This activity also relates to other activities: 8526-Basic Health Care & Support, 8531-OVC, 8543-CT, 8527-ARV Services, 8528-Lab, 8529-SI, 8530-Management & Staffing.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. Also during FY06, MUWRP supported activities that improved the identification of and provision of services to the Districts' population of orphans and vulnerable children. These activities link to MUWRP activities under Treatment, Care, OVC, CT, and Strategic Information. The Prevention/Abstinence and Being Faithful program as described below is part of a comprehensive program and activities do link to other program areas. Program activities that are included in this comprehensive program, such as care, treatment, OVC, and CT services will be budgeted under their respective earmarks. The Kayunga District Youth Recreational Center, which was founded in 2006 as a joint effort between the Kayunga District Hospital, the Kayunga District Government and MUWRP as an organization/facility to build district capacity in identifying and providing HIV prevention services to Kayunga Districts' youth population. The Center currently provides youth with counseling, care and clinical services in a manner which is specifically geared toward young persons. In 2007, they will continue to provide facility-based AB prevention counseling to youth, emotional support, and meet psycho-social needs through recreational games, sports, music, and drama. Community focused activities will include district-wide youth outreach and AB prevention counseling to schools and other youth appropriate venues. Also, in collaboration with Child Advocacy International (CAI), MUWRP will expand upon 2006 activities to support CAI in activities which include district-wide community sensitizations (24 scheduled for 2007) to combat HIV stigma and fear and promote HIV AB prevention and community education. As part of a community approach to increasing life expectancy of HIV infected persons in Kayunga, education must be provided to the community at large, including youth outreaches. Education of community members on issues specific to persons living with HIV/AIDS, especially pediatric HIV will not only help address stigma and discrimination directed against these persons but also assist in increasing successful identification of HIV positive persons and link them to care and treatment services. Under this submission, MUWRP, CAI, and the Kayunga District Youth Recreational Center will coordinate AB prevention and stigma activities through outreach, community mobilization and sensitization, often partnering with locally established civil society groups. This will ensure that consistent, fact based messages reach the maximum number of people through out the district.

11,000 youths, (aged 10-18) provided with HIV education and AB prevention messages through youth recreational facility and through weekly mobile outreaches to schools and youth groups. 10,000 individuals will provided with psycho-social activities, health promotion and HIV AB prevention messages through 24 community sensitizations. The role of men and how traditional male norms can impact HIV transmission will be addressed using drama. 10 staff will train in HIV AB prevention activities and conducting community sensitizations. Funding will support the youth center staffing needs, training, mobile outreaches to schools and youth groups, and the infrastructural integrity of a youth HIV prevention center. Funding will also support the costs of community sensitizations including staffing, training, community mobilizers, and sensitization resources.

This activity relates to other activities in; 8544-AB, 8531-OVC, 8543-CT, 8527-ARV Services,, 8528-Lab, 8529-SI, 8530-Management & Staffing.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. Also during FY06, MUWRP supported activities that improved the identification of and provision of services to the Districts' population of orphans and vulnerable children.

These activities link to MUWRP activities under Treatment, OVC, CT, Laboratory, and Strategic Information. At the beginning of FY06, facility based HIV clinical services in Kayunga District were only available through the Kayunga District Hospital. Very recently, MUWRP supported a rapid scale-up of HIV services, including ART, which increased the number of HIV/ART clinical care sites to include the Kangulamiria Health Center IV, the Baale Health Center IV, and the Kayunga District Youth Recreation Center. This not only increased the number of clinical care sites but also the geographic coverage within the district bringing services closer to individuals in both the far north and south of the district. Kayunga is a vastly underserved rural District and the majority of the HIV+ residents have limited resources. Identification of HIV+ patients in need of care and treatment has been difficult due to extremely limited CT services. In addition, Kayunga health facilities face the same fate as many African sites and do not have enough staff and have inadequate infrastructure to accommodate the rising demand for HIV services. These clinics need support to bring on additional personnel and existing staff are in need of appropriate HIV palliative care training. Furthermore, the remodeling of existing clinical space, especially at the Kayunga District Hospital and at the Baale Health Center IV needs to occur to accommodate the increasing patient loads. Modifications and improvement of the infrastructure will also allow these facilities to integrate HIV palliative care, ART, counseling and testing and PMTCT - which will decrease waiting time, strengthen referrals for care and treatment and improve overall services for the clients.

The overall goal of this program area is to provide basic palliative care services to 3,000 HIV infected Kayunga District residents and train 30 staff in palliative care and psycho-support of HIV+ persons by the end of FY07. This will be accomplished through MUWRP's collaboration with 4 health facilities, including: The Kayunga District Hospital, The Kangulamiria Health Center IV, The Baale Health Center IV, and the Kayunga District Youth Recreation Center. In order to address the gender equity issue this activity will determine the breakdown of women and men receiving palliative care services to help develop strategies to reach equal number of men and women. Elements of the care provided at these facilities include psychosocial counseling, education on healthy living choices for positives, prophylaxis and treatment of OI (including cotrim), nutritional evaluations using BMI indicators and nutritional counseling. The inclusion of the Youth Recreation Center was undertaken after discussions with the Kayunga District Director for Health Services. This facility poses a unique opportunity in that it tailors its services (including VCT, HIV education and general medical evaluations and treatment) to youth between the ages of 15 and 25. This population has traditionally been reluctant to access such services at the District Hospital. In an attempt to reach this population, the District Hospital and the Youth Recreation Center work together to provide clinical care with medical personnel from the hospital providing services and supervision. As an additional measure to improve upon pediatric outcomes, HIV+ pediatrics under care at these 4 HIV care and treatment facilities receive follow-up home-based care and support through MUWRP's sub-partner, Child Advocacy International (CAI). A strong relationship has developed between CAI and the Kayunga District Hospital over the past 2 years and this has led to establishment of a formal referral system between these two sub-partners to increase pediatric up take and improve upon facility based services for HIV+ pediatrics. CAI is a mobile clinical care

follow-up program which provides community based care and support for District pediatric HIV+ patients, their families, and the community. CAI will focus on expanding the number of HIV+ pediatric patients they directly support to 180 children through scheduled monthly home visits for the patients and their families. They will continue their on-going home-based education through these visits to include technical assistance to 180 caregivers and families on how to care for pediatric HIV+ patients as well as the direct provision of some basic palliative needs such as symptom control for the patients themselves. Funding will support part of the cost of remodeling two HIV clinics, staff training, transportation needs for continued technical assistance by MUWRP and provision of clinical supplies (including pain medication) at four HIV clinics. Funding will focus also on direct home based care service provision to pediatric HIV+ patients by CAI through support of commodities for care (non-prescription medication and disposables), assistance in supporting community providers, and training of caregivers.

This activity also relates to other activities in; 8544-AB, 8526-Basic Health Care & Support, 8543-CT, 8527-ARV Services, 8528-Lab, 8529-SI, 8530-Management & Staffing.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. Also during FY06, MUWRP supported activities that improved the identification of and provision of services to the Districts' population of orphans and vulnerable children. These activities link to MUWRP activities under Treatment, Laboratory, Care, CT, and Strategic Information. The OVC program described below is part of a comprehensive program and activities do link to other program areas. Program activities that are included in this comprehensive program, such as care, treatment, prevention and VCT services will be budgeted under their respective earmarks. In collaboration with Child Advocacy International (CAI), MUWRP will expand upon 2006 activities through a mobile clinical/counseling follow-up program which provides community based outreach, support, counseling, and education for District OVC's, their families, and the community. In this capacity, CAI works with local civil society groups to build local capacity for service delivery. The names of the local groups which CAI supports are below. During FY07 CAI will expand the number of OVC's they support to 1110 children through scheduled monthly home visits. CAI will offer OVC's a comprehensive list of home-based services which will include HIV education, counseling, psycho-social activities, emotional backing and (when appropriate) school fees, scholastic materials, clothes, and supplemental food. They will continue their on-going home-based education through these visits to include technical assistance to 180 caregivers and families on how to care for pediatric ART/HIV+ patients as well as the direct provision of some basic palliative needs such as symptom control for the patients themselves. Support for the caregivers will also include linking families of pediatric ART patients together for group/peer counseling and psychosocial support. The Kayunga District Youth Recreational Center was founded in 2005 as a joint effort between the Kayunga District Hospital, the Kayunga District Government and MUWRP as an organization/facility to build district capacity in identifying and providing HIV prevention services to Kayunga Districts' youth population, and especially their orphans and vulnerable children. The Center currently provides youth with counseling, care and clinical services in a manner which is specifically geared toward persons between the ages of 12-18 who are HIV positive or defined as OVC's. Between the months of March and July of 2006, the Center counseled and tested 278 youth and successfully referred 100%of those testing positive for evaluation for ART by clinical staff of the District Hospital. In 2007, they will continue to provide facility-based counseling to youth, emotional support, and meet psycho-social needs through recreational games, sports, music, and drama. Community focused activities will include district-wide youth outreach and mobile VCT to schools and other appropriate venues with emphasis on reaching OVC's and un-tested youths. As this program is also linked to care and treatment services, the Youth Center will expand upon the offering of quality facility-based clinical services to OVC's and others under age 18 in a youth-friendly atmosphere. This includes basic pain management, symptom control and, in conjunction with CAI, the formation of ART treatment groups and positive living networks/clubs for OVC's.

During FY06 CAI, the Kayunga Youth Recreational Center and MUWRP have collaborated and/or partnered with the following civil society groups in Kayunga in order to build local capacity: (1) Boy brigades, (2) Kayunga town youth council, (3) Kayunga District youth council, (4) Community and Response to AIDS, (5) Busaana Women Community HIV/AIDS Positive Living and Orphanage Care, (6) Girl guides, (7) Uganda scouts association of Kayunga, (8) Nazigo youth health and development association, (9) Disabled school of Bukoloto and (10) Fare Ministries, (11) Human Rights and Civic Education Forum, and (12) the Rubaga Youth Development Association. The Program defines orphans as a person under 18 years old who has lost a mother or a father. The program defines vulnerable

children as a person under 18 years old who resides in a household affected by HIV/AIDS - such as when a parent, principal caretaker, or family member is HIV infected. Program Youth and OVC's will be identified through the following means:(1) Pediatric referrals from District HIV clinics, (2) Family members of pediatric referrals from District HIV clinics; (3) Weekly mobile outreaches to schools and youth groups; (4) Presence at fixed-site Youth Recreational facility, or (5) Presence at community sensitizations. Funding will support the cost of CAI services, staffing, training, monthly home visits/follow-up visits to OVC's, care-giver counseling, tools for home monitoring of OVC's and household evaluation, psycho-social activities, and (when appropriate) school fees, scholastic materials, clothes, and supplemental food needs. Funding will also support care-giver clubs.

This activity also relates to other activities in; 8544-AB, 8526-Basic Health Care & Support, 8531-OVC, 8527-ARV Services, 8528-Lab, 8529-SI, 8530-Management & Staffing.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. These activities link to MUWRP activities under Treatment, Care, Prevention, Laboratory, OVC and SI. ART was first made available in Kayunga District in April 2005. Since that time the number of residents who have sought out VCT services has increased more than 20 fold going from 40 individuals tested during the month of May 2005 to more than 800 individuals tested during May 2006. District Health authorities have been unable to meet escalating VCT demands and many Kayunga residents are turned away from VCT venues each month due to lack of resources and test kits. This represents a serious lost opportunity to reach potential patients in need of HIV care and treatment. In Kayunga District, where most of the populace lives in very rural villages, people must travel great distances (expending important individual resources) in order to take this first step toward knowing their status and accessing HIV care and treatment. Also, as rapid ART scale up is occurring in Kayunga, it is becoming increasingly obvious that provider initiated CT services need to be expanded to at least the three in-patient facilities where ART is being provided in Kayunga. The increase in demand for this service needs to be met through training of additional counselors and medical staff to provide this service not only at the HIV clinic and VCT centers, but as part of inpatient and out patient services, including the TB clinic, where a majority of treatment eligible patients will be found. In 2007, MUWRP will work with the Kayunga District Hospital, Baale Health Center and Kangulamiria Health Center to meet CT demand in Kayunga District so that patients in need of HIV care and treatment can be identified and linked to established District HIV services. This will include supporting the integration of routine CT services to the three ART District clinics and the facilities' in-patient wards and out patient services. It also includes training of designated staff from each ward and clinic in VCT through nationally available programs. MUWRP will also work alongside other health agencies in Kayunga, such as Doctors with Africa (CUAMM) and the National TB and Leprosy Programme (NTLP), so that capacity is developed to ensure that individuals being screened for TB at NTLP sites will concurrently be tested for HIV and referred to HIV services if HIV-positive. In addition to clinic based CT and VCT, CT services targeting high-risk groups are lacking in Kayunga. Two at-risk populations in particular in this district that have been ignored in the past are youth and fishermen. In response to this demand, in 2006 MUWRP has collaborated with Kayunga District Health authorities to establish a Youth Center in Kayunga Town. MUWRP administers the Center while volunteer district clinicians staff the Youth HIV/ART clinic. Successes have been recorded in the four months since this center has opened. For example, between the months of March and July of 2006, the Center counseled and tested 278 youth and successfully referred 100%of those testing positive for evaluation for ART by clinical staff of the District Hospital. Notwithstanding this, the majority of the district youth population remains HIV untested. In 2007, funding will support the newly established Youth Center in Kayunga in promoting quality health activities, in particular VCT. Services at the Center are currently provided by nurses and counselors from the District Hospital and MUWRP on a rotational basis. Close links with the nearby District Hospital will be maintained through medical staff providing clinical services at the Center, ensuring quick referrals and evaluation for treatment eligibility at the Center or District Hospital. Increased outreach through advertising and community campaigns will focus on a youth approach/audience using such venues as sports, drama, and music concerts to increase youth attendance at the Center and accessing of VCT. The other at risk population in need of VCT and access to HIV care and treatment services in Kayunga are the residents of the many fishing communities along the banks of the Nile and at the inlet to Lake Kioga. Ecological data from District outreach activities has informed the program of high HIV prevalence within these communities as well as an extraordinary interest

among the population in receiving CT, care and treatment services.

The Kayunga District Authorities and District Medical Office have requested assistance from MUWRP in implementing a VCT mobile effort. In 2007, this outreach will look to mix "walk-in" mobile VCT as well as elements similar to one being run in Tororo by CDC using a house-to-house, family-testing approach. This mobile unit will be staffed with District health service personnel who work at the District HIV clinic and thus also provide a direct link and referral to HIV care and treatment services. Currently mobile VCT/community education efforts are underway with villages surrounding treatment sites. These focus on reaching villages during market days and have shown great success in testing (on average) 60 individuals/day and referring 100% of those testing positive for evaluation for treatment eligibility at the nearest HIV clinic. This mobile effort will be refocused to include the fishing villages and modifications in approach for such communities based on models tested in Uganda to maximize uptake. All the activities proposed by MUWRP above build upon an ongoing relationship with the Kayunga District Authorities and the District Director for Health Services in ensuring quality CT/VCT services are available to the population in this district. Under this submission, MUWPR will work with Kayunga District Authorities and facilities to introduce and implement CT services at HIV and TB clinics, inpatient wards and outpatient services at 3 District HIV/ART facilities. In order to address the gender equity issue this activity will determine the breakdown of women and men receiving CT services to help develop strategies to reach equal number of men and women. MUWRP will coordinate with Kayunga District authorities to expand and strengthen youth VCT as well as establish a mobile VCT/outreach program to rural villages and fishing communities. Funding will cover supportive supervision and on-going technical assistance by MUWRP, provision of materials and supplies for sites, infrastructure modifications where required to ensure confidential counseling space, and mobile resources.

This activity also relates to other activities in; 8544-AB, 8526-Basic Health Care & Support, 8543-CT, 8531-OVC, 8528-Lab, 8529-SI, 8530-Management & Staffing.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. Also during FY06, MUWRP supported activities that improved the identification of and provision of care and treatment services to the Districts' population of orphans and vulnerable children.

These activities link to MUWRP activities under Care, OVC, CT, PMTCT, and Strategic Information. The anti-retroviral drugs will be procured by USAID from Uganda's Joint Clinical Research Center. At the beginning of FY06, ART services in Kayunga District were only available through the Kayunga District Hospital. Very recently, MUWRP supported a rapid scale-up of ART services which increased the number of HIV/ART clinical care sites to include the Kangulamiria Health Center IV, the Baale Health Center IV, and the Kayunga District Youth Recreation Center. This not only increased the number of treatment sites but also the geographic coverage within the district bringing services closer to individuals in both the far north and south of the district. Kayunga is a vastly underserved rural District and the majority of the HIV+ residents have limited resources. Identification of patients in need of ART has been difficult due to extremely limited CT services. Furthermore, those patients who have been identified, evaluated, and determined eligible for ART are often unable to successfully start ART, or soon deemed "lost to follow-up" due to poverty related challenges, especially transportation. In an effort to reach out to these patients, MUWRP supported a tracing program of ART eligible patients who never successfully started ART or were lost to follow-up. Program counselors have helped many of these patients generate solutions and advocated the importance of regular clinic attendance. There are preliminary data that suggests that both this Program and the recent expansion of ART clinical care sites have contributed to recapturing some of the patients who were unable to successfully start ART or were lost to follow-up. It is estimated that 27 patients have been re-captured by the tracing program with another 40 identified at new clinic sites upon evaluation. Kayunga health facilities face the same fate as many African sites and do not have enough staff and have inadequate infrastructure to accommodate the rising demand for ART services. These clinics need support to bring on additional personnel and existing staff are in need of appropriate ART training. Furthermore, the remodeling of existing clinical space, especially at the Kayunga District Hospital and at the Baale Health Center IV needs to occur to accommodate the increasing patient loads. Modifications and improvement of the infrastructure will also allow these facilities to integrate ARV service, palliative care, counseling and testing and PMTCT - which will decrease waiting time, strengthen referrals for care and treatment and improve overall services for the clients. In the Kayunga District, pediatric patients on ART, pose an especially difficult challenge. Families of pediatric ART patients are usually constrained by finances and other responsibilities that the likelihood for successful care and treatment is often in jeopardy. HIV positive pediatrics are often left in the care of infected individuals or relatives who have limited resources which are then stretched even further with the addition of caring for an infected child. Caregivers often find it difficult to leave their other children to travel with one sick child to the hospital. This situation becomes even graver when the HIV infected child requires admission. Youths between the ages of 15-25, whom are infected with HIV pose a particularly difficult problem for Kayunga District Health authorities due to their unconventional reluctance to seek treatment through traditional clinical venues. These at-risk youth are a hidden population in the District and require a specialized, non-stigmatized setting to address their clinical needs. The challenges above have contributed to the difficulty in reaching 2006 treatment targets in Kayunga.

However, despite the above mentioned challenges, from October 2005 through June

2006, the number of patients receiving ART services through MUWRP supported HIV clinics increased from 99 to 332. Based on these data and considering both the recent expansion of ART clinics and MUWRP FY07 plans for implementing a coordinated VCT/CT program, it is anticipated that over 1100 clients will be on ART in Kayunga District by end of FYO7. This activity is targeting HIV positive men, women, children and infants inclusive of family members. The overall goal of this program area is to provide anti-retroviral therapy to 1100 HIV infected Kayunga District residents in need of treatment by the end of FY07. This will be done through the Kayunga District Hospital, the Baale Health Center IV, the Kangulamiria Health Center IV, and the Kayunga District Youth Recreation Center. In order to address the gender equity issue this activity will determine the breakdown of women and men receiving treatment to help develop strategies to reach equal number of men and women. All Kayunga District ART programs will include prevention for positive messages, nutritional counseling, adherence counseling and treatment club/adherence club availability during most clinic days. The activity supports the Kayunga District Health Services (Ministry of Health) to administer the ARV services. Anti-retroviral drugs will be procured by USAID from Uganda's Joint Clinical Research Center. Also, the program will continue to support the very successful tracing program of ART patients. Finally, in order to support ART services at all of these facilities, MUWRP will assist in contracting additional staff for the facilities, as well as meeting training needs. Infrastructure improvements, especially at the Kayunga District Hospital and the Baale Health Center IV will be addressed. In collaboration with Child Advocacy International (CAI), MUWRP will expand upon 2006 activities through a mobile clinical follow-up program which provides community based support for District pediatric ART patients, with emphasis on ART adherence counseling and nutrition counseling. Activities with CAI will focus on further improving the referral network for pediatric ART referrals to and from the District HIV clinicians. They will expand the number of pediatric ART patients they directly support in these activities to 120 children through scheduled monthly home visits. Funding will principally support emphasis areas which include expansion of staff, infrastructure remodeling, training, logistics, ongoing technical assistance, supportive supervisory visits and transportation of staff, and supervisory visits for monthly home visits to pediatric ART patients. The PEPFAR Country team approved $226,213 for ARV drugs which will be procured by USAID from Uganda's Joint Clinical Research Center.

This activity also relates to other activities in; 8544-AB, 8526-Basic Health Care & Support, 8543-CT, 8527-ARV Services, 8531-OVC, 8529-SI, 8530-Management & Staffing.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. Also during FY06, MUWRP supported activities that improved the identification of and provision of services to the Districts' population of orphans and vulnerable children.

These activities link to MUWRP activities under Counseling and Testing, Treatment, Care, OVC, and Strategic Information. In 2005 and 2006, MUWRP has supported Kayunga Districts' HIV/ART clinics by transporting blood samples from Kayunga back to the MUWRP laboratory in Kampala for testing, providing CD4 assays for determining treatment eligibility and conducting safety labs for monitoring ongoing treatment. Test results are then transported back to Kayunga for use by the District HIV clinicians. Currently, PEPFAR funding is supporting efforts to transition this capacity to the Kayunga District Hospital laboratory. This will include: the improvement of infrastructure, the provision of technical expertise, and the procurement of laboratory equipment to conduct chemistry, hematology and CD4 analysis as well as required reagents. If the HIV/ART program in Kayunga is to be maintained, the District Hospital laboratory must be supported through its development to ensure sustainable, quality services. This support includes the provision of materials and reagents for HIV patient management, improvement of irregular energy sources, support for scheduled equipment maintenance and repairs, and ongoing technical supervision. In addition, as ART is expanded in 2006 to an additional three facilities; the Kangulamiria Health Center IV, the Baale Health Center IV, and the Kayunga District Youth Recreation Center; these sites require the development of very basic lab services for ART monitoring. Their distance from the District Hospital requires that they be able to undertake the basic labs necessary for patient management for real time care with more "complicated" assays conducted at the District Hospital. MUWRP is uniquely poised to assist the District Hospital laboratory and the other three facilities in Kayunga in this undertaking, especially in the building of capacity of the District laboratory staff through direct training and mentoring. MUWRP presently operates a CAP certified laboratory in Kampala and thus can partner with District laboratory staff to develop SOP's and to ensure total quality lab management. In order to address the gender equity issue this activity will determine the breakdown of women and men receiving laboratory services to help develop strategies to reach equal number of men and women. Under 2007 funding, MUWPR will continue to develop the infrastructure and capacity of Kayunga District facility laboratories to support care and treatment of HIV infected patients. This will be accomplished by completing renovation of existing laboratory space, partnering District laboratory staff with MUWRP laboratory experts, ensuring equipment maintenance, supporting dependable energy sources, and continual provision of reagents and equipment. It is anticipated, based on target number for treatment in 2007 that the combined labs in Kayunga will need to undertake 6700 CD4, 7000 hematology and 7000 chemistry tests.

This activity also relates to other activities in; 8544-AB, 8526-Basic Health Care & Support, 8543-CT, 8527-ARV Services, 8528-Lab, 8531-OVC, 8530-Management & Staffing.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. These activities link to MUWRP activities under Treatment, Care, CT, OVC, and Lab. During FY06 MUWRP developed tools for its District partners for collecting data from distinct patient clinics and established a data system which enables the District to plan and report required indicators - such as number of new patients, current patients, and palliative care patients during semi annual and fiscal year reporting periods. Several other databases have also been established to support additional District level Program efforts in Kayunga. These databases include data from the following programs: VCT, Youth Center, and a program which identifies, traces, and provides support to ART patients who have been deemed non-adherent or possibly lost-to-follow up by District clinicians. More specifically this includes an electronic patient tracking system established in Kayunga District Hospital that oversees nine health centers, electronic data storage and retrieval system for periodical reporting data (e.g., quarterly, semi-annual etc) and a system for data linkage established to connect inpatient/outpatient data, inter-program data, and inter-health center data. Each of these databases may be used to support program activities but more importantly, these systems can inform District and Regional Health authorities in their planning of HIV programs and activities. Other key accomplishments in 2006 have been 4 staff trained in data management and analysis, 3 IT staff trained to maintain current database, and 7 staff trained in electronic patient tracking system. In the past, MUWRP's strategic information PEPFAR staff has coordinated efforts with MUWRP's research staff in Kayunga, often sharing research resources such as transportation, technical expertise, supplies, infrastructure, and staffing. Challenges in FY07 can be expected due to the Kayunga District's rapid scale up of ART and associated HIV programs. For the District/Regional Health authorities, this rapid scale up of ART may pose SI challenges in the absence of appropriate infrastructure and dedicated manpower. Toward this end, administrative information needs to be developed so that reporting and planning linkages can be established with the National program. Infrastructure for obtaining patient clinical information at and from the four District ART clinics needs to be established for the purpose of informing the District (and National) programs on how to better provide Program services. Also, a new PEPFAR supported outreach OVC program is already underway; developing its SI component as well as the ability of the District authorities to collect and manage this information will be crucial to this program's success.

It has become apparent that the MUWRP supported Kayunga District SI Program, in terms of infrastructure, supplies, staff and staff training will now need to be secured independently of MUWRP's research component. This is true particularly if this program is to wholly accomplish transfer of this capacity to its District partners. The ability of the District heath authorities to take over the collecting, management, analyzing and more specifically use of relevant data will be the key measure of success. Under this submission, capacity in SI, data collection and analysis will be transferred over to District partners through out 2007 and 2008. As this is being undertaken, information derived from MUWRP's system will be reported back to the Kayunga District/Regional and National Health authorities to assist them in further planning of HIV activities. Furthermore, there will be continued support of Kayunga Districts' strategic information program so that it can effectively address the emerging service demands of a rapidly expanding HIV/ART program. Funding will support: provision of SI infrastructure, equipment, maintenance, and supplies; Acquisition and training on administrative software; development of clinical patient information system to be utilized for District level services evaluation; development of outreach OVC program database and reports; training of District SI staff; provision of adequate power back-up sources; and technical expertise.

This activity also relates to other activities in; 8544-AB, 8526-Basic Health Care & Support, 8543-CT, 8527-ARV Services, 8528-Lab, 8529-SI, 8531-OVC.

The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV Research Program and has a Memorandum of Understanding with Makerere University of Uganda. MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities participating in HIV cohort studies and vaccine research. In FY06 MUWRP increased its PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving laboratory services, infrastructure, data collection, supplies, training and with provision of short-term technical staffing. This activity links to MUWRP activities under Treatment, Care, CT, OVC, Lab, S.I., and prevention programs in the Kayunga District of Uganda. In FY05, the program hired one fulltime staff dedicated to PEPFAR activities in the Kayunga District. The focus for FY07 will be to maintain this position.