At just 2 years old, Aaron was diagnosed with HIV. By 2019, at the age of six, he was transferred to Luweero Industries HC III, a military-managed, health facility in Uganda. His life took a difficult turn when his mother left him in the care of his aunt, a single mother of five. Aaron’s health was already fragile, with his weight dropping to just 17 kg at 9 years old. His medication adherence was inconsistent due to stigma and a lack of understanding in his new household.
In January 2022, Aaron and his aunt were enrolled in the Orphans and Vulnerable Children (OVC) program to provide HIV treatment and prevent new HIV infections. More than 2,000 children up to 17 years old are enrolled in the program, supported by the DoD-Uganda URC project in Uganda, implemented by URC.
The program provided nutritional and educational support, but Aaron’s health continued to deteriorate despite regular counseling sessions and home visits.
The Struggle for Viral Suppression
In Uganda, achieving viral suppression among children living with HIV remains a challenge. Of the 1.49 million people living with HIV in Uganda, approximately 72,000 are children under 15 years old, with only 72% achieving viral suppression, compared to 81% of adults. The difficulties Aaron faced were not unique – many children struggle with medication adherence due to caregiver issues, stigma, and health system weaknesses.
Despite being on antiretroviral therapy (ART), Aaron’s viral load remained alarmingly high, peaking at 76,699 copies per milliliter (ml) – a measure of viral load – in November 2022, whereas <200 copies/ml is suppressed. Frequent infections and continued weight loss further worsened his condition. Tests revealed that Aaron’s failure to adhere to his medication was causing the drugs to be ineffective.
“It was heartbreaking to see his condition deteriorate,” said Sgt. Kanyesigye Ronald Kinene, a counselor at Luweero Industries HC III. “We tried everything, but nothing seemed to work.”
The Turning Point: Directly Observed Therapy
In a final effort to save Aaron, the clinical team – guided by URC staff and with his aunt’s consent – introduced him to Directly Observed Therapy (DOTS). Under this approach, Aaron visited the clinic daily to take his medication under supervision, while his aunt received ongoing counseling. Aaron was the first to receive this approach.
“DOTS was our last resort,” Sgt. Kinene recalled. “We thought, ‘If it works for TB, why not for HIV?’ And it worked.”
The results were remarkable. Within four months, Aaron’s health dramatically improved – his weight increased from 29.5 kg to 34 kg (65 pounds to 75 pounds), his infections cleared, and by March 2024 his viral load dropped to undetectable levels.
Challenges Overcome
Aaron’s journey was not without obstacles. He faced significant barriers, including:
- Stigma: Aaron and his aunt struggled with social stigma, making it difficult to maintain regular clinic visits.
- Limited support: Aaron missed doses and meals when left in the care of others.
- Non-disclosure: At 9-years-old, Aaron didn’t fully understand his diagnosis, contributing to his irregular medication intake.
“The DOTS program helped overcome these challenges,” Sgt. Kinene said.
Ongoing Support
To ensure Aaron’s continued success, the team at Luweero Industries HC III will provide ongoing support, including home visits, peer support programs, and counseling through the OVC program. His caregiver will also stay engaged in these activities to ensure long-term stability.
Aaron’s story highlights the power of person-centered care and innovative treatment approaches, made possible through URC’s mentorship and support. “Without URC’s resources and training, we wouldn’t have achieved this success,” Sgt, Kinene emphasized.