Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4819
Country/Region: Uganda
Year: 2007
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $5,642,267

Funding for Prevention: HIV Testing and Counseling (HVCT): $0

plus ups: To support the national 'know your status campaign', USG will work with MOH to design an implementation plan and identify appropriate mechanisms for technical assistance and related commodities procurement for the public, NGO and private sector facilities to roll-out activities in FY07.

Targets

Target Target Value Not Applicable Number of individuals trained in logistics pull system for VCT  Number of laboratories with capacity to do HIV tests  Number of laboratories with capactiy to perform CD4=1  Number of individuals reached through community outreach that  promote VCT services, partuicularly for OVCs, disclosure of status to partners and families, couple counseling and testing. Post-test clubs established at service outlets to promote positive  living Number of service outlets in the country receiving HIV test kits and  accessories every two months. Number of Districts receiving HIV test kits and accessories every  two months Number of service outlets providing counseling and testing  according to national and international standards Number of individuals who received counseling and testing for HIV 280,000  and received their test results (including TB) Number of individuals trained in counseling and testing according to  national and international standards

Table 3.3.10: Program Planning Overview Program Area: HIV/AIDS Treatment/ARV Drugs Budget Code: HTXD Program Area Code: 10 Total Planned Funding for Program Area: $ 39,204,767.00

Program Area Context:

The procurement of Antiretroviral (ARV) drugs is a critical component of the Emergency Plan's program in Uganda as it supports the Ministry of Health (MOH) in its national roll out of antiretroviral treatment (ART). Although the costs of second line therapies and pediatric ART formulations are yet to decline to the same extent as first-line adult regimens, USG is able to leverage the availability of Global Fund for HIV/AIDS, TB, and Malaria (GFATM) drugs and other less expensive FDA approved generic ARVs to increase the number of people on first line regimens, address the needs of those needing second line and salvage therapies, and increase the number of children on ART. According to the FY06 Semi Annual PEPFAR report (SAPR), 39,712 people were receiving ART with direct support from the USG and an additional 36,000 were supported for treatment indirectly through USG's inputs in national logistics systems, training, quality assurance and policy work. USG will directly support 88,907 people in FY07, including 10,432 children. The three national mechanisms that currently support the procurement of ARVs include: (1) the Ministry of Health (MOH), which provides logistics management of GFATM ARVs using the National Medical Stores (NMS) for the public sector and Joint Medical Stores (JMS) for the faith based and other Non-Governmental Organization (NGO) facilities. (2) Direct central purchasing of generic and branded drugs by Joint Clinical Research Center (JCRC) and AIDS Relief from manufacturers with distribution to the ART points of service throughout the country; and (3) third party local procurement led by Medical Access Ltd, which is a non-profit NGO that began under the Drug Access Initiative in 1998. These three distinct procurement mechanisms evolved as the ART rolled out in Uganda prior to the existence of the Emergency Plan. A fourth procurement mechanism is currently being established with FY06 funds to allow procurement of drugs and commodities for the Inter-religious Council of Uganda (IRCU) through the Supply Chain Management (SCMS) project. While there are some challenges working with a variety of procurement mechanisms in the country, there are also advantages. A key advantage is the continued supply of ARVs should any one mechanism experience a stock out as borrowing across programs can be facilitated. One of the significant challenges facing Uganda in 2006 has been stock-outs of some GFATM procured ARV drugs since November 2005 when GFATM funding was reinstated after a two-month suspension. The funds were suspended (except for life saving commodities) and the Project Management Unit was disbanded due to mismanagement. In the months that followed, there were challenges in reconstructing contracts and procurements. USG partners have been filling gaps where possible at site level to assure continuous treatment among GFATM clients attending USG supported sites. Another challenge has been the expiration of GFATM procured ARV drugs. The SCMS project has been requested to conduct an assessment of all the existing procurement mechanisms and make recommendations to the USG on how best to rationalize the existing mechanisms and forge efficiencies, linkages, and synergies across them to obtain maximum benefit including cost savings in the procurement of ARVs; while continuing to build local capacity. To ensure an unbroken supply chain nationally, USG has consistently provided logistics and supply chain management support to the national ART program through MOH, its pharmacy department, National Medical stores and USG NGO partners. The support includes ongoing training and follow-up in forecasting, stock management, instituting standard operating procedures, and ensuring adequate buffer stocks among USG partners and within the national system. In FY07, USG will increase support to NMS, the primary source for public sector health drugs and commodities, and the JMS, which serves the faith based and other Non-Governmental Organization (NGO) health facilities. This increased support will minimize the likelihood of stock-outs of critical drugs and supplies and will improve efficiencies in distribution and logistics management. District-based programs and the national Prevention of Mother to Child Transmission (PMTCT) programs will play an active role in ensuring commodities reach health facilities in a timely fashion. Since early 2006, numerous FDA-approved generic ARV drugs have entered the market in Uganda. These drugs have led to significant cost savings of 15-50 percent, depending on the drug regimen. Individual formulations from Ranbaxy, Aurobindo, and combined regimens procured from Aspen, are now registered in Uganda and have contributed to these cost reductions. It is anticipated that the tablet co-formulation of lopinavir and ritonavir will be available in Uganda shortly, optimizing second line regimen choices without

the previous cold-chain requirement. Aurobindo's newly approved fixed-dose combination is also expected to enter the Uganda market shortly. While the new combination may not provide significant cost-reductions, it will provide an FDA-approved limited pill burden option for a first line regimen. Nearly half of all Ugandans receiving ART receive GFATM ARV drugs. Current in-country GFATM approvals suggest that by July 2008, over 50,000 Ugandans will receive ART through GFATM support. In June 2006, it was agreed that WHO would provide procurement services for the GTATM until the final management structure is finalized in November 2006. It is hoped that with the long term institutional GFATM arrangements to be adopted by the Ugandan government, the planning and procurements for ARVs and other HIV commodities will work more efficiently. However, USG proposes to include additional buffer stock in FY07 within select programs that work in GFATM sites to be able to respond quickly to any gaps in procurement. USG has and will continue to provide logistics management technical assistance, human resource, and material support. In FY07, USG support aims to reach 88,907 Ugandans directly with ART, train 62,863 individuals, and build capacity in about 200 service outlets throughout Uganda.

Table 3.3.10:

Funding for Treatment: Adult Treatment (HTXS): $200,000

PEPFAR currently provides funding for antiretroviral therapy for nearly 40,000 HIV-infected individuals through more than 10 Implementing Partners (IPs) in Uganda, most with several clinic sites. IPs adopt a variety of programmatic approaches and work in diverse settings throughout the country. These include home, facility and community based sites in urban and rural settings through government, NGO, faith based and private sector facilities. Some partners currently provide program-level summaries of clinical data on a quarterly basis. We would like to expand the extent of centralized data collection within PEPFAR-funded ART programs to develop a collaborative cohort of ART clients using program descriptive data, cost data and individual-level clinical data. Such a collaborative cohort could be used to answer numerous clinical and programmatic questions that cannot be examined within individual program analyses.

The PEPFAR ART cohort collaboration in Uganda, in the first instance, will be used to compare ART programs within Uganda, in terms of clinical outcomes, and service delivery associated costs; as well as to help to identify key program components which may be associated with improved outcomes. The specific objectives of this evaluation will be to 1) review approaches to the scale up of ART in Uganda; 2) to provide information on important clinical outcomes achieved by different program models and how different program components contribute to success and 3) to expand on existing cost data from these select sites with supplemental cost data to overlap with the timeframe that outcome data is being collected in order to estimate the comparative cost-effectiveness of different treatment models in relation to optimal clinical outcomes. This activity will complement the current multi-country targeted evaluation of ART costs funded centrally through OGAC by providing costing data parallel to clinical outcome data in a broad range of ART delivery programs in Uganda. In addition, the clinical data captured through this proposal could be contributed to the East African regional database on ART programs funded through the National Institutes of Health as part of the International Epidemiologic Database to Evaluate AIDS (IEDEA) program.

For additional information, please refer to supporting documents in this COP on Public Health Evaluation Study Background Sheet.

Funding for Laboratory Infrastructure (HLAB): $235,000

plus ups: Support supervison is required at all levels within the national health laboratory service from MOH to HCIII to ensure quality laboratory services. Normally this is the function of a department within MOH but, whilst government is willing to invest in this area, re-organization of MOH is unlikely to be effected in the near future and responsibility for this area has fallen upon the Central Public Health Laboratory. USG has made significant investments in CPHL on a technical level but currently, CPHL does not have professional leadership to oversee its own activities nor those of a national laboratory service. Government is fully commited to strengthening CPHL as the national institute responsible for overseeing and coordinating national laboratory strengthening and have requested a suitably qualified consultant or technical advisor as the counterpart to the head of CPHL. This would be an international recruitment through COMFORCE for two years. Initial funding will be with plus-up funds before this position is included in the staffing and mangement plan.

Table 3.3.13: Program Planning Overview Program Area: Strategic Information Budget Code: HVSI Program Area Code: 13 Total Planned Funding for Program Area: $ 13,970,458.00

Program Area Context:

The PEPFAR/Uganda strategic information activities support an expansive portfolio of initiatives including routine health services data collection at district and national levels through support to the Ministry of Health's (MOH) Health Management Information System (HMIS); sentinel surveillance rounds in antenatal and sexually transmitted disease clinics; information systems development and strengthening of national and implementing partner service delivery sites to effectively monitor care and treatment, track laboratory and pharmaceutical functions and conduct project evaluations; and technical assistance to the GoU for the coordination, analysis and dissemination of population based surveys and on-going public health evaluations.

Routine data collection: PEPFAR's support to routine data collection in Uganda is multifaceted and involves strengthening HMIS and logistical Management Information Systems (LMIS) at the national level through capacity building and technical support to the Ministry of Health's Resource Center. Similar work at the district and sub-district level is also supported to ensure accurate and timely data flow. PEPFAR/Uganda is also working with the Minister of Gender, Labor and Social Development (MGLSD) to develop a national monitoring and evaluation system for Orphans and Vulnerable Children (OVC). Additionally, USG provides technical assistance to the Ministry of Education to strengthen its Educational Management Information System (EMIS) at national and district levels. Another central component of USG support to routine data collection involves building the capacity of local government, civil society and faith-based organizations, including PEPFAR partners, to develop and implement effective monitoring and evaluation systems. Partners are also trained in data analysis and use of data in decision-making for more effective and efficient program management and quality improvement. The USG continues to work with the Ugandan People's Defense Force to strengthen its MIS and institute quality assurance systems for improved HIV/AIDS service delivery to military service persons, their families and surrounding communities.

Sentinel Surveillance: USG will continue to support ANC-based sentinel surveillance and revitalize dormant sentinel surveillance sites, as well as provide technical assistance for the collection of HIV-related program data for use in surveillance, STD clinic based surveillance, and a survey among commercial sex workers.

Population Based Surveys: USG will continue to support dissemination of findings from the 2005/06 Uganda HIV/AIDS Sero-Behavioral Survey. Field work for the 2006 Uganda Demographic and Health Survey (UDHS) is currently underway. Funding from other sources/donors has been leveraged for this survey which will provide a comprehensive picture of the health status and norms in Uganda's general population and preliminary results are expected in late October/early November 2006. Additionally, USG will support the conduct of a Ugandan Service Provision Assessment Survey (USPA) that will sample a nationally representative sample of government, non-government and private health facilities. Preliminary results will be available in March/April of 2007. FY07 PEPFAR funds will be used to conduct UDHS and USPA secondary analyses and disseminate findings nationally and internationally.

The ‘Three Ones': USG will collaborate with the GOU and other HIV/AIDS stakeholders to update the national M&E Framework to align with the new five year National Strategic Plan, which is currently under development. USG will facilitate the design of a M&E Plan to operationalize M&E data collection and reporting at the district and subcounty level. The USG database and data collection systems will be shared with GOU. PEPFAR IP's will feed into this umbrella framework as appropriate.

Public Health Evaluations: To inform GoU and the USG with specific information to key program issues, nine Public Health Evaluations are proposed: Evaluating Anti-Tuberculosis Drug Resistance Among Smear-Positive TB Patient; Assessing the Relationship between Intimate Partner Violence and HIV status Disclosure in Rakai District; Impact of Daily Ttrimethoprim-Sulfamethoxazole on Mortality of HIV-Exposed Infants; Evaluating the Utility of Re-testing HIV-negative VCT clients; Impact of Home-Based Counseling and Testing and the Provision of the Basic Care Package on HIV Incidence in Kumi District; Evaluating the

Utility of: (1) Using Routine Program HIV testing Data for Surveillance and (2) the HIV-1 Incidence Assay for Incidence-Based Surveillance; Sero-Behavioral Surveys among Most-at-Risk Populations (MARP) in Kampala; Developing a Collaborative Cohort of USG-Supported ART Programs in Uganda to Assess Costs and Clinical Outcomes Associated with Different Programmatic Approaches; and an Assessment of Multiple Distribution Models for Basic Health Care Commodities. Detailed outlines are provided as support documents.

The Strategic Information (SI) Team: As part of the reorganization of the country team into multiple technical workgroups to better support joint USG program planning and improved coordination, the composition of the strategic information workgroup, along with its role and responsibilities, are currently being reassessed and redefined. At this time, the core SI workgroup is comprised of two co-SI liaisons, two M&E specialists and the Monitoring and Evaluation of Emergency Plan Progress (MEEPP) contractor. With the reorganization of the SI team, it is expected that several times a year, and at least quarterly, this core workgroup will expand to include a surveillance specialist, a population based surveys specialist and public health evaluation project managers to review and coordinate on-going activities, share key findings from on-going studies and evaluations and discuss shifts in technical direction. The expanded SI workgroup will establish firm linkages with the national SI technical committee and other key SI stakeholders in country. In FY07, the SI team - in close collaboration with the Uganda Country Team - will also explore the most appropriate way of addressing SI staffing requirements.

System for Monitoring and Reporting PEPFAR Program Results: The contractor Social and Scientific Systems has assisted the SI workgroup with PEPFAR reporting since January 2005. The MEEPP project has established a dedicated SQL database to collect and consolidate data from all PEPFAR partners. This has greatly facilitated the SI workgroup's ability to track individual IP performance, minimize double counting and ensure timely and high quality reporting of results to OGAC, the GOU and other stakeholders. MEEPP staff also work closely with USG project officers and partners to ensure a comprehensive understanding of PEPFAR indicators and reporting requirements, to build capacity in monitoring and evaluation, to ensure solid data quality assurance systems are in place and to facilitate program monitoring and target setting. Additionally, MEEPP has conducted and will continue to conduct in-depth data quality assessment and data validation exercises with key partners, resulting in improved data collection and reporting. The core SI workgroup meets with MEEPP on a monthly basis to track progress and identify areas or partners requiring technical assistance for continuous quality improvement.

Program Area Target: Number of local organizations provided with technical assistance for strategic 262 information activities Number of individuals trained in strategic information (includes M&E, 1,883 surveillance, and/or HMIS)

Table 3.3.13:

Funding for Strategic Information (HVSI): $3,451,142

This activity complements 8377, 10176, 10178-Management and Staffing.

The Home-Based AIDS Care project is a public health evaluation designed to answer key operational questions to inform the scale-up of ART in rural Uganda. MOH, TASO and USG are partners in this important activity. The program involves provision of ART and three-years of follow-up for 1000 people, using a home-base approach to service delivery. The project will compare the effectiveness of three different ART monitoring systems: a clinical/syndromic approach using lay workers; the syndromic approach with CD4 laboratory monitoring; and, the syndromic approach with both CD4 and viral load monitoring. Protocols have been developed for lay workers to do weekly drug delivery and monitoring using motorcycles to cover a 100km radius. All family members in HBAC were offered VCT and care and treatment as needed. HBAC has developed counseling protocols and behavioral interventions for ART literacy, adherence, and prevention of HIV transmission. The clinical, behavioral, social and economic impact of ART is being monitored and evaluated and results will be disseminated and shared with MOH and ART stakeholders. USG also used HBAC as a venue for training Ugandans in ART service delivery as well as in key components of SI, including data analysis and data dissemination. Operations funding contributes to support staff salaries, commodities (other than ART), and general running costs for the project. Currently, 32 field officers are involved in conducting weekly visits to each client to provide antiretroviral therapy and collect data. Additional visits by 16 research counselors to collect data on sexual behavior, adherence to therapy and other behavioral outcomes occur at regular intervals. Five medical doctors and two nurses also provide medical care for clients with acute medical problems. Laboratory and informatics staff in Tororo and Entebbe conduct laboratory testing and data entry and management.

In FY07, the results of the first 3 years of HBAC will be analyzed and disseminated to the Ministry of Health and the scientific community in Uganda and internationally through presentations and research publications. Plans are in place to extend the study for an additional 3 years in order to fully answer important operational research questions relating to the impact of using clinical monitoring alone, in particular to determine precise definitions of treatment failure. Up to 500 additional clients will be recruited to examine the impact of proposed programmatic changes, a design that will make the HBAC project more generally replicable, with a focus on adherence to therapy and virologic suppression rates. Operations will continue as per the revised study protocol and key findings from routine data analysis will be disseminated to inform the USG portfolio of ART interventions.

In addition a number of CDC-Uganda technical staff from the behavioral, laboratory, and informatic units will continue to contribute significant level of effort to provide technical assistance to the HBAC program. With this support the informatics unit staff level of effort will focus on data collection, data entry and cleaning, and data analysis for the Tororo field HBAC site, as well as continued assistance for data entry systems and data management. Application systems developed for HBAC, including: pharmacy information management system, laboratory information management system, medical information management system, data management system, patient tracking system, photo ID system, and operations management systems will continue to be maintained and upgraded to meet the date demands of the station. CDC behavioral scientists will continue to assist with data collection and analysis of client interviews and questionnaires. Education and behavioral interventions for discordant couples will be further developed and adapted for use in HBAC, as well as with other IPs. Technical assistance to further the implementation of family member home-based VCT will be provided with the protocols and guidelines finalized for generalized use. Finally, the behavioral unit will provide training to field officers to expand counseling interventions to reduce HIV transmission risks for clients on treatment and continue in-depth evaluations on stigma and gender-based violence. And the CDC laboratory technologists will continue to provide ART monitoring services for those patients on treatment, including CD4 counts, viral loads, liver and renal function tests, full blood counts and tests for opportunistic infections, as well as participate in EQA schemes for these tests. Finally, the laboratory staff will continue to provide training opportunities and support supervision to the filed station.

Funding for Strategic Information (HVSI): $190,000

This activity relates to 8378-Palliative Care;Basic Health Care and Support, 8379-Palliative Care;TB/HIV, 8375,8382,8384,9108-SI, 8376,8381-Lab, 8380-ARV Services, 8377-M&S.

CDC will continue to work with Health Strategies International, a U.S. health economics consulting firm, to conduct a cost and cost-effectiveness evaluation of antiretroviral therapy (ART) using a home-based model for ART delivery (HBAC) in Tororo. The project will also evaluate the impact of ART on household economics in rural Uganda. These evaluations will be based on HBAC data as well as previous evaluation data from CDC-Uganda for cotrimoxazole and the safe water vessel. When applicable, impact on family members will also be assessed. A sub-component of the evaluation will involve conducting time and motion studies of various service providers within ART programs, including field officers, counselors, laboratory technicians and medical officers. Results will be shared initially with the primary partners in the project, MOH and The AIDS Support Organisation (TASO), and then will be disseminated broadly. Project implementation will involve training more than 40 Ugandans in data collection, eight in data analysis and two in writing. The first three years of HBAC data will be analyzed in FY07 and the results disseminated to the MOH, TASO and other ART stakeholders within Uganda and the international community. A cost-effectiveness analysis of the project will be included in these results.

Funding for Strategic Information (HVSI): $150,000

In FY07 the country team will review the need and come to a final decision whether to establish a full-time strategic liaison position, supervised by the PEPFAR Coordinator and co-located in the Embassy, to assist the Coordinator and the Country Team to support all SI activities. If the decision is made not to recruite this position, these funds will be reallocated within the SI program area.

Funding for Strategic Information (HVSI): $268,278

These activities compliment 10036, 10038, 10083, 10102-Strategic Information. The narrative below explains several Public Health Evaluations that CDC shall conduct.

Evaluating Anti-Tuberculosis Drug Resistance Among Smear-Positive TB Patient:

WHO and International Union Against TB and Lung Diseases (IUATLD) recommend countries to monitor anti-tuberculosis drug resistance either through ongoing surveillance or periodic surveys. There is no nationally representative data available on TB drug resistance in Uganda. In a drug resistance survey conducted in three regions in 1996-97, the resistance to rifampicin was found to be 0.8% and prevalence of MDR TB was 0.5% among all isolates collected. In 2005, a drug resistance survey was conducted among hospitalized patients at the national reference hospital, Mulago and the MDR TB prevalence was 4.5% among new TB patients, a 10 fold increase compared to the 1996-97 survey.

This survey will provide a national estimate of primary and acquired anti-tuberculosis drug resistance including MDR TB in Uganda. As per the National TB HIV policy all the TB patients included in the survey will be provided HIV counseling and testing. Given the importance of HIV infection in TB epidemic along with the importance of diagnosing HIV in TB patients, this survey will also serve as an important tool for HIV surveillance among TB patients. The survey will provide information to compare the prevalence of drug resistance (including presence of MDR TB and XDR TB) among TB patients with HIV and those without HIV. It will also help to assess the need for capacity building of the National Tuberculosis Reference Laboratory (NTRL) and National TB program to manage MDR TB cases especially among TB HIV co-infected patients.

Sero-Behavioral Surveys among Most-at-Risk Populations (MARP) in Kampala, Uganda:

HIV/AIDS surveillance in Uganda is largely carried out among ante-natal clients, research cohorts or through general population based surveys, all of which do not explicitly capture most-at-risk populations (MARPs), such as female sex workers (FSW), male sex workers (MSW), men having sex with men (MSM), and street children. Hence HIV control programs tend to focus on the general population, whereas the epidemic may heavily and disproportionally concentrate in and around MARPs. Due to a lack of data, the impact of MARPs on HIV transmission dynamics in Uganda is poorly understood. We propose to do a small series of surveys among MARPs to inform policy makers and HIV/AIDS control activities. We want to conduct separate surveys among four MARPs: FSW, MSW, MSM, and street children, all residing in greater Kampala. Through these surveys, we intend to estimate HIV prevalence, and identify HIV risk behavior and preventive practices in these populations.

Evaluating the Utility of: (1) Using Routine Program HIV testing Data for Surveillance and (2) the HIV-1 Incidence Assay for Incidence-Based Surveillance:

The traditional ante-natal clinic (ANC) based surveillance system relies on unlinked anonymous HIV testing (UAT), is relatively small (~10,000 clients/year) and slow in detecting changes in trend. In Uganda, PEPFAR is the largest donor for HIV testing for PMTCT and VCT clients. Such routine testing programs generate large amounts of HIV testing data (PMTCT: 250,000, VCT: >75,000 in 2005), therefore having the potential of facilitating more precise prevalence estimates for surveillance. Importantly, HIV-positive left-over blood from these programs can be tested with HIV incidence assays, with the prospect of establishing an incidence-based surveillance system for a more timely detection of trends in Uganda's HIV epidemic. We propose to evaluate the utility of routine PMTCT, VCT, and STD program data and specimens for an expanded prevalence and a new incidence-based surveillance system. Potential biases and limitations to be examined include self-selection bias for testing and the accuracy of laboratory-based incidence testing for surveillance. The new methodologies will be piloted at no more than a total of 10 PMTCT/VCT/STD clinics. Routinely collected program data will be transcribed and left-over HIV-positive blood will be collected on filter paper for incidence testing. As PMTCT and STD clinic clients are not consented for further testing and data analysis, testing of these left-over specimens will be performed unlinked, akin to the traditional UAT-based ANC surveillance

system. VCT clients are routinely consented for further testing and analysis allowing a more in-depth analysis using the standard VCT client questionnaire data. Same site PMTCT and UAT-based prevalence data will be compared, as well as PMTCT/VCT/STD-based incidence estimates generated.

For additional information, please refer to supporting documents in this COP on Public Health Evaluations Study Background Sheet.

Targets

Target Target Value Not Applicable Number of outlets providing targeted evaluation.  Number of patients to be reached  ART Sites piloting Quality Assurance activities  Number of local organizations provided with technical assistance for  strategic information activities Number of individuals trained in strategic information (includes 33  M&E, surveillance, and/or HMIS)

Target Populations: Adults Commercial sex workers Men who have sex with men Street youth Pregnant women Men (including men of reproductive age) Women (including women of reproductive age) TB patients

Coverage Areas: National

Table 3.3.13:

Funding for Management and Operations (HVMS): $950,000

This activity relates to 8377 and 10178-Management and Staffing.

In FY07 this funding will support the US Embassy assistance to CDC for financial management services, human resource services and general services including the health clinic, payroll and home-security provided to the nine direct hire positions.

Table 3.3.15:

Funding for Management and Operations (HVMS): $197,847

This activity relates to 8377 and 10176-Management and Staffing.

In FY07 this funding will support the calculated ‘head tax' required by the State Department.

Table 5: Planned Data Collection

Is an AIDS indicator Survey(AIS) planned for fiscal year 2007?  Yes  No If yes, Will HIV testing be included?  Yes  No When will preliminary data be available? Is an Demographic and Health Survey(DHS) planned for fiscal year 2007?  Yes  No If yes, Will HIV testing be included?  Yes  No When will preliminary data be available? Is a Health Facility Survey planned for fiscal year 2007?  Yes  No When will preliminary data be available? 3/30/2007

Is an Anc Surveillance Study planned for fiscal year 2007?  Yes  No if yes, approximately how many service delivery sites will it cover? When will preliminary data be available? 5/31/2007

Is an analysis or updating of information about the health care workforce or the  Yes  No workforce requirements corresponding to EP goals for your country planned for fiscal year 2007?

Other significant data collection activities

Name: Surveillance of sexually transmitted infections Brief description of the data collection activity: With PEPFAR funds provided through CDC, the Ministry of Health in FY07 plans to expand their traditional ANC surveillance activities to include specific sexually transmitted diseases (STDs) analysis. Following the '05 sero-behaviorial survey report demonstrating STDs as strong risk factors for HIV acquisition, additional data is required to inform program and policy for prevention and treatment. This methodology will sample at a selected number of sites clinic attendees with STD-related signs and symptoms. Clinic data will be transcribed, including demographics, STD diagnosis, and other routinely collected variables and analyzed to generate prevalence; trend estimates of select STDs; as well as, a describtion of high risk groups by demographic and other risk factors. Preliminary data available: August 31, 2007

Name: Female sex worker survey Brief description of the data collection activity: With PEPFAR funds provided through CDC, the Ministry of Health, in FY07 plans to conduct a survey of female sex workers in Kampala. Following results from the '05 sero-behaviorial survey, a national focus and priority is to identify prevalence and behaviors in known high risk groups for HIV to provide the science need to appropriately inform program and policy. The proposed protocol for this survey is currently under the review with the CDC-GAP Associate Director for Science and includes sampling from several hundred female within Kampala. Data collection will focus on demographic characteristics and risk bahaviors; and biological specimens will be collected, tested for HIV; and HIV prevalence estimates generated. Preliminary data available: June 30, 2007