Leveraging locally designed and led solutions to improve HIV treatment outcomes among men and youth in Uganda

Jun 12 2022

Through the USAID Social and Behavior Change Activity (SBCA), WI-HER supported Nagongera HCIII in Tororo District, Eastern Uganda, to apply our iDARE methodology to significantly improve viral load suppression (VLS) among men and youth actively enrolled in HIV care and treatment. Among adult men (>20 years old), VLS increased from 65% in August 2020 to 96% in September 2021, and from 60% to 96% in youth (<20 years old) over the same timeframe.

The iDARE team identified a gender gap in VLS results among youth. From August 2020 to September 2021, the iDARE team closed the gender gap from 47% among male youth and 71% among female youth (baseline) to 96% and 98%, respectively. The iDARE team sustained and further improved the results among men and youth actively enrolled in care through December 2021. Lessons from this work have been scaled and adapted in different parts of the country through the SBCA. As the lead gender equity, youth, and social inclusion (GYSI) partner on this activity, WI-HER currently supports five districts to drive locally led solutions to improve health outcomes in four areas: HIV, antenatal care, immunization (measles and DPT3), and tuberculosis.

WI-HER’s iDARE empowers local communities and individuals—regardless of determining factor—to Identify local issues impacting a desired local outcome; Design local, contextually-appropriate, and culturally-sensitive solutions to address identified issues; Apply/Assess locally-led solutions; Record learnings, including what is and is not working; and Expand efforts to scale their locally-led impact. This innovative, results-oriented methodology is grounded in improvement science, social and behavior change theory, and human-centered design. With an emphasis on GYSI, iDARE ensures that solutions to locally identified gaps, barriers, and issues are community owned, sustainably delivered, responsibly managed, and documented by communities.

Using available data, WI-HER supported Tororo District government leaders in reviewing the District Health Information System (DHIS) 2 data to identify their most significant challenges in achieving public health goals and targets in various health areas. Together, using iDARE, they prioritized areas they wanted to address. The first identified priority for immediate intervention was HIV VLS among men and youth receiving treatment in the District. A review of baseline data at a larger facility indicated that while 92% of adult women receiving treatment were virally suppressed, only 65% of adult men and 60% of youth receiving treatment were virally suppressed. District leadership selected the first facility to serve as a base to support locally led behavior change efforts to improve VLS in the community. Specific emphasis was put on addressing GYSI barriers that impacted retention and adherence behaviors in this first testing site.