From May 19 to 21, 2026, delegations from Eswatini and Sierra Leone traveled to Uganda to learn about the country’s chronic care health delivery service model. The model integrates HIV, advanced HIV disease (AHD), tuberculosis, non-communicable diseases, and sexual and reproductive health (SRH) services within a single framework.
“Uganda has built one of the most robust models for integrating HIV services among CQUIN member countries— including advanced HIV disease (AHD) services — into routine health care,” said John Bosco Matovu, CQUIN regional clinical advisor. “Eswatini and Sierra Leone came with different questions, but Uganda’s answer to both was the same: when HIV care is embedded in the routine health system, and community networks are part of that system, it becomes more sustainable and more effective.”
Despite having the world’s highest national HIV prevalence of adults living with HIV, 23.4 percent, Eswatini is one of only seven countries globally to have surpassed the UNAIDS 95-95-95 targets, making it a global success story. But sustaining a program that serves nearly one in four adults requires a health system that manages HIV as a chronic disease rather than through a vertical, standalone service.
Sierra Leone, in contrast, with an adult HIV prevalence of 1.3 percent, has approximately 77,000 people living with HIV and continues to have gaps across its treatment cascade: only an estimated 83 percent of people living with HIV are aware of their status, and 83 percent are on antiretroviral therapy. The visit was a chance for the two countries to see an integrated model in practice, as countries across the CQUIN network consider how to integrate their HIV programs during the next phase of the HIV response.
Uganda’s Chronic Care Model in Practice
The exchange started with a courtesy call to Uganda’s AIDS Control Program (ACP), where national teams provided the visiting delegation with an overview of Uganda’s approach to health systems integration — covering leadership and governance, service delivery, health workforce, health information systems, commodity management, and how departments coordinate to deliver integrated TB, HIV, AHD, and SRH services.
Clinicians from Naguru Hospital, a center for AHD management in Kampala, presented best practices on AHD diagnosis and treatment. Dr. Francis Nyanzi from the St. Balikuddembe Health Center II, a primary care and private not-for-profit facility, also presented. Together, the two facility teams demonstrated how Uganda’s integration model works in two different settings and highlighted how facility-based training and mentorship can equip health workers with the knowledge and skills to deliver integrated services. The presentations also covered how individuals living with AHD are identified and managed, and how community representatives facilitate referrals for continuity of care.
On May 20, the delegation visited the Kayunga Regional Referral Hospital, where Uganda’s model came alive. There, the teams observed decentralized oversight of integrated services at the regional level, AHD service delivery within a referral setting, and the integration of HIV, TB, and non-communicable disease services at outpatient and specialized chronic care clinics.
A round-table discussion followed on integration challenges, the role of community networks, and M&E best practices. The learning delegation was impressed to learn that the regional referral hospital had fully transitioned from paper-based to electronic medical records, and the chronic care clinic had been integrated into the general patient flow while maintaining patient confidentiality. Considering seemingly small but important details, the visiting team suggested that the clinic’s signpost should no longer read “ART Clinic” since it serves multiple chronic diseases. They proposed “Chronic Care Clinic” to the Ministry representatives, who agreed to implement the idea immediately. Community representatives from the hospital described their roles to the visitors, including supporting ART delivery, client follow-up, and expert adherence counseling. A working consensus emerged that integration would not replace differentiated service delivery but rather strengthen it.
“This has been an excellent learning exchange. We had rich discussions on how to better integrate health systems and services and improve care pathways for AHD,” said Susan Wandera, head, Health Systems Strengthening, Ministry of Health, Uganda. “The Ministry of Health sincerely appreciates the recommendations from our visiting colleagues and will take them forward to strengthen our integration work.”
Sierra Leone: Strengthening AHD Programming
Sierra Leone’s five-person delegation, led by Dr. Francis Lansana, manager of the National AIDS Control Program, came focused on AHD and plans to adapt Uganda’s AHD approach, beginning with a review of Uganda’s national guidelines, training materials, and SOPs, and a plan to scale up AHD training and mentorship for Sierra Leone facility staff by the end of 2026. “Integration works well with leadership commitment,” Dr. Lansana said.
The delegation included Idrissa Songo, Executive Director of the Network of HIV Positives in Sierra Leone, who attended as a representative of people living with HIV.
“This visit highlighted the importance of bringing non-communicable disease services closer to HIV care in a more coordinated and people-centered way,” he said. “It was encouraging to see health care workers providing services with professionalism, respect, and confidentiality, helping to reduce stigma while improving access to comprehensive care under one roof. As recipients of care in Sierra Leone, we return home motivated by the lessons and practical experiences shared in Uganda, and we remain committed to supporting efforts that strengthen integrated healthcare services and improve the well-being and dignity of our communities.”
Eswatini: Advancing Integration Across Programs
Eswatini’s nine-person delegation, led by Sindy Matse, Program Manager of the National HIV Program, and including focal points from the TB, non-communicable diseases, and SRH programs, as well as a recipient-of-care representative, demonstrated Eswatini’s understanding that integration on paper requires integration of the team in the room.
The delegation committed to completing a set of priority actions over the next 12 months: reviewing the Integrated Chronic Disease Management (ICDM) framework, coordination structure, and training manual to incorporate lessons from Uganda; conducting a Quality Improvement Plan to reduce the prevalence of AHD among people living with HIV; finalizing a mentorship and supportive supervision framework; adapting integration tracking standards; and completing the integration pilot before rolling it out to additional primary care facilities.
“We celebrate the leadership of Uganda and African countries in shaping a healthier future for all and look forward to applying these lessons to accelerate progress in Eswatini,” Matse said.
The May 2026 visit is the second time in less than a year that Uganda has hosted CQUIN country delegations for integration and AHD learning. Uganda is becoming a practical classroom for CQUIN member countries — a place where the question of how to make integrated HIV care work is answered through the lessons found in the daily routines of facilities, health workers, and communities.
