This activity is a continuation from FY2007 with the following updates:

During 2008, MUWRP prevention program will focus on training and supporting District lay workers,

treatment club members, youth volunteers and PHA groups to carry out AB prevention activities. In addition

to AB messages, these groups will concentrate on issues concerning: male norms and behaviors, the

counseling component of male circumcision, increasing gender equity, cross generational sex, increasing

women's legal rights and access to income and productive resources including life skills. Another primary

concentration will include reducing violence and coercion in the communities. A MUWRP prevention

coordinator will partner with these groups to ensure quality trainings and consistent, effective messages are

disseminated to the District communities through a variety of fixed and mobile venues. The Coordinator will

also implement a District-wide messaging program which will include radio, marketplace loud speakers,

roadside billboards and dissemination of state-of-the-art IEC materials. MUWRP's mobile prevention

program will also expand AB programs during 2008, targeting out of school youth, youth in schools, and

also high-risk fishing village youth populations along the Nile and at the inlet to Lake Kioga. Finally, the

program will continue to support the infrastructural integrity of the vibrant Kayunga District Youth Recreation

Center's activities. This Center is currently directed by a MUWRP sponsored Peace Corps Volunteer.

In FY2008 funding will support AB prevention activities including the costs of training, mentoring, prevention

materials, a messaging program, community sensitizations, mobile resources, staffing including community

mobilizers, and small scale renovations at the Kayunga District Youth Recreation Center.

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 FY2006 and FY2007MUWRP 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 counseling and testing, data collection, supplies, training and with

provision of short-term technical staffing. Also, MUWRP has 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

Condoms and Other Prevention program as described below is part of a comprehensive program and its

execution linked to other program areas. Program activities that are included in this comprehensive

approach, such as care, treatment, OVC, and CT services, will be budgeted under their respective program

areas. This OP Program will focus on training and supporting District lay workers, treatment club members,

youth volunteers and PLA groups to carry out most OP Program activities. An OVC MUWRP partner, Child

Advocacy International, will also disseminate OP messages through their bi-monthly community

sensitizations targeting OVC adult care givers and community members. A MUWRP Prevention

Coordinator will ensure that three Prevention with Positive groups, located through the Districts HIV clinics,

are trained and supported to play a pivotal role in OP prevention outreach, including condom education,

promotion and distribution through eight sites. Condom supply through the GOU is erratic and MUWRP will

serve as a back-up source for the District. MUWRP will follow GOU policy and guidelines pertaining to

condoms, not distributing condoms to persons under 18 years of age.

OP Programs will disseminate information on issues concerning: male norms and behaviors, the counseling

component of male circumcision, cross generational sex, gender equity through approaches such as

education on women's legal rights and access to income generating programs including life skills trainings.

Another primary focus will include reducing violence and coercion against women in the communities

through trainings, community sensitizations and messaging. Messages will be acquired from well-known

local and international sources such as the GOU MOH and from Straight Talk. Some resources and

messages will be modified or developed as required based on the assessment of the specific target

audience's needs, behaviors and gaps in understanding. All messages and programs will be coordinated

and vetted through the local MOH representatives to concur with national policy and approaches and to

ensure accuracy and relevance.

For implementation, the MUWRP prevention coordinator will partner with local groups to ensure quality

trainings and consistent, effective messages are disseminated to the District communities through a variety

of fixed and mobile venues and events including drama. This will include the establishment of a District-

wide messaging program which will be conducted through radio broadcasts, marketplace loud speakers,

and roadside billboards . MUWRP's mobile prevention program will complement district activities and will

include OP components, targeting out-of-school and in-school youth exhibiting high risk behaviors, married

couples (especially discordant), and high-risk fishing village youth populations along the Nile and at the inlet

to Lake Kioga. Data collected during CT and AB Prevention Program outreaches during FY2007 have

indicated that these District populations are at most risk for HIV infection.

As part of its youth prevention program, the Kayunga District Youth Recreational Center was founded in

2006 as a joint effort between the Kayunga District Hospital, the Kayunga District Government and

MUWRP. It functions 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.

Center activities will include: counseling to youth, emotional support, and a variety of activities upon which

they will interweave prevention messages including recreational games, sports, music, and drama.

MUWRP supports this Center's activities and is leveraging resources with the District Town Council to

support staffing and event planning. This Center is currently directed by a MUWRP sponsored Peace

Corps Volunteer whose main focus is to integrate the local government in taking more of a stakeholder role

in the Center.

In addition, during FY2008, the MUWRP Prevention Coordinator will; (1) set up the infrastructure for a

circumcision program, including renovations of the District Hospital surgical theater, training of medical

officers in circumcision services and counseling, (2) establish strong links between persons found to be

HIV+ and HIV care and treatment centers at the District Hospital, two Health Center IV's and one Health

Center III, (3) establish and support family planning services utilizing District health personnel through the

District Hospital anti-natal clinic, (4) establish and support an STD clinic through the Kayunga District Youth

Recreation Center, and (5) establish a Post Exposure Prophylaxis program at the District Hospital for

victims of rape, defilement or other persons at immediate risk of exposure to HIV.

In FY2008 funding under this submission will support the costs of training, facilitation of volunteers,

acquisition and/or production of prevention materials, family planning and STD management commodities, ,

renovations to the District Hospital surgical theatre, community sensitizations, mobile costs , and staffing

including community mobilizers. Funding will also be used for small scale renovations at the Kayunga

District Youth Recreation Center.

This activity is a continuation from FY2007 with the following updates:

During FY2008, MUWRPs intends to expand palliative care services to north of Kayunga District, to the

rural, underserved, fishing communities Galiyia. This will be done by supporting an HIV clinic at the Galiyia

Health Center III, training local clinicians and capacity building. Supportive supervision will be expanding

during FY2008 for all MUWRP supported HIV clinics, four visits per week. This will include two MUWRP

supported nurses and one medical officer. MUWRP will also implement a pilot family planning program at

the Kayunga District Hospital and will be distributing basic care packages for all (nearly 5000) HIV infected

persons attending HIV clinics. Both of these activities will be implemented via trained members of PLA

groups. A best practices guide for delivering palliative care services, including standard operating

procedures, will be developed through technical experts, site visits, and focus groups. .Finally, the in-

patient ward at the Kayunga District Hospital will be renovated to facilitate an isolation room for patients with

active TB and HIV.

Funding will support the cost of capacity building at the Galiyia Health Center III, remodeling of the Kayunga

District Hospital in-patient ward, staff training, and supportive supervision. Continued funding will also

support transportation needs for technical assistance by MUWRP and provision of clinical supplies

(including pain medication) at five HIV clinics. Funding will focus also on direct home based care service

provision to pediatric HIV+ patients by Child Advocacy International through support of commodities for care

(non-prescription medication and disposables), the cost, training and distribution of basic care packages,

assistance in supporting community providers, and training of District Health Workers and caregivers.

This activity is a continuation from FY2007 with the following updates:

During FY2008, MUWRPs primary OVC partner, Child Advocacy International (CAI), will maximize OVC

identification and expand provision of services District-wide. This will include expansion of home-based

OVC services to the fishing villages and remote northern areas of Kayunga District. Along these lines

MUWRP will also identify new civil society OVC organizations for sub-partnering activities, especially the

provision of psycho social and prevention activities. CAI also will examine and refine their quality of

services at each of the existing OVC points of service. This shall be accomplished by provision of quality

trainings, technical advisors, focus groups, institution of best practices, and standard operating procedures.

Furthermore, MUWRP will develop a pediatric patient cohort through the Districts HIV clinics which will be

utilized for monitoring and evaluating of pediatric care and treatment services. Finally MUWRP will ensure

all OVC support, either primary or supplementary, is captured via the District's data system and ensure that

these activities are reported to OGAC and to pertinent GOU authorities in a timely manner.

In FY2008, funding will support the cost of CAI services, staffing, training, mobile activities, focus groups,

monthly home visits/follow-up visits to OVC, care-giver counseling, tools for home monitoring of OVC and

household evaluation, psycho-social activities, and (when appropriate) school fees, scholastic materials,

clothes, and supplemental food needs. Funding will also support the identification of OVC via the Kayunga

District Youth Recreation Center, data collection; care giver clubs, and also used to expand MUWRPs sub-

partnering agencies to new civil society organizations.

This activity is a continuation from FY2007 with the following updates:

During 2008, MUWRP will work with District health authorities to rollout fixed site HCT services to six Health

Center IIIs in order to strengthen linkages between TB and HIV as well as PMTCT and HIV. This will be

accomplished by: (1) working alongside other health agencies in Kayunga so as to ensure that pregnant

mothers and individuals being screened for TB will be concurrently be tested for HIV and referred to HIV

services if HIV-positive, and (2) training District lay workers, treatment club members, youth volunteers and

PHA groups in CT service delivery to meet staffing demands. Due to the fact that availability of

commodities in Uganda remains a problem, MUWRP will provide supply chain technical support as well as

back-up commodity support to all of the CT sites to ensure that there will be no stock outs of CT

commodities. Working along-side MUWRP's prevention program, MUWRP's mobile CT program will also

expand programs during 2008, targeting out of school youth, youth in schools, and also high-risk fishing

village populations along the Nile and at the inlet to Lake Kioga. Another new aspect of the CT program in

FY2008 will be to implement a District-wide post-exposure prophylaxis program for victims of rape,

defilement, or for any other person who has had immediate exposure to HIV.

In 2008, funding will support services at eleven fixed CT sites, two mobile CT sites, and three RCT sites.

More specifically, funds will be earmarked for trainings, back-up commodity supplies, supportive supervision

and on-going technical assistance. Furthermore, funds will be utilized to modify infrastructure to ensure

confidential counseling space, scaling up CT services to six rural health center IIIs, and mobile resources.

This activity is a continuation from FY2007 with the following updates:

During FY2008, MUWRPs intends to expand ARV services to the north of Kayunga District, to the rural,

underserved, fishing communities of Galiyia. This will be done by supporting an HIV clinic at the Galiyia

Health Center III, training local clinicians and capacity building. Supportive supervision will be expanded

during FY2008 for all MUWRP supported HIV clinics, to four visits per week. This will include two MUWRP

supported nurses and one medical officer. One of the primary focuses of the MUWRP FY2008 ARV

services program will be to train district lay workers, treatment club members, youth volunteers and

members of PLW groups to deliver the most basic of ARV services. Another primary focus will be to form

more solid linkages with PMTCT groups so that HIV+ mothers will be firmly linked into HIV clinics. This will

be accomplished by partnering with other agencies already working in Kayunga, such as PREFA and the

anti-natal clinic at the Kayunga District Hospital. In addition, a treatment best practices guide, including

standard operating procedures, will be developed through technical experts, site visits, and focus groups.

Because ART supplies are not stable in Uganda, MUWRP will serve as a back-up source for ART to ensure

that neither PEPFAR nor GOU MOH Kayunga patients experience ART stock outs. Finally MUWRP

intends to implement a Post Exposure Prophylaxis Program for victims of rape, defilement, or any other

person who has had immediate exposure to HIV.

Funding will principally support emphasis areas which include expansion of staff, infrastructure remodeling,

capacity building at the Galiyia Health Center III, training of clinicians as well as District lay workers,

logistics, ongoing technical assistance, supportive supervisory visits and transportation of staff.

This activity is a continuation from FY2007 with the following updates:

During FY2008, MUWRPs will make assessments of two health center IV (Kangulamira and Baale) and one

health center III (Galiyia) laboratories. Capacity improvements will be made to those laboratories so that

they can perform routine assays. This will include infrastructure remodeling, training, and on-going

supportive supervision from MUWRP laboratory technicians. Due to the fact that commodity procurement in

Uganda is unstable, MUWRP will serve as a back-up source of commodities and laboratory perishables for

all HIV/AIDS laboratory services supported by MUWRP in the District. MUWRP will continue to partner with

and provide daily supportive supervision to the Kayunga District Hospital laboratory. This laboratory is at

capacity and technicians are now processing all District ART specimens. In FY2008, if any of the laboratory

machines in the District Hospital malfunctions, samples will be brought to the MUWRP research laboratory

in Ntenjeru as a backup. Further, a maintenance contract for the laboratory machines at the District

Hospital will be secured to ensure long-term ART specimen processing by that laboratory. Finally in

FY2008, MUWRP will help the district hospital improve testing standards by enrolling the district hospital

laboratory into different external quality assurance schemes to strengthen and provide external feedback on

testing performance of CD4 determination and automated hematology.

Under 2008 funding, MUWRP 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

adding capacity to lower level Health Center laboratories, partnering District laboratory staff with MUWRP

laboratory experts, ensuring equipment maintenance, implementing solid quality assurance and quality

control programs, supporting dependable energy sources, and provision of reagents and laboratory

perishables when necessary.

This activity is a continuation from FY2007 with the following updates:

During FY2008, MUWRPs SI program will strengthen HMIS capacity of Kayunga District Hospital and its

five health centers for accurate and timely reporting on required indicators to MOH and PEPFAR. Technical

assistance will be provided to continue collection, management and analysis of data across program areas:

OVC, ART/Care, CT, prevention.. MUWRP will provide computer and email access to seven key District

HIV staff personnel operating in remote areas. A MUWRP data officer will partner with HMIS staff of the

district hospital and health centers and ensure they receive adequate training in data collection,

management and analysis.

Funding will support salary of 4 SI staff, training, maintenance, six computers, supplies, technical expertise

and email service provision. In 2008, MUWRP will continue/initiate in-depth analysis of data that are

collected as a part of routine patient/client visits. Some of the analysis will include exploring and describing

change among treatment cohorts, factors associated with lost-to-follow-up, youth CT trend etc in order to

inform program implementers and policy makers.

This activity is a continuation from FY2007.

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 FY08 will be to maintain this position.