Implementing Biomedical HIV Prevention Advances in Uganda

Abstract

Uganda’s rising HIV epidemic is a cause of concern. HIV prevalence has increased from 6.4 to 7.3 % in a space of 6 years (2005–2011), and the number of new HIV infections in adults and children is estimated to have increased from 130,000 in 2010 to 145,000 in 2011 based on results from mathematical models. In order to reverse this trend, Uganda has adopted a national combination HIV prevention approach that involves implementation of biomedical, behavioral, and structural interventions at a scale, quality, and intensity necessary to impact the epidemic. This chapter discusses Uganda’s progress in implementing biomedical HIV prevention interventions, including HIV counseling and testing (HCT), voluntary medical male circumcision (VMMC), antiretroviral therapy (ART), and prevention of mother-to-child transmission (PMTCT) of HIV. Modeling studies suggest that the coverage of these interventions should reach 80–90 % of the adult population if Uganda is to reverse the current epidemic trends by 2015. Reports from the Ugandan Ministry of Health suggest that the coverage of HCT, PMTCT and ART services has increased over the past 5 years. For instance, the percentage of health facilities (HFs) offering HCT has increased from 37 % in 2009/10 to 38 % in 2011/12. The percentage of HFs offering PMTCT services has also increased from 23 % in 2009/10 to 36% in 2011/12. By the end of 2012, approx. 24 % of 4,493 HFs in Uganda were actively offering ART. Despite this level of coverage, only 26 % of Ugandan men are circumcised, 73 % of eligible HIV-positive patients receive antiretrovirals (ARVs), 87.4 % of all HIV-positive pregnant women identified at antenatal clinics, during labor and delivery, and during the post-natal period receive prophylactic ART to reduce the risk of mother-to-child transmission of HIV (constituting approx. 52 % of all expected HIV-positive pregnant women in Uganda), while 34 % of women and 55 % of men are not aware of their HIV status. Several challenges still inhibit national scale-up of these interventions, including the slow progress in translation of research into policy, lack of adequate resources to put everybody who is eligible for ART on treatment, and the fact that the majority of Ugandans present late for HIV diagnosis, and therefore enter late (with lower CD4 cell counts) into HIV care.