Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 1290
Country/Region: Uganda
Year: 2008
Main Partner: Catholic Relief Services
Main Partner Program: NA
Organizational Type: FBO
Funding Agency: HHS/HRSA
Total Funding: $12,718,502

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $687,500

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.

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $62,500

Follow-on to current Track 1 AIDSRelief activities.

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $744,881

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 LPTFsAt the end of Year 5,

AIDSRelief will be supporting a total of 23 LPTFs and 37 satellites.

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

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. 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 FY07, 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. 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.

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

Activity Narrative: service providers as part of the program's sustainability plan.

Funding for Care: Adult Care and Support (HBHC): $370,000

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 LPTFsAt the end of Year 5,

AIDSRelief will be supporting a total of 23 LPTFs and 37 satellites.

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.

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

Funding for Care: TB/HIV (HVTB): $100,000

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.

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.

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 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

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. 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.

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

Activity Narrative: 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.

Funding for Care: Orphans and Vulnerable Children (HKID): $500,000

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.

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.

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. 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 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. 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.

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,

Activity Narrative: 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

Funding for Testing: HIV Testing and Counseling (HVCT): $150,000

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.

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.

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. 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 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. 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.

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.

Activity Narrative: 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.

Funding for Treatment: ARV Drugs (HTXD): $4,667,621

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.

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.

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 13,418 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 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.

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 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.

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.

Funding for Treatment: Adult Treatment (HTXS): $4,686,000

AIDSRelief provides a comprehensive care and treatment program emphasizing strong links between

PLHAs, their family, communities and 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, 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 13,418 patients. The program will leverage additional resources for ARVs

from other donors such as the Clinton Foundation, but will cover associated 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 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.

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 carry out site visits

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.

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 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.

Funding for Laboratory Infrastructure (HLAB): $750,000

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.

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.

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 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 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 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.

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

Activity Narrative: 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.

Subpartners Total: $7,448,472
Christian HIV/AIDS Prevention and Support: $48,789
Meeting Point: $48,789
Villa Maria Hospital: $268,340
Kalongo Hospital: $178,893
University of Maryland: $1,520,594
Palladium Group (formerly Futures Group): $536,680
Comboni Samaritans of Gulu : $276,472
Nsambya Hospital: $569,207
Kamwokya Christian Caring Community: $365,918
St. Mary's Hospital, Lacor: $300,866
Kasanga Health Center: $252,077
Katungu Medical Center: $146,367
Kabwohe Medical Center: $219,551
Children's AIDS Fund International: $683,048
Kabarole Hospital: $195,156
Virika Hospital: $276,472
Kyamuhanga Comboni Hospital: $219,551
Nyenga Hospital: $97,578
Kasana Luwero Diocese: $56,921
Amai Community Hospital: $56,921
Not Identified: $943,257
St. Joseph's Hospital: $187,025