Uganda: Reproductive health, family planning and PMTCT

Reproductive health, family planning and PMTCT

Mildmay Uganda provided Prevention of Mother‑to‑Child Transmission (PMTCT) clinics, family planning, cancer screening, STI services and broader reproductive, maternal and newborn care. Joan Nangiya, coordinator of reproductive health services, said Mildmay worked mainly with women while increasingly encouraging male involvement: “For PMTCT particularly we needed the father’s support… in the African setting, men often decided what happened in a family.” Around 70 couples per month received PMTCT education and support.

Clients living with HIV were supported to make informed choices about pregnancy. Joan described an HIV‑positive client, Gertrude, who initially considered terminating her pregnancy; with counselling and clinical support, she continued the pregnancy and her baby, Edna, tested HIV‑negative at six months. Mildmay’s voluntary counselling and testing (VCT) unit referred pregnant women to the PMTCT team, which operated to World Health Organization (WHO) guidelines and coordinated care with delivery hospitals. Some women had not disclosed HIV status to spouses, which made adherence and PMTCT practices challenging.

ACASI programme – The Last 1,000 Infections

Mildmay Uganda participated in The Last 1,000 Infections, a CDC‑backed research initiative using Audio Computer‑Assisted Self‑Interview (ACASI) to collect sensitive behavioural data immediately after HIV testing. The tool asked about sexual behaviour, transactional sex, condom use and alcohol/drug use, with tailored questionnaires for men and women in English and Luganda, and audio for clients who could not read. Data from clients who tested HIV‑positive and were likely recently infected, and who consented, were analysed to identify trends and inform Ministry of Health service provision. The ACASI programme ran alongside Mildmay’s VCT tent on Mondays, Tuesdays and Thursdays; by early implementation (from September 2010), more than 600 people had completed interviews. Negative‑test interviews were discarded from research, but counsellors still used the reports to tailor advice. The pilot was a partnership among Makerere University School of Public Health, Mildmay International, CDC, Uganda’s Ministry of Health and the Office of the President.

Mutundwe Health Centre outreach

Once a month, a team of seven (doctors, nurses, counsellors, a pharmacist) visited Mutundwe Health Centre on Kampala’s southwestern edge to deliver HIV care, distribute antiretroviral therapy (ART), and offer services such as play therapy for HIV‑affected children. The outreach formed part of Mildmay’s CDC‑funded programme and served nine centres after caseloads at Mildmay’s Lweza site became too large. Outreach reduced travel costs and improved access. Centre manager Barbrah Magoba said, “People were very happy when services were extended to their home village, they could walk.”

Community‑based volunteers (CBVs), trained by Mildmay in counselling and adherence, organised clinic days that saw well over 100 clients, many living below the poverty line. As Mildmay’s Uganda work moved towards technical support, CBVs in Mutundwe transitioned to Ministry of Health management, with eventual handover of clinic days. Barbrah expressed concern about service quality during the transition; Mildmay’s Jolly Nakintu reassured, “Support would still be there.”

Family stories:

• Nsubuga and Nampija: Nampija, a news vendor, received HIV care from 2005. Her son, Nsubuga (11), later entered care under Mildmay’s family‑based approach, with regular home visits from Grace, a Mildmay‑trained CBV. Both adhered to treatment and managed challenges with support.

• Sophia and Douglas: Sophia (diagnosed 2007) and her son Douglas (six, HIV‑positive) regained health after starting ART at a Mildmay clinic, which reduced visible illness and the discrimination they faced. “Discrimination came with visible sickness,” said Grace, the CBV. Later, Sophia experienced health setbacks and renewed stigma; Douglas’s status remained undisclosed to neighbours. By then, all mothers‑to‑be at Mutundwe were tested for HIV and referred for PMTCT support.

Impact

Mildmay Uganda’s integrated model combined PMTCT, reproductive health, VCT and data‑driven outreach. It strengthened clinic‑community links through CBVs, improved access to ART, informed national policy discussions via ACASI research, and supported families to make informed reproductive choices while navigating disclosure and stigma.