The activity relates to 8856-Injection Safety, 8385-Condoms and Other Prevention, 8386-Palliative Care;Basic Health Care and Support, 8987-Palliative Care;TB/HIV, 8853-OVC, 8388-CT, 8391-ARV Services, 8387-SI, 8389-Management & Staffing.

As commander in chief of the armed forces, the President of Uganda mandated the UPDF's AIDS Control Program to oversee and manage prevention, care, and treatment programs throughout the forces and their families. PMTCT services have been implemented in five Army units over the past two years, and processes are underway to raise awareness and increase access of pregnant women to these programs. Midwives and nurses are being trained in 3 of the PMTC centers.

The FY07 activities aims to strengthen the services at the 5 PMTCT sites, expand the awareness and outreach to all sites, and emphasize the linkage to clinical services. PMTCT will also be used as an entry point to ART services and an avenue to identify discordant couples, for PWP (PMTCT).

The activity is relates 8390-PMTCT, 8385-Condoms & Other Prevention, 8386-Palliative Care;Basic Health Care & Support, 8987-Palliative Care;TB/HIV, 8853-OVC, 8388-CT, 8391-ARV Services, 8387-SI, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (ref. FY06 COP-$250,000 for ARVs, $250,000 for services).

In FY07, the UPDF proposes to initiate a new activity in the area of Injection Safety. The UPDF medical staff provides services to many HIV infected clients throughout their medical units, as well as patients with other blood and respiratory borne diseases. There is therefore potential for patient-health worker inter-transmission of HIV and other infections in the clinical settings. The UPDF intends to strengthen its infection control prevention strategies in the health units and hospitals to address risk factors and implement control measures. Safe injection practices and PEP will be promoted consistent with the existing national guidelines, in collaboration with the USG program being implemented by John Snow, Inc. (JSI) Rapid Interventions to Decrease Unsafe Injections and Preventing the Medical Transmission of HIV.

This activity relates to 8390-PMTCT, 8987-Palliative Care;TB/HIV, 8388-CT, 8391-ARV services, 8386-Palliative Care;Basic Health Care & Support, 8387-SI, 8853-OVC, 8856-Injection Safety, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (ref. FY06 COP:$250,000 for ARVs, $250,000 for services).

Uganda initiated programs for high-risk groups in the early phases of the epidemic that have a basis of excellent principles of nondiscrimination and span the spectrum of Abstinence, Be Faithful, and use of Condoms. The UPDF supports this National Framework, and has utilized post test clubs as one of the cornerstones for prevention strategies. Formed mainly from persons who have tested positive, the clubs are open to all military personnel, their families, and the people from the surrounding community who has tested for HIV. The clubs are also seen as an important link for care and treatment services and for follow-up for psychosocial support. Another common practice which has been highly effective for the commanders to reach through to the troops, has been the use of military parades, to pass on information using open discussions with disclosure by the PTC members. Current activities are the development of IEC materials that are contextualized for the military setting and to step up the BCC campaign, a training of trainers to have ‘focal points' of peer educators within these PTCs, expanding the peer education program to include an emphasis on gender issues, family planning, challenging male norms, and addressing stigma and discrimination. Distribution of condoms from the Ministry of Health has been extended to 12 centers, which will continue to be a focus of prevention activities.

For 07, the cadre of peer educators within the PTCs associated with each of the 13 VCTs will be expanded, with a concomitant increase in the HIV Prevention activities of awareness, abstinence and being faithful, and delaying of sexual debut, and pre and post test counseling. Training for these PTC counselors will also include prevention for positives and better inclusion of family members with testing, counseling, and clinical care. Extending the reach of these PTC counselors via mobile services is also planned. Specific individuals will be identified within each military unit as a distribution point for peer education and condom distribution to increase distribution beyond the 12 fixed sites.

This activity relates to 8390-PMTCT, 8385-Condoms and Other Prevention, 8388-CT, 8391-ARV Services, 8987-Palliative Care;TB/HIV, 8387-SI, 8853-OVC, 8856-Injection Safety, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (COP 06:$250K for ARVs, $250K for services).

The Ugandan military continues to have challenges in providing adequate clinical care services to the estimated 15,000 to 20,000 HIV infected personnel and family members. This is due to a lack of trained clinical staff, an automated medical information system, and inadequate laboratory diagnostics for OIs and co-infections. These inadequacies are being systematically addressed via the support from the USG, initially in the Kampala based Bombo military hospital, and Mbuya military Hospital, with expansion to military medical facilities in Nakasongola and Wakiso. Drugs for OI prophylaxis and treatment are being procured for these 3 sites. Particular attention is paid to widows and OVCs that are eligible for services. A course has been developed for nurses and clinical officers through the Infectious Diseases Institute, Kampala and for the past 2 years this training has been used to ramp up care in HIV clinical management, to include addressing military specific issues.

In 07, these activities (diagnosis and treatment of OIs, drug procurement, training, lab services), will continue and expand beyond the 2 major clinical sites in Kampala and 2 outside Kampala sites to all 8 sites within the military health network providing ARV access. STI diagnostics and therapeutics and training for HCWs will be initiated. A new and extremely important expansion, given the recent compelling data confirming efficacy, will be to provide access to the Basic Health Care Package (impregnated mosquito nets; safe water vessel; co-trimoxazole) to the UPDF HIV positive personnel and family members. This will include a piloting of use of the BHC package in deployment/field scenarios.

This activity relates to 8390-PMTCT, 8385-Condoms and Other Prevention, 8388-CT, 8391-ARV Services, 8386-Palliative Care;Basic Health Care & Support, 8387-SI, 8853-OVC, 8856-Injection Safety, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (COP 06:$250K for ARVs, $250K for services).

Co-infection with TB is a substantial challenge for the medical management of HIV infected patients in the UPDF. This is a new activity and will include diagnostics which remain limited, even in the 2 primary clinical centers in Kampala, and treatment strategies to ensure compliance. Activities will include enhancement of laboratory capabilities, and training of the HCWs and laboratory technicians in recognition and diagnosis of TB. Additionally, strategies to increase compliance within a military environment will be addressed, to include piloting alternatives to the current common practice of inpatient care for the initial 2 months of treatment, which does have a substantial medical resource cost.

This activity relates to 8390-PMTCT, 8385-Condoms and Other Preventions, 8388-CT, 8391-ARV Services, 8987-Palliative Care;TB/HIV, 8387-SI, 8386-Palliative Care;Basic Health Care & Support, 8856-Injection Safety, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (COP 06:$250K for ARVs, $250K for services).

AIDS and war continue to be the topmost causes of death among UPDF personnel and their families. As a result, the Uganda Peoples Defense Forces has got a large burden of orphans that are either infected by HIV or vulnerable to being infected. Most of these orphans are enrolled within the army schools. Little attention has to-date been given to this vulnerable group. In 07, the UPDF proposes to initiate support activities for the OVCs as a school based program through health education about Abstinence, strengthening counseling and care services in the schools, and fighting stigma against those infected, especially those on ART. In achieving this, the teachers will be specifically targeted, sensitized and empowered to enable them incorporate the activities in their routine duties. PHA's households will be targeted to ensure that the OVC are linked to OVC services as well as care and treatment.

This activity relates to 8390-PMTCT, 8385-Condoms and Other Prevention, 8386-Palliative Care;Basic Health Care & Support, 8391-ARV Services, 8987-Palliative Care;TB/HIV, 8387-SI, 8853-OVC, 8856-Injection Safety, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (ref. FY06 COP:$250,000 for ARVs, $250,000 for services).

The USG program has been highly successful in establishing, over the past 3 years, 13 CT centers across the military units and across the country. There has been a strong uptake of testing, which has in part been facilitated by the awareness and counseling services of the PTCs. This is in the process of being extended into hospitals and clinics (RTC), and as with the VTC centers, testing is linked to clinical services.

For 07, there will be continued support for the established CT centers, continuation of RCT, with a new activity of adding 2 mobile testing and counseling services teams. This will allow reach of military personnel and their family members that are not co-located with a military clinic and can be linked with other palliative care services for these hard to reach populations. One of the teams will be operating from the Gulu based static center to cover Gulu, Kitgum, Apac, and Adjumani. The other mobile team will be based in the eastern part of the country, in Mbale, to cover Tororo, Soroti, Katakwi, Moroto, and Kotido. It is estimated that an additional 8,000 additional people will be reached by the mobile teams.

This activity relates to 8390-PMTCT, 8385-Condoms and Other Prevention, 8388-CT, 8386-Palliative Care;Basic Health & Support, 8987-Palliative Care;TB/HIV, 8387-SI, 8853-OVC, 8856-Injection Safety, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (ref. FY06 COP:$250,000 for ARVs, $250,000 for services).

Beyond the estimated 20,000 military personnel and family members that are HIV infected, military medical clinics are also available to civilians, and in some locations are utilized by the surrounding civilian communities. Thus the demand to provide quality ARV services is continually growing. In mid-2004, two army hospitals were accredited to deliver ART, starting with drugs provided by the Global Fund. This has been expanded through the PEPFAR to 8 sites serving 1800 adults, spouses, and children. ARV services have been strengthened through training of health care providers, via the Infectious Diseases Institute (IDI) based in Kampala, and a partnership with San Diego DHAPP. A critical cornerstone of safe, effective ARV treatment is high compliance. Military personnel have unique challenges and obstacles for medication adherence, given barracks living, deployments, and the stigma associated with HIV/AIDS. A needs assessment and pilot adherence program is being initiated to specifically address ARV compliance in the military, and will be centered at Bombo Barracks and Mbuya Hospital.

In 2007, there are plans to support to expand ARV services in training of UPDF personnel and modify and extend the adherence protocol to the other 6 treatment sites. This program will also be evaluated, and clinic procedures modified to include adherence practices as standard protocol. Additional training of physicians (6) and nurses and clinical officers (25), through the IDI in Kampala and the DHAPP program (2) will also be conducted. The IDI in collaboration with the UPDF have developed a 4 week (and 2 week respectively) course aimed to ramp up skills in ARV use, recognition and management of OIs and PMTC. Monitoring of clinical services with a medical information systems (MIS) to optimize clinical management will be initiated. There will be more of an emphasis on integration of prevention care and treatment programs; and increasing the availability of materials for client-provider interaction. Provision of ART will continue through JCRC, with drugs worth $250,000.

This activity relates to 8390-PMTCT, 8385-Condoms and Other Prevention, 8388-CT, 8391-ARV Services, 8987-Palliative Care;TB/HIV, 8386-Palliative Care;Basic Health Care & Support, 8853-OVC, 8856-Injection Safety, 8389-Management & Staffing.

The UPDF is Uganda's national Army. As a mobile population of primarily young men, they are considered a high-risk population. Uganda initiated programs for high-risk groups in the early phases of the epidemic and continues to promote excellent principles of nondiscrimination in its National Strategic Framework. Starting in 1987, the Minister of Defense developed an HIV/AIDS program after finding that a number of servicemen tested HIV positive. As commander in chief of the armed forces, the President mandated the UPDF's AIDS Control Program to oversee and manage prevention, care and treatment programs through out the forces. Although the exact HIV prevalence rates from the military are unknown, it is estimated that approximately 10,000 military are living with HIV with up to an additional 10,000 HIV infected family members. The UPDF HIV/AIDS Control program is comprehensive and covers the critical elements of prevention, such as counseling and testing, peer education, condom distribution, and PMTCT; HIV care, such as palliative care services and ARV services; and human and infrastructure capacity building. More recently provision of ART has been initiated on a larger scale, in 8 military sites, with drug provision via JCRC (COP 06:$250K for ARVs, $250K for services).

Support is needed to accurately and completely capture PEPFAR targets from program activities in the field and the necessary routine clinical data at the service point level. This effort will be coordinated through the Uganda Country team S & I program/system. In FY05, the focus was on capacity building in terms of skills and training, with the initial primary clinical sites of Bombo Barracks and Mbuya in Kampala. Collection of accurate routine data has been a significant challenge, particularly at the service point level. There will be a growing emphasis on systems in 06. Additionally, preparation for a large randomized behavioral sero prevalence study of UPDF active duty personnel was accomplished; the sero prevalence survey will be completed in COP 06 activities.

For COP 07, the activities modifying the pilot MIS structure and extending it to at least 3 additional clinical sites. The sero prevalence survey will be conducted during 06, with analysis, study summaries, and modification and adoption of the protocols for ongoing surveillance as a primary activity in 07. A needs assessment and pilot QA activities for ART centers will be initiated.

The DOD HIV/AIDS Program has two associated staff members. One is a fulltime EFM/FSN coordinator who will be supervised by DAO American staff including the Defense Attaché and the OPSCO. A second full time position was funded in FY06 to provide technical public health and clinical expertise to program management and to the Uganda People's Defense Force, and to increase program integration with the other USG emergency plan initiatives. Presently, recruitment is underway for this position.

In addition, the ICASS service center recently issued an ICASS code for the program and an associated invoice, thus $32,000 of this funding will therefore be used to cover these ICASS costs.