World AIDS Day 2012: Combating Pediatric HIV in Uganda through the USAID SUSTAIN Project

December 1st marks World AIDS Day. URC supports HIV/AIDS projects in more than 20 countries worldwide.  This story highlights one component of our work through the USAID Strengthening Uganda's Systems for Treating AIDS Nationally (SUSTAIN) project in Uganda.

UNICEF estimates that in Uganda, 150,000 children between the ages of 0 and 14 have HIV (2009 data). Without early diagnosis, enrollment into care, and prompt treatment, half of HIV-infected children die by age two and an additional 25% die by the age of five. The leading cause of HIV infection in children is mother-to-child transmission, whereby infants are infected during pregnancy, childbirth, or breastfeeding.

The SUSTAIN project, funded by the U.S. Agency for International Development (USAID) and implemented by University Research Co., LLC (URC), is working with Uganda's Ministry of Health (MOH) to combat pediatric HIV by implementing prevention of mother-to-child transmission (PMTCT) programs; ensuring early HIV diagnosis by testing infants and at-risk children; and providing high-quality care and treatment services, including psychosocial services, for HIV-infected children. The project works in 16 high-volume regional referral and general hospitals.

Preventing Mother-to-Child Transmission of HIV

Six percent of pregnant women receiving antenatal care in Uganda have HIV. To reduce transmission risk, SUSTAIN supports hospitals to provide these women and their infants with antiretroviral drugs (ARVs) and care and support services. These services include PMTCT counseling for the women (including nutrition counseling) to help them adopt risk-reducing behaviors, support groups for them and their families, birth planning, involvement of male partners in counseling and support, and active follow-up for those who do not return for care. The project provides on-site training, mentorship, and tools to health workers to ensure effective PMTCT interventions and uses the science of quality improvement (QI) to implement hospital-initiated changes that advance PMTCT processes. 

SUSTAIN's PMTCT improvements are proving effective. In its first two years, over 90% of HIV-infected pregnant women at SUSTAIN-supported hospitals received ARVs, and more than 90% of HIV-exposed infants received medication to prevent opportunistic infections. The number of HIV-infected pregnant women enrolled in care rose from 49% to 71%.

Diagnosing Pediatric HIV to Enable Care and Treatment

Early diagnosis of HIV is critical to a child's survival; without diagnosis, a child cannot be enrolled into care and started on life-saving antiretroviral treatment (ART). SUSTAIN works to ensure that all HIV-exposed infants seen at project-supported hospitals are tested for HIV and assists health workers in proactively following up with mothers and caregivers to have their children tested, receive the results, and enroll HIV-infected children into care. 

SUSTAIN also supports initiatives to educate communities about the need to have children tested. These initiatives have included a Know Your Child's Status Campaign (a nationwide testing day on October 1, 2011), radio talk shows, and training sessions for health workers on educating the public about HIV. As a result of SUSTAIN's initiatives, 10% of the ART clients at project-supported hospitals are pediatric clients.

Providing Quality Pediatric HIV Care and Treatment

Guidelines from the World Health Organization recommend that all children below age two be initiated on ART as soon as they receive an HIV diagnosis; when SUSTAIN started in 2010, that percentage was at just 25%. SUSTAIN trained hospital workers and helped them use QI methods to improve pediatric HIV care and treatment. Through QI, the project found that creating peer support groups for mothers, following up with caregivers to ensure that they bring children for treatment, and providing targeted counseling for caregivers (including male partners) were effective in increasing ART initiation rates. In two years, the percentage of HIV-infected children under two starting ART increased to 89%.

The project also supports a holistic approach to pediatric HIV care and treatment, including family-focused care and psychosocial support. As HIV-infected children and adolescents mature, counselors at SUSTAIN-supported hospitals helped them develop skills related to disclosing HIV status, adhering to treatment, and preventing HIV transmission. This approach also involves growth and development monitoring, immunizations, nutritional supplements and education, prevention and aggressive treatment of opportunistic infections, and ART for all eligible children.


SUSTAIN is a five-year project (2010–2015) with three primary objectives: support the delivery of HIV/AIDS services, enhance the quality of these services, and support increased stewardship by the MOH and the hospitals over these services. In addition to its pediatric HIV work, SUSTAIN implements HIV/AIDS interventions in ART, HIV counseling and testing, laboratory services, nutrition, psychosocial support, TB, community-facility linkages, QI, health systems strengthening, leadership and governance, health management information systems, pharmaceutical logistics management systems, human resources strengthening, and grants distribution. SUSTAIN provides comprehensive support to 16 hospitals in Uganda and supports laboratory services in an additional two hospitals. The project is implemented in cooperation with sub-contractors The AIDS Support Organization (TASO), Integrated Community Based Services (ICOBI), Health Research, Inc. (HRI), and Initiatives, Inc.

Kate Howell is Knowledge Management Specialist at URC; Cordelia Katureebe is the PMTCT/Pediatric HIV Services Technical Advisor for SUSTAIN; and Sara Riese is a Technical Advisor at URC.

A mother has her daughter tested for HIV at the Know Your Child's status campaign. Photo credit: Deborah Murdoch, Health Systems Strengthening Advisor, URC.
A mother has her daughter tested for HIV at the Know Your Child's status campaign. Photo credit: Deborah Murdoch, Health Systems Strengthening Advisor, URC.
November 30, 2012
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