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.
Years of mechanism: 2008 2009
The Makerere University Walter Reed Program (MUWRP) falls under the auspices of the US Military HIV
Research Program and has a Memorandum of Understanding with Makerere University of Uganda.
MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently HIV care,
treatment, and prevention. Among the goals of MUWRP is to build the infrastructure and capacity of local
public and private partners in central Uganda to ensure quality HIV services for communities participating in
HIV cohort studies and vaccine research. Since 2005 MUWRP has increased its PEPFAR support to the
Kayunga District by supporting a comprehensive HIV program, which includes expanding the number of HIV
clinical sites; improving laboratory services, infrastructure, data collection, supplies, human capacity
development; innovative task shifting; short-term technical staffing, OVC services, a variety of counseling
and testing and prevention programs; and youth focused programs for HIV education.
The Sexual Prevention program area described below is part of a comprehensive program with activities
that link to other program areas, including care, treatment, strategic information, counseling and testing,
laboratory, and OVC services.
Sexual Prevention: Youth and Adult programming
During FY 2008, MUWRP's Abstinence and Be Faithful program trained and supported volunteers and
District lay workers including 1200 treatment club members, and 37 dedicated youth volunteers to carry out
AB prevention activities. Activities included counseling, messaging campaigns, prevention with positive
activities and the development and standardization of IEC materials. Messages and activities focused on
fidelity, partner reduction, couples counseling, and delay of sexual activity. In addition to AB messages,
these lay workers concentrated on male norms and behaviors, increasing gender equity, cross generational
sex, increasing women's legal rights and access to income and productive resources including life skills as
they are related to HIV prevention. In addition, the program has been supporting the infrastructure and
activities of a vibrant and well-attended youth center, the Kayunga District Youth Recreation Center. In
partnership with the US Peace Corps and the Kayunga Town Council, MUWRP supports this center to be a
place of recreation and education for young people, ensuring that they are active, engaged, and provided
with an array of health related services, including HIV education, testing and counseling. Finally, during
FY2008, MUWRP supported activities for and outreach to at-risk out of school youth, youth in schools, and
also high-risk fishing village youth populations along the Nile and at the inlet to Lake Kioga. Specific
community activities included bi-weekly mobile HIV education outreaches, youth outreaches to schools and
communities, and a District-wide sports competition with a HIV education, counseling and testing
component. By June 2008, more than 10,000 individuals had been reached and were provided with
abstinence and be faithful services and 20 persons had been trained
During FY2008 sexual prevention activities included reducing violence and coercion throughout Kayunga
District, in all 9 sub-counties. Several reinforcing approaches were used in this respect, including training
the entire Kayunga District police force, District clinicians, and lay workers - as well as a billboard campaign
utilizing treatment club members in the photos. The messages of the billboards focused on testing for HIV,
the benefits of disclosing ones' HIV status, and a billboard series on preventing domestic violence.
MUWRP partnered with technical experts from the SHARE project and Raising Voices, both local NGOs
with expertise in gender based violence to ensure quality trainings, billboard messages, and consistent
(WHO standards) effective IEC messages were disseminated to the District communities through a variety
fixed and mobile venues. Moreover, MUWRP supported a District-wide HIV drama competition that focused
on domestic violence and the winning group toured all 9 sub-counties performing their play deep in the
communities. Dissemination of messages under this program area continues to be District wide, utilizing:
radio, marketplace loud speakers, roadside billboards and (coordination of District) state-of-the-art IEC
materials. During FY2008, MUWRP implemented a post-exposure prophylaxis program at each HIV clinic
site in Kayunga for victims of rape, defilement, or any other person who has had immediate exposure to
HIV. Finally, MUWRP supported the NGO Reproductive Health Uganda to deliver age-appropriate
reproductive health training to 30 youth counselors as well as in-depth training to an additional 30 District
clinicians.
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
All of the above activities will continue during FY2009, however due to the start of MUWRP's house-to-
house (H2H) counseling and testing program, which began in Kayunga District during FY2008, there has
been a greatly increased need for AB and OP counseling, messages, and IEC materials. H2H program
counselors need to be trained to deliver messages pertaining to AB, domestic violence, gender issues, and
other HIV sexual prevention. These counselors need to be supplied with various IEC materials to deliver to
families participating in the program. Since the goal of the H2H program is to reach all Kayunga
households, these services delivered in conjunction with the program will strengthen HIV prevention for all
of Kayunga District. Radio and billboard messages, encouraging families to welcome H2H program
counselors into their homes will also be supported. In addition, during FY2009, MUWRP intends to enter
Mukono District to support the Kojja Health Center IV. The initial aims of this support will be to promote
sexual prevention, counseling and testing, and care and treatment for the entire sub-district of Mukono
South; which includes supporting 3 surrounding health center III's. These services will be extended via
mobile outreach programs offering sexual prevention counseling to the surrounding fishing communities
along Lake Victoria. Mukono South sub-district has a population of 120,000 persons and in May 2008, the
in-charge of Kojja reported that no prevention programs except PMTCT were available. Specific prevention
activities planned for this area will include training the Mukono police force, clinicians and treatment club
members on issues pertaining HIV sexual prevention, including: prevention with positives, living positively,
condom use, cross generational sex, and domestic violence/gender issues. Building on successes in
Kayunga District, MUWRP will expand drama and sports competitions to the sub-district of Mukono South
as a means to promote AB and OP messages. Dissemination of messages in Mukono south will also
involve utilizing: radio, marketplace loud speakers, and IEC materials.
Finally for FY2008, MUWRP has relied on research infrastructure in the past to support data entry activities
for sexual prevention reporting to OGAC. The increase in data requires the hiring of a new data entry staff
for recording of all sexual prevention activities.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15709
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15709 8544.08 Department of Walter Reed 7234 1245.08 Makerere $138,000
Defense University
Walter Reed
Project
(MUWRP)
8544 8544.07 Department of Walter Reed 4873 1245.07 Makerere $138,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Reducing violence and coercion
Health-related Wraparound Programs
* Family Planning
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $50,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $1,000
Economic Strengthening
Estimated amount of funding that is planned for Economic Strengthening $1,250
Education
Estimated amount of funding that is planned for Education $4,000
Water
Program Budget Code: 03 - HVOP Sexual Prevention: Other sexual prevention
Total Planned Funding for Program Budget Code: $13,311,143
Total Planned Funding for Program Budget Code: $0
Table 3.3.03:
MUWRP has been working in Uganda since 1998 in the area of HIV research and more recently care and
treatment. Among the goals of MUWRP is to build the infrastructure and capacity of local public and private
partners in the Kayunga District of eastern Uganda to ensure quality HIV services for communities
participating in HIV cohort studies and vaccine research. In FY2006 and FY2007MUWRP increased its
PEPFAR support to the Kayunga District and expanded the number of HIV/ART clinical care sites from one
to four. MUWRP assisted the District Health authorities by supporting HIV treatment sites in improving
laboratory services, infrastructure counseling and testing, data collection, supplies, training and with
provision of short-term technical staffing. Also, MUWRP has supported activities that improved the
identification of and provision of services to the Districts' population of orphans and vulnerable children.
These activities link to MUWRP activities under Treatment, Care, OVC, CT, and Strategic Information. The
Condoms and Other Prevention program as described below is part of a comprehensive program and its
execution linked to other program areas. Program activities that are included in this comprehensive
approach, such as care, treatment, OVC, and CT services, will be budgeted under their respective program
areas. This OP Program will focus on training and supporting District lay workers, treatment club members,
youth volunteers and PLA groups to carry out most OP Program activities. An OVC MUWRP partner, Child
Advocacy International, will also disseminate OP messages through their bi-monthly community
sensitizations targeting OVC adult care givers and community members. A MUWRP Prevention
Coordinator will ensure that three Prevention with Positive groups, located through the Districts HIV clinics,
are trained and supported to play a pivotal role in OP prevention outreach, including condom education,
promotion and distribution through eight sites. Condom supply through the GOU is erratic and MUWRP will
serve as a back-up source for the District. MUWRP will follow GOU policy and guidelines pertaining to
condoms, not distributing condoms to persons under 18 years of age.
OP Programs will disseminate information on issues concerning: male norms and behaviors, the counseling
component of male circumcision, cross generational sex, gender equity through approaches such as
education on women's legal rights and access to income generating programs including life skills trainings.
Another primary focus will include reducing violence and coercion against women in the communities
through trainings, community sensitizations and messaging. Messages will be acquired from well-known
local and international sources such as the GOU MOH and from Straight Talk. Some resources and
messages will be modified or developed as required based on the assessment of the specific target
audience's needs, behaviors and gaps in understanding. All messages and programs will be coordinated
and vetted through the local MOH representatives to concur with national policy and approaches and to
ensure accuracy and relevance.
For implementation, the MUWRP prevention coordinator will partner with local groups to ensure quality
trainings and consistent, effective messages are disseminated to the District communities through a variety
of fixed and mobile venues and events including drama. This will include the establishment of a District-
wide messaging program which will be conducted through radio broadcasts, marketplace loud speakers,
and roadside billboards . MUWRP's mobile prevention program will complement district activities and will
include OP components, targeting out-of-school and in-school youth exhibiting high risk behaviors, married
couples (especially discordant), and high-risk fishing village youth populations along the Nile and at the inlet
to Lake Kioga. Data collected during CT and AB Prevention Program outreaches during FY2007 have
indicated that these District populations are at most risk for HIV infection.
As part of its youth prevention program, the Kayunga District Youth Recreational Center was founded in
2006 as a joint effort between the Kayunga District Hospital, the Kayunga District Government and
MUWRP. It functions as an organization/facility to build district capacity in identifying and providing HIV
prevention services to Kayunga Districts' youth population. The Center currently provides youth with
counseling, care and clinical services in a manner which is specifically geared toward young persons.
Center activities will include: counseling to youth, emotional support, and a variety of activities upon which
they will interweave prevention messages including recreational games, sports, music, and drama.
MUWRP supports this Center's activities and is leveraging resources with the District Town Council to
support staffing and event planning. This Center is currently directed by a MUWRP sponsored Peace
Corps Volunteer whose main focus is to integrate the local government in taking more of a stakeholder role
in the Center.
In addition, during FY2008, the MUWRP Prevention Coordinator will; (1) set up the infrastructure for a
circumcision program, including renovations of the District Hospital surgical theater, training of medical
officers in circumcision services and counseling, (2) establish strong links between persons found to be
HIV+ and HIV care and treatment centers at the District Hospital, two Health Center IV's and one Health
Center III, (3) establish and support family planning services utilizing District health personnel through the
District Hospital anti-natal clinic, (4) establish and support an STD clinic through the Kayunga District Youth
Recreation Center, and (5) establish a Post Exposure Prophylaxis program at the District Hospital for
victims of rape, defilement or other persons at immediate risk of exposure to HIV.
In FY2008 funding under this submission will support the costs of training, facilitation of volunteers,
acquisition and/or production of prevention materials, family planning and STD management commodities, ,
renovations to the District Hospital surgical theatre, community sensitizations, mobile costs , and staffing
including community mobilizers. Funding will also be used for small scale renovations at the Kayunga
District Youth Recreation Center.
Continuing Activity: 15769
15769 15769.08 Department of Walter Reed 7234 1245.08 Makerere $100,000
HIV cohort studies and vaccine research. Since 2005MUWRP has increased its PEPFAR support to the
Kayunga District by supporting a comprehensive HIV program including: expanding the number of HIV
clinical sites, improving laboratory services, infrastructure, data collection, supplies, human capacity
development, innovative task shifting, youth focused programs, short-term technical staffing, OVC services,
and a variety of counseling and testing and prevention programs.
These activities link to MUWRP activities under Treatment, Care, OVC, HCT, Prevention, and Strategic
Information. The Biomedical Prevention program as described below is part of a comprehensive program
and its execution linked to other program areas. Program activities that are included in this comprehensive
approach, such as care, treatment, and prevention services, will be budgeted under their respective
program areas.
The Uganda Ministry of Health has recently approved the roll out male circumcision services. During FY
2009 MUWRP, responding to a request from health authorities in Kayunga District, intends to begin the
process of developing and partnering with the District in the implementation of a circumcision services
program at the Kayunga District Hospital. This program will also involve partnering with the Rakai Health
Services program in Rakai, Uganda for the purposes of training at least 5 Kayunga District medical officers
in surgical circumcision techniques and other program essentials. Clinical officers will also be trained in
service provision when that curriculum becomes available. The program will initially be geared toward
providing service to HIV negative men as a potential means of reducing HIV transmission. When the
Uganda MOH policy is extended to include service provision to infant males, MUWRP will include that age
group in circumcision services. The surgical theatre at the Kayunga District Hospital will be renovated and
supported throughout the program so that safe circumcision services and counseling can be effectively
carried out. This will include provision of a changing room for clinicians and an anti-room for scrubbing and
sterilization. Further, other materials such as gowns, gloves, and air conditioners will need to be supported.
Finally, a recovery room for service recipients will need to be arranged and equipped. Over the past year, it
has become very clear to MUWRP staff that the success of a circumcision program, while proven
scientifically effective through 3 independent randomized control studies, will depend on the perception of
those persons receiving the service. MUWRP intends to roll this program out carefully focusing on the
perception of circumcision recipients prior to service
delivery and incorporating a robust patient and community education component on the need to continue
safe sexual practices. Clear policies and procedures and IEC materials will be developed using PEPFAR
guidance on this issue as well as an advertising campaign utilizing a billboard message located in the
center of Kayunga town council. Toward this end, program counselors will be trained (vendor TBD) to
ensure that each service recipient fully understand the value and the risks associated with male
circumcision as to ensure that this program accomplishes its designated task of reducing HIV transmission.
New/Continuing Activity: New Activity
Continuing Activity:
Estimated amount of funding that is planned for Human Capacity Development $19,000
Table 3.3.07:
The Adult Care and Treatment program described below continues to be part of a comprehensive program
and activities do link to other program areas. Specific program activities that are included in this
comprehensive program include prevention, SI, CT, laboratory, ARV drugs, and OVC services. During
FY2008, MUWRP greatly expanded adult care and treatment services to the north of Kayunga District, to
the rural, underserved, fishing communities of Galilyra. This was done by supporting an HIV clinic at the
Galilyra Health Center III, and training local clinicians and capacity building. Two other HIV clinics, the
Kayunga District Hospital and the Bbaale Health Center IV, were completely renovated during FY2008 to
successfully address issues of patient flow, confidentiality, waiting times, and staff morale. MUWRP
supportive supervision was expanded during FY2008 for all MUWRP supported HIV clinics, to four visits per
week. This included two MUWRP supported nurses, two clinical officers, one pharmacist, and one medical
officer. One primary focus of the MUWRP FY2008 adult Care and Treatment program was to train district
lay workers, treatment club members, and members of PLWHA groups to deliver the most basic of ARV
services. As a result of of this capacity building, volunteers have now developed 5 rural treatment club
nutrition farms (23 acres total) to supplement the diet of adult care and treatment patients - each of the
farms has already had one successful harvest and all patients have benefited regardless of the percent time
they have spent working on the farms. Treatment club volunteers have also distributed over 1200 basic
care packages to adult care and treatment patients and spearheaded a follow-up program that traces
patients deemed lost-to-follow-up to their homes. Data from this lost-to-follow-up program was presented at
the International AIDS Conference in Mexico City. Also during FY2008, MUWRP supported the
implementation of Post Exposure Prophylaxis Programs at each of the 5 HIV clinics in Kayunga for victims
of rape, defilement, or any other person who has had immediate exposure to HIV and also supported 30
District clinicians in a two-week training on reproductive health. Finally, Because ART and OI supplies are
not stable in Uganda; MUWRP has always served as a back-up source to ensure that neither PEPFAR nor
GOU MOH patients in Kayunga experience ART or OI drug stock outs.
During FY2009, MUWRP will meet increasing adult care and treatment patient burden by expanding
services to one additional health facility in Kayunga and also expand services to the District of Mukono
South sub-district. The rate of adult care and treatment enrollment is rising in Kayunga due to HIV+
referrals from a house-to-house counseling and testing program which started in July 2008. Beginning in
FY2009 MUWRP will partner with the remote Busana Health Center III in eastern Kayunga so this clinic can
begin to provide HIV services, including adult care and treatment, to address the rising requirement for
services in this district. Additional activities in Kayunga will include the renovation of two more HIV clinics in
Kayunga, the Galyiria Health Center IV and the Busana Health Center III. In order to operate at capacity
these clinics will need to be renovated to address issues of patient flow, confidentiality and waiting times.
Also during FY2009 MUWRP intends to expand services into Mukono District in order to support the Kojja
Health Center IV. The initial aims of this support will be to promote care, treatment, laboratory services and
counseling and testing services for the entire sub-district of Mukono South; including supporting three
surrounding health center III's for the same services via mobile VCT outreaches into the surrounding fishing
communities. Presently, the only HIV service provision at Kojja is a PMTCT component including a
treatment club for mothers supported by EGPAF. Mukono South sub-district has a population of 120,000
persons and using data from the Uganda sera-survey, we can expect approximately 12,000 HIV positive
residents; at least 80% of these (9,600) would be HIV+ adults. Other FY2009 initiatives under this program
area include: (1) partnering with AIDS Treatment Information Center (ATIC) so that District HIV clinicians in
rural areas can receive a medical consultation over the phone from a HIV/AIDS specialist, (2) expansion of
adult care and treatment service provision to HIV+ prisoners residing in Bulawula (3) retraining of all HIV
clinic staff as the Uganda MOH has recently revised its policies on ART, and (4) support of the District HIV
team to meet weekly and conduct supportive supervision to the HIV clinics monthly (this is in addition to the
weekly MUWRP supportive supervision). The final new activity for FY2009 Funding will support the
expansion, training, technical assistance, transportation, capacity building, remodeling and provision of
commodities (including pain medication) to five HIV clinics operating in Kayunga District and expansion of
comprehensive services to Mukono South sub-district.
Continuing Activity: 15710
15710 4506.08 Department of Walter Reed 7234 1245.08 Makerere $435,000
8526 4506.07 Department of Walter Reed 4873 1245.07 Makerere $317,000
4506 4506.06 Department of Walter Reed 3365 1245.06 Makerere $134,999
* Increasing gender equity in HIV/AIDS programs
* TB
Estimated amount of funding that is planned for Human Capacity Development $120,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $27,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities $2,500
Estimated amount of funding that is planned for Economic Strengthening $22,000
Table 3.3.08:
Continuing Activity: 15713
15713 4507.08 Department of Walter Reed 7234 1245.08 Makerere $613,757
8527 4507.07 Department of Walter Reed 4873 1245.07 Makerere $523,787
4507 4507.06 Department of Walter Reed 3365 1245.06 Makerere $39,655
Estimated amount of funding that is planned for Human Capacity Development $116,000
Table 3.3.09:
The Pediatric Care and Treatment program described below continues to be part of a comprehensive
program with activities linked to other program areas. Specific program activities in this comprehensive
program include prevention, SI, CT, laboratory, ARV drugs, and OVC services.
During FY2008, and in partnership with Child Advocacy International (CAI), MUWRP has expanded
activities of its mobile clinical/counseling follow-up program which provides home-based care and treatment
to HIV+ pediatrics. CAI expanded their coverage of Kayunga District and consequently expanded the
number of HIV+ pediatrics they provide direct support through scheduled monthly home visits. This
included expansion to the fishing villages and the remote northern and southern most regions of Kayunga
District. CAI offers HIV+ pediatrics a comprehensive list of home-based services which include care,
treatment, HIV education, counseling, psycho-social activities, emotional backing and (when appropriate)
school fees, scholastic materials, clothes, and supplemental food. During FY2008, CAI continued their on-
going home-based care and treatment through these visits to include technical assistance to caregivers and
families on how to care for pediatric ART/HIV+ patients as well as the direct provision of some basic
palliative needs such as symptom control for the patients themselves. Support for the caregivers also
included linking families of pediatric ART patients together for group/peer counseling and psychosocial
support. CAI also has refined their quality of services at each of the existing points of service. This was
accomplished by provision of quality trainings, technical advisors, focus groups, institution of best practices,
and standard operating procedures.
The Kayunga District Youth Recreational Center was founded in 2005 as a joint effort between the Kayunga
District Hospital, the Kayunga District Government and MUWRP as an organization/facility to build district
capacity in identifying and providing HIV services to Kayunga Districts' youth population, and especially
HIV+ pediatrics. The Center currently provides youth with care and clinical services in a manner which is
specifically geared toward persons between the ages of 12-18 who are HIV positive. The Youth Clinic at
the Center counsels and tests youth and successfully retains 100%of those testing positive for care and
treatment. Finally, because ART and the array of OI supplies are not stable in Uganda, MUWRP has
always served as a back-up source to ensure that Kayunga District HIV+ pediatrics never experience ART
or OI drug/commodity stock outs.
MUWRP funding to CAI currently supports the cost of ART/OI drugs and commodities, some staffing,
training, mobile activity overhead, monthly home visits/follow-up visits to HIV+ pediatrics, care-giver
counseling, tools for home monitoring of HIV+ pediatrics, household evaluation, evaluation of nutritional
status, nutritional counseling and provision of supplemental food based on needs. However in June 2008,
due to shifting priorities and budgetary constraints, CAI lost its funding from its primary partner, the UK
based Elton John Foundation. Because of their excellent track record, MUWRP proposes take on full
funding of CAI for activities in Kayunga. With MUWRP as its primary partner, CAI will be able to continue to
provide high quality comprehensive services to HIV+ pediatrics in Kayunga in FY 2009. Currently, pediatric
care and treatment patient enrollment rates are rising in Kayunga due to HIV+ referrals from a house-to-
house counseling and testing program which started in July 2008. This trend is expected to continue. Also
during FY2009 MUWRP intends to expand services into Mukono District in order to support the Kojja Health
Center IV. The initial aims of this support will be to promote care, treatment, laboratory services and
surrounding health center III's with the same services via mobile VCT outreaches into the surrounding
fishing communities. Presently, the only HIV service provision at Kojja is a PMTCT component and a
treatment club for mothers, both supported by EGPAF. Mukono South sub-district has a population of
120,000 persons and using data from the Uganda sera-survey, we can expect approximately 12,000 HIV
positive residents; at least 20% of these (2,400) would be HIV+ pediatrics. Funding will support the
expansion, training, technical assistance, transportation, capacity building, and provision of commodities
(including pain medication) to five HIV clinics operating in Kayunga District and expansion of
comprehensive services to HIV+ pediatrics to Mukono South sub-district.
* Child Survival Activities
Estimated amount of funding that is planned for Human Capacity Development $33,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $4,000
Estimated amount of funding that is planned for Education $5,000
Table 3.3.10:
Table 3.3.11:
During FY2008, and in collaboration with Child Advocacy International (CAI), MUWRP has expanded
activities through this home-based counseling/ follow-up program which provides community based
outreach, support, counseling, and education for District OVC's, their families, and the community. CAI
expanded their coverage of Kayunga District and consequently expanded the number of OVC's they
provide primary direct support through scheduled monthly home visits. CAI offers OVC's a comprehensive
list of home-based services which include HIV education, counseling, psycho-social activities, emotional
backing and (when appropriate) school fees, scholastic materials, clothes, nutritional evaluation and
counseling and supplemental food based on need. Also during FY2008, a consultation was held with 120
caretakers of OVC and as a result nearly 400 mattresses and blankets were supplied to the caretakers.
CAI has continued their on-going home-based education through these visits to include technical assistance
to caregivers and families on how to care for pediatric ART/HIV+ patients as well as the direct provision of
some basic palliative needs such as symptom control for the patients themselves. Support for the
caregivers also includes linking families of pediatric ART patients together for group/peer counseling and
psychosocial support. During the past year, CAI has maximized OVC identification and expanded provision
of services District-wide. This included expansion of home-based OVC services to the fishing villages and
the remote northern and southern most regions of Kayunga District. CAI also has refined their quality of
services at each of the existing OVC points of service. This was accomplished by provision of quality
trainings, technical advisors, focus groups, institution of best practices, and standard operating procedures.
capacity in identifying and providing HIV prevention services to Kayunga Districts' youth population, and
especially their orphans and vulnerable children. The Center currently provides youth with counseling and
care in a manner which is specifically geared toward persons between the ages of 12-18 who are HIV
positive or defined as OVC's. Any youth found to be HIV+ are successfully referred for evaluation for ART
by clinical staff of the District Hospital. The Center continues to provide community based counseling to
youth, emotional support, and meet psycho-social needs through recreational games, sports, music, big
competitions, and drama. Community focused activities include district-wide youth outreach, education and
psycho-social activities at schools and in communities with emphasis on identifying orphaned children or
vulnerable adolescents. Special emphasis is put on vulnerable children, especially those made vulnerable
due to: unemployment, disability, early child labor, gender or those living outside of family care. This
Center also works closely with community structures which protect and promote healthy child development,
such as schools, churches, clinics, and the Kayunga District police force. Three of the volunteer youth staff
at the Center, all of whom were out-of-school and living outside of family care, were supported with school
fees with the goal of accessing higher paying careers. CAI and the Kayunga Youth Recreational Center
and MUWRP have collaborated and/or partnered with the following civil society groups in Kayunga in order
to build local capacity: (1) Boy brigades, (2) Kayunga town youth council, (3) Kayunga District youth
council, (4) Community and Response to AIDS, (5) Busaana Women Community HIV/AIDS Positive Living
and Orphanage Care, (6) Girl guides, (7) Uganda scouts association of Kayunga, (8) Nazigo youth health
and development association, (9) Disabled school of Bukoloto and (10) Fare Ministries, (11) Human Rights
and Civic Education Forum, and (12) the Rubaga Youth Development Association.
All of the above activities will continue in FY 2009. MUWRP funding levels to CAI currently supports the
cost of some staffing, training of volunteers in HIV service provision (home-based care), and community-
based activities including monthly home visits/follow-up visits to OVC, care-giver counseling, tools for home
monitoring of OVC and household evaluation, psycho-social activities, and community sensitizations.
However MUWRP has had to increase its funding to CAI. Because of their excellent track record MUWRP
proposes to continue this level of funding of CAI for activities in Kayunga.. With MUWRP as its primary
partner, CAI will be able to continue to provide high quality OVC services that link with other District
services such as PMTCT, care and support, ART, HCT as well as other NGO services in Kayunga (listed
above) to strengthen the capacity of the family unit (caregiver) to care for OVC.
Continuing Activity: 15711
15711 6408.08 Department of Walter Reed 7234 1245.08 Makerere $200,000
8531 6408.07 Department of Walter Reed 4873 1245.07 Makerere $200,000
6408 6408.06 Department of Walter Reed 3365 1245.06 Makerere $170,000
Estimated amount of funding that is planned for Human Capacity Development $23,500
Estimated amount of funding that is planned for Food and Nutrition: Commodities $16,000
Estimated amount of funding that is planned for Economic Strengthening $24,000
Estimated amount of funding that is planned for Education $22,000
Table 3.3.13:
The HIV counseling and testing (CT) program described below is part of a comprehensive program and
activities do link to other program areas. Specific program activities that are included in this comprehensive
program include care, treatment, prevention, laboratory, and OVC services. Since ART was first made
available in Kayunga District in April 2005, the number of residents who have sought out CT services has
increased extremely dramatically. Due to the fact that availability of commodities remains sporadic,
MUWRP has always provided technical support in supply chain management as well as back-up commodity
supplies to all of the CT sites in the District to ensure that there will be no stock outs. Funds have been also
used for training, staffing, transportation, supportive supervision, sub-contracts, and on-going technical
assistance in the areas of service delivery. The increase in demand for CT has been met through training
of additional counselors and medical staff to provide this service not only at the HIV clinic and VCT centers,
but as part of inpatient and out patient services, including the TB clinic, where a majority of treatment
eligible patients are found. MUWRP has worked alongside other health agencies in Kayunga, such as
Doctors with Africa (CUAMM) and the National TB and Leprosy Programme (NTLP), so that capacity was
developed to ensure that individuals being screened for TB at NTLP sites were concurrently tested for HIV
and referred to HIV services if HIV-positive. In addition to CT services provided through fixed sites and
clinics, a major focus on the MUWRP CT program has been provision of services to two high-risk groups,
especially youth and fishing communities. Toward this end, MUWRP collaborated with Kayunga District
Health authorities to establish a Youth Center in Kayunga Town. MUWRP administers the Center while
volunteer district clinicians staff the Youth HIV/ART clinic. Any of the youth that are counseled and tested at
the Youth Center who are identified as HIV+ are referred for evaluation for ART by clinical staff of the
District Hospital. Close links with the nearby District Hospital are maintained through medical staff providing
clinical services at the Center, ensuring quick referrals and evaluation for treatment eligibility at the Center
or the District Hospital. Increased outreach through advertising and community campaigns have focused on
a youth approach/audience using such venues as sports, drama, and music concerts to increase youth
attendance at the Center and accessing of CT. To reach the other at-risk population in need of CT and
access to HIV care and treatment services in Kayunga, such as fishing communities, MUWRP expanded
mobile operations to reach these populations along the Nile and at the inlet to Lake Kioga. Furthermore,
MUWRP mobile community program has also included bi-monthly community sensitizations, usually
implemented by a MUWRP partner, which always include provision of CT services. Working along-side
MUWRP's prevention program, MUWRP's mobile CT program expanded programs during 2008, targeting
out of school youth as well as youth in schools. Another aspect of the CT program implemented in 2008
was the District-wide post-exposure prophylaxis program for victims of rape, defilement, or for any other
person who has had immediate exposure to HIV. Beginning in 2007, MUWRP linked with MJAP for
technical assistance and supported implementation of RTC services at four fixed clinical sites in Kayunga,
including one health center III which primarily delivers services to fishing communities. The program has
gone extremely well with many unexpected benefits coming to light. This program was the subject of an
oral presentation at the 2008 implementers meeting in Kampala. All staff (approx 170) at each of these
health centers (including the District Hospital) have been comprehensively trained in RTC administration
and in particular, they have learned the finger stick method of blood draw to facilitate fast turn around times
for RTC clients. In order to strengthen linkages between TB and HIV as well as PMTCT and HIV, MUWRP
staff worked alongside other health agencies in Kayunga to ensure that pregnant mothers and individuals
being screened for TB were concurrently tested for HIV and referred to HIV services if HIV-positive. To
accomplish all of this, MUWRP trained District lay workers and youth volunteers in CT service delivery to
meet staffing demands. As a quality control measure, the MUWRP Lab Coordinator prepares serum
samples with known results on a quarterly basis. These samples are sent out to all the RTC sites for the
Health Worker to test and return for accuracy checks, feedback, and follow-up if needed. Funds were
utilized to modify infrastructure to ensure confidential counseling space and scaling up RCT services to
each of the four health centers. Finally in 2008, MUWRP implemented a house-to-house HIV CT (HTHCT)
program beginning in Busana sub-county in Kayunga. This program was modeled largely after the
successful HTHCT program implemented in Kumi and Busheni Uganda. MUWRP began the process by
coordinating with another partner in Kayunga, planning specific HTHCT activities, consultations with the
Kayunga District health authorities, sub-county sensitizations, and with the leaders of the Kumi and Busheni
programs. Staff were identified and trained in all the various subject matters. The HTHCT program
commenced on July 2, 2008. For program quality control, dried blood spots are prepared for every positive
result and for the negative partner in discordant situations. For negative results, dried blood spots are
prepared for every 25th or 50th negative result.
During FY09, the HTHCT program that began in Busana sub-district in Kayunga will continue until all 9 sub-
districts in Kayunga have been completed. In order for this program to operate successfully, MUWRP will
require more PEPFAR CT support to cover staffing, transportation, HIV testing, data management and
ongoing training and community sensitizations. This mobile unit will be staffed with MUWRP staff as well as
District health service personnel and will be supervised daily for quality counseling and testing. In addition,
in FY09 MUWRP intends to enter Mukono District in order to initially support the Kojja Health Center IV.
The initial aims of this support will be to promote VCT and RTC for the entire sub-district of Mukono South;
including supporting three surrounding health center III's for the same services via mobile VCT outreaches
into the surrounding fishing communities. If the partnership with Kojja works well, we could consider
duplicating a house-to-house VCT program throughout Mukono South. Presently, the only HIV service
Activity Narrative: provision operating at Kojja is a PMTCT component and a treatment club for mothers, both supported by
EGPAF. Mukono South sub-district has a population of 120,000 persons and using data from the Uganda
sera-survey, it is anticipated that approximately 12,000 residents are HIV positive.
Continuing Activity: 15712
15712 8543.08 Department of Walter Reed 7234 1245.08 Makerere $300,000
8543 8543.07 Department of Walter Reed 4873 1245.07 Makerere $216,000
Estimated amount of funding that is planned for Human Capacity Development $146,000
Table 3.3.14:
and an array of counseling and testing and prevention programs.
The laboratory program described below continues to be part of a comprehensive program and activities do
link to other program areas. Specific program activities that are included in this comprehensive program
include Counseling and Testing, Strategic Information, Adult and Pediatric Care and Treatment, ARV drugs,
and OVC services. During FY2008, MUWRP succeeded in giving full capacity to the Kayunga District
Hospital laboratory. This facility is now processing and reporting CD4 enumeration, chemistry, and
hematology for all HIV samples in Kayunga District. The lessons learned by MUWRP in the achievement of
this goal were presented at the 2008 International AIDS Conference in Mexico City. Throughout FY2008
MUWRP continued to support laboratory services in Kayunga District with external quality assurance
schemes, reagents, daily supportive supervision, staffing support, task shifting programs, power solutions,
perishables, trainings, and an equipment maintenance contract.
During FY2009, MUWRP will need to keep up with increasing demand for laboratory services by supporting
more staffing, reagents, trainings, additional diagnostic capacities, electronic data capacity, task shifting
programs, and the provision of laboratory equipment. MUWRP intends to expand HIV services to one
additional health facility in Kayunga and also expand services to the District of Mukono South sub-district.
These expansions will have an impact on laboratory services. Furthermore, in FY2009 MUWRPs intends to
make assessments of two health center IV (Kangulamira and Baale) and one health center III (Galyiria)
laboratories. Capacity improvements will be made to those laboratories so that they can perform routine
assays. Again, this will include training, provision of reagents/perishables, supportive supervision, staffing
support and possibly some infrastructure remodeling at the Galyiria Health Center III. In June 2008, the
chemistry analyzer at the Kayunga District Hospital was replaced so as to allow the laboratory technicians
the ability to process more specimen's thereby reducing staff time. However, the reagents used by this new
machine are more expensive and will need to be budgeted for in FY2009. The data system of the District
Hospital laboratory, which processes and reports all of the HIV samples for Kayunga District, needs to be
addressed and automated. Presently, that laboratory is operating on a paper-based system. Finally during
FY2009, MUWRP, as part of its comprehensive HIV program, would like to offer viral load assessments for
all patients receiving HIV care. Beginning with a baseline viral load, measurements would be repeated
every 6 months. The cost of these assays will have a large impact on the laboratory budget.
Continuing Activity: 15714
15714 4514.08 Department of Walter Reed 7234 1245.08 Makerere $368,267
8528 4514.07 Department of Walter Reed 4873 1245.07 Makerere $350,000
4514 4514.06 Department of Walter Reed 3365 1245.06 Makerere $232,666
Estimated amount of funding that is planned for Human Capacity Development $117,000
Table 3.3.16:
clinical sites, improving laboratory services, infrastructure, data collection and reporting, supplies, human
capacity development, innovative task shifting, youth focused programs, short-term technical staffing, OVC
services, and a vast array of counseling and testing and prevention programs.
During FY2008, the focus of MUWRP's SI program was to strengthen the HMIS capacity of Kayunga
District Hospital and its five health centers for accurate and timely reporting on required indicators to GOU
MOH. Technical assistance was provided to continue collection, management and analysis of data not only
across PEPFAR Program areas but to all District data collection and analysis. MUWRP provided technical
and infrastructural support to the District, including computer and email access to seven key District HIV
staff personnel operating in remote areas. A MUWRP data officer has partnered with District HMIS staff
(both at the District level and at 6 health facilities) to ensure they receive adequate training in data
collection, management and analysis. Monthly supportive supervision by District level HMIS staff to the
lower level facilities was also supported by MUWRP. Funding support salary of 4 SI staff, training,
maintenance, six computers, supplies, technical expertise and internet service provision. Finally during
2008, MUWRP staff continued to conduct analysis of data that are collected as a part of routine
patient/client visits. Some of the analysis will include exploring and describing change among treatment
cohorts, factors associated with lost-to-follow-up, youth, CT trends etc., in order to inform program
implementers and policy makers. Because of these analyses, MUWRP and Kayunga District officials were
was able to present 4 posters on HIV/AIDS activities in Kayunga at the International AIDS Conference in
Mexico City in August 2008.
THIS ACTIVITY IS A CONTINUATION FROM FY2008 WITH THE FOLLOWING UPDATES:
During FY09 a pilot MUWRP supported SI innovative will build on past successes. The goal of this new
activity is to develop capacity, infrastructure, and provide technical training to enable the Kayunga District
Health authorities to export all health indicator data from their locally maintained database directly to the
Uganda Ministry of Health databases. Success will require material support as well as technical assistance.
MUWRP intends to partner with the Hospital Information System Program (HISP) based in South Africa, to
accomplish this task. The HISP will send computer engineer consultants to configure their District Health
Information Software (DHIS) for Kayunga District purposes. The DHIS software has already been
successfully rolled out in rural areas similar to Kayunga District in South Africa and Nigeria. The HISP has
agreed to provide the DHIS soft wear free of charge to MUWRP and any other Ugandan Districts. Training
on the DHIS was given to a broad spectrum of persons so District and MUWRP staff will not be dependent
upon the HISP staff for technical assistance. Efforts so far have focused on completely customizing the
DHIS for the Uganda HMIS system, with over 2000 indicators added to the software and all of the Uganda
HMIS forms incorporated back to the year 1995. It is our hope that Kayunga will be a model site for this
endeavor since no other Districts have yet attained this capacity. MUWRP costs will cover a two-week
training by the DHIS engineers which will be offered to technicians from Uganda MOH, USG agencies, as
well as technicians from MUWRP and Kayunga District. Progress has already been made in this regard:
1600 Uganda specific health indicators have been tailored to the DHIS software and Kayunga District HMIS
staff have updated the database with one year of prior health data and made reports. Also during FY2009,
a CDC provided electronic tracking system for HIV/AIDS patients at the Kayunga District Hospital will be
rolled out. The current system being used is paper-based and with the staff and facility now operating at a
higher level of capacity with increased patient loads, the time is right for an automated system. This system
will provide more efficient means of managing files and tracking patients. This will involve providing
material and technical support to the District Hospital clinic which has the largest patient load of all the HIV
clinics in Kayunga District. ART treatment club members at the District hospital will be trained to administer
the tracking program. During the past year, other program areas within the MUWRP comprehensive model
experienced great success in task-shifting to treatment club members. Moreover during FY09, MUWRP
needs to address the SI needs of the District Hospital laboratory which processes and reports all of the HIV
samples for Kayunga District. This new automated laboratory information system, to be piloted at the
Kayunga District Hospital, will link lab reports to patients files. Finally in FY2009 MUWRP intends to expand
its services into Mukono District and initially support the Kojja Health Center IV. The initial aims of this
support will be to promote care, treatment and Counseling and Testing programs for the entire sub-district
of Mukono South; including supporting three surrounding health center III's in the same service provision.
Program activities that are included in MUWRP's comprehensive approaches, such as care, treatment,
laboratory, and CT services, will be budgeted under their respective program areas. However, in order for
these programs to operate successfully, MUWRP will leverage SI funding to cover required expansion of
staffing, increased materials and data management and training of local implementing partners.
Continuing Activity: 15715
15715 4516.08 Department of Walter Reed 7234 1245.08 Makerere $125,000
8529 4516.07 Department of Walter Reed 4873 1245.07 Makerere $107,000
4516 4516.06 Department of Walter Reed 3365 1245.06 Makerere $32,375
Estimated amount of funding that is planned for Human Capacity Development $21,500
Table 3.3.17:
This activity is a continuation from FY2008.
This activity links to MUWRP activities under Treatment, Care, CT, OVC, Lab, S.I., and prevention
programs in the Kayunga District of Uganda. In FY05, the program hired one fulltime staff dedicated to
PEPFAR activities in the Kayunga District. The focus for FY09 will be to maintain this position.
Continuing Activity: 15716
15716 5356.08 Department of Walter Reed 7234 1245.08 Makerere $243,000
8530 5356.07 Department of Walter Reed 4873 1245.07 Makerere $188,000
5356 5356.06 Department of Walter Reed 3365 1245.06 Makerere $104,705
Table 3.3.19:
