AIDS Information Centre-Uganda (AIC) is a local national Non-governmental Organization (NGO) that was

established in 1990 to provide HIV Counseling and Testing (HCT). Over the years AIC has incorporated a

number of other program areas that include; mobilization and sensitization of HIV and TB information

looking at the ABC model, prevention of HIV transmission through AB messages, education on condom use

and distribution, disclosure; provision of basic health palliative care through management of opportunistic

infections, distribution of the basic care kit and Septrin for prophylaxis, Prevention of Mother to Child

Transmission (PMTCT) by counseling and testing pregnant mothers and referral for ARVs in PMTCT as

well as the screening and management of Tuberculosis (TB), counseling and testing TB patients for HIV as

part of the TB/HIV integrated services. AIC since its inception, has grown from one branch to operate 8

branches today namely Arua, Jinja, Kabale, Kampala, Lira, Mbale, Mbarara and Soroti. AIC to provide the

above services it supports district health units to offer TB/HIV integrated services by carrying out provider

initiated CT. The implementation of TB/HIV activities is critical because AIC has observed that about 9%

HIV positive clients often are co-infected with TB while 36% of TB patients are HIV positive. At the 8 stand-

alone sites (branches), AIC uses VCT as the entry point to all services and those found to be HIV positive

are screened and treated for TB and if active TB is ruled out, these clients are screened for latent TB. HIV

negative clients that have symptoms of TB are also screened. All clients with positive TB results are either

treated at the branches or given referrals to TB clinics of their preference, which are easier for them to

access. Since AIC, offers Cotrimoxazole Prophylaxis Therapy (CPT) to all HIV positive clients, the co-

infected clients are given a daily dose of CPT as well as treatment of other medical opportunistic infections.

Co-infected clients are also given internal referrals for CD4 services and are continuously counseled for

positive living through our post test clubs. Those clients with a low CD4 and need Anti-Retroviral therapy

(ART) they are referred to accredited centers. At the district supported health units (indirect sites), AIC uses

TB clinics as the entry point into HIV services by providing provided initiated CT. HCT is offered to TB

patients in the TB clinics, particularly through targeting TB clinic days when most TB clients turn up for drug

refills. AIC also targets patients that are admitted on the TB wards. AIC has also been requesting TB

patients on CB-DOTS to go back to their health facilities for Provider Initiated Counseling and Testing

(PICT). TB patients found to be co-infected with HIV are given appropriate referrals for CD4 services and

ART at accredited ART centers. AIC also supports capacity building of the indirect sites to manage TB/HIV

co- infection as well as the mobilization and sensitization of communities to utilize the services both at the

main branches and in the public health facilities.

AIC's goal under this project is to reduce the burden of both diseases among the co-infected. The main

objectives of the project over the years have been to: strengthen and expand screening, diagnosis and

treatment for Active and Latent TB; promote HIV diagnostic counseling and testing among persons with TB

disease and to strengthen prevention, care and support to active TB/HIV co-infected clients. AIC has been

implementing TB/HIV integrated services since January 2001 and operations started with Kampala Branch.

In 2003, these services were introduced in Mbale and Jinja, while in 2004 Mbarara Branch started offering

these services. In 2007 TB/HIV integration was introduced to Soroti Branch. All the eight AIC branches

were able to diagnose and treat TB and to support the district supported health units implement TB/HIV

services. By the end of 2007, 4 (Mbarara, Kampala , Jinja and Mbale) centres were offering TB-HIV

integrated services. The remaining three (Kabale, Soroti and Arua had the challenge of not having a

functional Laboratory to screen for active TB. This is the reason for not meeting the 2007 targets. Since

then Soroti has acquired that capacity and is able to screen and treat for active TB and latent TB. Similar

work is taking place in Kabale and Arua Branches. Since 2001, AIC has screened 45,644 HIV positive

clients for TB at the AIC branches, of whom 1,717 had active TB. Of those with active TB, 1,062 were

diagnosed through sputum tests while 655 were diagnosed through X-rays. AIC offered Active TB

treatment to 649 clients and referred the rest to TB clinics of their choice. A total of 3,173 were diagnosed

with latent TB and started on the 9 month Isoniazid Prophylaxis (INH). In FY 2008, alone, a total of 6,072

HIV positive clients were screened for TB out of whom, 136 clients had active TB. Of these, 74 clients were

treated at the branches and the rest referred to clinics of their choice. Those that had latent TB were 1,543

and they were all started on a nine-month doze of INH. AIC has also worked with districts to scale up

provider-initiated HCT for TB patients at selected district hospitals, Health center IVs and Health center IIIs.

This activity started in January 2008 following a detailed technical needs assessment which was carried out

in 2007. By the end of FY 2008, 1,200 clients had been reached, of whom 36% were HIV positive. Those

found to be co-infected were given the relevant referrals for CD 4 services and ART. To ensure proper and

timely implementation of the planned activities, AIC built capacity at the health facility level, provided

technical assistance through regular support supervision by our medical teams at the branch, data

collection tools and HIV test kits were distributed to these health facilities. The indirect sites are supported

by medical officers and clinical officers at the branches. Furthermore, AIC has a dedicated team at

headquarters to support the branches and the indirect sites in the districts. In FY 2008, AIC trained 25 AIC

medical staff from the 8 branches in TB/HIV co-infection management. These trained staff have gone a

long way to scale up TB screening and treatment of HIV positive clients with TB. 25 out of a targeted 57

AIC medical staff were trained in TB-HIV integration. At the branches six TB educators have been trained

per Branch. To ensure drug adherence, AIC followed up TB patients and a total of 109 clients who had

defaulted were visited in their homes. All TB clients fill in a locator form and this enables the volunteers to

carry out patient visits to those that miss or default. During the home visits the volunteers check on the

progress of treatment and the amount of drugs left, the condition of the patient, establish why the patient did

not return for refills and assist accordingly and they also offer TB education to the family members and

communities. By the end of FY 2008, all the 8 branches had CD4 machines installed, thereby enhancing

AIC's laboratory capacity. Co-infected clients were able to have access to HIV disease monitoring. A total

of 11,205 clients received CD4 services in FY 2008, of these 40% had a CD 4 level below 200, hence were

eligible for ART and were appropriately referred. The indirect sites also have the opportunity to send HIV

positive clients to have their CD4 done at the AIC branches to ensure proper management and monitoring

of HIV. With assistance from other funding bodies like Uganda HIV support Program (UHSP), AIC is able to

diagnose and treat malaria among its clients including the TB-HIV co-infected. With provision of

Reproductive Health products like Family Planning Products from National Medical Stores, AIC will be able

to resume these services as part of the wrap around services. In terms of strategic information and data

management, AIC improved its data management through frequent review of its data collection tools

especially the ones for HCT and TB. This is a continuous exercise that facilitates the provision of quality

Activity Narrative: data. The online registration program is being used in Kampala branch and a total of 142,890 clients have

been registered since its inception in March 2006. This will soon be scaled up to all branches to facilitate

timely data collection, analysis and utilization. Service delivery also improved in the medical department as

a result of the procurement of computers for the medical staff, furniture and cupboards for the pharmacies

as well as the remodeling of the Kabale laboratory. This was further strengthened by the procurement of a

reliable and stable internet service provider. By the end of FY 2008, all AIC branches were on a reliable

network and AIC is moving towards a Wide Area Network (WAN).

In FY 2009, AIC will continue to strengthen TB/HIV integrated services in its 8 branches of Arua, Jinja,

Kabale, Kampala, Lira, Mbale, Mbarara and Soroti. Activities will include physical and clinical examination,

clinical monitoring, laboratory services, treatment and prevention of TB. AIC will use the NTLP registers

both for diagnosis and treatment in the clinics. At the branches, all HIV positive clients will be screened for

TB. In addition, HIV negative clients with TB symptoms will be screened to reduce the overall national TB

burden. It is estimated that AIC will screen a total of 12,000 clients during FY 2009. To carry out this

activity, AIC will procure materials for sputum testing and PPD. Since TB diagnosis continues to be a

challenge among HIV positive clients, x-ray services will continue to have a place in diagnosis and a total of

4,800 x-rays will be carried out during FY 2009.

Clients who will be diagnosed with Active TB will be treated at the AIC branches in line with the provisions

and guidelines of the National TB and Leprosy Program (NTLP). A total of 300 clients will be treated for

Active TB in FY 2009. For those diagnosed with latent TB, INH prophylaxis will be provided to 720 clients in

FY 2009. For clients who are initiated on the nine-month treatment there is still an increasing number of

cases who fail to adhere to the complete treatment and hence require follow up to eliminate drug resistance.

In order to improve adherence, AIC will carry out home visits to these clients. Bio data will be collected on

the locator card which will enable the TB volunteers to easily locate and follow up these clients. An

estimated 1,000 visits will be made in FY 2009. AIC will continue offering diagnostic HCT for TB patients in

TB clinics in 40 AIC indirect sites at a rate of 2 sites per district; in the districts of Kabale, Kanungu, Kisoro,

Ntungamo, Mbarara, Isingiro, Wakiso, Mukono, Jinja, Iganga, Mbale, Butalega, Soroti, Amuria, Lira, Gulu,

Apac, Arua, Nebbi, and Moyo. TB patients already diagnosed with TB will be offered provider-initiated

counseling and testing (PITC). AIC will reach 10,000 such clients in FY 2009. HIV test kits will be procured

and distributed to these supported sites and data collection tools provided. AIC will also carry out frequent

monitoring and support supervision visits to these sites. TB patients that will be found to be co-infected with

HIV will be referred for CD4 services and ARTs at accredited ART centers. AIC will therefore need to

maintain an updated referral register. AIC understands the limitations in human resource capacity both at

the branches and in the public health facilities. To build capacity in TB/HIV service delivery, AIC will train a

total of 160 staff of whom 40 will be AIC branch medical doctors/clinicians and medical counselors; and 120

will be from the indirect sites. Staff from the supported sites will include laboratory technicians, counselors

and TB/HIV program managers. To create TB awareness among communities, AIC will carry out TB

outreaches and will work closely with health workers of the indirect sites. Improved awareness about TB in

the communities is envisaged to lead to reduced spread of the disease and increased uptake of the TB/HIV

services. These outreaches will also act as an avenue for informing the communities about the availability

of TB/HIV services both at AIC and at the health units nearest to them. AIC will continue to provide

monitoring and supportive supervision in form of technical assistance, on-job/mentoring to the indirect sites

on a quarterly basis from the branch medical, laboratory, counseling and data teams. The data team will

provide technical assistance in collecting meaningful and timely data. The medical team will be giving

feedback on progress, while the laboratory and counseling team will dwell on the technicalities of HCT.

These teams will also be delivering test kits, laboratory consumables and data collection tools. AIC strongly

believes in reliable, timely and accurate data from the TB/HIV activities both at the indirect sites and the

branches. It is with this background that AIC will install the TB/HIV software at the NTLP for data collection.

To facilitate timely reporting and communication, AIC will continue to support internet connectivity for all

branches. Other operation charges that will support implementation will include office supplies, vehicle

maintenance, workshop facilitation and continuing medical education.

New/Continuing Activity: Continuing Activity

Continuing Activity: 13256

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13256 8366.08 HHS/Centers for AIDS Information 6426 5246.08 Tuberculosis/HI $600,000

Disease Control & Centre V Intergration

Prevention Activities

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $307,350

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

This PHE activity "Evalauting the Utility of Re-testing HIV Negative VCT Clients" was approved for inclusion

in the COP. The PHE ID associated with this activity is "UG.07.0155"

New/Continuing Activity: Continuing Activity

Continuing Activity: 13257

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

13257 10036.08 HHS/Centers for AIDS Information 6426 5246.08 Tuberculosis/HI $0

Disease Control & Centre V Intergration

Prevention Activities

10036 10036.07 HHS/Centers for AIDS Information 5246 5246.07 $0

Disease Control & Centre

Prevention

Emphasis Areas

Human Capacity Development

Public Health Evaluation

Estimated amount of funding that is planned for Public Health Evaluation $0

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17: