The National Expansion Program was designed to increase access and utilisation of paediatric HIV/AIDS services in the country. Baylor-Uganda with support from PEPFAR through CDC supports upcountry MoH facilities to integrate paediatric HIV/AIDS care and treatment services into the existing systems. Emphasis is put on rural, underserved facilities in high prevalence areas.

Sites are first assessed for basic competences, and to identify gaps in service delivery. Priorities are set and action plans drawn together with health facility and district staff. These serve as the baseline against which future performance is measured. Basing on the findings, health workers are then trained through didactic sessions, mentorship and support supervision to build their knowledge, skills and capacity.

A total of fifty eight health facilities (twenty six this reporting year) in thirty four districts have so far been assessed for support. Fifty eight facilities are already offering family centred paediatric HIV/AIDS services with eleven awaiting initiation. 

In 2008/2009, thirty seven new sites in thirty four districts were assessed for provision of paediatric HIV/AIDS services.  Twenty six have been initiated and are already providing the services. Available data indicates a remarkable improvement in the number of children and adults enrolled and active in care since the inception of the programme.

Number of children in HIV care by patient category before and after Baylor-Uganda’s national expansion programme (March 2008 – June 2009)

 

Access to standard HIV care increased three fold from 802 to 2568 for HIV positive children after initiation of paediatric HIV services in the facilities under the program. Only 802 children had been recruited over a four year period before Baylor –Uganda initiated the paediatric HIV expansion programme in these facilities.  Within only three months of initiation, April-June 2008, enrolment of children increased by 83% (from 802 to 1471).

As part of strengthening systems and developing the capacity of health facilities to successfully integrate paediatrics HIV/AIDS services, districts and health facilities under the programme were supported to develop paediatric HIV/AIDS specific work plans. To ensure sustainability of service delivery after the support from Baylor-Uganda health workers have been trained in the management of paediatric HIV/AIDS and in data management.

Number of Adults in HIV care over time
(March 2008 – June 2009)

Amidst the successes of the NEP, various challenges still exist. Loss to follow up of patients in care is perhaps still one of the biggest and most difficult challenges yet. Many clients once diagnosed do not return to the health centre or will return only when too sick to stay away. This has in many cases greatly compromised success of the anti retroviral therapy.

Weak planning and service delivery systems in some health facilities has also compromised the standard of care and treatment services offered. In many instances health workers are demotivated and disinterested resulting in poor service delivery. Inadequate planning has at times resulted in drug stock outs. Inadequate resource (especially human resources) for implementation of project activities has resulted in work overload and task-shifting.
 
Perhaps the greatest limitation has been poor laboratory coverage across the country, especially for early infant diagnosis of HIV. Most upcountry facilities must travel over hundreds of kilometres to deliver samples to testing labs nearest to them. Mothers have to wait for months to receive results. This has contributed to low infant enrollement.