Transforming HIV Care in Uganda: How Technical Assistance Shaped the CRPDDP Model

Africa Resource Centre (ARC) had the privilege of partnering with Uganda’s Ministry of Health (MOH) to develop and implement the CRPDDP model, a groundbreaking approach to supply antiretroviral (ARV) medicines to patients on long-term antitherapy (ART). This collaboration has not only improved access to life-saving medication for tens of thousands of people living with HIV PLHIV) but has also set a new standard for the application of differentiated service delivery in resource-limited settings.

The Journey from Concept to Implementation

Our engagement with the MOH followed a comprehensive process of Discovery, Design, Pilot, and Scale-up.

Here’s how technical assistance shaped each phase:

Discovery

The foundation of the CRPDDP model was built on a thorough understanding of Uganda’s healthcare landscape which was done in 2019. That process was supported by the Bill and Melinda Gates Foundation (BMGF).

The technical assistance for the Extended Pilot and Scale-up was funded by USAID, and implemented by PEPFAR partners funded by US Government agencies (USAID, CDC, and Department of Defense).

ARC supported a nationwide geo-mapping exercise, surveying approximately 8,500 health facilities and retail pharmacies. This data-driven approach allowed for strategic decision-making in the CRPDDP program design and implementation.

Simultaneously, we conducted an extensive literature review on models for the pick-up of ARVs, examining various aspects of design, costing, incentives, and implementation. This research led us to identify the Makerere University’s Infectious Diseases Institute’s (IDI) pilot applied in Kampala in which the retail pharmacy was used by PLHIV as a pick-up point for their ARVs medicines, t as a promising starting point.

Design

Building on the IDI pilot, ARC worked closely with the MOH (AIDS Control Program) to adapt the model for scalability and enhanced client-centeredness. Key innovations included:

• Eliminating the need for a nurse stationed in the pharmacy and using the retail pharmacist as the service provider to the recipient of care collecting the ARVs
• Synchronizing digital systems (UgandaEMR and ARTAccess) for seamless data management
• Leveraging PEPFAR implementing partners to undertake the regional piloting of the CRPDDP

The design process was inherently collaborative, involving key stakeholders from relevant MOH departments, implementing partners, private sector representatives, and people living with HIV. This inclusive approach ensured that the final model addressed the needs and concerns of all parties involved.

Pilot and Scale-up

With a robust design in place, ARC supported the MOH in implementing a nationwide CRPDDP pilot. This phase included:

• Developing methodologies for operating the CRPDDP
• Conducting regional Training of Trainers (TOTs) sessions to build local capacity
• Training of retail pharmacists on the CRPDDP on serving the recipients of care and reporting to the respective ART sites that refer patients to the retail pharmacy
• Providing ongoing support supervision, empowering the MOH to lead and oversee implementation
• Developing digital dashboards and trackers to monitor progress and facilitate coordination

As observed by the MOH, the result has been remarkable, with the CRPDDP model growing rapidly to serve over 50,000 by mid-2024.

Lessons Learned

Our experience with the CRPDDP model has yielded valuable insights for future public health initiatives:

• A structured process of Discovery, Design, Pilot, and Scale-up enables the development of evidence-based, contextually appropriate interventions.
• Successful public-private partnerships leveraging local expertise and other resources to address key gaps in service delivery are possible.
• Integrating digital tools and geospatial data can significantly enhance program decision-making, implementation and monitoring.
• Designing for scalability and integration from the outset allows for future expansion of services, as demonstrated by the emerging CRPDDP+ model.

Looking Ahead

The success of the CRPDDP model in Uganda demonstrates the power of targeted technical assistance, application of good practice, and services from the private sector in transforming public health systems. By combining local knowledge with global best practices, we’ve created a scalable, client-centered approach to HIV care that has the potential to improve countless lives.

The CRPDDP model serves as a blueprint for how strategic support can catalyze innovation, ultimately leading to more resilient and responsive health systems. As we look to the future, the lessons learned from this initiative will inform how the technical assistance approach can be shaped to respond to specific initiatives such as the CRPDDP model in the provision of development assistance.

At Africa Resource Centre, we remain committed to partnering with governments, the private sector, academia, and organizations to drive sustainable improvements in public health supply chains. The CRPDDP model is just one example of how targeted assistance can unlock transformative potential in healthcare delivery.