Department of Defense HIV/AIDS Prevention Program Uganda (DoD Uganda URC Project)

The Challenge

Uganda is known for leading a rigorous response to the HIV epidemic in the 1990s and early 2000s, making significant headway against the disease. Unfortunately, HIV infections surged between 2005 and 2013. Since then, the Ministry of Health and other stakeholders have been working to address the drivers of the epidemic and reach zero new infections.

PEPFAR estimates that the HIV prevalence among key and priority populations – including military services – is between 15% and 37%, much higher than that of the general population, although the exact HIV prevalence rate for the military is not known.

Overview and Objectives

With a comprehensive HIV program implemented through 40 military-run health facilities, the Uganda People’s Defence Forces (UPDF) can strengthen HIV services and reduce HIV transmission among military personnel and civilian communities.

The DoD Uganda URC Project is scaling up the UPDF HIV response in Uganda to achieve epidemic control. The program supports 40 military health facilities – including 31 with antiretroviral therapy (ART) accredited clinics – by providing custom-designed technical assistance and material support. The DoD Uganda URC Project is helping military health facilities’ efforts to improve access and quality of care for clients accessing the UPDF HIV services.

The project’s objectives are to:

• Reduce new HIV infections among the military and surrounding communities by 65% by 2026;
• Increase access to and quality of HIV testing services in the UPDF towards achieving 95% of people living with HIV (PLHIV) knowing their status by 2026;
• Strengthen provision and coverage of quality HIV care and treatment services in the UPDF towards achieving 95% of people with HIV who know their status getting on treatment by 2026;
• Scale up viral load coverage to 100%, optimize HIV treatment services, and achieve 95% viral suppression among PLHIV served by UPDF facilities by 2026; and
• Strengthen institutional capacity of the UPDF to lead, plan for, and monitor the UPDF HIV/AIDS response.

Achievements

• Established a virtual learning platform at 21 UPDF sites using the project ECHO model, which allows support, guidance, and feedback to be shared through a virtual community.
• Scaled up an electronic medical records system at 31 military health facilities, providing hardware and software as well as building capacity of health service providers.
• Provided HIV testing to 337,644 individuals, with 9,791 testing positive (2.9%) and community linkages to treatment have been strengthened to support test and treat efforts.
• Strengthened antenatal care (ANC) HIV testing services to cover 98% of all pregnant women at their first ANC visit at a UPDF facility. 100% of the newly identified pregnant women started on antiretroviral treatment (ART) and more than 3494 HIV negative exposed infants received DNA-polymerase chain reaction (PCR) testing for early diagnosis. Currently, all 31 facilities have mother-baby care points with resident midwives at their maternal and child health clinics.
• Facilitated circumcision for 125,039 men as part of the minimum package of safe male circumcision for HIV prevention services.  
• Supported UPDF’s peer-led model to enroll DREAMS beneficiaries from Gulu and Mubende military health facilities between October 2022 and March 2024, with a focus on reducing their vulnerability to HIV by providing a comprehensive package of services including life skills training and reproductive health counseling.
• Expanded gender-based violence screening and support services to include the Ministry of Health screening tool at all entry points in health facilities along with peer educators to screen young people. The project has collaborated with military administrative units to provide psychosocial, legal, and clinical support to survivors using military base structures. Of the 4,614 survivors receiving treatment, 94% are physical violence cases and 6% are sexual violence cases.
• Grew the number of ART-accredited facilities from 27 to 31.
• Increased the number of people living with HIV (PLHIV) in care to 21,228 clients at military health facilities. 41% of these were newly enrolled on ART.
• Screened 20,797 HIV positive patients for TB in HIV clinics, with an increase in patients using TB preventive therapy to 16,415 – up from nearly 1,000 at project launch in 2018. 3,481 registered TB patients received HIV testing services and now know their status.
• Achieved a 96% viral load suppression rate among PLHIV on treatment by end of March 2024.
• Included cervical cancer screening for women living with HIV at all 31 URC-supported UPDF health facilities. From October 2020 to March 2024, 8,520 women living with HIV were screened for cervical cancer, making up 72% of the 111,833 women living with HIV who received care from those facilities in that time period. A total of 962 women had abnormal results, with 96% of these women receiving treatment for precancerous lesions per national guidelines. The remaining 4% of these women were diagnosed with cervical cancer and referred to oncology services for further management.