This activity also relates to activities in Palliative Care: TB/HIV (8463), Orphans and Vulnerable Children (8464), Counseling and Testing (8900) and Treatment:ARV Services (8465). It is widely recognized that greater involvement of PHAs (GIPA) results in more appropriately designed and relevant programs and policies, greater access to prevention, care and treatment services for those infected and affected by HIV/AIDS and decrease stigma and discrimination through improved understanding of the PHA experience. The Program for expanding the Role of PHA Networks in Uganda, a 3-year program(2006-2009) implemented by the International HIV/AIDS Alliance(IHAA) serves to increase PHAs' access and utilization of HIV/AIDS services by mobilizing and strengthening PHA networks into sustainable and formalized self-help groups that will provide and/or facilitate access to treatment, care and support services.

The program through the provision of technical and financial support through sub-grants, is tasked with mobilizing and strengthening the national PHA organization (NAFOPHANU), 14 district and over 40 sub-district PHA networks in Uganda. The IHAA will build institutional and technical capacity of these PHA networks to increase their involvement in the provision of prevention, care and treatment services and in the establishment and management of effective referral mechanisms to link their members, families and the communities to HIV/AIDS care, prevention and treatment services.

In FY07 the program will train 160 NSA and 80 PHA Networks groups in psychosocial support, home-based care, ART literacy, communication and counseling skills - including how to support disclosure and adherence, living with a chronic condition-including prevention for HIV positive people themselves and their partners (the issue of discordant couples will be addressed here), stigma, including strategies to confront stigma, particularly linked to health care settings, record keeping and referrals and care for cares. PHA groups will receive small grants to facilitate and promote positive living among their members, and procure HIV/AIDS care and support commodities. Examples of these commodities include long lasting insecticides treated mosquito nets (LLITNs), condoms, gloves, safe water containers and co-trimoxazole prophylaxis. The PHA Net works and groups will also provide home-based care services ranging from psychosocial support services, home visits, elementary pain management, nutritional education and counseling. The program will work in collaboration with AFFORD, a USG-funded social marketing group, to market, procure, and distribute the HIV/AIDS commodities. es Through over 80 service outlets comprising of the PHA Networks community outreaches and health facilities working directly with the NSA, the program will provide palliative care to over 70,000 PHAs and their families.

A key focus of this program is to ensure that all people that test HIV-positive are linked to palliative care and treatment services either through services provided by PHA networks themselves, or through referral systems managed by these same networks to existing health facilities. PHA networks and groups will identify and second some of their members to be trained as Network support Agents (NSA). NSA will be attached to health facilities to facilitate referrals and linkages of clients to HIV/AIDS care and support services, Post-test clubs and community based groups including PHA networks and groups.

The NSA will also implement the family-based approach to Palliative Care delivery with the index HIV positive client serving as an entry point into the family and the community to provide counseling and testing to household members, and providing and/or linking those found HIV-positive to care, treatment and prevention services. The family approach also enhances easy identification of discordant couples, prevention of OIs and prevention of HIV transmission especially among discordant couples.

To ease on the shortage of human resources at the health facility and at community level, PHAs, religious leaders, FBOs and other volunteers will be trained and engaged in the delivery of home-based care and referrals at community level. Working with health facilities in the sub district, PHA networks will also facilitate outreaches, which will be used as a viable strategy for accessing palliative care services to individuals who are unable to reach static sites.

The Alliance has adopted the network model approach to deliver palliative care services to communities and households. The model aims at enhancing easy access to a wide rang of essential services for PHAs and their families. Prevention, care, treatment. The Alliance will

also work with and link PHA groups and District networks to the wrap around services like family planning and broader reproductive issues, supplementary feeding, livelihood programs, social and economic reintegration programs and access to safe water and sanitation. The program will train and build the capacity of local organizations providing palliative care to effectively refer and link their clients to the "wrap around" services. Alliance will also continue to work with other organizations like Ministry Of Health, UAC, USG-funded palliative care organizations and other local partners to support the delivery of quality palliative care people infected and affected by HIV/AIDS.

plus ups: Existing linkages between HIV services and traditionally non-HIV related services are weak. This activity will support linkages between HIV services with non-HIV related clinical services, enhance support for adherence through multiple avenues and establish best practices for linking facility-based care to community-based care. This activity will facilitate referral systems that ensure a patient is able to access a complete package of care throughout the HIV stages of disease progression. The program will identify, implement, document and share the best practices.The program will also provide support to USG partners in incorporating these approaches into the HIV/AIDS continuum of care across facility-based and community-based care settings.

This activity also relates to Palliative Care: Basic (8462), Orphans and Vulnerable Children (8464), Counseling and Testing (8900) and Treatment: ARV Services (8465).Uganda ranks 15th among the world's 22 countries with a high TB burden. There is a strong association between TB and HIV/AIDS and this association has exacerbated the TB and HIV/AIDS problems in Uganda. About 20 percent of TB patients are estimated to be HIV-positive and TB remains the leading cause of morbidity and mortality for people living with HIV/AIDS. In 2003, 30% of all death among PHAs was attributed to TB. The Government of Uganda launched the TB/HIV integration policy, and a communications strategy to guide the implementation of collaborative activities between TB and HIV aimed at reducing the burden of TB among PHAs. To support the roll out of this policy, the Alliance has designed a program to build the capacity of PHA Networks and groups to actively involve themselves in implementing the TB/HIV integration policy and reduce the burden of TB among their members.

The Program for expanding the Role of PHA Networks in Uganda, a 3-year program implemented by the International HIV/AIDS Alliance(IHAA) serves to increase PHAs' access and utilization of HIV/AIDS services by mobilizing and strengthening PHA networks into sustainable and formalized self-help groups that will provide and/or facilitate access to treatment, care and support services. TB/HIV integration aimed at reducing the burden of TB among PHAs is one of the core components of this program. The program through the provision of technical and financial support through sub-grants, is tasked with mobilizing and strengthening the national PHA organization (NAFOPHANU), 14 district and over 40 sub-district PHA networks in Uganda. The IHAA will build institutional and technical capacity of these PHA networks to increase their involvement in the provision of prevention, care and treatment services including TB/HIV integration, and in the establishment and management of effective referral mechanisms to link their members, families and the communities to HIV/AIDS care, prevention and treatment services.

80 PHA networks and groups will be trained in increasing TB awareness amongst their members and their families. This will facilitate access and utilization of TB screening services by PHAs and their household contacts. The PHAs will also be trained to demand for TB screening services from healthcare providers. Through 40 trained Network Support Agents(NSA), who are themselves PHAs trained to facilitate referrals and linkages to HIV/AIDS services, all those testing HIV-positive at counseling and Testing Centers will be linked to TB screening services. Those that are diagnosed with active TB will be referred and linked to TB treatment while those with latent TB will be facilitated to receive Isoniaziad Prophylaxis Therapy(IPT). The NSA working with CB-DOTS supervisors will ensure that TB/HIV co-infected patients adhere to their TB treatment, and receive the back-referral to HIV/AIDS services for Cotrimoxazole prophylaxis and ART if eligible. These clients will also be linked to home-based care, STI diagnosis and treatment, and prevention with positives services. The TB/HIV co-infected patients will also receive basic care packages ranging from long-lasting insecticide treated nets(LLITNs) , condoms, family planning commodities, and safe water vessels.

The program will work in collaboration with several USG-funded organizations that provide Counseling and Testing services(AIC, MJAP), those that provide TB screening (JCRC, TASO, MJAP, IRCU) and those providing PMTCT services(EGPAF, PREFA). The program will also work closely with programs that have a district focus(UPHOLD, Northern HIV/AIDS program, New TB/HIV activity) to ensure that the PHA networks approach to increase access of PHAs to TB screening is effectively integrated in the district plans. The Alliance will work closely with health facilities in the district and sub district, and communities to create awareness of HIV/TB co-infection and the impact this has on quality of life and longevity of PHAs. Communities and PHAs will receive information on the value of early screening for TB and tracing of contacts especially children. The network support agents and PHAs will be trained to increase TB awareness among PHAs and utilization of TB screening services. In the process of working to reduce TB at family and community level, Alliance will work with health facilities, communities and PHA households to look into issues of contact tracing - where other family members, especially children/OVCs are screened for TB and linked to TB treatment early if found to have TB.

The activity will provide technical support and financial assistance through sub grants to PHA networks and groups to build their capacity to effectively support TB/HIV integration activities. The Alliance will build institutional and technical capacity of PHA networks to

increase their involvement in the provision of prevention, care and treatment services and in the establishment and management of effective referral mechanism to link members and their families to TB services and community support program for increased TB detection rates and DOTS treatment success rates. In the area of TB/HIV integration, this activity will train PHA networks/groups/members to promote and support TB testing among their members and to link members and their families to clinical TB services as appropriate. Also during the training of NSAs, the issue of TB/HIV integration will be emphasized so that the Network Support Agents NSAs are able to counsel clients in relation to TB screening and treatment, and retrieval/back referral for access to HIV/AIDS services. The Network support agents will work with communities and health facilities in the district where people living with HIV/AIDS access services for both HIV and TB. The Network support Agents will also be trained in TB/HIV reporting systems so that they capture number of clients referred for TB/HIV services. Alliance will also work with existing programs supporting the delivery of CB DOTS where PHAS could work as CB-DOTS community volunteers and facilitate the linkages with HIV/AIDS services.

plus ups: From the 2005 biannual reviews conducted by the International Union Against TB and Lung Diseases(IUATLD) and the Global Drug facility(GDF) mission it was found that lack of knowledge of the TB/HIV collaborative activities hindered integration activities. It has also been established that lack of knowledge of the association between TB and HIV among People Living with HIV/AIDS(PHAs) hinders access to TB screening and diagnostic services. Working with Groups and networks of PHAs, this activity will accelerate access and utilization of TB screening services by PHAs and facilitate effective referral systems to and from TB and HIV services.With the plus-up funds, TB/HIV activities will be scaled up from 14 to 28 districts.

This activity also relates to Palliative Care: Basic (8462), TB/HIV (8463), Counseling & Testing (8900) and Treatment: ARV Services (8465). There are estimated 2 million orphans (14% of all the children), representing a more than 2 fold increase in the number of orphans since 1990. Approximately 46% of orphans are due to HIV/AIDS and the rest are orphaned primarily due to conflict. Of the 4 million children living in conflict, 1 million are living in IDP camps. 63% of all single orphans do not live in with their natural parents: 24% are double orphans and 35 % are maternal orphans. An estimated 84,000 - 104,000 children 0 - 14 are HIV + adding to the number of vulnerable children. It is widely recognized that greater involvement of PHAs (GIPA) results in more appropriately designed and relevant It is widely recognized that greater involvement of PHAs (GIPA) results in more appropriately designed and relevant programs and policies, greater access to prevention, care and treatment services for those infected and affected by HIV/AIDS and decrease stigma and discrimination through improved understanding of the PHA experience. The purpose of this program is to increase access to PHAs to HIV/AIDS services by mobilizing and strengthening PHAS networks into sustainable and formalized self-help groups that will provide and/facilitate access to treatment, care and support services including OVC services for the OVC in the house holds.

The Alliance will develop strategies with other partner organizations operating in the sub districts to support PHAs, their families and communities in providing an integrated response in their support for orphans and vulnerable children. Another approach Alliance will use to support the OVC is based on community mobilization to maximize community mobilization to maximize community ownership and the development of linkages between PHA groups and District probation officers, Community Development Officers and their Assistants, Church groups, NGOs and CBOs providing care and support to OVC and school authorities. Developing linkages and opportunities for synergies with the community allows children and their families to have access to the range of services that they needs like education, psychosocial support economic strengthening, health and nutrition as well as support for their social inclusion.

Where visible and appropriate, linkages will be created between the program and the grantees of the CORE Initiative for youth, orphans and vulnerable children in Uganda, which, are providing care and support to OVC. Districts, communities, civil society organizations and other providers of quality OVC services, will be targeted by the Alliance model for capacity building. Network Support Agents and health service providers will be linked to these providers to ensure referrals and backward linkages for OVC services and support supervision.

At district level, links will be created between NAFOPHANU - the national umbrella PHA networks program, district fora, community development officers and other OVC related community services supported b the CORE -initiative. This intervention will lead to improvement in district level OVC responses and reduce/eliminate duplication of OVC services. Partnership between organization involved in OVC programs and PHA groups will be encouraged to not only increase the number of children having access to OVC support services but also to foster PHA involvement in the design and delivery of OVC support services. NAFOPHANU will support the dissemination of the national OVC policy as well as the National Strategic Program of intervention of its member PHA groups at district and sub district levels.

This activity also relates to Palliative Care: Basic (8462), TB/HIV (8463), Orphans & Vulnerable Children (8464) and Treatment: ARV Services (8465). HIV/AIDS counseling and Testing (CT) is a recognized point of entry for HIV positive clients into HIV prevention, care, treatment and support services. Referrals and linkages to of CT services to care, treatment and prevention services is therefore a critical element of HIV/AIDS Counseling and Testing. The Program for expanding the Role of PHA Networks in Uganda, a 3-year program implemented by the International HIV/AIDS Alliance(IHAA) serves to increase PHAs' access and utilization of HIV/AIDS services by mobilizing and strengthening PHA networks into sustainable and formalized self-help groups that will provide and/or facilitate access to treatment, care and support services. The program through the provision of technical and financial support through sub-grants, is tasked with mobilizing and strengthening the national PHA organization (NAFOPHANU), 14 district and over 40 sub-district PHA networks in Uganda. CT is one of the new core areas that the program has taken on in FY07. The IHAA will build institutional and technical capacity of these PHA networks to increase their involvement in the provision of HIV counseling and testing and in the establishment and management of effective referral mechanisms to link their members, families and the communities to CT and HIV/AIDS care, prevention and treatment services.

In addition to providing counseling and testing services to PHA households and the community , PHA networks and groups will be trained to manage referral and linkages to HIV/AIDS care, treatment and prevention services of all those that test HIV-positive. 40 PHA networks and groups will receive financial and technical support to do CT community outreaches and carry out family-based CT and couples counseling and testing, using the HIV-positive index client as a point of entry into the household. It is estimated that this activity will train 80 CT providers and directly provide CT services to over 20,000 clients through 40 service outlets.

Post-test clubs(PTC) have for a long-time acted a transition point between CT services and care, treatment and prevention services. PTCs also play a critical role in breaking stigma and encouraging disclosure of sero-status to partners and family members. This activity will build the capacity of PHA networks and groups to create, support and sustain PTCs and link PTCs to community PHA networks and groups, and providers of care, treatment and prevention services. Key services will cover STIs diagnosis and treatment, TB screening and treatment, secondary HIV-prevention and family planning. Under this activity, in FY07, 80 PHAs, equal numbers of male and female, from 40 PHA groups will be trained as Network Support Agents (NSAs). NSA who are PHAs and members of PHA networks and groups will be identified and selected by the respective groups they belong to. They will be provided with bicycles to enable them do home visits and also commute between the community and the health facilities. Training of NSA will include the role of NSA including relationships with clinic staff, Counseling and Testing, Communication and counseling skills-including how to support disclosure and adherence, Living with a chronic condition-including prevention for HIV positive people themselves and their partners ( the issue of discordant couples will be addressed here ), stigma and gender-based violence reduction strategies. NSAs will be based at the CT facilities but will on rotational basis dedicate sometime each week to working directly with the communities they represent. This will enable NSA understand problems of PHAs and how these patients can be facilitated to access facility based care.

Over the course of the year, the PHA networks and groups will be trained to play a supportive role in providing CT in public health facilities. This will help alleviate the acute shortage of health workers in public health facilities. The program is working closely with Ministry of Health to develop a set of practices that will guide the working relationship between the PHAs - as auxiliary health workers, and the public health workers. It is planned that PHAs will be actively involved in Pre-test and post-test counseling, rapid HIV testing, running of post-test clubs and management of referrals and linkages to care, treatment and prevention services. PHA networks will also link their members to wrap around activities ranging from family planning to IGAs. As a trained cadre of support staff, Network Support Agents also play a crucial role in prevention work, which empowers people with HIV to protect their sexual health, to avoid new STIs, to delay HIV/AIDS disease progression and to avoid passing their infection on to others. Strategies for positive prevention act synergistically with other prevention, care and treatment efforts. The prevention-treatment-care and support continuum reinforces

the rationale for supporting prevention interventions for PHA. Access to medical care and psychosocial support services offer strategic opportunities for building the skills of PHA to adopt and maintain safe behavior. In Uganda, there is an urgent need to sharpen the focus on prevention among PHA as treatment becomes more accessible and as treatment programs and current studies show a high rate of discordance amongst couples.

Lastly, on key role that PHAs within their networks and group will play is to increase community awareness for CT leading to increased utilization of CT services. Through this program PHAs will also increase awareness of communities on the value of couples testing and early access to care, treatment and prevention activities including wrap around services like family planning, nutrition and other social re-integration services like IGAs.

This activity relates to Palliative Care: Basic (8462), TB/HIV (8463), Orphans & Vulnerable Children (8464) and Counseling & Testing (8900). PHA Networks and groups are closer to the community and can be used to communicate their experiences with HIV and the value of ART. ART literacy increases access and early utilization of ARV services, and the proper use of the ARV drugs. Adherence remains key to successful HIV/AIDS treatment outcomes. The Program for expanding the Role of PHA Networks in Uganda, a 3-year program implemented by the International HIV/AIDS Alliance(IHAA) serves to increase PHAs' access and utilization of HIV/AIDS services by mobilizing and strengthening PHA networks into sustainable and formalized self-help groups that will provide and/or facilitate access to treatment, care and support services. The program through the provision of technical and financial support through sub-grants, is tasked with mobilizing and strengthening the national PHA organization (NAFOPHANU), 14 district and over 40 sub-district PHA networks in Uganda. The IHAA will build institutional and technical capacity of these PHA networks to increase their involvement in the provision of prevention, care and treatment services and in the establishment and management of effective referral mechanisms to link their members, families and the communities to HIV/AIDS care, prevention and treatment services.

The program for Expanding the role of people living with HIV/AIDS in Uganda recognizes the role of PHA networks in increasing ART literacy and access to ARV services, and improving adherence to treatment once ARV treatment is initiated. This activity will use the Community Engagement in ART training course developed by the International HIV/AIDS Alliance to train 80 PHAs identified from 40 district and sub-district PHA networks and groups, NGOs/CBOs and communities. This training course will enable the PHA networks to explain in laypersons' terms the essential aspects of ARV treatment to their members. Its aimed at raising awareness and prepare PHAs and CBOs/NGOs for greater involvement on a number of levels:

Supporting people with HIV who are on ARV treatment, and their families, particularly in terms of facilitating treatment adherence;

Preparing people with HIV who are not yet on ARV treatment but who might need it in the future(ART literacy);

Providing information on ARV treatment, CT and PMTCT to the general population through community education, prevention work and promotion of HIV testing;

Advocating for ever-greater access and utilization of comprehensive HIV/AIDS services, particularly for the most disadvantaged, along with high-quality comprehensive care of people living with HIV.

Topics covered by the training include: Basic information on HIV and ARVs; Starting ARV treatment: who for and when?; Information on taking treatment and how to provide it; Adherence to ARV treatment; Monitoring ARV treatment and evaluating the success of the treatment; Changing treatment; ARV treatment: the differences between men and women; Living with ARVs (healthy living plans, including stigma reduction and positive prevention); ARVs and preventing mother-to-child transmission (PMTCT); ARV treatment for children; and The role of CBOs / NGOs in ARV treatment. A multidisciplinary team of trainers experienced in ARV treatment issues and in using participatory methods will provide the training. One trainer will have clinical experience in ARV treatment and at least one trainer will be a person living with HIV who is on ARV treatment. People who have already been involved in adherence support, for example a nurse, psychologist or social worker as well as staff and volunteers of CBOs / NGOs will be called on to share their experiences. With the support of JCRC, EGPAF and/or TASO, medically qualified personnel with an ability to demystify technical information and with experience in and respect for the value of participatory training, will be identified to support the trainings.

The PHA networks through the trained NSA will manage referral and linkages to and between ART service centers(JCRC, HCIVs, Hospitals, TASO) and services providing secondary prevention(Prevention with Positives), TB screening and treatment, family-based counseling and testing, STI diagnosis and management, nutrition counseling and education, home-based care, OVC care and wrap around services like family planning, Income Generating activities(IGAs) and other social re-integration services for PHAs

available in the respective communities. In Uganda it is well recognized that such linkages that provide a comprehensive and holistic approach to care of the infected and affected individuals including their families, increase the access, utilization and adherence to ART.

A key focus for this program will be to support successful ARV outcomes by linking all identified HIV-positive individuals to HIV treatment services and providing them with the necessary support required to initiate, maintain and adhere to ARV treatment. This activity will be closely linked to and coordinated with the IRCU, JCRC, TASO, Nutrition for PHAs activity, HIV in conflict North program, TB/HIV integration activity, EGPAF, CORE and AFFORD(for health marketing activities).

PLUS UPS: This activity will improve linkages between facility-based and community/home-based care to ensure integration of facility and community approaches to adherence to treatment. The program will train 400 People Living with HIV/AIDS(PHAs), in addition to the planned 1,000, to act as Network Support Agents(NSAs) linking health facilities providing treatment to the community. The NSAs will facilitate referrals from the community to the facilities and back to the community and follow-up patients on treatment. The program will also build the capacity of Networks of PHAs to provide home-based and community-based care to ensure a comprehensive continuum of care.