While considerable global attention is on increasing availability and access to antiretroviral therapy (ART) for people living with HIV/AIDS (PLHIV), these efforts are impeded by opportunistic infections that can be prevented through simple healthy practices like consumption of clean water, sleeping under an insecticide treated mosquito net (ITN) and practicing safe sex.
The Ministry of Health in partnership with Programme for Accessible Health, Communication and Education (PACE) and the US Centers for Disease Control and Prevention (CDC) implemented a ten-year Positive Living Project (PLP), which has proven that adoption of such positive lifestyles can greatly reduce opportunistic infections, delay HIV disease progression and improve quality of life among PLHIV.
With total funding amounting to US$ 19.783 million from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through CDC, the project distributed a Basic Care Package (BCP)-a simple health kit that included Cotrimoxazole, which is prescribed by clinicians upon confirmation of a positive HIV test; an insecticide-treated mosquito net; a safe water vessel with water treatment for disinfection; condoms and information on how to lead a positive lifestyle. It also integrated screening and management of sexually transmitted infections, family planning, partner testing and supported disclosure, partner discordance counseling, PMTCT, and safer sex practices, including abstinence and fidelity with correct and consistent use of condoms.
PACE today held a national PLP impact dissemination and close out meeting for the project that ends this month, at Hotel Africana in Kampala to share best practices and lessons learned. This follows an independent end of project evaluation by Makerere University School of Public Health.
“Our aim was to reduce opportunistic diseases like malaria, diarrhea, pneumonia and partner re-infection which take advantage of the compromised immunity of HIV-infected individuals. Findings from the end of project evaluation report show a significantly low incidence of these diseases among individuals that used the BCP kit along with their ART compared to those who used ART only, or the BCP only, especially in the first six months of treatment. Further still the incidence of the diseases dropped significantly in the same period among clients with the BCP only, compared to clients that did not have the BCP at all” says Dr. Dorothy Balaba, Director of Programs at PACE.
The report also showed that adoption of the positive living lifestyle behaviors was higher among PLHIV who had the BCP than those who did not even if they all nearly had equal knowledge about the lifestyle.
“We established that PLHIVs using the BCP were more likely to have only one sexual partner or to have abstained. Consistent condom use was generally moderate but higher among people using the BCP, even if exposure to positive living lifestyle information was high among both people using and not using the BCP,” says Prof Nazarius Mbona Tumwesigye, the team lead of the independent evaluators from Makerere University School of Public Health.
This project was adapted from the Positive Health, Dignity and Prevention framework developed by the Global Network of People living with HIV (GNP+) and UNAIDS, which calls for timely and uninterrupted treatment and care of patients, addressing stigma; while meeting the broader health and dignity needs of PLHIV; as well as protection and support of their human, sexual and reproductive rights.
PACE packed and delivered 671,745 BCP starter kits; as well as refills for the commodities in kits to 440 public and partner health facilities in 105 districts through PLHIV forums, and the MOH-VHT members. “We trained VHTs and peer educators to counsel people living with HIV and encourage them to adhere to the positive living lifestyle. They were able to reach over 430,000 individual people living with HIV with messaging on the positive living lifestyle,” Dr Balaba says.
Reacting to the project findings, Hon Sarah Opendi, the Minister of Health in charge of general duties, said, “Through our monitoring and evaluation system, and periodic reports from the project, we have over time been able to observe the above achievements. As the project closes, we have to look at sustaining the impact that the Positive Living Project has had, and how this fits into the UNAIDS 2020 “90-90-90” goal. The Positive Living Lifestyle will greatly contribute to our achievement of this goal.”
CDC, a key agency of the U.S. Department of Health & Human Services noted that majority of people with HIV live in low- and middle-income countries of sub-Saharan Africa, where access to quality health care is extremely limited.
“Such simple evidence-based interventions that are inexpensive, simple to implement, easily accessible, and beneficial to HIV-positive and negative people should be scaled up,” CDC Uganda Country Director Dr. Steven Wiersma. “Our focus is on evidence-based prevention interventions that can help reduce new HIV infections and improve the quality of life for persons living with HIV. We are passionate about everything that promotes good health and well-being, as the PLP has demonstrated.”
Part of the U.S. Mission in Uganda , CDC has for the last 25 years supported MoH through technical assistance and direct financial support to advance science-based public health initiatives designed to help the country confront its unique health issues and improve the health of its citizens. Informed by operational research, CDC led the development and piloting of the BCP for preventing opportunistic infections among people with or without HIV in resource-limited settings, which was scaled up for broad use in Uganda and adopted in most PEPFAR-supported countries around the globe.