Uganda

Uganda girl

Although health indicators are improving in certain regions of Uganda, many deaths are due to preventable diseases such as malaria and HIV/AIDS. The World Health Organization reports that nationwide, HIV/AIDS has an average prevalence of infection of 5.4% and is the leading cause of death in adults followed by tuberculosis and malaria. According to the UNAIDS Uganda has an orphan population of more than two million, nearly half as a result of HIV/AIDS. Additionally, Uganda is one of the US President's Emergency Plan Emergence Plan for AIDS Relief (PEPFAR) 15 focus countries receiving support comprehensive HIV/AIDS prevention, treatment and care programs.

The Hopkins CCGHE is engaged in a number of projects with colleagues in Uganda, including:

Medical Education Partnership Initiative (MEPI)

The CCGHE has launched a new distance education Grand Rounds initiative in partnership with the Medical Education Partnership for All Ugandans (MESAU), a consortium of five Ugandan medical schools, including Makerere University, Mbarara University, Gulu University, Kampala International University and Busitema University. MEASAU is supported by the Medical Education Partnership Initiative (MEPI). The inaugural Grand Rounds Webinar took place on August 25^th, 2011 from Makerere University in Uganda and was entitled “Mental Illness Among Health Professional Students”. The student case presentations and faculty discussions were chaired by Dr. Seggane Musisi, Professor and Head, Department of Psychiatry School of Medicine of Makerere University College of Health Sciences. You can view all of the sessions via webcast at the following link: MESAU-MEPI.

Please contact Dr. Bob Bollinger for questions about the Uganda MEPI Program:

PreventionRx: eMOCHA and Targeted HIV Prevention

In collaboration with the University of Washington and the Integrated Community Based Initiatives (ICOBI) NGO in Uganda, CCGHE adapted the eMOCHA platform to successfully deliver smartphone-assisted, home-based HIV prevention messaging and follow-up. This pilot study targeted households in the Bushenyi district of southwestern Uganda. Standard home-based counseling and testing (HBCT), including pre- and post-test counseling, served as a platform to target those at highest risk for transmitting HIV: individuals with multiple partnerships, HIV-infected persons unaware of their serostatus, and HIV serodiscordant couples. A questionnaire was administered for HIV risk assessment using eMOCHA. In addition to standard HIV prevention messaging for all participants, high-risk individuals received an individualized HIV “prevention prescription,” based on HIV serostatus, risk factors, and risk behaviors. The Prevention Rx algorithm contained brief counseling messages, follow-up questions, information about local resources and referral for appropriate HIV prevention services. Participants who received referrals for care were followed up monthly for up to 3 months to provide additional counseling and assess uptake. From November 2010-March 2011, 855 households received HBCT; 1587 of 1941 (82%) adults were present and 1557 (98% of those present) were tested and received HIV results. 47% were men; 152 (10%) were HIV+ (in a district with 5% prevalence by the Ugandan national serosurvey). Of HIV+ persons, median CD4 count was 456, 18% had CD4 <250 and were eligible for antiretroviral therapy (ART) by Ugandan guidelines, 65% were female, and 51% newly-identified as HIV+. Three months after HBCT, 89% of

HIV+ persons had attended an HIV care clinic, including 100% of those with CD4 counts <250, of whom ~70% had initiated ART. Among 123 high-risk HIV- men referred for MC, 40% had MC by 1 month and 60% by month 3. The eMOCHA platform was successfully deployed in conjunction with HBCT to achieve high levels of knowledge of HIV serostatus and is very effective in identifying at-risk persons and achieving high uptake of HIV prevention and care services through targeted referrals.