Baylor Uganda operates a clinical Center of Excellence (COE) on the campus of Mulago Hospital in Kampala, provides services to five Kampala city council suburban satellite clinics, five satellite COEs in Kaberamaido, Kasese and Kitgum, and in 81 Ministry of Health facilities across the country. At the government facilities, Baylor Uganda works to integrate pediatric HIV/AIDS care and treatment services into the existing district health systems.
The Baylor Children’s Foundation - Uganda, a BIPAI affiliated NGO, was legalized on May 17, 2006 and the COE was officially dedicated and opened on October 2, 2008. The 20,000 square foot (1,858 square meter) state-of-the-art COE delivers HIV/AIDS care and treatment to more than 4,000 HIV-infected children and family members. Nearly 7,000 additional patients receive care and treatment at affiliated outreach sites.
- Location: Kampala
- Years in operation: 10
- Services: tuberculosis, HIV/AIDS, OB/GYN, hematology & oncology
- Total employees: 413
- Total health professionals trained: over 2,000
High-quality clinical care
With support from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), Baylor Uganda provides integrated pediatric HIV/AIDS care and treatment in 91 health facilities across the country. Children remain the main focus of the program but family members also benefit from the services.
Services provided are based on the 10-point pediatric HIV/AIDS management plan which involves: HIV testing and counseling, anti-retroviral therapy, management of opportunistic infections, home based care and treatment, nutritional support, provision of the basic care package and psychosocial support among others.
Support to up-country health facilities includes mentorship, provision of antiretroviral drugs and laboratory supplies and support to ensure services meet required standards.
National Expansion Program
The National Expansion Program (NEP) was designed to increase access and utilization of pediatric HIV/AIDS services in Uganda. BIPAI Uganda, with support from PEPFAR supports up-country Ministry of Health facilities to integrate pediatric HIV/AIDS care and treatment services into existing health systems. Emphasis is put on rural, underserved facilities in areas with a high prevalence of HIV infection.
Sites are first assessed for basic competencies to identify gaps in service delivery. Priorities are set and action plans drawn with health facility and district staff. These plans serve as the baseline against which future performance is measured. Based on the findings, health workers are then trained through didactic sessions, mentorship and supervision to build their knowledge, skills and capacity.
Available data indicates a remarkable improvement in the number of children and adults enrolled and active in care since the inception of the program. In fact, access to standard HIV care increased three-fold after initiation of the program.
Beyond the Meds: Psycho-social Support
Without a strong social support system, antiretroviral therapy (ARV) cannot succeed. That is why the psychosocial unit at Baylor Uganda ensures that social factors do not undermine the success of clients’ ARVs. This team identifies, supports and helps retains children and adolescents in care.
The psychosocial unit intervenes or supports families in cases of child neglect, abandonment, lack of basic needs, poor adherence, disclosure, marital problems and children with special needs. They also provide much-needed pre-test and post-test counseling sessions for both individuals and families. In addition to this, ongoing counseling sessions are held for all clients during their scheduled visits.
This team also organizes two educational camps, Sanyuka and Power of Hope. Campers share experiences and advise one another on how to manage life with HIV and participate in arts and crafts.
Links to child services
Baylor Uganda maintains working relationships with many child-focused organizations in order to support its young clients with special needs education, disability and psychological problems. Organizations such as Steven Jota, A-Z Children’s Charity, Noah’s Ark, Uganda Children’s Center, AIDCHILD, Missionaries of the Poor and Cherish Uganda Entebbe Road have helped support some of our children in need.
These organizations have helped Baylor Uganda resettle children in orphanages receive specialized counseling and given scholarships for primary education scholarships and vocational skills training.
Identification of HIV Infected Children
The identification of HIV-infected children and their family members is one of the core activities of the psychosocial unit. This is mainly done through targeted voluntary counseling and testing campaigns; HIV screening in orphanages and child centers and Know Your Child’s Status campaign (KYCS). KYCS is a program to mobilize HIV-positive adults in rural areas to bring the children in their care to a special event for HIV counseling, testing and eventual enrollment into care.
This team looks forward to expanding its services to:
- Starting a project with Child Fund International that will improve follow-up and support of HIV infected and affected children in Busia, Pader, Masindi and Kitgum.
- Widening the spectrum of referrals for client needs such as disability, special needs education, school fees, nutritional support, etc.
- Partnering with organizations that support income-generating activities to support clients’ needs.
- Collaborating with more child-centered agencies to reach more children in need of HIV counseling and testing.
Training & Education
The education and training program at Baylor Uganda began in 2003 and seeks to strengthen and enhance medical education for health professionals involved in pediatric HIV/AIDS care and treatment. Results are measured to determine the success of the programs.
To-date, over 2,000 national and international health professionals have been trained. The training is conducted in collaboration with the Makerere University Department of Pediatrics and Child Health, Uganda Ministry of Health (MoH), African Network for the Care of Children Affected by HIV/AIDS (ANECCA) and BIPAI.
Educational topics include:
- Community home-based care and support
- Dry blood spot (DBS)
- Good lab practices
- Infant feeding
- Pediatric HIV/AIDS care management and counseling
- Positive prevention
- Routine counseling and testing
- Training of trainer (TOT)
Baylor Uganda trains interns and postgraduate students from Makerere University Medical School in pediatric HIV/AIDS management. The training helps students acquire the necessary skills and competency to establish and manage pediatric HIV/AIDS services. This program soon will be extended to include clinical officers and nurses.
Undergraduate students from Kampala International, Makerere, Kyambogo and Mukono universities come to the COE for internships in counseling, home health, laboratory, social work and human resources.
Baylor Uganda provides on-site mentorship to build clinical competency. The program takes three months to complete and helps expand pediatric HIV/AIDS health services outside the COE. Trainees are physicians, clinical officers, nurses, nursing students and nurse assistants.
Continuous professional development
To continuously update health practitioners on issues and developments in pediatric HIV/AIDS care and treatment weekly continuing medical education (CMEs) and organizational learning sessions are conducted for staff and others from nearby health institutions.
Mentorship and Support Supervision
In order to consolidate the knowledge given and ensure that it is translated into practice, three on-site mentorship visits are carried out in the facilities where trainees are placed. Only those who are able to provide standard care, including enrolling at least five children, graduate with a certificate of competence. To-date, 47% of students have graduated.
Facilities with a high proportion of health care providers and those that attain strengthened systems are graduated to support supervision. To date 23 out of the 33 facilities have achieved support supervision status.
Baylor Uganda performs clinical research under stringent standards and its findings contribute to worldwide best practices of pediatric HIV/AIDS care and treatment.
The ARROW Trial and the Cohort studies continue with the longest attending study participants at week 165 and 291 respectively. The trial has undertaken new randomizations to stop or continue cotrimoxazole and once verses twice daily Abacavir + Lamivudine with hopes to further improve adherence of children to their life-long antiretroviral treatment (ART). The cohort study is now assembling an infant cohort starting HAART as per the current Uganda Ministry of Health and WHO guidelines.
An Adolescent Intervention study has completed the first phase of developing the pilot intervention tailored to the needs of YPLH in Uganda and will proceed to evaluate the intervention among them.
Recent research projects completed at Baylor Uganda include:
- Evaluation of the T-Spot TB test in the diagnosis of latent tuberculosis infection in HIV-infected children in Uganda
- HIV-associated malignancies among children attending the BIPAI Uganda COE in Kampala, Uganda
- Association between anthropometric status and dietary diversity of complementary feeding among infants born to HIV-infected mothers in Uganda
- Formative evaluation of nutrition care and support interventions for children exposed to and infected with HIV and AIDS at BIPAI Uganda
Baylor Uganda will begin a new trial, CHAPAS 3 (Children with HIV in Africa -Pharmacokinetics Adherence/Acceptability of Simple Antiretroviral regimens), at the COE and University Teaching Hospital in Zambia. The trial will compare the pharmacokinetics, toxicity, acceptability, adherence, virological efficacy and cost-effectiveness of three first-line antiretroviral regimens. Both previously untreated (ARV naïve) and experienced (who have already been receiving stavudine based regimens) children ages one month to 13 years with undetectable viral load will be recruited. A total of 420 children (140 per site)will be recruited over a period of eighteen months and followed for a minimum of ninety six weeks