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
As of 1st July 2008 The Mildmay Centre (TMC) merged with her sister programme Mildmay Paediatric Care
Centre (MPCC) to form Mildmay Uganda. Mildmay Uganda (MU) is a faith-based organisation operating
under the aegis of the Uganda Ministry of Health since 1998 and managed by Mildmay International. It is
recognised internationally as a centre of excellence for comprehensive HIV/AIDS care and training,
particularly for children (less than 18 years), who constitute 28% of patients. MU has had a cooperative
agreement with CDC, Uganda since 2001 to support training in HIV/AIDS care and treatment. From April
2004 the support was expanded to include ART and palliative HIV basic care. MU runs one main clinic site
in one subcounty in Wakiso district which also serves as a referral center for clients outside the catchment
area, and eight rural clinics i.e. in one subcounty in Kamwenge district, two subcounties in Luwero district,
two subcounties in Mityana district, one subcounty in Mpigi district, two subcounties in Mukono district.
Since opening, MU has registered over 20,000 patients, of whom more than 13,000 are actively in care.
6,465 patients receive antiretroviral (ARV) drugs through PEPFAR, >500 through MOH (Global Fund), and
300 receive ART paying privately, but are supported to access the free palliative basic care package and
laboratory services i.e. CD4 counts and other laboratory tests, Cotrimoxazole prophylaxis, a safe water
vessel, free mosquito nets for malaria prevention, and other palliative care services i.e. morphine and
chemotherapy for HIV related cancers and management of opportunistic infections including TB. More
services to the patients including cervical cancer screening, reproductive health and family planning,
screening and treatment of HIV related eye diseases, dental care for children and mental health care are
now offered at MU and the rural sites (only eye clinic at rural sites). In order to decongest the main site, MU
started a community programme that covers two districts of Wakiso (6 subcounties) and Kampala (1
subcounty). Reach Out Mbuya (RO) is a sub-partner with MU in the provision of holistic HIV care services
and it has 3 sites in one subcounty in Kampala District. It is an initiative of Mbuya Parish in Kampala
archdiocese, serving the urban poor. RO started in May 2001 with 14 patients using a community-based
approach implemented by volunteers and people living with HIV. By the end of June 2008, RO had 2,848
patients in palliative care including 221 children. Of the 1,574 (60%) clients on ART; 69 are children, 789
PEPFAR funded, 741 MOH funded and 44 by JCRC/DART clinical trail. 124 were on TB treatment. By June
2008 RO had expanded to Kasaala in Luweero were needs assessment has already been conducted.
Training at MU is a key component of the programme, targeting doctors, nurses, HIV/AIDS counsellors,
pharmacists, laboratory personnel, nursing assistants, community health workers, school teachers, religious
leaders, community leaders and care givers of patients. MU views care and training as complementary
processes when offering HIV/AIDS services. The training programme reaches participants throughout
Uganda via a work-based training programme, mobile training teams (MTTs), clinical placements and short
courses. Courses include: HIV Programmatic issues; Use of ART in Children and Adults; Management of
Paediatric HIV/AIDS; HIV/AIDS Palliative Care; Laboratory Skills in an HIV/AIDS Context; Management of
Opportunistic Infections and others. MTT trains health workers from targeted rural districts of Uganda
through modular work based programmes. The work-based training programme targets health
managers/policy makers nationally from government facilities, faith-based organisations and other NGOs.
The work-based programme comprises a modular programme with six staggered residential weeks over an
18-month period but students have the option of undertaking extra 18 months of study for the award of the
degree. In between the training modules of the work-based programme, students are expected to practice
what they have learnt and to complete their assignments. The time between modules in the work-based
programmes is spent at the workplace doing assignments and putting into practice what has been learnt.
MU and RO both have electronic systems for capturing their data, analysis and reporting including an M&E
system for monitoring performance. The activities are regularly reported on coupled with very good public
relations. Further the support directorates of resources and quality assurance support more all the care,
treatment and training activities.
RO in partnership with MU has implemented PMTCT programme since 2004 using a peer model of mother-
to-mother supporters, this is aimed at reducing HIV transmission to the unborn baby to 3%. RO PMTCT
programme has been improving since its inception with HIV transmission of 33% in 2005 reducing to 7% in
2006.By July 2008, 461 mothers had been enrolled with 307 deliveries, 219 babies tested for HIV DNA PCR
with peri natal HIV transmission reduced to 3% 24/219, in these infants. The baby-mother pairs are offered
a comprehensive PMTCT package according to national and international standards. In addition MU has
been and will, in FY 2009, continue training nursing assistants, a key cadre involved in managing pregnancy
and childbirth in addition to nurses and midwives, to further strengthen PMTCT activities. Specific activities
include face-to-face training, field practicum and supervisory visits. Within the Mildmay regional approach
where the courses are run in the targeted rural districts. . MU PMTCT training has been carried out with
emphasis on nurses and midwives who are the direct implementers. 122 health workers have been trained.
Through the short courses; as an intensive two-week programme. 21 participants have been reached
through this program area. Participants are exposed to the National Hospital Referral PMTCT site. 101
participants have been reached through the work based programmes where PMTCT is done as a
component within the larger HIV clinical care module.
For FY 2009 RO is targeting to enroll 220 pregnant mothers onto comphrensive PMTCT package, provide
nutrition supplementation to 300 pregnant women, lactating mothers, and their babies up to 18 months of
age .We are targeting to train 32 health workers in the provision of PMTCT at RO and 100 at MU. The
capacity of the community health workers (68) and staff (32) will be built to provide PMTCT services, and
the referral systems will be strengthened. We are targeting to train 35 health workers in the provision of
PMTCT.
New/Continuing Activity: Continuing Activity
Continuing Activity: 17090
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
17090 17090.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $150,000
Disease Control & International Project
Prevention
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Safe Motherhood
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Estimated amount of funding that is planned for Water $20,000
Table 3.3.01:
leaders, community leaders and carers of patients. MU views care and training as complementary
MU and RO have been implementing the AB strategy and other prevention through a number of activities.
These include HCT, (which has been provided for over 22,423 people between April 07, and March 08 at
TMC and 4,391 at Mbuya RO), AB sensitization and awareness that has benefited 15,816 people in FY
2007 and through support clubs like Our Generation Mildmay Adolescent Club (OGMAC) and group of
persons living in discordant relationships. Other areas of prevention included condom distribution and
training. Training carried out in the AB approach targeted specific groups like religious leaders, teachers,
adolescents, and the youth. 35% of TMC patients are children and they benefited from the A aspect of
prevention at TMC and family members of TMC clients tested through the VCT programme, are also
targeted for AB messages. Couple counselling is offered to all patients and ‘B' messages are emphasized
for these couples. These activities are also extended to the communities around TMC clinics and clients at
the rural sites through patients' workshops. Between October 1, 2007 and March 31, 2008, there were 9
sites under MU providing CT with a total of 9,310 individuals receiving CT and 2300 at RO. Multi-disciplinary
hospital and home visits continued. The community programme was introduced in February 2008. Stable
children together with their carers are referred and followed up by Mildmay staff in selected near by health
facilities, in order to decongest the main clinic. 7 clinics are currently in operation. The main reasons for
which counselling services were sought were mainly pre-ART counselling, Adherence and positive
prevention which includes prevention of sexual transmission. 386 were trained and the training in this area
includes imparting communication and counselling skills where knowledge of HIV status enables the
individual to access care and support. Trainees are trained at both TMC and the rural districts. Workplace
sensitisation programmes have also been carried out, notably to the Parliament of Uganda, where 300
individuals were trained and encouraged to know their HIV status. Training courses are typically 5 days to
three weeks in duration. Between April 2007 and March 2008, through our AB strategy RO reached 2,719
youth aged between 12-24 years, 196 couples, 1,131 women, and 32 alcohol related adults. Several clubs
function and include; discordant, couples for life, operation Gideon (Males), good Samaritan (females),
Saturday children's club, AA, etc.
During FY 2009 MU will continue providing services and providing training activities at 12 sites of MU and 4
sites of RO. This is a continuing activity and involvement of rural partners and training will help the
sustainability of the activities. MU will continue to implement the ABC (Abstinence, Be Faithful, and Condom
use) strategy and Other Prevention (OP) through a number of activities, which include HIV Counselling and
Testing (HCT), sensitisation and education, condom distribution, support clubs like the persons living in
discordant relationships and positive prevention clubs. The prevention of sexual transmission will be done
for TMC clients, their families, communities around clinics, faith based organizations and schools and during
Activity Narrative: the VCT activities. The targeted numbers for FY2009 are 27,500 individuals (A=1,500; AB = 2,000 while
other prevention = 15,000) and 9,000 at RO. The numbers will go slightly up in FY2010 to about 30,500 at
both MU and its rural sites and RO. Abstinence messages are especially emphasized for the young people.
Married people and couples in discordant relationships benefit from the ABC messages so as to prevent
HIV transmission to the partner. These and other patients in risky situations are targeted with prevention
messages including condom use, STI prevention and treatment, and family planning. The training will cover
PMTCT, family planning, management of Sexually Transmitted Infections (STI) and adolescent sexual and
reproductive health. A new area of emphasis in these two years will be treatment literacy and sensitization
and follow up for persons who test HIV negative at TMC. The funding in this programme area will support
the integration and strengthening of existing AB and OP activities like training, community mobilisation and
awareness, production of IEC materials, support clubs, and monitoring and evaluation.
In FY 2009, AB activities under RO will be further strengthened targeting 5,980 youth and adolescents in
the communities and schools, 268 couples, 2,700 women, 100 local leaders, 100 discordant couples and
160 people affected by alcohol through spiritual and human awareness campaigns, sensitisation and
training. 300 female and 150 male clients will be reached through adult education to equip them with basic
writing and reading skills that will support the positive prevention strategies. RO shall expand their sexual
prevention services including "moon-light" VCT to high risk groups such as; sex workers (50) and truck
drivers (30).
Continuing Activity: 13283
13283 8641.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $280,000
8641 8641.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $135,000
Military Populations
Table 3.3.02:
Continuing Activity: 13284
13284 8643.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $220,000
8643 8643.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $200,000
Table 3.3.03:
in one subcounty in Wakiso district which also serves as a referral center for clients outside the catchmewnt
Between October 1, 2007 and March 31, 2008, 10,822 clients received palliative care/basic health care and
support (including children) under MU through 9 sites and RO through 3 sites. 437 were trained in palliative
care and support. There were 1,294 new naïve adult clients (+ 15 years) receiving ARVs and 6,548 who
had ever received ARVS. Two specialist clinics were started. Eye clinic was opened in November 2007 to
screen and treat patients with HIV related eye conditions. 28% of the clients seen in the eye clinic are
children. The community programme was introduced in February 2008. Stable adult patients are referred
and followed up by Mildmay staff in selected near by health facilities, in order to decongest the main clinic. 7
clinics are currently in operation. The trainings run at MU target the management of HIV/AIDS in adults. 410
health care workers were trained in HIV/AIDS treatment. These included doctors and nurses, allied health
professionals; counsellors, physiotherapists, occupational therapists, nutritionists and informal caregivers;
carers of patients. Training not only focuses on the physiological processes of HIV/AIDS but also on the
psychosocial and spiritual needs of patients living with HIV. Trainees come from various health facilities,
both rural and urban as well as both government and NGOs. Training courses are typically 5 days to three
weeks in duration.
During FY 2009 MU will continue providing HIV services and training activities at 12 sites of MU and 4 sites
of RO. In FY 2009, 15,422 adults will receive basic health care and support; of these 6025 will be at MU,
6000 at the satellite clinics and 3397 at RO. The funds for this programme area will finance the purchase of
drugs for management and prevention of OIs, along with symptom control and pain management. Family
planning services will be provided at MU as part of the care and treatment. The target population is people
living with HIV/AIDS in a 60-kilometre radius for TMC and population at its 12 rural sites and military
populations in the catchment area of RO plus persons who left the IDP camps and settled around RO. MU
will train 1500 individuals through formal courses and clinical placements. MU will also work in collaboration
with PSI to make the basic care kit (including 2 mosquito nets, safe water vessel, water guard, and
condoms) available to patients; MU will screen an estimated 500 HIV infected women at risk of cervical
cancer using both the visual method (VIA), and the pap smear. In addition, patients will be assessed for
mental illness and those found seen by a psychiatrist who runs a weekly clinic on site. In addition all
patients starting ART will be assessed for CMV retinitis to prevent blindness and those found with CMV
treated by a visiting ophthalmologist who runs a weekly clinic on site. Disabled (hemiplegic and paraplegic)
patients in care will be provided with transport to and from their homes whenever necessary but the home
visitors will also ensure that these patients receive their services at home. The patients whose homes are
visited will have an opportunity to have their fmily members tested for HIV and those already stable in care
will have their drugs and support provided at selected community sites with the help of community-based
Activity Narrative: volunteers (CBVs).This is a continuing activity and involvement of rural partners and training will help the
sustainability of the activities. Care and treatment plus training activities will be provided at 12 sites and 4
sites at RO. MU will continue training at the Centre as well as upcountry in targeted districts. Together with
Emerging Markets Group, a USAID - funded project MU will also train health practitioners in the private
sector in HIV management. MU will train - individuals through formal courses and clinical placements.
Continuing Activity: 13285
13285 4419.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $340,000
8338 4419.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $280,000
4419 4419.06 HHS/Centers for Mildmay 3344 1298.06 HIV/AIDS $172,000
Table 3.3.08:
Continuing Activity: 13290
13290 4414.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $4,490,301
8333 4414.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $4,490,301
4414 4414.06 HHS/Centers for Mildmay 3344 1298.06 HIV/AIDS $3,271,807
Table 3.3.09:
Between October 1, 2007 and March 31, 2008, 48 clients received TB+ HIV care/treatment. There were 9
sites under MU that provided TB/HIV treatment. 254 were trained in TB/HIV treatment. Two specialist clinics
were started. Eye clinic was opened in November 2007 to screen and treat patients with HIV related eye
conditions. 21% of the clients seen in the eye clinic are children. The community programme was
introduced in February 2008. Stable children together with their carers are referred and followed up by
Mildmay staff in selected near by health facilities, in order to decongest the main clinic. 7 clinics are
currently in operation. By June 2008 RO had expanded to Kasaala in Luweero were needs assessment
has already been conducted. 847 health care workers trained. These include health professionals; doctors
and nurses, allied health professionals; counsellors, physiotherapists, occupational therapists, nutritionists
and informal caregivers; carers of children. Training not only focuses on the physiological processes of
HIV/AIDS but also on the psychosocial and spiritual needs of children living with HIV. Trainees come from
various health facilities, both rural and urban as well as both government and NGOs. Training courses are
typically 5 days to three weeks in duration. The main topics in paediatric training include communication
with children, disclosure of HIV status to children, supporting children who attend school as well as the
usual ART and OI training issues. The challenges in paediatric treatment and care include measurement of
adherence in children on syrups, linking well children to school programmes, provision of food to the
families of malnourished children and those from food-insecure families, supporting carers who are elderly
and linkages to skills development and IGAs for children growing into adult hood.
During FY 2009 MU will continue providing services and providing training activities at 12 sites and 4 sites
at RO. In FY 2009, 4,357 children will receive basic health care and support; of these 3000 will be at TMC,
1067 at the satellite clinics and 290 at RO. The funds for this programme area will finance the purchase of
drugs for management and prevention of OIs, along with symptom control and pain management. This will
be done by provision of a basic care package including Cotrimoxazole, a safewater system, ITNs and
treatment of specific OIs. In addition ART will be provided to children who qualify through the MU
multidisciplinary team. There will be an in patient facility with 53 bed capacity where an average of 80
children with severe symptoms and OIs will be admitted for stabilisation. As part of this children will also be
provided with psychosocial support through the social workers, counsellors, the child care assistants and
through the children's and adolescents support group OGMAC. The adherence will also organise follow up
visits to homes and schools of selected children with adherence challenges. Children with severe dental
disease related to HIV, mental conditions and eye problems related to HIV will receive services on site
through these weekly special clinics. These services are provided to improve welfare of the children and
also to improve adherence to treatment and care regimens as well as reducing morbidity.TMC will train
Activity Narrative: 1500 individuals through formal courses and clinical placements to better the paediatric care in other rural
sites. TMC will also work in collaboration with PSI to make the basic care kit (including 2 mosquito nets,
safe water vessel, water guard,) available to patients. This is a continuing activity and involvement of rural
partners and training will help the sustainability of the activities. For this work to be done a multidisciplinary
team of health workers will be maintained. MU will continue training at the Centre as well as upcountry in
targeted districts. Together with EMG, a USAID - funded project MU will also train health practitioners in the
private sector in HIV management. MU will train - individuals through formal courses and clinical
placements. The targeted group are children living with HIV and already in the programme, newly
diagnosed children from the HIV testing routines at the Centre and surrounding community as welll as those
from the families of our established patients and the military in Mbuya.
Table 3.3.10:
team of health workers will be maintained.. MU will continue training at the Centre as well as upcountry in
Table 3.3.11:
in one subcounty in Wakiso district which also serves as a referral centre for clients outside the catchment
Between October 1, 2007 and March 31, 2008, 258 patients were treated for TB at the 12 sites providing
care under MU and RO. 287 health workers were trained in TB/HIV care during the reporting period.
Training is designed to provide technical knowledge and skills essential for the implementation of TB/HIV
collaborative activities in Uganda. The curriculum of this course has been adopted from the MOH training
for district health worker s and as such is in line with the national guidelines on TB/HIV management.
Cadres trained have been health workers; mainly doctors, nurses and clinical officers. We enrol an average
of 18 clients of TB per month, with 30% sputum smear positive and the TB treatment success rates of 63%.
Currently 258 patients are receiving treatment for TB through the 12 sites under MU and RO and we have
intensified case finding and prompt treatment of TB to reduce transmission and MDR.
During FY 2009 MU will continue providing TB/HIV services and related training activities at 12 sites of MU
and 4 sites of RO. This is a continuing activity and involvement of rural partners and training will help the
sustainability of the activities. At MU 150 health workers will be trained in TB/HIV with aim of delivering
quality TB services including examination, screening HIV patients for active TB, clinical monitoring, related
laboratory services, and clinical care. CBVs will also be trained to monitor patients on TB treatment through
DOTS (Directly Observed Short Course Therapy). For FY 2009 RO shall intensify TB case finding including
contact tracing for all the TB cases (120), build the community capacity for DOTs (83), improving the
laboratory services in the four RO sites with Kasaala as the new site, refresher training on TB management
for the staff (40) and ensure timely supply of equipment, reagents and drugs.
Continuing Activity: 13286
13286 8619.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $250,000
8619 8619.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $167,587
* TB
Table 3.3.12:
agreement with CDC-Uganda since 2001 to support training in HIV/AIDS care and treatment. From April
Between October 1, 2007 and March 31, 2008, there were 9 sites under MU providing services for OVCs
and 1,083 OVC received primary direct support while 2,139 received supplemental direct support. A total of
985 OVC received food and nutritional supplements. Further more 1,331 were reached with life skills
training. These activities were done through school visits, community outreaches, and training at TMC.
Other services provided to OVC include nutritional counselling, and psychosocial support. The program
continued to follow the national guidelines on OVC support, which is implemented through the Ministry of
Gender Labour, and Social Development (MOGLSD). The OVC programme at TMC networked with other
organisations providing complementary services and through working with schools, churches, and
communities. In the rural areas HIV-infected OVC in care were linked to existing community OVC
programs. Home visits were carried out for OVCs that needed special attention. The community programme
was introduced in February 2008 for children. The seven community outreaches are currently in operation
and the main activities under this program area include involvement of family members in caring for affected
children, home visits for the children faced with social problems like stigma and discrimination, trainings
carried out for families and schools nurses, carers and patients, provision of career guidance and
psychotherapy services plus peer support clubs for OVCs. By the end of FY 2008 it is expected that 200
persons will have been trained in care for children, and that 5,000 children (below 18 years) will have been
reached and it expects to offer psychosocial support to 35 child-headed and 65 grandparent-headed
homes. The trainings run at MU target improving the lives of orphans and other vulnerable children affected
or infected by HIV/AIDS. The OVC services at RO aim at supporting the children infected and affected in
areas of Income Generating Activities, school fees including scholastic material, nutrition and psychosocial
support. As per June 2008, a total of 221 OVC received support from RO in at least three core areas of
OVC support and 976 children benefited as supplemental direct support. On average three children are
supported per OVC family through RO. 100 service providers were trained, these were mainly health
professionals; doctors and nurses, allied health professionals; counsellors and social workers and informal
caregivers; carers of children. Training focuses on the psychosocial support of carers of OVCs. Trainees
come from various health facilities, both rural and urban as well as both government and NGOs. Training
courses are typically 5 days to three weeks in duration. During FY 2009 MU will continue providing services
and providing training activities at 12 sites of MU and 4 sites of RO. This is a continuing activity and
involvement of rural partners and training will help the sustainability of the activities. MU will continue
training at the Centre as well as upcountry in targeted districts. MU will train 150 individuals through formal
courses and clinical placements. Training of community Based Volunteers (CBVs) will be carried out both at
MU as well as targeted rural districts as this is a cadre that is directly involved in the care of OVCs living in
vulnerable families. Other funders like Oslo fund supports the children's choir and other recreational
Activity Narrative: activities in addition to what is received from PEPFAR and overall the emphasis areas include child survival
activities, strengthening households to cater fro the OVCs and training in life skills.
MU expects to reach 10,964 OVC (TMC 7,000 while MPCC covers 3,964) and in FY2010, a total of 12,464
OVC is expected to benefit from OVC services (8,500 OVC by TMC and 3,964 by MPCC). It is expected
that 140 people in FY2009 and 170 in FY2010 will be trained in OVC issues and communication with
children in order to strengthen the capacity of the family unit and community structures, which protect and
promote healthy child development. A total of 1,790 OVC will be reached with food and nutrition
supplementation in FY 2009 while the number is expected to come down to 1,540 in FY2010 due to the
planned move to the community and the expected training sessions planned for the community. The
caregivers targeted include; parents, guardians, other caregivers, extended family, neighbors, community
leaders, police officers, social workers, health care workers, teachers, and community workers will receive
training on how to address the needs of OVC. The funds under this program will finance training especially
in life skills development, HIV/AIDS prevention among the positives and negatives, communicating with
children skills, and, the funds will give psychosocial support, tuition for selected children, child advocacy,
and human resource. The schools, churches, clinics, child protection committees in the community around
TMC clinics will be targeted. This is a continuing activity and involvement of rural partners and training will
help the sustainability of the activities. RO intends to provide OVC support to 360 as primary direct target
and 1,080 supplementary direct target using a family based approach for FY 2009/10.
Continuing Activity: 13287
13287 4417.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $750,000
8336 4417.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $500,000
4417 4417.06 HHS/Centers for Mildmay 3344 1298.06 HIV/AIDS $909,020
Estimated amount of funding that is planned for Education $16,000
Table 3.3.13:
The Mildmay Centre provides HIV Counselling and Testing (HCT) using several strategies which include
HCT at TMC, community VCT outreach in collaboration with other partners, such as churches and private
businesses, home-based VCT for relatives of patients during home visits, couple counselling and testing,
and by supporting the rural sites to provide VCT to pregnant women and other patients who visit those
clinics. Partners of TMC clients are provided with CT as part of the package before starting ART to adults
who are sexually active. All adults attending TMC are strongly encouraged to bring their children for testing.
All Counselling and training for HIV/AIDS care providers is done using the national and international
guidelines. CT training targets doctors, nurses, counsellors, pharmacists, pharmacy technicians, laboratory
personnel, clinical officers, religious leaders, community leaders, people living with HIV/AIDS (PHAs),
schoolteachers, school nurses, and other lay caregivers. By March 2007, 22,423 people accessed CT at
TMC and 3,510 at Reach Out Mbuya. As part of the targeted evaluation, TMC provides home-based CT for
clients and their families. All patients who are found to be HIV positive are recruited into care, started on
Cotrimoxazole prophylaxis and CD4 tests are performed, and where appropriate ART is initiated. Between
October 1, 2007 and March 31, 2008, there were 12 sites under MU and RO providing CT with a total of
9,310 individuals receiving CT and 2300 at RO. This is progress for have the year. Multi-disciplinary hospital
and home visits continued. The community programme was introduced in February 2008. Stable children
together with their carers are referred and followed up by Mildmay staff in selected near by health facilities,
in order to decongest the main clinic. 7 clinics are currently in operation. The main reasons for which
counselling services were sought were mainly pre-ART counselling, Adherence and positive prevention.
386 were trained and the training in this area includes imparting communication and counselling skills
where knowledge of HIV status enables the individual to access care and support. Trainees are trained at
both TMC and the rural districts. Workplace sensitisation programmes have also been carried out, notably
to the Parliament of Uganda, where 300 individuals were trained and encouraged to know their HIV status.
Training courses are typically 5 days to three weeks in duration. By June 2008 RO had expanded its HCT
services to Kasaala in Luweero were needs assessment has already been conducted.
During FY 2009 MU will continue providing HCT and training activities at 12 sites of MU and 4 sites of RO.
This is a continuing activity and involvement of rural partners and training will help the sustainability of the
activities. MU will continue to train health workers and workplaces in counselling and testing, to encourage
employees to know their status. Using the TMC family approach, 31,000 patients will be provided with CT
(8,500 at TMC, 5,500 at rural sites, 8,500 in community outreaches and 1,700 at MPCC) and 7000 at RO,
while an additional 3000 will be reached in the FY2010. Areas around TMC clinics will take first priority. Two
special groups; drivers through their organisation of Uganda Taxi operators and armed personnel i.e Police
Activity Narrative: and Military will be targeted these two years. The funding for this programme is for the procurement of CT
logistics, the provision of CT services, human resources, training activities, and capacity building particularly
for the rural sites. The other targeted population is people living with or affected by HIV/AIDS. RO shall be
providing various forms of counselling services to 7,210 individuals and their family members both at
Nakawa Division, Kampala and Kasala (Luweero District). Males will be reached through the family
approach and through couple counselling.
Continuing Activity: 13288
13288 4418.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $200,000
8337 4418.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $200,000
4418 4418.06 HHS/Centers for Mildmay 3344 1298.06 HIV/AIDS $157,652
Table 3.3.14:
Between October 1, 2007 and March 31, 2008, 1,725 naïve adult clients were initiated on ART bringing the
total number of clients who have ever received ARVs to 10,214 through the 12 sites under MU and R0. 410
were trained in HIV/AIDS treatment/ARV services. The drug management at MU is now all electronic with
prescriptions entered into a database real time and stock control done using the same system. Two
specialist clinics were started. Eye clinic was opened in November 2007 to screen and treat patients with
HIV related eye conditions. 21% of the clients seen in the eye clinic are children. Multi-disciplinary hospital
together with their carers are referred for follow up by Mildmay staff in selected near by health facilities, in
order to decongest the main clinic. 7 clinics are currently in operation. The trainings run at MU target the
use of ARV drugs in resource limited settings. 410 were trained; these were mainly health professionals;
doctors and nurses, allied health professionals; counsellors, physiotherapists, occupational therapists,
nutritionists and informal caregivers; carers of patients. Training focuses on the side effects and drug
interactions of ARVs, when and how to initiate treatment, adherence and the principles of antiretroviral
therapy Trainees come from various health facilities, both rural and urban as well as both government and
NGOs. Training courses are typically 5 days to three weeks in duration. The challenges are inadequate
space in the pharmacy and store which means that all buffer stock is kept with the supplier and pharmacy
staff have limited space to work in.
During FY 2009 MU with RO its sub partner, will continue providing ARVs and training activities at 12 sites
of MU and 4 sites of RO. The funds for this programme area will finance the purchase of ARV drugs for both
adults and children with HIV abd fit within the criteria for starting on ART as per the Uganda National
Treatment Guideline Emphasis will be put on FDA-approved generics and branded ones will only be used
where the generic equivalent is not available. More than 90% of the patients are on firstline drugs and
therefore these will form the bulk of the ARV drug purchases. However all children and adult patients who
need the second line drugs either because of failure on first line or adverse events will also be provided with
ARV drugs. The procurement system will be strengthened to ensure sustained supply at all sites and a
buffer stock for 4 months will be maintained to avoid any risks. The drugs will be used to manage children
and adults who have reached the threshold for starting ART, any pregnant women at risk of transmitting the
virus to their unborn babies and victims of rape and sexual assault, health workers exposed to HIV as well
as patients on ART moving into the catchment area. The provision of ART will follow a strict preparation
exercise where patients will have CD4 tests done and for all adults with values above 250 are treated and
children with appropriate CD4 percentages as well as all infected infants are prepared for treatment and
family members screened for HIV and those found positive recruited too. This is a continuing activity and
Activity Narrative: involvement of rural partners and training will help the sustainability of the activities. MU will continue
training at the Centre as well as upcountry in targeted districts to handle the ARV drugs better. Together
with EMG, a USAID - funded project MU will also train health practitioners in the private sector in HIV
management and use of ARV drugs. MU will train - individuals through formal courses and clinical
placements. The targeted population is all people living with HIV/AIDS and health workers working
HIV/AIDS organisations within the target area for Mildmay and Reach Out Mbuya plus the military
population around Reach Out.
Continuing Activity: 13289
13289 4415.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $4,842,541
8625 4415.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $4,842,541
4415 4415.06 HHS/Centers for Mildmay 3344 1298.06 HIV/AIDS $3,195,003
Table 3.3.15:
MU currently supports laboratory services at all the sites. MU's laboratory has the capacity to perform HIV
tests, CD4 tests, Full Blood Counts (FBC), diagnostic tests for opportunistic infections (OI), and chemistry
analysis for liver and renal function. Links are maintained with facilities such as the CDC laboratory in
Entebbe and the National TB laboratory. Quality assurance measures include regular servicing of all
equipment in the laboratory through contracts with machine manufacturers or properly qualified technicians.
Quality control systems for all laboratory tests are maintained through contacts with the CDC lab in
Entebbe, the Ebenezer laboratory, and the National TB and Leprosy Laboratory for TB.Training of
laboratory staff from MU and all supported sites is conducted regularly. This ensures that a comprehensive
service is provided for patients and a quality assurance programme to monitor the services in place. The
laboratory supports patients recruited through CT (10,000 planned in FY 2007), those in palliative care (over
8,000 planned for FY 2007), and those accessing ARV services (more than 5,000 in FY 2007). Laboratory
staff at all MU sites, and other health units in Uganda, have been trained through practical and laboratory
specific short courses, and clinical placement schemes. The laboratory performs all tests required to
support an HIV clinic including HIV tests, haematological tests, clinical chemistry tests, CD4 counts,
diagnostic tests for TB and for other opportunistic infections, and other immunological tests. Histology,
diagnostic PCR and viral load are offered as well. The laboratory serves patients in all MU supported sites
including the rural sites and RO.
Equipment for which service contracts are maintained includes, a FACS Callibur and a FACS Count for
CD4 counts, 3 chemistry analysers, 2 coulter counter machines, an Elisa machine and reader, an
interscope for viewing TB sputum smears, microscopes and other general laboratory equipment. We are
now able to perform blood cultures.
Reach Out laboratory carries out HIV and TB testing using the National testing algorithm, and client
monitoring including follow-up CD4 cell counts, sputum analysis, biochemistry and any other tests
depending on the needs of the individual clients. We conduct about 800 sputum analyses (TB), 100 serum
crag (Cryptococcal Meningitis), 100 bio-chemistry tests, and 300 blood slides for Malaria parasites per
month. Between October 1, 2007 and March 31 2008, 36 individuals were trained in laboratory services.
The following laboratory tests were carried out , HIV (1,836), TB (1,964), Syphilis (1,684) and HIV Disease
monitoring (12,634). There were 9 laboratories under MU. The main laboratory acquired an automated
blood culture system (BACTALERT), which can also be used for TB cultures. An order has also been
placed for viral load and diagnostic PCR equipment (COBAS TaqMan 48 and AmpliPrep) that are expected
to be delivered soon. This will will help with diagnosis of HIV in infants which results have always been
delayed. All this lab infrastructure strengthening has led to an improved management of HIV patients in all
aspects of prevention, care and treatment.
Activity Narrative: In FY 2009 MU plans to increase to 15,000 the number of patients receiving ARV services, each having an
average of 2 CD4 counts a year, 3 full blood counts, and 2 liver function tests, 2 renal function tests and 1
lipid profile a year. MU also expects to carry out 700 pregnancy tests, 25,000 HIV tests, 30,000 CD4 tests
and 1,000 viral loads (particularly aimed at treatment-experienced patients who may need to switch to a
new regimen Some 3,000 patients will require diagnostic tests for OIs and other monitoring tests. RO
expects to carryout 3,600 HIV tests, 9,000 TB diagnostic tests, 300 syphilis tests, 3,300 disease monitoring
tests, 6,000 CD4 tests and 1,500 X-Rays (TB diagnosis). The total number of tests will be 63,700 (40,000
for MU and 23,700 for RO). Funds will be used for the purchase of reagents and test kits, maintaining
laboratory equipment, quality assurance costs, human resources, training of laboratory workers in HIV
related diagnostic skills, and transportation of samples from rural sites to MU and other testing centres as
necessary. MU plans to train 50 laboratory staff from various health centres across Uganda in HIV-related
laboratory practice. MU plans to equip two rural clinics to be able to perform CD4, FBC, TB diagnosis and
clinical chemistry. RO will expand its client laboratory monitoring from basic test to standard tests. It is
targeting to analyze 2,590 sputum samples, (TB diagnosis and follow-up), 600 serum Toxo screening, 600,
serum Cryptococcal Antigen, 4500, HB, 400 syphilis, 10,000 CD4 cell count, 100 Viral Load , 150 HIV
DNAPCR, 300 blood chemistry at both RO and TMC laboratories. As part of the quality improvement we
shall build the capacity of 12 laboratory/ and clinical staff in Laboratory services. MU will continue training at
the Centre as well as upcountry in targeted districts. Together with Emerging Markets Group, a USAID -
funded project MU will also train health practitioners in the private sector in HIV management. MU will train
50 individuals through the short courses. The targeted group are people living with HIV/AIDS and health
workers providing care, treatment and training in HIV/AIDS.
Continuing Activity: 13291
13291 4416.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $250,000
8335 4416.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $190,000
4416 4416.06 HHS/Centers for Mildmay 3344 1298.06 HIV/AIDS $189,200
Table 3.3.16:
This PHE activity 'Targeted Evaluation of Strategies to Decrease HIV-transmission Risk Behavior and
Increase Drug Adherence Among HIV-Infected Adults Initiating Antiretroviral Therapy in Uganda' was
approved for inclusion in the COP. The COP tracking ID associated with this activity is 'UG.07.0164'.
Continuing Activity: 13292
13292 8640.08 HHS/Centers for Mildmay 6433 1298.08 HIV/AIDS $350,000
8640 8640.07 HHS/Centers for Mildmay 4808 1298.07 HIV/AIDS $300,000
Estimated amount of funding that is planned for Public Health Evaluation $293,457
Table 3.3.17:
