The overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations

In FY 07 NUMAT supported 24 static PMTCT sites reaching over 4500 pregnant women with HIV

counseling and testing for PMTCT and received their test results with over 270 mothers provided with a

complete course of antiretroviral prophylaxis. NUMAT also created systems to increase uptake of mothers

in PMTCT at all levels of service delivery. In FY 08 NUMAT will support scaling up PMTCT services to cover

lower health units and reach people away from municipalities and those camps that will still be existing..

This will involve infrastructure and logistics support as well as training of PMTCT counselors and other

health workers. The project will provide integrated outreach services from health units to camps. Health

units will work with CBOs to help provide services, particularly focusing on mother/child follow up as well as

support and counseling regarding breastfeeding and infant nutritional support. Outreaches will also be

supported from level III heath units to lower levels on specified ANC days at the lower units. Improvement of

uptake of service will focus on involving males more positively into PMTCT services and seeking the

support of older women in the community to support infant feeding decisions.

The project will also work with community leaders to implement effective community mobilization strategies

with special emphasis on male involvement and infant feeding decision support, support community

mobilization efforts that target local stakeholders and trained male PMTCT advocates and village women

regarding messaging and counseling for infant feeding. In addition, NUMAT will support districts to engage

Traditional Birth Attendants (TBAs) through working with other initiatives like Safe motherhood to encourage

mothers attend Ante Natal Clinics and get tested. Gatherings of men such as drinking groups will be

reached with relevant messages to encourage participation in PMTCT activities. Couples counseling will be

encouraged and programs providing incentives to mothers to deliver in Health Centers (HCs) will be

supported. Incentives will include Insecticide Treated Nets (ITNs), delivery kits, prophylaxis for mothers and

infants and rapid referrals for HIV care for pregnant women, their children and spouses. Incentives like ITNs

for husband and wife will also be provided for those that test as a couple. Clients presenting as couples will

be fast tracked to access PMTCT and related care services.

The project will link up PMTCT activities in this year to PMI activities through other USG supported

programmes, specifically the provision of Interpersonal Psychotherapy in ANC. The project will also link up

with other USG supported initiatives to support OVC for on going care and other support through PMTCT as

the initial contact. The project will continue to facilitate and strengthen establishment of psychosocial

support groups at all PMTCT sites. NUMAT will have ART supported sites by then and mothers through

PMTCT will be given a priority to access ART services. This will include supporting the mothers to access

relevant immunological testing and monitoring through CD4 testing at sites with capacity to test and results

channeled back through support from NUMAT. NUMAT will put in place a system where blood samples can

be collected, correctly labeled and transported to laboratories with capacity to test and the results

channeled back within 72hours. Through supporting integrated service delivery mothers who have gone

through PMTC will be supported to access continuous basic health care within the health units and through

community organizations including Family Support Groups (FSGs). The project will train counselors in

special skills to support mothers and advocate with health unit staff to provide space for the mothers to

meet. In collaboration with district health team and CBOs, facility and community strategies to improve

follow up of mother-baby pairs will be developed. Facilities will work in close collaboration with Family

Support Groups and CBOs and other organizations providing "wrap-around" services to support mothers to

disclose their status to family members as well as link them to PHA groups and other CBOs. NUMAT will

also provide grants to other organizations like AVSI to support PMTCT.

The Overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations.

In FY07 NUMAT trained 30 master trainers for youth prevention and established a youth and a parent group

in each of the five districts. NUMAT also supported the development of effective life skills and the increase

risk perception among the youth through activities that involved community, religious and political leaders.

NUMAT also trained various leaders in issues related to HIV prevention through promoting positive social

norms and healthy sexual behaviours such as abstaining from sex till marriage and being faithful to one

faithful partner, for married couples.

The activities of FY08 are a continuation of the activities started in FY 07. NUMAT will in FY 08 support

activities that build on those achieved from FY 07 and they will include;

•Facilitating community dialogues about issues affecting young people such as improving parent-child

communication on HIV and sexuality.

•Using proven effective approaches like PIASCY, Channels of Hope, to train teachers, youth leaders, peer

educators and mentors identified through the community schools and youth groups. These activities will

equip youth with "value-based life skills" to enable them make informed choices and avoid risky behavior.

NUMAT will continue supporting youth-led community programs to help youth, their parents, and the

broader community to personalize the risks associated with early sexual activity, sex outside of marriage,

multiple partnerships, and cross-generational and transactional sex.

•Supporting media campaigns that reinforce and make abstinence, fidelity, partner reduction, HIV

counseling and testing, and other safer behaviors legitimate options and standards of behavior for both

youth and adults;

•Carrying out campaigns to sensitize the community about HIV prevention, sexual violence and gender

based violence

•With the mobilization of FBOs for prevention (primarily abstinence/faithfulness) activities using Channels of

Hope strategy, NUMAT will support activities that emphasis abstinence, fidelity, partner reduction, HIV

counseling and testing, and other positive social norms for both youth and adults

•NUMAT will also continue supporting the review, revision and adaptation of other curricula, interactive

materials, radio programs and toolkits available in the country to make them suitable for the districts in

Acholi and Lango regions. For out of school youth, HIV prevention messages will be linked to vocational

training.

The Overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations.

In FY07 NUMAT developed a comprehensive approach to reducing Sexual & Gender-based Violence

(SGBV). NUMAT trained community animators on SGBV and its link to HIV transmission. Community

animators were placed in camps and underserved communities to create awareness on gender, sexual and

reproductive health rights, to empower women to speak out and to promote dialogue between

camp/community residents and the service providers and administrators to improve enforcement of national

legislation and strengthen responsiveness of police and local courts. NUMAT closely coordinated with GOU

structures and UNICEF, the agency responsible for social protection in the North that has spear headed the

strategy for addressing SGBV.

Activities for FY 08 will build on FY 07 achievements and will include; supporting families and communities

to build skills that promote sexual norms and behaviors , working on issues related to Gender Based

Violence by promoting family life education and addressing other gender issues; engaging uniformed

services and the police including community security guards in programs to reduce SGBV and to prevent

HIV and empowering communities to promote societal norms that reduce the risk of HIV transmission and

promote the use and access to HIV counseling and testing services. Supporting IEC/BCC activities that

promote positive behaviors for the prevention of HIV infection, TB and malaria. Of particular interest will be

messages focusing on effects of excessive alcohol consumption and corresponding risk taking behaviors.

NUMAT will work with NGOs and CSO, as well as the UPDF to increase demand for condoms. Targeted

messages for most at risk groups will be developed, as well as determining best locations and distribution

points for condoms. The project will also work with PHA groups to integrate condom messages and

distribution into ongoing service provision activities.

NUMAT will also support other prevention efforts like syndromic management of STIs which will be

integrated in all other areas. This will include integrated training of health workers in management of STI

and HIV/AIDS, supporting logistics for STI drugs including procurement of STI drugs should situations of

stock outs occur. Supporting integrated support supervision of STI with HIV/AIDS activities. Linking STI

clients to HCT within their treatment areas and through referral from lower units.

The Overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations

In FY07 the project trained home based care providers in four of the nine districts. The project also

mobilized PHA groups and networks in all the nine districts. A total of 60 health workers were trained in

pain and symptom management for HIV patients, and palliative care teams have been set up in several

facilities. In FY 08, NUMAT will continue build on the activities initiated in FY 07.

Palliative care activities that will be support in FY 08 will include: Supporting the scaling up of Basic

Palliative Care services to lower health units and reach small camps in the peripherals. The project will

continue working closely with PHAs and their families in the project catchment area to increase use of

appropriate, well supported and supervised palliative care services linked to essential clinical services. The

project will work with PHA networks, health facilities and CBOs and Community Care Coalitions (CCC) to

strengthen and expand home and community care services and also strengthen the referral network for

those individuals who require clinic based care.

The project will also support promotion and delivery of a prevention & care package including septrin

prophylaxis for opportunistic infections (OIs), ITNs , peer psychosocial support, IEC/BCC for prevention

among the positives, condoms, ART, and linkages to wrap around services including food, material support,

and family planning. As much as possible these services will be delivered by community and home-based

care (HBC) community volunteers. The project will also work with other USG supported initiatives like

those implemented by PSI, IRCU, AFFORD and the Expanding of PHA network project to reach more PHAs

with basic palliative care.

In the Lango sub region where PHA networks do exist up to district level, these will be strengthened, in the

Acholi sub region where there may be groups of PHAs in different localities including in camps, these will be

supported to come together and later access services through either integrated outreaches or through

strengthened health facilities.

The Overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations.

In FY07 NUMAT supported the nine districts to scale up and to strengthen Community-based - Directly

Observed Treatment, Short Course (CB-DOTS) activities. Health workers were trained on CB DOTS and on

TB/HIV collaborative activities. Districts were also supported to conduct support supervision for health

workers and community volunteers involved in CB-DOTs. TB IEC/BCC materials pamphlets, posters were

printed and disseminated to health facilities and within communities. As a result a total 568 TB patients (by

June 30) have been started on TB treatment and out of these 67% were tested for HIV.

In FY 08, NUMAT will build on achievements of FY 07 and will support the following activities;

1.Identifying community and camp members to be trained as sub county health workers and develop

appropriate supervision systems for volunteers who administer drugs. More community health workers will

be trained to play the role of sub-county TB supervisors. Working with the district health officials, trained

volunteers will be facilitated with transport in form of bicycles, to do their work.

2.Supporting community education efforts that provide simple messages about TB symptoms and the

importance of early detection and complete cure. IEC/BCC activities to sensitize and mobilize communities

on TB will be supported building on effective materials and approaches tested by AIM.

3.Developing simple health worker tools to more easily screen patients who present with coughs. Priority

will be given to those providers who provide care to PHAs and their families.

4.Supporting improved sputum smear examination through re- training and routine supervision of laboratory

health workers.

5.Increasing the number of diagnostic units through support to mobile laboratories serving lower levels of

the health system.

6.Training non laboratory medical personnel (e.g. nursing assistants) as microscopists. And providing

logistical support to assure drugs and other supplies are secure and reach health units in time, as well as

documenting and disseminate lessons learned.

NUMAT will provide support to the zonal TB officers to provide supervision. NUMAT will support

strengthening of HIV/TB collaborative activities. This will be through activities that will see more TB patients

screened for HIV, more HIV patients screened for TB. Integrating screening of TB in patients in palliative

care and integrating co-trimoxazole prophylaxis and ART into care for Tb HIV positives. This will be through

training health workers in HIV/TB collaborative activities, supporting joint planning for TB and HIV, provision

of registers which cater for both TB and HIV activities.The project will work with NTLP, local government

structures, Gulu Independent and Lacor Hospital, CDC, WHO, AVSI, CUAM, CBOs, and GLRA on TB

activities as well as USG supply chain efforts such as DELIVER and the Supply Chain Management Project

(SCMS)

The Overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations.

In FY 07 meetings with district leaders to start HIV/AIDS Counseling and Testing (HCT) activities were

completed, preparatory work for starting Post Test Clubs (PTCs) were carried out in 5 districts and several

PTCs were formed and equipped. In FY 07, over 8,000 people accessed HCT services from project

supported sites.

Activities for FY08 will build on FY 07 achievements and will include: working closely with central and local

governments (MOH), CSOs and the private sector, to develop HCT services tailored to individual, family

and community needs and expectations and to most at risk populations. The Project will put primary

emphasis on scaling up HCT services to reach peripheral communities, including those still in Internally

Displaced People (IDP) camps. The project will implement a variety of complementary service delivery

models, including Routine HIV/AIDS Counseling and Testing (RHCT) in established health units, integrated

outreach including HCT, and other innovations that will be considered appropriate by the stakeholders. For

RHCT, the project will work with hospitals, Health Centre (HC) IVs and IIIs, to develop systems that target

the most at-risk clients including those on medical wards, presenting with STDs and TB patients.

NUMAT will also scale up HCT to selected level HC IIIs. The project will train staff, perform modest

rehabilitation, equip laboratories and form alliances with CBOs to provide counseling and referral to test

sites. Counselors will also be trained to deal with pediatric and couples counseling. Promote integrated

outreach to remaining IDP camps and/or peripheral communities through mobile HCT offered by hospitals

and HCs IV and III as well as CBOs currently providing HCT. Hospitals and HC IVs with sufficient human

capacity will be supported to conduct at least two integrated outreach efforts per month. These will be

initially to HC III facilities that do not have the capability to offer these services. This scenario will be

promoted more in the Lango region where most of the IDPs are back in their communities and can access

services at HCIII. We will support facilities with acceptable logistics to reach the IDPs. Logistical support

will be provided by NUMAT district staff.

In Acholi, where possible, outreach will be done in HCIII. However for the population that is still living in

camps and far from health centers, we will offer confidential services in temporary structures such as mobile

tents. Mindful of the rapidly evolving situation, the project will also quickly begin working with existing HCIII

in Acholi so that as people return to their homes, services will be available. In order to ensure the smooth

flow of supplies for uninterrupted service delivery, the project will invest in logistics training of the concerned

health workers with support from Deliver and MOH.

The project will also support the District Directors of Health services and CSO providers of HCT access to

supplies and test kits from National Medical Stores. The project will support procurement of US and

Ugandan government approved test kits and work with the existing distribution systems to ensure their

constant availability at all supported sites. The Project will support targeted HCT promotion and community

mobilization. Targeted populations will include groups at most risk like discordant couples and those

engaged in transactional sex. The project will support a wide distribution of existing IEC materials in all

target communities. Where appropriate materials do not exist for certain populations or language groups,

either existing materials will be translated and/or adapted or new materials will be developed using a

participatory process. NUMAT will establish PTCs at each health unit providing HCT as well as in all camps

that do not currently have such groups. Each PTC will be supported to form a drama group for sensitizing

and mobilizing people to access HCT, availed psychosocial support counselors to offer ongoing counseling

to members, provided with regular educational talks and indoor games and also provided with training in

peer education and other activities. Working with PTCs and through strengthening referral mechanisms,

those who test positive from the HCT sites will be supported and linked to a wide range of palliative care

and other wrap around services.

The Overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations.

In FY 07, a total of 27 sites were identified to be supported in the upcoming year. Preparatory activities have

been carried out including; assessment of site needs, ART and Pead HIV care training for health workers,

logistical training in quantification and forecasting for health workers, and formalising the relationship with

SCMS and JMS to facilitate procurement and delivery of drugs to the sites. Drugs to support a total of 1681

new patients have been ordered for and will be delivered in FY 07.

In FY 08, the activities will include continuing with the procurement of ARVs through the agreed upon

systems and deliver the drugs to the districts, facilities, camps and any other treatment area that would

have been accredited. To perfect the system, this may involve strengthening local logistics systems at NMS

and JMS. During the period the project will also build the capacity of facilities to monitor patients on ART.

This activity also relates to Prevention /Abstinence and Being Faithful, Prevention Other, PMTCT, Palliative

care: Basic health care, Counseling and testing, Laboratory infrastructure, Strategic Information and policy

analysis system and strengthening. The NUMAT project, which covers the sub regions of Acholi and Lango,

was awarded in August 06 with FY 06 resources. The project covers 9 districts in the post conflict region of

Northern Uganda with an overall goal of expanding access to and utilization of HIV, TB and malaria

prevention, treatment, care and support activities in Northern Uganda. This activity is a continuation from

FY2007.

A differentiated strategy is applied by the project in the two sub regions. In Lango, where the security

situation is more stable and displaced people have begun going back to their homes, NUMAT will support

activities aimed at strengthening existing community and facility based HIV/AIDS/TB and malaria services.

Services at static sites will be strengthened to meet the increasing demand by the returning population while

other particular services will continue to be scaled up at lower levels of service delivery.

In Acholi, though the conflict has almost disappeared, significant parts of the population remain in the main

camps while others have moved to smaller satellite camps closer to their homes and a good number are

also returning home. The NUMAT Project will continue supporting services to populations both in the

peripheral camps and those returning home. The project will continue working with a host of other

stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and malaria

services for both the returning and the remaining camp populations.

Planned activities for this period will include addressing the specific constraints facing the ART programme

in the project area.

In the NUMAT project area , the roll out of ART programs has been slower than in the rest of the country

due to the ongoing armed struggles, the highly mobile and fractured lives of PHAs and the precarious

transport routes that make continuous access to care and drugs challenging.

To address this, NUMAT will directly target PHA and families, especially HIV-positive children, pregnant

women and their families, PHA with TB, and PHA from medical wards to increase their access to ART

efforts underway in the region. The project will work with health workers, community volunteers and the

wider community to reach target populations.

The project will:

•Increase access to ART by establishing ART sites at all district hospitals, accredited private health facilities

and some HC IVs not currently served by other USG or other donor efforts. Assessment and capacity

building of more ART sites will be done. Training and site support will be prioritized based upon those skills

and areas that are critical for initiating ART programs. Examples of supported activities include: health

worker and "treatment supporters" in-service training, collaboration and creating linkages with other projects

to ensure that appropriate ARVs are in stock; provision of ARVs, strengthening existing distribution systems

to ensure ARVs are continuously available in the supported sites, developing site-specific standard

operating procedures, job aids, or data management training. Where possible, ART clinics will be fully

integrated into HIV care where clients are initially screened and registered before they begin ART. Where

integration of ART into existing HIV care centers is not an option, we will promote use of MOH's chronic

care register to link up clients to the closest available ART site. Collaboration with the MOH, SCMS and

DELIVER and others to, rapidly scale up logistic systems to ensure uninterrupted access to ART.

•Create community awareness about HIV treatment and support efforts to create a community culture of

treatment literacy.

•Establish client-centered referral systems that link ART clinics to facility and community based programs to

facilitate linkages with PMTCT and HCT sites, TB clinics, post-test clubs, and PHA support services.

Referral forms will be developed so that clients can more easily navigate between service delivery sites.

Integrated outreach to camps will include follow up of PHA on ART to provide adherence support as well as

routine re-supply of drugs Foster innovative, client centered ART adherence programs like personal

communication equipment (walkie-talkies, mobile phones) to PHA treatment supporters/ expert clients to

link them to treatment sites.

•Make pediatric ART a priority. Children living with HIV present a unique challenge, particularly in the North.

The project will work with partner organizations to develop simple tools to identify infants and children who

may be living with HIV but are not in care and refer them for testing and possible care. Continue to build

partnerships with other ART USG funded projects

The Overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations

In FY 07 NUMAT embarked on the process of refurbishing selected laboratories at HC III in the 9 districts.

The project also started on the training of lab personnel and a total of 15 laboratory personnel were trained

in laboratory work.

Planned activities for FY 08 will build on the laboratory work accomplished by NUMAT in the previous

period and other USG partners. The project will strengthen the laboratory capacity at the lower level of the

health systems, particularly HC III, by renovating infrastructure, training personnel and providing appropriate

equipment to enable units to undertake appropriate laboratory tests for the diagnosis and treatment of HIV,

TB and malaria. Previously trained HC III laboratory staff will receive refresher training in HIV rapid tests,

sputum smears, total and differential white blood cell counting, hemoglobin testing and malaria smears.

Clinical officers will receive in-service training in best practices in utilization of laboratory services. The

project will increase the number of functional labs based on rapid assessments, through site renovations,

equipment procurement and staff training. Capacity at referral labs will be increased through staff training

and incentives, supplies and equipment. The project will support and strengthen systems to transport

samples from lower level facilities to the referral labs to conduct higher level tests such as CD4 count, LFT,

RFT and PCR. NUMAT will strengthen the laboratory quality assurance efforts already underway in the

three districts and work with district health officials to enhance their ability to conduct supervision activities.

Specific activities to be undertaken include:

1.Train all HC III in HIV rapid testing for HIV so they can support home-based HCT and PMTCT outreach

linked to HC IIIs.

2.Develop HC III-focused quality assurance systems in support of broader district systems which AMREF is

developing under CDC support.

3.Support the MOH's Human Resource Development strategy by sponsoring at least 30 currently

unqualified staff to take the laboratory assistant's course.

4.Support laboratory staff to conduct outreach and provide services during national TB, HIV, child health,

and malaria health days.

5.Support and strengthen systems to transport samples to referral labs to conduct tests like CD4 count, liver

function tests, renal function tests and PCR.

6.Procure CD4 count machines for referral hospitals so they can provide care in accordance with national

guidelines.

7.Pilot programs for integrated approaches for the diagnosis of HIV, TB and malaria.

8. Document and disseminate innovative approaches to integrating HIV, TB and malaria diagnosis.

The overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations

In FY 07 NUMAT provided technical assistance for strategic information activities to 10 organizations and

supported the training 25 district people in strategic information. A program database was established at the

project to help in the management of data from districts and in the compilation of reports in indicators in

project's Project Monitoring Plan (PMP). In FY 08 NUMAT, will work with other stakeholders to support the

nine districts to develop their M&E plans in line with the National M&E framework and their HIV/AIDS plans.

District Health Management Information System Focal Persons will be trained to further the strengthening

existing data collection mechanisms in place within the health system in all districts. The Focal Persons will

be trained to manage data collection from the lower level health units and facilitate analysis, dissemination

and reporting of data. Record assistants at health sub-districts will be sensitized, equipped with skills and

facilitated to extract data from service registers and enter into summary forms. Where necessary, the

project will support procurement of equipment to facilitate collection analysis and storage of data at the

district level. The HMIS Focal Persons and the record assistants will be supported in data collection.

Districts will be supported to routinely utilize data for their planning purposes and supporting service

delivery. In addition districts will continue to be supported annually to monitor progress on critical HIV/AIDS,

TB and malaria indicators.

As a follow up to previous efforts by UPHOLD, UNICEF and Uganda AIDS Control Programs (UACP) in

some of the NUMAT districts, NUMAT will continue focusing on activities aimed at promoting evidence-

based planning and decision making at district and lower levels. Evidence-based planning and decision

making will be achieved through regular measurement of program performances and progress in all the

districts that this program will operate. Regular and timely feed back to the supported local governments,

non-governmental organizations ad civil service organizations will be conducted through the annual Lot

Quality Assurance Sampling (LQAS) survey. The LQAS survey will be conducted annually in all the

supported districts to track coverage and utilization of key indicators related to program performance. Key

stakeholders such as line ministries, local government authorities, civil society organizations and other

implementing partners will be involved in the development of questionnaires of this survey. The LQAS

results will be used to inform district level work planning in order to identify intervention areas and sub-

counties on which to focus in the future. LQAS will also track indicators under the President's Malaria

Initiative (PMI).

District planning units will also be trained and supported to manage data generated from the project and

other partners. The project will work with the Community Services Department (CSD) to strengthen and roll

out existing community services data collection mechanisms.

The overall goal of the Northern Uganda Malaria, AIDS/HIV, and Tuberculosis Project (NUMAT) is to

expand access to and utilization of HIV, TB and malaria prevention, treatment, care and support activities in

9 districts of North Central Uganda (Acholi and Lango Sub regions). Implementation of NUMAT project

activities began in FY 07 and NUMAT has used differentiated project implementation strategy in the Lango

and Acholi sub regions. This is because of the variation in the security situation in the two sub regions.

In Lango, where the security situation is more stable and 79% of the displaced people returned to their

homes, NUMAT supports activities aimed at strengthening existing community and facility based

HIV/AIDS/TB and malaria services. Services at static are strengthened to meet the increasing demand by

the returning population while other particular services will continue to be scaled up at lower levels of

service delivery. In Acholi, though the conflict has almost disappeared, significant parts of the population

remain in the main camps while about 45% have moved to smaller satellite camps closer to their homes

and a good number are also returning home. The NUMAT Project will continue supporting services to

populations both in the peripheral camps and those returning home. The project will continue working with a

host of other stakeholders to scale up mobilisation and service provision and referral for HIV/AIDS/TB and

malaria services for both the returning and the remaining camp populations.

.

In FY 07 the project worked with District health teams and the District HIV/AIDS coordination structures to

develop district specific HIV plans. Project teams participated in coordination activities involving other

agencies in the nine districts. Logistical and technical support was also provided to each of the districts to

strengthen their planning and coordination activities particularly at the sub county level. In FY 08, the

project will build on the achievements of FY 07 and will work with the districts to harmonize the different

district HIV/AIDS plans currently in place and support the process of integrating them into the overall District

development plans.

NUMAT will continue working with the Uganda AIDS Commission to operationalize the National HIV/AIDS

Coordination Guidelines in the program districts and support the districts to adapt the guidelines to reflect

the reality of the post conflict situations. In districts where DACs are well organized and operational (Lira,

Apac and Kitgum) they will be strengthened through training and logistical support. In districts where these

structures are weak or nonexistent (Pader, Gulu, Amolatar, Dokolo and Oyam)) the project will work with

other agencies like UNOCHA and other UN bodies to support existing Sector Working Groups structures,

like the DMMC, to ensure improved coordination of HIV/AIDS/TB activities. The project will advocate and

work closely with the local government leadership to ensure high profile officers are named to the District

Focal Point positions. Logistical support, incentives, facilitation and training in multi-sectoral coordination of

HIV/AIDS will be provided to focal point persons to enable them perform their roles more effectively.

Technical and logistical support will also be provided to the sub-county coordination structures (Sub-country

AIDS Committee and Task Force - SACs and SATs). Where camps still exist, the project will support camp

management structures to plan, coordinate and monitor implementation of HIV/AIDS activities and

encourage linkages with SACs. The project will support coordination, networking and referrals among

service providers in sub-counties and Internally Displaced Persons (IDP) camps.

In view of the acute human resource constraints facing the conflict affected districts of the North, one

specific area that the project will put focus on is to work with other stakeholders to address innovatively the

critical human resource gaps in the region. NUMAT will collaborate with UNICEF and other stakeholders in

the implementation of the minimum package of Health facilities support and with others to design and

implement appropriate incentive packages that will be linked to a broad human resource support strategy in

conflict and post conflict districts.

In addition to strengthening the official coordinating bodies, the project will invest in strengthening CSOs

and their networks in the district. The project will work with national partners like Uganda Network of AIDS

Service Organization, National Forum for people living with HIV/AIDS in Uganda and the NGO Forum to

build the capacity and improve coordination among HIV/AIDS CSOs involved in HIV/AIDS related services.

Specifically we will partner with NAFOPHANU to strengthen and/or establish district PHA networks and to

mobilize and support PHA groups in the IDP camps. In the IDP camps, through PTC and Psychosocial

support, newly identified PHAs will be encouraged to form new or join existing PHA groups in the camps.

The district PHA networks will also be supported to facilitate processes of identifying and selecting their

representatives to the district HIV/AIDS coordination and planning structures, taking into consideration not

only HIV-status but also gender and age.