increase in geographical coverage of PMTCT/EID services in Karamoja

5. PMTCT Coverage by level HSSP II, the national PMTCT programme aims at scaling up services to 50% of HC IIIs by 2010 and improving quality of services with particular focus on postnatal care. By Dec 2008, health facilities providing PMTCT was as shown in the table below. HospitalHC IVHC IIITotal Abim1034 Kotido0145 Moroto20810 Kaabong1102 Nakapiripirit1269

6. District performance The widening gap between ARV prophylaxis coverage for mothers and infants is a real concern. In all the districts the gap is higher than 50%. Impact of PMTCT is maximal when both mothers and infants receive ARV prophylaxis. Key question is r

7. Comprehensive HIV care and support Service delivery facilities Matany hospital Moroto hospital Abim hospital Kaabong hospital Kotido HC III Tokora HC IV

8. Comprehensive HIV care and support Cotimoxazole uptake. 43% reduction in mortality with Cotrimoxazole 23% reduction in hospital admissions with Cotrimoxazole With antiretroviral therapy, survival out comes are good (but we are treating older children ‘survivor bias’) 75% reduction in mortality if treatment started on diagnosis in first year of life (South Africa) Resource-poor setting also reporting survival into adulthood of children infected perinatally Co-trimoxazole prophylaxis (CPT) uptake among HIV exposed children - remains low.

9. HCT/ART uptake < 5 years Children MorotoNakapiripir it KotidoAbimKaabong Children tested 501017014 Tested positive 3413001 Given ARVs50000

10. DBS Performance Morot o Nakap s KotidoAbimKaabon g Total Children born to HIV+ mothers tested for HIV 22242128095 Children born to HIV+ mothers tested HIV+ 529No results 016

11. HCT/ART adult females MorotoNakapiripiritKotidoAbimKaabong Tested 277616382041573399 Positive 2951091588619 Given ARVs 131200114

12. HCT/ART Adult male MorotoNakapiripir it KotidoAbimKaabong Tested18499111482245269 Tested positive 279841063837 Given ARVs11412026

13. Key concern Quality of services Very few health workers have been trained Single dose vs Combined dose. The Programme is still largely using single dose nevirapine for PMTCT due to lack of trained health workers. Logistic management Limited support that is provided to HIV positive clients including mothers who would have otherwise opted not to breastfeed.

14. Key concern Training There is an overwhelming need for refresher trainings and training new staff in line with the revised PMTCT policy guidelines

15. Key concern Monitoring and Evaluation Whereas timely reporting has improved, it is still unacceptably low. Submission of monthly reports to the MoH Many districts are still using the HMIS other than the monthly PMTCT reporting format

16. Recommendations / Way Forward Strengthening planning, implement and monitor HIV/AIDS care services, PMTCT and infant feeding counseling services. Capacity building. Invest in information management Update and streamline the logistics management system

17. Discussion