V COLLEGE OF HEALTH SCIENCES

SCHOOL OF PUBLIC HEALTH

Checklist for Innovations write-up
Study: Innovations for continuity of HIV, TB and malaria services during the
COVID-19 pandemic in Uganda

Item Description
1 Name of Title of innovation to ensure sustained HIV, TB, or malaria health
innovation services in Uganda during the covid-19 pandemic (do indicate which
health condition it targeted) (25 words)

Social network strategy (SNS), Targeting HIV prevention services

among key and priority populations delivering Pre exposure
prophylaxis (PrEp), Anti-viral therapy (ART), condom and lubricant
distribution, distribution of HIV self-kiting kits by use of the
organization motor cycle and peer network model.

2 Problem Describe the context, background, and problem in HIV, TB, and
Malaria services that you sought to address (from the perspective of
the end users of services) during the covid-19 pandemic (200 words)

Modeling by the Uganda AIDS Commission estimated that sex workers,

their clients, and partners of clients contributed 10% of new infections by
2008, while another study in Kampala found that HIV prevalence among
sex workers was as high as 37%.(Star-E Technical Brief 2017).

There have been efforts to address the gap in accessing quality HIV
prevention and health care services targeting FSWs and their clients.
EADWA working with IDI, Komamboga Health Centre iii have conducted
outreaches, trained peers in mobilization and communication skills.
provide ART adherence support through home visits and homecare,
support adherence through delivery of drugs to HIV positive FSWs in

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 care.

Despite these interventions, there is a gap in access to HIV prevention

and care services for FSWs and their clients in Kampala because of
stigma, discrimination, and poor attitude, high transport costs brought
about by the pandemic, criminalization and negative attitude from the
general population. As a result, most of FSWs do not adhere to
treatment and clinical appointments for Viral load assessments.
It is these identified areas that EADWA proposes to address, to enable
FSWs have access to quality HIV prevention and care services. This will
be achieved through structural and peer outreach interventions,
collaboration with different partners and nearby health facilities. EADWA
will apply HIV Combination prevention approach to address the
challenges that predispose Key Populations at higher risk of HIV
infection and promote retention in care and treatment in Kawempe
division.

3 Innovation Describe the key components of the innovation instituted to ensure

sustained HIV, TB, or Malaria health services during the covid-19
pandemic. This could be accompanied by a detailed description, a
photograph, or a figure. Describe each of the processes, activities,
and elements used in the innovation, including any enabling or
supporting activities. (300 words)

Empowered At Dusk Women’s Association peer leaders were trained

as community HIV lay testers with support from Infectious Diseases
Institute of Makerere University and ministry of Health Uganda. where
peer leaders attained the necessary expertise to conduct HIV testing
without the help of health workers. The clients tested HIV positive
were referred and linked to Komamboga health center iv and
Nabweru health center iv for the data collected to be incorporated in
the health facility system, where our organization picks HIV
prevention drugs with the help of health workers under those facilities.
We conducted contact client tressing to find out where individuals
stay , their neighbors , and next of kin , this helped us in easy
distribution of HIV prevention drugs and health consumables and
constant follow ups for drug retention which supported adherence of

 Makerere University School of Public Health | https://sph.mak.ac.ug/

 our clients .and also helped in mapping new hotspots where key
populations especially sex workers lived.
EADWA trained one of its peers on how to ride the organization motor
cycle to deliver health consumables like condoms, self-testing kits,
ART, and PrEp. This helped in the distribution of health consumables,
and HIV prevention drugs, adherence support, since movement was
restricted. This helped peer leaders not to walk long distances.

4 End users Describe the end users of this innovation during the pandemic. How
are they direct or indirect beneficiaries of this innovation? (100 words)

The end users included key populations like female sex workers,
people who use and inject drugs, adolescent girls, children of sex
workers, people living with HIV, people with disabilities and clients of
sex workers. Through Social network strategy and our peer robust
mechanism who were in direct contact with the above mentioned
group of people and the hotspots they were living in.

5 Stakeholder Describe how you involved local stakeholders, including end users, in
involvement the design, development, implementation, and evaluation of the
innovation. Did you involve any vulnerable groups? If so, describe
them. (150 words)

Through brothel owners, local council leaders and peers we managed

to map out various hot spots around Kampala where most of the sex
workers stay, we also involved sex workers to direct and help us
locate areas of residence of some sex workers to facilitate ART and
PrEp refills and follow ups by delivering at their door step and also
tressing their contacts. EADWA also involved people who use and
inject drugs, children of sex workers, and clients of sex workers.
Project evaluation was done through a score card by our programs
teams to check the performance and degree of impact of the project.

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6 Inputs Describe any physical, digital, or informational materials used for this
innovation. Indicate how it can be accessed. (100 words)
Our peers distributed IEC materials on Sexual Reproductive Health
and Rights information, having information on how to effectively use
condoms, lubricants, and self-testing kits. (link)

7 Provider For the innovation providers (e.g., community member, trained

layperson, and other individuals), describe their expertise,
background, role, and any specific training provided. (100 words)

Our peers are skilled in quality improvement, gender based violence

response, hotspot mapping, DIC capacity assessment, quality
improvement, HIV literacy, infection prevention and control, financial
management, community impact assessment using the score card,
and resource mobilization.
Our peers trained community members on how to use self-testing kits
and read results correctly, proper condom use, PrEp and ART
education and the benefits of carrying out HIV tests every after three
months hence breaking the fear around HIV testing and living positive
amongst FSWs.

8 Implementation Describe the implementation strategy for the innovation and whether
strategy you deliver it individually, as a group, or in partnership. Describe the
level of external resources for implementation (e.g., internet access).
Describe the frequency and duration of the innovation delivery. (200
words)
We hope to Collaborate seamlessly across teams and
departments to gain visibility into the progress of our work, Keeping
everyone aligned with a platform and tools they will be able to use
perfectly with minimum occurrence of errors to ensure a smoother
execution, easily assign tasks and prioritize what's most important
amongst our team of peers. Set project timelines and milestones,
track progress, and manage the team’s entire workload all in one
place during the project implementation. Therefore for successful
implementation we shall need administrative costs like , monthly

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 peer stipend, staff salaries, electricity , internet , peer field
equipment , stationary, printing of M and E tools, office rent,
airtime , purchase of two laptops, servicing motor cycle , fuel,
sanitizer and face masks, and toll free line .

9 M&E strategy Describe what is measured, how, and when as part of monitoring
and evaluation. This includes measurement of health, social, and
any other impacts (150 words)

10 Setting Describe the population and type(s) of location(s) where the

innovation is delivered, including any necessary social, political,
cultural, environmental, or other contextual issues. Describe at what
level the innovation is implemented (e.g., district, subdistrict, and
village). This includes a description of the online setting for online
social innovation (200 words)

The innovation will be delivered in mostly sex work communities, in

slums of bwaise in Kawempe division and Nansana municipality,
hotspots like brothels, bars, lodges and residences where some of
these individuals stay. Our implementation will be done at village
level.

11 Adaptability Consider how the innovation could be adapted, scaled up, or used in
contexts other than the one described. Describe how adaptable it is.
(150 words)

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12 Financing Describe how the innovation has been/was funded at the design,
development, implementation, and evaluation stages. Describe how
the innovation could be institutionalized (if applicable) in order to be
sustained in the future. (100 words)

Our innovation was funded by the Infectious Disease Institute of

Makerere University (IDI) at all stages. This could be institutionalized
by establishing a drop in center at our organization offices to ensure
continued extension of such services and recruiting a full time
councilor.

13 Health impact Describe the impact of the innovation in sustaining HIV, TB, or
malaria health services during the pandemic. (100 words)

Through our project, during the pandemic we reached out to a

number of female sex workers with in the slums of Kampala and
offered health consumables like condoms, lubricants, HIV self-
testing kits, ART and PrEp refills , essential food items to support
drug adherence . Female sex workers who were near and close to
our Drop in Center (DIC) would come and attend our DIC clinical days
for checkups, psychosocial support, counseling , health talks , playing
card games for mental support and depression relief for sex workers.

14 Lessons learnt Describe the., lessons learned, new processes that emerged from the
project, and application of learned processes to other problems (150
words)
We got to learn that sex workers can better serve their colleagues
better with no discrimination, therefore involving fellow sex workers in

 Makerere University School of Public Health | https://sph.mak.ac.ug/

 the process of development and implementation is key for the
success of such a project.
On the other hand involving other stakeholders like brothel owners,
local council leaders, also improves the relationship between the sex
workers and other community members in the areas where they stay
and work.

15 Limitations Describe the limitations and potential unintended consequences of

the social innovation in health during the design, development, or
implementation. (100 words)

During the life cycle of the project we experiment delays in supplies to

some parts of due to lack of enough motor cycle to ensure timely
supply of health consumables , therefore there’s
need to purchase another motor cycle and training another peer on
its operation to ensure timely delivery and collection of health
consumables for effective results and quality service to our members.
We intended to rotate motor vehicle operators to avoid fatigue during
delivery and collection of health consumables but since most of the
peers didn’t have permits/ driving licenses this could not be carried
out. The organization didn’t have permanent medical personnel at the
DIC hence limiting continued provision of health services throught the
pandemic. Sometimes we had stock outs due to shortages in supplies
and other supply rigidities.

1 Strengths Describe how the innovation in health improves conventional practice

6 in HIV, TB, or malaria (150 words)

The innovation ensures timely ART and PrEp refills hence reducing
chances of infection amongst sex workers and their clients and the
entire community at large. Food distribution helped promote drug
adherence amongst those on ART. Through our DIC clinical days we

 Makerere University School of Public Health | https://sph.mak.ac.ug/

 offer medical checkups, mental health support, and psychosocial
support. HIV counseling and PrEp and ART refills.

17 Grant Describe how you intend to use the grant to improve the innovation
(150 words)

Empowered at dusk women’s association will improve and strengthen

the peer model to strengthen the social network strategy by training
more peers, we also intend to establish more community health,
enhancement and livelihood groups where members converge in
groups and also save from the little they earn which will help sex work
improve on their bargaining power hence reducing their chances of
getting infections.
The organization also seeks to purchase a new motor cycle to
improve service delivery even in the hard to reach areas. The grant
will also help the organization hire a permanent counselor and a
visiting doctor at the DIC.

 Makerere University School of Public Health | https://sph.mak.ac.ug/