Overall Goals and Objectives ROM's goal is to contribute to universal access to treatment, care, prevention, and social support in the communities served through the provision of comprehensive, community-based HIV and AIDS services. The main objective of the project is to provide comprehensive, community-based HIV/AIDS Services and Capacity Building of Indigenous Organizations within the catchment area. Specific objectives: To scale up HIV Counseling and Testing (HCT) in the communities served from its current figure of 27,000 to 50,000 by 2015; to reduce the transmission of HIV from mother to child by 50% by 2015; to increase access to quality HIV/AIDS Care, Treatment and Support services, including TB; to strengthen laboratory capacity to provide quality laboratory services; to scale up and intensify HIV prevention activities; to provide child protection, psychosocial, educational and support to OVC in the catchment area; to strengthen health systems for delivery of quality, equitable and timely services; to support capacity building of other indigenous organizations to scale up Community-Based Interventions in HIV care; and to enhance the livelihoods and economically empower individuals and households. Target Populations and geographic coverage Reach Out Mbuya provides services within Mbuya parish and Kasaala in Luwero District. The project plans to scale up care to 3,630 clients at ROM and 1,000 at ROK. Within Mbuya parish, Banda, Kinawataka, Giza Giza, Nakawa and Acholi quarters, are the defined area for operations of ROM. Although the villages are within the radius of the capital city, they are characterised by high levels of poverty and lack of basic social services including health care. Furthermore, Kinawataka is a central point for long distance truck drivers and is in close proximity to a military barracks, potentially fuelling prostitution and HIV transmission. Acholi quarters are a harbour for persons displaced by the Northern Uganda war with poverty and unemployment as potential drivers of the HIV epidemic. The clients served by ROM are highly mobile, many having migrated into the urban community from various parts of the country in search of work or health care.

Enhancing cost effectiveness and sustainability The project will foster active community participation to promote community ownership and ensure sustainability. Cost effective strategies such as task shifting using nurse led approach to provide the comprehensive HIV/AIDS care with support from a few medical doctors; and job merging. ROM will continue leveraging support and funding from other partners to ensure delivery of the full package of holistic services. Integration also allows flexibility in the utilization of various resources. In order to discourage over dependence on the organization for support resulting from the economic effects of HIV/AIDS and as a phase out strategy, clients will be engaged in income generation activities. They will be trained in entrepreneurship and business skills, trained clients will train other clients to form a cascade of community managed and initiated trainings. Health systems strengthening ROM will set up and institutionalize Quality Assurance (QA) in all its services and projects. Collaborative efforts will be enhanced with National QA systems. ROM will ensure a sufficient and competent workforce through recruitment and continuous training of facility and community health workers, school teachers and community leaders. It will also support four indigenous community-based organizations (CBOs) to build their capacity to provide comprehensive HIV/AIDS care and successful community-based interventions. In addition ROM will align its Monitoring and evaluation activities to the National HIV and AIDS Strategic Plan and the National Performance Measurement and Management Plan. ROM will submit monthly, quarterly and annual progress reports to the MoH and Uganda Catholic Medical Bureau (UCMB) using the national HMIS tools. Train the lead personnel in the basics of supplies management and ensure the guidelines are followed and availability of supplies at all the four outlets. Cross cutting Budget attribution 1. Human Resources for health; ROM will continue using task shifting approaches and capacity building including utilizing partnerships. ($30,000) 2. Food and Nutrition; Policy, Tools and service delivery; ROM will partner with Ministry of Health to align its tools and policies in respect to nutrition. ($85,000) 3. Food and Nutrition: Commodities. ROM will provide 300 Clients with nutrition support amounting to ($46,000). 4. Economic Strengthening; ROM will partner with Care Uganda through the Village Savings Loan Association (VSLA) to improve client livelihoods however, CDC will support vulnerable women and

children through skills building and IGAs amounting to USD 11,000. 5. Education; ROM has partnered with several individual donors such as ROSE,SIDECOLE,AVIS among others that are contributing to supporting 400 children with education support while CDC will support Children with education including scholastic materials at a cost of USD using USD 121,502 6. Water; Through partnership with PACE will provide clean water through provision of water guard to purify the water Key issues a) Health related wrap around 1) Child survival activities; ROM will integrate PHC including immunization and early linkage of those diagnosed with HIV into care 2) Family Planning; ROM will sensitization all clients about family planning during clinic visits and during PMTCT and eligible clients will be referred to Kiswa health center , a government supported health center 3) Malaria (PMI); ROM will provide mosquito nets to all clients with support from PACE while those who are diseased will receive antimalarials. 4) Safe Motherhood; Reproductive health and maternal health have been integrated into our activities including strong referral linkages with the community and other service providers. 5) TB; ROM will partner with National TB and Leprosy program to carry out TB infection control sensitizations

1. Target populations and coverage of target population or geographic area ROM will provide care and support services to 4260 adult clients in the catchment area of Mbuya, Kinawataka, Banda and Kasaala by the end of FY 2011.

2. Description of services delivery or other activity carried out The overall objectives of the HIV care, treatment and support interventions will be to improve the quality of life of those enrolled into care by decreasing the health effects of HIV/AIDS and mitigating the social, cultural and economic effects of HIV/AIDS at individual, Household and community level. ROM is currently providing HIV care and support to 3,516 adult Clients (Quarter Two report 2010) and planning to scale up this number to 4260 adult clients in FY 2011. Averages of 740 adult clients are newly enrolled into care yearly. The care and support activities will include; provision of laboratory and radiological investigations along with other diagnostic services, clinic consultations to the enrolled clients to treat opportunistic infections provide cotrimoxazole (septrin) prophylaxis and antiretroviral drugs. Clients will be provided with the basic care package and home based care to include palliative care as well. The bed ridden will be visited at home and hospital and supported physically and spiritually. Clients needing specialized treatment will be referred to hospitals or other facilities where the services are provided.

3. Integration with other health activities Through a developed protocol the most food insecure /malnourished adult clients will be provided with food items. To ensure self sustainability clients will be engaged in IGAs to reduce on the dependence on the program. Community hygiene and sanitation campaigns will be strengthened to improve the living conditions and reduce on the occurrence of hygiene related diseases. The community network of care activities shall be strengthened to ensure adherence to treatments, client follow up and community rehabilitation.

4. Relation to the national program The management of opportunistic infections, and various health related assessments will be guided by

the national and international policies and guidelines.

5. Health systems strengthening and Human Resources for Health The community workers will be trained in adherence monitoring and basic palliative care. The primary care givers will be equipped with practical caring skills to enable them care for their sick at home effectively. 09-HTXS Treatment: Adult treatment

1. Target populations and coverage of target population or geographic area ROM will continue providing antiretroviral drugs to its adult clients with an expected target of 2486 adults by the end of FY 2011.

2. Description of service delivery or other activity carried out Currently ROM offers treatment to 3516 adults at its 4 sites (Mbuya, Kinawataka, Banda and Kasaala).It is expected that 740 adults will be newly enrolled into care yearly with 442 newly enrolled on ART annually. Currently 2,044 clients are on ART and this number is expected to reach 2486 adults by the end of FY 2011. Based on current ROM statistics it is estimated that about 40% (1704) of the clients in care will not be eligible for ART. For all adult clients ROM will continue providing clinical services guided by the national policies and guidelines. These services include two CD4 counts to monitor ART treatment response and assess for ART eligibility for those not yet on ART, screening services for and treating opportunistic infections including TB and STIs, pain management and symptom relief, cotrimoxazole prophylaxis and linkages to hospitals or other facilities for specialized services (cancer management, in- patient services, family planning and others beyond the ROM's ability to manage). 3. Integration with other health activities ROM will carry out targeted home visits for clients who are bed ridden as one of the home based care strategies. As one of the strategies to promote community involvement 4. Relation to the national program All treatment activities will be in line with the National treatment guidelines. Ministry of health HMIS tools will be used and copies of monthly and quarterly reports submitted to MoH and other stakeholders. 5. Health Systems strengthening and Human Resources for health ROM will provide trainings to health workers and community workers to refresh their treatment skills. These will be informing of continuous medical education sessions on site and out of the sites and placements at various partner organizations such as Mildmay Uganda and the Infectious Diseases Institute. In addition they will participate in various trainings and workshops organized by MoH and other implementing partners/stakeholders. ROM will empower its community volunteers with the skills to carry

out drug adherence monitoring, client follow ups to monitor treatment responses, home based care and community based rehabilitation.

1. Target populations and coverage of the target population or geographic area ROM will support Orphan and vulnerable children (OVC) and their families/communities in Mbuya, Kinawataka, Banda (Kampala) and Kasaala in Luwero district. The target population includes 1,200 children in households of adult clients of ROM and children who are infected with HIV.

2. Description of service delivery or other activity carried out • Education support for OVC (Tuition/fees, scholastic materials, foot wear and uniforms, school monitoring, Alternative non-formal education for children not in school) will continue to be strengthened. • Psychosocial support (life skills training, peer to peer support, community-based child friendly recreational activities, emotional, social, mental and spiritual support, all of which are considered essential elements in the development of children) will be provided to OVC to ensure that the children's emotional related issues are handled. • ROM will continue working to ensure we provide children (OVC) under our care with a safe and structured environment (identify and refer child abuse cases)

3. Integration with other health activities ROM will integrate other OVC core service areas with in the prevention, medical and existing community structures and they include: • Health (Palliative care, home-based care, preventive and curative care and training in pediatric HIV care) • Food and nutrition (Food assistance) with emphasis to sustainable food security • Shelter (Grants in form of house rent will be given to Households in dare need) • Livelihoods and economically empowers OVC and their household (facilitate acquisition of skills, support access to vocational training and microfinance)

4. Relation to the national program Reach Out Mbuya (ROM) serves the Orphan and vulnerable children (OVC) according to the National Strategic Program Plan for Interventions for Orphans and Vulnerable Children (NSPPI) guidelines and addresses the seven core service areas in OVC programming as stated in the NSPPI.

5. Health systems strengthening and Human Resources for Health Staff and volunteers who directly work with the children will be trained to enable them identify, support and mentor our community workers and peers in the provision of appropriate OVC related services according to the NSPPI guidelines

1. Target populations and coverage of target population or geographic area ROM will continue providing antiretroviral drugs to its adult clients with an expected target of 2486 adults by the end of FY 2011.

2. Description of service delivery or other activity carried out Currently ROM offers treatment to 3516 adults at its 4 sites (Mbuya, Kinawataka, Banda and Kasaala).It is expected that 740 adults will be newly enrolled into care yearly with 442 newly enrolled on ART annually. Currently 2,044 clients are on ART and this number is expected to reach 2486 adults by the end of FY 2011. Based on current ROM statistics it is estimated that about 40% (1704) of the clients in care will not be eligible for ART. For all adult clients ROM will continue providing clinical services guided by the national policies and guidelines. These services include two CD4 counts to monitor ART treatment response and assess for ART eligibility for those not yet on ART, screening services for and treating opportunistic infections including TB and STIs, pain management and symptom relief, cotrimoxazole prophylaxis and linkages to hospitals or other facilities for specialized services (cancer management, in- patient services, family planning and others beyond the ROM's ability to manage). 3. Integration with other health activities ROM will carry out targeted home visits for clients who are bed ridden as one of the home based care strategies. As one of the strategies to promote community involvement 4. Relation to the national program All treatment activities will be in line with the National treatment guidelines. Ministry of health HMIS tools will be used and copies of monthly and quarterly reports submitted to MoH and other stakeholders. 5. Health Systems strengthening and Human Resources for health ROM will provide trainings to health workers and community workers to refresh their treatment skills. These will be informing of continuous medical education sessions on site and out of the sites and placements at various partner organizations such as Mildmay Uganda and the Infectious Diseases Institute. In addition they will participate in various trainings and workshops organized by MoH and other implementing partners/stakeholders. ROM will empower its community volunteers with the skills to carry

out drug adherence monitoring, client follow ups to monitor treatment responses, home based care and community based rehabilitation.

1. Target populations and coverage of target population or geographic area ROM targets 367 children at all the 4 sites for care and support services by the end of the FY 2011. ROM is currently offering care and support to 303 Children at all four sites within the catchment area of Mbuya and Kasaala representing 8.4% of the active patient pool. In FY 2011 ROM is planning to provide these services to 64 additional children.

2. Description of service delivery or other activity carried ROM shall continue providing treatment and prevention services for opportunistic infections including TB and malaria, and management of common childhood illnesses. Maternal and child Health services will also be provided to these children and these will include growth and development monitoring, child immunization, nutritional assessment and provision of therapeutic feeds, deworming and vitamin A supplementation. Psychosocial support will also be provided to the children through the children clubs, sports, exposure tours and child counseling. The follow up of these children will be strengthened through the CNC, peer supporters (mother to mother, adolescent and teenage supporters) to ensure proper adherence to treatment and will include home and hospital visits.

3. Integration with other health activities OVC support services shall be integrated into the care and support services.

4. Relation to the national program The implementation of the care and support services will be in line with the national child survival guidelines and the Maternal and Child Health policies.

5. Health systems Strengthening and Human Resources for health Training in pediatric HIV/AIDS care and treatment will be provided to all health workers through different partnerships with MoH, Mildmay and Baylor Uganda and will involve mentorship and placements.

1. Target population and coverage of target population or geographic area

ROM will provide 367 children in its catchment area with various HIV treatments by the end of FY 2011.

Out Of these, antiretroviral drugs will be provided to an estimated 159 children.

2. Description of services delivery or other activity carried out

Currently ROM has 121 children on ART and this number is expected to reach 159 children by the end of

FY 2011 with an addition of 38 newly enrolled on ART annually. For all children ROM will continue

providing clinical services which include two CD4 counts yearly to monitor ART treatment responses and

assess for ART eligibility for those not yet on ART, screening services for opportunistic infections

including TB and STIs, treatment of the various opportunistic infections including TB, pain management

and symptom relief. Cotrimoxazole prophylaxis will also be provided and children needing hospitalization

or specialized services will be linked to hospitals.

3. Integration with other health activities

Children requiring nutritional and other support services shall be linked to the nutritional and social

support sections respectively.

4. Relation to the national program

All pediatric treatments will be guided by the national pediatric treatment guidelines and policies.

Reach Out Mbuya will identify, mentor and build the capacity of at least 3 identified HIV/AIDS community

based organizations in the catchment area 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.

ROM will work under the guidance of Ministry of Health/AIDS Control Program (MOH/ACP), district

health teams and PEPFAR Uganda to empower the catchment communities and identified CBOs to

stimulate problem-solving and leadership. In addition, this mechanism will provide comprehensive

HIV/AIDS prevention, care, social support and treatment services to at least 4,000 adult and children with

HIV/AIDS in 4 health facilities in urban (Kampala) and rural (Luweero) districts in Uganda.

1. Target Populations and coverage of target population or geographic area

ROM will provide PMTCT services to its clients in Mbuya, Kinawataka and Banda in Kampala and

Kasaala in Luwero district with the objective of reducing the transmission of HIV from mother to child. The target population includes 500 HIV positive women screened for pregnancy, 270 HIV positive pregnant women, 100 HIV exposed infants, 108 couples involved in PMTCT and 80 health care providers and peer supporters.

2. Description of services delivery or other activity carried out ROM will under take different activities which include early diagnosis of pregnancy among the HIV clients already in care through screening for pregnancy. Screening for HIV among the ANC mothers so that early preventive methods can be instituted, sensitization of mothers on safe delivery and infant feeding options, provision of ARVS for prophylaxis or treatment to HIV positive pregnant women and ARV prophylaxis to the 100 newborns. ROM will also continue using community PMTCT peer supporters (mother-to-mother supporters) to encourage pregnant women to attend ANC, seek safe delivery options, and provide psychological support on the preferred feeding options. Through small groups educative information about MTCT will be provided to communities and couples. Mothers will be supported with milk and other feeds depending on the age of the child and the economic status of the family. Referral linkages will be strengthened to support use of ANC and delivery at health facilities. The capacity of Kasaala outlet to carry out deliveries will be strengthened. Screening of babies for HIV using the DNA PCR technique following the EID guidelines and protocols will be used. The exposed infants will be followed up until their final status is confirmed and either discharged from or enrolled into the HIV program.

3. Integration with other activities Maama Kits will be distributed to ensure a clean delivery environment. Insecticide treated nets will be obtained through PACE and distributed to pregnant women.

4. Relation to the National Program All the PMTCT activities will be implemented in line with the National PMTCT guidelines and Ministry of Health tools will be utilized to capture PMTCT information and monthly and quarterly reports submitted to Kampala city council and the Ministry of Health.

5. Health Systems strengthening and Human resources for health Eighty health care providers and community peer supporters will be trained to provide PMTCT services at the facilities and community respectively. The peer supporters will be trained to provide counseling, treatment adherence monitoring and follow up of mothers to ensure safe delivery and adherence to the chosen infant feeding option. Support supervision to the implementing sites will be conducted in collaboration with teams from the PMTCT/EID program of the Ministry of Health.

1. Target population and coverage of target population or geographic area The target populations for ARV drugs include HIV positive, ART eligible clients enrolled into ROM (2156 on the PEPFAR arm and 559 on the MoH/ global fund arm by FY 2011), 80 pregnant women enrolled onto the ROM PMTCT program, 80 exposed infants and 10 Health workers and community members needing occupational or non occupational PEP. In FY 2010/2011 ROM will enroll 480 new clients onto ART and maintain 2235 on ART.

2. Description of service delivery or other activity carried out ROM will continue providing ART to eligible clients using a nurse-based model under the supervision of medical doctors. Adherence to treatment and retention in the program shall be ensured through pre-ART education, the on-going counseling, adherence monitoring at home and adherence workshops. Adherence to treatment shall be monitored by the health workers at the facility and the CNC at household level. ART for post exposure prophylaxis shall be provided for occupational and non-occupational exposures to HIV. In addition ART for PMTCT shall be provided to pregnant women and their exposed infants.

3. Integration with other health activities ROM will continue providing an integrated PHC/HIV model at the Kasaala outlet so as to improve uptake of both services.

4. Relation to the national program ROM will use the Ministry of Health guidelines in the provision of ART and will continue leveraging for funds for ARVs from the MoH/Global fund arm and the Clinton foundation. In addition, ROM will continue to procure only nationally and internationally approved Drugs. To avoid stock-outs ROM will continue to work with suppliers following the Supply Chain Management guidelines including forecasting and quantification of requirements for a year with quarterly reviews. ROM has changed its drug formulary, adapting an FDA-approved generic medicine policy as a cost cutting strategy which allows more patients to be served using the same level of funding.

5. Health systems strengthening and Human Resources for health ROM will ensure availability of drugs and supplies at the supported sites through training of staff in LMIS, followed by regular monitoring of adherence to guidelines.

1. Target populations and coverage of target populations or geographic area ROM will continue screening persons for TB/HIV co-infection. All clients (4630) will be routinely screened for TB during their clinic visits and it is estimated that 280 will be diagnosed with TB and treated in FY 2011. In addition patients diagnosed with TB (100 per year) whose HIV status is not yet known will be counseled and tested for HIV at the Kasaala site.

2. Description of service delivery or other activity carried out An integrated TB/HIV approach will be used. All clients diagnosed with TB will be screened for HIV and vice Versa. TB screening will be integrated at the point of VCT and will involve clinical, radiological and laboratory (sputum analysis, Sputum cultures, mantoux test or any other TB screening method depending on the clinical picture) investigations. TB Contact tracing will be implemented and Isoniazid prophylaxis availed to those with latent TB after excluding active TB. Interventions for TB infection control for both staff and clients will be established.

3. Integration with other health activities TB screening will be integrated into the VCT activities. The monitoring for adherence to treatment using the DOTS strategy shall be integrated into the Community Network of Care (CNC) activities. 4. Relation to the national program All clients found with TB will be treated according to the national guidelines from the National TB and Leprosy programme (NTLP). TB drugs and reagents for sputum analysis will be obtained from support from the NTLP/Global fund. However we have included a 3 months buffer from the PEPFAR funds in case of stock outs. ROM will also continue utilizing Ministry of Health tools to capture patient information. Monthly and quarterly reports will be submitted to the National TB and Leprosy programme. 5. Health Systems strengthening and Human resources for health Health workers will be trained in TB screening, diagnosis, treatment and infection control in collaboration with MoH/NTLP. And ROM will continue utilizing the Tuberculosis Assistance Program (TB CAP) for technical assistance in form of trainings and support supervisions.