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
Faith-based organizations (FBOs) have been strong partners in the delivery of health services in Uganda.
Through their established and extensive network of health units, they support 47% of the country's health
care services. Besides the wide coverage, FBO health services are targeted and reach the most remote
areas of the country. FBOs have also been incredible partners in the national response to the HIV and AIDS
epidemic.
Since 2006, USAID/Uganda has been in partnership with the Inter-Religious Council of Uganda (IRCU),
which is a consortium of the five main traditional religions in Uganda to expand access to HIV and AIDS
care and treatment services through their network of faith-based health units and NGOs. Through this
network, IRCU has played an important role in rolling out HIV care and treatment services. As at March
2008, it had enrolled 23,746 individuals (8,787 males and 14,959 females) into care and 2,605 (964 males
and 1,641 females) on treatment through its twenty-two partner sites. 362 of these were pregnant women
received HIV counseling and testing. Thirteen of these sites jointly deliver care and treatment, an approach
that has been proved to alleviate pressure on the already overstretched capacity of the partner health units,
particularly personnel.
USAID/Uganda's partnership with IRCU ends in June 2009. Based on the proven viability of the faith-based
networks in quickly expanding access to services, USAID/Uganda plans to initiate a follow on program to
build upon and further expand the current achievements of IRCU.
Poor access to health services remains one of the major bottlenecks to uptake of PMTCT services. In
addition, psycho-socio and cultural factors also constitute major barriers to women's utilization of
MCH/PMTCT services in health facilities. These include limited male partner involvement in PMTCT
programs, high levels of HIV stigma, low levels of community HIV awareness and mobilization as well as
high community attachment to, and preferential use of Traditional Birth Attendants (TBAs) and home
deliveries by close relatives. Other factors include poor quality of services provided by government facilities,
poor linkages to HIV care and treatment services for HIV positive mothers, weak procurement and
distribution systems leading to frequent stock out of essential PMTCT commodities and inadequate staffing
levels at the health facilities.
0ver the last three years, IRCU has been supporting the Ministry of Health (MOH) PMTCT program with
special focus on intensifying primary prevention of HIV/AIDS, prevention of unintended pregnancies among
HIV positive women and comprehensive care to the mothers and family. The IRCU follow-on program will
continue to provide comprehensive PMTCT services in line with the new MOH guidelines. It will support
community advocacy programs, which include encouraging mothers to attend antenatal care (ANC), male
involvement during PMTCT activities, and training of midwives and TBAs to distribute mother-baby ARV
packs to mothers prior to delivery in case delivery takes place at home. This program will also facilitate the
supplies management at the units to increase the uptake of HIV counseling and testing at ANC and
provision of HAART and complex ARV regimens for prophylaxis by providing a steady supply of HIV testing
kits and more efficacious ARV regimens as stated in the revised PMTCT guidelines.
This program will further support the formation of PMTCT clubs consisting of HIV positive mothers,
community volunteers and counselors. These clubs then carry out extensive health education and
sensitization in the community, work with newly diagnosed mothers encouraging them to bring their
spouses or partners for testing and track mothers and infants after delivery to assess their health care
seeking habits. This follow-on program will work with MOH and EGPAF (located in 8 IRCU supported sites)
to train the implementing sites set up systems for PMTCT follow-up and male involvement. The sites will set
up PMTCT-support clubs to work with the newly diagnosed mothers and help them to cope with their new
health status, encourage them to test their other children and spouses and follow up on the male
involvement and testing. These clubs will also teach mothers about nutrition, infant feeding options and
other care. The sites will also set tracking teams to identify all diagnosed mothers, open a clinical record for
each mother, follow up each mother till time of delivery and during the postnatal period after which both the
mother and infant will be transferred to the HIV clinic on site for regular care. The program will train religious
leaders to mobilize couples especially the male partners of expecting mothers through their routine pastoral
work and home visitations to access PMTCT and related services. Individuals who test positive will be
assisted to receive care and treatment.
The program will further strengthen the PMTCT community follow up program by tracking HIV positive
mothers to asses their health seeking behaviors for themselves and their infants and at the same time
promote early initiation of cotrimoxazole prophylaxis and ART for the infants. Mothers will be encouraged to
deliver in health units.
This program will initiate links with the District Health Services Commissions and will collaborate with
existing PEPFAR PMTCT partners to streamline PMTCT services according to the district health sector
plan. This will involve holding coordination meetings with district leaders and partners and other stake
holders. Through partnerships, this program will build the capacity of key groups in the community such as
community leaders, and PHA networks so that they are an indigenous source of knowledge within their
communities and can be utilized to refer mothers or couples for HIV testing and PMTCT services.
The IRCU follow-on will prioritize CD4 testing for both the mothers and infants. The exposed infants will be
tested for HIV infection using RNA-PCR from the nearest Joint Clinical Research Center (JCRC) Regional
Labs of Excellence. 600 infants will receive HIV testing by the end of 2009. These children will be enrolled
into care and given the required basic HIV care including Cotrimoxazole prophylaxis and also assessed for
eligibility for ART.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15889
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15889 15889.08 U.S. Agency for Inter-Religious 6740 3327.08 IRCU $250,000
International Council of Uganda
Development
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
* Malaria (PMI)
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
Currently, Uganda is experiencing a mature and generalized HIV/AIDS epidemic with a high prevalence rate
of 6.4%. The 2006 National Sero-Behavioral Survey showed an increase in multiple concurrent partnerships
and a close relationship between the number of sexual partners and the risk to HIV infection. In addition, the
survey also showed a rise in the age of initiation of sex. The survey further indicates that 42% of the new
infections occurred among individuals who were either married or co-habiting. These findings signal and
further reaffirm the need to intensify abstinence and being faithful programs within the overall national HIV
prevention agenda.
care and treatment services through their network of faith-based health units and NGOs. Over the past two
years, IRCU has implemented a variety of HIV prevention interventions focusing on promotion of abstinence
and faithfulness through sixteen community based faith-based organizations. Working through the heads of
the main religious institutions in Uganda, HIV/AIDS prevention messages have been integrated into
sermons and other religious teachings across the country. As of March 2008, prevention activities had
covered 47,794 adults (17,684 males and 30,110 females) with interventions focusing on faithfulness, and
87,632 youth (32,424 males and 55,208 females) with abstinence only interventions. Pre-marital counselling
has also been revamped and religious leaders have been trained and equipped with more HIV/AIDS skills
to offer HIV prevention counselling. A total of 3,124 individuals were trained in activities that promote
abstinence and/or being faithful.
USAID/Uganda's partnership with IRCU ends in June 2009. USAID/Uganda plans to initiate a follow on
program to build upon and further expand the current achievements of IRCU. Using context appropriate and
innovative strategies, the follow-on program will aim to further expand prevention activities among the
youth. Special focus will also be put on reaching the adult population with the ultimate aim of promoting
mutual faithfulness and reducing concurrent sexual partnerships.
Youth in school shall be reached through their school environments by working through the school
administration including head teachers, teachers, School Management Committees (SMC) and Parents
Teachers Associations (PTA). The aim will be to create a supportive environment in the schools that allows
children to access age appropriate information on health, HIV/AIDS and sexuality. The program will train
senior male/female teachers and school nurses in basic HIV and AIDS communication and encouraged
pupils to seek support/advice from them. The program will further empower schools to strengthen the role
of students' bodies such as Anti AIDS Clubs and Straight Talk Clubs to act as channels for HIV/AIDS
education. These clubs shall be encouraged to organize and lead discussions on key issues identified by
the young people themselves.
The program will facilitate schools to encourage pupils and students to identify role models either from their
community or from elsewhere who they adore and along whose life they would like to model their own. The
proposed models shall then be discussed with pupils to ensure that their life history, regardless of their
current economic status, is consistent with the aim of promoting a healthy and responsible life. Where
possible, the chosen models shall be invited to talk to pupils about the need to protect themselves against
HIV/AIDS, as well as the importance of goal and vision setting. Where possible, the program will facilitate
schools to identify an adolescent mother/father or a young positive, willing to share their experience to come
and talk to the pupils.
The program will also facilitate health workers within the vicinity of the schools to come and give health
education to the pupils/students. Besides giving them an opportunity to ask questions on HIV/AIDS or any
other health related issues, the rapport created with health workers will create confidence that will enable
pupils/students to continually seek information from the health units at individual levels.
The follow-on program will be required to use innovative strategies to reach youth out of school,
predominantly absorbed into the informal sector. Targeted messages and segregation of target audiences
will be required since the target group consists of a mixture of those sexually active but not yet married,
those not yet sexually active as well as those married and/or cohabiting in long term relationships.
The IRCU follow on program will be required to harness the existing religious structures and institutions that
have historically been forums for discussing and addressing marital and other social development issues.
Examples include Mothers/Fathers Union, Women Catholic Guild, and the Muslim Women League. Weekly
meetings are held by these institutions throughout the religious structures and various topics are discussed.
Individuals with problems are counseled, either individually or through group therapy. The program will work
to integrate HIV/AIDS prevention as a key issue for discussion into these structures. Where necessary, the
structures will be facilitated to mobilize more members in the community in order to expand attendance and
hence coverage. Similar structures exist for the youth and they include the Young Christian Society (YCS),
Legion of Mary, Military Chaplains, Girl and Boy Scouts, Girls and Boys Brigade, all providing avenues for
reaching the youth.
The follow on program will continue to build the capacity of religious leaders at community level to enable
them deliver accurate HIV/AIDS information and integrate HIV preventions in their routine clerical duties.
Continuing Activity: 14206
14206 4685.08 U.S. Agency for Inter-Religious 6740 3327.08 IRCU $500,000
8426 4685.07 U.S. Agency for Inter-Religious 4836 3327.07 IRCU $500,000
4685 4685.06 U.S. Agency for Inter-Religious 3327 3327.06 IRCU $500,000
* TB
Table 3.3.02:
Faith-based organizations (FBOs) have been strong partners in delivery of health services in Uganda.
care services. Besides the wide coverage, FBO health services target and reach the most remote areas of
the country. FBOs have also been incredible partners in the national response to the HIV and AIDS
network, IRCU has played an important role in rolling out care and treatment services. As at March 2008, it
had enrolled 23,746 individuals (8,787 males and 14,959 females) into care and 2,605 (964 males and
1,641 females) on treatment through its eighteen partner sites. Twelve of these sites jointly deliver care and
treatment, an approach that has been proved to alleviate pressure on the already overstretched capacity of
the partner health units, particularly personnel.
One of the critical roles of the follow-on program (TBD) will be to sustain the individuals already enrolled in
care and treatment and to further build the capacity of faith-based health units and NGOs in delivery of
quality and sustainable services. Priority activities will, among others, include continuing to update service
providers on emerging challenges and new approaches to AIDS care and treatment, strengthening linkages
with other and non-PEPFAR activities to maximize synergies, continuous improvements in quality of
services as well as reaching out to new and underserved populations. The follow-on program (TBD) will
also be expected to continue building the capacity for holistic palliative care within faith-based health
centers and NGOs. Special focus will be put on integrating pain and symptom management within the
exiting AIDS care and treatment services. In addition, the follow-on program will continue working to further
build the skills of religious leaders and harness their respected positions and connectivity with communities
in the delivery of home based care, adherence monitoring and referral.
By the end of FY 2009, the follow-on program (TBD) will have provided care to 35,000 people living with
HIV/AIDS of whom 7,200 will be on treatment. From the baseline number of 2,065 individuals receiving
treatment in March 2008, IRCU anticipates to have enrolled a further 1,000 individuals by the end of
September 2008, bringing the total to 3,065. By June 2009 when it winds up, IRCU will have enrolled an
additional 2500 new individuals in treatment, bringing the total to 5,565. The follow on program will enroll a
further 1,635 new adult individuals between July and September 2009 and train a total of 100 health
workers in HIV and AIDS care and treatment, with the aim of ensuring that their knowledge and skills are in
currency with modern approaches and practices. In addition, the follow on program will train 1000
community and religious leaders in basic HIV and AIDS care and treatment to serve as HIV and AIDS
resource persons and to link facilities with communities.
The HIV and AIDS basic preventive care approach has continued to grow in prominence as a cost-effective
approach to care and treatment given its proven effectiveness in warding off opportunistic infections and
hence delaying the need for ART. IRCU has been engaged in rolling out elements of preventive care. Using
FY 2006 funds, IRCU procured and distributed 38,000 long lasting insecticide treated mosquito nets (ITNs)
to PHA and their immediate families through its network of FBOs. It will further procure and distribute
another 5,000 ITNs using FY 2007 funds.
Albeit with procurement challenges, IRCU has been prescribing prophylactic Cotrimoxazole as a standard
practice in care and treatment in accordance with the Ministry of Health (MOH) guidelines and policy. The
follow-on program (TBD) will be required to continue rolling out these basic care elements with a key focus
on strengthening procurement and distribution systems. While providing free basic care elements, the follow
-on program (TBD) will simultaneously raise awareness among its clients on the availability of these
commodities on the open market as a medium term strategy to eventually phase out free distribution in
order to guarantee sustainable access.
Ensuring a steady and demand sensitive system for supplying care and treatment commodities will be
essential for the successful implementation of this activity and achievement of targets. IRCU is working in
partnership with Supply Chain Management System (SCMS) to procure ARVs as well as other drugs
essential in managing critical OIs. The follow-on program (TBD) will be required to assess the efficiency and
viability of the SCMS procurement mechanism and if found effective, further strengthen it. If not, the follow
on program will be required to explore other alternatives that enhance efficient delivery.
IRCU has worked closely with the Ministry of Health and its partner health units to reinforce Post Exposure
Prophylaxis (PEP) for the health workers. The Ministry of Health has recently released guidelines on
occupational health and safety within the health sector, in which procedures for PEP management are well
articulated. In addition, the guidelines also provide guidance on creating a good working environment for
HIV-positive health workers and ensuring that they don't pose a transmission risk to their patients,
especially in aspects of health care that involve invasive procedures. The follow-on program (TBD) will be
required to glean and disseminate the relevant components of the guideline and ensure that infection
control is a mundane practice within all the supported HIV/AIDS care and treatment facilities.
Quality assurance is key to the success of the care and treatment programs. IRCU has initiated partnership
with IDI to ensure quality assurance and capacity maintenance. The follow-on program (TBD) will be
required to build upon the existing initiatives by working closely with MOH and the USAID supported Health
Care Improvement Project and HIVQAL to introduce continuous quality improvement and monitoring
approaches in all its supported facilities. The overall aim is to ensure that services delivered conform to the
national and international standards and that they are responsive to client needs. A key focus will be to
Activity Narrative: ensure that criteria for ART eligibility, prescription practices and adherence monitoring protocols are all in
line with the national policy.
To the extent possible, care and treatment services shall be linked with other HIV/AIDS programs,
especially counseling and testing, PMTCT and OVC care. To achieve this, the follow-on program (TBD) will
be required to build viable inter and intra collaborative networks within facilities and communities to enable
PHA access the full continuum of care.
Continuing Activity: 14210
14210 4365.08 U.S. Agency for Inter-Religious 6740 3327.08 IRCU $600,000
8424 4365.07 U.S. Agency for Inter-Religious 4836 3327.07 IRCU $600,000
4365 4365.06 U.S. Agency for Inter-Religious 3327 3327.06 IRCU $600,000
Estimated amount of funding that is planned for Food and Nutrition: Commodities
Table 3.3.08:
Activity Narrative:
Activity Narrative: approaches in all its supported facilities. The overall aim is to ensure that services delivered conform to the
ensure that criteria for ART eligibility, prescription practices and adherence monitoring protocols are all in
Continuing Activity: 14211
14211 4687.08 U.S. Agency for Inter-Religious 6740 3327.08 IRCU $1,000,000
8428 4687.07 U.S. Agency for Inter-Religious 4836 3327.07 IRCU $1,000,000
4687 4687.06 U.S. Agency for Inter-Religious 3327 3327.06 IRCU $100,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools
and Service Delivery
Table 3.3.09:
The number of children living with HIV and AIDS in Uganda is on the increase. An estimated 200,000
children are living with HIV and another 25,000 get infected annually. Currently 11,000 children are
accessing treatment, representing only 22% of all those in need. The need for pediatric care and treatment
is enormous. However, human resource constraints, poor accessibility to services and limited pediatric care
skills have in combination limited wide-scale accessibility to pediatric AIDS care and treatment. Expanding
access to pediatric and adolescent HIV and AIDS care and treatment is outlined as a critical priority in the
National Strategic Plan.
had enrolled 23,746 individuals into care and 2,433 on treatment through its eighteen partner sites. Using
FY 2007 and FY 2008 resources, IRCU has taken a leadership role in expanding access to pediatric ART
beyond the major urban areas. Through its partnership with the Infectious Disease Institute (IDI) and
Mildmay International, both PEPFAR partners, IRCU has trained health workers in its partner sites in
comprehensive pediatric HIV care including pediatric counseling skills. IRCU is currently setting up systems
at its sites to enhance pediatric care, in particular ART, by initiating HIV testing for all exposed infants.
One of the critical roles of the follow-on program will be to build upon and consolidate the achievements that
IRCU has attained in rolling out pediatric care. Priority activities will, among others, include continuing to
build capacity of health workers in pediatric care and update them on emerging challenges and new
approaches to management of HIV and AIDS care among children. Many parents and caregivers rarely
discuss HIV infection with children under their care. As a result, many HIV infected children live in
situations of uncertainty and often exhibit signs of serious depression. To address these challenges, the
follow on program will emphasize building skills in pediatric counseling among health workers to be able to
engage children and their caregivers in ongoing discussion of HIV and AIDS, and the implications of HIV
infection for their future. The program will offer further training to clinical staff to standardize prescription
practices and develop job aides for health workers to ensure that services are of uniform quality across all
sites and that they conform to national and international standards. Children will receive quality HIV medical
care which includes full access to ARV therapy as well as prophylaxis and treatment of opportunistic
infections to reverse disease progression. The program will also put emphasis on follow up of children
enrolled in the care and treatment program. This will involve regular periodic CD4 testing to determine ART
eligibility in accordance with the national standards. Children will also be monitored and assessed for other
health and growth indicators.
In the context where majority of the children are under the care of poor widows and grandparents, the threat
of malnutrition is real. Efforts will be made to routinely assess children for malnutrition and if symptoms
occur, therapeutic foods will be provided through linkages with other PEPFAR partners such as the USAID
funded NuLife. Caregivers including parents and guardians will also be counseled on infant and child
nutrition. The program will undertake home visits to be able to assess the living environment of enrolled
children initiated on treatment, anticipate potential barriers to treatment adherence and hence develop a
supportive foundation and individualized care plan for each child. By the end of FY2009, the follow-on
program (TBD) will have provided care to 2,000 children living with HIV and AIDS of whom 200 will be on
treatment. In addition, a total of 100 health workers will be trained in pediatric HIV and AIDS care and
treatment, with the aim of ensuring that their knowledge and skills are in currency with modern approaches
and practices. Quality assurance is key to the success of the care and treatment programs. IRCU has
initiated partnership with IDI to ensure quality assurance and capacity maintenance. The follow-on program
(TBD) will be required to build upon the existing initiatives by working closely with MOH and the USAID
supported Health Care Improvement Project and HIVQAL to introduce continuous quality improvement and
monitoring approaches in all its supported facilities. The overall aim is to ensure that services delivered
conform to the national and international standards and that they are responsive to client needs. A key
focus will be to ensure that criteria for ART eligibility, prescription practices and adherence monitoring
protocols are all in line with the national policy.
Table 3.3.10:
Table 3.3.11:
Activity Narrative
TB continues to be the leading cause of morbidity and mortality among People Living with HIV/AIDS (PHA)
in Uganda. Of the TB patients 51% are co-infected with HIV. Uganda has an estimated annual TB incidence
of 158/100,000 population and mortality rate of 6%. In 2006, there were 41,792 TB case notifications and 30
% of all TB patients that received HCT. The treatment success rate is currently 73% far below the 85%
target. Case detection rates are still below the 70 percent target. TB treatment success rate has been
improving, but the overall result is still low because only 31% of TB patients have documented smear
conversions, far too many die during treatment, default and/or transfer without follow up.
years, IRCU has established HIV/AIDS care and treatment programs in 18 faith-based health units and four
non-governmental organizations. Through these facilities IRCU has embraced the national policy to
integrate TB into HIV/AIDS care. Initiatives undertaken in this endeavor include routine screening of all
PLHA for any leading TB symptoms, training of health workers in TB management, strengthening of TB
laboratories and quality assurance, among others. These initiatives have greatly improved case detection
and as at March 2008, 3,769 individuals had been screened for TB and 513 (190 males and 323 females)
initiated on treatment. A total of 909 (337 males and 572 females) received counseling and testing in TB
settings and got their results.
program to build upon and further expand the current achievements of IRCU. The follow-on program will
aim to further strengthen the existing TB/HIV integration initiatives with a key focus on further training of
health workers to orient their attitudes and practices towards integrated HIV/TB care and further
improvement in infection control procedures.
The follow on program will continue to work to ensure that routine TB screening of HIV-infected clients and
adherence counseling and support for both TB and HIV/AIDS clients are internalized across all health
workers. The program will also continue to improve TB diagnostic capacity at its partner health units by
further strengthening laboratory infrastructure, provision of key laboratory equipment and reagents as well
as training laboratory staff. More importantly the follow on program will strive to ensure that all TB
microscopy equipment and protocols are routinely tested for proficiency in order to sustain the validity of the
test results.
Integrating TB care within an immune compromised population requires a high degree of care to minimize
cross infection. Therefore, the follow on program will strive to ensure that adequate infection control
procedures are in place within the partner facilities health facilities to prevent TB transmission among PHA
and health workers. This will entail expansion of and improvements in ventilation within waiting areas,
training health workers in effective waste disposal procedures and counseling PLHA to be part of the
infection control agenda.
Albeit with a few challenges, IRCU has initiated counseling and testing within TB clinics at all its facilities.
Initially only TB-confirmed individuals were offered counseling and testing. The follow-on program will build
upon and consolidate this initiative by introducing routine counseling and testing for all individuals attending
TB clinics.
By the end of FY 2009, the follow on program will have screened at least 50,000 HIV positive clients for TB.
Of these, an estimated 20,000 clients will require three sputum examinations and where needed X-ray tests
to confirm the infection. Using a TB positivity rate of 10%, an estimated 2,000 co-infected individuals will be
treated for active TB. All these individuals will also be assessed for ART eligibility and will immediately be
initiated on cotrimoxazole prophylaxis to ward off other potential opportunistic infections.
Follow up of individuals on treatment is great factor in treatment success. Prior to initiation on treatment,
individuals will be required to report with an adherence monitor who will be counseled on the importance of
adherence in addition to infection control in the household. The program will also invoke the community
based religious leaders trained by IRCU to periodically visit the patients and report progress on adherence.
Monthly drug refills will be followed as a mechanism for treatment monitoring.
The follow on program will continue to work with National TB and Leprosy program to streamline provision
of sputum collection containers, slides for microscopy and any TB related IEC materials. The NTLP will also
be expected to provide on-going support supervision and maintain oversight on the quality of TB care and
the progress of efforts towards TB/HIV integration.
Continuing Activity: 14207
14207 4363.08 U.S. Agency for Inter-Religious 6740 3327.08 IRCU $1,200,000
8422 4363.07 U.S. Agency for Inter-Religious 4836 3327.07 IRCU $1,200,000
4363 4363.06 U.S. Agency for Inter-Religious 3327 3327.06 IRCU $1,500,000
Table 3.3.12:
The Inter-Religious Council of Uganda (IRCU) is an indigenous, faith-based organization uniting the efforts
of five major religious institutions of Uganda including Roman Catholics Church, The Province of Church Of
Uganda, Uganda Muslim Supreme Council, Uganda Orthodox and Seventh Day Adventists Uganda Union
to jointly address together development challenges.
care and treatment services through their network of faith-based health units and NGOs. Over the past
three years, IRCU has been working through its network of community based organizations to deliver a
range of services focusing on care and protection of orphans and other vulnerable children (OVC) and their
immediate families. The major focus has been on initiatives that aim to keep OVC in school as the most
appropriate mechanism for guaranteeing their protection and survival. Both basic education and vocational
training have been emphasized. Other interventions have been in areas of health, psychosocial support, as
well as HIV prevention education. Economic strengthening of caretaker families has also been embarked
on, with activities focusing on training in micro-enterprise development and linking groups of caregivers,
mainly widows to local markets for their produce.
As at March 2008, IRCU had provided care and support to 11,752 OVC. Of these, 3,342 (1,540 males and
1,802 females) received primary direct care while 8,410 (3,947 males and 4,463 females) received
supplemental direct services. 3,077 caregivers (791 males and 2,286 females) were trained in micro-
enterprise development and linked to various local markets for their produce. This strategy of linking groups
of caretakers to markets has yielded promising results, both in terms of stimulating production of indigenous
crops and ultimately reducing economic vulnerability of households. Over 1,000 community-based religious
leaders have been trained and complement IRCU's efforts in following up OVC at community level.
program to build upon and further expand the current achievements of IRCU. One of the primary priorities
for the follow-on program will be to strengthen the economic capacity of OVC households as a long term
strategy of enhancing their ability to effectively meet OVC needs.
The follow-on program will also strive to ensure that OVC enrolled for basic education continue since this is
the foundation for their future growth and survival. Vocational training, sourced through community based
schools and apprenticeship arrangements will also continue to be prioritized as a way to fast track the OVC
capacity to earn a living. This will entail building the capacity of teachers to create conducive environments
within schools that support and encourage OVC to remain in school. Key strategies include training
teachers in basic counseling to be able to detect and address emotional needs of OVC, as well as
negotiating flexible regimes for payment of school dues, uniforms and other scholastic materials.
Psychosocial support and legal protection for orphans and caregivers remain strongly felt but least
addressed needs. The follow-on program will work to ensure that psychosocial care becomes a key and
integral component of OVC care. Children and their caregivers shall be provided opportunities and trusting
environments where they engage in frank discussions about HIV and mutually agree upon plans for the
future. The program will continue to emphasize legal and child protection by training caregivers and orphans
in succession issues, including writing and discussing of wills at family level. This will also entail training the
community on the basic child protection laws and rights in order to make child protection a shared
responsibility. Also the follow-on program shall identify community based sources of psychosocial care and
child protection to which OVC and their caregivers can turn in case of distress. These include among
others, community development officers at sub-county levels, religious leaders, Probation and Welfare
Officers, as well as local leaders mandated to oversee children affairs.
The program shall educate OVC caregivers on the availability of PEPFAR care and treatment services
within their localities so that they can refer or take their OVC for health care when in need. Using simple job
cards, program staff and community level volunteers will undertake routine nutritional assessment of OVC
and where OVC are found to be malnourished, they will be referred to other PEPFAR support programs that
address nutrition, such as the NuLife program. The program staff will also counsel and educate caregivers
will on nutrition, especially on aspects of dietary diversity using locally grown foods.
The follow-on program will adopt a holistic and family based approach to OVC care. This will entail
assessing the entire household to determine potential barriers to normal growth and development of
children and develop strategies for addressing them. Since most OVC live within households that are
vulnerable, picking one OVC for assistance and living others results in stigma, hatred and tension within the
family and ultimately compromises program outcomes. Therefore, the program will adopt the family
approach which will emphasize care targeted at all eligible OVC in the household.
Continuing Activity: 14209
14209 4686.08 U.S. Agency for Inter-Religious 6740 3327.08 IRCU $600,000
8427 4686.07 U.S. Agency for Inter-Religious 4836 3327.07 IRCU $600,000
4686 4686.06 U.S. Agency for Inter-Religious 3327 3327.06 IRCU $600,000
Estimated amount of funding that is planned for Economic Strengthening
Estimated amount of funding that is planned for Education
Table 3.3.13:
network, IRCU has played a lead role in expanding access to counseling and testing, using both static and
outreach models. As at March 2008, IRCU had counseled and tested 52,878 individuals. Of this total,
33,314 were women and 19,564 were men. Using FY2007 funds, IRCU has trained several community
based religious leaders to serve as HIV and AIDS resource persons at community level, whose primary
roles include among others, mobilization and referral of individuals for counseling and testing. The approach
is paying off already as some of the outreach sites often report challenges with failure to meet the demand.
At the current level of service delivery, IRCU is poised to become one of the leading providers of counseling
and testing in Uganda.
for the follow-on program will be to consolidate the facility and community outreach networks already
established by IRCU and continue to harness and optimize their potential to reach more people. The follow-
on program is also expected to come up with more creative ways, particularly in the area of strengthening
couple counseling and testing as well as reaching out to high risk and vulnerable groups.
IRCU procures HIV testing kits through the Joint Medical Stores (JMS) and the distribution process is
managed by the Logistics Officer working at the IRCU secretariat. With support from the Program for Supply
Chain Management Systems (SCMS), IRCU has developed a logistics log frame for the implementing sites
to facilitate proper forecasting and ordering of HIV test kits. This resulted in greater improvements in the
supply and distribution of HIV testing kits and other associated supplies. The follow-on program will be
expected to review this partnership and assess its viability in meeting increased demand for counseling and
testing services. If found appropriate, it will continue to be strengthened through FY2009.
IRCU initiated the newly introduced provider-initiated testing and counseling model, commonly known as
Routine Testing and Counseling (RTC) as part of the routine clinical care at all it is hospital based sites.
However, this approach remains largely nascent and the follow on program will be required to make further
improvements in terms of further training for health workers, establishment of protocols with partner sites as
well as raising awareness among patients and health care providers about this strategy. Similarly, IRCU
has initiated counseling and testing within TB care settings. This will also require further focus, particularly
training and orientation of health workers in TB facilities to integrate counseling and testing as a routine
practice within TB care. The follow on program will also be required to continue consolidating and
streamlining the existing referral systems between HCT, care, treatment and PMTCT units to ensure access
to comprehensive HIV/AIDS services for its clients.
Given the high opportunity cost of seeking medical care in Uganda, facility based delivery of counseling and
testing services severely limits access. The follow-on program will emphasize and devote substantial
resources in supporting the outreach model of counseling and testing. Priority will be given to areas located
further away from health units, targeting populations such as house wives, taxi drivers, fishermen,
subsistence farmers, and pastoral communities whose activities entail a high opportunity cost of seeking
facility based care services. All the IRCU supported health units that offer counseling and testing also
receive support from Ministry of Health with support from the Global Fund. To maximize resources, the
follow on program will only provide counseling and testing at these sites during periods when MOH supplies
have stocked out.
The National Counseling and Testing Policy is based on a three-tier algorithm using Determine® to screen
for HIV infection, Statpac® to confirm infection and Unigold® as a tie breaker. Unless modified, the follow-
on program will be required to conduct counseling and testing in line with this policy. In case of stock outs of
testing kits from MOH, the program will use PEPFAR resources to procure buffer stocks for MOH sites to
enable facilities deliver services in a reliable manner. Besides aligning the services to the national policy,
the follow-on program will be required to ensure that counseling and testing services offered at its facilities
pass for quality on both clinical and behavioral aspects.
The follow on program will be required to ensure that counseling and testing services offered at all
supported sites are linked to other HIV and AIDS services, particularly PMTCT, ART and OVC services. By
the end of FY2008 IRCU targets to counsel and test 112,000 individuals. With the same level of resources,
the follow-on program will counsel and test approximately 120,000 by intensifying cost-effective approaches
such as outreaches.
Table 3.3.14:
Efficient laboratory services including HIV counseling and testing as well as monitoring of individuals on
care and treatment remains at the helm of an effective HIV/AIDS care program. However, access to
laboratory services still remains a challenge, especially to individuals living in rural areas. In many of the
rural areas in Uganda, diagnostic services are deplorable. Health facilities, especially those at level III and
below lack laboratories and where they exist, there are acute shortages of staff, equipment and/or reagents.
Despite these limitations, these facilities serve the largest number of people, given that they the most easily
accessible.
care and treatment services through their network of faith-based health units and NGOs. Improvement in
laboratory infrastructure has been an integral component of this program. Over the past two years, IRCU
has worked with faith based 18 health facilities to strengthen the existing laboratory infrastructure to enable
them carry out basic tests that enhance HIV/AIDS care and treatment. This included procuring basic
laboratory equipment, limited refurbishment of facilities, training of laboratory staff and reinforcing the
human resource needed to carry out the laboratory tests. Of these 18 labs, 12 are hospital labs while the
remaining six are lower health center labs. As at March 2008, the following test were carried out through
these laboratories: 58,115 HIV screening tests, 3,769 TB screening microscopic and radiological tests,7,008
baseline syphilis screening tests and 11,641 HIV disease monitoring tests.
for the follow-on program will be to further strengthen clinical investigative capability among the supported
faith-based partners and to further improve quality assurance mechanisms to enhance state of the art
service delivery.
The follow on program will further work with the faith-based facilities to expand the scope of their laboratory
services to cover organ function tests as well. IRCU currently has 45,000 clients enrolled on palliative care
and this number is projected to rise to 55,000 by June 2009 when then current program ends. By the end of
FY 2009, it is estimated that IRCU will have enrolled over 60,000 individuals (adults and children) in care
and treatment. All these individuals will require routine medical tests to better inform basic palliative care
management options, particularly with respect to OI management. In addition, they will need routine
baseline CD4 tests; lymphocyte and hemoglobin level counts in order to effectively monitor their eligibility
for ART. This is essential in order to ensure that individuals initiate ART at the most optimum time. Also
over 3,000 patients currently enrolled on ART will continue to have quarterly hemoglobin and lymphocyte
estimates and bi-annual CD4 cell counts.
Most of the IRCU related labs are limited to performing basic microscopy and hematology tests including
hemoglobin estimations and total lymphocyte counts, and are unable to carry out more advanced tests like
CD4 counts and biochemistry tests while these tests are a key ingredient to an efficient ART service.
Therefore, IRCU entered into a Memorandum of Understanding with JCRC to provide laboratory services
for advanced disease monitoring from its regional centers of excellence. Under this arrangement, most
IRCU supported facilities with proximal JCRC centers of excellence access services, particularly specific
tests like full blood counts, organ biochemistry, CD4 cell counts, Polymerase Chain Reaction (PCR) for
infant HIV testing and resistance testing. The follow on program will be required to further consolidate this
partnership. However, as access and utilization of ART services continues to grow, it is realistic to expect
that JCRC regional laboratories will be overwhelmed. Therefore, the follow-on program will explore
establishment of auxiliary laboratories building upon the investments already made by IRCU in its faith-
based health units, basing on factors like distance between JRC regional labs and the faith-based partners
as well as the workload, handling capacity and efficiency of the existing JCRC regional labs.
Based on the projected number of clients to be served, it is estimated that by the end of FY 2009, the IRCU
follow on program will have further built the capacity of the existing labs to perform 78,000 HIV screening
tests, 5,000 TB screening tests, at least 15,600 CD4 tests, 9,500 syphilis tests, 1,000 pregnancy tests, and
0 organ functions tests (Liver and Renal).
The follow on program will be expected to work with the Ministry of Health, Program for Supply Chain
Management Systems (SCMS) and Joint Clinical Research Centre (JCRC) to train laboratory staff in
ordering and forecasting of laboratory reagents and other relevant inputs to ensure a reliable supply; HCT
and other HIV/ART monitoring tests and finally good lab practices. The program will undertake routine
reliability and quality assurance checks to ensure that lab services conform to nationally acceptable
standards. The laboratory activities are coordinated by the Ministry of Health through the Central Public
Health Laboratory which will provide quality control, guidelines and where necessary, technical assistance.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.16:
