1. Overall goals and objectives

The overall project Goal is to contribute to Ministry of Health's efforts to reduce the incidence of HIV infection and HIV/AIDS related morbidity and mortality among children and adults in the Eastern and West Nile regions of Uganda. The project purpose is to support the target districts, health facilities and Civil Society Organizations (CSO) to provide quality and sustainable comprehensive HIV/AIDS services. In FY 2010/2011 Baylor Uganda will implement the project through existing District health structures focusing on but not limited to the following specific objectives: I. To strengthen organizational and technical capacities of target districts to plan and manage a sustainable programme for comprehensive HIV/AIDS services II. To support provision and utilization of prevention services to reduce sexual transmission of HIV III. To support implementing health facilities strengthen medical waste management activities through waste management and related committees IV. To increase coverage and utilization of PITC services within health facilities in target districts V. To Expand coverage and utilization of PMTCT services in target districts VI. To Increase coverage and utilization of comprehensive TB/HIV/AIDS care and treatment services within the target districts VII. To Scale up access to comprehensive OVC services to OVCs and their households

07-CIRC Biomedical Prevention: Male Circumcision

Baylor-Uganda will support safe medical male circumcision to children and adults as part of prevention in 51 Health facilities in the two regions. The range of safe male medical circumcision support services will include: Training of health workers in safe male medical circumcision, procurement and distribution of pharmaceuticals (anesthetics, antibiotics and pain relievers), mobilization of communities through local radio programs and targeted circumcision campaigns through conducting surgical camps and development of IEC materials. Technical support to health facilities through on site mentorship and support supervision will be provided to develop systems, and competencies of staff in SMC management. 08-HBHC Care: Adult Care and Support

Baylor will support care in the context of family clinic or family centered HIV/AIDS services in the two regions. The types of HIV care and support services will include: prevention and management of opportunistic infections, palliative care including pain and symptom relief. Psychosocial care will be prioritized to enhance adherence to anti-TB treatment and ART, as well as improving positive and healthy living.. Technical support to health facilities through on site mentorship and support supervision will be provided to develop systems, and competencies of staff in HIV/AIDS management. Community volunteers who are part of the village team will be identified and trained to support both care to ensure client retention and adherence to treatment. Effort will be made to link HIV adult clients to support groups and PHA networks to help them access income generating activities. There will be focus on fostering partnerships to link clients for complementary services including food support and security. Reproductive health services including family planning and cervical cancer screening will be provided to all sexually active females. Procurement and distribution of pharmaceuticals (non ARVs) to supported sites. Health workers will be mentored and supported in data collection, storage, simple analysis, utilization and dissemination.

09-HTXS Treatment: Adult Treatment The Baylor support for comprehensive package will include ART provision, cotrimoxazole prophylaxis and tuberculosis screening and treatment to adult patients on ART. In order to provide quality treatment to the clients, Baylor will offer support to the districts to conduct various trainings, mentorships and support supervision in Logistic management for HIV/AIDS commodities; records management, data management, data utilization and reporting; comprehensive HIV management; HIV counseling and positive prevention. Health care providers will be trained in ARV logistics management and forecasting. Installation of drug storage cabinets for proper storage of ARV stock and provision of technical support (mentorship, support supervision, tools and systems development) will be done. 10-HVTB Care: TB/HIV Baylor will collaborate with the National TB/Leprosy Programme and National TB/HIV coordination committee to implement TB activities in supported sites. Implementation will be based on the National TB/HIV policy guidelines including strengthening coordination mechanisms at District and Health facility

levels, contributing to reduction in TB among HIV positive individuals and advocacy, communication and social mobilization for TB/HIV. In order to maintain the district TB/HIV services delivery mechanisms in place, the programme will utilize the available health facility staff and will work in regular consultation with the District TB/Leprosy Supervisor. Support to health facilities and districts will be based on quantified unmet needs identified by the health facility and/or district. Baylor's approach will be to strengthen the capacity of the health workers at the facilities to diagnose and manage TB/HIV patients. Monitoring and Support Supervision teams will be formed mainly using local capacity, with Baylor-Uganda staff offering support only in areas not covered by district capacity.

13-PDTX Treatment: Pediatric Treatment Baylor in partnership with MOH, will work with district health offices and management of the health facilities to strengthen pediatric HIV treatment services by capacity building through training of health providers, procurement of equipment and commodities, support CBC/CD4 patient monitoring tests, distribution of appropriate IEC materials, conducting drugs audits and local radio programs.

14-PDCS Care: Pediatric Care and Support In partnership with MOH, will continue to work with district health offices and management of the health facilities to strengthen pediatric HIV care and support services that were initiated in the previous fiscal year in the eastern districts and initiate in all the 8 west Nile districts. The activities will include training of health care providers in paediatric HIV/AIDS management and paediatric and adolescent counseling, infrastructure improvement, procurement of equipment and commodities and sustenance of human resources for health; community mobilization for pediatric HIV testing, care and support through "know your child HIV status" campaigns and local radio programs; service delivery through provision of integrated comprehensive HIV/AIDS care and functional referral between HIV testing and care. Baylor will establish/strengthen early infant diagnosis (EID) services and referral especially among lower level health facilities and improve feedback to mother-baby pair for timely care and treatment.

15-HTXD ARV Drugs To ensure continued enrollment of patients into care, Baylor-Uganda will continue to procure and provide ARVs buffer stock for the 600 clients in the supported sites to avoid stock outs. Recommended 1st line & 2nd line regimens for children and 1st line regimens for adults and children will be procured. Funding for this program area will be ring fenced to procure ARV drugs.

11-HKID Care: OVC Baylor will define and strengthen collaboration between District Health Offices (DHO) and Community Development Offices (CDO) for coordinated provision of care and support of OVC in the districts. Districts

will develop formal partnerships with CBOs/FBOs and locally operating CSOs to form a consorted effort to delivery of OVC services. The DHO and CDO will work jointly develop schemes for livelihood and IGA that will be funded by the consortium. Caretakers of the OVC will form groups that will be funded through the district system. To promote self reliance and sustainability, the groups will operate a revolving fund scheme from the initial funding support. Each group will be provided technical support for management of the revolving fund by the CDO and the DHO. Linkages between CBOs/ FBOs and facilities will be established for effective referral for continuum of care and support.

12-HVCT Care: Counseling and Testing Baylor plans to carry out the following activities: Support health facilities conduct know your family status campaigns; Support districts to carry out internal and external quality control for HIV tests; Support home based HCT outreaches; Offer PITC in all units including OPD and inpatient wards; Support district health facilities to offer PITC; Train health care providers in HIV counseling and testing; Support sensitization of persons in testing points to link identified HIV positive children and adults to ART clinics for care

2. Target populations and geographic coverage

The project will be implemented in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo.

From projections of 2010, the population of the target districts is estimated at 5,890,800 and with an estimated prevalence of HIV in the region being 5.0%, 293,702 PLWHA are expected. These PLWHA in the target districts are the primary beneficiaries of the project. The secondary beneficiaries are family members and to a lesser extend the residents of neighboring districts and the border areas of DRC and Sudan. The strategic beneficiaries are the district Local Governments and the MoH.

In FY 2010/2011 Baylor plans to reach 140,000 clients with HIV counseling and testing services; 29,650 with HIV/AIDS/TB care and support services; 11,680 (40% of those in care) with ART services and 24,400 with OVC services

3. Enhancing cost effectiveness and sustainability The strategies for increasing effectiveness and efficiencies include the following: The first strategy entails working within existing health system of MoH and District Local Governments, to institutionalize planning and M&E, and building technical and institutional support capacity for leadership and management of comprehensive HIV/AIDS services. These will be affected through training, technical supportive supervision, rigorous M&E system, developing and strengthening clinic-based and family-based care

systems, strengthening referral networks and supplying stocks of HIV/AIDS commodities to complement government stock. The second concerns building strategic partnerships to coordinate and complement joint efforts and improve effectiveness and efficiency of implementation, and address the comprehensive HIV/AIDS services needs in the population of the targeted districts. The third focuses on performance- based sub-granting for funding district-based plans. Regular feedbacks, performance ranking and recognition certification will stimulate motivation and innovativeness in planning, implementing and performance monitoring. A performance management system, based on results, will be adopted to guide objective measurement of achievements and ranking of performance on which basis funding will be disbursed to districts.

4. Health Systems Strengthening

Baylor will work with the MOH and districts to address gaps in human resources through didactic training, on-job mentorship and supporting district health teams to conduct support supervision. In addition Baylor will support laboratory services through provision of buffer stocks, transportation of samples and results between health facilities and referral labs, as well as infrastructural improvement to make the facilities more client friendly. Support supervision will help strengthen the entire health service delivery and management areas other than HIV/AIDS e.g. malaria control, management of childhood illnesses, improvement in records and data management and use for facility and district activities. Infrastructural and logistical improvements will also benefit other areas. Baylor will enter strategic partnerships with donors, other PEPFAR implementing partners and Civil Society Organizations (CSVs) to create functional linkages for better service delivery and leveraging of resources. All the above efforts are aimed at improving quality and capacity of health care delivery.

5. Cross-Cutting Budget Attributions a. Human Resources for Health - Baylor will work with the MOH and districts to address gaps in human resources through didactic training, on-job mentorship and supporting district health teams to conduct support supervision ($180,321) Construction/Renovation - REDACTED b. Food and Nutrition: Policy, Tools, and Service Delivery - None

c. Economic Strengthening - Train OVC caregivers in agro-business skills and other income generating activities, and providing grants to CBOs - $106,140

6. Key issues:

o Child Survival Activities - Routine immunization, EID, provision of HIV care and treatment, referral to child protection services o Family Planning - Reproductive health services including family planning and cancer cervix screening will be provided to all sexually active females o Malaria (PMI) - provision of ITNs and safe water vessels. o Safe Motherhood - provision of ARVs to pregnant HIV infected women o TB - strengthen TB screening by training Health care providers and providing appropriate guideline and job aids; TB diagnosis by facilitating access to CXR services and sputum samples referral and; TB treatment thought provision of buffer stocks for TB drugs o b. Gender - conduct campaigns for increasing male access to HIV/AIDS services and support women groups for IGA (Including: increasing women's legal rights and protection; increasing gender equity in HIV/AIDS activities and services; addressing male norms and behaviors; increasing women's access to income and productive resources)

C. End-of-Program Evaluation - Conduct End of Project Evaluation

d. Mobile Population - provide condoms, HCT and HIV prevention messages to truck drivers along the highway towns in Eastern Uganda and West Nile

. Target populations and coverage of target population or geographic area The project will be implemented in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo. The target adult population of PLWHA in these regions is 264,332 (based on projected 2010 population of 5,890,800, 5.0% HIV prevalence and assuming 90% of PLWHA are adults). It is estimated that up-to 29,650 individuals will be provided with a minimum of two care services by Baylor - Uganda during FY 10/11 in 51 health facilities. 2. Description of service delivery or other activity carried out The types of HIV care and support services will include: training of health care workers in palliative care including pain and symptom relief, prevention and management of opportunistic infections and procurement and distribution of pharmaceuticals (non ARVs). Technical support to health facilities through on site mentorship and support supervision will be done. VHT will be supported to ensure client retention and adherence to treatment. PHA peer support groups will be formed and supported to access auxiliary services like IGA and nutrition support. Reproductive health services including family planning and cancer cervix screening will be provided to all sexually active females. Health workers will be mentored and supported in data collection, storage, simple analysis, utilization and dissemination. Psychosocial care will be prioritized to enhance adherence to anti-TB treatment and ART, as well as improving positive and healthy living. 3. Integration with other health activities Facilities will be supported to integrate HIV/AIDS activities into routine care points and vice versa to facilities appropriate inter care referrals. Availability of reproductive health services including cancer cervix screening will be supported in the HIV clinic while HIV screening at each care point within the facility. 4. Relation to the national program Baylor will support care in the context of family clinic or family centered HIV/AIDS services in 51 Health facilities in the two regions. This model of care fits into the Ministry of Health strategy of caring for families together as this improves efficiency and quality of care given to clients. It will support district-led efforts in planning, implementation and coordination of the HIV/AIDS response thus supporting the 3 - ones framework of the national HIV/AIDS strategic plan. 5. Health Systems Strengthening and Human Resources for Health Baylor will work with the MOH and districts to address gaps in human resources through didactic training (pre and in-service), on-job

mentorship and supporting district health teams to conduct support supervision. This project will liaise with the Strengthening of National HIV/AIDS training systems (SNATS) project and the Capacity project in the MOH to 100 train health care workers in provision of adult care and support services. In addition Baylor will support laboratory services through provision of buffer stocks, transportation of samples and results between health facilities and referral labs, as well as infrastructural improvement to make the facilities more clients friendly. Baylor will enter strategic partnerships with other donors, other PEPFAR implementing partners and Civil Society Organizations (CSVs) to create functional linkages for better service delivery and leveraging of resources. All the above efforts are aimed at improving quality and capacity of health care delivery.

1. Target populations and coverage of target population or geographic area The total target for all our OVC interventions is 24,400 children to be reached. These will be provided by at least one Core program area (CPA). Most of these OVCs will be reached through working with CBO's. About 1500 children are targeted to be provided with at least 3 CPA's. 2. Description of service delivery or other activity carried out The following OVC activities will be carried out in collaboration with districts health and social care departments: Conduct capacity assessment of CBO; Jointly develop capacity building plans for CBO; Conduct bi-annual planning and review meetings with CBO; Support capacity building workshops and planning for CBOs; Conduct support supervision to CBO; Train caregivers in agro-business skills and other income generating activities; Support community mobilization for HCT to OVC households; Provide grants to CBOs to support OVC ; Link caregivers and OVC with other services; Provide life planning skills training (including making of hand crafts); Conduct Know Your Child HIC Status campaigns; Conduct nutrition education to OVC families; Provide basic treatment and care services for OVC at Baylor-Uganda supported facilities; Establish networks and build alliances with other stakeholders and social groups with an aim to provide holistic; and comprehensive services and mobilize resources to support OVC's 3. Integration with other health activities Baylor will establish networks and build alliances with other stakeholders and social groups with an aim to provide holistic comprehensive services and mobilize resources to support OVC's. VHTs will be trained to identify, refer, manage and follow-up OVCs in their respective communities. 4. Relation to the national program Baylor will define and strengthen collaboration between District Health Offices (DHO) and Community Development Offices (CDO) for coordinated provision of care and support of OVC in the districts. Districts will develop formal partnerships with CBOs/FBOs and locally operating CSOs to form a consorted effort to delivery of OVC services. Caretakers of the OVC will form groups that

will be funded through the district system. 5. Health Systems Strengthening and Human Resources for Health 100 care givers will be trained in comprehensive OVC Management. To promote self reliance and sustainability, OVC groups will operate a revolving fund scheme from the initial funding support. Each group will be provided technical support for management of the revolving fund by the CDO and the DHO. Linkages between CBOs/ FBOs and facilities will be established for effective referral for continuum of care and support.

1. Target populations and coverage of target population or geographic area Baylor will support adult treatment in the context of family clinic or family centered HIV/AIDS services in 51 health facilities in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo. The target adult population of PLWHA in need of adult treatment services is 132,166 (Assuming 50% of adult PLWHA require being on ART). It is estimated that up-to 11,680 individuals will be supported on ART services. 2. Description of service delivery or other activity carried out The comprehensive package for adult treatment services will include treatment and management of OIs through provision of cotrimoxazole, tuberculosis treatment and basic diagnostic equipment; training of health workers in adult treatment, logistics management, counseling and positive prevention; support the collection and transfer of data from the health facilities to the districts; and support follow-up of patients on treatment by VHT and community volunteers. District health teams will be supported to conduct support supervision to ensure sustainability of standards of care. 3. Integration with other health activities Facilities will be supported to integrate HIV/AIDS activities into routine care points and vice versa to facilities appropriate inter care referrals. Availability of reproductive health services including cancer cervix screening will be supported in the HIV clinic while HIV screening at each care point within the facility. 4. Relation to the national program Baylor will support adult treatment in the context of family clinic or family centered HIV/AIDS services in 51 Health facilities in the two regions. This model of care fits into the Ministry of Health strategy of caring for families together as this improves efficiency and quality of care given to clients. It will support district-led efforts in planning, implementation and coordination of the HIV/AIDS response thus supporting the 3 - ones framework of the national HIV/AIDS strategic plan. 5. Health Systems Strengthening and Human Resources for Health Baylor will work with the MOH and districts to address gaps in human resources through didactic training

(pre and in-service), on-job mentorship and supporting district health teams to conduct support supervision. This project will liaise with the Strengthening of National HIV/AIDS training systems (SNATS) project and the Capacity project in the MOH to 100 train health care workers in provision of adult treatment services. In addition Baylor will support laboratory services through provision of buffer stocks, transportation of samples and results between health facilities and referral labs, as well as infrastructural improvement to make the facilities more clients friendly. Baylor will enter strategic partnerships with other donors, other PEPFAR implementing partners and Civil Society Organizations (CSVs) to create functional linkages for better service delivery and leveraging of resources.

1. Target populations and coverage of target population or geographic area Baylor-Uganda plans to reach 140,000 clients with HIV counseling and testing services supporting 51 health facilities in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo and through outreach activities.2. Description of service delivery or other activity carried out The counseling and testing process will be based on the approved Ministry of Health testing algorithm. Internal and external quality control measures will be instituted. The facilities will send samples to UVRI for QA/QC. HCT services will be provided through Voluntary counseling and testing (VCT), Home based HCT (HBHCT) and provider-initiated routine HCT in clinical settings. Baylor- will continue to support transportation of DBS samples to JCRC and later CPHL laboratories to facilitate early infant diagnosis (EID). The main client mobilization strategies will include 'Know Your Child HIV Status' (KYCS) campaigns, RCT, couple testing and VCT. Baylorin partnership with MoH will continue to build capacity for EID and disseminate the guidelines and necessary monitoring tools. 3. Integration with other health activities • Support health facilities conduct 'know your family status' campaigns • Offer PITC in all units including OPD and inpatient wards • Train health care providers in HIV counseling and testing 4. Relation to the national program Baylor-Uganda will support provision of HCT services according to the National HCT guidelines that recommend various approaches including Voluntary counseling and testing (VCT), Home based HCT (HBHCT) and provider-initiated routine HCT in clinical settings. For the diagnosis of HIV among infants, DNA-PCR is essential. 5. Health Systems Strengthening and Human Resources for Health This project will liaise with the Strengthening of National HIV/AIDS training systems (SNATS) project and

the Capacity project in the MOH to train health care workers in HCT, EID and DBS sample collection. Up to 200 health care providers will be trained. Baylor will also work with the districts and UVRI on a system to accredit HIV testing and a system for appropriate QC/QA.

1. Target populations and coverage of target population or geographic area Baylor will provide pediatric HIV/AIDS care and support 51 health facilities in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo. Our target population will be children and adolescents up to 18 years of age. About 2,965 children and adolescents will be provided with Pediatric Care and Support. 2. Description of service delivery or other activity carried out The strategies will include capacity building through training of health providers in pediatric HIV/AIDS management and pediatric HIV/AIDS counseling; infrastructure improvement, procurement of equipment and commodities and sustenance of human resources for health; procurement and distribution of basic care package, pediatric supplies including weighing scales, stadiometers and pediatric stethoscopes; community mobilization for pediatric HIV testing through mass media and "know your child HIV status" campaigns; conduct radio talk shows addressing pediatric HIV/AIDS issues; provision of therapeutic food interventions for malnourished children; and establishing and strengthening existing MOH mechanisms for supervision, monitoring and evaluation. The strategies will be coordinated through district structures to ensure continuous quality services provision and sustainability of operations. 3. Integration with other health activities Facilities will be supported to integrate HIV/AIDS activities into routine care points and vice versa to facilities appropriate inter care referrals. Integration of paediatric HIV care and support services with routine pediatric care, nutrition services and maternal health will be supported. Availability of HCT in young child clinics and immunization in HIV chronic care clinics will be supported. 4. Relation to the national program Baylor will support care in the context of family clinic or family centered HIV/AIDS services in 51 Health facilities in the two regions. This model of care fits into the Ministry of Health strategy of caring for families together as this improves efficiency and quality of care given to clients. It will support district-led efforts in planning, implementation and coordination of the HIV/AIDS response thus supporting the 3 - ones framework of the national HIV/AIDS strategic plan. 5. Health Systems Strengthening and Human Resources for Health Baylor will work with the MOH and districts to address gaps in human resources through didactic training (pre and in-service), on-job mentorship and supporting district health teams to conduct support

supervision. This project will liaise with the Strengthening of National HIV/AIDS training systems (SNATS) project and the Capacity project in the MOH to 100 train health care workers in provision of paediatric treatment services. In addition Baylor will support laboratory services through provision of buffer stocks, transportation of samples and results between health facilities and referral labs, as well as infrastructural improvement to make the facilities more clients friendly. Baylor will enter strategic partnerships with other donors, other PEPFAR implementing partners and Civil Society Organizations (CSVs) to create functional linkages for better service delivery and leveraging of resources.

1. Target populations and coverage of target population or geographic area Baylor will support provision of pediatric HIV/AIDS treatment in 51 rural health facilities in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo. Our target population will be children and adolescents up to 14 years of age. 1400 children and adolescents will benefit from this life saving treatment with ARVs. 2. Description of service delivery or other activity carried out The strategies for provision of paediatric treatment services will include capacity building through training of health providers in paediatric HIV/AIDS treatment, logistics managements of HIV commodities, EID; procurement of equipment and commodities and sustenance of human resources for health; community mobilization for pediatric HIV testing, care and support through "know your child HIV status" campaigns and local radio programs; service delivery through provision of integrated comprehensive HIV/AIDS care and functional referral between HIV testing and care; establishing and strengthening existing MOH mechanisms for supervision, monitoring and evaluation; training VHTs in home based care; procurement and distribution of IEC materials. The strategies will be coordinated through district structures to ensure continuous quality services provision and sustainability of operations and programmes. 3. Integration with other health activities Facilities will be supported to integrate HIV/AIDS activities into routine care points and vice versa to facilities appropriate inter care referrals. Integration of HIV treatment services with routine pediatric care, nutrition services and maternal health will be supported. Availability of HCT in young child clinics and immunization in HIV chronic care clinics will be supported. 4. Relation to the national program Baylor will support care in the context of family clinic or family centered HIV/AIDS services in 51 Health facilities in the two regions. This model of care fits into the Ministry of Health strategy of caring for families together as this improves efficiency and quality of care given to clients. It will support district-led

efforts in planning, implementation and coordination of the HIV/AIDS response thus supporting the 3 - ones framework of the national HIV/AIDS strategic plan. 5. Health Systems Strengthening and Human Resources for Health Baylor will work with the MOH and districts to address gaps in human resources through didactic training (pre and in-service), on-job mentorship and supporting district health teams to conduct support supervision. This project will liaise with the Strengthening of National HIV/AIDS training systems (SNATS) project and the Capacity project in the MOH to 100 train health care workers in provision of paediatric treatment services. In addition Baylor will support laboratory services through provision of buffer stocks, transportation of samples and results between health facilities and referral labs, as well as infrastructural improvement to make the facilities more clients friendly. Baylor will enter strategic partnerships with other donors, other PEPFAR implementing partners and Civil Society Organizations (CSVs) to create functional linkages for better service delivery and leveraging of resources.

Baylor will support target districts in Eastern and West Nile regions to provide and improve utilization of quality, comprehensive HIV/AIDS services. These include: Eastern districts of Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido and Amuria. West Nile districts of Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo. The mechanism will work to provide technical assistance and build the capacity of these districts in the 6 key health systems strengthening functions including: 1) Service delivery; 2) Leadership and governance; 3) Finance; 4) Medical products, vaccines and technologies; 5) Information systems for M&E; and 6) Human Resources for Health.

Baylor will work with the PEPFAR team, Ministry of Health/ AIDS Control Program (MOH/ACP) and district health teams to address gaps in human resources through didactic training, on-job mentorship and supporting district health teams to recruit staff and conduct support supervision. Baylor will enter strategic partnerships with donors, other PEPFAR implementing partners and Civil Society Organizations (CSOs) to create functional linkages for better service delivery and leveraging of resources. In the health facilities, HIV/AIDS services will be integrated in all service delivery points; and an internal and external patient referral system will be established. Through training, on-site mentorship and support supervision, Baylor-Uganda will build the capacity of district and facility staff in logistics and supply chain management systems of the MOH. Baylor-Uganda will work with districts to support accreditation of facility laboratories to provide services commensurate to their level. Baylor Uganda will sub-grant to the districts and Community Based Organizations (CBO) through a performance based model and follow the official funding procedures. Through joint planning and reviews,

Baylor Uganda will support districts and health facilities to develop district HIV/AIDS plans, M&E plans and Performance Measurement Plans (PMP) that address their information needs, and the indicators of the program, PEPFAR II and MOH. Reporting will be through established MOH channels to enhance facility, district and MOH ownership of the information. To improve coordination and leadership for implementation and management, district and health facility leadership and coordination structures such as District AIDS Committees and others will be activated and supported. Program planning will be harmonized with the MOH planning cycle. Baylor will work under the guidance of MOH/ACP, district HIV/AIDS and PEPFAR policy guidelines.

1. Target populations and coverage of target population or geographic area Baylor - Uganda will support safe medical male circumcision activities in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo. The target population will comprise of all male infants, children and adults. It is estimated that up-to 1,024 males will benefit from these services.

2. Description of service delivery or other activity carried out Baylor will support safe medical male circumcision to children and adults as part of prevention. The range of safe male medical circumcision support services will include training of health workers (a team compromising of Nurses, Clinical Officers, and Counselors from each facility) in collaboration with Walter Reed and Rakai projects, procurement and distribution of basic supplies, pharmaceuticals and equipment, communities mobilization using local radio programs, Conducting Safe MMC surgical camps as well as distribution of IEC materials. 3. Integration with other health activities MMC counseling and education will be integrated into routine care points within the facility including young child clinic. Through technical and logistical support, facilities will be supported to have required supplies and equipment for safe male medical circumcision and other surgeries. VHT will be trained and supported to link and support clients for safe male circumcision at the family level. 4. Relation to the national program Baylor will work with the ministry of Health to finalize the guidelines relating to safe male medical circumcision and will fully participate in the implementation of the recent MMC policy. To improve coordination and leadership for implementation and management, district and health facility leadership and coordination structures such as DAC and SAC will be activated and supported.

5. Health Systems Strengthening and Human Resources for Health 72 health workers will be trained in conducting safe MMC and facilities will be supported with necessary equipment and supplies for safe MMC.

1. Target populations and coverage of target population or geographic area Baylor - Uganda will continue to secure ARV drugs from Clinton foundation till December 2011. Most of ARVs drugs procured by Baylor-Uganda will be accessed through Medical Access. To ensure continued enrollment of children and adults into care, Baylor-Uganda will continue to procure and provide ARVs buffer stock for the 600 clients on ARV's in the supported sites to avoid stock outs. Recommended 1st line & 2nd line regimens for children and 1st line regimens for adults and children will be procured. 2. Description of service delivery or other activity carried out Baylor will continue to secure ARV drugs from Clinton foundation till December 2011. Most of ARVs drugs procured by Baylor will be accessed through Medical Access. The target is to have 80% of all the supported facilities without ARV stock outs in 2010/11 and 100% in 2012. Strategies will focus on improving health workers skills in logistics chain management systems and close stock monitoring and drug audits. Other activities will include installation of drug storage cabinets for proper storage of ARV stocks, procurement of drugs for PEP and supporting regular and consistent supply of MOH ARV stock cards and registers. 3. Integration with other health activities Facilities will be supported to integrate ARV service activities into routine care points and vice versa to facilities appropriate inter care referrals. ARV drugs for PEP will be provided to all facility staff who will require them While Health care workers will be trained in logistics and supplies management which cover all supplies even outside the ARV services scope. 4. Relation to the national program The project will support the MoH supply chain as the main source of commodities. Staff will be trained in logistics management to enhance timely forecasting, ordering and accounting (using MoH tools) to minimize wastage, expiry and stock outs. The project will support procurement of buffer stocks. It will ensure proper storage through refurbishing and supporting installation of cabinets. Periodic audits and support supervision will be conducted to continuously strengthen logistics management and accountability systems. 5. Health Systems Strengthening and Human Resources for Health Baylor will work with the MOH and districts to address gaps in human resources through didactic training (pre and in-service), on-job mentorship and supporting district health teams to conduct support

supervision. This project will liaise with the Strengthening of National HIV/AIDS training systems (SNATS) project and the Capacity project in the MOH to 51 train health care workers in logistics management.

1. Target populations and coverage of target population or geographic area Baylor will collaborate with the National TB/Leprosy Programme and National TB/HIV coordination committee to implement TB activities in all the 51 sites in 19 districts in Eastern and West Nile regions of Uganda: Jinja, Tororo, Manafwa, Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo. The target of 29,650 PLWHA will be provided with HIV/AIDS/TB screening, care and support services. It is estimated that up-to 593 individuals will be treated for active TB as a result.

2. Description of service delivery or other activity carried out Baylor's approach will be to strengthen the capacity of the health workers at the facilities to diagnose and manage TB/HIV patients; train health care workers to plan, manage and forecast anti TB drugs and diagnostic supplies; and health management Information systems support. Health facilities will be supported to collect, analyze and utilize data for TB/HIV services using existing MOH data collection tools. Facilities will also be supported to provide HCT at TB care points, to refer or do CXRs and samples, IEC materials, job aides, patient management tools and registers and TB infection control measures at HIV care clinics.

3. Integration with other health activities Facilities will be supported to integrate HIV/AIDS activities like HCT into TB care points and vice versa to facilities appropriate inter care referrals. TB screening will be integrated all service points for facilities with X-ray equipment support will be given to maintain them which will serve the entire health facility X-ray need. Screening for TB in HIV clinics will also be intensified with appropriate training of health care workers. The project will also promote cross referrals between HF and community referrals by DOTS volunteers. Referral of specimens for anti mycobacterial culture and Drug Susceptibility testing (DST) will be supported. 4. Relation to the national program This project will adopt the WHO strategy for TB/HIV co-infection, by: i) working through the National TB Leprosy Program of the MoH and its structures at regional, district and health facility level; ii) focusing on the three I's for decreasing the burden of TB in PLHA (Intensified TB case finding-ICF, Isoniazid

prevention therapy, and Infection control) and; iii) implementing interventions to decrease the burden of HIV in TB patients e.g. PITC, co-trimoxazole prophylaxis and ART. The project will work through and support the VHT and DOTS structures to enhance community, family and patient roles in TB care and treatment.

5. Health Systems Strengthening and Human Resources for Health This project will liaise with the Strengthening of National HIV/AIDS training systems (SNATS) project and the Capacity project in the MOH to 100 train health care workers in provision of TB/HIV services. Emphasis will be placed on diagnosis and treatment of pediatric TB through supporting tuberculin skin tests, contributing towards the maintenance of X-ray machines, and building the skills of health workers in TB screening, PPD placement and reading.