THRIVE Community AHD Champions drive case finding in HIV screening and care

In Kasenyi, Uganda, three-month-old Innocent Ainnomugisha was fighting a battle for survival. At an age where life should be just beginning, Innocent was already enduring the dual burden of HIV and Tuberculosis (TB). His situation was made even more perilous by the fact that he was not on medication; his health was rapidly failing while he remained hidden away in the home of his mother, Florence Nalwanga. The vital lifeline for Innocent finally arrived in the person of Sarah Aturinda, a Community Champion for Advanced HIV Disease (AHD), working with the community organization AFROCAB through the Unitaid-funded THRIVE project. It is Sarah’s intervention through a routine community visit that would rewrite the infant's future.

His mother, Florence, struggling with the weight of her circumstances and alcohol use, had defaulted on her own life-saving HIV treatment. This left her newborn profoundly vulnerable. During the visit, Sarah utilized her training to perform a prompt screening on the infant. The results were sobering: the three-month-old was diagnosed with both TB and HIV, a dangerous combination that required immediate medical intervention to prevent a fatal outcome.

The Path to Recovery

Sarah ensured the baby was urgently referred to a health facility, where a medical team immediately started him on TB treatment, followed by the initiation of antiretroviral therapy. However for Sarah, the work did not end at the hospital doors. To protect the gains made during the infant’s hospitalization, a  post-discharge plan was implemented. To overcome barriers to access, medication is now delivered directly to the home, ensuring the baby never misses a dose. Sarah continues to provide specialized psychosocial support to Florence, ensuring the home environment remains stable for the child's growth.

A New Chapter

Today, the transformation in this child’s life is profound. Helped by the consistent support of AHD community champions, the infant is adhering to his treatment and recovering well. His mother has stopped drinking alcohol, shifting her entire focus to the health and future of her family.

The Challenge

Due to a combination of factors, such as long travel distances to health facilities, a lack of adequate knowledge regarding their condition, and the persistent weight of stigma, individuals in settings like Florence’s often do not regularly seek out health services. These social and financial barriers create a silent crisis, leaving both parents and their children at extreme risk. This is precisely where Community Champions like Sarah Aturinda become indispensable; they bridge the gap by taking critical health information and life-saving services directly to the doorsteps of the people who need them most. Often, they represent the thin line between a tragic outcome and a new beginning for babies like Innocent.

The successful identification, linking to treatment, and sustained road to recovery for Innocent provides a profound sense of hope and a blueprint for what community-led health systems can achieve. However, this success brings a somber realization, as shifts in the global funding landscape and recent funding cuts put such life-saving work at high risk. These funding shortfalls directly impede the delivery of recommended interventions for optimal care, creating a precarious environment for children who are already disproportionately affected.

When resources for community champions are stretched thin, the intensive, home-based support required to link vulnerable infants to care, especially in donor-dependent and hard-to-reach settings, threatens to reverse hard-won gains and exacerbate preventable mortality. Ultimately, jeopardizing the very structures that ensure neglected populations are not left behind, leaving the future of paediatric AHD programming in a state of dangerous uncertainty.

The Wider Impact: Closing the Paediatric Gap

While broad initiatives have made strides, significant gaps remain in identifying and linking children to care. Children are disproportionately affected by the AHD crisis with an estimated 30% of children and adolescents presenting with severe immunosuppression at their initial HIV diagnosis (Frigati et al., 2023; WHO guidance). All children under the age of five are classified as having AHD due to their exceptionally high risk of mortality.

Traditional models often fail to reach those in hard-to-reach areas where health facilities are inadequate or demand for services is low.

The THRIVE Response: Scaling Success

AFROCAB, through the Unitaid-funded, CHAI-led THRIVE project, is addressing these gaps via a localized, community-led approach. By deploying a network of AHD champions, the project has successfully normalized screening and transformed AHD testing into a community priority. Data from June 2025 to March 2026 across five countries where the community-facility interventions are being implemented reveals the scale of this impact.

The number of individuals reached by THRIVE community programs surged more than six-fold. Starting at a modest 8,388 people in June, outreach efforts peaked at over 72,000 in November , with nearly 55,000 reached in March alone.

Perhaps the most telling metric of the program's success is the rise in actionable health behavior. Referrals to clinical  services by AHD champions and facilitators rose steadily from just 198 in June 2025 to 1,224 by March 2026.

Source: 33 health facilities across five THRIVE supported countries.

Source: 33 health facilities across five THRIVE supported countries

A noted significant trend was that even as the total number of people reached began to stabilize, the number of referrals continued to rise. This suggests that the demand for care is not merely a byproduct of one-time outreach events but is becoming a sustained, deep-rooted priority within the community, providing clear evidence that sensitization is translating into real-world action, as individuals identified through community screening are actively motivated to seek facility-based care.

The Challenge of Scale

As the program expanded, the yield, or the percentage of screened individuals confirmed to have AHD shifted from a high of 70% in June to 36% in March. However, it is key to point out that this decline is a natural result of broader population screening in the community.

By casting a wider net, the program is reaching individuals across a broader spectrum of clinical risk, rather than only those with the most obvious symptoms. The number of confirmed cases rose from 139 to 440 from June 2025 to March 2026, ensuring that hundreds of people with advanced disease are now receiving urgent, life-saving care that might have otherwise been delayed.

Identified cases rose by 217% from June 2025 to March 2026

A Call for Resources

The success of these community platforms is driving increased demand at the facility level, making supply chain readiness a critical priority. Ensuring the consistent availability of AHD commodities across AHD hub and spoke health facilities is essential to sustaining that momentum. The current shifts resulting from funding cuts have effectively burned the candle at both ends. Not only are funding shortfalls threatening the existence of the community champions who identify and link patients to care, but they have also jeopardized the supply of the essential commodities those champions depend on.

Sustaining the gains made through THRIVE and the work of the THRIVE community AHD champions requires a steady and predictable supply of these tools.

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Through the generous support of Unitaid, the Clinton Health Access Initiative (CHAI)-led THRIVE Project is enabling access to critical prevention, screening, and treatment commodities for advanced HIV disease to dramatically reduce mortality among adults and children living with HIV. The THRIVE project is conducted in partnership with Afrocab and Penta.  

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 Disclaimer: The views expressed are those of CHAI and AFROCAB and do not necessarily reflect those of Unitaid or other partners.