Uganda’s progress towards ending the HIV/AIDS epidemic has steadily improved over years with a drop in adult HIV/AIDS prevalence rates from 6.2% in 2017 to 5.8% in 2019 as per the UNAIDS country data. However, there is still work to be done! With the HIV incidence at 2.61 per 1,000 population and new infections at 53,000 annually there are gaps to be closed. In 2019, over 21,000 deaths were due to AIDS in Uganda!
In order to fast track the realization of epidemic control by 2030, there is the 95–95–95 UNAIDS strategy that speaks to 95% of people living with HIV will know their HIV status; 95% of people diagnosed with HIV will be on antiretroviral treatment (ART), and 95% of people on ART will have viral load suppression (VLS). Uganda’s performance against this ambitious strategy is still below the targets with 89% of HIV positive people aware of their status, 84% of HIV positives being on ART treatment and of these only 75% having VLS.
There exists a myriad of challenges along the HIV treatment cascade including stigma, distant health facilities, lack of access to health information and knowledge on service location points and personal attributes like forgetfulness leading to poor adherence for those on treatment. The need to be more innovative to cause a paradigm shift is more evident than before if the remaining gap is to be closed which calls for a change in the way of delivering HIV/AIDS health services.
The opportunity digital health offers in bridging the gaps in health information access, driving demand for HIV/AIDS service uptake, improving adherence to treatment among others can no longer be underestimated. The Medical Concierge Group (TMCG) a private digital health company headquartered in Kampala-Uganda has for the past 7 years built a track record of integrating digital tools and interventions along the HIV/AIDS treatment cascade and a few use cases are highlighted.
To drive demand for HIV testing so as to increase proportions of HIV positives that know their status, TMCG operates a 24/7 medical call centre that coordinates referrals and linkages to health facilities for HIV testing.
Callers are directed to HIV testing points and followed to confirm uptake of services. In addition, a telehealth supported delivery of HIV self-testing (HIVST) kits was piloted in Kampala with over 174 HIVST kits distributed in a 3 months period and a positive yield of 0.6%. These interventions are implemented in partnership with developmental organizations like the USAID funded Regional Health Integration to Enhance Health Services(RHITES), North-Lango, Academic and Research institutions like the University of Minnesota and Infectious Diseases Institute (IDI).
Digital approaches towards supporting linkages to HIV/AIDS treatment services and retention in care that TMCG is implementing include mobile SMS reminders to clients to improve facility appointments and treatment adherence. These interventions have been scaled in the 9 districts of the Lango sub-region (Lira, Kwania, Alebtong, Oyam, Kole, Apac, Amolator, Otuke and Dokolo) with learning experiences of its impact assessed in selected supported health facilities showing over 90% improvement in adherence.
As we celebrate this World’s AIDS Day, 2020 under the theme of “Ending the HIV/AIDS Epidemic: Resilience and Impact”, we call upon all stakeholders to come together with concerted efforts to curb the Epidemic with more inclusive, agile and innovative approaches at all levels. As the leading digital health entity in Africa, we commit to this fight and Uganda’s realization of the ambitious 95–95–95 UNAIDS strategy as per our mission through delivering innovative digital solutions that are value-based, efficient and achieve the best outcomes throughout the HIV/AIDs treatment care chain.
Order for an HIV self-testing kit today to know your status as your ‘Negative status expires each time you have unprotected sex with a partner whose status you do not know’ (Dr Diana Atwine, PS MoH Uganda).
Authors: Dr Louis Kamulegeya and Sandra Arinaitwe