PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2010 2011 2012
Introduction and overview
Baylor College of Medicine Children's Foundation-Uganda (Baylor Uganda) is a child health, not-for-profit NGO committed to delivering high quality, high impact and highly ethical paediatrics & family HIV/AIDS prevention, care and treatment services, health professional training and clinical research in Uganda. It is affiliated to Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) based in Houston, Texas, USA. Baylor Uganda started in 2003 with support to the Paediatric Infectious Diseases Clinic (PIDC), an integral service of the Makerere University Department of Pediatrics and Child Health at Mulago Hospital. Baylor Uganda signed a memorandum of understanding with Ministry of Health in 2005 to support the expansion of paediatric and adolescent HIV services in Uganda.
It also works collaboratively with the Makerere University Department of Pediatrics and Child Health in training of health workers. With support from Bristol-Myers Squibb Foundation, BIPAI, and Government of Uganda, a new Children's Centre of Excellence has been constructed at Mulago Hospital. This Centre provides additional space for provision of HIV/AIDS services to children and their families, training and research.
Since 2007, Baylor-Uganda is implementing a 5-year project to expand paediatric and adolescent HIV/AIDS services in the country. The project is funded by PEPFAR through CDC grant contract number 1U2GPS000942. The goal of the project is to reduce new HIV infections and HIV/AIDS associated morbidity and mortality amongst children & adolescents in Uganda.
The project objectives are to increase by 40%, the proportion of HIV infected children and adolescents utilizing HIV prevention, care & treatment services in Uganda; expand access to paediatric and adolescent HIV/AIDS care and treatment to 133 Ministry of Health accredited ART sites and strengthen capacity of Baylor-Uganda ART supported sites to generate, manage, utilize & disseminate information on paediatric & adolescent HIV/AIDS.
The organization also receives support from UNICEF and Clinton Foundation for specific pediatric HIV/AIDS programs. Other collaborating partners include Canadian Feed the Children which supports the nutrition program, Pediatric AIDS Canada that support 250 children and 50 adults on ART; and Save the Children in Uganda, Children's Fund International (CFI) for community programs support.
Baylor -Uganda is operating a family-centred model for care and treatment, and support of Children Living with HIV and AIDS (CLHA). In this model, CLHA are an entry point into the family where they live; to care and treat adult caretakers alongside their children.
Two service delivery modes are used:
(a) Direct provision of comprehensive HIV/AIDS services through 12 health facilities: Mulago Hospital Pediatric Infectious Diseases Clinic (PIDC), six urban satellite clinics [Kiswa, Kiruddu, Kawempe and Kitebi under Kampala City Council, Kanyanya TASO Centre and Upper Mulago Post Natal Clinic] and 5 UNICEF supported health facilities: Northern Uganda (Kitgum Hospital), North Eastern region (Kaberamaido HCIV and Lwala Hospital) and Western region (Kilembe Mines & Bwera Hospitals). Five of the urban satellites are run as family clinics with KCC and other partners which include Infectious Diseases Institute (IDI), Mulago-Mbarara Joint AIDS Program (MJAP) and The AIDS Support Organization (TASO). The service package includes HIV counseling and testing for children (6 weeks 14 years) and their adult family members, growth and development monitoring, immunization, nutrition supplementation, OI prophylaxis and treatment, TB screening and treatment, psychosocial support groups, home-based HIV counseling, testing and follow-up, and ARVs when indicated.
(b) Indirect provision through integration of pediatric and family-centered HIV/AIDS/TB services into existing MoH ART accredited health facilities in Uganda. The support includes capacity building; training, mentorship and support supervision, infrastructure improvement, systems strengthening, commodities for HIV testing, care and treatment, Paediatric ARV formulations and buffer stocks of adult ARV formulations and opportunistic infection drugs.
Progress to-date and achievements
In FY2009, Baylor Uganda conducted additional site assessments (for ART preparedness) in 46 health facilities in 34 districts in Uganda. Memoranda of Understanding were signed with all districts to financially support integration of pediatric HIV care in MOH ART accredited health facilities. To date 78 health facilities are being supported to provide pediatric HIV/AIDS services in their adult clinics. The program has achieved remarkable results; 241,749 people received HCT services in 74 service outlets. Know Your Child's HIV Status' (KYCS) campaign a new strategy implemented by Baylor-Uganda among children of clients in care yielded 260 HIV positive children, an HIV prevalence of 3.4%. A total 8,889 children (0-14 years) and 29,681 adults (15+ years) were receiving HIV/AIDS related care & support from Baylor-Uganda sites; of these 4,664 children and 11,201 adults were receiving ART.
Pediatric HIV services at the COE, six Kampala satellites and the five UNICEF supported health facilities have continued to receive direct support to manage the clinics. The patients at the COE continue to be closely monitored so as to inform practice in the other facilities. The treatment efficacy at COE -measured as the number of children initiating HAART who attain 10+% increases in CD4 after 6 months on therapy has remained high at 76.3% well above the world average of 70%; mortality over the last years has reduced from 4% in FY06/07 to 3.2% in FY07/08 to the current 2.8%.
To achieve this close to 2000 health care providers have been trained in pediatric HIV management and community follow up. Through support of regional coordinators who are district based pediatricians or senior medical officers, Baylor Uganda has continued to conduct monthly on-site mentorship to staff graduating from didactic trainings.
Health Information systems have also been strengthened by training of 265 records assistants and data management personnel and provision of Ministry of Health data collection tools and equipment to respective districts. Baylor-Uganda regional assistant data managers and district Health Management Information officers (HMIS) mentor the health facility data clerks/records assistants to enhance data management and utilization.
In terms of leadership, HIV focal teams at health facilities have been rejuvenated to start monthly meetings. Currently each facility is at a different stage on the continuum of capacity to lead and manage its programs and hence, out of the 66 rural health facilities supported only 22 have so far graduated from mentorship to support supervision. Through such assistance, over time, the district is expected to expand its capacity to plan, oversee and manage programs, to deliver quality services sustainably once Baylor-Uganda exits.
Infrastructure improvement and remodeling of health facilities to enhance privacy, confidentiality and provision of adolescent friendly services was carried out in Kitgum Hospital, Kiswa, Kiruddu and Kitebi Health Centers.
Five laboratories were strengthened to perform CD4 laboratory tests with provision of CD4 machines at the following facilities; COE at Mulago Hospital, Kaberamaido HCIV, Pallisa, Kitgum and Kilembe Hospitals while 52 laboratories received haemacue machines for Hemoglobin monitoring. An assortment of pediatric clinical equipment was provided to 63 health facilities e.g. weighing scales, height scales, thermometers and suction machines.
A system for measuring performance, tracking progress and informing programmatic fine-tuning and further planning has been instituted by directly engaging the district Health management and Health Management Information officers.
Monitoring and evaluation
Baylor Uganda has a robust M&E system that will take charge of this process. Quarterly support supervision visits will be conducted to monitor progress and ensure continuous implementation to achieve project milestones. Standardized Ministry of Health (MOH) tools will be used in all Baylor Uganda supported health facilities including registers, ART cards, logistics management and support supervision tools. All partnership reporting agreements will be respected to avoid data duplication. Memoranda of understanding will be drawn with implementation partners to complement each other's activities and avoid duplication. Routine program reporting will be done to inform program implementation and to update partners of program progress. By 2011, Baylor Uganda targets to have computerized data in all the supported health facilities and districts to simplify data collection, analysis, reporting and enhance utilization. This will contribute towards efforts of creating a national database of paediatric HIV care.
In FY 2010, Baylor-Uganda will continue to support adult care in the context of family clinic or family centered HIV/AIDS services in 84 NEP sites in 36 districts. Our target population will be adult women and men who are caretakers or family members of HIV infected children and adolescents, and adolescents who have matured into adulthood with HIV. This model of care fits into the Ministry of Health strategy of caring for families together as this improves efficiency and quality of care given to clients. The types of HIV care and support services will include: prevention and management of opportunistic infections eg malaria, diarrhea, pain, and symptom relief, nutrition support, procurement and distribution of pharmaceuticals (non ARVs), basic care package (ITN's, safe water vessel, etc) to all supported sites. Technical support to upcountry health facilities through on site mentorship and support supervision will be provided to develop systems, and competencies of staff in both adult and adolescent HIV/AIDS management.
Community volunteers who are part of the village team will be identified and trained to support both pediatric and adult care to ensure client retention and adherence to treatment. Through the use of Ministry of Health registers client attendance will be tracked daily and details of those who will not have turned up will be given to the community health worker to track. In return the community volunteer will give a report to a designated heath worker for follow up. In addition, community volunteers will follow up clients with poor adherence, critical laboratory results and those with nutrition deficiencies.
It is estimated that up-to 30,047 adults will be reached in 2009/2010 and by 2010/2011 these numbers are estimated to reach 32,150. As not all health facilities have the capacity to provide laboratory services efforts will be made to link with facilities that can offer more laboratory support. Linkages will be made with lower health facilities that may not be able to offer ART to so that they can refer clients for further care. Effort will be made to link HIV adult clients to support groups and PHA networks to help them access income generating activities. Quarterly meetings for clients to deliberate on issues pertaining to their care will be supported through this initiative. There will be focus on fostering partnerships to link clients for complementary services including food support and security. Reproductive health services including family planning and cancer cervix screening will be provided to all sexually active females.
Systems for measuring performance, tracking progress and informing programmatic fine-tuning and further planning will continue to be instituted by directly engaging the district health management teams and Health Management Information officers. The existing Assistant Data Managers who are Baylor-Uganda employees will continue to mentor and support the health workers in data collection, storage, simple analysis, utilization and dissemination. In collaboration with School of Public Health a fellow has been identified to support Baylor-Uganda to develop a community monitoring and evaluation framework.
In order to ensure sustainability, Baylor-Uganda will continue to work though the health systems to strengthen the HIV/AIDS prevention care and treatment services in the various rural health facilities.
Below are activities for adult care and support services:
Continuous clinical and laboratory monitoring of the clients Procurement and distribution of basic supplies for management of adult HIV/AIDS where needed Prevention and management of opportunistic infections as above Provision of reproductive health services including cancer cervix screening Procure and distribute pharmaceuticals, basic care package to all supported sites Provide technical support to upcountry health facilities through on site mentorship and support supervision in provision of family centered HIV/AIDS treatment and care Support care taker support groups and community groups that aid in the client retention and adherence Mobilize communities on family centered HIV/AIDS treatment and care Support for data management and utilization Undertake quality improvement projects for adult HIV care
Baylor-Uganda is a child health organization serving majorly orphaned and vulnerable children. Up to 56% of the children under Baylor care have lost at least one parent while 35% have lost both parents. These children are often marginalized and require support to live with dignity. The priority OVC areas Baylor-Uganda addresses include:
Increase data development and use for strategic planning: Baylor -Uganda will provide computers to all health facilities with reliable power sources. Records assistants/personnel responsible for data management will be trained to ensure proper data capture and storage to enhance accurate and timely reporting. Baylor-Uganda regional Assistant Data managers will mentor these personnel to acquire basic analysis skills and results interpretation to inform decision making and practices for improved livelihood of the children. Community volunteers will also be equipped with basic skills in records management and reporting to improve OVC follow up. This action addresses the care and support service area.
Strengthening systems/Government/policy: Baylor-Uganda will continue to advocate for orphans and vulnerable children due to HIV that they too can live a healthy and productive life if they receive appropriate and timely care and support. Through strategic partnership with other organization, resource mobilization for OVC services shall be continued. Canadian feed the children will continue providing Food and nutrition commodities to the COE and the six satellites in Kampala. A to Z another child health organization dealing in psychosocial assistance also provides transport to children living in, Kawempe, one of administrative divisions of Kampala. This action cuts across several service areas including care and support, child protection and psychosocial assistance.
Community support and coordination: Baylor-Uganda will train community volunteers in home based care and support of clients. In partnership with Food and Nutrition for Uganda (NuLife), these volunteers will also be empowered to integrate nutrition support interventions (education, assessment and referral) in home based HIV care programs. Support to hold community peer support groups' meetings which strengthen follow up (for adherence to treatment and clinic appointments) and referral of clients. This addresses the care and support service area.
Family/household strengthening: in partnership with Canadian Feed the Children, clients attending the COE and the six satellites in Kampala are provided with snacks as they wait to receive treatment and individual food rations. In addition they provide 50 family food rations to the most food insecure households. Emergency feeds will continue to be provided to food insecure families especially those failing in replacement feeding. This is in response to the food security and nutrition service area.
Primarily, the target population will be children below 18 years that are attending HIV/AIDS clinics at COE and Satellites in Kampala and their care takers.
Activities to include:
Provide life planning skills training (including making of hand crafts).
Provide clinic based feeding for children attending clinics and supplemental take home food rations for OVC families.
Provide play therapy to children attending supported clinics
Provide transport reimbursement to (960/year) OVC identified with the greatest need to ensure their regular clinic attendance and treatment adherence.
Support child participation activities such as monthly, quarterly and annual meetings and camps for OVC who are HIV infected.
Procure and supply toys and other play materials for children to play with while waiting for treatment and care at the COE, satellites and national expansion facilities
Conduct nutrition education to OVC families.
Provide basic treatment and care services for OVC at Baylor-Uganda supported facilities
Organize and Facilitate participation of children in observation of nationally and internationally important advocacy days (like World AIDS Day, Day of the African Child, candle light Memorial Day etc)
Establish networks and build alliances with other stakeholders and social groups with an aim to provide holistic comprehensive services and mobilize resources to support OVC's
In FY 2010, Baylor-Uganda will continue to support adult treatment in the context of family clinic or family centered HIV/AIDS services in 84 health facilities in 36 districts. 35 will be rural districts covering 77 health facilities that include district hospitals, health centre IV's and some health centre III's. The comprehensive package will include ART provision, cotrimoxazole prophylaxis and tuberculosis to adult patients on ART. Our target population will be adult women and men who are caretakers or family members of HIV infected children and adolescents; and adolescents 15 years and above who have matured into adulthood with HIV. 12,096 clients on ART in FY2009/2010 will be reached.
In order to provide quality treatment to the clients, Baylor-Uganda will continue to offer support to the districts to conduct various trainings. Districts will take lead in selection of participants to attend the different didactic trainings and in organizing the trainings. As most of the districts already have resident trainers, these will be used to facilitate the trainings while Baylor-Uganda staff will ensure quality of the trainings. The following in service trainings will be conducted:
Training on Logistic management for HIV/AIDS commodities to ensure that there are no stock outs of HIV commodities including Non ARVs and ARV's
Training on records and data management and use
Pediatric HIV management that includes PMTCT management to impart knowledge to health care providers
Community volunteer's trainings that impart knowledge and skills in HIV care, tracking loss to follow up and adherence monitoring
Counselor training to impart knowledge and skills to health workers to be able to provide quality counseling to clients
Positive prevention to HIV positive clients and health care providers
Following the above didactic trainings, on site mentorship will be conducted to various cadres of health providers to ensure that knowledge is translated into practice. Baylor-Uganda overtime has developed regional and district mentors and these will be facilitated to support the mentorship activities. In addition, district health teams will be supported to conduct support supervision to ensure sustainability of standards of care. Baylor- Uganda will conduct technical supervision quarterly or as needed.
Tracking of clinical outcomes will be monitored through clinical evaluation through the use of data capture using MOH tools. Baylor- Uganda will continue to mentor MOH facility staff in the use of these tools and where the tools are not available they will be procured with the support of MOH. The clinical outcomes to be tracked will include: WHO stage, weight, Karnofsky performance score to assess quality of life, opportunistic infections especially tuberculosis, drug toxicities and correction of malnutrition.
In order to ensure good clinical outcomes, adherence activities that will be supported include: adherence assessment in the clinic and at home by community volunteers , supporting drama groups and client support groups, and conducting adolescent camp activities geared to improving adherence and positive prevention. The outcome of these adherence activities will be improved health status and quality of life of the clients that Baylor-Uganda will support.
Baylor-Uganda will support the districts plans geared towards the activities mentioned below. Funds will be transferred to a designated district account where they will be requisitioned from by the health facilities. In order to ensure that funds are utilized for the intended purpose, internal audit will be regularly conducted.
Activities:
Conduct training as mentioned above
Organize and conduct on site mentorship to different cadres of staff
Organize clinical placement in high volume HIV adult clinics for those health care providers that have potential to supervise
Collection and transfer of data from the health facilities to the districts
Orient district health teams in support supervision tools
Conduct support supervision
Conduct camps for adolescents
Conduct client meetings
Identify and support the volunteers to work in the clinic to support adherence activities
Monitor the training activities and budget implementation
Funding for these activities is provided for under budget code12 (ARVs)
In FY 2010 Baylor-Uganda plans to reach 180,069 clients with HIV counseling and testing services for each of the years 2009/2010 and 2010/2011: 13,865 aged < 5 years; 28,811 between 5-17 years; and 13,7393 =18 years. The geographical coverage will be across the country in 84 Baylor-Uganda supported sites (COE inclusive) in the 36 districts. For quality assurance, the counseling and testing process will be based on the approved Ministry of Health testing algorithm. Internal and external quality control measures will be instituted. For the COE and Kampala satellites 5% samples will be sent to the Makerere University Johns Hopkins University collaboration (MUJHU) Core laboratory for quality assurance while the NEP point laboratories send samples to the district Joint clinical research centres laboratories.
HIV Counseling and Testing (HCT) is the entry point to HIV prevention, care and treatment. Baylor-Uganda will offer HCT services according to the National HCT guidelines that recommend various approaches including Voluntary counseling and testing (VCT), Home based HCT (HBHCT) and provider-initiated routine HCT in clinical settings. For the diagnosis of HIV among infants, DNA-PCR is essential, Baylor-Uganda will continue to support transportation of DBS samples to JCRC laboratories to facilitate early infant diagnosis (EID).
The main client mobilization strategies will include 'Know Your Child HIV Status' (KYCS) campaigns, RCT, couple testing and VCT. Baylor Uganda will continue with the KYCS strategy which targets children of HIV positive adults attending the ART clinics who may have asymptomatic or ill children that are not yet identified as infected. RCT will continue to be done in all paediatric wards and mother and child clinics to increase child identification. Outreach counseling and testing services will be conducted for high risk communities aiming to identify both infected children and adults. Baylor-Uganda in partnership with MoH will continue to build capacity for EID and disseminate the guidelines and necessary monitoring tools.
Counseling and testing services will be provided by facilities accredited for provision of prevention, care and treatment services, so that clients testing HIV positive will be actively linked to care and treatment services. HIV negative clients will also be linked to preventive services.
Train health care providers in HIV counseling and testing
Train health care providers in Dry Blood Spot (DBS) sample collection
Procure and supply buffer stocks of HIV test kits to all Baylor-Uganda supported sites
Provide HIV counseling & testing services: EID using DNA-PCR, RCT to children and adults in supported sites
Support the roll out of Paediatric HIV Routine Counseling & Testing (RCT) in all facilities through provision RCT registers
Support counseling and adolescent peer support groups to provide psychosocial counseling & support, including stigma reduction
Conduct monthly meetings with community volunteers to empower them with mobilization skills and aid linkage of clients into care
Revise and translate the community reporting tool used in monitoring support services to clients
Support health facilities to conduct "Know Your Child's HIV Status" campaigns
Conduct HIV Counseling and Testing outreach services to most at risk populations and underserved areas such as orphanages, detention centers
Develop and distribute customized calendars and T-shirts with prevention messages for patient mobilization and advocacy purposes
Support and hold radio talk shows and public service announcements to increase public awareness and mobilize communities to seek pediatric HIV/AIDS services
Sensitize persons in testing points to link identified HIV positive children and adults to ART clinics for care
In FY 09/10, Baylor-Uganda will continue to provide pediatric HIV/AIDS care and support at the Baylor Uganda Centre of Excellence (PIDC), 6 Kampala city council satellite clinics and 77 rural health facilities in 35 districts. Our target population will be children and adolescents up to 18 years of age. This is intended to scale up pediatric service coverage to nearly 80% of the 364 health facilities currently providing adult HIV/AIDS care and support in the country.
Mechanism: In partnership with MOH, Baylor-Uganda will continue to work with district health offices and management of the 64 health facilities to strengthen pediatric HIV care and support services that were initiated in the previous fiscal year. The strategies will include capacity building through training of health providers, infrastructure improvement, procurement of equipment and commodities and sustenance of human resources for health; community mobilization for pediatric HIV testing, care and support through "Know your child's HIV status" campaigns and local radio programs; service delivery through provision of integrated comprehensive HIV/AIDS care and functional referral between HIV testing and care; establishing and strengthening existing MOH mechanisms for supervision, monitoring and evaluation. The strategies will be coordinated through district structures to ensure continuous quality services provision and sustainability of operations.
Activities that provide drugs, food and other commodities:
Procure and distribute basic care package (ITNs, safe water vessels, etc) to all supported sites
Procure and distribute pediatric supplies including weighing scales, stadiometers and pediatric stethoscopes
Procure and distribute office supplies and medical supplies to the COE, urban facilities and buffer stocks to the district health facilities
Provide drugs for prevention & treatment of opportunistic infections (excluding TB) to HIV +ve and HIV exposed infants
Train health workers in pediatric HIV/AIDS management and pediatric HIV/AIDS counseling
Train community volunteers in home based care
Conduct team building exercise to support sustenance of human resources for health
Conduct radio talk shows addressing pediatric HIV/AIDS issues
Write news paper articles to create awareness on pediatric HIV/AIDS
Procure and distribute Information, Education and Communication materials
Support community outreach & individual child/family psychosocial needs counseling, including coordination of OVC & community program
Conduct camps for children and adolescents to enhance adherence to drugs, promote positive prevention and build life support skills
Provide therapeutic food interventions for malnourished children
Provide food rations for all clients attending the COE and urban satellite clinics and provide snacks to all children and adolescents as they wait for services.
Provide family food rations to the food insecure while working with the families on improving food security
Activities for supervision, improved quality of care and strengthening of health services
Conduct quarterly technical support supervision with district health teams
Support MOH and district staff to conduct mentorship
Support the district health teams to conduct monthly support supervision
Conduct quality improvement projects in collaboration with HIVQUAL program under the Ministry of Health
Carry out minor infrastructure improvement to make the health facilities child friendly
Participate in International Pediatric HIV/AIDS Conferences/Meetings
Integration with routine pediatric care, nutrition services and maternal health
Support in-patient care costs for HIV infected children admitted at Acute Care Unit, Mulago Hospital
Conduct and or support routine HIV testing in all pediatric outpatients and wards in particular nutrition and TB wards
Laboratory support and diagnostics for pediatric patients
Train in logistics for commodities to ensure no stock outs of laboratory supplies
Procure and distribute HIV testing commodities
Train health workers in Early Infant Diagnosis to ensure integration of the services in Maternal and Child Health activities
Train in Dry Blood spot collection, packaging and transportation
Procure and distribute MOH HIV testing registers
Provide technical support supervision by Baylor-Uganda laboratory staff
Support district Health teams to conduct support supervision
Support districts to transport DBS samples
Monitoring and Evaluation of the program
Support the routine collection, compilation, analysis and reporting of program data
Print and distribute MOH ART cards for capturing data
Train records staff in records, data management and reporting
Conduct bi annual review meetings with the districts and key health facility staff
In FY 2010, Baylor-Uganda will continue to provide pediatric HIV/AIDS treatment at the Baylor Uganda Centre of Excellence (PIDC), 6 Kampala city council satellite clinics and 77 rural health facilities in 35 districts. Our target population will be children and adolescents up to 14 years of age. This is intended to scale up pediatric treatment coverage to nearly 80% of the 364 health facilities currently providing adult HIV/AIDS care and support in the country. 5838 children and adolescents will benefit from this life saving treatment contributing 30% of the country pediatric target of 20,000.
Mechanism: In partnership with MOH, Baylor-Uganda will continue to work with district health offices and management of the 64 health facilities to strengthen pediatric HIV treatment services that were initiated in the previous fiscal year. The strategies will include capacity building through training of health providers, infrastructure improvement, procurement of equipment and commodities and sustenance of human resources for health; community mobilization for pediatric HIV testing, care and support through "know your child HIV status" campaigns and local radio programs; service delivery through provision of integrated comprehensive HIV/AIDS care and functional referral between HIV testing and care; establishing and strengthening existing MOH mechanisms for supervision, monitoring and evaluation. The strategies will be coordinated through district structures to ensure continuous quality services provision and sustainability of operations.
Train community volunteers in home based care to ensure adherence to ART
Write news paper articles to create awareness on pediatric HIV/AIDS treatment
Conduct camps for children and adolescents to enhance adherence to ARV drugs, promote positive prevention and build life support skills
Carry out minor infrastructure improvement to secure drug stores for ARV's
Conduct quarterly drug audit in health facilities and monthly spot audits at the COE
Conduct value for money audit to ensure proper utilization of drugs
Procure and distribute HIV patient monitoring commodities
Train health workers in Early Infant treatment
Procure and distribute MOH HIV ART registers
Support districts to transport samples for monitoring labs
Print and distribute MOH HIV logistics tools for capturing data
The target by age goup in 2009/2010 for AB activities are: 10-14 years, 1,305; 15-24 years, 1,740; = 25 years, 1,305. Overall the sex ratio of persons reached will be, 50% females in age group 10-14, 60% females in 15-24 and 25+ in the implementation periods. Interventions will cover Mulago COE and 84 NEP sites in 2009/2010.
In reaching out to the targeted population, the following activities will be implemented:
Conduct health education and counseling sessions at COE, Kampala Satellites and national expansion health facilities on clinic days on AB prevention interventions.
Hold monthly adolescent & youth peer support group meetings that include counseling, health education, condom distribution, etc, targeting 120 individuals per month
Organize annual adolescent (9 - 11 years) meeting at Sanyuka Camp & children (12 - 18 years) Hope camp; with 80 children participating in both camps.
Conduct quarterly care givers meetings to discuss AB prevention messages with about 150 participants/meeting
Train youth and community volunteers in positive prevention.
Support radio programs that disseminate messages on AB and other prevention.
Conduct ABC meetings with adolescent and adults
Produce IEC materials to support health education and community sensitization
Coordinate advocacy activities for upcountry sites
Document best practices, print quarterly reports
Majority of Baylor Uganda clientele in Kampala are children with an average age of 6 years. This is a population that needs sexual prevention services of abstinence. In up country sites Baylor Uganda takes care of both adults and children therefore; requiring the ABC strategy.
In total, 9,650 clients in 2009/2010 and 10,150 clients in 2010/2011 COP periods are targeted. The target for PwP is 5,300 for each budget period, but 4,350 and 4,850 other clients are targeted for 2009/2010 and 2010/2011 respectively. The target by age group in 2009/2010 is: 10-14 years, 600; 15-24 years, 1,740; = 25 years, 1,305. In 2010/2011, the target by age group is: 10-14 years, 1,455 ; 15-24 years, 1,940 ; and = 25 years, 1,455. Overall, 50% of females in age group 10-14, 60% of females in 15-24 and 25+ years will be reached in the implementation periods. Interventions will cover Mulago COE and 76 NEP sites in 2009/2010 and 92 sites in 20/2011.
Health education sessions on AB held bi-annually in NEP sites and quarterly in Kampala clinics and upcountry sites employing the direct mode of service delivery will be conducted for children aged 10-14.
As part of the strategy we intend to take HIV prevention messages of Abstinence, AB and ABC (as appropriate) to schools around Kampala. Teachers in selected schools from the different divisions in Kampala will be trained in delivering abstinence, AB and ABC messages to children. In the upcountry schools in the North Eastern and Western regions of the country where Baylor Uganda operates will be supported to incorporate Abstinence and AB messages in their schools programs.
Family planning and sexually transmitted Infections/Cervical cancer screening services as part of prevention services will continue to be provided at the COE in Kampala. Untreated STIs increase the risk of HIV acquisition and transmission.Therefore, treating them and addressing their sexual and reproductive health needs in a manner that reduces the risk of HIV (re)infection with their partners is vital in sexual prevention program. Identified cases will continue to be managed and referred appropriately. Family Planning and condoms will continue to be provided to clients (who need them) at all supported facilities.
Implementation of sexual prevention interventions is aimed at increasing the proportion of the target audience adopting safer sex practices (abstinence, being faithful and condom use) to reduce the risk of new HIV (re)infection.
Conduct health education and counseling sessions at COE, Kampala Satellites and national expansion health facilities on clinic days on AB and other prevention options.
Conduct quarterly care givers meetings to discuss prevention messages with about 150 participants/meeting
Purchase Home Based Care kits for home health workers and community volunteers, and supplies for health education
Procure and distribute condoms, and demonstrate their effective use during counseling, health education talks and service delivery
Provide sexual and reproductive health services: STI management, family planning and screening of cancer of the cervix
Support radio programs that disseminate messages on sexual prevention (AB and others).
In order to expand and fully integrate paediatric HIV/AIDs care and treatment services in MoH ART accredited health Facilities, Baylor - Uganda will continue to provide basic laboratory equipment, reagents and consumables to all its 84 supported health facilities country wide. In partnership with MoH, training of health facility personnel in Good clinical Laboratory Practice (GCLP), laboratory logistics management and quality improvement/Assurance will be continued with aim of strengthening diagnosis and monitoring of clinical outcomes. Four PointCare equipment have been procured and installed in four regions across the country. Baylor Uganda will continue to procure reagents for running the equipment. In addition, a referral system will be developed for samples tested with PointCare equipment to other selected laboratories with a similar equipment to ensure external quality for the CD4 results generated at supported health facilities. To strengthen internal quality assurance, quarterly monitoring of batch samples collected from the four sites shall be tested at the COE.
Activities supported will be integrated into the overall district health plans to ensure sustainability of programs. These invlude:
Train Health facility personnel in GCLP and laboratory logistics and supply chain management
On-site training in dry blood spot collection
Conduct mentorship and Support supervision visits to sites provided with Point Care Equipment for CD4 testing in the four sites
Bi-annually service and maintain Point Care Equipment
Hold bi-annual meetings with the District laboratory focal persons (DFLP) and facility laboratory in-charges to review the logistics management of laboratory supplies in the district
Provide support for transportation of laboratory tests that are not performed on-site, including DNA-PCR and CD4 samples.
To procure and supply all NEP sites with buffer stock for HIV test kits for routine and voluntary counseling and testing
Procure and supply laboratory equipment (including Hamocue 201/ StatSite Hb machines), supplies & reagents for supported health facilities.
Facilitate accreditation process of health facility laboratories
Link all NEP sites to regional reference laboratories (for example JCRC, National TB lab)for proficiency testing for complete blood counts, CD4 and sputum smears
Lobby district health management team integration of laboratory activities into district health work-plans
Conduct internal and external quality assurance and quality control programmes for COE and all NEP sites
Provide Standard Operating Procedures and Bio-safety manuals for reference when performing routine sample testing
Regularly review Standard Operating Procedures for laboratory practices
Baylor-Uganda currently supports integration of paediatric services in 78 health facilities majority of which are public. Drug supplies are often erratic and not sustained in these facilities. With on-going mobilization we anticipate increase in the number of children to be enrolled and retained in ART program. Many factors including lack of ARVs may affect enrolment, adherence and retention of children into ART, with negative impact on resistance development, treatment failure and subsequent increased childhood morbidity and mortality. To ensure continued enrollment of children into care, Baylor-Uganda will continue to procure and provide ARVs to the more than 4,600 children and a buffer stock for the 11,201 adults currently on ARV's in the supported sites to avoid stock outs. Recommended 1st line & 2nd line regimens for children and 1st line regimens for adults will be procured in line with MOH guidelines.
We plan to procure adult ARVs in order to provide family-centred HIV/AIDS care for infected children and their care givers at the same time and in the same place. Baylor Uganda will continue to secure ARV drugs from Clinton foundation till October 2010. Paediatric AIDS Canada will provide additional ARVs to 250 children and 50 care givers who are on treatment from Baylor-Uganda supported sites.
Most of ARVs drugs procured by Baylor-Uganda will be accessed through Medical Access.
The family-centred HIV/AIDS care strategy builds on experience at COE, 6 Kampala satellite sites and 5 up-country UNICEF facilities where there was no reported ARV stock outs in the previous year. In the NEP sites, there were no stock outs reported in 60% of the sites. The target is to have 80% of all the supported facilities without ARV stock outs in 2010 and 100% in 2011. Strategies will focus on improving health workers skills in logistics chain management systems and close stock monitoring and drug audits. Up 30% of buffer stocks for paediatric ARVs will be procured in 2009/2010 and 15% of adult ARVs.
Train health care providers in logistics and supplies management
Fore cast, procure and distribute of both first and second line ARVs for children in the 84 supported sites
Fore cast, procure and distribute first line ARVs for adult care givers in context of family-centered approach in all supported sites
Train health providers to compile and submit end of cycle ARV reports
Install drug storage cabinets for proper storage of ARV stock
Provide on-going technical support (mentorship, support supervision, tools and systems development) to all Baylor-Uganda supported sites for better ARV management and accountability.
Procure ARVs for management of Post exposure prophylaxis
Conduct weekly, monthly and quarterly drug audits in all supported sites
Provide logistical and operational policies and procedures to accurately forecast, procure and store are availed to Baylor-Uganda health facilities
Baylor Uganda will collaborate with the National TB/Leprosy Programme and National TB/HIV coordination committee to implement TB activities in all the 84 sites to be supported. Implementation will be based on the National TB/HIV policy guidelines including strengthening coordination mechanisms at District and Health facility levels, contributing to reduction in TB among HIV positive individuals and advocacy, communication and social mobilization for paediatric TB/HIV. Emphasis of Baylor Uganda's TB/HIV activities will be geared to reducing the inequalities between access to TB care between adults and children.
In order to maintain the district TB/HIV services delivery mechanisms in place, the programme will utilize the available health facility staff and will work in regular consultation with the District TB/Leprosy Supervisor. Support to health facilities and districts will be based on quantified unmet needs identified by the health facility and/or district. Baylor Uganda's approach will be to strengthen the capacity of the health workers at the facilities to diagnose and manage TB/HIV patients; provide buffer stocks of anti TB drugs, diagnostic supplies and patient management tools for children and adults; and health management Information systems support.
Monitoring and Support Supervision teams will be formed mainly using local capacity, with Baylor-Uganda staff offering support only in areas not covered by district capacity. Health facilities will be supported to collect, analyze and utilize data for TB/HIV services using existing MOH data collection tools.
Perform PPD testing in all children, adolescents and adults attending in high volume clinic attendance health facilities. This will target at least 2600 children
Support x-ray services for children suspected of TB.
Procure and distribute buffer stocks of TB diagnostic supplies
Support TB diagnostic microscopy on sputum, biopsies and nasogastric aspirates.
Provide buffer stocks of drugs for TB treatment and prophylaxis in all Baylor-Uganda supported health facilities.
Train health workers through didactic, on site mentorship and support supervision in prevention, diagnosis and management of tuberculosis among HIV infected individuals.
Initiate TB infection control measures at HIV care clinics by providing face masks to TB cases and health workers
Perform HIV counseling and Testing for TB patients
Reproduce and distribute MOH TB/HIV job aides, patient management tools and registers
Produce and distribute TB/HIV IEC materials in local languages and with particular emphasis on paediatric tuberculosis
Support the health facilities and districts to record, compile and report TB/HIV data to the MOH TB control program
Accomplishments, lessons learnt and proposed activities to address challenges
During the last year, 945 patients had been targeted to be provided with TB treatment but up to 920 were treated from 44 sites. The inability to reach the target was a result of the lack of appropriate diagnostic skills, materials and equipment in most sites. PPD was only availed at the Mulago centre due to logistical and technical constraints. The PPD vial contains 20 doses which must be used in 24 hours of opening. This is not feasible for sites that have few patients as it would create wastage. Chest X-ray machines are also available only in limited high level health units. We however piloted supporting patients to travel to where these facilities are available and it worked for one of the centres in Eastern Uganda. This is going to be replicated during this year's COP. In order to improve case finding, Baylor Uganda has recruited a TB/HIV focal person who will work closely with MOH/TB control program team to train health workers in the 84 supported sites in TB/HIV diagnosis and management. Also PPD will be provided to high patient volume facilities while chest x-ray availability mapping will be done and a referral system will be drawn to link patients from facilities that do not have access.
