This activity links to activities in AB (3983), Other Prevention (3988) Palliative Care: Basic Health Care (3986), counseling and testing (3984), and strategic Information (3984).

Below activities are continuing into FY07 but with FY06 funding.

CRD's goal is to contribute to the reduction of vertical HIV transmission through increased accessibility and utilization of PMTCT and CT services. CT acts as an entry point for PMTCT services for pregnant women to reduce their risks of producing babies infected with HIV virus. This program component will be provided to pregnant women and their partners in Gulu and Kitgum districts, which are the most affected war areas in Uganda. AVSI, a member of the CRD consortium, has accumulated a lot of experiences in provision of PMTCT services in Kitgum and Pader districts, where over 95% of ANC mothers are reported to have tested for HIV. To maintain that level of response, AVSI will consolidate PMTCT services by targeting two hospitals and 8 peripheral health centers in Kitgum district to provide quality PMTCT services. According to program reports, majority of women who are pregnant in conflict districts live in IDP camp and are young (below 24) with low education standards. Such women need special services to enable them know and also benefit from PMTCT services. AVSI intends to support CT activities for diagnostic purposes for pregnant women, their children and partners.

One of the biggest challenges of PMTCT to-date is involvement of male partners. With the infection rate of about 7% among women attending ANC services, only 60% of these women enroll and also deliver in hospital. There are plans to involve male partners through special education/counseling plus training of couples in income generating activities through wrap around initiatives. In addition, support will go to the two hospitals to provide related PMTCT services like home based care services, monitoring mothers and their babies, replacement feeding and monthly meeting for PMTCT mothers and partners. In Gulu district, PMTCT is still registering low uptake. Stigma and discrimination have been reported to be among the contributing factors for women's acceptance PMTCT services. CRS, another member of the CRD consortium, is working to improve the situation through supporting Lacor hospital to link CT to PMTCT services. Using AVSI experiences in the provision of holistic approach, CRS will offer improved PMTCT services to pregnant women and the follow up services for the HIV positive mothers. Activities to involve male partners and communities will be conducted. With experience in ART services, CRS will work with other agencies to support PMTCT mothers with ARVs through referrals to St Josephs's Hospital in Kitgum. Implementation of PMTCT services in Gulu district will require CRS to conduct community mobilization exercises to public about PMTCT, procure kits/drugs, training staff and other activities like those in Kitgum district. Funding will be used to provide support to 12 PMTCT outlets, training of 115 health workers, serving 9,000 mothers with CT services, providing a complete course of antiretroviral prophylaxis in PMTCT setting to 360 mothers, and facilitation of a complete follow up at home to 500 (250 mothers and 250 babies).

This activity links to activities in PMTCT (3985), Other Prevention (3988) Palliative Care: Basic Health Care (3986), counseling and testing (3984), and strategic Information (3984).

Activities are continuing into FY07 but are funded by FY06 money.

Studies in conflict affected areas show low knowledge on HIV transmission and prevention strategies. In addition to the effects of on-going conflict, a number of social, cultural and economic factors were identified as contributing to spread of HIV infection. These include; polygamy, female genital mutilation, rape, defilement, wife inheritance and low socio-economic status. Stigma and discrimination were also seen as major barriers for people to seek HIV services. Within this context, CRD partners saw the need to intensify HIV prevention campaigns to change HIV risk behaviors among youths and adults.

AB activities will be implemented in five-conflict districts of Uganda (Gulu, Kitgum, Nakapiripirit, Moroto, and Kotido). Our past operations in these areas have shown the need to increase mobilization and awareness campaigns on HIV ransmission/prevention strategies. IRC will work with its partners, AVSI, and SCiU, to conductthe following AB activities.

IRC will operate in the 3 districts of the Karamoja region to conduct AB campaigns through open air, radio talk shows, sports, dramas by Post Test club members, and the production of IEC materials with AB messages. These activities will address economic factors contributing to the spread of HIV (polygamy, FGM, rape, defilement, and wife inheritance) and to further stigma and discrimination.

AVSI will train primary and secondary school teachers on HIV/AIDS prevention behaviors (AB) and will guide them to teach the same to students within the schools. AVSI will also support two local agencies (Meeting Point and CHAPS) to conduct HIV/AIDS awareness among the communities through the production of T-shirt with AB messages, IEC materials, and radio shows.

SCiU plans to collaborate with other partners in Gulu to design a communication strategy for youth between 10-18 years. Messages will emphasize abstinence as the best prevention method, but will also educate youth on life saving skills. In addition, SCiU will work with parents, religious leaders, teachers, and radio stations to encourage youth to adopt positive behaviors and reinforce these behaviors through peer-to-peer discussions in and out of school.

This activity links to activities in PMTCT (3985), AB (3983), Palliative Care: Basic Health Care (3986), counseling and testing (3984), and strategic Information (3984).

Activities are continuing into FY07 but with FY06 funding.

This component is related to activities of abstinence, being faithful and CT, as information regarding other forms of prevention provided in counseling services. The activities will be implemented directly by IRC and its sub-grantees. IRC's 3 local partners, one in each of the three districts of Karamoja region, will identify and train community immobilizers to provide support to abstinence, faithfullness and other activities that include condom education and promotion. Given that condom knowledge and use are still low in Karamoja, training involving leaders in program ownership and promotion will be conducted. Condom distribution guidelines from the MOH will be used in training. PLWHA with success stories on condom use will be supported to give their testimonies/ messages to encourage those at high risk to adopt safer sex practices. The gender issues associated with condom use will be explained through promotion activities some of which will be spearhead by women. This component will supplement A/B activities in Karamoja region. The target is to establish 50 condom service outlets, 50 individuals trained in promotion of HIV/AIDS behavior beyond A/B, and that 75,000 community members are reached with such messages.

This activity links to activities in PMTCT (3985), AB (3983), Other Prevention (3988), counseling and testing (3984), and strategic Information (3984).

Activities are continuing into FY07 but with FY06 funds only.

Palliative Care/Basic Health Care and Support is also related to VCT, PMTCT, A/B and Prevention components, in supporting clients to cope and also to prevent HIV transmission. CRD partners (IRC, SCiU and AVSI) have implemented these activities in the past and have acquired enormous experience that will be consolidated to provide quality palliative services to clients in the districts of Kitgum, Kotido, Moroto and Nakapiripirit. Past operations in Karamoja districts have showed that provision of palliative care services is still too low. Karamojong is a closed society with strong cultural beliefs, thus low knowledge of HIV/AIDS is still a barrier to utilization of HIV services. In order to have a breakthrough, IRC wants to continue with provision of palliative care services. In collaboration with Church of Uganda in Kotido, IRC plans to provide basic health care services to two health centers. In one of these, IRC and the experienced local partners in this field will provide quality services to greater number of people than before through consolidated linkages with other sectors, to enhance the quality of services to PLWHAs and their families. In the second health center, IRC will support the Church of Uganda to pursue its integrated approach by providing behavior change communication, CT, OVC and palliative care services. IRC will provide technical input through support supervision in the implementation of these activities; community mobilization and participation, IEC, training of service providers, commodity procurement for home based care activities, OVC, CT and A/B/C activities.In Kitgum palliative care services would be provided by AVSI in collaboration with two local agencies. Services will be almost similar to those mentioned above. Specifically, AVSI will support the two hospitals (Kitgum and St. Joseph) to strengthen and also expand counseling and psychosocial support services to decrease stigma and discrimination. The component targets (adults males and female) youths and children, caregivers, PLWHA and their families. The funding will cater for training of staff in care protocols, community mobilization with balanced gender participation, development of network/linkages/referral and IEC on care and support messages. Through this funding, 160 service providers will be trained to serve 2320 adults and 100 children PLWHAs.

This activity links to activities in PMTCT (3985), AB (3983), Other Prevention (3988) Palliative Care: Basic Health Care (3986), counseling and testing (3984), and strategic Information (3984).

Activities will continue into FY07 but with FY06 funding only.

OVC component is related to Palliative care and aims at reducing vulnerability of children in conflict districts through improved access to education and health services. Two CRD partners will be involved in implementation of OVC activities. One of these is SCiU that plans to complement palliative services with OVC activities. In Gulu, Health Alert Uganda in collaboration with district probation and welfare officers will provide education support, IGA training for out of school children, capacity building for community care /support groups to provide psychosocial support to OVCs. palliative care and support activities for children will also be emphasized. Where as there has been a general increase in funding for care and support activities, specific interventions targeting HIV positive children have been small. Staff that has been providing care services to children lacked competence of communicating with children suffering from HIV/AIDS, in addition, too few communities follow up interventions to support such children. These services will include following up children on ARVs with education, adherence counseling, on going counseling for prevention, treatment of opportunistic infections, referrals, psychosocial and nutritional support.

In Karamoja region, support to OVC is a notable gap. Thus, IRC in addition to its other operations in this region plans to implement these activities directly. It will also implement OVC related services with Church of Uganda in Jie county. Reduction in poverty at household level will lead to reduced vulnerability of women and children, improved access to social services such as education and health, and improved general health outcomes. Thus emphasis on this program will be on education support and livelihood activities for out of school, protection and capacity building for the community care groups to provide psychosocial support to OVCs. Funding will go on community mobilization, IEC material development, training in OVC services including its related stigma and discrimination issues, collaboration/networking with other agencies, capacity building of local communities with OVC programs, and procurement (mainly drugs). Through this component 240 OVCs will receive school support, 90 to be trained in apprenticeship, 100 in IGA activities and 170 caretakers to be trained in caring for OVCs. Due to the vast geography of the Karamoja region and the nomadic nature of its communities, the management and oversight costs of the OVC programs are higher as compared to other regions.

This activity links to activities in PMTCT (3985), AB (3983), Other Prevention (3988) Palliative Care: Basic Health Care (3986), and strategic Information (3984).

Activities will continue into FY07 but with FY06 funding only.

CRD has been providing HCT services to war affected regions of Western Uganda, Northern and Northeastern Uganda. Data collected shows high demand for such services especially among the female population where prevalence is high. Hence, with this new funding CRD through its partners (CRS and IRC) plan to continue with the provision of high quality CT services in severely affected war districts of Uganda. One of these districts is Gulu where HIV prevalence is estimated to be at 12% (9.1% regionally). CRS in collaboration with a missionary hospital (Lacor HSP) will continue providing technical support to CT service provision to clients visiting this hospital. In addition, arrangements will be made to extend the same support to two health units in IDP camps.

The 18 years war in Northern Uganda has had a devastating effects on the region and caused displacement of over 1.6 million persons, mostly women and children who now live in camps as internally displaced persons (IDP), with limited access to health services such as CT. The high HIV prevalence means the spread will continue if prevention, care and treatment activities are not conducted for high risk populations. Other districts are being supported in a similar manner in the underserved region of the North. IRC will work with other partners in the region to provide support to CT static sites, outreach operations, and home based CT services. Implementation of CT services in these regions will require staff to be identified by the management centers to be trained in provision of quality CT services. The training will be conducted by MOH in collaboration with other HIV/AIDS training agencies in the country, using the newly developed CT curriculum.

In addition, the training will address gender, stigma and discrimination issues in HIV service provision. CRS and IRC will link CT centers to MOH stores to get testing kits for client. In events that MOH will have stock outs, plans will be made to supplement commodities through procurement of test kits. In order to provide quality services, the MOH will be consulted in provision of quality assurance and supportive supervision. Community mobilization, information, education and communication activities will be carried out for the public to know more about HIV/AIDS facts, availability of CT in their areas, benefits of testing/knowledge of HIV status and referral services including ARVs. The principal target populations for this component are: adults (males and females) children, youths and couples. Funding will go specifically to support training of staff, community mobilization, commodity procurement, IEC, quality assurance, development of network/referral, and linkages with other sectors. In total the component will support 9 static CT sites, 10 outreach sites, training of 35 CT staff and the will serve 11,300 clients.

This activity links to activities in PMTCT (3985), AB (3983), Other Prevention (3988) Palliative Care: Basic Health Care (3986), and counseling and testing (3984).

Activities will continue into FY07 but with FY06 funding only.

This component provides data on the type of services provided and numbers of clients served. One of the objectives of CRD is to strengthen districts' capacity in HIV/AIDS data capture and utilization in planning and the budgeting required for prevention, care and support services. In past, efforts have been made to create capacity in this line and IRC wants to consolidate it in Karamoja region. In all the health centers supported data will be collected on routine basis and managed centrally. To motivate service providers in data collection on clients served, user-friendly data collection forms will be developed and distributed to HIV services providers in the region. Where MOH has standard forms, these will be used. Training of staff on data collection forms will take place in all the health centers. Periodically data collected will be analyzed and shared with all stakeholders, including health service providers, to know more on characteristics of clients served and to compare data between appointments and different locations. The Strategic Information component will aim at establishing and also strengthening data collection, reporting and use for program planning. This will be achieved through training clinic and district staff, hiring of data clerks, procurement of computers and accessories, development of data entry screens and reporting formats.