Between 2011 and 2013, the number of antiretroviral therapy recipients has risen by 75 per cent from 329,060 to 577,000. However, over the same period, the number of people living with HIV also rose from 1.2 million to 1.6 million.

The government has also adopted the 2013 World Health Organization (WHO) guidelines, recommending earlier antiretroviral treatment, which means more people are now eligible for the drugs. These guidelines changed the threshold for eligibility for treatment from a CD4 count of 350 cells/mm³ to one under 500 cells/mm³ (the level of infection-fighting white blood cells in a patient's blood).

1.4 million eligible for treatment

According to the mid-term review report of the National HIV/AIDS Strategic Plan, released by the Uganda AIDS Commission on 3 October in Kampala, about 1.4 million people are eligible for treatment. Of these, about 193,500 are children below the age of 15.

"The new guidelines have brought the antiretroviral coverage figure down to 43.6 per cent from 70.2 per cent (under the 2010 guidelines) among eligible children and adults, with fewer adult males (174,582) enrolled on treatment programmes compared to females (349,068)," said Dr Andrew Balyeku, a treatment and care consultant with the Uganda AIDS Commission.

The new recommendations also include providing antiretroviral therapy to all infected children under five irrespective of their CD4 count.

Option B+ reduces new infections

Within the report's review period (2011-2013), Uganda has seen a decrease in new HIV infections from 162,000 in 2011 to 137,000 in 2013.

This is attributed to the expansion of Option B+, a programme aimed at having all HIV-positive pregnant mothers enrolled on lifelong treatment. It aims to eliminate mother-to-child transmission of HIV by 2015.

"By the end of 2013, services for eliminating mother-to-child transmission had been rolled out in all government facilities in health centres [at sub-county level] and the number of active sites increased from 965 in March 2012 to 2,130 in September 2013," the report says.

Consequently, the number of paediatric new infections fell from 28,000 in 2011 to 9,000 by the end of 2013. There was also a sustained increase in the coverage of paediatric antiretroviral therapy between 2011 and 2013, from 25 per cent in 2011 to 41 per cent in 2013.

"The figure is predicted to [fall] to 8,000 by the end of this year and we now need to refocus our strategies on other sources of new infections such as the [most at] risk populations and youths," says Dr Ruhakana Rugunda, Minister for Health, who was appointed Uganda's Prime Minister in September.

Challenges to HIV response

According to the report, more than 1.4 million men have been circumcised, exceeding the mid-term target of 1.2 million men. In the early phase of the HIV pandemic, Uganda received global acclaim for successfully reducing its HIV prevalence from 18 per cent in the 1990s down to five per cent in 2005.

Subsequently, the annual rate of new HIV infections stabilised to an adult HIV prevalence of between six and seven per cent for the past ten years. However, these earlier gains have been pushed back by many challenges and HIV remains a major public health problem.

"There is generally inadequate supply of HIV test kits, poor counselling services - especially in private clinics - and quality concerns about safe male circumcision and thus, some clients miss follow up visits," said Dr Joseph Matovu, a consultant with the Uganda AIDS Commission.

Source: / - Photo: fundsforngos