1. Overall goals and objectives To provide a comprehensive health service delivery to the people of northern Uganda and integration between HIV/AIDS, TB, Malaria, Maternal Child health, Sexual reproductive health and Water and sanitation activities. Specific objectives include: Increase accessibility of HIVIAIDS, Malaria, TB, Sexual Reproductive health, Nutrition, child survival and malaria services for Ugandans using integrated approaches, Strengthen coordinated and integrated health service delivery systems and increased utilization of quality HIV&AIDS, SRH, Nutrition, tuberculosis and malaria prevention, care and treatment services

2. Target populations and geographic coverage The project will target all district residents in Acholi and Lango region. The 15 districts in the Northern Uganda region (Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar) will be served.

3. Enhancing cost effectiveness and sustainability A key priority will be to support the existing national Health system and working within district hospitals and lower health facilities for purposes of building sustainability.

4. Health Systems Strengthening The project will improve the functionality of District Health Team (DHT), District AIDS Committees (DACs), District AIDS Teams (DATs), and Health Sub Districts (HSDs), DLTFP and other district leadership and management structures. Strengthening of Health Management Information system (HMIS) and capacity building of district staff in key technical areas will be undertaken as well as supplies for

HMIS

5. Cross-Cutting Budget Attributions a. Human Resources for Health The project will support pre-service and in-service training for district health staff and CSO staff in all the technical areas and encourage the task shifting both within facilities and at community level for tasks such as community-based client follow-up to ensure adherence for TB and ART, children on ARVs and community PMTCT (REDACTED)

b. Construction/Renovation REDACTED

c1. Food and Nutrition: Policy, Tools, and Service Delivery • The project will train service providers in nutritional supplementation and promotion of household food security and nutritional status of the people especially children, pregnant and lactating mothers. (REDACTED)

e. Education Education will be promoted through working with institutions of higher learning to carry out HIV prevention campaigns and behavior change interventions. (REDACTED)

f. Water Clean and safe water will be provided as part of a Basic Care Package to PLWHA. It is important to integrate WASH approaches into programs through implementation of hygiene and sanitation programmes, treatment and safe storage of drinking water, hand washing with soap, and sanitation promotion, behavior change activities and reinforcement, enhancing access to safe water sources, improved sanitation facilities in households, hygiene promotion and building the capacity of community members to effectively and in a sustainable manner, manage the installed water and sanitation facilities. (REDACTED)

g. Gender: Reducing Violence and Coercion Prevention of gender-based violence will be supported by responding to sexual violence as well as address other forms of GBV including rape, defilement, early marriage and domestic violence that may be more common. In addition, adequate drugs and equipment will be provided as well as structures where the redress of victims of SGBV can be availed. Training and conducting support supervision of the partner CSOs to conduct action oriented community discourses on issues of gender power relations.

(REDACTED)

6. Key issues: Briefly (one sentence) identify activities in each key issue that this mechanism will address. a. Health-Related Wraparounds o Child survival will be addressed through training of health workers in pediatric care using the Integrated Management of Childhood Illnesses approach. o Family planning will be integrated in PMTCT through routine delivery of goal oriented antenatal care. o Prevention of malaria in pregnancy will be integrated in PMTCT through routine delivery of goal oriented antenatal care, and the program will obtain long lasting insecticide treated nets from President's Malaria Initiative and distribute them to pregnant mothers. o Safe motherhood will be integrated in PMTCT through routine delivery of goal oriented antenatal care and safe delivery kits will be distributed to ensure a clean delivery environment. o The project will facilitate district and sub-district joint TB and HIV/AIDS coordination and review meetings, district planning workshops, and fund M&E activities related to TB/HIV. o TB/HIV collaboration activities will be strengthened through screening of all HIV positive suspected TB cases. o Adult care and treatment will be another central activity of the program to ensure all patients are enrolled for care and treatment. o Safe male circumcision will also for part of HIV prevention strategy. o Counselling and testing at both static and outreach sites will be part of the program. o Pediatric care and support will be provided to on-going care and support for the Pre-ART children. A comprehensive care package will be provided which will include preventive care, palliative care and prevention with positives. o Pediatric treatment to current ART pediatric clients and enrollment of new clients will be undertaken. o Laboratory support will be extended to ART clinics and for TB diagnosis. o Strategic information will be a component of the program to strengthen HMIS and use of project information for decision making

b. Gender Gender issues will be addressed through integrating gender issues into district workplans and other CSOs working in the project to promote positive behaviors such as: gender equity; couple dialogue; couple visits to ANC; partner counseling and testing and disclosure.( REDACTED)

d. Mobile Population Uniform forces, Fishing communities, migrant workers, boda boda cyclists and long distance truck drivers

will be targeted with prevention activities.

f. Workplace Programs Uniform forces, Fishing communities, migrant workers, boda boda cyclists and long distance truck drivers will be targeted with prevention activities.

1. Target populations and coverage of target population or geographic area The project will support public health units up to HC IIs]in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide Adult care and support services. Integrated HIV/AIDS care and support services will be implemented at both facility and community levels. Clinical care interventions will include diagnosis and treatment of opportunistic infection, medical prophylaxis using Cotrimoxazole for OIs and Fluconazole for prevention of Cryptococcal meningitis will be provided as part of routine care. Pain and symptom management integrated in to supported health facilities including HC3's. Other services include psychosocial support, spiritual support, bereavement counseling and end-of-life care. The program will strengthen the provision of laboratory tests for diagnosis of HIV and other opportunistic infections; including TB. Target beneficiaries for this program are adolescents, adults, women, MARPs, People Living with HIV/AIDS, their families and communities.

2. Description of service delivery or other activity carried out There will be improvement to care and support services for the HIV+ population. This will be achieved through training for health workers in various aspects of palliative care and treatment as well as support the mobilization and training of PHA volunteers to work as Network support agents (NSA) in the health facilities aiming at linking fellow PHA to other services. Home based care will additionally be strengthened with the training of home based care providers from the 15 districts

3. Integration with other health activities The project will support best practices and proven interventions and approaches that would improve access to the continuum of HIV/AIDS services. Quality assurance/ Quality improvement in care and support services will be emphasized as its key in addressing client retention. The program will establish facility-base quality improvement teams. Program monitoring will occur through Lot quality Assurance surveys, integrated support and supervision to strengthen data collection, utilization and reporting.

4. Relation to the national program The project will implement national guidelines for adult HIV/AIDS care and treatment. The MoH l tools for data collection and reporting will be used. Focus will also be made to ensure that key changes in the national policy and strategy are implemented in the project.

5. Health Systems Strengthening and Human Resources for Health Health workers will be trained to provide ARV prophylactic regimen according to the Ministry of Health (MoH) The project will support support in-service/refresher training for clinic staff at the target facilities on

the comprehensive HIV care package.

1. Target populations and coverage of target population or geographic area The project will support public health units in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide Adult HIV treatment services. The project will increase access and availability of antiretroviral therapy to adult populations in need. ART will be part of comprehensive HIV/TB activities.

2. Description of service delivery or other activity carried out Public health facilities in the region will be supported to attain accreditation for ART and those already accredited will be supported to maintain the standards of offering quality ART services. Adult PHLWAs will be screened for ART eligibility using WHO Staging and CD4 monitoring. PLWHAs currently accessing treatment from the NUMAT supported health centre IVs in the target districts will be transitioned to this program. The program will establish and/or strengthen adherence to ART at both facility and community level through adherence counseling, community follow-up, and active management of side effects in order to reduce drug resistance. Public health laboratories will be strengthened to conduct clinical monitoring tests for ART toxicity e.g. Full blood counts, renal and liver function tests according to national guidelines. Samples for viral load will be collected and transferred to regional labs to monitor response to treatment and ART drug resistance. The program will explore and implement cost effective models for providing quality services at lower unit cost which will include but not limited to task shifting, increased local ownership and commitment (increased staffing and other resources), networking and linkages, triage, and reduced patient waiting time.

3. Integration with other health activities The ART program will be integrated with PMTCT, TB, and family planning. The project will support best practices and proven interventions and approaches that would improve access to the continuum of HIV/AIDS services. Quality assurance/ Quality improvement in care and support services will be emphasized as its key in addressing client retention. The program will establish facility-base quality improvement teams. Program monitoring will occur through Lot quality Assurance surveys, integrated support and supervision to strengthen data collection, utilization and reporting.

4. Relation to the national program

The project will implement national guidelines for adult HIV/AIDS care and treatment.

5. Health Systems Strengthening and Human Resources for Health Health Systems will be strengthened to facilitate improved delivery and uptake of ART services i.e. health management information systems (HMIS), supply chain management, strategic information, and laboratories. Health workers will be trained to provide ART service through in-service training, mentoring, and continuing medical education. Monitoring and evaluation will involve integrated support and supervision, and data quality assessments.

1. Target populations and coverage of target population or geographic area The project will support HCT in all health units [up to HC IIs] in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide Counselling and testing services. Target beneficiaries are individuals most at risk populations, pregnant women as an initial step to PMTCT access, HIV exposed children, TB patients, discordant couples, presence of clinical signs and symptoms which indicate increased risk of HIV infection i.e. STDs, opportunistic infections, and during occupational and non-occupational exposure and prophylaxis.

2. Description of service delivery or other activity carried out The project will strengthen access to HIV counseling and testing to promote early knowledge of HIV status, enhance positive behavior change through HIV prevention counseling for both the HIV-negatives and positives and support effective referral of HIV positive clients to HIV treatment and care services. HVCT will be done at both static and outreach sites. Service outlets will be created to provide testing and counseling services. Focus will also be made in creating Youth friendly environment for services to the Youth. HCT services will be provided at all health units up to health centre II as well as community level through outreaches, HCT camps, and HCT moonlighting. The program will engage in the implementation of the National HCT campaigns in the targeted districts. Provider - initiated HIV counseling and testing will be provided to all patients as part of routine health care services within public and private health units in the target districts. Specific prevention counseling will be offered based on the HIV status and risk assessment.

3. Integration with other health activities SMC will be integrated in HCT through HCT counseling. This will further be linked to PMTCT and ART clinics for care and treatment

4. Relation to the national program The project will be aligned to the MoH guidelines on HCT

5. Health Systems Strengthening and Human Resources for Health Health workers will be trained to provide HCT at both static and outreaches according to the Ministry of Health (MoH) HCT guidelines. Outreaches to reach the communities at HC IIs will be conducted by health workers. The PHAs will be trained to mobilize community for HCT as well as to ensure adherence to ARVs. The STAR-SW program will strengthen access to HIV counseling and testing to promote early knowledge of HIV status, enhance positive behavior change through HIV prevention counseling for both the HIV-negatives and positives and support effective referral of HIV positive clients to HIV treatment and care services. HCT services will be provided at all health units up to health centre II as well as community level through outreaches, HCT camps, and HCT moonlighting. HCT services will be provided at all health units from hospital level up to health centre II. The program will engage in the implementation of the National HCT campaigns in the targeted districts. Provider - initiated HIV counseling and testing will be provided to all patients as part of routine health care services within public and private health units in the target districts. Specific prevention counseling will be offered based on the HIV status and risk assessment. Target beneficiaries are individuals most at risk populations, pregnant women as an initial step to PMTCT access, HIV exposed children, TB patients, discordant couples, presence of clinical signs and symptoms which indicate increased risk of HIV infection i.e. STDs, opportunistic infections, and during occupational and non-occupational exposure and prophylaxis. The program will provide in-service training of health workers to strengthen skills for HCT. REDACTED. The program will update and/or develop QA/QI protocols that will be distributed to the service providers.

1. Target populations and coverage of target population or geographic area The project will support public health units in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide pediatric care and support. Target beneficiaries are HIV-exposed, infected or affected children, their guardians/parents, families and communities.

2. Description of service delivery or other activity carried out The project will scale up and strengthen pediatric care and support services at all facility levels. HIV exposed children identified through the PMTCT program will be linked to care and support services. The

comprehensive pediatric care and support service package that will be supported include scaling up early infant HIV diagnosis with DNA/PCR starting at six weeks of age, Cotrimoxazole prophylaxis, treatment of opportunistic infections, immunization, deforming, treatment of all HIV infected infants regardless of CD4+ count, screening older children for ART eligibility according to national policy guidelines, pediatric HIV counseling, growth and development monitoring, pain and symptom management, nutritional assessment, nutrition counseling and promotion of infant and young child feeding according to national and WHO guidelines. Pediatric care and support services will be provided as an integral component of routine Pediatric in- and out patient services; maternal, child health, nutrition and community outreach activities. Capacity of providing pediatric care and support services will be strengthened through in- service didactic training of health workers, mentoring, continuing medical education and regular support supervision. The program will establish networks and referral systems within and between facilities and communities in order to strengthen follow-up, retention in care and adherence to treatment.

3. Integration with other health activities The project will integrate with PMTCT, TB/HIV, nutrition, and child survival activities. It will also linked to other wrap around services like access to insecticide treated nets, hygiene, sanitation, food security and OVC services

4. Relation to the national program The project will implement the revised MoH guidelines for pediatric care and treatment.

5. Health Systems Strengthening and Human Resources for Health The project will support pre-service and in-service/refresher training for clinic staff at the target facilities on the comprehensive HIV care and treatment package. Quality assurance as well as institution of support supervision mechanism will be emphasized to ensure compliance with MOH guidelines.

1. Target populations and coverage of target population or geographic area The project will support public health units in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide pediatric treatment. The project will support ART pediatric clients who were previously supported under NUMAT program and enroll new pediatric clients in line with the USG scale-up plan.

2. Description of service delivery or other activity carried out

The project will scale up Early infant diagnosis in all support health units up to health center III and strengthen linkage of HIV exposed infants identified through the PMTCT program to care and treatment, and follow-up for ART adherence. The program will support the increased access and uptake of Pediatric ART according to national guideline. Infant and young child feeding services will entail counseling on appropriate feeding practices according to national policy guidelines, maternal nutrition counseling, nutrition assessments, and referral of malnourished children to the therapeutic and supplemental feeding programs. Pediatric ART services will be provided as an integral component of routine pediatric care, nutrition and MCH. The program will further support the supply chain management, and monitoring of pediatric ART outcomes in the target districts. The project will implement proved interventions for increasing pediatric adherence to ART. It will closely work with key pediatric ART providers like Baylor, Joint Clinical Research center and the Regional Center for Quality Health Care to build technical capacity at lower level. It will support districts and facilities to roll out the new MoH guidelines for pediatric care and treatment.

3. Integration with other health activities The project will integrate key activities like early infant diagnosis within services like immunization, postnatal care, nutrition programs, child survival interventions and MCH at supported facilities.

4. Relation to the national program The project will implement the revised MoH guidelines for pediatric care and treatment.

5. Health Systems Strengthening and Human Resources for Health The project will support pre-service and in-service/refresher training for clinic staff at the target facilities on the comprehensive HIV care and treatment package. Quality assurance as well as institution of support supervision mechanism will be emphasized to ensure compliance with MOH guidelines.

1. Target populations and coverage of target population or geographic area The project will support the use of strategic information in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts for decision making and promote evidence based planning.The activity will also support the key national HIV/AIDS data use (including reporting) processes and activities taking place at the districts in order to build sustainability.

2. Description of service delivery or other activity carried out

Evidence-based planning and decision making will be achieved through regular measurement of program performance and progress at the districts and lower levels. This will be achieved through the use of LQAS as a methodology to measure performance. Regular and timely feedback to the supported local governments, non-governmental organizations ad civil service organizations will be provided through coordination systems based at the districts.

3. Integration with other health activities The strategic information program will be integrated with all the sectors

4. Relation to the national program TBD

5. Health Systems Strengthening and Human Resources for Health Health Systems will be strengthened to facilitate district-level monitoring and reporting systems including HMIS and PMMP. This will support the existing national data collection, collation, use, and reporting systems at the district and lower levels for purposes of building sustainability.

1. Target populations and coverage of target population or geographic area The project will support HSS in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts. The target population includes will be the district staff involved in the health service delivery. Support to HSS will enhance the delivery of effective, safe, and quality health services to the communities. The program will support the dissemination of national policy and implementation guidelines to the direct service providers and establish facility based quality improvement programs to monitor health outcomes of the beneficiaries. The program will create institutional networks and improved referral systems at facility and community level to ensure continuum of care.

2. Description of service delivery or other activity carried out HSS will focus on supported services and strengthening services in peripheral areas beyond towns and municipalities with emphasis to strengthen services at lower level facilities, which will go a long way in supporting the health system in the districts. This will include advocacy, limited infrastructural development, capacity building, provision of resources and technical assistance to the districts. The project will work with districts to ensure that all the five health system blocks are addressed. The project

will support logistics management, laboratories, human resources and information. It will also support districts to recruit and retain critical human resources like Clinical and laboratory personnel. The project will ensure electronic monitoring of patients in high volume sites.

3. Integration with other health activities HSS will be integrated in all the technical areas within the health system

4. Relation to the national program TBD

5. Health Systems Strengthening and Human Resources for Health Key HSS interventions for this new program include supporting institutional capacity building at district level in supply chain or procurement systems, strategic information, human resources for health, service delivery, leadership and governance, and financing. Health workers capacities will be strengthened to support the health service deliveries in all the supported districts. The program will build the capacity for effective data collection, analysis and timely reporting to the district and national level.

1. Target populations and coverage of target population or geographic area The project will support HSS in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts. The target population includes will be the district staff involved in the health service delivery.

2. Description of service delivery or other activity carried out Safe male circumcision is an effective biomedical prevention strategy that will contribute to reducing the occurrence of new infections amongst the people of the region. Priorities will therefore be on circumcision, planning for equipping of health facilities with the basic theatre equipment, drugs and supplies for the SMC to become operational. There will be need to invest in community sensitization and mobilization to increase uptake of the service. , health teams from facilities will help in handling post care for the SMC cases and for sustainability. Radio talk shows will be conducted to sensitize the community and create awareness on the benefits of SMC, change people's perception on the practice and where eligible males can access the service. SMC will be promoted as a package with HCT, risk reduction counseling partner reduction and condom use

3. Integration with other health activities SMC will be integrated in Family planning and ANC

4. Relation to the national program The project will be aligned to the national policy for Safe Male Circumcision.

5. Health Systems Strengthening and Human Resources for Health Health workers capacities will be strengthened to support SMC sensitization and performing operation at the facilities.

None

1. Target populations and coverage of target population or geographic area The project will support sexual and other behavioral risk prevention based on Abstinence and Be faithful (AB) in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide prevention services. The target population includes sexually active individuals which include youths, adults and most at risks population.

2. Description of service delivery or other activity carried out The project will support districts to reach people with HIV prevention interventions that are based on abstinence or being faithful to reduce risk of HIV and increase protective behaviors. Strengthen prevention messages among people in discordant monogamous relationships, mobilize mothers and women for PMTCT services and reach to groups of people involved in multiple relationships and casual sex. Scale up prevention activities in adult populations through activities such as seminars and workshops in order to gain knowledge and skills for HIV prevention and increase risk perception and also trained Behaviour change agents to help disseminate prevention messages. Provision of support to increase comprehensive knowledge and risk perception of HIV/AIDS through advocacy interventions that promote positive behavior change for risk reduction and risk avoidance among populations at high risk of HIV infection, and promotion of protective social norms for both women and girls will be carried. Behavior change approaches among youth, including educational counseling

and communication efforts will be strengthened.Linkages to other service provides such as social marketing programs to ensure distribution and availability of condoms and the use of abstinence programs among young people 10-14 years old will be emphasized. Prevention counseling and messages targeting discordant couples and concurrent sexual relations will emphasize faithfulness as well as correct and consistent condom use within discordant relationships. Couples will be encouraged to receive HIV counseling and testing and disclosing their Sero-status to their sexual partners.

The project will provide prevention programming for targeted high risk, vulnerable and mobile populations, as they remain sources of new infections e.g. commercial sex workers, internally displaced persons (IDPs), truck drivers and fishermen. They are more prone to have many sexual partners, to use condoms inconsistently, and consequently increase the risk of acquiring and/or transmitting HIV to several partners, including their cohabiting spouses.

3. Integration with other health activities Sexual prevention will be integrated in HCT and PMTCT through HCT counseling. This will be further strengthened through the use of IEC and BCC comprehensive strategies.

4. Relation to the national program The project will be implemented in line with the National Prevention guideline.

5. Health Systems Strengthening and Human Resources for Health Health workers will be trained to provide Sexual prevention activities at both static and outreaches according to the Ministry of Health (MoH) Sexual prevention guidelines. At the community level the use of VHTs trained as Behaviour Change Agents (BCA) will be effective in information dissemination and mobilization.

1. Target populations and coverage of target population or geographic area The project will support Sexual prevention in Gulu, Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide prevention services. The target population includes all adults and youth.

2. Description of service delivery or other activity carried out

The project will support districts to reach people with HIV prevention interventions that are evidence based and consistent with epidemiologic context of individual district and target population. Project will prioritize high-risk populations like discordant couples, people in multiple concurrent partnership, migrant populations, trackers, and commercial sex workers. Based on abstinence or being faithful to reduce risk of HIV and increase protective behaviors. The project will implement combination prevention including consistent use of condom, reduction in multiple concurrent partnerships, address structural issues, address male norms and gender based violence.

3. Integration with other health activities Prevention activities will be integrated with HIV counseling and testing, PMTCT, prevention with positive, HIV care and treatment and other community outreach activities.

4. Relation to the national program The project will implement the national prevention guidelines

5. Health Systems Strengthening and Human Resources for Health The project will implement prevention in communities and also within the health care systems. The project will work with the SURE project to ensure that the health system is able to quantify, procure and distributes key supplies like condoms.

1. Target populations and coverage of target population or geographic area The NUMAT follow-on project will support the Ministry of Health to provide comprehensive PMTCT services in all hospitals, health centre IVs, IIIs and functional health centre IIs in the targeted districts in the Lango sub-region. The Acholi sub-region PMTCT services will be provided by UNICEF. The target population includes pregnant and lactating women and their spouses, infants of HIV positive women, heath workers and community volunteers providing PMTCT services at facility and community level.

2. Description of service delivery or other activity carried out Routine opt-out HIV testing and counseling will be provided in the antenatal, maternity, postnatal, and young child clinics, in addition to community immunization outreaches with the goal of identifying HIV positive pregnant and lactating women, and enrolling them for the PMTCT service package. HIV positive pregnant and lactating women will be screened for ART eligibility using WHO clinical staging and/or CD4 testing and will be provided with HAART or ARV prophylaxis according to the new national

PMTCT revised policy guidelines that promote option A or B and infant ARV prophylaxis. Family support Group network will also be use for follow up as well as support supervisory visits. PMTCT target beneficiaries will be provided with cotrimoxazole preventive therapy and TB screening and management and actively linked to care and treatment services for on-going long-term HIV/AIDS services. Post-natal transmission will be prevented through the implementation of age-appropriate infant and young child feeding services according to national guidelines. The program will link mothers and babies to nutrition programs at community level through the networks.

3. Integration with other health activities Sexual Reproductive health/Family planning and prevention of malaria in pregnancy will be integrated in PMTCT through routine delivery of goal oriented antenatal care. HIV positive women will be counseled on and provided family planning services to reduce unwanted pregnancies. Safe delivery kits will be distributed to ensure a clean delivery environment. The program will obtain long lasting insecticide treated nets from President's Malaria Initiative and distribute them to pregnant mothers. SMC for new born babies will be promoted.

4. Relation to the national program The project will be aligned to the national policy for PMTCT.

5. Health Systems Strengthening and Human Resources for Health Health workers will be trained to provide ARV prophylactic regimen according to the Ministry of Health (MoH) new PMTCT guidelines up to HC III. Outreaches to reach the communities at HC IIs will be conducted by health workers. The family support groups will be trained to counsel mothers, trace defaulters; to ensure adherence to therapy and the chosen method of Infant and Young Child Feeding.

1. Target populations and coverage of target population or geographic area The project will support public health units in Gulu,Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide laboratory services. The program will focus on public health unit laboratories at health centre IV and III where the majority of the target population for this program can easily access health services. The program will establish linkages/coordination structures and referral systems with National Public Health Laboratory and other laboratories at district and regional referral hospital for external quality assurance, and handling of tests that are not offered in the lower health units i.e. biochemistry tests, CD4+ tests, DNA/PCR, Serum Crag,

etc.

2. Description of service delivery or other activity carried out Key program interventions will be the improvement of laboratory infrastructure for improved ventilation, waste management, and water supply in order to ensure safety. Laboratories will be renovated to conform to national standards and guidelines for space and safety. The program will support laboratories at each level of health care to provide the recommended tests for that level according to the national MOH guidelines. These include complete blood counts, Hemoglobin tests, malaria tests, TB diagnosis, and HIV diagnosis at District hospitals, health centre IVs, and health centre IIIs. In addition, the program will support provision of CD4, liver function tests, renal function test, pregnancy tests and serum glucose tests at the districts hospitals. The project will - support districts to implement the National Laboratory Strategy, and strengthen the capacity of laboratory personnel to conduct quality laboratory tests as recommended by the national laboratory policy guidelines. The project will also coordinate with the new PEPFAR mechanism for pre-service training of lab personnel to ensure that candidates from conflict affected north are prioritized for enrollment into the program. The project will work with MoH and districts to ensure that graduates are recruited by districts and facilities in northern Uganda. As part of the project laboratory logistics management systems will coordinate with the project for Securing Ugandans' Right to Essential Medicines (SURE) to ensure an effective supply chain management system for supplies. A system for equipment maintenance and servicing will be established utilizing MOH Regional/Central maintenance units. The program will establish a system of quality assurance for laboratory tests including internal quality control, external quality assurance and quality improvement. Regular support and supervision will be done to monitor efficiency and effectiveness of laboratory services.

3. Integration with other health activities Laboratory services will be supportive of the ART and other diagnostic functions within the facilities.

4. Relation to the national program The project will implement national guidelines for laboratories.

5. Health Systems Strengthening and Human Resources for Health Laboratory personnel will be trained through pre-service training, in-service training to ensure adherence to standards and offering quality services.

1. Target populations and coverage of target population or geographic area The project will support HIV/TB care in Gulu, Amuru, Nwoya, Kitgum, Pader, Lamwo, Agago, Oyam, Kole, Lira, Otuke, Alebtong, Dokolo and Amolatar districts to provide HIV/TB collaborative services. The target population includes all HIV clients and those screened for TB.

2. Description of service delivery or other activity carried out The project will support districts to integrate HIV/TB activities. All TB patients will be screened for HIV and positives enrolled on ART. Others will include: Rapid expansion of quality directly observed short course ( DOTS), strengthen TB/HIV collaborative activities at health facility and community level, joint HIV and TB planning at district, health sub district and facility level, Training of health workers to recognize Tuberculosis and HIV as co infection, drug logistics management, improved laboratory support leading to more efficient Tuberculosis screening and CD4 laboratory monitoring and capacity building of health workers handling HIV programs with emphasis on HIV commodity logistics within the context of strengthening the existing health delivery system. The project will leverage USAID TB infectious disease resources to expand facility and community based for TB DOTS.

3. Integration with other health activities HIV/TB will be integrated in PMTCT and ANC. This will further be linked to ART clinics for care and treatment of HIV positive clients.

4. Relation to the national program TBD

5. Health Systems Strengthening and Human Resources for Health Health workers will be trained to provide HCT/TB collaboration activities according to the Ministry of Health (MoH) guidelines.