Gloria Akullo, a 24-year-old female volunteer in Uganda. Photo credit: URC

Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN)

The Challenge

Though Uganda has made great strides in curbing the HIV epidemic, there are still many people living with HIV who do not have access to care and treatment, with women disproportionately affected. The SUSTAIN Project aimed to ensure the provision and sustainable scale-up of quality HIV/AIDS prevention, treatment, and care services at regional and general hospitals throughout Uganda and strengthen the health system to improve the quality of comprehensive HIV/AIDS services.

Overview and Objectives

URC worked with the Ugandan Ministry of Health (MOH) to ensure provision and sustainable scale-up of comprehensive HIV and AIDS services for people living with HIV and AIDS (PLHA) at 10 regional referral and six general hospitals across the country. Services include a basic care package for PLHA, antiretroviral therapy, the prevention of mother-to-child transmission of HIV (PMTCT), management of TB and HIV co-infection, laboratory services, HIV counseling and testing, and voluntary medical male circumcision (VMMC). In addition to the 16 hospitals receiving support for these services, SUSTAIN supported selected services at two regional referral hospitals and laboratory services at four health care facilities in the Karamoja Region. The project achieved its objectives, which were to:

  • Ensure provision of quality and sustainable HIV/AIDS care and treatment, laboratory, PMTCT, and TB/HIV services;
  • Enhance the quality of HIV/AIDS care and treatment, laboratory, PMTCT, and TB/HIV services;
  • Support the MOH to scale up PMTCT and VMMC as HIV biomedical interventions for infection prevention; and
  • Increase stewardship by the MOH to provide sustainable and quality HIV/AIDS care and treatment, laboratory, PMTCT, and TB/HIV services within the public health system.


SUSTAIN set the pace for national programmatic changes to the HIV/TB response in Uganda. The project efficiently rolled out national policies at regional referral hospitals by supporting pilot-testing of each change using short-learning-cycle pretests. This work yielded several innovations, such as an HIV screening tool, cell phone text-based reminders for reporting, and facility performance reviews, which have been adopted at the national level and scaled up by other implementing partners in the country. The project’s health systems strengthening approach, based on the World Health Organization’s Health Systems Framework, established stakeholder involvement for each building block to ensure sustainability and attainment of results. In 2014, the project was recognized among the top 10 best worldwide health systems strengthening projects by USAID.

Working with the MOH, URC developed the capacity of 165 trainers of trainers at the regional referral level and subsequently built the capacity and skills of more than 1,421 additional health workers through didactic and on job skills building training sessions. More than 95% of the health workers trained are employed by the Government of Uganda and are equipped to offer sustainable HIV services to clients.

SUSTAIN supported institutionalization of quality improvement approaches at regional referral hospitals and supported the establishment of functional regional and health facility quality improvement committees. These committees spearheaded data utilization and focused on process and system improvements to enable continued improvement in all health facility units. To ensure efficient HIV service delivery, the project implemented robust supply chain management systems strengthening activities, leading to over 92% HIV commodity availability rates, and accurate programmatic data in the health management information system to facilitate reporting to both the MOH and donors on a quarterly basis.

SUSTAIN transformed regional referral hospitals into sustainable regional centers of excellence for the delivery of HIV/ AIDS and TB care and laboratory monitoring. A total of 256,187 clients received lifesaving antiretroviral treatment, including 30,223 pregnant and lactating mothers, resulting in a decrease in vertical transmission of HIV from 8% in 2011 to 2.5% by March 2018. A total of 13,081 registered new and relapsed TB cases were successfully treated. Additionally, 259 of the identified cases of multidrug-resistant TB were confirmed cured after treatment. A total of 143,072 males were offered VMMC services as HIV prevention.




Digital Health, Health Systems Strengthening, HIV/AIDS, Infectious Diseases, Quality Improvement, Supply Chain, Tuberculosis

U.S. President's Emergency Plan for AIDS Relief (PEPFAR), USAID

ACLAIM Africa Limited, AIDS Information Centre (AIC), Children’s Chance International (CCI-Uganda), Health Research, Inc., Initiatives, Integrated Community Based Initiatives (ICOBI), The AIDS Support Organization (TASO), Uganda Catholic Medical Bureau (UCMB), Uganda Muslim Medical Bureau (UMMB), Uganda Protestant Medical Bureau (UPMB)