The Devil (and the Gold) Both lie in the Details

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This week, I am in Kihihi, in Kanungu, South East of the Rwenzoris. Kanungu is one of the 13 districts part of the Strengthening TB and AIDS Response in South Western Uganda – STAR-SW – a USAID supported Technical Assistance Program in Uganda. STAR-SW is one of various technical assistance programs implemented by the Elizabeth Glazer Pediatric AIDS Foundations, along with 5 others – See Here.

The week, is to help us all, appreciate the work over the last 3 years, as well as to examine the cross linkages between the various programs at the district level. There are 5 technical areas that EGPAF programs support in the region: HIV Counseling and Testing (HCT), Prevention of Mother to Child Transmission (PMTCT), HIV Care & Treatment (ART C&T), Safe Male Circumcision (SMC), and Tuberculosis Interventions.

The temptation to explain away the numbers was always going to be there, but this week is not about facing a court session, its about facing the facts. Districts where leadership seems vibrant ‘on paper’ but the district level numbers in the technical program areas show otherwise, small districts punching way above their weight, large districts with similarly large attention and funding producing meagre figures. But this is about taking a 30,000 ft view of the facts, and the data. Seeing it as it is.

Health Based Interventions needs to be evidence driven, absolute numbers do affect percentages and country specific estimations of (and for) populations can be misleading when it comes to designing programs that will deliver effective interventions in particular communities. Now that the Uganda Population Census will be taken, come 2014, I can see a lot of numbers changing in the next year.

Even as a Global Health Corp Fellow, my background is mostly ICT, and my experiences in the health Sector have been limited to technical assistance but without a world’s care for the program based interventions. But what do you do when you have been thrust into the deep end of an epidemiology class? Swim!

DNA PCR Positivity average is 6.84% (13 STAR-SW Districts) for the quarter ending September 2013, but this is incomplete information if Mothers are not delivering at the Facility, and the second PCR test is not done for this negative baby. (See South African Example) What happens in those 6 weeks can make the difference in the data, determine the intervention, and frankly, also, a baby could acquire the HIV Virus.

A high rate of TB Treatment Success is nearly revealing if the Cure rate in the same district is low. The numbers, are nothing, if we cant save lives. If Exposed infacts are not started on Nevirapine, its not any help to say we beat the target and soared above the National average.

But there are amazing opportunities when you look at this data – from an eagle’s perspective. This week, we will dive closer to the ground with each day, and we will try to understand why things are happening the way they are, at a site-specific perspective. This data needs to be mined, there are hundreds of research papers to write and success stories that need to be told.

For a quarter of a century, EGPAF has stood at the forefront of elimination of Mother to Child Transmission of HIV, and as a global leader in this fight, 25 is a very telling number. Its time to tell our 25 year old stories, and to share with the world how much wiser we have become, it started with 1 mother, 1 child, 1 family, and now, in Uganda alone, we have:

  • Tested more than 1.9 million pregnant women for HIV.
  • Provided more than 2.4 million women with PMTCT services

The devil, and the gold, both lie in the details.