Providing HIV care and responding to a refugee crisis

An MSF staff member administers the oral cholera vaccine to a child in Kyangwali, Uganda.
UGANDA 2018 © Geraint Hill
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This information is excerpted from MSF’s 2016 International Activity Report.

Doctors Without Borders/Médecins Sans Frontières (MSF) has offered viral load testing for people on HIV treatment in Arua regional hospital since 2013—performing 20,845 tests over the past three years. Sixty patients who were not improving on second-line antiretrovirals (ARVs) benefited from drug-resistance testing; 19 of them were started on third-line treatment.  

In Kasese, MSF ran a clinic providing health care to adolescents, including sexual and reproductive health services, and HIV and TB prevention, screening, and treatment. More than 11,700 outpatient consultations were carried out and 3,200 adolescents were tested for HIV at the clinic in 2016.

In the three districts around Lake George and Lake Edward, MSF ran a project to improve detection and care for HIV, TB, and malaria in fishing communities. The team launched a proactive screening campaign in February, testing 13,771 people for HIV. MSF provided technical support in five health centers that offered comprehensive care at these sites, performing 1,234 viral load tests for people on HIV treatment.

Uganda hosted more than a million refugees, including approximately 700,000 South Sudanese. In Bidibidi, in the north of the country, MSF filled gaps in refugee care, including medical consultations, disease surveillance, and provision of water and sanitation. In November, MSF trucked in 66,000 liters of water per day. 

Crisis Update: June 19, 2017

Facts and Figures

International staff: 46

Ugandan and South Sudanese staff: 853

Crisis Update: June 19, 2017

Facts and Figures

International staff: 46

Ugandan and South Sudanese staff: 853

  April 2017 May 2017
Outpatient Consultations 21,092 33,442
Inpatients Admitted 171 228
Deliveries Assisted 32 100
Patients Treated for Malnutrition at Ambulatory Therapeutic Feeding Centers 74 53
Vaccinations 23,606 19,304
Malaria Cases 3,307 10,926
Patients Treated for Sexual and Gender-Based Violence - 31

Malaria: Cases nearly doubled from 488 in week 20 (May 15 to 21) to 853 in week 21 (May 22 to 28) in Palorinya and Rhino. In an inpatient clinic in Rhino, there were 54 admissions from May 19 to June 4, 74 percent of which were due to malaria. In Bidi Bidi, there were 8,623 malaria cases in May in comparison to 5,390 cases in April.

Rubella: There have been 18 cases of suspected rubella in Palorinya and five in Rhino (two confirmed). MSF is focusing on awareness through messaging and active case-finding.

Mental health: in Imvepi, MSF conducted 338 consultations and 58 follow-up diagnoses at the reception center, while 88 follow-up cases were conducted in mobile clinics for symptoms including depression, post-traumatic stress disorder, and epilepsy.

It is estimated that more than 950,000 South Sudanese refugees are now in Uganda, with an average of 1,613 arriving daily throughout May 2017. Refugees now make up more than 30 percent of the populations in the northern Ugandan districts of Adjumani, Yumbe, and Moyo.

As these numbers grow, food supplies are becoming an increasing concern for both the host population and the refugees. The World Food Program cut food rations by 50 percent due to a lack of funding and a continued drought is impacting food prices throughout northern Uganda. In some of the refugee settlements, tensions have risen as rations are cut and some refugees are even returning to South Sudan because of a lack of food.

Imvepi refugee settlement, to which newly arrived refugees have been relocated since February 2017, is expected to be full in the coming weeks. A new settlement, an extension of Rhino, is planned to open in the coming weeks.

On June 22 and 23 the Uganda Solidarity Summit on Refugees will be held in Kampala to mobilize international support and funding to meet the needs of both refugee and host communities, as well as showcase Uganda’s model of refugee management, protection, and social integration. A team from MSF will attend the summit and do advocacy rounds on the side lines.

With the rainy season underway, floods have affected parts of Palorinya refugee settlement, further displacing more than 100 households and necessitating an extension of the refugee settlement. MSF donated latrines as people were moved before the site had been prepared. Heavy rains have also caused the roads to deteriorate, leading to decreased access to clean water as well as poorer sanitation services in the areas affected. There is now a high risk of cholera and other waterborne diseases. An MSF emergency preparation plan is ongoing for a potential cholera outbreak.

Due to the rains, MSF is also seeing increasing numbers of malaria cases. From May 22 to 28 MSF treated 853 patients for malaria in the Palorinya and Rhino settlements, compared to just 488 in previous week. Plans are in place to start mobile clinics and open malaria points in the settlements to improve access to patients and decrease the load on the clinics. Malaria is also the top morbitidy in Bidi Bidi and Imvepi.

There has been a continuous increase in the total number of consultations, which could be attributed to the increase in the number of malaria cases. Due to flooding in some zones in Bidi Bidi, MSF set up a weekly mobile clinic for one month to prevent diarrhea outbreaks and built 10 communal latrines as an emergency response.