Implementing and Integrating HIV Partner Services in Uganda

By Habtamu Girma June 1, 2016

Uganda has made significant progress in the fight against HIV over the last two decades, in large part due to the improvement and scale up of HIV services with the implementation of provider-initiated HIV testing and counselling (PITC), targeted HIV testing and counseling outreach and the use of linkage facilitators for linking patients to care and treatment. Despite these efforts, the Ministry of Health AIDS Control Program estimates that an estimated 71% of all people living with HIV (PLHIV) in Uganda have been identified and only 61% of PLHIV are retained on antiretroviral therapy (ART) across 1,500 health facilities.  In order to stop the spread of the disease, it will be critical to identify those PLHIV who have not yet entered into care and ensure that they initiate ART. But it is proving increasingly difficult to do this using the traditional outreach approaches, demonstrating a need for a more focused and targeted testing approach that will effectively identify PLHIV.

This led the Uganda Ministry of Health to explore implementing a HIV Partner Services program, which would enable health care providers to identify sero-discordant couples, and ultimately link a greater number of PLHIV to HIV care. Partner Services are longstanding cornerstones of public health efforts to control the spread of sexually transmitted diseases (STD) and HIV.  An increasing body of research suggests that successful partner elicitation, notification and testing improves the success of HIV care in a population.  However, until recently, Partner Services have not been a component of HIV prevention programs in most countries in sub-Saharan Africa, including Uganda.  In most African countries, patients diagnosed with HIV are advised to notify their partners, but clinics do not offer assistance or systematically follow-up with patients to ensure that their partners are notified.  Despite the limited availability of Partner Services in Africa, mounting evidence suggests that partner services are both feasible and highly effective in this setting.

In collaboration with CDC/Uganda and the Uganda Ministry of Health, NASTAD developed a concept paper on HIV Partner Services in Uganda and assessed the feasibility of pursuing this intervention in the country. The Program Planning Assessment, which was implemented in August 2015, was designed to inform the pilot of a Partner Services program in the Rakai and Kiboga districts in Uganda. The findings of the Program Planning Assessment clearly demonstrated the feasibility of Partner Services and importance of integrating Partner Services with existing HIV programs and structures at the facility level for better results.

Ugandan public health experts visit the Idaho Department of Health and Welfare. 

Following the successful Program Planning Assessment, NASTAD partnered with the Washington and Idaho State Departments of Health to support a one-week study tour to the U.S. to build the capacity of Ugandan institutions and staff in the design, implementation, and administration of HIV Partner Services and Disease Investigation Specialist (DIS) activities.  Senior public health technical experts from the Uganda Ministry of Health, Kiboga and Rakai Districts, Makerere University School of Public Health, Uganda Infectious Disease Institute, Rakai Health Science Program and CDC/Uganda participated in this study tour.  The study tour enabled members of the Uganda delegation team to better understand the planning, management and monitoring and evaluation of HIV Partner Services and DIS programs in the United States. Through discussions with their U.S. peers supporting HIV Partner Services and DIS, the Uganda delegation strengthened their understanding of the different ways in which HIV Partner Services and DIS may be implemented in settings with varying resource constraints.

Building on the Program Planning Assessment and the U.S. study tour, NASTAD supported the development of a Partner Services Implementation Guide and a Standard Operating Procedures to standardize the intervention strategy and provide guidance to the Rakai and Kiboga districts and their health facilities on the standard delivery of HIV Partner Services. Moving forward, the MoH will collaborate with local partners and stakeholders to facilitate the integration of HIV Partner Services into the national HIV testing policy, and will continue to provide support and leadership to the Rakai and Kiboga districts to ensure the successful implementation, integration and roll-out of the pilot program.  An effective Partner Services program will improve case finding among the population exposed to HIV in Uganda and will generate higher positivity rates than the traditional outreaches. This innovative approach will support the implementation of high quality, targeted, and sustainable HIV interventions that will allow for the achievement of the UNAIDS 90-90-90 targets and ultimately epidemic control.