Gerald Mutungi, Ivan Arinaitwe and Mina Nakawuka from the AIDS Control Program at the Ministry of Health in Uganda write:
Uganda has embraced the World Health Organization’s (WHO) updated framework, which now includes chronic illnesses such as non-communicable diseases (NCDs), in its new categorization of Rapid Initiation of Antiretroviral Therapy. In response, the country has undertaken a comprehensive review of its 2022 consolidated guidelines, integrating all these changes into the updated version. This revision has notably expanded the eligibility criteria for differentiated service delivery (DSD), emphasizing client-centered approaches.
Previously, individuals with both HIV and NCDs were classified as “unstable”, resulting in them solely receiving medication refills from healthcare facilities, even if their conditions were well-controlled. This practice posed a barrier to accessing community-based models of care under DSD. In light of the evolving landscape of HIV programming, which increasingly emphasizes community interventions and innovations, Uganda has embarked on pioneering initiatives to prioritize client-centered care across all service delivery approaches.
Through the adoption of the “5 As” framework (Assess, Advise, Agree, Assist, Arrange), individuals receiving care can access comprehensive information, empowering them to select the most suitable approach for their needs. To address the challenge of individuals with comorbidities having to access HIV services separately from other essential healthcare services, Uganda is currently in the process of developing integration guidelines and Standard Operating Procedures (SOPs). These guidelines aim to seamlessly incorporate services such as pre-exposure prophylaxis (PrEP), family planning, NCD management, and tuberculosis (TB) services into community pharmacies, transforming them into holistic one-stop centers.
This integrated approach ensures that all eligible individuals with comorbidities receive comprehensive care without having to visit multiple healthcare facilities. Furthermore, it aims to address the unmet need for family planning, enhance TB case identification, improve access to PrEP services, and enhance screening and management of NCDs. Through these initiatives, Uganda is taking significant strides towards improving healthcare delivery and promoting client-centeredness across its healthcare system.
