The overall program goal is to increase the uptake of PMTCT interventions that are currently being offered

for pregnant women and their families in Uganda. The Uganda Ministry of Health (MOH) together with

development partners have been implementing a national PMTCT program since 2001 through integration

of the PMTCT interventions into existing health care services. PMTCT services have now been expanded to

all districts countrywide. However, despite the improvement in availability and accessibility of effective

interventions to prevent MTCT, the coverage of HIV positive pregnant women enrolling for PMTCT services

is still low (30%). Routine opt-out HIV counseling and testing strategy has been introduced in all antenatal

clinics to address this problem; but there is still a cascade drop out of clients at every level of PMTCT

intervention through antenatal, delivery and Postnatal care. In addition, currently most pregnant mothers

learn about the possibility of preventing the transmission of HIV to their children during visits to antenatal

clinics and about 62 percent of mothers deliver outside health facilities with traditional birth attendants (TBA)

or relatives which makes it impossible for some HIV positive mothers to access appropriate interventions for

PMTCT. Socio-cultural and economic factors constitute major deterrents for women's utilization of PMTCT

services and their failure to come back to the health facilities for deliveries as recommended under PMTCT

guidelines. This includes limited male partner involvement in PMTCT programs, social stigma and the high

community attachment and preferential use of traditional birth attendants (TBA). The current PMTCT policy

recommends the implementation of a four-pronged comprehensive PMTCT strategy including: primary

prevention; preventing pregnancies among HIV positive pregnant women (family planning); provision of

effective ARV prophylaxis and provision of care and support services in all PMTCT sites. This program will

develop and implement several community-led approaches to address the social and behavioral factors that

affect the uptake of PMTCT services through social mobilization, local-language behavior-change

communication, and service provision. These approaches will focus on PMTCT promotion, education,

motivation and increasing the demand for services in the communities systematically. The program will also

establish and use referral networks for an array of HIV/AIDS and other health services to ensure HIV-

infected mothers and their families receive appropriate health care services. Community support groups,

including TBA and other organized community groups in Uganda, will participate in the provision of psycho-

social support to address issues such as disclosure, stigma, discrimation, and appropriate infant feeding; in

addition, they will participate in the mobilization of communities and referral for the utilization of PMTCT

interventions, in accordance with Ugandan Ministry of Health guidelines. This program will forge a strong

partnership with the national coordination team and PMTCT service providers for the implementation of

activities.

Key strategies for this program will include, among others mass-media, local language information,

education and communication (IEC) campaigns, interpersonal channels and community dialogue. In

addition, professional linkages and family-based outreaches will support community-based PMTCT. This

program will also put special emphasis on improving the participation of male partners and family support

for PMTCT activities by establishing appropriate strategies at both the health facility and community levels.

The program will design effective follow-up activities and the provision of linkages to the health units where

PMTCT is available; it will also develop and implement systems for support, supervision, and monitoring of

program activities. This program will contribute to the following PMTCT results:

The proportion of pregnant woman who attend ante-natal care (ANC) at least three times will increase from

50% to 70% (534,590 - 700,000).

The proportions of pregnant women who receive HCT will increase from 72% to 90% (368,000 - 480, 000).

The number of HIV-positive women identified will increase by from 20,000 to 50,000.

The proportion of women who deliver at health facilities will increase from 38% to 50% (242,200 - 500,000)

According to the recent Sero-Behavioral Survey (2004/05), almost one million people in Uganda are

infected with HIV i.e. 6.4% of adults aged 15-49 years and about 0.7% of children aged less than 5 years

(MOH and ORC Macro, 2006). Women are disproportionately affected at younger age compared with men;

for instance, the male : female ratio among teenagers aged 15-19 years is 1:9, while among young people

15-24 years is 1:4. HIV prevalence is generally higher for women than for men in the reproductive age-

group i.e. 15-49 years, with the pattern reversing after the age of 50, where HIV prevalence is slightly higher

among men than women. The current PMTCT policy recommends the implementation of a four-pronged

comprehensive PMTCT strategy including: primary prevention; preventing pregnancies among HIV positive

pregnant women (family planning); provision of effective ARV prophylaxis and provision of care and support

services in all PMTCT sites. This program will develop and implement several community-led approaches

that focus on preventing HIV infection among young women in communities by promoting safer sexual

behaviors and sexual norms through Abstinance and Be faithful interventions; promotion of HIV sero status

knowledge among young women and advocating for change in the cultural and sexual norms which

encourage high risk sex for young women. The program will establish and use referral networks for an

array of HIV/AIDS and other health services (Abstinence and Be Faithful, condoms and other prevention

activities). Community support groups, opinion leaders and other organized community groups in Uganda,

will participate in the promotion of safer sexual practices in the communities. The program will also forge a

strong partnership with the national coordination team and PMTCT service providers for the implementation

of activities.

Key strategies for this program will include, among others, promotional and motivational activities for

PMTCT through mass-media, local language information, education and communication (IEC) campaigns,

interpersonal channels and community dialogue. In addition, professional linkages and family-based

outreaches will support community-based PMTCT. The program will provide linkages to the health units for

the provision of other components such as HCT services.

It is estimated that in Uganda about 1 million women get pregnant yearly and with an estimated HIV

prevalence of 6.5%, about 65,000 HIV-infected women get pregnant yearly. Moreover, Uganda's population

growth is among the highest in Africa with an annual growth rate of 3.4% while utilization of modern family

planning methods remains below 25%.

The current PMTCT policy recommends the implementation of a four-pronged comprehensive PMTCT

strategy including: primary prevention; preventing pregnancies among HIV positive pregnant women (family

planning); provision of effective ARV prophylaxis and provision of care and support services in all PMTCT

sites. The primary goal of this program is to improve the utilization of family planning services specifically for

HIV infected women in Uganda through community led approaches. Family planning in the context of

PMTCT is intended to prevent both re-infection and unintended pregnancies among women living with HIV.

The program will address the family planning needs of sexually active HIV positive women. Pregnant

women living with HIV in the communities will be counselled and supported to avoid subsequent

pregnancies. Dual protection (Condoms + hormonal contraceptives) family planning services will be

promoted for HIV positive women and their partners. Community support groups, including TBA, opinion

leaders, community health workers and other organized community groups in Uganda will participate in the

Education, Mobilization and Sensitization of communities for the utilization of family planning services for

PMTCT .The program will forge a strong partnership with the national coordination team and PMTCT

service providers for the implementation of activities.

Key strategies for this program will include, among others, promotional and motivational activities for

PMTCT through mass-media, local language information, education and communication (IEC) campaigns,

interpersonal channels, referral and community dialogue. In addition, professional linkages and family-

based outreaches will support community-based PMTCT. This program will also put special emphasis on

improving the participation of male partners and family support for PMTCT activities by establishing

appropriate strategies at both the health facility and community levels. The program will design effective

follow-up activities and the provision of linkages to the health units where PMTCT is available; it will also

develop and implement systems for support, supervision, and monitoring of program activities.

This program will contribute to the increase in the proportion of HIV-positive mothers who use modern

contraceptive methods on a voluntary basis to 50 percent. (The baseline for this indicator is currently not

available.)

This activity was initiated in FY 2007 but has not yet been implemented because the partner has not yet

been awarded funds. This initiative will provide 100% access to confidential home-based HIV counseling

and testing services in selected high HIV prevalence districts in the central region of Uganda. The program

will ensure that the entire adult population and their family members are offered confidential counseling and

testing services in their home-settings as outlined in the national HIV counseling and testing policy

guidelines. The program will establish a systematic approach to reach all households using outreach teams

comprising counselors, laboratory assistants, and community mobilizers. Following the national rapid testing

algorithm, these teams will be trained to work throughout the community, visiting each home to offer

confidential counseling and testing services. To ensure the accuracy of this home-based testing, a

laboratory quality assurance process will be developed in collaboration with the national reference

laboratory. A consistent supply chain for essential HIV testing commodities will be established and

maintained for sustainability after the end of the project period. In addition, routine program data will be

collected to inform program implementation and management, identify gaps in services, and address

reporting requirements.

The overall goal of the Full Access Home Based Confidential Counseling and Testing program is to identify

HIV positive clients and refer them to appropriate sources of care, treatment and support services within the

district. The key components of this activity include strengthening the referral systems in the districts,

including public and non-governmental organization health units, to be able to provide basic preventive and

palliative care, and supporting community based organizations to establish, expand, and strengthen

indigenous sources of ongoing psychosocial support in the communities. The target population for this

activity includes all HIV positive clients identified through this program. All clients testing positive will receive

a Basic Preventive Care package that includes: cotrimoxazole prophylaxis information; a safe water vessel

and chlorine solution; long-lasting insecticide treated bednets; condoms, as appropriate; educational

materials; and prevention with positives counseling. In addition, the program will establish an effective

referral system for all HIV positive individuals identified. The program will facilitate technical assistance as

to ensure that comprehensive HIV/AIDS services are readily available at nearby health facilities. Community

structures for HIV prevention education, post-test clubs and peer support groups to assist and follow-up HIV

positive clients and their families will also be developed or strengthened as needed. Health unit staffs as

well as community mobilizers will receive training on the provision of the basic care package. In addition, all

health units in the district will be strengthened with additional staffs, infrastructure, logistics and supplies to

be able to provide care for the medical needs of HIV-infected people. Finally, the program must facilitate

access to dedicated couples counseling services or support establishment of these services if it is not

already available in the community.

In FY 2008, the program will continue to implement these activities in the region ensuring individuals are

offered home based counseling and testing and for those testing positive, a basic care preventive care

package as well as effective referral to appropriate health services. The program will also continue to

development and implement community support networks as needed for HIV positive individuals and their

families in the communities.

This initiative will establish 100% access to confidential home-based HIV counseling and testing services in

selected high HIV prevalence districts in the central region of Uganda. The program will ensure that the

entire adult population and their family members are offered confidential counseling and testing services in

their home-settings as outlined in the national HIV counseling and testing policy guidelines and establish a

systematic approach to reach all households using outreach teams comprising counselors, laboratory

assistants, and community mobilizers. Following the national rapid testing algorithm, these teams will be

trained to work throughout the community, visiting each home to offer confidential counseling and testing

services. To ensure the accuracy of this home-based testing a laboratory quality assurance process will be

developed in collaboration with the national reference laboratory. A consistent supply chain for essential

HIV testing commodities will be established and maintained for sustainability after the end of the project

period. In addition, routine program data will be collected to inform program implementation and

management, identify gaps in services, and address reporting requirements.

The primary goal of this activity is to decrease the burden of TB among PHAs in identified by the HBCT

program through integrated TB/HIV interventions.

All clients testing positive will receive a Basic Preventive Care package that includes: cotrimoxazole

prophylaxis information; a safe water vessel and chlorine solution; long-lasting insecticide treated bednets;

condoms, as appropriate; educational materials; and prevention with positives counseling. In addition, the

program will establish an effective referral system for all HIV positive individuals identified for care and

support including TB screening and treatment at the health facilities within the districts. Routine counseling

and testing will be offered to all TB patients receiving treatment at the health facilities. TB diagnostic

capacity in the district will be built by equipping health facilities, recruitment and training of health personnel.

CB-DOTS will be introduced in all sub-counties and supervision by sub-county health workers will be

supported.

The program will continue to implement these activities in the region ensuring individuals are offered home

based counseling and testing and for those testing positive, a basic care preventive care package as well as

effective referral to appropriate health services. The program will also continue to development and

implement community support networks as needed for HIV positive individuals and their families in the

communities.

This initiative will establish 100% access to confidential home-based HIV counseling and testing services in

selected high HIV prevalence districts in the central region of Uganda. The program will ensure that the

entire adult population and their family members are offered confidential counseling and testing services in

their home-settings as outlined in the national HIV counseling and testing policy guidelines and establish a

systematic approach to reach all households using outreach teams comprising counselors, laboratory

assistants, and community mobilizers. Following the national rapid testing algorithm, these teams will be

trained to work throughout the community, visiting each home to offer confidential counseling and testing

services. To ensure the accuracy of this home-based testing a laboratory quality assurance process will be

developed in collaboration with the national reference laboratory. A consistent supply chain for essential

HIV testing commodities will be established and maintained for sustainability after the end of the project

period. In addition, routine program data will be collected to inform program implementation and

management, identify gaps in services, and address reporting requirements.

Communities will be mobilized and sensitized about the program using appropriate media channels in the

district with the assistance of community based volunteers. HIV counseling and testing activities in the field

will be supervised by a qualified lab technician, counselor and project coordinator. A sample of tested

specimens will be routinely stored on filter paper and transported to the national reference laboratory for

quality assurance testing. This system will ensure accurate performance of the HIV tests in a field setting.

By offering counseling and testing services to 100% of the population, the program will dramatically

increase the number of people testing for HIV in a short time thus identifying HIV positive clients for care

and treatment early enough.

In FY 2008, the program will continue to implement these activities in the region ensuring individuals are

offered home based counseling and testing and for those testing positive, a basic care preventive care

package as well as effective referral to appropriate health services. The program will also continue to

development and implement community support networks as needed for HIV positive individuals and their

families in the communities.