HIV is a serious health threat in Uganda. The prevalence of HIV in the adult population here is 5.5%, with 40% of those infected being in an advanced stage of the disease (AHD, advanced HIV disease, definition: CD4 cell count < 200/mm3). Despite these high case numbers, there are also positive things to report. In the last 10 years, access to antiretroviral drugs has improved significantly in the developing country, so that AIDS-related deaths have decreased by more than 50%. A further reduction in mortality can be achieved through the AHD care package implemented since 2020, which aims to ensure optimal care for the sick. According to Dr. med. Proscovia Namuwenge (Centre for Operational Research, Uganda), this is to be ensured through the following steps:
The above-mentioned efforts have already led to significantly better care for those affected after a short period of time: The availability of rapid CD4 cell count tests has been significantly expanded, which ensure rapid identification of AHD and can be performed in primary care medical centres. In addition, screening options for tuberculosis and cryptococcal meningitis, both associated with AHD, are now available at many clinics. Furthermore, guideline-based treatment of cryptococcal meningitis is now possible for the first time.
Through strict implementation of the WHO care package and good organisational skills, significantly better care for people suffering from AHD has been achieved. However, as Dr Namuwenge pointed out, this is not the end of the story. In order to maintain the success in the long run, numerous aspects have to be taken into account. These include a permanent optimisation of drug supply, the highest possible utilisation of capacities (staff training, maintenance of testing equipment) and the continuous monitoring and evaluation of the entire process.
For more articles, please visit our dedicated AIDS 2022 congress page
Namuwenge, Proscovia. Dr. med., Zentrum für Operationsforschung in Afrika, Uganda. Vortrag: Experiences, challenges, and reflections, implementing the AHD package of care in resource limited settings. Sitzung: The Road to Zero: successes, learnings, and the work ahead to end advanced HIV disease-related mortality, AIDS Kongress 2022, Vancover, 29.07.2022.