The Ministry of Health (MoH) with support from the Global Fund (GF), has been implementing several research studies in Uganda, in conjunction with Makerere University School of Public Health (MakSPH).
On the 11th-13th of March, 2018, MakSPH held a workshop at Kampala Serena Hotel for the purpose disseminating findings from these researched. These studies will be used as a basis for planning, programming and implementation and they can also be cited as evidence based to conduct future interventions.
These studies were carried out between 2013 and 2017 among different HIV subgroups across the different regions of the country. The studies include:
- Implementation of Option B+ for PMTCT in Uganda: Assessing Adherence to ART and Retention of Mothers and Infants unto PMTVT Services which was presented by Dr. Aggrey Mukose
- Family Planning and Sexual Reproductive Health survey among HIV infected women in HIV care in Uganda which was reviewed by Dr Joseph Matovu
- Priorities for Local AIDS Control Efforts in Uganda was presented by Prof Freddie Ssengooba
- Condom Programming Assessment by Dr. Justine Bukenya
- Review of HIV Prevention Programming in Uganda 1987-2014 by Prof Noah Kiwanuka
Present at the workshop were several dignitaries including the Deputy Vice Chancellor Finance (DVC) Makerere University, Professor William Bazeyo, and the Chairman Country
Coordinating Mechanism (CCM)) of the Global Fund, Professor Edward Kirumira. The workshop also had representatives from the Ministry of Health, District Health Officer (DHO) representatives, Members of Parliament among other guests. Also present was Joshua Musinguzi, the Programme Manager of AIDS Control Program (ACP).
We now have the evidence needed for interventions, Professor Rhoda Wanyeze, Dean of MakSPH
In her opening remarks, she mentioned that often times when they suggested on interventions for over 10 funding proposals, they were asked for the evidence. For example when they suggested integration of family planning in HIV service delivery they were questioned about the evidence which comes from the many studies that have been conducted by MakSPH.
She thanked colleagues from the district, researchers from MakSPH, and Ministry of Health partners for the work well done. She also thanked Country Coordinating Mechanism CCM of the Global Fund for trusting them with the funds because these have been used to generate evidence for programming. She went ahead to thank Professor William Bazeyo, the former Dean of MakSPH who is now part of administration of the university and asked that he continues to support MakSPH as he previously used to.
Speaking at the beginning of the workshop, Prof Kirumira, the country chairman of CCM pointed out that data affects very many departments including the generation of concept notes where data is necessitated. He gave scenarios where few or many mosquito nets have been distributed and he blamed this anomaly on the absence of data.
He informed the workshop that about $ 17 million was given to 20 countries, Uganda inclusive, to strengthen the data system and support initiatives that focus on the analysis of data. In Uganda, three priority areas were funded which included; key populations programmatic mapping and size estimation. He also said that $ 350,000 was accorded to a mortality study and $ 400,000 to country analytic capacity to support analyzing routine epidemiological data.
Professor Kirumira said that PMTCT Retention, Uptake and adherence, family planning and sexual and reproductive health survey among HIV infected individual among other studies were funded by GF through Ministry of Health. He also informed the meeting that that CCM had extended funds to MakSPH in the three disease areas of HIV, Malaria and TB and pledged support from CCM in the three program areas. He thanked the development partners, MakSPH in the work they under took to complete the studies and in organizing the dissemination which will contribute to the analysis and use of data in programming.
Professor Bazeyo, former Dean, excited about the findings
Excited about the findings, Prof Bazeyo emphasized that it is important for researches to disseminate their findings. He also informed participants that Makerere University had been recognized as the second best research University in Sub-Saharan Africa which would not have been possible without dissemination of research findings. He encouraged the researchers to make policy briefs which can easily be read and understood by parliamentarians and other stakeholders.
He further mentioned that recently he had asked Ministry of Finance to start funding research and they agreed that they will have a slot for research in their budget. He also pointed out that he had been closely working with the Uganda Communication Commission (UCC) so that they can offer airtime to researchers on television for at least 2 hours. This will enable research finding s which have an impact on the community to be shared, an idea that was seconded by the Minister of Education. He stated that having been at MakSPH he had realized that often times research findings remain with the school without reaching the people who need them. He also informed participants that Makerere University is tending towards a research university and the university was in the advanced stages of negotiating with government to fund postgraduate students so that they focus on conducting research to help the nation.
As much as it may not be very easy to get funding, Prof Bazeyo beseeched researchers to give more attention to conducting research and to take advantage of partners like USAID, GF and CDC.
Implications of the Study Findings on Policy and Program Implementation
Below is a summary of each of the study findings showing ways in which findings can be used as policy and program implementation:
Review of HIV prevention programming in Uganda, 1987-2014
- Primary HIV prevention was noted as an important component in the control of HIV epidemic even with the face of biomedical prevention that is regarded as evidence base. There is still need to roll out primary HIV prevention just like it was at the beginning.
- SBBC communication that led to behavior change which is not looked at as a strategy now but rather modeled into other strategies should be promoted.
- SBBC which is underfunded affect the promotion of IEC materials which carry very important messages for the community.
Condom programming assessment
- There is still is still a high demand of condoms versus the procurement, delays in distribution to the end user and issues in the payment of the distributors.
- Strengthening coordination at all levels right from the district to the end users however that should come with easy access and privacy for the end user.
- Training on use of both male and female condoms
- Many condoms are door funded thus there us need for the government to make an input in finding condoms
Implementation of Option B+ for PMTCT in Uganda: Assessing adherence to ART and retention of mothers and infants into PMTCT services
- High initiation rates of women on ART at 90% while only three quarters of them are retained in care which is suboptimal.
- 3% transmission of HIV to babies among 85% adherent women who took drugs.
- Strengthening of Option B+ at health facilities still needed especially enhancing health education, involvement of men and the community.
- Quality of counseling was not up to date thus calls for strengthening training of health providers and more counseling required for the mothers.
Family planning and sexual and reproductive health survey among HIV infected women in HIV care in Uganda
- Integration of HIV services with sexual and reproductive health services.
- High Unmet need for family planning at 41% which was high among those who want to limit child birth.
- Family Planning counseling not efficient
Priorities for Local AIDS Control Efforts (PLACE II) in Uganda
- Districts have a challenge in the use of data; a lot of data is generated however they don’t know what data to put into use thus there is need for districts to find local data.
- There are groups found in the social places that have not been reached and examples are the women who work in the social places who have similar characteristics and behaviors like the sex workers. There is need for strategies to target them too.
- Lack funds to fund interventions at the districts where
The funds were a result of advocacy-Dr Joshua Musinguzi
In his remarks at the end of the workshop, Dr Musinguzi, the CCM chairman thanked the entire team for organizing the meeting which he pointed out as having been a long journey.
He was happy that all the studies had generated detailed reports and publications and were now moving towards making policy recommendations noting further that a body of evidence is required for HIV programming.
He pointed out that most of the funds used for these studies were not grants but rather, had been gotten through mobilization and advocacy.
Prof Musinguzi also revealed that findings of primary prevention of HIV which is still very key in the prevention of HIV for example, were already being utilized although there are few interventions on primary prevention lately. He said that they are happy because there is now kind of data which can inform their planning and programming in these areas.
He also talked about the condom programming study which identified implementation gaps in areas of governance, utilization and provision of condoms. He mentioned that condoms need to reach all part of the country yet the number that reaches the population is far less than what is needed in Uganda. He revealed that as much as there has been a decline in supporting condom programming and noted that there is need to revitalize the support so that they don’t lose the gain.
He also commented about the big challenges in retention which he said require all the stake holders and the PMTCT champions to see how they can improve retention of mother in Option B+.
He went further to talk about the family planning study among HIV positive women in care. This study also reported a gap of unmet need which is very vital in taking up the holistic approach on PMTCT.
Commenting about the PLACE II study which pointed out issues to do with localizing interventions, he said there is need to use data which can also inform concepts notes for the GF.
He concluded by emphasizing that there is need to translate findings into policy, guidelines and also using them in implementation and programming. And also expressed how he was looking forward to the policy briefs which can be used for programming and resource mobilization and also pledged to continue engaging MakSPH.
NOTE:
- The preliminary findings of the study on ‘Assessment of all cause and trends of the magnitude and cause of HIV/Aids and Malaria mortality and treatment outcomes in selected health facilities in Uganda from 2000-2015’ were also discussed at the workshop with the final report coming out soon.
- Full details of these studies can be obtained from the Ministry of Health which requested for them.
