In October 2025, delegates from six countries in the CQUIN network exchanged lessons on integrating HIV services, including advanced HIV disease (AHD) management, into routine health care. Uganda and Nigeria led the way, sharing practical examples with Tanzania, Lesotho, Kenya, and Eswatini on national policies, operational tools, service delivery monitoring, and data on service coverage.
As countries across Africa work to sustain their HIV programs, integrating HIV services into routine health care – a longstanding goal of the HIV response – has become increasingly central to achieving a sustainable model of continuity of care.
“Despite the perceived strategic importance, integration of HIV services into routine health care has progressed slowly in many countries due to persistent concerns around maintaining service quality, data fidelity, workforce capacity, and the risk of diluting HIV-specific expertise within the broader system,” said Maureen Syowai, MBChB, MSc, CQUIN and HIVE program director. “We designed this learning exchange to create space for honest discussion and peer-to-peer problem-solving as countries move integration from concept to routine practice.”
The exchange began virtually on October 2 and 16, culminating in an in-person learning visit to Uganda from October 22 to 24, where delegations from the ministries of health in Tanzania and Lesotho observed integrated HIV and AHD services at Kayunga Regional Referral Hospital and Wakiso Health Center.
A screenshot of participants in one of the virtual country-to-country visit sessions
Uganda’s Chronic Care Approach
Uganda presented on how service integration has been woven into the country’s chronic-care model, which links HIV, AHD, tuberculosis (TB), non-communicable diseases (NCDs), and maternal health within a single framework.
Cordelia Katureebe, MD, National Coordinator for Health Service Integration at the Ministry of Health, explained that reorganizing care around chronic conditions has improved efficiency and strengthened continuity of care. Facilities now operate under shared systems – space, staff, and data tools – reducing fragmentation while improving the patient experience.
For example, Uganda’s Kayunga Regional Referral Hospital has combined their HIV, TB, and hypertension clinics into a single chronic-care department, where patients can access comprehensive services in one visit. The Ugandan team presented data that shows that the hospital continues to provide strong diagnostic services to recipients of care even after combining services. Nearly all recipients of care (approximately 96 percent) receive CD4 tests – a blood test that checks how strong the immune system is – and most are also screened for TB and cryptococcal infection, two illnesses that often affect people with advanced HIV. The hospital also reported reaching 91 percent of those in need of CrAg (cryptococcal) testing and 64% of those in need of TB-LAM testing, with 19 to 29 percent of the latter testing positive, demonstrating that TB remains a key area of concern.
Uganda’s Ministry of Health has also introduced a national framework for integrating HIV services into the broader health system. This framework includes practical tools such as guidelines, training materials, and standard procedures that help health workers and managers deliver consistent services. Training starts at regional hospitals and then expands to districts and local facilities, ensuring that government-led teams at every level understand how to organize and oversee integrated care.
“We’ve made a strategic shift to promote patient-centeredness,” said Dr. Katureebe during the virtual meeting. “It’s a holistic approach that allows us to optimize our available resources for sustainability. Our goal is to ensure that integration leads to greater efficiencies, improved outcomes, and ultimately, country ownership.”
Nigeria’s Coordination and Early Measurable Gains
Nigeria’s journey has centered on coordination, quality, and consistency. Jonathan Modugu, MBBS, DSD/AHD/ART Specialist with the Ministry of Health’s National AIDS, Viral Hepatitis, and STI Control Program (NASCP), shared that integration is being driven through a national coordination mechanism and standardized implementation tools.
“The Ministry of Health has set up a Service Integration Core Group to coordinate this work at the national level. We have developed an operational manual to guide implementation and conducted facility assessments and stakeholder engagements. Training-of-trainers has been completed, and integration champions have been identified to support quality and coordination across facilities,” said Dr. Modugu.
He explained that Nigeria first piloted integrated AHD management in 28 facilities to inform a broader national rollout. Across these facilities, key testing indicators such as CD4, TB-LAM, and cryptococcal antigen testing (CrAg) coverage remained strong – demonstrating that HIV diagnostics can be sustained under an integrated model. The approach has since expanded nationwide, reaching all 36 states and the Federal Capital Territory, with about 600 activated sites and over 1,200 health-care workers trained.
At the Federal Medical Center in Birnin Kebbi, for example, HIV services are now part of a multidisciplinary outpatient department serving internal medicine, pediatrics, obstetrics, and community medicine. The hospital manages roughly 1,200 people on HIV treatment and provides screening for AHD, TB, and CrAg at all key service points.
Introducing the Integration Capability Maturity Model
During the October 2 virtual session, Syowai introduced the CQUIN Services Integration Capability Maturity Model (CMM) – a structured tool that will help countries assess, benchmark, and strengthen their integration efforts. Building on earlier CMMs for differentiated treatment, testing, and AHD, the new CMM will support countries as they design and/or scale up efforts to integrate HIV services into routine healthcare. The current CMM draft focuses on 12 domains, staging each from early to mature performance.
Following feedback at the 2025 CQUIN Annual Meeting, selected countries will pilot the tool in early 2026. It will then be finalized and made available to all countries in the CQUIN network and will complement other CQUIN-developed tools and resources.
From Virtual to Physical Learning
Participants met in person with national and facility teams to review patient flow systems, training approaches, and monitoring tools, and to see how the integration tools presented during the virtual visit work in practice. The visiting teams also provided peer feedback, identifying common challenges and areas for improvement.
“We learned a lot from the visit to Uganda and were highly impressed by how the country developed an integration curriculum for health care workers,” said Motselisi Lehloma, BA, Monitoring and Evaluation Officer for Lesotho’s Ministry of Health. “We are taking these lessons back home and plan to draft an integration roadmap and implementation framework with support from Uganda and CQUIN.”
As countries in the network continue adapting their HIV programs to evolving changes in funding, integration is emerging as a necessary pathway to sustainable, person-centered health systems. and a marker of program maturity. These exchanges highlight how shared learning, structured tools, and country leadership can accelerate progress toward resilient, integrated HIV programs.
