TASO is the oldest and most experienced non governmental organization (NGO) providing HIV/AIDS services in Uganda. To date, TASO has cumulatively cared for over 200,000 clients of whom over 90,000 are active; while over 30,000 clients cumulatively enrolled on ART. TASO has the widest non-government HIV/AIDS service delivery network in Uganda and directly complements the efforts of Ministry of Health (MoH). TASO has 11 Service Centres located in the districts of Gulu, Jinja, Kampala, Masaka, Masindi, Mbale, Mbarara, Rukungiri, Soroti, Tororo and Wakiso in the 4 geo-political regions of Uganda. These Centres provide services for the host districts and 3 to 4 neighboring districts. Although Centers are located in the urban district towns/cities, they have extensive service delivery networks up to grassroots communities. TASO also operates 1 International HIV/AIDS Training Centre and 4 Regional Training Centres. The Training Centres conduct various HIV/AIDS courses for service providers. TASO Head Office is located in Kampala and is in charge of: Finance Management; Human Resources & Administration; Advocacy; Training & Capacity Building; Program Management; Planning & Strategic Information.

TASO provides a continuum of comprehensive HIV/AIDS prevention, care, treatment and related support services to HIV-positive people and their families. TASO activities include provision of antiretroviral therapy; counseling services for empowering PHA and supporting ART adherence; TB screening and treatment services; services for prevention, diagnosis and treatment of OI; PHA with the Basic Care Package (BCP); prevention with positives interventions; confidential Home-Based HIV Counseling and Testing (HBHCT) services for clients' family members; Home Care services; training and capacity-building of different caliber of staff in HIV/AIDS service delivery; supporting and maintaining linkages and referral mechanisms for expanded access to services. In addition, TASO conducts advocacy on the driving factors of the epidemic, issues inhibiting access to services and addresses stigma due to HIV/AIDS. Each TASO Centre is equipped with pharmacy, adequate storage space for supplies and a laboratory that has capacity for diagnosis of opportunistic infections and HIV disease monitoring.

TASO works closely with MoH, and all its service centres operate within or close to District, Regional Referral and National Referral Hospitals. This facilitates contribution to and strategic collaboration with the public health care system. In many cases the 11 Service Centres serve as specialized HIV/AIDS clinics to the MoH district and regional referral hospitals as well as other lower level government health facilities. TASO maintains a referral mechanism with all levels of government health facilities. As a way of contributing to universal access and equitable service delivery, TASO has also trained and supports 23 peripheral partners to provide TASO-like services in under-served districts; these partners include government hospitals, private-not-for profit hospitals and community-based organizations.

TASO through support of PEPFAR and other funding partners has developed all the 11 Service Centres into leading HIV/AIDS prevention, care, support and treatment provider in the regions of Uganda where they are located. TASO Centres have an experienced, well-qualified and well-trained workforce of over 1,000 personnel, an average of 75 staff per Centre. The Centre teams are multi-disciplinary including Medical Doctors, Counselors, Clinical Officers, Nurses, Pharmacy Technicians, Laboratory Technicians, Data Managers, Social Workers and Support staff. Individual staff have received multi-disciplinary on-job training to facilitate multi-tasking in deployment for service delivery; the workforce is organized in cohesive small teams (departments and sections) under supervisors; the supervisors undergo regular training and mentoring in leadership and supervisory management. All frontline staff are trained, facilitated and motivated to cultivate and maintain personal contact with the clients. Staff are required to be fluent in the local languages of the Centres of their respective deployment. All jobs have comprehensive Job Descriptions (JD) and the Human Resources & Administration Directorate ensures regular update of all JDs. Apart from their formal qualifications (Degrees, Diplomas, etc), TASO requires all job applicants to have undergone robust HIV/AIDS training with a practicum component. TASO also provides regular didactic and experiential training to keep service providers up-to-date. TASO will manage and oversee program activities the following system: -

Governance: The TASO governance structure includes a national Board of Trustees (BOT), 4 Regional Advisory Councils (RAC), 11 Centre Advisory Committee (CAC) and the Clients' Council. The BOT oversees the TASO program nationally and is the highest decision-making organ; the RAC oversees the TASO program in the 4 Regions of Uganda; the CAC oversee the activities of each of the 11 Centres; and the Clients' Council advocates for clients' rights, mobilizes clients to exercise their responsibility and advise management on clients' issues. All of these governance structures are periodically elected by the Annual General Assembly.

Program Leadership & Oversight: Overall management and leadership of the TASO program at national level will be done by the Executive Director. This position is assisted by 2 Deputy Executive Directors (in charge of Program Management, and Support Services) and other Directors oversee Planning & Strategic Information, Training & Capacity Building and Advocacy. All the Directors are highly-trained, highly-skilled and experienced individuals in HIV/AIDS programming.

Management of Activities: Each of the 11 Centres is headed by a Centre Manager. The 11 Managers in charge of TASO Centres are well-qualified and experienced individuals who have undergone specialized experiential and didactic training in leading HIV/AIDS programming and managing TASO Centres, in addition to other training. The Managers ensure adherence to organizational policies and systems. Each Centre Manager is assisted by 5 heads of department, namely Medical Coordinator, Counseling Coordinator, Accountant, Human Resource Officer, Project Officer and Data Manager. These 5 officers supervise multi-tasked teams of highly motivated frontline staff.

Service Teams at Centres: TASO has just over 800 frontline staff. All staff are well-qualified, have undergone comprehensive training in their respective responsibilities and undergo regular refresher training to keep up-to-date. Besides their service delivery skills, the frontline staff have other beneficial skills in planning, customer care and teamwork among others. TASO will maintain the existing personnel at Headquarters and Centres to steer the program during FY 2009.

Quality Assurance: TASO ensures that all service providers and Service Centres adhere to the National Guidelines for delivery of various HIV/AIDS services. TASO has Standard Operating Procedures (SOPs) for all services provided by the 11 Service Centres. The SOPs comply with National Guidelines and are observed by all service providers. These SOPs are regularly reviewed in a participatory manner to match the fast paced developments in HIV care and support technologies. TASO has a comprehensive Quality Assurance Manual spelling out the basic minimum standards to be ensured by all service providers.

Management Information Systems: TASO with support from partners, has developed robust computer-based management information systems (MIS) for generating strategic information and managing/tracking resource utilization. The key organizational systems include Navision 3.0 Accounting System; the Health Management Information System (HMIS); Appointments Management System; Clients' Identification/Mapping System; Clinical Laboratory Information System; Pharmacy and stores Information Management System; Supply Chain Management System; Fleet Management System and Human Resources Information System. These systems are integrated in order to maximize the quality and integrity of information produced. TASO regularly updates these systems and re-trains data staff to keep the MIS up-to-date. Updates of the MIS shall continue during FY 2009.

Organizational Policies: All TASO Centres are managed in accordance with documented organizational policies. TASO policies are developed through an inclusive process that harmonizes the views and interests of all key stakeholders. The policies are in harmony with the laws and guidelines of Government of Uganda and the funding agencies. TASO policies are approved by the TASO Board of Trustees. TASO has policies for Procurement, Human Resource Management, Governance, Financial Accounting and other issues.

Performance Monitoring: TASO has a comprehensive internal performance monitoring mechanism. The Directorate of Planning & Strategic Information (PSI) at TASO Headquarters leads the performance monitoring function. Annual work plans and targets are developed from the TASO Strategic Plan. Each of the 11 Centres has monthly, quarterly semi-annual and annual targets to achieve. Service providers fill data collection forms that measure the quantity and quality of work. Data personnel manage service data as well as data from other systems. Centres submit monthly programmatic and financial reports to TASO Headquarters based on data, lessons and observations recorded. TASO Headquarters generates regular (monthly, quarterly and annual) reports and adhoc reports, Programmatic and Financial Reports for CDC/HHS, Ministry of Health, and other national partners. The reports are also used internally for reviewing performance and improving quality of service delivery.

Audit Arrangements: TASO has an elaborate Internal Audit system implemented by the Internal Audit Unit comprising the Chief Internal Auditor and three other Auditors. The Auditors are well-qualified and undertake regular performance enhancement training. The Team conducts comprehensive audit of all TASO Centres twice a year, and also conduct other audits as need arises. The audits include both financial and programmatic reviews. TASO operations are also audited externally by internationally recognized audit firms. Internal Audit Unit reports to the Board of Trustees on a quarterly basis.

Procurement Procedures: TASO conducts competitive open procurement of drugs, medical supplies, stationary, equipment and other program needs. All Centres adhere to the Procurement Policy. Each of the 11 TASO Centres and other TASO units have a Procurement Committee constituted according to the TASO Procurement Procedures policy. There are clear cross-cutting guidelines for situations where prequalified suppliers such as Medical Access will be used.

Technical Support: The program will have a three-tier technical support mechanism to the services at the 11 Centres. This will be done by the Program Management Directorate at TASO Headquarters, Ministry of Health (MoH) and the CDC/PEPFAR Country Team. The teams from MoH and CDC will provide regular support to the Directorates of Program Management and Strategic Information at TASO Headquarters. The Directorates will in turn support the TASO Centres through quarterly support visits. The 11 TASO Centres will also collaborate with MoH in the areas of capacity-building for the Centres, availing of the national guidelines by MoH, provision of supplies for TB management, providing consultancy on ART delivery and providing counseling and psychosocial support at MoH facilities by TASO staff.

TASO will continue offering both facility-based and community-based care to clients at the 11 centres, 34 outreach clinics at adjacent Government facilities, client homes and over 900 Community Drug Distribution Points (CDDP). The TASO centres are in 11 districts strategically located in the country and each centre serves clients from the host district and 3 to 4 neighboring districts. Apart from the index clients, services will also target household members and the general community especially in relation to stigma reduction, and adherence to HIV/AIDS care, support and prevention. The services will include both clinical and non-clinical activities.The following will be the key services to be offered:

Management of Opportunistic Infections (OI): TASO will provide medical care aimed at early OI diagnosis and management. Medical care will target new and continuing clients registered at the TASO Centres. Major interventions will include: screening and management of common OI; malaria management; STI management; provision of cotrimoxazole prophylaxis and the basic care package; regular follow up of clients in care; referral of clients for specialized care; networking with other partners for quality care; client empowerment activities; and others. Service delivery is provided at TASO centres, client homes and outreach clinics. Medical services conform to national and international quality standards. The quality assurance procedures for medical care will include: refresher trainings, supervision of clinicians, meetings on quality medical care, Continuing Medical Education (CME) sessions, support visits and clients' satisfaction reports.

Counseling adult clients and family members: Counseling sessions oriented to HIV/AIDS care and support will be conducted for clients. These sessions will focus on HIV prevention, supporting clients to disclose serostatus to sexual partners and significant other persons; and provision of information on STI, FP, PMTCT nutrition, TB/AIDS, cotrimoxazole and safe water vessels. Counseling sessions will be conducted at TASO Centres, Outreach Clinics, Community Drug Distribution Points (CDDP) and client homes. Counseling services will conform to national and international quality standards. Quality assurance procedures for counseling services will include: refresher trainings, counselor supervision, meetings on quality counseling, Continuing Counseling Education (CCE) sessions, support visits and client satisfaction feedback. TASO will continue to address gender-related challenges affecting HIV care and support through messages focusing on male norms and behaviors, gender equity, women's rights, domestic violence and coercion.

Provision of the Basic Care Package (BCP)

TASO will continue to receive and distribute the BCP in partnership with Program for Accessible Health Communication and Education (PACE). Staff at the 11 Centres will continue to train/retrain clients on the use of the BCP commodities.

Cotrimoxazole Prophylaxis: Has been found to reduce the incidence of OI including malaria among PHA. It has been mainstreamed into the TASO care and support package. TASO will provide cotrimoxazole prophylaxis to all the eligible existing 81,000 adult clients and 18,000 new adult clients. Dapsone will be provided as an alternative for the few clients who are allergic to cotrimoxazole. All TASO clients will be educated and counseled on cotrimoxazole prophylaxis. 95% of all clients on ART will be enrolled on cotrimoxazole prophylaxis and at least 75% of all TASO active clients.

Safe Water System: Clients will be provided with Safe Water Vessels and chlorine water treatment as part of the BCP. This will prevent contamination of drinking water and consequently reduce the spread of water borne diseases, especially diarrhea among PHA at TASO.

Male Condoms: These are provided depending on the age of the client; the BCP would contain condoms for the adult packages and none for children. In addition condoms are distributed at all TASO centers, outreaches, CDDP and by community volunteers; so clients can access condoms whenever they need them.

Long-Lasting Insecticide Treated Nets (LLITN): Clients will be provided with LLITN for malaria prevention. New index clients and their children aged below 5 years will be prioritized.

Capacity-Building for Adult Care: TASO has over 4,000 community volunteers including 1,000 expert clients. All new staff at the 11 TASO centers will receive training in HIV/AIDS care and support. In addition TASO will train staff at the 21 Mini-TASO/CBO partners and public health facilities with emphasis on hard to reach areas, conflict and post conflict areas. This training will also include the training of clients in the provision of peer support.

Client Education/Mobilization: TASO will facilitate provision of information to communities through music, dance, drama and giving testimonies. This will be done by 11 PHA groups; each of the 11 Centres has 1 group consisting of 25 people. These groups simplify the messages by presenting them in ways easily understood by the communities and in the local languages. The audience can also easily identify with the experiences shared through the messages.

Reduction in HIV transmission to spouses and children through PWP interventions including behavioral change communication, provision of condoms, partner reduction, partner testing and disclosure, controlling alcohol use, biomedical interventions like STI care, prevention of unintended pregnancy.

Other cross cutting issues like gender mainstreaming, linkages between facility and community based care, human resources for health, supply chain management.

Appropriate Monitoring and Evaluation (M&E) of the quality of care and support.

TASO programming for FY 2010 will be influenced by the following broad principles: evidence-based programming; greater focus on the family; greater focus on community empowerment; greater involvement of Persons with HIV/AIDS (PHA); enhancing partnerships; quality assurance; consolidating the gains of the national response; enhancing comprehensive accountability (financial, programmatic, governance and cost-effectiveness); ensuring value addition to national programming; addressing key drivers of the epidemic; and supporting efforts towards a strong public health sector. In conflict and post-conflict settings, TASO proactively address challenges faced by refugees and internally displaced persons.

About 81,000 active adult clients were served at various service delivery venues operated by TASO Centres. In FY 2008, the TASO priorities for Adult Care & Treatment were: providing counseling services to clients and their family members; management of opportunistic infections (OI); management of sexually transmitted infections (STI); provision of the basic care package (cotrimoxazole prophylaxis, safe water system, condoms, and information on nutrition, STI, FP, PMTCT, TB/HIV); conducting various courses to train service providers to provide HIV care and treatment.

By the end of FY 2009, TASO will target over 27,000 adult clients on ART at the 11 TASO Centres nationwide. The TASO ART program registered very high levels of adherence. Over 95% of the clients on ART had adherence levels of over 96% using a three-day recall. Service providers continued to support the few clients with low adherence through follow-up. Clients with high adherence were counseled to maintain the good performance. Clients received ARV drugs both through the facility arm (11 TASO Centres) and the community arm (client homes and Community Drug Distribution Points). Field Officers delivered ARV drugs to Community Drug Distribution Points and client homes. TASO continued evolving and supporting delivery models that meaningfully involve PHA. The 1,000 expert clients that had been trained as Community ART Support Agents (CASA) continued playing a grassroots role in supporting ART clients in the community (these TASO trained resource persons support other clients in the community to access treatment from other partners).

The 11 Centres continued running multidisciplinary Case Conferences to: assess eligibility for ART initiation; assess client readiness for ART initiation; and switch clients between the facility and community ARV delivery arms. TASO evaluated the MIS modules for Pharmacy, Laboratory and Stores Management in order to identify and address the gaps in their capacity to support quality assurance, M&E and logistics management. TASO also evaluated the ART Data Management modules to enhance generation of information and knowledge from program data. TASO improved the Clients' Appointment System to ease the pressure of client load on Centre resources through scheduling clients to visit Centres on appointment. The system was also aimed at enhancing the quality of services through adequate preparation by service providers. TASO Centres continued using the Pharmacy Information Management System (PIMS) for facilitating upfront planning of drug refills through providing critical information such as clients who did not pick up drug refills for follow-up. TASO units were supported with refurbishment of the existing infrastructure to improve the environment for service delivery and improve the filing and archive rooms for clients' records. Procurements were made to fill the identified gaps in various program areas. TASO solicited feedback through periodic meetings for various teams of service providers. Key issues addressed by meetings and workshops included: program guidelines; strategic information and knowledge; capacity-building; strategic planning; service delivery models; ART implementation challenges; and other key issues.

During FY 2010, TASO will provide Adult Care & Treatment services at the 11 Centres located in the districts of Gulu, Jinja, Kampala, Masaka, Masindi, Mbale, Mbarara, Rukungiri, Soroti, Tororo and Wakiso. Each of the Centres will directly serve clients from the host district and up to 6 neighboring districts. All the 90,000 active adult clients will be facilitated to access a comprehensive package of high quality adult care and treatment services. The adult care and treatment package will comprise: counseling for clients and family members; provision of antiretroviral therapy (ART); screening and treating opportunistic infections; screening and treating sexually transmitted infections (STI); providing vital information on cotrimoxazole prophylaxis, safe water, nutrition, STI, FP, PMTCT, TB/HIV; enrolling clients on cotrimoxazole prophylaxis; providing and promoting use of the safe water system; providing LLITN; providing condoms to sexually active clients; conducting various courses to build capacity of service providers to provide HIV/AIDS treatment; and provision of nutritional supplements for clients. In order to reach the targeted beneficiaries, TASO will provide HIV/AIDS treatment services through various venues, using appropriate and proven service delivery models. TASO is a key partner in developing innovative client-friendly and community-friendly service delivery models. The 11 TASO Centres will deliver services to clients through the 11 static outlets, clients' homes and 34 outreach clinics sites (each of the 11 TASO Centres conducts monthly outreach clinics in about 3 public health facilities within 75 km radius). The broad service delivery strategies will include mobilization and sensitization, capacity-building, beneficiary involvement, greater PHA involvement, partnership and collaboration and others. TASO will continue sensitizing clients on the importance of the various care and treatment services in improving the quality of life of clients. Sensitization will be done through counseling, health education talks, music dance and drama performances and IEC materials at all service outlets. Staff at the 11 Centres will educate clients on various Care & Treatment issues through individual and group sessions. The messages delivered to clients also address male norms and behaviors, gender equity, women's rights and gender violence. The various TASO field teams will monitor use of treatment services during regular visits to clients' homes. TASO will provide STI information to all adolescents and adult clients with emphasis on sexually active clients. All sexually active clients will be screened for STI routinely and all clients will be screened for STI at least twice a year. All clients diagnosed with STI will be counseled, treated, helped to mobilize sexual partners for treatment, given condoms and condom education. Teams at the 11 TASO Centres will follow up specific STI cases and refer for specialized care where necessary. STI screening is vital as increasing proportions of clients resume sexual activity as part of the paradigm shift arising from improved health due to ART. During FY 2010, TASO Centres will scale up cervical cancer screening for the female clients above the FY 2009 level. Teams will support clients to uphold the high adherence levels recorded (over 95% of the clients on ART had adherence levels of over 96% using a three-day recall) and supporting the few clients with low adherence through follow-up. Clients will continue to receive ARV drugs both through the facility arm (i.e. 11 TASO Centres) and the community arm (i.e. Clients' Homes and Community Drug Distribution Points). TASO teams will use experience and program feedback to improve the existing models and explore more client-friendly service delivery models. Gender-related challenges often impede the success of adult treatment services. TASO will continue addressing gender issues affecting HIV/AIDS treatment through messages focusing on male norms and behaviors, gender equity, women's rights, domestic violence and coercion. Messages will be delivered through individual and group sessions to clients that encourage feedback by the recipients and dialogue. Quality assurance will be done through ensuring adherence to national and international standards, conducting regular refresher training for service providers, rigorous support supervision of service providers, technical support visits to service outlets and teams, conducting regular QA meetings in service delivery departments and conducting regular client satisfaction feedback exercises. The Adult Treatment program area is related to the program areas of PMTCT, TB/HIV, Counseling & Testing, ARV Drugs and Services and Laboratory Infrastructure. The activities under Adult Care & Treatment will not be delivered in isolation but the program area will be implemented in an integrated service delivery model bringing together activities under all the above program areas to form a comprehensive service package accessed by TASO clients.

TASO will continue providing confidential HIV counselling and testing to family members of all registered clients. The focus will be to test all children in households of TASO clients who are aged 5 years and below and spouses/sexual partners of all the registered clients. By the end of June 2009, TASO had cummulatively visited 17,056 homes of clients to conduct Home Based HIV Counselling and Testing (HBHCT) and tested 79,710 household members. Of the household members tested; 14.7% were aged less than 5 years; 36.8% were aged 5 - 15 years and 48.5% were aged over 15 years; 5.2% (4,127) tested HIV positive. For households where there are school going children, TASO teams schedule repeat visits at appropriate times when the children are home such as during school holidays. Alternatively children are given appointments at outreaches or nearby Community Drug Distribution points (CDDP). TASO uses a multi-pronged approach in mobilizing family members for HIV counselling and testing including: health talks to index clients at various service delivery points; drama groups using music, dance, drama and testimonies; home visits through a network of over 4,000 community volunteers; IEC materials; at public eents and using mass media. Testing is done at client homes, TASO centres, outreach clinics, CDDP or referred to other accessible HIV counselling and testing service providers. The testing is conducted using a 3-tier rapid HIV testing algorithm in line with the national HIV counselling and testing guidelines provided by the MoH. Testing is done by TASO Field Officers, Counsellors or Medical personnel who were all trained in HBHCT using a curriculum developed by Strenthening Counsellor Training in Uganda (SCOT); an organization founded by a consortium of partners including TASO, MoH and other partners to strenthen counsellor training and skills in Uganda. TASO conducts annual refresher training for staff participating in HBHCT to refresh their skills, share experiences and update knowledge. Test samples undergo both internal and external quality assurance at nearby Regional Referral Hospitals. Dry Blood Spots (DBS) samples are taken from children 18 months and below for testing at the Joint Clinical Centre (JCRC) Laboratory. The primary goal of the activty is to: identify people who are HIV positive and refer them for HIV/AIDS prevention, care, support and treatment services; identify discordant couples and refer them for appropriate services; and identify HIV negative persons and reinforce HIV/AIDS prevention messages

The identification of infants born to HIV-infected women is a necessary step in infant diagnosis. TASO shall continue to use the national ART and PMTCT diagnostic protocols by screening children using Dried Blood Spots (DBS) where HIV is suspected, starting as early as six weeks after birth. DBS will be obtained by finger or heel prick and transported to Regional Referral Laboratories for Virologic Polymerase Chain Reaction (PCR) test. Children under 18 months will be closely monitored. Children under 18 months who are known or suspected to have been exposed to HIV will be closely monitored and early timely interventions including ART instituted to reduce early morbidity and mortality. Children of any age confirmed HIV positive will be counseled and linked to care, treatment and support. All infants once confirmed HIV positive willl be started on ART (Irrespective of CD4/CD4% status).The decision as to when to start ART in children more than 12 months shall be guided by immunologic and clinical staging of thee children.Regimens will be based on the National ART and care guidelines for infants and children.Most of the ARVs available for adults can also be used in children, though not all formulations are suitable for children. History of PMTCT shall be considered in selection of 1st line regimens. Use of Paediatric Fixed Dose Combinations (FDCs) shall be considered. Modification of treatment regimens will be considered for tuberculosis co-infection as there is potential for multiple drug interactions. (Rifampicin plus NNRTIs/PIs). Counselling for ART is crucial ion children. Basic monitoring of children on ARVs shall consist of: clinical examination and WHO staging; immunologic CD4 %/CD4 counts; viral loads will be reserved for complicated management decisions following case conferences and training of TASO staff in Paediatric HIV care, treatment and support will be undertaken. Growth and development monitoring will be done using revised WHO growth charts for early identification of growth faltering and institution of corrective measures including nutritional supplements to promote growth and development. Weighing scales, Stadiometers and tape measures shall be procured. Infant feeding within the context of HIV shall be done according to National guidelines. Optimal feeding to minimize MTCT, prevent malnutrition and promote growth and development shall be practiced. Cotrimoxazole (CTX) prophylaxis shall be instituted for all HIV exposed and infected children starting at 6 weeks of age and continued until HIV is excluded. For HIV-exposed children of any age that are still breastfeeding, CTX will be continued until HIV is excluded i.e. 12 weeks after complete cessation of breastfeeding. Paediatric-specific adherence issues e.g. availability and palatability of drug formulations, relationship of drug administration to food intake in young infants and dependence on caretakers for administration of drugs shall be considered. Adherence shall be monitored through pharmacy refill records, pill counts and home visits for spot checks. Opportunistic Infections Prevention and Care. Provision of opportunistic infections prevention and care will be based on recommendations contained in the National Guidelines for CTX preventive therapy. All HIV infected children, regardless of CD4%/CD4 count shall receive CTX preventive therapy. All TASO HIV exposed and infected children shall be linked to appropriate specialized health facilities and community care e.g. Immunization clinics. Comprehensive Paediatric HIV care, treatment and support shall be provided according to the Ten-point package of the African Network for the care of children affected by HIV/AIDS (ANNECA) and adapted by the government of Uganda. This includes: confirming HIV infection status as early as possible; monitoring the Childs' growth and development; immunizations according to National guidelines; prophylaxis against OIs particularly Pneumocystis Carina Pneumonia (PCP); treatment of acute infections and other HIV-related conditions; counselling on infant feeding, good personal and food hygiene; conducting disease staging; ART for the infected child if needed; provide psychosocial support for the infected child, mother/caretaker & family and referral to higher levels of specialized care when necessary.

TASO currently takes care of over 6,000 HIV infected childrenages 0 - 18 years at the 10 TASO Centres of Entebbe, Gulu, Jinja, Masaka, Masindi, Mbarara, Mbale, Rukungiri, Soroti and Tororo. TASO runs a collaborative family clinic with Baylor Uganda at TASO Mulago Annex in Kanyanya where TASO reports on psychosocial issues at the site whereas Baylor Uganda reports on medical issues of the children. Baylor Uganda is phasing out from the clinic and the process will be complete by April 2010. TASO will thereafter assume full responsibility of service provision at the clinic. TASO targets to have 10% (3,290) of the total (32,940) benefiting child clients. HIV exposed infants and children will be routinely screened for antiretroviral therapy starting at six weeks of age and following the TASO pediatric ART carepathway through a series of counselling sessions to the caregivers, the children as appropriate, pyschosocial assessment and support to the caregiver, laboratory and clinical evaluations at TASO centres and outreaches. Antiretroviral drugs will be provided to eligible children at their homes, TASO centres, outreach clinics and at Community Drug Distribution Points (CDDP). Infant diagnosis will be done using the Dried Blood Spot (DBS) for HIV DNA-PCR starting at six weeks. The antiretroviral drugs regimens, pediatric eligibility criteria for ART and other pediatric HIV care guidelines will be as per national guidelines provided by MoH. Pediatric ARV drugs will be procured alongside adult ARV drugs and using the same supply chain processess. In addition it is expected that the UNITAID donation comming through the Clinton Foundation for pediatric ARVs and adult 2nd line ARV drugs will continue comming through for most of 2010. TASO has also adopted the comprehensive African Network for the care of Children affected by AIDS (ANNECA) ten point package for comprehensive pediatric HIV care. Support supervision of the TASO pediatric ART program will be done by a team from TASO headquarters that includes a pediatrician who will conduct bi-annual field visits to all the 11 centres. Support supervision tools developed by the Planning and Strategic Information Directorate will be used in accordance with the ANNECA ten point plan to enable a holistic approach to monitoring of children under care. Clinical and related data on the children will be monitored on a monthly basis by the data team including periodic CD4/CD4%, hemoglobin, occurance of opportunistic infections and drug adherence. Children will be linked to nearby health units for immunization, social/community based programs and specialized care when need a rises. All Monitoring and Evaluation activities will be conducted in accordance with the national Antiretroviral therapy treatment and care guidelines for adults and children. TASO will also provide therapeautic feeding to malnourished children during the first three months of initiating antiretroviral therapy or anti TB treatment.

Mother to Child transmission (MTCT) is the second most common mode of HIV transmission in Uganda accounting for up to 20% of new infections. An estimated 25,000 new HIV infections occur in Uganda each year due to mother to child transmission of HIV (MTCT). Over 67% of the more than 90,000 active TASO clients are females. Of these, an estimated 60% are in the 15 to 49 year reproductive age bracket. Among key paradigm shifts due to improved health status resulting from ART are rebuilding broken relationships and families; and resumption of active sexual activity. Feedback has shown that with restoration of hope due to improved quality of life, clients regard having children as a key part of the plan to rebuild their lives and families. In FY 2010, TASO priorities for PMTCT will include: identification and counseling of pregnant clients; medical examination of identified clients at various points of service; provide information on PMTCT and infant feeding in the context of HIV/AIDS; prioritize pregnant women for ART eligibility screening; scale up combined ART therapy, improve adherence support, monitor pregnant women, nursing mothers and their infants; provide ARV prophylaxis for mothers and their new born babies; strengthen early infant diagnosis of HIV/AIDS (EID) and linkages to pediatric HIV/AIDS care and treatment; conduct supportive home visits; engage pregnant clients and their sexual partners in counseling sessions and promote greater male involvement by continuous education of the male partners and communities; link pregnant clients to antenatal services as part of a two-way referral mechanism; follow up pregnant clients to support them deliver from health facilities under the care of trained health workers; follow up and test all HIV exposed infants starting 6 weeks of age using Dried Blood Spot (DBS). Infants confirmed to be HIV positive will be started on ART according to current Uganda National ART guidelines. Cotrimoxazole prophylaxis will be provided to all HIV exposed and infected children irrespective of clinical stage or CD4%. Futhermore, TASO will: engage in partnership with other PMTCT stakeholders to promote key issues including the 2 way referral, infant feeding in the context of HIV exposure or infection and essential postnatal care for HIV exposed infants; provide Family Planning information and access commodities for all sexually active clients; provide couple counseling to both HIV concordant and HIV discordant couples; empower sexually active clients to disclose their HIV status to their sexual partners; support discordant couple and concordant positive peer clubs. The activities under PMTCT will be implemented in an integrated service delivery model. This activity is linked to other USG funding through USAID and other non-USG partners including Government of Uganda, DANIDA, DFID, and Irish Aid through the Civil Society Fund (CSF).

TASO will continue to carry out activities under Laboratory Infrastructure to support service delivery at the 11 Centres located in the districts of Gulu, Jinja, Kampala, Masaka, Masindi, Mbale, Mbarara, Rukungiri, Soroti, Tororo and Wakiso and to contract competent companies to conduct periodic servicing and maintence of selected equipment. Each of the Centres will directly serve clients from the host district and up to 6 neighboring districts. The equipment will also be used among public health facilities and other partners in the region. The Laboratory Infrastructure related activities will comprise of: automation of laboratory processes such as hematology and clinical chemistry as a way of improving quality of service by reducing on client waiting time and decreasing staff workload; enhancing quality assurance of laboratory services and linking with reference laboratories for external quality assurance; capacity building for laboratory personnel; ensure steady supply of laboratory reagents and consumables; review laboratory guidelines and standard operating procedures; improve clinical waste management; and enhance Laboratory Information Management System (LIMS). TASO will continue providing testing for HIV, Opportunistic Infections (OI), Sexually Transmitted Infections (STI), Tuberculosis, Malaria, Hemoglobin, white blood cell counts and differentials, CD4 counts, ESR, clinical chemistry tests for clients pre-ART, and monitoring drug toxicities. Clinical chemistry test services will be provided to public health facilities and other HIV/AIDS care and treatment partner programs. Adequate capacity to cater for requirements of the various partners in the areas where they are located has been developed at TASO Mulago, Kanyanya Annex, Mbarara and Gulu. These centres serve as TASO centres and partners in Central Region, South western region and Northern region respectively. Other tests like DNA-PCR, viral load and resistence testing will be done by TASO partners with the necessary capcity. TASO will continue training and retraining laboratory staff on the use of modern laboratory diagnostic equipment. The Laboratory Infrastructure program area is related to the program areas of PMTCT, Adult Care & Treatment, TB/HIV, Counseling & Testing, ARV Drugs and ARV Services. The activities under Laboratory Infrastructure will not be delivered in isolation but the program area will be implemented in an integrated service delivery model bringing together activities under all the above program areas to form a comprehensive service package accessed by TASO clients.

TASO procures US Food and Drug Administration (USFDA) approved generic ARV or FDA approved branded ARVs. ARV drug procurements are done centrally by TASO Headquarters from Medical Access Uganda Limited (MAUL). MAUL was started under the United Nations Joint Programme on HIV/AIDS (UNAIDS) Drug Access Initiative (DAI). After adjusting forecast estimates using current consumption trends and projected enrollment rates, Headquarters places an order with MAUL for a two-month ARV drugs supply. The Pharmacy Support Officer (PSO) receives and checks requests and consumption reports from all the 11 TASO centres. Requests are then consolidated and a Local Purchase Order (LPO) raised and issued in accordance with TASO procurement guidelines. A distribution schedule is prepared and forwarded to TASO Headquarters Stores copied to all the 11 centres. The order is delivered to TASO Headquarters' controlled stores environment by the supplier under their own insurance cover. The PSO verifies the commodities and a Goods Received Note (GRN) is issued to the vendor. Quarterly 12 months forecasts are prepared and submitted to MAUL to guide the supply chain basing on current and expected client enrollment on ART. The forecasts are updated on a quarterly basis to take care of unforeseen variations during a quarter. Quantification to adjust forecast estimates to suit the replenishment cycle/actual need is done. ARV drug quantification is done based on the actual consumption trend and the projected enrolment at a time. Monthly transactions data from all the 11 centres are collected and compiled by Headquarters. Thereafter at end of a calendar month, the PSO is able to know TASO Global ARV stock status in terms of; physical closing stock, available client months, expenditure in client months, cost per client months, total physical closing stock value in monetary terms, total value of expenditure, number of months the available stock can sustain TASO clients per each individual item and physical stocks and consumption at each ART site. Subsequently decisions such as, quantity to order, relocation of some items from one center to another that may be in excess, low consumption or reduced consumption of a particular item are made. The ARV drugs buffer is kept in the range of 3 - 4 months worth of stock; its value is not static because of changes in: consumption per item; policy changes such as those regarding switch of clients to other regimens; unit cost at the time; availability of generic alternatives; enrollment trends. Both a manual and a computerized records keeping system are in place to quickly help obtain vital strategic information. However the current Pharmacy Information Management System (PIMS) has some challenges and processes of developing a faster and a more user friendly system to address current shortcomings in order to produce real time data. The PSO checks and receives ARVs from the supplier and distributed basing on the pull system. The schedule of distribution is forwarded to Headquarters' Storekeeper. Communication is sent to Medical Coordinators through Center Managers to come and pick up ARVs. Centers are guided to start the replenishment process when they are left with a 2-month supply. As the ARVs leave headquarters a delivery note is issued and centers issue a GRN in duplicate with both the center and the headquarters retaining a signed copy of each. AT centres, ARVs cage/room with a double lock system is provided for. The Store Keeper and the Pharmacy Technician keep a copy of the key each. A double lock system cabinet is also provided to each center Pharmacy. The center Pharmacy Technician makes weekly requisitions of ARVs from the Center ARV Cage in the store to the cabinet in the pharmacy. As ARVs leave the store, the following signatures are obtained: Store keeper to sign stock out of ARV cage; Pharmacy Technician to sign for stock taken out of center ARV cage. The delivery of drugs to clients is done at three levels: - Pharmacy Technician to Field Officer (FO) for clients that receive their refills at home; Pharmacy Technician signs stock out of DDA to FO; FO signs to acknowledge receipt; FO signs stock brought back into DDA and Pharmacy Technician signs for receipt of the returns. The pharmacy Technician then balances the stock cards. FO and Client: FO signs for delivery; client signs for receipt; client signs in missed doses; FO signs to acknowledge receipt of the missed doses; FO compiles his drug distribution report and Pharmacy Technician compiles FO daily reports into his consolidated daily report. Pharmacy Technician to Client for facility based clients: Pharmacy Technician signs the doses out to the client; client signs for received doses; client signs in returned doses and Pharmacy Technician receives the returned doses. The TASO ARVs tracking system emphasizes documentation at every point the ARVs change hands, from supplier up to the final beneficiary who is the client.

TB management is an integral component of the TASO care and support package due to the high prevalence of TB/HIV co-infection among persons with HIV (PHA) and transmission to close contacts. The TB management component comprises: TB health education for clients and community members; training of health service providers in management, finance and logistics for TB control; routine TB screening for all clients using an array of methods; TB diagnosis with smear microscopy being the primary diagnostic tool for pulmonary TB; provision of anti-TB drugs and ensuring reliable supply chain for anti-TB drugs to deliver uninterrupted supply of standardized short course chemotherapy (SCC); support for adherence to anti-TB treatment using the Directly Observed Treatment Short course (DOTS) strategy; home visits to clients on TB treatment; follow up of all TB clients notified for treatment until treatment completion and a definitive treatment outcome given for every registered case; support partnerships and linkages for TB treatment; ensure proper record keeping for TB treatment and accountability of every registered case; clinical waste management; referral of TB patients; and advocacy as an integral part of effective TB control. All clients seen at TASO clinics are screened for TB using various methods including history taking, clinical examination, sputum examination, and chest X-ray. Those diagnosed with TB were linked to treatment at TASO Centres and through MoH facilities. TASO will continue to partner in the national Community-Based DOT TB strategy. All TASO Centres are located within government hospitals and provide support to the hospital TB clinics. The TASO Centres get regular technical support from the National TB and Leprosy Program (NTLP). TASO will continue providing TB/HIV services at the 11 Centres located in the districts of Gulu, Jinja, Kampala, Masaka, Masindi, Mbale, Mbarara, Rukungiri, Soroti, Tororo and Wakiso using the DOTS Strategy as the gold standard for TB management and control. Each of the 11 TASO Centres will directly serve clients from the host district and up to 6 neighboring districts. All the 100,000 projected active clients will have the opportunity to be screened for TB and access TB/HIV services at least once a year. The broad service delivery strategies will include mobilization and sensitization, capacity-building, beneficiary involvement, health education, partnerships and collaboration. Health education also addresses male norms/behaviors, gender equity, legal rights and gender violence.TB infection control will be an ongoing activity through strategies including: (1) continuous TB education for clients and carers;( 2) TB infection control at all client waiting areas and within the clinics;( 3) mandatory segregation and appropriate disposal of clinical waste;( 4) use of hoods in the laboratories; and (5) proper ventilation of the clinic infrastructure. The TB/HIV program area is related to the program areas of PMTCT, Adult Care & Treatment, Paediatric Care & Treatment, Counseling & Testing, ARV Drugs and Laboratory Infrastructure. The activities under TB/HIV will not be delivered in isolation but the program area will be implemented in an integrated service delivery model bringing together activities under all the above program areas to form a comprehensive service package for TASO clients.