The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Catholics, Anglican Protestants, Muslims, Orthodox

and Seventh Day Adventists to address mutually identified development challenges. IRCU also works with

other religious organizations including Pentecostal and other independent churches. IRCU coordinates the

largest network of faith-based health units in Uganda, which together deliver close to 50% of the health care

services in Uganda. In June 2006, IRCU initiated a program to scale up access to and utilization of quality

HIV/AIDS prevention, care and treatment through the network of faith-based organizations and community-

based organizations. This program is funded by USAID under the President's Emergency Plan for AIDS

Relief (PEPFAR).

Mother to child transmission is the second most common means of transmission of HIV in Uganda. In

Uganda, about 1 million women get pregnant yearly. With an estimated HIV prevalence of 6.5%, about

65,000 HIV-infected women get pregnant yearly and will transmit HIV to about 20,000 infants if there is no

intervention. Using either Nevirapine at the onset of labour and Nevirapine syrup to the baby within 72 hours

of birth or Zidovudine from 36 weeks of gestation until one week after delivery and syrup to the baby for the

first week after birth minimizes the risk of mother to child transmission (MTCT) by 50%. In 2001 the Ministry

of Health (MOH) started implementing a robust national PMTCT program, focusing in integrating it into

existing antenatal services. Currently, there are 405 PMTCT sites in Uganda with each of the 80 districts

having at least one site. The Ministry of Health, in partnership with its partners (donors, NGOs, FBOs and

the private for profit organizations) have developed a national PMTCT policy which aims to provide

universal access to PMTCT services by 2010.

Despite these landmark achievements, access and utilization of PMTCT services remains dismal. Poor

access to health services remains one of the major bottlenecks to uptake of PMTCT services. In addition,

Psycho-socio and cultural factors also constitute major barriers to women's utilization of MCH/PMTCT

services in health facilities. These include limited male partner involvement in PMTCT programs, high levels

of HIV stigma, low levels of community HIV awareness and mobilization as well as high community

attachment to, and preferential use of Traditional Birth Attendants (TBAs) and home deliveries by close

relatives. Other factors include poor quality of services provided by government facilities, poor linkages to

HIV care and treatment services for HIV positive mothers, weak procurement and distribution systems

leading to frequent stock out of essential PMTCT commodities and inadequate staffing levels at the health

facilities.

In FY 2006 IRCU began the PMTCT program to support the MOH plan of intensifying primary prevention of

HIV/AIDS, prevention of unintended pregnancies among HIV positive women and comprehensive care to

the mothers and family. IRCU undertook an assessment of the existing PMTCT program at 18 hospital

based sites in order to establish the gaps within existing services as well as the demand for PMTCT in

health units where these services were not yet initiated. Of these 18 hospital based unit, eight are currently

carrying out PMTCT services supported by their individual districts through Elizabeth Glazer Foundation for

Pediatric HIV care (EGPAF). The rest are lower health centers which have not been accredited to provide

PMTCT services. For these sites, IRCU is working with MOH to accredit these sites to provide PMTCT

services by the end of FY 2007.

Using FY 2007 funds, IRCU will implement joint facility and community based PMTCT services. Currently,

there are estimated 5-25 mothers who test HIV positive each month at the implementing sites. In FY 2008,

IRCU will continue to provide comprehensive PMTCT services in line with the new MOH guidelines as well

as support community advocacy programs which include encouraging mothers to attend antenatal care

(ANC), male involvement during PMTCT activities, and training of midwives and TBAs to distribute mother-

baby ARV packs to mothers prior to delivery in case delivery takes place at home. IRCU will also facilitate

the supplies management at the units to increase the uptake of HIV counseling and testing at ANC and

provision of ARVs for prophylaxis by providing a stead supply of HIV testing kits and more efficacious ARV

regimens as stated in the revised PMTCT guidelines.

In this program, IRCU will encourage the formation of PMTCT clubs consisting of HIV positive mothers,

community volunteers and counselors. These clubs then carry out extensive health education and

sensitization in the community, work with newly diagnosed mothers encouraging them to bring their

spouses or partners for testing and track mothers and infants after delivery to assess their health care

seeking habits. IRCU will work with MOH and EGPAF to train the implementing sites set up systems for

PMTCT follow-up and male involvement. With IRCU help, the sites will set up PMTCT-support clubs to work

with the newly diagnosed mothers cope with their new health status, encourage them to test their other

children and spouses and follow up on the male involvement and testing. These clubs will also teach

mothers about nutrition, the hazards of breast feeding, alternative feeding for the infants and other care.

The sites will also set tracking teams to identify all diagnosed mothers, open a clinical record for each

mother, follow up each mother till time of delivery and during the postnatal period after which both the

mother and infant will be transferred to the HIV clinic on site for regular care.

With the FY 2008 funds, IRCU will specifically strengthen the PMTCT community follow up program by

tracking HIV positive mothers to asses their health seeking behaviors for both them and exposed infants

and at the same time promote early initiation of Cotrimoxazole prophylaxis and ART. IRCU will also

continue to educate mothers and encourage them to deliver in health centers. The team will then counsel

the mother and either refer to the nearest center or encourage them to continue seeking care at that

particular health unit.

IRCU will initiate links with the district health Services Commissions especially the department of PMTCT,

and EGPAF to work as partners to streamline PMTCT services according to the district health sector plan.

This will involve holding coordination meetings with district leaders and partners and other stake holders.

This will be incorporated in the IRCU quality assurance plan for provision of PMTCT services according to

national standards.

As part of the gender equality strategy for the HIV/AIDS care provision, IRCU will prioritize promotion of

male involvement in the PMTCT program. This will be done by encouraging wives to disclose their HIV

status to their spouses and encourage them to enroll in the program. Once the male partners have enrolled

in the program, they too will be counseled and encouraged to go for HIV/AIDS testing so that they know

their status. They will be encouraged to escort their wives during required PMTCT visits to health facilities

Activity Narrative: for sessions. Religious leaders will trained to mobilize couples especially the male partners of expecting

mothers through their routine pastoral work and home visitations to access PMTCT and related services.

Individuals who test positive will be assisted to receive care and treatment.

The implementing sites will be required to follow up all the children born to Mother infected with HIV through

the PMTCT program. IRCU will prioritize CD4 testing for both the mothers and infants. The exposed infants

will be tested for HIV infection using RNA-PCR from the nearest Joint Clinical Research Center (JCRC)

Regional Labs of Excellence. IRCU signed a Memorandum of Understanding with JCRC which institution

has agreed to provide this lab service. By the end of FY 2008, IRCU is targeting to test over 600 infants

through the various sites. These children will be enrolled into care and given the required basic HIV care

including Cotrimoxazole prophylaxis and also assessed for eligibility for ART.

Through partnerships, IRCU will build the capacity of key groups in the community such as community

leaders, PHA networks and traditional birth attendants so that they are an indigenous source of knowledge

within their communities and can be utilized to refer mothers or couples for HIV testing and PMTCT services

at the IRCU related health units.

PMTCT will also be strengthened by promoting linkages and inter departmental referral between HIV

counseling and testing (HCT), Tuberculosis (TB) as well as referral to other health units, in particular ART,

at all its implementing sites. IRCU will specifically ensure that PMTCT services are linked to the onsite HIV

clinic and mothers will be assessed for eligibly of ART and those eligible will be fast tracked to receive ART.

By the end of FY 2008, IRCU will have supported community mobilization around the 18 sites delivering

PMTCT services, enrolled 500 mothers in the program and strengthened male involvement by encouraging

300 couples to test for HIV infection.

Currently, Uganda is experiencing a mature and generalized HIV/AIDS epidemic with a high prevalence rate

of 6.4%. Despite high levels of knowledge on HIV/AIDS, high risk sex is still the main driver of the epidemic

in Uganda. The main factor that influences the continuation of high risk sex is attributed to lack of

personalization and internalization of HIV risk. Extra marital sex, mother to child transmission have also

continued to drive the epidemic. Data from the Rakai Health Sciences Program also shows that HIV sero

discordance among couples is high. Most of these couples are not aware of their HIV Status and therefore

not motivated to take action towards prevention. Other factors such as poverty that influences people and

especially girls to engage in commercial sex and other social cultural factors such as the position of women

in society have also continued to increase the transmission of HIV in our country. In November, 2006 IRCU

joined other major HIV/AIDS partners in launching of the Road map towards Universal Access to HIV

prevention in Uganda. The road map sets out key actions that need to be taken to arrest the spread of new

infections and turn the tide against HIV/AIDS. They include bridging the HIV prevention gap, building of

synergies between HIV prevention and care and ensuring the sustainability of HIV treatment scale up.

In FY 2006 IRCU initiated a robust prevention program to promote the country's vision on prevention as

outlined in the Road map. Several initiatives in the area of primary HIV prevention were undertaken,

particularly activities that promoted abstinence and mutual fidelity among married couples using both mass

media and our religious structures. Working through the heads of the main religious institutions in Uganda,

HIV/AIDS prevention messages were integrated into sermons and other religious teachings across the

country. In addition, IRCU implemented a mass media campaign where religious leaders spearheaded

HIV/AIDS advocacy, particularly appealing for abstinence and mutual fidelity. IRCU also rented billboards in

strategic sites across the country to disseminate HIV/AIDS prevention messages. IRCU has also developed

a comprehensive curriculum to train religious leaders, pastoral agents and volunteers in HIV/AIDS. The

curriculum aims to build the capacity of religious leaders and equip them with easy facts and skills in

HIV/AIDS prevention. Using FY 2007 funds, an initial 25 senior religious leaders were trained as trainers

and these will in turn train other high quality trainers in our communities. This will create a source of

knowledge in our communities at as we continue to roll out our HIV prevention program.

In the same year, we expanded our HIV prevention approaches to ensure that as many people as possible

benefit from our prevention activities. Using our faith based tenets; we emphasized primary prevention

approaches as a corner stone of our program. This was undertaken through public dialogues on radio and

TV that we organized during the world AIDS day campaigns. We also emphasized primary prevention to all

our partners by organizing workshops on the importance of prevention as the most effective means against

contracting HIV/AIDS. We emphasized abstinence for the youth and other unmarried persons and mutual

faithfulness among those who are married by printing flyers, posters and by encouraging the partners whom

we fund to focus on these areas. By doing what? During this year, IRCU PEPFAR supported activities were

crucial in expanding the scale and coverage of our prevention programs. We enroled16 faith based

organizations across the country to implement HIV prevention. To date at least 600 couples and more than

10,000 youth have benefited from our prevention activities.

Using FY 08 funds, we shall put emphasis on couple counselling and testing. By knowing their sero status,

couples will be able to make informed choices those who test negative will be encouraged to stay negative

and those that test positive will be enrolled in our other HIV/AIDS services or referred to seek other

preventive measures. This program will entail supporting religious leaders with more HIV/AIDs skills to offer

HIV prevention knowledge during pre-marital counselling. We shall also expand our community and facility

based testing This will ensure that people access services and in particular pregnant mothers in PMTCT.

We shall strengthen linkages between our HIV/AIDS services within facilities so that clients who come for

HIV/AIDS services will be able to receive information on prevention And other available services either in

our facilities or beyond.

Throught the program, we will use information, education and communication materials to promote

prevention activities. We shall use radio and drama in our communities to pass on information in local

languages concerning HIV prevention. In this way even the uneducated will benefit. Based on the current

studies that indicates that HIV prevalence has shifted from the young people (15-240 to adults (30-34), we

shall particularly try as much as possible to concentrate on reducing HIV infection among couples. We shall

use abstinence seminars for youth, conduct parental workshops for parents and guardians towards helping

them to acquire skills for responsible behaviour. We shall also use person to person interaction by

encouraging peer to peer dialogues, distribution of pledge cards towards abstinence and holding of public

rallies on HIV/AIDS in tertiary institutions.

Using our Curriculum, we shall strengthen the role of volunteers and religious by equipping them with skills

in referral so that they are able be a source of HIV prevention knowledge within communities. Finally we

shall support health facilities supported will continue to carry out their routine infection measures such as

blood safety and STI treatment.

During the year we shall support institutional and community AIDs clubs to deliver HIV information. The

institutional based clubs such as those in schools will be supported to deliver prevention activities for

children in upper primary while community clubs will be supported to give information to youth out of school.

Twenty (20) organisations will implement these activities reaching up to 400,000 couples, 800,000 youths in

school and out of school. We shall support 500 religious leaders including lay readers to deliver our

prevention activities during the year.

Activity Narrative

The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Catholics, Anglican Protestants, Muslims, Orthodox

and Seventh Day Adventists to address mutually identified development challenges. IRCU also works with

other religious organizations including Pentecostal and other independent churches. IRCU coordinates the

largest network of faith-based health units in Uganda, which together deliver close to 50% of the health care

services in Uganda. In June 2006, IRCU initiated a program to scale up access to and utilization of quality

HIV/AIDS prevention, care and treatment through the network of faith-based organizations and community-

based organizations. This program is funded by USAID under the President's Emergency Plan for AIDS

Relief (PEPFAR).

The National HIV Sero-Behavior Survey 2004/05 showed that approximately 900,000 are living with

HIV/AIDS in Uganda and all of them require palliative care. Palliative care remains the main hub for

HIV/AIDS care in Uganda, even with increased access to ART. Effective palliative care services are needed

to delay the onset of symptoms and hence the need for ART. Despite being on ART, individuals still need

intensive palliative care to adhere to the treatment regimens and to prevent opportunistic infection.

Currently less than 50% of PHA in Uganda access palliative care. Services are more accessible in urban,

than in rural areas. Working in partnership with its partners and stakeholders, the Uganda AIDS

Commission (UAC) has developed a new National HIV and AIDS Strategic Plan (NSP) 2007/8 - 2011/12,

which provides a road map for HIV/AIDS interventions over the next five years. Palliative care is one of the

priority components of the NSP with a goal of improving the quality of life of PHA by mitigating the health

effects of HIV/AIDS. The key focal areas for the NSP in regard to palliative care include increasing equitable

access to quality services by those in need, from 105,000 to 240,000 by 2012;, increasing access to

prevention and treatment of opportunistic infections; expanding the provision of home based care as well

as strengthening referral systems between health facilities and complementary services.

In support of the UAC vision to expand access to palliative care, IRCU delivers basic care in 22 sites. Of

these 12 are hospital based, 6 are health-Centers of level III and five are community based organizations.

Using FY 2006 funds, IRCU provided care to 24,000 PHA. The care offered includes prevention and

treatment of opportunistic infections (OIs), psychosocial care, as well as pain and symptom control.

Services are delivered through static facilities, outreaches to communities as well as home based care. In

FY07 IRCU will continue to expand its palliative care program and targets to enroll an additional 20,000

PHA by September 2008. With FY 2008 funds, IRCU will enroll further 31,000 new clients bringing a

cumulative total of 75,000 by September 2009. .

A study carried out in Eastern Uganda showed that Cotrimoxazole prophylaxis given as routine care in HIV

clinics was associated with a reduction in overall HIV related mortality as well as reduction in malaria

morbidity, even in an area with high bacterial resistance. These results reinforce the need for large-scale

provision of Cotrimoxazole prophylaxis for all HIV-positive patients in developing countries including

Uganda. A combination of Cotrimoxazole, antiretroviral therapy, and insecticide-treated bed nets

substantially reduced the frequency of malaria in adults with HIV. IRCU has been engaged in rolling out

these elements of preventive care. Using FY 2006 funds, IRCU procured and distributed 38,000 long lasting

insecticide treated mosquito nets (ITNs) to PHA through its network of FBOs. This activity will continue in

FY 2007 and through FY 2008, with the vision of accessing ITNs to all the targeted 74,000 clients. In

addition, IRCU will continue prescribing Cotrimoxazole prophylaxis as standard care in accordance with the

Ministry of Health (MOH) guidelines and policy.

IRCU has initiated collaboration with Population Services International (PSI) to distribute the preventive

package kits (ITNs, safe water vessels, water guard solution, and Information Education Communication

(IEC) materials) in at least 10 sites. This partnership will greatly complement IRCU's efforts in expanding

access to preventive care for its clients. IRCU has committed to facilitate follow up on usage of the

components in the community through out FY 2008. PSI is committed to carry out on-site training sessions

on the use of the prevention package in collaboration with IRCU

In FY 2006, IRCU had key challenges in implementing basic HIV care. The main ones included delays in

supply of drugs to treat OIs, lack of ARV drugs for PMTCT and post exposure prophylaxis, and lack of

standardized home based care. IRCU is working in partnership with Supply Chain Management System

(SCMS) to procure some specific drugs essential in managing critical OIs, but not supplied through the

national essential drugs program. Examples of these drugs include Amphotericin B, Acyclovir, Antifungal

ointments and Ciprofloxacin. Besides procurement of drugs, IRCU partnership with the SCMS project is

envisaged to further strengthen and improve commodity procurement and delivery systems within our

partner facilities. IRCU will promote the new home based guidelines developed by MOH at all its sites. To

harmonize this home based care, IRCU will work with MOH to carry out on site training sessions for new

community home based model. This will involve training both facility and community based workers in the

new guidelines. They will also be trained on the standard data to be collect while carrying home based care.

With FY 2006 funds, IRCU built endeavored improve the human resource capacity for palliative care in its

partner health centers. This entailed training and re-training of existing health staff and in some cases filling

staffing gaps through volunteer and locum arrangements. IRCU trained 40 health workers in psychosocial

care, pain and symptom control through Hospice Africa Uganda, In addition, Hospice Africa Uganda also

trained 15 spiritual leaders in spiritual counseling and care. In FY 2008, IRCU will provide refresher courses

for 40 health workers, 25 community volunteer workers and 15 religious leaders on pain assessment rating

scale, the use of oral morphine including its safety requirements, legal counsel, spiritual and end of life care.

IRCU will also train 100 health workers on the basic HIV care through our partnerships with Mildmay

International and Infectious Disease Institute (IDI).

By the end of 2008, IRCU plans to care for 75,000 people living with HIV/AIDS, train a total of 140 health

workers in basic HIV care, 25 community workers and will continue to carry out training of the 1270 religious

leaders carried forward from FY 2007.

The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Roman Catholics Church, The Province of Church Of

Uganda, Uganda Muslim Supreme Council, Uganda Orthodox and Seventh Day Adventists Uganda Union

to jointly address together development challenges. In June 2006, IRCU signed a contract with United

States Agency for International Development (USAID) to Scale up access to and utilization of quality

HIV/AIDS prevention, care and treatment through the network of faith-based organizations and community-

based organizations. This program is funded by the United States Government (USG) under the President's

Emergency Plan for AIDS Relief (PEPFAR).

In FY 2007, IRCU worked with 17 implementing sites in the TB/HIV program and screened 2,800 clients for

TB, diagnosed and treated 275 HIV positive clients for TB and these are also assessing palliative care and

ART at these sites. Using funds for FY06 and 07, IRCU trained 40 laboratory staff in TB diagnosis through

Joint Clinical Research Center (JCRC) and equipped all 17 laboratories with microscopes, centrifuges and

other necessary lab equipment for TB diagnosis. IRCU also refurbished 10 laboratories to facilitate TB

diagnosis procedures.

In FY 2008, IRCU plans to integrate TB screening in all HIV counseling and testing (HCT) sites targeting all

individuals who test HIV positive. Working with the existing 17 sites and possible ten new sites, IRU will

work with these 27 sites targeting to clinically screen 20,000 HIV positive clients for TB of which an

estimated 8,000 clients will further be screened by subjecting each client to three sputum examinations and

where needed X-ray tests to confirm the infection. Using a TB positivity rate of 10%, we expect to treat 800

clients in FY 2008 for active TB and follow them up in the community.

The clinical team in FY08 will also screen and identify those found with symptoms suggestive of TB in the

HIV clinics and will actively screen them for TB. IRCU will continually support implementing organizations

and health units with the necessary manpower and equipment to improve systems for TB screening,

diagnosis and treatment. IRCU will continue to work with National TB and Leprosy program through each

implementing unit to streamline provision of sputum collection containers slides for microscopy and any TB

related IEC materials.

The increase in the number of TB cases in HIV infected individuals is attributed to primary infection in the

immune incompetent who cannot control infection after exposure, reactivation of TB and flaring up of latent

TB as part of immune reconstitution in patients starting ART. The dual infection of TB and HIV presents

challenges of confirming TB infection, making a choice of ART regimens and the timing when to start ART

in patients on TB treatment. As a result, the World Health Organization (WHO) is advocating for an

integration of TB and HIV control and management activities. The integration is expected to improve

detection of TB in HIV infected individuals and HIV infection in TB patients allowing for early intervention

hence better treatment outcomes. The integration will further maximize use of available resources and

strengthen control measures for the two interrelated infections. Unfortunately in most IRCU implementing

health facilities this integration has not yet been attained. In FY 2008, IRCU will make this a priority area to

ensure that TB diagnosis, management and treatment is integrated in HIV/AIDS service delivery.

IRCU targets to screen 20,000 PLHA for TB in 27 sites and provide TB treatment and prevention services to

800 PLHA. 54 health workers will be trained in TB management, 27 lab technicians will be trained in

diagnosis of TB, 60 counselors in TB screening and referral.

The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Roman Catholics Church, The Province of Church Of

Uganda, Uganda Muslim Supreme Council, Uganda Orthodox and Seventh Day Adventists Uganda Union

to jointly address together development challenges. In June 2006, IRCU signed a contract with United

States Agency for International Development (USAID) to Scale up access to and utilization of quality

HIV/AIDS prevention, care and treatment through the network of faith-based organizations and community-

based organizations. This program is funded by the United States Government (USG) under the President's

Emergency Plan for AIDS Relief (PEPFAR).

During the FY06), IRCU worked with a wide range of faith based organizations to implement OVC related

activities nation wide. Using funds for FY06, IRCU has served 9,000 OVC and trained 4,500 caregivers.

OVC services among others included; enrolment for formal education and vocational education,

apprenticeship skills training, scholastic materials, psychosocial support, meeting health care needs of

OVC. At the same time, OVC caregivers were trained in income generating activities (IGAs) to enhance

their business skills and ability to manage IGAs. OVC have also had their cognitive and life skills built and

have been provided with HIV/AIDS education. Currently, IRCU is using funds for FY07 to enhance child

protection, in collaboration with our implementing partners, and the Police. In addition, Community

awareness programs are conducted to ensure increased OVC support are being promoted through drama

and information, education and communication activities at community level. In the process of carrying out

these activities, IRCU and FBOs have had a year of strong collaborations with a wide base of partners, and

our interventions have resulted in the increased enrolment and retention of OVC in school, and the

provision of totality of care for OVC. During FY08, IRCU will continue supporting similar initiatives

Currently, IRCU is using funds for FY06 and 07 to conduct training OVC caregiver's in small scale business

enterprises in order to enhance their income generating activities. This is aimed at strengthening their

economic security of OVC households. Therefore, during FY08 IRCU will continue to support this activity

and as such, OVC care givers will be linked to micro finance institutions, to access funds in order to expand

their small business and be able to support OVC services.

During FY 2008, IRCU intends to strengthen the existing strategies and ultimately improve access to and

utilization of comprehensive services for OVC and their households. New approaches will include

identification and referral of OVC that are HIV positive for palliative care services and ART and, increase

community capacity to respond to the needs of children affected by AIDS and their caregivers by

strengthening family and community structures. IRCU will again work in collaboration with the Ministry of

Gender Labor and Social Development (MGLSD) through CORE Initiative program that support the roll-out

of the OVC policy and implementation plan, district-wide mapping, a gap analysis of the multi-sectoral

response, development of integrated and comprehensive work plans for district local government and civil

society organizations (CSOs). IRCU through its myriad of partners will work towards supporting this

mechanism to ensure that comprehensive, networked services are accessible to OVC and their families.

The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Catholics, Anglican Protestants, Muslims, Orthodox

and Seventh Day Adventists to address mutually identified development challenges. IRCU also works with

other religious organizations including Pentecostal and other independent churches. In June 2006, IRCU

initiated a program to scale up access to and utilization of quality HIV/AIDS prevention, care and treatment

through the network of faith-based organizations and community-based organizations. This program is

funded by the United States Government (USG) under the President's Emergency Plan for AIDS Relief

(PEPFAR).

HIV counseling and testing (HCT) coverage in Uganda still remains low. The National HIV Sero-Behavior

Survey 2004/05 showed that only 13% of women aged 15-49 years and 11% of men in the same age group

had been tested. The Uganda Demographic and Health Survey (UDHS) 2006 further indicates that 71% of

women and 77% of men in Uganda have never tested at all. The same survey indicated, interestingly, that

over 80% of the population knew where to get an HIV test. This implies that constraints related to physical

access to facilities is a major issue. In 2005, the Ministry of Health launched the new National Policy

Guidelines for HIV Counseling and Testing with the vision of putting high-quality voluntary counselling and

testing (VCT) services within the reach of every Ugandan. The policy further acknowledges that with the

advent of affordable treatment options, there is urgent need to increase access to HCT in order to reach

those who need treatment, care and support. Therefore, MOH has moved on to adopt new approaches to

delivery of HCT, including routine testing in clinical settings, as well as home and family-based counselling

and testing. These approaches are designed to remove some of the barriers to testing imposed by the VCT

approach. IRCU works through its faith-based partners to support the MOH in operationalising its vision of

scaling up HCT coverage, especially to rural and underserved areas.

Using FY 2006 funds, IRCU rolled out counseling and testing in 22 faith-based sites based in 17 districts in

Uganda. Through these sites, over 30,000 individuals were counseled and tested of which 95% were adult

clients. IRCU also supported these sites with improvements in infrastructure, strengthening human

resources through training in new HCT technologies. IRCU worked extensively with the Program for Supply

Chain Management Systems (SCMS) to develop a logistics log frame for the implementing sites to facilitate

proper forecasting and ordering of HIV test kits. This resulted in greater improvements in the supply and

distribution of HIV testing kits and other associated supplies. This partnership will continue to be

strengthened through FY 2007 and FY 2008. With FY 2007 funds, IRCU will continue to expand access to

quality HCT services through the existing networks of faith based organizations (FBOs). Currently IRCU is

in the final stages of site assessment which will culminate into adding ten new sites to those currently

supported. This will facilitate delivery of quality HCT services to approximately 160,000 individuals by the

end of FY 2008.

IRCU initiated the newly introduced provider-initiated testing and counseling model, commonly known as

Routine Testing and Counseling (RTC) as part of the routine clinical care at all it is hospital based sites.

RTC has been initially implemented in high HIV prevalence units of these hospitals such as the medical

wards and STI clinics. With the new PEPFAR guidance to monitor individuals with TB that access HCT,

IRCU will move rapidly to expand RCT to cover TB wards. Focal persons at these units will continue to

coordinate the testing and counseling process. IRCU will also continue to consolidate and streamline the

existing referral systems between HCT, care, treatment and PMTCT units to ensure access to

comprehensive HIV/AIDS services for its clients.

HCT services are provided in accordance with the Ministry of Health (MOH) guidelines. For instance the

HIV testing algorithm is aligned with the national policy which emphasizes a three tier protocol using

Determine® to screen for HIV infection, Statpac® to confirm infection and Unigold® as a tie breaker. IRCU

procures and stores the HIV kits at Joint Medical Stores and the distribution process is manned by the

logistics officer working at the IRCU secretariat. As part of the quality assurance, all sites implementing HCT

are required to send 10 samples of specimens out of every 100 tests performed for re-testing at other major

HCT providers in Uganda. Using FY 2006 funds, IRCU trained scores of religious leaders at community

level who have played vital roles in raising community awareness and referral for HCT.

In FY 2008, IRCU in partnership with other USG-funded partners, including the Strengthening of Counseling

and Testing Training (SCOTT) and Mulago-Mbarara Joint AIDS Program (MJAP), will continue to build the

capacity within its supported health facilities to deliver quality HCT by focusing on training more staff and in

particular lay providers like PHAs involved in the out reach VCT clinics in new HCT technologies.

In FY 2007, IRCU provided support to form Post-Test Clubs composed of individuals who are found to be

HIV positive through the HCT services. These cadres of volunteers are used to further raise advocacy for

HCT in the communities surrounding the health units and also act as a support system for living positively in

the community. In FY 2008, IRCU will continue to consolidate these programs.

Some of the main challenges the IRCU HCT program has faced relate to limited pediatric counseling skills

and poor integration of PMTCT. This has led to low coverage of both pediatric HIV testing and PMTCT at

the implementing sites. In FY 2008, IRCU will focus on these issues as to increase the number of mothers

and children in care. IRCU in FY 2008 targets to counsel and test 160,000 clients, train 240 counselors,

250 district leaders and 1,270 religious leaders.

Activity Narrative:

The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Catholics, Anglican Protestants, Muslims, Orthodox

and Seventh Day Adventists to jointly address HIV/AIDS and other development challenges. IRCU also

works with other religious organizations including Pentecostal and other independent churches. In June

2006, IRCU signed a contract with United States Agency for International Development (USAID) to Scale up

access to and utilization of quality HIV/AIDS prevention, care and treatment through the network of faith-

based organizations and community-based organizations. This program is funded by the United States

Government (USG) under the President's Emergency Plan for AIDS Relief (PEPFAR).

By the end of December 2006, there were 24.7 million HIV infected adults and children living in Sub

Saharan Africa (SSA) with 2.8 new infections that year. SSA contributed to 72% of the HIV related deaths in

2006. The HIV epidemic in Uganda has since stabilized at a national prevalence rate of 6.7%. The burden

on women still remains high as they are the most infected at a prevalence rate of 8% and most affected as

they carry the burden of caring for those with the disease. In Uganda, we have approximately 1.2 million

people living with HIV and just over 80,000 of the people living with HIV infection are on the life saving

antiretroviral therapy (ART). Though the national scale up of the ART program in Uganda is yield promising

results, there are still many HIV infected people still in need of ART but can not access these services.

In FY 2006, IRCU initiated partnerships with 13 implementing sites to offer antiretroviral drugs. To date, we

have over 900 new clients on the IRCU program receiving life saving antiretroviral drugs. IRCU is also

supporting over 2,000 clients under Ministry of Health (MOH) in various aspects of care. IRCU has

intervened by providing ARVs to the Ministry of Health (MOH) in addition to providing ARVs to the MOH

clients at our sites. Thus the total number of clients we served by providing drugs was approximately 3070

using FY 2006 funds.

AT the beginning of FY 2006, IRCU initiated a partnership with Supply Chain Management Systems

(SCMS) in to procure the required Food and Drug Administration (FDA) approved antiretroviral drugs for the

program. SCMS sources the market and procures from well established reliable pharmaceuticals with the

cheapest market prices for individual drugs. This is one of their strategies to save as much drug money for

the program which allows the program to recruit more clients on ART.

The first procurement assignment arrived in country in January 2007 and consisted only of United states

(US) brand ARVs. Our first line choice of therapy is Nevirapine (NVP) + Zidovidine (ZDV) + Lamuvidine

(3TC) as a combination pack or blister pack called Combi-pack. We procured the drug items in reference to

the Uganda National treatment guidelines which includes first line alternatives. In FY 2006, IRCU through

SCMS worked with MOH to provide all the needed second line regimens and pediatric formulations for the

implementing partners. The MOH drugs are provided through the country partnership with Global Fund

Initiative.

Due to the sudden drop of ARV drug prices worldwide, IRCU is still procuring drugs using FY 2006 funds. In

view of this, we have ordered a second consignment of ARV drugs which will contain both US brand drugs

as well as FDA approved generics. Triomune (NVP + 3TC + Stavudine (D4T)) manufactured by Cipla ® was

recently approved by FDA. We have included Triomune 30 in our forecast to cater for the MOH clients and

Truvada (TDF/FTC) as an alternate drug for either first or second line therapy. We have also decided to

procure our own second line drugs as the MOH supply is not reliable. In regard to pediatric formulations,

IRCU will continue to collaborate with the Clinton Foundation Agency, who will provide these drugs for the

IRCU related sites. I

Once the drugs arrive in country, they are cleared by the Uganda customs and there after registered by the

National Drug Authority (NDA). The drugs are verified and analyzed by NDA at a total of 2% of the drug

cost.

In FY 2006, IRCU approached Joint Medical Stores (JMS) to establish a collaboration with them to store

and distribute the ARVs to the IRCU implementing partners at 5% of the cost of drugs. IRCU later signed a

memorandum of understanding (MOU) with JMS as a sign of commitment.

SCSM trained the technical staff at IRCU in logistic management information systems using a standard soft

ware which tracks the consumption rates both at JMS and at the individual sites. The 13 implementing sites

providing ARV drugs submit bimonthly reports and forecasts to the logistic officer at IRCU. The reports are

feed into supply chain manager software which assess the consumption rates and develops an allocation

list which is submitted to JMS for distribution. In addition, IRCU together with SCMS have set up working

logistic systems at each site to ensure there is prompt reporting and forecasting of ART usage to IRCU,

which will lead to prompt delivery of ARVs from JMS at these sites and will minimize the issue of stock outs

of medicines.

IRCU working with SCMS offered technical support and training to the health unit staff in forecasting, supply

chain management as well as drug recording and storage using FY 2006 funds. In FY 2007, IRCU is

planning to bring on board 10 new sites for the ART program. Using FY 2007 and FY 2008 funds, IRCU will

continue to provide targeted training and capacity building for the old and new staff at the implementing

sites directly responsible for the ARVs to promptly forecasting and report in order to avoid stock out of drugs

which interrupts care and is a renowned factor for ARV drug resistance.

In FY 2006/07, IRCU had two main challenges which included delays in supply of drugs to treat

opportunistic infections and lack of ARV drugs for PMTCT and post exposure prophylaxis (PEP). As a

strategy to optimally use our FY 2007 fund for drugs as well as try to solve this challenge, IRCU with

permission from USAID will procure essential life saving drugs to treat fatal opportunistic infections. In FY

2008, IRCU through SCMS will continue to work at ensuring the timely supply of these drugs.

IRCU also in FY 2007has made provisions in the ARV forecasting and quantifications to include quantities

of drugs to cater for PMTC and PEP in cases where the MOH supplies are erratic. In FY 2008, IRCU will

continue to consolidate the procurement of these line items and will adjust the forecasts according to the

drug needs at the sites

Activity Narrative: Using FY 2008 funds, IRCU will continue to provide the necessary human resource, data systems and

logistics to ensure both IRCU and MOH drugs are optimally utilized and accounted for at all sites.

By the end of FY 2008, IRCU will support 1,600 new IRCU adult clients and 500 new Pediatric clients on

ART as well as maintain care for the 910 old IRCU clients from FY 2007 and 2100 MOH clients thus IRCU

will be providing ARV drugs for over 5,000 clients on ART through this program. An estimated 2% of these

clients will be receiving second line drugs through the program. Of the total drug budget, we estimate that

IRCU will spend 98% of the money to procure ARV drugs and 2% to procure drugs for treating opportunistic

infections.

The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Catholics, Anglican Protestants, Muslims, Orthodox

and Seventh Day Adventists to address mutually identified development challenges. IRCU also works with

other religious organizations including Pentecostal and other independent churches. IRCU coordinates the

largest network of faith-based health units in Uganda, which together deliver close to 50% of the health care

services in Uganda. In June 2006, IRCU initiated a program to scale up access to and utilization of quality

HIV/AIDS prevention, care and treatment through the network of faith-based organizations and community-

based organizations. This program is funded by USAID under the President's Emergency Plan for AIDS

Relief (PEPFAR).

By the end of December 2006, there were 24.7 million HIV infected adults and children living in Sub

Saharan Africa (SSA) with 2.8 new infections that year. SSA contributed to 72% of the HIV related deaths in

2006. In Uganda, we have approximately 1 million people living with HIV and of these, just over 80,000 are

on the life saving antiretroviral therapy (ART). Despite the national scale up of the ART program in Uganda,

there are still many HIV infected people in need of ART but can not access the services. The burden on

women still remains high as they are the most infected at a prevalence rate of 8% and most affected as they

carry the burden of caring for those with the disease. In view of this, IRCU has established linkages with

faith based organizations in 12 districts in Uganda to build the capacity of specific health facilities and their

catchment communities as means of improving the channels and access to HIV related services and in

particular ART services.

To date, IRCU has worked with 13 sites to provided ART services and drugs to 2,900 PHA. Of these, 900

were new (treatment naïve) clients. IRCU supported these sites through a sub granting mechanism which

supported reinforcement of human resources, limited refurbishment of the clinical rooms and patient waiting

areas, provision of drugs, support for laboratory tests and training of various cadres of staff including

community workers and religious leaders affiliated to the sites. In partnership with the Joint Clinical

Research Center (JCRC) IRCU also trained 40 laboratory staff. To reinforce the adherence monitoring

program, IRCU procured motorcycles and other relevant equipment for the sites. IRCU is currently

assessing ten additional sites which will bring the total number of supported sites to 23 by the end of FY

2008. The sites have mainly been selected from areas recovering from war and conflict particularly the

north and north-eastern regions of Uganda.

The IRCU approach is to integrate the ART services with existing HIV care and overall health services at

the implementing facilities to mitigate pressure on the already overstretched capacity of our partners. In FY

2008, IRCU will consolidate the ART services at these 23 sites with emphasis on quality of care.

In FY 2008, the ART services shall continue to be integrated and linked to counseling and testing services;

PMTCT; palliative care and prevention programs through inter departmental referrals and linkages to

ensure that all HIV positive individuals are screened for ART and those eligible treated. All sites carry out

WHO clinical staging and baseline CD4 count for each client referred and enrolled into care. Sites will be

encouraged to adhere to the guidelines of initiating ART through support supervision and training.

IRCU like other partners delivering ART has invested resources in setting up optimal adherence monitoring

systems. In FY 2008, IRCU will focus on strengthening the human capacity, development of logistics

systems, strengthening laboratory systems as well as building networks at community level to build a strong

and coordinated adherence monitoring mechanism. IRCU will support each site to establish an adherence

team comprising of 10 members constituted by a mix of health professionals, PHAs (expert clients), family

members and religious leaders. These teams will monitor adherence at the family and community level.

Currently IRCU uses two adherence monitoring methods at the sites, namely, pill counts and three day self

recall methods. In FY 2008, IRCU will train clinical teams on site to use the visual analogue scale (VAS)

instead of 3 day self recall method and continue to carry out pill counts at drug refills. We will also initiate

the use of electronic pharmacy records in this period. For the latter, IRCU will engage the technical

assistance of Supply Chain Management System (SCMS) to install the needed soft ware and train the

dispensing staff at the units to ably use the new program using FY 2008 funds.

The number of children with HIV infection is steadily growing with a paradoxical low growth in pediatric care

services. In FY 2008, IRCU will continue to target children for ART as a special and vulnerable population

and to take a leadership role in expanding access to pediatric ART beyond the major urban areas. In FY

2008, IRCU will continue training all cadres of staff in comprehensive pediatric HIV care including pediatric

counseling skills. IRCU is working with the Infectious Disease Institute (IDI) and Mildmay International, both

PEPFAR partners, to offer this specialized training. IRCU is currently setting up systems at the 23 sites to

enhance pediatric care, in particular ART, by initiating HIV testing for all exposed infants. To date, IRCU

has tested over 50 and will continue to consolidate these services in FY 2008. IRCU is targeting to test over

600 infants by the end of FY 2008. These children will be enrolled into care and also assessed for eligibility

for ART.

IRCU has been strengthening PMTCT activities at all 13 implementing sites. These sites carry out both

clinical and community based PMTCT services. Using FY 2008 funds, IRCU will set up PMTCT-support

clubs at the sites to support the newly diagnosed mothers and also encourage male involvement. For

mothers not returning for set antenatal and postnatal appointments, the PMTCT team will track the mothers

and once found, they will either counsel the mother to continue seeking care at that particular health unit or

refer them to the nearest center.

IRCU has worked closely with the administration at all units to reinforce Post Exposure Prophylaxis (PEP)

for the health workers. In FY 2008, IRCU will continue to ensure that the sites have the needed protocols,

information about PEP, ARV drugs, and we will identify PEP focal persons to coordinate these activities. In

FY 2008, IRCU will continue to upgrade the skills of 127 cadres of staff running the HIV/ART clinics in all its

23 supported sites. This will entail training them in comprehensive adult and pediatric HIV and ART service

provision with key focus on pediatric care, treatment efficacy, drug resistance and drug counter-indications.

A total of 1,270 religious leaders will also be trained in adherence monitoring and in mobilization skills to

encourage the people to seek services.

Activity Narrative:

IRCU has initiated partnership with IDI to ensure quality assurance and capacity maintenance. In FY 2008,

IRCU will continue to work with IDI in monitoring the quality of care at the 23 sites and continue to carry out

baseline resistance studies as biomarker of quality. Currently we annually take 20 blood samples from

patients who have been on ART for at least six months at the sites including women referred from the

PMTCT program to determine the extent of Nevirapine resistance. In FY 2008, IRCU plans to work with

SCMS to streamline the procurement and timely supply of these drugs.

In FY 2008, IRCU will support 1,600 new adult clients and 500 new Pediatric clients on ART as well as

maintain care for the 3,010 IRCU clients from FY 2006/07. By the end of FY 2008, we shall have over 5,110

clients on ART through this program. IRCU plans to train a total of 127 health workers in ART care and will

continue to carry out training of the 1,270 religious leaders carried forward from FY 2007.

The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts

of five major religious institutions of Uganda including Catholics, Anglican Protestants, Muslims, Orthodox

and Seventh Day Adventists to address mutually identified development challenges. IRCU also works with

other religious organizations including Pentecostal and other independent churches. IRCU coordinates the

largest network of faith-based health units in Uganda, which together deliver close to 50% of the health care

services in Uganda. In June 2006, IRCU initiated a program to scale up access to and utilization of quality

HIV/AIDS prevention, care and treatment through the network of faith-based organizations and community-

based organizations. This program is funded by USAID under the President's Emergency Plan for AIDS

Relief (PEPFAR).

In general, laboratory services are a crucial part of health care. Without laboratories to diagnose correctly,

medical personnel would be challenged to prescribe the right treatment for patients. Yet this aspect of the

diagnostic process can be undervalued, resulting in laboratories being under equipped and staff unexposed

to continuous process of training in the workplace.

Efficient laboratory services including HIV counseling and testing as well as monitoring of individuals on

care and treatment remains at the helm of an effective HIV/AIDS care program. However, access to

laboratory services still remains a challenge, especially to individuals living in rural areas. In many of the

rural areas in Uganda, diagnostic services are deplorable. Health facilities, especially those at level III and

below lack laboratories and where they exist, there are acute shortages of staff, equipment and/or reagents.

Despite these limitations, these facilities serve the largest number of people, given that they the most easily

accessible.

In FY 2006, IRCU worked with 18 health facilities to establish the infrastructure to enable them carry out

basic tests that enhance HIV/AIDS care and support including procuring basic laboratory equipment,

Limited refurbishment, training of lab staff and reinforcing the human resource need to carry out the lab

tests. Of these 18 labs, 12 are hospital labs while the remaining six are lower health center labs. Through

these laboratories, the following test were carried out: 90,000 HIV screening tests, 5,000 TB screening

microscopic and radiologic tests, 40,000 baseline syphilis screening tests and 2,000 pregnancy tests.

By the end of FY 2008, IRCU will have built the capacity of 28 labs to perform 160,000 HIV screening tests,

20,000 TB screening tests, at least 90,000 CD4 tests, 80,000 syphilis tests, 3,000 pregnancy tests, and

60,000 organ functions tests (Liver and Renal). With the support from Supply Chain Management Systems

(SCMS) and Joint Clinical Research Centre (JCRC), IRCU plans to train 112 laboratory staff in: ordering

and forecasting of laboratory reagents; logistical inputs to ensure a reliable supply; HCT and other HIV/ART

monitoring tests and finally good lab practices. Routine reliability and quality assurance checks will be

undertaken to ensure that lab services conform to nationally acceptable standards.

IRCU currently has 24,000 clients enrolled on palliative care and targets to enroll another 20,000 in FY

2007. An additional 31,000 individuals are targeted to receive care in FY 2008. This implies that by the end

of FY 2008, IRCU will have over 75,000 PHA receiving care. All these individuals will require routine

baseline CD4 tests, lymphocyte counts and hemoglobin levels in order to effectively monitor their eligibility

for ART. This is essential in order to ensure that individuals initiate ART at the most optimum time. Also

over 5,000 patients currently enrolled on ART will continue to have quarterly hemoglobin and lymphocyte

estimates and bi-annual CD4 cell counts. Most of the IRCU related labs are limited to performing basic

microscopy and hematology tests including hemoglobin estimations and total lymphocyte counts, and are

unable to carry out more advanced tests like CD4 counts and biochemistry tests while these tests are a key

ingredient to an efficient ART service.

Therefore, IRCU entered into a Memorandum of Understanding with JCRC to out source laboratory

services from its regional centers of excellence. Under this arrangement, most IRCU supported facilities

with proximal JCRC centers of excellence access services, particularly specific tests like full blood counts,

organ biochemistry, CD4 cell counts, Polymerase Chain Reaction (PCR) for infant HIV testing and

resistance testing.