Uganda: Constructing a seamless web of effective prevention, treatment, and care (February 2006)

With support from the Emergency Plan, the AIDS Support Organization (TASO) in Uganda is providing comprehensive, holistic care using a clinic- and home-based model of service delivery. Rural communities are severely limited in their ability to access needed services. To meet the care needs of isolated communities, TASO has integrated prevention, care and treatment services. TASO approaches the family unit as an entry point for services, and the home as a venue for HIV counseling and testing and prevention education. TASO provides services such as weekly home visits by lay workers in lieu of clinic visits; access to cotrimoxazole prophylaxis, multivitamins and medications, including antiretroviral therapy (ART), and treatment for tuberculosis (TB)-HIV/AIDS co-infection; and ART adherence counseling. TASO's efforts are providing outlying populations with comprehensive clinical care.

One of the common threats faced by patients suffering from HIV/AIDS is exposure to common infections, so TASO introduced cotrimoxazole prophylaxis as part of its palliative care services. This intervention produced a 46% reduction in mortality, and 30-70% reductions in incidences of malaria, diarrhea, and hospitalization. By improving the health and well-being of program beneficiaries, the intervention helped to reduce the pressure on the strained health care system.

The integrated care package also included multivitamins and treatment for TB-HIV co-infection. Multivitamins have been associated with a reduction in mortality rates among people living with HIV/AIDS. Additionally, the provision of INH prophylaxis for 6-12 months to TB/HIV co-infected individuals has been associated with a 60% decrease in active TB and a possible 20% reduction in mortality. By providing multivitamins and treatment for TB/HIV co-infection, TASO has helped to improve overall health and reduce mortality rates among program beneficiaries.

Poor hygienic conditions adversely impact both HIV-positive people and their communities at large. To improve hygienic conditions, TASO designed a home care package that includes the provision of an inexpensive and locally produced Safe Water Vessel and a chlorine water treatment kit, allowing for storage of purified water in the home. Since diarrhea is six times more common among people living with HIV than among the general population, the ability to provide clean drinking water to the family as a whole is crucial.

With support from the Emergency Plan, TASO is providing rural Ugandans with quality comprehensive care - and building an evidence base to support an effective response that can be sustained in the future. The success of this project is also yielding valuable information on best practices that can inform efforts in Uganda and other PEPFAR countries.

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