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Same same, but different

I write this, sitting out on the patio of my (temporary) apartment, enjoying the comfortable Kampala climate (not too hot, never too cold, perfect combination of the warming sun and a refreshing breeze). This first Sunday in Uganda provides me with the opportunity to contemplate on my first week with the Clinton Health Access Initiative. If I would have to describe my experiences so far in one sentence it would be: same, same, but different. This holds both for work and life in Kampala.

After meeting many of my CHAI colleagues in the office on Tuesday, I was off to a flying start joining the Drug Access Conference. All CHAI people that work on drug access in 17 countries in Africa and Asia gathered in Entebbe, Uganda. Over the course of three days we discussed recent developments, World Health Organisation guideline updates, demand forecasting and supply chain issues. The location to do this was a beautiful resort on the shores of the Victoria Lake (different), with luxurious rooms with wifi (same, same), good food (same, same), that can only be reached by suffering through a 30 minute drive on the most terrible dirt road (different). The man escorting me to my room explained that half of the resort (marina, golf course, etc.) was still under construction. I think the road is also still on the to do list.

The conference was a useful start of my time here at CHAI. I could meet many of my colleagues working on drug access in person, people I will be interacting with via mail and Skype mostly after this. Furthermore, in three days I could soak up all the knowledge and information on the organisation and the disease areas CHAI is working on, such as HIV, malaria and (multi-drug resistant) tuberculosis. Initially, the Clinton Health Access Initiative worked almost exclusively in the area of HIV, with a specific focus on paediatrics. Only in recent years the scope has widened to include other infectious diseases. To honour these foundations I will provide a brief overview of the HIV situation in Uganda.

Uganda has an estimated 1.5 million people living with HIV, with adult HIV prevalence at little over 7% of the population. Young women are disproportionately affected. In the 1990s, the country achieved success in the control of HIV, bringing down the HIV adult prevalence from 18.5% in 1992 to 6.4% in 2004. This means that the national average has increased in recent years. This is not all bad, although the rate of new infections is high, the trend shows a decline. The HIV burden is also a result of increased longevity among persons living with HIV. The management of HIV/AIDS usually includes multiple antiretroviral drugs (also known as antiretroviral treatment – ART) aimed at suppressing the viral load (virologic response) and to increase the CD4 cell count (immunologic response). In Uganda, based on the 2013 World Health Organisation guidelines, only 40% of all people living with HIV eligible for antiretroviral treatment actually are on treatment.

So less than half of those in need of treatment are receiving it. Less than half… The implications for the quality of life, prevention of HIV transmission in the future and economic growth are enormous. All the work I will do in the coming 12 months will be aimed at increasing that percentage. This includes working on costing models, quality assurance, procurement planning (same, same), while taking into account ART uptake, mother-to-child-transmission, Option B+ and tenofovir (different).

I cannot wait to get started.

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