Baylor College of Medicine Childrens Foundation-Uganda (Baylor-Uganda) is a national not-for-profit, child health and development organization providing family centered pediatric HIV prevention, care and treatment services, health professional training and clinical research. The program Scaling up Comprehensive HIV/AIDS Services including Provider Initiated Testing and Counseling, TB/HIV, OVC, Care and ART for Adults and Children in Eastern and West Nile Regions will now operate in 16 and not 19 districts, the three districts will receive PEPFAR support through another mechanism. These 16 districts include: Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido, Amuria, Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo districts. By September 2011, 21,642 patients received clinical care, and 9,666 clients received treatment from 47 health facilities. Targets for this program for the next 12 months were derived using burden tables based on HIV prevalence and services need in the 16 program districts. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. The programs coverage will expand to additional health facilities to achieve the targets, and support will now include PMTCT services. Baylor-Ugandas main strategy is to improve the Ministry of Health system at district and health facility levels using a health system strengthening approach. In this regard, Baylor-Uganda will provide sub grants to the 16 districts for planning and coordination, and to also support health facilities provide comprehensive HIV prevention, care and treatment services. Five double cabin pickups have been purchased to-date and two additional vehicles will be procures in FY 2013.

PEPFAR will support the Government of Uganda to expand access to HIV care and support with the goal to achieve universal access to care and support by 2015. Scaling up Comprehensive HIV/AIDS Services including Provider Initiated Testing and Counseling (PITC), TB/HIV, OVC, Care and ART for adults and children in Eastern and West Nile regions program will support the provision of care services to 60,075 as a contribution to the overall PEPFAR target of 812,989 HIV positive individual in care and support services in FY 2013. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations. Baylor-Uganda, the partner implementing this program will be expected to use approaches to promote an effective Continuum of Response model and monitor key indicators along the continuum. They will work in 16 districts in Uganda.Baylor-Uganda will provide comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthen positive health dignity and prevention (PHDP), strengthen linkages and referrals using linkage facilitators, implement quality improvement for adherence and retention, pain and symptom management, and provide support to targeted community outreach activities in high prevalence, hard to reach and underserved areas.Focus will be placed on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with Ministry of Health (MOH) guidance. This has been a major challenge to treatment scale up nationally. Working with the Central Public Health Laboratory (CPHL) and other stakeholders, CD4 coverage will be improved from the current 60% to 100% over the next 12 months. Baylor-Uganda will support the sample referral network in line with this national CD4 expansion plan; and will monitor and report clients access to CD4 in quarterly reports. In addition, they will regularly track and report on potential client waiting lists making sure they do not develop. Gender will be integrated in existing services, with provision of GBV services or referral of clients as well as training of providers.Baylor-Uganda will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, liaise with National Medical Stores and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, lab reagents). They will build the capacity of facility staff to accurately and timely report, quantify and order commodities.In addition, Baylor-Uganda will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. Collaboration with other key stakeholders at all levels for provision of required wrap around services including family planning will occur.The program will be aligned to the National Strategic Plan for HIV/AIDS (2011/12 2014/15); support and strengthen the national M&E systems; and work within district health plans. Baylor-Uganda will work under the guidance of MOH/ACP and Quality Assurance Department for trainings, mentorship, quality improvement and supportive supervision.Funding has been provided to support the recruitment of 135 additional staff of varying cadres in the districts to meet the achievement of the targets. This will be done working with the PEPFAR Health Systems Strengthening technical working group.

The Baylor-Uganda supported program Scaling up Comprehensive HIV/AIDS Services including Provider Initiated Testing and Counseling (PITC), TB/HIV, OVC, Care and Treatment for adults and children in Eastern and West Nile regions in Uganda VC program plans to scale-up access to comprehensive OVC services to 11,154 OVCs and their households in FY 2013. Focus will be put on the following program areas under OVC as stipulated in the current OVC strategic plan. Identification of vulnerable children will be done using the vulnerability index tool; economic strengthening, food security and nutrition, education support, child protection, health care and psycho social and spiritual support.

The OVC program plans to provide: supportive supervision to caregivers implementing OVC activities, community growth monitoring, school-based monitoring of youths and children at risk of dropping out, continuous follow up of OVCs, quarterly support supervision for households trained in agronomic practices and support mapping of OVC households. Working with the district staff, Baylor-Uganda will also support planning and quarterly review meetings for community based organizations, trainings in agronomic practices for 180 OVC heads of households, nutrition care for the chronically ill, and income generation activities and small loan management will be carried out. The program will provide: improved seeds and hybrid animals, revolving loans to PHA/Caregiver through village savings schemes, short term care packages for children and vulnerable households as determined by the vulnerability index identification process.

The Baylor-Uganda program, Scaling up Comprehensive HIV/AIDS Services including provider initiated Testing and Counseling, TB/HIV, OVC, Care and ART for adults and children in Eastern and West Nile regions in Uganda will support Ministry of Health (MOH) to scale up TB/HIV integration; and specifically the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care. In addition, the plan is to initiate about 24,390 HIV positive clients in care on TB treatment in FY 13. This target was derived using burden tables based on district HIV prevalence and treatment need. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages.

Baylor-Uganda working in 16 districts will contribute to this target by screening 59,414 HIV positive clients for TB, and 1,980 will be started on TB treatment. The program will improve Intensified Case Finding (ICF) and the use of the national ICF tool, as well as, improve diagnosis of TB among HIV positive smear negative clients, extra pulmonary TB and pediatric TB through the implementation of new innovative technologies-GeneXpert and fluorescent microscopy. Baylor-Uganda will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

In FY 2013, the program will ensure early initiation of all HIV positive TB patients on treatment through the use of linkage facilitators and/or the provision of treatment in TB clinics. This program 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 identified to enforce infection control at facilities using interventions such as: cough hygiene, cough sheds and corners, fast tracking triage by cough monitors and ensure adequate natural ventilation.

The MOH/ACP and National TB and Leprosy Program (NTLP) will be supported to roll out provision of IPT, in line with the WHO recommendations; they will in turn support Baylor-Uganda to implement IPT at facility level.

In addition, Baylor-Uganda will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. The program will collaborate with other key stakeholders at all levels for provision of required wrap around services in the target districts.

This program is 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. Baylor-Uganda will work under the guidance of MOH/ACP, NTLP and Quality Assurance Department in trainings, quality improvement, TB/HIV mentorship and support supervision. Additionally, Baylor-Uganda will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

Baylor-Uganda will support Ministry of Health (MOH) expand pediatric HIV care and OVC with the goal to achieve universal access to care by 2015. Scaling up Comprehensive HIV/AIDS Services including Provider Initiated Testing and Counseling (PITC), TB/HIV, OVC, Care and ART for adults and children in Eastern and West Nile regions in Uganda program working in 16 districts will support enrolment of 5,941 children contributing to the overall PEPFAR target of 812,989 individuals in care, including 74,555 children in FY13. Targets were derived using burden tables based on district HIV prevalence and treatment need.

Baylor-Uganda will provide child friendly care services in line with national guidelines, PEPFAR guidance and Continuum of Response model. Key activities include: improve adolescent services, strengthen linkages and referrals using linkage facilitators, implement quality improvement for adherence and retention, and provide support to targeted community outreaches in high prevalence, underserved areas. Early infant diagnosis services and focal points at facilities will be scaled up to ensure follow up and active search of exposed children in facilities and communities to enable early enrolment of children in care. Baylor-Uganda will implement community mobilization and targeted activities such as Know Your Childs Status (KYCS) campaigns to identify more children. Focus will be placed on improved assessment of pre-ART children for ART eligibility for timely initiation on treatment in line with MOH guidance. Efforts will be made to scale up low cost approaches such as use of care taker support groups to support retention in care.

Baylor-Uganda will support retention of adolescents in care using expert peers and support groups. They will be provided with positive, health, dignity and prevention services including, sexual/ reproductive health services, psychosocial support and life skills training. Lessons learned from the planned national adolescent service assessment will be adopted.

Key priority will be to establish strong referrals between OVC and care and support programs to ensure HIV positive children are linked to OVC services, and children receiving OVC services are screened for HIV and appropriately linked to care. Baylor-Uganda will also support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

Baylor-Uganda will liaise with PACE and UHMG for provision basic care kits to clients; and work with National Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). The program will build the capacity of facility staff to accurately and timely report, quantify and order commodities.

Baylor-Uganda will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with nutrition, OVC and other services. As well as collaborate with UNICEF and key stakeholders at all levels for provision of wrap around services.

Baylor-Uganda will work with MOH and PEPFAR to support the recruitment of about 135 additional district staff of varying cadres to achieve the targets. This program is aligned to the National Strategic Plan for HIV/AIDS (2011/12-2014/15) and will support and strengthen the national M&E systems and work within district health plans.

During FY 2013, changes will be made in PEPFAR support for laboratory program in Uganda in line with the identified pivots. The pivots will focus on a change from facility based to lab network strengthening. Building on success of early infant diagnosis hubs there will be an increase in the number of hubs from 19 to 72 thus increasing the geographical coverage and access for specimen transportation, testing and result transmission. This effort is aimed at the ART targeted population receiving CD4 tests and improving coverage from 60% to 100%, therefore, improving the quality of laboratory services, reducing stock out of reagents, laboratory supplies and commodities, reducing equipment downtime and improving data collection, result transmission, analysis and utilization. To achieve this, technical staff will need to be hired and retained and where possible task shift non-technical activities to appropriately trained lay health workers.

Implementation of the WHO Strengthening Laboratory Management Towards Accreditation (SLMTA) will be the mainstay for quality improvement in addition to other quality assurance activities.

The hubs are strategically located health facilities identified by the MoH to serve as coordination centers for specimen referral, testing and result transmission for a catchment area of 30 to 40km radius serving 20 to 50 facilities.

Baylor-Uganda will support development and strengthening of laboratory systems and facilities to support HIV/AIDS-related activities. It will establish five new hubs in Adjumani and Yumbe hospitals in the West Nile region and Atutur Hospital in Eastern Uganda, as well as, Katakwi and Kapelebyong Health Center (HC) IVs in North Eastern Uganda. Major renovations will be done at Kapelebyong HC IV while Katakwi, Yumbe and Adjumani will receive minor renovations to accommodate CD4 testing equipment. Baylor-Uganda will work with the district authorities to ensure recruitment of three laboratory technologists at Yumbe hospital, two laboratory technologists and one laboratory technician at Atutur hospital, two laboratory technicians at Katakwi HC IV and one laboratory technician at Kapelebyong HC IV. Baylor will support all the five hubs with the procurement of CD4, clinical chemistry and hematology testing capacities. In addition, Baylor will support Strengthening Laboratory Management Towards Accreditation (SLMTA) including distributing MoH standard operating procedures to all Baylor supported facility laboratories and training health workers in Good Laboratory Practices (GLP).

The results of the Uganda AIDS Indicator Survey 2010/2011 show an increase in HIV prevalence and very low circumcision prevalence (approximately 25%). USG has prioritized Voluntary Medical Male Circumcision (VMMC) a prevention intervention, as a major pivot to reduce the number of new HIV infections. SMC/VMMC is being offered in Uganda as part of a comprehensive HIV prevention package, which includes: 1) promoting delay of sexual debut (for primary abstinence), abstinence and reduction in the number of sexual partners, and be faithful; 2) providing and promoting correct and consistent use of male condoms; 3) providing HIV testing and counseling (HTC) services and referral to appropriate care and treatment services if necessary, and also providing services for the treatment of sexually transmitted infections.

The Baylor-Uganda program, Scaling up Comprehensive HIV/AIDS Services including provider initiated Testing and Counseling, TB/HIV, OVC, Care and Treatment for Adults and children in Eastern and West Nile regions in Uganda will support provision of VMMC services targeting about 44,652 men in 16 districts in Uganda. This will contribute to the national VMMC target of one million procedures in 2012/2013. Baylor-Uganda will recommend VMMC along with HTC as this presents as an opportunity to offer reproductive health care, and appropriately refer to HIV services. Female partners will be engaged to advocate, mobilize men and involve women in seeking HTC with appropriate referrals, including ANC and PMTCT services. The program will target eligible men (adolescents and male) 15 years and above who are likely to be sexual active and at higher risk of acquiring HIV. Additionally, multiple delivery approaches will be employed to ensure safe scale up of services including: standalone sites; integrated services within existing health facilities, seasonal outreaches, mobile and camps service delivery.

Baylor-Uganda will implement the Model for Optimizing the Volume for Efficiency (MOVE) to optimize the efficiencies and increase the volume safely. Special focus will be placed on quality assurance and regular internal and external quality assessments of the VMMC program will be done. Baylor-Uganda will create acceptance and demand for VMMC through community campaigns based on information from the Uganda National Communication Strategy on VMMC employing both media campaigns and person to person communication targeting localities with high numbers of men like markets, churches, taxi parks, boda boda stages, etc. The program will support provider training and will liaise with Medical Access Uganda Limited to obtain VMMC supplies and commodities. Baylor-Uganda will report to the VCCM National Operational Center as required by MOH. The programs VMMC interventions are geared towards contributing to goal one of Uganda National HIV/AIDS Strategic Plan To reduce the incidence rate of HIV by 40% by the year 2012 and to objective 5 To promote use of new prevention technologies and approaches proven to be effective.

The Baylor-Uganda supported program Scaling up Comprehensive HIV/AIDS Services including provider initiated Testing and Counseling, TB/HIV, OVC, Care and Treatment for adults and children in Eastern and West Nile regions in Uganda has a goal is to reduce HIV related morbidity and mortality among infected and affected children, adolescents and their families in Africa. The program area of coverage includes 16 districts in two regions: Eastern region; Bukedea, Kumi, Ngora, Soroti, Serere, Katakwi, Kaberamaido and Amuria; and West Nile region; Nebbi, Zombo, Arua, Maracha, Adjumani, Koboko, Yumbe and Moyo.

Baylor-Uganda will increase coverage and utilization for up to 90% of clients accessing services at supported health facilities. By using Provider Initiated Testing and Counseling (PITC) services within health facilities, pregnant and breast feeding mothers and male partners in ANC settings, at labor, delivery and post-partum will be targeted. The general population including children will also be targeted based on existing HIV prevalence data and unmet need using VCT outreaches, routine HTC for safe medical male circumcision and Know Your Child HIV Status (KYCS) campaigns. Innovative VCT outreaches like Peer to Peer, mobile clinics and special events will be used to target key populations (commercial Sex workers and Fisher Folks). The program will support districts and health facilities to program and conduct targeted home-based outreaches and support health facilities to mobilize children for HCT using the KYCS strategy. In FY 2013, the program will offer HTC services to at least 125,000 individuals using the national testing algorithm as prescribed by the Ministry of Health (MOH) standards. Activities to strengthen successful referrals and linkages will include use of linkage facilitators to track or follow-up HIV positive individuals not enrolled in care or treatment services.

Training in Routine counseling and testing trainings (at least one per region), data management (HMIS) for district health workers, training on MOH tools and data management for district health workers will be conducted. Quality assurance of both testing and counseling, and monitoring and evaluation of HTC, including incorporation of couples HTC indicator and other new PEPFAR and WHO recommendations will be implemented. Baylor-Uganda will work in collaboration with Medical Access Uganda Limited, National Medical Stores and Joint Medical Stores to ensure availability of HTC test kits and other required reagents so as to minimize stock outs.

In FY 2013, Baylor-Uganda will facilitate implementation of PMTCT Option B+ activities in 16 districts of Eastern and West Nile regions.

Key strategic pivots for PMTCT focus on:

1)Improving access and utilization of eMTCT services in order to reach more HIV infected pregnant women as early as possible during pregnancy. To achieve this Baylor-Uganda will ensure provision of universal HIV Testing and Counseling (HTC) services during ANC, labor and delivery, and community mobilization.

2)Decentralizing treatment and Option B+ through accreditation of all PMTCT sites at hospital, Health Center (HC) IV and HC III levels. Activities will include: site assessments for accreditation, identification of training needs, procurement of equipment, printing M&E tools, job aides, and Option B+ guidelines, training of service providers, and sample referral system for CD4+ and Early Infant Diagnosis (EID). Transition of Option B+ in Baylor-Uganda sites will be done in accordance with MOH guidance, and a total of 88 facilities will be accredited by end of FY 2013. Baylor-Uganda will support the delivery Option B+ services using a family focused model within MNCH settings. In this model, family support groups will be formed at all PMTCT sites and will meet monthly to receive adherence counseling and psycho-social support, IYCF counseling, EID, family planning (FP) counseling, couple HTC, supported disclosure and ARV drug refills. Village health teams will also be utilized to enhance follow-up, referral, birth registration, and adherence support. Through this model, male partners will receive condoms, STI screening and management, support for sero-discordant couples, treatment for those who are eligible and linkage to Voluntary Medical Male Circumcision (VMMC). At least 100,000 partners of pregnant women will be tested within the MNCH setting.

3)Supporting intensive M&E of activities to inform Option B+ roll out through cohort tracking of mother-baby pairs and electronic data reporting. All sites will actively document services provided to the mother-baby pairs at both facility and community level. Each beneficiary will have a standard appointment schedule that will be aligned to the follow-up plan of each PMTCT site. Mobile phone technology will be used to remind mothers and their spouses on appointments, EID results, and ARV adherence. Service providers will conduct home visits to trace client who are lost to follow-up. All sites will submit daily reports on key program elements electronically to support effective monitoring and timely management.

4)Facilitating quarterly joint supportive supervision and mentorships at all PMTCT/ART sites involving MOH, AIDS Development Partners, Districts, USG, and implementing partner staffs in accordance with MOH guidance.

5)Integrating voluntary and informed FP services with PMTCT services. Baylor-Uganda will ensure FP sessions are integrated within PMTCT trainings, counseling, education and information during ANC, labor, delivery and postnatal periods, as well as, for women in care and treatment based on respect, womens choices and fulfillment of their reproductive health rights.

6)The program will support the recruitment of 124 critical cadres of health staff in the 16 districts including midwives, clinical officers and laboratory technicians. Additionally establish 11 laboratory hubs to facilitate EID sample collection and transportation.

Baylor-Uganda will support the National Strategic Plan 2011/12-2014/15 objective to increase access to treatment from 57% to 80% by 2015. This will e done through Scaling up Comprehensive HIV/AIDS Services including Provider Initiated Testing and Counseling (PITC), TB/HIV, OVC, Care and ART for adults and children in Eastern and West Nile regions program. Baylor-Uganda will support the enrollment of at least 11,662 new adults and maintain 31,362 adults on treatment in 16 districts. These targets contribute to overall national and PEPFAR targets of 190,804 new clients and 490,028 individuals currently on treatment. Specific attention will be given to key populations including truck drivers, fisherman, commercial sex workers and men who have sex with men. These targets were derived using burden tables based on district HIV prevalence and treatment need, and are flexible, allowing for higher achievements with continued program efficiencies. Priority will be given to enrolment of pregnant women, TB/HIV patients and key populations.

Baylor-Uganda will support Ministry of Health (MOH) roll out of Option B+ through: accreditation of at least 88 additional health facilities, training, mentorship and joint PMTCT/ART supportive supervision. Baylor-Uganda will support ART/PMTCT integration at facilities piloting feasible service delivery models. Continuum of response linkages and referrals will be strengthened using linkage facilitators in facilities and communities. Facilitators will also be utilized for TB/HIV integration to ensure early ART initiation for TB/HIV patients. Baylor-Uganda will support family planning and cervical cancer screening integration at facilities through service provision or referrals. Gender will be integrated in existing services, with provision of GBV services or referral of clients as well as training of providers.

Baylor-Uganda will work with MOH/ ACP and Quality Assurance Department to implement quality improvement initiatives for the ART framework including: early initiation of ART eligible clients, improve adherence and retention and monitor treatment outcomes. The use of innovative, low cost approaches for adherence, retention and follow up e.g. mobile phone technology, appointment registers, and alert stickers will be strengthened. Emphasis will be placed on adherence and retention of women enrolled under Option B+.

Increasing access to CD4 for routine monitoring of clients in line with MOH guidelines will be prioritized. Baylor-Uganda will support the sample referral network in line with the national CD4 expansion plan; and monitor and report clients access to CD4 in quarterly reports.

The program will liaise with PACE and UHMG for provision basic care kits, and with National Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities. Baylor-Uganda will build the capacity of facility staff to accurately and timely report, quantify and order commodities. In addition, they will work with USG partners and other key stakeholders for provision of required wrap around services.

Recruitment of about 135 additional district staff of varying cadres will be funded to achieve targets, with guidance from MOH and PEPFAR Health Systems Strengthening technical working group.

Baylor-Uganda will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to treatment from 57% to 80% by 2015. Scaling up Comprehensive HIV/AIDS Services including Provider Initiated Testing and Counseling (PITC), TB/HIV, OVC, Care and ART for adults and children in Eastern and West Nile regions in Uganda program operating in 16 districts will enroll at least 2,915 new HIV positive children and maintain 4,686 children on treatment. This will contribute to overall national and PEPFAR target of at least 38,161 new clients and 63,704 children current on treatment over the next 12 months.

In FY 2013, Baylor-Uganda will support the national pediatric treatment scale up through strengthening identification, follow up and treatment for infants using EID focal persons, peer mothers, SMS messages/phone calls and flagging files with initiate ART immediately stickers. Facilities will be supported to strengthen test and treat for all HIV positive children under two years in line with the national treatment guidelines.

The program will support the early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups. They will be provided with positive, health, dignity and prevention services including sexual and reproductive health services, psychosocial support and life skills training.

A key priority will be to establish strong referrals between OVC and care and support programs to ensure children on treatment are linked to OVC services, and children provided with OVC services are screened for HIV and appropriately linked to treatment.

Baylor-Uganda will support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

Baylor-Uganda will coordinate with National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). The program will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Baylor-Uganda will build the capacity of facility staff to report, quantify and order commodities both accurately and timely. In addition, the program will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration of nutrition, OVC and other health services. Baylor-Uganda will collaborate with UNICEF and other key stakeholders at all levels for provision of required wrap around services in the districts of operation. These districts will be supported to recruit about 135 additional staff of varying cadres so as to achieve the targets. This will be done working with MOH and PEPFAR Health Systems Strengthening technical working group.

The program is aligned to the National Strategic Plan for HIV/AID (2011/12-2014/15), supports and strengthens the national M&E systems and works within district health plans. Baylor-Uganda work under the guidance of MOH/ACP and Quality Assurance Department to support pediatric trainings, quality improvement, implementation of the national pediatric mentorship framework and support supervision.