HIV and TB Overview: Uganda

Background

In 1991, the U.S. Centers for Disease Control and Prevention (CDC) started work in Uganda focused on HIV and AIDS research. An official country office was established in 2000. With the launch of PEPFAR in 2023, Uganda became a focus country for the delivery of high-quality HIV and TB services.

Currently, CDC supports Uganda’s Ministry of Health (MOH) and numerous partners (most are local institutions) in HIV/TB prevention and control efforts. These partnerships also work to strengthen public health emergency preparedness and response.

CDC focuses on finding more people living with HIV (PLHIV) and linking and maintaining PLHIV to antiretroviral therapy (ART). Additionally, CDC is also focusing on scaling up viral load testing to monitor for viral suppression. All these efforts use an integrated service delivery model. CDC also supports TB diagnosis, preventive therapy, and treatment among PLHIV.

HIV and TB data

HIV/AIDS

Tuberculosis (TB)

Key activities and accomplishments

HIV prevention

CDC supports efforts to reduce new HIV infections through:

• Prevention of mother-to-child transmission.
• Voluntary medical male circumcision.
• Peer-based programs for key populations.
• Prevention of gender-based violence.
• Pre-exposure prophylaxis (PrEP).

Additionally, CDC supports efforts to reduce new HIV infections through the PEPFAR DREAMS (Determined Resilient Empowered AIDS-free Mentored, Safe) program.

Of the 69,303 PEPFAR-supported pregnant and lactating women with HIV identified in 2022, 57 percent (39,559) received services at CDC sites. Of these, 100 percent were enrolled on ART, enabling infants to be born HIV-free. Early mother-to-child transmission of HIV dropped from 7.5 percent in 2014 to 1.9 percent in 2022.

CDC supports a robust program designed to reach people at higher risk, including policy, surveillance, community-led monitoring, and tailored services. People at higher risk for acquiring HIV include:

• Female sex workers.
• Men who have sex with men.
• Transgender persons,
• Persons who inject drugs.
• The incarcerated populations.

The Medically Assisted Therapy program, which treats and rehabilitates people who inject drugs, has enrolled 424 individuals since October 2020.

Comprehensive HIV & TB care and treatment

In 2022, CDC supported ART optimization among adults and children living with HIV. The effort resulted in 96 percent of people living with HIV transitioning to optimized regimens. Of these individuals, 94 percent were virally suppressed. CDC’s use of differentiated service delivery models has improved retention of HIV and TB clients. The proportion of interruptions in treatment reduced from 2.4 percent to 1.9 percent.

CDC-supported services prevent TB among PLHIV through scale-up of TB preventive therapy (TPT). CDC achieved 58 percent of TPT enrollment target and 92 percent TPT completion among all PLHIV in 2022. Among TB patients diagnosed with HIV, 97 percent started ART, and 99 percent of PLHIV diagnosed with TB initiated TB treatment.

CDC also supports other clinical services for advanced HIV disease, including access to cryptococcal treatment. In 2022, CDC supported MOH to expand cervical cancer screening and treatment services for pre-cancerous lesions for women living with HIV. CDC reached 299,640 women (106 percent of the annual target) and 75 percent of all age-eligible women in 2 years.

Laboratory systems strengthening

CDC-supported efforts focus on HIV and TB testing, diagnostic interventions for emergency preparedness and response, and laboratory services for non-communicable diseases. CDC strengthens lab network capacity through a variety of initiatives, such as staff skilling programs and robust laboratory quality management framework.

Other initiatives include personnel safety and environment programs, laboratory information systems, and innovation supply chain. An equipment management initiative also ensures access to timely, accurate, and reliable laboratory results.

In July 2023, over 40 laboratories in Uganda were internationally accredited, compared to only seven in 2015.

Use of data for improved impact

CDC supports program monitoring and evaluation, disease and case-based surveillance, information systems, and public health research. These efforts generate up-to-date data to drive evidence-based HIV, TB, and other global health programs and policies. CDC supported MOH and partners in conducting national surveys for children (Violence against Children) and adults (Uganda Population-based HIV Impact Assessment).

CDC also supported conducting national surveys for refugees (Refugee Uganda Population-based HIV Impact Assessment). These surveys have provided critical data to focus national HIV epidemic control efforts.

Resources

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