PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
Makerere University Faculty of Medicine was awarded a cooperative agreement titled "Provision of routine
HIV testing, counseling, basic care and antiretroviral therapy at teaching hospitals in the Republic of
Uganda" in 2004. The program named Mulago-Mbarara Teaching Hospitals' Joint AIDS Program (MJAP)
implements HIV/AIDS services in Uganda's two major teaching hospitals (Mulago and Mbarara) and their
catchment areas in close collaboration with the national programs run by the Ministry of Health (MOH).
MJAP also collaborates with the National tuberculosis and Leprosy Program (NTLP), and leverages
resources from the Global fund. MJAP provides comprehensive HIV/AIDS services including: 1) hospital-
based routine HIV testing and counseling (RTC), 2) palliative HIV/AIDS basic care, 3) integrated TB-HIV
diagnosis with treatment of TB-HIV co-infected patients, 4) ART and HIV post- exposure prophylaxis, 5)
family based care (FBC) which includes services for orphans and vulnerable children (OVC), in addition to
home-based HIV testing and prevention activities (HBHCT), and 6) capacity building for HIV prevention and
care through training of health care providers, laboratory strengthening, and establishment of satellite HIV
clinics. Mulago and Mbarara hospitals are public referral institutions with a mandate of training, service-
provision and research. Annually 3,000 health care providers are trained and about one million patients
seen in the two hospitals (500,000 outpatients and 130,000 inpatients for Mulago, and 300,000 in and
outpatients for Mbarara). Approximately 60% of medical admissions in both hospitals are because of HIV
infection and related complications. Within Mulago, MJAP works closely with the Infectious Diseases
Institute (IDI). IDI is an independent institute within the Faculty of Medicine of Makerere University with a
mission to build capacity for delivering sustainable, high-quality HIV/AIDS care, treatment and prevention in
Africa through training and research. At IDI health care providers from all over sub-Saharan Africa receive
training on HIV care and antiretroviral therapy (ART); people living with HIV (PHA) receive free clinical care
including ART at the Adult Infectious Diseases Clinic (AIDC) - the clinic is integral with Mulago teaching
hospital. The main HIV clinics in Mbarara and Mulago teaching hospitals are the Mbarara ISS (HIV) clinic
and AIDC, respectively; MJAP supports HIV care and treatment in both clinics. In FY 2005 and FY 2006
MJAP opened eight satellite clinics within the catchment areas of these two clinics due to the rapidly
increasing demand for HIV/AIDS care services; increasing the total number of treatment sites to 10. The
eight satellite clinics include Mulago hospital ISS clinic, Kawempe, Naguru, Kiswa and Kiruddu (under
Kampala City Council - KCC), Mbarara municipality clinic (under the Mbarara municipal council),
Bwizibwera health center IV (under MOH and Mbarara local government), and Mulago TB/HIV clinic, which
provides care for TB-HIV co-infected patients. The satellite clinic activities are implemented in collaboration
with several partners including KCC, Mbarara Municipal Council, IDI, Baylor-Paediatric Infectious Disease
Clinic (PIDC), Protection of Families against AIDS (PREFA), MOH, and other partners.
MJAP has been providing HIV prevention counseling including Abstinence and Be faithful (AB) counseling
through the HIV testing programs. Prevention counseling has also been integrated into the care and
treatment programs and OVC interventions (counseling and life skills training). In the RTC program, couple
testing is encouraged thus promoting disclosure and strengthening the B messages for concordant HIV
negative couples. ‘A' messages are encouraged for single youth below 20 years who are not yet sexually
active, among other interventions. Family members who are tested through the HBHCT program also
receive prevention counseling. Since November 2004, more than 5,000 children and youth have been
served through the MJAP counseling and testing, care and treatment programs. We have provided HIV
testing to over 3,000 couples, 19% of who were sero-discordant and 60% concordant negative.
In FY08 (April 2008 to March 2009), MJAP will strengthen the integration of AB activities into the existing
programs. Through HBHCT program, we will provide C&T to 2,000 households of index patients in care. We
anticipate reaching 3,000 children and youth through integration with the OVC, RTC and HBHCT
interventions. The AB activities will be integrated with other prevention to ensure a comprehensive HIV
prevention package. The A activities will primarily target children and single youth below 20 years but those
who are sexually active and/or married will also receive "B" messages and other prevention support
including condom use, as appropriate. These will be reached through the HIV testing programs and the
OVC services. The children will receive health education, counseling support and life skills training to
enable them make informed choices. The B activities will also be integrated with couples counseling (in
RTC and HBHCT) to encourage couples' HIV testing and mutual faithfulness to partners in concordant HIV
negative partnerships. We will also integrate the entire spectrum of prevention activities within the care and
treatment sites through the positive prevention and family planning interventions. The funding in this
category will support the integration and strengthening of existing AB activities, support for personnel
involved in AB activities, production and dissemination of information, education and communication
materials to support the AB programs, training of health care providers to integrate AB activities, improved
data collection, reporting, and M&E. Requirements for HIV testing will be covered under the CT budget.
diagnosis with treatment of TB-HIV co-infected patients, 4) ART and HIV post- exposure prophylaxis (PEP),
5) family based care (FBC) which includes services for orphans and vulnerable children (OVC), in addition
to home-based HIV testing and prevention activities (HBHCT), and 6) capacity building for HIV prevention
and care through training of health care providers, laboratory strengthening, and establishment of satellite
HIV clinics. Mulago and Mbarara hospitals are public referral institutions with a mandate of training, service
-provision and research. Annually 3,000 health care providers are trained and about one million patients
training on HIV care and antiretroviral therapy (ART); people living with HIV receive free clinical care
MJAP has integrated HIV prevention services into all the existing HIV counseling and testing, care and
treatment interventions. We have integrated prevention interventions at the following levels 1) prevention
counseling and couples counseling and testing in the RTC and HBHCT programs, 2) prevention with
positives counseling and support for all patients in the HIV/AIDS clinics, 3) Discordant couple clubs at two of
the HIV/AIDS clinics (one in Mulago and one in Mbarara), 4) Post-exposure prophylaxis for health care
providers, and 5) community prevention interventions in collaboration with the Mulago hospital sexually
transmitted diseases (STD) clinic, targeting high-risk groups. All patients receive health education and
prevention counseling, and are encouraged to disclose their HIV status to their partners. Partner HIV testing
is also provided at all the HIV/AIDS clinics and RTC wards. Through the HIV testing programs, we provide
couples' HIV testing, counseling support and condom provision for discordant couples. Since November
2004, the program has provided HIV testing to more than 3,000 couples, 19% of who were sero-discordant.
MJAP has also been engaged in activities to prevent HIV transmission in the health care setting. These
include training of health care providers in universal precautions, development and distribution of
information, education and communication materials, assessment and provision of post-exposure
prophylaxis PEP for health care providers following exposure to infectious materials. To date, we have
trained over 500 health care providers and provided PEP to more than 90 health care providers in Mulago
and Mbarara teaching hospitals. The STD unit in Mulago serves a significant number of high risk groups. In
collaboration with the STD unit, MJAP provides prevention services at the facility as well as the community
level. At the facility (STD clinic) patients receive prevention counseling and HIV testing through the RTC
program, screening and treatment of sexually transmitted infections. Within the community, the
interventions include prevention education and counseling for high-risk groups including bar attendants,
commercial sex workers (CSW) and their clients, condom distribution in 10 busiest entertainment centers in
Kampala, and outreach voluntary HIV counseling and testing (VCT).
In FY08 the program will continue to provide training for health care providers and provision of PEP in all
the HIV testing, care and treatment sites that are supported by MJAP (14 HIV clinics, Mulago, Mbarara and
five regional referral hospitals). We will strengthen the prevention with positives and family planning
activities in all clinics, and will involve People living with HIV/AIDS (PHA) in prevention education and
counseling for patients. We will also strengthen the support for discordant couples identified through HIV
testing programs. All HIV testing facilities and care and treatment sites will provide condoms to support
discordant couples, in addition to the prevention counseling. Through collaboration with the Mulago STD
clinic, we will also provide STI diagnosis and treatment and HIV testing for some individuals referred from
the community. Within the community we will provide outreach voluntary HIV counseling and testing (VCT).
High-risk and CSW communities have organized networks with peer leaders (queen mothers). We will use
peer leaders to distribute coupons for facility based VCT for individuals who do not wish to test within the
community. These coupons will be numbered and tracked to evaluate the response rate of these referrals.
HIV infected individuals identified through community-based and facility-based HIV testing activities will be
referred to MJAP supported clinics and others facilities within Kampala. Education within the community will
address STI and HIV prevention, and will address the entire spectrum of prevention (AB and condom use)
as appropriate. We will identify and train peer leaders to mobilize the high-risk communities, provide
education and support for distribution of condoms. We will also work with bar owners and attendants to
distribute condoms through 10 established outlets for high-risk groups. Through these activities we will
reach over 3,500 individuals in high-risk communities. Overall, 40,000 individuals will be supported in FY
2008 (includes HIV positive patients in the clinics, discordant couples, and high-risk groups in selected
communities in Kampala). The other prevention program will have 31 condom distribution outlets (all 14 HIV
clinics, 10 community outlets for high-risk groups, Mulago and Mbarara, and five regional referral hospitals).
The ‘other prevention' budget will cover training, information, education, and communication materials,
health education and support for the PHA who will be involved in the prevention interventions. We will also
improve on the data management, reporting and M&E for ‘other prevention' programs. The capacity of the
STD laboratory will be reinforced through purchase of additional laboratory supplies. We will also procure
some additional drugs for treatment of STIs in order to supplement the MOH drugs, and support additional
Activity Narrative: staff to improve the clinical management at the unit. The ARV drugs for PEP and supplies for HIV testing
will be covered under the ART drugs and HIV counseling and testing budgets. Training in PEP for health
care providers and service provision at the clinic sites will be continued.
This activity refers to the CDC component ($166,000) of the three-country PEPFAR Gender Special
Initiative on Gender-Based Violence and covers the funds allocated by OGAC to PEPFAR Uganda. This
funding is not tied to any specific fiscal year and will be allocated to TBD existing partners.
This activity links to:The HQ-led component of the Initiative implemented by two USAID-funded Technical
Assistance partners, the Population Council and Health Policy Initiative; Any additional activities that may
build upon Special Initiative activities with FY08 funding.
The overall goal of the Special Initiative is to increase access for victims of sexual violence to
comprehensive treatment services, including HIV post-exposure prophylaxis (PEP) in three selected
countries: Rwanda, Uganda and South Africa. Lessons learned from these three countries will be used to
inform program design and scale-up in countries throughout Africa.
Specific Initiative objectives are to:
1) Implement and evaluate comprehensive sexual violence services delivery models building upon existing
services in the three selected PEPFAR focus countries. This includes to: Strengthen the capacity of local
partners and institutions to deliver quality health care services to victims of sexual violence, e.g., medical
management of sexual violence at the point of first contact with victims (including children), HIV PEP, and
psychological counseling; Establish and strengthen linkages between health, law enforcement, legal, and
community services (e.g., shelter, child care, economic opportunities, etc.) for delivery of a coordinated
response to sexual violence victims; and
Assess changes in the utilization and quality of services.
2) Measure the costs (and cost effectiveness) of implementing the service delivery models to inform model
transfer and scale-up.
3) Foster South-South exchange of programmatic experience, protocols, and tools across the three
countries and through linkages with a network of partners throughout Africa that are implementing similar
service delivery models.
Funding for initiative activities in Uganda will be used to:
•Implement the services strengthening activities described above in selected pilot locations where the
designated partners currently work -- in partnership with relevant government, local NGO, and other
community organizations;
•Participate in training and technical assistance activities that will be provided by the two Technical
Assistance partners for the Special Initiative and by other training partners funded through linked activities;
•Support collaboration across all Ugandan partners that are participating in the Initiative;
•Assist the Technical Assistance Partners in evaluating and measuring costs of the interventions through
input into the design of these evaluations and data collection;
•Participate in discussions and forums with partners from the other Initiative countries and other
organizations from throughout Africa to share tools, protocols and lessons.
MJAP also collaborates with the National Tuberculosis and Leprosy Program (NTLP), and leverages
resources from the Global Fund. MJAP provides comprehensive HIV/AIDS services including: 1) hospital-
training on HIV care and ART; people living with HIV (PHA) receive free clinical care including ART at the
Adult Infectious Diseases Clinic (AIDC) - the clinic is integral with Mulago teaching hospital. The main HIV
clinics in Mbarara and Mulago teaching hospitals are the Mbarara ISS (HIV) clinic and AIDC, respectively;
MJAP supports HIV care and treatment in both clinics. In FY 2005 and FY 2006 MJAP opened eight
satellite clinics within the catchment areas of these two clinics due to the rapidly increasing demand for
HIV/AIDS care services; increasing the total number of treatment sites to 10. The eight satellite clinics
include Mulago hospital ISS clinic, Kawempe, Naguru, Kiswa and Kiruddu (under Kampala City Council -
KCC), Mbarara municipality clinic (under the Mbarara municipal council), Bwizibwera health center IV
(under MOH and Mbarara local government), and Mulago TB/HIV clinic, which provides care for TB-HIV co-
infected patients. The satellite clinic activities are implemented in collaboration with several partners
including KCC, Mbarara Municipal Council, IDI, Baylor-Paediatric Infectious Disease Clinic (PIDC),
Protection of Families against AIDS (PREFA), MOH, and other partners.
MJAP palliative basic care activities are currently implemented at 10 sites as listed above, with over 27,000
patients in active care; 9,000 at AIDC and 5,500 at Mbarara ISS. Mulago ISS, the largest of the new clinics
has registered over 5,000 patients while the smaller seven satellite clinics serve more than 8,000 patients.
The number of HIV patients in all the clinics continues to increase with the expansion of RTC in the
hospitals (over 18,000 HIV infected individuals were identified through RTC in FY 2006). By March 2008,
12 clinics will be operational and providing palliative basic care (two additional satellite clinics will be
established in collaboration with KCC and IDI). The palliative basic care activities include provision of a
package comprising cotrimoxazole for prophylaxis, insecticide treated mosquito nets, safe water provision
for diarrhea prevention, diagnosis and treatment of malaria and other opportunistic infections (OI). All
patients attending the HIV clinics receive daily cotrimoxazole for prophylaxis. Newly diagnosed HIV positive
patients from the RTC program also receive a month's supply of cotrimoxazole prophylaxis and are
provided with referrals for follow-up care in the HIV clinics. Patients eligible for ART are able to access
services at the same clinics. The AIDC and Mbarara ISS clinics provide care for adult patients while children
receive care from PIDC and Mbarara paediatric HIV clinics. However, in the satellite clinics MJAP
collaborates with other partners to provide comprehensive HIV care to entire families, including children in
collaboration with PIDC, KCC, MOH , NTLP and other partners. KCC provides clinic space and drugs for
management of OI. NTLP provides TB medications and support supervision. Other existing HIV programs
include VCT under AIDS Information Centre, PMTCT under PREFA, ART under MOH-Global Fund
Program and PEPFAR, and OVC support through Ministry of Gender, Labour and Social Development.
These programs are working together to ensure comprehensive care for families affected by HIV/AIDS
while avoiding duplication of services. Up to 27,000 individuals in the MJAP supported outlets are provided
with care including prophylaxis and treatment of opportunistic infections. More than 14,000 have received
safe water vessels and insecticide treated mosquito nets. The program also offers pre and in-service
training in palliative care to medical and other allied health workers.
In FY 2008 (between April 2008 and March 2009), two additional satellite care and treatment sites will be
established in collaboration with IDI bringing the total number to 14. The program will increase access to
basic HIV palliative care from 40,000 individuals to 70,000 (including 30,000 newly diagnosed patients who
will receive one month's supply of cotrimoxazole) prior to referral. MJAP will provide cotrimoxazole
prophylaxis and other OI care, malaria diagnosis and treatment, and Population Services International (PSI)
will provide safe water supplies and insecticide treated mosquito nets. We will supplement the basic care
items from PSI to ensure that at least 90% of the patients have access to mosquito nets and safe water.
The basic care and ART programs are integrated; all patients on ART receive basic care, and patients
receiving basic care are evaluated for ART eligibility. The funding will support the 14 clinics in terms of basic
care supplies, and other OI treatment and prophylaxis. Children within the clinics will receive some
nutritional supplementation and will also be linked to other partners for additional OVC services. Through
the home-based HIV care program which targets families of HIV infected patients in the clinics, the non-HIV
infected children within these households will also be linked to OVC services. The home-based care
program will continue to provide HIV testing for all family members, and support disclosure to partners
through counselor-assistance when requested; this will ensure that all family members including men,
women and children are served. In line with Uganda's HIV/AIDS National Strategic Plan 2007/2008-
2011/12, MJAP will extend RTC services to regional referral hospitals (eight regional referral hospitals will
have functional RTC programs in FY 2008). All newly diagnosed HIV positive patients in these hospitals will
receive a month's supply of cotrimoxazole before referral for follow-up palliative care and treatment. To
ensure sustainability, MJAP will support the improvement of existing structures and systems within the
facilities. The program will hire additional staff to support care and prevention efforts, provide training for
new and existing staff in the clinics 300 health care providers will be trained in the coming year), support
logistics management and supplies, quality assurance and support supervision, and enhance the existing
referral systems between the main HIV clinics and the satellite clinics, and linkage to care for newly
diagnosed HIV patients. The program will also support the improvement of data management/ M&E and
reporting to all stakeholders within the districts and MOH. The program has recently developed a strategy
Activity Narrative: for involvement of PHA in aspects of patient care, and training of the PHA has commenced. The strategy
also addresses issues of PHA supervision and motivation.
MJAP supports a TB screening program, which is aimed at augmenting TB diagnosis in Mulago and
Mbarara hospital wards and the specialized HIV/AIDS clinics. TB and HIV service integration happens at
several levels 1) integration of TB screening and RTC on the wards/clinics, where patients are offered both
HIV testing and screening for TB, 2) RTC in the TB wards and clinics, 3) enhanced TB screening in all the
supported HIV clinics, and 4) provision of both TB and HIV care and treatment for patients who are co-
infected with TB and HIV. Implementation of the TB screening and treatment services is done in
collaboration with MOH-NTLP. The MOH-NTLP supplies free TB medications, some laboratory equipment
and reagents; the HIV clinics dispense TB medications supplied by MOH-NTLP, monitor patients, and
report regularly to MOH-NTLP. Since February 2005, over 20,000 individuals have been screened for TB
and more than 2,000 sputum positive patients identified and linked to care. Additionally, more than 1,500
patients have received TB and HIV treatment in the HIV care centers. The program established a special
TB-HIV clinic in Mulago that provides care for TB-HIV co-infected patients. In this clinic, TB/HIV patients
receive TB treatment, HIV palliative and basic care, assessment for ART eligibility, and initiation of ART if
eligible. After completion of TB treatment, these patients are referred for follow-up HIV care in the other
established clinics. The TB-HIV clinic has provided care for more than 700 adult TB-HIV patients since
September 2005, 52% of who also received ART (children receive care from PIDC and the Mbarara
pediatric HIV clinic). The program is also currently setting up an integrated TB-HIV clinic in Mbarara
hospital. TB treatment has been integrated into all the other care and treatment sites, with a dedicated day
for treatment of co-infected patients in each site. Integrated TB-HIV diagnosis has been extended to three
regional referral hospitals in FY 2007.
In FY08 (April 2008 to march 2009), two new satellite care and treatment sites will be opened in
collaboration with IDI. The integrated RTC-TB screening program will also be expanded to 2 additional
MOH regional referral hospitals. It is expected that integrated TB/HIV activities will be replicated at five
regional referral hospitals in collaboration with MOH and NTLP. This funding will support TB screening in 21
sites (Mulago and Mbarara hospital wards, five regional referral hospitals, and all the 14 MJAP supported
HIV clinics); 14 sites will provide integrated care and treatment while seven will provide integrated diagnosis
with referral to existing care and treatment facilities. The aim is to screen 25,000 patients for TB and provide
TB-HIV care to 2,000 TB-HIV co-infected patients in the coming year. To ensure sustainability, MJAP will
continue to support the improvement of existing structures and systems within the facilities. The program
will hire additional staff to support the TB-HIV integration efforts, provide training for new and existing staff
in the clinics (400 health care providers will be trained in the coming year), support logistics management
and supplies, quality assurance and support supervision, and enhance the existing referral systems
between the diagnosis and the care and treatment sites. The program will also support the improvement of
data management/M&E and reporting to all stakeholders within the districts, zonal supervision offices and
MOH-NTLP. Although implementation will happen in the regional and national referral hospitals, health
providers in the lower level health centers (including CB-DOTS providers) will also be trained, to enhance
TB-HIV care and CB-DOTS. The laboratory personnel at the regional referral hospitals will be trained and
supported to provide support supervision for the lower level laboratories (an area within their mandate but
currently not fully implemented). The HIV testing, care and treatment supplies will be covered under the
care, treatment and CT budgets. The program will target both adults and children in all the clinics and
hospitals.
Makerere University Faculty of Medicine is expanding TB/HIV integration.The program,Mulago-Mbarara
Teaching Hospitals' Joint AIDS Program (MJAP), implements HIV/AIDS services in Uganda's 2 major
teaching hospitals at Mulago & Mbarara & their catchment areas in close collaboration with MOH national
programs. MJAP also collaborates with NTLP & leverages resources from GFATM. It provides
comprehensive HIV/AIDS services including: hospital-based RTC; palliative HIV/AIDS care; integrated TB-
HIV diagnosis with treatment of TB-HIV co-infected patients; ART & HIV PEP; family based care (FBC)
including OVC services, home-based HIV testing & prevention activities (HBHCT); capacity building for HIV
prevention & care through training HCWs, lab strengthening, & establishment of satellite HIV clinics. The
hospitals are public referral institutions with a mandate of training, service-provision & research.
Approximately 60% of medical admissions are due to HIV infection & related complications. MJAP works
closely with IDI, an independent institute within the Faculty of Medicine & has a mission to build capacity for
delivering sustainable, high-quality HIV/AIDS care, treatment & prevention in Africa through training &
research. PHAs receive free clinical care including ART at the Adult Infectious Diseases Clinic (AIDC);
MJAP supports HIV care & treatment at Mbarara ISS clinic & AIDC. In FY05/FY06 MJAP opened 8 satellite
clinics: Mulago Hospital ISS clinic, Kawempe,Naguru,Kiswa,Kiruddu (under Kampala City Council - KCC),
Mbarara Municipality Clinic (under Mbarara Municipal Council), Bwizibwera HCIV (under MOH/Mbarara
local government), & Mulago TB/HIV clinic, which provides care for TB-HIV co-infected patients. Satellite
clinic activities are conducted with other partners. MJAP integrated TB services into its HIV testing & care
programs in 2005 & expanded these services to regional referral hospitals starting with Jinja. TB/HIV
integrated services include diagnosis of TB & HIV infections among in- & out-patients in general wards &
clinics through integrated routine HCT & TB diagnosis, enhanced TB screening for HIV positive patients in
care including those on ART, HIV testing for hospitalized TB patients on anti TB treatment, & linkage of
infected patients to existing care & treatment services. TB screening is conducted at several levels
beginning with clinical evaluation. The main diagnostic tool is sputum smear microscopy, CXR for those
who have no cough & biopsies for the extra pulmonary TB. MOH, NTLP & MJAP reviewed existing
materials on HIV & TB care & developed training materials for HCWs in delivery of integrated TB-HIV
diagnosis, care & treatment. MOH & MJAP assessed the existing TB-HIV services at Jinja hospital to
identify strengths & gaps. Gaps were identified in: number of clinical personnel in medical units, lab
equipment & supplies for TB/HIV testing & treatment monitoring, logistics management system, data
management system, the hospital community health department which is responsible for monitoring TB
treatment & care, referral & follow-up, & skills in TB-HIV collaborative activities. Gaps were addressed
through: development of TB-HIV training materials & training of staff in various aspects of TB-HIV diagnosis,
procurement of lab equipments/supplies, training in logistics management, development of data tools,
databases & procurement of computers to enhance data management, M&E/reporting. Since December
2006, the program has provided HIV counseling and testing to over 3952 patients, 768 of whom tested
positive. 741 patients with TB symptoms were screened including sputum smears, 125 were found to have
smear-positive TB. 178 patients were co-infected and are receiving treatment in the Jinja hospital clinic.
Scale-up of service delivery has just started because the focus was on training & improving systems &
infrastructure. In FY08 MJAP will consolidate & strengthen existing TB-HIV services in Jinja Hospital to
include care & treatment for patients with both TB & HIV. MJAP will also expand integrated activities to 2
additional hospitals (Hoima & a third hospital to be identified in consultation with MOH). The 2 hospitals will
be supported to develop TB infection control plans & to implement procedures e.g. establishment of
infection control committees, early recognition of suspects, education on cough hygiene, provision of
protectives such as masks, tissues & contact tracing for all patients with TB disease seen in the hospital. To
ensure sustainability, MJAP will continue to support improvement of existing structures & systems within the
hospitals. Additional staff will be hired to support data management, M&E, reporting, integrated TB-HIV
services, training staff (200 HCWs will be trained in coming year), support logistics management & supplies,
quality assurance & support supervision, & enhance the existing referral systems between the regional
referral hospitals & lower level health facilities, & linkage to care for newly diagnosed TB-HIV patients.
Reporting to MOH &all stakeholders within the districts will improve. MJAP has recently developed a
strategy for involvement of PHAs in patient care, & training has commenced. The strategy addresses issues
of PHA supervision & motivation. MJAP will support regional referral hospitals to enhance support
supervision for lower level units. IPT activities will be piloted in Mulago HIV/AIDS clinic & scaled up sites
after an assessment of several parameters including patient follow-up, monitoring, adherence rates &
support mechanisms, & side effects to INH. Patients with latent infection of mycobacterium TB & HIV-
infected patients will receive IPT according to WHO & MOH/NTLP guidelines. MJAP will develop/update
current guidelines for provision of IPT & IEC materials for patient education; the data management system
will be finalized, HCWs will be trained in the provision of IPT. NTRL, which is a sub partner, supports NTLP
to achieve its aim of TB case finding & management by supporting sputum smear microscopy services
country wide. NTRL's provides training, supervision & QA with an emphasis on EQA as a priority to the
district labs & NGOs supporting CB-DOTS programs & providing reference support to the districts in the
diagnosis & monitoring of extremely difficult cases, as well as support for national TB drug resistance
surveillance. NTRL aims at strengthening & intensifying TB screening in HIV/AIDS infected patients &
encourages HIV screening to TB patients. Realization of these goals depends on nationwide coverage of an
EQA system at HIV prevention, care, & treatment sites as well as training & re-training in basic TB
diagnostic procedures & establishing a system that encourages & provides all TB patients with access to
HIV screening. NTRL expects TB/HIV collaborative activities will lead to increased detection & treatment of
TB among PLHAs. In addition, an increased number of TB patients will have their HIV status established.
The burden of TB/HIV co-infection will be reduced by providing quality AFB smear diagnostic services.
These services will be achieved through implementation of an EQA scheme & targeted supportive
supervision as well as refresher trainings which will be conducted at NTRL's newly equipped training lab.
The improvement of human resource development in qualitative & quantitative aspects will improve
accessibility to TB diagnostics services for patients with HIV/AIDS. FY07 achievements include the
introduction of EQA in Western & Northern Zones & strengthening of EQA in Kampala, South Western,
South Eastern, Central, Eastern & North Western Zones through re-visiting of areas with inadequate
performance e.g. slides not collected or technical problems, provision of feedback reports to DTLS for
further encouragement to continue collecting slides & addressing administrative problems concerning
forwarding of slides & transmitting feedback reports; protocol to establish a system of sample transport as
well as piloting drug surveillance has been completed & purchasing of sample carrier boxes is in process.
Rehabilitation of the training lab, offices & wash up was completed; plans for rehabilitation of the TB culture
lab have been approved; 2 laptop computers, 248 EQA slide boxes, 1 refrigerator, 1 Water distiller, 40
chairs & stools for the training room & 1 media hood were purchased. A MGIT culture system will be
purchased. 4363 TB tests were performed, 2095 TB cultures were done, 2018 fluorescent slides were read
& 250 susceptibility tests were made; 320 slides for EQA activities were read & 205 feedback reports were
Activity Narrative: written & sent back to districts for targeted support supervision;160 people were trained in TB/HIV activities
& 200 TB/HIV diagnostic units districts were supervised. Due to improvements made, NTRL has been
nominated to become a supra national reference lab in the region. FY08 will focus on further strengthening
the EQA System by increased problem-oriented supervision as well as training of lab staff & consolidation in
the poorly performing areas. District & regional labs will be strengthened to sustain the EQA System. 100
lab staff will be trained & DFLPs will carry out support & problem-oriented supervision. A lab coordinator will
be hired to oversee the daily activities, prepare, submit & follow up EQA reports to peripheral labs, compile
budgets & prepare quarterly reports. A data manager will also be hired. NTRL will also focus on better
patient care for HIV/AIDS patients through purchase & use of more sensitive fluorescent (LED) microscopes
for busy HIV/AIDS care centers, identifying possible MDR through a specimen referral system & expansion
of TB culture facilities to 2 other labs. Second line drug susceptibility testing as well as rapid MDR-TB
screening tests will be introduced to support the DOTS-plus programs. Support training for roll-out of
national TB speciman referral system with Uganda Central Public Health Laboratory.
OVC activities have been integrated into all MJAP programs. These activities include HIV testing, linkage to
HIV/AIDS care for the positives, psychosocial support, nutrition education as well as referral for other OVC
services that MJAP does not offer. The OVC services are provided for the following categories of children:
1) Children receiving HIV care and treatment in the 10 clinics, 2) Children of HIV infected patients within the
clinics (seen at home through the home based care program), 3) Children receiving RTC in the hospital
wards and clinics, 4) Exposed children (children born to HIV infected women) followed up within the
hospitals. The MJAP RTC program provides HIV testing to children in six pediatric wards (five in Mulago
and one in Mbarara hospital). The current program also provides HIV Counseling and Testing to family
members of patients in the hospital, including children of HIV infected patients. The program provides
HBHCT for family members of index HIV patients in Bwizibwera, Mbarara Municipality, Kawempe and
Naguru health centers, and the Mulago ISS clinic. The program has hired social workers who work closely
with health care providers to identify families of OVC from among the patients receiving care within the
clinics or those receiving HIV testing. Through these activities, over 3,000 children have received HIV
testing (15% of who were HIV-infected) and more than 1,500 households of index HIV positive patients
have been visited. In the satellite clinics,, MJAP provides family-based HIV care and treatment and OVC
and their caretakers receive services through this intervention.
In FY08 (April 2008 to March 2009), the program will continue to provide HIV testing, care and treatment to
OVC and their caretakers. We will improve the linkage with PMTCT facilities within Jinja and Mbarara
hospitals, and tracking of exposed children, with early diagnosis and linkage to care (PREFA and PIDC do
the follow-up for the Kampala-based sites). Children will receive some food, and basic care items. Exposed
children who will be followed up will also receive some food supplements; a snack for the children as they
wait to be seen and a package of foods for the children when they leave the clinic (once a month). The
home-based teams will also leave a small package of food for the children within the home, in addition to
the basic care items (mosquito nets, safe water vessels, cotrimoxazole for those who are HIV infected, and
de-worming of all children within the homes). HIV infected children will receive care and treatment in the
clinics. Referral linkages with other OVC service providers will be strengthened for other OVC services
including ongoing psychosocial support and counseling, vocational and life skills training, legal support,
educational and nutritional support, and income generating activities; we are in the process of signing
memorandum of understanding with three OVC service providers. Through these programs we hope to
reach 4,500 OVC and their caretakers. The OVC budget will cover personnel who will provide OVC
services, counseling, development of referral networks and linkage to other OVC services. The program will
also train providers in the clinics and C&T services to enable them initiate and provide referral for OVC
services; 150 OVC care givers will be trained in FY08. Other requirements for OVC care and treatment will
be covered under palliative care; basic care and support, ART services, ART drugs, ART laboratory
services, and counseling and testing budgets.
MJAP started implementing RTC in November 2004, in Mulago and Mbarara teaching hospitals. In RTC,
HIV testing is routinely offered to all patients seeking care in the wards/clinics where the program is
operational but those who decide not to test receive other clinical services without discrimination. HIV care,
including ART eligibility assessment, cotrimoxazole prophylaxis and TB screening, for individuals who are
HIV infected is initiated on diagnosis. The HIV negative patients are also screened for TB and both HIV
negative and positive patients receive prevention counseling. The program has trained over 1,200 health
care providers in Mulago and Mbarara hospitals in the provision of RTC. Since November 2004, the RTC
program has expanded from six to 42 hospital wards and clinics (23 in Mulago and 19 in Mbarara).
Cumulatively, more than 170,000 in- and outpatients have received HIV testing and over 35,000 HIV
infected individuals identified and linked to care and treatment. The current unit coverage represents 95% in
Mbarara. Although the unit coverage in Mulago is 50%, over 95% of the high prevalence units provide RTC.
In line with Uganda's HIV/AIDS National Strategic Plan 2007/2008-2011/12, MJAP has expanded RTC to
three regional referral hospitals; implementation in Soroti has already started. The RTC program is
implemented in line with the three C's - confidentiality, informed consent (opt out) and
counseling/information, as recommended by WHO, and the MOH HIV testing policy. HIV positive patients
are also referred for follow-up care in the HIV clinics where they receive basic HIV care, psychosocial
support and ART. For patients found to be HIV negative, HIV prevention messages are emphasized to
reduce risk of infection. Training in RCT for health providers from other units is ongoing at the request of
MOH. The program also implements other HIV testing strategies. MJAP offers VCT to family members of
patients who are available in the hospital and has found a high HIV prevalence (24%). In order to extend the
reach of HIV testing to family members, MJAP provides home-based HIV counseling and testing (HBHCT)
for index ART patients attending Bwizibwera and Kawempe health centers. In HBHCT, HIV counseling and
testing are offered within the homes of consenting index clients. This approach identifies other HIV infected
individuals in their households, facilitates disclosure of HIV status to sexual
partners and identifies many discordant couples. Additionally, testing of family members encourages early
entry into care and support for the HIV infected individuals.
In FY 2008 (between April 2008 and March 2009), MJAP will extend RTC services to two additional regional
referral hospitals, increasing the number to five. Patients from another three regional referral hospitals will
also receive HIV testing through the MJAP integrated TB-HIV services. We will achieve 100% coverage of
high-prevalence wards and clinics in Mulago and Mbarara hospitals. The regional hospitals will be selected
in collaboration with the MOH. The target is to provide HIV testing to a minimum of 170,000 individuals by
March 2009. In the RTC units, all patients with undocumented HIV status will be routinely offered HIV
testing but this will not preclude the right to opt-out of testing. The program will target all categories of
patients and family members; including adults, infants, children, health care workers, and MJAP program
staff. Through the HBHCT program, MJAP will provide HIV C&T to 2,000 households (10,000 family
members) of index patients in care. Newly diagnosed HIV positive patients will receive a month's supply of
cotrimoxazole before referral for follow-up palliative care and treatment. The program will integrate TB
screening for all newly diagnosed HIV-infected patients. MJAP will strengthen prevention with positives
counseling and support including HIV testing for spouses of patients in the HIV clinics and RTC wards.
Discordant couples will be referred to the ‘Discordant couples' clubs which are currently being piloted at two
sites. To ensure sustainability, MJAP will support the improvement of existing structures and systems within
the facilities. The program will support the engagement of PHA to supplement personnel for HIV counseling
and testing, provide training for new and existing staff in the facilities (800 health care providers will be
trained in the coming year), support logistics management and supplies, quality assurance and support
supervision, and enhance the existing referral systems to improve linkage to care for newly diagnosed HIV
patients. The program will also support the improvement of data management/ M&E and reporting to all
stakeholders within the districts and MOH.
Currently, MJAP procures ARV drugs through Medical Access Uganda Limited and distributes them to 10
service outlets as listed above. The 10 service outlets serve over 27,000 patients in care, 4,215 of who have
their ARV drugs procured through MJAP funding. The current (June 2007) distribution of these patients are
900 at AIDC, 810 in Mbarara ISS clinic, 885 in Mulago ISS clinic, 352 in Mbarara municipality clinic, 350 in
Kawempe KCC, 246 in Bwizibwera HCIV, 72 at Mulago TB/HIV clinic, 200 in Naguru, and >400 at Kiruddu
and Kiswa combined. The target is to procure ARVs for up to 7,000 patients by March 2008. The program is
currently switching patients from branded ARVs to the available cheaper generic FDA approved ARVs to
further reduce the treatment costs. Demand for ART in the clinics continues to increase with the expansion
of RTC in the hospitals. The Mbarara ISS and Mulago AIDC will be at maximum capacity as a result by
March 2008 if the current trends of enrolment remain constant. Two additional satellite clinics will be
operational in Kampala by March 2008 (in collaboration with IDI and KCC), increasing the number of service
outlets to 12. Majority of HIV positive patients identified through the RTC program (over 70%) need ARVs
(WHO Stages 3 and 4). Currently, we estimate that only about 60% of clinically eligible patients are
receiving ART at the clinic sites. MJAP has trained over 500 health care providers in the provision of
antiretroviral therapy and strengthened systems for ART delivery including staffing, laboratory support,
logistics and data management. The ARVs forecasting is done for the entire year with quarterly revisions,
but purchase of drugs including three months buffer stock for each patient are done on a quarterly basis.
Drugs are delivered to the program store by Medical Access, checked and received by a pharmacist of the
program and storekeeper before storage. An entry is made into the goods received note (GRN) and stock
cards for all drug items received. Stocktaking and reporting is done monthly at the service delivery points
and quarterly at all stores. As a result of the capacity building of lower level clinics within the catchment's
areas of Mulago and Mbarara for HIV care by MJAP, an additional >6,500 patients are able to access ARV
drugs from MOH/GFATM at the MJAP supported sites. In the past year, due to ARV drug procurement
interruptions for Global Fund, MJAP supported the procurement of two to three months' buffer stock for up
to 3,000 of these patients.
In FY08 (April 2008 to March 2009), two new satellite care and treatment sites will be opened in
collaboration with IDI, bringing the total to 14 sites. With the increased access to FDA approved generic
ARVs registered in the country, there is an anticipated increase in number of ART eligible patients who will
be able receive treatment; the program will procure and distribute ARVs for at least 10,000 patients by
March 2009. Allocation of the slots across the 14 sites in FY08 will be done according to demand (number
of eligible patients) and capacity of the facilities. Special attention shall be given to pregnant women
attending the HIV clinics or referred from PMTCT sites. MJAP will hire and train new and existing staff to
enhance care in the clinics - 300 health care providers will receive training in ART delivery. Training shall
be for both program clinics and other national needs. Health care providers in three regional referral
hospitals will also receive training in logistics management for ART delivery. Training will ensure quality of
services and continued access to GFATM ARVs at the sites. Within Mulago and Mbarara hospitals, the
program will target mainly adult patients receiving care from all the clinics (children receive ART from the
PIDC, and the Mbarara pediatric HIV clinic); in the satellite clinics MJAP will support some children. The
funding for ART drugs will go towards the purchase of ARVs (including three months buffer for MOH/Global
fund patients), logistics and ARV drug distribution and tracking. MJAP ARV procurement in FY08 will
continue to happen through Medical Access Uganda Limited. The ARVs forecasting, procurement (including
a three month buffer stock for all patients) will continue on a quarterly basis. Drugs will be delivered to the
program store by Medical Access, checked and received by the program pharmacist and storekeeper
before storage. An entry is made into the goods received note (GRN) and stock cards for all drug items
received. Monthly stocktaking and reporting will continue at the service delivery points and quarterly at all
stores. MJAP will continue to support training of pharmacy technicians, stores and logistics managers in the
partners' sites to improve on the overall management of logistics for drugs and other supplies; this activity
will continue in FY 2008. It is anticipated that some ARV drugs especially second line regimens will be
donated by the Clinton Foundation.
In FY08, MJAP anticipates that Ministry of Health and the Clinton Foundation/UNITAID will provide pediatric
Activity Narrative: ARV drugs, for its activities. The cost of pediatric ARV drugs is not included in MJAP's FY08 PEPFAR
funding for ARVs.
MJAP ARV services include regular screening for ART eligibility, provision of ART drugs, promotion of
adherence to treatment, ongoing counseling on HIV prevention, care and treatment, monitoring of ART both
clinically and by laboratory, and training of health care providers. Currently, the MJAP ARV services'
activities are implemented at 10 outlets as listed above. The 10 service outlets serve over 27,000 patients in
care, 10,641 of who are on ART (4,280 at AIDC, 2,620 in Mbarara ISS clinic, 1,395 in Mulago ISS clinic,
262 in Mulago TB/HIV, 482 in Mbarara municipality clinic, 560 in Kawempe KCC, 282 in Bwizibwera HCIV,
360 in Naguru KCC and >400 in Kiswa and Kiruddu (>6326 of these receive ARVs from MOH/Global fund
support). Two additional satellite HIV/AIDS clinics will be established within Kampala district by March 2008,
in collaboration IDI and KCC increasing the number of sites to 12. The number of HIV patients in the clinics
continues to increase with the expansion of RTC in the hospitals. The AIDC and Mbarara ISS clinics provide
care for adult patients (children receive care from the PIDC and Mbarara pediatric ISS clinics). However, in
the satellite clinics MJAP collaborates with other partners to provide comprehensive HIV care to families,
including children. The two satellite clinics of Bwizibwera and Mbarara municipality offer both paediatric and
adult ART. The demand for ART is very high in all the care and treatment sites. Majority of HIV positive
patients identified through the RTC program (70%) need ARVs (WHO Stages 3 and 4 or CD4<200).
Majority of RTC recipients that are HIV infected also receive CD4 testing at baseline. The program provides
ARV services in line with national treatment guidelines. In the outpatient HIV clinics, patients undergo
orientation to prepare them for ART. Patients who fulfill the eligibility criteria receive a second orientation
meeting with their treatment supporter. ARVs are initiated on the third visit if the medical officer is satisfied
that the patient is ready to begin therapy. Patients are seen by the adherence nurse counselor on day 0,
day 15, 1 month and then monthly for counseling and ARV refills. Adherence to ARVs is monitored by self
report using a visual analogue scale, ART patient cards and pill counts (patients return the bottles with any
remaining pills). CD4 monitoring is performed at least twice a year, CBCs on a quarterly basis and
chemistries as needed. In both Mulago and Mbarara AIDS clinics, we estimate that only about 60% of
clinically eligible patients are receiving ART although the majority (70%) of HIV infected persons identified in
the ongoing RTC program are eligible for ART. MJAP has trained over 500 health care providers in the
provision of antiretroviral therapy and strengthened systems for ART delivery including staffing, laboratory
support, logistics and data management. By March 2008, the program will be providing ARVs services to an
estimated 17,000 (including 10,000 patients who receive ARVs from MOH) in terms of staffing, laboratory
and clinical monitoring.
In FY 2008 (April 2008 to March 2009), two new satellite clinics will be established in collaboration with IDI,
bringing the total to 14 sites. MJAP will provide ARV services to >25,000 patients by March 2009 (including
10,000 patients who will access ARV drugs from GFATM - Ministry of Health). To ensure sustainability,
MJAP will continue to support the improvement of existing infrastructure and systems within the facilities.
Funds will go towards additional staffing and training of new and existing staff. There will be continued use
of the core staff of the host institutions to reduce on the hiring of new personnel. MJAP will strengthen
prevention with positives counseling and support including HIV testing for spouses of patients in the HIV
clinics. The program will reinforce adherence counseling and support, and follow-up of ART patients. MJAP
will hire and train additional and existing staff and up to 200 health care providers will receive training in
ART delivery. The program will strengthen ART patient tracking and adherence support; enhance ART
treatment and HIV prevention integration in the clinics, promote prevention with positives activities and
involvement of people living with HIV/AIDS (PHA) in patient care and support. The program will provide care
for adult patients in AIDC and Mbarara ISS clinics (children receive ART from PIDC and the Mbarara
pediatric HIV clinic). In the satellite clinics, MJAP will provide comprehensive HIV/AIDS care and treatment
for families including children in partnership with other programs. Special attention shall be given to
pregnant women attending the clinics to ensure that all those who are eligible for treatment receive it. It is
expected that many pregnant women will be referred from PMTCT sites and ANC clinics. The funding for
ART services will go towards the hiring and training of health care providers, PHA and other support staff,
initiation and follow-up of patients on ART, quality assurance, support supervision and M&E.
with several partners including KCC, Mbarara Municipal Council, IDI, Baylor-Pediatric Infectious Disease
MJAP HIV care and treatment laboratory activities are currently implemented at the 10 sites listed above.
By March 2008, 12 clinics will be operational and providing palliative basic care (an additional two satellite
clinics will be opened in collaboration with KCC and IDI). Three regional referral hospitals will also be
supported to implement TB and HIV screening. Up to 40,000 patients will access laboratory services
through MJAP support at the 12 HIV clinics. The number of HIV patients in the clinics continues to increase
with the expansion of RTC in the hospitals. In FY 2006 and FY 2007, MJAP strengthened the Mulago and
Mbarara laboratory infrastructure. The program procured two fFacs caliburs (for CD4 testing), haematology
and chemistry machines for the Mulago hospital laboratory; these machines support five Kampala based
HIV care and treatment sites and have significantly reduced the costs for HIV treatment monitoring tests.
MJAP also procured a Facs Count, haematology and chemistry machine for the Mbarara Municipality Clinic.
The program procured two ELISA machines for HIV testing and microscopes for TB and malaria diagnosis;
microscopes have been procured for all satellite clinic laboratories and the three regional referral hospitals.
The program provides supplies and maintenance of all the equipment. The Elisa testing for in-patients has
reduced demand for rapid HIV test kits. MJAP has also trained laboratory technicians and hired additional
staff to enhance HIV diagnosis and laboratory monitoring for patients on treatment. In Mbarara,
collaboration with The AIDS Support Organisation (TASO) and the Italian Cooperation-supported laboratory
has ensured ART laboratory monitoring for the Mbarara satellite care and treatment sites. TB diagnostics
and quality management are implemented in collaboration with NTLP and MOH.
In FY 2008 (April 2008 to March 2009), two new satellite care and treatment sites will be opened (increasing
the number of treatment sites to 14), and RTC-TB diagnosis will expand to two (2) additional regional
referral hospitals. MJAP will provide ART laboratory screening and monitoring support to > 25,000 patients
(including 15,000 accessing Global Fund ARV drugs). To ensure sustainability, MJAP will continue to
support the improvement of existing infrastructure and systems within the facilities. Funds will go towards
additional staffing, training and support for laboratory monitoring including CD4 counts. Our aim is to have
14 units with capacity to provide HIV testing malaria diagnosis, TB sputum microscopy, syphilis testing, and
to improve capacity of the two hospital laboratories (Mulago and Mbarara) in CD4 and lymphocyte counts
and chemistry (liver and renal function tests). We will also equip the laboratories in the five regional referral
hospitals to provide HIV testing and TB sputum microscopy as the RTC-TB diagnosis program expands.
The program will train new and existing staff to support the laboratories - 70 people will be trained in the
coming year. This program will strengthen the laboratory infrastructure in Mulago and Mbarara teaching
hospitals in order to provide quality ART services at the two hospitals, and the satellite clinics including
adults and children. The laboratory funding will cover the purchase of equipment and supplies, recruitment
of additional personnel, training of new and existing laboratory staff, and will enhance laboratory quality
assurance systems. In Mbarara hospital, MJAP will continue to collaborate with partners including JCRC
and the Italian cooperation who are also providing laboratory support to the hospital, to ensure existing gaps
are filled without duplication of activities, and access by all patients who require these services.
