The following report was provided by Dr Rick Hutchinson following his visit to Kamutuuza in June 2009. He and his team held meetings with various health professionals and AIDS organisations in the Masaka area to discover the best way forward in developing a Wellspring AIDS outreach programme.
On a previous trip to Uganda I went out on a Kitovu mobile and discovered it was one of the first AIDS outreach projects in Africa, and is hugely successful at handling the complex issues brought by AIDS in rural communities. For this reason we felt we could learn a lot, not only about AIDS outreach, but also about pioneering a project like HIV outreach, in rural Uganda.
Kitovu mobile works primarily with “AIDS” patients that present to Kitovu hospital, who express a need for social intervention. It provides holistic and palliative care. This includes supplying: nutritional supplements; social support; on-going community based follow up; counselling; and pain control. Drugs are provided at a cost to the patient, (even if very small) and they are only free if it is known the patient definitely cannot afford them.
Kitovu Mobile also has Involvement in education of schools and communities to ensure that the communities Kitovu mobile visit are able to work well with the staff and the patients.
Though there is great need in the Kamatuuza area we must not try to stretch our resources to finely, and trust God that we can gradually grow larger as our resources (ie. Trained HIV staff, ART supplies, transport, budget to include petrol prices and vehicle maintenance etc..) allow. AIDS is a complex disease requiring on-going, committed treatment, therefore we cannot let our ambition to reach as many as we can harm our goal to treat the disease and its surrounding issues well.
We should remember many of our patients with HIV will not have AIDS, as many will be young and therefore not have progressed into the later stages of the infection. If we can, our aims should be preventing children progressing into AIDS by identifying HIV and starting ART early, with adequate counselling, follow up and education. However we most definitely will meet many children with AIDS, so Kitovu mobile remains a valuable source for advice, guidance and support with these children.
TASO is one of Ugandas largest HIV/AIDS agencies. They are very closely tied with the government and do huge amounts of VTC, ART therapy and counselling, as well as training many professionals to be counsellors. From the meetings we had it became clear that TASO is widely considered the gold-standard for HIV counselling and training of counsellors.
TASO is a vital resource for Wellspring. As we start to do VTC we will fall heavily on TASO for both advice and as a referral centre. Ideally all our staff would be VTC trained by TASO (however this might not be practical).
Aids Healthcare Foundation, an Amercian NGO, together with the Uganda Ministry of Health opened the first Uganda Cares clinic in Masaka in February 2002 and was the first organization to provide antiretroviral therapy outside the capital city of Kampala.
All VTC must involve both pre- and post-test counselling, and patients must be counselled again before commencing ART.
Uganda Cares does have the capacity to perform Virology tests however these have to be sent to Kampala so results will take time to come back.
Uganda Cares provides ART for other hospitals and NGOs, including Kitovu mobile, often providing drugs free of charge.
Uganda Cares is a very well set-up ART / VTC centre. If Wellspring were to send patients from the clinic for either VTC or ART we should only be sending to one centre, for the time being. Personally I believe TASO would be a better option, partly as building a strong relationship with them may help in the future when it comes to training staff. However Uganda Cares remains a resource for support and advice. It also may provide a source for ART medications.
As HIV still carries a lot of stigma in Uganda, many patients are unwilling to be seen to have a test. This leads to less people getting tested and treated, which allows for greater spread of the disease. For this reason Masaka use opt-out testing. This involves pre-test counselling in the waiting room of the general medical clinic, followed by the patients being told if they do not want the test they will need to opt-out, usually by moving to a different section of the room. Dr Albert felt this may work well at Wellspring. Though importantly post-test counselling should, in all circumstances, be absolutely confidential!
It was advised by Dr Musisi, head of the Masaka Health Directorate, one of the best ways to start the HIV outreach was to ask TASO if they would start VTC outreach clinics at Wellspring, and then enter some staff into Januaryâ€™s TASO counselling course. (Dr Mussisi stated he could provide a percentage of funding a staff member through the course).
As we look ahead to having a maternity service we should know all midwives are already trained in VTC, and are also able to provide prophylactic ARVs to pregnant / nursing mothers to prevent vertical (mother-to-child) transmission.
Wellspring believes that a “know your status” campaign initiated by the Just Care schools and promoted in the local communities would be the best way forward towards AIDS prevention, together with the ABC prevention project initiated by the Ugandan Health Department. this may be the key to our HIV outreach project. Know your status should be the next Ugandan HIV campaign!