20 years of dedicated service, commitment
By Elvis Basudde
AIDS Information Centre (AIC) has clocked 20 years of dedication and commitment in providing HIV counselling and testing (HCT) services.
The centre, which started on February 14, 1990 in Kampala, is internationally recognised as one of the first organisations of its kind in Sub-Saharan Africa.
It is a centre of excellence in the provision of HCT, a core component in comprehensive HIV/AIDS care and support.
AIC came at a time when there were many cases of suicide due to lack of proper counselling to those who discovered they were HIV- positive. These people did not know where to go for help.
With its headquarters at Musajja Alumbwa Road, Mengo-Kisenyi, AIC in collaboration with the health ministry and other partners operates eight regional branches providing HCT and related services in different parts of Uganda.
Achievements
Robert Ntalaka, the AIC information and documentation officer, says the centre offers services in 33 districts.
The wide geographical coverage has resulted in high numbers of people getting the services.
Initially, AIC could only serve 9,466 clients. Currently, it has the capacity to serve over 500,000 clients and over 2,600,000 clients have been counselled and tested for HIV.
In the last three years, AIC served over 400,000 clients annually.
The centre is currently the largest non-governmental organisation providing HCT services contributing to about 30% of the total number of individuals tested for HIV in Uganda annually.
Initially, the centre mainly focused on HCT but later expanded its services to include medical care.
A couple attending a counselling session during the AIC
Home-To-Home HIV counselling and testing programme
The medical wing handles opportunistic infections, septrin prophylaxis, sexually transmitted infections (STIs), screening and management of active and latent TB among HIV clients and treating active TB with anti-TB drugs or providing INH prophylaxis to those with latent TB.
More than 120,000 people have received medical treatment, care and support.
AIC also offers CD4 and CD8 cell count tests for HIV-positive clients, family planning services and psychosocial care and support services.
Training centre for capacity building
AIC has a training department established in 1996. The department offers different HCT capacity building programmes for individuals, civil society organisations and private health institutions.
The capacity building programmes include training counsellors and laboratory personnel in HIV rapid testing, laboratory management and communication skills.
Training is also offered in palliative care, HCT supervision skills, HIV basic health care for community mobilisers, peer education and TB/HIV integration skills.
Same day counselling and testing protocols
Initially, clients received VCT for over two visits and received test results after.
In 1997, rapid testing and same day result issuance was introduced and now clients get results in 30 minutes.
Strategies for providing HCT and preventing transmission
AIC started with a client initiated approach at the branches but later introduced a multi-faceted approach to increase accessibility and HCT utilisation.
Different strategies have been piloted and developed over the years. These strategies, which include the following, have been used as national strategies.
Targeted outreaches and mobile HCT for the hard-to- reach populations and most-at-risk-populations (MARPs).
These comprise commercial sex workers, long distance truck drivers, fishing communities, uniformed personnel, prisoners, IDPs, migrant labourers and institutions of higher learning.
Routine Counselling and Testing (RCT): This is an-opt-out arrangement in health facility setup.
It was pioneered in 2004 in Mpigi and Kaberamaido hospitals. RCT was later adopted as a national strategy in hospitals and health centre IVs in outpatients’ departments.
It is a provider-initiated approach through which AIC, through its eight regional branches, supports over 200 government hospitals and health centres to scale up HCT services to communities in 49 districts.
Home-to-Home HCT: The services are taken to homes. The strategy was piloted in 2004 in Mbale and Busia districts. It is one of the approaches being highly promoted, especially in rural communities.
Community camping and Moonlight HCT: This was pioneered in 2007 in Kabale, Arua and Kampala districts.
The strategy has been taken on by many other HCT providers and modified to suit different situations to increase access and utilisation of HCT services among the hard-to-reach and MARPS.
SMS text messaging: This was piloted in 2008 in Mbarara and some organisations are already using it.
AIC started Post Test Club (PTC) in 1990 for HIV-positive and negative clients.
This received national and international recognition as an effective behaviour change model.
Recently, AIC introduced ‘Know-Your-Status’ clubs and discordant couple clubs, instrumental in behaviour change.
The community owned HCT: The services are initiated and managed by communities with technical assistance and support from AIC.
Prevention-of-mother-to- child-transmission(PMTCT) services: AIC was involved in the initial stages of PMTCT by training health workers.
Research and documentation work: Being the pioneer of HCT in Uganda, AIC is instrumental in driving or influencing policy and practice in HCT.
AIC conducts research to find answers to emerging questions and provide evidence-based data on HCT.
Challenges
Inadequate resources for service delivery is a key challenge in improving the quality of services for people affected and infected with HIV.
Follow-up on VCT clients is difficult and many clients referred to other care facilities do not access some services.
The unmet demand for HCT is increasing. Many people have never been tested for HIV and do not know their status.
Only 13% of women aged 15-49 and only 11% of men in this age bracket have been tested and received results.
Many HIV-positive people have not joined PTC activities due to stigma, still existent in many communities.
Way forward
AIC has developed a strategic plan to address internal and external challenges in the delivery of HCT services.
The strategic plan takes into consideration the need to reduce new HIV infections by 40% by 2014.
This will be achieved through interventions such as scaling up initiatives for counselling, testing, care and support to over three million people in five years.
AIC also plans to promote disclosure, anti-stigma and non discrimination through post test clubs, couple clubs and ‘know-your-status’ clubs.
Provision of effective referral guidance to clients found to be HIV-positive will also be emphasised.
