Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 7204
Country/Region: Uganda
Year: 2009
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $4,841,206

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $552,000

This activity relates to PMTCT, VCT, sexual prevention, care and treatment (adult care and treatment,

pediatric care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), Health

systems strengthening, and Strategic information.

The activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD) follow

-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities have

been approved in COP08.

The district-based program will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery.

This activity will focus on increasing access to PMTCT services through support to eight districts in the

Eastern region of Uganda including Busia, Budaka, Bududa, Bukwa, Butaleja, Kapchorwa, Pallisa and

Sironko. Whereas these districts are estimated to have more than 42,000 people living with HIV, they are

among those districts underserved by USG and non-USG funded partners providing HIV/AIDS care and

treatment services. This will expand delivery of PMTCT services by strengthening district leadership and

management, health management information systems (HMIS), as well as improvements in human

resources for health, supply chain management systems, strategic information, infrastructure and

laboratories. The primary emphasis in districts without a PEPFAR PMTCT partner will be to directly support

PMTCT programs to provide Opt-out HIV counseling and testing, ARV prophylaxis, HAART, psychosocial

support, community follow-up and mobilization, training, adequate counselor and laboratory technician staff,

upgraded laboratory facilities and counseling rooms, management information systems and strengthened

MCH/FP services. The above Technical assistance will be provided in Districts that have PEPFAR PMTCT

implementing partners depending on the prevailing need.

The program will also work with facilities on other initiatives aimed at improving quality and efficiency of care

and treatment services within health facilities and community organizations, building of community-facility

linkages to enhance referrals as a way of improving access to, coverage of and utilization of care and

treatment services. Community programs will strengthen social mobilization in order to enhance demand

for PMTCT services. Involvement of the Private Sector and TBAs in the provision of Comprehensive

PMTCT services and strengthening of follow-up mechanisms for the Mother-baby pair will be strengthened.

During FY 2009, objectives for the PMTCT services will focus on:

1. Support the scale up of PMTCT services from 16% to reach 85% of the expected population of pregnant

women in the eight districts.

2. Promote the use of more efficacious ARV regimens for PMTCT through strengthening capacity building

and logistics management.

Key Activities

The district based program will aim at contributing to the national PMTCT strategy(2006 - 2010) whose

focus is to roll out the revised PMTCT policy, support the holistic implementation of the four-year pronged

PMTCT strategy (primary prevention, family planning, provision of ARV prophylaxis, care and support). In

order to achieve the policy implementation goals, the district based program will focus on the following

areas:

- Increasing program coverage for PMTCT: Focus will be placed on the scaling up PMTCT services up to

Health Center IIIs in all districts without a USG PMTCT Implementing Partner. Outreach services will be

extended to H/C II or lower level health facilities that do not have the capacity to offer maternity services.

Strengthening quality improvement interventions at health district and health facility levels will increase

program coverage. Strengthened linkages between the community and the health facility will be enhanced

through peer educators selected from HIV positive parents (mothers and their male partners) identified

during PMTCT, trained, and assigned roles alongside professional health workers at the care and treatment

sites.

- Increase the uptake of combination ARV regimen for the maternal/infant pair. Capacity to offer the more

efficacious regimen will be developed through increased training and the streamlining of logistics

management at both national, district and health facility level. Significant improvement in access to

combined regimens for PMTCT will be through improvement of quantification of ARV requirements and use

of innovative approaches to increase access to HIV positive pregnant women. Logistical support for the

procurement and distribution of ARVs, drugs for opportunistic infections and HIV test kits will continue to be

major activity. All of eligible HIV positive pregnant women (CD4+ > 350/ml) will be started on HAART and

50% of pregnant women (CD4+ <350) will receive Combined ARV regimens.

- Continuum of care and treatment of the HIV positive mothers and their families: The provision of

treatment, care and support services to eligible individuals has been shown to improve the uptake of all

other PMTCT services. Focus will be directed at strengthening the enrollment of identified HIV-exposed and

infected infants into continuum of treatment and care programs through the scale up early infant diagnosis

of HIV and follow-ups. This program will further support to HIV infected families to adopt safe infant feeding

practices in relation to the revised infant feeding materials.

- Capacity building and mentoring: The program will reinforce the skills of health workers in the

MCH/HIV/AIDS/ART clinics by the provision of mentoring programs (from the Regional Referral hospitals)

and Continuing Medical Education (CME) in order to improve program uptake. Approximately, 150 service

providers (such as counselors, mid wives, laboratory staff and data/records management assistants) will be

trained. Individuals trained from the community will focus on encouraging community discussions in areas

Activity Narrative: such as gender power relations aimed at reducing gender-based violence, increasing male involvement and

facilitating couple dialogue. Support and supervision will be directed at enhancing the quality of PMTCT

service delivery and the development of linkages between PMTCT and other HIV/AIDS care services,

including care and treatment, and supporting the full integration of PMTCT programs into district and MOH

work plans.

- In collaboration with other stakeholders, the district based program will review, print, distribute and

disseminate new/updated information, education and communication (IEC) materials (including job aides)

that will focus on increasing uptake of PMTCT services and create positive behaviors such as supportive

male involvement, appropriate/alternative infant feeding practices, spouse disclosure, partners support,

living positively and IPT uptake.

- Integration of family planning services into HIV/AIDS/MCH/Treatment services.

- Through community mobilization, support will be provided to psychosocial support (PSS) groups for HIV+

mothers and their spouses as coping mechanism on top of accessing the care services. The PSS groups

will be supported to leverage other wrap around services such as mosquito nets from the President's

Malaria Initiative (PMI), nutrition support from World Food funded programs, etc

This activity will also support integrated support supervision conducted quarterly within each health sub

district; establish and/or maintain facility based quality improvement teams; introduction of continuous ART

quality improvement tools in coordination with HCI or HIVQUAL; support accreditation of new ART sites,

mapping community resources; and create community and facility networks.

This activity will also endeavor to scale up adult care and treatment services through community

partnerships through efficient and transparent grant mechanism and by providing technical support to civil

society organizations.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21110

Continued Associated Activity Information

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

System ID System ID

21110 21110.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing women's access to income and productive resources

* Increasing women's legal rights

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

* Safe Motherhood

* TB

Military Populations

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.01:

Funding for Sexual Prevention: Abstinence/Be Faithful (HVAB): $183,333

This activity relates to PMTCT, sexual prevention, care and treatment (adult care and treatment, pediatric

care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), Health systems

strengthening, and Strategic information.

The USAID funded district-based HIV/AIDS/TB program will be a follow-on project to the Uganda Program

for Human and Holistic Development (UPHOLD) program ending in September 2008. The USAID funded

district-based program - Eastern will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery. The project will cover eight districts Busia, Budaka, Bududa, Bukwa, Butaleja,

Kapchorwa, Pallisa and Sironko.

Even with the positive trends among young people regarding delayed sexual debut and increased

abstinence, secondary data HIV Sero Behavioral analysis shows that certain behaviors particularly among

adults are regressing towards those of the late 1980s when HIV prevalence was at its peak in the country:

there is an increase in casual sex, an increase in multiple partners, and a decrease in condom use with

casual partners. A secondary analysis of available faithfulness data from the Uganda HIV/AIDS Sero-

Behavioral survey 2004-05 shows that 88% of men are not lifetime faithful, compared to 56% of women,

and only 10% of couples are mutually lifetime faithful.

The district-based program will support the civil society to improve on the gains attained through the existing

abstinence programs for the 10 -19 year olds, through a combination of in-school and out-of-school

programs, media and community mobilization approaches. The in-school abstinence programs will be

complemented by other USG partners programs that focused on strengthening and scaling up of the

national Presidential Initiative for AIDS Strategy. Other abstinence activities will focus on the following:

• Promoting tailor-made talk shows on various topics aimed at creating more risk-free community

environments to address legal issues on sex abuse, harassments, value of virginity, stigma and

discrimination, care for persons affected and infected with HIV/AIDS.

• Information, Education and Communication (IEC) messages targeting out-of-school youth, couples, and

the general community. The IEC messages will focus on creating an enabling environment for sexually

active youth to abstain from early sexual activity; reduce sexual partners and to remain faithful to each

other.

• Promotion of other IEC mechanisms that may include but not limited to radio programs, civil society drama

groups to perform other targeted music, dance and drama that fosters community dialogue, addressing

issues like couple dialogue, faithfulness and non violent behaviors, gender based violence. All together, it

is estimated that 150,000 will be reached by abstinence and faithfulness messages including couples and

out of-school youth

Recent findings have shown that high risk populations, such as commercial sex workers (among whom

prevalence is thought to be as high as 50% and on the increase), long distance truck drivers, urban

motorcycles riders (commonly refereed to as ‘Boda boda in Uganda), discordant couples, fishermen and the

Communities living at the landing sites, and other mobile populations remain major pockets of HIV

prevalence within generalized epidemic in Uganda.

The district-based program will use its financial and technical support to provide resources to civil society

organizations (CSOs) to reach most-at-risk populations with HIV/AIDS education, counseling and testing as

well as condom education and distribution services in collaboration with other key stakeholders such as

Ministry of Health and organizations involved in social marketing. Key activities to be supported will include

but not limited to the following:

• Condom distributions to key commercial outlets such as lodges, night clubs and bars (approximately 200

outlets)

• Supporting communities living near the landing sites for fishing with prevention interventions

• Promoting responsible behaviors such as couple counseling and mutual disclosure, consistent and correct

condom use among discordant couples and casual partners and reduction of multiple concurrent

partnership'

• Training community resources persons to undertake community based mobilization and education on

gender based violence prevention.

• Empowering couples and communities to promote societal norms that reduce the risk of HIV transmission

and promote use and access to HIV counseling and testing services.

• Encourage the use of IEC and behavior change communication (BCC) materials promoting couples testing

together, promotion of mutual disclosure and increasing awareness of discordance among couples.

• Promotion of prevention among positives through PLHA network activities that increase knowledge on the

importance of partners testing, diagnosis of sexually transmitted infections (STIs), treatment and prevention,

family planning and PMTCT.

Activity Narrative: • Promotion of STI prevention through supporting CSO's access to MOH and other partners' STI treatment

guidelines and education on Herpes Simplex type 2 virus (HSV-2).

• Supporting sexually youth who are mainly out-of-school to access youth friendly services such as

counseling and testing, treatment, information, entertainment and recreational services.

• Training at least 2500 community volunteers from CSOs and most at risk populations with different skills

related to HIV sexual prevention

New/Continuing Activity: Continuing Activity

Continuing Activity: 21454

Continued Associated Activity Information

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

System ID System ID

21454 21454.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

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:

Funding for Sexual Prevention: Other Sexual Prevention (HVOP): $316,666

This activity relates to PMTCT, sexual prevention, care and treatment (adult care and treatment, pediatric

care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), Health systems

strengthening, and Strategic information.

The USAID funded district-based HIV/AIDS/TB program will be a follow-on project to the Uganda Program

for Human and Holistic Development (UPHOLD) program ending in September 2008. The USAID funded

district-based program - Eastern will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery. The project will cover eight districts Busia, Budaka, Bududa, Bukwa, Butaleja,

Kapchorwa, Pallisa and Sironko.

Even with the positive trends among young people regarding delayed sexual debut and increased

abstinence, secondary data HIV Sero Behavioral analysis shows that certain behaviors particularly among

adults are regressing towards those of the late 1980s when HIV prevalence was at its peak in the country:

there is an increase in casual sex, an increase in multiple partners, and a decrease in condom use with

casual partners. A secondary analysis of available faithfulness data from the Uganda HIV/AIDS Sero-

Behavioral survey 2004-05 shows that 88% of men are not lifetime faithful, compared to 56% of women,

and only 10% of couples are mutually lifetime faithful.

The district-based program will support the civil society to improve on the gains attained through the existing

abstinence programs for the 10 -19 year olds, through a combination of in-school and out-of-school

programs, media and community mobilization approaches. The in-school abstinence programs will be

complemented by other USG partners programs that focused on strengthening and scaling up of the

national Presidential Initiative for AIDS Strategy. Other abstinence activities will focus on the following:

• Promoting tailor-made talk shows on various topics aimed at creating more risk-free community

environments to address legal issues on sex abuse, harassments, value of virginity, stigma and

discrimination, care for persons affected and infected with HIV/AIDS.

• Information, Education and Communication (IEC) messages targeting out-of-school youth, couples, and

the general community. The IEC messages will focus on creating an enabling environment for sexually

active youth to abstain from early sexual activity; reduce sexual partners and to remain faithful to each

other.

• Promotion of other IEC mechanisms that may include but not limited to radio programs, civil society drama

groups to perform other targeted music, dance and drama that fosters community dialogue, addressing

issues like couple dialogue, faithfulness and non violent behaviors, gender based violence. All together, it

is estimated that 150,000 will be reached by abstinence and faithfulness messages including couples and

out of-school youth

Recent findings have shown that high risk populations, such as commercial sex workers (among whom

prevalence is thought to be as high as 50% and on the increase), long distance truck drivers, urban

motorcycles riders (commonly refereed to as ‘Boda boda in Uganda), discordant couples, fishermen and the

Communities living at the landing sites, and other mobile populations remain major pockets of HIV

prevalence within generalized epidemic in Uganda.

The district-based program will use its financial and technical support to provide resources to civil society

organizations (CSOs) to reach most-at-risk populations with HIV/AIDS education, counseling and testing as

well as condom education and distribution services in collaboration with other key stakeholders such as

Ministry of Health and organizations involved in social marketing. Key activities to be supported will include

but not limited to the following:

• Condom distributions to key commercial outlets such as lodges, night clubs and bars (approximately 200

outlets)

• Supporting communities living near the landing sites for fishing with prevention interventions

• Promoting responsible behaviors such as couple counseling and mutual disclosure, consistent and correct

condom use among discordant couples and casual partners and reduction of multiple concurrent

partnership'

• Training community resources persons to undertake community based mobilization and education on

gender based violence prevention.

• Empowering couples and communities to promote societal norms that reduce the risk of HIV transmission

and promote use and access to HIV counseling and testing services.

• Encourage the use of IEC and behavior change communication (BCC) materials promoting couples testing

together, promotion of mutual disclosure and increasing awareness of discordance among couples.

• Promotion of prevention among positives through PLHA network activities that increase knowledge on the

importance of partners testing, diagnosis of sexually transmitted infections (STIs), treatment and prevention,

family planning and PMTCT.

Activity Narrative: • Promotion of STI prevention through supporting CSO's access to MOH and other partners' STI treatment

guidelines and education on Herpes Simplex type 2 virus (HSV-2).

• Supporting sexually youth who are mainly out-of-school to access youth friendly services such as

counseling and testing, treatment, information, entertainment and recreational services.

• Training at least 2500 community volunteers from CSOs and most at risk populations with different skills

related to HIV sexual prevention

New/Continuing Activity: Continuing Activity

Continuing Activity: 21462

Continued Associated Activity Information

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

System ID System ID

21462 21462.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Reducing violence and coercion

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.03:

Funding for Care: Adult Care and Support (HBHC): $544,000

This activity relates to PMTCT, VCT, sexual prevention, care and treatment (adult care and treatment,

pediatric care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), Health

systems strengthening, and Strategic information.

The activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD) follow

-on and the TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities

have been approved in COP08.

The district-based program will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery.

In FY 2009, this activity will focus on increasing rural access to HIV/AIDS care and treatment through

support to eight districts in the Eastern region of Uganda including Busia, Budaka, Bududa, Bukwa,

Butaleja, Kapchorwa, Pallisa and Sironko. These districts are among those districts with poor infrastructure,

few accredited ART sites and underserved by USG and non-USG funded partners. This will expand delivery

of HIV/AIDS care and treatment services by strengthening district leadership and management, health

management information systems (HMIS), as well as improvements in human resources for health, supply

chain management systems, strategic information, infrastructure and laboratories. The primary emphasis

will be to strengthen care and treatment service delivery systems at health center IV's, III's and build

community outreaches that serve to provide intermediate care and generate demand for facility based

services.

During FY 2009 the project will ensure delivery of quality of ART services in all 16 health center IVs and

district hospital in the eight districts. In subsequent years the project will work with respective districts and

health facilities in order to ensure that selected health center III's are also accredited for HIV care and

treatment services. This is very critical as these districts have limited number of health center IV's. This

would require renovation of clinical space, build lab infrastructure, ensure availability of skilled health

workforce, and task shifting.

The program will also work with facilities on other initiatives aimed at improving quality and efficiency of care

and treatment services within health facilities and community organizations, building of community-facility

linkages to enhance referrals as a way of improving access to, coverage of and utilization of care and

treatment services.

In addition to supporting expanding delivery of HIV/AIDS services, this activity will also support capacity of

decentralized health delivery system to improve uptake of services at lower level facilities. Support will focus

on areas of leadership, management, health management information systems (HMIS), and human

resources for health, supply chain management, strategic information, infrastructure and laboratories.

Specific adult care and treatment activities to be supported under this mechanism will include:

• Training health workers in delivery of quality care and treatment services that adhere to national and

international standards, guidelines and protocols. Specifically, services shall be tailored to the existing

Ministry of Health HIV/AIDS care and treatment guidelines, treatment eligibility criteria and standard 1st and

2nd line treatment regimens.

• Provision of comprehensive care and support including treatment and prophylaxis for OIs, psychosocial

support, as well as basic preventive care to people living with HIV/AIDS (PLHAS) in all the target districts.

• Provide support to PLHAs with a focus on strengthening/setting up of PLHA networks to serve as hubs for

community level care, adherence monitoring and referral.

• Integrating symptom, pain management, spiritual as well as culturally appropriate end of life care into

routine HIV/AIDS care.

• Ensure that patients under HIV/AIDS care and treatment receive regular laboratory tests for HIV-disease

monitoring including a CD4 cell count every six months and samples for viral load collected and transferred

to regional labs at least once a year.

• Support districts to establish functional networks within and between health facilities and communities to

improve access to and uptake of HIV/AIDS care and treatment services.

• Support districts to institutionalize infection control procedures as standard integral practices within the

services delivered both at facility and community level.

•Support best practices and proven interventions and approaches that would improve access to continuum

of HIV/AIDS services, including critical services not directly supported by PEPFAR or other activities.

• Promotion of a family approach to the delivery of palliative care services through partnerships with CSOs

using the HIV+ client as an entry point into the family and community.

• Support various community based groups in the delivery of care services and referrals at community

levels. Groups to be supported will include: post-test clubs, psycho social support groups for HIV+ mothers

and spouses, religious leaders, faith-based organizations and volunteers. These groups will address

legislative issues such as stigma, discrimination and gender based violence.

• Support linkages that support leveraging other resources to benefit PLHAs in the areas of malaria, TB,

family planning and safe motherhood, nutrition and child survival support, and education.

This activity will also support integrated support supervision conducted quarterly within each health sub

district; establish or maintain facility based quality improvement teams; introduction of continuous ART

quality improvement tools in coordination with HCI or HIVQUAL; support accreditation of new ART sites,

Activity Narrative: mapping community resources; and create community and facility networks.

This activity will also endeavor to scale up adult care and treatment services through community

partnerships, through efficient and transparent grant mechanism and by providing technical support to civil

society organizations.

Moreover, the activity will explore approaches and best practices for strengthening the network model of

service delivery; innovative ways of using existing structures like village health teams, community

volunteers and family members.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15622

Continued Associated Activity Information

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

System ID System ID

15622 15622.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $1,646,933

This activity relates to PMTCT, VCT, sexual prevention, care and treatment (adult care and treatment,

pediatric care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), Health

systems strengthening, and Strategic information.

The activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD) follow

-on and the TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities

have been approved in COP08.

The district-based program will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery.

In FY 2009, this activity will focus on increasing rural access to HIV/AIDS care and treatment through

support to eight districts in the Eastern region of Uganda including Busia, Budaka, Bududa, Bukwa,

Butaleja, Kapchorwa, Pallisa and Sironko. These districts are among those districts with poor infrastructure,

few accredited ART sites and underserved by USG and non-USG funded partners. This will expand delivery

of HIV/AIDS care and treatment services by strengthening district leadership and management, health

management information systems (HMIS), as well as improvements in human resources for health, supply

chain management systems, strategic information, infrastructure and laboratories. The primary emphasis

will be to strengthen care and treatment service delivery systems at health center IV's, III's and build

community outreaches that serve to provide intermediate care and generate demand for facility based

services.

During FY 2009 the project will ensure delivery of quality of ART services in all 16 health center IVs and

district hospital in the eight districts. In subsequent years the project will work with respective districts and

health facilities in order to ensure that selected health center III's are also accredited for HIV care and

treatment services. This is very critical as these districts have limited number of health center IV's. This

would require renovation of clinical space, build lab infrastructure, ensure availability of skilled health

workforce, and task shifting.

The program will also work with facilities on other initiatives aimed at improving quality and efficiency of care

and treatment services within health facilities and community organizations, building of community-facility

linkages to enhance referrals as a way of improving access to, coverage of and utilization of care and

treatment services.

In addition to supporting expanding delivery of HIV/AIDS services, this activity will also support capacity of

decentralized health delivery system to improve uptake of services at lower level facilities. Support will focus

on areas of leadership, management, health management information systems (HMIS), and human

resources for health, supply chain management, strategic information, infrastructure and laboratories.

Specific adult care and treatment activities to be supported under this mechanism will include:

• Training health workers in delivery of quality care and treatment services that adhere to national and

international standards, guidelines and protocols. Specifically, services shall be tailored to the existing

Ministry of Health HIV/AIDS care and treatment guidelines, treatment eligibility criteria and standard 1st and

2nd line treatment regimens.

• Provision of comprehensive care and support including treatment and prophylaxis for OIs, psychosocial

support, as well as basic preventive care to people living with HIV/AIDS (PLHAS) in all the target districts.

• Provide support to PLHAs with a focus on strengthening/setting up of PLHA networks to serve as hubs for

community level care, adherence monitoring and referral.

• Integrating symptom, pain management, spiritual as well as culturally appropriate end of life care into

routine HIV/AIDS care.

• Ensure that patients under HIV/AIDS care and treatment receive regular laboratory tests for HIV-disease

monitoring including a CD4 cell count every six months and samples for viral load collected and transferred

to regional labs at least once a year.

• Support districts to establish functional networks within and between health facilities and communities to

improve access to and uptake of HIV/AIDS care and treatment services.

• Support districts to institutionalize infection control procedures as standard integral practices within the

services delivered both at facility and community level.

• Support best practices and proven interventions and approaches that would improve access to continuum

of HIV/AIDS services, including critical services not directly supported by PEPFAR or other activities.

• Promotion of a family approach to the delivery of palliative care services through partnerships with CSOs

using the HIV+ client as an entry point into the family and community.

• Support various community based groups in the delivery of care services and referrals at community

levels. Groups to be supported will include: post-test clubs, psycho social support groups for HIV+ mothers

and spouses, religious leaders, faith-based organizations and volunteers. These groups will address

legislative issues such as stigma, discrimination and gender based violence.

• Support linkages that support leveraging other resources to benefit PLHAs in the areas of malaria, TB,

family planning and safe motherhood, nutrition and child survival support, and education.

This activity will also support integrated support supervision conducted quarterly within each health sub

district; establish or maintain facility based quality improvement teams; introduction of continuous ART

quality improvement tools in coordination with HCI or HIVQUAL; support accreditation of new ART sites,

Activity Narrative: mapping community resources; and create community and facility networks.

This activity will also endeavor to scale up adult care and treatment services through community

partnerships, through efficient and transparent grant mechanism and by providing technical support to civil

society organizations.

Moreover, the activity will explore approaches and best practices for strengthening the network model of

service delivery; innovative ways of using existing structures like village health teams, community

volunteers and family members.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15913

Continued Associated Activity Information

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

System ID System ID

15913 15913.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $136,000

This activity relates to PMTCT, VCT, sexual prevention, pediatric, TB/HIV, ARV drugs and laboratory

infrastructure, Health systems strengthening, and Strategic information.

The activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD) follow

-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities have

been approved in COP08.

The district-based program will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery.

In FY 2009, this activity will focus on increasing rural access to HIV/AIDS care and treatment through

support to eight districts in the Eastern region of Uganda including Busia, Budaka, Bududa, Bukwa,

Butaleja, Kapchorwa, Pallisa and Sironko. These districts are among those districts underserved by USG

and non-USG funded partners. This will expand delivery of HIV/AIDS care and treatment services by

strengthening district leadership and management, health management information systems (HMIS), as

well as improvements in human resources for health, supply chain management systems, strategic

information, infrastructure and laboratories. The primary emphasis will to strengthen care and treatment

service delivery systems at health center IV's, III's and build community outreaches that serve to provide

intermediate care and generate demand for facility based services. The program will also work with facilities

on other initiatives aimed at improving quality and efficiency of care and treatment services within health

facilities and community organizations, building of community-facility linkages to enhance referrals as a way

of improving access to, coverage of and utilization of care and treatment services.

Significant progress has been made in the area of pediatrics HIV/AIDS care and treatment. There are nine

laboratories nationwide have the capacity of conducting DNA-PCR for early infant diagnosis; the number of

sites providing pediatric ARV services has increased from 30 to 147 over the last 12 months and an

estimated 12,000 children are currently on ART.

Despite progress Pediatric HIV/AIDS treatment has been identified as a major gap and area of focus by the

Uganda MoH and USG. The national and PEPFAR target is that 15% of ART patients should be children.

Data from PEPFAR and MoH shows that children constitute only 11% of those on treatment.

Likewise access to pre-ART care is suboptimal and associated with high levels of drop out.

Some programs have made significant progress of increasing access of children to HIV care and treatment.

Some of the best practices include: integration of ART and PMTCT services; assessment of infants and

children for ART eligibility in every clinic visit; routine counseling adults on bring children for testing,

intensified case findings of exposed infants within immunization units, scheduling the same appointment

dates for children and parents/caretakers, and introduction of specific clinic days for children. This activity

will support districts and health facilities to implement proven innovations and practices.

The roll out of pediatric HIV/AIDS care and treatment to lower level facilities is hampered by lack of

adequate counseling and clinical skills among health workers, suboptimal access to laboratory services,

and suboptimal linkages to services. This activity will build the skills of health workers on pediatric care, and

treatment through didactic and on job trainings, clinical mentoring and availing simplified tools and aides.

This activity will closely work with the JCRC follow-on and other relevant partners to support districts and

health facilities to build an effective mechanism for transferring samples for DNA-PCR, CD4, viral load and

other advanced laboratory test.

This activity will also support integrated support supervision conducted quarterly within each health sub

district; establish or maintain facility based quality improvement teams; introduction of continuous ART

quality improvement tools in coordination with HCI or HIVQUAL; support accreditation of new ART sites,

mapping community resources; and create community and facility networks.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15721

Continued Associated Activity Information

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

System ID System ID

15721 15721.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $411,733

This activity relates to PMTCT, VCT, sexual prevention, pediatric, TB/HIV, ARV drugs and laboratory

infrastructure, Health systems strengthening, and Strategic information.

The activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD) follow

-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities have

been approved in COP08.

The district-based program will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery.

In FY 2009, this activity will focus on increasing rural access to HIV/AIDS care and treatment through

support to eight districts in the Eastern region of Uganda including Busia, Budaka, Bududa, Bukwa,

Butaleja, Kapchorwa, Pallisa and Sironko. These districts are among those districts underserved by USG

and non-USG funded partners. This will expand delivery of HIV/AIDS care and treatment services by

strengthening district leadership and management, health management information systems (HMIS), as

well as improvements in human resources for health, supply chain management systems, strategic

information, infrastructure and laboratories. The primary emphasis will to strengthen care and treatment

service delivery systems at health center IV's, III's and build community outreaches that serve to provide

intermediate care and generate demand for facility based services. The program will also work with facilities

on other initiatives aimed at improving quality and efficiency of care and treatment services within health

facilities and community organizations, building of community-facility linkages to enhance referrals as a way

of improving access to, coverage of and utilization of care and treatment services.

Significant progress has been made in the area of pediatrics HIV/AIDS care and treatment. There are nine

laboratories nationwide have the capacity of conducting DNA-PCR for early infant diagnosis; the number of

sites providing pediatric ARV services has increased from 30 to 147 over the last 12 months and an

estimated 12,000 children are currently on ART.

Despite progress Pediatric HIV/AIDS treatment has been identified as a major gap and area of focus by the

Uganda MoH and USG. The national and PEPFAR target is that 15% of ART patients should be children.

Data from PEPFAR and MoH shows that children constitute only 11% of those on treatment.

Likewise access to pre-ART care is suboptimal and associated with high levels of drop out.

Some programs have made significant progress of increasing access of children to HIV care and treatment.

Some of the best practices include: integration of ART and PMTCT services; assessment of infants and

children for ART eligibility in every clinic visit; routine counseling adults on bring children for testing,

intensified case findings of exposed infants within immunization units, scheduling the same appointment

dates for children and parents/caretakers, and introduction of specific clinic days for children. This activity

will support districts and health facilities to implement proven innovations and practices.

The roll out of pediatric HIV/AIDS care and treatment to lower level facilities is hampered by lack of

adequate counseling and clinical skills among health workers, suboptimal access to laboratory services,

and suboptimal linkages to services. This activity will build the skills of health workers on pediatric care, and

treatment through didactic and on job trainings, clinical mentoring and availing simplified tools and aides.

This activity will closely work with the JCRC follow-on and other relevant partners to support districts and

health facilities to build an effective mechanism for transferring samples for DNA-PCR, CD4, viral load and

other advanced laboratory test.

This activity will also support integrated support supervision conducted quarterly within each health sub

district; establish or maintain facility based quality improvement teams; introduction of continuous ART

quality improvement tools in coordination with HCI or HIVQUAL; support accreditation of new ART sites,

mapping community resources; and create community and facility networks.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21645

Continued Associated Activity Information

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

System ID System ID

21645 21645.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $280,463

This activity relates to PMTCT, VCT, sexual prevention, care and treatment (adult and pediatric), ARV drugs

and laboratory infrastructure, Health systems strengthening, and Strategic information.

The activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD) follow

-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities have

been approved in COP08.

The district-based program will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery.

In FY 2009, this activity will focus on increasing rural access to HIV/AIDS care and treatment through

support to eight districts in the Eastern region of Uganda including Busia, Budaka, Bududa, Bukwa,

Butaleja, Kapchorwa, Pallisa and Sironko. These districts are among those districts underserved by USG

and non-USG funded partners. This will expand delivery of HIV/AIDS care and treatment services by

strengthening district leadership and management, health management information systems (HMIS), as

well as improvements in human resources for health, supply chain management systems, strategic

information, infrastructure and laboratories. The primary emphasis will to strengthen care and treatment

service delivery systems at health center IV's, III's and build community outreaches that serve to provide

intermediate care and generate demand for facility based services. The program will also work with facilities

on other initiatives aimed at improving quality and efficiency of care and treatment services within health

facilities and community organizations, building of community-facility linkages to enhance referrals as a way

of improving access to, coverage of and utilization of care and treatment services.

In addition to supporting expanded delivery of HIV/AIDS services, this activity will also support the capacity

of the decentralized health delivery system to improve uptake of services at lower level facilities. Support

will focus on areas of leadership, management, health management information systems (HMIS), and

human resources for health, supply chain management, strategic information, infrastructure and

laboratories.

Specific TB/HIV activities to be supported under this mechanism will include:

• Support to district-level TB/HIV Coordination to integrate TB and HIV services

• Assisting in the rapid scale-up of routine HCT services for suspected and confirmed TB patients

• Support linkages for co-infected patients to HIV/AIDS care and treatment services

• Strengthen routine TB screening among HIV-infected clients; among those who are co-infected,

• Provide cotrimoxazole chemoprophylaxis for TB/HIV patients

• Support implementation of simple, low-tech TB infection control measures in health facilities to prevent TB

transmission among PHA and health care workers

• Increase the availability and quality of TB and HIV diagnostic services by strengthening laboratory systems

in facility, infrastructure, training of lab technicians, and availing standard operations procedures and

guidelines

This activity will also support integrated support supervision conducted quarterly within each health sub

district; establish or maintain facility based quality improvement teams; introduction of continuous ART

quality improvement tools in coordination with HCI or HIVQUAL.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21476

Continued Associated Activity Information

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

System ID System ID

21476 21476.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Health-related Wraparound Programs

* Child Survival Activities

* Family Planning

* Malaria (PMI)

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $100,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $300,000

This activity relates to PMTCT, sexual prevention, care and treatment (adult care and treatment, pediatric

care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), Health systems

strengthening, and Strategic information.

This activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD)

follow-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities

have been approved in COP 08. The USAID funded district-based HIV/AIDS/TB program - Eastern will be a

follow-on project to the Uganda Program for Human and Holistic Development (UPHOLD) program ending

in September 2008. The district-based program will support the national efforts to improve the quality,

utilization and sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner

at both facility and community levels. In partnership with the Government of Uganda and other

stakeholders, the district-based HIV/AIDS/TB program will strengthen the national response to the

HIV/AIDS epidemic. Within the National Strategic Framework, the district-based HIV/AIDS/TB program will

continue to work through local governments, the private sector, other USG and non-USG implementing

partners and civil society organizations (including faith-based and community based organizations) towards

improved quality of life and increased equitable access to preventive and clinical services at both district

and lower level facilities. Key activities at the district level include technical support at the policy and

technical level, systems strengthening including quality assurance, M&E and support supervision as well as

financial resources for services delivery.

This activity that will focus on increasing rural access to HIV/AIDS Counseling and Testing (HCT) and anti-

retroviral therapy (ART) through support to 8 districts in the Eastern region of the country. This region has a

low ART coverage and lies along the highway connecting Uganda to neighboring countries. According to

the 2005 Uganda national HIV/AIDS Sero-Behavioural Survey 2004-2005, 79% of HIV- Ugandans do not

know their HIV sero-status due to various reasons including limited access and utilization of HIV counseling

and testing (HCT) services. The District HIV/AIDS/TB program will increase access and utilization of HCT

services at both district hospital/lower level facilities and the community through the following initiatives:

• Increasing HCT service access and utilization for people in the rural setting and hard-to-reach high risk

populations e.g. fishing communities, out-of-school youth, internally displace populations, etc.

• Promotion of home-to-home and family-based HCT. Routine counseling and testing (RCT) will be

supported in all district and lower level facilities with emphasis on referring all HIV+ clients into care and

treatment facilities for follow on support services such as TB. In these health facilities, HCT will be routinely

provided in the high HIV-prevalence clinics namely tuberculosis and sexually transmitted clinics and medical

in-patient wards.

• Promotion of outreach activities in high activity areas such as landing sites for fishing communities,

communal markets, camps for internally displaced people, tertiary institutions and trading centers

• Training of health service providers such as counselors, laboratory staff, and data assistants. The training

to cover personnel from approximately 50 outlets will support the role out of routine counseling and testing,

strengthening counseling skills, logistics and records management, laboratory services, referral and general

integrated patient care. A total of 300 personnel will be trained

• Increase support for and utilization of post test services through post test clubs (PTCs). PTCs will be used

to promote awareness about disclosure, discordance and stigma.

• Promotion of couple counseling and testing coupled with referral linkages to post test services for both HIV

- and HIV- individuals

To achieve the required results, the program will support provider-initiated HCT services in 50 health

facilities. It is estimated that over 50,000 clients will receive HCT services in FY 2009 and those testing HIV-

positive linked to palliative care and treatment services. The program will build capacity of Networks and

groups of People Living with HIV/AIDS (PHAs) to provide pre-test and post-test counseling to clients and

facilitate family-based HCT. PHAs will be trained to function as expert clients facilitating linkages and

referrals between community-based and facility-based care and linking all those testing HIV-positive to

palliative care and wrap around services.

New/Continuing Activity: Continuing Activity

Continuing Activity: 15987

Continued Associated Activity Information

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

System ID System ID

15987 15987.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Addressing male norms and behaviors

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* TB

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.14:

Funding for Laboratory Infrastructure (HLAB): $153,333

This activity relates to PMTCT, VCT, sexual prevention, care and treatment (adult care and treatment,

pediatric care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), Health

systems strengthening, and Strategic information.

The activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD) follow

-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities have

been approved in COP08.

The district-based program will support the national efforts to improve the quality, utilization and

sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner at both facility

and community levels. In partnership with the Government of Uganda and other stakeholders, the district-

based HIV/AIDS/TB program will strengthen the national response to the HIV/AIDS epidemic. Within the

National Strategic Framework, the district-based HIV/AIDS/TB program will continue to work through local

governments, the private sector, other USG and non-USG implementing partners and civil society

organizations (including faith-based and community based organizations) towards improved quality of life

and increased equitable access to preventive and clinical services at both district and lower level facilities.

Key activities at the district level include technical support at the policy and technical level, systems

strengthening including quality assurance, M&E and support supervision as well as financial resources for

services delivery.

In FY 2009, this activity will focus on increasing rural access to HIV/AIDS care and treatment through

support to eight districts in the Eastern region of Uganda including Busia, Budaka, Bududa, Bukwa,

Butaleja, Kapchorwa, Pallisa and Sironko. These districts are among those districts underserved by USG

and non-USG funded partners. This will expand delivery of HIV/AIDS care and treatment services by

strengthening district leadership and management, health management information systems (HMIS), as

well as improvements in human resources for health, supply chain management systems, strategic

information, infrastructure and laboratories. The primary emphasis will to strengthen care and treatment

service delivery systems at health center IV's, III's and build community outreaches that serve to provide

intermediate care and generate demand for facility based services. The program will also work with facilities

on other initiatives aimed at improving quality and efficiency of care and treatment services within health

facilities and community organizations, building of community-facility linkages to enhance referrals as a way

of improving access to, coverage of and utilization of care and treatment services.

In the 8 focus districts, the program will provide support to the Directorates of District Health Services

(DDHS) and over 16 primary health centers to provide laboratory services for improved laboratory testing

for diagnosis of HIV infection and other opportunistic infections and for monitoring patients during care and

treatment. Through the DDHS office, the program will support the establishment of effective laboratory

networks in the 12 focus districts. The program will build the capacity of the district hospitals to provide

laboratory support to lower health centers (HCIVs, HCIII and HCII) through referral testing and support

supervision. The program will build capacity of the district hospital to provide quality assurance and train

laboratory personnel.

Through support to the districts the program will generate support from the local government structures and

provide an environment for a sustainable long-term impact. The program will provide financial and technical

support to the District Directorate of Health Services (DDHS) to provide support supervision to health

workers in the district and monitor establishment of tiered-quality-assured laboratory networks in the

respective districts. Lab strengthening activities will be coordinated with CPHL/MOH activities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 21647

Continued Associated Activity Information

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

System ID System ID

21647 21647.08 U.S. Agency for To Be Determined 10369 10369.08 Districts East

International

Development

Emphasis Areas

Gender

* Increasing gender equity in HIV/AIDS programs

Health-related Wraparound Programs

* Family Planning

* Malaria (PMI)

* TB

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $50,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16:

Funding for Strategic Information (HVSI): $251,745

This activity relates to PMTCT, sexual prevention, care and treatment (adult care and treatment, pediatric

care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), counseling and

testing, and health systems strengthening.

This activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD)

follow-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities

have been approved in COP 08. The USAID funded district-based HIV/AIDS/TB program - Eastern will be a

follow-on project to the Uganda Program for Human and Holistic Development (UPHOLD) program ending

in September 2008. The district-based program will support the national efforts to improve the quality,

utilization and sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner

at both facility and community levels. In partnership with the Government of Uganda and other

stakeholders, the district-based HIV/AIDS/TB program will strengthen the national response to the

HIV/AIDS epidemic. Within the National Strategic Framework, the district-based HIV/AIDS/TB program will

continue to work through local governments, the private sector, other USG and non-USG implementing

partners and civil society organizations (including faith-based and community based organizations) towards

improved quality of life and increased equitable access to preventive and clinical services at both district

and lower level facilities. Key activities at the district level include technical support at the policy and

technical level, systems strengthening including quality assurance, M&E and support supervision as well as

financial resources for services delivery.

This activity that will focus support to 8 districts in the Eastern region of the country. As a follow up to

previous efforts by UPHOLD, UNICEF and Uganda AIDS Control Programs (UACP), the district based

HIV/AIDS/TB program - Eastern will continue focusing on activities aimed at promoting evidence-based

planning and decision making at district and lower levels. Districts to be covered in this region include:

Busian, Budaka, Bukwa, Butaleja, Kapchorwa, Pallisa and Sironko. Evidence-based planning and decision

making will be achieved through regular measurement of program performances and progress in all the

districts that this program will operate. Regular and timely feedback to the supported local governments,

non-governmental organizations ad civil service organizations will be provided through systems

strengthening of district level monitoring and reporting systems including HMIS and other civil society

reporting tools developed under the new civil society fund as well as through the annual Lot Quality

Assurance Sampling (LQAS) survey. Up to FY 2008, LQAS has been carried out in 43 UPHOLD and

NUMAT districts as well as some UNICEF districts. LQAS was previously supported through the World

Bank MAP project in selected other districts. Under the FY 2009 activity (new design), the mission will work

closely with the GOU to determine the best way to transfer ownership and management of the annual

survey. From FY 2009 onwards under the three new district-based activities, LQAS survey will be

conducted annually in approximately 50 districts in order track coverage and utilization of key indicators

related to program performance. LQAS will be supported at the national level by one of the HIV/AIDS/TB

projects to provide one major source of data/information for the USG programs. Key stakeholders such as

line ministries, local government authorities, civil society organizations and other implementing partners will

be involved in the development of questionnaires of this survey. The LQAS results will be used to inform

district level work planning in order to identify intervention areas and sub-counties on which to focus in the

future. LQAS will also track indicators under the President's Malaria Initiative (PMI).

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.17:

Funding for Health Systems Strengthening (OHSS): $65,000

This activity relates to PMTCT, sexual prevention, care and treatment (adult care and treatment, pediatric

care and treatment, TB/HIV, HIV/AIDS treatment/ARV drugs and laboratory infrastructure), counseling and

testing, and Strategic information.

This activity is a combination of the Uganda Program for Human and Holistic Development (UPHOLD)

follow-on and TBD District Support for Rural Access to ART in Eastern and Western Uganda. Both activities

have been approved in COP 08. The USAID funded district-based HIV/AIDS/TB program - Eastern will be a

follow-on project to the Uganda Program for Human and Holistic Development (UPHOLD) program ending

in September 2008. The district-based program will support the national efforts to improve the quality,

utilization and sustainability of services delivered in the areas of HIV/AIDS and TB in an integrated manner

at both facility and community levels. In partnership with the Government of Uganda and other

stakeholders, the district-based HIV/AIDS/TB program will strengthen the national response to the

HIV/AIDS epidemic. Within the National Strategic Framework, the district-based HIV/AIDS/TB program will

continue to work through local governments, the private sector, other USG and non-USG implementing

partners and civil society organizations (including faith-based and community based organizations) towards

improved quality of life and increased equitable access to preventive and clinical services at both district

and lower level facilities. Key activities at the district level include technical support at the policy and

technical level, systems strengthening including quality assurance, M&E and support supervision as well as

financial resources for services delivery.

Since supportive policy environment is very important for the implementation of activities, the district based

HIV/AIDS/TB program - Eastern will complement the efforts of the Ministry of Health (MOH), Ministry of

Gender, Labor and Social Development (MGLSD) and other national bodies like Uganda AIDS Commission

and National TB and Leprosy Programs towards the dissemination of policies that are relevant to the

activities that the program will support. The project will cover activities in 6 districts. For example, the

district based program will support the continued roll out of the revised policies of PMTCT, RCT, ART, TB

and any other policies as they get approved. This program will build on past efforts by the AIM, UPHOLD

and Uganda AIDS Control Program (UACP) to strengthen district planning (fresh support for new districts)

through continued support to the District AIDS Committees. The support will facilitate streamlining district

capacity to manage HIV/AIDS structural plan development, coordination of activities and monitoring

progress. Other activities will include:

• Once completed, the dissemination of the following policies and/or guidelines will be undertaken:

integrated TB/HIV management, management of opportunistic infections, scaling up of the utilization of co-

trimoxazole prophylaxis among people living with HIV/AIDS (PLHAs) as well as the provision of isoniazd

prophylaxis in PLHAs at high risk of acquiring tuberculosis

• Supporting the printing and distribution of policies and implementation guidelines and the re-training and

orientation of health workers to improve service delivery in HIV/AIDS management targeting private and

public health facilities. The training will benefit at least 500 persons (health workers and CSO staff).

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.18:

Cross Cutting Budget Categories and Known Amounts Total: $650,000
Human Resources for Health $100,000
Human Resources for Health $100,000
Human Resources for Health $100,000
Human Resources for Health $100,000
Human Resources for Health $100,000
Human Resources for Health $100,000
Human Resources for Health $50,000