This activity also relates to activities in 8340-AB, 8342-CT, 8343-Basic Health Care & Support, 8346-ARV Services, 8344-Injection Safety, 8347-Laboratory Infrastructure, 8345-Strategic Information, 8348-Other Policy.

The program area in Phase 1 (2001-2005), focused on scaling up basic PMTCT services to all Uganda's former 56 districts. Phase II (2006-2010) focuses on the revised national PMTCT policy, supporting the holistic implementation of the four-pronged PMTCT strategy (primary prevention; family planning; provision of ARV prophylaxis; care and support) and includes the consolidation of services to increase uptake, male involvement, strengthening of family planning services, improvement of comprehensive care for HIV positive women, their spouses and their exposed children through early HIV diagnosis and linkages to care. This activity supports and relates to broader activities of scaling up and strengthening HIV/AIDS prevention, care, support and treatment in Uganda as part of the National Minimum Health Care Package outlined in the second phase of the Health Sector Strategic Plan (2006-2010) and the National Strategic Framework for HIV/AIDS Control in Uganda (2006-2010) with emphasis on increasing access to quality HIV prevention, care and treatment services. The Programme for Prevention of Mother to Child HIV transmission contributes to the Millennium Development Goal to reverse and halt the spread of HIV/AIDS by 2015.

The Ministry of Health has continued to expand access to PMTCT services and improve quality of services provided. A total of 340 health facilities were providing PMTCT services in FY06 with support from USG and other partners. In terms of geographical coverage 85% of the 56 districts PMTCT services at all Health centre IVs ( i.e. county level). The PMTCT statistics show that in FYO6 with support from USG and other partners 244,956 pregnant women were tested , 19,509 (7.96%) tested HIV positive. Among those who tested HIV-positive, 12,353 mothers and 8,202 babies received ARV prophylaxis. With support from USG capacity building in the area of PMTCT was conducted as follows, 225 health workers were trained in PMTCT, (150 in strategies for PMTCT, 50 in infant feeding and 25 in counselling for PMTCT service provision). District HIV focal persons in 13 districts were trained on supervision of PMTCT services and guidelines on priority PMTCT communication interventions for year 2005/2006, infant and young Child feeding and male involvement were developed. This support also streamlined Quality Assurance and co-ordination through technical support supervision to 13 districts, facilitated co-ordination meetings in four regions of the country and facilitated review of drafted guidelines for quality assurance of rapid HIV testing. Other accomplishments included finalization and printing of strategy for early diagnosis of HIV among infants and young children, and guidelines for health workers on early HIV diagnosis and care for infants and young children; sensitization of district officials on programme for early diagnosis of HIV among infants; training of health workers in 11 health units in collection of dry blood spots for PCR testing.

During fiscal year 2007, this activity aims at strengthening capacity for delivery of PMTCT services in line with the HSSP II and revised PMTCT policy 2006 - 2010. Overall activities in the FY07 target is to reach 25% of HC III, to provide counseling and testing to 95% of pregnant women through routine opt out approach, to reach 80% prophylaxis coverage for mothers and 65% for babies, and to start offering short course AZT in addition to intra-partum single-dose nevirapine (SD-NVP) as an improved PMTCT prophylaxis as stipulated in the revised PMTCT policy. This will include;

Review/update, printing and dissemination of guidelines, training manuals and job aids for overall PMTCT implementation and counselling to streamline flow of clients in ANC to support implementation of routine HIV counselling and testing with opt out. Printing additional copies of the revised training package on PMTCT strategies (training manual, Participants Booklet and Presentation Graphics) and infant feeding training manual.

Conducting refresher training for trainers and follow up training for tutors on the revised materials and the integration of PMTCT and infant feeding into pre-service training of medical and paramedical staff will be pursued.

Expansion of services to HC IIIs and building capacity for implementation of the revised PMTCT policy including giving more effective regimens (AZT+SD NVP PMTCT) for prophylaxis. The MoH seeks support to implement this in 6 districts. Hospital

administrators and health workers will also be sensitized on BFHI.

Support the integration of family planning education into the PMTCT pretest counseling.

Review the Psychosocial support strategy and build consensus on modalities for its implementation

Male involvement will be promoted through the family centered model for HIV care through PMTCT and reproductive health in general. This strategy proposes to use HIV negative pregnant women to access Counseling and testing to their male spouses and link them to other reproductive services.

In keeping with the strategy for early HIV diagnosis and care among infants and young children, the early infant diagnosis program which began in FY06 will be strengthened and expanded with a goal to reach 3,000 infants in FY07. This will include training, supervision and M and E

To continue to support the evaluation of safe infant feeding strategies for HIV-positive mothers including modified counseling strategies and the use of animal milk in selected sites.

Strengthen integration of PMTCT into care and treatment programs.

Peer support groups for PMTCT clients will be established through the involvement of NGOs, CBOs, FBOs and the private sector. This will also include support to HIV negative pregnant women and their spouses to remain HIV negative.

National level program coordination and supervision will be supported to improve quality assurance of PMTCT services. The monitoring and evaluation system will be strengthened through the involvement of regional supervision teams and district medical offices. Key PMTCT indicators have now been integrated into the HMIS and ANC registers will be revised to include other indicators for PMTCT. Records staff will also be trained on use of updated registers.

Conduct targeted evaluations in collaboration with the partners on the acceptability, accessibility and feasibility of early infant testing and the updated AZT-NVP PMTCT protocol.

This activity also relates to 8341-PMTCT, 8342-CT, 8343-Palliative Care;Basic Health Care & Support, 8346-ARV Services, 8344-Injection Safety, 8347-Lab, 8345-SI, 8348-Other Policy.

Information, Education and Communication/Behaviour Change Communication (IEC/BCC) strategy has been critical in facilitation of the behaviour change process by creating awareness, influencing attitudes and beliefs as well as promoting skills. It has played a role in promoting the uptake and utilization of existing services which have increased with time in both scope and variety. This IEC/BCC strategy of the AIDS Control Program of the Ministry of Health supports and relates to broader activities of expanded HIV/AIDS prevention, treatment and care. The activities provided in this project component are in line with HSSP II (2006-2010) and the National HIV/AIDS strategic Framework (2000/01-2005/6). Owing to the cross cutting nature of IEC/BCC strategy it addresses the needs of specific HIV sub-programmes and other relevant health sector programmes such as Infection control, STD Treatment and Control, Condom promotion, RH, Nutrition, PMTCT, HCT, ART, TB and other Opportunistic infections (OI). The strategy therefore, contributes greatly to improved delivery of the national minimum health care package. The popularly known Abstinence, Be faithful, Condom use (ABC) strategy still remains core in the national response against HIV/AIDS. This approach has been broadened to ABC+ to include other services such as HCT, PMTCT and ART, which contribute to HIV prevention. The Health sector through the IEC/BCC Unit continues to play a major role in implementation of this strategy. This is consistent with the national re-launching of accelerated HIV prevention. Emanating from efforts of different stakeholders, the national responses have contributed to the following achievements: ? Universal awareness on HIV/AIDS from 90% (2000/2001) to 100% (2004/2005). ? Increase in age of first sexual intercourse from 16 years in 2000-2001 to 17 years in 2004/ 2005. ? Condom use in most recent high risk sex reported by 50% of the respondents. ? The knowledge of at least 2 ways of preventing HIV transmission at 74% for women and 84% for men. According to the Uganda National Sero-Behavioral Survey 2004/2005, there are a number of emerging priority communication challenges which include: • Comprehensive knowledge on HIV/AIDS which remains low in the population at 38% in women and 35.8% in men • Inadequate national coverage and utilization of HIV Counseling and Testing services at 13% for women and 11% for men • Increased multiple sexual partners in women (2%-4%) and men (25% - 29%) which calls for more advocacy for mutual faithfulness. • Increased proportion of people engaged in unprotected sex: 15% in men and 37% in women justifying the need to promote correct and consistent condom use and support strategies that increase availability and access to users • There is a significant proportion of the Ugandan population who are at very high risk of HIV infection. • A secondary analysis of faithfulness data shows that 88%of men are not lifetime faithful, compared to 56% of women, and only 10% of couples are mutually lifetime faithful.

With the support of the funding from PEPFAR funding in FY06, the IEC unit has been able to accomplish some targeted activities in the area of HIV prevention knowledge, skills and desirable practices including; • Airing of messages on AB and other HIV/AIDS strategies in 15 FM radios in which 1,400 radio spots & 20 talk shows were supported • Support for community film shows in 13 districts targeting specific groups • Building capacity of IEC partners in 20 media houses to support behaviour change interventions • Meeting with IEC/BCC Stakeholders for review and coordination of on-going interventions. • Development of advocacy materials with HIV/AIDS messages, • Completion of a peer educators' handbook and manual

In FY 07, Uganda will continue to focus on HIV prevention and four different components. The first component will target dissemination of AB messages through mass media

channels: 16 FM radio stations and 7 local newspapers due to wider acceptability and popularity in the districts. This component will target HIV preventive options for different population groups. 1) Abstinence and faithfulness for youth in and out of school working through peer leaders and community leaders including faith based leaders and Village Health Teams, and health workers. 2) The second component of the activities will focus on increased advocacy to support acceleration of HIV prevention in the districts and this will mainly target district political leaders, representatives for youth and women organizations, District HIV/AIDS focal persons, relevant technical departments and the leadership of most at risk groups. 3) Another component will focus on revision, development and production of reference IEC materials for peer educators, health workers and the general public to promote effective utilization of the AB approach. The IEC materials that will be finalized include: leaflets on AB, peer educators manual and translation of IEC/BCC materials developed in 7 local languages. For wider publicity, the material will be printed and distributed to the target audiences that are defined in the first and second components of the activity. 4) The last component will include provision of technical supervision to HIV prevention partners. The supervision will involve IEC/BCC unit staff of the AIDS Control program, Health promotion & Education Division, Reproductive Health division and relevant officials from the UAC for effective integration and coordination of HIV prevention efforts.

This activity also relates to 8340-AB, 8342-CT, 8343-Palliative Care;Basic Health Care & Support, 8346-ARV Services, 8341-PMTCT, 8347-Lab, 8345-SI, 8348-Other Policy.

This activity also supports and relates to the broader activities of the Uganda health sector including scaling up of accelerated HIV Prevention, care, support and treatment in the country as an integral part of the National Minimum Health Care package outlined in the Second Health Sector Strategic Plan 2006-2010 (HSSP II), and the National Strategic Framework for HIV Control in Uganda. The main role of the Infection Control Unit of ACP/MOH is to prevent medical transmission of HIV/AIDS of which injection safety is a key component. Infection control is mainly in health care setting, however recently, medical transmission of HIV in the community has aroused interest because of the shift in health care provision to include home based care for AIDS patients.

This activity has continued to build capacity of districts to initiate and implement Infection Prevention Programmes. The main focus of activities has been promoting standard precautions against blood borne pathogens. Coverage has been Hospitals and HC IVs, and a few of the busy HC IIIs. The Infection control unit which leads this activity operates in collaboration with the injection safety program of the clinical services department of the MOH. The main activities implemented under this program in FY06: evaluation of Infection Prevention and Control practices and technical support supervision in 5 districts, on the job training covering 160 health care workers in the same districts and training of 67 trainers drawn from districts in most need. The Infection Control Unit recently developed a draft policy on Post Exposure Prophylaxis (PEP) and it awaits review before the final document is ready for printing. Auditing of infection prevention and Injection safety in health units has commenced in the districts of Masaka, Kamuli, Kiboga and Nakasongola. The out put will be an audit report that will be used to monitor quality of infection prevention practices in future. Training of 80 health unit managers and setting up of Infection Control Committees.

Despite the above achievements, coverage of districts is still very limited. More districts need to be brought on board to generate a desired impact of infection prevention interventions. There is a need to scale up training to cover 10 more districts. A training of trainers is planned. The principle of choosing districts in most need will be upheld.

During the FY 2007 the activity will cover the following: training of Infection Control Committee members in hospitals and Home Based Care trainers in Infection Prevention and Injection Safety, and procurement of injection safety demonstration materials. We will continue to sensitization of district leaders, District Health Management Teams and Health Unit Managers on basics of Infection prevention, Injection safety, and their roles and responsibilities. Furthermore, auditing of infection prevention and Injection safety practices will be carried out as well as developing infection prevention standards. In addition, development of a policy on Post Exposure Prophylaxis and Post Exposure Prophylaxis implementation guidelines will be implemented. 7 more districts will be targeted in the FY07 plan. Training of 140 health unit managers and Infection Control Committees will continue in the targeted 7 districts. Training of district trainers to meet a target of 10 trainers per district in 11 districts (total 110). Printing of 5,000 copies of PEP policy, launching of the policy and dissemination workshops. The need to initiate and strengthen community involvement is very critical. We plan to train 110 Home Based Care trainers. Hazardous waste disposal in health units using safe boxes for sharps will be supported.

This activity also relates to 8341-PMTCT, 8340-AB, 8342-CT, 8346-ARV Services, 8344-Injection Safety, 8347-Lab, 8345-SI, 8348-Other Policy.

This activity supports and relates to broader activities of scaling up and strengthening HIV/AIDS prevention, care, support and treatment in Uganda as part of the National Minimum Health Care Package outlined in the second phase of the Health Sector Strategic Plan (2006-2010) and the National Strategic Framework for HIV/AIDS Control in Uganda (2000/1-2005/6) with emphasis on increasing access to quality HIV prevention, care and treatment services. The MOH has developed policy and technical guidelines for home-based care (HBC), including the technical areas of home basic care, palliative care, cotrimoxazole prophylaxis among HIV infected people, STI syndromic management and nutrition for People Living with HIV/AIDS (PLWHA), all delivered as part of a continuum of services from prevention through diagnosis, care and treatment in a holistic package.

During the past fiscal year, 160 district HBC trainers were trained, the policy guidelines on HBC and cotrimoxazole policy were disseminated to 40 more districts. By the end of the fiscal year, HBC trainers in 20 more districts will be trained and thirty districts facilitated to scale HBC to communities. Up-to-date home care materials will be printed and distributed and a support supervision mission will be conducted. In the area of STI case management, 50 more District STI trainers (TOTs) from 12 districts have been trained and updated in current STI syndromic management protocols. 250 STI/HIV peer educators from 5 tertiary institutions (universities) have been trained and equipped with knowledge in reference to early health care seeking, symptom recognition, VCT and, referral centers. In addition, 120 MCH/Family planning providers from 20 districts have been oriented in STI syndromic case management and RPR syphilis testing. As an intervention measure, 10 sites for the provision of condoms to commercial sex workers (CSW) were established and 30 CSW peer educators trained. An operational research sero-prevalence study of Genital Herpes (HSV-2) was completed and showed a high prevalence of HSV~70% in an urban area of Kampala. An STI health based facility survey was conducted and findings showed a progressive improvement in STI service delivery indicators. Over 10,000 copies of STI materials were printed. In the area of opportunistic infections management, 48 district trainers from 12 districts were trained as trainers of PHC workers.

In FY07 support under this activity will cover several components including: capacity building for provision of home based care services; treatment of STI; development and building capacity for nutrition support; TB HIV collaborative activities and palliative care. For HBC services, trainers for 20 more districts will be trained and 30 more districts facilitated to scale up services to community levels as well as printing of more home based care materials and support supervision of service delivery in enrolled districts. The palliative and basic care policies will be reviewed and updated and disseminated. In the areas of STI care, activities will include scaling up capacity building to districts not yet reached, strengthening interventions among the high risk groups including CSW, strengthening capacity to handle STIs among the youth and adolescents and training/updating of tutors/instructors in health/medical training schools in current STI syndromic management protocols. A consultation on the way forward regarding treatment and control of HSV-2 will be held. In addition, support for the nutrition component will address adaptation of a nutrition training manual, building capacity of counselors and communities for nutrition support and mapping community programs that support nutrition activities. Activities in support of palliative care will mainly focus on redirecting technical policies and guidelines to enhance provision of services at the community level. The component supporting TB/HIV collaborative activities will ensure that more TB patients undergo diagnostic HIV counseling and testing (HCT). This activity will provide training for more TB/HIV service providers in HCT and in intensify TB case finding among HIV positive patients. TB infection control guidelines for health facilities providing HIV care services will also be disseminated. The component on oral health will support printing and disseminate IEC materials on oral health care for PLWHA and provide support to improve service providers' knowledge on infection control procedures in the dental clinics.

This activity also relates to 8340-AB, 8341-PMTCT, 8343-Palliative CareBasic Health Care & Support, 8346-ARV Services, 8344-Injection Safety, 8347-Lab, 8345-SI, 8348-Other Policy.

This activity supports and relates to broader activities of scaling up and strengthening HIV/AIDS prevention, care, support and treatment in Uganda as part of the National Minimum Health Care Package outlined in the second phase of the Health Sector Strategic Plan (2006-2010) and the National Strategic Framework for HIV/AIDS Control in Uganda (2000/1-2005/6) with emphasis on increasing access to quality HIV prevention, care and treatment services

HIV/AIDS Counseling and Testing (CT) is a recognized entry point for HIV-positive clients into HIV prevention, care, treatment and support services. In a country with mature HIV interventions like Uganda, a desired goal for HIV prevention should be that every adult, including sexually active adolescents should know their HIV status.

Uganda launched a year of accelerated HIV prevention beginning 2006. For the uninfected, a negative HIV test result offers an opportunity for reinforcement of information and advice on safe behaviors. For infected individuals referral for care, treatment and support can be made early enough. In addition, prevention with positives interventions for those infected would further contribute to HIV prevention efforts. According to the Uganda HIV/AIDS Sero-Behavioral Survey [2005], 79% of HIV positive Ugandans do not know their sero-status due to stigma, poverty, insecurity, limited access and lack of information. In addition, 58% of all coupes are discordant. The two main challenges of HCT service provision is inadequate human resource and HIV test kits stock-outs.

In FY06 over I million Ugandans received HIV counseling and testing. The revised National policy for HCT was launched and disseminated to stakeholders. Currently there are over 450 testing sites nationwide. Nevertheless HCT access to the rural poor and special groups especially internally displaced persons, uniformed services, prisoners and hard to reach areas like fishing communities is still low.

By the end of FY07, approximately 2 million people through USG funding and support will access HCT. This will increase the National testing coverage by 10%.

In a bid to increase access to testing, Uganda has already embraced most of the latest innovations and approaches to providing HCT. The revised HCT policy now includes routine HCT in clinical settings and Home-based HCT. Currently Home-based HCT is being supported at district levels by CDC/PEPFAR funding. VCT remains the traditional approach to HCT. In the provision of HCT services, during the Post-test counseling protocol, referral linkages to treatment, care and support for all those testing HIV-positive is emphasized.

In FY 07, the main thrust for increasing access to HCT will be through VCT sites and Routine HIV counseling and testing in clinical settings. The Home based VCT services will be implemented by selected NGOs and some public facilities. VCT services will need support to conduct outreaches with emphasis on couple counseling in attempt to identify HIV discordance and reducer HIV transmission among couples. Additional resources for scaling-up VCT and Home Based HCT will be required from other donors.

The scale up of HCT in clinical settings is primarily the role of the Ministry of Health. This approach is vital for early diagnosis and treatment of HIV because in the health care settings, HIV prevalence ranges from 40-60% especially in medical wards. Currently only 5 hospitals out of 102 provide Routine HIV Testing and Counseling services. Of the 102 hospitals 11 are regional hospitals. So far only 2 regional hospitals have capacity to provide HCT in clinical settings. The plan in FY 07 is to start HCT in the 9 Regional and Referral Hospitals. This mainly entails training of the service providers and supply of HIV test kits. Regional hospitals have 300 - 400 health workers. Starting RTC in 9 Regional hospitals implies training over 3000 health workers. Under the Strengthening of HIV counselor training project in Uganda (SCOT), standards for Routine HIV Testing and Counseling training have already been developed. Opportunities to expand these services through leveraging resources from several USG-supported projects will be explored.

This activity also relates to activities in 8340-AB, 8342-CT, 8343-Basic Health Care & Support, 8341-PMTCT, 8344-Injection Safety, 8347-Laboratory Infrastructure, 8345-Strategic Information, 8348-Other Policy.

This activity supports and relates to broader activities of scaling up and strengthening HIV/AIDS prevention, care, support and treatment in Uganda as part of the National Minimum Health Care Package outlined in the second phase of the Health Sector Strategic Plan (2006-2010) and the National Strategic Framework for HIV/AIDS Control in Uganda (2000/1-2005/6) with emphasis on increasing access to quality HIV prevention, care and treatment services.

In fiscal year 2006, this activity supported the training of 85 health workers from health facilities in 5 districts in comprehensive AIDS care and treatment including ART, supported supervision of health facilities providing ART services in all districts in the country. In addition, support for the on-going ART site accreditation assessments was undertaken.

In FY07 this activity will support several different Ministry of Health activities including;

Training of health workers in district health facilities in comprehensive HIV/AIDS care including ART, targeting medical officers, clinical officers, nurses, counselors and nursing assistants running HIV care and treatment clinics. Counselors and nursing assistants will be trained in counseling of patients on ART with emphasis on adherence to treatment. This will increase the number of health workers in district hospitals and Health centre IVs who are able to provide ART and reduce workload and contribute to building capacity of health facilities to provide ART services.

Training and updates for regional trainers and supervisors for pediatric HIV/AIDS care including ART, targeting physicians, medical officers and nurses at regional referral hospitals who have already been trained as trainers and supervisors for ARV services for their respective regions. They will then be able to train and supervise health workers in district health facilities so as to improve the coverage and quality of treatment for HIV-infected children.

Support for assessment and accreditation of 100 public and private health facilities that are not yet accredited for ART service delivery. This activity fits in well with the national ART scale up plan which is to prepare all health centre IV as ART centres by the end of 2007 so as to expand access to ARV services countrywide and to the lowest levels of health service delivery.

The HIVQUAL-Uganda Project (HIVQUAL-U) is a capacity-building program for HIV-specific quality management support that facilitates the development of sustainable quality improvement activities. The overarching goal of the Project is to improve the quality of care provided to people living with HIV/AIDS in Uganda. The project has recruited two full time staff a program officer and data manager at STD/ACP-MOH to take lead in implementation of project activities. Two international project consultants visited the country and together with the project staff oriented 20 pilot ART sites to the project activities. Customization of the HIVQUAL-I soft ware to the Uganda situation was done, development and pre-testing of data collection tools was undertaken.

Another the key activities planned is to standardize a minimum package of HIV treatment and care for PHAs accessing services from both private and public sectors.

Support regional inter-site coordination meetings for all health workers and district stakeholders in HIV/AIDS care in the districts that are essential for coordination of ARVs services in the districts and at regional levels. This activity will facilitate learning from the experiences of ART centres and the review of operational issues pertaining to provision of ARVs. The goal here is to improve the quality of care provided at all active ART sites in the country.

Support supervision of health facilities providing ART services, to continuously build local capacity and motivate health workers to provide quality services. One of the key activities under this component would be the establishment of strong regional teams with clear roles for mentoring, training and provision of advanced ART services to lower health

facilities providing ART. The other activity under this component is to bring on board all district health managers to supervise and plan ART services in their districts and work hand in hand with the regional referral hospitals. This is with a view of eventually setting up a robust referral system for the care and treatment of PHAs leading to strong links between health facilities and the Community Based Support Program.

Review and update the national ART policy, treatment guidelines and training materials. These activities are pertinent in view of the rapidly changing knowledge on ART. Finally, the materials once developed or updated will be printed and distributed to health facilities providing care. The resources provided here leverage other ART resources from Government of Uganda, Global Fund and other donors.

This activity also relates to 8340-AB, 8342-CT, 8343-Basic Health Care & Support, 8346-ARV Services, 8344-Injection Safety, 8341-PMTCT, 8345-SI, 8348-Other Policy.

This activity supports and relates to the broader activities of scaling up and strengthening HIV/AIDS prevention, care, support and treatment in Uganda as part of the national minimum health package outlined in the second phase of the Heath sector Strategic Plan (2006-2010) and the National Strategic Frame work for HIV/AIDS Control in Uganda (2000/1-20005/6) with emphasis on increasing access to quality HIV prevention, care and Treatment services.

Strengthening lab capacity to support quality HIV testing services as well as HIV services quality improvement are key to effective HIV /AIDS prevention and control programs.

In FY06, the MoH, with support from CDC/ PEPFAR, has been carrying out activities to strengthen lab services in Uganda. The main areas supported are strengthening the capacity of the Central Public Health Laboratory (CPHL) to provide public health laboratory services, early diagnosis of HIV infection among infants, rolling out training for HIV rapid testing and improvement of quality services for HIV/AIDS countrywide with a focus on treatment. As part of the support to CPHL, additional office and laboratory space was rented, and procurement of reagents, equipment and supplies done. In addition, technical and administrative capacity at CPHL has been strengthened by hiring technical and support staff. Zonal and district level support supervision will be improved by hiring of a Zonal Laboratory Supervisor and purchasing a vehicle to be dedicated to this activity. A draft laboratory policy document will be finalized. External QA for CD4 testing has started with 16 labs participating and assessment of laboratory capacity to support ART was completed. In addition, training and support supervision on logistics management was conducted. The rolling out of laboratory testing for HIV rapid testing program held a stakeholders meeting and a standardized training package adopted. 181 service providers will be trained. The central training team was set up and it represents various stakeholder organizations. A draft QA guidelines for HIV rapid testing was developed with input from stakeholders and end-users and support was provided to program for early diagnosis of HIV infection in infants and young children. This program started in FY05 and by the end of FY06 will have been established in 17 districts including; Mbale, Soroti, Jinja, Masaka, Arua, Lira, Gulu and Hoima. Dry blood spot specimens will be collected, packaged and transported to 7 referral labs in the regions.

The focus of lab services and quality improvement activity in FY07 will be; Establishment of quality assurance and control policies, proficiency testing, standardized guidelines and SOPs, safety guidelines, equipment management plans and support supervision. The funding will support the following activities of the CPHL; Central coordination of CPHL activities, support for 4 zones comprising 18-19 districts each, quarterly support supervision from the centre, strengthened district-level support supervision by District Laboratory Focal Persons and monitoring of laboratory supplies procured the National Medical stores PEPFAR funding. In addition, the development of policy guidelines for laboratory services will be done, and the policy produced and disseminated. Availability of support supervision checklists, equipment management plans, safety manuals and SOPs will be ensured. The program will develop and implement national quality control/quality assurance schemes, consolidate and expand EQA for CD4 testing, start QA schemes for other test procedures. Distribution of QC/QA materials, reporting and timely feedback undertaken. The training coordination unit at CPHL will be strengthened in order to meet the additional needs. This includes increasing the number of service providers trained in HIV rapid testing annually from 200 to approximately 500, expanding training to include other testing procedures and basic management skills, increasing advocacy for better consensus, and coordination among stakeholders and establishing links and working relationships with other countries, in order to share experiences and lessons learnt. The Program for early diagnosis of HIV in infants and young children will be continued in FY07 and expanded to 10 more districts. This will require training 200 service providers, coordinating specimen transportation to referral labs, data management and dissemination of results and support supervision. The Quality improvement project will send one staff for training in the USA, sensitization of district personnel, developing of information systems and organizational management assessment, trainings of site data supervisors and ART site staff in quality improvement (QI). Baseline and follow up data collection on the seven piloted indicators. Site visits for

QI mentoring and coaching. The project will engage 60 new ART sites into QI activities to expand project coverage and improve ART quality services in the country. Printing of data collection tools, baseline and follow up of data collection to measure indicators and bench mark performance of sites at national level. Regional implementing site meetings to share experience on tried out QI projects. National stakeholders meeting and official launch of project to improve awareness of project operations at national level. Training of health workers in QI projects management and HIVQUAL soft ware operations at site level to improve health workers` ability to manage quality improvement and performance measurement activities.

plus ups: The training coordination unit at CPHL (MOH) continues to roll-out refresher training in HIV rapid testing at all health facilities across the country. Add'l funding of $200,000 will be used to expedite this process and to carry out regular project performance appraisals. The existing system for lab support supervision has been shown to be extremely weak. As part of the plan to strengthen lab services, ensure GLP and protect the investment already made by USG in lab commodities, additional zonal/regional supervisors are needed to compliment those already supported by other national programs, particularly the TB and malaria programs. Supervisors will need transport and facilitation for themselves and for DLFPs amounting to $200,000. Basic QA activities for the minumum diagniostic package, currently the responsibility of CPHL, are grossly inadequate. Some institutions/programs run their own EQA schemes for CD4+ counting, viral load, hematology and serum chemistries but there is little coordination and many health facilities conduct no EQA at all. To address the issue of QA in the laboratory across the country, existing activities need to be expanded and strengthened, data collected, collated and analyzed and action taken to remedy poor performance. QA activities will, wherever possible be merged into support supervision activities; reference laboratories need new/additional funding in order to prepare PT panels and conduct the QC component of QA systems; a central coordinator for national QA in the laboratory is needed at CPHL and together, QA strenthening will require addtional funding of $75,000. In order to manage, analyze and interpret the vast amount of data generated within the laboratory sector for effective management, a LIMS is being developed at CPHL, linked to the MOH Resource Center. The data sets include records of facility commodities consumption on which forecasting is based, performance of individual technicians/lay counselors in HIV rapid testing, training history for individual technicians, constraints at health facility laboratories recorded during support supervision visits etc: an additional US$ 150,000 is requested to strengthen the capacity of the LIMS at CPHL.

This activity also relates to 8340-AB, 8342-CT, 8343-Basic Health Care & Support, 8346-ARV Services, 8344-Injection Safety, 8347-Laboratory Infrastructure, 8341-PMTCT, 8348-Other Policy.

This activity also supports and relates to the broader activities of the Uganda health sector including scaling up of accelerated HIV Prevention, care, support and treatment in the country as an integral part of the National Minimum Health Care package outlined in the Second Health Sector Strategic Plan 2006-2010 (HSSP II), and the National Strategic Framework for HIV Control in Uganda. The objective of this SI activity is to provide accurate data to inform strategic planning, M&E of HIV prevention, care and treatment as well as broader integrated Health sector programmes.

The SI program focus has continued to register various achievements: HIV and STI surveillance have expanded and improved in quality including antenatal and population based surveillance. In the past year, the activity supported annual antenatal HIV surveillance in twenty-five surveillance sites including training of site staff, procurement and distribution of laboratory reagents and supplies, field data collection including support supervision and testing of samples. This provided data that has continued the trend observations as well as aiding derivation of estimates of the overall burden of HIV/AIDS and potential targets and impacts of prevention and care programmes. Dissemination of surveillance findings through surveillance reports and technical dissemination meetings were also supported. Furthermore, the SI activity supported secondary analysis of UAIS in order to inform the overall landscape of the epidemic and guide the focus of accelerated prevention. To improve interpretation of surveillance data, this activity supported mapping of the catchment areas of the antenatal sentinel surveillance sites using GIS and aiding a systematic comparision of ANC surveillance based and population based estimates. This has improved calibration of the HIV surveillance system when obtaining national estimates of HIV/AIDS and other paramenters as well as estimation of the potential targets and impacts of programmes. Furthermore, this activity supported dissemination of the national HIV serological survey and results of the secondary analysis of survey data. About 12 manuscripts are currently in preparation for publication in peer reviewed journals. The findings will also be used in developing policy papers that will guide the approach to implementation of programmes for HCT, targeting HIV prevention, care, and treatment programmes, resource allocation and design of future population based HIV serological surveys. The activity supported programme officers to present papers at the International AIDS Conference in Toronto. This activity has supported discussions of the apparent reversal of trends of HIV sero-prevalence and incidence. The activity continues to support implementation of HIV/AIDS/STI surveillance at district levels and utilisation of surveillance data; during the past year, 60 district surveillance focal persons were trained and 30 districts were provided with technical support for monitoring and evaluation of HIV/AIDS activities. In collaboration with other stakeholders, this activity supported operational research activities on ART adherence and integration of HIV Prevention in AIDS care as well as evaluation of quality of care in Health facilities. Furthermore, the activity supported the integration of PMTCT monitoring into the routine HMIS as well as training of staff from 24 ART centres in ART data management.

The SI focus during FY07 will support improvement of second generation HIV surveillance, programme M&E and targeted evaluation. The HIV surveillance system will be strengthened and expanded to include surveillance sites in the districts of Kabarole, Kasese, Kyenjojo, Kamwenge and Bundibugyo districts that were previously supported by GTZ in order to continue the trend observation. The strengthened surveillance system is particularly important in light of the current trends of HIV prevalence that call for enhanced trend observation. Under this activity, support for the annual round of antenatal sentinel surveillance will be provided including training of sentinel site staff, field data collection, procurement of test kits and their distribution to sites, central laboratory testing and quality control and data analysis. HIV surveillance will continue to be conducted as part of second generation surveillance recommended by WHO/UNAIDS. Therefore, the programme will continue to support elements of STI surveillance, behavioural surveillance and AIDS case surveillance as part of monitoring of the ART programme. STI sentinel surveillance in 20 sites and STI case reporting through the national universal reporting system (HMIS) will be supported through training of sentinel, district and sub-district based staff and collection, analysis and dissemination of data. HIV/STI surveillance among high risk groups will be supported including supporting sero-prevalence surveys among

selected high risk groups such as sex workers, fish mongers, truckers etc. The activity will continue to support updating the relevant surveillance protocols and obtaining institutional ethical approvals. The SI activity will also support collection of sero-prevalence data from ancillary sources including programmatic data such as HCT, PMTCT and blood transfusion. To this end, field trips to collect and analyse data arising from these sources will be supported as well as technical meetings to discuss these data with various stakeholders. Dissemination of findings will continue to be supported including printing of surveillance reports and dissemination meetings. This activity will also provide support for integrated M&E of Health sector HIV programmes bringing together M&E components for STI, PMTCT, ART, HCT, condom promotion, AB programmes and AIDS care programme data. The activity will also support a platform for integration of programme monitoring and surveillance data. To this end, this activity will support improved data management for the STD/ACP data unit including procurement of relevant software, supporting internet connectivity of the data centre and incorporating geo-referencing in surveillance and programme monitoring activities. As part of building capacity for M&E, technical support to districts and other organisations will continue to be provided in order to improve competence for local M&E with emphasis on output and process monitoring. Progamme indicators for output, process, outcome and impact monitoring will be reviewed and updated, particularly taking into account emerging programme areas such as ART, co-trimoxazole prophylaxis and TB/HIV collaborative activities. In addition, utilisation of M&E and surveillance data will be strengthened through appropriate training of users and enhanced dissemination of M&E findings. The SI component will also support quality improvement of integrated HIV prevention care and support programmes through support supervision, technical assistance and targeted evaluation. Under this plan, at least two targeted evaluation activities will be conducted to provide outcome indicators for national programme evaluation, but also data to guide quality improvements. Surveillance of emerging resistance to anti-retroviral drugs is an area requiring urgent attention. During the year, consultations will be supported with a view to develop a national strategy for surveillance of drug resistance and relevant protocols will be developed and piloted.

This activity also relates to 8340-AB, 8342-CT, 8343-Basic Health Care & Support, 8346-ARV Services, 8344-Injection Safety, 8347-Laboratory Infrastructure, 8345-Strategic Information, 8341-PMTCT.

This activity supports and relates to broader activities of scaling up and strengthening HIV/AIDS prevention, care, support and treatment in Uganda as part of the National Minimum Health Care Package outlined in the second phase of the Health Sector Strategic Plan (2006-2010) and the National Strategic Framework for HIV/AIDS Control in Uganda (2000/1-2005/6) with emphasis on increasing access to quality HIV prevention, care and treatment services The Ministry of Health constitutional role is developing policies, standards and technical guidelines for the provision of quality health services. The STD/ACP is responsible for the development, dissemination and review of technical policies relating to HIV/AIDS to guide district health authorities and the frontline service providers in providing prevention and care services. These should be evidence based, relevant, appropriate and responsive to ensure the achievement of the program goals. During policy development, the programme conducts wide consultation with experts and stakeholders, service providers, nongovernmental organizations, community based organizations, other sectors whose activities impact on the program as well as the intended users of the services. Advocacy activities are conducted by the program to ensure support for the various policies that it formulates. The priority areas that currently warrant specific policies and guidelines include condom policy, HIV Counseling and Testing (HCT) policy, the Prevention of Mother-to-Child Transmission (PMTCT) policy, policies for Antiretroviral therapy (ART), cotrimoxazole prophylaxis, Isoniazid prophylaxis, home based care, Post-exposure prophylaxis (PEP) nutrition/breastfeeding, and prevention with positives. Policies that will strengthen TB/HIV collaboration has also been identified as an important area of emphasis. In FY 06 policies for the following program areas have been completed and disseminated: Condom policy, ART, HCT, PMTCT, cotrimoxazole prophylaxis. The home-based care policy has been drafted, but needs to be completed and then printed and disseminated. The PEP policy is also in its final stages of development.

While some policies have been completed and disseminated, the rapid development of new information and technologies, and consequently approaches to HIV prevention, care and treatment necessitates the continuous review of rolled out policies. In FY 07 this activity will support the completion of unfinished policies and guidelines as well as review existing ones. More copies of the HCT, PMTCT, ART and cotrimoxazole prophylaxis policies will be printed and dissemination. The policies on PMTCT, ART and cotrimoxazole prophylaxis will be evaluated and reviewed. The home-based care policy will printed and disseminated after its completion. The nutrition and breastfeeding policy in patients living with HIV/AIDS will be reviewed to take into account the prevailing context of HIV/AIDS. Consensus needs to be built on the INH prophylaxis in people living with HIV/AIDS. The implementation guidelines for the HCT policy will be completed. Under this activity, we shall develop a counseling hand book that will serve as a resource book for service providers. Gaps have also been identified in community counseling and child counseling, and the Program will develop service providers' guidelines in these. Furthermore, given the high prevalence of HSV-2, policy guidelines need to be developed on viral suppression using acyclovir. Finally, the program will also undertake activities to evaluate existing policies with a view identifying gaps and reviewing them.