Country Updates: Forging the Future of the HIV Response  

Over the past 20 years, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has saved millions of lives as a leader in the global response to two of the world’s deadliest infectious diseases – HIV and TB. As a key implementing agency of PEPFAR, CDC is at the forefront of these global efforts to treat and prevent these diseases. Below, read stories from countries supported by CDC and learn how the agency is making an impact in eliminating HIV as a global epidemic.

Unwavering Commitment: Guatemalan HIV Care and Treatment Center Sets New Standards of Excellence

Hospital Roosevelt’s HIV Care and Treatment Clinic, the largest, oldest, and highest-quality HIV care and treatment center in Guatemala, recently became the first clinic in Central America to be fully funded by the local government. This significant milestone marks an important step forward in the fight against HIV, as it ensures the longevity and continued provision of high-quality care for individuals affected by the virus. With financial sustainability achieved, individuals living with HIV now have access to comprehensive and top-level care without fiscal barriers.

Nearly Four Decades of Service

Hospital Roosevelt’s HIV Care and Treatment Clinic began treating people living with HIV (PLHIV) in Guatemala City in 1985 as part of clinical studies. The clinic was later named after the hospital’s former director, who provided care to the first individuals with HIV in the country and deeply believed patients have the right to comprehensive quality services. A legacy that lives on in the work today.  “Access to comprehensive HIV services is not only a fundamental human right but also an indispensable driver for public health. By prioritizing and ensuring that the population, especially those at high risk, have equitable access to these services, we not only empower individuals to take control of their own health but also safeguard the collective well-being of our society,” explained Dr. Johanna Samayoa, Head of the HIV unit at Hospital Roosevelt. “Promoting inclusivity and addressing health disparities are key pillars in the fight against HIV, fostering a more just and resilient future for all.”

In the nearly forty years since the start, HIV patients from all over the country have received high-quality treatment, achieving viral suppression among more than 95 percent of patients.

A Model for Sustainability

In 2018, through PEPFAR, CDC began supporting the Hospital Roosevelt’s clinic with a pilot for rapid antiretroviral (ARV) initiation – which was later introduced at all CDC-supported sites in Central America. Over the next five years, the clinic’s cohort grew to 5,120 persons, about 25 percent of all PLHIV in the country.

Through the partnership, CDC supported ARV decentralization and differentiated delivery models to increase treatment retention and viral load suppression. CDC also assisted the laboratory and surveillance systems in reaching the highest HIV-related testing, diagnosis, and case management standards. A critical component in achieving viral suppression and treatment retention in 95 percent of patients. “The partnership with the clinic to initiate innovations and get to the highest standards of care has led to new horizons in the fight against HIV in Guatemala. And it began with the end in mind,” explained Janell Wright, Regional Director of the Division of Global HIV and TB in CDC Central America. “Each new staff position and intervention was supported with a plan to be fully funded by the hospital in a few years. CDC partnered with the clinic to launch the initiatives and demonstrate a model with World Health Organization (WHO) standards that the hospital could fund without compromising the quality and access of services. This is the first center in Central America to reach this achievement. A major contribution has been the clear and unwavering dedication to the mission by hospital and clinic leadership.” As of October 2023, the Government of Guatemala has absorbed all staff previously funded under a CDC cooperative agreement with the Commission of Ministers of Health in Central America.

Going Forward

Through the partnership and commitment to excellence, the Hospital Roosevelt has become a reference center for HIV-related testing, including CD4 count*, viral load, and opportunist infections, and a training facility for clinicians and other staff from across the country to receive comprehensive HIV service delivery.

“Providing high-quality and sustainable HIV care is not just a commitment, but a responsibility toward the present and future generations,” added Dr. José Rodas, the point of contact in Guatemala for CDC’s HIV programs. “By seamlessly integrating innovative medical advancements, compassionate care, and community involvement, we can create a holistic healthcare system that not only meets the immediate needs of HIV patients but also ensures long-term sustainability, fostering hope, empowerment, and wellbeing for all.”

*CD4 count refers to the number of CD4 cells in the bloodstream, which help fight infections.

Revolutionizing HIV Treatment and Prevention in Laos

In the heart of Southeast Asia, where the lush landscapes of Laos unfold, a quiet revolution has been taking place. Behind the serene façade lies a remarkable innovation that vividly exemplifies the impact of CDC’s Division of Global HIV and Tuberculosis (DGHT) in the global battle to eliminate HIV and TB as public health threats.

Developed in partnership with DGHT Thailand, CDC Laos introduced a groundbreaking tool – the Viral Load-Assisted Ordering and Reporting (VLAO) application. VLAO, a web-based innovation, is a lifeline designed to improve ordering and reporting viral load tests between antiretroviral (ARV) clinics and laboratories.

Technology that Keeps People at the Center

VLAO is more than technology; it’s about lives, communities, and a brighter future. The new technology is addressing HIV challenges in Laos – like communication barriers and compromised data integrity – and overcoming roadblocks that have been met with commendable efforts in the past. “In the battle against HIV, time is of the essence. VLAO has made timely, accurate viral load testing a reality in the most remote corners of Laos. This isn’t just an application; it’s a game-changer, ensuring that every patient counts,” shared Dr. Lattanavanh Sadettanh, Vice Chief of the Surveillance and Evaluation Unit in the Center for HIV/AIDS and STIs (CHAS), Lao.

First launched in January 2022, VLAO began in a few facilities in the Vientiane Capital and scaled nationwide within two months. It replaces traditional paper-based systems with electronic ordering and reporting, enhancing data accuracy and efficiency. The application employs advanced technology to seamlessly integrate with the District Health Information System 2 – allowing for real-time data exchange. Unique to VLAO is its alert system via the LINE phone app, ensuring prompt notifications of unsuppressed viral load results, ultimately leading to timely patient intervention.

The Impact is in the Data

Marking a revolutionary turning point in HIV care, following VLAO’s implementation, viral load coverage realized a remarkable surge from 67 percent to 88 percent within just a single year. The transformation in turnaround times for viral load testing was even more astounding, which plummeted from an average of 19 days to an astonishing three days. This electronic innovation has also enabled healthcare providers to rapidly identify patients requiring intervention, leading to a significant enhancement in the management of HIV treatment.

Another game-changing feature of VLAO is its ability to generate patient reminder lists for missed appointments. This feature empowers ARV clinic staff to efficiently collect specimens during the same visit and reschedule appointments, ensuring optimal patient care. This not only improves the patient experience but also contributes to more effective HIV management in Laos.

VLAO application is more than a success; it’s a model, a beacon of hope. It tells a powerful tale of how innovation can overcome healthcare challenges and, in doing so, save lives. VLAO stands as a tribute to our pursuit of excellence in public health, serving as a testament to the power of technology to transform healthcare outcomes and gain better control of HIV.

Uganda: Transforming Communities and Saving Lives

In 2003, Uganda became the first country to implement activities supported by PEPFAR. It was also the first to provide PEPFAR-supported antiretroviral medicine to people living with HIV.

Over the past two decades, PEPFAR has invested more than $5 billion to address the HIV epidemic in Uganda, resulting in significant progress against HIV. As a key implementing agency of PEPFAR, CDC has played a key role in Uganda’s HIV successes, working closely with the Ugandan government, partners, and local implementors to scale up HIV prevention, treatment, care, and support services.

Nowhere has that success been more notable than in the Soroti District in eastern Uganda, a region known for having the nation’s highest poverty and HIV rates. Here, the collaborative efforts of PEPFAR, CDC, and local partners, the AIDS Support Organization (TASO), are transforming communities and saving lives.

Community Volunteer Leads Local Awareness

Meet Peter EKILU, 43, a married father of 10 children, lives in a small fishing village of just over 2000 people in the Soroti District of Uganda. In 2005, his mother was diagnosed with HIV. Thanks to PEPFAR and CDC-supported programs, she was started on antiretroviral therapy (ART) and is living an active, healthy life.

Inspired by the positive impact of these efforts on his family, Peter, himself HIV-negative, became an HIV volunteer through The AIDS Support Organization (TASO). “I am forever grateful to this lifesaving program and want to support it any way I can,” he said. When he is not on his fishing boat, Peter educates people about HIV, conducts door-to-door talks, encourages newcomers to the village to get tested, and even drives patients to the health center to pick up their medicine. Peter is one of countless volunteers who form the backbone of HIV efforts in Uganda and play a crucial role in the fight against HIV.

Addressing HIV among Teens

Uganda has one of the highest HIV prevalence rates among adolescents in the world. To address the challenges faced by HIV-positive young people, the Uganda Ministry of Health and partners launched the Young Adolescent Peer Support (YAPS) program in 2018. YAPS recruits young people aged 18 to 24 as volunteer community health workers. Their role is to mentor and counsel young people living with HIV.

In the Soroti District, CDC supports the AIDS Support Organization (TASO) in implementing the YAPS program. TASO oversees 72 YAPS counsellors in 34 high-volume facilities in the district. Emmanuel is one of the program’s young volunteers. “I am very excited about my work,” he said. “I’m able to help my clients get better, physically, emotionally, and psychologically.” With this unique and focused approach to addressing HIV among young people, YAPS — and the young volunteers who drive it – is helping teens living with HIV in Uganda thrive and lead fulfilling lives.

From Treatment to Empowerment 

When Stanley, 45, and his wife, Jesca Rose, 36, tested positive for HIV, they were referred to TASO, CDC’s implementing partner in the Soroti District. Stanley and Jesca were started immediately on HIV treatment. Today, they are virally suppressed, meaning their HIV viral load is undetectable through lab testing. The couple’s seven children are also all HIV-negative.

Yet, Stanley and Jesca not only received treatment through this PEPFAR- and CDC-supported effort, but they were also enrolled in an economic empowerment program. The program, designed to assist vulnerable households, provided the couple with support and resources to build a sustainable livelihood.

PEPFAR’s Impact Around the World

Over the past two decades, PEPFAR and CDC have dramatically altered the course of the HIV epidemic. Today, PEPFAR has saved 25 million lives, prevented millions of HIV infections, and, in 2022, supported more than 20 million people on lifesaving HIV treatment worldwide – with CDC’s efforts accounting for more than 50 percent of the most important outcomes. The progress in countries like Guatemala, Laos, and Uganda underscores this tangible impact. We cannot stop now.