Table 2 Content of hepatitis B “Training for integration” Curriculum for Health Care Workers in West Nile Region, Uganda

Module 1

Natural history, epidemiology and transmission of infection

I. Emphasized burden of HIV, of HBV, of dual infection, and similarities between HBV and HIV infection transmission

II. The influence of HIV on HBV natural history, and the influence of HBV on HIV natural history

Module 2

Laboratory diagnosis

I. Basics of laboratory diagnosis for HBV

II. Similar platforms for diagnosis of HIV and HBV (ELISA),

III. HIV viral load and HBV viral load

IV. Similar transportation systems for samples (the hub system) for viral load samples

V. Same processing facility for viral load tests

(Central Public Health Laboratories)

Module 3

Care and treatment

I. Covered for HBV and HBV-HIV co-infection

II. Both being chronic diseases with no cure but life-long care and treatment

III. The HIV “test and treat” strategy, versus the HBV treatment strategy that requires additional tests to decide who is eligible for treatment

IV. Medications for HBV treatment provided in public hospitals by the Government and ART by both Government and Partners

Module 4

Prevention

I. Commonalities between prevention of HIV and of HBV, including preventing mother-to-child HBV transmission

II. Community-linkage for continued follow-up and prevention of complications for HBV mono-infected persons

III. Community engagement

Community networks of HBV (treatment peer support, community groups to have patients’ voice) to be woven into existing structure for HIV

Need for continuous monitoring emphasized, and to remain in care

Need for raising community awareness, to eliminate erroneous disease perceptions and fight stigma addressed as part of curriculum, through local radio-based programs, where individuals calls-in and have their questions and concerns discussed as part of community engagement

Module 5

Cross-cutting issues, rationale, planning and coordination of integration

I. Why integrate? (i)Significant overlap between both infections and the need to offer care for both infections in a well-coordinated care system. (ii) Need for a public health response, to give the widest possible reach for HBV care, treatment and continuous monitoring would be efficiently met through care integration

II. HIV as a “high profile” disease (Well-structured clinics all over the country; funded laboratories and pharmacy, strong patient and community networks, clinician task-shifting and data capture services) versus HBV as a “neglected” disease (Runs a silent course, with high levels of stigma and discrimination, lacks all infrastructure, apart from free tenofovir, has insufficient media representation and advocacy among health workers, patients and at political level)

III. Leverage on the well-developed infrastructure for HIV to offer HBV services to all who need it

IV. Co-planning, training and coordination for integrated HIV and HBV service delivery across the care continuum