Utilization of a basic care and prevention package by HIV-infected persons in Uganda.

Opportunistic infections are the leading cause of mortality among HIV-infected people. Several simple interventions prevent illness, prolong life, or prevent HIV transmission from HIV-infected people in Africa. These include: cotrimoxazole prophylaxis; insecticide-treated bed nets; supplies for household water treatment and safe storage; materials promoting family voluntary counselling and testing (VCT); and condoms. We provided these interventions to adults and children with HIV who were members of the AIDS Support Organization in Uganda. To evaluate use of this basic care and prevention package, we surveyed a representative sample of 112 clients of TASO in their homes. Among respondents, 95% reported taking cotrimoxazole everyday, 89% said they had slept under a bednet the night before, 65% reported current treatment of household drinking water, 89% of sexually active respondents reported using condoms, and 96% reported family use of VCT. Household observations verified that use of cotrimoxazole, bednets, and water treatment products were consistent with reported use. This evaluation suggests successful distribution and use of basic care and prevention services at an AIDS organization in Uganda.

A mathematical model for the dynamics of HIV/AIDS with gradual behaviour change.

An HIV/AIDS model that incorporates gradual behaviour change is formulated with a variable force of infection for the adult population. The variability is modelled using a general function of time since introduction of the initial infective and exemplified for three specific functions. Expressions for the time taken for the reproductive number to reduce to unity and expressions for the time taken to attain a stationary steady state are deduced and discussed. Model projections for urban, peri-urban and rural Uganda are compared with corresponding antenatal clinic sites prevalence trends. The analysis shows that the dramatic decline in HIV prevalence in Uganda in the early 1990s was only possible through drastic declines in the force of infection. Since prevalence was high and reductions in frequency of sexual acts was minimal, the huge reduction could be attributed to reductions in probability of transmission per sexual act probably due to increased selective condom use among high risk sexual partnerships since overall condom use was low.

Mathematical model for HIV/AIDS with complacency in a population with declining prevalence.

An HIV/AIDS model incorporating complacency for the adult population is formulated. Complacency is assumed a function of number of AIDS cases in a community with an inverse relation. A method to find the equilibrium state of the model is given by proving a stated theorem. An example to illustrate use of the theorem is also given. Model analysis and simulations show that complacency resulting from dependence of HIV transmission on number of AIDS cases in a community leads to damped periodic oscillations in the number of infectives with oscillations more marked at lower rates of progression to AIDS. The implications of these results to public health with respect to monitoring the HIV/AIDS epidemic and widespread use of antiretroviral (ARV) drugs is discussed.

The effect of introducing a fee for HIV counselling and testing at the AIDS Information Centre; Kampala; Uganda. (p.159)

"The objective was to assess the impact on demand and return rates of introducing a User-fee for HIV counseling and testing (C/T) services in Uganda. The AIDS Information Centre (AIC) was established in Kampala in 1990 with support from USAID; by 1992 this service was available daily in four main urban areas; and on an intermitent basis; in an additional 14 districts. A modest user fee was introduced in 1994. Data for 1993 (before fees) and 1994 (after fees) were compared to assess the impact of introducing user fees; data from the four urban sites with daily services is presented. Results showed that demand for HIV C/T declined by 8.3; from a total of 45;484 clients in these urban sites in 1993 to 41;686 in 1994. The impact of user fees was much more pronounced for male clients; who declined by 12.6; female clients declined by only 1.8. Those clients who had not completed primary school declined by 44.3; though there was an increase of 20in those with primary education or more. There was a decrease in utilisation for all age groups; though this decrease was greater among youth; especially young men under age 20. It was concludedthat introduction of a user fee may affect both demand and client demographics. Though the decline in clients with less education was expected; it was also expected that the user fee would impact women more than men. There was no significant decline in women clients; suggesting that the demand for HIV C/T continues to be high among women in Uganda. The decline in young male clients suggests the need to introduce alternatives; such as special""free days"" to accommodate this potentiallyt high risk group."