After the briefing we returned to our transport for a four-hour drive through the Ugandan countryside, over the mouth of the Nile, past the sugar and tea plantations to Tororo, a district town center in rural Uganda. After checking in at the Rock Classic Hotel, we dined with Ambassador Kolker and representatives from the Uganda Ministry of Health, the Medical Superintendent of Tororo District Hospital, The AIDS Service Organization (TASO), CDC, and USAID. The conversations were quite lively as we had gained a better understanding of AIDS in Africa by this point. We had visited three African countries and seen firsthand on-the-ground successes.

Tororo is home to Tororo District Hospital, the site of one of CDC’s ARV treatment protocol studies. CDC is funding a very innovative Home Based AIDS Care (HBAC) project at the hospital. The Home Based AIDS Care project is a collaboration between the Uganda government, TASO, CDC, and the Ministry of Health. The goal is to bring ARV treatment to millions of Ugandans living in rural areas. The program, which utilizes ARV case managers on motorbikes for home delivery of life-saving drugs to widely dispersed patients, is testing a protocol that does not rely on laboratory results, but on the eyes, ears, hearts, and minds of trained HBAC case managers who provide weekly home visits and supportive counseling to persons living with AIDS and their families. The project is helping to establish a standard of treatment in resource limited settings, answering the questions: Can antiretroviral drugs be delivered appropriately in settings such as Tororo? What will it take, in terms of training, service monitoring, treatment interventions, counseling services and evaluation?

Our morning in Tororo began with a tour of Tororo District Hospital and the CDC offices. The CDC offices are an oasis in a sea of deep need. The hospital is in need of upgrading. The physical plant is very old and has seen better times. Everywhere we toured there were family members gathered on the outside of the hospital, washing clothing, cooking food, waiting for any news of their loved ones. As we toured the “facility” many of us wondered about providing ARVs in such an environment. We wondered if the priorities should focus on building a new medical facility, providing clean water, modern cooking facilities, and a hostel-type setting for relatives.