District and National HIV and Development Stakeholders advocate for more District-level Evidence-based Planning

District and National HIV and Development Stakeholders advocate for more District-level Evidence-based Planning

The Priorities for Local AIDS Control Efforts (PLACE) method identifies and maps venues and events attended by persons who have high rates of new sexual partnerships, then characterizes the venues in terms of current prevention activities, and then interviews and tests a representative sample of venue patrons and staff in order to identify the most important gaps in HIV prevention among populations most likely to acquire and transmit HIV infection.

PLACE provides a systematic way to generate information to tailor HIV prevention interventions to local drivers of HIV transmission. It also provides indicators about hot spots and key populations that are critical to designing effective prevention programmes.

The method was implemented in Uganda in thirty districts July 2013-July 2014. While district-level dissemination events were conducted for the respective districts, results and insights from the thirty districts were compiled and shared at national level.

The overall objective of the PLACE exercise was to build the capacity for 30 districts to generate and use local evidence in their HIV prevention action plans and monitoring functions.
In the implementation of PLACE, Makerere University School of Public Health (MakSPH) worked closely with Measure Evaluation (University of North Carolina), USAID, Uganda AIDS Commission and the AIDS Control Programme at the Ministry of Health.

National level sharing of PLACE results was held July 29th 2014 at the Protea Hotel in Kampala.
At the sharing event, a panel of district stakeholders, including administrators, political leaders and implementing partners revealed that some districts like Masaka have already acted on the actions in their action plans. ÔÇ£After your departure, in our action plan we moved very fast; we had a meeting with partners-TASO, Uganda Cares, MRC, Kitovu Mobile- and wanted to design a system where all partners can participate. There is no reason all partners going to one site. We have started moving; moonlight clinics in Nyendo, supply of condoms, designing our ordinances so that every socialising place has condoms or risk getting closedÔÇØ, said Hajji Jamir Miwanda, the Secretary for Health Masaka District Local Government.

In Masaka, TASO has supported the establishment of 14 more condom distribution centres including the female condom. The Manager TASO Masaka said that the organisation has continued to conduct moonlight clinics since the key populations that were identified by the PLACE survey are best targeted at night.

Members of the district stakeholdersÔÇÖ panel sharing their view on the next steps
In Kibale district, the Assistant Chief Administrative Officer, Mr. Ssekitoleko also reported that implementing partners have taken on the implementation of the action plan developed after the PLACE survey. From the results sharing event, he said he had picked the idea of a bye-law. The Kibale Chief Administrative Officer, Dr. Kyamanywa said that the districts will be targeting more events and sites.

The Deputy Resident District Commissioner Lira, Mr. Emmanuel Mwaka Lutukumoi said that the district has domesticated the PLACE activity. ÔÇ£We are emphasising behaviour change, we are encouraging testing for everyone, we are encouraging Safe Male Circumcision and increased condom supply and use.
Providing a national perspective of things, a national panel of stakeholders including civil society organisations, the Ministry of Health and Uganda AIDS Commission Betty Atai Ngabirano, the Senior Medical officer in charge of district-led programming committed that the PLACE methodology will be will be implemented in all districts, adding that most of the data available is routine and population-based studies which are not exactly applicable at district-level. She said the unit she heads will work closely with the School of Public Health and leverage the capacity built at the districts. ÔÇ£This is a new way of thinking. We should advocate for full financing and resources to enable districts use this evidenceÔÇØ, she said.

Mrs. Sheila Marunga Coutinho, a civil society representative, said that HIV prevention in Uganda has to move away from mega interventions that end up more like events. ÔÇ£This should be the beginning of the process for us to implement interventions that are in contextÔÇØ, she said.
She also pointed out the need to re-evaluate cultural and traditional beliefs in regard to the youth. ÔÇ£If a youth comes to you for a condom and you consistently tell them they are too young to have sex, they will go and have unprotected sexÔÇØ.

The Jinja District Chairman, also Chair, Uganda Local Government Authorities Association, Mr. Frederick Gume said the findings are a wake-up call, necessitating a change in policy, the need for flexibility in the budgeting system. ÔÇ£The money from the centre to Local Governments is highly conditional. There is need to give Local Governments flexibility to address local needsÔÇØ.
The Commissioner, Infectious Diseases, at the Ministry of Health, Dr. Alex Opio said the process was a good start to get data at local level, demand for it has been there and it can facilitate better planning at local level. He said PLACE fits well in the countryÔÇÖs HIV response which emphasises involvement of everyone, including local communities. He said current HIV prevention interventions like condom distribution and HCT are sub-optimal yet demand for them is there. He said the data from the 30 districts can be used for planning at district level. ÔÇ£Work for HIV prevention is done at district level and so money should go thereÔÇØ, he said.

Dr. Mudiope of the Uganda AIDS Commission noted that there are several planning processes on-going which provide opportunities to feed in the findings. He said several low hanging fruits exist like the demand for safe male circumcision and the demand for condoms.

The event was also addressed by a team from the Global Fund (Uganda and Geneva)