This activity also relates to activities; 8289-ARV Services, 8288-ARV Drugs, 8290-Laboratory, 8291-AB, 8292-Basic Health care & support, 8293-TB/HIV, 8294-OVC, and 8295-CT.

AIDSRelief (AR) is a comprehensive HIV CARE program, providing ARV drugs, preventive, curative, palliative care and ARV services to HIV positive people and their families. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AIDSRelief is a consortium of five organizations with Catholic Relief Services as the lead agency responsible for overall coordination and management of consortium activities, Constella Futures Group provides support for Strategic Information and the Institute of Human Virology guides and informs the establishment of treatment, adherence and care protocols. Based on care for 17,170 patients by February 28, 2008 Services will be offered through 15 Local Partner Treatment Facilities (LPTFs), distributed throughout Uganda. Most of the above LPTFs have outreaches and sometimes they collaborate with a CBO for adherence purposes. AIDSRelief can maintain the 12,000 patients on ART but could also continue to accept patients in its palliative care program in case the funding provided will enable this expansion.

Funding for the provision of PMTCT will be used to support all 15 LPTFs to strengthen linkages between the PMTCT and HIV care and treatment services. Training through a mentoring/preceptorship program will be provided to staff. In order to ensure that the patients receive the highest quality personnel care in accordance with the best practices, the AIDSRelief technical team will assist LPTF staff (e.g. physicians (59), counselors (113), and nurses (67)) with training. Other services will include clinical monitoring, related laboratory services, nutrition education and community adherence activities. One of the cornerstones of the AIDSRelief program is the development of quality assurance programs at the LPTF level. By this intervention, AIDSRelief will address the legislative area of gender inequality by providing yet another avenue for HIV positive women to access ARV drugs, hence improving their chances for survival and their continued ability to care for their families. Through sound VCT messages and through community mobilization activities, stigma and discrimination will continue to be targeted as a key area to be addressed by this program. In the AIDSRelief LPTFs, counseling and education for the pregnant women will be conducted and ANC clinics will be supported to create a conducive environment for pregnant mothers and their partners. Strengthening of PMTCT services requires excellent linkages for client referrals and infant follow-up. AR's strengths at community levels will enhance this. HIV exposed babies will be tested using the DNA/PCR testing (DBS) or PCR testing at those facilities where this is available. HIV exposed babies will receive cotrimoxazole prophylaxis from 6 weeks of age and be linked to care services. The program will train 356 health care providers, especially nurses and counselors, using the new PMTCT curriculum with orientation to the revised PMTCT policy. AIDSRelief will continue to strengthen linkages between local partner health facilities and the surrounding community. Community members, including traditional birth attendants and female community leaders, will be engaged to take part in outreach activities that promote PMTCT awareness and to provide a supportive network for HIV positive women in the post-partum period, especially as it relates to maintaining their chosen feeding option, and for encouraging infant follow-up for definitive diagnosis.

Consetlla Futures will ensure through its support for strategic information systems, that PMTCT information is incorporated into SI activities. This will enable program level reporting, enhancing the effectiveness and efficiency of both paper-based and computerized patient monitoring and management (PMM) systems, assuring data quality and continuous data quality improvement, and using SI for program decision making across LPTFs. Activities will include, ensuring collection and compilation of complete & valid HIV PMTCT data; assuring collection and analysis of required indicators for quality PMTCT program monitoring & reporting; TA for LPTF to develop specific plans to enable sites to easily look at areas that could be enhanced or improved as a program.

This activity also relates to activities; 8584-PMTCT, 8289-ARV Services, 8588-ARV Drugs, 8290-Laboratory, 8292-Basic Health care & support, 8293-TB/HIV, 8294-OVC, and 8295-CT.

AIDSRelief(AR) is a comprehensive HIV CARE program, providing ARV drugs, preventive, curative, palliative, social and ARV services to HIV positive people their families & communities. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AIDSRelief is a consortium of five organizations. Catholic Relief Services is the lead agency responsible for overall coordination and management of consortium activities, Constella Futures (CF) leads the Projects Strategic Information systems which provide essential clinical and programmatic information for high quality care; Institute of Human Virology guides and informs the establishment of treatment, adherence and care protocols. The Children Aids Fund is a sub-grantee supporting 5 sites.

The funding allocation that has been provided by USG is primarily for AB activities and will be supporting the beneficiaries described in the targets section below. This approach to prevention adheres to the official CRS policy on HIV prevention and thus the policy of AIDSRelief. CRS does not finance, distribute or promote the distribution of condoms. However, CRS does provide complete and correct information about HIV prevention, including the use of condoms, through the HIV/AIDS partner projects that it supports. CRS believes the prevention and treatment of HIV and AIDS must be approached holistically and thus, attention focuses on the impact of HIV/AIDS on individuals, families and communities. The program will address the physical and emotional needs of AIDS-affected people. The primary focus will be on behavior change for risk reduction and risk avoidance, counseling and testing as well as education to patients and community health volunteers.

AR services in prevention, abstinence and being faithful in FY07 will be offered through 18 local partner treatment facilities (LPTF) which include 3 community based programs, distributed throughout Uganda. Based on its successes and lessons learned, the AIDSRelief program in Uganda will continue to develop and promote primary and secondary HIV prevention through abstinence and being faithful. Community mobilization around ART requires education about HIV, including important information on prevention. AR will support LPTF activities targeting HIV + clients that access care at these points as well as their families and communities. Prevention priorities will include behavior change for risk reduction and risk avoidance, counseling and testing. All sites will provide education to patients and community health volunteers on secondary prevention.

The strong adherence support program developed by LPTFs in the AR program will continue to serve as the foundation for outreach to communities. In years 1, 2 and 3 of the project, outreach workers reached out to community and religious leaders to educate them about HIV. In year 4 community workers in the program will continue to play a significant role in the dissemination of the messages. For those patients on ART, adherence staff will educate on secondary prevention, focusing on being faithful and abstinence and encourage counseling and testing of all family members. Training will be an integral part of this program and will be directed at nurses (67), counselors (113), adherence counselors (83) and the community workers (450). These will be given adequate skills to be able to promote abstinence and being faithful to patients, their families and communities. The program will also seek to link up with other community- and faith-based organizations that serve the same geographic areas, as well as partners working in other sectors, wherever possible.

Strategic Information (SI) activities incorporate program level reporting, enhancing the effectiveness and efficiency of both paper-based and computerized patient monitoring and management (PMM) systems, assuring data quality and continuous data quality improvement, and using SI for program decision making across LPTFs. In COP07, CF will continue to enhance the PMM Systems at these LPTFs. They will carry out regular site visits and reviews to ensure continued quality data collection, data entry, data validation and analysis, dissemination of findings; data management & continuous quality improvement. With assistance from CF, AIDSRelief will provide appropriate data-gathering tools to ensure collection and compilation of data in Prevention/Abstinence and being faithful.

This activity also relates to activities; 8584-PMTCT, 8289-ARV Services, 8288-ARV Drugs, 8290-Laboratory, 8291-AB, 8293-TB/HIV, 8294-OVC, and 8295-CT.

This program area also relates to activities in HIV/AIDS Treatment/ARV Services, HIV/AIDS Treatment/ARV Drugs, Laboratory Infrastructure, Prevention Abstinence and Being faithful, Palliative Care - Basic Health care & support, Orphans and Vulnerable Children, and Strategic Information.

AIDSRelief (AR) is a comprehensive HIV care and treatment program, providing ARV drugs, preventive, curative, palliative, social and ARV services to HIV positive people, their families and communities. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AR is a consortium of five organizations. Catholic Relief Services is the lead agency responsible for overall coordination and management of consortium activities, Constella Futures Group provides assistance for Strategic Information which provides essential clinical and programmatic information for high quality care whereas Institute of Human Virology (IHV) guides and informs the establishment of treatment, adherence and care protocols. The Children Aids Fund is a sub-grantee supporting 5 sites. Based on its successes and lessons learned, AR will maintain 12,000 patients on ART until February 28, 2008. Additionally, AIDSRelief will provide care services to 17,170 HIV positive patients. AR services will be offered through 15 Local Partners Treatment Facilities (LPTF), distributed throughout Uganda.

Under Cop07, AR will specifically strengthen the diagnosis and treatment of an estimated 5200 HIV+ patients who may also be co-infected with Tuberculosis (TB). TB drugs and basic laboratory investigations are already sponsored by MOH through the National TB and Leprosy Program. In year 4, AR will provide training and clinical preceptoroships to raise awareness and clinical skills among LPTF staff on the linkages between HIV and TB and TB diagnosis. In doing this AR will follow the recently launched Government of Uganda policy guidelines on TB/HIV integration and a TB/HIV communication strategy. This training will target nurses (67), adherence counselors (83) and the community workers (450). As part of the technical assistance to the LPTFs, the Institute of Human Viorology will provide the clinicians with guidance on managing co-infected patients so that they have the capacity to provide the highest quality of care. Clinicians will be trained in the topics including the following: diagnosis of TB in the HIV infected, which ART regimen for patients starting therapy for TB, and when the ART should be started in a patient who is currently on anti TB therapy. Constella Futures will provide on-site training and hands-on technical assistance that will reinforce the need for good patient record keeping. This will enhance AR's ability to capture information on TB and HIV through CAREWare and IQCare. This will form the basis of continuous quality improvement at the LPTFs, enabling clinicians to provide better care to their patients. TB/HIV reporting systems will continue to be developed and TB registers will be modified to capture information on HIV counseling and testing, and provision of cotrimaxazole prophylaxis and ART to TB/HIV co-infected patients. Indicators for TB screening among the HIV-positive clients will be captured in the HIV registers.

Linkages and referrals to other ART and palliative care providers will be taken under consideration as part of the overall development of health care treatment networks. This would mean dealing with sites managed by the local government as well as other USG implementing partners.

This program area also relates to activities in 8289-ARV Services, 8288-ARV Drugs, 8290-Laboratory, 8291-AB, 8292-Basic Health Care & Support, 8294-OVC, 8584-PMTCT, 8295-CT.

AIDSRelief (AR) is a comprehensive HIV care and treatment program, providing ARV drugs, preventive, curative, palliative, social and ARV services to HIV positive people, their families and communities. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AR is a consortium of five organizations. Catholic Relief Services is the lead agency responsible for overall coordination and management of consortium activities, Constella Futures Group provides assistance for Strategic Information which provides essential clinical and programmatic information for high quality care whereas Institute of Human Virology guides and informs the establishment of treatment, adherence and care protocols. The Children Aids Fund is a sub-grantee supporting 5 sites. Based on its successes and lessons learned, AR will maintain 12,000 patients on ART until February 28, 2008. Additionally, AIDSRelief will provide care services to 17,170 HIV positive patients. AR services will be offered through 15 Local Partners treatment facilities (LPTF), distributed throughout Uganda.

Under Cop07, AR will specifically strengthen the diagnosis and treatment of an estimated 5200 HIV+ patients who may also be co-infected with TB. TB drugs and basic laboratory investigations are already sponsored by MOH through the National TB and Leprosy Program. In year 4, AR will provide training and clinical preceptoroships to raise awareness and clinical skills among LPTF staff on the linkages between HIV and TB and TB diagnosis. In doing this AR will follow the recently launched Government of Uganda policy guidelines on TB/HIV integration and a TB/HIV communication strategy. This training will target nurses (67), adherence counselors (83) and the community workers (450). As part of the technical assistance to the LPTFs, IHV will provide the clinicians with guidance on managing co- infected patients so that they have the capacity to provide the highest quality of care. Clinicians will be trained in the topics including the following: diagnosis of TB in the HIV infected, which ART regimen for patients starting therapy for tuberculosis, and when the ART should be started in a patient who is currently on anti TB therapy. Constella Futures will provide on-site training and hands-on technical assistance that will reinforce the need for good patient record keeping. This will enhance AR's ability to capture information on TB and HIV through CAREWare and IQCare. This will form the basis of continuous quality improvement at the LPTFs, enabling clinicians to provide better care to their patients. TB/HIV reporting systems will continue to be developed and TB registers will be modified to capture information on HIV counseling and testing, and provision of cotrimaxazole prophylaxis and ART to TB/HIV co-infected patients. Indicators for TB screening among the HIV-positive clients will be captured in the HIV registers.

Linkages and referrals to other ART and palliative care providers will be taken under consideration as part of the overall development of health care treatment networks. This would mean dealing with sites managed by the local government as well as other USG implementing partners.

This program area also relates to activities in 8584-PMTCT, 8289-ARV Services, 8288-ARV Drugs, 8290-Laboratory, 8291-AB, 8292-Basic Health Care & Support, 8293-TB/HIV, 8295-CT.

AIDSRelief (AR) is a comprehensive HIV care and treatment program, providing ARV drugs, preventive, curative, palliative, social and ARV services to HIV positive people, their families and communities. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AIDSRelief is a consortium of five organizations led by CRS and includes the Institute of Human Virology and Constella Futures. The Children Aids Fund is a sub-grantee supporting 5 sites. CRS has considerable experience in working with orphans and vulnerable children through other funding sources. Under AR, with the limited COP07 funding, AR will focus on establishing a family centered care model for HIV care and treatment services in 15 Local Partner Treatment Facilities (LPTFs), distributed through out Uganda.

AR, in total, since scale up is not possible under this funding scenario, will support 855 children on treatment. Under this program area, AR will work on clinic organization to provide family-centered care. This involves strengthening links between PMTCT, MCH, in patient and out patient services. It also requires training of health care personnel in basic pediatric HIV with a focus on the diagnosis of HIV + children or HIV exposed children so that cotrimoxazole prophylaxis can be started. Infant diagnosis will be strengthened through linkages with the Government of Uganda and other organizations which are promoting dried blood spot testing. AR will focus on increasing pediatric counseling skills at all LPTFs and among outreach community workers. Special training programs will be offered to the caregivers. AIDSRelief will strengthen its LPTFs networks to other community- based OVC services as well as to work with People Living With HIV/AIDS (PHA) households to ensure that children in these households are linked to critical OVC services. This builds upon other CRS resources: CRS private funds, WFP and GFATM. Through these networks AIDSRelief will address some of the nutritional needs of children born to HIV+ households and those living in HIV+ households. . This program will take advantage of the already existing support groups such as Comboni Samaritans in Gulu, Meeting point and CHAPS in Kitgum as well as the community workers and the volunteers within the LPTFs. The Training in OVC programs will be carried out in the 15 LPTFs and will be directed at the nurses and adherence counselors (150) and the community workers (450).

AIDSRelief will make a concerted effort to link OVCs with community- and faith-based organizations that provide support, and will involve local community and religious leaders in helping to find community-based solutions to this crisis. Constella Futures here will also provide support for program level reporting, enhancing the effectiveness and efficiency of both paper-based and computerized patient monitoring and management (PMM) systems, assuring data quality and continuous data quality improvement, and using SI for program decision making across LPTFs. In COP07, Constella Futures will carry out regular site visits and reviews to ensure continued quality OVC data collection, data entry, data validation and analysis, dissemination of findings; data management & continuous quality improvement.

plus ups: In order to provide comprehensive OVC services to HIV+ve children, the partner will expand provision of HIV palliative care to these children as part of the non pediatric treatment OVC activities. With these resources, more HIV infected children will receive OI management, pain alleviation, counseling for themselves and their families from skilled providers, and will also be linked to other OVC services in their communities. Improving and expanding palliative care for HIV +ve children is a critical service. CRS through its 15 partners will use these funds to expand peds palliative care provision in its facilities and surrounding communities to reach out to more HIV+ve children and their families. Services will include OI prevention and treatment, pain alleviation, and related supplies, counseling children and their families, relevant immunizations, address children's nutritional needs through nutrition counseling and supplements. Providers will actively link these children and their families to other community based OVC services in their catchment areas adn conversely the facilites will provide HIV palliative care services to the OVC referred from teh CSOs within their areas. With this intervention, more vulnerable HIV+ve children will receive more integrated OVC services.

This program area also relates to activities in 8289-ARV Services, 8288-ARV Drugs, 8290-Laboratory, 8291-AB, 8292-Basic Health Care & Support, 8294-OVC, 8293-TB/HIV, 8584-PMTCT.

AIDSRelief (AR) is a comprehensive HIV CARE program, providing ARVs, preventive, palliative, curative and ARV services to HIV positive people, their families and communities. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AR is a consortium of organizations led by Catholic Relief Services who is responsible for overall coordination and management of consortium activities. Constella Futures Group provides support for Strategic Information while the Institute of Human Virology guides and informs the establishment of treatment, adherence and care protocols; and Children's AIDS Fund is a sub-grantee. Based on its successes and lessons learned, the AIDS Relief program in Uganda will continue to offer counseling to all patients in care. AIDSRelief services are offered through 15 Local Partner Treatment Facilities (LPTFs), distributed throughout Uganda.

AR has the capacity to significantly scale up patients under care and treatment should resources be forthcoming. AR will, however, provide on going training to staff in the 15 LPTFs to increase their skills in counseling and testing. This training will be directed at the nurses, adherence counselors and the community workers. Possible linkages to other programs will be explored.

AR will build on the established VCT and PMTCT services existing in 11 participating AR sites prior to PEPFAR funding. Generalized VCT will continue in FY 07, but AR could move to strategically target higher-risk populations with greater numbers of infected individuals in need of therapeutic care, particularly TB patients and pregnant women. A strong emphasis is being placed on home based/family testing with the patient initiating ART as the entry point, and spousal testing during PMTCT. Abstinence/Be Faithful counseling will be fully integrated into our family and spousal VCT initiatives. Post test counseling and referral linkages to care and treatment for all those testing HIV-positive will be emphasized. The program will further strengthen the People Living With HIV/AIDS (PHA) networks and groups and will utilize them to sustain the active referral systems between, communities and care and treatment services and "wrap around" activities for PLHAs available in the community. These linkages between households, communities and CT services will ensure that couples, children and adolescents receive CT services. The value of testing as couples and identification of discordant couples will be highlighted. Special focus too will be made to ensure that OVCs access HIV care and support through CT programs and use of pediatric HIV- positive clients to gain entry into household for CT will be ensured.

Monitoring and evaluation: AR will provide clinical management tools to ensure collection and compilation of data on counseling and testing program area to reinforce the SI capabilities at the LPTFs. This will enable sites to use CAREWare or IQCare for data entry, data validation and data analysis and continuous data quality improvement by engaging in on-going data cleaning and validation at the LPTFs. Thorough the strategic information systems in place the required accurate reports will be produced on a timely basis. These include Annual and quarterly CDC reports; OGAC/PEPFAR biannual report and any other report that may be requested by the LPTFs or MOH.

This program area also relates to activities in 8289-ARV Services, 8588-PMTCT, 8290-Laboratory, 8291-AB, 8292-Basic Health Care & Support, 8294-OVC, 8293-TB/HIV, 8584-PMTCT.

AIDSRelief (AR) is a comprehensive HIV care and treatment program, providing ARV drugs, preventive, palliative, curative, social and ARV services to HIV positive people, their families and communities. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AR is a consortium of five organizations with CRS as prime; Constella Futures Group and the Institute of Human Virology (IHV) providing technical assistance. AR works through 15 Local Partner Treatment Facilities (LPTFs), many of which are in rural and underserved areas.

Procurement of ARV drugs follows USG grant guidelines and National Drug Authority regulations and agrees with National Treatment Guidelines. AR's procurement system, encompasses cost effectiveness through global procurement orders & contracts with a regional pharmaceutical procurement company; local sustainability is supported through the Joint Medical Stores (JMS) for warehousing and distribution. AR substitutes innovator proprietary ARVs with FDA approved generic equivalents. Over 60% of drugs used in the program are generically bioequivalent. All the drugs are purchased at Access prices. For generics AR has negotiated prices even lower than those offered under the Clinton Foundation agreement with selected pharmaceutical companies. The Pharmaceutical Management team manages in-country operations with a Therapeutic Drug Committee (TDC) of clinicians, pharmacists, strategic information advisors and program managers. The TDC reviews drug utilization patterns across all LPTFs, assesses scale-up progress and develops required technical support plans. The TDC will be replicated at all LPTFs to ensure ARV SCM is clinically informed and logistically supported.

The Logistic Management Information System (LMIS) used, includes a web-based enterprise inventory and financial management system that allows drug tracking from procurement to dispensing, interfacing with the ART Dispensing Software developed by MSH RPMPlus Program installed at LPTFs. This permits continuous modulation of patient enrollment to reflect ARV availability and to ensure a guaranteed and continuous supply of drugs for each patient initiated on therapy.

Under COP07, AR Uganda will provide ARV drugs to maintain the 10,700 people started on treatment. AR estimates that an additional 5,000 patients across the 15 ART sites will not be able to access ARV drugs through this mechanism in the coming year because of limitatations in funding. ARV services are provided to additional 1300 patients on treatment with non-USG funded drugs making a total of 12,000 patients. The funding scenario under COP07 will only allow replacement of patients who have died or transferred to another program (March 2007-February 2008). AR will, however, also look into options of enrolling additional number of patients if at all possible. AR will continue to procure adult 1st line, alternative 1st line, and 2nd line therapies for both adults (9845) and children (855). Standard Operating Procedures (SOPs) have been developed in accordance with national guidelines that guide supply chain activities from product selection, forecasting, procurement and drug use monitoring. AR will ensure excellent supply chain management and uninterrupted ARV provision through local capacity building at critical points within the supply management chain. Emphasis will be made on strengthening all these systems, especially at LPTF level. AIDSRelief will also work closely with the Government of Uganda, the USG team in-country, and other partners and programs to harmonize and strengthen pharmaceutical supply chain systems.

IHV will participate in the periodic review of National Treatment Guidelines in order to assist in the selection of regimens most appropriate to the Ugandan context. Choice of regimen is guided by most recent evidence to ensure that the most effective & durable regimen available within the national guidelines with the best possible toxicity and resistance profile. Current choice of primary regimen for AR sites consists of Truvada (TVD) combined with Nevirapine (NVP) or Efavirenz (EFV).Kaletra and/or Combivir (AZT/3TC) will be substituted in case of toxicity or failure. Alternative regimens including Stavudine (D4T) and Lamivudine (3TC) are also procured to be used for patients with both renal insufficiency and anemia. The choice of regimen is based on the more favorable pharmacokinetic and safety profile and is supported by extensive clinical evidence. This is also designed to preserve optimal therapeutic choices for second line regimens.

AIDSRelief site activation process includes a 2- week on site program with both didactic and clinical preceptorship activities. AIDSRelief has and will continue to support its sites with frequent on-site mentoring, quarterly focus group meetings and access to a web based site on which difficult cases can be discussed. This process is designed to provide LPTFs with ongoing clinical technical assistance and to keep them abreast with the latest developments in the care of HIV patients.

This activity relates to 8288-ARV Drugs, 8584-PMTCT, 8290-Laboratory, 8291-Abstinence and Being faithful, 8292-Palliative Care; Basic Health Care & Support, 8293-Palliative care;TB/HIV, 8294-OVC, 8295-CT.

AIDSRelief (AR) is a comprehensive HIV CARE program, providing ARVs, preventive, curative, palliative care and ARV services to HIV positive people and their families. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AIDSRelief is a consortium of five organizations. Catholic Relief Services is the lead agency responsible for overall coordination and management of consortium activities, Constella Futures Group leads the Projects Strategic Information activities and the Institute of Human Virology guides and informs the establishment of treatment, adherence and care protocols. Based on its successes and lessons learned, the AIDSRelief program in Uganda will maintain 12,000 patients on ART. AR will also provide care services to 17,170 HIV positive patients. New patients will be added into the program based on treatment spaces" being opened if a patient dies or is transferred out of the AR program. Services will be offered through 15 Local Partner Treatment Facilities (LPTFs), distributed through out Uganda. The Children's Aid Fund is a sub-grantee supporting 5 of these sites AR has demonstrated considerable programmatic success to date. This has been verified through results from a quality assurance/quality improvement (QA/QI) set of activities which includes viral load testing from a 15% sample of patients who have been on therapy for longer that 9 months, plus chart abstractions and adherence questionnaires. Results indicate an overall viral suppression rate (< 400 copies/ml) of 86%. AR believes that its drug regimen and comprehensive program, especially strong LPTF mentorship/preceptorship, adherence and community activities have contributed towards this.

COP07 funding for the provision of ARV services at 15 LPTFs will support staff, laboratory reagents, medicines to treat opportunistic infections, other supplies, logistical support, quality assurance, Technical Assistance (TA), supervision, provision of infrastructure (as needed), and training of clinicians and other HIV care providers and community outreach. Training will be carried out through a mentorship/preceptorship model in the 15 LPTFs and will be directed at medical/clinical officers (59), nurses (67), adherence counselors (113) and the community workers. The results of the QA/QI have been shared with all LPTFs. In year 4 of the program, AIDSRelief will provide supportive supervision through hands-on preceptorship to continue to assist the LPTFs to developing the internal capacity to implement quality assurance and quality improvement on-site. This will include further viral load sampling for those patients who have been on treatment for longer than 9 months together with chart abstraction and an adherence questionnaire. AIDSRelief will help to create networks of providers among the LPTFs, and to link these facilities with other sites providing ART services. AIDSRelief will actively promote learning across LPTFs, through periodic web-based/CD learning in order to provide LPTFs with the most up to date HIV information. Those enrolled in care will be provided with Cotrimoxazole and treatment of OIs. Therapeutic feeding for severely malnourished HIV+ patients will be provided. LPTFs will be encouraged to form PLHA support groups. Sensitization of key community leaders will be key.

Had funding been available Year 4 was planned to be a growth year for the provision of pediatric and family centered services reaching an estimated 19,000 patients with treatment. Under the current funding scenario, patient treatment numbers will be maintained through replacement for those who have died or transferred out of the program. No additional children will be started on ART. AR will however strengthen skills among clinical staff in the areas of pediatric HIV knowledge and pediatric counseling. The AIDSRelief program will devote resources to developing strong adherence programs which has been demonstrated as a key component of good clinical outcomes. Adherence to ART is one of the critical factors to achieving durable viral suppression. The program will work to adapt existing, locally appropriate IEC and BCC materials, as well as to identify gaps in these media and develop materials as needed. In northern Uganda there are examples of hospital/CBO linkages which provide excellent adherence support at community level. AIDSRelief, because of its work through partners who are firmly embedded within communities has the ability to support increased capacity and involvement of communities. This would also have been an important and cost effective component of Year 4 activities had sufficient COP funds been made available.

Coordinated by Constella Futures (CF), Strategic Information (SI) activities incorporate program level reporting, enhancing the effectiveness and efficiency of both paper-based and computerized patient monitoring and management (PMM) systems, assuring data quality and continuous data quality improvement, and using SI for program decision making across LPTFs. AR has built a strong system using in-country networks and available technology at 15 LPTFs in COP06. AIDSRelief will carry out regular site visits and reviews to ensure continued quality data collection, data entry, data validation and analysis, dissemination of findings; data management & continuous quality improvement. This information will be used to provide the regular USG, OGAC and MOH reports as well as input to LPTF QA/QI activities.

Sustainability lies at the heart of the AR program. To date, AR, through its comprehensive programming, has been able to increase access to quality care and treatment, while simultaneously strengthening health facility systems themselves through human resource support, equipment, financial training and improvements in health management information. In addition, AR has strengthened referral linkages between health facilities themselves, and significantly among these facilities and their communities. In COP07 AR will further build on this foundation to work both at national network and LPTF levels to identify and begin to implement a sustainability plan for the future. The focus will be on building health care treatment networks where different services will be provided by different providers under the same geographic location. Focusing on building the institutional, technical, financial and political capacity of AIDSRelief sites will help create the conditions for the long term support to patients on treatment and care.

This program area also relates to activities in 8584-PMTCT, 8289-ARV Services, 8288-ARV Drugs, 8291-AB, 8292-Basic Health Care & Support, 8294-OVC, 8293-TB/HIV, 8584-PMTCT.

AIDSRelief (AR) is a comprehensive HIV Care and treatment program, providing ARV drugs, preventive, curative, palliative, social and ARV services to HIV positive people and their families. Its goal is to ensure that people living with HIV/AIDS have access to ART and high quality medical care. AR is a consortium of five organizations. Catholic Relief Services is the lead agency responsible for overall coordination and management of consortium activities, Constella Futures Group leads the Strategic Information component of the program whereas the Institute of Human Virology (IHV) guides and informs the establishment of treatment, adherence and care protocols. The Children Aids Fund is a sub-grantee supporting 5 sites. AR will offer services through 15 Local Partner Treatment Facilities (LPTFs), distributed through out Uganda. Based on its successes and lessons learned, the AR program in Uganda will continue to support laboratory services at all 15 sites. These services will be accessed by 12,000 patients on ART, and 17,170 patients receiving care through 15 LPTFs distributed throughout Uganda. In years 1, 2 and 3 of the program, LPTFs were provided with lab equipment accompanied by on site LPTF training of laboratory staff so that they are able to perform all baseline tests and diagnostic tests for opportunistic infections. In COP07 AR will continue to strengthen the laboratory capacity of the LPTFs so that they can effectively monitor parameters (CD4 count, hematocrit, liver and renal function tests, and diagnostic tests for OIs) related to the care of patients on ART and those waiting to initiate therapy. Training will emphasize standard operating procedures and quality control to ensure a safe working environment, personal safety and reliable laboratory test results. IHV will also provide assistance for an ongoing Quality Assurance/Quality Improvement process. A total of 34 laboratory personnel will be trained and will receive refresher courses. AR support to LPTFs will include procuring and shipping the necessary reagents for the tests to support the treatment of HIV infected patients (CD4 tests, cryptococal antigen, reagents for basic laboratory tests). It will also provide the tools and reference materials needed to monitor the OIs, and ARV drug toxicities. The program will work with the MOH and UGS teams to ensure that all procurement of equipment and reagents as well as trainings is in accordance with national guidelines. Linkages and referrals to other ART provider lab facilities will be strengthened. AIDSRelief will strengthen LPTFs laboratory capacity to diagnose HIV, TB, malaria and other opportunistic infections through provision of equipments and supplies. It will improve laboratory infrastructure of LPTFs by providing solar back up power, surge protectors, storage facilities, computerized record keeping, adequate man power and air conditioners.

AIDSRelief will provide support for viral load testing at certain of the LPTFs which have, or will shortly obtain, this capacity. AIDSRelief will provide clinical management tools to ensure collection and compilation of laboratory data for all HIV patients. Computers and related hardware that will enable computerization of all laboratory data will be provided. AR has also built a strong Project Monitoring and Management system using in-country networks and available technology at 15 LPTFs in COP06. In COP07, Constella Futures will carry out regular site visits and reviews to ensure continued quality data collection, data entry, data validation and analysis, dissemination of findings; data management & continuous quality improvement. Activities will include, ensuring collection and compilation of complete & valid Laboratory data; assuring collection and analysis of required indicators for quality laboratory reporting and monitoring as well as will include Technical Assistance for LPTFs.