AFFORD strengthened the Uganda Health Marketing Group (UHMG) to accelerate the growth of the health market in Uganda through innovative health marketing approaches. Since 2005, AFFORD has supported UHMG to implement strategies that support the health sector strategic investment plan (HSSIP) goals of a 40% reduction in new HIV infections and increased access to care and treatment among people living with HIV (PLHIV). AFFORD supports distribution of health products and provision of quality services for HIV/AIDS, maternal and child health (MCH), family planning (FP) and Malaria through a network of 200 private clinics which are branded as the Good Life clinics (GLC). AFFORD also designs and disseminates research and theory-based prevention communication in 45 districts.AFFORDs FY 2013 combination HIV prevention, care and support activities target sexually active 1549 year olds; married/co-habiting couples; youth out of school; commercial sex workers and their clients; fisher folks; truckers; and (PLHIV) through: HCT services in private clinics and outreach; Mobilization for voluntary medical male circumcision (VMMC) in collaboration with other USG funded partners; PMTCT services in selected private clinics; Social marketing affordable and high impact through private drug shops, general merchandise outlets, pharmacies, & GLCs; Provision of care and support and positive health dignity and prevention (PHDP) services through PLHIV networks; and multi-channel communication promoting HCT, consistent condom use and partner reduction.Afford will monitor and evaluate its interventions through regular support supervision, retail audits, quarterly reports and other evaluation studies. No vehicle procurement planned in this COP.

AFFORD will support 14 ART accredited Good Life clinics (GLCs) to provide HIV/AIDS care and support to HIV positive women under Option B+ and their HIV positive partners. The pre-ART clinics will be integrated with Option B+ services to be provided using a family-centered approach. AFFORD will implement approaches to promote an effective Continuum of Response (CoR) model and monitor key indicators along the continuum. The project will provide on-site mentorship and training of private health providers in HIV care and support, in line with Ministry of Health (MOH) guidelines and policies.

Focus will be placed on increasing access to CD4 assessment among pre-ART clients for early/timely ART initiation, in line with MoH guidance. This has been a major bottleneck for treatment scale up in the PEPFAR program. Working with the Central Public Health Laboratory and other stakeholders, CD4 coverage will be improved from the current 60% to 100% over the next 12 months. AFFORD will support a sample referral network from supported sites to identified CD4 hubs under the national CD4 expansion plan. AFFORD will monitor and report clients access to CD4 in quarterly reports to USAID.

Due to capacity limitations, AFFORDs GLCs will refer HIV positive clients identified through their outreach HTC services to other USG comprehensive partners with larger capacity. AFFORD will establish formal referral network mechanisms with other partners so as to ensure the clients referred are enrolled in care and receive services. AFFORD will provide basic care kits to clients within the GLCs. Additionally, AFFORD will liaise with National Medical Stores, Joint Medical Stores and Supply Chain Management Systems for other HIV commodities (cotrimoxazole, lab reagents). AFFORD will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.

In addition, AFFORD will work with USG partners to support integration with other health and nutritional services. AFFORD will collaborate with other key stakeholders to provide required wrap around services.

AFFORD will ensure gender awareness and issues are integrated into its programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men may face in adhering to treatment or receiving ongoing care.

AFFORD will leverage private sector funds and support the GOU to scale up TB/HIV integration in the private sector. AFFORD will contribute to this target by screening 180 HIV positive clients for TB; and at least 6 will be started on TB treatment.

The project will support improved intensified case finding (ICF) within the supported facilities; increase the use of the national ICF tool and improve the diagnosis of TB among HIV positive smear negative clients, extra pulmonary TB and pediatric TB.

In FY12, AFFORD will ensure early initiation of all HIV positive TB patients on ART through the use of linkage facilitators and/or the provision of ART in TB clinics. AFFORD will increase focus on adherence and completion of TB treatment, including DOTS through use of proven low cost approaches. A TB infection control focal person will be supported to enforce infection control at facilities using interventions such as cough hygiene, cough sheds and corners, fast tracking triage by cough monitors, ensured adequate natural ventilation, etc.The program will be aligned to the National Strategic Plan for HIV/AIDS and National TB Strategic Plan (2011/12 2014/15), support and strengthen the national M&E systems and work within district health plans. AFFORD will work under the guidance of the MoH AIDS Control Program, National TB and Leprosy Program and Quality Assurance Department in trainings, TB/HIV mentorship and supportive supervision. Additionally, AFFORD will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

AFFORD will contribute to HCT goals by increasing demand for and utilization of HCT services by MARPs (commercial sex workers and their clients, long distance truck drivers and fisher folk). Additionally, AFFORD will target couples and young people out of school, especially motorcycle taxi drivers. These populations will be addressed throughout the programs 45 implementation districts, with particular attention paid to high prevalence communities.

AFFORD has the benefit of being located in the same districts as the USAID-supported, comprehensive STAR programs. This arrangement provides the client the benefit of being referred to a quality health provider for HIV Care and Treatment or other health services. Through initiatives like community health fairs, AFFORD collaborates closely with the STARs and other district comprehensive program to enhance the continuum of response to those clients that may need, treatment , VMMC and other services that AFFORD doesnt offer.Through their 200 Good Life Clinics (GLCs), AFFORD will be able to scale up the HTC pivots, namely PITC scale-up. AFFORD will use targeted outreach to reach MARPs, couples and young people out of school. To this end, AFFORD will also work with district hospitals, Health Center IVs and other USG-supported HCT outlets and implementing partners to scale up HCT services and ensure their quality and accessibility. These partnerships will also increase the provision of referral information, support for increased early diagnosis, and initiation of treatment and follow-up care for HIV positive individuals and VMMC. AFFORD will address institution-level needs by strengthening the systems and capacity of the 200 GLCs to integrate successful HIV/AIDS and health network models. Activities will largely feature workplace support for HTC through media campaigns and testing events, as well as the development of workplace policies. In FY 2013, AFFORD expects to counsel, test and provide results to 115,640 people, including couples and MARPs.Other non-biomedical activities will involve advocacy, formal community-facility linkages and staff training to ensure continuum of HIV services in key catchment areas. Special attention will be directed towardsthe 16 fish boat landing sites outside urban settings through outreach camps to meet the unmet demand for HCT among MARPs. In all interventions, efforts will be made to bring VCT services as close to the workplace or community as possible.

A total of 200 health workers from GLCs will be trained on approved national HCT protocols and approaches including child counseling and testing, home-based counseling and nutritional counseling so as to increase opportunities and coverage among target groups. For Quality Assurance, re-testing with the use of panels will be done quarterly.

AFFORD services target MARPs including fisher folk, truckers, CSW and their partners, and out of school youth. Truckers are supported in West Nile, where there is much cross border movement. AFFORD targets CSW and their partners at major transit points on routes in Migyera and will extend to Kasese. AFFORD will continue to provide condoms to the Most at Risk Population Initiative ( MARPI), an initiative that offers services to MARPS including MSM. Additionally, AFFORD will be providing condoms to all organizations that have been trained to offer services to MSMAFFORD targets 16 landing sites in the Kalangala, Masaka, Mpigi and Wakiso districts. The total fisher folk population in the central region is 55,523, with a sexually active adult population of 27,762. AFFORD will reach 18,000 fisher folk (65% of the total sexually active population). AFFORD will reach 3,500 truckers (11% of the estimated 31,588 truckers nationally) through interventions in West Nile. AFFORD will reach 1,000 CSWs, their clients and surrounding communities with HIV prevention and risk reduction services in West Nile, Kalangala, Kasese and Migyera. AFFORD aims to reach 68% (50,000) of the 73,300 youth out of school in Oyam and Nebbi districts.MARP and youth services will be supported by peer educators who engage targeted beneficiaries through small group discussions to increase their personal assessment of HIV risk and encourage appropriate behavior change. This is a continuation of activities implemented in the previous year. Volunteers will engage truckers, fisher folk and CSW in discussions to increase their HIV risk perception and encourage appropriate behavior change, including reduction in numbers of sexual partners and casual sex, consistent and appropriate condom use, referral for sexually transmitted infections (STI) management, MMC and HCT, and provision of condoms. Truckers will be provided tailored HIV prevention materials. For CSW, issues of alcohol abuse and unprotected sex will be discussed as key sources of vulnerabilities to HIV infection, and CSWs will be encouraged to adopt risk reduction behaviors including persistent condom use with clients, referral for HCT and STI management, and counseling on alternative livelihoods. Fisher folk will be engaged in discussions about transactional sex, sharing partners and partner reduction, condom use, and referrals for HCT, STI management and MMC (for men). AFFORD will also distribute condoms in these communities.AFFORD promotes HIV prevention among out of school youth through youth clubs formed by trained peer educators. Youth are engaged in assessing their HIV risk and to adopt risk reduction strategies through repeated contacts with the peer counselors. This approach will be continued in FY 2012. In addition, youth will be targeted through motor cycle riders (bodaboda) associations, where HIV prevention and utilization of GLC prevention services will be promoted. Peer educators will promote HCT, abstinence, consistent condom use for the sexually active, faithfulness for those in relationships, and referral for MMC. AFFORD will also provide HIV prevention education for men and women living in communities surrounding truck stops, fish landing sites, and bodaboda stages.The National HIV/AIDS response identifies key populations where the epidemic is more concentrated. In Uganda this includes youth out of school, especially those who operate bodaboda transport, truckers, CSW, and fisher folks.

AFFORD will support 14 ART accredited Good Life Clinics (GLCs) to provide HIV/AIDS treatment to HIV positive women under Option B+ and their HIV positive partners who are eligible. The ART clinics will be integrated with Option B+ services and provided using a family-centered approach. AFFORD will be expected to implement approaches to promote an effective Continuum of Response (CoR) model and monitor key indicators along the continuum. The project will provide on-site mentorship and training for private health providers in HIV care and treatment, in line with Ministry of Health guidelines and policies.

AFFORD will support all private sector ART accredited sites. The program will enroll at least 2,749 new HIV positive adults on treatment and support 5,722 HIV positive adults on ART by September 2013, contributing to an overall national and PEPFAR target of 190,804 new clients and 490,028 individuals on treatment. This target is not a ceiling, allowing for higher achievements with continued program efficiencies. Priority in enrollment will be given to HIV positive pregnant women and their families.

Due to capacity limitations, AFFORDs GLCs will refer HIV positive clients identified through their outreach HTC services to other USG comprehensive partners with larger capacities. AFFORD will establish formal referral network mechanisms with other partners so as to ensure the clients referred are enrolled in care and receive services. AFFORD will provide basic care kits to clients within the GLCs. Additionally, AFFORD will liaise with National Medical Stores, Joint Medical Stores and Supply Chain Management Systems for other HIV commodities (cotrimoxazole, lab reagents). AFFORD will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.

In addition, AFFORD will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. AFFORD will collaborate with other key stakeholders for provision of required wrap around services.

AFFORD will ensure gender awareness and issues are integrated in programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men may face in adhering to treatment or receiving ongoing care.