Approximately 9,000 people currently receive care at the IDI clinic, and an additional 6,000 receive care through outreach activities at Kampala City Council clinics and through the Kibaale Kiboga Project. HIV positive patients (called Friends at IDI) are supported with a number of services including free antiretroviral therapy, specialist consultation and a supportive clinical environment. The clinic also serves as a platform for IDI’s research and training activities. There is an increasing emphasis on developing models of care for infections that are closely related with HIV—for example TB and Kaposi’s Sarcoma.
Key Components of the Programme:
HIV prevention is central to all clinical activities. Because People Living with HIV (PLHIV) are the main beneficiaries of IDI’s PCT services, prevention activities are mainly targeted at PLHIVs (using the concept of “prevention with positives”). The underlying strategy is to increase the number of individuals who are aware of their HIV sero-status and target the HIV-positive and their partners with interventions that effectively reduce the likelihood that they will transmit the virus. This strategy is based on the observation that most HIV infections occur in a settings where the majority (over 80%) of HIV-infected individuals are unaware of their status. Some of the special prevention-related activities that IDI engages in are:
- Identifying HIV discordant couples, and helping them to maintain their discordant status
- Integrating sexual and reproductive health activities into all clinical care—including PMTCT, providing more contraceptive choices, prevention and treatment of sexually transmitted infections (STIs), and screening for cervical cancer
- Preventing the onset of opportunistic infections (secondary prevention) among those already living with HIV, through provision of basic care kits (including cotrimoxazole) and careful management of detected opportunistic infections
- Training and enabling PLHIVs to support HIV prevention through behavior change communication and the provision of peer support and peer counseling
- Focusing particular attention on young adults, as a particularly high risk group for acquiring or transmitting the virus
- Providing antiretroviral therapy (ART) for as many people as possible (prevention through treatment)
- Improving and maintaining HIV/AIDS skills, including those related to prevention, in the health work force Including sexual reproductive health and HIV/opportunistic infections prevention as research focal areas
IDI strives for a case mix that provides quality services for as many people as possible, while also enabling research to generate information on better approaches to care in low resource settings. All Friends receive on-going counseling, safe water, mosquito nets, condoms, and diagnosis and treatment for opportunistic infections. Sexual reproductive health services are an important part of all care, as well.
- Approximately 2,893 people are receiving routine care at the IDI clinic, but are not yet on ART. Everyone in this group receives Cotrimoxazole, in order to reduce the likelihood that they will contract opportunistic infections.
- Approximately 5,454 people are on first line ART at the IDI clinic. This group is monitored during routine visits. Those that are stable on their treatment and have a good record of adherence may have nurse-only or pharmacy-only visits, in order to reduce the amount of time they need to spend in the clinic.
- Approximately 520 people are on second line ART (drugs taken after the development of resistance to first line therapy) at the IDI clinic. This is one of Africa’s largest cohorts of patients receiving second line therapy, and IDI is carefully monitoring their progress, in an effort to develop more effective and replicable approaches to managing these complicated cases. This area of clinical activity, and the learning that is derived from it, is becoming increasingly important as more and more people in Uganda and sub-Saharan Africa begin to develop resistance to first-line therapy.
Services for Specialized Populations
IDI provides special services for particularly high risk groups, or those requiring specialized care. At the moment special clinics are run for young adults (age 16-24) and for HIV discordant couples (couples where only one member of the couple is HIV positive).
Clinics for Special Conditions:
Tuberculosis (TB) / HIV: Although TB and HIV are different diseases, it is very common for people who have HIV to contract TB. Over the course of this year a TB/HIV clinic was established, in order to ensure that Friends who have TB/HIV co-infection receive the monitoring and care that they need.
Kaposi’s Sarcoma (KS): KS is the most common cancer in the world, among people that are HIV positive. In Uganda, it accounts for six out of every ten cancer diagnoses made in the Cancer Institute. All patients who come to the IDI clinic are given a skin examination, and biopsies are conducted in cases of suspected KS. Persons who are found to have KS are put on ART immediately, if they are not already on it.
For the young adults clinic exist questionnaire click here