After USAID: HIV Care at Lacor Hospital
June 26, 2025
AFTER USAID: HIV CARE AT LACOR HOSPITAL
I visited the HIV clinic at Lacor Hospital yesterday.
I spent the afternoon with Denis, a senior nurse who has worked in the HIV department since 2008. He was kind enough to meet with me in between patients while he was on his break. Denis has been here for nearly two decades. He knows his patients well, and they trust him implicitly. They tell him they wish he would stay forever.
Denis's day begins at 7:30 a.m. There's no cleaning staff, so the nurses methodically clean the clinic themselves before the first patients arrive. Each day starts with a health education session. These sessions rotate throughout the week, with each of the clinic's teams taking turns to lead. Topics range from antiretroviral adherence and HIV prevention to managing co-infections like tuberculosis and malaria.
Once education is complete, patients receive their files and pay a small token fee — 6,000 UGX, approximately $ 1.80. But no one is turned away due to inability to pay.
Inside the clinic, the daily routine is familiar to everyone. Each patient is screened for malnutrition, and their vitals are checked. Sick patients receive referrals to the clinical officers or the doctor. Stable patients, many of whom are long-term recipients of antiretroviral therapy, report to the external desk, where Denis and other nurses manage refills and request routine tests, such as viral load monitoring.
Before the USAID funding cuts, patients received medication for up to six months at a time. Now, outside of extenuating circumstances, the most offered is three months. Newly initiated patients receive only one month's supply. It's a small but necessary rationing due to the uncertainty of future medication availability.
The good news is that the clinic still has a supply of drugs. Since the end of USAID funding, Lacor no longer directly receives a supply of HIV medications. For now, the pharmacist reaches out to nearby government hospitals that still receive CDC-supported drugs. When these hospitals have a surplus, they share. Currently, there are drugs in supply through August.
The team at the clinic consists of a small group: two clinical officers, one doctor, four nurses (including a nurse counselor), a pharmacist, two dispensers, three records personnel, and one community worker. Nine key community-based staff members had to be let go, as their salaries were paid for by USAID — including peer mothers, village health team members, and adolescent peer supporters.
These community workers were responsible for organizing community activities, monitoring patient attendance, and assisting with patient files and tracking. Now, only the nurse counselor and one other staff member try to manage it all, in addition to their regular work inside the clinic.
HIV outreach teams continue to visit the community on a monthly basis. They still distribute medications, but testing and counseling have stopped. Twice a week, however, a separate health team serves rural communities, offering a multitude of services, including HIV testing.
Since February, Lacor's doctors and staff have successfully found ways to replenish the drug supply, ensuring that their patients receive the necessary medication.
Patients are frightened.
They want to know what will happen come September. For now, there is enough medication. But what happens when it runs out? Where will they go? What will they do?
These are questions that still have no answers, but Lacor Hospital is working every day to find them.