Programs | Rakai Health Sciences Program (2024)

Comprehensive Healthcare at RHSP STI and Staff Clinic

The Rakai Health Sciences Program (RHSP) extends its commitment to healthcare beyond the community through its STI and Staff Clinic. This facility caters to the outpatient medical needs of RHSP staff and their children under 5 years, ensuring convenient access to quality healthcare without disrupting their work responsibilities. While the clinic offers primary care services, individuals with complex illnesses requiring specialised treatment are referred to higher-level facilities for comprehensive management.

Services Offered

Enhancing Healthcare Access with the RHSP Mobile Clinic

As part of its commitment to community health and well-being, the Rakai Health Sciences Program (RHSP) operates a Mobile Clinic to deliver essential medical services alongside the Rakai Community Cohort Study (RCCS) activities. This initiative aims to bridge healthcare gaps by providing diagnosis and symptomatic management of outpatient illnesses directly within the communities.

Key Services

2. Referral Services: In cases where specialised care is necessary, the clinic facilitates referrals to higher-level healthcare facilities. This ensures that individuals receive appropriate treatment and follow-up care, optimising health outcomes.

Impact on RCCS Participation

The provision of medical services through the Mobile Clinic plays a crucial role in motivating community members to engage in RCCS activities. By offering accessible healthcare within the community, participants are more likely to actively participate in research activities, contributing to the success and effectiveness of the RCCS.

The RHSP Mobile Clinic exemplifies the organisation's commitment to promoting community health and facilitating research activities. By bringing essential medical services directly to the doorstep of community members, the clinic not only improves healthcare access but also strengthens community engagement in health research initiatives such as the RCCS.

Empowering Communities with HIV Services: The RHSP Centre of Excellence (COE) Clinic

The RHSP Centre of Excellence (COE) Clinic stands as a beacon of hope for HIV prevention, care, and treatment services in Kalisizo and its surrounding areas. With a comprehensive range of services tailored to meet the diverse needs of its clients, the COE Clinic plays a pivotal role in promoting health and well-being within the community.

Key Services Offered

1. HIV Testing Services: The clinic provides confidential HIV testing services, ensuring early detection and timely initiation of treatment.

2. Antiretroviral Therapy (ART) Services: Both paediatric and adult ART services are available, catering to the specific needs of different age groups.

3. Cervical Cancer Screening: Regular cervical cancer screening services are offered to enhance women's health and well-being.

4. Early Infant Diagnosis and Treatment: The clinic focuses on eliminating mother-to-child transmission of HIV through early infant diagnosis and treatment interventions.

5. Tuberculosis (TB) Screening and Treatment: Screening and treatment services for TB are provided to address co-infections and improve overall health outcomes.

6. TB Preventive Therapy (TPT): The clinic offers TB preventive therapy to individuals at risk of developing TB, contributing to disease prevention efforts.

7. Pre-exposure Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP): PrEP and PEP services are available to individuals at risk of HIV infection, offering effective preventive measures.

8. Family Planning Services: Family planning services are integrated into the clinic's offerings, promoting reproductive health and choice.

9. Viral Load Testing: Regular viral load testing is conducted to monitor treatment efficacy and ensure optimal outcomes for clients.

Patient-Centered Care

To enhance patient retention and engagement, the COE Clinic adopts differentiated service delivery models. These models include both clinic-based care and community outreach programs, ensuring accessibility and continuity of care for clients.

Impact and Achievements

By December 2023, the COE Clinic had a remarkable impact, serving 2,647 active clients on antiretroviral therapy. Impressively, 98% of these patients achieved viral suppression, a testament to the clinic's commitment to quality care and treatment outcomes.

Support and Collaboration

The COE Clinic's activities are made possible through support from a sub-grant under the IDI PEPFAR grant, enabling the continuation and expansion of vital HIV services within the community.

The RHSP Centre of Excellence (COE) Clinic stands as a cornerstone in the fight against HIV/AIDS, providing essential services and support to individuals and families affected by the virus. Through its holistic approach and collaborative efforts, the clinic continues to make significant strides towards achieving HIV elimination goals and promoting community health and well-being.

Promoting Well-being through counselling

The RHSP Counselling Section stands as a pillar of support within the Rakai Health Sciences Program's (RHSP) research and programs directorate. With a mandate to provide ongoing psycho-social support counselling, the section plays a vital role in safeguarding the well-being of research participants, patients, staff, and other community members within RHSP-supported communities.

Core Responsibilities

1. Psycho-social Support: The counselling section offers a range of psycho-social support services tailored to meet the diverse needs of individuals within the community. Whether facing challenges related to health, relationships, or personal well-being, individuals can access confidential counselling to navigate through difficult times.

2. Well-being Assurance: Ensuring the well-being of all stakeholders is paramount to the counselling section. By providing a safe and supportive environment, the section strives to address mental health concerns, alleviate stress, and promote resilience among community members.

3. Community Engagement: Through community outreach initiatives, the counselling section actively engages with community members to raise awareness about mental health, destigmatize seeking help, and encourage proactive self-care practices.

Commitment to Confidentiality

Confidentiality is upheld as a cornerstone of the counselling section's ethos. All interactions between counsellors and clients are treated with the utmost discretion and respect for privacy, fostering an environment of trust and openness.

The RHSP Counselling Section exemplifies the organisation's dedication to holistic health and well-being. By offering compassionate support and guidance, the section plays a vital role in nurturing resilient communities and fostering a culture of care and support within RHSP-supported areas.

Empowering Our Communities: Health Education and Community Mobilisation (HECM)

The Health Education and Community Mobilisation (HECM) section serves as the vital link between the Rakai Health Sciences Program (RHSP) and the communities where research and program activities are carried out. With a primary focus on community engagement, the HECM section plays a pivotal role in fostering awareness, participation, and collaboration within these communities.

Core Functions

• Community Awareness: The HECM section is dedicated to raising awareness about RHSP research initiatives, as well as the various services and programs offered. Through targeted educational campaigns and outreach efforts, community members are informed about the importance of research participation and encouraged to actively engage in RHSP activities.
• Compliance and Participation: By fostering a sense of ownership and involvement, the HECM section aims to increase community compliance and participation in RHSP endeavours. Through community mobilisation efforts, individuals are encouraged to take an active role in their own health and well-being.
• Friendly Environment Creation: Creating a welcoming and supportive environment is paramount to the success of RHSP activities. The HECM section works to cultivate positive relationships and trust within communities, ensuring that research and program activities are conducted in a manner that is respectful and responsive to community needs.

Additional Activities

• Dissemination of Research Findings: The HECM section ensures that research findings are effectively communicated to the communities involved, fostering transparency and accountability.
• Preparation for Services: Communities are prepared and informed about the various services offered by RHSP, facilitating access and utilisation.
• Community Advisory Board (CAB) Collaboration: Working closely with the Community Advisory Board (CAB), the HECM section facilitates dialogue and feedback between research communities and RHSP, ensuring that research activities are conducted in a manner that is ethical, respectful, and beneficial to all parties involved.

The HECM section serves as a cornerstone of community engagement within RHSP-supported areas. By fostering awareness, participation, and collaboration, the section contributes to the success and impact of RHSP research and program activities, ultimately improving health outcomes and well-being within the community.

The Masaka HIV Regional mechanism (2017-2023)

The Health Education and Community Mobilization (HECM) section serves as the vital link between the Rakai Health Sciences Program (RHSP) and the communities where research and program activities are carried out. With a primary focus on community engagement, the HECM section plays a pivotal role in fostering awareness, participation, and collaboration within these communities.

Theproject involved capacity building of the district leadership to plan,coordinate, supervise, monitor, evaluate and fully own the implementation ofHIV programs in addition to strengthening of health facility and communitylevel (District Led Programming(DLP).

Project implementation was geared towards achieving an AIDS freegeneration by targeting populations at the greatest risk of HIV and in urgentneed of services in line with the revised UNAIDS 95-95-95 targets andthe PEPFAR priorities.

Theproject objectives were:

• Use targeted HIV testingservice (HTS) models to men, key populations (KP) and priority populations (PP)to improve identification ofPLHIV in community and health facilities inscale-up districts.

• Provide combination preventioninterventions to KP/PP scale-up districts.

• Provide linkage to high-impactprevention, ART, and other community services.

• Provide ART services to alleligible PLHIV as outlined in the latest national HIV treatment guidelines:

•Improve coverage and quality of integrated eMTCT, EID, better track newlyenrolled maternal and infant outcomes:

•Work with DHTs and Health Facilities to reduce TB burden in PLHIV and HIV in TB clients:

•Support the nationalcommodity supply chain systems:

•Strengthen lab quality management systems for CQI in viral load, laboratory sample transportation/results transmission system, and other HIV relatedtesting.

Strengthened governance and oversight functions at district level for jointplanning, coordination, support supervision, and performance monitoring for sustainedepidemic control.

HIV Prevention, Care and Treatment Services (2004 - 2017)

From June 2004 to September 2017, HIV services were provided in the districts on Rakai, Kyotera and Lyantonde. The services were funded by the President’s Emergency Plan for AIDS Relief (PEPFAR) through a subgrant from the Makerere School of Public Health, Cooperative Agreement (CoAG) with the US Centers for Disease Control and Prevention (CDC) to develop human resource capacity for management of HIV/AIDS and other health programs in Uganda and deliver comprehensive community based HIV/AIDS prevention, care and treatment services to persons at risk of getting HIV and HIV infected persons and their family members in Rakai and surrounding districts. RHSP supported the provision of comprehensive HIV/AIDS prevention, care and treatment to HIV positive clients using the District-led HIV programming approach. RHSP also supported provision of Voluntary Medical Male Circumcision, Pre-exposure prophylaxis and DREAMS (Determined, Resilient, Empowered, AIDS-free Mentored and Safe).

The overall goal of this project was to scale up of comprehensive HIV prevention, HIV/ Tuberculosis (TB) care, HIV care and treatment services in Rakai district through a district-led approach.

The project implementation strategy focused onprovision of HIV prevention, care and treatment to children and adults through community-basedclinics located in Rakai and Lyantonde districts. In an effort to take servicescloser to the patients, services were provided initially through seventeen (17)HIV clinics then through 35 government health facilities, including, hospitals,health center IV, III and II.

Services included.

To facilitate durability of second line regimens, surprisehome visits were conducted at home to verify adherence before change to secondline treatment. The peer support program. The peersupport groups attached to all clinics offeredadherence support to fellow patients on ART. They also helped identify clients with social and other problems which might impacttreatment outcomes. For patients or caretakers of children with difficulty understanding the ART dosages, the peer supports assisted with Directly ObservedTherapy until the patients fully understood drugdosing.

4) Laboratory infrastructure: The RHSP laboratory supported all HIV testing and monitoring forbiological samples collected from the HIV clinics and HIV counseling andtesting centers within Rakai and Lyantonde districts. The only exception wasthe qualitative PCR for infant diagnosis, which is provided MOH central publichealth laboratory. The laboratory provided a range of tests including HIVtesting (rapid testing), serology like syphilis, Cryptococcus (serum CRAG)testing, microbiology testing like TB diagnosis, molecular e.g. viral loadtesting, CD4 count testing, and chemistry tests. The laboratory quality controland assurance staff provided support supervision and quality assurance,ensuring accurate performance. We supported district health center laboratorydiagnosis of opportunistic infections through training of the lab staff,provision of supplies and microscopes.

5) TB/HIV care was provided to all clients enrolled in the HIV clinics. Allclients who came into contact with the HIV clinic system were screened for TBthrough clinical evaluation. ARTclients were screened using the Intensified Case Finding Form (ICF) whilepre-ART clients were screened at the time of the clinical assessment. Ifindicated (i.e. Signs or symptoms of tuberculosis present), such patients werefurther investigated using sputum examination (Ziehl-Neilsen (ZN) smear. All TBpositive patients received anti-TB treatment.We supported integration of TB treatment into the existing governmenthealth units, and trained laboratory staff to diagnose TB provision oflaboratory reagents, to address stock outs. All care providers receivedtraining in comprehensive HIV care.

6) Prevention of Mother tochild transmission of HIV (PMTCT): We provided PMTCT servicesto 725 pregnant women and their babies exposed to HIV. PMTCT activitiesincluded provision of antiretroviral prophylaxis for mothers and their babies,infant feeding education to encourage safe feeding options as well as reproductivehealth (family planning) services for the mothers. All services were providedin accordance with the Ministry of Health guidelines, and practices changed asper MOH changes. All babies born to HIV positive mothers were tested for HIVusing HIV-1 DNA PCR at 4-6 weeks with the aim of early HIV diagnosis among theexposed infants. Exposed babies who initially test negative were followed upfor repeat testing until HIV infection is definitely excluded. Babies whotested HIV positive were initiated on ART. Mothers of babies exposedto HIV will were educated on how to feed their babies, including idealbreastfeeding practices, weaning feeds and food preparation.

8) DREAMS:

Since October 2016, westarted delivery of the DREAMS(Determined Resilient Empowered AIDS-free Mentored Safe women) program toadolescent girls and young women at risk of acquiring HIV. The DREAMS intervention targeted 1) pregnantwomen 15-24 years, 2) married women 15-19 years, 3) women 15-24 years who gavebirth by 15 years, 4) women 15-24 years in transactional sex, 5) in-schoolgirls 15-19 years, 6) HIV-negative uncircumcised men 15+ years and 7)HIV-positive men 15+ not receiving HIV care.

Thecore package of activities for the adolescent girls and youngwomen (AGYWs) included: 1) combined social-economic strengthening, 2) expandedcontraceptive mix, 3) post-violence care, 4) parenting and caregiver programs,5) HIV testing and counseling, 6) condompromotion and provision, 7) community mobilization and norms change, and 8)cash transfers. We also targeted male partners of the eligible AGYWs, toprovide ART for HIV-positive men 15-49 years and VMMC for HIV-negativeuncircumcised men 15-49 years.

By September 30th, 2017, RHSP had provided ART to over 24,000 HIVpositive adults and children, provided medical male circumcision to over140,000 men and provided the DREAMS program to 50,196 AGYW.