This activity also relates to activities numbers: 8517-Palliative Care:Basic Health Care and Support, 8539-Palliative Care;TB/HIV, 8518-CT, 9636-Condoms and Other Prevention.

Research Triangle Institute (RTI International) is an international, independent not-for-profit organization dedicated to improving the human condition through multidisciplinary technical assistance, training and research services that meet the highest standards of professional performance. RTI is partnering with AIDS Healthcare Foundation (AHF) to support the Uganda Ministry of Health (MOH) in providing Routine HIV Testing and Counseling (RTC) and basic care (BC) services to patients in district hospitals and health center (HC) IV facilities. In this partnership RTI contributes to the national response to address the significant service gaps that still exist in the provision of HIV counseling and testing (HCT) and post -test support for individuals and couples aimed at preventing HIV acquisition or transmission.

RTI will support the promotion of abstinence and being faithful (A&B) interventions aimed at stemming HIV infections among patients and caregivers attending target health facilities and among residents in communities surrounding the target health facilities. Volunteers will be trained to conduct prevention education to patients on behavior change practices that emphasize mutual fidelity among partnerships. Health workers will also be trained to disseminate A&B prevention messages when counseling patients. In collaboration with the DDHS, local community groups and PHA networks, the program will also use a variety of communication channels; e.g., drama, community meetings, and where appropriate, radio programs at local FM stations that reach target groups such as women and adolescents to disseminate A&B HIV prevention messages in the catchment areas surrounding the target health facilities.

plus up: RTI will integrate AB messages in in the in the Hospital based Routine HIV testing and counselling (RTC) program and expand services to nearby communities. AB messages will be integrated in daily clinic talks at the waiting areas and during counselling session. Training will be provided to health workers and community educators who facilitate clinic talks and community education events. In collaboration with the DDHS, RTI will use IEC materials developed and translated in local languages.Referrals will be made to appropriate prevention, care and treatment centers in the district. This approach will complement RTC services implemented in clinical settings.

This activiy relates to 8540-AB, 8517-Palliative Care;Basic Health and Support, 8539-Palliative Care;TB/HIV, 8518-CT.

Research Triangle Institute (RTI International) is an international, independent not-for-profit organization dedicated to improving the human condition through multidisciplinary technical assistance, training and research services that meet the highest standards of professional performance. RTI is partnering with AIDS Healthcare Foundation (AHF) to support the Uganda Ministry of Health (MOH) in providing Routine HIV Testing and Counseling (RTC) and basic care (BC) services to patients in district hospitals and health center (HC) IV facilities. In this partnership RTI contributes to the national response to address the significant service gaps that still exist in the provision of HIV counseling and testing (HCT) and post -test support for individuals and couples aimed at preventing HIV acquisition or transmission.

During FY07, RTI will support other HIV prevention approaches with emphasis on prevention with positives (PWP) interventions that can be incorporated into HIV-related counseling of patients, palliative care and treatment. Interventions will include counseling of patients on disclosure of sero-status to partners, partner testing and promotion of behavior change that emphasizes correct and consistent condom use among sero-discordant couples and populations that engage in high-risk behaviors. Working with local community groups, and PHA networks, RTI will support the set up or strengthening of clinic-based support groups and post-test clubs to assist in providing psychosocial support to persons who test for HIV. The program will also support efforts to reduce HIV/AIDS-related stigma and discrimination by providing information and education aimed at changing people's perceptions and attitudes about HIV/AIDS. Through radio programs, community meetings, education sessions at health facilities and other similar forums, the program will foster a dialogue among residents, with a view towards reducing negative attitudes about persons infected and affected by HIV/AIDS.

This activity also relates to activities numbers: 8540-AB, 8539-Palliative Care;TB/HIV, 8518-CT, 9636-Condoms and Other PRevention.

Research Triangle Institute (RTI International) is an international, independent, not-for-profit organization dedicated to improving the human condition through multidisciplinary technical assistance, training and research services that meet the highest standards of professional performance. RTI is partnering with AIDS Healthcare Foundation (AHF) to support the Uganda Ministry of Health (MOH) in providing Routine HIV Testing and Counseling (RTC) and basic care (BC) services to patients in district hospitals and health center (HC) IV facilities. In this partnership RTI contributes to the national response to address the significant service gaps that still exist in the provision of HIV counseling and testing (HCT) and linkages to care and support services in Uganda.

As of July 31, 2006, the project has identified 4,337 HIV positive clients who have been linked to health facilities so as to receive Palliative Care (PC) that includes cotrimoxazole prophylaxis, basic care kits and specialized care. RTI has supported the strengthening of the referral system for HIV+ together with the provision of septrin to cover for shortfalls at the supported health facilities. Currently, more than 80% of HIV+ patients attending HIV clinics in the project supported health facilities have been identified through the RTI RCT/BC program.

During FY07, a total of 13,100 HIV+ patients will be initiated on cotrimoxazole prophylaxis and referred for specialized care in 14 health units. In addition, the program will aim at having at least 95% of all identified HIV+ patients enrolled in the chronic care clinics where they will be started on cotrimoxazole, and receive basic care kits and information on the prevention of diarrheal diseases and malaria. An equally important aspect to palliative care that the program will work one is to institute measures that improve the quality of care provided to HIV+ patients. Clinical staff will be trained to show compassion and hope rather than discrimination when treating and/or caring for HIV-infected patients and their dependents. The program will also ensure that patients receive other specialized PC services including psychosocial counseling and support. To bridge the existing human resource gaps in the health facilities, volunteer health workers and/or PHAs will be recruited and trained to support the provision of on-going counseling, psychosocial support and help patients to develop care and treatment plans in order to improve adherence. All health care workers in the new facilities and newly recruited staff in currently supported health facilities will be trained to provide facility-based palliative care and /or referral for further assessment and specialized care for HIV+ patients. Refresher training and technical support supervision will also be provided as needed to ensure quality delivery of PC services. The project will also distribute MOH standard operating procedures, protocols and job aids on PC to all supported health facilities. In order to minimize stock-outs, RTI will support health unit staff to enable them forecast and requisition for the right amounts of septrin, ARVs and other relevant drugs.

This activity also relates to activities numbers: 8540-AB, 8517-Palliative Care;Basic Health Care and Support, 8518-CT, 9636-Condoms and Other Prevention.

Research Triangle Institute (RTI International) is an international, independent not-for-profit organization dedicated to improving the human condition through multidisciplinary technical assistance, training and research services that meet the highest standards of professional performance. RTI is partnering with AIDS Healthcare Foundation (AHF) to support the Uganda Ministry of Health (MOH) in providing Routine HIV Testing and Counseling (RTC) and basic care (BC) services to patients in district hospitals and health center (HC) IV facilities. In this partnership RTI contributes to the national response to address the significant service gaps that still exist in the provision of HIV counseling and testing (HCT) and linkages to care and support services in Uganda as well as early identification and management of TB/HIV co-infected individuals and families.

During FY06 RTI has made significant progress in the integration of TB and HIV management through the linkage between CT service delivery points, chronic care clinic and the TB clinic in all project-supported facilities. RTI contributed to the response to the challenges to effective TB/HIV care for patients. These challenges include a limited capacity to identify TB cases using either sputum smears or chest x-rays in some facilities; limited access to TB treatment centers by patients; shortage of qualified/well trained health workers and; poor treatment adherence.

During FY07, RTI will support this activity by ensuring that all HIV positive patients are referred to the chronic care clinics where TB screening is routinely done. The program will continue to support efforts that provide cross-referral and integrate diagnosis, treatment and support services for TB and HIV in the target facilities. HIV+ patients will be actively screened and treated for TB at initial diagnosis and during follow up at the chronic care clinics. HIV counseling and testing will be offered to all patients in the TB clinics. Opportunities will be explored to counsel TB patients under the DOTS program about the importance of HIV testing and treatment adherence for ARVs. The program will also emphasize strengthening of laboratory capacity for TB and HIV. RTI will conduct an assessment of laboratory capacities at all target facilities to identify areas that will need priority actions. The assessment will examine factors such as the availability of laboratory staff and their level of training/experience, the number and types of laboratory services currently available (with emphasis on HIV/AIDS and TB diseases), current infrastructure (quality of testing tools, and other non-expendable equipment), availability of supplies (reagents and protective gear) and the frequency of stock-outs, availability of operating procedures and protocols for laboratory management and performance, and the level of resources allocated to laboratory performance by district planning committees. Following the assessments, the program will then develop and implement a support plan for strengthening existing capacity depending on the needs identified, using MOH guidelines and in collaboration with various partners including the National TB and Leprosy Program. Working with district IEC teams, the program will provide support for a communications campaign aimed at increasing TB-DOTS and ART literacy in the target health facilities and surrounding communities. Health facility staff will be supported in data management and analysis to enable them better monitor adherence to relevant treatment regimes and to track progress in the performance of their activities. RTI will collaborate with MOH to ensure constant supply of TB drugs, septrin and ARVs to TB/HIV co-infected patients. Support supervision and on-job training will be done to strengthen TB/HIV integrated services.

This activity also relates to activities numbers: 8540-AB, 8517-Palliative Care;Basic Health Care and Support, 8539-Palliative Care;TB/HIV, 9636-Condoms and Other Prevention.

Research Triangle Institute (RTI International) is an international, independent not-for-profit organization dedicated to improving the human condition through multidisciplinary technical assistance, training and research services that meet the highest standards of professional performance. RTI is partnering with AIDS Healthcare Foundation (AHF) to support the Uganda Ministry of Health (MOH) in providing Routine HIV Testing and Counseling (RTC) and basic care (BC) services to patients in district hospitals and health center (HC) IV facilities. In this partnership RTI contributes to the national response to address the significant service gaps that still exist in the provision of HIV counseling and testing (HCT) services in Uganda. Currently, HCT services are available mainly in select district and regional hospitals. In some cases, even the available services are accessible only to selected population groups; e.g., pregnant women through antenatal clinics. Frequent shortages of HIV test kits and poor (and at times absent) testing and counseling support due to limited laboratory and human resources capacity further reduce access to HCT by the population. Fear of stigma and violence in case of an HIV-positive result also still hinder effective utilization of HCT services.

Currently, the RTC/BC program is being implemented in six health facilities in Kaberamaido, Mpigi and Masindi districts. A number of accomplishments have been made that include the following. RTI contributed to the development of materials for use in training and implementing RTC activities by health workers in collaboration with several other partners in the country. These materials which include training manuals, provider cue cards, standard operating procedures and implementation protocols have been useful in the harmonization of HCT training programs for health workers around the country. Using these training materials, RTI has trained 645 health workers in RTC/BC implementation from target health facilities in Kaberamaido, Mpigi and Masindi districts. By the end of July, 2006, a total of 35,426 persons had been counseled and tested for HIV in Kaberamaido and Mpigi while Masindi health facilities started RTC activities in August 2006. Four additional HCIV facilities will be added to the program by November 2006 and it is hoped that by the end of FY06, more than 55,000 persons will have been tested under this program. RTI has also conducted several sensitization meetings with health facility, district and community leaders so as to increase program awareness. Information, education and communication (IEC) materials have been developed in English and local languages for distribution in target health facilities so as to further inform patients and health workers about the program. The program has adapted MOH health management information (HMIS) tools to generate accurate RTC/BC data.

The proposed FY07 activities aim at consolidating and expanding the model RTC and BC program in the target districts and facilities, as part of the routine health care package. RTI has ensured district and health unit ownership of the RTC/BC program through identification and training of local district staff and having the program actively incorporated in district health plans. The program will promote activities that emphasize combining HIV testing with counseling and equipping of patients with important information that will enable them to change behaviors so as to reduce sexual and vertical (mother-to-child) transmission of HIV once they know their sero-status after testing. This program will be part of a sustained holistic approach to increasing a wide range of HIV/AIDS-related services available along a continuum of prevention, care, and treatment. During FY07, RTI will scale up project activities to four new health facilities in Kasese district that has been identified in consultation with MOH. This scale up will lead to a total of 14 health facilities where the program will be working in FY07, each with an average attendance of 1,100 patients per month. Technical support supervision and in-service training will be provided so as to help build the capacity of health workers to implement CT and to maintain a high quality of service delivery. Standard operating procedures and protocols for implementation of RTC will be distributed to the news sites. Partner testing will be strengthened through use of index patients as a point of entry to the family so as to provide HCT to the other family members (spouses and children). In the case of infant testing, the program will develop protocols and strengthen mechanisms for transporting specimens from lower level facilities to referral laboratories for conducting polymerase chain reaction (PCR) HIV testing on the dry blood spot samples and for submitting results back to the facilities. To increase utilization of CT services, sensitization meetings will be held with key community leaders in the areas surrounding the new project facilities. The

program will also produce IEC materials on RTC and BC which will be disseminated in the health facilities and where appropriate to community leaders. RTI will collaborate with other partners to strengthen logistics management so as to minimize stock-outs. Technical support will be provided to improve the collection, analysis, distribution and use of data on routine HIV counseling and testing so as to inform and improve program activities.

plus ups: To expand Routine HIV counseling and testing services in the district hospitals and lower level health units. RTI will collaborate with districts and communities to consolidate and expand RTC services in 4 additional districts as part of the routine health care package