When Uganda’s President, H.E. Yoweri Museveni, announced a nationwide lockdown in March 2020, he also banned mass gatherings. This was done to control the spread of the COVID-19 pandemic in the country.
To Amati Odraru, prohibiting gatherings meant limiting her monthly visits to the HIV clinic at Yumbe Health Centre IV. Her worry was that if she attended the clinic days, chances were high that many people would come on the same day for treatment and they would be either arrested for violating the presidential directive or contract the Coronavirus disease as there is no social distancing as the clinic is often over crowded.
Due to this misinterpretation, Odraru, a resident of Lukutua village in Yumbe District, West Nile sub-region, and her five-year-old daughter missed their refill for antiretroviral therapy (ART) drugs.
Odraru is among the 541 people living with HIV and AIDS (PLWHIV) in Yumbe District who missed treatment during the COVID-19 lockdown. The 546 include 56 children, 20 adolescents, 61 mother baby pairs, 26 pregnant mothers and 378 adults. All of these have since been traced and linked back into care, thanks to the efforts of the district authorities.
The authorities proactively conducted a data validation exercise at 25 Anti-Retroviral Treatment sites out of a total of 45 health facilities in the district and noted a significant drop in the number of adolescents, children and mother baby pairs on treatment. Yumbe District has 2,553 HIV positive clients of whom 195 are children.
“After conducting the validation exercise, we traced all those who were missing through expert mothers, male champions, adolescent peers and other (PHA) networks. Given the challenges of transport at that time, the district engaged PHAs to deliver medicines to those who were no longer coming to the health centre,” explains Abassi Mansour, Yumbe District HIV Focal Person.
Odraru was surprised to see the arrival of health centre staff and ‘expert mothers’ at her home, bringing ARVs for her daughter and herself. Expert mothers are women living with HIV with personal experience in PMTCT programs, and who are able to draw on their own personal experience to support other women and their families. The involvement of expert mothers in HIV care was an opportunity to empower women and communities to trigger behavior change among their peers, especially during the COVID-19 lock down.
“When I missed the appointment for a month, the clinic staff came looking for me. They brought drugs for us. They sensitized me about the directives and encouraged me to return to the health facility when my next appointment is due,” says Odraru, a mother of two.
Her second born is HIV negative, having enrolled on the elimination of mother-to-child transmission (eMTCT) programme at the health center. She is grateful to UNICEF for enabling the tracing process and the delivery of ARVs to her home during these tough times.
Pamela Candiru, an expert mother involved in the tracing of mother baby pairs, adolescents and children says, “we make a line list and go out in the community with health workers to take the drugs to those that have missed appointments. We also take for the HIV positive pregnant women and children because all these clients are registered at the clinic and their files are there.”
UNICEF, with funding from UKaid and the Unified Budget, Results and Accountability Framework (UBRAF), supported the continuity of treatment for People Living with HIV including children, in the district.
Sister Zainabu Ojako, the In-Charge of the HIV clinic at Yumbe Health Centre IV, says that six community drug distribution centres have been established where PLWHIV coming from far locations can collect their medicines. The centres were established after several of the clients dropped out of care. “We want to bring the services closer to our people, especially those who are still having challenges of transport to the clinic. We go with their files and record the data and quantities of medicine given. For our clients who are nearby, we have encouraged them to visit the clinic and adhere to their appointments,” she says.
Before the lock-down, the clinic would attend to 50–60 patients on a daily basis.
“Through the PHA networks, we take the drugs to our clients. PHAs hire motorcycles and ride them to the clients’ home. The cost is covered by the district,” Ojako further reveals.
UNICEF Health Specialist, Dr. Rabin Drabe, explains that despite the COVID-19 lockdown, there is need for patients to continue getting their medication in order to live a healthy life. “We shall continue working with expert mothers and People Having HIV networks at community level to ensure access to medicines, adherence support, Early Infant Diagnosis, viral load monitoring for children, adolescents and mother-baby pairs living positively and at health facility level the focus is quality of services so that pregnant mothers and adolescents who are positive continue to enjoy the services. We need to keep them in care so that they can look after their children as we also strengthen the component of prevention,” he says.
Odraru is happy that her daughter can now play and run around, which was not the case before she was enrolled on treatment. Her only challenge now is that one of the regimens the daughter takes is sour while another set has to be swallowed twice a day.
The good news is that the revised Consolidated National guidelines for HIV prevention, care and treatment will soon be rolled out to the districts and regional level. In addition, Pediatric and Adolescent care and treatment clinical guidelines that will address the service utilization and quality gaps have also been finalized. The quality gaps aggravated by the effects of the COVID-19 pandemic on the health system has affected children, adolescents and women living with HIV.