HIV testing and education outreach with troops at an outpost. Photo credit: Lance Corporal Peter Kirya, Uganda People’s Defence Force

Uganda spearheaded a rigorous response to the HIV epidemic in the 1990s and early 2000s, making significant headway in the fight against HIV. But between 2005 and 2013 a resurgence of HIV infections occurred. The Ministry of Health and partners are now focused on addressing the key drivers of the epidemic among priority populations – including in the military services.

The Department of Defense HIV/AIDS Prevention Program Uganda (DoD Uganda URC Project) is working with the Uganda People’s Defense Forces (UPDF) to scale up HIV prevention and treatment to achieve and surpass the 90-90-90 UNAIDS targets (90% of people with HIV diagnosed, 90% of those diagnosed on antiretroviral treatment (ART), and 90% of those on ART virally suppressed by 2020) to reach epidemic control.

The DoD Uganda URC Project supports 28 antiretroviral-accredited military hospitals and 12 HIV testing service -only sites to:

  • Scale up of HIV testing and HIV/sexually transmitted infection care and treatment services;
  • Improve tuberculosis diagnostics and treatment;
  • Strengthen prevention of mother-to-child transmission and voluntary medical male circumcision (VMMC) services;
  • Improve laboratory quality management, diagnostics, and HIV clinical monitoring systems;
  • Strengthen HIV impact mitigation and orphans and vulnerable children services; and
  • Strengthen the institutional capacity of the UPDF to lead, plan, and monitor the HIV response.

With a comprehensive HIV program implemented through 40 military-run health facilities, including 28 ART-accredited facilities, the UPDF has a clear opportunity to reduce HIV transmission among military personnel and local civilian communities. Accomplishments to date include:

  • Following the PEPFAR 3.0 data-driven approach to control the epidemic, the project is collecting and using data in a granular (disaggregating by sex, age, and site) manner to find and reach the “last troop” missing from care.
  • Achieving the first 90 target (90% of people with HIV diagnosed) with revitalized screening and targeted testing, and by streamlining the supply chain for test kits to address frequent stock-outs.
  • 1,541 newly identified HIV-infected persons were initiated on ART, resulting in 19,276 patients receiving care at military health facilities. These numbers were driven by a “Bring Back to Care” campaign focused on identifying and following up with patients who dropped out of care.
  • The VMMC program circumcised 14,691 men in just under four months. It is estimated that VMMC reduces sexual transmission of HIV by 60%. Success was achieved by engaging military commanders in the planning and mobilization of mobile camp teams, assigning daily tracking targets to teams, implementing the “MOVE model” where each surgical table is assigned one surgeon and two assistants to improve efficiency, and intensifying community mobilization.  
  • Enrolling five military labs in the Stepwise Laboratory Quality Improvement Process towards Accreditation initiative to ensure quality HIV testing. There has been a 100% pass rate for lab proficiency tests conducted.