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
AIDSRelief provides a comprehensive care and treatment program emphasizing strong links between
PLHAs, their family, communities and the health institutions. Its goal is to ensure that people living with
HIV/AIDS have access to Antiretroviral Therapy (ART) and quality medical care.
AIDSRelief is a consortium of five organizations which includes Catholic Relief Services (CRS) working as
the lead agency, the Institute of Human Virology (IHV), Constella Futures Group (CF), Catholic Medical
Mission Board (CMMB) and Interchurch Medical Assistance World Health (IMA); AIDSRelief services are
offered through 15 Local Partner Treatment Facilities (LPTFs), distributed throughout Uganda working in
some of the most underserved and rural areas, including Northern Uganda. These include St. Mary's Lacor,
St Joseph Kitgum, Nsambya Hospital, Kamwokya Christian Caring Community, Family Hope Center
Kampala, Family Hope Center Jinja, WTC Kololo, Virika Hospital, Villa Maria Hospital, Kabarole Hospital,
Bushenyi Medical Center 1- Katungu, Bushenyi Medical Center 2- Kabwohe, Kyamuhunga Comboni
Hospital, Kasanga Health Centre and Kalongo Hospital. In order to get services closer to the communities it
serves, AIDSRelief supports 26 satellite sites in selected LPTFs. The Children's AIDS Fund is a sub-
grantee in AIDSRelief and manages a number of the LPTFS. AIDSRelief is planning to activate 4 additional
LPTFs and phase out 1 LPTF in this grant year. As of June 30, 2007, AIDSRelief in Uganda was providing
care and support to 46,500 patients and antiretroviral treatment to 12,700 HIV-infected people of which 877
are children.
In FY08, AIDSRelief will expand its services to 5 new LPTFs and 11 satellite sites with the goal to reach
23,618 patients on ART, of which 2,834 will be children, and 54,813 patients in care and support. . This
request will provide ARVs for 20,026 patients. The program will leverage additional resources for ARVs
from other donors such as the Clinton Foundation, but will cover other ART related support such as
purchase of OI drugs, laboratory supplies and technical assistance to the LPTFs. At the end of Year 5,
AIDSRelief will be supporting a total of 23 LPTFs and 37 satellites.
The overall objective of the AIDSRelief PMTCT program in FY08 is to reduce mother to child transmission
of HIV in AIDSRelief supported facilities while improving quality of life of HIV positive pregnant women and
their babies. In FY07, AIDSRelief focused its PMTCT program in 10 LPTFs. This service will be expanded
to reach 15 sites in FY08 as the program will continue increasing uptake and strengthening PMTCT
services. AIDSRelief will promote an essential package of PMTCT services which includes provider initiated
HIV testing in ANC, encouraging mothers to deliver in a health facility (the program will also encourage
linkages with Traditional Birth Attendants), CD4 testing of all pregnant HIV+ mothers, DBS for babies, the
provision of ARV prophylaxis to mother and infant and referral for HAART as required. The PMTCT
program will be underpinned by strong community outreach and follow-up of all HIV positive mothers and
their babies. This will include ensuring that all exposed babies receive cotrimoxazole prophylaxis from the
age of 6 weeks until a diagnosis of HIV can be excluded. The program will also strengthen linkages
between other services within the LPTFs.
AIDSRelief will focus in increasing accessibility and utilization of health services. The improved quality of
counseling, the provision of friendly services, refitting of facilities as required and community sensitization
will increase awareness, uptake and access to ANC and PMTCT services. Provider initiated HIV testing,
including pilot mobile CT services, will increase the number of pregnant women, and also a significant
number of their partners, who know their HIV status. All HIV positive pregnant women will have CD4
assessment and those qualifying for ART will be referred to the ART services. The program will provide
ARV prophylaxis or triple drug therapy to both mothers and their infants in accordance to national
guidelines. Laboratory links will be developed to increase access to earlier infant diagnosis using PCR
testing. As part of the essential components of a PMTCT program, all HIV positive mothers will be provided
with nutritional information as regards to exclusive breastfeeding and alternative feeding options, so that
they can make an informed decision. At the end of FY08, 45,000 mothers will have been counselled and
tested, and will have received results, 3,450 HIV+ mothers will be aware of their status and 2,550 HIV+
mothers and infants (75%) will receive full course ARV prophylaxis throughout the 15 AIDSRelief supported
facilities.
Training including update on the new MOH adopted PMTCT guidelines, will be provided to 25 health
workers including midwives in ANC clinics providing PMTCT services, 25 counsellors, and twenty laboratory
staff will receive training on blood collection for CD4 screening and dry blood spots, and on HIV rapid tests.
Additional training of volunteers and community mobilization, some specifically targeting men, will promote
increased uptake of PMTCT services, partner testing the importance of antenatal care in general, as well as
PMTCT services, facility delivery and infant prophylaxis. Linkages will be created between PMTCT and the
ART clinics at all LPTFs, and also between other health facility services (eg MCH). Pregnant mothers will
be referred from the satellite clinics to antenatal care providing sites. Strategies will be developed to
improve antenatal care, community activities/follow up (for HIV+ patients on ART). Long lasting insecticide
treated nets will be provided to the mothers through linkages with PSI/CDC and community volunteers
trained to reinforce malaria prevention messages during their outreach activities and given skills to enhance
the early identification of suspected malaria and referral to a health institution. There will be increased
sensitization of care providers to provide Suphadoxine Pyrimethamide(SP)/Cotrimaxazole to pregnant
women in care.
Coordinated by Constella Futures, strategic information (SI) activities incorporate program level reporting,
enhancing the effectiveness and efficiency of both paper-based and computerized patient monitoring and
management (PMM) systems, assuring data quality and continuous quality improvement, and using SI for
program decision making across all LPTFs. AIDSRelief has built a strong PMM system using in-country
networks and available technology at 15 LPTFs in FY07. In FY08, Constella Futures will work with the new
sites and also carry out site visits to all LPTFs to provide technical assistance that will ensure continued
quality data collection, data entry, data validation and analysis, and dissemination of findings across a range
of stakeholders.
To support provision of PMTCT services, AIDSRelief will identify all females of reproductive age and refer
them for pregnancy tests. The program will refer and document referrals from ANCs to PMTCT, and to ART
services within LPTFs. It will also identify babies born of HIV positive mothers, so that they are tested for
HIV, followed up and linked to care and support services. This will involve allocating unique identifiers that
link mothers to their children, and enhance pediatric AIDS care.
Activity Narrative: Constella Futures will ensure compilation of complete and valid HIV patient treatment/ARV data; enhance
analysis of required indicators for quality HIV patient treatment and ARV program monitoring and reporting;
and provide relevant, LPTF-specific technical assistance to develop specific data quality improvement
plans. In year 5, AIDSRelief will support LPTFs roll-out of IQCare, an electronic data management software
deployed in FY'07, to enhance sustainability of PMM systems. The program will promote these systems
through a Training of Trainers (TOT) and peer to peer training model in SI, where "expert" LPTF staff will
train others in various skills. AIDSRelief will promote the data use culture, to enable LPTFs use data for
informed clinical decisions and adaptive management.
AIDSRelief developed a sustainability plan in Year 4 focusing on technical, organizational, funding, policy
and advocacy dimensions. To date, the program has been able to increase access to quality care and
treatment, while simultaneously strengthening health facility systems through human resource support,
equipment, financial training and improvements in health management information. In FY08, the program
will further build on this foundation to closely work and collaborate with Makarere University Department of
nursing and other nursing schools attached to the LPTFs to incorporate comprehensive HIV/AIDS training
modules into existing curricula. The program will also support linkages between LPTFs and the MOH to tap
into locally available training institutions. These approaches will ensure continuity of skills training.
AIDSRelief will particularly focus on its relationship with indigenous organizations such as the Uganda
Catholic Medical Bureau and Uganda Protestant Medical Bureau to build their institutional capacity to
support LPTFs integrate ART and other care and support programs into their health care services. These
strategies will enable AIDSRelief to fully transfer its knowledge, skills and responsibilities to in country
service providers as part of the program's sustainability plan.
Follow-on to current Track 1 AIDSRelief activities.
purchase of OI drugs, laboratory supplies and technical assistance to the LPTFsAt the end of Year 5,
AIDSRelief services in abstinence and being faithful in FY08 will be offered through 23 local partner
treatment facilities (LPTF), 37 satellites and 3 community based programs. The program will support LPTF
activities targeting HIV + clients, their families and communities who access care at these points. Prevention
priorities will include behavior change for risk reduction and risk avoidance, counseling and testing. All sites
will provide education to patients and community health volunteers on secondary prevention.
The strong community and adherence programs developed by LPTFs in the AIDSRelief program will
continue to serve as the foundation for outreach to communities. In Year 5, the program will continue to
ensure that all sites provide education to patients and community health volunteers on secondary
prevention. Prevention activities focusing on primary prevention and prevention for positives will include
distribution of patient education materials, community sensitizations, increased couple testing, encouraging
LPTFs to support couple support groups, advocate for new preventive measures e.g. male circumcision.
Fidelity in relationships will be promoted through community programs, drama groups and Information
Education and communication (IEC) materials. Messages will also target to reduce high risk behaviors such
as alcohol abuse and drug use AIDSRelief will link to other CRS programs which address improved
livelihood options in order to decrease the need for transactional and cross-generational sex. Training will
be an integral part of this program and will be directed at facility and community level staff. A total of 240
facility staff, 480 community volunteers, 240 community and religious leaders will be trained and given
adequate skills to be able to promote abstinence and being faithful to patients, their families and
communities.
The program will also seek to link up with other community- and faith-based organizations that serve the
same geographic areas, as well as partners working in other sectors, wherever possible to guide one
another on the needs of the community. With the family centered approach, primary prevention messages
will be provided to families of those affected by HIV/AIDS especially the children. These messages will
focus on abstinence and avoidance of high risk behaviors. OVC support group meetings will emphasize
prevention massages
of stakeholders. It will ensure compilation of complete and valid HIV patient treatment/ARV data; enhance
deployed in FY07, to enhance sustainability of PMM systems. The program will promote these systems
informed clinical decisions and adaptive management. It will also capture and report on individuals reached
with abstinence and be faithful prevention messages using relevant data collection tools and the PMM
system.
Activity Narrative: service providers as part of the program's sustainability plan.
AIDSRelief supports a comprehensive continuum of care for HIV infected patients. The palliative care
component builds on existing services that have been present in the LPTFs. Services provided will
comprise of psychosocial and spiritual support, clinical follow-up, laboratory testing (including CD4,),
treatment of opportunistic infections and nutrition counseling and education for the 54,813 HIV + patients
enrolled in care throughout 23 LPTFs and 37 satellite sites
This program will support a model of clinical preceptorship for service providers with a special emphasis of
maximizing the role of nurses, adherence counselors and community workers. Activities will include training
of health workers in improved pain and symptom evaluationand control, recognition and appropriate referral
for management of opportunistic infections (OIs), and supply of the basic care package (ITNs, safe water,
information on cotrimoxazole prophylaxis and prevention for positives). Palliative care will be expanded to
include comprehensive training for non medical as well as medical staff to support and maintain care and
treatment for all PLWHAs and their home caregivers. A total of 290 health workers and 720 community
workers will be trained.
Outreach teams led by a community nurse or a clinical officer are present at the LPTF level. These teams
link with community based volunteers, many of whom are PLHAs themselves on treatment, to support
patients in their communities. Education on the importance of using ITNs, basic hygiene and good nutrition
will be provided at household level and to communities, in addition to specific symptomatic care. The
community nurse will provide community based support to the CHWs in the field and also support the
decentralization of care which defines a major part of the AIDSRelief palliative care approach.
To strengthen the palliative care package, AIDSRelief will increase the capacity of LPTFs to appropriately
evaluate and recognize patients with TB, improve referral linkages and /or treatment for TB and encourage
family centered HIV and TB treatment. In addition, the program will link LPTFs to the Ministry of Health to
access cotrimoxazole, malaria and TB treatment. LPTFs will also be linked to organizations that provide
community based therapeutic feeding programs to support the malnourished
Pediatric palliative care will be strengthened and linked to the OVC program. The OVCs will receive care
services at the respective LPTFs. The pervasive effects of HIV infection on families brings enormous stress
into such families, repeated bereavements and places the family especially children in high risk situations.
The training in pediatric and adult counseling will strengthen LPTF staff capacity to address some of these
problems. LPTFs will form support groups which allow opportunities to strengthen knowledge, provide
mutual support and promote adherence for children and adults on treatment as well as address the many
psychological problems faced.
In addition, AIDSRelief will link with other NGOs such as UNICEF, Better Way Foundation to provide
additional psycho-social support which may extend from food supplements to assistance with schooling. All
patients attending palliative care services will receive information on prevention of positives. Family
centered HIV/AIDS counseling and testing will increase the number of males that attend palliative care
services. In FY07, care services were enhanced through commodities obtained through a CDC/PSI
partnership to provide a basic health care package (ITNs and safe water). This collaboration will continue in
FY08.
Strategic information (SI) is crosscutting in all program areas. Coordinated by Constella Futures, SI
activities incorporate program level reporting, enhancing the effectiveness and efficiency of both paper-
based and computerized patient monitoring and management (PMM) systems, assuring data quality and
continuous quality improvement, and using SI for program decision making across project Local Partner
Treatment Facilities (LPTFs). AIDSRelief has built a strong PMM system using in-country networks and
available technology at 15 LPTFs in FY07. In FY08, Constella Futures will carry out site visits to provide
technical assistance that will ensure continued quality data collection, data entry, data validation and
analysis, and dissemination of findings across a range of stakeholders. It will ensure compilation of
complete and valid HIV patient treatment/ARV data; enhance analysis of required indicators for quality HIV
patient treatment and ARV program monitoring and reporting; and provide relevant, LPTF-specific TA to
develop specific data quality improvement plans. In year 5, AIDSRelief will support LPTFs the roll-out of
IQCare, an electronic data management software deployed in FY'07, to enhance sustainability of PMM
systems. The program will promote these systems through a Training of Trainers (TOT) and peer to peer
training model in SI, where "expert" LPTF staff will train others in various skills. AIDSRelief will promote the
Activity Narrative: data use culture, to enable LPTFs use data for informed clinical decisions and adaptive management. Using
the new system, it will collect data on various clinical indicators that will enable clinicians shift patients from
care to treatment. These indicators will include: WHO stages, BMI, history active TB, previous exposure to
ARVs, and risky social behaviors like alcoholism. LPTFs will also be able to track and report on patients
accessing the basic care package (ITNs, safe water, Cotrimoxazole) so that this information is linked to
prevalence and or incidence of certain OIs, like malaria, and chest infections, and overall patient morbidity
trends.
service providers as part of the program's sustainability plan
AIDSRelief will strengthen the diagnosis and treatment of 3,837 HIV+ patients who may also be co-infected
with TB throughout its 23 LPTFs and 37 satellite sites. The program will increase the capacity of LPTFs to
appropriately evaluate and recognize patients with TB. It will incorporate routine opt out counseling and
testing for HIV within TB treatment facilities, systematic referral for TB screening within HIV testing facilities
and systematic TB screening within HIV care and treatment facilities. The program will target implementing
a family centered approach to both HIV testing and TB screening. All HIV+ patients will be evaluated and
symptomatic patients will be followed up for TB; family members of TB patients will also be encouraged to
be screened for TB. HIV prevention messages will be part of the counseling and testing sessions for TB
patients. All patients diagnosed with TB will also be given information on avoidance of high risk behaviors
and secondary prevention. All patients diagnosed will be treated for TB.
LPTFs' laboratory infrastructure will be strengthened to assure safe and quality processing of TB samples.
TB drugs and supplies for basic laboratory investigations are already supported by the Ministry of Health
(MOH) through the National TB and Leprosy Program. Hence, AIDSRelief will continue linking LPTFs to
MOH's supply system. Referral linkages within the LPTFs and between LPTF and satellite sites for TB
patients will be improved. HIV + patients who need palliative care will be referred to HIV/AIDS clinics in their
respective LPTFs or clinics of their choice. These patients will be treated for other opportunistic infections
and also receive the palliative basic care package through the CDC/PSI program.
On-going training of medical and clinical officers in TB X-ray interpretation and clinical mentorship on TB
diagnosis and care will be provided. AIDSRelief will also offer training to community health nurses and
volunteers on how to recognize TB signs and sympotms. Provider initiated opt-out HIV testing will be
promoted in patients attending TB clinics at the LPTFs. A total of 290 clinical officers, nurses and
counselors and 720 community volunteers will be trained. In addition, AIDSRelief will encourage LPTFs to
coordinate with the MOH's District health department to train health workers in TB/HIV.
AIDSRelief will follow the Government of Uganda policy guidelines on TB/HIV integration and TB/HIV
communication strategy. The program will also get guidance from the AIDS Control Program and the MOH
on the interpretation of policies and guidelines for TB/HIV collaboration.
program decision making across project LPTFs. AIDSRelief has built a strong PMM system using in-country
networks and available technology at 15 LPTFs in FY07. In FY08, Constella Futures will carry out site visits
to provide technical assistance that will ensure continued quality data collection, data entry, data validation
and analysis, and dissemination of findings across a range of stakeholders. It will ensure compilation of
patient treatment and ARV program monitoring and reporting; and provide relevant, LPTF-specific technical
assistance to develop specific data quality improvement plans. In year 5, AIDSRelief will support LPTFs roll-
out of IQCare, an electronic data management software deployed in FY'07, to enhance sustainability of
PMM systems. The program will promote these systems through a Training of Trainers (TOT) and peer to
peer training model in SI, where "expert" LPTF staff will train others in various skills. The use of IQCare will
enable LPTFs track TB patients who are counseled, tested, and receive their HIV results and HIV + patients
screened for TB. AIDSRelief will promote the data use culture, to enable LPTFs use data for informed
clinical decisions and adaptive management. It will ensure that different data systems at health facilities are
harmonized for effective and efficient reporting.
Activity Narrative: support LPTFs integrate ART and other care and support programs into their health care services. These
23,618 patients on ART, of which 2,834 will be children, and 54,813 patients in care and support. This
AIDSRelief will strengthen the delivery of an integrated package of family centered services. In Year 5,
12% of the patients on ART will be children. Increased efforts will sensitize health professionals within the
health institutions, and increase provider initiated HIV testing in Maternal Child Health (MCH), Out Patient
Departments (OPD) and in- patient's settings. Additional activities will include family centered care in the
ART clinic itself, increased skills of health professionals for them to be able to care and treat children and
community sensitization.
In order to build the capacities of health workers, social workers and counselors in the care and treatment of
children affected and infected by HIV, the program will ensure that all health professionals working with
children who are affected or infected with HIV have adequate skills in clinical diagnosis, counseling and
psychosocial support in order to provide quality care. Clinical training courses in pediatric HIV care and
treatment will be provided for all LPTFs. In addition, AIDSRelief, in collaboration with the African Network for
Caring for Children with HIV (ANECCA) has developed training in pediatric counseling targeted at
counselors in all facilities providing HIV/AIDS treatment. The program will also strengthen mentoring at all
LPTFS both in the clinical, counseling and supportive care components of a comprehensive family centered
program. Adolescent friendly clinics will be established in which both HIV care and treatment can be offered
as well as advice of reproductive health and the importance of abstinence and fidelity. A total of 360 health
workers including medical officers, nurses, counselors, social workers and 720 community workers will be
trained to have improved skills in caring for children.
With increased health professional staff skills in health facilities and a corresponding sensitization of
community based volunteers, it is expected that a focus will be put on increased and earlier diagnosis and
treatment of HIV positive children.. For children below the age of 18 months identified either in MCH, in
patient or outpatient settings, a presumptive diagnosis according to WHO Guidelines or, if at all possible
through PCR testing. Increased efforts to identify older children will be made through encouraging mothers
and fathers to bring their children for HIV testing when they themselves attend the ART clinic. A family
centered approach to HIV/AIDS counseling and tested will be emphasized so that both the males and
females of different age groups are targeted.
Other child focused support mechanisms such a support groups which allow opportunities to strengthen
knowledge, provide mutual support and promote adherence for children on treatment as well as address the
many psychological problems faced by these children will be encouraged. Prevention messages focusing
on abstinence and reduction of risk behaviors will be a key focus within the child support group meetings. In
addition, AIDSRelief will link with other NGOs to provide additional psycho-social support which may extend
from food supplements to assistance with schooling. Collaboration with the Ministry of health will continue to
provide opportunistic infection drugs such as cotrimoxazole.
informed clinical decisions and adaptive management. Using standard data collection tools, the program will
track and report on OVCs supported under each core program area. This will enable LPTFs to accurately
report on OVCs receiving primary direct, primary supplemental, or any leveraged support.
Activity Narrative: equipment, financial training and improvements in health management information. In FY08, the program
AIDSRelief has currently 15 LPTF and 14 satellite sites providing counseling and testing services. Sites
semi annual reporting ending in March 2007 showed that 11,400 patients have been counseled and tested
and received their results. By the end of FY07, the program will have 19 LPTF and 26 satellite sites
providing such services. Having these satellite sites closer to communities has enabled community
members to have easier access to testing and counseling services. Community volunteers have played a
major role in mobilizing communities to come for these services. In selected LPTFs, community volunteers
are people living with HIV/AIDS (PLHA) who have been trained on how to engage communities. They serve
as key agents in linking household members, communities and CT services. The existing system of
networks from the service provision all the way to the household level has ensured that couples, children
and adolescents receive CT services. In FY'07, AIDSRelief has emphasized on the importance of providing
pediatric CT services. Roll-out of the pediatric counseling training will increase the number of children being
tested for HIV. One major challenge in CT services has been the shortage of test kits at the LPTFs and the
satellite sites which are supplied and distributed by the Ugandan Ministry of Health (MOH).
In FY08, AIDSRelief will support 23 LPTFs with their 37 satellite sites and 4 community based organizations
to provide CT services. Through these sites, the program expects to have 40,000 people tested, counseled
and receiving their results. In order to address LPTFs challenges of test kits shortages, AIDSRelief will
strengthen the linkages of the sites with MOH supply chain system and will purchase kits for 20,000 tests to
temporarily fulfill the gap created. Linkages will be created between the MCH, out- and in-patient
departments promoting provider driven HIV testing and testing focused on families. More adolescents will
be reached through adolescent friendly services. Staff focusing on counseling and testing will be present at
each site and will be responsible of ensuring effective linkages with all other HIV services.
AIDSRelief will further strengthen the existing PLHA networks and will utilize them to sustain the active
referral systems between communities and care and treatment services. Community volunteers will be
trained to increase knowledge on HIV care and treatment and to reinforce their role in conducting
community sensitization on CT services. Clinicians, nurses and counselors will also be trained on CT
services. A total of 290 health workers and 720 community volunteers will be trained.
informed clinical decisions and adaptive management. The program will work with LPTFs to document and
report individuals counseled, tested, and received results, including family members. This information will
show those eligible to enroll into care, discordant couples, and those who should be targeted with
prevention messages. Technical assistance will be provided to LPTFs on how to eliminate double counting
of repeat testers, identifying clients testing under other program areas such as PMTCT and TB, and putting
in place data collection tools to track CT information.
Activity Narrative: AIDSRelief will particularly focus on its relationship with indigenous organizations such as the Uganda
St Joseph Kitgum, Nsambya Hospital, , Kamwokya Christian Caring Community, Family Hope Center
Kampala, Family Hope Center Jinja,, WTC Kololo, Virika Hospital, Villa Maria Hospital, Kabarole Hospital,
AIDSRelief has developed and improved the supply chain management capacity of the 15 sites it supports.
AIDSRelief procures Antiretroviral drugs (ARV) through a global procurement mechanism which provides
very competitive pricing, with delivery, warehousing and distribution through Joint Medical Stores (JMS).
This collaboration builds and strengthens the existing distribution network that specifically works for faith-
based healthcare facilities in Uganda. In year 4, AIDSRelief received drugs from Clinton Foundation which
enabled the program to scale up treatment despite the flat-lined budget.
Standard Operating Procedures (SOPs) have been developed in accordance with national guidelines that
guide supply chain activities from product selection, forecasting, procurement and consumption monitoring.
AIDSRelief has ensured excellent supply chain management and uninterrupted ARVs provision through
local capacity building at critical points within the supply management chain. In addition, the program has
implemented an ARV dispensing software developed by MSH RPM Plus enabling LPTFs to track the use of
ARVs; this dispensing tool has enabled LPTFs to enter accurate pharmacy data, forecast drug needs,
monitor patient numbers on ARVs and generate accurate pharmacy reports and initiate appropriate stock
replenishment. These reports, used to track inventory movement through the chain, permit continuous
modulation of patient enrollment to reflect ARV drugs availability and ensure a guaranteed and continuous
supply of drugs for each patient initiated on therapy.
request will provide ARVs for 13,418 patients. The program will leverage additional resources for ARVs
The program will continue to procure adult 1st line, alternative 1st line, and 2nd line therapies for adults and
children. The AIDSRelief Supply Chain Management Team will assist with capacity building, technical
backstopping and on-going training in supply chain logistic management which includes forecasting, stock
management, standard operating procedures and use of ART Dispensing Tool at the LPTF level. This will
turn the supply situation into a pull system; AIDSRelief has and will continue to support its sites with
frequent on-site mentoring, quarterly partner forums and access to a web based site on which difficult cases
can be discussed. This process is designed to provide LPTFs with ongoing clinical technical assistance
and to keep them abreast with the latest developments in HIV patient care. Therapeutic Drug Committees
will continue to be rolled out from the country program level to all LPTFs and this will further improve
management and forecasting of drugs for better patient outcomes. Technical assistance will also be
provided to laboratory, finance and monitoring and evaluation staff.
The Institute for Human Virology will participate in the periodic review of National Treatment Guidelines in
order to assist in the selection of regimens most appropriate to the Ugandan context. Choice of regimen is
guided by most recent evidence to ensure that the most effective and durable regimen available within the
national guidelines with the possible toxicity and resistance profile is used. The current choice of primary
regimen for AIDSRelief sites consists of Truvada (TVD) combined with Nevirapine (NVP) or Efavirenz (EFV)
for patients on Rifampicin containing tuberculosis protocols or intolerant to NVP. Aluvia (lopinavir/ritonovir)
is used for those who are intolerant to both NVP and EFV. For those who have renal insufficiency,
AZT/3TC will be substituted for TVD. Limited quantities of Stavudine (D4T) to be combined with
Lamivudine (3TC) are also procured to be used for patients with both renal insufficiency and anemia. The
choice of regimen is based on the more favorable pharmacokinetic and safety profile and is supported by
extensive clinical evidence. The choice of regimen is also designed to preserve optimal therapeutic choices
for second line regimens, which in the AR program consists of AZT (or D4T in cases of anemia, or TDF in
patients failing AZT or D4T as their primary regimen) coupled with 3TC and Aluvia. All drugs with exception
of TVD and Aluvia (which are currently not available as generics) are procured in generic form. AIDSRelief
provides AZT, 3TC and NVP for children less than 5 years of age, and D4T, 3TC and EFV/NVP for those
above 5 years and ABC as an alternative for those affected by severe anemia.
AIDSRelief will continue to work closely with the Ugandan Ministry of Health (MOH), the USG team in-
country, and other partners and programs to harmonize and strengthen pharmaceutical supply chain
systems. It will coordinate with other procurement and treatment agencies to ensure that LPTFs have
access to a stable chain of supply and no occurrence of any stock outs.
networks and available technology at 15 LPTFs in FY07. In COP08, Constella Futures will work with the
new sites and also carry out site visits to all LPTFs to provide technical assistance that will ensure
continued quality data collection, data entry, data validation and analysis, and dissemination of findings
across a range of stakeholders. It will ensure compilation of complete and valid HIV patient treatment/ARV
data; enhance analysis of required indicators for quality HIV patient treatment and ARV program monitoring
and reporting; and provide relevant, LPTF-specific technical assistance to develop specific data quality
improvement plans. In year 5, AIDSRelief will support LPTFs roll out of IQCare, an electronic data
management software deployed in FY'07, to enhance sustainability of PMM systems. The program will
Activity Narrative: promote these systems through a Training of Trainers (TOT) and peer to peer training model in SI, where
"expert" LPTF staff will train others in various skills. AIDSRelief will promote the data use culture, to enable
LPTFs use data for informed clinical decisions and adaptive management. It will ensure that different data
systems at health facilities are harmonized for effective and efficient reporting.
Nursing and other nursing schools attached to the LPTFs to incorporate comprehensive HIV/AIDS training
PLHAs, their family, communities and health institutions. Its goal is to ensure that people living with
Kampala, Family Hope Center Jinja, Virika Hospital, Villa Maria Hospital, Kabarole Hospital, Bushenyi
Medical Center 1- Katungu, Bushenyi Medical Center 2- Kabwohe, Kyamuhunga Comboni Hospital,
Kasanga Health Centre and Kalongo Hospital. In order to get services closer to the communities it serves,
AIDSRelief supports 26 satellite sites in selected LPTFs. The Children's AIDS Fund is a sub-grantee in
AIDSRelief and manages a number of the LPTFS. AIDSRelief is planning to activate 4 additional LPTFs
and phase out 1 LPTF in this grant year. As of June 30, 2007, AIDSRelief in Uganda was providing care
and support to 46,500 patients and antiretroviral treatment to 12,700 HIV-infected people of which 877 are
children.
from other donors such as the Clinton Foundation, but will cover associated ART related support such as
The program will continue to provide comprehensive assistance to LPTFs. This includes training and on-site
mentorship of medical staff, strengthening of HIV/AIDS community outreach activities, quality
assurance/quality improvement of HIV services, strategic information, capacity building of management and
financial staff, provision of opportunistic infection drugs, medical supplies and laboratory reagents, and staff
and minor infrastructure support. The decentralization of HIV services through 37 satellite sites will increase
accessibility of such services to those who live in remote areas. This approach reinforces AIDSRelief's care
model with communities, satellite sites and LPTFs strongly interlinked by health providers and community
volunteers in order to meet the need of HIV/AIDS patients. AIDSRelief technical staff with significant
experience in this area will assist local partners in improving community nursing support, building
community health teams, and establishing clinic feedback mechanisms. Hands-on training of trainers will
replicate the model throughout the AIDSRelief network, an effort which will have positive benefits for
surrounding communities and treatment programs.
AIDSRelief, because of its work through partners who are firmly embedded within communities, has the
ability to support involvement of communities. AIDSRelief supported facilities are currently providing varying
levels of home based care and community preventative services. Further development of these community
health programs to provide integrated HIV care and preventative services is critical to ensuring sustainable
treatment programs and maximizing funding investments. Community health programs will be structured to
promote family based care through disclosure counseling, secondary prevention, and family based testing
and education. In addition, motivated patients who make up most of the LPTFs' community volunteers will
be used as resource to support patients on therapy, disseminate HIV care and prevention literacy.
AIDSRelief will adapt existing, locally appropriate Information Education and Communication (IEC) and
Behavior Change Communication (BCC) materials, as well as to identify gaps in these media and develop
materials as needed to be used by health workers and community volunteers.
AIDSRelief will assist LPTF networks with PLHA groups serving as volunteers in the community to
strengthen adherence programs, which have been demonstrated to be a key component of good clinical
outcomes. Emphasizing the importance of adherence and community linkages at all AIDSRelief supported
sites has enabled the program to achieve high and durable viral suppression. The program will also
strengthen linkages within the LPTFs, particularly those between PMTCT, TB and CT services with ART
services. Emphasis will also be given to build capacity and develop strong linkages with the satellite sites
and other community interventions. LPTFs external and internal integration will be reinforced so that core
AIDSRelief care and treatment activities will be integrated with ancillary services and program activities of
other providers in the same region. A total of 290 facility level staff and 720 community volunteers will be
given comprehensive HIV/AIDS training enabling them to fulfill their responsibilities. AIDSRelief will follow-
up classroom-based training with on site clinical mentorship for clinicians and site level support for other
cadres of workers. Regional CME and quarterly partners' forums will complement LPTF's staff training,
allow experience sharing and reinforce knowledge and skill transfer from AIDSRelief technical staff.
Task shifting to maximize human resources will be emphasized at facility and community levels. At the
LPTFs, the strategy will be based on using nurses and clinical officers for the routine follow-up of stable
patients, using protocol driven nurse and clinical officer management of non-critical acute symptoms and
using nurses and pharmacists for routine medication dispensing to stable patients. At the community level,
AIDSRelief will encourage the development of community based satellite clinics staffed by clinical
officers/nurses/community health workers for the routine care of stable patients and the use of community
health teams for the delivery of home based care and for medication delivery.
AIDSRelief will continue to strengthen the health system management of LPTFs. The program will conduct
biannual finance and compliance trainings and program finance staff will carry out regular site visits to
provide technical assistance. LPTF trained finance staff in key internal control operations will be able to set
up appropriate cost accounting systems and adopt a program budgeting approach. LPTFs will also be
assisted to develop a more efficient organizational management structure.
Activity Narrative: to provide technical assistance that will ensure continued and improved quality data collection, data entry,
data validation and analysis, and dissemination of findings across a range of stakeholders. It will ensure
compilation of complete and valid HIV patient treatment/ARV data; enhance analysis of required indicators
for quality HIV patient treatment and ARV program monitoring and reporting; and provide relevant, LPTF-
specific technical assistance to develop site specific data quality improvement plans. In year 5, AIDSRelief
will support the roll out of IQCare, an electronic data management software deployed in FY'07, which will
enhance sustainability of PMM systems. The program will promote these systems through a Training of
Trainers (TOT) and a peer to peer training model, where "expert" LPTF staff will train others in various skills.
AIDSRelief will promote the data use culture to enable LPTFs to use data for informed clinical decisions and
adaptive management.
Catholic Medical Bureau and Uganda Protestant Medical Bureau to build their institutional capacity and to
support LPTFs integration of ART and other care and support programs into their health care services.
These strategies will enable AIDSRelief to fully transfer its knowledge, skills and responsibilities to in
country service providers as part of the program's sustainability plan.
purchase of OI drugs, laboratory supplies and technical assistance to the LPTFs at the end of Year 5,
AIDSRelief has provided 15 LPTFs with laboratory equipment and conducted on site training of laboratory
staff so that they are able to initiate and monitor patients on ARVs as well as conduct diagnostic tests for
opportunistic infections. As many of the LPTFs are in rural areas with limited access to reliable electricity
supply, some sites frequently experience power outage and fluctuations. In order to address this challenge,
AIDSRelief has put in place adequate power backup systems, including solar energy systems, for all LPTFs
to enable proper storage of reagents and functional laboratories all the time.
In FY08, the program will continue to support all 23 existing and new sites with laboratory services. The
program will strengthen LPTFs laboratory capacity to diagnose TB, malaria and other opportunistic
infections through provision of equipment and supplies. It will also provide support for viral load testing at
selected LPTFs which have the capacity or link them to nearby facilities that provide such services.
AIDSRelief will provide clinical management tools to ensure collection and compilation of laboratory data for
all HIV patients. Computers and related hardware that will enable computerization of all laboratory data will
be provided at all LPTFs.
As AIDSRelief will focus on decentralization of services closer to communities, it will increase the
laboratory capacity of 37 satellites enabling them to perform VCT, malaria smears, TB smears and other
diagnostic tests and to collect and process specimens for other tests to be performed at an identified
referral laboratory. Pediatric diagnostic capacity will be accessed by all LPTFs and their satellite sites.
Earlier infant diagnosis will enable the earlier initiation of therapy as required.
AIDSRelief support to LPTFs will include identifying local service providers for the procurement and
distribution of necessary reagents for the tests to support treatment of HIV infected patients (CD4 tests,
LFT, RFT, cryptococal antigen, reagents for basic laboratory tests). The program will ensure there is
improved LPTF forecasting to avoid stock outs of reagents at all LPTFs. In addition, the program will ensure
all laboratory equipment is serviced and properly maintained through external service contracts. AIDSRelief
will also continue to improve laboratory infrastructure of LPTF by ensuring solar back up power, surge
protectors, storage facilities, computerized record keeping and air conditioners. Tools and reference
materials to monitor OIs and ARV drug toxicities will also be provided.
Training will emphasize standard operating procedures, good laboratory practices, reagents forecasting and
procurement and quality control to ensure a safe working environment, personal safety and reliable
laboratory test results. A total of 96 laboratory personnel will be trained and will receive refresher courses.
AIDSRelief will work with the MOH and USG teams to ensure that all procurement of equipment and
reagents as well as trainings are in accordance with national guidelines. The program will continue its
collaboration with Center for Disease control (CDC) Uganda to get support for viral load testing for QA/QI,
and referral CD4 testing. AIDSRelief LPTF laboratories will continue to participate in UKNEQAS external
assessment scheme for CD4 testing with support from CDC.
program decision making across project Local Partner Treatment Facilities (LPTFs). AIDSRelief has built a
strong PMM system using in-country networks and available technology at 15 LPTFs in FY07. In FY08,
Constella Futures will carry out site visits to provide technical assistance that will ensure continued quality
data collection, data entry, data validation and analysis, and dissemination of findings across a range of
stakeholders. It will ensure compilation of complete and valid HIV patient treatment/ARV data; enhance
deployed in FY07, to track different program indicators. All laboratory tests done at LPTFs will be captured
in this electronic data base, reported on, and linked to analysis of patient treatment outcomes. Using the
relevant tools, AIDSRelief will obtain LPTF de-identified data. Data will be stored at a central computer
depository where the technical team will have easy access for QA/QI processes, and routine analysis of
program indicators.
Activity Narrative: treatment, while simultaneously strengthening health facility systems through human resource support,
