Integrated Community Based Initiatives (ICOBI is an indigenous Non-Governmental Organization (NGO),founded in 1994, registered with the National NGO Board in 1996 and incorporated in 2004. ICOBI is operating in both South Western (15 districts) and central districts (6 districts) of the Republic of Uganda. Its head quarters are located at Plot 37 Lumumba Avenue, Kampala with field offices in districts and a regional office located in Kabwohe-Itendero Town Council-Bushenyi District.

In July 2008, Integrated Community Based Initiatives (ICOBI) received funding from CDC/PEPFAR to implement a Full Access Home Based HIV Counseling and Testing (HBHCT) and provision of basic care project in six central districts of the Republic of Uganda in five years (1st July 2008- 30th June 2013). The project integrates four components namely HCT, Basic care, sexual prevention (AB and other prevention options) and TB/HIV. HBHCT project goal is to provide 100% Full access Home Based HIV Counseling and testing services to all adults and at risk children residing in the six districts. Currently it has scaled up project activities from Mubende and Mityana districts to other two districts of Nakasongola and Luwero.

During the period from April-June 2009, HBHCT project implementation focused on HCT in homes, HIV/AIDS prevention activities, by collaborating with district health systems and other service providers, Care and support of identified HIV infected clients and we reached 18,817 Households, 36,653 clients were counselled and tested for HIV and given results at home, 12,000 individuals were counselled and tested as couples; overall identified 1,816 individuals were HIV infected and all were referred for care and 631 reached the health units and were assessed and initiated on Cotrimoxazole prophylaxis. 1,349 individuals were reached with Abstinence only message in schools and 10,472 individuals with AB messages both in schools (private) and communities through outreaches by community educators, 57 condom outlets established in parishes by the counseling and testing teams and 22,780 pieces of condoms were distributed. The project intervention activities to be implemented with funds provided under this budget code will cover the districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso districts of Central Region of Uganda.

Specific objectives and activities for COP 2010.

To achieve 100% awareness on HCT among community members living in 6 districts of Mubende, Mityana, Luwero, Nakaseke, Nakasongola, Wakiso and beyond by the end of September 30th 2010.

o To offer HBHCT to 150,000 people above 14 years of age (adults and children with potential risk of HIV) in 6 districts by the end of September 30th 2010.

o To reach 75,000 people with AB messages and other prevention strategies in Mubende, Mityana, Luwero, Nakaseke, Nakasongola and Wakiso by the end of September 30th 2010.

To provide basic health care, ongoing support and Counseling to 6,000 HIV+ clients by the end of September 30th 2010.

o To obtain simple data on utility of HBHCT in various service outlets (sub counties

o To document and disseminate good practices

Activities

Community mobilization and education

o District, sub county, parish and village sensitization meetings

o Radio talk shows

HBHCT in six district of Mubende, Mityana, Luwero, Nakaseke, Nakasongola and Wakiso districts

o Training for supervisors (ICOBI and district), field teams in HBHCT

o Collection of DBS from adults, children and infants for quality control and assurance of field test processes and for PCR to enhance EID and paediatric care

o Identification and training of RPMs as Counseling aides

Intensify HIV prevention messages through radio, community outreaches, meetings and home visits

o Peer educator training among MARPS from each parish.

o Orientation of Model couples for Mubende and Mityana

o VHTs orientation in HBHCT so as to enhance prevention and care at community level.

o Holding FGDs, Film shows, sports, drama, PTCs meetings to communicate and reach people with prevention messages

To reach HIV positive clients with basic care and psychosocial support

o Distribution of starter kits by Basic Care Officers and Health Workers

o Demonstration of proper usage of basic care commodities by health workers and RPMs

o Follow up home visits by RPMs, Counselors, Field Teams and VHTs

o Formation of post test clubs, PTC meetings

Integration HBHCT into prevention, care and HIV/ TB prevention activities.

o Awareness on TB prevention at village level and testing TB clients for HIV in homes by VHTs and health Workers

o Referral of HIV+ with chronic cough for TB screening at health units

o DOTs support by VHTs and RPMs

To strengthen linkages and collaboration with the Districts health system through

o Purchase and distribution of Cotrimoxazole supplements and monthly stipend to health units.

o Training for health workers in basic health care package

o Orientation for Village health teams.

o Training of health workers in Comprehensive HIV/AIDS management(Care and treatment)

Carry out support supervision and monitoring of project activities through

o Field supervision visits,

o Support interpretation of data and use for program improvement

o Monthly review meetings for RPMs

o Quarterly review meetings for supervisors and field teams

o Review meetings (DHT, ICOBI, and CDC).

o Sharing reports with stakeholders

Introduction

In July 2008, Integrated Community Based Initiatives (ICOBI) an Indigenous Organization received funding from CDC/PEPFAR to implement a Full Access Home Based HIV Counseling and Testing(HBHCT) and provision of basic care project in six central districts of the Republic of Uganda in five years(1st July 2008- 30th June 2013). HBHCT project provides 100% Full access Home Based HIV Counseling and testing services to all adults(>14 years) and at risk children residing in the six districts of Mubende, Mityana, Luwero, Nakaseke, Nakasongola and Wakiso. Currently it has scaled up project activities from Mubende and Mityana districts to other two districts of Nakasongola and Luwero.

In addition the project provides preventive basic care and support to all identified HIV infected individuals and their families through an established referral process to health units (both public and private), support organisations like TASO and post test clubs in communities. The clients are visited in homes by basic care officers, health workers, counselors and volunteers called resident parish mobilizers (RPMs).

During the period from April-June 2009, we visited 18,817 Households, 36,653 individuals were counselled and tested for HIV and given results at home, 12,000 individuals counselled and tested as couples; overall identified 1,816 individuals were HIV infected and all were referred for care and 631 reached the health units and were assessed and initiated on Cotrimoxazole prophylaxis. 1,349 individuals with Abstinence only message in schools and 10,472 individuals with AB messages both in schools (private) and communities through outreaches by community educators, 57 condom outlets established in parishes by the counseling and testing teams and 22,780 pieces of condoms were distributed. The project intervention activities to be implemented with funds provided under this budget code will cover the districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso districts of Central Region of Uganda.

Types of HIV care and support services: HIV infection prevalence in the districts of Mubende and Mityana is on average about 5-6%. We shall scale HBHCT implementation to all the six districts during FY2010. We will identify about 7,500 HIV infected people while implementing HBHCT in 46 service outlets. ICOBI through collaboration with the district health systems and other service providers will provide preventive basic care and support to all identified HIV infected individuals and their families. HIV care and support services include; Procurement and distribution of starter kits(each containing safe water vessel,ITNs,Condoms,water guard solution to treat water, information in local languages to support use by the client),supply of Cotrimoxazole tablets to health units, initiation, formation and support of existing Post test clubs/PTCs, home visits and follow up of PLHIV and support of a network of volunteers like peer educators, model couples,RPMs,CDOs in care.

Working closely with the RPMs, VHTs and health units (levels 2, 3, 4 and hospitals) the project basic care officers deliver Basic Care Kits to the infected individuals at parish level through Post Test Clubs and health units. So far PACE has provided about 300 basic care kits that have been distributed to HIV infected clients in homes and are being used by families. The PLHIV families have been supported by RPMs and members of post test clubs through demonstrations on the use of commodities and actual hanging of mosquito nets in orphan PLHIV homes and elderly care givers

Cotrimoxazole supplementation to the health units: ICOBI supplements the health units with Cotrimoxazole tablets (CTX) to ensure CTX is available at health units for all the referred by the HBHCT teams from homes. Since March 2009; 300 x 1,000 CTX tablets have been supplied to 25 health units in Mubende district and Mityana. All the HIV infected clients (HIV+/PLHIV) identified will be referred by the HIV Counseling and Testing teams with referral chits/letters to health centres and hospitals to be assessed for eligibility and initiation of Cotrimoxazole prophylaxis,TB screening and treatment of OIs within each of the project districts. We intend to work and supplement about 120 units with CTX in FY 2010. Similarly referred clients to health units will be referred to other support groups and individuals like PLHIV support net work agents (SNA) that exist in some of the project districts for additional psychosocial support by health workers and vice versa.

Strengthening health the health system

The DHOs office and DHT, health units used as referral points will be supported with a monthly stipend to support them as they provide care to referred clients at health units as well as making follow up visits in homes to provide home based care and supportive counseling. In order to ensure success, RPMs and all health workers in the project districts will be trained in the provision of the basic care package (130 HWs from Mubende and Mityana were trained) using a curriculum developed by CDC/MOH and more will be trained from other project districts, 65 health workers that include doctors and clinical officers will be trained in comprehensive HIV/AIDs management and treatment. The above trainings will ensure availability of staff in health units to receive and provide basic care to the referred clients In order to ensure that the HIV+ receive basic health care, priority is given to collaboration and strengthening of the Mubende,Mityana,Nakasongola, Wakiso, Luwero and Nakaseke districts health systems. The health system in the six districts will be supported and strengthened to be able to receive and care for HIV-infected people. Specifically health units will be supplied with Cotrimoxazole and provided with the necessary infrastructure (e.g. renovations and remodeling of health units so as to create space for the increased numbers of clients visiting health units as a result of referrals by the project implementation in the districts.

Follow ups/Home visits: Collaborating with the health staffs, RPMs , basic care officers, HIV positive peers and model discordant couples the project conducts home visits to positive individuals, discordant couples, PMTCT mothers and bedridden clients for continued psychosocial and supportive counseling especially among the discordant couples. During the visits the following issues domestic violence, divorce and neglect as a result of positive results or discordance are attended to. Sometimes the issues are referred to the CDOs mandated with family and children issues and have been oriented on project activities and their roles. Additionally a range of health issues are discussed ranging from components of basic care, nutrition, family planning, PMTCT, early infant diagnosis, hygiene and making appropriate referrals depending on clients' preference.

Initiation, Formation and Expanding of existing of Post Test Clubs: As an effort to improve the quality of life of PLHIV identified by the project, efforts will be put in mobilizing them to join existing PTCs or form new ones at parish levels so as to promote disclosure among those testing as individuals to their families, to enhance health seeking behaviours, psychosocial support and ongoing peer counseling and support. When field teams test an individual positive s/he is counselled about the importance of disclosure to the family members, RPMs and to staffs at health units of referral. The same is done during the data dissemination meetings every after completion of a village/ cell. 30 new PTCs will be formed at parish levels where they do not exist. As positive individuals disclose to RPMs and the health units staff they are counselled on the importance of formation and joining post test and at times they are referred to existing PTCs. During PTCs meetings there is more information dissemination, education on HIV/AIDs, psychosocial support and member discuss life challenges and get solutions to them from their peers. PTCs are problem solving strategies to the subscribing members because it is in such meetings when they get life skills, livelihood skills and entrepreneurship skills from the already trained peers by the project or other organization working in the project areas like Mild may International, PREFA, NOPHOFANO, NIFEAD and others. All PTCs will be supported by CDOs in respective sub counties to register as and be recognized as CBOs or support groups which will be linked to other services in the districts in future. So far 10 PTCs have been formed with an enrolment of HIV positive members 230 tested by the program.

In addition, PLHIV clients will be given additional psychosocial support by health workers, basic care assistants, and counselor supervisors during follow up visits and ongoing counseling and support will be given by RPMs to those who will have disclosed to them.

Home based care is provided during follow up visits of infected clients by health workers, basic care officers and resident parish Mobilisers (RPMs).

Coverage in the geographical area: HIV care and support services are currently provided in Mityana and Mubende and will be scaled to include all six central district of; Luwero, Nakasongola, Nakaseke and Wakiso and basic care services target all adults and children identified HIV positive during HBHCT in homes by field CT teams. We shall provide basic care to about 3,000 PLHIV and this will contribute to country and PEPFAR targets for care in FY 2010.

Client retention and referrals: HIV positive individuals from homes are referred to health units for treatment and care, however after medical assessment and treatment at the health units, health workers may refer to community support groups (PTC) at parish levels for continued psycho social and sustained follow up support by peers, health workers, RPMs, basic care officers, counselors and community educators, peer counseling, on CTX adherence, income generating activities, training in legal and clients rights plus positive living. Specifically follow up and support of clients in homes will be intensified by health workers and basic care assistants as well as RPMs to ensure retention.

Linkages between program sites with other HIV care, treatment and prevention sites within jurisdiction and linkages and /or referrals between programs sites and non-HIV specific sites(at minimum food support,IGA,RH/FP and PLHIV support groups): The project refers positive individuals from homes to health units for CTX prophylaxis, TB screening and diagnosis, pre-ART assessment (CD4 counts) to accredited centers in districts where blood can be drawn for CD4 counts, initiation on ART and treatment of OIs. The project also refers to other centers like Mild may in Mityana/Mityana hospital and JCRC for specialized HIV pediatric care .The project networks with other organization and faith based institutions for spiritual needs of clients, OVC support ( Kiyinda diocese ) in Mityana , Minnesota International for Family Planning needs and OVC support, ACTION AID in providing legal support in issues of in heritance in Mubende district, NOPHOFANO in income generating activities in Mityana and government programs such as NAADS and SACCOs in agriculture and microfinance services to individuals living with HIV/AIDS. The above is coupled with establishment and strengthening of community support groups (PTCs) for clients' psycho social support at parish levels in all the six districts. We hope to reach out to other service providers in communities and district as project implementation evolves.

Methods of program monitoring and evaluations, monitoring the quality of care and support services: The project utilizes CTX registers and cards, TB registers, pre ART registers and ART registers at the health units to access the number of successful referrals and services given to these clients. Successful referrals and services received from health units are monitored at referral points mostly Health centers 2, 3, 4 levels by health workers and basic care assistants who also do follow up through home visits and are supported by RPMs. Also monitored are the clients mobilized to join the existing support groups or new ones formed in the communities/ parish levels for purposes of psychosocial support and ongoing peer counseling by members.

The above is coupled with support supervision from the district health offices in the various districts and the health sub districts to lower health units plus field visits to homes of beneficiaries by CDC technical team and other stakeholders. Follow up visits by implementers like BCOs, RPMs and health workers. The project also uses daily activity reports, weekly reports, monthly reports, quarterly, bi annual and annual reports coupled with monthly review meetings with RPMs, quarterly review meetings with health staffs, review meetings with field staffs and weekly supervisors meeting at the district

level to assess the progress of the project towards realization of objectives and goal. There are no planned evaluations or studies for the adult care and treatment component of the project.

Funding under budget code HBHC(adult care and support): The funds under this activity will be used for procurement of commodities like basic care kits to ensure availability of preventive basic care package all the time to PLHIV clients, Cotrimoxazole, training of health workers in caring for the HIV positive and for supporting the districts' healthy system in handling and tracking the HIV+ referred, follow up and home visits to the clients started/ enrolled in chronic care, supporting establishment and meetings of post test clubs in parishes, re-training of basic care officers, community educators, RPMs and VHTs in basic care provision, follow up clients in homes by health workers, staff salaries, stipend to health units , community development officers etc.

Introduction : In July 2008, Integrated Community Based Initiatives (ICOBI) an Indigenous Organization received funding from CDC/PEPFAR to implement a Full Access Home Based HIV Counseling and Testing(HBHCT) and provision of basic care project in six central districts of the Republic of Uganda in five years(1st July 2008- 30th June 2013). The project integrates four components namely HCT, Basic care, sexual prevention (AB and other prevention options) and TB/HIV. HBHCT project provides 100% Full access Home Based HIV Counseling and testing services to all adults and at risk children residing in the six districts. Currently it has scaled up project activities from Mubende and Mityana districts to other two districts of Nakasongola and Luwero.

During the period from April-June 2009, HBHCT project implementation focused on HCT in homes, HIV/AIDS prevention activities, by collaborating with district health systems and other service providers, Care and support of identified HIV infected clients and we reached 18,817 Households, 36,653 counselled and tested for HIV and given results at home, 12,000 individuals counselled and tested as couples; overall identified 1,816 individuals were HIV infected and all were referred for care and 631 reached the health units and were assessed and initiated on Cotrimoxazole prophylaxis. 1,349 individuals with Abstinence only message in schools and 10,472 individuals with AB messages both in schools (private) and communities through outreaches by community educators, 57 condom outlets established in parishes by the counseling and testing teams and 22,780 pieces of condoms were distributed. The project intervention activities to be implemented with funds provided under this budget code will cover the districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso districts of Central Region of Uganda.

Location and Coverage: During the period 1st October 2009- 30th September 2010; Home Based HIV Counseling and Testing project (HBHCT) implementation will be in the districts of Mubende, Mityana, Luwero and Nakaseke, Nakasongola and Wakiso. HBHCT (provider initiated) will be offered to the following principal target populations: adults above 14 years of age and all children at risk of HIV infection [e.g. mother HIV+ or mother suspected to have died of AIDS related illness]) in the six districts.

The six districts have 75 sub counties; Mubende (15), Mityana (9), Luwero (13) and Nakaseke (9), Nakasongola (9) and Wakiso (20). The project service outlet will be a sub county. HBHCT will be implemented in about 46 service outlets/sub counties. We will offer HBHCT to 150,000 individuals adults (>14 years) and children at risk of HIV infection (e.g. mother HIV positive) at home and provide them with same day HIV test results at home. 20,000 couples (40,000 individuals) will be among those offered HBHCT. 7,500 HIV infected individuals will be identified. In the covered areas proportion of eligible people for HCT who will have accessed and known their HIV status will increase from as low as 20% to above 80%.

Promotional activities to react the target population: The promotional activities include meetings with the District Health Management teams (DHMT) for each of the districts. We hold sensitization meetings/workshops in a decentralised manner from district, Sub County, parish and communities and villages. All the meetings involve stakeholders from local, political, civic/religious, cultural leaders, health workers, community workers and organisations implementing HIV/AIDS interventions. Communities are involved in selecting parish representatives called resident parish mobilisers (RPMs) who continuously hold community meetings for the purposes of creating awareness and sustain community mobilisation and they are supported by an extensive community mobilisation, sensitization and education efforts through a weekly radio talk shows, radio spots, health talks by DHOs, announcements of field team visits to communities aired on local FM stations in the program districts. Other informal activities like music, dance and drama shows, games and sports competitions will continue to be used to promote program activities. The RPM is supported by Village health teams (VHT) in some districts where the structure is established. The program activities are further promoted in the households and communities as RPMs map households including listing of the household residents in each of the villages and later compiling a parish register to be referred to and used by CT teams during HBHCT implementation. Once HBHCT has started in the communities' beneficiaries of the service in homes promote the activities through testimonies and eventually this translates to increase up take of HCT and other care services in homes, special events, like youth camps are also used to give prevention messages. Across the six program districts a project launch was held in April 2009 as an important promotional activity for the program in the beneficiary districts.

Activities for support supervision, quality assurance, M+E: The CT teams responsible for HCT in homes are supported through field visits by counselor supervisors, laboratory supervisors, data officers and occasionally by the monitoring and evaluation officer at least twice a month for each team. The teams are also supported by community educators, basic care officers and health workers from sub county level health units. All the staff especially supervisors had an integrated training in HBHCT. The RPMs are supported by community educators, basic care officers and health workers who from time to time attend to their activities as they map out households and carry community education activities in villages including follow up of clients in homes. The community educators ensure that the mapping has been completed in each village before the teams are deployed to carry out HBHCT in homes. On the converse the RPMs, VHTs, local councils and residents support the CT teams as they lead them from door-door while implementing HBHCT in homes.

The laboratory supervisors support CT teams to observe standard operating procedures (SOPS) as they do HIV testing in homes as well as ensuring proper waste management. The laboratory supervisors also ensure that quality dried blood spots(DBS) are collected and labelled from the 20th HIV negative clients in the negative series by each team and all HIV positive clients and later shipped for re testing at UVRI/HRL/CDC Entebbe.

Similarly the counselor supervisors use the quality assurance guide/ check list so as to support CT teams and counselors self assessment of HBHCT sessions guide is also used to ensure the quality of counseling in homes. Client satisfaction assessments are done by supervisors, as well as assessing the competence and confidence of the field CT teams in addressing issues and concerns that arise during the counselling session and dialogue. Proficiency assessments using a guide/check list about the quality of HIV testing by the field CT teams are done during joint supportive supervision with the district laboratory supervisors. Furthermore, through collaboration health workers have started supporting the CT teams in homes as part of supportive supervision of health activities in their areas of jurisdiction.

The data officers, M+E officer supports the CT teams in data collection of all variables on the HCT card and eventually submitted for data entry, processing, analysis, reporting and dissemination of lessons learnt as well as decision making to improve program implementation.

The project monitoring plan has set targets that are periodically monitored against actual achievements on a monthly, quarterly, semi-annual and annually basis. The program activities will be monitored with stakeholders during review meeting at community, service outlet level (quarterly) ,districts by DHMTs as well as reporting on National indicators to Ministry of Health through the district health services departments and PEPFAR indicators through semi-annual and annual reporting/MEEPP. The district level output indicators monitored in this project are also in line with the national performance measurement and management plan and this is aggregated data from all service outlets in each of the project districts and is reported to the respective district health officers on a monthly basis. The DHOs eventually report through the HMIS to MOH.

HBHCT is a provider initiated intervention in homes. However, individual, Couple, group, peer counseling in HIV discordance relationship, children and crisis counseling happen in homes. 46 outreach teams (each consisting of a counselor and laboratory assistant) trained in HBHCT implementation by TASO/SCOT and are currently implementing HBHCT in homes in two districts of Mubende (15 service outlets/sub counties) and Mityana (9 service outlets/sub counties), during the period 1st October 2009- 30th September 2010; HBHCT implementation will be scaled to 46 service outlets in the six district. The teams move systematically from door-door guided by RPM, VHTs or other volunteers. CT teams educate household members present about HIV/AIDS. Consenting eligible household members will be tested for HIV results given after post test counseling. HIV infected clients will all be referred to health units offering basic care services that include Cotrimoxazole prophylaxis, TB screening, pre-ART assessment.

HIV testing algorithm used: All CT teams do pre-test HIV Counseling for the eligible clients identified after health education and listing of household members, consenting individuals and couples are tested for HIV using the National approved testing algorithm, serial that include determine for screening, stat pak for confirmation and unigold as a tie breaker. Same day HIV test results are given to individuals and couples after post-test counseling. While CT teams are in homes individual specific data is collected on a standardised HCT Card approved by Ministry of Health (MOH).

Assessment of the performance in ensuring effective referrals and linkages to care, treatment, and prevention services: About 7,500 HIV infected clients will be identified by the project and all will be referred to health units mostly for Cotrimoxazole prophylaxis, TB screening/examination of those with a chronic cough to enhance TB case finding and treatment of opportunistic infections. Successful referrals are monitored at referral points mostly at health centres 2, 3, 4 levels by health workers and basic care assistants who also do follow up through home visits and are supported by resident parish mobilisers. The HIV infected are supported by CT teams and basic care officers who help them to disclose and this improves on their health seeking behaviours, clients will be mobilised/referred to existing support groups or new ones will be formed at parish levels for purposes of psychosocial support as well as positive prevention interventions like peer counseling by members. The members joining post test groups, adhering to Cotrimoxazole and treatment of opportunistic infections will be monitored at both the referral points; health units and in their respective communities or homes during follow up visits.

The funding under this budget code will go specifically to support the procurement of HIV test kits, related consumables and materials, payment of staff salaries, providing logistics for home-based counseling and testing, re-training of staff 46 counselors and 46 laboratory assistants, 4 counselor and 4 laboratory supervisors, 4 community educators, 4 basic care assistants and 1 M+E officer and 4 data clerks in HIV counseling and testing and provision of basic care including data collection and management. 350 RPMs will also receive re-orientation and training using a tailored curriculum as assistant counselors. About 200 health workers will also be oriented on HBHCT and basic care provision for the HIV infected and 600 village health teams/local councils will be oriented on HBHCT, supporting health units and for community education and mobilization.

Introduction:

In July 2008, Integrated Community Based Initiatives (ICOBI) an Indigenous Organization received funding from CDC/PEPFAR to implement a Full Access Home Based HIV Counseling and Testing(HBHCT) and provision of basic care project in six central districts of the Republic of Uganda in five years(1st July 2008- 30th June 2013). The project integrates four components namely HCT, Basic care, sexual prevention (AB) and other prevention options) and TB/HIV. HBHCT project provides 100% Full access Home Based HIV Counseling and testing services to all adults and at risk children residing in the six districts. Currently it has scaled up project activities from Mubende and Mityana districts to other two districts of Nakasongola and Luwero.

During the period from April-June 2009, HBHCT project implementation focused on HCT in homes, HIV/AIDS prevention activities, by collaborating with district health systems and other service providers, Care and support of identified HIV infected clients and we reached 18,817 Households, 36,653 counselled and tested for HIV and given results at home, 12,000 individuals counselled and tested as couples; overall identified 1,816 individuals were HIV infected and all were referred for care and 631 reached the health units and were assessed and initiated on Cotrimoxazole prophylaxis. 1,349 individuals with Abstinence only message in schools and 10,472 individuals with AB messages both in schools (private) and communities through outreaches by community educators, 57 condom outlets established in parishes by the counseling and testing teams and 22,780 pieces of condoms were distributed. The project intervention activities to be implemented with funds provided under this budget code will cover the districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso districts of Central Region of Uganda.

Mechanism target population and contribution to scaling up pediatric participation in treatment programs, including pediatric targets:

During HBHCT activities in the homes, pregnant mothers are offered HBHCT and identified HIV infected mothers are referred to health center 3, 4 and hospitals for preventive services provided by PMTCT programs by respective district health systems and other providers. HIV positive children above 18 months are referred to JCRC where there is free HIV/AIDS pediatric care. The prevalence of HIV infection in the Central region/districts of Mubende and Mityana is about 5-6%. During the period between 1st October 2009- 30th September 2010, we hope to counsel and test about 150,000(adults and children), We estimate about 15,000 shall be children below 14 years who will have been tested by the project and 5% of these about 750 HIV infected children with will be identified during HBHCT in the six districts by the counseling and testing teams. We shall also identify about 100 HIV infected pregnant and breast feeding mothers who will be referred and about 200 infants and children born to HIV infected mothers (HIV exposed children) of six weeks to 18 months will also be identified during HBHCT in the six districts. The HIV counseling and Testing teams ,basic care teams collect blood samples from the children (6 months -> 2 years)and submit them to DHOs to be shipped to centers carrying out HIV DNA PCR virologic tests like JCRC to confirm HIV infectivity (enhance early infant diagnosis). All HIV exposed children <2 years (parents and care givers) are referred to health units for immunization updates as well as growth development, nutrition counseling, promotion and monitoring. The children > 2years to 14 years born to HIV infected mothers or any other potential risk of HIV infection identified are offered HIV counseling and tested (consent from guardian or parent) using the serial(three tier) test algorithm. All identified HIV exposed infants(< 18 months) during HBHCT in homes will have an EID dried blood spot sample taken, prepared and submitted to district health officers to be submitted to the Joint Clinical Research centre(JCRC) as a district batch. However we have had recently challenges of having no feed back to what came out of the tests for the samples submitted to the district. All the 46 teams and health workers trained in basic care have had training in EID sample collection by JCRC.

ICOBI counseling and testing teams will refer all children infected with HIV using referral forms to health units(hospitals and health center 4) and service providers offering pediatric HIV care and treatment and the referral centers for pediatric care and treatment. Pediatric care and treatment is offered at ART accredited centres that include hospitals and health center 4s in the districts. Notable is JCRC sites that continue to offer these services free. In the six districts the services are offered at about 10 centers (both public and private).other samples are collected from health units by midwives and nurses for those who deliver in health units and the samples are submitted as a district batch. PMTCT activities in the districts of Mubende and Mityana are supported by PREFA. The process is supported by basic care officers (BCO) with collaboration of health workers when results come back and a dialogue is held depending on result outcome plus risk reduction plans in cases of breast feeding mothers. There is continued follow up in homes by the BCO teams for more psychosocial support to the parents and treatment adherence for those positive children.

Activities that provide drugs, food and other commodities for pediatric clients: The project uses the networking and referral mechanism to ensure a holistic approach to the HIV pediatric care. Here the project refers to known pediatric centers like JCRC and Mild may for medical, food and other commodities in pediatric care in all the two districts. Through post test club meetings, home visits by the basic care team, and Peer educators; nutrition in HIV infection is emphasized and parents/ care takers of this children are linked to existing programs like NAADS programs and the USAID LEAD project and other food relief agencies to be able to able to produce enough and quality foods using affordable technologies and usual local food stuff to prepare nutritious recipes for the pediatric HIV infected children for sustainability purposes. The pediatric age group is also provided with basic care commodities in the starter kit as well as initiation and maintenance on Cotrimoxazole prophylaxis.

Activities for supervision, improved quality of care and strengthening of health services: Routine supervision from the district teams and health sub districts is done to health centers doing pediatric care centers where we refer the children. The above is coupled with the routine procedures in maternal and child health/pediatric clinics i.e. temperature taking and weighing to assess weight gain and if not to find out the cause and possible solutions and this is done together with the children guidelines. The above is coupled with routine support visits to children's family home by the basic care team, health staffs RPMs and Peer Educators. During review meetings there is experience sharing and adaptation of acceptable good practices to improve the quality of care to pediatrics.

In order to ensure success in pediatric care, health workers (doctors, midwives, nurses, health educators etc) at health center 4 and hospital level and all HBHCT counselors and laboratory assistants will be trained in pediatric HIV care and treatment, pediatric HIV counseling and psychosocial support, infant feeding counseling for the HIV positive children, nutritional counseling and feeding options for the children to caregivers and orientation of all RPMS on infant feeding for the HIV positive children.

Furthermore to ensure that the HIV+ children receive pediatric care and treatment; priority is given to collaboration with other institutions offering pediatric care like JCRC that can provide services related to ART eligibility assessment free, PREFA which is offering PMTCT preventive services in the districts, OVC programs and strengthening of the Mubende, Mityana, Luwero, Nakasongola, Wakiso and Nakaseke districts health systems at hospital level and health center levels. The health system hospitals and health center 4 levels will be strengthened to be able to receive and care for HIV-infected children. Specifically health units will be supplied with Cotrimoxazole syrup and tablet forms appropriate for the HIV infected children and provided with the necessary infrastructure (e.g. renovations and remodeling of health units so as to create space for the increase in numbers of clients visiting hospitals and sub district hospitals that are approved to offer pediatric care and treatment (ART),within in the districts and logistics (stipend for staff) to handle the HV+ infected children as well as carrying out home visits to families of HIV infected children to provide psychosocial support to both the children ,mothers/,caregivers and family. The health system hospitals and health center 4 levels will be strengthened to be able to receive and care for HIV-infected children. Specifically health units will be supplied with Cotrimoxazole syrup and tablet forms appropriate for the HIV infected children and provided with the necessary infrastructure (e.g. renovations and remodeling of health units so as to create space for the increase in numbers of clients visiting hospitals and sub district hospitals that are approved to offer pediatric care and treatment (ART),within in the districts and logistics (stipend for staff) to handle the HV+ infected children as well as carrying out home visits to families of HIV infected children to provide psychosocial support to both the children ,mothers/,caregivers and family.

Activities promoting integration of routine pediatric care, nutrition services and maternal health services: During HBHCT activities, both positive and negative pregnant mothers are referred for antenatal services to the health units. At the health units' tetanus immunization, intermitted preservative treatment of malaria to pregnant mothers in the second and third trimester, family planning, screening and treatment of STDs, breast feeding and alternative options to PMTCT mothers, nutrition for pregnant mothers, child nutrition activities and referral for TB screening, iron supplementation, weighing and general examination of mothers plus the routine immunization, deworming and weighing of children to access their growth and development is done. Vitamin A supplementation and provision of mosquito nets to infants and their mothers is also done. The above is supplemented by home visits specifically to PMTCT mothers and their babies to give more support and exploring different options depending on client's requirement. It's during such visits that DBS for early infant diagnosis is done by the basic care team or midwives if it was not at the health units. The pediatric activities need to be integrated e.g. for example during immunization days mothers can access HCT for themselves and their infants and health workers can take of DBS for the HIV exposed infants as well.

In addition, all the identified HIV positives (HIV infected children inclusive) will receive basic care commodities from health centers (4, 3, & 2) and will be initiated on Cotrimoxazole prophylaxis. Homes and families of HIV infected will have follow up visits by the community volunteers called Resident parish Mobilisers (RPMs) to provide supportive counseling, demonstration on use of preventive basic care commodities.

Activities to strengthen laboratory support and diagnostics for pediatric clients: Health units especially health center 111s with no functional laboratories shall be equipped with Binocular Microscopes and calorimeters to start TB screening and other OIs diagnosis for quality management of pediatric clients and to access hemoglobin levels so as to enhance care for children and subsequent referrals for further management. .

The funds under this activity will be used for procurement of commodities, community mobilization and sensitization of parental groups, training of health workers ,HBHCT counselors and laboratory assistants, community volunteers in pediatric counseling, home care for the HIV positive children and for supporting the districts' healthy system in handling and tracking the HIV+ children referred for care

Introduction: In July 2008, Integrated Community Based Initiatives (ICOBI) an Indigenous Organization received funding from PEPFAR through CDC/ to implement a Provision Full Access Home Based HIV Counseling and Testing(HBHCT) and basic care project in six central districts of the Republic of Uganda for five years(1st July 2008- 30th June 2013). HBHCT project provides 100% Full Access Home Based HIV Counseling and testing services to all adults and at risk children residing in the six districts. Currently it has scaled up project activities to other two districts of Nakasongola and Luwero in addition to Mubende and Mityana districts. In addition the project provides preventive basic care and support to all identified HIV infected individuals and their families. During implementation of HBHCT in homes prevention strategies are discussed with a focus on communicating appropriate information to individuals, couples and children. Sexual prevention (AB) and other prevention (OP) options components of the project will aim to reach about 75,000 adults and youth through various strategies. During the period from April-June 2009, we reached 1,349 individuals with Abstinence message in schools and 10,472 individuals with AB messages both in schools and communities through outreaches by community educators, 57 condom outlets established in parishes by the counseling and testing teams and 22,780 pieces of condoms were distributed. The project intervention activities to be implemented with funds provided under this budget code will cover the districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso districts of Central Region of Uganda.

Populations that will be targeted: Females and Males in the age groups of 10-14 years, 15-24 years and above 25 years in about 300 parishes in the districts of Mubende, Mityana, Luwero, Nakasongola and Nakaseke will be reached. The population in the age group 15-24 year some of them are married/sexually active, adults(mostly 25 years and above of age are in marriage (couples), single(out of school or in school), and those in long sexual relationships/partnerships who do not know their HIV status, discordant couples all targeted with sexual prevention(AB) interventions

Description of interventions specific for each target population:

10-14 years age group (Male and Female): This age group faces biological changes in their bodies and predisposes the group to risky behaviors that include pre-marital sex (casual sex) including cross-generational sex with sugar daddies/mummies, boda-boda cyclists in exchange for petty things like a ride to school, pocket money cell phones/airtime and the desire to look like other peers from well to do families and sex as a result of drug abuse. The above something for something "love" behaviors put this age group at risk of acquiring the STIs and HIV infection. This age group is found both in school and out of school. This group will be targeted with Abstinence messages only and skills development. In schools we shall only target private schools (secondary) in each of the sub counties in project districts. Out of schools children will mobilized by peers collaborating with RPMs using the Home Based HIV Counseling Testing parish registers (census). We shall hold sessions for out of schools in small groups of 10 people in about 500 villages thus reaching more than 5,000 persons in the age category.

Out of school youth(10-24 years, Male and Female):

Out of school youth will be reached through community meetings by organizing youth friendly activities where they can convene, enjoy and participate in dialogue sessions with their peers trained in HIV prevention. The activities will involve sports(football and net ball competitions with a related theme either A only or AB focus, film shows/video shows on abstinence, debates on abstinence using trigger videos and testimonies, focused group discussions on abstinence, drama/dance competitions on the role of abstinence in HIV prevention among the age categories at parish levels. We shall reach about 5,000 people with AB messages in the communities.

In school youth(14-24 years, Male and Female) : The above categories constitute the young people (mostly in schools) and are more vulnerable to acquiring STI/HIV infection as they usually succumb to various challenges related to sexuality. This age category will be reached during the school calendar and we shall target 74 private schools (secondary) of age group 14-24 years old. The strategy here is to hold interclass debates on the roles of abstinence and being faithful(AB) in HIV prevention, identification of peers and training peers, inter-house(club) debates, competitions in music dance and drama (scripts on HIV prevention from MOH resource Center),film shows(10 per district at selected schools), netball( 30)and football(30) competitions as well as students radio modulated programs on abstinence and Be faithful. We shall reach 5,000 school going children in private secondary schools in the six project districts.

Providing life skills building and development among these age groups gives them resilience amidst sexual desire, peer pressure, temptations from sugar daddies and mummies so as to focus on their pre determined objectives of completing studies and getting married at the right age. Such life skill helps in HIV sexual prevention in this age category.

Secondly when peers are identified and trained among them in communication of abstinence messages, it has a multiplier effect in that they go on telling the same to other peers thus causing behavior change among the age group. Thirdly peers understand and listen more from their peers as compared when they will be communicated to by other people of different age groups like adults. Activities like films, music, sports that have high appeal among the age group help this age category to perceive and internalize better the advantages of abstinence and the disadvantages of early sexual intercourse, share life experiences thus delaying their indulgence in sexual activities sustains increased age of sexual debut and eventually reducing on the risk of STIs/ HIV transmission

25 years of age and above (adults): Both females and males in this category will be reached through community outreaches. Mainly this will be by holding formal and informal community meeting e.g. during gatherings like parties, church services, women groups/ councils and other associations in the communities. Activities like video shows, sports, music dance and drama will be used to mobilize people and in small group's discussion will be held and focused messages communicated. The strategy will facilitate us to reach about 10, 000 with AB messages. In addition using model couples(50) to be identified one per sub county, trained in Be faithful and Couple counseling and trained in model couple counseling will hold couple sessions or family dialogue sessions (4 sessions per month) to promote HCT for couples and sustain B message communication in the program areas through reaching 5,000 individuals among couples. Model couples training (Manuals for training model couple counselors will be used) in peer education and communication will sustain AB messages in the general population.

Drivers for the epidemic targeted:

The above interventions will address factors related to drivers of the epidemic among the targeted population age groups in different settings mentioned above. These include; Individual behaviors contributing to increased risk of sexual transmission (early age at sexual debut, casual sex, and poor health seeking behaviors for STIs among young people etc), knowledge about their HIV status, STI/HIV and where to seek services like HBHCT, poverty (predisposes to transactional sex), Gender issues related to sexual violence, rape, inability to negotiate for safer sex, lack of skills to use protective options during sex, coerced sex etc. locations e.g. in urban, peri -urban ,rural areas, in school/institutions that increases their vulnerability to acquiring STIs/HIV infection including early pregnancies.

Geographical and population coverage:

All targeted age groups of both females and males of age categories 10-14 years, 15-24 years and above 25 years will be reached with AB messages in about 300 parishes in the districts of Mubende, Mityana, Luwero, Nakasongola, Wakiso and Nakaseke(6 districts). In school (74 private schools[2 schools per sub county]) and 300 parishes (community outreaches) using debates, FGDs, film shows, music, sports, dance and drama we shall reach 10,000 and out of school in parishes about 30,000 and using model couples we shall reach 5,000. In total we shall reach 45,000 individuals with AB messages during COP 2010.

Mechanisms to promote Quality Assurance: During implementation of HIV prevention activities the project we use the ABC guide lines by Ministry of Health to ensure quality of messages communicated thus leading to quality results and communicating relevant information to the targeted age groups. The messages will be communicated in small groups. Standardized materials for HIV prevention relevant to age categories will be used (IEC materials production, material interpretation, training and dissemination plus support supervision) will be done in conjunction with reputable organizations in communication strategies under the guidance of MOH. The sessions will be supported by health workers and district health educators, community educators/trainers and community development officers in respective sub counties and districts. We shall ensure there is no double counting, through data quality checks and validation using our community/parish registers for HBHCT as our reference to ensure right age category is focused on.

Linkages to other services:

We build net works with other service providers to efficiently reach the target audiences. There are various CBOs with funding from CSF fund (PEPFAR) who are carrying out various prevention interventions in the program districts at parish and sub counties e. g NFED is working with youth and communities in Bulera and Busimbi sub counties in Mityana and these areas are not sub counties of our prevention interventions during COP 2010. Similarly for other districts we shall avoid overlap of our interventions as we use scarce resources. However, we integrate HIV prevention messages during household education and risk reduction session to clients in homes during HBHCT by CT teams and RPMs during mobilization of communities although our primary intentions in homes are to do HCT. Other linkages are with Government health units for STI management, PNFPs for HCT for the youth, OVC support organizations, Government programs e.g. NAADS, UPE, USE and SACCOs, religious denomination to sustain the AB interventions among their folks, businesses like hotels and bars are being used as condom distribution outlets, community support groups (PTCs) for continuing psycho social support, preventive counseling and improved health seeking behaviors among PLHIV, care, treatment and support centers.

Monitoring and Evaluation plan: Project progress and evaluation will be monitored through daily activity reports, weekly reports, monthly reports, and monthly and quarterly review meetings with RPMs, health educators, health workers, school administrators, community leaders, beneficiaries' youth, couples and adults, CBOs implementing HIV prevention interventions, semi-annual and annual reports to District officials, standardized indicators according to national performance and monitoring plan as well as CDC/PEPFAR indicators will be reported on to MOH and through MEEPP to PEPFAR. There is no evaluation studies planned under this project.

The funds under this budget code will be spent on paying staff salaries, community mobilization and Education (IEC), supporting radio program, development and adaptation of IEC/BCC materials, identification and training of model couples and peer educators, facilitating community educators, basic care officers, resident parish mobilizers,health workers, peer educators among the youth, counseling and testing teams to carry out family dialogue and community educations sessions to emphasize AB messages among targeted age categories of people.

Introduction In July 2008, Integrated Community Based Initiatives (ICOBI) an Indigenous Organization received funding from PEPFAR through CDC/ to implement a Provision Full Access Home Based HIV Counseling and Testing(HBHCT) and basic care project in six central districts of the Republic of Uganda for five years(1st July 2008- 30th June 2013). HBHCT project provides 100% Full Access Home Based HIV Counseling and testing services to all adults and at risk children residing in the six districts. Currently it has scaled up project activities to other two districts of Nakasongola and Luwero in addition to Mubende and Mityana districts. In addition the project provides preventive basic care and support to all identified HIV infected individuals and their families. During implementation of HBHCT in homes prevention strategies are discussed with a focus on communicating appropriate information to individuals, couples and children. Sexual prevention(AB) and other prevention(OP) options components of the project will aim to reach about 75,000 adults and youth through various strategies. During the period from April-June 2009, we reached 1,349 individuals with Abstinence message in schools and 10,472 individuals with AB messages both in schools and communities through outreaches by community educators, 57 condom outlets established in parishes by the counseling and testing teams and 22,780 pieces of condoms were distributed. The project intervention activities to be implemented with funds provided under this budget code will cover the districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso districts of Central Region of Uganda. Target population We shall target the following population groups with people of 15 and above years that will include both male and female. The groups to be targeted will include adults in marriage (couples) who do not know their HIV status, discordant couples, those in long term sexual relationships and high risk populations that will include uniformed men and women, like fishing communities(men and women), alcohol brewers and sellers, tea plantation workers, mine workers, market vendors, long distance truck drivers, construction(road) workers, boda- boda riders, gold miners in Mubende district, commercial sex workers in urban centers, Bar maids and hotel waiters, fish mongers and residents on Islands in Lake Wamala in Mityana and Lake Kyoga shores in Nakasongola districts and 7,500 PLHIV(individuals and HIV+ mothers) to be identified during HBHCT. More population groups will be identified in due course. In addition people tested as HIV negative will be supported to remain HIV negative by encouraging adoption of appropriate prevention behaviors; this will be through outreaches to communities where meetings will be held. The mobilization for the meetings will be by RPMs. Basis for selection, strategies and activities We have selected the mentioned categories of population groups basing the drivers to be addressed in the national response to the HIV epidemic and on the results from our HBHCT implementation in Mubende and Mityana districts. For example HIV prevalence is 10.2% among the market vendors. Specifically for other Prevention and condom distribution we shall use various strategies that will include Film shows that will be followed by health talks and behavioural change communication of preventive messages mainly to target out of school youth between 15-24 years of age and general population through outreaches and film staging. Music dance and drama; community groups like PTCs will be identified and scripts with specific prevention messages (already developed) will be in cooperated in relevant plays and songs to target audiences and will be performed at parish and sub county levels to sustain preventive messages and information dissemination among the population. Similar messages targeting the general population (those tested for HIV and those not) throughout the project implementation through a weekly radio talk show program. Sports that will include netball and football competitions will be organized to bring the youth and general population at half time there will be health talks by health educators and community educators to people especially the youth present. Market booth strategy at bi-monthly and monthly market venues to reach to market vendors with BCC messages including distribution and social marketing of HIV prevention options like condoms. Other population groups to be reached will include military populations and their families of Kabamba, Bombo and Nakasongola Barracks of about 20,000 men and women in Mubende, Luwero and Nakasongola districts respectively despite constraints to accessing their families in barracks environment, there has been sustained demand from the military populations to access project services like HCT, preventive basic care package, TB awareness and other available HIV prevention options.. Additionally the civilian populations use the military health establishment for their health service needs, others have had a great interaction with the project implementers like basic care assistants, community educators and field teams as well as interfacing with their post test clubs and drama groups that we are using in prevention activities and some of them have been enrolled as peers responsible for distributing condoms. Aside from the uniformed personnel, motorcycle (boda-boda) cyclists, long distance drivers, commercial sex workers in urban centers, widows and divorcees will be targeted and reached by identification and training of peer educators in HIV/AIDS prevention and care.

Peer identification, enrollment, orientation & training There are many at risk population groups and most of them hard to reach, our plan is to map the groups using RPMs and village health teams. High risk groups and their strategic sites where they congregate for leisure and targeted employment will be mapped. In order to effectively reach out to the target group, peer educators will be identified and enrolled from each of the category of the target population in the 46 sub counties. The enrolment of the peer educators will be a participatory process, different categories of the groups will meet and select their colleagues who will undergo training in peer education and will be responsible to carry a one- -one peer education and support to their groups. They will encourage their peers through focus group discussions to mobilize and participate in home based HIV counseling and testing during outreach visits by the counseling and testing teams in the target area/homes. Peers will be trained using a curriculum for peer educators by MOH. We will identify, enroll and train 300 adults and youth as peereducators and 50 model couples (1 per each sub county). We hope the 300 peer educators should be able to identify and induct others based at village level that will be able to interact on one to one in one year at about 10 individuals@ per month thus reaching about 30,000 individuals with abstinence and be faithful messages and behavioral change information. Prevention with positives among HIV infected individuals and discordant couples As part of positive prevention intervention and ongoing supportive counseling we will mainly target HIV infected individuals (7,500 HIV+ to be identified annually) e.g. couples with discordant results will be supported through prevention with positives activities to reduce transmission and other negative consequences such as marital separation and breakdown, domestic violence and neglect that may put the negative partners and others at risk of acquiring HIV infection. Peers among discordant couples who may be model couples will be identified and trained using model couple training manuals available and developed by USAID complemented with training materials for peer educators among positives (prevention with positives materials) from TASO/SCOT. About 50 discordant couples will be identified, recruited and trained as peer educators, condom distributors as well as reaching the couples with AB messages and behavior changes interventions. We shall identify discordant model couples and encourage establishment of discordant couple clubs that will be used in behavior change communications specifically the use of condoms in discordant relationships. There will be one discordant club per Sub County that will responsible in mobilizing and sensitizing communities about HBHCT, discordance and condom use. Similarly other high risk population groups that will be identified will be reached through identification and training of their peer educators among themselves. The peers through a one to one be able to discuss behavioral change interventions and options as well as life skills building among peers. Disclosure Tested individuals in the homes especially those diagnosed positives are encouraged to disclose to their immediate family members ,RPMs and to the health staffs at referral health units for treatment of OIs , care and support especially behavior change as regards to use of condoms. When individuals disclose to RPMs they are encouraged to join post test clubs at parish levels where issues of stigma and discrimination are addressed by the peers. We hope about 6,000 HIV+ individuals will have disclosed to at least a family member and are able to seek for basic care services. Condom Distribution The mobilization will be through the trained peer educators (model couples, expert clients among PLWHA, others depending on risk groups) who will assist in condom use promotion, education, demonstration, condom distribution and also in identifying community condom outlets. This will involve initially encouraging identified HIV infected clients to join existing post test clubs or form new post test clubs or expand the existing post test clubs in each parish. The PLHIV clients who will get the starter kits(contain packets of condoms as one of the commodities) already will have received and had demonstration on condom use by the health worker, basic care assistants, members of post test clubs and will be from time to time be supported by the Resident Parish Mobilisers (RPMs). This will provide an opportunity of using the RPMs or PTCs in parishes as supply points. Similarly other peers from any risk group will be given responsibility of supplying the condoms to their peers. At minimum we hope to open and establish condom supply points in each of the 500 parishes in the project six districts however during the period 2009-2010 we hope to establish about 300 condom distribution points. .Geographical /population coverage During COP 2010 we will reach 7,500 HIV infected individuals, about 500 discordant couples (HIV negative individuals among the discordant couples), 30,000 individuals among the high risk groups, and establishment of 300 condom distribution outlets (300 parishes in about 46 sub counties) in six districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso. Quality assurance During the implementation, the project will make use of standard national guidelines from the ACP/MOH and other reputable organizations in other preventions. Specifically the project will utilize ABC strategy and PMTCT guidelines by MOH during its implementation. During training of peer educators we shall use trainers from PACE, PREFA, TASO SCOT and MOH. Supportive supervision will routinely be performed by community educators, health workers, health educators and other trainers from NGOs and CBOs working with the beneficiary communities. Linkages to other services We build net works with other service providers throughout the project life. PMTCT interventions in districts; for example during HBHCT, pregnant mothers and those breast feeding mothers identified infected with HIV are counseled about PMTCT interventions and are referred to the nearest PMTCT sites of their choice. Early Infant Diagnosis to babies born to PMTCT mothers is done in conjunction with midwives in collaboration with health units' staff and basic care officers of the project. The DBS from this babies are collected and submitted to districts which latter submits to JCRC for a PCR DNA analysis. When the results come at times we delivered them to clients homes where other dialogues are held depending on the results out comes. Some other organizations already have peer educators working in the area OP and we have worked with them during their community outreaches as facilitators and similarly we shall tap their experiences as we implement. We are utilizing the project resources to be able to distribute condoms in hard to reach communities where other implementers have constraints in transport. We closely collaborate with Government health units to provide condoms for distribution by the HBHCT teams at the moment, FBOs/PNFPs, OVC support organizations, Government programs e.g. NAADS, USE and SACCOs, community support groups (PTCs) ,network support agents(NSA) who link the PLHIV with health units.

The funds for this activity will be spent mainly on paying staff salaries, allowances for peer educators, model couples, setting up of condom distribution outlets in locations of populations at risk e.g. urban centers like bars, disco halls, hotels etc, training of community condom distributors among the high risk population groups (300 peer educators) in communicating and demonstrating how to use condoms effectively to avoid HIV sexual transmission, distribution of condoms at community level and social marketing of condoms by peer educators in market places so as to reach to the vendors in market places by using the market booth strategy at monthly or bi monthly markets venues, hold peer modulated radio programs(20) and debates addressing factors that lead to high risk behaviors among young people and hold meetings for discordant couples and post test clubs to promote condom education(discuss health seeking behaviors) and distribution among faithful but discordant couples and high risk individuals, procurement, development and distribution of IEC/BCC materials. Health units in the implementation of this strategy. In an effort to implement this activity, RPMs whom the positives disclose to, will joins hands in implementations of this activity to deliver and demonstrate effective condom use to positives and discordants.

Introduction: In July 2008 Integrated Community Based Initiatives (ICOBI) an Indigenous Organization received funding from CDC/PEPFAR to implement a Full Access Home Based HIV Counseling and Testing(HBHCT) and provision of basic care project in six central districts of the Republic of Uganda in five years(1st July 2008- 30th June 2013). The project integrates four components namely HCT, Basic care, sexual prevention (AB and other prevention options) and TB/HIV. HBHCT project provides 100% Full access Home Based HIV Counseling and testing services to all adults and at risk children residing in the six districts. Currently it has scaled up project activities from Mubende and Mityana districts to other two districts of Nakasongola and Luwero. During the period from April-June 2009, HBHCT project implementation focused on HCT in homes, HIV/AIDS prevention activities, by collaborating with district health systems and other service providers, Care and support of identified HIV infected clients and we reached 18,817 Households, 36,653 counselled and tested for HIV and given results at home, 12,000 individuals counselled and tested as couples; overall identified 1,816 individuals were HIV infected and all were referred for care and 631 reached the health units and were assessed and initiated on Cotrimoxazole prophylaxis. 1,349 individuals with Abstinence only message in schools and 10,472 individuals with AB messages both in schools (private) and communities through outreaches by community educators, 57 condom outlets established in parishes by the counseling and testing teams and 22,780 pieces of condoms were distributed. The project intervention activities to be implemented with funds provided under this budget code will cover the districts of Mubende/Mityana, Luwero/Nakaseke, Nakasongola and Wakiso districts of Central Region of Uganda.

Alignment of partner activities with country policy: is the partner able to show that activities are aligned with host country national policies and strategic plans for TB and HIV: ICOBI will provide preventive basic care and support to all HIV infected individuals and their families ultimately this includes care for clients co infected with HIV/TB. The prevalence of HIV infection in the central region/districts of Mubende and Mityana is about 5-6%. During the period between 1st October 2009- 30th September 2010, we hope to identify 7,500 HIV infected people. All the HIV+ will be assessed and initiated on Cotrimoxazole prophylaxis, and will receive safe water vessels, water guard, and mosquito nets from public health units or delivered by ICOBI basic care officers and RPMs during their home visits. We will procure these commodities put them to referral centers/health units and the health workers will provide the HIV infected clients with basic care kits and Cotrimoxazole prophylaxis. With the clients referred from homes to the health units to receive basic care package commodities provides an important and unique linkage to offer TB screening and examination for the HIV infected clients during those visits to health units. Even at home level our CT teams are in position to use the MOH TB case finding tool to identify those who had had a cough >2 weeks and other signs that may point to TB infectivity. Similarly those living/in contacts with known pulmonary TB cases are referred to health units for TB screening and further examination (clinical assessment). TB activities are organized under the district TB and Leprosy supervisor assisted by the health assistants based at sub counties who link up to the communities and clients with the support of volunteers under the CB DOTs to the health units mostly health center 3 level.. The sub county health assistants, health workers, RPMs, Village health teams and Peer Educators, the basic care team does the follow up at homes to counsel on drug adherence and to ensure the implementation of CBDOTs at the community level and to do community sensitization meetings on TB transmission, treatment and prevention strategies in place. Coordination across partners: Does the partner activities ensure added value relative to other related partner activities that target similar technical and geographical areas The project uses a networking and referral mechanism to ensure a holistic approach to HIV/TB care. During the HBHCT in homes individual HIV+ clients are referred for TB screening and other assessments at health centers. Other needs ranging from OVCs support, IGAs, spiritual support and psycho social support or micro finance services and an appropriate referral is made. All TB activities in the district are coordinated under the TB/L supervisor. We have ensured coordination of the activities initially through training of health workers in basic care and TB/HIV was facilitated by TB/L supervisors. We have ensured that all health assistants are involved in all community activities by sharing information of suspected referred clients to health units and those who could be getting treatment from other units beyond the district to be included in the TB registers at sub county levels. HBHCT activities in homes and referral of HIV Infected initially with a chronic cough will enhance TB case detection rate in the district. With continued follow up of HIV positives by RPMs, Basic care officers and PTCs members will contribute to adherence and completion of TB drugs/treatment. This in long run will have an added value in prevention and control of TB in the general population. Human resource capacity and sustainability: How does the partner activity ensure that there are sufficient trained personnel to carry out proposed activities and sustain the program over time? Training health staffs and RPMS, Field Teams in Basic care delivery In conjunction with district health department, PACE, ICOBI more than 120 health workers were trained in Mubende and Mityana in basic care and TB/HIV infection and control was integrated in this training and more health workers will start training in comprehensive HIV/AIDS management and the training content has TB. All the field teams of counselors and laboratory assistants, supervisors, basic care officers, community educators and RPMs have had an orientation on TB/HIV co-infection. All have been creating awareness on TB/HIV infection explaining the relationship and the referral system related to the disease and where to seek TB screening and examination. In addition the field staffs, RPMs, Peer educators and health workers in basic care delivery components of Basic care because of their continued presence in the communities have an added advantage of engaging the community residents to actively participate in TB/HIV prevention and increase their knowledge on the relationship between TB and HIV which will in a long run increase utilization of TB/HIV services as well as increase in referrals of patients for TB and HIV. Training HIV/AIDS Comprehensive Management: Health workers (80) specifically registered nurses; clinical officers, registered midwives and medical officers from health centre 111 to Hospital are trained in comprehensive management of HIV/AIDS which includes adults and paediatrics care. This improves staffing levels at health units and the quality of care, thus ensuring sustainability of project activities. Training health workers and lab assistants in sputum examination so as to enhance TB screening and confirmation For increased detection of TB and early initiation of smear positive cases on treatment, laboratory personnel above shall be trained in quality TB screening and detection with support from the Ministry of Health and the various district health teams in the six districts. Equipping of health units with Microscopes and reagents Health units especially health centres 111s with no functional laboratories in sub counties with very high HIV prevalence shall be equipped to start TB screening and other OIs diagnosis to improve TB case detection and management among HIV infected clients. Monitoring and evaluation: Does the partner regularly review and report high quality data using the national TB and HIV M&E framework and tools to track progress towards stated objectives/targets? To what degree is the partner prepared to report on the revised TB/HIV indicators? The project implements TB/HIV activities in collaboration with health units. We only monitor referrals for TB screening who reach the health units and we tend to reach and support those who have not gone to referral points to encourage them to respond to the referral. We review with respective health units on a quarterly basis all the results for the program in each of the districts. All the services offered to the clients and other related information is integrated in HMIS of districts/MOH. The contribution of this program is its unique presence in homes and influencing to be taken at that level thus influencing the health seeking behaviours that translates in increased utilisation of TB and HIV services starting from referring all HIV positives with a cough> 2 weeks to health units for TB screening and any other care that is appropriate for PLHIV. There are so many registers capturing similar data at health units these include and PMTCT, TB, pre ART, ART and HCT registers plus clients profiles from the MOH in data capture, analysis and evaluation to discern successful referrals for HIV infected individuals screened and diagnosed for TB, started on treatment, but the program network of the human resource it avails at community level uniquely contributes to the success of TB/HIV interventions and the CB-DOTS strategy in homes and communities. The above will be coupled with support supervision from the district health teams and health sub district, together with the project coordinator and the basic care team. This will be supplemented by review meetings with the stake holders and activity reports. Accomplishments: what were the key accomplishments and lessons learnt since last year's COP and how do proposed activities take this into considerations The project has tested about 37,000 individuals during the quarter April to June 2009. About 1,800 HIV among them 40 were referred for TB screening; in Mityana alone where only 8 clients had initial symptomatic TB screening in homes and referred only 4 reported to the Hospital and confirmed with TB infection the client is benefiting from the program presence at home. Some TB clients confuse assume that the two diseases and others believe it is witch craft and may not seek treatment unless they are meant to understand TB/HIV co-infection and this can be advanced with people that live in those communities like PTCs members, local leaders, VHTs, RPMs and field teams. Most of the health units at level 3 hardly to any laboratory tests save for inadequate staffing levels. 500 were initiated on Cotrimoxazole.