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Implementing Biomedical HIV Prevention Advances in Uganda

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Biomedical Advances in HIV Prevention

Abstract

Uganda’s rising HIV epidemic is a cause of concern. HIV prevalence has increased from 6.4 to 7.3 % in a space of 6 years (2005–2011), and the number of new HIV infections in adults and children is estimated to have increased from 130,000 in 2010 to 145,000 in 2011 based on results from mathematical models. In order to reverse this trend, Uganda has adopted a national combination HIV prevention approach that involves implementation of biomedical, behavioral, and structural interventions at a scale, quality, and intensity necessary to impact the epidemic. This chapter discusses Uganda’s progress in implementing biomedical HIV prevention interventions, including HIV counseling and testing (HCT), voluntary medical male circumcision (VMMC), antiretroviral therapy (ART), and prevention of mother-to-child transmission (PMTCT) of HIV. Modeling studies suggest that the coverage of these interventions should reach 80–90 % of the adult population if Uganda is to reverse the current epidemic trends by 2015. Reports from the Ugandan Ministry of Health suggest that the coverage of HCT, PMTCT and ART services has increased over the past 5 years. For instance, the percentage of health facilities (HFs) offering HCT has increased from 37 % in 2009/10 to 38 % in 2011/12. The percentage of HFs offering PMTCT services has also increased from 23 % in 2009/10 to 36% in 2011/12. By the end of 2012, approx. 24 % of 4,493 HFs in Uganda were actively offering ART. Despite this level of coverage, only 26 % of Ugandan men are circumcised, 73 % of eligible HIV-positive patients receive antiretrovirals (ARVs), 87.4 % of all HIV-positive pregnant women identified at antenatal clinics, during labor and delivery, and during the post-natal period receive prophylactic ART to reduce the risk of mother-to-child transmission of HIV (constituting approx. 52 % of all expected HIV-positive pregnant women in Uganda), while 34 % of women and 55 % of men are not aware of their HIV status. Several challenges still inhibit national scale-up of these interventions, including the slow progress in translation of research into policy, lack of adequate resources to put everybody who is eligible for ART on treatment, and the fact that the majority of Ugandans present late for HIV diagnosis, and therefore enter late (with lower CD4 cell counts) into HIV care.

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Notes

  1. 1.

    Government health facilities are graded into Health Centers and Hospitals, depending on the population and geographical areas served. The lowest level facility is Health Center I (HC I) which serves the village level, approximately 1,000 people. From HC I, the assignment of levels increases in grade as the population and geographical areas served increase—from HC II (which serves a parish, approximately 5,000 people) through HC III (which serves a subcounty, approximately 20,000 people) and HC IV (which serves a county, approximately 100,000 people) to a District Hospital (district level, approximately 500,000 people), Regional Referral Hospital (which serves approximately 3 million people or 3-5 districts), and National Referral Hospital, which serves approximately 10 million people.

  2. 2.

    HCT was provided as a service to study participants. Therefore, HCT services were available to community residents who had participated in research and who had provided a blood sample. Approximately 15,000 adults (15–49 years) were followed up through annual HIV surveillance surveys conducted in 50 communities in Rakai district.

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Authors and Affiliations

  1. Community Health & Behavioral Sciences, Makerere University School of Public Health, Mulago Hill Lane, P.O. Box 7072, Kampala, Uganda

    Joseph KB Matovu

  2. Division of Social Statistics and Demography, Academic Unit of Primary Care and Population Sciences, University of Southampton, Mailpoint 805, C Floor South Academic Block, Southampton General Hospital, SO166YD, Southampton, UK

    Dr. Nuala McGrath

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  1. Joseph KB Matovu
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Correspondence to Joseph KB Matovu .

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Editors and Affiliations

  1. Dept. of Human Develop. & Family Studies, University of Connecticut, Storrs, Connecticut, USA

    Lisa A. Eaton

  2. Ctr for Health Intervention & Prevention, University of Connecticut, Storrs, Connecticut, USA

    Seth C. Kalichman

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Matovu, J., McGrath, N. (2014). Implementing Biomedical HIV Prevention Advances in Uganda. In: Eaton, L., Kalichman, S. (eds) Biomedical Advances in HIV Prevention. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8845-3_10

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  • DOI: https://doi.org/10.1007/978-1-4614-8845-3_10

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