1. OVERCOMING BARRIERS TO ACCESS: Experiences from the Call to Action Uganda Program Joanna Robinson Elizabeth Glaser Pediatric AIDS Foundation June 17, 2010

2. Uganda PMTCT Cascade Results(January 1, 2000 – March 31, 2010) * Cumulative cascade includes data from EGPAF’s privately-funded PMTCT activities in Uganda, initiated in 2000. USAID Call to Action funding in Uganda started in October ‘02. 2

4. Poverty

5. Limited access to transport to health services

6. Stigma and discrimination

7. Non-disclosure of HIV status to women's sexual partners

8. Health services that are not ‘user-friendly’

9. Lack of community support3

11. Integration of PMTCT, C&T into Reproductive & Child Health services

12. Involvement of PLHIV in HIV prevention, care and treatment as part of a comprehensive care model

13. Working with communities and families to optimize access to a broad network of services beyond scope of the PMTCT project4

15. Dispel myths and misconceptions about HIV

16. Create empowerment through peer supportData from internal quantitative analysis of PSS (2005) showed higher uptake of individual services among those women who received PSS services through FSGs 5

17. Peer Educators Peer educator program developed in 2007, introduced at sites implementing FSGs Peer educators selected from among HIV-positive parents identified during PMTCT Provision of formal training strengthened peer educator strategy by expanding assigned roles 6

18. PEER EDUCATORS AFTER A TRAINING 7

20. Peer counseling

21. Distribution of Basic Care Packages

22. Assisting patient flowHome-based care provided by joint HCW-peer educator teams assisted in disclosure, strengthened linkages between community and health facility by involving PLHIV in patient care 8

23. Working in Partnership with Communities Through community dialogue, Foundation outreach teams lead efforts to inform and educate communities about available HIV prevention, care and treatment services for children and families Local drama shows and electronic/print media used to disseminate both prevention and stigma reduction messages 9

24. Psychosocial Support for Children Children’s groups established to support children of HIV-positive mothers attending health facilities Goal: To provide HIV-infected and affected children a chance to receive a “quality life” while meeting their psychological, social, spiritual, and physical needs Established at 4 referral hospitals, then rolled out to 19 support groups with active membership of over 1,000 children EGPAF’s experiences in setting up and running PSS services for HIV-infected children documented and disseminated in publication “A Guide on How To Start and Implement Ariel Children’s Clubs” 10

25. Children’s Groups Activities emphasize: stigma reduction, disclosure, adherence to medication and positive living while building peer support Referral networks to other community-based service providers help families access other “wrap around” services Parents and caregivers are trained in long term care for chronically ill children Holiday children’s camps focused on development of life skills, prevention with positives and improved adherence to ART Groups serve as advocacy channels for children 11

26. ARIEL CLUB CHILDREN SHARING MESSAGES ABOUT HIV THROUGH TRADITIONAL DANCE 12

27. Male Partner Participation 100% coverage of HCT for pregnant women and comprehensive HIV care for HIV-positive women and their families is hampered by lack of male involvement “Male friendly" interventions include: Allowing pregnant mothers with male partners to receive ANC service priority Sending personalized invitations home for men to attend ANC with their partners Use of male peer educators to assist in couple counseling and disclosure Number of male partners tested for HIV increased from 3,577 in 2005 to over 29,000 in 2009 13

29. Integration of psychosocial support for families into PMTCT and pediatric ART programs introduced a new standard of care that has enhanced clinical programs14

30. Lessons Learned “Every Child Deserves A Lifetime” A Family Care Approach Ensures a Healthy Family 15

31. EGPAF Uganda Team 16

32. Acknowledgements Elizabeth Glaser Pediatric AIDS Foundation staff in Uganda, Regional, and USA Uganda Ministry of Health, ACP, RH, Nutrition, UAC, MOLG Partner Organizations incl. but not limited to: JCRC, SCMS, AHF/Uganda Cares, URC-NULIFE & HCI, IBFAN, GAIN, Baylor Ug, ANECCA, AIC, MJAP, PSI/PACE, HIPS, UMEMS, MEEPP, MUJHU, JSI, ICOBI, HIVQual, CRS, AIDS Relief, World Vision, Abbott Fund, CHAI, The UN agencies UNICEF, WHO All the clients who have entrusted their care to us THANK YOU 17 DISCLAIMER: This program was made possible through support provided by the Office of HIV/AIDS, Global Bureau Center for Population, Health and Nutrition, of the United States Agency for International Development (USAID), through the President’s Emergency Plan for AIDS Relief, as part of the Elizabeth Glaser Pediatric AIDS Foundation's International Family AIDS Initiatives (“Call To Action Project”/ Cooperative Agreement No. GPH-A-00-02-00011-00). Private donors also supported costs of activities in many countries. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID.