There are an estimated 24.7 million people living with HIV (PLWH) in sub-Saharan Africa (SSA) – over 70% of the global total. Uganda is one of the top 10 countries that, together, account for 81% of PLWH in SSA. Despite a steady decline in global HIV mortality, rates in high-burden, low-income countries, particularly in SSA, have increased, and HIV remains the leading contributor to disease burden. Although Uganda reduced its HIV prevalence rate from 18% in the 1990s to 6.4% in 2005, by 2011, prevalence had rebounded to 7.3% among adults, and an estimated 1.6 million Ugandans are living with HIV.
The Ugandan National HIV/AIDS Strategic Plan includes systems-strengthening to attract, train, and retain staff for delivery of health, prevention, and community-based HIV/AIDS services in both public and non-public sectors. This includes harmonizing HIV/AIDS pre- and in-service training of diverse professional cadres; mainstreaming HIV/AIDS in curricula of education institutions at all levels; and building leadership and management capacity and structures to enhance a decentralized national HIV/AIDS response.
The Mbarara University of Science and Technology (MUST) in rural southwest Uganda and its regional partners train undergraduate medical, nursing, and allied health professional students to become frontline health workers. Yet, the ever-increasing numbers of new HIV/AIDs patients poses critical challenges for effective HIV/AIDs service delivery. For instance, nurses assume a major role in provider-initiated HIV testing and counseling (PITC), but lack of time and resources and have other work demands that challenge practice. In SSA, nurses have expressed the need for training, managerial support, and health systems reform to promote PITC. To be HIV/AIDS health care leaders, SSA health professionals need clinical care and research training to better understand and address the complexities of HIV health care delivery; to strategically plan, implement, and test more efficient and sustainable service models; and to inform policy that can optimize care and prevention service delivery.
To address the health-professional training that will be critical to lessening the HIV/AIDS burden – particularly in rural Uganda – MUST and its partner institutions in Uganda (Bishop Stuart, and Lira Universities) and the US (Massachusetts General Hospital) proposed the HEPI-TUITAH (Transforming Ugandan Institutions Training Against HIV/AIDS). This inter-professional HIV/AIDS service-improvement training program for health professionals is building on the MEPI-MESAU consortium and Mbarara University Research Training Initiative (MURTI; D43TW010128, PI: Obua), which focuses on building research capacity in rural southwestern Uganda.
TUITAH has the following specific aims:
- To increase the competency of undergraduate medical, nursing, midwifery, and allied health professional students in the management of HIV/AIDS through the “low dose, high frequency” training model for quality clinical education, patient care, and HIV prevention services in Uganda.
- To enhance the capacity of primary health care providers to provide comprehensive HIV services and strengthen bidirectional linkages between health facilities and communities in rural Uganda.
- To develop the capacity of undergraduate health professional students in rural Uganda to conduct locally relevant biomedical, behavioral, clinical, and operations research in HIV and its co-morbidities.
- To strengthen a network of health professional training institutions (HPTIs) by building a community of practice and leveraging local resources and expertise to mitigate the national HIV/AIDS burden.