The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care.

RO was initiated in May 2001 with 14 clients but now has a total of 2400 clients with 50% on ART. Over

70% of the clients accessing care and treatment from Reach Out are women and about 60% of these

women are in the reproductive age and are therefore prone to reproductive health challenges including

pregnancy.

The PMTCT component was started in 2004 due to the increasing number of pregnant HIV positive women

in the program. By April 2007 278 mothers had been reached through this program. The package offered

now includes: Counseling on PMTCT, ART, Nutrition, Feeding options education and nutrition support for

both the mother and baby, Community follow up, referrals for Antenatal and DND/ PCR testing

Reach Out is planning to continue with the above mentioned activities in FY08. Through three service

outlets we hope to reach a total of 380 mothers and their families on Councelling and Testing according to

the national and international standards. Through our routine HIV clinics we hope to screen 1600 women in

the reproductive age-group 15-49 for pregnancy. All HIV positive women found pregnant will be linked to the

PMTCT minimum package. Through the male involvement program we hope to sensitize 6000 Men on male

involvement in reproproductive age we hope to reach through our community outreach and prevention

programs we hope to sensitize 30,000 youth in and out of school on prevention of unwanted pregnancy.

In FY08 we hope to strengthen our community linkages and follow up for our PMTCT recipients. Eight

Mother 2 Mother (M2M) supporters will be facilitated to carry out follow up mothers and babies in the

community. In addition the capacity of these M 2 M supporters will be enhanced for quality services through

4 workshops.

All 380 Pregnant mothers, their babies and families will receive nutrition support and special feeding options

for babies in need will be provided. 380 mothers will be reached with family planning messages and

empowered to practice the methods of their choice. All pregnant mothers will be empowered to bring their

spouses for PMTCT sessions so as to strengthen MTCT+

We hope to reach 200 eligible pregnant mothers with antiretroviral prophylaxis through our on site PMTCT

programs. All pregnant mothers reached through ART prophylaxis will receive adherence counseling and

follow up. Furthermore, all 380 pregnant mothers targeted will receive prophylaxis against opportunistic

infections

A total of 350 babies delivered will be referred to PIDC for DNA-PCR testing. Through a MOU with PIDC

and Naguru Health centre we hope to strengthen our referral linkages and reduce the loss to follow- up by

50%. Approximately 150 pregnant women will be managed for STI's. Assuming each pregnant mother

receives 2 CD4 counts per year; during the FYO8 approximately 800 CD4 counts will be done. Assuming

2% suspected ART first line failure then 75 viral loads will be required.

A total of 8 M2M supporters will receive a seven day comprehensive training in HIV/AIDS care and

treatment, Furthermore, a total of 4 refresher workshops will be conducted during FY08. A six months

comprehensive HIV training program will be initiated and implemented in the FY08 and a total of 24 Nurse

practitioners will be trained and facilitated to participate in this training program. A total of 40 health workers

from other HIV/AIDS programs will be supported through placements at Reach Out. A total of 40 Reach Out

Health workers will be sent for short courses or placements to other Organizations. Capacity of the PMTCT

section will be enhanced through provision of office space at all the three outreaches

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g. morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 management of opportunistic infections, and 1,118 received the basic care

package. A total of 137 community health workers received training in HIV and ART related issues. A family

-centred approach is used in the recruitment of patients on to ART at TMC and all willing family members

are offered testing and care within the context of available resources. A new clinic has also been started at

Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY 2007 TMC plans to

support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a second site in Mukono

district (in addition to Naggalama), and a second clinic in Mityana District (in addition to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at Mbuya RO.

TMC and RO are faith-based organisations that have been implementing the AB strategy through a number

of activities. These include HCT, (which has been provided for over 5,756 people between April 06, and

March 07 at TMC and 3,492 at Mbuya RO), AB sensitisation, and awareness plus support clubs like Our

Generation Mildmay Adolescent Club (OGMAC). Training has been carried out in the AB approach with

emphasis on specific groups like religious leaders, teachers, adolescents, and the youth. 39% of all ART

recipients at TMC are children less than 18 years old and the growing number of adolescents in care

continues to present a special challenge. Abstinence messages are especially emphasized for these young

people. Family members of TMC clients, tested through the VCT programme, are also targeted for AB

messages. Couple counselling is offered to all patients and ‘B' messages are emphasized for these

couples. These activities are also extended to the clients at the rural sites through patients' workshops at

Naggalama, Kyantungo and Buwama.

In FY 2008, AB activities will be further strengthened targeting youth and adolescents in the communities

and schools, couples, family members of index clients, and health care professionals through awareness

campaigns, sensitisation, and training. There will be more emphasis on reaching these populations directly

in their communities and through networking with other existing organisations and linking the activities with

others such as providing Voluntary Counselling and Testing (VCT) to other people in the community. This

will be according to the TMC AB strategy. Specific activities will include drama and life skills training. A forty-

five minutes play has been developed to communicate these messages in both English and Luganda to

make the messages attractive to the audience. The funding in this programme area will support the

integration and strengthening of existing AB activities through community mobilisation and awareness,

support training of personnel, production of information education and communication (IEC) materials,

support couple clubs, and improve monitoring and evaluation. The number of individuals reached will be

27,500 (i.e. 15,500 for TMC and 12, 000 for RO) and 500 trained at TMC. At the rural clinics these activities

will be integrated into the community outreach events and working together with World Vision, Mukono

Multipurpose Youth Organisation (MUMYO), local schools, and the other CBOs in the catchment area. This

is a continuing activity and involvement of rural partners and training will help the sustainability of the

Activity Narrative: activities.

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g. morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 management of opportunistic infections, and 1,118 received the basic care

package. A total of 137 community health workers received training in HIV and ART related issues. A family

-centred approach is used in the recruitment of patients on to ART at TMC and all willing family members

are offered testing and care within the context of available resources. A new clinic has also been started at

Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY 2007 TMC plans to

support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a second site in Mukono

district (in addition to Naggalama), and a second clinic in Mityana District (in addition to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at Mbuya RO.

TMC is a faith-based organization that has been implementing the ABC (Abstinence, Be Faithful, and

Condom use) strategy and Other Prevention (OP) through a number of activities, which include HCT,

sensitisation and education, condom distribution, and support clubs like the persons living in discordant

relationships - RO, Mbuya, through ‘Operation Gideon', targets men under the Friends for Life project.

Family members of TMC clients, tested through the HCT programme, are targeted for ABC messages in

line with the Government of Uganda and PEPFAR guidelines. Couple and partner Counselling and Testing

(CT) is offered to all patients to identify persons in discordant relationships, and provide support to prevent

HIV transmission to the negative partner. These and other patients in risky situations are targeted with

prevention messages including condom use, STI prevention and treatment, and family planning. The

training will cover PMTCT, family planning, management of Sexually Transmitted Infections (STI) and

adolescent sexual and reproductive health.

In FY 2008, OP activities will continue targeting groups such as the young, couples in care, and family

members of patients through positive prevention interventions. Training at TMC and RO will be offered to

various cadres: village leaders (local councillors), police officers, uniformed officers from the armed forces,

healthcare workers, and the media. Persons in the workplace will receive training to promote OP

interventions such as post exposure prophylaxis (PEP), family planning, PMTCT, and sexually transmitted

infections (STI) management. Individuals reached through community outreach are estimated to be 17,000

for TMC and 12,000 for RO. There will be three condom service outlets for TMC and 500 individuals trained

in OP related issues to encourage the provision of the service. The funding in this programme area will

support the integration and strengthening of existing AB and OP activities like training, community

mobilisation and awareness, production of Information, Education and Communication (IEC) materials,

support clubs, and monitoring and evaluation. All clients interfacing with TMC will be provided with AB and

OP services and messages where appropriate. The AB component will mainly target the adolescents and

youth who are not sexually active whereas OP will mainly target the sexually active groups including

patients in discordant relationships.

Activity Narrative:

Other people in the community where TMC runs services will be provided with the services in a targeted

manner to reduce the risk of transmission for those who are infected and acquiring the infection for those

who are negative. The same services will also be linked to the provision of HCT.

Condoms will be provided at all the sites where TMC is active in the consultation rooms; toilets and other

designated dispensing points near the pharmacy.

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g. morphine and chemotherapy for HIV related cancers and

management of opportunistic infections (OI) including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007, 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 received management of opportunistic infections, and 1,118 received the

basic care package. A total of 137 community health workers received training in HIV and ART related

issues. A family-centred approach is used in the recruitment of patients on to ART at TMC and all willing

family members are offered testing and care within the context of available resources. A new clinic has also

been started at Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY

2007 TMC plans to support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a

second site in Mukono district (in addition to Naggalama), and a second clinic in Mityana District (in addition

to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at Mbuya RO.

TMC's basic health care activities are currently implemented at six sites (TMC, Mbuya Parish church,

Kinawataka, Banda, Naggalama hospital, Kyantungo, and Buwama). Activities include prevention and

treatment of opportunistic infections (Cotrimoxazole provision, safe water, and provision of long lasting

insecticide treated bed nets for malaria prevention), training of health care providers in basic health care

provision, nutritional education and supplementation, regular follow-up for care and ART eligibility

assessment on a monthly basis etc. End of life care and pain control are provided. By the end of FY 2006

9,674 individuals were in active care 4220 at TMC, 3084 RO, and 2,370 at Naggalama and Buwama. 588

clients attended client workshops and 387 care providers attended courses focusing on palliative care for

HIV infected individuals. A cumulative total of 11,198 mosquito nets have been distributed at TMC. By

March 2008, the total number receiving basic health care is expected to be over 10,000 from seven districts.

Voluntary Counselling and Testing (VCT) has been extended to the public and TMC continues to receive

referrals from other facilities. All clients are offered the basic care package (BCP) and are regularly

screened for ART eligibility using national and international guidelines. Training for all cadres of health care

providers in basic health care is ongoing. Training in palliative care is carried out in collaboration with

Hospice Africa Uganda. Trainees come from various clinics, both rural and urban, and from Government

and NGO programmes.

During FY 2008 TMC will continue providing services and providing training activities at six sites. In FY

2008, 14,500 patients will receive basic health care and support; of these 7,000 will be at TMC, 3,500 at the

satellite clinics, and 4,000 at RO. The funds for this programme area will finance the purchase of drugs for

management and prevention of OIs, along with symptom control and pain management. TMC will train 1500

individuals through formal courses and clinical placements. TMC will also work in collaboration with PSI to

make the basic care kit (including two mosquito nets, safe water vessel, water guard, and condoms)

available to patients. Through a pilot intervention, TMC will screen an estimated 500 women at risk of

cervical cancer, using the PAP smears, and will send all smears to a pathology/cytology laboratory in

Kampala.

Activity Narrative: The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g. morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 received management of opportunistic infections, and 1,118 received the

basic care package. A total of 137 community health workers received training in HIV and ART related

issues. A family-centred approach is used in the recruitment of patients on to ART at TMC and all willing

family members are offered testing and care within the context of available resources. A new clinic has also

been started at Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY

2007 TMC plans to support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a

second site in Mukono district (in addition to Naggalama), and a second clinic in Mityana District (in addition

to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at RO.

TB/HIV activities implemented by TMC and RO, include regular TB screening for all HIV infected patients

attending the operational, provision of ARVs for co-infected patients according the MOH guidelines,

ensuring adherence for both TB and HIV through the use of treatment supporters and community DOTS,

monthly follow-up of patients, and tracking of those lost to follow-up. TB screening is carried out through

history taking, sputum smears, radiological examinations, and abdominal ultrasound examinations. Co-

infected patients with a CD4 of less than 200 are counselled and initiated on ART, while those with CD4

counts in the range 200 to 350 and those not eligible for ART are reassessed after three months. TB

medications and diagnostic reagents are available on site through the MOH National TB and Leprosy

Program (NTLP). All TB patients are reviewed monthly and sputum collection and examination is

emphasised and testing is done on site. Like all other HIV care services, TB services are provided free of

charge to all patients at TMC and RO plus the outreach clinic sites at Naggalama, Buwama and Mityana.

Patients are screened for active TB using sputum smears, radiology, and ultrasound techniques. Most TB

medications are provided free of charge by the NTLP which also provides support supervision for all the

sites. RO, which operates in one urban parish, has a strong TB program that employs a community DOTS

strategy using volunteers referred to as community ART and TB supporters (CATTS). These volunteers

reside in the same community and support adherence to both ART and TB treatment while ensuring follow-

up. By March 2007, TMC had performed TB tests on over 1,621 patients and treated 344 for TB. In the

same period RO screened 718 patients for TB, of whom 299 were treated for TB. TMC has a TB officer who

manages the TB registers and links patients to community-based support and arranges the patient visits as

well as monitoring adherence to TB drugs. The TB officer also ensures that contact tracing is done and

arranges the ordering of TB cultures for patients who are being treated for the second time. Training in TB

management is also incorporated in the short courses being run.

In FY 2008, all TB services will continue at all six TMC supported sites. The funds under this programme

area will be used to procure any drugs plus laboratory and X-ray supplies for TB care, which are not

provided by the NTLP. Other expenses include human resources, training and the operational costs of

contact tracing and follow up to ensure TB treatment adherence and completion. It is expected that TMC will

Activity Narrative: screen 1,300 patients and RO will screen 1,200 patients for TB. TMC expects to start 450 patients on TB

treatment (TMC 300 and RO 150). The funding will also support data management and M&E activities. TMC

plans to train 50 health workers in TB/HIV. All patients who are being retreated for TB will have TB cultures

to ascertain that they do not have drug resistant TB.

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g. morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 management of opportunistic infections, and 1,118 received the basic care

package. A total of 137 community health workers received training in HIV and ART related issues. A family

-centred approach is used in the recruitment of patients on to ART at TMC and all willing family members

are offered testing and care within the context of available resources. A new clinic has also been started at

Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY 2007 TMC plans to

support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a second site in Mukono

district (in addition to Naggalama), and a second clinic in Mityana District (in addition to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at RO.

The OVC services provided by the programme include health, psychosocial support, nutritional support,

education/school fee support, play therapy, and others. The targeted population includes HIV infected

children attending the clinics, children of infected adults attending the clinics, or identified through the

voluntary counselling and testing (VCT). Training in OVC related issues is also provided to carers of

children, health workers, social workers, and teachers who handle the OVC services. Referrals are also

made to other providers for services and collaboration with community groups is encouraged. RO offers

school fee support, food from World Food Programme (WFP), and nutritional education. By the end of FY

2007 it is expected that 200 persons will have been trained in care for children, and that 5,000 children

(below 18 years) will have been reached. Health care for OVC is covered under the headings of Palliative

care, ARV drugs, and ART services. By March 2007, children comprised 39 % of ART recipients at TMC

and 4% at RO. RO expects a further 60 children to be on ART by March 2008. Other services provided to

OVC include counselling and testing (CT), psychosocial support, and life skills training. The program follows

the national guidelines on OVC support, which is implemented through the Ministry of Gender Labour, and

Social Development (MOGLSD). The OVC programme at TMC networks with other organisations providing

complementary services. In the rural areas, HIV-infected OVCs are provided with care and linked to existing

community programmes, especially World Vision in both Buwama and Naggalama. Health workers and

other providers from those areas are trained.

In FY 2008 TMC expects to reach 10,000 children (4,000 for TMC and 6,000 for RO) with OVC services and

expects to train 510 adults (500 by TMC and 10 by RO) in OVC issues and communication with children.

TMC has observed that a large number of child clients come from homes headed by a grandparent. TMC

expects to offer psychosocial support to 35 child-headed and 65 grandparent-headed homes. RO expects

to offer psychosocial support to 200 child-headed and 200 grandparent-headed homes. TMC will reach

2,500 school children as part of a school outreach programme. The funds under this programme will finance

training, psychosocial support, tuition for selected children, vocational training, child advocacy, and human

resource.

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g. morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 management of opportunistic infections, and 1,118 received the basic care

package. A total of 137 community health workers received training in HIV and ART related issues. A family

-centred approach is used in the recruitment of patients on to ART at TMC and all willing family members

are offered testing and care within the context of available resources. A new clinic has also been started at

Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY 2007 TMC plans to

support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a second site in Mukono

district (in addition to Naggalama), and a second clinic in Mityana District (in addition to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at RO.

The Mildmay Centre provides HIV Counselling and Testing (HCT) using several strategies which include

voluntary counselling and testing (VCT) at TMC, community VCT outreach in collaboration with other

partners we have trained such as churches and private businesses, home-based VCT for relatives of

patients during home visits, couple counselling and testing, and by supporting the rural sites to provide VCT

to pregnant women and other patients who visit those clinics, Partners of TMC clients are provided with

counselling and testing (CT) as part of the package before starting ART to adults who are sexually active..

All adults attending TMC are strongly encouraged to bring their children for testing. (RO) provides HCT to

children and adults and training for HIV/AIDS care providers, using national and international guidelines. CT

training targets doctors, nurses, counsellors, pharmacists, pharmacy technicians, laboratory personnel,

clinical officers, religious leaders, community leaders, people living with HIV/AIDS (PHAs), schoolteachers,

school nurses, and other lay caregivers. In FY 2006 5,756 people accessed CT at TMC and 3,510 at RO. In

FY 2007 TMC expects to test 6,000 people and RO expects 4,000 people to access CT. As part of the

targeted evaluation, TMC will provide home-based CT for clients and their families. All patients who are

found to be HIV positive are recruited into care, started on Cotrimoxazole prophylaxis and CD4 tests are

performed, and where appropriate ART is initiated.

During FY 2008, TMC will continue to strengthen CT activities at all sites. Using the TMC family approach,

15,000 patients will be provided with CT (4,000 at TMC, 4,000 at rural sites, 3,000 in community outreaches

and 4,000 at RO). 200 people will be trained in CT-related issues at TMC. TMC expects 30% and RO

expects 13% of those tested to be children below 18 years. The funding for this programme is for the

procurement of CT logistics, the provision of CT services, human resources, training activities, and capacity

building particularly for the rural sites.

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g. morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 management of opportunistic infections, and 1,118 received the basic care

package. A total of 137 community health workers received training in HIV and ART related issues. A family

-centred approach is used in the recruitment of patients on to ART at TMC and all willing family members

are offered testing and care within the context of available resources. A new clinic has also been started at

Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY2007 TMC plans to

support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a second site in Mukono

district (in addition to Naggalama), and a second clinic in Mityana District (in addition to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HCT, and

palliative care among others. By March 2008, an additional 250 children will be receiving ART at Mbuya

RO.

TMC currently provides ARV treatment to six sites, which include two TMC rural sites, and three RO sites.

During FY 2008 services will extend to three further districts namely Mityana, Luwero and Kamwenge.

Procurement is through Medical Access for the PEPFAR ARV drugs, and Joint Medical Stores (JMS) for

MOH drugs. Sites also receive ARVs through the Global Fund-MOH programme. Forecasting, procurement,

storage, distribution and tracking are performed monthly by TMC pharmacy staff keeping three months

buffer stock at the suppliers. The drugs are taken to the sites every two weeks and are delivered by the

rural clinics team. All ARVs are procured through Medical Access and JMS. By March 2007, TMC had

2,635 patients receiving ART (1,778 PEPFAR-funded, 521 MOH, and 336 privately sponsored) while RO

had 1,370 patients (480 PEPFAR-funded, 814 MOH, and 76 under DAART). The targets for FY 2007 are

5,803 patients on ART (4,688 at TMC and 1,115 at RO). ARVs forecasting is done for the whole year but

purchase of ARVs including a three to six month buffer stock is done on a quarterly basis. Stock taking and

reporting is done monthly at the points of service.

During FY08 TMC will continue to procure ARVs from Medical Access and JMS and distribute them to all

the sites. The target for FY08 is 6,367 patients receiving ARVs; 4687 will be at TMC and 1,680 at RO.

Patients newly initiated will be 1,940 (840 at TMC, 500 rural sites, and 600 at RO). The rate of clients lost

due to reasons like lack of contacts, dead, transferred out etc is estimated at 7%. Funding under this

programme area will mainly go towards procurement and training costs. This is a continuing activity and

involvement of rural partners and training will help the sustainability of the activities.

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 38% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g., morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 management of opportunistic infections, and 1,118 received the basic care

package. A total of 137 community health workers received training in HIV and ART related issues. A family

-centred approach is used in the recruitment of patients on to ART at TMC and all willing family members

are offered testing and care within the context of available resources. A new clinic has also been started at

Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY 2007 TMC plans to

support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a second site in Mukono

district (in addition to Naggalama), and a second clinic in Mityana District (in addition to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at RO.

TMC provides screening for ART readiness to patients with HIV by testing their CD4 counts to determine

their immunity levels. If the CD4 count is below 250 in adults [for children different criteria are used

according to age] ART is initiated. Those whose CD4 count is between 250 and 500 will have repeat CD4

tests every six months; those over 500 are tested every 12 months unless there is an obvious indication for

an earlier repeat. Patients on ART have their CD4 count checked every six months. They also receive

monthly follow-up for toxicity, immunological monitoring, and adherence at the clinic. Furthermore, they are

supported through home visits for patients with adherence problems. TMC also integrates HIV prevention

strategies into care by emphasising prevention with positives (PWP), and training care providers in ART

provision. Adherence initiatives include the recruitment of an adherence and treatment supporter for each

patient initiated on ART, and holding adherence support workshops for patients, their supporters and family

members. Preparation of patients for ART involves at least three counselling sessions, tracing their sexual

partners, and helping the clients disclose to these partners. Adherence to ART is assessed by pill counts,

use of the adherence card, and self reports through a seven-day drug recall. Currently all the blood

samples for CD4 counts are brought to the TMC laboratory and results are sent back to the respective sites.

Patients who miss their visits are followed up initially using a mobile phone contact and if this proves

unsuccessful, a home visit is made using the map in their patient record. Viral load testing is carried out for

patients going onto second line ART, for pregnant women, and for patients who are not improving while still

on first line ART.

By the end of FY 2006, TMC had 2,635 patients receiving ART (1,778 PEPFAR-funded, 521 MOH, and 336

privately sponsored) while RO had 1,370 patients (480 PEPFAR-funded, 814 MOH, and 76 under DAART).

All patients including those paying privately were supported to access palliative basic care and laboratory

services. At RO, 1,228 were receiving ART, (463 through PEPFAR, 710 through the MOH, and 55 on a

Joint Clinical Research Centre (JCRC) DAART study). All patients, attending any of the sites, and who are

eligible for ART are offered the appropriate treatment. In FY 2006, 1,450 Health providers were trained at

Mildmay in ARV service provision. Training at TMC is a key component of the programme, targeting

doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other health workers,

schoolteachers and school nurses, religious leaders, and caregivers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. In FY 2007, the target is to have

Activity Narrative: 5,815 patients on ART, (4,700 at TMC and its rural sites and 1,115 at RO). All patients in care are regularly

screened for ART eligibility, and when found eligible, undergo preparatory counselling sessions focusing on

ART adherence, behaviour change, partner testing, and disclosure. TMC monitors adherence to ART by

patient report and pill counts on drug refill visits. TMC's adherence team holds regular client adherence

support workshops to enhance adherence. The same team also carries out the patient tracking. ROs

Community AIDS TB treatment supporters (CATTS) carryout home visits to clients to monitor their

adherence to drugs. TMC and RO also provide all patients on ART with palliative basic care, TB screening

and treatment, and laboratory monitoring.

During FY08 TMC will continue to procure ARVs from Medical Access and JMS and distribute them to all

the sites. The target for FY08 is 8,572 patients ever received ARVs; 7703 at TMC and 2549 at RO. In

addition, a minimum three months' buffer stock of ARVs will be maintained to cover MOH patients on ARVs

at all sites. Patients newly initiated will be 1,940 (840 at TMC, 500 rural sites, and 600 at RO). The rate of

clients lost due to reasons like lack of contacts, dead, transferred out etc is estimated at 7%. The target for

training in ARV services is 1,450 (1,000 at TMC and 450 at RO). Funding under this programme area will

mainly go towards procurement and training costs. This is a continuing activity and involvement of rural

partners and training will help the sustainability of the activities.

The Mildmay Centre (TMC) is a faith-based organisation operating under the aegis of the Uganda Ministry

of Health since 1998 and managed by Mildmay International. TMC is recognised internationally as a centre

of excellence for comprehensive HIV/AIDS care and training, particularly for children, who constitute 36% of

patients. TMC has had a cooperative agreement with CDC, Uganda since 2001 to support training in

HIV/AIDS care and treatment. From April 2004 the support was expanded to include ART and palliative HIV

basic care. TMC also runs three rural clinics: at Naggalama, a catholic church facility in Mukono District and

Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi district and Kyantungo Health Centre

IV, a Ministry Of Health facility in Mityana District which was opened in June 2007. Since opening, TMC has

registered over 17, 000 patients, of whom 3,500 are seen monthly on site. 2,600 patients receive ARV

drugs through PEPFAR, >500 through MOH (Global Fund), and 300 receive ART paying privately, but are

supported to access the free palliative basic care package and laboratory services i.e. CD4 counts and

other laboratory tests, Cotrimoxazole prophylaxis, a safe water vessel, free mosquito nets for malaria

prevention, and other palliative care services, e.g., morphine and chemotherapy for HIV related cancers and

management of opportunistic infections including TB. Training at TMC is a key component of the

programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists, laboratory personnel, other

health workers, schoolteachers and nurses, religious leaders and carers of patients. TMC views care and

training as complementary processes when offering HIV/AIDS services. The training programme reaches

participants throughout Uganda via a work-based diploma/degree programme, mobile training teams

(MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses include: Use of ART in

Children; Use of ART in Adults; Communication with Children; Palliative Care in the Context of HIV/AIDS;

Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections and others. Training

through the MTTs covers the same cadres and topics for selected clinics in targeted districts throughout

Uganda. The MTTs have to date reached over 36 districts and are currently active in six, covering 64

participants in the period April 2006 to March 2007. The work-based degree/diploma programme targets

health workers nationally from government departments and facilities, faith-based organisations and other

NGO facilities. The diploma comprises a modular programme with six staggered residential weeks over an

18-month period that can now be extended to a further 18-month period to yield a full degree. The time

between modules is spent at the workplace doing assignments and putting into practice what has been

learnt. Between April 2006 and March 2007 1,161 Ugandans received training in HIV/AIDS in more than

55 weeks of training courses based both at TMC and in the rural districts. 1,308 participants have attended

courses, 291 participants came for clinical placements providing 2,866 clinical placements days. Since the

rural clinics opened, 1500 HIV patients have registered at Naggalama (over 530 on ART through PEPFAR

and 56 through MOH) and 375 patients at Buwama with more than 100 on ART. In addition, 5,875 patients

received VCT services, 2,370 management of opportunistic infections, and 1,118 received the basic care

package. A total of 137 community health workers received training in HIV and ART related issues. A family

-centred approach is used in the recruitment of patients on to ART at TMC and all willing family members

are offered testing and care within the context of available resources. A new clinic has also been started at

Kyantungo in Mityana district and another at Mityana District Hospital. By the end of FY 2007 TMC plans to

support HIV/AIDS care and training activities in Luwero and Kamwenge districts, a second site in Mukono

district (in addition to Naggalama), and a second clinic in Mityana District (in addition to Kyantungo).

The activities run at the rural TMC supported sites include provision of HIV testing kits, CD4 testing,

haematological, clinical chemistry and other immunological tests, drugs for opportunistic infections, ARV

drugs, training of staff at the rural sites to run their HIV clinics, training of community volunteers to provide

adherence support and counselling, provision of a mobile clinic team which comprises of a doctor,

nurse/counsellor, laboratory technician, pharmacy technician and TB quality assurance visits, support for

data collection and M&E support.

Reach Out Mbuya (RO) is a sub-partner with TMC in the provision of holistic HIV/AIDS care. It is an

initiative of Mbuya Parish in Kampala and is based at Our Lady of Africa Church in a poor urban

neighbourhood. RO started in May 2001 and adopts a community-based approach using volunteers and

people living with HIV/AIDS (PHA). By the end of March 2007, RO had 2,437 active patients in palliative

care with 1,370 on ART (132 were children), 480 PEPFAR funded, 814 MOH funded and 76 by

JCRC/DAART clinical trail. By the end of March 2007, 299 patients had been treated for TB while 158 were

trained in various areas including practicum/internship, clinical experience, client training, HIV counselling

and testing (HCT) and palliative care among others. By March 2008, an additional 250 children will be

receiving ART at Mbuya RO.

TMC currently supports laboratory services at all the sites. TMC's laboratory has the capacity to perform

HIV tests, CD4 tests, Full Blood Counts (FBC), diagnostic tests for opportunistic infections (OI), and

chemistry analysis for liver and renal function. X-ray facilities are available at TMC. Links are maintained

with facilities such as the CDC laboratory in Entebbe and the National TB laboratory. Quality assurance

measures include regular servicing of all equipment in the laboratory through contracts with machine

manufacturers or properly qualified technicians. Quality control systems for all laboratory tests are

maintained through contacts with the CDC lab in Entebbe, the Ebenezer laboratory, and the National TB

and Leprosy Laboratory for TB. In-house staff undergo regular training, as do those from the rural districts.

This ensures a comprehensive service is provided for patients and a quality assurance programme to

monitor the services is in place. The laboratory supports patients recruited through CT (10,000 planned in

FY 2007), those in palliative care (over 8,000 planned for FY 2007), and those accessing ARV services

(more than 5,000 in FY 2007). Training was provided to laboratory staff at all sites and other health units in

Uganda through short courses, and clinical placement schemes. The laboratory performs all tests required

to support an HIV clinic including HIV tests, haematological tests, clinical chemistry tests, CD4 counts,

diagnostic tests for TB and for other opportunistic infections, and other immunological tests. The PCR DNA

tests are currently performed at the CDC laboratory whereas histological tests are sent to Nsambya

Hospital. The laboratory serves patients in all TMC supported sites including the rural sites and RO.

Equipment for which service contracts are maintained includes, a FACS Calibur and a FACS Count for CD4

counts, three chemistry analysers, two coulter counter machines, an Elisa machine and reader, an

interscope machine for viewing TB sputum smears, microscopes and other general laboratory equipment

In FY 2008 TMC plans to increase to 7,665 the number of patients receiving ARV services, each one having

two CD4 counts a year, three full blood counts, and three liver function tests. TMC also expects to carry out

500 pregnancy tests, 10,000 HIV tests, and 1,000 viral loads (particularly aimed at pregnant women and

treatment-experienced patients who may need to switch to a new regimen). Some 3,000 patients will

require diagnostic tests for OIs and other monitoring tests. RO is expects to carryout 3,600 HIV tests, 9,000

TB diagnostic tests, 300 syphilis tests, 3,300 disease monitoring tests, 6,000 CD4 tests and 1,500 X-Rays

(TB diagnosis). The total number of tests will be 63,700 (40,000 for TMC and 23,700 for RO). Funds will be

Activity Narrative: used for the purchase of reagents and test kits, maintaining laboratory equipment, quality assurance costs,

human resources, training of laboratory workers in HIV related diagnostic skills, and transportation of

samples from rural sites to TMC and other testing centres as necessary. TMC plans to train 50 laboratory

staff from various health centres across Uganda in HIV-related laboratory practice.

FY07 COP activity number linked to PHE project: 8640

Title: Targeted evaluation of strategies to decrease HIV-transmission risk behavior and increase drug

adherence among HIV-infected adults initiating antiretroviral therapy in Uganda

Time and money summary: Year of activity: Year 2; Year started: 2006; Expected year of completion: 2009;

Budgets received or expended to date:$254,000 (SI FY07). Expected additional monies needed for

completion (including FY08 request):$350,000 (FY08); $350,000 (FY09);

Local Co-investigator: Jordon Tappero-CDC Uganda, PI; Emmauel Luyirika-The Mildmay Centre, PI;

George Rutherford-UCSF, PI; John R. Lule-CDC Uganda, co-PI; Lisa Butler-UCSF, co-PI;

TMC is a faith-based organisation operating under the aegis of the Uganda Ministry of Health since 1998

and managed by Mildmay International. TMC is recognised internationally as a centre of excellence for

comprehensive HIV/AIDS care and training. TMC has had a cooperative agreement with CDC, Uganda

since 2001 to support training in HIV/AIDS care and treatment. From April 2004 the support was expanded

to include ART and palliative HIV basic care. TMC also runs three rural clinics: at Naggalama, a Catholic

church facility in Mukono District and Buwama Health Centre III, a Ministry of Health (MOH) facility in Mpigi

district and Kyantungo Health Centre IV, a Ministry Of Health facility in Mityana District which was opened in

June 2007. Since opening, TMC has registered over 17,000 patients, of whom 3,500 are seen monthly on

site. 2,600 patients receive antiretroviral (ARV) drugs through PEPFAR, >500 through MOH (Global Fund),

and 300 receive ART paying privately, but are supported to access the free palliative basic care package

and laboratory services i.e. CD4 counts and other laboratory tests, Cotrimoxazole prophylaxis, a safe water

vessel, free mosquito nets for malaria prevention, and other palliative care services i.e. morphine and

chemotherapy for HIV related cancers and management of opportunistic infections including TB. Training at

TMC is a key component of the programme, targeting doctors, nurses, HIV/AIDS counsellors, pharmacists,

laboratory personnel, other health workers, schoolteachers and nurses, religious leaders and carers of

patients. TMC views care and training as complementary processes when offering HIV/AIDS services. The

training programme reaches participants throughout Uganda via a work-based diploma/degree programme,

mobile training teams (MTTs), clinical placements and short courses run at TMC. Multidisciplinary courses

include: Use of ART in Children; Use of ART in Adults; Communication with Children; Palliative Care in the

Context of HIV/AIDS; Laboratory Skills in an HIV/AIDS Context; Management of Opportunistic Infections

and others. Training through the MTTs covers the same cadres and topics for selected clinics in targeted

districts throughout Uganda. The MTTs have to date reached over 36 districts and are currently active in

six, covering 64 participants in the period April 2006 to March 2007. The work-based degree/diploma

programme targets health workers nationally from government departments & facilities, faith-based

organisations and other NGO facilities. The diploma comprises a modular programme with six staggered

residential weeks over an 18-month period that can now be extended to a further 18-month period to yield a

full degree. The time between modules is spent at the workplace doing assignments and putting into

practice what has been learnt. Between April 2006 and March 2007 1,161 Ugandans received training in

HIV/AIDS in more than 55 weeks of training courses based both at TMC and in the rural districts. 1,308

participants have attended courses, 291 participants came for clinical placements providing 2,866 clinical

placements days. Since the rural clinics opened, 1500 HIV patients have registered at Naggalama (over

530 on ART through PEPFAR and 56 through MOH) and 375 patients at Buwama with more than 100 on

ART. In addition, 5,875 patients received VCT services, 2,370 management of opportunistic infections and

1,118 received the basic care package. A total of 137 community health workers received training in HIV

and ART related issues. A family-centred approach is used in the recruitment of patients on to ART at TMC

and all willing family members are offered testing and care within the context of available resources. A new

clinic has also been started at Kyantungo in Mityana district and another at Mityana District Hospital By the

end of FY07 TMC plans to support HIV/AIDS care and training activities in Luwero and Kamwenge districts,

a second site in Mukono district (in addition to Naggalama), and a second clinic in Mityana District (in

addition to Kyantungo). TMC's role in the evaluation includes provision of all clinical care, including

antiretroviral therapy, following national guidelines that have received approval by the Ugandan Ministry of

Health. The evaluation trial will not interfere with the current approach to counseling of other patients

initiating ART at the Mildmay Centre, except that some participants will be randomized to receive additional

counseling and home-visits.

Project description :

Study design: A three-arm randomized controlled trial to evaluate the effectiveness of clinic-centered, clinic

-and home-centered, and standard counseling strategies for reducing HIV-transmission risk and increasing

drug adherence among HIV-infected adults initiating ART in a peri-urban area of Uganda. TMC patients

who are age 18 years and older, ART naïve, and determined to be eligible for ART initiation and who meet

other eligibility criteria will be randomized into one of three study arms. A total of 570 participants will be

recruited, each of whom will be followed up over a 12-month period.

Main study question: The primary objective will be to measure the effects of these strategies on sexual

behavior at 6 and 12 months after randomization. We will also examine the effects on drug adherence,

family planning, uptake of HIV voluntary counseling and testing among participants' household members,

and drug resistance, as well as the cost-effectiveness of the different approaches. The factors associated

with poor adherence and changes in sexual behavior that may occur over time among participants will be

explored.

Importance and planned use of findings: The epidemic of HIV infection in sub-Saharan Africa represents

the most significant public health crisis of our generation. As ART becomes more available throughout sub-

Saharan Africa, it is essential that effective, low-cost, and sustainable strategies are identified that are

applicable and scalable in resource-poor settings for reducing HIV-transmission risk as well as supporting

patient's adherence to ART. Understanding the relative efficacy of different counseling interventions will be

an important contribution to the overall management of HIV disease in Africa. The results of this trial are

expected to have important public health implications for HIV/AIDS programs, treatment and prevention in

many settings in Africa where ART programs are being expanded.

Status of study and progress to date:

The protocol has been written and approved for implementation by four different ethics committees.The

protocol has current human subjects approval (e.g., Institutional Review Board, national Ethics Committee)

and continues to undergo annual review from the following institutions:US Centers for Disease Control and

Activity Narrative: Prevention (CDC) [CDC Protocol ID 4875];The Uganda Virus Research Institute (UVRI); The Ugandan

National Council for Science and Technology (UNCST); University of California at San Francisco (UCSF)

Implementation: The hiring of staff for the targeted evaluation began in July 2006. Piloting of procedures

and documentation ended in February 2007. Active screening and recruitment into the evaluation began in

March 2007 and as of August 31, 2007, 134 participants have been enrolled.

This targeted evaluation is set in an HIV/AIDS treatment center whose own procedures must evolve as per

funding request and clinical recommendations from the Ministry of Health. The Mildmay Centre has

increased its work in voluntary counseling and testing (VCT) and there are now 80 adults enrolling in the

clinic per week. This increase in adults attending the clinic has impacted the enrollment into the targeted

evaluation thus making our numbers increase to approximately 9 new adults enrolling in the evaluation per

week. With this new expected average, we anticipate an additional 14 weeks of enrollment necessary in

order to achieve our target of 570 adults enrolled into the study. We expect the enrollment period to end in

August 2008 and the follow-up period to end in August 2009.

Lessons Learned: No reports, abstracts, or publications have yet been produced as we have not yet

finished the evaluation.

Information Dissemination Plan: Results of the study will be disseminated to TMC, the Ministry of Health,

the USG PEPFAR team in Uganda, the Uganda AIDS Commission, and other stakeholders in written and

oral form. In addition, results may be presented in local, national, and international conferences, as well as

through peer-reviewed journal publication.

Planned FY08 activities:

-Finish enrollment of the 570 participants

-Continue with follow-up activities

-Begin initial analysis and dissemination of results in the form of midway progress reports

-Revise evaluation procedures as per TMC's dynamic treatment centre policies

Budget Justification for FY08 monies:

Salaries/fringe benefits: $147,045

Equipment: $2,256

Supplies: $64,844

Travel: $16,875

Participant Incentives: $0

Laboratory testing: $45,844

Other: $73,136

Total: $350,000