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: 2007 2008 2009
AIDSRelief provides a comprehensive care and treatment program emphasizing strong links between
PLHAs, their family, communities and the health institutions. Its goal is to ensure that people living with
HIV/AIDS have access to Antiretroviral Therapy (ART) and quality medical care. AIDSRelief is a consortium
of five organizations which includes Catholic Relief Services (CRS) working as the lead agency, the Institute
of Human Virology (IHV), Constella Futures Group (CF), Catholic Medical Mission Board (CMMB) and
Interchurch Medical Assistance World Health (IMA); AIDSRelief services are offered through 18 Local
Partner Treatment Facilities (LPTFs), distributed throughout Uganda working in some of the most
underserved and rural areas, including Northern Uganda. These include St. Mary's Lacor, St Joseph
Kitgum, Nsambya Hospital, Kamwokya Christian Caring Community, Family Hope Center Kampala, Family
Hope Center Jinja, Virika Hospital, Villa Maria Hospital, Kabarole Hospital, Bushenyi Medical Center 1-
Katungu, Bushenyi Medical Center 2- Kabwohe, Kyamuhunga Comboni Hospital, Kasanga Health Centre,
Kalongo Hospital, Amai Hospital, Aber Hospital, Nkozi Hospital, and Nyenga Hospital. In order to get
services closer to the communities it serves, AIDSRelief supports 24 satellite sites in selected LPTFs. The
Children's AIDS Fund is a sub-grantee in AIDSRelief and manages a number of the LPTFs.
In FY 2008, AIDSRelief expanded its services to four new LPTFs and three community based
organizations. It also decentralized services by encouraging LPTFs to open satellite sites and outreach
clinics. As of July 31, 2008, AIDSRelief in Uganda was providing care and support to 55,781 adult patients
18 years and older, and antiretroviral treatment to 16,833 HIV-infected patients 15 years and older.
AIDSRelief has supported a comprehensive continuum of care for adults living with HIV, in order to enhance
their quality of life throughout the entire span of their illness. The adult care and treatment component has
built on existing clinical and social services in all LPTFs. Clinically, the program continued providing adults
with 1st line, alternative 1st line, and 2nd line therapies, clinical follow-up, laboratory testing (including CD4),
and treatment of opportunistic infections. Social services supported consist of psychosocial and spiritual
support, as well as nutrition counseling and education were available to all 55,781 HIV+ adult patients
enrolled in care in FY 2008.
To get services closer to the PHAs, AIDSRelief has encouraged and supported LPTFs to open up satellite
clinics and this has increased accessibility of these services to those in rural areas. All LPTFs had outreach
teams led by a community nurse/clinical officer and are linked with community based volunteers, many of
whom were PLWHAs on treatment. Emphasis has been placed on excellent adherence in order to achieve
durable viral suppression. As a result there has been very good retention rate for patients on ART, low drug
toxicity, and an average adherence rate of over 95%. The teams also provided community based and
household ARV treatment support and preventative services which included education on the importance of
using ITNs, basic hygiene and good nutrition. Emphasis has been put on the creation of linkages within the
different services provided at the LPTFs and other service providers. The referral linkages between ANC,
PMTCT and ART services have been encouraged at the LPTFs to enable HIV+ mothers, their partners and
their babies to access ART services through the facilities.
AIDSRelief also continued employing a model of clinical preceptorship for service providers, with a special
emphasis on maximizing the role of nurses, adherence counselors and community workers. Activities
included training of health workers in improved pain and symptom evaluation and control, recognition and
appropriate referral for management of opportunistic infections (OIs), as well as supply of the basic care
package (ITNs, safe water, information on cotrimoxazole prophylaxis and prevention for positives). Activities
were expanded to include comprehensive training for 720 non-medical community workers as well as 290
medical staff to support and maintain care and treatment for all PLWHAs and their home caregivers. The
program has recognized the strong link between nutritional and Antiretroviral therapy and adherence to ART
but this remains a significant challenge. LPTFs have been encouraged to link with other organization able to
provide food, especially for severely malnourished PHAs. Training and guidance (national guidelines in
nutrition and HIV/AIDS) was provided to staff at LPTFs so that they could conduct nutritional assessment,
education and counseling at community and clinical levels.
By the end of FY 2008, AIDSRelief will have evaluated the program by relating patient outcome measures
such as viral suppression rates, adherence, and treatment support models to program level characteristics
at each LPTF. Over 1500 patients receiving care and treatment from 14 LPTFs were included in this
analysis, grouped into three cohorts (36, 24 and 12 months) representing the length of time they had
received therapy.
In FY2009, due to projected flat-lined funding, AIDSRelief activities will concentrate on consolidating the
quality of services provided at existing LPTFs and satellite sites in order to maintain 17,200 adult patients
on AIDSRelief provided ARVs and 55,781 adult patients in care. Support will consist of ARVs, OI drugs,
laboratory supplies and technical assistance to the LPTFs. A major focus will be to increase the devolution
of services to alternate cadres of service providers through ‘task shifting,' and networking with facilities and
with other service providers including the Ministry of Health. At the LPTFs, this strategy will focus on
protocols enabling nurses and clinical officers to do routine follow-up of stable patients and manage non-
critical acute symptoms as well as enabling nurses and pharmacy staff to do routine medication dispensing
to stable patients. This will increase service delivery, and ensure greater coordination and integration of
services provided within the community. Should additional funding from the USG become available,
AIDSRelief is poised to expand the services it supports to other underserved areas of Uganda to reach an
additional 6300 adult patients on ARVs and 10,000 adults in care.
AIDSRelief will continue to support a comprehensive and integrated continuum of care for HIV infected
patients building on existing services at the LPTFs. Services provided will comprise psychosocial support,
prevention for positives, clinical follow-up, laboratory testing (including CD4), treatment of opportunistic
infections and nutrition counseling and education for the 55,781 HIV + patients enrolled in care in 18 LPTFs
and their satellites. There will also be strengthened linkages between other health facility services,
especially for PMTCT and TB
The AIDSRelief technical team will provide comprehensive training and technical assistance to 290 medical
and 720 non-medical staff to increase the capacity of LPTFs to appropriately manage and monitor patients
with HIV infection. This will include the recognition and management of opportunistic infections, treatment
Activity Narrative: failure, adult counseling, and psycho-social assessments. AIDSRelief will follow-up didactic training with
on- site clinical mentorship for clinicians and site level support for other cadres of workers. AIDSRelief will
also establish a network of model centers from exemplary LPTFs, where practitioners can gain practical
clinical experience in a controlled setting. Regional Continuous Medical Education Sessions and Partner
Forums will complement LPTF's staff training, allowing experience sharing, and reinforcing knowledge and
skill transfer from AIDSRelief technical staff.
At the community level, AIDSRelief will encourage further development of community based satellite clinics
and outreach staffed by clinical officers and nurses for the routine care of stable patients and a community
health team for the delivery of home based care and medications. The decentralization of HIV services
through the use of satellites and outreach will aim at increasing access to those who live in remote areas.
This approach reinforces AIDSRelief's model of providing integrated services to families at the community,
satellite sites and LPTFs level by inter-linking facility-based health providers and community health workers
and volunteers in order to meet the need of HIV/AIDS patients. AIDSRelief will continue providing
education on the importance of using ITNs, basic hygiene and good nutrition at household and community
levels. It will further enhance its community health programs by promoting family-based care through
symptom monitoring, disclosure counseling, secondary prevention, and family-based testing and education.
In FY 2009, LPTF community volunteers will continue to support patients on therapy, but will additionally
disseminate HIV care and prevention literacy. AIDSRelief will identify gaps in the media and adapt or
develop locally appropriate Information Education and Communication (IEC) and Behavior Change
Communication (BCC) materials on prevention, care, and treatment of HIV. AIDSRelief will also assist
LPTF networks with PLHA groups serving as volunteers in the community to strengthen adherence
programs. Emphasizing the importance of adherence and community linkages at all AIDSRelief supported
sites has enabled the program to achieve high and durable viral suppression.
The program will also strengthen linkages with other service providers operating within the communities
served by AIDSRelief supported facilities. Current relationships with organizations such as PSI and UHMG
(Uganda Health Marketing Group) will be strengthened in order to increase access to ITNs and clean water
at all LPTFs. In addition, the program will link LPTFs to the Ministry of Health to access cotrimoxazole and
malaria treatment. Reinforcing the integration of services that can be accessed through LPTFs will
enhance the overall package of care available to adults.
Coordinated by Constella Futures, SI activities incorporate program level reporting, enhancing the
effectiveness and efficiency of both paper-based and computerized patient monitoring and management
(PMM) systems, assuring data quality and continuous quality improvement, and using SI for program
decision making across project Local Partner Treatment Facilities (LPTFs). In FY 2009, AIDSRelief will
ensure that 100% of the LPTFs use the new PMM system, IQCare, and other IT solutions that enhance
data use, like IQTools. It will also ensure that LPTFs collect and enter their data in real time, maintain clean,
valid databases, and collect data across all program areas. This will support the program to reach and
report on its patients. During the year, great efforts will be put on ensuring that outreach/satellite information
is collected and integrated with that from the center. On-site training will be given to LPTF clinical and M&E
staff focusing on data analysis and use. Staff will be given skills to analyze their own data, and use the
information to carry out quality of life analyses to be able take informed clinical decisions. The program will
collect data on various clinical indicators that will enable clinicians provide improved care and treatment
services. These indicators will include: CD4, WHO stage, BMI, history and active TB, previous exposure to
ARVs, and risky social behaviors like alcoholism. LPTFs will also be able to track and report on patients
accessing the basic care package (ITNs, safe water, Cotrimoxazole) so that this information is linked to
prevalence and or incidence of certain OIs, like malaria, and chest infections, and overall patient morbidity
trends.
Through the already established CQI plans, and the "small test of change" methodology that is being used
at all LPTFs, staff will be assisted in generating, collecting and using patient level outcome information to
continuously assess, define gaps and improve the services they provide. Through the monthly multi-
disciplinary meetings at LPTFs, cross cutting issues on patient management will be discussed, and
strategies to improve the program developed as a team. This will enhance better understanding and
ownership of the program, and indicators that enhance good clinical practice. The program will also promote
these systems through a Training of Trainers (TOT) and peer to peer training model in SI, where "expert"
LPTF staff will train others in various skills. AIDSRelief will also conduct a QA/QI process with a sample of
patients, to evaluate the program by relating patient level outcome measures, viral suppression rates,
adherence and treatment support models to program level characteristics at each LPTF. In FY 2009 this
process will involve over 2000 patients from 18 LPTFs who would have been on therapy for 48, 36, 24 and
12 months respectively.
Sustainability lies at the heart of the AR program, and is based on durable therapeutic programs and health
systems strengthening. AR will focus on the transition of the management of care and treatment activities to
indigenous organizations by actively using its extensive linkages with faith based groups and other key
stakeholders to develop a transition plan that is appropriate to the Ugandan context. The plan will be
designed to ensure the continuous delivery of quality HIV care and treatment, and all activities will continue
to be implemented in close collaboration with the Government of Uganda to ensure coordination,
information sharing and long term sustainability. For the transition to be successful, sustainable institutional
capacity must be present within the indigenous organizations and LPTFs they support; therefore, AR will
strengthen the selected indigenous organizations according to their assessed needs, while continuing to
strengthen the health systems of the LPTFs. In FY2009, the program will support linkages between LPTFs
and the MOH to tap into locally available training institutions. AIDSRelief will particularly focus on its
relationship with indigenous organizations such as the Uganda Catholic Medical Bureau and Uganda
Protestant Medical Bureau to build their institutional capacity to support LPTFs integrate ART and other
care and support programs into their health care services. This capacity strengthening will include human
resource support and management, financial management, infrastructure improvement, and strengthening
of health management information systems.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13260
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13260 10139.08 HHS/Health Catholic Relief 6428 5342.08 AIDSRelief $3,169,926
Resources Services
Services
Administration
10139 10139.07 HHS/Health Catholic Relief 5342 5342.07 AIDSRelief $2,932,296
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Malaria (PMI)
* TB
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $2,315,674
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Estimated amount of funding that is planned for Food and Nutrition: Commodities $72,388
Economic Strengthening
Education
Water
Table 3.3.09:
PLHAs, their families, communities and the health institutions. Its goal is to ensure that people living with
HIV/AIDS have increased access to Antiretroviral Therapy (ART) and quality comprehensive medical care.
AIDSRelief (AR) is a consortium of five organizations which includes Catholic Relief Services (CRS)
working as the prime agency, the Institute of Human Virology (IHV) of the University of Maryland School of
Medicine, Constella Futures Group (CF), Catholic Medical Mission Board and Interchurch Medical
Assistance World Health (IMA); AIDSRelief services are offered through 18 Local Partner Treatment
Facilities (LPTFs), distributed across Uganda in some of the most underserved and rural areas. These
include St. Mary's Lacor, St Joseph Kitgum, Kalongo Hospital, Aber Hospital and Amai Hospital in Northern
Uganda; Nsambya Hospital, Kamwokya Christian Caring Community, Family Hope Center Kampala, Villa
Maria Hospital and Nkozi Hospital in Central Uganda; Family Hope Center Jinja and Nyenga Hospital in
Eastern Uganda; Virika Hospital, Kabarole Hospital, Bushenyi Medical Center - Katungu, KCRC -
Bushenyi, Kyamuhunga Comboni Hospital, Kasanga Health Centre in Western Uganda. In order to get
services closer to the communities served, AIDSRelief supports devolution of services to satellite sites in
selected LPTFs. The Children's AIDS Fund is a sub-grantee in AIDSRelief and manages a number of the
LPTFS.
As of July 31, 2008, AR in Uganda was providing care and support to 5144 pediatric patients <18years, and
ART to 1726 patients <15 years. We maintained and supported 18 LPTFs and their satellites providing care
and treatment to adults and children and a number LPTFs expanded and decentralized their services by
opening satellites and outreach clinics. Specific pediatric focused sessions occurred at the various partner
forums; topics covered were Adult and Pediatric ARV provision with a focus on switching to second line
therapy; prevention of transmission of HIV from mothers to their infants; TB and the integration of TB and
HIV care and treatment services. AR also provided training in pediatric counseling to all LPTFs using a
newly developed curriculum produced in partnership with the African Network for Caring for Children with
AIDS. Subsequent to this training, LPTFs have established child friendly corners, organized family
treatment days and formed child support groups. Barriers to disclosure to children which had been a difficult
issue for health workers have been overcome. The hallmark of the model is to provide a continuum of care
from health facility to community supported by ongoing on-site mentorship/preceptorship for all cadres of
staff at supported LPTFs. By the end FY 2008 the AR Technical team will have made an average of one
weekly visit to each LPTF/quarter. Additional technical support visits will have been made to all LPTFs
focusing on the areas of pediatric care and PMTCT, TB/HIV service integration and pediatric psycho-social
support. The program has recognized the strong link between nutritional inputs, ART and adherence but
this remains a significant challenge. LPTFs have been encouraged to link with other organizations to able to
provide food, especially for severely malnourished patients. Training and guidance (national guidelines in
In FY 2009, AR will concentrate on consolidating the quality of services provided at existing LPTFs and
satellite sites with the goal of maintaining 2800 pediatric patients on ART (16%) and 7,839 pediatric patients
in care and support through the provision of ARVs, OI drugs, laboratory supplies and technical assistance to
the LPTFs. In FY2009, AR proposes to expand its services to bring more 2500 children in care, and 750
children on ART and continue to support a comprehensive and integrated continuum of care for HIV
infected patients building on existing services at the LPTFs to provide psychosocial and counseling
support, clinical follow-up, laboratory testing (including CD4), treatment of opportunistic infections and
nutrition counseling and education for the 55,781 HIV+ patients including 7,839 pediatric patients enrolled in
care and 20000 patients including 2800 children on ARVs in 18 LPTFs and their satellites. In many of the
regions supported by AR, access to pediatric care and treatment services is limited. AR will bring infants
and children into care and treatment as an area of targeted expansion and will ensure integration and
linkages between ANC, Labor and Delivery Services, MCH and Immunization services to identify and
enhance the follow-up of HIV infected mothers and their exposed children. AR will maintain linkages with
JCRC and other groups, who can provide early infant diagnosis so that all HIV exposed infants can be
diagnosed in a timely manner, receive their results and be referred for comprehensive HIV care.
Strengthening a provider initiated testing in out and inpatient pediatric services will also identify more HIV
infected children to assure continuity of care and to minimize losses to follow-up all exposed children will be
followed up in the ART program until they are at least 2 years and are documented negative and later they
will continue to access services through the OVC program up to the age of 5 years. In an effort to ensure
that all children and their families have access to the BCP, linkages with organizations such as PSI and
UHMG will be strengthened. AR will continue to ensure that nutritional assessment, education and
counseling are provided to mothers/caretakers and their children at LPTFs. The programs will strengthen
integration of the nutrition component into the LPTFs adherence and community outreach activities in order
to assure that all children receiving services at AR supported facilities receive comprehensive age
appropriate psycho-social counseling and treatment and adherence support, provide training and technical
assistance to all service providers in the area of pediatric psycho-social counseling. Task shifting to
maximize human resources will be emphasized at facility and community levels, focusing on using nurses
and clinical officers for the routine follow-up of stable patients, using protocol driven nurse and clinical
officer management of non-critical acute symptoms; nurses and pharmacy staff will also be trained in
routine medication dispensing to stable patients. In line with a family centered approach to care, at the
community level, we will encourage the development of community based satellite clinics and outreaches
staffed by clinical officers/nurses/community health workers for the routine care of stable patients and the
use of community health teams for the delivery of home based care and for medication delivery. The
decentralization of HIV services satellites and outreaches will increase access to those who live in remote
areas. This approach reinforces the model of providing integrated services to families at the community by
inter-linking facility based health providers and community health workers and volunteers. Currently, AR
provides varying levels of home based care, ARV treatment support and community preventative services
using outreach teams led by a community nurse or a clinical officer. The outreach teams coordinate with
CHWs and community based volunteers, many of whom are motivated PLHAs in their communities.
Development of these community health programs to provide integrated HIV care, support adherence and
promote preventative services is critical to ensuring sustainable treatment programs and maximizing
funding investments. They also promote family based care through symptom monitoring, disclosure
counseling, secondary prevention, and family based testing and education. In addition, the LPTFs'
Activity Narrative: community volunteers will be used as resources to support patients on therapy, disseminate HIV care and
prevention literacy. AR will adapt existing, locally appropriate IEC and BCC materials, identify gaps in these
media and develop materials as needed to be used by HCWs and community volunteers. Education on the
importance of using ITNs, basic hygiene and good nutrition will be provided at household level and to
communities. AR will assist LPTF networks with PLHA groups serving as volunteers in the community to
strengthen adherence programs. We will support several LPTFs in Northern Uganda and will continue to
assist them in developing outreach programs that provide support to those affected by internal
displacement. The program will also strengthen linkages within the LPTFs, particularly those between
PMTCT, TB and CT services with ART services. LPTFs will also be linked to organizations that provide
community based therapeutic feeding programs to support the malnourished. Linkages with organizations
such as PSI and AFFORD will be strengthened in order to increase access to ITNs and clean water. In
addition, the program will link LPTFs to the Ministry of Health to access cotrimoxazole and malaria
treatment. Reinforcing LPTFs external and internal integration will ensure that core AIDSRelief care and
treatment activities will be integrated with ancillary services and program activities of other providers in the
same region. Pediatric technical capacity is an area of emphasis, the program will continue to ensure that
all involved cadres of service providers have the capacity to provide age appropriate services to children.
To accomplish this, the technical team, will provide comprehensive pediatric training and technical
assistance to medical and non-medical staff to increase the capacity of LPTFs to appropriately manage and
monitor pediatric patients with HIV infection. AR will provide training in pediatric counseling and will
strengthen LPTF staff capacity to develop community based psycho-social assessments. AR is developing
a network of model centers where practitioners can gain practical clinical experience in a controlled setting.
12 Regional CME (including 3 focusing on pediatrics and 3 on PMTCT) and 2 partners' forums will
complement LPTF's staff training, allow experience sharing and reinforce knowledge and skill transfer from
AIDSRelief technical staff. Coordinated by CF, SI activities incorporate program level reporting, enhancing
the effectiveness and efficiency of both paper-based and computerized patient monitoring and management
decision making across project Local Partner Treatment Facilities (LPTFs). In FY 2009, AR wiill ensure that
100% of the LPTFs use the new PMM system, IQ Care, and other IT solutions that enhance data use, like
IQ Tools. It will also ensure that LPTFs collect and enter their data in real time, maintain clean, valid
databases, thus support the program to reach and report on its patients. During the year, efforts will be put
on ensuring that outreach/satellite information is collected and integrated with that from the center. On-site
training will be given to LPTF clinical and M&E staff focusing on data analysis and use. The program will
services which will include: CD4, WHO stage, BMI, history and active TB, previous exposure to ARVs, and
risky social behaviors like alcohol intake; track and report on patients accessing the basic care package
(ITNs, safe water, Cotrimoxazole) so that this information is linked to prevalence and or incidence of certain
OIs. The program will maximize tracking of activities that lead to scale up of pediatric care and treatment.
Documenting and reporting on enrolled children, followed up by age group, treatment regimens, and those
receiving the basic care package. Through the already established CQI plans, and the "small tests of
change" methodology that is being used at all LPTFs, staff will be able to identify patient management gaps,
and decide how and when these will be addressed. Through the monthly multi-disciplinary meetings at
LPTFs, cross cutting issues on patient management will be discussed, and strategies to improve the
program developed. The program will also promote these systems through a Training of Trainers (TOT) and
peer to peer training model in SI, where "expert" LPTF staff will train others in various skills. We will also
conduct a QA/QI process with a sample of patients, to evaluate the program by relating patient level
outcome measures, viral suppression rates, adherence and treatment support models to program level
characteristics at each LPTF. In FY 2009 this process will involve over 2000 patients from 18 LPTFs who
would have been on therapy for 48, 36, 24 and 12 months respectively. In addition, AIDSRelief will initiate a
CQI process in which LPTFs will be assisted in generating, collecting and using patient level outcome
information to continuously assess and improve the services they provide. AR will focus on the transition of
the management of care and treatment activities to indigenous organizations by actively using its extensive
linkages with faith based groups and other key stakeholders to develop a transition plan that is appropriate
to the Ugandan context. The plan will be designed to ensure the continuous delivery of quality HIV care
and treatment, and implemented in close collaboration with the Government of Uganda to ensure
coordination, information sharing and long term sustainability. For the transition to be successful,
sustainable institutional capacity must be present within the indigenous organizations and LPTFs they
support; therefore, AR will strengthen the selected indigenous organizations according to their assessed
needs, while continuing to strengthen the health systems of the LPTFs. In FY 2009, the program will
support linkages between LPTFs and the MOH to tap into locally available training institutions, and focus on
its relationship with indigenous organizations such as the UCMB and UPMB to build their institutional
capacity to support LPTFs.
AR will continue to strengthen the health system management of LPTFs, conduct biannual finance and
compliance trainings and program finance staff will carry out regular site visits to provide technical
assistance, and to set up appropriate cost accounting systems.
* Child Survival Activities
Refugees/Internally Displaced Persons
Estimated amount of funding that is planned for Human Capacity Development $271,459
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $9,872
and Service Delivery
Estimated amount of funding that is planned for Water $20,000
Table 3.3.11:
of Human Virology (IHV- UMSOM), Constella Futures Group (CF), Catholic Medical Mission Board (CMMB)
and Interchurch Medical Assistance World Health (IMA); AIDSRelief services are offered through 18 Local
Kitgum, Nsambya Hospital, , Kamwokya Christian Caring Community, Family Hope Center Kampala, Family
Kalongo Hospital, Amai Hospital, Aber Hospital, Nyenga Hospital and Nkozi Hospital. In order to get
Children's AIDS Fund is a sub-grantee in AIDSRelief and manages four of the LPTFs.
In FY 2008, AIDSRelief expanded its services to four new LPTFs. As of July 31, 2008, AIDSRelief in
Uganda was supporting 18 LPTFs and 24 satellite sites to provide care and support to 61,859 patients and
antiretroviral treatment to 20,590 (18,395 supported by AIDSRelief) HIV-infected people of which 1,726
were children.
AIDSRelief improved supply chain management capacity at all 18 LPTFs . AIDSRelief procured
Antiretroviral drugs (ARVs) through a global procurement mechanism which provides very competitive
pricing, with delivery, warehousing and distribution through Joint Medical Stores (JMS). Strengthening local
capacity at critical points has ensured excellent supply chain management and uninterrupted ARVs
provision. To date, AIDSRelief has not experienced any stock-out. The program continues to work closely
with the USG in-country team and the Ministry of Health to harmonize and integrate the procurement of
ARVs. The choice of regimen has been guided by recent evidence to ensure that the most effective and
durable regimen with the minimum toxicity and resistance profile is used. The choice of regimen is based on
the more favorable pharmacokinetic and safety profile and is supported by extensive clinical evidence. The
choice of regimen is also designed to preserve optimal therapeutic choices for second line regimens. In
order to support existing institutions and avoid creating parallel systems, Joint Medical Stores (JMS) a local
faith based organization continued to warehouse and distribute ARVs on behalf of the program with
continued support from AIDSRelief. Reporting and forecasting of ARVs by LPTFs has been improved with
the introduction of the dispensing tool. In FY 2008, AIDSRelief received additional drug support from Clinton
Foundation which enabled the program to scale up treatment beyond that supported by FY 2008 funding.
AIDSRelief continued to institutionalize Standard Operating Procedures (SOPs), which were developed in
accordance with national guidelines. These guide supply chain activities from product selection and
forecasting, procurement, distribution and consumption monitoring. Throughout FY 2008, AIDSRelief
institutionalized these SOPs to ensure efficient supply chain management, and thus provided an
uninterrupted supply of ARVs to LPTFs.
The program also conducted further trainings for all LPTF staff on the general principles of supply chain
management and the ART Dispensing Tool, developed by MSH RPM Plus. This dispensing tool allowed
LPTF to capture accurate pharmacy data, forecast drug needs, monitor patient numbers on ARVs and OI
drugs, generate accurate pharmacy reports, and initiate appropriate stock replenishment through placing
monthly orders. These pharmacy reports tracked stock inventory movement through the supply chain from
deliveries by JMS up to the point of use by the patient. This permitted continuous modulation of patient
enrollment to reflect ARV drugs availability, and ensured a guaranteed and continuous supply of drugs for
each patient initiated on therapy. The use of the dispensing tool has been found to be very helpful in
ensuring patient adherence because it maintains a patient diary. This was further enhanced by on site
training and one-on-one mentoring during routine Pharmaceutical TA for all LPTFs. Furthermore,
AIDSRelief supported LPTFs to establish Therapeutic Drug Committees (TDCs) to assist among others in
the pharmaceutical and clinical management of the program.
In FY 2009 AIDSRelief will maintain its support for services at the 18 LPTFs and 24 satellite sites in order to
maintain 20,590 patients on ART, of which 2,800 will be children (provided additional funding is made
available). AIDSRelief will also provide care and support to 63,620 (55,781 adults, and 7,839 children). The
program will continue to leverage ARVs for pediatric patients from the Clinton Foundation, but will cover
other ART related support such as purchase of OI drugs, laboratory supplies and technical assistance to the
LPTFs. The program will continue to procure adult 1st line, alternative 1st line, and 2nd line therapies for
adults and children. The AIDSRelief Supply Chain Management Team will continue capacity building
through technical backstopping and on-going training and mentoring in Supply Chain Management.
Technical support to LPTFs to institutionalize standard operating procedures (SOPs) for drug management
will continue in COP09. AR will train and retrain the LPTF pharmacists and other health workers including
pharmacy technicians or assistants in the development and use of SOPs which are in line with national
guidelines. In-depth training of the LPTF staff in the utilization of SOPs, forecasting and quantification for
ARVs and general drug management issues will be conducted.
The Pharmaceutical Management Team manages country operations with a Medicines and Therapeutic
Committee (MTC/TDC) of clinicians, pharmacists, strategic information advisors and program managers.
The MTC/TDC reviews drug utilization patterns across all LPTFs, assesses scale-up progress and develops
required technical support plans. The Pharmaceutical Management Team will support the strengthening or
establishment of medicines and Therapeutics committees (MTC) at all Local Partner Treatment Facility. The
Medicines and Therapeutic committees will have the key responsibility of developing policies for managing
medicines use and administration, evaluating the clinical use of drugs and managing a formulary system.
The MTC will promote rational use of medicines (RUM) through the medication use reviews, provision of
drug information to patients, monitoring medication errors, development and implementation of
pharmacovigilance plan and development and implementation of continuing education plans. The AR
Activity Narrative: technical team will provide technical assistance through training and on site mentorship for these
committees. Technical assistance will be provided to the LPTFs in development and implementation of
Pharmacovigilance plan (data gathering activities relating to detection, assessment and understanding of
adverse drug events / reactions i.e. ADEs or ADRs and treatment failure). Functional MTC at LPTF level will
ensure that the ARV supply chain management is clinically informed and logistically supported. The training
and backstopping on the use of electronic tools like the dispensing tool will be continued to further improve
the Drug Information Management System of the LPTFs. To facilitate the recruitment and retention of
competent pharmacy staff for LPTFs, linkages will continue to be strengthened with pharmacy training
institutions with a purpose of recommending graduate students to AIDSRelief LPTFs.
The Institute for Human Virology will participate in the periodic review of National Treatment Guidelines in
order to assist in the selection of regimens most appropriate to the Ugandan context guided by the Ministry
of Health. Choice of regimen is guided by most recent evidence to ensure that the most effective and
durable regimen available within the national guidelines with the least possible toxicity and resistance profile
is used. The current choice of primary regimen for AIDSRelief sites consists of Truvada (TVD) combined
with Nevirapine (NVP) or Efavirenz (EFV) for patients on Rifampicin containing tuberculosis protocols or
intolerant to NVP. Aluvia (lopinavir/ritonovir) is used for those who are intolerant to both NVP and EFV. For
those who have renal insufficiency, AZT/3TC will be substituted for TVD. Limited quantities of Stavudine
(D4T30) to be combined with Lamivudine (3TC) are also procured to be used for patients with both renal
insufficiency and anemia. The choice of regimen is based on the more favorable pharmacokinetic and
safety profile and is supported by extensive clinical evidence. The choice of regimen is also designed to
preserve optimal therapeutic choices for second line regimens, which in the AR program consists of AZT (or
D4T in cases of anemia, or TDF in patients failing AZT or D4T as their primary regimen) coupled with 3TC
and Aluvia. All drugs with exception of Aluvia (which is currently not available as generics) are procured in
generic form. AIDSRelief provides AZT, 3TC and NVP for children less than 5 years of age, and AZT or
D4T, 3TC and EFV/NVP for those above 5 years and ABC as an alternative for those affected by severe
anemia.
Constella Futures coordinates the overall monitoring and evaluation of the AIDSRelief program, and will
support LPTFs in harmonizing patient numbers for both adults and children, to ensure that accurate reports
are produced. This will be done through: updating of the clinical management tools to ensure that they
capture relevant pharmacy information; training and targeted TA to staff focusing on identifying and
reporting active and terminated patients; and properly documenting clients on each regimen. This will
involve emphasizing to clinical staff the relevance of documenting patients switching regimens, and the
reasons for the same. Every quarter, this information will be available, and harmonized with that from the
dispensing tool, so as to inform forecasting and procurements processes
AIDSRelief initiated the development of its sustainability plan in Year 5 focusing on technical,
organizational, funding, policy and advocacy dimensions. To date, the program has been able to increase
access to quality care and treatment, while simultaneously strengthening health facility systems through
human resource support, equipment, financial training and improvements in health management
information. In FY2009, the program will support linkages between LPTFs and the MOH to tap into locally
available training institutions. These approaches will ensure continuity of skills training. AIDSRelief will
particularly focus on its relationship with indigenous organizations such as the Uganda Catholic Medical
Bureau and Uganda Protestant Medical Bureau; Joint Medical Stores to build their institutional capacity to
support LPTFs integrate ART and other care and support programs into their health care services. These
strategies will enable AIDSRelief to fully transfer its knowledge, skills and responsibilities to in country
service providers.
Continuing Activity: 13259
13259 10137.08 HHS/Health Catholic Relief 6428 5342.08 AIDSRelief $3,094,749
10137 10137.07 HHS/Health Catholic Relief 5342 5342.07 AIDSRelief $3,332,379
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,000
Table 3.3.15:
