Uganda: High quality treatment for the poorest (February 2006)

As Uganda scales up HIV care and treatment programs, the great challenge is to make services available to the poor and disadvantaged, who make up over 70 percent of the country's population. With Emergency Plan funding, Reach Out Mbuya, a faith-based organization serving a Kampala neighborhood, is providing comprehensive, holistic care to poor people using a clinic/home-based model of service delivery.

Ms. Rose Namukasa was a 37-year-old widow caring for her four children and two orphaned relatives when she arrived at the Reach Out clinic in 2002. HIV-positive with active TB and too poor to access private medical care, Rose was at high risk of contracting other opportunistic and possibly fatal infections. She recounts her journey from sickness and destitution to health and strength through three stages. At first, she felt desperation as the unemployed head of a family that had come to Kampala to escape the conflict in northern Uganda. But after deciding to undergo HIV testing at Reach Out, she was able to accept her HIV-positive status and learn how to follow a treatment regimen. The final stage of her transformation is her improved health and her employment as a community antiretroviral treatment (ART)/TB treatment supporter (CATTS) at Reach Out. She now looks forward with hope to rebuilding her life and planning a future for her family.

Reach Out is now able to provide treatment to 800 HIV-positive clients and care for over 1,800 clients and their families. The Reach Out comprehensive service delivery model combines clinic care by nurses, who work under a doctor's supervision, with home-based follow-up linked to a network of community workers, 80 percent of whom are HIV-positive clients themselves. Clients are provided extensive counseling on ART adherence and every client is visited at home for an assessment of their psychosocial environment. In addition, the CATTS conduct weekly visits for pill counts, health assessments and general assistance. Reach Out also offers its clients nutrition support, microfinance loans, school fees for dependent children, and training in income-generating activities.

With Emergency Plan support, Reach Out has developed a comprehensive HIV/AIDS care and treatment service delivery model at a low cost that has saved and transformed lives. As Rose Namukasa can testify, Reach Out has shown a community that there is hope for people living with AIDS, even for the poor.

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