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
ACTIVITY UNCHANGED FROM FY 2008
The HHS/CDC Base GAP funding supports the USG goal of appropriate staffing and level of effort in order
to provide technical assistance, programmatic oversight and performance monitoring for all implementing
partner (IP) activities. Over 80% of CDC operations and staffing are covered through GAP funding and the
balance is covered by GHAI funds. In the laboratory sector, GHAI funds are used to support implementing
partner activities. The HHS/CDC Uganda office is comprised of six units; Operations, Program, Laboratory,
Epidemiology, Informatics and Behavior.
In FY 2008, the CDC laboratory unit continued to provide support for diagnostic testing, logistics
management, national and international technical and management training and workshop/conference
attendance for CDC projects and for IPs. Diagnostic testing in the CDC laboratory included 31,361 HIV
serological tests, mostly for quality control testing in support of full-access HBCT in two Districts, 5,781 viral
load tests, 1,602 HIV DNA tests (for exposed infants), 287 serum chemistries, 19,002 CD4+ counts and
7,498 complete blood counts. The evaluation of immune activation markers as surrogates for viral load
became possible with the gift of an LSR II flow cytometer that allows up to 10 phenotypic markers to be
investigated on a single immune cell and potentially makes HIV disease monitoring simpler and cheaper. An
Ampliprep for automated nucleic acid extraction from plasma, whole blood and dried blood spots was
procured for viral load and especially for HIV DNA PCR for infants. This will add capacity to the national
Early Infant Diagnosis (EID) program that currently only has 7 testing centers countrywide, allowing faster
turnaround times. CDC-Uganda maintained substantial stocks of laboratory commodities including HIV
rapid test kits to offset national stock-outs and also directly supplied a number of partners with CD4+ count
tests - currently the National Medical Stores has insufficient capacity to manage diagnostic tests for ART
eligibility and disease monitoring. A new approach to the quality assurance of HIV serology in the country
was validated by the CDC laboratory based on dried serum samples. A number of CDC staff completed
B.Sc. and M.Sc. graduate courses and CDC and partner laboratory staff participated in training courses in
good laboratory practice, laboratory management and technical training to improve their own training skills.
The CDC laboratory unit, working with the PEPFAR Laboratory TWG and the national Laboratory Technical
Committee (LTC), continued to strengthen national laboratory systems by: direct hiring of program staff
under the MOH/AIDS Control Program Cooperative Agreement (CoAg), including laboratory personnel,
instead of paying existing MOH staff supplementary allowances thus ensuring full-time attention to CoAg
activities; assigning two full-time CDC staff to the Central Public Health Laboratory (CPHL) to provide
leadership and mentoring for the national Laboratory Training Coordination and Quality Assurance (QA)
units - activities included the continued roll-out of the HIV rapid test training package towards the goal of
3,500 technicians trained, the roll-out of the TB smear microscopy training package and the identification of
64 sites with CD4+ count capacity, mapping their locations by GIS for networking of services, enrolling them
in an EQA scheme (NEQAS) and training them in it's use; providing a senior Technical Advisor (TA) to
MOH to help finalize and implement the National Laboratory Services Policy and create a
Department/Division of Laboratory Services within MOH to oversee it's implementation; supporting the
national laboratory commodities credit line at the National Medical Stores (government) and Joint Medical
Stores (NGO) that provides basic laboratory commodities to over 1000 laboratories in the country;
overseeing the building and renovation of (20) laboratories at lower health facility levels, (2) blood banks
and a new CPHL (not yet started); supporting technical and management training (SMDP) through the
OGAC-Becton Dickinson Public Private Partnership and GAP/CDC Atlanta in CD4+ EQA, TB smear
microscopy and TB specimen referral; funding the HIV Reference Laboratory at the Uganda Virus Research
Institute (UVRI) to conduct national QA for HIV serology and to validate new HIV serological assays and
testing algorithms, facilitating the national QA program for TB smear microscopy and establishing a national
TB specimen referral system with POSTA Uganda for re-treatment cases through the National TB
Reference Laboratory (NTRL); renovating the training laboratory and clinical laboratories at NTRL to
provide a safe environment for MDR/XDR culture and resistance testing; establishing a laboratory
information management system (LIMS) at CPHL and in collaboration with the CDC Informatics Unit,
providing support to both CPHL/MOH for databases on technicians' training history and laboratory
commodities management and the DHOs, for Health Management Information Systems and mobile
telephony to help coordinate activities within the laboratory sector and with the MOH Resource Centre and,
collaborating with MOH in the design of the 2009 national HIV/Malaria Indicator Survey (UMAIS).
In FY 2009, the CDC-Uganda laboratory will continue to service CDC and partner laboratory needs,
including the establishment of laboratory capacity in partner laboratories coupled with continued monitoring
by the QA unit at CPHL. Dried blood spot testing by HIV DNA PCR for the national EID program will be
expanded and the EID monitoring unit at CPHL strengthened. Immuno-phenotyping to monitor disease
progression will be further explored for the Tororo Child Cohort study following the acquisition of an LSR II
flow cytometer. The national STI laboratory will be strengthened through technical and financial support
channeled through the CRANE survey. Laboratory testing for a further two PHEs, one on incidence testing
by pooled PCR and the other on ‘the last 1000 infections' will be completed. Diagnostic testing capacity at
the CDC laboratory in Tororo Hospital will be expanded to include CD4+ counts, complete blood counts
(CBC) and serum chemistries while a new laboratory, currently under construction, will be completed to
support both HBAC and a number of new initiatives including the Pre-Exposure Prophylaxis Study, funded
by the Gates Foundation. The College of American Pathologists will inspect the CDC Entebbe laboratory for
accreditation in late 2008.
Under national laboratory systems strengthening activities, there will be renewed emphasis on increasing
the District Health Officer's (DHO) engagement with the laboratory sector - IPs will be encouraged to
provide both technical and financial support to the DHO directly which is in line with PEPFAR Uganda's
plans for competitive Partnership Compacts. With the hiring of a TA to work alongside the Director of
Clinical and Community Health at MOH, the National Health Laboratory Policy, currently in it's second draft,
will be completed. The TA will work with senior MOH officials to develop a five-year implementation plan for
the policy. A further responsibility for the TA will be to act as a full-time liaison between the PEPFAR
Laboratory TWG and the non-government IPs - the latter have tended to develop vertical programs in the
laboratory sector, duplicating national activities such as procurement, training, quality assurance and
infrastructure development which are the responsibility of MOH/CPHL. IPs have now been asked to work
more closely with MOH/CPHL and to include in their activity narratives, details of proposed spending on
equipment, commodities and salary support for laboratory-related staff. The strengthened CPHL will house
both traditional CPHL activities including environmental health and hygiene, outbreak investigation, etc. and
also coordination activities in support of national health laboratory systems including; infrastructure
Activity Narrative: development (20 additional lower health-facility laboratories will be built/renovated, 3 of the remaining 5
blood banks will be renovated and the building of the new CPHL will be started, GIS mapping of health
facilities for the whole country to facilitate networking of services, instrument maintenance contracts with
vendors consolidated); human resources (3,500 HIV serological testing providers trained, continued roll-out
of both the TB smear microscopy and TB specimen referral training and laboratory management training);
logistics management (increased funding to NMS, updated commodities management software tools,
national training in logistics management, monitoring laboratory logistics distribution); quality assurance
(extend CD4+ count EQA to all facilities with capacity, expand HIV serological QA to all sites using
proficiency testing (DTS PT) panels, introduce EQA for CBC and serum chemistries at sites with capacity);
support supervision (facilitate DHO to support Regional Laboratory Coordinator and District Laboratory
Focal Person, facilitate central and zonal supervisors with vehicles); informatics (implement mobile
telephony at lower-level health facilities, provide hardware for CPHL informatics and additional staff, liaise
with MOH RC on coordination ); infection control (coordinate activities with African Medical & Research
Foundation - AMREF). The long-term objective is that staff employed at CPHL to strengthen national health
laboratory systems will naturally transition into a Department/Division of Laboratory Services within MOH -
the positioning of the new CPHL building adjacent to MOH should facilitate this transition. Under the OGAC-
BD PPP, the CDC laboratory will provide continued technical support for CD4+ count EQA and
management training to the remaining 30+ sites, support NTRL to roll-out the WHO/CDC national training
program in AFB smear microscopy and extend the national TB specimen referral system beyond the
Kampala District - a toll-free telephone line to POSTA Uganda will be set up to allow facilities to call in
when there are specimens to be collected. The only new activity in 2009 under PEPFAR funding will be
support for the HIV Drug Resistance secretariat based at UVRI and for HIVDR surveillance, funded through
an existing CoAg with UVRI. The CDC-Uganda laboratory will continue to play an active role in the
preparation, funding and implementation of the 2009 UAMIS.
New developments in FY 2009 are the collaboration between CDC (NCZVED) and UVRI on the
establishment of a center for Infectious Diseases Ecology that will encompass prevention, detection,
surveillance and control of new and emerging infectious agents including plague, arboviruses, influenza,
hepatitis E and viral hemorrhagic viruses and, the proposed biotechnology unit, a collaboration between
Inverness Medical Innovations and UVRI, for both of which, CDC-Uganda staff will provide TA.
New/Continuing Activity: Continuing Activity
Continuing Activity: 15738
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
15738 15738.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $1,041,237
Disease Control & Disease Control
Prevention and Prevention
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* TB
Military Populations
Refugees/Internally Displaced Persons
Workplace Programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.16:
This activity is not new - according to the FY 2009 COP Guidance Clarifications [October 24, 2008], third
party company contractors such as CTS Global (COMFORCE) should be teased out.
The 261 staff total includes 8 non-personal services contractors, who have been hired through a contract
with COMFORCE. CDC Atlanta issued a cost-reimbursement agreement to COMFORCE in March 2006 to
provide field offices with a mechanism to hire individuals to provide much needed technical expertise in-
country.
New/Continuing Activity: New Activity
Continuing Activity:
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $17,523,972
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
The USG SI Program Area provides technical oversight and expertise in: 1) support for M&E of overall PEPFAR country
performance; 2) strengthening national surveillance activities; 3) supporting the development and maintenance of HIV/AIDS
management information systems (MIS) within GOU and USG IPs; 4) SI capacity building for the MOH, Uganda AIDS
Commission (UAC) and Ministry of Gender, Labour, and Social Development (MoGLSD); 5) data support and statistical analyses
of PEPFAR funded activities; and 6) participation in PHEs with dissemination of primary findings.
In order to more fully implement these activities, a full-time SI Liaison was recruited in FY08 as a key member of the PEPFAR
Coordinator's office. This individual will help coordinate and facilitate all SI and related activities and ensure that a coherent
strategy is implemented. The SI team includes staff from USG agencies with expertise in M&E, epidemiology, surveillance,
Management Information Systems and PHEs. This team works with other PEPFAR TWGs to strengthen their SI related activities,
reinforce planning, implementation and coordination of IP activities.
Country Context
A key objective of Strategies for Strengthening Systems within the National HIV/AIDS Strategic Plan, 2007/8-2011/12 (NSP) is "to
effectively coordinate collection, analysis, use, and provision of information that will enable tracking the progress made in the
national response to HIV/AIDS." In order to determine progress of the NSP, the Performance Measurement and Management
Plan (PMMP) was finalized in FY08. This is a major step towards ensuring a single country-level M&E system for HIV/AIDS. The
goal of the Plan is to harmonize existing systems of data collection, reporting and review, and facilitate M&E and data use in
policy-making, implementation and resource allocation. The National Joint AIDS Review (JAR) held in October 2008
recommended that national data systems within all sectors be strengthened to capture HIV/AIDS, social and health indicators. It
also recommended that the Uganda National Research Organization and Makerere University Institute of Social Research take a
lead in strengthening the national capacity to undertake and coordinate priority HIV and AIDS-related research to inform strategy
and programming.
The UAC Report on the Implementation of the NSP October 2008 highlights last year's achievements:
1. Irish AID provided a 3-year grant to the Ministry of Local Government to improve data management within 50 districts.
2. Facility level data management and reporting improved: 77% of facilities were reporting by mid 2008 compared to 52% in June
2006.
3. Data quality assurance of routine HMIS reporting is improving, although additional financial and technical support for the
Resource Center (RC) are still needed
4. MOH established the HIV Drug Resistance Working Group (HIVDR WG) to implement the National Plan for ARV Drug
Resistance Monitoring. Last year, the HIVDR WG conducted a survey on Early Warning Indicators (EWI) at 41 ART sites and a
threshold DR survey.
The UAC cited the following challenges:
1. Weak, slow and unreliable information and reporting systems at local and national levels, despite investments in the MOH and
MoLGSD.
2. Poor coordination, harmonization and data quality of HIV/AIDS and health indicators within the various government sectors and
among donors.
3. Local government M&E systems are extremely weak, and lack both human and physical infrastructure.
4. Lack of dedicated M&E staff at the majority of ART sites.
5. Coordination among multiple donors at sites is poor, resulting in both multiple and inadequate reporting to HMIS. Systems and
reporting are often based on individual agency needs.
6. Limited demand for data use at all levels.
7. Limited capacity at the local level to make use of data, coupled with lack of data feedback to sites generating the data.
8. No national system for M&E of HIV/AIDS social support services. There is limited financial support and technical guidance for
M&E of social support activities at all levels.
The SI TWG also notes the following challenges:
1. Lack of adequate M&E capacity within many IPs. Most partners have M&E staff, although many are not appropriately trained or
supervised.
2. M&E and the importance of data are not well appreciated, adversely affecting data quality, staffing, and reporting and reducing
the ability to perform meaningful quantitative program evaluations.
UAC developed a 2-year operational plan, the National Priority Action Plan (NPAP), to guide all stakeholders and which makes
the following recommendations:
1. Equipment, materials and dedicated staff for M&E should be a priority and meet demands at district levels and facilities.
2. Strengthen coordination and reporting across stakeholders; harmonize M&E indicators from NSP, MOH and other stakeholders.
3. Institute uniform reporting formats and procedures for IPs at all levels.
4. Implement a coherent M&E system at the District level and ensure adequate funding.
5. Conduct regular data quality assurance of HMIS and other data sources.
6. Build capacity of UAC, government sectors, districts and facilities to collect and use data.
7. Expedite database construction at UAC, along with appropriate data collection tools
FY08 Accomplishments:
HMIS: The SI team formed an HMIS sub-working group to develop a strategy to help address the many issues facing the national
HMIS system. The USG worked with the MOH Resource Center (RC) to convene a series of meetings aimed at mapping and
coordinating the activities of the multiplicity of stakeholders and donors involved. Several HMIS reviews were performed by donors
e.g. Belgian Technical Cooperation and DANIDA, which also assisted the MOH/RC to develop a central server and data base.
USG requested and received support from the OGAC HMIS Working Group to work with the SI TWG, WHO and other
stakeholders to review the HMIS strategy. This resulted in a strategic plan called Vision 2012, that outlines activities the RC needs
to implement to develop and operationalize a vibrant HMIS. The Laboratory MIS for MOH and Central Public Health Laboratory
was supported by USG and DANIDA to effectively monitor needs of service delivery sites and track lab and drug commodities.
PEPFAR continued to work with the Uganda People's Defense Force to strengthen their HMIS and institute quality assurance
systems for improved HIV service delivery.
The SI TWG performed reviews to inform FY09 programming. This included participation in a health facility mapping workshop,
efforts towards coding facilities and harmonizing indicators for health facility assessments, and site visits to evaluate HMIS
capacity. USG reviewed and will continue to support the various HMIS data management and reporting systems used by USG
and its partners, including web-based systems and Epi-Info.
Surveillance: The protocol for the joint Malaria and AIDS Indicator Survey was developed and submitted for IRB clearance, with
logistical preparations in the final stages. Annual ANC sentinel surveillance was conducted at 30 sites. Testing of samples is
taking place, after which data analysis and dissemination of results should occur.
Secondary analysis of the UDHS (2006) was performed with funding leveraged by other donors; findings were published in a
report and disseminated nationally. Results of the Uganda Service Provision Assessment Survey were disseminated nationally
and internationally. The surveillance on anti-TB drug resistance among smear-positive TB patients was initiated. The Most at Risk
Populations (MARP) survey was conducted with excellent recruitment of clients using Respondent Driven Sampling and Audio
Computer Assisted Self Interview (ACASI) methods. USG actively participated in the HIVDR WG that was established as a
subgroup of the National MOH ART TWG. The WG conducted surveys on Early Warning Indicators and transmitted HIV drug
resistance.
To inform GOU and PEPFAR with specific information on key program issues, USG supported the following PHEs. Details are
described in the activity narratives.
1) The "Last 1000 infections", to evaluate the utility of re-testing HIV-negative VCT clients to identify "window period" infections.
Laboratory testing began and will continue in FY09.
2) Continuation of HBAC I, to evaluate the relative utility of viral load versus CD4 cell monitoring.
3) The Tororo Child Cohort study, to determine interactions between HIV and malaria in African children.
4) Comparison of facility and home-based ART delivery systems, implemented by MRC-UK. Field work will be completed by end
calendar 2008.
5) Evaluating home-based confidential counseling and testing in Kumi and Bushenyi Districts. Field activities have ended; current
efforts focus on data cleaning.
6) PHAs as Change Agents. Field activities have yet to start.
7) Strategies to decrease HIV-transmission risk behavior and increase drug adherence among HIV-infected adults initiating
antiretroviral therapy in Uganda.
8) Assessing the relationship between intimate partner violence and HIV status disclosure in Rakai District. This activity is
awaiting IRB approval.
9) Evaluating two types of male circumcision procedures. Protocol revision is taking place based on comments from OGAC.
M&E. The functionalities of the dedicated SQL database to collect and consolidate PEPFAR indicator data from all partners were
enhanced. This system was used to review partners' targets based on performance, data assessments and validations, and to
minimize double counting within and across IPs. On-going TA was provided to IPs to ensure understanding of indicator reporting
requirements and improve M&E capacity. Data Quality Assessments and site visits were conducted for PMTCT, Care, ART, TB,
SI; training on data management occurred within all program areas. USG continued to work with MoGLSD to develop a national
M&E system for OVC. USG shared PEPFAR results for FY08 SAPR and APR with the GOU, UNAIDS, UNICEF, WHO and other
major stakeholders.
Efforts to improve the ability of partners to collect and analyze their program data continued. Training was provided to
implementing partners on STATA, Epi-Info, and electronic registries. Evaluation of various Electronic Medical Record (EMR)
systems was undertaken, and assistance provided to IPs in either developing an EMR or ensuring that their current system was
appropriate. The development of an electronic registry system was completed and installed at several partner sites, improving
their ability to track visits and triage clients
USG supported the piloting of new technologies for data collection including a review of various portable devices such as mobile
phones and personal digital assistants (PDA). It is expected that PDAs will be used for reporting facility-based data, helping to
overcome the problems with lack of computer infrastructure and support. ACASI technology is also being used. An evaluation of
Health Commodities Distribution Systems was completed and included an assessment of MIS of the National Medical Stores.
FY09 Plans:
HMIS: In FY09, USG will actively participate in the scheduled revision of HMIS tools and indicators. The USG strategy to support
the Vision 2012 and HMIS activities will be developed and guided by the strategic vision of MOH. In support of national reporting,
an SI meeting with IPs will be convened to discuss obstacles and barriers to reporting to HMIS, and to ensure that IPs report to
the District level using appropriate HMIS forms. The goal of having single rather than multiple reports from each facility will be
stressed.
USG will support the roll-out of the PMMP, assist UAC in disseminating the Plan, and work with IPs to report on PMMP indicators.
Special effort will be made to support the collection, collation and analysis of data on community based activities. In addition, the
USG will continue to participate in the National M&E Technical Working Group.
M&E: SI will work closely with PEPFAR TWGs to review partner targets, provide on-going technical assistance to guarantee
adequate understanding of PEPFAR indicators and reporting requirements, and to minimize double counting within and across
IPs. Challenges include comparing trends in PEPFAR I to PEPFAR II indicators, and trying to reconcile the PEPFAR definition of
palliative care with the national and international recognition of HCT as part of prevention.
Efforts to increase data use for planning and decision making among PEPFAR funded IPs will continue to be a major activity. The
SI TWG will work with other TWGs to help build institutional M&E capacities. This requires an evaluation of M&E staffing and skill
levels, and greater technical assistance, training, and support supervision in data management and analysis. The SI TWG will
work towards harmonizing USG program reporting and indicators to reduce reporting time and improve data quality. In addition, SI
will assist programs to generate and analyze data that can inform planning and indicate the extent to which PEPFAR programs
are making an impact. A situation analysis of service delivery models for OVC will be conducted.
Surveillance: USG will continue to support the implementation of ANC sentinel surveillance, and the timely availability of data and
reports. Surveillance of MARP will continue, with completion of recruitment of all groups, except for female partners of MSM, who
have proven more difficult to access. Uganda's second AIS will be merged with the Malaria Indicator Survey and completed. Part
of this survey will include the piloting of ACASI as a data collection tool for national surveillance activities. USG will work with
MOH to develop a national strategic surveillance plan for HIV/AIDS, particularly with respect to the timeline, scope and frequency
of key surveillance activities. A pilot evaluation of incidence-based HIV surveillance will take place using PMTCT program data
and lab-based incidence testing. A bio-behavioral surveillance activity to evaluate determinants for HIV acquisition in a routine
VCT setting is also planned. The SI portfolio will support the HIVDR Working Group in surveillance of early warning indicators and
acquired ART drug resistance. Evaluation of anti-TB drug resistance among smear positive TB patients will also be performed, as
well as ART outcome monitoring. .
PHEs: In FY09, of the nine active PHEs, five will be continued and four completed. Several new multi-country and country-specific
PHEs have been proposed and are pending approval by OGAC.
Table 3.3.17:
This PHE activity 'Home Based AIDS Care Project' was approved for inclusion in the COP. The PHE
tracking ID associated with this activity is 'UG.07.0159'.
Continuing Activity: 13331
13331 4821.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $2,400,000
8373 4821.07 HHS/Centers for US Centers for 4819 3481.07 $3,451,142
4821 4821.06 HHS/Centers for US Centers for 3481 3481.06 $1,757,445
Estimated amount of funding that is planned for Public Health Evaluation $2,400,000
This is not a new activity but a continuation of Activity ID 4703.08
The CDC Informatics Unit provides technical assistance for the development and implementation of
strategic information systems to the country office and national prevention, care and treatment
implementing partners. These service providers, who are key recipients of PEPFAR funds, are given direct,
hands-on support by the informatics team to design strategic information systems tailored to meet the
specific needs of the programs and to build institutional capacity across the organization. The team actively
engages partner management and clinic staff at all levels to build consensus and develop applicable
standards for effective information system development. Strategic information program interventions range
from the design of patient care records, and clinic management and logistics system to the integration of
monitoring and evaluation of national indicators between the MOH HMIS and the PEPFAR program.
The Informatics Unit develops computer-related capabilities such as biological patient recognition, computer
power sources, and hand held computer applications which support our public health partners. The unit
supports the MOH resource center for development of computer capacity for national data collection and
reporting; connectivity and computer infrastructure from internet access to specific network topology design
and implementation. The Unit provides application development for standard information systems and
tools for clinics, development and design of SI collection instruments; data entry and management; analysis
and reporting of SI; and, information and infrastructure security and maintenance.
Training in each of these areas will also be developed and supported either directly by the CDC Informatics
team or through utilization of outside resources and partners. The goal of training and technical support
provided will be to build capacity in partners to implement and maintain their own HMIS with limited on-
going technical support from CDC. Technical assistance will also be provided in the interconnectivity of MIS
for all partners into the national HMIS and USG systems where required or relevant. Finally, the CDC
Informatics Unit will conduct on-going SI needs assessments of partners to ensure informatics resource
growth to match needs necessitated by increasing care and prevention activities. The increases in demand
reflect the success in implementing initial programs since the partners have used these initial systems and
by passed the systems capacity. This activity works closely with MEEPP to maximize synergies and avoid
duplication.
This funding will be used to pilot new methods for population-based, PEPFAR-funded surveys.
ACASI (audio-computer assisted self-interviewing) is an interview technique that eliminates the interviewer.
The respondent reads and/or listens to questions on a computer and enters the answer by use of a
keyboard, mouse, or touch screen. There is a growing body of literature suggesting that respondents more
frequently confirm socially undesirable behaviors when asked through ACASI than through face-to-face
(FTF) interviews. ACASI also has been evaluated or used in Africa, including in rural household based
surveys, confirming its feasibility among respondents who are illiterate or may not have used a computer
before. Facilitating more accurate answers to sensitive questions or questions on socially undesirable
behaviors may help to better analyze HIV-related survey data. ACASI may be a suitable data collection tool
for population-based HIV-related surveys but thus far has never been piloted or evaluated in AIDS Indicator
Surveys (AIS). This is primarily a proof of concept evaluation with the aim of demonstrating the feasibility of
using ACASI for a bio-behavioral household-based survey and its potential advantages. This evaluation will
take place in enumeration areas (EAs) separate from the main AIS survey. Data from this evaluation will
not be included in the main survey. Consenting adult household members will undergo the same survey
procedures as in the main survey including biomarker collection and testing. The sequence of events will
be identical to that in the main survey. A few questions will be asked twice: through FTF and through
ACASI. The ACASI will include the entire AIS questionnaire. Qualitative interviews will be conducted with a
small number of survey respondents in both old and new EAs.
The protocol describing the methods in detail is nested into the main AIS protocol that is currently under
review.
We anticipate that the field methods will take place immediately following the planned Uganda AIDS and
Malaria Indicator Survey. UAMIS will start in May 2009 and likely end in August or September 2009.
Estimated amount of funding that is planned for Human Capacity Development $25,000
This surveillance activity aims at most-at-risk populations including men having sex with men (MSM),
female sex partners of MSM, female sex workers, male sex partners of female sex workers, university
students, and transport workers in Kampala, Uganda. The project goal is to inform Uganda's public health
system about groups at high risk for HIV infection and to eventually facilitate and evaluate prevention
activities and related services. The project objectives include identification and recognition of selected high
risk groups, monitoring trends in prevalence of HIV and other selected sexually transmitted infections
(STIs), and identifying and describing risk factors associated with HIV infection. This PEPFAR-funded
surveillance system is conducted in collaboration with the Ugandan MOH and the School of Public Health,
Makerere University.
The target sample size is approximately 600 per MARP group; the estimated sampling period is 3-6 months
per group. All MARP groups will be sampled using the same infrastructure. Respondent-driven sampling
will be employed; quantitative data will be collected through computer-assisted self interviews; qualitative
data will be collected through individual semi-structured interviews. Specimen collection includes blood and
urine, as well as rectal and vaginal swabs. HIV voluntary counseling and testing will be provided, as well as
testing and treatment for selected STIs. The activity started its field procedures in May 2008.
Currently, sampling is progressing. We anticipate that sampling of the above mentioned groups will end in
FY 2009. Thereafter, this activity will prepare to sample new potential high risk groups. Findings will be
disseminated to develop or improve control activities and services.
Continuing Activity: 16782
16782 16782.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $26,650
* Addressing male norms and behaviors
* Reducing violence and coercion
strategic information systems to the PEPFAR/Uganda country partners. The informatics initiatives include
support to the Ministry of Health Uganda Government, routine health service data collection at the district
and National levels and support to USG partners offering ART care to patients, through the development
and deployment of system.
Two main activities were funded in FY 2008 - Appropriate Technologies for Health and Electronic Medical
Records.
** Appropriate technologies for Health: A survey within Uganda, Tanzania and Rwanda at both public and
private sites as well as CDC offices was conducted by CDC Informatics team and consultants to assess
availability of health related information communication technologies in healthcare delivery and a report
written. Key findings show that a variety of technologies exist in the countries mentioned, all at various cost
levels. These include usage of mobile phones, PDAs, wireless technology, GPRS among others. One key
finding was that sometimes the technology is pushed without a clear business case defined (in other words,
the technical solution was available before it was known in which field it should be applied, which does not
necessarily result in the best solution) The results will further inform a technical pilot on mobile technologies
in Government health facilities including the usage of GPS, GPRS, PDAs and mobile phones, which is in
the design phase now, to assess the use of these technologies in capturing, transferring and reporting
information collected at public health facilities. Currently there is an activity to pilot power backup
alternatives in resource limited settings; solar panels and PDA are being used for data collection to enhance
the use and quality of data received at the district level. Two Implementing Partners have been identified to
assess this technology and execution will begin by early December for a period of one year. Results will
inform Ministry of Health, donors and partners as to whether it is feasible to roll out this technology to rural
settings.
** Electronic Medical records: Several meetings have been held to work out an implementation plan that will
be acceptable to all stake-holders. An ART EMR database will now be installed at six PEPFAR funded
partners whereby all indicators have the same definition, thus allowing for easy comparison and analysis of
data. Several clinical reports have been suggested and will be developed to assist the USG partners in
tracking the progress of their programs. In FY 2008, the focus was on ART indicators. Additionally, besides
the clinical reports, program reports for monitoring purposes will be developed, including national reports
which feed into the national system, and the PEPFAR specific reporting needs. Currently, this activity
focuses on PEPFAR partners only, but it is expected that the dataset being developed can be adopted by
the Ministry of Health as it will be based on the WHO HIV Care and Treatment card.
The above activities will continue in FY 2009. Several PEPFAR funded Implementing Partners have limited
capacity to evaluate and select appropriate laboratory information systems - it should be noted that
laboratories are a key component to the provision of appropriate and quality HIV/AIDS care and treatment
for PLWHAs. This activity will assist PEPFAR funded partners in the selection and implementation of clinical
laboratory system(s) and assess the feasibility for each to function in a typical clinical laboratory setting,
such as found at PEPFAR funded sites or non PEPFAR funded Ministry of Health facilities. It will also pilot
and identify appropriate technologies in the electronic transfer of laboratory results between collaborating
laboratories, while considering the sensitivity of the data, for the provision of health care. There will also be
a continuation of the technology pilot activities started in FY 2008 and an evaluation will be carried out to
assess if the technologies can be scaled up within the country to meet the reporting needs.
There will be a continuation of the EMR activities started in FY 2008. For FY 2009, it is projected that more
partners will benefit from the common dataset, and technologies will be tested to transfer data on clients
who receive services from multiple sites for various reasons (for example, using a smart card). This will
reduce double counting during reporting. It will also provide an electronic data transfer mechanism to
various stakeholders, such as the Ministry of Health AIDS Control Program and the Resource Centre. This
activity will be a continued effort with the PEPFAR Uganda Care and Treatment Working Groups.
Additionally, the activity will assess the feasibility of including VCT indicators in the EMR. The feasibility of
feeding data from this system directly to the MOH (such as the Resource Centre and the AIDS Control
Program) will also be addressed. This activity will bring the various service databases that currently exist at
partner sites together in one database, so that comprehensive reports for clinical monitoring and program
monitoring (national and PEPFAR) can be developed, reducing the burden of reporting.
Continuing Activity: 13332
13332 13332.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $550,000
Estimated amount of funding that is planned for Human Capacity Development $302,500
CDC Uganda and the Ministry of Health Uganda National TB & Leprosy Program (NTLP) will support a
survey of anti-tuberculosis drug resistance among smear-positive TB patients. This survey will provide
national data regarding primary and acquired anti-TB resistance, and multi-drug resistance (MDR) in
Uganda. In addition, further data will be obtained on HIV prevalence among smear positive TB patients.
The survey will provide an estimate of the extent of mono-drug resistance, MDR, and extreme drug
resistance (XDR) among smear positive TB patients as well as those who are HIV co-infected. This activity
is a continuation from last year, during which planning, protocol development, and NRD/IRB clearances
were initiated.
The World Health Organization (WHO) estimates that approximately 19% of adults with active TB disease in
Uganda are HIV-infected. However, a recent study among a select group of patients in Uganda found that
50% of newly registered TB clients were HIV positive. HIV co-infection poses additional challenges in the
prevention, diagnosis and treatment of drug-resistant TB. Mortality rates for MDR TB are greater among
those who also have HIV--as high as 89% compared to 37% among those without HIV infection. It was
recently reported that among 52 co-infected South African patients with XDR TB and on antiretroviral
therapy, the median survival was only 16 days.
The WHO and the International Union Against TB and Lung Diseases (IUATLD) recommend monitoring of
anti-TB drug resistance either through ongoing surveillance or periodic surveys. In Uganda, however, no
nationally representative TB drug resistance data are available. A survey conducted in three regions in
1996-97 found that resistance to rifampicin was 0.8% and the prevalence of MDR TB was 0.5% among all
TB isolates collected. In 2005, a survey conducted among hospitalized patients at Mulago, the national
referral hospital in Kampala, found the prevalence of MDR TB to be 4.5% among new TB patients,
representing a 10-fold increase in drug resistance in less than a decade.
In order to address the lack of country-level data, the survey proposed here will provide a national estimate
of primary and acquired anti-TB drug resistance including MDR. As per the National TB/HIV policy, all TB
patients included in the survey will undergo HIV counseling and testing. Given the important overlap
between TB and HIV epidemics, this survey will also serve to obtain HIV prevalence data among TB
patients. Data will allow comparison of the prevalence of drug resistance (including MDR TB and XDR TB)
between TB patients with and without HIV infection. It will also help assess the capacity to diagnose and
manage MDR TB at the National Tuberculosis Reference Laboratory (NTRL) and within the National TB
program.
The surveillance activity will be a cross-sectional survey of patients aged 13 years and above with sputum
smear-positive TB in Uganda. The sampling frame has been designed to be representative of all sputum
smear positive TB patients within the 9 NTLP zones of the country. A modified weighted 30-cluster sampling
technique proportional to the number of new smear positive TB cases diagnosed in health facilities
throughout the country will be used (population proportionate cluster sampling). The 30 clusters have been
selected from a 2007 list of facilities reporting the requisite number of smear positive cases. The number of
new sputum smear positive cases registered by NTLP in 2005 and officially reported by WHO was 20,559,
from which the sampling interval (20,559/30= 685) was calculated. The WHO recommends powering drug
resistance surveys for significance based on the estimated prevalence of rifampicin resistance. In a recent
survey conducted at Mulago Hospital, the prevalence of rifampicin resistance was 1.4%. Therefore, a
sample size of 1,500 smear positive TB patients was calculated based on detecting a prevalence of 1.4%
with a precision of 1-2%, using a 95% confidence interval; at least 50 smear-positive sputum cases would
be needed within each of 30 clusters. Selected facilities (clusters) identifying less than 50 smear positive
cases will be grouped into pseudo-cluster facilities so that at least 50 cases are available for sampling. All
eligible diagnosed patients within clusters will be consecutively sampled from the time of survey initiation
until the required number for each cluster is reached. Enrolment will take place over a maximum of 12
months. All re-treatment cases identified during the intake period at survey sites will also be evaluated, but
will be in addition to the sample of 50 newly diagnosed cases per cluster.
Suspected TB patients will undergo sputum smear evaluation at the facility; if positive and eligible for
enrolment, they will be administered a consent form by on-site clinical staff. Two new sputum samples from
each enrolled patient will be transported to the NTRL for culture examination using the existing National
Sputum Referral System, which employs POSTA, the Ugandan postal service. Results of drug resistance
testing will be returned to the originating health facility through the same system, to ensure that clinical staff
have timely access to results. All isolates found to be MDR TB will be tested for second line drug
susceptibility to determine the presence of XDR TB. HIV testing and counseling will be provided to all
patients at the site of enrolment according to the national TB HIV policy, and persons identified as HIV
infected will be referred for HIV care & treatment. Patients with MDR or XDR TB will be referred to one of
two national referral sites for treatment of resistant TB.
Data will be entered centrally at the NTLP and analyzed using specifically designed WHO software. Results
will be written up and presented in report form and published, and disseminated to interested stakeholders.
These results will help provide information on the extent of drug resistant TB in Uganda, and guide
programming, policy and guidelines for detection and management of TB and TB/HIV co-infection.
This activity began in FY2008 during which time the sampling methodology was developed, protocols were
written and submitted, and initial logistical preparations made including procurement of some laboratory
supplies. The sampling methodology was reviewed by statisticians at CDC-GAP, and revised accordingly.
A protocol was then completed and submitted to the CDC GAP-ADS office for technical review and ethical
clearance (October, 2008). Comments are pending. The protocol has also been submitted to the Makerere
University Faculty of Medicine IRB for review. The time line for completion of the project is 18 months from
the start of client enrolment.. This surveillance activity can begin as soon as IRB and ADS comments are
received, revisions made, and final approvals obtained.
Continuing Activity: 13334
13334 10084.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $120,000
10084 10084.07 HHS/Centers for US Centers for 4819 3481.07 $268,278
This activity was originally proposed as a PHE but was subsequently determined to be a SI activity.
Note: The protocol title for this activity has been changed to "VCT-based surveillance of HIV-acquisition"
Conventional HIV surveillance focuses on monitoring HIV prevalence. Prevention programs however need
information on the determinants of acquiring and transmitting HIV. The surveillance system described here
is tailored after the slogan "Know your epidemic - the last 1000 HIV infections". It primarily aims at tracking
recently HIV-infected persons to better inform about the current determinants that put people at risk. At
selected sites VCT clients' demographic and behavioral characteristics will be evaluated by their HIV status:
HIV-negative, recently HIV-infected, long-term HIV infected. The clients' left-over HIV-positive blood will
undergo additional off-site testing to identify those likely to have been recently infected. Same-site HIV-
negative "controls" serve as a comparison group. At the sites where this activity will be implemented, a
more risk profile will be available to counselors for the purpose of counseling. Further, the introduction of
computer-assisted self interviews (CASI) may decrease workload for site staff. This activity intends not to
monitor HIV acquisition/transmission risk behaviors and characteristics.
Its main objectives are to describe:
1) HIV acquisition determinants (among recently infected individuals)
2) HIV transmission risk behaviors (among both recently and long-term infected individuals)
These data will facilitate the tailoring of prevention activities targeting HIV-uninfected and ‘Prevention With
Positives' (PWP) programs. It will also facilitate more targeted counseling for VCT clients at the involved
VCT centers.
The protocol for this activity is currently under review at CDC Atlanta. Work is undergoing with the
implementing partner to revise the client form and prepare the ACASI interview format; also to integrate the
new IT components in the partner's routine system and work flow.
In FY 2009, upon obtaining human subjects approval, we will implement this activity first at the main site in
Kampala, and thereafter at other sites.
Continuing Activity: 16832
16832 16832.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $75,000
Estimated amount of funding that is planned for Human Capacity Development $5,000
This activity is a continuation from FY 2008 and is largely unchanged. The main changes are that the
previously described methods will be limited to PMTCT sites, i.e., the activity will not include STD clinics or
VCT centers. This actitivity focuses on Evaluating the Utility of: (1) Using Routine Program HIV testing
Data for Surveillance and (2) the HIV-1 Incidence Assay for Incidence-Based Surveillance. Note: The
protocol title is "Program and incidence-based HIV surveillance in Uganda"
The traditional ante-natal clinic (ANC) based surveillance system relies on unlinked anonymous HIV testing
(UAT), is relatively small (~10,000 clients/year) and slow in detecting changes in trend. In Uganda,
PEPFAR is the largest donor for HIV testing for PMTCT. Such routine testing programs generate large
amounts of HIV testing data (PMTCT: 250,000), therefore having the potential of facilitating more precise
prevalence estimates for surveillance. Importantly, HIV-positive left-over blood from the PMTCT program
can be tested with HIV incidence assays, with the prospect of establishing an incidence-based surveillance
system for a more timely detection of trends in Uganda's HIV epidemic. This activity evaluates the utility of
routine PMTCT program data and specimens for an expanded prevalence and a new incidence-based
surveillance system. Potential biases and limitations to be examined include self-selection bias for testing
and the accuracy of laboratory-based incidence testing for surveillance. The new methodologies will be
piloted at no more than a total of 5 PMTCT clinics. Routinely collected program data will be transcribed and
left-over HIV-positive blood will be collected on filter paper for incidence testing. As PMTCT clients are not
consented for further testing and data analysis, testing of these left-over specimens will be performed
unlinked, akin to the traditional UAT-based ANC surveillance system. Same site PMTCT and UAT-based
prevalence data will be compared, as well as PMTCT-based incidence estimates generated. The sampling
populations constitute PMTCT clinic clients. Akin to traditional ANC-based surveillance, PMTCT-based
prevalence (and incidence) estimates and trends would be extrapolated to the general adult populations
with or without adjustments.
The protocol is fully developed and is currently under review locally and at CDC Atlanta. We anticipate that
this activity will commence its "field activities" by in the first quarter of FY 2009. The activity will first be
implemented at 5 PMTCT sites, and expanded to 15 sites in FY 2010 and likely 30 sites in FY 2011. We
expect that in FY 2011 this activity may be fully handed over programmatically to Ministry of Health.
Continuing Activity: 16546
16546 16546.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $50,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $5,000
and Service Delivery
Table 3.3.19:
The HHS/CDC Uganda Management and Staffing (M&S) budget for FY 2009 supports the USG goal for
appropriate staffing and level of effort in order to provide technical assistance, programmatic oversight, and
performance monitoring for HHS/CDC funded implementing partner activities. Over 70 percent of these
CDC operations and staffing costs are covered through GAP base-funding, with the balance covered by
GHCS. The GHCS funds support direct technical assistance to indigenous local implementing partners to
strengthen national surveillance and policy initiatives, develop laboratories services, improve care and
treatment programs, expand counseling and testing approaches, enhance PMTCT activities, improve
TB/HIV integration, and implement public health evaluations.
The HHS/CDC Uganda staffing plan includes the following approved U.S. Direct Hire (USDH) staff
positions: Country Director; Deputy Director; two Public Health Advisors, one administrative and one
technical; three Senior Scientists that serve as unit chiefs for Laboratory Services, Behavioral and Social
Science, and Informatics; and four Medical Officer/Epidemiologists, one of whom serves as the President's
Malaria Initiative advisor. Three approved personal services contractors (PSCs) include a Laboratory
Services Coordinator, Behavioral Scientist, and Medical Officer/Epidemiologist for PMTCT.
For FY 2009, two new PSCs are requested to provide technical assistance to the Epidemiology and
Informatics Units, respectively. In addition two (1) non-PSC will support care and treatment activities in the
Program Unit, and thirteen (13) LES positions are planned. These sixteen positions are necessary for
HHS/CDC to continue to provide high quality technical assistance that strengthens indigenous partners'
capacity thus ensuring the sustainability of PEPFAR activities. As shown in the organizational charts
provided, the HHS/CDC Uganda office is comprised of seven units: Office of the Director, Operations,
Program, Laboratory, Epidemiology, Informatics, and Behavioral.
The Program Unit oversees HHS PEPFAR-supported partners and provides technical assistance for
program implementation to ensure partner initiatives are based on current evidence-based science. Direct
country project officer management is in place for seven of ten active PEPFAR treatment partners:
Makerere University Faculty of Medicine, The AIDS Support Organization, Mildmay Center, Reach-Out
Mbuya, Rakai Health Sciences Program, Uganda Baylor College Foundation, and Catholic Relief Services-
AIDS Relief. These partners work in over 80 public and non-governmental organization (NGO) facilities,
treat over 65,000 clients [including 7200 pediatric patients] and provide care to 157,000 HIV-infected
persons [of which 18,000 are pediatric patients] and their families. Currently, CDC has twenty-eight local
and central cooperative agreements supporting a broad range of predominantly indigenous partners.
Partner activities include implementation of HIV prevention interventions, laboratory services, blood safety
activities, TB/HIV integration, care and treatment for adult and pediatric patients, and, for orphans and
vulnerable children (OVC), PMTCT program expansion, strategic information initiatives and health systems
strengthening interventions. HHS/CDC also provides direct funding and technical support to the Ministry of
Health (MOH) and the National Medical Stores (NMS). In FY 2009, funding opportunity announcements will
likely add two to three new implementing partners.
Working with the national Laboratory Technical Committee and PEPFAR Laboratory Technical Working
Group the, CDC laboratory staff will continue to support the strengthening of the national laboratory system
by providing technical advice and financial inputs to develop and implement a national laboratory services
policy and development of the Department of Laboratory Services within MOH. Laboratories at Regional
and District Health Facilities will continue to be renovated and equipped to provide full HIV testing and
monitoring services. The new Central Public Health Laboratory (CPHL), where CDC will assign technical
staff to provide leadership and mentoring and will establish a laboratory information management system to
coordinate activities within the laboratory sector and with the MOH Resource Centre. The CDC Laboratory
Unit will continue to coordinate technical and management training through the OGAC-Becton Dickinson
Public Private Partnership in collaboration with CDC Atlanta. Quality assurance schemes for HIV serology
managed by the Uganda Virus Research Institute (UVRI) and for CD4+ counting through CPHL will also be
supported by direct technical assistance from CDC laboratory staff. Finally, CDC laboratory staff will
provide support supervision assistance to both the District Laboratory Focal Persons and Regional
Laboratory Coordinators by working in close collaboration with the District Health Officer.
Other Laboratory Unit activities include: assisting National Medical Stores to forecast, procure, store,
distribute and monitor laboratory reagents through the national Laboratory Credit Line; support for national
HIV drug resistance activities; and, collaboration with MOH in the design and implementation of national
HIV/AIDS surveys. The CDC Laboratory will also provide substantial financial and technical support to the
National TB Reference Laboratory to rehabilitate training facilities; roll-out a national training program in
AFB smear microscopy; establish a national TB specimen referral system; provide containment laboratories
for the safe handling of MDR and XDR TB strains, and conduct a national TBDR survey.
The Epidemiology Unit leads and supports the implementation of twelve public health evaluations (PHEs)
and HIV surveillance activities. Currently, the team has seven continuing PHEs:
1. Strategies to decrease HIV-transmission risk behavior and increase drug adherence among HIV-infected
adults initiating antiretroviral therapy in Uganda;
2. Evaluating the utility of re-testing HIV-negative voluntary counseling and testing clients;
3. Evaluating home-based confidential counseling and testing in Kumi District;
4. Interactions between HIV and malaria in African children;
5. Evaluating anti-tuberculosis drug resistance among smear-positive TB patients;
6. Collaborative cohort of USG-supported anti-retroviral treatment programs in Uganda to assess costs and
clinical outcomes associated with different programmatic approaches;
7. Evaluating the utility of (1) using routine program HIV testing data for surveillance, and (2) the HIV-1
incidence assay for incidence-based surveillance.
The Epidemiology Unit staff coordinates the Tororo field station Home-Base AIDS Care (HBAC) project.
HBAC is an approved PHE designed to answer key operational questions that will provide valuable
information to the MOH and the international community on how to best scale-up ART in rural settings;
develop appropriate policies for selection of second line ART drug regimens; evaluate the need for
continued cotrimoxazole in ART patients; and, examine the risks and benefits associated with early versus
late ART drug switching. HBAC has one of the largest cohort on ART that is being followed up in sub-
Saharan Africa. This field station infrastructure will be used to launch additional multi-country PHEs and
Activity Narrative: provide a training venue for other PEPFAR country staff with a less developed infrastructure.
Other PHE activities conducted by partners and supported by Epidemiology Unit staff include: Comparison
of Facility and Home-based Antiretroviral Therapy Delivery Systems; Assessing the relationship between
intimate partner violence and HIV status disclosure in Rakai District; and Evaluating two types of male
circumcision procedures. CDC Uganda will participate in four new PHEs of global significance proposed for
FY 2008.
This team also provides the MOH AIDS Control Program direct technical assistance to conduct antenatal
clinic surveillance, and to develop and conduct the combined Malaria and AIDS Indictor Survey. Scientists
in the unit are key members of the national technical Surveillance workgroup, the PEPFAR strategic
information workgroup, and the OGAC PHE task force. They also advise the MOH and related government
agencies on national evaluations and studies.
The Informatics Unit provides Ugandan public health partners with computer system expertise, performs
CDC laboratory data management, and provides in-country scientific staff with data management and
statistical support. This team also provides technical assistance to the MOH Resource Center in the design
and implementation of the national Health Management Information System and provides direct technical
assistance to over twenty local implementing partners on data collection applications for clinical and
laboratory services, data management and analysis, and the building, maintenance, and management of
electronic communication, connectivity and data networking systems. The Informatics Unit provides
extensive on-site training opportunities for all HIV partners to strengthen their institutional capacities, and
holds on-campus training sessions on Epi-info, SQL, and network management. Trainings are also
available for staff, MOH and partners on management of national survey data. Need to add the on-going
FY08 activities for piloting technologies for health data collection and electronic medical records systems.
The Behavioral Unit provides scientific leadership and technical assistance to numerous indigenous
partners, including the MOH, NGOs, universities, other PEPFAR country units, USG agencies, and various
international health institutions. The goals of the Unit are to inform the development and implementation of
innovative and effective programs addressing HIV prevention, care, and treatment by using multidisciplinary
methods based on psychology, anthropology, economics, and epidemiology. The Unit has previously
focused on reducing HIV risk behavior and transmission, PMTCT implementation and program
harmonization, reducing social harm and stigma associated with HIV testing and home-based care, ART
adherence, identifying reproductive norms and reducing unwanted pregnancies among HIV-infected
women, increasing social support for care and HIV status disclosure, developing discordant couple
counseling protocols, and informing interventions for OVC and HIV-infected children. Future activities will
address HIV epidemiology, prevention, care, and treatment within the uniformed services of Uganda with a
specific emphasis on Uganda Prison Services, identifying factors related to ART adherence among HIV-
infected children, developing task shifting approaches for male circumcision and ART initiation and care,
conducting evaluations addressing HIV risk behavior disinhibition within biomedical prevention trials of pre-
exposure prophylaxis and HIV vaccines as well as male circumcision roll-out programs.
To fully implement the activities described above, the HHS/CDC office has planned for a full compliment of
261 staff positions, including the fifteen planned positions. These staffing needs are required to support the
expanded activities for PMTCT, laboratory services, and strategic information to ensure adequate technical
assistance to partners; increased surveillance activities; and additional data management and analysis for
the PHEs. M&S staff-specific costs include travel, training, and communication services. The M&S
operational costs are inclusive of office and warehouse space, and associated utility and security costs.
Continuing Activity: 16093
16093 16093.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $349,852
The $639,207 M&S cost is for procurement of information technology support office (ITSO) services from
Atlanta. The ITSO charges are broken down into four cost areas: headquarter support cost, regional
support, connectivity to Internet and CDC headquarters, and hardware refresh and software license refresh
costs. These costs include support for the base-level connectivity for the primary CDC office, maintaining
the IT equipment in the offices, the regional technology support services executive, and strengthening the
ITSO global activities team in Atlanta to better support the field as well as transitional costs from traditional
Desktop PCs to Complete Docking stations.
Continuing Activity: 16094
16094 16094.08 HHS/Centers for US Centers for 6445 3481.08 CDC GHAI $552,208
