This activity also relates to activities in Treatment: ARV services (8420) and Laboratory Infrastructure (9100).

Hospice Africa Uganda (HAU), a registered national NGO, is at the forefront of palliative care (PC) throughout Africa. Commenced in 1993, it has now been one of the most successful projects and it'sstaff are recognized as technical experts for the Ministry of Health in palliative care. As a result of Hospice Africa Uganda's work, Uganda is a model for bringing affordable and culturally acceptable palliative care, for HIV/AIDS and/or cancer patients and families, throughout Africa. From the experience and initiative of HAU, two support organizations have been born: Palliative Care Association of Uganda (PCAU) whose brief is to support each of the Districts in Uganda with standards, education and follow up of services, and the African Palliative Care Association (APCA) to coordinate, assess and promote services throughout the continent, through advocacy, education, and setting standards. Currently HAU operates from three sites: Kampala (Head office), Hoima District and Mbarara District. Each of these district branches has a network of outreach sites in other districts around it. In addition, each branch has a technical team that offers palliative care training and follow up supervision for other HIV/AIDS care organizations.

In FY07, HAU plans to continue its mission of expanding access and scope of palliative care services to People Living with HIV/AIDS and their families, with a focus on increasing competence of HIV/AIDS care and service providers to engage in delivery of PC services and strengthening linkages between households, communities and palliative care delivery sites. HAU will build the capacity of service providers through both training/education and sensitization of health care providers and allied professionals. This is intended to support existing HIV/AIDS care organizations (public, private for profit and private not for profit) to integrate pain and symptom control, spiritual care and end of life care and bereavement support into their existing programs. This will be achieved through targeted trainings and through support visits to assist them internalize these skills.

As HAU continues strengthening the direct provision of comprehensive palliative care for PLHA and their immediate families it has also realized that optimizing quality of life for PLHA necessitates increasing their access to a variety of services ranging from pain & symptom management, prophylaxis and treatment of opportunistic infections, psycho-social support, HIV prevention, basic care (mosquito nets, family VCT), succession planning, spiritual care, as well as end of life and bereavement care. HAU recognizes that no one agency can provide all the components of care and support and will hence collaborate with existing networks of other service providers to co-manage patients to maximize synergies . Therefore linkages with and across partners is essential to maximize efficiency and improve access to holistic care. In this light, care in the community using HAU Community Volunteer Workers, and co-managed care with sister organizations will underpin this activity. Home based care will form the basis of this activity, especially to address the needs of PLHA during the critical stages of illness. HAU will use its family-centered approach to build capacities of families and communities to offer intermediate care to PLHA, and refer those needing professional care to the appropriate sources of care. We aim to provide palliation, spiritual support and support to the family to ensure peace and dignity at the end of life to an estimated 1,500 HIV/AIDS patients of whom 700 will be newly enrolled on program. Care provided by HAU is typically intensive and will be achieved through engaging in delivery of care services from home visits, outpatient clinics, day care centers (site & community), hospital consultations, outreaches and roadside clinics. The latter have proved to be viable strategies for accessing palliative care services to individuals who are unable to reach static sites. In addition to the patients enrolled on program, HAU expects to assess/consult, provide one-off care and/or refer ‘to appropriate care, treatment and support services', another 1,000 PLHAs. This latter group of patients includes those who may be assessed and found ineligible for on-going palliative care and are usually referred to other organizations for appropriate care.

HAU also plans to work with PCAU in the setting of standards, technical assistance, and development of appropriate IEC for PC, and advocate for palliative care focal persons at the district level and palliative care teams within health systems, at hospital and community levels. Additionally, HAU will finalize updating all HAU training courses with information on referral networks and collaborations and setting up of local palliative care groups to support each other in palliative care delivery.

This activity also relates to activities in Palliative Care: Basic (8419) and Laboratory Infrastructure (9100). Hospice Africa Uganda (HAU), a registered national NGO, is at the forefront of palliative care (PC) throughout Africa. Commenced in 1993, it has now been one of the most successful projects and is recognized as technical experts for the Ministry of Health in palliative care. As a result of Hospice Africa Uganda's work, Uganda is recognized as a model for bringing affordable and culturally acceptable palliative care, for HIV/AIDS and/or cancer patients and families, throughout Africa. From the experience and initiative of HAU, two support organizations have been born: Palliative Care Association of Uganda (PCAU) whose brief is to support each of the Districts in Uganda with standards, education and follow up of services, and the African Palliative Care Association (APCA) to coordinate, assess and promote services throughout the continent, through advocacy, education, and setting standards. Currently HAU operates from three sites: Kampala (Head office), Hoima District and Mbarara District. Each of these district branches has a network of outreach sites in other districts around it. In addition, each branch has a technical team that offers palliative care training and follow up supervision for other HIV/AIDS care organizations. HAU is one of the few specialist organizations within Uganda providing and supporting palliative care interventions (in accordance with WHO definition, 2002) which focus on palliation- pain and symptom management, adherence to treatments, prophylactic care and treatment of opportunistic infections, HIV prevention, psycho-social and spiritual support, to the patient and to the family to optimize the quality of life and to ensure peace and dignity at the end of life. Central to HAU philosophy is the delivery of services at times and places convenient for the patient and their carers' in a culturally and socially sensitive way.

Home based care and community care will form the backbone of HAU services, especially for PLHAs during the critical stages of illness. HAU will continue to use its close link with families and communities of people affected by HIV/AIDS to support treatment adherence, not only for HIV/AIDS but also for other critical illnesses such as tuberculosis. HAU will build capacities of families and communities to offer intermediate care to PLHA, ensure adherence to treatments, and refer those needing professional care and treatments to the appropriate sources of care and treatment. In addition this approach offers unique opportunities (with sensitivity) for reaching families with prevention messages to minimize further transmissions of HIV, and delay onset of infections among PLHA; address sexuality issues such as condoms and family planning; and counseling for testing (PMTCT/VCT for both adults and children), as well as facilitating them with HIV testing, so as to link them to other forms of care such as ART. In this coming year, HAU will seek to broaden these to include training family carers on the value of counseling and testing, promote couple testing and disclosure of results and safe sex. HAU will use its network of 122 palliative care trained Community Volunteer Workers to work with families and communities to further strengthen basic care and adherence support within the HAU operational areas. Monthly community day centers, will be designed as places that bring together patients and carers together in order to provide care and treatment, and improve access to prevention services as well adherence support at the community level. HAU plans to pilot at least two community day centers, one in Hoima and the other in Kampala. HIV prevention messages will focus on giving correct information on recent developments such as infection control, adherence support, disclosure etc.

The second component of this activity is co-managed care with sister organizations. HAU recognizes that no one agency can provide all the components of care and support and will hence collaborate with existing networks of other service providers to co-manage patients to maximize synergies and enable PLHA to access the broad spectrum of services, such as ART (adults and pediatrics). For instance, HAU refers patients to ART providers for initiation of ART while the same providers also refer to HAU the patients that need pain and symptom control and psycho-social support to enhance adherence to ART and prophylactic care, such as, cotrimoxazole and fluconazole. With increasing access to ARVs, many patients are experiencing restored health and longer term survival, often with complex psycho-social needs and punctuated with periods of ill health and symptoms due to infections. Some also experience severe ARV-related side effects, in some instances so distressing that they cause patients to stop their ARVs and jeopardize their health. In order to meet these needs, complementary care is required between organizations, not only to enhance the quality but also to avoid duplication of care. HAU will also continue to network with organizations that formally provide services that are not provided at HAU such as social support interventions (food assistance, income generating activities, and

support for orphans). These linkages will be strengthened to maximize efficiency and improve access to holistic care. Efforts will also be made to encourage two-way referral systems and ‘fast track' arrangements for patients referred between programs for ‘shared care'.

In FY07 HAU targets to reach 700 new HIV/AIDS patients to be taken ‘on program' as patients requiring palliative care specifically for pain and symptom management and/or end of life care to ensure peace and dignity. HAU will train at least two family members responsible for caring for the patient in home care and referral. HAU will also update the skills of its clinical and training staff (45) and community volunteers(122) in comprehensive HIV/AIDS management skills (diagnostic, treatments, adherence, and education). These activities will aim to address the key legislative issues of gender, stigma and discrimination, and wrap around activities related to increasing food and nutritional resources for HIV affected and infected individuals.

OGAC Reviews: Hospice Africa - 8420- should be in palliative care section.

Hospice Africa Uganda (HAU) is an indigenous organization offering palliative care with a focus on pain management, symptom control and end of life care. In this role HAU provides care for hundreds of ART patients who develop pain and other symptoms resulting from ARVs. In addition HAU delivers its services through a family approach which puts it in a strategic position to identify individuals with PLHA and link them to ART delivery sites and provides community and clinical support for ART adherence. These interventions constitute a valuable element of ART services.

This activity also relates to activities in Palliative Care: Basic (8419) and Treatment: ARV Services (8420). Hospice Africa Uganda (HAU), a registered national NGO, is at the forefront of palliative care (PC) throughout Africa. Commenced in 1993, it has now been one of the most successful projects and is recognized as technical experts for the Ministry of Health in palliative care. As a result of Hospice Africa Uganda's work, Uganda is recognized as a model for bringing affordable and culturally acceptable palliative care, for HIV/AIDS and/or cancer patients and families, throughout Africa. From the experience and initiative of HAU, two support organizations have been born: Palliative Care Association of Uganda (PCAU) whose brief is to support each of the Districts in Uganda with standards, education and follow up of services, and the African Palliative Care Association (APCA) to coordinate, assess and promote services throughout the continent, through advocacy, education, and setting standards. Currently HAU operates from three sites: Kampala (Head office), Hoima District and Mbarara District. Each of these district branches has a network of outreach sites in other districts around it. In addition, each branch has a technical team that offers palliative care training and follow up supervision for other HIV/AIDS care organizations. HAU is one of the few specialist organizations within Uganda providing and supporting palliative care interventions (in accordance with WHO definition, 2002) which focus on palliation- pain and symptom management, adherence to treatments, prophylactic care and treatment of opportunistic infections, HIV prevention, psycho-social and spiritual support, to the patient and to the family to optimize the quality of life and to ensure peace and dignity at the end of life. Central to HAU philosophy is the delivery of services at times and places convenient for the patient and their carers' in a culturally and socially sensitive way.

HAU is one of the few specialist organizations within Uganda providing and supporting PC interventions (in accordance with WHO definition, 2002) which focus on palliation- pain and symptom management, adherence to treatments, prophylactic care and treatment of opportunistic infections, HIV prevention, psycho-social and spiritual support, to the patient and to the family to optimize the quality of life and to ensure peace and dignity at the end of life. Central to HAU philosophy is the delivery of services at times and places convenient for the patient and their carers' in a culturally and socially sensitive way. Care provided by HAU is typically intensive and is achieved through engaging in delivery of care services from home visits, outpatient clinics, day care centers (site & community), hospital consultations, outreaches and roadside clinics. The latter have proved to be viable strategies for accessing palliative care services to individuals who are unable to reach static sites. Home based and community care remain the backbone of HAU services, especially for PLHAs during the critical stages of illness.

In keeping with our goal of not duplicating services, HAU does not have laboratories on site but will use selected and approved local laboratory services and/or refer patients to treatment providers with laboratory facilities. The laboratory services sought are those directly linked to services offered by HAU, hence examinations for conditions for which HAU refers patients to other providers will not be covered. Patients will be supported and/or facilitated with investigations in a number of ways. Mobile needy patients will be facilitated with transport and/or investigation costs to source laboratory services at selected providers (public, private not for profit, private for profit sector). For bed-ridden patients, HAU clinical staff are trained in rapid tests (such as malaria) and in taking clinical samples such as blood, malaria slides which will be taken to the testing laboratories. An assessment of necessity of the investigations against the inconvenience to the patient is always taken. Patients will also be assessed for the importance of investigations in their palliative management and enhancement of quality of life. If a patient is too sick to travel for investigations, and they really need treatment, sometimes empirical treatment (treatment of most likely illness without investigations) can be given at home by the clinical team.

PLHA will be referred to ART providers for diagnosis, investigations and initiation of ARV therapies where appropriate. Patients will be supported with access to investigations and treatment of malaria, HIV/AIDS and related cancer diagnosis and sexually transmitted infections. A component of this activity will be to strengthen the linkages between HAU and organizations that provide services that are not provided at HAU, to maximize efficiency and improve access to holistic care. In FY07 HAU targets to provide care to 1,500 PLHA. HAU will provide support/facilitate investigations to an estimated 250 individuals, and train at least 12 clinical/education staff in clinical diagnosis and use of

rapid test kits.

These activities will aim to address the key legislative issues of gender, and stigma and discrimination