At TASO's office, Muhwezi demonstrates his inventory control system: a set of supply cards. He says the system works because
the numbers are small—about 1,400 patients are on ARVs. But TASO is aiming for 3,000 patients by March 2005, and at some point
the supply cards won't be enough.
"You can call me today and tell me, 'I really need nevirapine,'" says Muhwezi. "I will call Medical Access and I will get
it tomorrow. But that won't be possible if I say, 'I need 1,000 boxes.' Now I need 100. Now I need 50. I can get those."
TASO is working with the US Centers for Disease Control to implement a new pharmacy information system that will enable Muhwezi
to manage larger and more complex amounts of information. That will help TASO keep bigger stocks of ARVs at their headquarters
and at the service centers—which will make for less disruption to the supply—and help better manage medicines' expiration
Pastor Paddy Luzige plays "football" with children at New Life Church's Saturday afternoon programs.
What is less clear is how TASO will scale up the hard part of its job: taking drugs the final step from the CBO to the patient.
Into the Countryside
To appreciate what the AIDS epidemic looks like, you need to go to the villages where the bulk of Ugandans make their homes—and
where many city dwellers with AIDS come to die. Go, for instance, to Bukulula, a cough of dust in south Uganda, not far from
Rakai, where the country's first AIDS case was diagnosed in 1982. It's a place where time passes slowly, mornings and evenings
marked by the clockwork of children chewing sugarcane along the road, carrying water and firewood on their heads. But there's
something really disturbing about this district—even for a country whose average life expectancy is hovering just over age
40, according to the Population Reference Bureau. There are few adults, a picture of what the mature epidemic will look like.
Here, Abdul Kakande, a registered nurse and one of the original co-founders of TASO's Masaka center, rides his boda-boda (Swahili for motorcycle), delivering drugs and care to patients too sick or too far away to make it to the clinic.
Kakande stops outside a clinic and meets up with Ssemwanga Godfrey, a "community nurse" for TASO. Community nurses are human
infrastructure, put in place to run (and curb the costs of) very effective but very expensive home-based care. Godfrey closes
his clinic/pharmacy to join Kakande in visiting TASO clients.
Innovative partnerships between the more established community organizations and grass-roots groups help providers overcome
lack of resources. In Masaka, for example, the Ministry of Health coordinates TASO's efforts with Uganda Cares (See "Outside
PEPFAR," ), Kitovu Mobile, a home care program focused on providing palliative care, and other providers to share doctors,
counselors, and equipment.
The pair drive through Bukulula, passing trees filled with bananas, mangos, and passion fruit, before finally arriving at
the patient's straw-thatched hut. The woman, who is co-infected with AIDS and tuberculosis (TB), sits on a feather filled
mattress in the corner. She was expecting Kakande and Godfrey and has laid out her medications.
Her story is a familiar one: She lived in Kampala and was even buying ARVs at the JCRC. But when she could no longer afford
to pay for the drugs, she stopped taking them and began to grow weak. She decided to to live with her sister in Bukulula so
her children would be close to a caretaker. Before long, she was in the hospital, weighing only 66 pounds and with a CD4 count
of three. (A normal count in a healthy, HIV-negative adult is usually between 500 and 1,500 CD4 cells per cubic millimeter
of blood, according to