AZ and AMREF
Our partnership with the African Medical and Research Foundation (AMREF) centres on strengthening healthcare systems and integrating the management of TB, HIV and malaria programmes in Uganda, where there is a high burden of all three diseases.
TB is the leading cause of death in people living with HIV. Together, the two diseases are a deadly combination. In Uganda, there is the added burden of malaria, which in that country causes more illness and death than any other single disease. There is compelling evidence that HIV infection results in greater risks of mortality from malaria because malaria infection increases the HIV viral load among adults, leading to increased mother-to-child transmission of HIV during pregnancy. The links between the three diseases are not being managed in an integrated way. Ugandans with TB/HIV, malaria and other conditions have to attend separate health services for treatment.
With our support, AMREF worked together with the Ministry of Health in Uganda to develop a model for integrating the management of malaria, HIV/AIDS and TB that provides a framework for effective and efficient healthcare at both local and national levels. This approach to managing all three diseases had not been widely addressed previously. The programme centres on the poor and remote communities in the Luwero and Kiboga districts of central Uganda, particularly women of child-bearing age, people living with HIV/AIDS and children under the age of seven. These districts were selected because of high disease incidence rates, partly as a result of lack of funding in healthcare and conflict in preceding years, which has destroyed much of the local healthcare infrastructure.
AMREF’s strategy reflects the importance of involving affected communities at every stage of the programme to combat TB, HIV/AIDS and malaria. Substantial training and support for health workers, coupled with public campaigns, is essential for effective implementation. Engagement at a local level is also critical to the success of this project and AMREF works with district health teams in Luwero and Kiboga to encourage ownership and continued implementation.
What is the programme focused on?
- Enhancing the capacity of health centres to more effectively prevent, diagnose and treat malaria, HIV/AIDS and TB, particularly through improvement of laboratory diagnostic capacity
- Improving community-based prevention, treatment and care for malaria, HIV/AIDS and TB
- Developing and strengthening links between formal health system and informal community based capabilities
- Gathering qualitative and quantitative data to support evidence based advocacy for an integrated and community based strategy for malaria, HIV/AIDS and TB prevention, care and treatment
The programme is aligned to the Ugandan Ministry of Health targets and also to MDGs 4 and 5, which focus on the reduction of child and maternal mortality.
What impact is it having?
- 1,434,516 visits have been recorded in the Health Management Information System (HMIS) as having received MAT – diagnostic, treatment and other services. 8,474 young people have benefited from the programme, through the work of peer educators.
- Six laboratories have been renovated to Ministry of Health standards and management of these has been formally handed over to the district management teams in the area.
- 116 health workers have been trained on drugs logistics management
- 1114 Village Health Teams have been established with a total of 6334 members who have been trained in health promotion in their local communities
- 108 records assistants were re-trained on community based Health Management Information Systems
- 206 health outreach activities were conducted, aimed at driving awareness, de-stigmatise the disease and encouraging people to get tested. 474 peer educators have been trained in reproductive health, life skills, counselling and MAT (Malaria HIV/AIDS TB) testing service, and placed to engage with local communities
The District Health Teams working with AMREF have adopted the integrated MAT testing approach. The Ministry of Health is interested in the integrated MAT approach and is keen for AMREF to roll it out and test it in additional districts with a view to considering adopting it into policy.
The establishment of trained Village Health Teams, together with laboratories providing diagnostic services and effective records mangement systems, has had a considerable impact on the prevention of MAT and their more timely diagnosis and treatment. In addition, the improved staffing and infrastructure has benefited the health system more widely and has been leveraged by other organisations to further the treatment of MAT diseases as well as other diseases too, such as childhood diarrhoea.
Hear more from AMREF, AstraZeneca and the local people involved in the programme
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