TASO Gulu

 

Background

Established in 2004, TASO Gulu is one of the eleven TASO centers. It is located in Northern Uganda, 365 kilometers from the capital city, Kampala. Gulu is a district bordered by the other districts of Oyam, Amuru, Nwoya, Pader and Kitgum. The centre operates in an area which has suffered the LRA rebel group insurgency for the last 20 years, characterized by brutal killings, displacement, and breakdown of social services. The centre serves victims of war, terror and trauma due to the prolonged war in the north.

During the time of insurgency, most of the population was living in Internally Displaced people’s Camps. The centre had to offer services in a camp setting. With more people living in small grass thatched houses and associated poor living conditions, there was high HIV/AIDS prevalence in the region. 

TASO Gulu was originally  being housed in a small building within Gulu Regional Referral Hospital and serving few clients. As the demand for TASO services increased, the centre rapidly registered a large number of clients. With funding from SIDA, PEPFAR, MOH and USAID, a new premise was erected along Matthew Lukwiya road, within Gulu Regional Refferal Hospital where the centre is currently serving over 12,000 clients. 

Now that there is peace in the region, most people have gone back to their homes and villages and are engaging in developmental activities. TASO Gulu has embarked on intensive follow up of clients with more remapping and home visits, through Community Drug Distribution Points (CDDP), Outreaches, Home Based HIV Counseling and Testing and intensive HIV/AIDS community education and sensitization with an aim to contributing to the HIV prevention strategy. 

Days of Operation 

  • Monday and Tuesday – Home care and Home visits
  • Wednesday and Friday – General Clinic Day at the Center
  • 1st Thursday of the month – Awach outreach
  • 2nd Thursday of the month – Bobi outreach
  • 3rd Thursday of the month – Pabbo outreach
  • 4th Thursday of the month – L’bongogali outreach.

  * There is however a hotline to respond to emergencies of clients who may fall very ill within the community and may not be able to reach to the nearest health care delivery facility. 

Activities (during clinics / outreaches) 

  • Registration of New clients
  • Handling of clients referred from other Service Providers (especially those joining the TASO health care delivery pathway)
  • Support visits and Monitoring and evaluation of clients in the Sub counties in Gulu and Amuru on the Sustainable Livelihood Project and Income Generating Projects.
  • The centre has a current total of 36 CDDPs spread through the districts of Gulu, Amuru, Oyam and refills are done every month. There is also a CDDP at the centre operating two times a week.

Staffing The centre is currently run by a vibrant and energetic workforce of full time staff, volunteers and part timers, who are qualified in various fields as follows;   

 

Department Full time staff Part time Volunteers
Medical 26 2 4
Counseling 15 0 5
Projects 1 0 0
Program Management (PM) 8 0 0
Advocacy 3 0 0
Accounts 4 0 0
OPSP 13 0 0
Total 70 2 9

The medical staff comprise of doctors, clinicians, nurses and nursing assistants. The medical department also takes charge of the field office. The counselors are social and medical workers while Program Management staff are ICT professionals.          

Counseling Services

HIV education and sensitization through Music Dance and Drama, Pre and post test counseling for new clients, and for clients on CD4 test, Adherence counseling for clients on ART, Couple counseling (both Discordant and Concordant), Child Counseling, Adolescent counseling, Family counseling, bereavement counseling. This could be carried out during sessions of individuals or groups.    The centre also carries out demand driven VCT and also VCT in conjunction with other partners.   

Medical Services

The centre since inception has always provided PLHIV with septrin prophylaxis on immediate enrollment with TASO. The centre treats all forms of opportunistic infections during the clinic and outreach days. TASO Gulu rolled out Antiretroviral Therapy in 2005. This has led to the improvement of PMTCT, Condom education and distribution, Family planning, Home care, Aromatherapy and reflexology, TB Management, and Laboratory services. With support from the community, the centre has established CDDPs where clients are able to meet and collect their medicine instead of travelling all the way to the centre. TASO Gulu has also identified community based volunteers called Community ART Support Agents (CASA). These are expert clients who monitor adherence levels as well as home visits to the clients. They give reports to TASO on the progress of clients on ART in the community. Home based HIV Counseling and Testing is done to household members of the TASO index clients and relevant HIV/AIDS prevention treatment and care information extended to the family members thereby enhancing the clients’ wellbeing at home.

Social Support

TASO Gulu has Sustainable livelihood activities for clients including kitchen gardening and backyard agriculture, bee keeping and animal and crop husbandry.  Child support activities include basic education and provision of scholastic materials. With support from Civil Society Fund (CSF), the centre is currently supporting over 2000 children in both primary and secondary. The centre has facilitated the formation of AIDS Challenge Youth Clubs (ACYC) in schools. Adolescent community drama groups for HIV/AIDS prevention have also been established to sensitize young people about HIV. TASO Gulu has encouraged clients to form groups and with support from partners, Income Generating Activities (IGAs) for clients have been established. There are currently over 20 client groups carrying out activities like maize milling, Groundnut paste milling, tailoring, small business entrepreneurship among others. Nutrition supplementation in conjunction with partners is on going especially for clients who are most vulnerable and are on ART. Therapeutic feeding for children less than 14 years is being conducted by the centre to improve on the health of HIV positive children and boost their immunity.  

Advocacy and Networking

The centre is conducts HIV/AIDS Training and capacity building for individuals and communities to respond to the complexity paused by HIV and build their capacity in providing accurate up to date information on HIV/AIDS.  

Referral and receipt of new clients is conducted on every clinic and outreach day to respond to the movement of clients from one place to the other. 

TASO Gulu in a bid to respond to the pressing needs of its clients, conducts networking collaboration, and partnership building. In this, the centre has created coalitions with other service providers to deliver some services that it can not offer to clients. TASO Gulu is therefore a member of the district HIV/AIDS task force, Gulu network of HIV/AIDS service organizations and the District AIDS committee.  

The centre does Capacity building for CBOs and NGOs, Capacity building through the TASO EXPERIENCIAL ATTACHEMENT TO COMBAT HIV/AIDS program. Since inception of TEACH in 2005, 76 people from over 12 counties in sub-Saharan Africa have been trained through hands on experience. The centre has also supported and is open for capacity building for visitors, local and international students on placement or internship. The centre has conducted collaborative and operational research in conjunction with partners for example IFPRI and PATA has. We also welcome other partners to come up and collectively undertake research.  

HIV/AIDS Prevention

The centre mandate of addressing HIV/AIDS prevention is being done through community education by way of music and drama performances, testimonies, HIV Prevention sensitization for adolescents, PMTCT Services, Condom education and distribution, Prevention for most risk groups, Prevention with positives, community capacity building for HIV  prevention, care and support.  

What makes TASO Gulu different from other centers?

Centre operates in an area were there has been war and civil strife for the last 20 years. It also operates in an area were people are moving from one place to the other especially those repatriating back to homes from their places of refuge now that peace is being realized. The location of the centre in a place linking southern Sudan to Uganda has attracts business people, urbanization and high population rates, and this means that people being served may not readily be available on the stated appointment dates because of the cross boarder movements. The centre operates in a place were there are very many NGO both national and international, carrying out various interventions and rehabilitation. There is still some number of people living in camps or trading centers and so the centre delivers services to most people in that setting.

Center specific challenges

  1. Difficulty in tracing some clients who were enrolled while in camps but have  now gone back to their villages because there is peace in the region.
  2. There is still high risk of infection especially in the camp settings because of congestion and disparity in finding best survival strategy.
  3. The war has broken down efforts to engage in productive agriculture. There is now a risk of starvation as reported especially among clients on ART and this is likely to affect the adherence levels.

SUCCESS STORIES/CLIENTS PROJECTS

PMTCT Progress

It must be noted that globally, the AIDS epidemic has claimed the lives of nearly 3 million children and another 1 million are living with HIV. The risk of vertical transmission from infected mother to baby ranges from 21% to 43% in developing countries depending on breastfeeding patterns. During the period July 2007 to June 2008, when most PMTCT services across the country begun, 739656 pregnant women attended antenatal care at health facilities providing PMTCT services in Uganda. Of these, 95 percent received HIV counselling, 82 percent were tested for HIV, 39328 {6 percent} tested positive, 31990 {81 percent}  of the HIV positive pregnant women and 16304 {41percent} babies born to these HIV positive pregnant women received ARV drugs for PMTCT. 

The large number of infants dying of AIDS has stimulated efforts aimed at preventing vertical {mother to child} transmission. Success has been registered in some parts of the world where short courses of WHO recommended ARVS have reduced MTCT by 38% to 44% in non breastfeeding women. The cost of drugs {ARVs particularly} and safe alternatives to breast feeding {feeding options are particularly problematic} in developing countries like Uganda owing to cultural beliefs and in view of the fact that health programs have continued to discourage weaning, for example, have all hampered efforts to effective PMTCT implementation. The effects of the dwindling global/donor support for HIV/AIDS thence PMTCT implementing programmes in third world countries like Uganda remain to be seen, keeping in mind that most mothers and children rely on these very programmes to see them try to secure an HIV free life.  

The TASO PMTCT program applies Ministry of health protocols and guidelines for implementation of the four pronged approach of PMTCT which includes;

·         Prevention of HIV in women

·         Prevention of unintended pregnancies in HIV infected women

·         Prevention of HIV transmission from HIV infected women to infants

·         Provision of care, treatment and support to mothers living with HIV, their children and families 

The TASO Gulu PMTCT activities started in 2008, steadily improving and registering key achievements despite numerous challenges, and to date has seen a good number of mothers and children benefit from the program. 698 mothers have been enrolled into the program to date, with 382 babies delivered, followed up, tested with appropriate therapy/support subsequently given, HAART initiation inclusive.  

We have also registered a notable surge in male partner involvement with a number of male clients responsibly bringing their children for PMTCT services. 

The major challenges in implementation of the PMTCT program include; 

1.      The resettlement exercise has hampered follow up and monitoring of a bulk of the mothers and babies delivered. 

2.      Delays in DBS results, which in effect affects feeding options chosen by the mothers, as TASO wholly, relies on JCRC (Joint Clinical Research Centre) Gulu centre for running DNA PCR samples 

3.      Infant feeding options are limited for the mothers, thus the continued exposure of the infants to HIV post partum.  

Testimony

Baby O.N.B is one of the beneficiaries of the TASO Gulu PMTCT program. Born about a year ago, his mother, a registered client with TASO Gulu, was enrolled in the program at 6 months of pregnancy. Albeit with the distant travel she had to endure to the centre from her village, a distance of 28km, she religiously met her appointments with the PMTCT nurse at the centre. A teacher by profession, she had lost her job because of supposed inconsistencies ( her pregnancy, and the fact that she was in and out of ill health as a result of her sero-status meant she was never going to be a regular in the classroom) in her performance at the school and was deemed surplus to requirements by her employers. Sadly, her husband, previously a soldier with the national army, had died 2 months into the pregnancy, and all the property they shared as a married couple was taken by her in-laws after his death.  

In the course of her visits, she was found to be eligible for HAART, subsequently starting the medicines and, by her own words adhering to the dos and don’ts of ARV use. Her pregnancy was further complicated by the fact that with a history of two caesarean sections, to her bemusement, meant that she had to deliver O.N.B by caesarean section. The medical fact is that Caesarean sections are estimated to reduce MTCT by approximately 15%, and with the education given to her by staff at TASO, she was referred to the local RRH where a date for an elective procedure was to be given.

Two months on, she had made several trips to the hospital with no date set, the expected date of delivery drawing close, and the recommended date of elective caesarean section well past. She then reported to the centre, almost all hope lost, only to have the reassurance that a medical officer within the centre had scheduled to do the caesarean section at the local referral hospital, after consultations with the hospital administration...the value of partnership! O.N.B was born at 2.3kg BW, as healthy as any baby. The recommended ARVs for mother and baby in place, subsequent post partum tests for the baby all were non revelatory. Major challenges faced through the first year of his life were fevers, respiratory illnesses, an odd rash, and ultimately feeding options.  

His mother turned to TASO again, and with an apt referral to HEALTH ALERT. Partnerships again! The problem of feeds was solved.  Today mother and baby are healthy, enjoying every aspect of life. She has gone on to find another job, is in court reclaiming property due to her and her family. O.N.B is a bubbly 2 year old boy. 

SUSTAINABLE LIVELIHOOD PROGRAMS

Omed gen women’s group is a client group located in Koro sub county, Gulu district composed of 22 members. The group members came together with the aim of increasing income households. They organized themselves and elected their leadership, and started pulling together revolving funds within the registered members. With support from taso, they wrote a proposal which was in turn submitted to ACDI/VOCA. They had the interest in tailoring work and they were given some sewing machines. ACDI/VOCA organized training on small scale business management for them and to date, they have 5 sewing machines, 1 electrical sewing machine and 1 designer machine. 

Since then, the group members have said to be living a new life, with increased income households and able to cater for all their basic needs. The care and support received from taso is making their health even better as compared to what it was before and they are looking forward to a brighter future. 

ART Lokokwo, is one client support group, located in Ongako Sub County and composed of 12 members. TASO Gulu supported them in the process of proposal development and linked them to ACDI/VOCA. To ensure accountability, and safety, he group opened a bank account were all returns shall be deposited and the proceeds further revolved to run other group projects. They received a maize milling machine and their projected income inflow per month will be 300 Shillings. 

The grant will support group members to generate household income and to make them support their children in the areas of school fees, scholastic materials and improve on their nutrition thereby promoting drug adherence and lifespan. 

OVC activities

Over 30 students in presence of their parents/guardians received start up kits after successful completion of their vocational education.The students, mostly OVCs, have been supported by CSF, through Gulu district local government and TASO Gulu.These children were drawn from TASO needy client’s households through the TASO OVC support selection criteria, and were trained in the fields of catering, metal works, hair dressing, carpentry, brick laying and tailoring.Equipment worth 30 million comprising of sewing machines, hair cutters, fabricating machines, hair treatment chemicals, chairs, source pans, cooking stoves, carpentry tools among others were handed to them by the TASO Uganda Board of Trustees chairperson, Rev. Willy Olango. Because of the need to scale up HIV prevention at all levels, the beneficiaries have been encouraged to disseminate HIV prevention information during their day to day running of their various businesses. 

Membership drive

TASO Gulu has a cumulative total of over 1000 subscriber members. The numbers is steadily growing as information about TASO membership continues to be given out to the people. We also have a good response from the general public who are not necessarily TASO clients which is a sign of acceptance and appreciation of the efforts to fight against HIV/AIDS. We are calling up on all persons to come up and make contributions to respond to the needs of people living with HIV/AIDS by joining in the membership in the TASO family.  

Contact:

Mr. Robert Nkabala
Centre Manager, TASO Gulu
Gulu Regional Hospital
P.O. Box 347, Gulu
Email: ;
Tel: +256-471-32743
Cell-Phone: +256- 752 774 142
Fax: +256 471 432 599
 

TASO Gulu Briefs and Newsletters

1.       Center report to the 2010 AGM

2.       Highlights of January – March 2011