Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN)

URC is working with the Ugandan Ministry of Health (MoH) to ensure continued provision and sustainable scale-up of comprehensive HIV and AIDS services for people living with HIV and AIDS (PLHA) at 10 regional referral and six general hospitals across the country.  Such services include a basic care package for PLHA, antiretroviral therapy, the prevention of mother-to-child transmission of HIV, management of TB and HIV co-infection, laboratory services, HIV counseling and testing, and safe medical male circumcision. In addition to the 16 hospitals receiving support for these services, SUSTAIN supports selected services at two regional referral hospitals and laboratory services at four health care facilities in the Karamoja region. The project aims to strengthen the public health system to ensure the delivery of quality services that meet clients’ needs. 

• Support the delivery of HIV prevention, care, and treatment services at 22 health care facilities;
• Strengthen laboratory services in the public sector by improving physical infrastructure, providing equipment for HIV-related laboratory and general health care tests (e.g., CD4 and complete blood counts, liver and renal function tests, and HIV and TB diagnosis, etc.), strengthening laboratory staff skills, and improving systems and processes to ensure timely and accurate laboratory test results;
• Institutionalize quality improvement (QI) approaches in routine service delivery, guided by the Uganda MoH National QI Framework;
• Improve service provider skills for the management of HIV and AIDS through training, routine mentorship, and supportive supervision; and
• Enable the MoH to provide fully integrated and sustainable quality care and treatment for people living with HIV and AIDS.

• From June 2010 to March 2013, over 367,000 clients received tests for HIV infection, their results, and referrals to appropriate care and prevention services.  
• Over 158,000 pregnant women seeking antenatal care were tested during the same period for HIV infection; those who were HIV positive (about 14,000) received care to prevent mother-to-child transmission of HIV (PMTCT).  
• As of March 2013, over 37,000 clients were receiving antiretroviral treatment at the 16 SUSTAIN-supported hospitals.  
• The project renovated and equipped nine hospital laboratories and trained and supported their personnel to provide quality laboratory services.  This support has given the public health sector the capacity to conduct CD4, hematology, and chemistry tests at all 18 project-supported public hospitals in the country.
• The project helped computerize data on all HIV clients at 16 hospitals using the Open Medical Records System, a newly developed MoH electronic patient data management system.
• The project also helped strengthen supply chain management systems for drugs and supplies: the average overall order submission rate for HIV-related medical commodities, including antiretrovirals, PMTCT supplies, HIV test kits, and other related commodities, at the SUSTAIN-supported hospitals improved from about 35% in December 2010. to over 84% in March 2012. This higher rate has resulted in increased availability of HIV-related commodities at the hospitals.
• The project helped equip hospital management teams with the skills and knowledge required for managing health care resources and improving the quality of services.
• The project launched its website: www.sustainuganda.org/ in March 2013. Knowledge sharing between SUSTAIN-supported hospitals has been challenging, with traditionally limited communication across health care facilities in Uganda.  The new website enables the hospitals to share the results of their work and learn what other hospitals are doing.  Each hospital has its own webpage with practical tools for documenting, analyzing, and sharing results, such as how many new clients were tested for HIV and how many of those tested accepted treatment. The site also offers a range of electronic technical resources and hosts an interactive blog. Beside health care providers, website users include the general public and SUSTAIN partners.