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
ACTIVITIES UNCHANGED FROM FY 2008
Baylor College of Medicine Children's Foundation-Uganda (Baylor - Uganda) is a child health, not-for-profit
NGO committed to delivering high quality, high impact and highly ethical paediatric & family-centered
HIV/AIDS prevention, care and treatment services, health professional training and clinical research in
Uganda. It is affiliated to Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) based at
Houston, Texas, USA. Baylor - Uganda started in 2003 with support to the Paediatric Infectious Diseases
Clinic (PIDC), an integral service of the Department of Pediatrics and Child Health at Mulago
Hospital/Makerere University. With support from Bristol-Myers Squibb Foundation, BIPAI, and Government
of Uganda; a new Children's Centre of Excellence has been constructed and is due to open in October,
2008. This Centre will provide additional space for HIV/AIDS services provision to children and families,
training and research in collaboration with Department of Pediatrics & Child Health of Mulago
Hospital/Makerere University. Baylor - Uganda has been receiving some support from UNICEF and Clinton
Foundation for specific pediatric HIV/AIDS programs in Eastern (Soroti) and Western (Kasese) Uganda, and
is due to initiate one site in the North (Kitgum). Other collaborating partners include Feed the Children-
Uganda which supports the nutrition program, Pediatric AIDS Canada provides some support for 320
children on ART, Save the Children in Uganda, Christian Children's Fund, Plan International, AIDS
Information Centre, etc.
Baylor - Uganda is the single largest provider (3,750 children) of pediatric ART services in Uganda; and has
enrolled over 8,000 children and care givers in active HIV/AIDS care. Baylor - Uganda uses two services
delivery modes: (a) direct services provision through 11 separate health facilities: Pediatric Infectious
Diseases Clinic (PIDC) and Post Natal Clinic at Mulago Hospital; 4 rural clinics in Soroti and Kasese
districts, and five satellite clinics (Naguru, Kirudu, Kawempe, Kanyanya and Kitebi Kampala City Council
(KCC) clinics,) run as family care clinic consortium with KCC, and other partners: Makerere University John
Hopkins University Research collaboration (MUJHU); Infectious Diseases Institute (IDI) and Mulago-
Mbarara Joint AIDS Program (MJAP), The AIDS Support Organization (TASO). A comprehensive package
of paediatric and family HIV care and treatment services are provided through the PIDC and its satellite
clinics. These services include HIV counseling and testing for children 6-weeks to 18 years and their family
members, growth and development monitoring, immunization, nutrition supplementation, OI prophylaxis and
treatment, TB screening and treatment, psychosocial support groups, home-based HIV counseling, testing
and follow-up, and ARVs when indicated. (b) Baylor - Uganda provides indirect services through integration
of pediatric HIV/AIDS services in ART accredited public health facilities in rural parts of Uganda. Baylor-
Uganda has successfully integrated paediatric HIV/AIDS services in 33 public health facilities in this first
year of the grant & will roll out to 133 sites in total, over the five year period. More than 1,200 adults and
their 305 children have been enrolled into care and ART respectively from these rural health facilities in 3
months time.
Baylor - Uganda has trained more than 1,000 health professionals in pediatric HIV/AIDS management
since 2003, by multiple teams of trainers from PIDC, Ministry of Health and Makerere University Department
of Pediatrics and Child Health. Since January 2008 with the current grant, the training program takes on a
three-pronged approach with (1) didactic training combined with (2) practical clinical training attachments
and on-site mentorship, and (3) implementation of work plan developed, which include achieving enrollment
of at least 5 children into care and treatment. To date, more than 200 and 320 health professionals have
benefited from clinical attachments and on-site mentorship support respectively through the 32 health
facilities where pediatric HIV/AIDS services have been integrated. Continuing Medical Education programs
are offered weekly at COE and monthly at the satellite clinics. In addition, a weekly case conference is held
at the PIDC for education and consultation on challenging cases.
Monthly mortality audits to further understand the causes of death are also held for all the clinics in
Kampala. In addition to clinical services, a specialized paediatric HIV data management system has been
developed and is in use at COE and Satellites to manage vital patient information. Support for
strengthening Health Management Information System (HMIS) in the targeted health facilities and District
Health Offices is on-going. We hope these will lead to the development of many clinical best practices for
pediatric HIV care in Uganda and other international Baylor network countries. In October 2008, the COE
will roll out Electronic Real Time Medical records and with the support of CDC roll it to all our supported
health facilities over the five years.
Baylor-Uganda took a leadership role in the development of the a national ‘Positive Prevention' Curriculum,
especially in the area of adolescent care and prevention of HIV transmission, e.g. disclosure of HIV status,
sex and sexuality, sexual and reproductive health (including family planning) counseling and services
provision. Over the period, more than 45,000 people have participated in our sexual prevention messages.
Implementation of sexual prevention interventions is aimed at increasing the proportion of target audience
adopting safer sex practices to reduce the risk of new HIV (re)infection.
Family Planning (FP) and STD/cervical cancer screening services have been introduced as part of the
prevention services on Tuesdays during Adolescent Clinic and on Thursdays during Family-Clinic at PIDC
since June 2007; with 57 women & adolescents receiving pap smear and 495 put on family planning
methods. About 600 children in our HIV/AIDS care and treatment program are adolescents who have grown
through the program, and who are likely to express their natural sexual, fertility and/or reproductive desires.
Already 40 out of a probable 420 female HIV positive adolescents in our care and treatment program have
become pregnant. This implies; they have had unprotected sex with likely risk of (re)infection to themselves
and their partners and future risk of transmission to unborn babies. Untreated STIs increase the risk of HIV
acquisition and transmission. Similarly, there are care givers who are also diagnosed with HIV at PMTCT,
from other referral points or during care to their children. All these categories of people need HIV prevention
services to avoid HIV (re)infection. Therefore, treating STIs and addressing their sexual & reproductive
health needs in a manner that reduces the risk of HIV (re)infection with their partners is vital in our sexual
prevention program. Our interventions include: health education talks, individual and group counseling,
positive prevention, training for adolescent peer educators & counselors, peer support groups, condom
promotion, STI management, development of IEC materials, etc. Baylor - Uganda has partnered with
Population Services International to provide Basic Care Package (which includes condoms), SCOT for
Activity Narrative: development and implementation of adolescent and youth positive prevention programming, and with
Ministry of Health for other contraceptive supplies.
The Baylor-Uganda sexual prevention interventions target HIV infected & affected adolescents and family
members of HIV infected children (siblings, care givers, etc) utilizing HIV/AIDS care and treatment programs
from our services delivery points. In UNICEF (NON-PEPFAR) supported Regional Centres of Excellence in
Eastern (Soroti) & Western (Kasese) regions and other rural areas where Baylor- Uganda works indirectly
through government facilities, support will be provided to community groups to provide similar messages
during home visits, health education and counseling sessions, as well as over radio programs in the local
languages.
oConduct of health education and counseling sessions at COE and Satellites on clinic days on AB and
other prevention options (Target: 20,050 unique individuals/year).
oOrganize annual adolescent (9 - 11 years) meeting at Sanyuka Camp & children (12 - 18 years) Hope
camp; with 80 children participating in both camps.
oPurchase and equip home health workers/community volunteers with Home Based Care kits.
oSupport related staff positions from this program area (counselors, social worker, etc.)
oSupport radio programs that disseminate messages on sexual prevention (AB and others).
ACTIVITIES MODIFIED FROM FY 2008
oWe have modified our Home Health Program. Instead of our staff doing community level mobilization and
health educations sessions, we will work with and support 7 community based groups (one group of 30
participants in each of the 7 Divisions of Kampala) to make the necessary community link: home visits,
community sensitization. Each Volunteer visits 2 homes/week, making 20,160 visits/year .
NEW ACTIVITIES
oDevelopment of a standard communication strategy covering HIV/AIDS prevention, treatment & care in
children, which will be used as a guide for all health education messages across the program.
oTrain health care providers (integrated with other trainings) in addressing sexual and reproductive health
needs of PHAs (Target: 300)
oConduct ‘teen' mothers support group meetings quarterly with about 50 adolescents participating in each
meeting (200 participants).
oCommunity mobilization and sensitization at parish level within the Home Health Program of Baylor -
Uganda, with about 20 people/quarter/person/division (16,800)
oTrain adolescents and members of community groups in Home Based Care, including sexual prevention of
HIV transmission.
oCommunity mobilization and sensitization in partnership with groups supported by Christian Children's
Fund, Save the Children in Uganda, Plan International as part of strengthening community link component
of the program and leveraging resources
New/Continuing Activity: New Activity
Continuing Activity:
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
* Reducing violence and coercion
Health-related Wraparound Programs
* Child Survival Activities
* Family Planning
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.02:
Progress to-date; activities and achievements on sexual prevention:
Activity Narrative: Population Services International to provide Basic Care Package (which includes condoms), SCOT for
development and implementation of adolescent and youth positive prevention programming, and with
For 2009; we plan to implement the following activities :
oHold monthly Adolescent & Youth peer support group meetings that include counseling, health education,
condom distribution, etc. targeting about 120 adolescents per month (200/year).
oConduct quarterly care givers meetings to discuss prevention messages with about 150
participants/meetings (600/year).
oConduct routine Home Based HCT where sexual prevention messages and services are provided. (Target:
480 households will be visited for HBHCT, with 1920 HBHCT done for unique individuals who will be
reached with sexual prevention messages.]
oProcure, distribute and demonstrate effective use of condoms during counseling, health education talks
and services delivery y counselors, clinicians & home health workers/community volunteers.
oProvide sexual an reproductive health services: STI management, family planning methods, screening of
cancer of the cervix, etc.
oTrain youth and community volunteers in positive prevention.
of the program and leveraging resources.
Estimated amount of funding that is planned for Human Capacity Development $220,500
Table 3.3.03:
NGO committed to delivering high quality, high impact and highly ethical paediatric & family HIV/AIDS
prevention, care and treatment services, health professional training and clinical research in Uganda. It is
affiliated to Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) based at Houston,
Texas, USA. Baylor - Uganda started in 2003 with support to the Paediatric Infectious Diseases Clinic
(PIDC), an integral service of the Department of Pediatrics and Child Health at Mulago Hospital/Makerere
University. With support from Bristol-Myers Squibb Foundation, BIPAI, and Government of Uganda; a new
Children's Centre of Excellence has been constructed and was opened in October, 2008. This Centre will
provide additional space for HIV/AIDS services provision to children and families, training and research in
collaboration with Department of Pediatrics & Child Health of Mulago Hospital/Makerere University. Baylor -
Uganda has been receiving some support from UNICEF and Clinton Foundation for specific pediatric
HIV/AIDS programs in Eastern (Soroti) and Western (Kasese) Uganda, and is due to initiate one site in the
North (Kitgum) with UNICEF. Other collaborating partners include Feed the Children- Uganda which
supports the nutrition program, Pediatric AIDS Canada provides some support for 320 children on ART,
Save the Children in Uganda, Christian Children's Fund, Plan International, AIDS Information Centre, etc.
year of the grant and will roll out to 133 sites in total, over the five year period. More than 1,200 adults and
at the PIDC for education and consultation on challenging cases. Monthly mortality audits to further
understand the causes of death are also held for all the clinics in Kampala.
In addition to clinical services, a specialized paediatric HIV data management system has been developed
and is in use at COE and Satellites to manage vital patient information. Support for strengthening Health
Management Information System (HMIS) in the targeted health facilities and District Health Offices is on-
going. We hope these will lead to the development of many clinical best practices for pediatric HIV care in
Uganda and other international Baylor network countries. In October 2008, the COE will roll out Electronic
Real Time Medical records and with the support of CDC roll it to all our supported health facilities over the
five years.
By June 2008, there were 328 ART accredited sites in Uganda, most of which (60% - 70%) are urban
based and mostly in central part of Uganda. AT Baylor - Uganda, there are over 7,500 children and their
care givers who are in active HIV/AIDS care from Baylor - Uganda Center of Excellence, 6 satellite centres
in Kampala, 4 regional centres in Soroti and Kasese areas and now 32 public rural health facilities. Adults
make up 2,275 and 792 of those in active HIV/AIDS care and on ART respectively. Baylor - Uganda
provides HIV/AIDS family-clinic twice a week in Naguru and Kawempe Health Centre IV and once a week at
the COE and in three Satellite Clinics. Rural facilities are being supported to provide integrated family/child
HIV/AIDS clinic, but because of large number of people enrolled on ART, this programme will only provide
support for contingency and buffer supplies. As such, as children are being enrolled into HIV/AIDS care
and treatment, their care givers are provided with services too, in order to enhance adherence, observance
of return visits and reduce costs associated with seeking care from multiple sources for same family
members, but with different age groups. In 2008, Baylor - Uganda has integrated pediatric HIV/AIDS
services in 33 health facilities and through this initiative more than 1,200 and 305 children and care givers
have been enrolled in active HIV/AIDS care and ART respectively within three months period. This
demonstrates immense potential for patient recruitment, but also shows the opportunity to increase
equitable access to HIV/AIDS care and treatment. However, our initial ART Site Preparedness Assessment
showed gaps in capacities of these lower level health facilities to initiate and sustain integrated pediatric and
adult HIV/AIDS services in the area of infrastructure; number, skills and motivation of personnel; pharmacy
and logistics management; laboratory support; data management & use; support supervision; etc.
Population Services International provides support to Baylor - Uganda with Basic care kit for people living
with HIV/AIDS (PHAs).
In FY2009, Baylor - Uganda will continue providing adult HIV/AIDS care and treatment services in the
context of family clinic of family-centered services at the Baylor- Uganda Center of Excellence (COE),
Satellite clinics & rural health facilities. The following will be the key activities to be implemented over this
Activity Narrative: period:
- Provision of ART services to eligible care givers and continual clinical and laboratory monitoring of those in
HIV/AIDS care and on ART.
- Prevention & management of opportunistic infections (excluding TB), malaria, diarrhea, pain & symptom
relief, nutritional support, etc.
- Procurement and distribution of pharmaceuticals (non-ARVs), basic care package (ITNs, safe water
vessels, etc) to all supported sites.
- Working with partners to train/orient health workers and lay community volunteers in adult HIV/AIDS
management, Home based Care, etc.
- Continuous provision of technical support to rural health facilities through on-site mentorship (at least for 3
consecutive months to develop systems and competencies of trained staff) and routine support supervision
& monitoring.
- Minor infrastructure improvements such as renovations, painting to make service areas user-friendly,
building of tents as waiting space for facilities without such provisions
- Procurement and distribution of basic supplies for managing adult HIV/AIDS where needed.
- Support for personnel involved in the training, national expansion program, monitoring & evaluation and
former Plus-Up sites in Anyeke Health Centre IV and Kagadi & Kiryandongo Hospitals.
- Support for pediatric HIV/AIDS training curriculum development for in-service in order to incorporate
aspects of family-centered care/treatment.
- Support for data management and utilization through strengthening capacities of Baylor - Uganda, District
Health Offices and targeted health facilities with computers, internet connectivity, hands-on training, in
various data management programs/packages, routine data collection and analysis, with report writing.
- Routine monitoring and evaluation of the program for ARV services, bi-annual regional program review
meetings, and best practice documentation and dissemination will also be covered under this program area.
- Formation & working in partnership wit other actors will be important in rolling our adult ARV services and
related care needs for nutrition, income generating activities, etc.
- Community mobilization on family-centered HIV/AIDS treatment and care through radio and community
dialogues, etc.
- Provision of activity related incentives for rural health facility staff such as staff tea break, overtime
allowance, across the facility.
Undertake quality improvement initiatives in all sites with support from HIVQUAL; a capacity building
program for quality improvement in HIV care and treatment.
New/Continuing Activity: Continuing Activity
Continuing Activity: 13258
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
13258 12442.08 HHS/Centers for Baylor College of 6422 5739.08 Expansion of $600,000
Disease Control & Medicine National
Prevention Children's Pediatric
Foundation/Ugand
HIV/AIDS
a
Prevention,
Care and
Treatment
Services and
Training of
Service
Providers
12442 12442.07 HHS/Centers for Baylor University, 4798 1186.07 Pediatric $600,000
Disease Control & College of Infectious
Prevention Medicine Disease Clinic
Estimated amount of funding that is planned for Human Capacity Development $50,519
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $15,000
and Service Delivery
Estimated amount of funding that is planned for Water $20,000
Table 3.3.08:
Continuing Activity: 13248
13248 4381.08 HHS/Centers for Baylor College of 6422 5739.08 Expansion of $2,065,771
8284 4381.07 HHS/Centers for Baylor College of 5739 5739.07 Expansion of $1,925,771
4381 4381.06 HHS/Centers for Baylor University, 3331 1186.06 Pediatric $368,415
* Malaria (PMI)
Table 3.3.09:
of Pediatrics and Child Health.
Since January 2008 with the current grant, the training program takes on a three-pronged approach with (1)
didactic training combined with (2) practical clinical training attachments and on-site mentorship, and (3)
implementation of work plan developed, which include achieving enrollment of at least 5 children into care
and treatment. To date, more than 200 and 320 health professionals have benefited from clinical
attachments and on-site mentorship support respectively through the 32 health facilities where pediatric
HIV/AIDS services have been integrated. Continuing Medical Education programs are offered weekly at
COE and monthly at the satellite clinics. In addition, a weekly case conference is held at the PIDC for
education and consultation on challenging cases. Monthly mortality audits to further understand the causes
of death are also held for all the clinics in Kampala.
based and mostly in central part of Uganda. Of an estimated 110,000 children living with HIV, about 50,000
require ART. However, only 11,000 are currently enrolled on ART. Baylor-Uganda is the largest provider of
pediatric antiretroviral therapy (ART) in Uganda supporting provision of ART to more than 3,750 (35%) of
pediatric patients countywide. Over 7,500 children and their care givers are enrolled in active care at Baylor-
Uganda supported clinics (Baylor- Uganda Center of excellence, 6 satellites centres in Kampala districts, 4
regional centres in Soroti and Kasese areas and now 32 public rural health facilities. Baylor - Uganda has
also spearheaded the scale-up of pediatric ART services in rural lower level health facilities (Health Centre
IVs & HC IIIs) in Uganda through integration of pediatric, adolescent and family centered HIV/AIDS services
within existing public health facilities. In 2008, Baylor - Uganda has integrated pediatric HIV/AIDS services
in 33 health facilities and through this initiative more than 1,200 and 305 children have been enrolled in
active HIV/AIDS care and ART respectively within three months period. This demonstrates immense
potential for patient recruitment, but also shows the opportunity to increase equitable access to HIV/AIDS
care and treatment. However, our initial ART Site Preparedness Assessment showed gaps in capacities of
these lower level health facilities to initiate and sustain pediatric HIV/AIDS services in the area of
infrastructure improvements; number, skills and motivation of personnel, pharmacy and logistics
management, laboratory support, data management & use, support supervision, etc. Population Services
International provides support to Baylor - Uganda for basic care services for people living with HIV/AIDS
(PHAs).
In FY2009, Baylor - Uganda will continue to support pediatric HIV/AIDS care/ARV services at the Baylor-
Uganda Center of Excellence (COE), Satellite clinics & rural health facilities. The following will be the key
activities to be implemented over this period:
Activity Narrative: - Provision of ART services to eligible children, adolescents and their family members and continual clinical
and laboratory monitoring of those in HIV/AIDS care, including those ART.
- Procurement and distribution of pharmaceuticals (non-ARVs), basic care package (Insecticide Treated
Mosquito Nets (ITNs), safe water vessels, etc) to all supported sites, and support to the Acute Care Unit of
Mulago Hospital,
- Training various cadres of staffs in pediatric HIV/AIDS management, Pediatric HIV/AIDS Counseling,
Home based Care, etc. through didactic, attachment and on-site mentorship. More than 600 health
professionals will be trained.
- Minor infrastructure improvements such as renovations, painting to make service areas child-friendly,
- Support for pediatric HIV/AIDS training curriculum development for in-service training
- Routine monitoring and evaluation of the program for ARV services, bi-annual regional and program
review meetings, best practice documentation and dissemination will also be covered under this program
area.
- Support for human resources such as team building, effective executive training, finance for non-finance
managers, and human resources information system,
- Formation & support to partners will be important in rolling out pediatric ARV services and related care
needs for nutrition, education, OVC issues, etc.
- Administrative support and IT maintenance
- Community mobilization on pediatric HIV/AIDS through radio and community dialogues, etc.
- Site assessment for additional 32 facilities for integration of paediatric HIV/AIDS services.
program for quality improvement in HIV care.
Estimated amount of funding that is planned for Human Capacity Development $100,000
Estimated amount of funding that is planned for Food and Nutrition: Policy, Tools $30,000
Table 3.3.10:
ACTIVITY UNCHANGED FROM FY 2008
Children's Centre of Excellence has been constructed and is due to open in October, 2008. This Centre will
supports the nutrition program, Pediatric AIDS Canada provides some support for 250 children and adults
on ART; and Save the Children in Uganda, Christian Children's Fund, Plan International, AIDS Information
Centre, etc.
Baylor - Uganda is the single largest provider of pediatric ART services in Uganda. By June 2008, 4,918
children (0 - 14 years) and 1,254 adults (15+ years) were directly receiving ART from Baylor - Uganda
sites, and indirectly 281 children were on ART through the supported 32 upcountry public health facilities.
An additional 4,240 adults are being served indirectly from the upcountry public health facilities with drugs
for OI management, systems strengthening, etc. In total, 6,330 children and 3,122 adults in were receiving
HIV/AIDS related care & support (this includes those on ART) from her direct services delivery sites; while it
had 13,647 adults and 1223 children in care from the indirectly supported upcountry sites. From direct
services delivery sites, HIV positive child is used as the index of entry and basis for testing care givers &
other family members. Depending on HIV test result, the adults are appropriately enrolled into HIV/AIDS
prevention, care &/or treatment. Baylor - Uganda uses two services delivery modes:
(a)direct services provision through 11 separate health facilities: Pediatric Infectious Diseases Clinic (PIDC);
4 Regional Centres of Excellences (COEs) in Soroti (Lwala Hospital & Kaberamaido HCIV) and Kasese
(Kilmebe Mines & Bwera Hospitals) areas; and six satellite clinics [Naguru, Kirudu, Kawempe and Kitebi
Kampala City Council - KCC clinics; Kanyanya TASO Centre and Post Natal Clinic at Mulago Hospital] run
as family care consortium with KCC and other partners: Makerere University John Hopkins University
Research collaboration (MUJHU); Infectious Diseases Institute (IDI), Mulago-Mbarara Joint AIDS Program
(MJAP) and The AIDS Support Organization (TASO). A comprehensive package of paediatric and family
HIV care and treatment services are provided through the PIDC and its satellite clinics. This includes HIV
counseling and testing for children (6 weeks - 14 years) and their adult family members, growth and
development monitoring, immunization, nutrition supplementation, OI prophylaxis and treatment, TB
screening and treatment, psychosocial support groups, home-based HIV counseling, testing and follow-up,
and ARVs when indicated.
(b)Baylor - Uganda provides indirect services through integration of pediatric and family-centered HIV/AIDS
services into existing ART accredited public health facilities in upcountry parts of Uganda. Within 3 months
period of the first project year, Baylor - Uganda has supported 33 public health facilities (32 upcountry & 1
Kampala satellite clinic - Kitebi HCIV) to integrate paediatric HIV/AIDS services, and plans to roll out in
additional 100 facilities over the remaining 4 years. From the 32 upcountry health facilities already covered,
104 children (0 - 14 years) and 1,200 (adults & children) were enrolled on ART and HIV/AIDS care
respectively within the 3 months.
since 2003, using multiple teams of trainers from PIDC, Ministry of Health and Makerere University
Department of Pediatrics & Child Health. Since January 2008, the training program uses a three-pronged
approach with (1) didactic training combined with (2) practical clinical training attachments and on-site
mentorship, and tied to (3) implementation of work plan that includes enrollment of at least 5 children into
HIV/AIDS care or treatment. By June 30, 2008, 200 and 320 health professionals have benefited from
clinical attachments and on-site mentorship support respectively. Continuing Medical Education programs
are offered weekly at COE & monthly at Satellite clinics. In addition, a weekly case conference is held at the
PIDC for education and consultation on challenging cases. Monthly mortality audits to further understand
causes of death are also held for all the clinics in Kampala.
Management Information System (HMIS) in the targeted health facilities and their District Health Offices is
on-going based on the national Health Management Information System (HMIS). In October 2008, the COE
will roll out Electronic Real Time Medical records and with support of CDC, we plan to modify and roll it out
to the targeted health facilities over the project period. We hope these will lead to development of paediatric
HIV/AIDS database in Uganda.
Progress to-date and outline activities and achievements
By June 2008, there were 328 ART accredited sites (60 - 70% in central part) in Uganda, only 110 of which
had integrated paediatric HIV/AIDS services. Within 3 months of CDC support in 2008, Baylor - Uganda
has integrated paediatric and adolescent HIV/AIDS treatment and care in 33 health facilities (1 Satellite
clinic and 32 upcountry health facilities: hospitals, Health Centre IV and Health Centre III), giving Baylor -
Uganda a coverage share of 39%. Of an estimated 110,000 children living with HIV, about 50,000 require
ART. Yet only 11,000 are currently enrolled on ART. Of those children on ART, 4,918 children (0 - 14
years) and 1,254 adults (15+ years) were directly receiving ART from Baylor - Uganda sites, making Baylor
- Uganda the single largest provider of paediatric ART (44.7%). Indirectly Baylor - Uganda supported 281
children on ART through the 32 upcountry public health facilities. In total, 6,330 children and 3,122 adults
were receiving HIV/AIDS related care & support (this includes those on ART) from Baylor - Uganda's direct
services delivery sites; while 13,647 adults and 1223 children were receiving care from the indirectly
supported upcountry sites. From direct services delivery sites, HIV positive child is used as the index of
entry and basis for testing care givers & other family members.
Activity Narrative: This rapid enrollment in upcountry sites and the high unmet need for treatment in children demonstrate
potential for patient recruitment and show the opportunities to increase equitable access to HIV/AIDS care
and treatment. However, our initial ART Site Preparedness Assessment showed gaps in capacities of
these lower level health facilities to initiate and sustain pediatric HIV/AIDS services. Gaps were in the area
of infrastructure; number, skills and motivation of personnel, pharmacy & logistics management, laboratory
support, data management & use, support supervision, etc. Population Services International provides
support to Baylor - Uganda for basic care services for PHAs.
FY 2009 activities
Uganda Center of Excellence (COE), 6 Satellite clinics & 4 Regional COEs, 32 upcountry health facilities
and 10 new upcountry facilities to be initiated in FY2009. We plan for 10% increase in each of the services
to be provided. The following will be the key activities to be implemented over this period:
oProvision of ART services to eligible children, adolescents and their family members and continual clinical
oPrevention & management of opportunistic infections (excluding TB), malaria, diarrhea, pain & symptom
oProcurement and distribution of pharmaceuticals (non-ARVs), basic care package (ITNs, safe water
vessels, etc) to all supported sites, Acute Care Unit of Mulago Hospital,
oTraining various cadre of staffs in pediatric HIV/AIDS management, Pediatric HIV/AIDS Counseling, Home
based Care, etc. through didactic, attachment and on-site mentorship. More than 600 health professionals
will be trained.
oContinuous provision of technical support to rural health facilities through on-site mentorship (at least for 3
oMinor infrastructure improvements such as renovations, painting to make service areas child-friendly,
oProcurement and distribution of at least 2 sets of medical equipment; and supplies for managing pediatric
oSupport for personnel involved in the training, national expansion program, monitoring & evaluation.
oSupport for in-service pediatric HIV/AIDS training curriculum development to incorporate aspects of family-
centered care/treatment.
oSupport for data management and utilization through strengthening capacities of Baylor - Uganda, District
oRoutine monitoring and evaluation of the program for ARV services, bi-annual regional an program review
meetings, best practice documentation and dissemination will also be covered under this program area.
oSupport for human resources such as team building, effective executive training, finance for non-finance
oFormation & support to partners will be important in rolling our pediatric ARV services and related care
oAdministrative support and IT maintenance
oCommunity mobilization on pediatric HIV/AIDS through radio and community dialogues, etc.
oSite assessment site initiation and continuous support for additional 10 facilities for integration of paediatric
HIV/AIDS services.
oProvision of activity related incentives for rural health facility staff such as staff tea break, overtime
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
Undertake quality improvement in all sites with support from HIVQUAL; a capacity building program for
quality improvement in HIV care.
Estimated amount of funding that is planned for Human Capacity Development $982,500
Table 3.3.11:
(a) direct services provision through 11 separate health facilities: Pediatric Infectious Diseases Clinic
(PIDC); 4 Regional Centres of Excellences (COEs) in Soroti (Lwala Hospital & Kaberamaido HCIV) and
Kasese (Kilmebe Mines & Bwera Hospitals) areas; and six satellite clinics [Naguru, Kirudu, Kawempe and
Kitebi Kampala City Council - KCC clinics; Kanyanya TASO Centre and Post Natal Clinic at Mulago
Hospital] run as family care consortium with KCC and other partners: Makerere University John Hopkins
University Research collaboration (MUJHU); Infectious Diseases Institute (IDI), Mulago-Mbarara Joint AIDS
Program (MJAP) and The AIDS Support Organization (TASO). A comprehensive package of paediatric and
family HIV care and treatment services are provided through the PIDC and its satellite clinics. This includes
HIV counseling and testing for children (6 weeks - 14 years) and their adult family members, growth and
(b) Baylor - Uganda provides indirect services through integration of pediatric and family-centered
HIV/AIDS services into existing ART accredited public health facilities in upcountry parts of Uganda. Within
3 months period of the first project year, Baylor - Uganda has supported 33 public health facilities (32
upcountry & 1 Kampala satellite clinic - Kitebi HCIV) to integrate paediatric HIV/AIDS services, and plans to
roll out in additional 100 facilities over the remaining 4 years. From the 32 upcountry health facilities already
covered, 104 children (0 - 14 years) and 1,200 (adults & children) were enrolled on ART and HIV/AIDS care
The Baylor-Uganda/PIDC has an established TB care program providing diagnostic and treatment services.
In FY 2008, Baylor- Uganda supported 11 service outlets to provide a family- centered approach to
diagnosis and treatment of 239 children co-infected with TB and HIV. 3157 children and adults received
TB/HIV related care from the direct sites. This mainly incorporated systematic TB screening within HIV care
and treatment facilities. TB screening and care services include tuberculin skin testing (Mantoux) using PPD
- Purified Protein Derivative performed on all newly diagnosed HIV infected children and existing PIDC
patients who are symptomatic for TB. Symptomatic children are also actively screened for TB using sputum
smears and radiological examination. Family members of TB patients are also encouraged to be screened
for TB. Available data suggests a ~16% PPD reactive rate among newly diagnosed HIV infected PIDC and
Kampala satellite clinic patients. Unmasking of post-antiretroviral TB infection within 6 month of initiating
ART occurred in 6.2% (104/1669) of all children without prior TB. During the first 100 days of ART, clinic
data revealed that the risk of unmasking TB-IRIS at PIDC increased 2.7 fold compared to pre-ART (95%
CI=2.1 to 2.5; P<.001). Children with CD4 counts <200 cells/ul at initiation of ART will have a second PPD
placed 6 months later as evidence has shown that such children had a 41% longer time to TB unmasking,
implying a longer time was needed for restoration of antigen-specific immunity. As most of the TB
Activity Narrative: medications received through the National TB and Leprosy Program (NTLP) are adult formulations which
are not convenient for use in paediatric patients, most of the TB medications used by the Baylor - Uganda
program are purchased through PEPFAR funding with supplements from donations from other partners like
Feed the Children-Uganda. The program follows guidelines provided by MOH/NTLP for management of TB
in children. Children with reactive Mantoux but without evidence of active disease are provided with INH
prophylactic treatment for duration of 8 months. However, as Mantoux testing is currently not feasible in
rural settings due to its packaging and storage requirements, this service is only available in health facilities
located in Kampala. Training of health workers in the management of TB and HIV was a key activity in
FY08 reaching 359 health care providers working in both urban and rural areas. On-going training of
medical and clinical officers in TB X-ray interpretation and clinical mentorship on TB diagnosis and care was
also provided.
In FY2009, palliative TB/HIV care activities will continue at the Mulago PIDC and its satellite clinics in
Kampala through the PEPFAR program, while Baylor-Uganda/PIDC supported satellite clinics in rural
settings will work directly with the district health system to provide TB screening and treatment services
according to the National guidelines. The program will continue implementing a family-centered to both HIV
and TB diagnosis and care.
- Perform PPD on an estimated 2,520 children, based on average monthly HCT rates at COE (195 with
46% positive) and the Kampala Satellite clinics (708 with 17% positive). PPD will also be performed on
approximately 4 family members (care givers) per PPD reactive child; therefore, ~1800 family/household
members will be screened for TB using PPD.
- Perform chest X-ray on approximately 16% of those screened with PPD (403) who will be reactive or have
symptoms suggestive of TB & will, thus, require chest x-rays performed.
- Procure equipment, supplies and reagents for diagnosis of Tuberculosis in collaboration with the National
TB and Leprosy program.
- Perform laboratory diagnostic services (sputum smear tests) for TB.
- Provide TB treatment to an estimated 10% of the roughly 5,000 HIV infected children in active follow-up by
end of June 2008, plus the ~1890 HIV+ patients recruited by March 2009, who will require TB treatment.
Children will receive treatment at one of the Baylor - Uganda supported clinics, while adults -not in the
family clinic- diagnosed with TB as a result of the family TB counseling and testing initiative will be referred
to a National TB Program.
- Perform HIV counseling and testing for children & adolescents diagnosed with TB and who are identified
and/or referred from other services entry points and vice versa.
- Provide transport reimbursement to needy clients to return for PPD reading at the clinic (It is estimated
that 22% [~555] patients will need such assistance).
- Due to the frequent unavailability of pediatric TB treatment formulations, a buffer stock of TB medications
will be procured to supplement medications received through the National TB and Leprosy Program.
- Conduct training for about 570 health professionals in various aspects of pediatric HIV/AIDS management,
which include diagnosis, treatment and care of children with TB/HIV co-infection since TB has significant
effect on morbidity, mortality and ARV treatment options and outcomes.
- Provide co-trimoxazole prophylaxis and INH to clients who are eligible for them.
- Provide antiretroviral therapy to eligible TB-HIV co-infected patients in accordance with the National
treatment guidelines.
- Provide face masks to suspicious patients, those with active TB waiting for treatment and care, and to
services providers.
- Provide pediatric TB formulations to support TB management in 32 rural up-country facilities, linked to TB
clinics and TB DOTs program.
Continuing Activity: 13244
13244 4382.08 HHS/Centers for Baylor College of 6422 5739.08 Expansion of $300,000
8285 4382.07 HHS/Centers for Baylor College of 5739 5739.07 Expansion of $275,000
4382 4382.06 HHS/Centers for Baylor University, 3331 1186.06 Pediatric $46,920
* TB
Estimated amount of funding that is planned for Human Capacity Development $105,000
Table 3.3.12:
Baylor College of Medicine Children's Foundation-Uganda (Baylor-Uganda BU) is a child health, not-for-
profit NGO committed to delivering high quality, high impact and highly ethical paediatric & family HIV/AIDS
Texas, USA. BU started in 2003 with support to the Paediatric Infectious Diseases Clinic (PIDC), an
integral service of the Department of Pediatrics and Child Health at Mulago Hospital/Makerere University.
With support from Bristol-Myers Squibb Foundation, BIPAI, and Government of Uganda; a new Children's
Centre of Excellence has been constructed. This Centre will provide additional space for HIV/AIDS services
provision to children and families, and training in collaboration with Department of Pediatrics & Child Health
of Mulago Hospital/Makerere University. In addition this facility will serve as a referral center for HIV inflicted
OVCs with complicated health issues. BU has been receiving some support from UNICEF and Clinton
Foundation for specific pediatric HIV/AIDS programs in Soroti and Kasese, and is due to initiate one site in
Kitgum so as to reach more OVCs in this war torn area. Other collaborating partners like Feed the Children
- Uganda support our nutrition program as a way of mitigating malnutrition that may arise due to HIV/AIDS.
Save the Children in Uganda, Christian Children's Fund and Plan International serve as our links to the
community for cross referral of OVCs that are suspected to have HIV/AIDS while BU refers clients to them
for other OVC support. BU is the single largest provider (3,750 children) of pediatric ART services in
Uganda; and has enrolled over 8,000 children and care givers in active HIV/AIDS care. BU uses two
services delivery modes: (a) direct services provision through 11 separate health facilities: Pediatric
Infectious Diseases Clinic and Post Natal Clinic at Mulago Hospital; 4 rural clinics in Soroti and Kasese
districts, and five satellite clinics in Naguru, Kiruddu, Kawempe, Kanyanya and Kitebi Kampala City Council
clinics run as family care clinic consortium with partners. These partners include: KCC, Makerere University
John Hopkins University Research collaboration; Infectious Diseases Institute and Mulago-Mbarara Joint
AIDS Program and The AIDS Support Organization. A comprehensive package of paediatric and family
HIV care and treatment services and some OVC services are provided through the PIDC and its satellite
and follow-up, ARVs when indicated, play therapy, and linking OVC and their families to other services like
education, Income Generating Activities and food security within the communities. A small number of in and
out school adolescents are supported in senior secondary education and in vocational skills training. Over
the last year, numeric and literacy lessons have been introduced in order to give a chance to those OVC's
who may never have had a chance to benefit while they wait to see clinicians. (b) BU provides indirect
services through integration of pediatric HIV/AIDS and OVC services in ART accredited government
facilities in rural parts of Uganda. BU has successfully integrated paediatric HIV/AIDS and OVC services in
33 government facilities in this first year of the grant & will roll out to 133 sites in total, over the five year
period. More than 1,200 adults and their 305 children have been enrolled into care and ART respectively
from these rural health facilities in 3 months time; the identified OVCs are provided/linked to appropriate
services according to need. In districts where we collaborate with PLAN International and Christian
Children's Fund HIV infected children are linked to OVC services that include nutrition support and
education; where BU operates together with Save the Children in Uganda, play areas and play materials
are supported through this partnership. BU has trained more than 1,000 health professionals in pediatric
HIV/AIDS and OVC management since 2003, by multiple teams of trainers from PIDC, Ministry of Health
and Makerere University Department of Pediatrics and Child Health. At the PIDC, approximately 350
caretakers have benefited from training in income generation to support and sustain the OVCs that live
within their households. Since January 2008 with the current grant, the health professional training program
takes on a three-pronged approach with (1) didactic training combined with (2) practical clinical training
attachments and on-site mentorship, and (3) implementation of work plan developed, which include
achieving enrollment of at least 5000 OVCs into care. This approach was devised so as improve the care
and support of OVCs in the designated health facilities. To date, more than 200 and 320 health
professionals have benefited from clinical attachments and on-site mentorship support respectively through
the 32 health facilities where pediatric HIV/AIDS and OVC services have been integrated. Continuing
Medical Education programs are offered weekly at COE and monthly at the satellite clinics in order to
sustain the knowledge and skills in managing paediatric HIV as a key issue with OVCs. Monthly mortality
audits to further understand the causes of death in these OVCs are also held for all the clinics in Kampala
and will be initiated in all our supported sites in the next year. In addition to clinical services, a specialized
paediatric HIV data management system has been developed and is in use at COE and Satellites to
manage vital patient information. This has been very useful in mapping OVCs so that they can be linked to
Civil Society Organizations for OVC care. Support for strengthening Health Management Information
System (HMIS) in the targeted health facilities and District Health Offices is on-going to support similar OVC
mapping.
The main BU COE at Mulago Hospital and its satellite clinics in Kampala retain the services of play
therapists. The main COE has 1 full-time play therapist, while the satellite clinics support volunteer play
therapist on clinic days. Through this service, children benefit from education and recreational activities
while waiting for their appointment. This could be the only exposure some children have to an educational
environment as some have been denied opportunity to attend school due to their health status or their
caregivers' poor socio-economic situation. In collaboration with Feed the Children-Uganda, Baylor-Uganda
provides direct nutritional support to OVCs at the clinic and also supports a few families in the Kampala
satellites with starter seeds as part of improving food security. In all the newly added health facilities,
PEPFAR funds provide for in-clinic snack to children, i.e. porridge and a banana in the morning and juice
and a cake in the afternoon while they wait for their appointments. As Uganda's national referral hospital,
Mulago provides care and treatment to patients from a variety of socio-economic strata. A recent review of
clinic data revealed that ~54% of the children seen at the COE/PIDC have lost one or more biological
parent; 66% have baseline weight and height less than the 2.5th centile indicating inadequate nutrition;
while others are deemed vulnerable simply due to their HIV positive status, care giver's low household
income, and lack of access to education. Hence, all children attending BU's supported clinics are
considered vulnerable. By March 2008, BU had provided OVC services such as psychosocial support, basic
health and food to 16,298 beneficiaries. A few families (350) that participate in the caregivers support group
received social economic security and food security and knowledge on IGA. Over 300 children and
adolescents borrowed story books which are currently got through donations and gifts from friends of the
Activity Narrative: organization. Two camps, one for children aged 9-11 years another for the adolescents were held
successfully and post camp analysis showed children's perception to life was changed. In FY 2009, based
on new patient projections, more than 9,000 HIV+ children and their siblings from vulnerable households,
will benefit from OVC services. The following activities are planned for implementation over the period.
- Vulnerable adolescents (about 600) would benefit from life skills training, including making of handcrafts to
be sold.
- Providing clinic based feeding and supplemental take home food rations for those OVC families in rural
health facilities that have severe food security as determined by a standardized tool. As many families
leave their homes for their clinic appointments before breakfast, BU will continue to provide clinic-based
nutritional supplementation through PEPFAR grant to 42 health facilities which we currently support. This
supplementation includes a morning and afternoon snack for children where feasible. We will also work with
Canadian Feed The Children and Feed the Children-Uganda, to provide individual and family take-home
nutritional supplements for children attending COE and Kampala Satellite clinics. However, the nutritional
support for Feed The Children NGOs is only available to children <12 years who attend the main COE.
Hence more food will be required to support those not catered for.
- Three play therapists will continue to support children play & early stimulation at the COE
(50children/clinic, with 4 clinic days/month) and in the Kampala Satellite clinics (120/month). In all these
facilities the play therapists have organized teaching for the children including teaching about life skills. A
technical person preferably a PHA hired on part time basis, will continue to teach adolescents (100/year) at
the clinics how to make hand craft while they wait to see clinicians. The Social Worker hired in 2008 and a
new one who will be hired will continue to support community outreach & individual child/family
psychosocial needs counseling, including coordination of OVC & community program. One social worker
will be dedicated to support OVC linkages from health facilities in districts where we collaborate with
partners.
- The adolescent and caretaker drama groups will continue to be empowered so that the individuals can
later be professionals in this area and use the skill for their livelihoods.
- Through recently conducted operation research, over 60% of clients at the Mulago PIDC earn less than
Uganda Shillings 50,000 per month. Hence as an additional support to the neediest of families, OVC funds
will continue to be used to provide transport reimbursement to those identified with the greatest need
(960/year) to facilitate their transportation in order to ensure their regular clinic attendance, treatment
adherence including in clinic OVC services.
- Support for child participation/adolescent activities such as monthly, quarterly and annual meetings and
camps for OVC who are HIV infected. Training adolescents OVCs in leadership during camp and the
monthly meetings will continue.
- Procurement and supply of toys for children to play with while waiting for treatment and care at the COE
and some supported sites.
- Regular assessment and provision of psycho-social and emotional support services, including counseling
to OVCs and strengthening capacity of communities to provide counseling and identification of OVC.
- Conducting nutritional education to OVC families both at the COE and the rural clinics while caretakers
wait to be seen by clinicians.
- Providing basic treatment and care services for OVCs at our facilities as a way of mitigating the impact of
HIV/AIDS and other forms of child neglect.
- Through our collaboration with FTCU, clients served at COE and Kampala Satellites will be linked to the
FTCU micro finance project (100/year). The responsible officer has already met the care takers in the
support group to teach them on the modalities involved.
- Clients served through BU's supported rural health facilities will be linked to OVC supported programs of
our new partners: Save the Children in Uganda (150/year), Plan International (200/year), Christian
Children's Fund (200/year), AIDS Information Centre (150/year) and Northern Uganda Malaria, AIDS and
TB program (180/year) according to OVC need.
- In order to take services closer to OVCs, Baylor-Uganda will conduct targeted pediatric outreaches for
(HCT, Early Infant Diagnosis) and use these opportunities to offer OVC services to both those identified
positive and negative; such as provision of insecticide treated bed nets, clean water vessels and, training
caregivers in IGAs and food security. These activities will seek the collaboration of Ministry of Gender,
Labour and Social Development (MoGLSD) to assist in the trainings. In collaboration with our community
partners- SCiU, Plan, CCF and MOGLS - we will support monitoring of the OVC activities that Baylor-
Uganda will have participated in.
- In partnership with other actors, Baylor - Uganda will also be involved in tracking & monitoring children's
well being as part of national advocacy campaign
- Increase the number of out of school adolescents benefiting from vocational skills training from 10 to 50.
We will work with FCU to support these adolescents.
- Train about 200 community volunteers and counselors in provision of quality care and support to OVC's
and other concepts of OVCs.
- BU will also continue to support partnership coordination meetings at national and district levels in order to
identify potentials for networking on OVC issues as well as bring synergy in HIV/AIDS response. Support
will go towards issues that directly tackle OVC issues in the national paediatric HIV/AIDS conference and
participation in meetings
- Support will be provided for orientation of Civil Society Organizations (CSOs) on linkage between OVC
services and improving delivery of health care services for OVC
- A second teacher for older OVCs at the COE (6-12years) will be hired to allow for smaller and age
appropriate classes at the COE. This will also allow for none interruption of this important educational
services while one is away on leave.
- Procurement and supply of more toys for children to play with while waiting to be seen at the COE and the
district health facilities.
- Procurement of books and other educational materials to read and borrow while waiting (for clinics that
have at least 50 HIV positive children and their siblings in care).
- 3 camps supported where OVCs from our upcountry health facilities will attend.
Continuing Activity: 13245
13245 4392.08 HHS/Centers for Baylor College of 6422 5739.08 Expansion of $300,000
8286 4392.07 HHS/Centers for Baylor College of 5739 5739.07 Expansion of $200,000
4392 4392.06 HHS/Centers for Baylor University, 3331 1186.06 Pediatric $985,033
* Increasing women's access to income and productive resources
Refugees/Internally Displaced Persons
Estimated amount of funding that is planned for Human Capacity Development $90,000
Estimated amount of funding that is planned for Education $16,000
Table 3.3.13:
NGO committed to delivering high quality, high impact and highly ethical pediatric & family HIV/AIDS
Texas, USA. Baylor - Uganda started in 2003 with support to the Pediatric Infectious Diseases Clinic
districts, and five satellite clinics (Naguru, Kiruddu, Kawempe, Kanyanya and Kitebi Kampala City Council
Mbarara Joint AIDS Program (MJAP), and The AIDS Support Organization (TASO). A comprehensive
package of paediatric and family HIV care and treatment services are provided through the PIDC and its
satellite clinics. These direct services include HIV counseling and testing for children 6-weeks to 18 years
and their family members, growth and development monitoring, immunization, nutrition supplementation, OI
prophylaxis and treatment, TB screening and treatment, psychosocial support groups, home-based HIV
counseling, testing and follow-up, and ARVs when indicated. (b) Baylor - Uganda provides indirect services
through integration of pediatric HIV/AIDS services in ART accredited public health facilities in rural parts of
Uganda. Baylor-Uganda has successfully integrated paediatric HIV/AIDS services in 33 public health
facilities in this first year of the grant & will roll out to 133 sites in total, over the five year period. More than
1,200 adults and their 305 children have been enrolled into care and ART respectively from these rural
health facilities in 3 months time.
understand the causes of death are also held for all the clinics in Kampala. In addition to clinical services, a
specialized paediatric HIV data management system has been developed and is in use at COE and
Satellites to manage vital patient information. Support for strengthening Health Management Information
System (HMIS) in the targeted health facilities and District Health Offices is on-going. We hope these
activities will lead to the development of many clinical best practices for pediatric HIV care in Uganda and
other international Baylor network countries. In October 2008, the COE will roll out Electronic Real Time
Medical records and with the support of CDC roll it to all our supported health facilities over the five years.
Counseling and Testing is the prime entry point into HIV prevention and/or HIV/AIDS care and treatment
services. Baylor-Uganda conducts HIV Counseling and Testing in several forms: 1) early diagnosis of
children below 18 months of age with DNA-PCR; 2) VCT for children aged 18 months to 18 years; 3) in
clinic HIV counseling and testing of family/household members of our index clients; 4) clinic based HIV
counseling & testing of index TB patients; 5) home-based HIV counseling and testing (HBHCT) of
family/household members of index patients from our clinic; and, 6) support routine counseling and testing
in all the national expansion health facilities and UNICEF supported sites. The target populations benefiting
from these services include vulnerable infants, children and youth, and adults in HIV/AIDS-affected families.
HIV infected individuals are linked to palliative and ART services while the HIV negative have enhanced
prevention messages during post test counseling. Specialized infant feeding counseling messages are
provided to HIV+ mothers who continue to breastfeed their HIV- infants to reduce future possibilities for HIV
transmission to the infant. Baylor - Uganda supported the development of and will continue to disseminate
guidelines on early infant diagnosis (EID) and monitoring tools, and is currently the chair of the EID sub-
committee. Abbott Laboratories made donation of 50,000 HIV test kits in 2007, which we hope to continue
in 2008/9. By March 2008, Baylor- Uganda had provided HCT to 15,077 individuals at the various sites
using the approaches outlined above.
In FY2009 Baylor-Uganda will procure HIV test kits for mass screening, confirmatory test and tie-breaker.
- Procure reagents for running of CD4 machine and regularly service the machine.
- Provide HIV counseling and testing services: EID, VCT, HBHCT to an estimated 40,000 children and
adults from Baylor - Uganda direct service outlets (COE -1; Satellites - 6; UNICEF supported sites - 4) &
their outreaches; and indirect services points (33 rural sites & their outreaches). More than 10,000 of the
40,000 screened, are anticipated to be infants <18 months. These infants will require DNA-PCR testing.
- In line with HIV counseling and testing (HCT) policy of 2005, Baylor-Uganda will increase access to HCT
by rolling out Paediatric HIV Routine Counseling & Testing (RCT) in all facilities (30/52) supported by Baylor
-Uganda, where there is no other provider doing RCT.
- Baylor - Uganda in collaboration with Ministry of Health will continue to train about 570 health care
Activity Narrative: professionals in early infant diagnosis, pediatric HIV/AIDS counseling, etc. through didactic training
sessions, mentorship and support supervision
- Counseling and peer support groups will continue to provide psychosocial counseling & support, including
stigma reduction, of the Baylor-Uganda clinic patients.
- Community outreach activities and drama by peer support groups will be enhanced to support community
knowledge of the need for pediatric HIV CT services and care, since 75% of HIV+ children who do not
receive any care services die before their 5th birthday.
- Baylor - Uganda will continue to directly conduct HIV counseling and Testing outreach services to most at
risk populations and underserved areas such as orphanages, children retention centres; and indirectly
through partners to support to rural health facilities we support, to rural based Early Childhood Care and
Development centres, Internally Displaced Camps, etc. Initially, Baylor - Uganda would conduct
outreaches in the general communities and the patient yield (HIV+ positive children were low), questioning
the cost effectiveness of such interventions.
- Baylor - Uganda will also modify her "Know Your Child's HIV Status" campaign to target only the positive
community receiving HIV/AIDS care and treatment services or through mobilization from PHA networks.
- In rural areas, Baylor-Uganda will support the transportation of samples for DNA-PCR testing to regional
sites, since previous fee-for-service contract with Joint Clinical Research Centre (JCRC) have been
waivered.
- In rural health facilities where there are no Routine Counseling and Testing services, Baylor - Uganda will
introduce and support this component in order to prevent any missed opportunity in patient identification
and enrollment into HIV/AIDS care and treatment.
- Some minor renovations of rural health facilities may be undertaken to provide space for confidential and
private counseling and safe custody of patient records.
Continuing Activity: 13246
13246 4378.08 HHS/Centers for Baylor College of 6422 5739.08 Expansion of $250,000
8282 4378.07 HHS/Centers for Baylor College of 5739 5739.07 Expansion of $250,000
4378 4378.06 HHS/Centers for Baylor University, 3331 1186.06 Pediatric $175,261
Estimated amount of funding that is planned for Human Capacity Development $92,500
Table 3.3.14:
Children's Centre of Excellence (COE) has been constructed and was opened in October, 2008. This
Centre will provide additional space for HIV/AIDS services provision to children and families, training and
research in collaboration with Department of Pediatrics & Child Health of Mulago Hospital, Makerere
University. Baylor - Uganda has been receiving some support from UNICEF and Clinton Foundation for
specific pediatric HIV/AIDS programs in Eastern (Soroti) and Western (Kasese) Uganda, and is due to
initiate one site in the North (Kitgum). Other collaborating partners include Feed the Children- Uganda
which supports the nutrition program, Pediatric AIDS Canada provides some support for 320 children on
ART, Save the Children in Uganda, Christian Children's Fund, Plan International, AIDS Information Centre,
etc.
are offered weekly at the COE and monthly at the satellite clinics. In addition, a weekly case conference is
held at the PIDC for education and consultation on challenging cases. Monthly mortality audits to further
and is in use at the COE and Satellite clinics to manage vital patient information. Support for strengthening
Health Management Information System (HMIS) in the targeted health facilities and District Health Offices is
on-going. We hope these will lead to the development of many clinical best practices for pediatric HIV care
in Uganda and other international Baylor network countries. In October 2008, the COE will roll out Electronic
Real Time Medical records and with the support of CDC extend it to all our supported health facilities over
the five years.
Funds allocated to ARV Drugs Program Area primarily focus on ARV drug management (forecasting,
procurement, transportation, storage, distribution, prescription and dispensing) and HIV/AIDS treatment for
HIV-infected children and care givers attending Baylor-Uganda supported clinics. Currently, more than
8,000 HIV exposed and infected children and their care givers are in active care from 44 Baylor - Uganda
supported sites. About 3,750 children receive ART through Baylor-Uganda CDC supported service outlets
at the Mulago Hospital Baylor Center of Excellence (COE); 6 Satellite clinics at Mulago post natal clinic,
Naguru HCIV, Kawempe HCIV, Kitebi HCIV, Kirudu HCIV and Kanyanya TASO centre); and UNICEF
supported Regional Centres in Eastern Uganda (Lwala Hospital, Kaberamaido HCIV) and Western
(Kilembe Mines & Bwera Hospitals). The 32 rural health facilities have recorded more than 1,200 children
enrolled in active care, with 305 enrolled on ART in 3 months period, yet they have no functional system for
regular supply and management of their ARVs and non-ARV drugs. In the previous year (2007/8), the
majority of 1st & 2nd line ARV drug regimens were donated through Clinton Foundation support, which is
due to end by December, 2009. Baylor-Uganda procures ARV drugs through Medical Access Uganda
Limited and ensures supply chain management and uninterrupted ARV provision through strengthening of
local capacity at critical points.
In FY2009, the following activities are anticipated to continue, while some will be modified to suit
circumstances;
- Forecasting, procurement, distribution, handling and storage of both 1st and 2nd line ARV drugs.
- Procurement of equipment, including pill cutters, fitting drug cabinets/shelves, refurbishing and reinforcing
security in pharmacies, etc.
- Continued provision of ART services to about 5,000 (about 3,500 old cases and 1,500 new cases enrolled)
children, adolescents and family members infected with HIV from existing and 32 additional health facilities
that will have integrated paediatric HIV/AIDS management. Approximately 250 additional patients will
Activity Narrative: receive ARV treatment from other sources specifically, Pediatric AIDS Canada (PAC). Adults are treated
within Baylor - Uganda's supported facilities in the context of family centered care, using an index HIV
infected child.
- Provision of ARV for management of Post Exposure Prophylaxis for victims of rape/defilement.
- As the national referral hospital, children who are failing on 1st line treatment are often referred to PIDC. It
is estimated that approximately 5% of the children receiving ARVs through Baylor-Uganda will need to
switch from 1st to 2nd line treatment in 2008/2009.
- Our pharmacy staff will continue to develop logistical and operational policies and procedures to
accurately forecast, procure, store, and inventory the ARVs dispensed to Baylor-Uganda/PIDC supported
patients at all the clinics.
- The pharmacy and data management teams will also work closely with locally identified ARV procurement
and distribution organizations to develop an automated stock control/pharmacy management database to
more efficiently track, forecast and manage ARV procurement and dispensing practices at the main PIDC
and the satellite centers.
- In addition, program management will continue to hire services of external auditor to conduct monthly &
quarterly drug audits. These activities will be developed and documented for sharing of best practices with
other local health institutions to enhance national capacity to care for & prescribe ARVs to HIV-infected
children and their families.
- Our pharmacy staff will provide training in logistics management (ARV) and on-going technical support
(mentorship, support supervision, tools and systems development) to all Baylor - Uganda supported sites
for better ARV and other logistics management and accountability. In addition, the Baylor-Uganda
supported health professional trainings will continue to include pediatric ARV dosing and principles as part
of its curriculum. It is estimated that such training initiatives will reach no less than 570 health professionals
in this period. The Baylor-Uganda/PIDC program will continue to work with the MOH, PAC, and the Clinton
Foundation in order to maximize access to ARVs from all available sources.
Continuing Activity: 13247
13247 4380.08 HHS/Centers for Baylor College of 6422 5739.08 Expansion of $2,706,832
8283 4380.07 HHS/Centers for Baylor College of 5739 5739.07 Expansion of $2,306,832
4380 4380.06 HHS/Centers for Baylor University, 3331 1186.06 Pediatric $861,623
Estimated amount of funding that is planned for Human Capacity Development $119,900
Estimated amount of funding that is planned for Food and Nutrition: Commodities $3,000
Table 3.3.15:
HIV/AIDS programs in Eastern (Soroti) and Western (Kasese) Uganda, and is due to initiate one site in
Kitgum. Other collaborating partners include Feed the Children- Uganda supporting the nutrition program,
Pediatric AIDS Canada providing support for 250 children and adults, Save the Children in Uganda,
Christian Children's Fund, Plan International and AIDS Information Centre.
Baylor - Uganda is the largest provider of pediatric ART services in Uganda. By June 2008, 4,918 children
(0 - 14 years) and 1,254 adults (15+ years) were directly receiving ART from Baylor - Uganda sites, and
indirectly 281 children were on ART through the supported 32 upcountry public health facilities. 4,240 adults
were being served indirectly from the upcountry public health facilities with drugs for OI management,
systems strengthening, etc. In total 6,330 children and 3,122 adults were receiving HIV/AIDS related care &
support (this includes those on ART) from direct services delivery sites; while 13,647 adults and 1223
children were in care from the indirectly supported upcountry sites. From direct services delivery sites, the
HIV positive child is the index and point of entry for testing care givers & other family members. Depending
on HIV test result, the adults are appropriately enrolled into HIV/AIDS prevention, care &/or treatment.
Baylor - Uganda uses two services delivery modes:
(a) Direct services provision through 11 separate health facilities: Pediatric Infectious Diseases Clinic
3 months of the first project year, Baylor - Uganda has supported 33 public health facilities (32 upcountry &
1 Kampala satellite clinic - Kitebi HCIV) to integrate paediatric HIV/AIDS services, and plans to roll out
in100 additional facilities over the remaining 4 years. From the 32 upcountry health facilities, 104 children (0
- 14 years) and 1,200 (adults & children) receive ART
Baylor - Uganda performs a number of laboratory services for diagnosis and monitoring of patients with
HIV/AIDS and related conditions. Laboratory services provided include diagnosis of HIV using antibody
tests for adults and children aged 18 months or older, and DNA-PCR for infants below 18 months of age;
diagnosis of opportunistic infections (including TB), assessment for ART eligibility and monitoring treatment
using CD4, Complete Blood Count (CBC) and serum chemistry. Some of the tests are performed directly
from our sites, while others are done in partnership with other providers: MJAP, MUJHU, JCRC and private
providers such as Ebenezer Laboratory. By June 2008, Baylor - Uganda had performed 4706 and
supported 439 DNA-PCR tests from her direct and indirect services delivery sites. About 60661 HCT were
performed. In 2008, Baylor - Uganda acquired a CD4 test machine and CBC as well as Chemistry
Analyzer which will be installed in the new Baylor-Uganda COE located at Mulago. All the 11 direct and 32
indirect services delivery sites and 10 new sites to be initiated in FY2009 will require continuous support
with appropriate laboratory reagents and supplies, as well as support for transportation of samples for the
tests from the Baylor - Uganda's supported health facilities to health facilities with appropriate testing
equipment. To facilitate this process and ensure a lower negotiated rate, Baylor - Uganda has secured free
tests for DNA-PCR and CD4 from JCRC under MOH supported initiative of Early Infant Diagnosis.
However, tests for CBC, blood chemistry, etc. need to be paid for. While Baylor - Uganda promotes use of
WHO staging criteria for initiation of ART especially in rural resource- constrained environment, support will
be provided for transportation of samples collected from children, adolescents and family members for HIV
diagnosis and monitoring to various testing centres. Baylor - Uganda uses Ministry of Health's approved
tools and systems for this work, and will not introduce new systems. By March 2008, Baylor-Uganda had
trained 243 individuals in the provision of laboratory-related activities.
FY 2009 activities: Baylor - Uganda will provide the following laboratory related services with a 10%
increase every year
- Support for laboratory monitoring, including transportation of samples for CD4 count, DNA-PCR, etc. from
Activity Narrative: 23 upcountry health facilities and 6 Satellite clinics. We expect to perform at least 2 CD4 tests for more than
the 6,330 children and 3,122 adults enrolled in care by June, 2008. More than 5145 children/infants will be
provided with DNA-PCR services.
- Provision of mentorship and support supervision to laboratory personnel in all the program sites.
- On-going training in Dry Blood Spot and Good Laboratory Clinical practices in 10 new sites.
- Home based services to children on ARVs and their families in an effort to support adherence. For the
bedridden patients, those that miss scheduled appointments, those with poor adherence and to extend VCT
and other HIV services to the family members of the index client.
- Development/improvement in Standard Operating Procedures for laboratory practices will also be done.
- Providers training in pediatric HIV/AIDS management will also have some component of laboratory
monitoring.
- Personnel support for laboratory staff at Baylor - Uganda's COE as well as partial contribution for
administrative/support staffs that support laboratory functions such as procurement officers and data
entrants, executive director, etc.
- Procurement & distribution of laboratory equipment (CD4 count machine, centrifuge, etc.), supplies &
reagents for the COE & upcountry public health facilities. Baylor - Uganda will continue extending some
support for laboratory supplies for these health facilities where it is working indirectly to increase access to
paediatric HIV/AIDS care and treatment.
- Development of external & internal laboratory quality assurance mechanisms for all Baylor - Uganda
supported sites, in line with Ministry of Health's approved protocols.
Continuing Activity: 13249
13249 8745.08 HHS/Centers for Baylor College of 6422 5739.08 Expansion of $500,000
8745 8745.07 HHS/Centers for Baylor College of 5739 5739.07 Expansion of $450,000
Estimated amount of funding that is planned for Human Capacity Development $120,105
Table 3.3.16:
