Integrated Community Based Initiatives (ICOBI) is an indigenous not for profit NGO founded in 1994 with a mission of improving the quality of life of people living in rural communities. Its head office is located in Kampala, the Capital City of Uganda. It has field liaison offices in the districts where it is operating. ICOBI has implemented several programs with community bias since its inception including; the World Bank STI Project (1995-2000), MAP Project (2001-2006), Nutrition and Early Childhood Development Project (1999-2003). Other projects included; EGPAF supported facility based PMTCT Project (2003-2005) and CDC supported Full Access Door to door home based Voluntary Counseling and Testing (2004-2007). These projects were mainly carried out in Bushenyi district in South Western Uganda. ICOBI has expanded its services and geographical coverage. Currently, ICOBI is implementing three projects in different parts of the country. It is implementing a three year NPI supported OVC Empower Project in Bushenyi and Mbarara districts (2008-2011). It is also implementing two five year CDC supported projects (July 2008 June 2013). The Home based Voluntary counseling and testing (HBVCT) project is going on in 6 districts in Mid-central Uganda, while the Community PMTCT project is being implemented in 6 districts in South-western Uganda.

The Community PMTCT Project has a national character with a special focus on 6 districts: Bushenyi, Ntungamo, Mbarara, Ibanda, Isingiro and Kiruhuura; with a total population of 2,720,459 people. The expected number of pregnancies is 136,023 annually, of whom 8,161 pregnant women are expected to be living with HIV annually. The main purpose for the community PMTCT project is to contribute towards the improvement of child survival through increasing the uptake of PMTCT interventions in Uganda through appropriate and effective community based approaches which include social mobilisation, local language behavioral change communication and service provision. The project intends to achieve the following objectives;

1. To promote innovative community based primary prevention of HIV through community mobilisation.

2. To prevent un-intended pregnancies among women living with HIV through use of modern family planning methods and other family planning strategies

3. To reduce the transmission of HIV from the pregnant or lactating women living with HIV to their babies by referring them to health units for appropriate ARV prophylaxis for PMTCT as well as for other strategies

4. To promote care, support and treatment for pregnant women living with HIV, their partners and families through active referral networks in the community and health facilities

5. To enhance advocacy, capacity building and behavior change communication for community PMTCT interventions

Implementation strategy: The implementation of the project has been phased; with Bushenyi and Ntungamo in the first year, Mbarara and Ibanda in the second year while Isingiro and Kiruhuura will be in third year. However, during the expansion of the project, the same activities will be maintained in the already implementing districts without interruption. There have been some adjustments in the implementation design after realizing that some of objectives were not going to be achieved as earlier planned. These changes were made in consultation with the CDC technical advisor. For example, the project is now carrying out home based HIV testing targeting male partners having realized that male partners were not taking up referral to health facilities for antenatal care in the company of their pregnant wives. Dry blood spot is being done at home for early infant HIV diagnosis (EID) and mothers encouraged to take their babies to the health facilities for other MCH services. ICOBI is expected to work closely with the existing community structures like the village health teams (VHTs) system for sustainability of the community PMTCT program, but these structures are not yet in place. ICOBI is going to assist these districts to train the VHTs and functionalize them.

Progress: ICOBI has recruited and trained key project staff that includes 44 Community PMTCT Officers (CPOs) and 264 community volunteers for Bushenyi and Ntungamo districts. We are in the expansion phase to Mbarara and Ibanda. We have submitted annual and quarterly progress reports to CDC. The number of pregnant women referred for CT for HIV from the community is 8,490 (41%) and the 137 (8%) male partners have been counseled tested and received results in the community. The number of pregnant women who attended ANC with their partners was 136 (26%).

Activities: Major activities will include identification and training of VHTs in Isingiro and Kiruhuura districts, selection and training one member of the VHT to be in charge of Community PMTCT in each parish in Isingiro and Kiruhuura. Other ongoing activities will include community moblisation and sensitization, identification, referral and follow up of pregnant mothers with their partners for antenatal care including PMTCT services. Other activities include HCT for male partners in the community, infant feeding, early infant diagnosis and family planning. M&E activities will include technical support supervision, data collection,analysis, generating/writing reports and organizing program review meetings.

Community PMTCT project is being implemented in six districts of South-western Uganda in a phased manner; scaling up to two new districts every year. We started with Bushenyi and Ntungamo districts. We are right now doing preliminary activities for starting implementation in Mbarara and Ibanda in this second year. In third year (April 2010), Isingiro and Kiruhuura will be brought on board. Activities continue uninterrupted in the old districts as we expand to new ones. The Community PMTCT Project has a national character with a special focus on 6 districts: Bushenyi, Ntungamo, Mbarara, Ibanda, Isingiro and Kiruhuura; with a total population of 2,720,459 people. The expected number of pregnancies is 136,023 annually, of whom 8,161 pregnant women are expected to be living with HIV.

Program Activities

1. ICOBI will develop and implement a systematic approach of local language community education and participation that will ensure information about ABC strategy on primary prevention of HIV reaches over 50% of women in the reproductive age-group and other people in the community in South Western and Central Uganda and beyond. The key strategies to achieve this will include promotional and motivational activities for ABC through mass media, local language information, education and communication (IEC) or behavior change campaigns (BCC) including use of drama shows, interpersonal channels and community dialogue with small groups of 25-30 people.

a) As part of mass media, ICOBI will use radio programs to disseminate information on ABC. ICOBI has experience using radio as a means of information sharing. We will use two approaches, one will be radio talk shows to be held once every week for 52 weeks in a year; and the other will be using various radio spots promoting ABC. In Uganda, Radio is the major source of HIV/AIDS related information to the public as 65% of Ugandan households own a radio set and only 33% get information by word of mouth according to the 2002 National Census. These programs are aired in Runyankole and the public is given time to call and participate in the program either by asking questions or contributing to the debate. ICOBI is going to support the national community mobilisation activities organized by Ministry Of Health.

b) In year three of project implementation, ICOBI will have built capacity of the community resource persons through training members of the Village Health Teams (VHTs) covering all parishes in this region. These community volunteers together with the health unit staff conduct monthly community dialogue meetings in each parish where they cover topics on HIV, PMTCT, Abstinence, being faithful and other prevention methods (OP).

c) The project will identify other community based structures like the 'mothers' and 'fathers' unions and PHA networks who will provide preventive counseling to women and their spouses for long term risk reduction of HIV transmission; encourage women to disclose their HIV sero-status to their partners. ICOBI will promote faithfulness in marriage (zero grazing) through training of model couples who will be used in sensitizing other couples; promote correct and consistent use of condoms; promote ongoing follow-up counseling and education through established community peer psycho-social support groups. ICOBI is supporting the community psycho-social support groups where they exist and rejuvenating dormant ones while at the same time assisting the formation of new ones. We target to have at least one group per parish.

d) Music, dance and drama is another powerful strategy for community sensitization on ABC in prevention of HIV. ICOBI has formed a drama group which performs in the communities. During the drama show, a health worker gets an interlude and gives health education talk targeted to the audience. During the drama shows, the public is given opportunity to ask questions and also test for HIV.

e) Targeted health education will be given to the community on condom use. The VHT members will distribute condoms in the community to increase access, consequently reducing the risks of persons engaged in risk behaviors like bar maids, multiple or concurrent sex partners, negative partners in long-term sero-discordant relationships, widows and divorcees and young people especially out of school youth. ICOBI will out source free condoms from the Ministry of Health and the district departments of health. Linkages will also be strengthened with the USAID supported AFFORD (social-marketing) to make condoms available in private sector at a subsidized cost.

f) Monitoring and evaluation (M&E): The project management team will carry out technical support supervision on the health facilities and community based volunteers to ensure proper project implementation. The district based coordinator will supervise the health units on a monthly basis. The health unit based coordinator will supervise the community volunteers on a monthly basis. ICOBI team will support the district coordinator on a monthly basis. Data collection tools will be provided and monthly reports submitted by the community volunteers. Data will be analysed and disseminated in form of reports and review meetings for various stakeholders. There will be monthly meetings for the health unit coordinators and quarterly stakeholders review meetings at district level.

ICOBI will develop and implement a systematic approach of local language community education and participation that will ensure information about risk reduction strategies and condom distribution as a contribution to primary prevention of HIV to reach over 50% of women in the reproductive age-group, their spouses and other people in the community in South Western Uganda and beyond. The key strategies to achieve this will include promotional and motivational risk reduction activities through mass media, local language information, education and communication (IEC) or behavior change campaigns (BCC) including use of drama shows, interpersonal channels and community dialogue with small groups of 25-30 people.

a) As part of mass media, ICOBI will use radio programs to disseminate information on ABC including sexual partner reduction, STD/STI management and condom use. ICOBI has experience using radio as a means of information sharing. We will use two approaches, one will be radio talk shows to be held once every week for 52 weeks in a year; and the other will be using various radio spots promoting the relevant behaviors. In Uganda, Radio is the major source of HIV/AIDS related information to the public as 65% of Ugandan households own a radio set and only 33% get information by word of mouth according to the 2002 National Census. These programs are aired in Runyankole and the public is given time to call and participate in the program either by asking questions or contributing to the debate. ICOBI is going to support the national community mobilisation activities organized by Ministry Of Health.

b) In year three of project implementation, ICOBI will have built capacity of the community resource persons through training members of the Village Health Teams (VHTs) covering all parishes in this region. These community volunteers together with the health unit staff conduct monthly community dialogue meetings in each parish where they cover topics on HIV, PMTCT, Abstinence, being faithful and other prevention methods (OP).

c) The project will identify other community based structures like the 'mothers' and 'fathers' unions and PHA networks who will provide preventive counseling to women and their spouses for long term risk reduction of HIV transmission; encourage women to disclose their HIV sero-status to their partners. ICOBI will promote faithfulness in marriage (zero grazing) through training of model couples who will be used in sensitizing other couples; promote correct and consistent use of condoms; promote ongoing follow-up counseling and education through established community peer psycho-social support groups. ICOBI is supporting the community psycho-social support groups where they exist and rejuvenating dormant ones while at the same time assisting the formation of new ones. We target to have at least one group per parish.

d) Music, dance and drama is another powerful strategy for community sensitization on ABC in prevention of HIV. ICOBI has formed a drama group which performs in the communities. During the drama show, a health worker gets an interlude and gives health education talk targeted to the audience. During the drama shows, the public is given opportunity to ask questions and also test for HIV.

e) Targeted health education will be given to the community on condom use. The VHT members will distribute condoms in the community to increase access, consequently reducing the risks of persons engaged in risk behaviors like bar maids, multiple or concurrent sex partners, negative partners in long-term sero-discordant relationships, widows and divorcees and young people especially out of school youth. ICOBI will out source free condoms from the Ministry of Health and the district departments of health. Linkages will also be strengthened with the USAID supported AFFORD (social-marketing) to make condoms available in private sector at a subsidized cost.

f) Monitoring and evaluation (M&E): The project management team will carry out technical support supervision on the health facilities and community based volunteers to ensure proper project implementation. The district based coordinator will supervise the health units on a monthly basis. The health unit based coordinator will supervise the community volunteers on a monthly basis. ICOBI team will support the district coordinator on a monthly basis. Data collection tools will be provided and monthly reports submitted by the community volunteers. Data will be analysed and disseminated in form of reports and review meetings for various stakeholders. There will be monthly meetings for the health unit coordinators and quarterly stakeholders review meetings at district level.

Community PMTCT project is being implemented in six districts of South-western Uganda in a phased manner by scaling up to two new districts every year. We started with Bushenyi and Ntungamo districts. We are right now doing preliminary activities for starting implementation in Mbarara and Ibanda in this second year. In third year (April 2010), Isingiro and Kiruhuura will be brought on board. Activities continue uninterrupted in the old districts as we expand to new ones. The Community PMTCT Project has a national character with a special focus on 6 districts: Bushenyi, Ntungamo, Mbarara, Ibanda, Isingiro and Kiruhuura; with a total population of 2,720,459 people. The expected number of pregnancies is 136,023 annually, of whom 8,161 pregnant women are expected to be living with HIV.

Program activities:

1. The main activity for community PMTCT project is community mobilisation and sensitization through a number of innovative appropriate and effective approaches aimed at fostering behavior change and creating demand for PMTCT interventions including; community dialogue meetings, radio programs, drama shows and home visiting. The project has recruited one community volunteer (Member of VHT) for each parish within the project area who mobilizes his community for PMTCT interventions. By 2010, we expect to have 519 community volunteers in the six districts. The community volunteer links up with the health facility based staff for support in carrying out mobilisation activities like giving health education talks at the community dialogue meeting. There is one such a meeting in every parish every month targeting the general population including pregnant women and their partners, HIV positive or negative people in the community are encouraged to attend and ask questions. ICOBI will carry out 6,228 community dialogue meetings in 2010.

a) Targeted drama shows will be conducted at the parish level to strengthen the mobilisation activities. ICOBI has built up a fully fledged drama group which will show performances in communities where PMTCT services uptake will be low. Drama has been found to attract big gatherings for entertainment. At the same time, the songs and the plays convey meaningful messages. During a drama show, people are put in smaller groups of not more than 25 people according to their age category and given health education on HIV and other health related issues. People are given opportunity to ask questions for clarification. We target to have one drama show per parish for Isingiro and Kiruhuura districts, totaling to 136 drama shows.

b) Radio is an important medium of communicating health messages in Uganda. We will hold one radio talk show every week. Runyankole which is the language understood by majority of the people in the Ankole region will be used.

c) ICOBI supports the national community mobilisation activities as deemed by Ministry of Health; either radio programs or production and distribution of IEC materials like brochures, calendars, stickers, diaries and booklets in different languages.

d) ICOBI will conduct stakeholders/advocacy meetings at both district and sub-county levels to update the opinion leaders and political leaders on their mobilisation roles in the community. We also build consensus on the implementation of the project with full support of the local communities. We will conduct two introductory district level meetings for Isingiro and Kiruhuura and 25 sub-county level meetings in the same districts.

2. Identification, referral and follow up of pregnant mothers with their partners for MCH services including PMTCT interventions to make at least 4 ANC visits before delivery, delivery in health units under supervision of qualified health worker, infant feeding, early infant diagnosis, family planning and TB services. Community volunteers will identify clients and refer them to the health units and those identified at the health units are referred back to the community volunteers for follow up and compliance issues. ICOBI will identify and follow up 90% of the pregnant mothers in the community, 100% of the HIV positive mothers and their babies, 80% of whom will be enrolled on ARV prophylaxis with their babies. We expect to increase health unit deliveries to 50% and mobilize 90% of the HIV positive couples will be on dual method for family planning.

3. Out-reach programs: ICOBI will carry out community out-reach programs to provide targeted HIV counseling and testing in the community/homes. This came after realizing that male partners were not forthcoming for PMTCT services at the health facilities or community meetings in spite of constant encouragement from the community volunteers. Health workers will be facilitated to carry out community out-reaches. There will be one out-reach per parish per month, totaling to 6,228 out-reaches in a year.

4. Psycho-social support: ICOBI will work with the existing post test clubs or PHA networks to provide psycho-social support to the identified women with their partners in the community. Where such groups do not exist, ICOBI will establish them, one per parish. ICOBI will provide expertise in different fields of psycho-social support including counseling and income generating activities. ICOBI has identified a gap in the leadership for the existing post test clubs which need to be addressed by giving on job training for the leaders in leadership and management. ICOBI will hire experts to do that. Currently, psycho-social support groups are supported by the Community PMTCT Officer based at the sub-county level who is going to be phased out and will be replaced by the health facility based coordinator for sustainability reasons..

5. Capacity building: Identification and training of the community volunteers in Isingiro and Kiruhuura districts and conducting refresher trainings for health workers to orient them on community PMTCT will be conducted. A one week training workshop will be conducted for 519 Community volunteers who will be equipped with knowledge and skills for implementing Community PMTCT. These are members of the VHT as explained in number 1 above. We will conduct refresher training workshops for the health workers as well. All community volunteers will have refresher training workshops for two days every six months.

6. Monitoring and evaluation (M&E): The project management team will carry out technical support supervision on the health facilities and community based volunteers to ensure proper project implementation. The district based coordinator will supervise the health units on a monthly basis. The health unit based coordinator will supervise the community volunteers on a monthly basis. ICOBI team will support the district coordinator on a monthly basis. Data collection tools will be provided and monthly reports submitted by the community volunteers. Data will be analysed and disseminated in form of reports and review meetings for various stakeholders. There will be monthly meetings for the health unit coordinators and quarterly stakeholders review meetings.

Targets for 2010 and 2011

We expect to achieve the following targets

We expect to reach 108,818 (80%) pregnant women and lactating mothers with ABC messages in 2010 and 119,799 (85%) in 2011.

We expect to distributed condoms among 40,807 (30%) pregnant women, lactating mothers and their partners in the community in 2010 and 56,368 (40%) in 2011

We expect to form 219 active male peer groups in 2010 and 300 in 2011. N.B: Active means trained, holding meetings and participating in community education and any other RH/HIV prevention activities

We target 20,403 (15%) male partners to receive counseling, testing and results at community out-reaches in 2010 and 28,184 (20%) in 2011.

We expect 68,011 (50%) partners to disclose test results to the partners in 2010 and 84,552 (60%) in 2011.

We target to identify 108,818 (80%) mothers and follow them up for a minimum of 2 visits, one during ANC and one in PNC in 2010 and 119,782(85%) in 2011.

We target to train 3,000(100%) VHT members in Kiruhura and Isingiro in 2010.

We expect 2,400(80%) VHT members to be active in 2010 and 2,700 (90%) in 2011.

We expect to train all the 519 peer educators in Kiruhura and isingiro in 2010.

We expect 415(80%) active peer educators in 2010 and 467 (90%) in 2011

We target to refer 108,818(80%) pregnant women for ANC and 28,184(20%) in 2011.

We expect to refer 108,818(80%) pregnant women to deliver from health facilities in 2010 and 126,828 (90%) in 2011.

We target to refer 108,818 (80%) mothers for PNC in 2010 and 119,782 (85%) in 2011

We target to refer 108,818 (80%) mothers for FP in 2010 and 119,782 (85%) in 2011