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
AIDSRelief (AR) provides a comprehensive care and treatment program emphasizing strong links between
PLHAs, their family, communities and the health institutions. Its goal is to ensure that people living with
HIV/AIDS have access to Antiretroviral Therapy (ART) and quality medical care. AR is a consortium of five
organizations which includes Catholic Relief Services (CRS) working as the lead agency, the Institute of
Human Virology, Constella Futures Group (CF), Catholic Medical Mission Board and Interchurch Medical
Assistance World Health; AR services are offered through 18 Local Partner Treatment Facilities (LPTFs),
distributed throughout Uganda working in some of the most underserved and rural areas, including Northern
Uganda. These include St. Mary's Lacor, St Joseph Kitgum, Nsambya Hospital, Kamwokya Christian Caring
Community, Family Hope Center Kampala, Family Hope Center Jinja, Virika Hospital, Villa Maria Hospital,
Kabarole Hospital, Bushenyi Medical Center 1- Katungu, Bushenyi Medical Center 2- Kabwohe,
Kyamuhunga Comboni Hospital, Kasanga Health Centre, Kalongo Hospital, Amai Hospital, Aber Hospital,
Nkozi Hospital, and Nyenga Hospital. In order to get services closer to the communities it serves, AR
supports 24 satellite sites in selected LPTFs. The Children's AIDS Fund is a sub-grantee in AR and
manages a number of the LPTFs.
As of July 31st, 2008, AR in Uganda was providing care and support to 55,781 adult patients 18 years and
older, and antiretroviral treatment to 16,833 HIV-infected patients 15 years and older. In addition it was
providing care and support to 5,144 infected children under the age of 18, and antiretroviral treatment to
1726 children under the age of 15.
In FY 2008, AR promoted a comprehensive package of PMTCT services at 9 LPTFs. This included
provider-initiated HIV testing in ANC, encouraging mothers to deliver in a health facility (the program also
encourage linkages with Traditional Birth Attendants), CD4 testing of all pregnant HIV+ mothers, DBS for
babies, the provision of ARV prophylaxis to mother and infant and referral for HAART as required. The
program additionally encouraged comprehensive PMTCT services at all 18 AR supported LPTFs through
internal and external linkages. A total of about 30,000 pregnant mothers have been counseled, tested and
have received results in FY 2008. Of those tested, about 8% were HIV positive and of these, 2,400 HIV+
mothers and infants received full course of ARV prophylaxis.
AR increased accessibility and utilization of PMTCT services by increasing the skills of staff working in ANC
and by providing access to rapid HIV testing in ANC. HIV positive pregnant women were referred from
satellite clinics to antenatal care providing sites. Laboratory links were developed to increase access to
earlier infant diagnosis using PCR testing. As part of the essential components of a PMTCT program, all
HIV positive mothers were provided with nutritional information as regards to exclusive breastfeeding and
alternative feeding options.
Training including and update on the new MOH adopted PMTCT guidelines, was provided to 290 health
workers including midwives in ANC clinics providing PMTCT services. Additional training was conducted in
PMTCT and malaria prevention for 720 community volunteers enabling them to carry out community
mobilization and early referral to facilities for suspected malaria in pregnant women. Linkages were created
between PMTCT and the ART clinics at all LPTFs, and also between other health facility services (e.g:
MCH). Long lasting insecticide treated nets were provided to the mothers through linkages with PSI/CDC.
There was also increased sensitization of care providers to provide Cotrimaxazole to infected pregnant
women in care.
Coordinated by CF, strategic information (SI) activities incorporate program level reporting, enhancing the
effectiveness and efficiency of both paper-based and computerized patient monitoring and management
(PMM) systems, assuring data quality and continuous quality improvement, and using SI for program
decision making across all LPTFs. AR has built and maintained a strong PMM system using in-country
networks and available technology at 18 LPTFs in FY 2008. CF carried out site visits to all LPTFs to
provide technical assistance to ensure continued quality data collection, data entry, data validation and
analysis, and dissemination of findings across a range of stakeholders.
AR will continue to encourage increased uptake of PMTCT services at 18 LPTFs. The program will promote
a comprehensive package of PMTCT services, as occurred in FY 2008. In FY2009, with access to
additional funding, AR proposes to reach 25,000 pregnant women with HIV counseling and testing for
PMTCT and about 2,400 HIV positive pregnant women and their exposed infants with antiretroviral
prophylaxis in accordance with Uganda National Guidelines, supported by treatment preparation and
adherence support.
The PMTCT program will continue to be underpinned by strong community outreach and follow-up of all HIV
positive women during pregnancy and after delivery.
This community linkage will ensure reduced losses to follow-up of both mothers and their babies. The
program will also focus on the coordination and integration of services provided at the HIV clinic, ANC,
delivery and MCH clinic within the facilities it supports. Provision of nutritional information and education
will continue and HIV + mothers will also be linked to access to nutritional programs during pregnancy and
breastfeeding as part of a commitment to promoting better maternal and infant health. Long lasting
insecticide treated nets will be provided to the mothers through linkages with PSI/CDC and 720 additional
community volunteers trained to reinforce malaria prevention messages during their outreach activities and
given skills to identify the symptoms of suspected malaria and refer to a health institution. There will be
increased sensitization of care providers to provide intermittent Cotrimaxazole to infected pregnant women
in care.
Training, including updates on the new MOH adopted PMTCT guidelines as well as blood collection for CD4
screening and dry blood spots, and on HIV rapid tests will be provided to 290 health workers including
midwives in ANC clinics providing PMTCT services, counselors, and laboratory staff.
decision making across all LPTFs. Using the MOH standard guidelines and data collection tools, CF will
ensure compilation of complete and valid PMTCT data that relate to adult and infant patient information at
the sites. On-site technical assistance and training will be provided to LPTF staff, focusing on identifying
Activity Narrative: barriers to data collection, avoiding double counting and reporting, and timeliness of reports. In addition to
capturing data in IQCare, a new electronic data base will be rolled out to all LPTFs implementing PMTCT
that will capture relevant PMTCT data, from ANC to L&D. The same will be used to efficiently and effectively
report on PMTCT indicators to all stakeholders, including USG, MOH, and the donors. Staff will be trained in
using the data base for sustainability purposes. On a monthly basis, LPTFs will compile and disseminate a
PMTCT report based on already agreed upon indicators, but also compile similar reports on a quarterly,
semi-annual, and annual basis. Feedback from these reports will be used by AR and LPTFs to improve
service delivery, provide forecasting for drugs and testing kits, and gauge the need for human resource
planning. Using available data, AR will strengthen the linkages between ANCs and HIV/AIDS clinics, and
provide information for accurate tracking of pregnant mothers in the community and at health facilities
during the duration of a pregnancy.
To support provision of PMTCT services, AR will identify all females of reproductive age attending the ART
and care clinics and refer them for pregnancy tests. The program will refer and document referrals from
PMTCT to ART services within LPTFs. A system that supports EID will be strengthened and infant-mother
pairs referred to the ART clinic for care and treatment follow-up. Sustainability lies at the heart of the AR
program and is based on durable therapeutic programs and health systems strengthening. AR will focus on
the transition of the management of care and treatment activities to indigenous organizations by actively
using its extensive linkages with faith based groups and other key stakeholders to develop a transition plan
that is appropriate to the Ugandan context. The plan will be designed to ensure the continuous delivery of
quality HIV care and treatment, and all activities will continue to be implemented in close collaboration with
the Government of Uganda to ensure coordination, information sharing and long term sustainability. For the
transition to be successful, sustainable institutional capacity must be present within the indigenous
organizations and LPTFs they support; therefore, AR will strengthen the selected indigenous organizations
according to their assessed needs, while continuing to strengthen the health systems of the LPTFs. In
FY2009, the program will support linkages between LPTFs and the MOH to tap into locally available training
institutions. AR will particularly focus on its relationship with indigenous organizations such as the Uganda
Catholic Medical Bureau and Uganda Protestant Medical Bureau to build their institutional capacity to
support LPTFs integrate ART and other care and support programs into their health care.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13261
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13261 8584.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $687,500
Resources Services
Services
Administration
8584 8584.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $703,667
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Malaria (PMI)
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $206,250
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
AIDSRelief provides a comprehensive care and treatment program emphasizing strong links between
HIV/AIDS have access to Antiretroviral Therapy (ART) and quality medical care. AIDSRelief is a consortium
of five organizations which includes Catholic Relief Services (CRS) working as the lead agency, the Institute
of Human Virology (IHV), Constella Futures Group (CF), Catholic Medical Mission Board (CMMB) and
Interchurch Medical Assistance World Health (IMA); AIDSRelief services are offered through 18 Local
Partner Treatment Facilities (LPTFs), distributed throughout Uganda working in some of the most
underserved and rural areas, including Northern Uganda. These include St. Mary's Lacor, St Joseph
Kitgum, Nsambya Hospital, Kamwokya Christian Caring Community, Family Hope Center Kampala, Family
Hope Center Jinja, Virika Hospital, Villa Maria Hospital, Kabarole Hospital, Bushenyi Medical Center 1-
Katungu, Bushenyi Medical Center 2- Kabwohe, Kyamuhunga Comboni Hospital, Kasanga Health Centre,
Kalongo Hospital, Amai Hospital, Aber Hospital, Nkozi Hospital, and Nyenga Hospital. In order to get
services closer to the communities it serves, AIDSRelief supports 24 satellite sites in selected LPTFs. The
Children's AIDS Fund is a sub-grantee in AIDSRelief and manages a number of the LPTFs.
AIDSRelief supported partners (such as Comboni Samaritan in Gulu, Meeting Point and Christian HIV/AIDS
Prevention and Support (CHAPS), who built their behavior change activities on their strong community
networks, to provide community sensitization using other "Faithful House" curriculum for the married
couples and the Value of Life curriculum for the youth and adolescents. 585 people were trained through all
the LPTFs. These facilitators then work with couples and youth at community level. Prevention priorities
included behavior change for risk reduction and risk avoidance, counseling and testing and emphasized the
prevention of the sexual transmission of HIV, and education to patients and community health volunteers on
secondary prevention. As a way of integration the AB activities were integrated with the PMTCT, OVC and
Care and treatment activities at LPTFs. Pregnant women who tested negative in ANC were also
encouraged to attend these trainings with their partners. The OVCs were supported to attend the Value of
Life trainings and were encouraged to form support groups that help them keep positive values.
Coordinated by Constella Futures, strategic information (SI) activities incorporate program level reporting,
enhancing the effectiveness and efficiency of both paper-based and computerized patient monitoring and
management (PMM) systems, assuring data quality and continuous quality improvement, and using SI for
program decision making across all LPTFs. In FY 2008, AIDSRelief built a strong PMM system using in-
country networks and available technology at 18 LPTFs. Constella Futures carried out site visits to all
LPTFs to provide technical assistance to ensure continued quality data collection, data entry, data validation
and analysis, and dissemination of findings across a range of stakeholders. Using standard data collection
tools, the program tracked and reported on Sexual Prevention activities.
In FY 2009 AIDSRelief will maintain its services at the 18 LPTFs and 24 satellite sites with the goal to
maintain 20,000 patients on ART, of which 2,800 will be children, and 63,620 in care and support (55,781
adults, and 7,839 children) provided additional funding is made available. The program will continue to
leverage ARVs for pediatric patients from the Clinton Foundation, but will cover other ART related support
such as purchase of OI drugs, laboratory supplies and technical assistance to the LPTFs.
AIDSRelief services in abstinence and being faithful in FY2009 will continue to be offered through 18 local
partner treatment facilities (LPTF), 24 satellites and 3 community based programs. These facilities are
located in the Northern, Western, Southern, Central and Eastern areas of Uganda. The program will support
LPTFs to implement abstinence and being faithful activities that target the HIV negative and sero status
naïve persons. The interventions will include behavior change for risk assessment, risk reduction and risk
avoidance.
The strong community and adherence programs developed by LPTFs during FY 2008 of the AIDSRelief
program will continue to serve as the foundation for outreach to communities. In FY 2009, the program will
continue to ensure that all sites provide education to patients and community health volunteers on
secondary prevention, in and around each sites' catchment areas. Prevention activities focusing on primary
prevention and prevention for positives will include distributing patient education materials, conducting
community sensitizations and trainings, promoting couple testing, encouraging LPTFs to support couple
support groups, and advocating for additional preventive measures such as male circumcision.
Various forms of media will be used for patient education and community sensitization, including radio,
community volunteer efforts, and the provision of Information Education and Communication (IEC)
materials, translated into the local languages. Additionally, the continued use of trainings in the Faithful
House curriculum will promote fidelity amongst married couples and the Value of Life curriculum will
contribute to positive character formation and the delay of sexual debut in young people. Messages
delivered will also address the reduction high risk behaviors such as alcohol and drug use.
Training will be an integral part of this program and will be directed at facility and community level staff. A
total of 240 facility staff, 630 Community based facilitators will be trained in the Faithful House and Value of
Life curriculums. In order to increase the sustainability and continued diffusion of AB messages, 72 couples
will be trained as trainers in the Faithful House curriculum and 72 individuals will be trained as trainers in the
Value of Life curriculum. Each LPTF will also have one staff trained in each of the curriculums for the
purpose of then monitoring and evaluating the performance of the newly trained trainers.
An additional element of AIDSRelief AB programming will include a referral system for AB training
participants to counseling and testing. The program will therefore establish and enhance linkages with
organizations that offer counseling and testing services, such as TASO, AIC, JCRC, etc HIV positive
persons shall further be linked to facilities that provide care and support, while negative couples and youths
will form support groups that help them to maintain their status through behavior change enhancement.
Secondary prevention messages will also be further integrated into the care and treatment activities at the
LPTFs through providing training to counselors, social workers and nurses. In addition an emphasis will be
put on discordant couples to adopt risk reduction strategies.
Activity Narrative: AIDSRelief will also link abstinence and being faithful activities to other program areas, other organizations
community- and faith-based organizations that serve the same geographic areas, and programs in other,
related sectors. For example, pregnant women who attend PMTCT clinics and test negative will be
encouraged to bring their spouses for the Faithful House trainings, and eventually encourage the spouses
to test. Orphans and vulnerable children will be identified and integrated into the Value of Life trainings.
OVC support group meetings will emphasize prevention messages such as being faithful, abstinence and
avoidance of high risk behaviors. AIDSRelief will collaborate with partners working in other sectors,
wherever possible to synchronize efforts to address the needs of the community. The program will also
liaise with other CRS programs, such as microfinance and community savings groups, which promote
improved access to income and productive resources.
With respect to strategic information, in FY 2009, Constella Futures will continue to carry out site visits to all
LPTFs to provide technical assistance that will ensure continued quality data collection, data entry, data
validation and analysis, and dissemination of findings across a range of stakeholders. The use of the IQ
Care system, employed in FY 2008 to track AB activities, will be improved upon through providing further
training to LPTF staff in the areas of data collection and interpretation. An appropriate electronic database
will be designed to track AB community and facility activities, which will help facilities to capture and report
on individuals, reached with abstinence and being faithful prevention messages. Furthermore, AIDSRelief
will continue promoting evidenced-based decision-making, and enhance LPTF staff ability to use data for
informed clinical decisions and adaptive management.
Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health
systems strengthening. AR will focus on the transition of the management of care and treatment activities to
indigenous organizations by actively using its extensive linkages with faith based groups and other key
stakeholders to develop a transition plan that is appropriate to the Ugandan context. The plan will be
designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will continue
to be implemented in close collaboration with the Government of Uganda to ensure coordination,
information sharing and long term sustainability. For the transition to be successful, sustainable institutional
capacity must be present within the indigenous organizations and LPTFs they support; therefore, AR will
strengthen the selected indigenous organizations according to their assessed needs, while continuing to
strengthen the health systems of the LPTFs. In FY2009, the program will support linkages between LPTFs
and the MOH to tap into locally available training institutions. AIDSRelief will particularly focus on its
relationship with indigenous organizations such as the Uganda Catholic Medical Bureau and Uganda
Protestant Medical Bureau to build their institutional capacity to support LPTFs integrate ART and other
care and support programs into their health care
Continuing Activity: 13262
13262 4393.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $744,881
8291 4393.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $744,881
4393 4393.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $744,881
* Addressing male norms and behaviors
* Increasing women's access to income and productive resources
* Reducing violence and coercion
Refugees/Internally Displaced Persons
Estimated amount of funding that is planned for Human Capacity Development $197,392
Estimated amount of funding that is planned for Food and Nutrition: Commodities $15,000
Estimated amount of funding that is planned for Economic Strengthening $50,000
Table 3.3.02:
PLWHAs, their family, communities and the health institutions. Its goal is to ensure that people living with
In FY 2008, AIDSRelief expanded its services to four new LPTFs and three community based
organizations. It also decentralized services by encouraging LPTFs to open satellite sites and outreach
clinics. As of July 31, 2008, AIDSRelief in Uganda was providing care and support to 55,781 adult patients
18 years and older, and antiretroviral treatment to 16,833 HIV-infected patients 15 years and older.
AIDSRelief has supported a comprehensive continuum of care for adults living with HIV, in order to enhance
their quality of life throughout the entire span of their illness. The adult care and treatment component has
built on existing clinical and social services in all LPTFs. Clinically, the program continued providing adults
with 1st line, alternative 1st line, and 2nd line therapies, clinical follow-up, laboratory testing (including CD4),
and treatment of opportunistic infections. Social services supported consist of psychosocial and spiritual
support, as well as nutrition counseling and education were available to all 55,781 HIV+ adult patients
enrolled in care in FY 2008.
To get services closer to the PHAs, AIDSRelief has encouraged and supported LPTFs to open up satellite
clinics and this has increased accessibility of these services to those in rural areas. All LPTFs had outreach
teams led by a community nurse/clinical officer and are linked with community based volunteers, many of
whom were PLWHAs on treatment. Emphasis has been placed on excellent adherence in order to achieve
durable viral suppression. As a result there has been very good retention rate for patients on ART, low drug
toxicity, and an average adherence rate of over 95%. The teams also provided community based and
household ARV treatment support and preventative services which included education on the importance of
using ITNs, basic hygiene and good nutrition. Emphasis has been put on the creation of linkages within the
different services provided at the LPTFs and other service providers. The referral linkages between ANC,
PMTCT and ART services have been encouraged at the LPTFs to enable HIV+ mothers, their partners and
their babies to access ART services through the facilities.
AIDSRelief also continued employing a model of clinical preceptorship for service providers, with a special
emphasis on maximizing the role of nurses, adherence counselors and community workers. Activities
included training of health workers in improved pain and symptom evaluation and control, recognition and
appropriate referral for management of opportunistic infections (OIs), as well as supply of the basic care
package (ITNs, safe water, information on cotrimoxazole prophylaxis and prevention for positives). Activities
were expanded to include comprehensive training for 720 non-medical community workers as well as 290
medical staff to support and maintain care and treatment for all PLWHAs and their home caregivers. The
program has recognized the strong link between nutritional and Antiretroviral therapy and adherence to ART
but this remains a significant challenge. LPTFs have been encouraged to link with other organization able to
provide food, espically for severely malnourished PHAs. Training and guidance (national guidelines in
nutrition and HIV/AIDS) was provided to staff at LPTFs so that they could conduct nutritional assessment,
education and counseling at community and clinical levels.
By the end of FY 2008, AIDSRelief will have evaluated the program by relating patient outcome measures
such as viral suppression rates, adherence, and treatment support models to program level characteristics
at each LPTF. Over 1500 patients receiving care and treatment from 14 LPTFs were included in this
analysis, grouped into three cohorts (36, 24 and 12 months) representing the length of time they had
received therapy.
In FY2009, due to projected flat-lined funding, AIDSRelief activities will concentrate on consolidating the
quality of services provided at existing LPTFs and satellite sites in order to maintain 17,200 adult patients
on AIDSRelief provided ARVs and 55,781 adult patients in care. Support will consist of ARVs, OI drugs,
laboratory supplies and technical assistance to the LPTFs. A major focus will be to increase the devolution
of services to alternate cadres of service providers through ‘task shifting,' and networking with facilities and
with other service providers including the Ministry of Health. At the LPTFs, this strategy will focus on
protocols enabling nurses and clinical officers to do routine follow-up of stable patients and manage non-
critical acute symptoms as well as enabling nurses and pharmacy staff to do routine medication dispensing
to stable patients. This will increase service delivery, and ensure greater coordination and integration of
services provided within the community. Should additional funding from the USG become available,
AIDSRelief is poised to expand the services it supports to other underserved areas of Uganda to reach an
additional 6300 adult patients on ARVs and 10,000 adults in care.
AIDSRelief will continue to support a comprehensive and integrated continuum of care for HIV infected
patients building on existing services at the LPTFs. Services provided will comprise psychosocial support,
prevention for positives, clinical follow-up, laboratory testing (including CD4), treatment of opportunistic
infections and nutrition counseling and education for the 55,781 HIV + patients enrolled in care in 18 LPTFs
and their satellites. There will also be strengthened linkages between other health facility services,
especially for PMTCT and TB.
The AIDSRelief technical team will provide comprehensive training and technical assistance to 290 medical
and 720 non-medical staff to increase the capacity of LPTFs to appropriately manage and monitor patients
with HIV infection. This will include the recognition and management of opportunistic infections, treatment
failure, adult counseling, and psycho-social assessments. AIDSRelief will follow-up didactic training with
Activity Narrative: on- site clinical mentorship for clinicians and site level support for other cadres of workers. AIDSRelief will
also establish a network of model centers from exemplary LPTFs, where practitioners can gain practical
clinical experience in a controlled setting. Regional Continuous Medical Education Sessions and Partner
Forums will complement LPTF's staff training, allowing experience sharing, and reinforcing knowledge and
skill transfer from AIDSRelief technical staff.
At the community level, AIDSRelief will encourage further development of community based satellite clinics
and outreach staffed by clinical officers and nurses for the routine care of stable patients and a community
health team for the delivery of home based care and medications. The decentralization of HIV services
through the use of satellites and outreach will aim at increasing access to those who live in remote areas.
This approach reinforces AIDSRelief's model of providing integrated services to families at the community,
satellite sites and LPTFs level by inter-linking facility-based health providers and community health workers
and volunteers in order to meet the need of HIV/AIDS patients. AIDSRelief will continue providing
education on the importance of using ITNs, basic hygiene and good nutrition at household and community
levels. It will further enhance its community health programs by promoting family-based care through
symptom monitoring, disclosure counseling, secondary prevention, and family-based testing and education.
In FY 2009, LPTF community volunteers will continue to support patients on therapy, but will additionally
disseminate HIV care and prevention literacy. AIDSRelief will identify gaps in the media and adapt or
develop locally appropriate Information Education and Communication (IEC) and Behavior Change
Communication (BCC) materials on prevention, care, and treatment of HIV. AIDSRelief will also assist
LPTF networks with PLHA groups serving as volunteers in the community to strengthen adherence
programs. Emphasizing the importance of adherence and community linkages at all AIDSRelief supported
sites has enabled the program to achieve high and durable viral suppression.
The program will also strengthen linkages with other service providers operating within the communities
served by AIDSRelief supported facilities. Current relationships with organizations such as PSI and UHMG
(Uganda Health Marketing Group) will be strengthened in order to increase access to ITNs and clean water
at all LPTFs. In addition, the program will link LPTFs to the Ministry of Health to access cotrimoxazole and
malaria treatment. Reinforcing the integration of services that can be accessed through LPTFs will
enhance the overall package of care available to adults.
Coordinated by Constella Futures, SI activities incorporate program level reporting, enhancing the
decision making across project Local Partner Treatment Facilities (LPTFs). In FY 2009, AIDSRelief will
ensure that 100% of the LPTFs use the new PMM system, IQCare, and other IT solutions that enhance
data use, like IQTools. It will also ensure that LPTFs collect and enter their data in real time, maintain clean,
valid databases, and collect data across all program areas. This will support the program to reach and
report on its patients. During the year, great efforts will be put on ensuring that outreach/satellite information
is collected and integrated with that from the center. On-site training will be given to LPTF clinical and M&E
staff focusing on data analysis and use. Staff will be given skills to analyze their own data, and use the
information to carry out quality of life analyses to be able take informed clinical decisions. The program will
collect data on various clinical indicators that will enable clinicians provide improved care and treatment
services. These indicators will include: CD4, WHO stage, BMI, history and active TB, previous exposure to
ARVs, and risky social behaviors like alcoholism. LPTFs will also be able to track and report on patients
accessing the basic care package (ITNs, safe water, Cotrimoxazole) so that this information is linked to
prevalence and or incidence of certain OIs, like malaria, and chest infections, and overall patient morbidity
trends.
Through the already established CQI plans, and the "small test of change" methodology that is being used
at all LPTFs, staff will be assisted in generating, collecting and using patient level outcome information to
continuously assess, define gaps and improve the services they provide. Through the monthly multi-
disciplinary meetings at LPTFs, cross cutting issues on patient management will be discussed, and
strategies to improve the program developed as a team. This will enhance better understanding and
ownership of the program, and indicators that enhance good clinical practice. The program will also promote
these systems through a Training of Trainers (TOT) and peer to peer training model in SI, where "expert"
LPTF staff will train others in various skills. AIDSRelief will also conduct a QA/QI process with a sample of
patients, to evaluate the program by relating patient level outcome measures, viral suppression rates,
adherence and treatment support models to program level characteristics at each LPTF. In FY 2009 this
process will involve over 2000 patients from 18 LPTFs who would have been on therapy for 48, 36, 24 and
12 months respectively.
care and support programs into their health care services. This capacity strengthening will include human
resource support and management, financial management, infrastructure improvement, and strengthening
of health management information systems.
Continuing Activity: 13263
13263 4395.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $370,000
8292 4395.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $200,000
4395 4395.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $110,362
* TB
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,000
and Service Delivery
Estimated amount of funding that is planned for Water $20,000
Table 3.3.08:
Continuing Activity: 13268
13268 4386.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $4,686,000
8289 4386.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $4,186,630
4386 4386.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $3,286,630
Table 3.3.09:
PLHAs, their families, communities and the health institutions. Its goal is to ensure that people living with
HIV/AIDS have increased access to Antiretroviral Therapy (ART) and quality comprehensive medical care.
AIDSRelief (AR) is a consortium of five organizations which includes Catholic Relief Services (CRS)
working as the prime agency, the Institute of Human Virology (IHV) of the University of Maryland School of
Medicine, Constella Futures Group (CF), Catholic Medical Mission Board and Interchurch Medical
Assistance World Health (IMA); AIDSRelief services are offered through 18 Local Partner Treatment
Facilities (LPTFs), distributed across Uganda in some of the most underserved and rural areas. These
include St. Mary's Lacor, St Joseph Kitgum, Kalongo Hospital, Aber Hospital and Amai Hospital in Northern
Uganda; Nsambya Hospital, Kamwokya Christian Caring Community, Family Hope Center Kampala, Villa
Maria Hospital and Nkozi Hospital in Central Uganda; Family Hope Center Jinja and Nyenga Hospital in
Eastern Uganda; Virika Hospital, Kabarole Hospital, Bushenyi Medical Center - Katungu, KCRC -
Bushenyi, Kyamuhunga Comboni Hospital, Kasanga Health Centre in Western Uganda. In order to get
services closer to the communities served, AIDSRelief supports devolution of services to satellite sites in
selected LPTFs. The Children's AIDS Fund is a sub-grantee in AIDSRelief and manages a number of the
LPTFS.
As of July 31, 2008, AR in Uganda was providing care and support to 5144 pediatric patients <18years, and
ART to 1726 patients <15 years. We maintained and supported 18 LPTFs and their satellites providing care
and treatment to adults and children and a number LPTFs expanded and decentralized their services by
opening satellites and outreach clinics. Specific pediatric focused sessions occurred at the various partner
forums; topics covered were Adult and Pediatric ARV provision with a focus on switching to second line
therapy; prevention of transmission of HIV from mothers to their infants; TB and the integration of TB and
HIV care and treatment services. AR also provided training in pediatric counseling to all LPTFs using a
newly developed curriculum produced in partnership with the African Network for Caring for Children with
AIDS. Subsequent to this training, LPTFs have established child friendly corners, organized family
treatment days and formed child support groups. Barriers to disclosure to children which had been a difficult
issue for health workers have been overcome. The hallmark of the model is to provide a continuum of care
from health facility to community supported by ongoing on-site mentorship/preceptorship for all cadres of
staff at supported LPTFs. By the end FY 2008 the AR Technical team will have made an average of one
weekly visit to each LPTF/quarter. Additional technical support visits will have been made to all LPTFs
focusing on the areas of pediatric care and PMTCT, TB/HIV service integration and pediatric psycho-social
support. The program has recognized the strong link between nutritional inputs, ART and adherence but
this remains a significant challenge. LPTFs have been encouraged to link with other organizations to able to
provide food, especially for severely malnourished patients. Training and guidance (national guidelines in
In FY 2009, AR will concentrate on consolidating the quality of services provided at existing LPTFs and
satellite sites with the goal of maintaining 2800 pediatric patients on ART (16%) and 7,839 pediatric patients
in care and support through the provision of ARVs, OI drugs, laboratory supplies and technical assistance to
the LPTFs. In FY2009, AR proposes to expand its services to bring more 2500 children in care, and 750
children on ART and continue to support a comprehensive and integrated continuum of care for HIV
infected patients building on existing services at the LPTFs to provide psychosocial and counseling
support, clinical follow-up, laboratory testing (including CD4), treatment of opportunistic infections and
nutrition counseling and education for the 55,781 HIV+ patients including 7,839 pediatric patients enrolled in
care and 20000 patients including 2800 children on ARVs in 18 LPTFs and their satellites. In many of the
regions supported by AR, access to pediatric care and treatment services is limited. AR will bring infants
and children into care and treatment as an area of targeted expansion and will ensure integration and
linkages between ANC, Labor and Delivery Services, MCH and Immunization services to identify and
enhance the follow-up of HIV infected mothers and their exposed children. AR will maintain linkages with
JCRC and other groups, who can provide early infant diagnosis so that all HIV exposed infants can be
diagnosed in a timely manner, receive their results and be referred for comprehensive HIV care.
Strengthening a provider initiated testing in out and inpatient pediatric services will also identify more HIV
infected children to assure continuity of care and to minimize losses to follow-up all exposed children will be
followed up in the ART program until they are at least 2 years and are documented negative and later they
will continue to access services through the OVC program up to the age of 5 years. In an effort to ensure
that all children and their families have access to the BCP, linkages with organizations such as PSI and
UHMG will be strengthened. AR will continue to ensure that nutritional assessment, education and
counseling are provided to mothers/caretakers and their children at LPTFs. The programs will strengthen
integration of the nutrition component into the LPTFs adherence and community outreach activities in order
to assure that all children receiving services at AR supported facilities receive comprehensive age
appropriate psycho-social counseling and treatment and adherence support, provide training and technical
assistance to all service providers in the area of pediatric psycho-social counseling. Task shifting to
maximize human resources will be emphasized at facility and community levels, focusing on using nurses
and clinical officers for the routine follow-up of stable patients, using protocol driven nurse and clinical
officer management of non-critical acute symptoms; nurses and pharmacy staff will also be trained in
routine medication dispensing to stable patients. In line with a family centered approach to care, at the
community level, we will encourage the development of community based satellite clinics and outreaches
staffed by clinical officers/nurses/community health workers for the routine care of stable patients and the
use of community health teams for the delivery of home based care and for medication delivery. The
decentralization of HIV services satellites and outreaches will increase access to those who live in remote
areas. This approach reinforces the model of providing integrated services to families at the community by
inter-linking facility based health providers and community health workers and volunteers. Currently, AR
provides varying levels of home based care, ARV treatment support and community preventative services
using outreach teams led by a community nurse or a clinical officer. The outreach teams coordinate with
CHWs and community based volunteers, many of whom are motivated PLHAs in their communities.
Development of these community health programs to provide integrated HIV care, support adherence and
promote preventative services is critical to ensuring sustainable treatment programs and maximizing
funding investments. They also promote family based care through symptom monitoring, disclosure
counseling, secondary prevention, and family based testing and education. In addition, the LPTFs'
Activity Narrative: community volunteers will be used as resources to support patients on therapy, disseminate HIV care and
prevention literacy. AR will adapt existing, locally appropriate IEC and BCC materials, identify gaps in these
media and develop materials as needed to be used by HCWs and community volunteers. Education on the
importance of using ITNs, basic hygiene and good nutrition will be provided at household level and to
communities. AR will assist LPTF networks with PLHA groups serving as volunteers in the community to
strengthen adherence programs. We will support several LPTFs in Northern Uganda and will continue to
assist them in developing outreach programs that provide support to those affected by internal
displacement. The program will also strengthen linkages within the LPTFs, particularly those between
PMTCT, TB and CT services with ART services. LPTFs will also be linked to organizations that provide
community based therapeutic feeding programs to support the malnourished. Linkages with organizations
such as PSI and AFFORD will be strengthened in order to increase access to ITNs and clean water. In
addition, the program will link LPTFs to the Ministry of Health to access cotrimoxazole and malaria
treatment. Reinforcing LPTFs external and internal integration will ensure that core AIDSRelief care and
treatment activities will be integrated with ancillary services and program activities of other providers in the
same region. Pediatric technical capacity is an area of emphasis, the program will continue to ensure that
all involved cadres of service providers have the capacity to provide age appropriate services to children.
To accomplish this, the technical team, will provide comprehensive pediatric training and technical
assistance to medical and non-medical staff to increase the capacity of LPTFs to appropriately manage and
monitor pediatric patients with HIV infection. AR will provide training in pediatric counseling and will
strengthen LPTF staff capacity to develop community based psycho-social assessments. AR is developing
a network of model centers where practitioners can gain practical clinical experience in a controlled setting.
12 Regional CME (including 3 focusing on pediatrics and 3 on PMTCT) and 2 partners' forums will
complement LPTF's staff training, allow experience sharing and reinforce knowledge and skill transfer from
AIDSRelief technical staff. Coordinated by CF, SI activities incorporate program level reporting, enhancing
the effectiveness and efficiency of both paper-based and computerized patient monitoring and management
decision making across project Local Partner Treatment Facilities (LPTFs). In FY 2009, AR wiill ensure that
100% of the LPTFs use the new PMM system, IQ Care, and other IT solutions that enhance data use, like
IQ Tools. It will also ensure that LPTFs collect and enter their data in real time, maintain clean, valid
databases, thus support the program to reach and report on its patients. During the year, efforts will be put
on ensuring that outreach/satellite information is collected and integrated with that from the center. On-site
training will be given to LPTF clinical and M&E staff focusing on data analysis and use. The program will
services which will include: CD4, WHO stage, BMI, history and active TB, previous exposure to ARVs, and
risky social behaviors like alcohol intake; track and report on patients accessing the basic care package
(ITNs, safe water, Cotrimoxazole) so that this information is linked to prevalence and or incidence of certain
OIs. The program will maximize tracking of activities that lead to scale up of pediatric care and treatment.
Documenting and reporting on enrolled children, followed up by age group, treatment regimens, and those
receiving the basic care package. Through the already established CQI plans, and the "small tests of
change" methodology that is being used at all LPTFs, staff will be able to identify patient management gaps,
and decide how and when these will be addressed. Through the monthly multi-disciplinary meetings at
LPTFs, cross cutting issues on patient management will be discussed, and strategies to improve the
program developed. The program will also promote these systems through a Training of Trainers (TOT) and
peer to peer training model in SI, where "expert" LPTF staff will train others in various skills. We will also
conduct a QA/QI process with a sample of patients, to evaluate the program by relating patient level
outcome measures, viral suppression rates, adherence and treatment support models to program level
characteristics at each LPTF. In FY 2009 this process will involve over 2000 patients from 18 LPTFs who
would have been on therapy for 48, 36, 24 and 12 months respectively. In addition, AIDSRelief will initiate a
CQI process in which LPTFs will be assisted in generating, collecting and using patient level outcome
information to continuously assess and improve the services they provide. AR will focus on the transition of
the management of care and treatment activities to indigenous organizations by actively using its extensive
linkages with faith based groups and other key stakeholders to develop a transition plan that is appropriate
to the Ugandan context. The plan will be designed to ensure the continuous delivery of quality HIV care
and treatment, and implemented in close collaboration with the Government of Uganda to ensure
coordination, information sharing and long term sustainability. For the transition to be successful,
sustainable institutional capacity must be present within the indigenous organizations and LPTFs they
support; therefore, AR will strengthen the selected indigenous organizations according to their assessed
needs, while continuing to strengthen the health systems of the LPTFs. In FY 2009, the program will
support linkages between LPTFs and the MOH to tap into locally available training institutions, and focus on
its relationship with indigenous organizations such as the UCMB and UPMB to build their institutional
capacity to support LPTFs.
AR will continue to strengthen the health system management of LPTFs, conduct biannual finance and
compliance trainings and program finance staff will carry out regular site visits to provide technical
assistance, and to set up appropriate cost accounting systems.
Table 3.3.10:
Table 3.3.11:
Progress to-date; activities and achievements
As of July 31, 2008, AIDSRelief in Uganda was providing care and support to 55,781 adult patients 18 years
and older, and antiretroviral treatment to 16,833 HIV-infected patients 15 years and older; and to 5144
pediatric patients 18 years and younger, and antiretroviral treatment to 1762 HIV-infected patients 15 years
and younger. In FY 2008 AIDSRelief supported 18 LPTFs and 24 satellite sites to provide a family-centered
approach to diagnosis and treatment of 3,600 TB, co-infected HIV positive patients. This incorporated
routine opt out counseling and testing for HIV within TB treatment facilities, systematic referral for TB
screening within HIV testing facilities, and systematic TB screening within HIV care and treatment facilities.
Family members of TB patients were also encouraged to be screened for TB. HIV prevention messages,
such as avoidance of high risk behaviors and secondary prevention, were integrated into counseling and
testing sessions for TB patients. AIDSRelief followed the Government of Uganda policy guidelines and
AIDS Control Program guidance on TB/HIV integration and TB/HIV communication strategy.
LPTFs' laboratory infrastructure was strengthened to assure safe and quality processing of TB samples.
AIDSRelief continued linking LPTFs to the Ministry of Health's National TB and Leprosy Program for TB
drugs and supplies for basic laboratory investigations. Referral linkages within the LPTFs and between
LPTF and satellite sites for TB patients were improved, and HIV + patients who required care were referred
to HIV/AIDS clinics. These patients were also treated for other opportunistic infections and received the
basic care package through the CDC/PSI program.
Training of health workers and community volunteers were key activities in FY 2008. AIDSRelief trained
290 community health nurses and 720 volunteers on how to recognize TB signs and symptoms. On-going
training of medical and clinical officers in TB X-ray interpretation and clinical mentorship on TB diagnosis
and care was also provided. Additionally, three regional continuous medical education (CME) sessions,
focused on TB and the integration of TB and HIV care and treatment services, were held in FY 2008. The
AIDSRelief technical team made an average of one week-long visit each quarter to all LPTFs to provide
technical assistance related to TB/HIV. The program also encouraged LPTFs to coordinate with the MOH's
District Health Department to train health workers in TB/HIV.
Coordinated by Constella Futures, strategic information (SI) activities incorporated program level reporting,
program decision making across all LPTFs. AIDSRelief has built and maintained a strong PMM system
using in-country networks and available technology at 18 LPTFs in FY 2008. Constella Futures carried out
site visits to all LPTFs to provide technical assistance to ensure continued quality data collection, data entry,
data validation and analysis, and dissemination of findings across a range of stakeholders.
at each LPTF. Over 1500 patients receiving care and treatment from 14 LPTFs will be included in this
FY 2009 activities
In FY2009, AIDSRelief program will intensify the diagnosis and treatment of TB/HIV co-infected patients by
ensuring that all HIV+ patients presenting with symptoms suggestive of or previous history of TB infection
are appropriately evaluated and properly managed if found to be positive. AIDSRelief will provide treatment
to 3,600 HIV + patients, and all family members of TB patients will be screened for TB. A total of 4,800
registered TB patients will receive HIV counseling and testing results at AIDSRelief supported LPTFs and
all patients testing positive will be referred to HIV care and treatment. Routine, opt-out counseling and
testing for HIV within TB treatment sites will continue, as will systematic referral for TB screening at HIV
testing sites.
The program will continue implementing a family-centered approach to both HIV testing and TB screening.
Under this approach AIDSRelief will assist the LPTFs to implement a contact tracing strategy that ensures
that family members of all HIV+ patients diagnosed with TB be screened for TB. This will be accomplished
using the community based treatment support mechanisms that are implemented at all AIDSRelief
supported centers. AIDSRelief will strengthen the TB-DOTS system through integration with the existing
HIV community follow-up programs. A total of 290 LPTF staff will be trained in the provision of clinical
treatment for TB to HIV+ patients, and 720 community volunteers will be trained to provide community-
based treatment support for TB patients. On-going training clinical mentorship of medical and clinical staff
(including laboratory personnel) will also be provided by the AIDSRelief technical team. This will include TB
diagnosis and management (including TB X-ray interpretation), preparation and handling of specimens,
proper infection control procedures. In addition, AIDSRelief will continue to encourage LPTFs to coordinate
with the MOH's District Health Department to train health workers in TB/HIV.
Activity Narrative: AIDSRelief will ensure that all Uganda National TB reporting requirements are followed and collaborate with
the Uganda National regional and District TB programs to assist all LPTFs to become MOH-registered
TB/HIV treatment centers. The ability to treat co-infected patients at one site will increase adherence to
treatment and simplify monitoring, lessen the health-care burden on co-infected patients, and enhance
sustainability. The program will continue strengthening LPTF laboratory and clinical infrastructure to assure
safe and quality processing of TB samples and effective infection control. AIDSRelief will also ensure
participation of all supported labs in an external and internal quality control program for TB specimens. In
addition, through linkages with the NTLP labs will increase surveillance for MDR- and XDR-TB. To enhance
TB tracking and reporting, Constella Futures, the monitoring arm of AIDSRelief, will ensure compilation of
complete and valid HIV patient treatment/TB data; enhance analysis of required indicators for quality HIV
patient treatment and ARV program monitoring and reporting; and provide relevant, LPTF-specific technical
assistance to develop specific data quality improvement plans for tracking TB cases. The program will use
IQ Care, the current PMM system, to track TB patients who are counseled, tested, and receive their HIV
results and HIV+ patients screened for TB. In addition, all patients accessing care and treatment, and being
treated for TB, will be captured using the existing clinical management tools, and their data captured in the
data base for further analysis and reporting.
To enhance tracking and reporting of comprehensive TB data, LPTF staff will receive training in the
following areas: TB indicator definitions; analysis of TB data captured on the different tracking tools-both
manual registers and electronic; and tracking and reporting on patients completing treatment, and capturing
defaulters. AIDSRelief will promote the data use culture, to enable LPTFs use data for informed clinical
decisions and adaptive management. It will ensure that different data systems at health facilities are
harmonized for effective and efficient reporting.
care and support programs into their health care.
Continuing Activity: 13264
13264 4396.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $100,000
8293 4396.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $30,000
4396 4396.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $13,625
Estimated amount of funding that is planned for Human Capacity Development $26,500
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,000
Table 3.3.12:
HIV/AIDS have access to Antiretroviral Therapy (ART) and quality medical care.
AIDSRelief is a consortium of five organizations which includes Catholic Relief Services (CRS) working as
the lead agency, the Institute of Human Virology (IHV), Constella Futures Group (CF), Catholic Medical
Mission Board (CMMB) and Interchurch Medical Assistance World Health (IMA); AIDSRelief services are
offered through 18 Local Partner Treatment Facilities (LPTFs), distributed throughout Uganda working in
some of the most underserved and rural areas, including Northern Uganda. These include St. Mary's Lacor,
St Joseph Kitgum, Nsambya Hospital, Kamwokya Christian Caring Community, Family Hope Center
Kampala, Family Hope Center Jinja, Virika Hospital, Villa Maria Hospital, Kabarole Hospital, Bushenyi
Medical Center 1- Katungu, Bushenyi Medical Center 2- Kabwohe, Kyamuhunga Comboni Hospital,
Kasanga Health Centre, Kalongo Hospital, Amai Hospital, Aber Hospital, Nkozi Hospital, and Nyenga
Hospital. In order to get services closer to the communities it serves, AIDSRelief supports 24 satellite sites
in selected LPTFs as well as three CBOs. The Children's AIDS Fund is a sub-grantee in AIDSRelief and
As of the end of February 2009, AIDSRelief in Uganda will have supported 18 LPTFs and 24 satellite sites
to provide 7839 orphans and vulnerable children (OVC) with support including psychosocial, life skills,
leveraged education, leveraged nutrition support and leveraged child protection.
In order to enhance linkages and access to health care for OVC, AIDSRelief carried out regional trainings
using facilitators from the Ministry of Gender and Social Development. Trainings were conducted in line with
the Ministry's OVC policy and reached 360 health professionals (Social Workers, Counselors, and medical
personnel) and community volunteers. The objectives of the trainings included equipping OVC service
providers with information and skills in all key areas of focus for OVC, as outlined in the NOP & NSSPI. The
primary goal was to enable OVC community service providers to strengthen linkages between various OVC
interventions and to enhance collaboration and partnership between various stakeholders involved in
implementing OVC work. Following these trainings, the health workers and volunteers acquired relevant
skills that helped them in identifying and sensitizing communities about OVC issues.
Additionally, positive parenting training targeting parents and guardians of OVCs was carried out at 18
LPTFs. 72 such trainings took place, reaching out to 1,500 parents/guardians. The trainings focused on:
parenting skills; children's rights and responsibilities; child abuse and neglect; substance and drug abuse
among adolescents; communicating to children; and general hygiene and nutrition for OVCs.
AIDSRelief has created two entry points in the identification of OVC, the AIDSRelief HIV clinics at all the
LPTFs and the community. At the clinic, the program has identified and supported the HIV+ children as well
as OVCs under the care of the adult clients. Support for OVCs at the facility level includes: identifying the
vulnerable households, nutritional counseling and food supplements as needed, psychosocial support and
training of care givers in OVC management. Also at the facility level, AIDSRelief supported LPTFs to create
a family-centered care environment, and enhanced community support systems, including support for OVC
peer groups, foster homes and paralegal support. All LPTFs established two support groups each, one for
children and one for adolescents, making a total 36 support groups; 70% of the facilities have designated
child friendly corners and child days that typically occurred quarterly.
On child days, children were grouped by age and age appropriate activities were carried out. These
activities included sessions on discipline, behavior life skills, and leadership skills. Identification of skills and
talents also took place, and the OVC were linked to livelihood support programs such as vocational skills
and apprenticeship. Additionally, adolescents were trained in prevention activities, using the Value of Life
Curriculum, with a focus on abstinence. Every year, the program organizes 80 such child days throughout
the supported LPTFs.
Through the community approach, trained health workers and volunteers carried out community
mobilization and sensitization at community and family level using existing structures like churches and
religious leadership, community meetings, and youth peer groups. As a result, they were able to identify
2,900 OVCs and linked them to comprehensive OVC packages provided by the program. AIDSRelief
additionally connected LPTFs with other organizations that provide vital nutritional services often required
by OVC. Through establishing linkages with the Ministry of Health and the Clinton Foundation, LPTFs in
Northern Uganda were trained in the Community Therapeutic Care model. This training equipped them to
provide out-patient care for severely malnourished children without other medical complications, including
the provision of ready to use therapeutic food (PlumpyNut) to 245 OVC. Additional linkages in other
geographical areas have been established with government facilities, such as Mwanamujimu in Mulago
Hospital, which also provides nutritional support. The AIDSRelief Nutritionist also identified nutritional
centers close to the AIDSRelief LPTFs and has engaged these centers to allow the AIDSRelief facilities to
refer the OVC that need nutritional supplements. Other linkages for OVC services including school fees,
and additional nutritional support have been established at nearby health facilities e.g. Jajja's home in
Bushenyi. A total of 2,000 OVCs were supported with school fees; over 3,500 accessed food supplements,
especially OVCs in the Northern LPTFs.
enhancing the effectiveness and efficiency of both paper-based and computerized client monitoring and
management (CMM) systems, assuring data quality and continuous quality improvement, and using SI for
program decision making across all LPTFs. AIDSRelief has built and maintained a strong CMM system
data validation and analysis, and dissemination of findings across a range of stakeholders. Using standard
data collection tools, the program tracked and reported on OVC supported under each core program area.
This enabled LPTFs to accurately report on OVC receiving primary direct, primary supplemental, or any
leveraged support.
Activity Narrative: In FY 2009 AIDSRelief will maintain its services at the 18 LPTFs and 24 satellite sites with the goal to
provide supplemental direct support to 7,300 OVCs. The core areas under here will include: psychosocial
support to infected and affected OVCs; and health care services including nutrition security on child days.
In FY 2009 AIDSRelief will provide a comprehensive OVC package that caters for the provision of age
appropriate interventions to children in order to meet the social, physical and psychosocial needs of the
OVC. The OVC services offered through AIDSRelief will include; care and support, health services, and
psychosocial support (including the mitigation of conflict impact on OVC). Care and support will focus on
empowering families and communities to provide quality care and support for OVC, and ensuring that OVC
are able to get their basic needs. AIDSRelief will provide a package of psychosocial support that will
include: counseling for families of the OVCs in positive parenting skills; caring skills to parents and
guardians; and career guidance to OVCs to enable them live in the challenging environment. The
psychosocial activities will also address: reproductive concerns of adolescent OVCs and trauma and how to
treat it. Through linkages with paralegal programs identified by the LPTFs, succession planning activities
will be carried out. These will target parents/guardians of OVCs, to give them skills to write wills, talk to their
children about their family history, and help families prepare for life after death. The program aims at
reaching 1,080 care providers with these activities.
AIDSRelief will continue to build the capacities of health workers, social workers, counselors and community
volunteers to be able to identify OVC both at the health facilities and in the community and to link them to
comprehensive OVC packages. Specific regional trainings in OVC management will be provided for LPTF
health workers and volunteers with facilitators from the Ministry of Gender, Labour and Social Development.
Training for health workers will enhance skills for providing an OVC friendly approach, i.e. empathy skills,
counseling and listening skills as well supervision and monitoring of OVC activities. Training for community
health workers will include identification and referral of sick OVC to health care facilities for necessary
health services. A total of 290 health workers and 720 community volunteers will be trained. AIDSRelief,
will also provide mosquito nets to 3,500 OVCs families identified in communities.
The LPTFswill be supported to establish adolescent clubs, with adolescent days and targeted services.
Additional child focused support mechanisms such as support groups, which strengthen knowledge, provide
mutual support and address the many psychosocial problems faced by these children, will continue to be
strengthened. The 36 psychosocial support groups for children and adolescents, established in FY 2008,
will remain active. These will bring together over 7,000 OVCs both HIV negative and positive, to share
experiences, access career guidance, ongoing counseling support, and acquire life skills, like being
assertive. AIDSRelief will work with both in-school and out of school OVC support groups, supporting them
with communication messages, leadership trainings, and peer to peer counseling skills.
To ensure that the OVC identified under the AIDSRelief program get a holistic OVC package, LPTFs will be
supported to create linkages with other programs that provide additional OVC program components.
AIDSRelief will leverage support for the following services: 1) Food and nutrition - AIDSRelief will continue
linking with organizations that provide ready to use therapeutic food for severely malnourished children. It is
hoped this activity will reach 2,900 OVCs. 2) With respect to education, AIDSRelief will link with existing
CRS and other agencies that support OVC programs to meet OVC educational needs, such as school fees,
vocational training and apprenticeship opportunities, reaching 3,000 OVC. 3) Activities that support child
protection and economic security will be leveraged from agencies that provide the same, like district
probation offices, and GOAL Uganda in Northern Uganda. Under the CRS Savings and Internal Lending
Communities (SILC) program, 300 families will be reached. This will provide opportunities for caregivers of
OVC to increase their economic resources, enabling them to provide for the basic needs of children in their
care. The SILC program activities will also serve as a venue for identifying additional OVC needs not
addressed by the caregivers.
Additionally, AIDSRelief will dedicate staff time and effort towards strengthening the implementation,
monitoring and reporting on OVC activities. A full time Project Officer (PO) will be supported by the program
for this activity. The PO will be the contact person for OVC activities, follow up on linkages with other
service providers, and organize and facilitate OVC trainings. The PO will work with LPTFs to look for
additional opportunities in their catchment areas for OVC support programs and relevant linkages.
AIDSRelief will also continue working within the Ministry of Gender and Social Development OVC policy in
carrying out all its activities, and access OVC materials.
With respect to strategic information activities, Constella Futures will continue to utilize paper-based and
computerized client monitoring and management systems. All 18 LPTFs will continue to receive site visits
and technical assistance, in order to ensure continued quality data collection, data entry, data validation and
analysis, and dissemination of findings across a range of stakeholders. In FY 2009, further efforts will be
made to track OVC at community level, using existing infrastructure and resource persons like community
volunteers. LPTF staff will be trained to acquire skills in tracking, monitoring, and reporting on OVC
activities. The training will also focus on understanding the various definitions of OVC activities, core
program areas, and avoiding double reporting.
Sustainability lies at the heart of the AIDS RELIEF program, and is based on durable OVC support
programs and health systems strengthening. AR will focus on the transition of the management of OVC
activities to indigenous organizations by actively using its extensive linkages with faith based groups and
other key stakeholders to develop a transition plan that is appropriate to the Ugandan context. The plan
will be designed to ensure the continuous delivery of quality OVC activities to be implemented in close
collaboration with the Government of Uganda to ensure coordination, information sharing and long term
sustainability. For the transition to be successful, sustainable institutional capacity must be present within
the indigenous organizations and LPTFs they support; therefore, the organization will strengthen the
selected indigenous organizations according to their assessed needs, while continuing to strengthen the
health systems of the LPTFs.
Continuing Activity: 13265
13265 4397.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $500,000
8294 4397.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $400,000
4397 4397.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $85,313
Estimated amount of funding that is planned for Human Capacity Development $137,500
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
Table 3.3.13:
the prime agency, the Institute of Human Virology (IHV) of the University of Maryland School of Medicine,
Constella Futures Group (CF), Catholic Medical Mission Board (CMMB) and Interchurch Medical Assistance
World Health (IMA); AIDSRelief services are offered through 18 Local Partner Treatment Facilities (LPTFs),
distributed across Uganda in some of the most underserved and rural areas. These include St. Mary's
Lacor, St Joseph Kitgum, Kalongo Hospital, Aber Hospital and Amai Hospital in Northern Uganda; Nsambya
Hospital, Kamwokya Christian Caring Community, Family Hope Center Kampala, Villa Maria Hospital and
Nkozi Hospital in Central Uganda; Family Hope Center Jinja and Nyenga Hospital in Eastern Uganda; Virika
Hospital, Kabarole Hospital, Bushenyi Medical Center - Katungu, KCRC - Bushenyi, Kyamuhunga Comboni
Hospital, Kasanga Health Centre in Western Uganda. In order to get services closer to the communities
served, AIDSRelief supports devolution of services to satellite sites in selected LPTFs. The Children's AIDS
Fund is a sub-grantee in AIDSRelief and manages a number of the LPTFS. As of July 31, 2008, AIDSRelief
in Uganda was providing care and support to 55,781 adult patients 18 years and older, and antiretroviral
treatment to 16,833 HIV-infected patients 15 years and older. In addition it was providing care and support
to 5,144 infected children under the age of 18, and antiretroviral treatment to 1762 children under the age of
15.
In FY2008 at AIDSRelief supported centers, 40,000 individuals (35,200 excluding TB patients) received
counseling and testing for HIV and received test results (including TB patients). This comprised 19,600
males (17,248 excluding TB patients) and 20,400 females (17,952 excluding TB patients). In order to avoid
stock outs of test kits at the LPTFs, In FY2008 AIDSRelief procured test kits to carry out tests on 100,000
individuals through community outreaches and at the health facilities. The program, in addition, integrated
counseling and testing services into AB and OVC activities. This encouraged couples who participated in
the Faithful House trainings and the youth who participated in the Value of Life trainings to undergo HIV
testing. The program encouraged LPTFs to strengthen their linkages with the Ministry of Health for
additional support in provision of HIV Test kits to supplement on those procured by AIDSRelief.
AIDSRelief has built strong community networks and has also provided mentoring at all LPTFs on
counseling and testing. In Northern Uganda Community based organization Comboni Samaritan in Gulu,
Meeting Point and Christian HIV/AIDS Prevention and Support (CHAPS) have been following up patients on
ART treatment as well as carrying out community mobilization and sensitization. In other LPTFs AIDSRelief
has encouraged the enrollment of Community volunteers who have played a key role in mobilizing the
community, linking them to counseling and testing facilities. The clients that test positive are further linked to
AIDSRelief care and treatment facilities. Those that test negative are encouraged to join existing community
groups that assist in the retention of the negative HIV status.
By the end of FY2008 the AIDSRelief Technical team will have made an average of one visit to each
LPTF/quarter, each lasting on the average one week. As part of the purpose of the above trainings and
CMEs is to further equip the LPTFs with knowledge and skills to improve their support to patients.
In FY2009, through greater coordination and integration of services provided within the community by
networking with other service providers including the Ministry of Health, and should additional resources be
made available, AIDSRelief will endeavor to strengthen counseling and testing services. In the area of
testing and counseling the program will focus on three essential aspects: strengthening the capacity of
LPTFs to perform CT at satellites, at community outreaches; integrating RTC in all clinical areas of the
facilities it supports; enhancing referral networks between the LPTFs and other service providers in their
areas to ensure that all patients identified as positive are referred to HIV care and services. Due to limited
funding AIDSRelief will support LPTFs to build strong referral networks to access C&T and those people
who test positive are referred for care and treatment to other service providers.
Decentralizing counseling and testing services to satellite sites, community outreaches and integrating RCT
will enable community members to have easier access to testing and counseling services and will increase
HIV status awareness particularly among under-represented populations such as men and children in line
with Ministry of Health Guidelines. Community volunteers, especially people living with HIV/AIDS (PLHA)
who have been trained on how to engage communities will mobilize communities to come for these services
and will continue to be supported in this role by AIDSRelief. These will serve as key agents in linking
household members, communities and CT services. The existing system of networks from the service
provision all the way to the household level will ensure that couples, children and adolescents receive CT
services in line with the Ministry of Health Guidelines. In FY2009, AIDSRelief will continue to emphasize the
importance of providing pediatric CT services in line with the Ministry of Health Guidelines. This emphasis
will be supported by ongoing pediatric counseling training aimed at enhancing the capacity of LPTFs to
increase the number of children being tested for HIV.)
In FY2009, AIDSRelief will support LPTFs to provide CT services through which the program expects to
have 40,000 people tested, counseled and receiving their results. In order to address LPTFs challenges of
test kits shortages, AIDSRelief will strengthen the linkages of the sites with MOH supply chain system and
will purchase kits for 20,000 tests to temporarily fulfill the gap created. Linkages will be created between the
MCH, out- and in-patient departments promoting routine counseling and testing and testing targeting
families of infected patients. A concerted effort will be made to reach adolescents through collaborations
with organizations that target adolescent services.
AIDSRelief will further strengthen the existing PLHA networks and will utilize them to sustain the active
referral systems between communities and care and treatment services. Community volunteers will be
trained to increase knowledge on HIV care and treatment and to reinforce their role in conducting
community sensitization on CT services. A total of 290 health workers and 720 community volunteers will
be trained.
Activity Narrative: AIDSRelief will support the LPTFs to integrate Counseling and testing services within the AB trainings and
community activities that focus on OVCs. This will encourage couple testing as well as the OVCs will know
their HIV status and those that are positive will be linked into care and treatment facilities.
program decision making across all LPTFs. AIDSRelief has built a strong PMM system using in-country
networks and available technology at 18 LPTFs in FY 2008. In FY 2009,. It will ensure compilation of
complete and valid HIV patient treatment/ARV data; enhance analysis of required indicators for quality HIV
assistance to develop specific data quality improvement plans. In FY 2009, AIDSRelief will support LPTFs
roll-out of IQCare, electronic data management software deployed in FY 2008, to enhance sustainability of
PMM systems. The program will promote these systems through a Training of Trainers (TOT) and peer to
peer training model in SI, where "expert" LPTF staff will train others in various skills. AIDSRelief will promote
the data use culture, to enable LPTFs use data for informed clinical decisions and adaptive management.
The program will work with LPTFs to document and report individuals counseled, tested, and received
results, including family members. This information will show those eligible to enroll into care, discordant
couples, and those who should be targeted with prevention messages. Technical assistance will be
provided to LPTFs on how to eliminate double counting of repeat testers, identifying clients testing under
other program areas such as PMTCT and TB, and putting in place data collection tools to track CT
information.
Continuing Activity: 13266
13266 4398.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $150,000
8295 4398.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $150,000
4398 4398.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $120,000
Estimated amount of funding that is planned for Human Capacity Development $41,250
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $1,500
Table 3.3.14:
of Human Virology (IHV- UMSOM), Constella Futures Group (CF), Catholic Medical Mission Board (CMMB)
and Interchurch Medical Assistance World Health (IMA); AIDSRelief services are offered through 18 Local
Kitgum, Nsambya Hospital, , Kamwokya Christian Caring Community, Family Hope Center Kampala, Family
Kalongo Hospital, Amai Hospital, Aber Hospital, Nyenga Hospital and Nkozi Hospital. In order to get
Children's AIDS Fund is a sub-grantee in AIDSRelief and manages four of the LPTFs.
In FY 2008, AIDSRelief expanded its services to four new LPTFs. As of July 31, 2008, AIDSRelief in
Uganda was supporting 18 LPTFs and 24 satellite sites to provide care and support to 61,859 patients and
antiretroviral treatment to 20,590 (18,395 supported by AIDSRelief) HIV-infected people of which 1,726
were children.
AIDSRelief improved supply chain management capacity at all 18 LPTFs . AIDSRelief procured
Antiretroviral drugs (ARVs) through a global procurement mechanism which provides very competitive
pricing, with delivery, warehousing and distribution through Joint Medical Stores (JMS). Strengthening local
capacity at critical points has ensured excellent supply chain management and uninterrupted ARVs
provision. To date, AIDSRelief has not experienced any stock-out. The program continues to work closely
with the USG in-country team and the Ministry of Health to harmonize and integrate the procurement of
ARVs. The choice of regimen has been guided by recent evidence to ensure that the most effective and
durable regimen with the minimum toxicity and resistance profile is used. The choice of regimen is based on
the more favorable pharmacokinetic and safety profile and is supported by extensive clinical evidence. The
choice of regimen is also designed to preserve optimal therapeutic choices for second line regimens. In
order to support existing institutions and avoid creating parallel systems, Joint Medical Stores (JMS) a local
faith based organization continued to warehouse and distribute ARVs on behalf of the program with
continued support from AIDSRelief. Reporting and forecasting of ARVs by LPTFs has been improved with
the introduction of the dispensing tool. In FY 2008, AIDSRelief received additional drug support from Clinton
Foundation which enabled the program to scale up treatment beyond that supported by FY 2008 funding.
AIDSRelief continued to institutionalize Standard Operating Procedures (SOPs), which were developed in
accordance with national guidelines. These guide supply chain activities from product selection and
forecasting, procurement, distribution and consumption monitoring. Throughout FY 2008, AIDSRelief
institutionalized these SOPs to ensure efficient supply chain management, and thus provided an
uninterrupted supply of ARVs to LPTFs.
The program also conducted further trainings for all LPTF staff on the general principles of supply chain
management and the ART Dispensing Tool, developed by MSH RPM Plus. This dispensing tool allowed
LPTF to capture accurate pharmacy data, forecast drug needs, monitor patient numbers on ARVs and OI
drugs, generate accurate pharmacy reports, and initiate appropriate stock replenishment through placing
monthly orders. These pharmacy reports tracked stock inventory movement through the supply chain from
deliveries by JMS up to the point of use by the patient. This permitted continuous modulation of patient
enrollment to reflect ARV drugs availability, and ensured a guaranteed and continuous supply of drugs for
each patient initiated on therapy. The use of the dispensing tool has been found to be very helpful in
ensuring patient adherence because it maintains a patient diary. This was further enhanced by on site
training and one-on-one mentoring during routine Pharmaceutical TA for all LPTFs. Furthermore,
AIDSRelief supported LPTFs to establish Therapeutic Drug Committees (TDCs) to assist among others in
the pharmaceutical and clinical management of the program.
In FY 2009 AIDSRelief will maintain its support for services at the 18 LPTFs and 24 satellite sites in order to
maintain 20,590 patients on ART, of which 2,800 will be children (provided additional funding is made
available). AIDSRelief will also provide care and support to 63,620 (55,781 adults, and 7,839 children). The
program will continue to leverage ARVs for pediatric patients from the Clinton Foundation, but will cover
other ART related support such as purchase of OI drugs, laboratory supplies and technical assistance to the
LPTFs. The program will continue to procure adult 1st line, alternative 1st line, and 2nd line therapies for
adults and children. The AIDSRelief Supply Chain Management Team will continue capacity building
through technical backstopping and on-going training and mentoring in Supply Chain Management.
Technical support to LPTFs to institutionalize standard operating procedures (SOPs) for drug management
will continue in COP09. AR will train and retrain the LPTF pharmacists and other health workers including
pharmacy technicians or assistants in the development and use of SOPs which are in line with national
guidelines. In-depth training of the LPTF staff in the utilization of SOPs, forecasting and quantification for
ARVs and general drug management issues will be conducted.
The Pharmaceutical Management Team manages country operations with a Medicines and Therapeutic
Committee (MTC/TDC) of clinicians, pharmacists, strategic information advisors and program managers.
The MTC/TDC reviews drug utilization patterns across all LPTFs, assesses scale-up progress and develops
required technical support plans. The Pharmaceutical Management Team will support the strengthening or
establishment of medicines and Therapeutics committees (MTC) at all Local Partner Treatment Facility. The
Medicines and Therapeutic committees will have the key responsibility of developing policies for managing
medicines use and administration, evaluating the clinical use of drugs and managing a formulary system.
The MTC will promote rational use of medicines (RUM) through the medication use reviews, provision of
Activity Narrative: drug information to patients, monitoring medication errors, development and implementation of
pharmacovigilance plan and development and implementation of continuing education plans. The AR
technical team will provide technical assistance through training and on site mentorship for these
committees. Technical assistance will be provided to the LPTFs in development and implementation of
Pharmacovigilance plan (data gathering activities relating to detection, assessment and understanding of
adverse drug events / reactions i.e. ADEs or ADRs and treatment failure). Functional MTC at LPTF level will
ensure that the ARV supply chain management is clinically informed and logistically supported. The training
and backstopping on the use of electronic tools like the dispensing tool will be continued to further improve
the Drug Information Management System of the LPTFs. To facilitate the recruitment and retention of
competent pharmacy staff for LPTFs, linkages will continue to be strengthened with pharmacy training
institutions with a purpose of recommending graduate students to AIDSRelief LPTFs.
The Institute for Human Virology will participate in the periodic review of National Treatment Guidelines in
order to assist in the selection of regimens most appropriate to the Ugandan context guided by the Ministry
of Health. Choice of regimen is guided by most recent evidence to ensure that the most effective and
durable regimen available within the national guidelines with the least possible toxicity and resistance profile
is used. The current choice of primary regimen for AIDSRelief sites consists of Truvada (TVD) combined
with Nevirapine (NVP) or Efavirenz (EFV) for patients on Rifampicin containing tuberculosis protocols or
intolerant to NVP. Aluvia (lopinavir/ritonovir) is used for those who are intolerant to both NVP and EFV. For
those who have renal insufficiency, AZT/3TC will be substituted for TVD. Limited quantities of Stavudine
(D4T30) to be combined with Lamivudine (3TC) are also procured to be used for patients with both renal
insufficiency and anemia. The choice of regimen is based on the more favorable pharmacokinetic and
safety profile and is supported by extensive clinical evidence. The choice of regimen is also designed to
preserve optimal therapeutic choices for second line regimens, which in the AR program consists of AZT (or
D4T in cases of anemia, or TDF in patients failing AZT or D4T as their primary regimen) coupled with 3TC
and Aluvia. All drugs with exception of Aluvia (which is currently not available as generics) are procured in
generic form. AIDSRelief provides AZT, 3TC and NVP for children less than 5 years of age, and AZT or
D4T, 3TC and EFV/NVP for those above 5 years and ABC as an alternative for those affected by severe
anemia.
Constella Futures coordinates the overall monitoring and evaluation of the AIDSRelief program, and will
support LPTFs in harmonizing patient numbers for both adults and children, to ensure that accurate reports
are produced. This will be done through: updating of the clinical management tools to ensure that they
capture relevant pharmacy information; training and targeted TA to staff focusing on identifying and
reporting active and terminated patients; and properly documenting clients on each regimen. This will
involve emphasizing to clinical staff the relevance of documenting patients switching regimens, and the
reasons for the same. Every quarter, this information will be available, and harmonized with that from the
dispensing tool, so as to inform forecasting and procurements processes
AIDSRelief initiated the development of its sustainability plan in Year 5 focusing on technical,
organizational, funding, policy and advocacy dimensions. To date, the program has been able to increase
access to quality care and treatment, while simultaneously strengthening health facility systems through
human resource support, equipment, financial training and improvements in health management
information. In FY2009, the program will support linkages between LPTFs and the MOH to tap into locally
available training institutions. These approaches will ensure continuity of skills training. AIDSRelief will
particularly focus on its relationship with indigenous organizations such as the Uganda Catholic Medical
Bureau and Uganda Protestant Medical Bureau; Joint Medical Stores to build their institutional capacity to
support LPTFs integrate ART and other care and support programs into their health care services. These
strategies will enable AIDSRelief to fully transfer its knowledge, skills and responsibilities to in country
service providers.
Continuing Activity: 13267
13267 4377.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $4,667,621
8288 4377.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $3,667,621
4377 4377.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $3,667,621
Table 3.3.15:
As of July 31st, 2008, AIDSRelief in Uganda was providing care and support to 55,781 adult patients 18
years and older, and antiretroviral treatment to 16,833 HIV-infected patients 15 years and older. In addition
it was providing care and support to 5,144 infected children under the age of 18, and antiretroviral treatment
to 1726 children under the age of 15. The program provided a total of 18 LPTFs with laboratory equipment
and supplies. Equipment procurement was done in accordance with CDC and MOH guidelines through
local vendors; AIDSRelief identified local service providers for the procurement and distribution of lab
reagents needed for the tests to support treatment of HIV infected patients (CD4 tests, LFT, RFT,
cryptoccocal antigen, malaria, syphilis, HIV& TB, HB, TOXO, CBC, WBC count). AIDSRelief also provided
support for viral load testing at selected LPTFs and linked others to nearby facilities that provide such
services. The program continued its collaboration with Center for Disease control (CDC) Uganda to get
support for viral load testing for QA/QI, and referral CD4 testing, and AIDSRelief LPTF laboratories
participated in UKNEQAS external assessment scheme for CD4 testing with support from CDC. AIDSRelief
also provided support to LPTFs to enhance continuous power supply so that reagents and other lab
materials are properly stored at all times. These included solar powered backup systems. Accessories such
as surge protectors, stabilizers and UPS were also supplied in order to protect delicate equipment from
frequent power surges.
The program additionally conducted on-site and continuing medical education trainings for laboratory staff
to strengthen their capacity to initiate and monitor patients on ARVs, and to conduct diagnostic tests for
opportunistic infections. A total of 96 laboratory personnel received refresher courses in standard operating
procedures, good laboratory practices, reagents forecasting and procurement , quality assurance and
quality control, infection control, DBS collection techniques, Direct TB smear Microscopy, HIV rapid testing,
basic flow cytometry and viral load techniques. These trainings were conducted in accordance with the
national guidelines. As AIDSRelief focused on decentralization of services, it further increased the
laboratory capacity of 24 LPTF satellite sites, enabling them to perform rapid HIV tests, malaria smears, TB
smears and other diagnostic tests and to collect and process specimens for other tests to be performed at
identified referral laboratories. Pediatric diagnostic capacity was accessed by all LPTFs and their satellite
sites and early infant diagnosis enabled the earlier initiation of therapy as required. AIDSRelief provided
support for viral load testing at Some LPTFs. AIDSRelief provided clinical management tools to ensure
collection and compilation of laboratory data for all HIV patients.
In FY 2009, AIDSRelief will maintain its services at the 18 LPTFs and 24 satellite sites with the goal to
maintain 20,000 patients on ART, of which 2,800 will be children, and 63,620 patients in care and support.
The FY 2009 request will include provision for lab supplies and technical assistance to the LPTFs. In FY
2009, AIDSRelief laboratory support will continue to include the procurement and distribution of necessary
reagents from local distributors (HIV test kits, reagents for the identification of opportunistic infection).
AIDSRelief will further strengthen LPTFs laboratory capacity to diagnose TB, malaria and other
opportunistic infections through additional equipment and supplies and technical assistance Laboratory staff
skills in forecasting will be strengthened. There will be some provision for viral loads measurements. Tools
and reference materials to monitor OIs and ARV drug toxicities will also be provided. The program will
continue the provision of clinical management tools to ensure collection and compilation of laboratory data
for all HIV patients. Through strengthening internal controls, and with support from CDC, AIDSRelief will
ensure that all laboratories build on the current quality assurance program through participation in external
quality assurance schemes such as UKNEQAS. AIDSRelief will also ensure that service contracts for
laboratory equipment remain in place, and that routine preventative service visits and prompt maintenance
occurs. The program will also maintain support for the maintenance of solar back up power systems and
surge protectors. To enforce sustainability the program will build local capacity in country to perform
equipment maintenance/ service by collaborating with private service providers.
AIDSRelief will again provide refresher trainings for 96 laboratory personnel to emphasize standard
operating procedures, good laboratory practices, reagents forecasting and procurement and quality control
to ensure a safe working environment, personal safety and reliable laboratory test results. Additionally, in
order to address the shortage of laboratory personnel, the program will train nurses and midwifes to conduct
HIV rapid tests and link them to MOH and CDC for quality assurance support and laboratory training
schools to increase the number of qualified staff. Additional efforts will be made to create linkages between
LPTFs and training institutions in order to facilitate the recruitment of qualified staff. As AIDSRelief
continues its focus on decentralization of services, it will continue support for the 24 satellites laboratories.
This includes continued training for these sites in rapid HIV testing, malaria smears, TB smears and other
diagnostic tests and in the collecting and processing of specimens for other tests to be performed at an
identified referral laboratory. Laboratory services will also be further extended to include home based HIV
testing and mobile laboratories in case sufficient funding) is made available for this.
In FY 2009, AIDSRelief will engage the Ministry of Health to ensure that AR is represented in the Laboratory
Technical Working Group, and diffuse relevant information from this group to LPTFs. The program will
continue its collaboration with Center for Disease control (CDC) Uganda to get support for viral load testing
Activity Narrative: for QA/QI, and referral CD4 testing. AIDSRelief LPTF laboratories will continue to participate in UKNEQAS
external assessment scheme for CD4 testing with support from CDC. Through Constella Futures,
AIDSRelief will continue to support all sites to accurately document and track laboratory tests. All data will
be captured in the current electronic data base for easy retrieval. On a monthly basis, reports will be made
indicating number of tests performed and staff trained. The PMM system will help to identify those clients
that need monitoring tests like CD4s, and link up with relevant personnel to have the tests performed. The
close monitoring and reporting will eventually feed into forecasting and procurement of laboratory reagents
and supplies.
Continuing Activity: 13269
13269 4390.08 HHS/Health Catholic Relief 6429 1290.08 AIDSRelief $750,000
8290 4390.07 HHS/Health Catholic Relief 4799 1290.07 AIDSRelief $755,871
4390 4390.06 HHS/Health Catholic Relief 3330 1290.06 AIDSRelief $755,871
Table 3.3.16:
