AZ and AMREF

AstraZeneca and the African Medical and Research Foundation (AMREF) have been working together in the fight against disease in the developing world for over five years.  

Our partnership initially focused on TB control and management in the Eastern Cape province of South Africa. In 2006, however, we extended our commitment and are supporting AMREF in their work to strengthen healthcare systems and integrate 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. Ugandans with TB/HIV, malaria and other conditions have to attend separate health services for treatment. The focus on addressing single diseases coupled with inadequate access to information at the community level, has hindered any collaborative activity from taking place and thus the effectiveness of treatment has been reduced.

This is placing a huge strain on Uganda’s already fragile health system. Health centres are under-funded and under-staffed. Information gathering is inaccurate and unreliable. Laboratories lack fundamental equipment, qualified staff and supplies. Medicines are sometimes available but the infrastructure is not in place to ensure appropriate delivery. And the evident links between the three diseases, which exacerbate early mortality, are not being managed in an integrated way.

Since 2007, AMREF and AstraZeneca have been working together with the Ministry of Health in Uganda on the development of a model for integrating the management of malaria, HIV/AIDS and TB that will provide a framework for effective and efficient healthcare at both local and national levels. This approach to managing all three diseases has not been widely addressed previously and AZ is one of the few organisations involved in such work.

The first programme is now underway. Those who will benefit are 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 have been 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.

The programme is 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

Key targets include:

• Improved case detection rates (currently 65% - 2011 target: 75%)
• Increased treatment success rate (currently 55% - 2011 target: 85%)
• Improved default rate (currently 23% - 2011 target: 5%)
• Reduced rate of death due to TB (currently 12% - 2011 target: 0)

Progress during 2008 included:

• Increased detection rate in the Luwero district (59% in March to 73% in June), attributed mainly to AMREF’s support of a TB focal person who regularly followed up with lab personnel, the records assistants and other health workers dealing with TB patients.
• Provided education and training to 117 key opinion leaders, 46 District Aids Taskforce members, all 28 District Health Team members in 2 districts and 87 out of 89 health unit supervisors.
• Collaboration with District Health Teams on the development and roll-out of community based health management information systems (HMIS), resulting in improved data gathering, health planning and decision making.
• Technical support on improved data management provided to records assistants at 88 out of 104 health units. Top up training in supervisory roles also provided for district Health Management Information Systems and records assistants.
• Trained 847 community health workers/Village Health Team members who are now working to strengthen health service delivery at household and village level.

Plans for 2009 include:

• Refurbishment of five laboratories.
• Training workshops (eight in total) for health personnel, (service providers, lab personnel and Village Health Teams) in the integrated model of service delivery, and training for lab assistants and microscopists to build capabilities.
• Assessment of specific problems in logistics management of MAT medicines and supplies.
• Training of 32 Village Health Teams for each village on MAT as part of Home-Based Care programme.
• Creation of 12 youth groups (in and out of school) to act as agents for change, including establishment of youth-oriented health and education services using music and drama to increase awareness.
• Training of 60 youth peer educators to provide referrals for young people.
• Training in Health Management Information Systems for 103 Records Assistants.
• Support all 28 sub-county health workers to carry out TB contact and defaulter tracing
• Operational research to ensure the effectiveness and efficiency of the MAT model with particular emphasis on the drug supply chain

The content of this page was externally assured by Bureau Veritas, February 2009.