An update on the management of HIV infected persons in Uganda

1. Updates on management of
HIV-infected persons in Uganda
WCO Uganda

2. Outline
• Country status
• ART guidelines
• When to start ART
• ART Regimens
• Monitoring response to ART
• Adherence support
• Service integration
• Contraceptives and ARVs
• Special considerations:
• Active TB in HIV
• Cryptococcal disease and HIV;
• Current challenges/priorities

3. Country Status
Table of Active ART Enrolment in Various Facilities Countrywide: Sept-2014.
Number %
Total Active clients
Total clients on ART during the quarter 713,744 (year target737,658)
[155,987 new/208,472 target]
Adults 15+ years 659,064
Males 215,540 (32.7)
Females 443,524 (67.3)
Children years 54,680
Males 26,001
< 2years 3,587 (13.8)
2 – 4 years 6,192 (23.8)
5 – 14 years 16,222 (62.4)
Females 28,679
< 2years 3,147 (11.0)
2 – 4 years 6,744 (23.5)
5 – 14 years 18,788 (65.5)
Facilities reporting 1,631

4. ART guidelines
• When to start ART

6. Patient monitoring

8. Approaches to patient adherence support
• Comprehensive health education at every clinic visit;
• Client reminders using text messaging;
• Family support groups;
• Family clinic days;

9. Service Integration and Linkage
• Mother-baby care point Service delivery model:
• located in the MCH section of health facilities;
• For delivery of lifelong ART to HIV positive pregnant and breastfeeding
mothers as well as HIV exposed infants (up to 18 months after delivery);
• HIV/TB Co-Management:
• TB treatment may be provided to HIV+ individuals in HIV Care settings where
TB diagnosis has also been made;

11. Contraceptives and ARVs
• Contraception is a major component of comprehensive HIV care;
• Contraceptives have no effect on CD4 cell levels, viral load or even
progression to AIDS/death;
• HIV medicines of the NNRTI group commonly interact with
contraceptives;
• Couples should be adequately counselled in making contraceptive choices

12. Special considerations (1)
• Active TB in HIV:
• Start ART irrespective of CD4 cell count NOT LATER than 8 weeks and WITHIN
2 weeks of starting TB treatment;
• In TB meningitis, ART should be deferred until 2 months after initiation of TB
treatment.

13. Special considerations (2)
• Cryptococcal Disease and HIV:
• Cryptococcal meningitis still accounts for 20-39% mortality in Uganda;
• All ART naïve clients with CD4 less than 100cells/cubic ml should be screened for
presence of cryptococcal antigen;
• In Cryptococcal meningitis, ART should be deferred until:
• there is sustained clinical response to antifungal therapy and after 4 weeks of induction and
consolidation of treatment with Amphotericin B-containing regimens; or
• After 4-6 weeks of treatment with a high dose oral fluconazole induction and consolidation
regimen

14. Current challenges/priorities
• How to get the many HIV+ adolescents on treatment;
• How to maintain mothers on ART after discharge from the Mother-
Baby-care Point;
• Sustaining the ART needs after adopting the current guidelines;
• Securing adequate laboratory supplies for patient entry and
maintenance into care

15. Focus of next issue: Post Exposure Prophylaxis
THANK YOU FOR YOUR ATTENTION