Uganda and beyond: Expanding interventions offered at primary health care centers

In 2002, U.S. government researchers in Uganda (in partnership with the Ugandan Ministry of Health and Ugandan nonprofit organizations) developed a "Basic Care Package" to prevent the most debilitating opportunistic infections among people living with HIV. The elements of the Basic Care Package are designed to be simple to implement, so they can be delivered at primary health care centers. The essential elements include cotrimoxazole (a powerful antibiotic), insecticide-treated bed nets to prevent malaria, screening and management of sexually transmitted infections (STIs), prevention of mother-to-child transmission (PMTCT) services, and counseling (e.g., condom use and family planning), and point-of-use safe water systems.

As of December 2009, five countries have expanded distribution of Basic Care Package programs: Uganda, Kenya, Nigeria, Ivory Coast, and Ethiopia. Four additional countries are integrating household drinking water treatment products with HIV services: Vietnam, Rwanda, Zambia, and Malawi. In 2010, a national basic care package program will be launched in Mozambique.

The net result: each intervention has been shown to improve health while remaining cost effective. Alone, the Safe Water System has been documented to reduce diarrhea among persons with HIV by 25-35 percent, at a cost of $10 per family per year. Combining the safe water system with cotrimoxazole reduces diarrhea episodes among people living with HIV by 77 percent and days of work or school lost to diarrhea by 47 percent, at a cost of roughly $15 per family, per year. Because of these successes, the integrated Basic Care Package is now being scaled up under PEPFAR.