IeDEA Uganda

Uganda

Infectious Disease Institute (IDI)

Location: Kampala, Uganda

Site Principal Investigator(s): Dr. Barbara Castelnuovo, Dr. Aggrey Semeere

Data Manager: John Matovu

The Infectious Disease Institute (IDI) is a regional centre of excellence for HIV/AIDS treatment, research and training in sub-Saharan Africa. With initial support from Pfizer, the Infectious Disease Institute was established by the Academic Alliance for AIDS Care and Prevention in Africa, a prominent group of infectious disease experts from Uganda and North America. The Infectious Disease Institute clinic provides comprehensive HIV care to adults in the age range 16-84 with a median age of 44 years. They provide special services for high-risk groups or those requiring specialized care.  Since 2004, over 33,000 HIV-positive patients have registered for care at IDI, and over 96 percent are receiving antiretroviral therapy as of September 2019. Just over 1,600 patients are receiving second-line ART at the clinic; making it one of Africa’s largest cohorts of patients receiving second-line therapy. Approximately 200 receive more complex ART drug regimens, either due to co-current opportunistic infections, other medical problems (such as kidney disease) or failure of second-line ART treatment.

There is an increasing emphasis on developing models of care for co-morbidities of HIV—such as TB and Kaposi’s sarcoma. The range of services include: HIV patients, integrated TB-HIV clinic, sexual and reproductive health (SRH) services, adolescents’ clinic, discordant couples’ clinic, senior citizens’ (over 60) clinic, mental health clinic, non-communicable diseases (NCDs) clinic and Kaposi’s sarcoma (KS) clinic.

The Infectious Disease Institute (IDI) also supports the provision of HIV prevention, care and treatment services through outreach activities at Kampala Capital City Authority clinics and in several districts in North West and Mid West Uganda. By the end of September 2019, Infectious Disease Institute had supported the enrolment of over 319,769 active HIV positive individuals into HIV care across its supported outreach projects. The clinic also serves as a platform for IDI’s research and training activities. 

Masaka Regional Hospital HIV Care Clinic

Location: Masaka City, Uganda

Site Principal Investigator(s): Dr. Charles Kasozi

Data Manager: Matthew Ssemakadde

Masaka Regional Hospital HIV Care Clinic is located in Masaka City, the largest city in the South-West Buganda sub-region. It is approximately 137 kilometres southwest of Uganda’s capital city, Kampala.  It was built in 1927 as a centre for treating WWI veterans with syphilis. Later, it served as a district hospital until 1999, when it was made a regional referral hospital.

The hospital serves as the referral facility for the nine districts in South-West Buganda sub-region (Masaka, Kalungu, Lwengo, Bukomansimbi, Kalangala, Lyantonde, Sembabule, Rakai and Kyotera) with a catchment area population of about three million people (NHPC 2014). It is a teaching hospital for Habib medical school of Islamic University In Uganda (IUIU) and the medical school of Lahore University of Pakistan.

The hospital has a bed capacity of 500 and a staffing level of 247 excluding project and university staff (specialist lecturers). In addition to the core function of clinical care, it is also an internship training center for new medical doctors, nurses and pharmacists.

The HIV Clinic at Masaka Regional Referral Hospital, operated through a partnership between the Uganda Ministry of Health and AHF/Uganda Cares,  provides a wide range of services including: HTS (HIV testing services), Psychosocial Support, provision of anti-retroviral therapy (ART), treatment of opportunistic infections (OIs), cervical cancer screening, STI screening and treatment, CD4 counts, viral loads and other laboratory investigative services, family planning, prevention of mother-to-child transmission (PMTCT), palliative care, and social economic empowerment for the clients (SEEP).  All services are free of charge.

The clinic also provides comprehensive HIV care to adults and children, male and female, in age range less than one year to 96 with a median age of 35. The site has cumulatively enrolled over 32,476 patients, of which about six percent are children, and over 14,681 patients are active in care as of December 31, 2019. This clinic maintains an electronic database for the patients based on the Open MRS application.

Mbarara University ISS Clinic

Location: Mbarara, Uganda

Site Principal Investigator(s): Dr. Winnie Muyindike and Dr. Helen Byakwaga

Data Manager: Michael Kanyesigye

The Immune Suppression Syndrome (ISS) Clinic in Mbarara, Uganda, is a prototypical municipal HIV/AIDS clinic in Western Uganda. The ISS Clinic provides comprehensive HIV care for both children and adults, male and female patients, with an age range of 0 – 84. The median age for children is 10 and 38 for adults.  ISS has enrolled more than 31,000 HIV-infected adults and 2,421 children since it began in 1998. As of December 31, 2019, just over 12,000 patients are in active follow-up.

The experience of this clinic, including basic epidemiologic, clinical, and laboratory parameters, is captured in an electronic medical record system which uses OpenMRS. The Core, as part of the Joint CFAR International Collaboration with Harvard, the University of California San Francisco (UCSF) and Mbarara University of Science and Technology (MUST), has had a prominent role in the development of the ISS Clinic Cohort.

Services include: clinical care consultations, counseling services, laboratory services, biopsy services for the diagnosis of Kaposi's sarcoma (KS), ART for all patients who qualify, treatment of opportunistic infections, platform for training/ teaching medical students, referral of women for cervical cancer screening, and provision of a basic care kit including safe water vessels, water guard, condoms and insecticide treated mosquito nets.

Rakai Health Sciences Program (RHSP)

Site Principal Investigator(s): Dr. Fred Nalugoda

Co-Investigators: Dr. Steve Reynolds

Data Manager: Anthony Ndyanabo

The Rakai Health Sciences Program (RHSP) was established in 1987 as a collaboration between researchers at Makerere, Columbia University and the Uganda Virus Research Institute of the Ministry of Health. Subsequently, the collaboration extended to Johns Hopkins University, and in 2002, to the Division of Intramural Research (DIR) at the National Institute of Allergy and Infectious Diseases, U.S. National Institutes of Health (NIH). In that year, the RHSP was designated by the DIR as one of only three International Centres for Excellence in Research (ICER).

The ART Program at RHSP sees adults and children ranging in age from less than one year to 84 years, both male and female, with a median age of 36 years. Since 2004, the Rakai Program has provided HIV care to infected persons via a central clinic in the Rakai Health Sciences Centre in Kalisizo and through 17 mobile clinics that visit communities bi-weekly. In 2013, all HIV programming in the Rakai district was integrated with the Uganda Ministry of Health services in a district-led approach with technical support from RHSP. Currently HIV services are offered through 34 health facilities also known as health centres (HCs) including two general hospitals, one HC level IV, 22 HC level IIIs, and nine HC level IIs.

As of December 2019, approximately over 25,436 (95. % adults, 5.04% children) individuals were active in HIV care and treatment. Services offered by the program include: comprehensive HIV care and treatment; TB/HIV services; HIV counseling and testing for adults, adolescents and paediatrics; prevention of mother-to-child transmission (PMTCT); laboratory services and safe male circumcision. The program maintains an electronic database for the patients based on the Open MRS application

In April 2017, the RHSP was awarded a cooperative agreement with the CDC, to support comprehensive community-based HIV/AIDS prevention, care and treatment services to persons in 12 districts in Masaka region including: Rakai, Kyotera, Lwengo, Bukomansimbi, Lyantonde, Kalungu, Masaka, Mpigi, Gomba, Sembabule, Butambala, and Kalangala. This cooperative agreement aims to realize rapid HIV epidemic control in the Masaka region, through implementation of targeted, novel, evidence-based, effectual, user-friendly and sustainable differentiated service models for increased demand, linkage, retention and adherence to HIV services. Some of the prevention services include: HIV self-testing for special populations, PrEP for key populations, early infant diagnosis and PMCT among others. As of 31^st September 2019, RHPS through this Cooperative Agreement had reached 610,196 individuals with HIV Testing Services (HTS), and enrolled 121,179 HIV-positive individuals on ART.