TASO works closely with MoH. Since inception TASO 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 and 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 care, support and treatment partners 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 staffs 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 staffs 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. Staffs 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 all program activities through 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 elected by the Annual General Assembly periodically.

Program Leadership & Oversight: Overall management and leadership of the TASO program at national level will be done by Mr. Robert Ochai the Executive Director. The Executive Director is assisted by a Deputy Executive Director and other Directors in charge of 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 Apac Project: The project will be headed by a Project Coordinator who is a well-qualified and experienced individual who will have undergone specialized experiential and didactic training in leading and managing HIV/AIDS programming in addition to other training. The Project Coordinator will ensure adherence to organizational policies and systems. The Project Coordinator will be assisted by 3 County Coordinators, Accountant, an Administrative Assistant, and a Data Manager. The Project Coordinator will also be supported by public health structures in the district.

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. 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. Update of the MIS shall continue during FY 2010.

Organizational Policies: All TASO facilities 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 regulations of the 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 facility 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 (data entry, data cleaning, data storage, data analysis) together with data for other systems. Facilities 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 units twice a year, and also conduct other audits as need arises. The audits will include both Financial Reviews 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 for drugs, medical supplies, stationery, equipment and other program needs. All facilities adhere to the Procurement Policy. Each facility has 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 project will have a three-tier technical support mechanism to the services provided in Apac district. 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 project through quarterly support visits. The project will also collaborate with MoH in the areas of capacity-building, availing of the national guidelines by MoH, supply chain management, referral among others.

TASO project team will refer for care and treatment people who are diagnosed with HIV during testing in the district. All the project 6,400 HIV positive persons facilitated through referral to access a comprehensive package of high quality Adult Care & Treatment services from the district comprising of counseling for clients and family members; antiretroviral therapy (ART) as appropriate; screening and treating opportunistic infections; screening and treating sexually transmitted infections (STI); providing vital information on cotrimoxazole prophylaxis, safe water, nutrition, STI, FP, PMTCT; enrolling clients on cotrimoxazole prophylaxis; providing safe water vessels and promoting safe water use; providing LLITN and promoting malaria prevention; providing condoms to sexually active clients; conducting various courses to train service providers to provide HIV care and support;

The support will include mobilization and sensitization, capacity-building, beneficiary involvement, greater PHA involvement, partnership and collaboration and others. In partnership with the district, TASO will support provision of a basic care starter kit consisting of safe water vessels and chlorine solution (Water guard®), LLITN (bed nets) for prevention of mosquito bites, cotrimoxazole prophylaxis and condoms to sexually active clients. All adult clients will have the option to access condoms as part of their kits and the sexually active clients will be empowered to appreciate access and use condoms correctly and consistently; all HIV positive persons will be targeted for cotrimoxazole prophylaxis and Dapsone will be provided as alternative medicine for a few clients that are allergic to cotrimoxazole. The project will continue sensitizing clients on the importance of the various Care & Treatment services in improving the quality of clients' lives. Sensitization will be done through counseling, health education talks, MDD performances and IEC materials at service outlets. The various TASO field teams will monitor use of Care & Treatment services during visits to clients' homes. TASO will provide STI information to all adolescents and adult clients with emphasis on sexually active clients. 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.

During the second year of Apac project implementation, TASO will continue providing full access home based confidential HIV counselling and testing to all individuals in Apac district who will have not taken the tests during the first year of project implementation. HIV antibody testing will be done alongside Malaria testing using the same blood samples. Testing for malaria will be done using the rapid paracheck test. All persons tested, will receive their test results. The testing will be done at respective homes. Apac district has one of the highest malaria infectivity in the world with 1,564 bites per person per year. Testing for HIV and Malaria will serve as an entry point to prevention of both conditions and referral for care. HIV testing will be done using a-three tier rapid test algorithm as approved by the MoH. The approach will integrate both HIV and Malaria initiatives with a strategic focus on sustainable strengthening of health systems. For households where there are school going children, project team members will schedule to make repeat visits to such households at appropriate times when the children are at home such as afternoons for children that attend half day school time; during school holidays when children who spend full working days at school and those in boarding schools are back for vacation. TASO will use a multi pronged approach in mobilizing family members for HIV counselling and testing including. The Village health Teams (VHTs) will constitute key local resource persons in mobilizing community members and guiding the field teams. The approaches to mobilization will include: meetings with various stakeholders, collaboration with health facilities in the district to provide health talks at various service delivery points, use of existing drama groups in music, dance, drama and testimony giving presentations, working through PHA and AIDS service organizations net works, through community development initiatives, IEC materials, during public functions, Civil Society Organizations (CSOs), TASO and partners' organized events and the mass media. Testing will be done at each of the 15 sub-counties by a team consisting of a County Coordinator who supervises a team of 15 people (three per Sub-County i.e. 2 HCT Counsellors and 1 Laboratory Assistant). All field team members will have undergone specialized training in conducting rapid HIV and Malaria tests. TASO will conduct annual refresher training for project staff to renew their skills in HBHCT and Malaria testing, share experiences and receive updates. Blood samples for children aged below 18 months will be processed for DNA-PCR testing using the Dry Blood Spot (DBS) technique and transported using existing mechanisms to Joint Clinical Research Centre (JCRC) Laboratory or other laboratory with facilities for doing DNA-PCR. Samples of rapid HIV and Malaria tests will be submitted for both internal and external quality control at nearby Regional Referral Hospitals or any other certified Laboratories. The Primary goal of the activity is to identify people who are HIV positive and those with malaria and refer them for HIV and malaria care services and prevention including the Basic Care Package (BCP), PMTCT and ART. Those who are HIV negative will be given support on how to prevent HIV infection and to remain sero-negative. The project will also support health systems strengthening in Apac district.

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TASO AB interventions in Apac will aim at addresssing the key HIV driversthe epidemic by discouraging high risk behaviors and practices such as; early sex, premarital sex, casual sex, multiple sexual partnerships and extramarital sex. The program will also highlight other social economic factors that increase vulnerablity to HIV infection including; the plight of OVC and child-headed households; domestic violence and sexual abuse, human rights abuses; excessive consumption of alcohol and negative gender norms underlying male behavior.

Abstinence interventions will target youths and/or young people in and out of school. The interventions will empower male and female youth in Apac district with life skills to prevent HIV infection through abstaining from sex. Service providers will be empowered with appropriate communication skills and facilities to support abstinence issues among youth. TASO will develop and implement effective IEC interventions for addressing abstinence issues among the youth in Apac district. Be Faithful interventions will target people engaging in marital sex and/or sex in stable ongoing relationships such as married couples and cohabiting couples (these will mostly comprise of adult community members). The interventions will empower adult male and female community members to prevent HIV infection by practicing mutual faithfulness in their sexual relationships. Service providers dealing with adults will be empowered with appropriate communication skills and facilities to support this target group. TASO will develop and implement effective IEC interventions for addressing "be faithful" issues among sexually active adult community members in Apac.

Sexual Prevention (AB) activities during FY2010 will include: building capacity of local communities and indigenous organizations in AB; supporting AB partnerships, networks and linkages; conducting AB outreach activities in communities; providing technical support to identified local AB partners; conducting group and/or individual counseling sessions in the communities; conducting health talks on AB issues; mobilizing and empowering community structures such as cultural, social, economic and political entities to promote/advocate for AB. These interventions have been selected because they align the TASO AB approach to the National HIV/AIDS Strategic Plan (NSP) 2007/08-2011/12. The interventions also respond to the gaps in the national HIV response as identified by the UHSBS and other key studies. The interventions are also backed with evidence of their effectiveness. The TASO-supported AB activities will have partnership and referral linkages to other services/platforms in health service delivery in Apac district. AB activities will also promote other HIV Prevention approaches, HIV Care/Support and HIV Treatment services by partners in the district.

Activities will be implemented with full consciousness of gender disparities and vulnerability to infection; appropriate messages will be passed on. The barriers to prevention efforts paused by stigma and discrimination issues will be addressed. TASO will work with the office of the DHO, Ministry of Health and social marketing organizations.

This activity will target prevention of HIV/AIDS through interventions that promote consistent condom use and other prevention methods as appropriate to enable adults access a variety of complimentary approaches to prevent HIV infection in any given situation. In particular, this approach will be used to strengthen "Prevention with Positives' for cleints identified in the home based counselling and testing program especially the sexually active clients and discordant couples. TASO will also make targeted interventions for at-risk populations, including but not limited to boda boda riders, truck drivers, mobile populations, commercial sex workers, plantation workers, and others to whom abstinence and faithfulness are difficult options. Project staff will reach these populations by organizing educational events within their respective communities. Through collaboration with the District, TASO will access free condoms for distribution amongst the population including discordant couples. These condoms will be available with the field staff. Trained project staff will provide appropriate information assisting clients to consider condom use as an appropriate option to avoid further transmission of HIV. Particular effort will be taken to ensure that target audiences are all adults and exclude children.

The second component of this activity is staging Drama Group performances in the community. The program will train PHA net works and community residents to utilise music and drama to pass on HIV prevention messages in the rural communities, institutional settings and other venues. Drama Groups convey their messages through singing, dancing, acting plays, sharing personal HIV/AIDS testimonies and providing HIV/AIDS information. Through these drama performances the audiences will be able to ask questions and also relate their own experiences. These discussions will lead to recommendations for prevention activities beyond abstinence and faithfulness. TASO will ensure prevention message conveyed through Music and drama performamces are reinforced by age appropriate small group discussions facilitated by trained counsellors. In addition, TASO will also provide various training programmes to promote condom use and other prevention methods using a variety of adult learning methods.

The third component of this activity is staging community education and action through peer groups who, among other roles, will carry out HIV/AIDS education including the promotion of prevention activities beyond A&B in different venues in the community. The community workers will mobilize community residents to come together to attend HIV/AIDS talks, drama shows and other events aimed at providing HIV/AIDS information to the residents. The community workers will be trained in community facilitation skills and promotion of HIV/AIDS prevention through behavior change beyond A&B. Community workers will also inform community members where free condoms can be accessed.