A peer support initiative in Uganda is transforming HIV care for adolescents and young people living with HIV. The young people and adolescent peer support (YAPS) program, launched in 2019, pairs young people with trained peer supporters, leading to higher retention in care, increased viral load testing, and improved viral suppression rates.
A recent evaluation the by the METS program at Makerere University School of Public Health (MakSPH) and the Ministry of Health, with PEPFAR funding found the support initiative to be a critical part of Uganda’s strategy to end HIV by 2030, aligning with WHO recommendations for peer-led interventions.
The evaluation, covering 122 YAPS and 122 non-YAPS facilities in 14 regions, used a mixed-methods approach, including checklists, record reviews, and interviews, to assess the program’s impact.
It revealed that the YAPS program greatly improved HIV treatment outcomes. Adolescents and young people living with HIV in YAPS facilities had ten times better retention in care, four times better viral load testing, and were twice as likely to achieve viral suppression compared to those in non-YAPS facilities.
“The YAPS program is making a real difference in the lives of young people living with HIV in Uganda,” said Dr Simon Muhumuza, a Senior Technical Officer Health Systems Strengthening at the MakSPH-METs program. “By providing peer support and mentorship, the government is helping young people stay in care, adhere to their treatment, and achieve viral suppression. In our evaluation, we found that youth who were supported by peers were doing far better than those not, meaning we should encourage the program”.
The evaluation also highlighted positive feedback from YAPS participants and adolescents and young people living with HIV, who appreciated the program’s role in reducing stigma, improving disclosure, and boosting emotional resilience and self-confidence. These factors contributed to better treatment adherence and outcomes.
However, the evaluation also identified challenges in the implementation of the YAPS program. Fidelity to the model was highest at the implementing partner level but suboptimal at the health facility level. Gaps in multi-sectorial coordination and financial constraints were also identified as barriers to the program’s full potential.
Despite these challenges, the evaluation concludes that the YAPS program has improved outcomes for adolescents and young people living with HIV across the HIV treatment cascade. The program’s success is attributed to its ability to provide peer support, reduce stigma, and improve emotional resilience among young people living with HIV.
The evaluation recommends integrating the YAPS program into district-level multi-sectoral coordination structures and institutionalizing program reviews at the district level to address challenges promptly. It also calls for the development of a minimum costed package for YAPS implementation to enhance feasibility for countrywide scale-up.
The evaluation also included a cost analysis of implementing the YAPS model, using data from both the government and implementing partners. It was found that the cost of reaching one adolescents and young people living with HIV through the program was USD 1,386 (UGX 5,058,900) per year. The cost of facilitating a YAP peer was USD 1,401 (UGX 5,109,750) in the first year and USD 1,047 (UGX 3,820,000) annually for each subsequent year. Training accounts for 33% of the overall cost, while personnel accounts for 19%.
This cost analysis helps provide insight into the financial investment required to sustain and expand the YAPS program.
By addressing the identified challenges and scaling up the YAPS program, Uganda can further improve HIV treatment outcomes for adolescents and young people and accelerate progress toward ending the HIV epidemic by 2030.
Dr. Charles Olaro, Director General of the Ministry of Health, emphasized the importance of using evidence-based findings to address Uganda’s pressing health challenges. “We can no longer afford to deliver services without evidence, especially as we work toward Agenda 2030,” he said, stressing how studies like these are crucial for supporting policy implementation. Dr. Olaro also acknowledged the Makerere University School of Public Health for its 70 years of service in shaping the country’s public health landscape.
Professor Rhoda Wanyenze, Principal Investigator of the METS Program at the School of Public Health, emphasized the importance of the findings, saying, “The evidence we present has significant implications for policy and program improvement across Uganda’s health system. These insights come at a critical time and will directly inform the National Strategic Plan currently under development. Our evaluations offer actionable recommendations to strengthen service delivery, improve health outcomes, and optimize resource use. As always, the MakSPH-METS Program remains committed to bridging the gap between research and policy implementation.”
The Makerere University School of Public Health’s longstanding partnership with the U.S. Centers for Disease Control and Prevention (CDC) through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been instrumental in building a skilled health workforce, supporting impactful health programs, and advancing implementation science. For decades, this collaboration has strengthened health systems, informed policies, and improved health outcomes across Uganda.
