By Dr Mina Nakawuka, Program Officer, Adult HIV Care & Treatment, Ministry of Health, AIDS Control Program, Uganda
When the initial US executive order led to a temporary freeze of foreign aid, Uganda, like many countries, felt the shockwaves immediately. Some people living with HIV feared there would not be access to treatment, and reports surfaced of clients visiting multiple clinics to stockpile antiretrovirals. It was a moment that reminded us of the fragility of global health gains and the urgency of building more resilient, locally integrated systems.
Fortunately, in the weeks that followed, many CDC-supported programmes resumed operations, restoring services in approximately half the country. But the panic was a wake-up call. It underscored the importance of a health system that can withstand external shocks and of service delivery that is people centred, accessible and integrated.
Uganda has long been a leader in differentiated service delivery (DSD) for HIV. Our HIV programme has developed significant infrastructure, human resource capacity and systems that are ahead of many other chronic disease programmes. Recognizing this, the Ministry of Health is taking deliberate steps towards bi-directional integration – both integration of HIV services into primary care and integration of other chronic conditions into HIV services.
We are transitioning away from vertical HIV programmes and towards a model that leverages existing strengths to provide care for a wider range of health needs. This includes both moving HIV services into outpatient departments and transforming some standalone HIV clinics into chronic care centres. These will serve people living with HIV alongside those managing other chronic conditions – such as hypertension, diabetes and mental health challenges – without compromising the quality of HIV care.
We are currently developing detailed plans, guidance and training packages to support this integrated future. At the heart of this transformation is a commitment to evolving DSD models to serve broader populations. Community drug distribution points, pharmacy refill models and group-based models will be extended to reach people living with HIV and others managing chronic conditions. We are also expanding access to preventive services, including pre-exposure prophylaxis and contraceptive commodities, as part of our integrated offering.
Critically, we are designing differentiated models that respond to the diverse needs of our population. Age-appropriate variations will be a cornerstone of our updated DSD implementation guidance, which we are now in the process of revising.
Integration is not just a policy shift – it is a person-centred imperative. Uganda is committed to a future where DSD is not only sustained, but expanded and reimagined to meet the full spectrum of chronic care needs.
