This activity relates to 8313-Condoms and Other Prevention, 8315-Palliative Care; Basic Health Care and Support, 8317-Palliative Care; TB/HIV, 8318-ARV Drugs, 8319-ARV Services, 8320-Lab, 8321-OVC, 8316-CT.

Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing , 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment , 5) provision of HIV post- exposure prophylaxis , and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the Faculty of Medicine of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

MJAP has been providing prevention counseling including AB counseling through the HIV testing programs. Prevention counseling has also been integrated into the care and treatment programs and OVC interventions (counseling and life skills training). In the RTC program, couple testing is encouraged thus promoting disclosure and strengthening the B messages for couples. ‘A' messages are encouraged for single youth below 20 years. Family members who are tested through the HBHCT program also receive prevention counseling. Since November 2004, more than 5,000 children and youth have been served through the MJAP CT, care and treatment programs. We have provided HIV testing to over 1,500 couples, 19% of who were sero-discordant and 21% concordant negative.

In the next year (FY07), MJAP will strengthen the integration of AB activities into the existing programs. Through HBHCT program we will provide HIV counseling and testing to 2,000 households of index patients in care. We anticipate reaching 1,000 children and youth through the RTC program. The HBHCT and RTC programs will integrate AB activities. The AB activities will be integrated with other prevention to ensure a comprehensive HIV prevention package. Abstinence focused activities will primarily target children below 12 years while older children who are not sexually active will be targeted with age appropriate AB messages. Youths and older children who are sexually active

and/or married will also receive "B" messages and other prevention support including condom use, as appropriate. These will be reached through the HIV testing programs and the OVC services. The children will receive health education, counseling support and life skills training to enable them make informed choices. The B activities will also be integrated with couples counseling (in RTC and HBHCT) to encourage couples' HIV testing and mutual faithfulness to partners in concordant HIV negative partnerships. We will also integrate the entire spectrum of prevention activities within the care and treatment sites through the positive prevention and family planning interventions. The funding in this category will support the integration and strengthening of existing AB activities, support for personnel involved in AB activities, production and dissemination of IEC materials to support the AB programs, training of health care providers to integrate AB activities, improved data collection, reporting, and M&E. Requirements for HIV testing will be covered under the CT budget.

plus ups: Plus up funds will be used to develop IEC materials and training health workers to integrate AB messages during clinic talks and counselling sessions for couples and individual clients at Mulago STD clinic. Similar trainings will be extended to Community Educators to facilitate integration of AB messages in community STD/HIV education events

This activity relates to 8772-AB, 8315-Palliative Care;Basic Health Care and Support, 8317-Palliative Care;TB/HIV, 8316-CT, 8318-ARV Drugs, 8319-ARV Services, 8320-Lab, 8321-OVC. Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing , 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment , 5) provision of HIV post- exposure prophylaxis , and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the Faculty of Medicine of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

MJAP has integrated HIV prevention services into all the existing HIV counseling and testing, care and treatment interventions. We have integrated prevention with positives interventions into the HIV/AIDS clinics and the Routine HIV Testing and Counseling (RTC) units. All patients receive health education and prevention counseling, and are encouraged to disclose their HIV status to their partners. Partner HIV testing is also provided at all the HIV/AIDS clinics and RTC wards. Through the HIV testing programs, we provide couples' HIV testing, counseling support and condom provision for discordant couples. Over the past year, the program has provided HIV testing to more than 1,500 couples, 19% of who were sero-discordant. MJAP has also been engaged in activities to prevent HIV transmission in the health care setting. These include training of health care providers in universal precautions, development and distribution of IEC materials, assessment and provision of post-exposure prophylaxis for health care providers following exposure to infectious materials. To date, we have trained over 400 health care providers and provided post-exposure prophylaxis (PEP) to more than 70 health care providers in Mulago and Mbarara teaching hospitals.

In FY07 the program will continue to provide training for health care providers and provision of PEP in all the care and treatment sites that are supported by MJAP including three regional hospitals. We will strengthen the prevention with positives and family

planning activities in all clinics, and will involve People living with HIV/AIDS (PHAs) in prevention education and counseling for patients. We will also strengthen the support for discordant couples identified through the HIV testing programs. All HIV testing facilities and care and treatment sites will provide condoms to support the discordant couples, in addition to the prevention counseling. The ‘other prevention' budget will cover training, IEC materials, health education and support for the PHAs who will be involved in the prevention interventions. We will also improve on the data management, reporting and M&E for ‘other prevention' programs. The ARV drugs for PEP and supplies for HIV testing will be covered under the ART drugs and CT budgets. Training in PEP for Health care providers and service provision at the clinic sites will be continued. plus ups: Makerere Faculty of Madicine and the STD clinic in Mulago hospital will develop prevention intereventions that target Most at risk groups in Kampala including; commercial sex workers and their custromers, Truckers and bar atendant. The program will work with owners of bars and places of entertainment to establish condom distribution points. Targeted HIV/STI prevention and awareness activities will be conducted through outreach programs. Peer educators will be trained to provide basic HIV/STD information and refer clients for care and treatment. This approach will promote networking and referral between the the STD clinic and community groups. This model will be eveluated and documented to be replicated in other referral hospitals. In addition, the the STD clinic in Mulago will be upgraded to provide diagnostic services for selected STIs and training for health workers. The STD clinic is mandated with the provision of diagnostic, care, and treatment services for selected sexually transmitted infections, including HIV. STDs are a known risk factor for the acquisition and transmission of HIV, hence, diagnosing, counseling, and treating (non-HIV) STDs facilitates HIV prevention.

This activity relates to 8320-Lab, 8319-ARV services, 8318-ARV drugs, 8316-CT, 8321-OVC, 8317-alliative Care;TB/HIV, 8313-Condoms and Other Prevention, 8772-AB.

Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing; 2) provision of palliative HIV/AIDS basic care; 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients; 4) antiretroviral treatment; 5) provision of HIV post- exposure prophylaxis , and; 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually, 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both hospitals are public facilities that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and anti retroviral therapy in the Adult Infectious Diseases Clinic (AIDC) and at Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the Faculty of Medicine of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy; people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

MJAP palliative basic care activities are currently implemented at multiple service outlets including Mbarara ISS (HIV) clinic with more than 6,500 active patients, AIDC providing care for over 7,000 patients, Mulago and Mbarara hospital wards implementing RTC, and the satellites clinics of Mulago ISS (HIV) clinic, Mulago TB-HIV clinic, Kawempe, Naguru, Bwizibwera and Mbarara municipality health centers which have registered over 6,000 new patients in the past year. The number of HIV patients in all the clinics continues to increase with the expansion of RTC in the hospitals (over 25,000 HIV infected individuals have been identified through RTC since November 2004). By March 2007, 10 clinics will be operational providing palliative basic care. The palliative basic care programs include provision of a package comprising cotrimoxazole for prophylaxis, insecticide treated mosquito nets, safe water vessels for clean water provision, diagnosis and treatment of malaria and other opportunistic infection (OI) treatment and prophylaxis. All patients attending the HIV clinics receive daily cotrimoxazole for prophylaxis. Newly diagnosed HIV positive patients from the RTC program also receive a month's supply of cotrimoxazole prophylaxis and are provided with referrals for follow-up care in the HIV clinics. The AIDC and Mbarara ISS clinics provide care for adult patients while children receive care from the Mulago Pediatric Infectious Diseases Clinic (PIDC) and Mbarara pediatric HIV clinics. However, in the satellite clinics MJAP collaborates with other partners to provide comprehensive HIV care to entire families, including children in collaboration with

Baylor-PIDC, Kampala City Council (KCC), Ministry of Health , NTLP and other partners. KCC provides clinic space and drugs for management of OIs. NTLP provides TB medications and support supervision. Other existing HIV programs including VCT under AIDS Information Center (AIC), PMTCT under PREFA, ART under MOH-Global Fund Program, OVC support through Ministry of Gender, Labour and Social Development (MoGLSD). These programs are working together to ensure comprehensive care for families affected by HIV/AIDS while avoiding duplication of services. Up to 20,000 individuals in the MJAP supported outlets are provided with care including prophylaxis and treatment of OIs. More than 7,500 have received safe water vessels and insecticide treated mosquito nets. The program also trained over 300 health care providers in HIV/AIDS care over the past year.

In FY07, two additional satellite care and treatment sites will be opened in collaboration with the Infectious Disease Institute (IDI) bringing the total to 12 sites. MJAP's aim is to increase access to basic HIV palliative care from the current 20,000 individuals to 40,000 at 10 sites. MJAP will provide cotrimoxazole prophylaxis and other OI care, malaria diagnosis and treatment, and Population Services International (PSI) will provide safe water vessels and supplies and insecticide treated bed nets. The basic care and ART programs are integrated; all patients recieve basic care and are evaluated for ART eligibility regularly. The funding will support the existing 10 and 2 new clinics in terms of basic care supplies, and other OI treatment and prophylaxis. In FY07, as MJAP extends RTC services to three regional referral hospitals, all newly diagnosed HIV positive patients in these hospitals will also receive a month's supply of cotrimoxazole before referral for follow-up palliative care and treatment. The program will hire additional staff to support care and prevention efforts, provide training for new and existing staff in the clinics (400 health care providers will be trained in the coming year), data management/M&E, quality assurance and support supervision, and enhance the existing referral systems between the main HIV clinics and the satellite clinics, and linkage to care for newly diagnosed HIV patients.

This activity relates to 8320-Lab, 8319-ARV services, 8318-ARV drugs, 8316-CT, 8321-OVC, 8315-Palliative Care;Basic Health Care and Support, 8313-Condoms and Other Prevention, 8772-AB.

In 2004 Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" . The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy Program (NTLP), and leverages resources from the Global Fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing, 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment, 5) provision of HIV post-exposure prophylaxis, and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually, 3,000 health care providers are trained and about one million patients are seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in-and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. From June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda MOH, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the FOM with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI, health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

MJAP supports a TB screening program that is integrated with the RTC program within Mulago and Mbarara hospitals. All patients with a history of cough for more than three weeks are screened for TB using sputum smear microscopy and all patients who get tested for TB also get testing for HIV. Patients attending the 10 MJAP supported HIV clinics are also regularly screened for TB. Since February 2005, over 6,500 individuals have been screened for TB and more than 1,500 (22%) sputum smear positive patients started on TB therapy. Additionally, more than 1,000 patients have received TB/HIV treatment in the main HIV care centers in Mulago and Mbarara (AIDC and Mbarara HIV clinic). TB screening and treatment are done in collaboration with the MOH-NTLP. The MOH-NTLP supplies free TB medications in both TB and HIV clinics. MOH-NTLP has established a special TB-HIV clinic in Mulago that provides care for TB-HIV co-infected patients. In this clinic, TB/HIV patients receive TB treatment, HIV palliative and basic care, and initiation of ART if eligible. After completion of TB treatment, these patients are referred for follow-up HIV care in the other established clinics. The TB-HIV clinic has provided care for more than 300 adult TB-HIV patients since September 2005, 75 of who are also receiving antiretroviral therapy in addtion, children receive care from the Pediatric Infectious Diseases Clinic - PIDC and the Mbarara pediatric HIV clinic. TB treatment has been integrated into all the other care and treatment sites.

In the next year (FY07), two new satellite care and treatment sites will be opened in collaboration with IDI. The integrated RTC-TB screening program will also be expanded to 3 MOH regional referral hospitals. This funding will support expansion TB screening in hospital wards and clinics, and integrated TB-HIV care and treatment in all 12 MJAP supported HIV clinics. We will procure supplies for TB diagnosis to augment the NTLP supplies, and improve on the systems for delivery of integrated TB-HIV services (logistics management, laboratory quality assurance, data management and M&E, and referral systems for TB-HIV infected patients. The aim is to screen 20,000 patients for TB and provide TB-HIV care to 1,500 TB-HIV co-infected patients in the coming year. The budget will cover TB microscopy supplies, chest X rays and logistics, human resources for TB-HIV care, and quality assurance and support supervision. The program will hire and train additional and existing staff at the clinics; 200 health care providers will receive training in delivery of TB-HIV diagnosis, care and treatment. The funding will also support data management and M&E. The HIV testing, care and treatment supplies will be covered under the care, treatment and CT budgets. The program will target both adults and children in all the clinics and hospitals.

Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: HIV testing through hospital-based routine HIV testing and counseling (RTC) and home-based counseling and testing (HBCT); provision of palliative HIV/AIDS basic care; provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients; antiretroviral treatment; provision of HIV post- exposure prophylaxis; and, capacity building for HIV prevention and care through training of health care providers, strengthening laboratory services, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate to train clinicians and provide services. Annually 3,000 health care providers are trained and one million patients seen in the two hospitals, both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in these two hospitals are because of HIV infection and related complications. Between June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. These are: ISS clinic, Kawempe and Naguru Health Center IVs, Mbarara municipality clinic), Bwizibwera Health Center IV and, Mulago TB/HIV clinic. The satellite clinic activities are implemented in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. In FY06 MJAP is working to fully integrate TB-HIV at the Jinga Regional Referral Hospital to include diagnosis of TB and HIV infections among in- and out-patients through integrated routine HIV testing and counseling and TB diagnosis, with linkage to care and treatment for infected individuals. All patients attending high prevalence clinics and wards will routinely be offered HIV testing and screening for TB. The TB screening will be conducted at several levels beginning with clinical evaluation to investigations including sputum smear microscopy, CXR and mantoux, as appropriate. These activities will be integrated into the existing care and treatment services in the hospital. Patients attending the HIV clinic in Jinja Hospital will also routinely be screened for TB. In collaboration with MOH and NTLP and following the new HIV/TB integration policy and guidelines, MJAP will revise the Jinja Hospital guidelines and training materials for the delivery of integrated TB-HIV diagnosis, care and treatment, and will provide training for health care providers. 10,000 individuals will be tested for HIV inclusive of TB infected patients, and 2,000 HIV-infected patients will be screened for TB. The MOH-NTLP will provide some supplies for TB screening and free TB medications; and cotrimoxazole prophylaxis will be initiated in all newly diagnosed HIV infected patients (including those who are co-infected with TB) before referral for follow-up care and treatment.

In FY07, MJAP plans to extend these HIV/TB services to three additional regional referral hospitals and leverage RTC funds to provide integrated and expanded TB diagnosis-RTC. This will increase the number of regional referral hospitals providing integrated TB diagnosis-RTC activities from one to four in FY07. MJAP will complete revision of the TB-HIV training curriculum and materials, and scale-up the training of health care providers in all the four hospitals. Also in FY07, Isoniazid Preventive Therapy (IPT) activities will be piloted in one site (Mulago HIV/AIDS clinic) and will be scaled up to other sites after an assessment of several parameters including patient follow-up, monitoring, adherence rates and support mechanisms, and side effects to INH. IPT will be given to patients with latent infection of mycobacterium tuberculosis. Additionally, MJAP will develop/update current guidelines for provision of IPT and IEC materials for patient education; the data management system will be finalized, health care providers will be trained in the provision of IPT; and IPT will be provided to HIV-infected patients according to the recommended WHO and MOH/NTLP guidelines. This funding will also support expansion of the TB screening and HIV testing in selected hospital wards and clinics and provided comprehensive TB-HIV care and treatment in the HIV clinics at the four regional referral hospitals.

plus ups: Funding will be used to scale up TB/HIV integration activities to 3 more regional sites and to strengthen the referral mechanisms to lower level facilities in these regions including the CD-DOTS for TB. This will include support to the regional staff to conduct supervision to the lower level facilities. In colaboration with the National TB program the regional referral hospitals and lower health facilities will be trained in TB/HIV care and treatment. Service delivery sites will be facilitated to institute TB infection control plans and activities. Laboratory support will be provided incuding diagnostic supplies and equipment for TB diagnosis and training in logistics management. Some funding will be designated for role out of TB microscopy training to be conducted jointly by NRTL and CPHL. With the plus up funds an additional 200 HIV infected clients attending HIV care and treatment will receiveTB treatment.

This activity relates to 8320-Lab, 8319-ARV services, 8318-ARV drugs, 8316-CT, 8317-Palliative Care;TB/HIV, 8315-Palliative Care;Basic Health Care & Support, 8772-AB, 8313-Condoms and Other Prevention.

Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing , 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment , 5) provision of HIV post- exposure prophylaxis , and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the Faculty of Medicine of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

OVC activities have been integrated into all MJAP programs. The MJAP RTC program provides HIV testing to children in four pediatric wards (three in Mulago and one in Mbarara hospital). The current program also provides C&T to family members of patients in the hospital, including children of HIV infected patients. In order to extend the reach of counseling and testing to family members, the program provides home-based HIV counseling and testing (HBHCT) for index ART patients in Bwizibwera and Kawempe health centers. The program hired four social workers (two based in Mulago and two in Mbarara). These work closely with health care providers in the HIV/AIDS clinics and the C&T providers to identify families of OVC from among the patients receiving care within the clinics or those receiving C&T. Limited home visits are conducted in order to provide counseling to the families (these are restricted to families within a 20km radius of the targeted facilities and are integrated into the HBHCT program). Through these activities, over 3,000 children have received HIV testing (17% of who were HIV-infected) and more than 1,000 households of index HIV positive patients have been visited. In the satellite clinics, MJAP provides family-base HIV care and treatment and OVCs and their caretakers receive services through this intervention.

In the next year (FY07), the program will continue to provide HIV testing, care and

treatment to OVCs and their caretakers. Through HBHCT, program we will provide C&T to 2,000 households (10,000 family members) of index patients in care. The HBHCT program will fully integrate OVC activities. HIV basic care including cotrimoxazole prophylaxis, provision of insecticide treated mosquito nets and safe water vessels will be initiated for HIV positive OVC and their care takers and referrals for follow up care to the HIV/AIDS clinics either directly supported by MJAP or other programs. Referral linkages with other OVC service providers will be strengthened for other OVC services including ongoing psychosocial support and counseling, vocational and life skills training, legal support, educational and nutritional support, and income generating activities. Through these programs we hope to reach 4,000 OVCs and their caretakers. The OVC budget will cover personnel who will provide OVC services, counseling, development of referral networks and linkage to other OVC services. The program will also train providers in the clinics and C&T services to enable them initiate and provide referral for OVC services; 200 OVC care givers will be trained in FY07. Other requirements for OVC care and treatment will be covered under palliative care; basic care and support, ART services, ART drugs, ART laboratory services and CT budgets.

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, address nutritional needs, counselling for themselves and their families from skilled providers and link them to other OVC services in their communities. Improving and expanding palliative care provision for HIV+ve children is a critical service. MJAP through its rural sites in Mbarara and Jinja, 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 familie, relevant immunizations, address children's nutritional needs through nutritional counseling and supplements. Providers will actively link these children and their families to other community based OVC services in their catchment areas and conversely the faciliteis will provide HIV palliative care services to the OVC referred from CSOs within their areas. With this intervention, the vulnerable HIV+ve children will receive more integrated OVC services.

This activity also complements activities 8320-Lab, 8319-ARV Services, 8318-ARV Drugs, 8321-OVC, 8317-TB/HIV, 8315-Basic Health Care & Support, 8313-Condoms and Other Prevention, 8772-AB.

Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing , 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment , 5) provision of HIV post- exposure prophylaxis , and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the Faculty of Medicine of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

MJAP implemented the first RTC program in Uganda and contributed towards the revision of the national HIV counseling and testing policy and development of training materials. The program has trained over 1,000 health care providers in Mulago and Mbarara hospitals in the provision of RTC. Since November 2004, the RTC program has expanded from six to 32 hospital units (19 in Mulago and 13 in Mbarara). Cumulatively, more than 100,000 in- and outpatients have received HIV testing and over 25,000 HIV infected individuals identified and linked to care and treatment. The current unit coverage represents 90% in Mbarara. Although the unit coverage in Mulago is 40%, over 90% of the high prevalence units provide RTC. The RTC program is implemented in line with the three C's - confidentiality, informed consent (opt out) and counseling/information, as recommended by WHO. Care for identified HIV positive patients is initiated at the time of diagnosis; all HIV positive patients receive cotrimoxazole prophylaxis, and TB screening is provided for all patients with history of cough for more than 3 weeks irrespective of the HIV status. HIV positive patients are also referred for follow-up care in the HIV clinics where they receive basic HIV care, psychosocial support and ART. For patients found to HIV negative, HIV prevention messages are emphasized to reduce risk of infection. The program also offers HIV testing to family members of patients in the hospital and has found a high HIV prevalence (26%) among these. In order to extend the reach of HIV

testing to family members, MJAP provides home-based HIV counseling and testing (HBHCT) for index ART patients attending Bwizibwera and Kawempe health centers. In HBHCT, HIV C&T is offered in the homes. HIV testing for family members of HIV positive patients identifies other HIV infected individuals in their households, facilitates partner disclosure and testing and identifies many discordant couples. Additionally, testing of family members encourages early entry into care and support for the HIV infected individuals.

In FY07, MJAP will extend RTC services to three MOH regional referral hospitals, in addition to expansion of RTC coverage in Mulago and Mbarara hospitals to ensure 100% coverage of high prevalence units. The program will establish 12 new sites in the 3 regional hospitals (4 in each). The regional hospitals will be selected in collaboration with the MOH. The target is to provide HIV testing to a minimum of 150,000 individuals by March 2008. In the RTC units, all patients with undocumented HIV status will be routinely offered HIV testing but this will not preclude the right to opt-out of testing. The program will target all categories of patients and family members; including adults, infants, children, health care workers, and MJAP program staff. Through the HBHCT program, MJAP will provide HIV C&T to 2,000 households (10,000 family members) of index patients in care. Newly diagnosed HIV positive patients will receive a month's supply of cotrimoxazole before referral for follow-up palliative care and treatment. The program will integrate TB screening for all newly diagnosed HIV-infected patients. MJAP will strengthen prevention with positives counseling and support including HIV testing for spouses of patients in the HIV clinics and RTC wards. A new activity, ‘Discordant couples' clubs will be piloted at two sites in the coming year to enhance prevention with positives focusing on peer education and support. The MJAP program will strengthen linkages with other HIV/AIDS care programs to improve referral of identified HIV/AIDS patients. The funds will cover HIV testing supplies, logistics, quality assurance for HIV testing and counseling, support supervision and referral linkages for identified HIV positive patients. The program will also provide training for at least 400 health workers in RTC provision. This will ensure participation of health workers in provision of RTC and will facilitate integration of RTC into routine hospital activities. The program will hire and train additional staff to support RTC in understaffed units and to provide HBHCT. The funding will also go towards quality assurance and support supervision, data management and monitoring and evaluation (M&E).

This activity relates to 8316-CT, 8317-Palliative care; TB-HIV, 8315-Palliative care; Basic Health Care and Support, 8319-ART services, 8320-Lab, 8321-OVC , 8313-OP, 8772-AB. Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing , 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment , 5) provision of HIV post- exposure prophylaxis , and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-Dec 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda MoH and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the FoM of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

Currently, MJAP procures and distributes ARV drugs for 8 service outlets including Mbarara ISS clinic, AIDC, Mulago ISS clinic, Mulago TB-HIV clinic, Kawempe, Naguru, Bwizibwera and Mbarara municipality health centers. The 8 service outlets currently attend to up to 20,000 patients in care, 2,100 of who have their ARV drugs procured through MJAP funding (900 at AIDC, 600 in Mbarara ISS clinic, 200 in Mulago ISS clinic, 150 in Mbarara municipality clinic, 100 in Kawempe KCC, 100 in Bwizibwera HCIV, and 50 in Naguru KCC (by June 2006). An additional two satellite HIV/AIDS clinics will be established within Kampala district by March 2007 in collaboration with IDI and KCC increasing the target to 2600. The demand for ART in the clinics continues to increase with the expansion of RTC in the hospitals. Majority of HIV positive patients identified through the RTC program (70%) need ARVs (WHO Stages 3 and 4). It is estimated that an additional 5,000 patients who are eligible for ART at the 8 service outlets supported by MJAP will not be able to access ARV drugs through this mechanism in FY07 due to funding constraints. Currently, we estimate that only 50% of clinically eligible patients are receiving ART at the clinic sites. MJAP has trained over 300 health care providers in the provision of antiretroviral therapy and strengthened systems for ART delivery including staffing, laboratory support, logistics and data management. As a result of the capacity building of lower level clinics within the catchment's areas of Mulago and Mbarara for HIV care by MJAP, an additional >6000 patients are able to access ARV drugs from MOH/MAP/GFATM at the MJAP supported

sites. In the past year, due to ARV drug procurement interruptions for GF, MJAP supported the procurement of 3 months' buffer stock for up to an estimated 2000 of these patients attending Mbarara.

In the next year, two new satellite care and treatment sites will be opened in collaboration with IDI, bringing the total to 12 sites. As a result of increased availability of less expensive FDA approved generics in-country, the MJAP program will switch from the branded ARVs to the FDA approved generic ARVs to reduce costs and double the number of individuals receiving ARV drugs from 2,600 to >5000 by March 2008. Allocation of the slots across the 12 sites in FY07 will be done according to patient numbers and ART requirements in the facilities. MJAP will hire and train additional and existing staff to enhance care in the clinics - 200 health care providers will receive training in ART delivery. Training is both for program clinics and other national needs. Health care providers in three regional referral hospitals will also receive training in HIV care and treatment. Training will ensure quality of services and continued access to GFATM at the sites for eligible patients. The program will target mainly adult patients receiving care from all the clinics (children receive ART from the Pediatrics Infectious Diseases Clinic - PIDC, and the Mbarara pediatric HIV clinic) but will also include some children in the satellite clinics. The funding for ART drugs will go towards the purchase of ARVs (including 3 months buffer for Global fund clients), logistics and ARV drug distribution and tracking. MJAP ARV procurement through Medical Access will be maintained. Forecasting is done for the whole year but purchase of drugs including three months buffer stock for each patient is done on a quarterly basis. Drugs are delivered by Medical Access, checked and received by the program pharmacist and store keeper before storage. An entry is made into the goods received note (GRN) for all drug items received. Stocktaking and reporting is done monthly at the points of service.

*Expansion of ARV treatment to eligible patients currently in care and those identified through the expanded HIV CT. Over 2,000 new HIV cases are identified monthly through this program and the majority of these are ART eligible. The program leverages resources for MOH/GF by providing capacity building for ARV service provision at 10 MOH sites. In the past year, the sites have experienced stock-outs for ARVs procured through GF. The program will support procurement of ARV buffer stock for GF clients attending these clinics and provide the lab services for these clients.

This activity relates to 8320-Lab, 8318-ARV drugs, 8316-CT, 8321-OVC, 8317-Palliative Care;TB/HIV, 8315-Palliative Care;Basic Health Care and Support, 8313-OP, 8772-AB.

Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing , 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment , 5) provision of HIV post- exposure prophylaxis , and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-Dec 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the FOM of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

Currently, the MJAP ARV services' activities are implemented at 8 outlets. The 8 service outlets currently attend to up to 20,000 patients in care, 7000 of who are on ART (35%) - 3,556 at AIDC, 2,610 in Mbarara ISS clinic, >487 in Mulago ISS clinic, >62 in Mulago TB/HIV, >159 in Mbarara municipality clinic, >182 in Kawempe KCC, >55 in Bwizibwera HCIV, and>98 in Naguru KCC (an estimated 6000 of these receive ARV drugs through Global fund support). (data for June 2006). Two additional satellite HIV/AIDS clinics will be established within Kampala district in FY06 in collaboration IDI and KCC. The number of HIV patients in the clinics continues to increase with the expansion of RTC in the hospitals. The AIDC and Mbarara ISS clinics provide care for adult patients (children receive care from the Pediatric Infectious Diseases Clinic - PIDC and Mbarara pediatric ISS clinics). However, in the satellite clinics MJAP collaborates with other partners to provide comprehensive HIV care to families, including children. The demand for ART is very high in all the care and treatment sites. Majority of HIV positive patients identified through the RTC program (70%) need ARVs (WHO Stages 3 and 4). Patients undergo orientation to prepare them for ART. Patients who fulfill the eligibility criteria receive a second orientation meeting with their treatment supporter. ARVs are initiated on the third visit if the medical officer is satisfied that the patient is ready to begin therapy. Patients are seen by the adherence nurse counselor on day 0, day 15, 1 month and then monthly for counseling and ARV refills. Adherence to ARVs is monitored by self report using a visual

analogue scale, pharmacy records, ART patient cards and pill counts (patients return the bottles with any remaining pills). In both Mulago and Mbarara AIDS clinics, we estimate that only 50% of clinically eligible patients are receiving ART although the majority(70%) of HIV infected persons identified in the ongoing RTC program are eligible for ART. MJAP has trained over 300 health care providers in the provision of antiretroviral therapy and strengthened systems for ART delivery including staffing, laboratory support, logistics and data management. In FY06 the program will provide ARVs services to > 9,000 including 6,000 patients who receive ARVs from MOH in terms of staffing, laboratory monitoring, and other drugs.

In the next year, two new satellite care and treatment sites will be opened in collaboration with IDI, bringing the total to 12 sites. MJAP will provide ARV services to >15,000 patients by March 2008 (including 10,000 patients in the 12 clinics who will access ARV drugs from Global Fund - Ministry of Health). Funds will go towards additional staffing and training of new and existing staff. MJAP will strengthen prevention with positives counseling and support including HIV testing for spouses of patients in the HIV clinics. The program will reinforce adherence counseling and support, and follow-up of ART patients. MJAP will hire and train additional and existing staff and up to 200 health care providers will receive training in ART delivery. The program will strengthen ART patient tracking and adherence support; enhance ART treatment and HIV prevention integration in the clinics, promote prevention with positives activities and involvement of PHAs in patients care and support. The program will provide care for adult patients in AIDC and Mbarara ISS clinics (children receive ART from the Pediatrics Infectious Diseases Clinic - PIDC, and the Mbarara pediatric HIV clinic). In the satellite clinics, MJAP will provide comprehensive HIV/AIDS care and treatment for families including children in partnership with other programs. The funding for ART services will go towards the hiring and training of health care providers, PHAS and other support staff, initiation and follow-up of patients on ART, quality assurance, support supervision, and M&E.

*Expansion of ARV treatment for eligible patients currently in care and those id'd through expanded HIV CT. The program leverages resources for MOH/GF by providing capacity building for ARV service provision at 10 MOH sites. The sites experienced stock-outs of ARVs procured through GF last year. Support procurement of ARV buffer stock for GF clients attending these clinics and provide lab services for these clients.

This activity also relates to 8316-CT, 8317-Palliative care; TB-HIV, 8315-Palliative Care; Basic Health Care and Support, 8318-ART drugs, 8319-ART services, 8321-OVC 8313-Condoms and Other Prevention, 8772-AB. Makerere University Faculty of Medicine (FOM) was awarded a cooperative agreement titled "Provision of Routine HIV Testing, Counseling, Basic Care and Antiretroviral Therapy at Teaching Hospitals in the Republic of Uganda" in 2004. The program named "Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP) is implementing comprehensive HIV programs in Uganda's two major teaching hospitals (Mulago and Mbarara) and their catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH). MJAP also collaborates with the National Tuberculosis and Leprosy program (NTLP), and leverages resources from the Global fund (GFATM). The program provides a range of HIV/AIDS services including: 1) HIV testing through hospital-based routine HIV testing and counseling (RTC) in addition to home-based HIV testing , 2) provision of palliative HIV/AIDS basic care, 3) provision of integrated TB-HIV diagnosis with treatment of TB-HIV co-infected patients, 4) antiretroviral treatment , 5) provision of HIV post- exposure prophylaxis , and 6) capacity building for HIV prevention and care through training of health care providers, laboratory strengthening, and establishment of satellite HIV clinics. Mulago and Mbarara hospitals are tertiary referral institutions with a mandate of training, service-provision and research. Annually 3,000 health care providers are trained and about one million patients seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and outpatients for Mbarara). Both are public hospitals that largely provide care for the poor. Approximately 60% of medical admissions in both hospitals are because of HIV infection and related complications. Between June-December 2005, the program expanded its clinical activities by partnering with other institutions to establish 6 satellite HIV/AIDS clinics in order to provide care for the large number of HIV patients identified through the RTC program. The six satellite clinics include Mulago hospital ISS clinic, Kawempe and Naguru (under Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV (under the Uganda Ministry of Health and Mbarara local government) and Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. The satellite clinic activities are done in collaboration with several partners including KCC, Mbarara Municipal Council, Baylor-Paediatric Infectious Disease Clinic (PIDC), Protection of Families against AIDS (PREFA), the Uganda Ministry of Health, and other partners. In addition to the satellite clinics, the program supports basic care and ART in the Adult Infectious Diseases Clinic (AIDC) and Mbarara HIV (ISS) clinic. By March 2007, two additional satellite HIV/AIDS clinics will be established within Kampala district in collaboration with the Infectious Diseases Institute (IDI) and KCC. IDI is an independent institute within the Faculty of Medicine of Makerere University with a mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care including ART at the AIDC (the IDI clinic is integral with Mulago Teaching Hospital).

Currently, the MJAP ART activities are implemented at 8 outlets including Mbarara ISS clinic, Adult Infectious Diseases Clinic (AIDC), Mulago ISS clinic, Mulago TB-HIV clinic, Kawempe, Naguru, Bwizibwera and Mbarara municipality health centers. An additional two satellite HIV/AIDS clinics will be established within Kampala district by March 2007 in collaboration with IDI and KCC. Up to 20,000 patients are accessing lab services through MJAP support at the 8 operational sites (AIDC- >7,000, Mbarara ISS -6500, and across the 6 satellite clinics- > 6000. The number of HIV patients in the clinics continues to increase with the expansion of RTC in the hospitals. In FY06, MJAP strengthened the Mulago and Mbarara laboratory infrastructure. The program procured a facs calibur for the Mulago hospital laboratory; the machine supports CD4 testing for five Kampala based HIV care and treatment sites and has significantly reduced the costs for CD4 testing. MJAP also procured a haematology and chemistry machine, two ELISA machines for HIV testing and microscopes for TB and malaria diagnosis. MJAP provides supplies and maintenance of all the equipment. The Elisa testing for in-patients has reduced demand for rapid HIV test kits. MJAP has also trained over 50 laboratory technicians and hired additional staff to enhance HIV diagnosis and laboratory monitoring for patients on treatment. In Mbarara, collaboration with TASO has ensured ART lab monitoring for the Mbarara satellite care and treatment sites. TASO operates a fully equipped regional lab at Mbarara able to perform CD4 testing and support other basic HIV related lab testing.

In the next year (FY07), two new satellite care and treatment sites will be opened and RTC-TB diagnosis will expand to 3 regional referral hospitals. MJAP will provide ART lab screening and monitoring support to > 15,000 (10,000 accessing Global Fund ARV drug support). Funds will go towards additional staffing, training and support for laboratory monitoring including CD4 counts. Our aim is to have 12 units with capacity to provide HIV testing malaria diagnosis, TB sputum microscopy, syphilis testing, and to improve capacity of the two hospital laboratories (Mulago and Mbarara) in CD4 and lymphocyte counts and chemistry (liver and renal function tests). We will also equip the laboratories in the three regional referral hospitals to provide HIV testing and TB sputum microscopy as the RTC-TB diagnosis program expands. The program will train new and existing staff to support the laboratories - 50 people will be trained in the coming year. This program will strengthen the laboratory infrastructure in Mulago and Mbarara teaching hospitals in order to provide quality ART services at the two hospitals, and the satellite clinics including adults and children. The laboratory funding will cover the purchase of equipment and supplies, recruitment of additional personnel, training of new and existing laboratory staff, and will enhance laboratory quality assurance systems. In Mbarara hospital, MJAP will collaborate with partners including JCRC and the Italian cooperation who are also providing laboratory support to the hospital, to ensure existing gaps are filled without duplication of activities, and access by all patients who require these services.