Uganda: Mildmay’s double impact on vital Early Infant Diagnosis programme

Early Infant Diagnosis (EID) is a critical pillar in the response to HIV in Uganda as it allows health services to work alongside mothers and families to make decisions as soon as possible about the HIV care needed by every baby born across the country.

The Ugandan government began its current EID programme in late 2006 to encourage the early testing of babies, to determine as soon as possible the most effective care for each child and to prevent the spread of HIV from mothers to their children.

American donor Centers for Disease Control (CDC) began supporting the initiative in 2007 and seven testing labs were duly set up in different regions of Uganda.

However, it soon became clear that this network of labs was rather fragmented and administration costs were high. The search for a more efficient, cost-effective model began.

The Ugandan Ministry of Health’s EID programme team – led by Dr Charles Kiyaga, a graduate of the Mildmay diploma course in A Health Systems Approach to HIV and AIDS Care and Management – decided to move to working out of just one laboratory, improving efficiency by having centralised, state of the art government-run facilities and infrastructure.

Mildmay’s important role in the programme is to act as a clearing centre for CDC funding for the EID programme. The NGO’s good standing with the donor built up over many years working at the cutting edge of HIV care and treatment in Uganda means this can happen quickly, and that money reaches the programme without undue delay. With EID, time is very much of the essence. “Having studied at Mildmay Uganda, I knew their financial systems,” said Dr Kiyaga. “I suggested money for this programme should be channelled through Mildmay.”

The improved EID programme began earlier this year and is already gathering momentum. Civil works took place to set up the lab in central Kampala in March and April and staff were recruited. Actual testing began in July at eight regional hospitals and other district hospitals with an initial target of 90,000 babies to be tested.

The lab has the capacity to run almost around the clock to handle the large numbers of samples coming. Test results will be returned to the regional and district hospitals by mobile phone technology, an SMS printing system which removes the need for reliable internet connection in regional hospitals.

“We won’t begin everywhere, we will start gradually. But by 2014 we hope to test every baby in the country,” said Dr Kiyaga. A cooperative agreement is in place between the partners in the EID project which will be renewed every five years.

Although the programme has started well, transport remains a key challenge.

Fifteen transport hubs will be created to support 20 health facilities across Uganda. A motorbike and rider will be stationed at each hub to support the EID programme, but also to carry CD4 and viral load test samples.

Dr Kiyaga said the EID progamme would directly reduce the HIV rate in Uganda.

He also praised Mildmay’s education programmes. “It was a hands-on thing and I learnt a lot of things to actually improve the standards of my day-to-day work, he said.

“I found it very relevant. It’s a course to improve performance for managers – doctors, health professionals, those from social care backgrounds, and working at  senior management levels.

“The people who designed this course must have thought things through very well.” In July 2011, Dr Kiyaga advanced to the Mildmay degree programme in A Health Systems Approach to HIV Care and Management, taught in East Africa and affiliated to the University of Manchester in the UK.