Inception

Anecca was founded in September 2001 during an international conference held in Kampala to launch the Global Call to Action for the Prevention of HIV Transmission from Mother to Child. At the conference there was very little mention of the care of children living with HIV. As a result of this gap, some of the conference attendees (clinicians and social scientists) came together and founded Anecca.

             Life-Saving Milestones

The network’s first efforts included advocating for and teaching health workers on how to care for children living with HIV. In 2002, an unexpected encounter in Kampala with a Canadian lawyer from British Columbia Province who was visiting Uganda for the first time led the lawyer to donate USD1,000 to purchase anti-retroviral medications for children living with HIV.

This money was used to purchase adult tablets of Triomune (a combination antiretroviral drug that has since been discontinued) and the only ARVs available at the time from Kampala’s Joint Clinical Research Centre. The first ARVs to be administered to children at a public health institution in Uganda were provided to children attending the Paediatric HIV clinic at Mulago Hospital in Kampala, and we had to split up adult tablets to give them to the children. Working with Dr Sabrina Kitaka, it was extremely difficult to identify the first beneficiaries for this initial donation because over 200 children were critically ill and eligible for ARVs. At that time there were no national guidelines for treatment of children living with HIV.
Another significant milestone for Anecca was the workshop on cotrimoxazole prophylaxis for HIV exposed children. It had been established that cotrimoxazole could be advantageous to HIV exposed children. The problem was determining whether a child coming for immunization was exposed to HIV and should be given cotrimoxazole. Participants at an Anecca workshop in Kampala in 2003 suggested that labeling the child’s immunization card (often obtained shortly after birth with BCG vaccination) with HIV exposure status could enhance cotrimoxazole uptake in this group of children. Of course, there were concerns about increased stigma for moms and children. Dr. Angela Mushavi, a workshop participant from Zimbabwe later tested the idea in Zimbabwe, and it was found to be practical and acceptable.

             Handbook of Paediatric AIDS launched

The Handbook of Paediatric AIDS in Africa, written by over 30 clinicians and social scientists from Africa, was completed in 2004. USAID East Africa supported the writing workshops, and Mary Pat Kieffer, who was then with USAID/EA, provided ardent and enthusiastic support. Jeffrey Ashley, who was then in charge of HIV programs in USAID East Africa, launched the book in Dar es Salaam, Tanzania, in 2005.

This handbook became a popular resource for both in-service and pre-service health professionals in Africa. The hand book was used to train health workers in Uganda, Kenya, Tanzania, Rwanda, Lesotho, Ghana, Swaziland, Zambia, Namibia, and, later, Burundi and the Democratic Republic of the Congo. The training expanded to French speaking countries in East and Central Africa after the handbook was translated into French in 2007. Five years later It was translated into Portuguese.

             Navigating the Path to Institutional Growth and Development

Anecca was formally registered in Uganda as a not-for-profit company limited by guarantee in 2007, and the process of developing organizational capability began. Similar registrations of Anecca occurred in Tanzania, Ethiopia, Nigeria, Niger, and Burkina Faso. The network’s secretariat was housed by Makerere University’s Regional Centre for the Quality of Health Care (RCQHC). USAID East Africa provided funding for RCQHC and the Anecca secretariat.

The secretariat moved out of RCQHC in 2012 but in order to continue being funded by USAID East Africa Anecca had to sign an MoU with Makerere University. USAID East Africa funded most of Anecca’s activities from inception in 2001until 2013.
In June 2013 Anecca got its first Board of Directors, although previously, since the beginning, there was a Steering Committee that provided strategic oversight, but because of the secretariat’s location in RCQHC, the steering committee’s powers were limited. In 2013 Anecca started developing its own institutional policies and guidelines to guide its operations.

             CRS/AIDS Relief under a project funded by CDC

CRS/AIDS Relief under a project funded by CDC, contributed funding to the development of a pediatric and adolescent HIV counseling training package, which was utilized for training service providers in Tanzania, Uganda, Kenya, Swaziland, and Zambia.

This training package was later upgraded in 2018 with USAID AIDS free Project money, resulting in a Handbook on Counseling and Psychosocial Care for Children and Adolescents Living with and Affected by HIV in Africa.

              Anecca took the lead , with support from USAID Ethiopia, in scaling up paediatric HIV services

Anecca took the lead in 2009, with support from USAID Ethiopia, in scaling up paediatric HIV services through offering technical support for comprehensive pediatric HIV and tuberculosis care, treatment, and support at the Health Center level in five Ethiopian regions. Between 2009 and 2011, 643 health care providers from 350 health centers received pediatric HIV care training, which was followed by monthly on-site clinical supervision.

The number of HIV-positive children enrolled in care at the 350 health centers rose from 1,447 in 2008 to 9,869 in 2011, while the number of children receiving ART climbed from 48 to 3,763. From 2011 to 2014, Anecca mentored health workers at Ethiopian health facilities with a USD 1,798,258 sub-grant from MSH as part of the USAID-funded ENHAT-CS project. In one year (October 2011 to September 2012), 255 and 284 health workers in the two regions received thorough Paediatric training (IMNCI and Paediatric HIV), as well as PMTCT. Mentoring took place in 59 and 103 health centres in Tigray and Amhara, respectively. Of the patients who were initially began on ART during the same period, 902 (8.8%) were Children under the age of 15, including 51 babies. The national target for children receiving ART was 10%. In West Amhara, the proportion of paediatric clients was 9.2%, compared to 6.3% in East Amhara and 6.6% in Tigray. From October 2012 to September 2013, 479 intense mentorship sessions concentrating on Paediatric HIV/AIDS were carried out at 277 HCs in the Amhara and Tigray areas, resulting in 1107 children (including 56 babies) being freshly introduced on ART. From January 2012 to April 2013, Anecca , through a World Vision Ethiopia sub-grant, assisted Ethiopia’s Federal Ministry of Health in scaling up the Paediatric component of the national Preventive Care Package (PCP). With EGPAF financing (through a CDC funded project), Anecca trained trainers and service providers in Lesotho, Malawi, and Swaziland in psychosocial care and counseling HIV-infected children and adolescents in 2010 and 2011. Anecca also assisted the Ministry of Health in Swaziland in developing a nationwide HIV counseling and psychosocial support curriculum for children and adolescents.

             From September 2015 to February 2017, with funding from UNICEF Uganda

ANECCA conducted country-wide assessment of services for adolescents and supported the Ministry of Health to: • develop priority actions for accelerating and improving the quality of adolescent services. • strengthen monitoring and evaluation of the national adolescent HIV program by conducting bi-annual quantitative data collection on adolescent HIV care and treatment services, • develop a national Paediatric and Adolescent HIV indicator matrix; • develop a Clinical Systems Mentorship (CSM) toolkit,

             Funding from UNICEF Uganda continued from March 2017 to October 2018

To support Uganda MOH for National Level Scale up of Quality eMTCT, EIMC, Paediatric and Adolescent Health and HIV services. The key program outputs were: • Strengthened national and subnational capacity to ensure quality, access and utilization of prevention of vertical transmission of HIV
1. The percentage of HIV+ pregnant women who received ART to reduce MTCT of HIV was 96% (target was 85%),
2. The percentage of infants born to HIV infected mothers who become infected at 6 weeks was 1% (target 1.9%) and after breastfeeding 5.27% (target is <5%);

• There was improved access and quality of Paediatric and adolescent HIV services (Proportion of children enrolled in HIV care services was 67%), and
• There was increased coverage of Adolescent and Early Infant Voluntary Medical Male Circumcision (43% for clients aged 15-49 years); and
• Point of Care (POC) diagnostics were integrated into Ministry of Health conventional diagnostic systems and POC policy was developed.

             From October 2018 to October 2019 funding from UNICEF Uganda

Again with funding from UNICEF Uganda, ANECCA supported the Ministry of Health to achieve the following outputs:
• The Ministry developed the national costed MTCT of HIV elimination plan (2019-2024)
• The Ministry conducted the national PMTCT path to elimination validation as per WHO guidance.
• It increased the number of facilities in targeted areas (37 priority districts) offering ART to adolescents aged 10-19 years from 85% to 99% (553/557).

• It conducted a formative assessment of Differentiated Service Delivery (DSD) for children and adolescents and developed appropriate DSD tools.
• The number and % of children 0-14 years diagnosed with TB (all forms) and HIV who were receiving ART increased from less than 70% to 96% in Karamoja.
• Anecca trained 80 health workers in all the districts of Karamoja region (Amudat, Nakapiripirit, Nabilatuk, Napak, Moroto, Abim, Kotido, Kaabong and Karenga district), Soroti and Wakiso districts on Early Infant Male Circumcision using Mogen Clamps and topical anesthesia (EMLA cream) and circumcised over 1,200 newborns in a period of 3 months.
• ANECCA provided technical assistance to over 56 health facilities (with 336 health workers) in Karamoja region on HIV, TB, Laboratory services including district laboratory hubs and establishment and maintenance of Amudat Laboratory Hub.
• Working in Partnership with Central Public Health Laboratories (CPHL), Anecca strengthened the implementation of the national Point of Care (POC) laboratory technologies (for HIV & TB) with additional focus on the Karamoja region.
From November 2015 to October 2018 Anecca was a Principal Recipient of a regional grant of USD 3,865,587 by the Global Fund to “Catalyze Access to quality services for Children and Adolescents living with HIV” in seven counties, namely: Malawi, Tanzania, Burundi, Uganda, South Sudan, Ethiopia and Nigeria. Anecca’s performance was consistently rated as A1 by the Global Fund for the 3 years. Information available on: https://data.theglobalfund.org/grant/QPA-ANECCA/1/performance-rating and https://data.theglobalfund.org/grant/QPA-H-ANECCA/1/ Under this grant, ANECCA was provided additional funds to support two important activities on TB/HIV in collaboration with WHO.
1. A Regional consultation meeting to support country implementation of the top ten indicators to monitor the End TB Strategy, collaborative TB/HIV activities and programmatic management of latent TB infection. The meeting, held in September 2016 in Nairobi Kenya, brought together 80 participants from 11 African countries (Benin, Ethiopia, Kenya, Malawi, Mozambique, Nigeria, Swaziland, South Africa, Uganda, Tanzania, and Zimbabwe) that discussed and debated issues in introduction and implementation of the top ten indicators to monitor the End TB Strategy and identified bottlenecks.
2. A Regional workshop on Understanding and tracking the TB epidemic for policy and programmatic action (5-9 December 2016 Kampala, Uganda). This meeting brought together participants from 16 countries (Cameroon, Chad, Central African Republic, Ethiopia, the Democratic Republic of the Congo, Kenya, Lesotho, Malawi, Mozambique, Namibia, Sudan, Swaziland, the United Republic of Tanzania, Uganda, Zambia and Zimbabwe) to support strengthened national surveillance and country-level analysis and use of data.

             USAID Local Partner Health Services – Karamoja

In October 2021, Anecca was awarded a grant from USAID to implement the USAID Local Partner Health Services – Karamoja Uganda for 5 years up to September 2026. The Activity is implemented in the districts of Abim, Kaabong, Karenga, Kotido, Moroto, Amudat, Nabilatuk, Napak and Nakapiripirit in the Karamoja region. The expected key results for this project are:
1. Quality facility-based HIV and TB prevention services provided at scale.
2. Quality, targeted, high yield, facility-based HIV testing, and counseling services provided at scale.
3. All diagnosed people living with HIV and TB are promptly initiated on treatment.
4. All diagnosed people living with HIV and TB on treatment achieve viral suppression.
5. Target districts have the institutional capacity to sustain epidemic control and maintain the response.