Q And A Forum: Maximizing PEPFAR Funding By KP To Meet UNAIDS 2030 Goals In Uganda

Key Populations can now lead activities formulating appropriate HIV Prevention interventions in Uganda. 

But, what exactly are these interventions?

Presently, there are over 107 KP organizations scattered in all over Uganda. 44 of these are registered with the Uganda KP Consortium. A rapid appraisal of HIV Prevention Strategies of 7 of these between 2018-2020 shows the following:

1. HIV Prevention is about Condom and Lubricant sourcing and distribution
2. Five (5) out seven (7) had conducted internal 3-5 internal meetings or short trainings for staff and during the events tasked the staff to give out Condoms and Lubricant consumables. 
3. Four (4) out of the seven (7) are Kampala-based KP Led organizations, which means they are overlapping in the catchment zone. Two (2) were Kampala-based but had outreach stations 100 miles out of Kampala City

PEPFAR And Global Fund, A History:

The U.S. is the single largest donor to the Global Fund. Congressional appropriations to the Global Fund totaled $16.6 billion from FY 2001 through FY 2018. The Global Fund provides another mechanism for U.S. support by funding programs developed by recipient countries, reaching a broader range of countries, and supporting TB, malaria, and health systems strengthening (HSS) programs in addition to (and beyond their linkage with) HIV. To date, over 150 countries have received Global Fund grants; 53% of Global Fund support has been committed to HIV and HIV/TB programs, 29% to malaria, 16% to TB, and 2% to other health issues. The original authorization of PEPFAR, and subsequent reauthorizations, included a limit on annual U.S. contributions to the Global Fund that prevented them from causing cumulative U.S. contributions to exceed 33% of the Global Fund’s total contributions; this requirement is in effect through FY 2023.

Aligning  And Stepping Up The HIV Prevention By KP:

An effective plan must maximize opportunities to meet UNAIDS 2030 Goals. This is possible by creating optimizing activities for funds to be spent on:

1. Treatment 
2. Palliative care 
3. Prevention
4. Abstinence-until-marriage programs
5. OVC
6. Delay of sexual debut
7. Monogamy
8. Fidelity
9. Counselling geared at increasing events where sex with partner is with any kind of HIV prevention method (that is with a condom, PrEP or an undetectable viral load).
10. Partner reduction activities in any host country with a generalized (high prevalence) epidemic.

Addendum:

The KP situation in Uganda, now makes it possible for them to access funding. For most of the organizations, it will be an opportunity for autonomy and self-directed agency. For the money to be spent on efforts to eradicate HIV, there is need to include self assessment. Making a readiness examination to conduct HIV Prevention services is possible by using the 6W1H model we devised. We are sure that with this model, KP-led organizations will devise and own ways to make HIV Prevention roll out to meet UNAIDS 2030 Goals.

Determined Prevention Service Delivery	Category	Goals
	6W1H	Executive	Outcome
Office Space	Why, What, Where, When, Which, Whom & How	Rent	Address, location and resource facility in place
	Why, What, Where, When, Which, Whom & How	Utilities	Wellness and Occupant comfort
	Why, What, Where, When, Which, Whom & How	Consumables	Wellness, Occupant comfort including prevention materials and merchandise
	Why, What, Where, When, Which, Whom & How	Recurrent Administration	Staff managing day to day activities including doing case work, desk work and report formulation
Treatment	Why, What, Where, When, Which, Whom & How	Link up with clinics, health facilities and hospitals	A social map and stakeholder memo developed for referral
	Why, What, Where, When, Which, Whom & How	Arrange and schedule clinic attendance days	Increase opportunities for testing, ARV Adherence, treatment of Opportunistic Infections and Optimizing Viral Load suppression
	Why, What, Where, When, Which, Whom & How	ARV and Medical Check up appointments	Increase opportunities for testing, ARV Adherence, treatment of Opportunistic Infections and Optimizing Viral Load suppression
Palliative Care	Why, What, Where, When, Which, Whom & How	Follow up	Increase opportunities for testing, ARV Adherence, treatment of Opportunistic Infections and Optimizing Viral Load suppression
	Why, What, Where, When, Which, Whom & How	Maintain Housing of person living with HIV	Stable housing increases opportunities for ARV Adherence, reduces vulnerability and ensures personal security
	Why, What, Where, When, Which, Whom & How	Provide Food	Stable Food increases availability of nutrition, opportunities for ARV Adherence, reduces vulnerability and ensures personal security
	Why, What, Where, When, Which, Whom & How	Provide Companionship	Companionship increases chances for sharing with people who care, opportunities for ARV Adherence, reduces vulnerability and ensures personal security
Prevention for couples intending to have children IEC+	Why, What, Where, When, Which, Whom & How	Couple counselling opportunities	Child spacing and planning, Mother and Child Health, Partner health
Prevention With Condom IEC+	Why, What, Where, When, Which, Whom & How	Procuring, distribution, use and proper disposal of condoms	Increased number of people reached with prevention message
Prevention with PrEP IEC+	Why, What, Where, When, Which, Whom & How	Attending counseling sessions on use of PrEP	Increased number of people reached with PrEP prevention message
Prevention With Undetectable Viral Load	Why, What, Where, When, Which, Whom & How	Attending counseling sessions and taking ARVs as scheduled	Increased number of people reached with Undetectable Viral Load PrEP prevention message
Partner reduction Practices	Why, What, Where, When, Which, Whom & How	Provide IEC services to inform decisions on partner reduction	Increased number of events making it possible to motivate people to reduce sexual partners
Vulnerable KPs	Why, What, Where, When, Which, Whom & How	Identify and provide support to reduce vulnerability	Address stigma, discrimination and violence toward KPs
Livelihood IEC	Why, What, Where, When, Which, Whom & How	Provide Livelihood IEC	Increased number of opportunities to engage in sustainable livelihood, vocations and productive work
Delay Sexual Debut IEC	Why, What, Where, When, Which, Whom & How	Provide IEC services to inform decisions on delaying sexual debut	Increased number of people reached with delaying sexual debut message
Monogamy IEC	Why, What, Where, When, Which, Whom & How	Provide IEC services to inform decisions on monogamy	Increased number of people reached with monogamy message
Fidelity IEC	Why, What, Where, When, Which, Whom & How	Provide IEC services to inform decisions on fidelity	Increased number of people reached with fidelity message

™Making Prevention Goals Realistic; Supporting HIV Prevention By KPs in Uganda (T. muyunga-Mukasa)