1. Overall goals and objectives STAR-SW will support the Uganda National AIDS Control Program to increase utilization of, access to, and coverage of quality comprehensive HIV/AIDS and TB services. This district-based project aims to: improve uptake and strengthen decentralized HIV and TB service delivery systems; improve quality and efficiency of HIV and TB services; strengthen networks and referrals systems to improve access to, coverage and utilization of HIV and TB services; and intensify demand generation activities for HIV and TB prevention, care and treatment services.

2. Target populations and geographic coverage STAR-SW will target an estimated population of 3.5 million people of the following 13 south western districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. 20 ART sites, 179 PMTCT and TB treatment sites plus 130 sites with TB diagnostic services will be supported.

3. Enhancing cost effectiveness and sustainability The STAR-SW team will play a technical supportive role while service implementation will remain the responsibility of the District Health Offices and health facilities. From the outset of program implementation, STAR-SW will seek program efficiencies and document results. Evidence-based innovative and cost efficient approaches will be applied during project implementation.

4. Health Systems Strengthening STAR-SW will implement health systems strengthening activities in close collaboration with USG programs, SDS, HCI and SURE. Activities will focus on supply chain management, strengthening the

technical and management capacity of the District Health Teams, support national scale-up plans and revision of policies, in-service training of health facility staff as well as support to health management information systems.

5. Cross-Cutting Budget Attributions a. Human Resources for Health Training in various aspects of service provision will be supported by STAR- SW and will target both health workers as well as community resource persons including VHTs.

b. Construction/Renovation REDACTED

c1. Food and Nutrition: Policy, Tools, and Service Delivery Training and job aides will be provided to support the routine nutritional assessment of HIV-positive pregnant and lactating women with special attention paid to health care worker skill development in carrying out nutritional assessment using weight, height and mid-upper arm circumference (MUAC) measurements. c2. Food and Nutrition: Commodities Nutrition education and therapeutic feeding including micronutrient supplementation will be provided to eligible HIV-positive pregnant women and post natal mothers.

d. Economic Strengthening n/a

e. Education Health education campaigns for behavior change will be conducted in collaboration with schools and institutions of higher learning.

f. Water Through collaboration with PACE, PLHIV will be provided with safe water supplies.

g. Gender: Reducing Violence and Coercion Support and screening for gender-based violence will be integrated into facility and community based HIV /AIDS services.

6. Key issues: a. Health-Related Wraparounds

• Child survival activities will be addressed through integrating HIV treatment and care into child health services for example early infant diagnosis, growth monitoring for HIV-exposed and infected infants as well as in-service training of health workers in IMCI if needed. • Family planning will be addressed through capacity building for RH-HIV integration and through PMTCT services. • Malaria (PMI) will be addressed through the distribution of long lasting insecticide treated bed nets for pregnant mothers and children and provision of Intermittent Presumptive Treatment of malaria for pregnant mothers.

b. Gender The STAR-SW team will provide equal opportunities for men and women under project implementation so as to mitigate service inequities between men and women in HIV/AIDS programming, and to increase male involvement and support for women and children's health. Couple HCT and reduction of multiple concurrent partners will be promoted through community HIV prevention activities.

c. End-of-Program Evaluation N/A

d. Mobile Population Long distance truck drivers, commuter bus drivers and boda boda cyclists will be targeted for HIV prevention services.

f. Military Population Military and other uniformed services will be targeted for HIV prevention services.

g. Workplace Programs Both formal and informal workers will be targeted for HIV prevention services including post exposure prophylaxis for health workers.

1. Target populations and coverage of target population or geographic area STAR SW will target the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. 20 ART sites will be supported with a comprehensive HIV/AIDS care package, quality improvement, community engagement through strengthened referral networks, and demand generation. STAR-SW will fully take over support for 11 HIV care and treatment clinics that were previously supported by the TREAT project, 6 sites formerly supported by Baylor-Uganda and 3 sites formerly supported by the former EGPAF CTA project. Emphasis will be placed on the establishment of HIV care clinics at the HC IV level facilities and PMTCT implementing sites. This will facilitate the follow up of patients and retention of patients in ART programs.

2. Description of service delivery or other activity carried out In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services and to minimize the loss to follow-up of pre-ART clients. STAR SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed. Planned activities will encompass preventive care services, palliative services and prevention with positives. Priority will be given to the following: development and implementation of establishment of specialized psychosocial support packages to address both the non-clinical and clinical needs of patients and family members; rolling-out of home- based care; establishment collaborative linkages with Hospice and PACE for the provision of complementary technical and commodity support for HBC services; strengthen role of PLHIV networks/groups to generate demand for, and uptake of services by household members.

3. Integration with other health activities. The main focus for integration will be support for timely enrollments of ART eligible HIV positive women and children from the MCH and Post natal care clinics onto HIV care programs. STAR-SW will aim to improve coordination, referral and linkages of patients with other facility service points like TB clinics, wards and other facility service points.

4. Relation to the national program Technical support will be provided to the Uganda MOH AIDS Control program with an emphasis on advocating for the introduction of identified best practices in the field of HIV care and treatment. Support to the MOH technical working groups will be provided during the first project year when major revisions to the national guidelines for PMTCT and ART are anticipated. The STAR-SW partners will participate in national technical committees for adult and pediatric care and treatment as well as in EGPAF global special initiatives.

5. Health Systems Strengthening and Human Resources for Health STAR-SW partners will implement the following activities related to training in order to build health care provider capacity, improve program quality and uptake, strengthen community facility linkages and promote sustainability of project interventions: over 180 health workers will be trained during the first year of implementation. The training strategy will primarily target health workers providing key services supported by STAR-SW, program management staff and community resource persons. Training activities will reflect new approaches for ART in line with the recent revision to international and national guidelines for service delivery. 180 peer educators/expert clients and VHTs will be trained to support community mobilization, sensitization and home visits. Continuing Professional Development (CPD) approach will be used to offer training courses as modules at the health facility. Technical assistance for strategic information will focus on supporting and strengthening decentralized M&E systems at the district level by utilizing established MoH registers to ensure efficiency of district-level data collection and reporting, including the flow of information up to national-level HMIS.

1. Target populations and coverage of target population or geographic area. STAR SW will target the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. 20 ART sites will be supported, with comprehensive HIV/AIDS and TB services, systems strengthening, quality

improvement, community engagement through strengthened referral networks, and demand generation. STAR-SW will fully take over support for 11 HIV care and treatment clinics that were previously supported by the TREAT project, 6 sites formerly supported by Baylor-Uganda and 3 sites formerly supported by the former EGPAF CTA project. Subject to the ability of the national programme to expand, STAR-SW plans to scale up ART services to more 5 sites during the year.

2. Description of service delivery or other activity carried out. In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. STAR SW will address quality in terms of both 1) the process for quality improvement through the development of a quality management program, and 2) ART services targeted interventions. Capacity will be developed and district health teams supported to integrate HIV care and treatment into the routine district health service delivery. The establishment and maintenance of CD4 count assessment opportunities for all the districts through the existing laboratory infrastructure will be supported and basic capacity for hematology, clinical chemistry and CD4 count measurement in each of the supported districts maintained. Sample transportation system for CD4, DNA PCR, and clinical chemistry and viral load assessments in support of ART and PMTCT services in the STAR-SW area will be reviewed and strengthened. A quality management plan for adult treatment services will be introduced in all implementing sites. 3. Integration with other health activities Support for the integration of ART services provision in the MCH and Post natal care clinics will be provided, including support for timely enrollments of ART eligible HIV positive women onto ART. Integration process will also be geared to improving coordination and referral of patients from the other facility service points like TB clinics, wards and health facility service points.

4. Relation to the national program Technical support will be provided to the Uganda MOH AIDS Control program with an emphasis on advocating for the introduction of identified best practices in the field of HIV care and treatment. Support to the MOH technical working groups will be provided during the first project year when major revisions to the national guidelines for PMTCT and ART are anticipated. The STAR-SW partners will participate in national technical committees for adult and pediatric care and treatment as well as in EGPAF global special initiatives.

5. Health Systems Strengthening and Human Resources for Health

STAR-SW partners will implement the following activities related to training in order to build health care provider capacity, improve program quality and uptake, strengthen community facility linkages and

promote sustainability of project interventions: over 180 health workers will be trained during the first year of implementation. The training strategy will primarily target health workers providing key services supported by STAR-SW, program management staff and community resource persons. Training activities will reflect new approaches for ART in line with the recent revision to international and national guidelines for service delivery. 180 peer educators/expert clients and VHTs will be trained to support community mobilization, sensitization and home visits. Continuing Professional Development (CPD) approach will be used to offer training courses as modules at the health facility. Technical assistance for strategic information will focus on supporting and strengthening decentralized M&E systems at the district level by utilizing established MoH registers to ensure efficiency of district-level data collection and reporting, including the flow of information up to national-level HMIS.

1. Target populations and coverage of target population or geographic area STAR SW will provide services targeting the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. 179 HCT sites will be supported, with a particular focus on increasing the number of individuals (children and adults) who know their HIV status and are linked to care and treatment. A total of 180,000 clients will be counseled, tested and given test results at the supported sites.

2. Description of service delivery or other activities carried out In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. STAR SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed. Planned activities will cover the following program service areas: • The project will provide technical support and on site mentorship for HCT at the implementing health facilities. • Establish HCT outreaches with a focus on most at risk populations (MARP) and referral of HIV-positive individuals for appropriate care. The most at risk populations to be targeted will include the fishing communities, armed forces and the communities in the refugee camps. • Support will be provided to promote couple counseling through couple conferences, working with faith based organizations/ Inter Religious Council of Uganda (IRCU), VHT and other CSOs to mobilize, identify

and test couples and couple counseling advocacy activities.

3. Integration with other health activities • The project will support TB/HIV collaborative activities through capacity building of health workers to screen for TB during the provision of HCT. • The integration of HCT services into other health services like Out-Patient, In-patient, special clinics like MCH, dental clinics, nutrition departments will be strengthened in all the HCT implementing facilities. HCT services will be extended to family members caring for the HIV tested patient at the health facility. • HCT will be integrated in community HIV/AIDS activities like home visits, home-based care, community outreaches and community dialogues for targeted populations. All the newly diagnosed HIV clients will be referred and linked to care and treatment services.

4. Relation to the national program The STAR-SW partners will serve on national technical committees for HCT, the CT 17. Technical assistance for strategic information will focus on supporting and strengthening decentralized M&E systems at the district level by utilizing established MoH registers to ensure efficiency of district- level data collection and reporting, including the flow of information up to national-level HMIS, and data for decision-making.

5. Health Systems Strengthening and Human Resources for Health STAR-SW partners will implement the following activities related to training in order to build health care provider capacity, improve program quality and uptake, strengthen community facility linkages and promote sustainability of project interventions: 450 health workers will be trained in Provider Initiated Testing and Counseling (PITC), couple counseling skills during the first year of implementation. The training strategy will primarily target health workers providing HCT services at the implementing sites.

1. Target populations and coverage of target population or geographic area STAR-SW will target the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. 20 ART sites will be supported with comprehensive HIV/AIDS care package, systems strengthening, quality improvement, community engagement through strengthened referral networks, and demand generation. STAR-SW will

fully take over support for 11 HIV care and treatment clinics that were previously supported by the USAID TREAT project under JCRC, 6 by Baylor and 3 by the former EGPAF CTA project. The program intends to reach 950 HIV exposed children with PCR services and 650 children will be started on septrin prophylaxis in line with the national guidelines. All HC IV facilities will be supported to initiate all exposed babies into care clinics in line with the EID strengthening programme.

2. Description of service delivery or other activity carried out

In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. STAR-SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed. Planned activities will cover the following program service areas: strengthen integration of routine care in well-child clinics as a component of the EID process and establish regular visit schedules for HIV-exposed infants; establish referral system for testing and follow up at EID care points, community outreaches and treatment at ART clinic; introduce new MOH EID registers to improve longitudinal tracking for follow up of infants; provide therapeutic feeding including micronutrient supplementation to eligible HIV-exposed and infected children; support retention of children into care through training of health workers, teachers, caretakers and CSOs in the implementation of psychosocial services for children; and develop and roll- out a communication campaign to advocate for community support for the testing of children and enrollment of those identified as HIV-positive into care programme.

3. Integration with other health activities HIV care and treatment services will be integrated into child health services through the provision of early infant diagnosis and the strengthening of infant and young child feeding counseling and maternal nutrition. Malaria prevention through IPT for pregnant women and distribution of long lasting insecticide treated bed nets will complement PMTCT as part of antenatal and post-natal care.

4. Relation to the national program Technical support will be provided to the Uganda MOH AIDS Control program with an emphasis on advocating for the introduction of identified best practices in the field of pediatric care and treatment. Continued support to the MOH technical working groups will be most critical during the first project year, when it is anticipated that there will be major revisions to the national guidelines for pediatric ART. The STAR-SW partners will continue to serve on national technical committees for pediatric care and treatment and will benefit from inclusion in EGPAF global special initiatives and capacity building

activities. Technical assistance for strategic information will focus on supporting and strengthening decentralized M&E systems at the district level by utilizing established MoH registers to ensure efficiency of district-level data collection and reporting, including the flow of information up to the national-level HMIS.

5. Health Systems Strengthening and Human Resources for Health STAR-SW partners will implement the following activities related to training in order to build health care provider capacity, improve program quality and uptake, strengthen community facility linkages and promote sustainability of project interventions: over 180 health workers will be trained during the first year of implementation on comprehensive HIV/AID care with a particular emphasis on pediatric care. The training strategy will primarily target health workers providing key services supported by STAR-SW, program management staff and community resource persons. Training activities will reflect new approaches for Pediatric care and treatment in line with the recent revision to international and national guidelines for service delivery. 180 peer educators/expert clients and VHTs will also be trained to support community mobilization, sensitization with a plan to promote pediatric care and treatment. Continuing Professional Development (CPD) approach will be used to offer training courses as modules at the health facility. In order to support the ongoing care and roll out of children, on job mentorships will be used to train more health workers on job in comprehensive pediatric care. Special emphasis will also be put in the strengthening of data management for pediatric care.

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

STAR-SW will target the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. 179 PMTCT and 20 ART sites will be supported with comprehensive HIV/AIDS and TB services, systems strengthening, quality improvement, community engagement through strengthened referral networks, and demand generation. STAR-SW will fully take over support for 11 HIV care and treatment clinics that were previously supported by the USAID TREAT project under JCRC, 6 by Baylor and 3 by the former EGPAF CTA project. In total, STAR-SW will continue to support the treatment of 745 children from TREAT and 107 children transitioned from Baylor-supported sites. STAR-SW also plans to enroll an additional 320 pediatric patients on ART at all the implementing sites, subject to availability of funds.

2. Description of service delivery or other activity carried out

In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. Strengthening quality improvement interventions at health district and health facility levels will increase program coverage. STAR SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed. Planned activities will cover, but not limited to, the following areas: • Support MOH in the dissemination and roll out of new WHO recommendations for pediatric ART including the development of SOPs and other job aides. • Support the scale up of pediatric ART services in the STAR-SW districts to all ART sites and as per the MOH National Pediatric ART Scale up Plan. • Support the training of health workers on PMTCT - EID Strengthening programme and support the MOH roll out plan for "strengthening EID" and early initiation of care and treatment. • Strengthen integration of routine care in well child clinics as a component of the EID process and establish regular visit schedule for HIV-exposed infants according to the national Visit schedules. • Introduce a quality management plan for pediatric care and treatment at all implementing sites 3. Integration with other health activities The integration of pediatric care services into main stream HIV care at the facilities will largely focus on integration of pediatric care specific trainings into the comprehensive HIV related trainings. Efforts will also be focused on strengthening of supply chain for pediatric ARVs and EID supplies. Community activities will also aim to increase awareness of pediatric service availability at the sites in order to generate demand for and increase uptake of services.

4. Relation to the national program Technical support will be provided to the Uganda MOH AIDS Control program with an emphasis on advocating for the introduction of identified best practices in the field of pediatric care and treatment. Continued support to the MOH technical working groups will be most critical during the first project year, when it is anticipated that there will be major revisions to the national guidelines for pediatric ART. The STAR-SW partners will continue to serve on national technical committees for pediatric care and treatment and will benefit from inclusion in EGPAF global special initiatives and capacity building activities. Technical assistance for strategic information will focus on supporting and strengthening decentralized M&E systems at the district level by utilizing established MoH registers to ensure efficiency of district-level data collection and reporting, including the flow of information up to the national-level HMIS.

5. Health Systems Strengthening and Human Resources for Health

STAR-SW partners will implement the following activities related to training in order to build health care provider capacity, improve program quality and uptake, strengthen community facility linkages and promote sustainability of project interventions: over 180 health workers will be trained during the first year of implementation on comprehensive HIV/AID care with a particular emphasis on pediatric care. The training strategy will primarily target health workers providing key services supported by STAR-SW, program management staff and community resource persons. Training activities will reflect new approaches for Pediatric care and treatment in line with the recent revision to international and national guidelines for service delivery. 180 peer educators/expert clients and VHTs will also be trained to support community mobilization, sensitization with a plan to promote pediatric care and treatment. Continuing Professional Development (CPD) approach will be used to offer training courses as modules at the health facility. In order to support the ongoing care and roll out of children, on job mentorships will be used to train more health workers on job in comprehensive pediatric care. Special emphasis will also be put in the strengthening of data management for pediatric care.

1. Target populations and coverage of target population or geographic area Strategic information support will be provided to all the 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda and Kabale. The following district health office staff will be targeted: • Biostatistician and HMIS officer in each district health office • HMIS officers/Records assistants/midwives/nurses at Health sub-districts and health facilities At facility level contact persons in charge of data entry in ART clinics, HIV/TB care clinics, in-patient and out-patient departments, HCT, PMTCT and Laboratory technician/assistants will be targeted. A total of 13 hospitals, 31 HCIVs and 139 HCIII will be target for year 1.

2. Description of service delivery or other activity carried out In order to address the gaps in information management, STAR-SW will support training of HMIS officers, provision of data management equipment and provide technical support. STAR-SW will also support training and dissemination of new MoH reporting tools as well as provide and maintain internet connectivity services for all district health offices.

3. Integration with other health activities STAR-SW will focus on improving the health management information system that captures data for the different health services. Emphasis will be directed to strengthening district and health sub-district teams

to manage and utilize data for different programmes design and project planning.

4. Relation to the national program STAR-SW will support MoH SI technical working groups during the first project year, when it is anticipated that there will be major revisions to the national guidelines for managing HIV patients.

5. Health Systems Strengthening and Human Resources for Health STAR-SW partners will focus on building capacity of health workers in strategic information management through streamlining the data collection coordination structures at the districts and health sub-districts and training of the HMIS officers in strategic information management with initial emphasis on district and health sub-district HMIS .

1. Target populations and coverage of target population or geographic area STAR SW will provide services targeting the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. The total number of service sites to be supported are: 147 PMTCT sites, 20 ART sites and 130 functional laboratory sites for TB diagnosis.

2. Description of service delivery or other activity carried out In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. STAR SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed. STAR-SW health system strengthening approach will be consistent with the objectives, strategies and planning cycles of existing government health sector policies and frameworks. Star-SW efforts will complement current or planned efforts to strengthen the health system by government, civil society and health sector partners like STAR-E, SDS and SURE. Barriers to service delivery will be identified in the baseline survey and LQAS and strategies to address these bottlenecks will be developed and implemented through a continuous quality improvement model. Capacity will be developed in the different service areas like supply chain management and data management including data utilization for program improvement.

Health Work force STAR-SW will undertake capacity development of health workers in the different the following areas o Data Quality Management/HMIS targeting 120 medical officers, clinical, nurses/midwives, Biostatisticians/HMIS officers and records assistants in all districts. o Logistics management training for 180 health facility staff. Participants will include laboratory technicians/assistants, nurses/midwives/clinical officers/medical officers. o Continuing Professional Development for 750 target medical officers, clinical officers, nurses/midwives, laboratory assistants/technicians. o Quality improvement model training targeting 70 medical officers, laboratory assistants/technicians, nurses/midwives and clinical officers. The capacity development activities will initially be carried out for all ART/PMTCT/laboratory services implementing sites; 20/147/130 sites respectively; and those destined for scale-up in all the 13 districts of focus. • A mentorship program will be established to support implementation in the different service areas using the trainers' base that will have been developed in each district. • Re-establish Continuing Professional Development (CDP) as a key approach for providing technical updates to health workers. Health information system • In collaboration with STAR E LQAS, STAR-SW will support the 13 districts in the implementation and institutionalization Lot Quality Assurance Sampling (LQAS) as a means of collecting information for monitoring and evaluation purposes. The LQAS for the community, health facility assessment and service delivery performance will be conducted in each district twice in a year. There will be district capacity building by conducting training and providing supportive supervision to the district staff during sampling, data collection and data compilation. • Technical assistance for strategic information will focus on supporting and strengthening decentralized M&E systems at the district level, utilizing established MoH registers to ensure efficiency of district-level data collection and reporting including the flow of information up to national-level HMIS. Procurement and supply chain management system: • Health workers capacity to perform logistics functions at their respective health units will be strengthened the through mentoring on supplies records management, supplies quantification and ordering during the support supervision visits. • Districts will be supported in the formation of district logistics coordination teams with clearly defined roles and responsibilities. Suggested composition will include the ACAO- Health, Assistant DHO, District Laboratory Focal person, HIV/AIDS/PMTCT focal person, District Assistant Drug Inspector, Stores Officer and Biostatistician/HMIS focal person. • Training of logistics coordination team members at both district level and sub-district that will form the

logistics mentorship team to provide support supervision health workers in the lower level health units.

Service delivery: • Dissemination of existing and new policy guidelines and educational material on Maternal and child health, HIV/AIDS prevention, treatment, care and support and TB/HIV integrated care. • Improve referral systems through: sensitizing stakeholders on referral guidelines; improving communication capacity of health facilities by introducing the internet and covering internet expenses at health sub-districts and support the VHT support system in the districts.

3. Integration with other health activities The intervention for the health system strengthening will cut across the whole sector focusing on the different components of the health system. The interventions are linked to the national health sector strategic plan, national health policy, district development plan and plans for particular health system components to address constraints within the system.

4. Relation to the national program STAR-SW will work with the MOH pharmacy division, National Medical Stores and SURE to continue strengthening the supply chain management system for antiretroviral drugs, HIV test kits and essential medicines.

5. Health Systems Strengthening and Human Resources for Health As stated above for different components

None

1. Target populations and coverage of target population or geographic area STAR SW will target the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. Specific focus will be on married and co-habiting couples, young people, mobile populations of long distance truck

drivers, bus drivers and boda boda cyclists, HIV negative pregnant women, military populations, plantation/tea estate workers, fishing communities, and the general public at large. Activities will focus on behavior change communication and community engagement through CSOs, VHTs and peer groups of PLHIV and demand generation.

2. Description of service delivery or other activity carried out In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. Strengthening quality improvement interventions at health district and health facility levels will increase program coverage. STAR SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed. Planned activities will cover the following services: orient and train health workers to strengthen AB counseling in HCT activities; develop and execute a targeted communication campaign for most at risk populations; promoting the use of information and communication technologies (ICT) such as community chat rooms and text messaging to enhance community dialogue and participation in AB services; establish collaborative partnerships with CSOs, village health teams (VHTs) and special interest groups (e.g. PLHIV and cultural institutions) as key implementers of AB services in the community. Prevention with positives will also be a focus area.

3. Integration with other health activities AB services will be integrated in Health education and counseling offered in the different departments like ANC, PNC, TB, OPD, In-Patient and ART clinics. It will also be integrated in all community HIV/AIDS and TB services supported by STAR-SW. Capacity building for integration of AB services in other health services will include training of health workers, VHTs, community volunteers and CSOs. The project will also support the development of SOPs and job aides.

4. Relation to the national program Technical support will be provided to the Uganda MOH AIDS Control program with an emphasis on advocating for the introduction of identified best practices in the field of HIV prevention. Support will be provided to the MOH technical working group on HCT (CT 17) and the Health promotion and Education department of MOH.

5. Health Systems Strengthening and Human Resources for Health In-service training will be provided as well as other capacity building activities. 450 health workers and community volunteers will be trained in the provider initiated HIV counseling and testing and HIV

prevention strategies during the first year of implementation. The training strategy will primarily target health workers providing key services supported by STAR-SW, program management staff and community resource persons. Decentralized M&E systems at the district level will be supported to collect strategic information using established MoH registers in order to more efficiently track trends in the HIV epidemic. Training support in collaboration with the SURE project will strengthen logistics management at the district.

1. Target populations and coverage of target population or geographic area STAR SW will target the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. Specific focus will be on married and co-habiting couples, young people, mobile populations of long distance truck drivers, bus drivers and boda boda cyclists, HIV negative pregnant women, military populations, plantation/tea estate workers, fishing communities, and the general public at large. Activities will focus on behavior change communication and community engagement through CSOs, VHTs and peer groups of PLHIV and demand generation.

2. Description of service delivery or other activity carried out In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. Strengthening quality improvement interventions at health district and health facility levels will increase program coverage. STAR SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed. Planned activities will cover the following program service areas: collaborate with MOH to develop messages aimed at reducing the number of casual sex and multiple partners; coordinate with USG partners, HCP and UHMG to disseminate standardized prevention messages; support activities aimed at discrimination reduction, gender based violence and combat stigma through working with the district leadership (probation officers, those in charge of human rights) to enable male involvement and increase women participation in seeking services; address cultural norms and beliefs i.e. promote male circumcision, address issues concerning the marriage age, gender and education; and create and strengthen links between prevention, sexual and reproductive health. STAR-SW also plans to collect

baseline data on prevention as well as undertake operational research that would inform STAR-SW long- term prevention strategy.

3. Integration with other health activities The integration of other sexual prevention services into HIV will focus on developing a Comprehensive Behavior Change Based Strategy, of sensitizing and involving not only health personnel, traditional healers and traditional birth attendants, but also high-level political commitment and a diverse spectrum of Community Based Participation (PLHIV groups, CBOs, FBOs, local and religious leaders). The integration of OP in all heath services at the health facility and community levels will be supported. This will help facilitate individual behavior change as well as changes in community norms.

4. Relation to the national program Technical support will be provided to the Uganda MOH AIDS Control program with an emphasis on advocating for the introduction of identified best practices in the field of HIV prevention, care and treatment. Continued support to the MOH technical working groups will be most critical during the first project year. The STAR-SW partners will continue to serve on national technical committees for Health Promotion and Education department of the MOH.

5. Health Systems Strengthening and Human Resources for Health In-service training provided as well as other capacity building activities. STAR-SW partners will implement the following activities related to training in order to build health care provider capacity, improve program quality and uptake, strengthen community facility linkages and promote sustainability of project interventions: 120 community volunteers /VHT and 180 peer educators will be trained during the first year of implementation. Build capacity of service providers, e.g. HWs, DHTs, VHTs, CBOs, since they will be the supervisors of activities implemented. STAR-SW will build the capacity of service providers in areas such as male circumcision, female condom use and demonstration, effective communication for single partner interventions, abstinence and sex education, Routine Counseling and Testing for pregnant women and effective referral mechanisms.

1. Target populations and coverage of target population or geographic area STAR SW will provide services targeting the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. Approximately 162,000 women will be targeted for PMTCT services in 179 PMTCT sites, with a

particular focus on the integration of new program activities for PMTCT, EID and community engagement through strengthened referral network from the community to the sites. 1960 HIV positive pregnant women will be targeted to receive ART (20% of total HIV positive) while the rest (7,840) will receive other more efficacious combination regimens. Particular emphasis will be placed on scale up of services to lower level health facilities in accordance with the national PMTCT scale up plan with particular emphasis to the MOH PMTCT - EID strengthening processes. Major effort will be placed on the support toward adoption of the national revised PMTCT guidelines by all the PMTCT implementing sites.

2. Description of service delivery or other activity carried out In order to address the gaps in service coverage, and meet the required changes in the national PMTCT guidelines, a multidisciplinary approach of training, infrastructure development, and technical support will be employed. Efforts to increase service uptake will be closely linked to improving the quality of services and community targeted activities geared at improving mothers' health seeking behavior. Strengthening quality improvement interventions at and district levels will increase program coverage. STAR SW will support districts to develop a PMTCT quality management program and assist sites to adopt and use the MOH developed PMTCT Quality improvement indicators. Support will be through specific and targeted quality improvement trainings and set up of quality improvement support teams at the district and health sub-district levels. STAR-SW will support the national "Scale up Plan for PMTCT and Care of HIV- Exposed Infants 2010-2015", which aims at "Virtual Elimination" of MTCT.

3. Integration with other health activities STAR-SW will ensure integration of reproductive health services into HIV services. Focus will be placed on technical support for family planning, and strengthening of supply chain for infection control materials, including "Mama Kits" and assorted delivery equipment to boost utilization of health facility-based labor and delivery services. HIV will also be integrated into child health services through the provision of early infant diagnosis and the strengthening of infant and young child feeding counseling and maternal nutrition. Malaria prevention through IPT for pregnant women and distribution of long lasting insecticide treated bed nets will complement PMTCT as part of goal oriented antenatal care. Special attention will be paid to development of skills for routine nutritional education and for carrying out nutritional assessment using weight, height and mid-upper arm circumference (MUAC) measurements. In collaboration with the NuLife project therapeutic feeding including micronutrient supplementation will be provided to eligible HIV-positive pregnant women and post natal mothers.

4. Relation to the national program Technical support will be provided to the Uganda MOH AIDS Control program with an emphasis on advocating for the introduction of identified best practices in the field of PMTCT. Continued support to the MOH technical working groups will be most critical during the first project year, when it is anticipated that

there will be major revisions to the national guidelines for PMTCT. The STAR-SW partners will continue to serve on national technical committees for PMTCT and will benefit from inclusion in EGPAF global special initiatives and capacity building activities. STAR SW will support MOH efforts to introduce revised job aides for PMTCT and a longitudinal client register to improve client tracking and follow up in line with the revised implementation guidelines for PMTCT.

5. Health Systems Strengthening and Human Resources for Health In-service training will be provided: 180 health workers will be trained during the first year of implementation. Training activities will reflect new approaches for PMTCT as seen in the recent revision to international and national guidelines for service delivery. Special emphasis will be placed on linking/integrating services of the preventive and treatment. 180 peer educators/expert clients and VHTs will also be trained to support community mobilization, sensitization and home visits. Continuing Professional Development (CPD) approach will be used to offer training courses as modules at the health facility.

1. Target populations and coverage of target population or geographic area STAR-SW project will support the provision laboratory services in the 13 Districts of Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. REDACTED

2. Description of service delivery or other activity carried out STAR-SW will contribute to the development of an effective laboratory infrastructure to ensure that patients' conditions are accurately diagnosed, staged, and monitored. This will be effected through the strategic approaches, including the following: adequately training the laboratory personnel at participating sites, provision of laboratory equipment and ensuring the optimal functioning of laboratory equipment; establishing a plan for service and preventive maintenance of laboratory equipment through the use of in- country service contracts where available; and strengthening the supply systems to ensure availability of laboratory commodities at all health units with laboratory facilities.

3. Integration with other health activities STAR SW will support the integration of EID services in Child days Plus and immunization outreaches.

Support will also be geared to integration of HCT in community outreaches, maternity services and home based care, TB wards and clinic. Linkage of identified patients to care services will also be strengthened.

4. Relation to the national program STAR SW will work in close collaboration with the national TB leprosy control programme and the MOH ACP logistics team in streamlining laboratory services in the region. STAR SW will focus on provision of regional performance updates to the MOH in areas of laboratory logistics, quality assurance and identified service provision gaps/lessons learnt.

5. Health Systems Strengthening and Human Resources for Health STAR SW will support the building of health worker's capacity in HCT, EID and TB screening to other cadres of staff like midwives. Support will also be offered to institutionalize quality improvement within the routine laboratory service provision.

1. Target populations and coverage of target population or geographic area STAR SW will provide services targeting the population of the following 13 districts: Ntungamo, Kiruhura, Kisoro, Rukungiri, Bushenyi, Sheema, Mitooma, Buhweju, Rubirizi, Kanungu, Isingiro, Ibanda, and Kabale. The program will implement a comprehensive approach to TB and HIV/AIDS services targeting a population of 3,450,500 people and estimates to support about 2,400 TB cases and screen them for HIV. Sites implementing TB diagnostic services are 130 while 179 sites are offering TB treatment services. 2. Description of service delivery or other activity carried out In order to address the gaps in service coverage, activities will be implemented through a multidisciplinary program of training, infrastructure development, and technical support. Efforts to increase uptake will be closely linked to improving the quality of services. Strengthening quality improvement interventions at health district and health facility levels will increase program coverage. STAR SW will address quality in terms of both 1) the process for quality improvement through the development a quality management program, and 2) targeted interventions tailored for the technical area being addressed.

Planned activities will cover the following program service areas:

TB

• The zonal TB office will be supported to strengthen TB and TB/HIV technical working groups at the zonal level and in each of the STAR-SW districts. a) Support will be offered for quarterly zonal TB and TB/HIV meetings to review activities of the last quarter and plan for the following quarter. b) The ZTLS will be supported to conduct support supervision to the district, HSD, H/CIII and community levels to make sure that treatment is given according to the national treatment guidelines and support the health workers on recoding of TB activities. • Scale up of CB - DOTS in the selected communities through integration of activities into the VHT structure and the home based care teams. a) Support the sub county health workers to distribute drugs to the treatment supporters (VHT and family members) and supervise the activities done by the treatment supporters. b) Support the HSD TB focal person to conduct support supervision of TB activities to sub county health workers at the H/CIII level and treatment supporters at the community level • Intensify case finding through screening patients in congregate populations such as medical wards, antenatal care (ANC) clinics, outpatient departments (OPD), and HIV clinics to increase case detection and improve infection control for TB. • Peers will be facilitated to support TB contact tracing. • The health units will be supported to establish infection control committees who will develop and support the implementation of the infection control plans.

TB/HIV collaborative activities • Support the TB/HIV coordination teams at district level and work with the SDS project to facilitate TB and Leprosy program structures at the sub-county, district and zonal levels (support supervision, drugs and supplies, planning). • Introduce TB screening for HIV-positive mothers identified through PMTCT and support the provision of INH prophylaxis to TB-exposed infants and young children as per the revised WHO and national guidelines. This will target hospitals and HC IVs with the capacity to exclude active TB disease. • Conduct monitoring and evaluation of TB, TB/HIV activities and the referral network within and between facilities and the community. This will be through use of existing MOH monitoring tools and the project will work with the MOH to develop quality improvement indicators to monitor the referral network. • In collaboration with MOH, SUSTAIN project and MJAP follow on, a multi-drug resistant (MDR) TB management centre at Mbarara University Teaching Hospital will be established.

3. Integration with other health activities TB services will be integrated in the Out Patient, MCH, ART clinics and In-patient departments of health facilities through capacity building, provision of job aides and SOPs to equip the health workers with knowledge and skills to screen and refer TB suspects for appropriate care.

Health facilities will be supported to provide nutritional assessment to all TB patients and refer them for appropriate care and support.

4. Relation to the national program Technical support will be provided to the National TB and Leprosy Program (NTLP) in TB and TB/HIV collaborative activities such as policy revision, guideline dissemination, SOPs and IEC materials. Participation and support to the NTLP advocacy activities.

5. Health Systems Strengthening and Human Resources for Health • Pre- and in-service training will be provided: Over 180 health workers will be trained on TB and TB/HIV during the first year of implementation. The training strategy will primarily target health workers providing TB and TB/HIV services supported by STAR-SW, program management staff and community resource persons. Orientation trainings for health workers will be conducted for infection control, TB/HIV collaborative activities, CB DOTs and TB case management. • The DTLS and the District Laboratory focal person (DLFP) will be supported to conduct external quality assurance (EQA) at all the TB diagnostic centers. • Support the TB data collection, analysis and reporting whereby all the HSD TB FPs/HMIS officer will be supported to collect TB data from the treatment and diagnostic centers to the HSD level. Data analysis and presentations will be made during the coordination and planning meetings to support evidence based planning and program improvement.