PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
ACTIVITY UNCHANGED AND ENDING IN DECEMBER 2008. NO FY 2009 FUNDS ARE PLANNED FOR
THIS ACTIVITY.
This activity will focus on community mobilization activities to promote positive behaviors such as: gender
equity; couple dialogue; partner counseling and testing; disclosure; and accessing treatment together.
Community mobilization activities will also be directed towards elimination of negative behaviors that bring
about stigma and discrimination associated with HIV/AIDS. TASO will support to strengthening/setting up of
PLHA networks through training and logistics support in 28 districts of Uganda. PLHA networks will increase
community mobilization, address stigma, denial and discrimination among PLHAs and their communities,
and facilitate referral for treatment. This support is expected to increase the overall capacity of PLHA
networks to access additional funding opportunities.
New/Continuing Activity: Continuing Activity
Continuing Activity: 24543
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
24543 24543.08 U.S. Agency for The AIDS Support 9320 9320.08 TASO $221,660
International Organization
Development
Table 3.3.02:
Continuing Activity: 21457
21457 21457.08 U.S. Agency for The AIDS Support 9320 9320.08 TASO $407,340
Program Budget Code: 04 - HMBL Biomedical Prevention: Blood Safety
Total Planned Funding for Program Budget Code: $4,900,000
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Medical transmission is not a primary driver of the HIV/AIDS epidemic in Uganda, however biomedical transmission deserves
continued attention because of the potential for spreading HIV infection in the health care setting, as well as the important
contribution to health systems strengthening. Uganda's Ministry of Health (MOH) seeks to establish an environment where health
workers, patients, and communities are better protected against transmission of blood borne pathogens. USG supports a
comprehensive approach to both injection safety and blood safety in line with national priorities and to meet the needs of the
Ugandan population.
A high rate of injections (3 per person per year) has been documented in Uganda, which underscores the importance of limiting
unnecessary injections through Injection Safety interventions. Blood transfusion is an essential life-saving therapy; more than 3
out of 4 of the beneficiaries are children due to malaria-associated anemia and mothers with post- partum hemorrhage.
Injection Safety
With USG Track 1 funding the Making Medical Injections Safer (MMIS) project has continued to provide technical and financial
assistance to the Ministry of Health (MOH) in prevention of medical transmission of HIV through rapid reduction of unsafe and
unnecessary injections. Given that the country has adopted the use of auto-disable syringes and needles, there is need to build
capacity among health workers countrywide on injection safety practices, management of medical waste, and logistics
management. In order to increase coverage of infection control activities, the PEPFAR country program and WHO provided
additional resources to support rapid scale up infection control activities.
The key strategies for the program include: improving service provider skills; behaviour change and communication aimed at
reducing unnecessary injections; improving the logistics system to ensure regular supply of injection commodities; and improving
health care waste management. Consistent with the MOH plans of introducing syringes with re-use prevention features
nationwide, USG supported the scale up of interventions in 5 expansion districts while sustaining desired practices in the initial
twenty districts. The main challenge envisaged in supporting injection safety activities is the anticipated phase out of USG
centrally funded mechanism in FY09. The USG country program is not in position to bridge the gap due challenges associated
with level funding.
The Injection Safety program has been operating for 4 years. Findings from the recently concluded Service Provision Assessment
survey show that sharps boxes while not widely available were more available than other infection control items. Guidelines on
injection safety were scarce at surveyed facilities being available in only 17% of them. Almost 70% of facilities surveyed had an
adequate sharps waste disposal system. In additional almost all injections observed were administered using a new needle and
syringe from a sealed sterile pack, and the majority of the time the used injection equipment was immediately disposed of
appropriately
FY09 is the last year during which the centrally funded MMIS project will be operational globally and in Uganda. The USG team
plans to continue funding injection safety activities using country funds, albeit at a decreased level, to ensure that gains are not
reversed. No decision has yet been reached on the type of option that is best suited to program injection safety activities beyond
FY09 (e.g., directing funding of MOH or through USAID central mechanism).
Health Care Waste Management
Recognizing that final disposal of health care waste is one of the biggest challenges in medical transmission of HIV, and in
response to the Ministry of Health policy of allocating at least 10% of the commodity budget towards Health Care Waste
Management (HCWM), USG funds are being used to support the Ministry of Health to roll out the health care waste management
policy in MMIS project areas of operation and to provide technical assistance to the PEPFAR partners who will meet the actual
cost of their HCWM plans.
Blood Safety
The Government of Uganda is committed to ensuring elimination of HIV transmission through blood transfusion. Uganda's
National HIV/AIDS Strategic Plan 2007-12, blood safety objective is ‘‘maintaining 100% blood transfusion safety, ensure 100%
adherence to universal precautions and promote 100% access to PEP at ART centers". The program is, however, challenged to
meet the increasing demand for blood and blood products, mainly due to rapidly growing population and upgrading of health
facilities to Health Center IV and district hospital especially in the newly created districts.
Currently, the centrally funded PEPFAR blood safety program is the main donor to the Uganda blood safety program. While this
support is expected to phase out in 2010, the blood safety program will still require substantial financial resources from the
USG /PEPFAR country program, government and development partners in order to sustain and expand blood transfusion
services.
The Blood Safety Program is implemented by the Uganda Blood Transfusion Service (UBTS) a semi autonomous institution under
the MOH and sub-partner Uganda Red Cross Society (URCS) a charitable, not for profit organization. Currently, about 100,000
patients receive blood or blood products annually in roughly 160 major public and private health facilities throughout the country.
Nearly half of the recipients of blood or blood products in Uganda are pediatric, a quarter are obstetric, with the remaining
recipients comprising medical (many HIV-related) and surgical patients.
USG/PEPFAR, through Track 1 funding, supports a comprehensive approach to blood safety in line with national priorities to meet
the needs of the Ugandan population. Key goals of the blood safety program include: 1) retention of low-risk, voluntary, non-
remunerated repeat blood donors; 2) care referrals for HIV-positive donors; 3) collection, testing, storage and distribution of blood
products; 4) staff training; 5) quality assurance; and 6) monitoring and evaluation. In addition, USG supports adequate and
appropriate infrastructure, transport, supplies and equipment to ensure that program goals are met.
Blood transfusion needs are expected to grow by 20% annually to reach 200,000 units of blood in FY09, and with Uganda's
rapidly growing population, blood transfusion needs are expected to grow in the subsequent years. Therefore, maintaining
adequate quantities of safe blood and blood products will become an ever-increasing challenge. Community mobilization and
education for donor recruitment is jointly implemented by the UBTS and URCS. Together, these institutions have built a
countrywide network to access communities, schools and workplaces. Access to and regular communication with individuals and
communities has greatly improved with the recruitment of additional staff, and purchase of additional transport for program field
activities. The program has worked collaboratively with URCS and the blood safety technical assistance group, Sanquin
Consulting Services (SCS), to improve blood donor selection and counseling, and this collaboration will continue in FY09.
Compared to new donors, repeat donors have a lower HIV sero-prevalence. Repeat donors currently represent 55% of all donors,
and in FY09, the proportion of repeat donors is targeted to increase by 10%. Retention of voluntary, non-remunerated HIV
negative donors through URCS supported blood donor clubs is particularly vital for running a successful blood safety program.
Recruitment and retention of voluntary, non-remunerated low-risk blood donors has been enhanced through increased use of
electronic and print media, mobile phone text messages, and scheduled visits by counselors. Plans are in place to increase the
participation of corporate bodies, churches and Rotary Club Uganda in community sensitization and mobilization activities in
FY09.
Quality assurance activities, as well as the implementation of a newly developed quality assurance system covering all stages of
the transfusion process, will be strengthened. Related QA manuals have been completed, along with staff training and
supervision. Quality indicators have also been finalized and will be utilized to secure a safe blood supply.
Human capacity improvements have been made, and UBTS's staff structure has been approved by the Ministry of Public Service,
and the MOH will continue to support salaries for these staff.
Maintaining high standards for blood collection, testing, storage and distribution is also critical to the program's strategy. UBTS
tests all transfusion bloods for HIV and TTI (hepatitis B and C, and syphilis) using effective testing algorithms at the seven
regional blood bank laboratories: Arua, Fort Portal, Gulu, Kitovu, Mbale, Mbarara and Nakasero. Development and expansion of
blood bank infrastructure in the western and eastern regions (Mbarara and Mbale respectively) is being completed, while in FY08
under RPSO, work is in progress for the expansion and renovation of the national referral laboratory and the UBTS administrative
offices in Kampala, Nakasero. The reference laboratory at Nakasero continues to offer technical assistance for HIV counseling
and testing programs, and laboratory equipment for this purpose has been purchased for these centers. In addition, improvements
in the cold chain and distribution of blood have been made with purchase of refrigerators, freezers and cold boxes.
CDC Uganda has provided technical assistance for strengthening the Management Information System (MIS) for the program,
and this will continue through FY09. Data reporting forms have been revised to enable the program to generate MIS reports for all
vital activities on daily, weekly and monthly basis. Computerization of laboratory equipment is now in progress.
In FY09, capacity building will remain a priority for the program, particularly in the area of enhancing infrastructure. Inadequate
infrastructure and space at the regional blood banks and the national referral laboratory remains a major challenge to the
expansion of the program operations and meeting the ever-increasing demand for safe blood in the country. In FY 09,
construction of 2 additional regional blood banks in northern (Gulu) and western Uganda (Fort Portal) will be undertaken. The
MOH has offered the land for the construction of these new buildings. Availability of adequate transport is also crucial for running
an effective blood safety program. Therefore, in FY09, more vehicles will be purchased to support mobilization, blood collection,
and monitoring and evaluation activities.
To encourage repeat donations in FY09, post donation counseling will continue to be provided and appropriate referral of HIV-
positive donors to HIV/AIDS care and treatment services will continue. Although not the main service of the program, thousands of
potential and repeat donors benefit from the HIV and transfusion transmitted infections (TTI) prevention counseling and referral to
HIV prevention and care services.
Training remains a critical component of the program. In FY09, varying approaches will be used to train all cadres of program staff
in country in line with the national blood safety training program. In collaboration with SCS, a Masters Degree training program in
Management of Transfusion Medicine for regional blood bank directors will continue to be offered in the Netherlands. Additionally,
UBTS and SCS will work to finalize blood safety course modules for adoption in pre-service curricula of medical training
institutions, with the aim to foster appropriate clinical use of blood and blood products in the long term. In the interim, the program
will continue with regular continuing medical education seminars with clinical staff at major teaching hospitals along with support
for formation of, and regular interactions with hospital transfusion committees.
Medical Male Circumcision
Medical Male Circumcision (MMC) is being championed by the MOH as an effective prevention intervention, and is included in the
2007-2012 NSP. A situation analysis was conducted by the MOH and the Makerere University School of Public Health, with USG
support, using the WHO and UNAIDS toolkit. Analysis of the results has been completed and public dissemination considered for
November- December of 2008. A series of professional and public debates have been organized with press coverage in the local
media. USG has supported the MOH in the development of a communication strategy for medical male circumcision, which will be
finalized and disseminated in FY09.
In FY08, the USG team received a request from the MOH to support a scale up of MMC services in the country. As a result of this
request, the USG team will provide assistance to the MOH to develop a MCC policy as well as a strategy for scale up of services,
which will be based on the results of the situation analysis. Pending a scale up strategy, USG support for service delivery will
proceed cautiously. To date, USG has supported the training of providers in a limited number of districts, particularly those
adjoining Rakai District, who have requested assistance from the Rakai Health Sciences Program (RHSP) to support service
delivery and supervision in selected facilities (Health Center IVs). Rakai Health Sciences Program (RHSP), which carried out one
of the three definitive MCC trials, serves as the training center. The RHSP has a state-of- the art outpatient surgical facility and
highly experienced surgical teams, and has been selected by WHO to serve as a regional MMC training center. RHSP has
proposed to facilitate safe MMC by offering training to different cadres of medical personnel.
In FY09, MMC training, supervision and service delivery will extend to Kayunga Hospital which is supported by the Makerere
University /Walter Reed Project (MUWRP). MUWRP is responding to a request from health authorities in Kayunga district to
implement male circumcision services at the district hospital. A similar model will be followed with RHSP providing the training and
supervision for providers at the Rakai district hospital.
There is still some reluctance in Uganda, outside of the MOH, to embrace MMC as an effective prevention intervention, due
mainly to socio-political factors. In addition to proceeding cautiously on training and service delivery in FY09, the USG will
continue to support advocacy efforts by the MUSPH and the MOH to improve understanding of MCC, increase acceptance and
decrease opposition to this effective prevention measure.
During FY09 the USG will support 2 MMC service sites and the training of 45 MMC surgeons and 50 other MMC-related
providers.
Table 3.3.04:
Continuing Activity: 21469
21469 21469.08 U.S. Agency for The AIDS Support 9320 9320.08 TASO $1,954,780
Table 3.3.08:
Continuing Activity: 21640
21640 21640.08 U.S. Agency for The AIDS Support 9320 9320.08 TASO $50,000
Table 3.3.16:
