The Infectious Disease Institute - Kampala City Council Authority (IDI-KCCA) will provide comprehensive HIV prevention, care, support and treatment services to HIV positive individuals in Kampala District which comprises of five divisions: Central, Nakawa, Makindye, Kawempe, and Rubaga. IDI-KCCA will support a total of 10 facilities: eight public health facilities including Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe, Kisugu HealthCcenters and two Private Not-For Profit (PNFP) Kawempe Home Care and Hope Clinic Lukuli to provide HIV/AIDS services in FY 2013.

IDI-KCCA will scale up Provider Initiated HIV Testing and Counseling (PITC) in the out-patients departments in-patients wards, TB, STI and ANC clinics in all the supported facilities and scale-up Voluntary Medical Male Circumcision (VMMC) using the public private partnership with International Hospital Kampala (IHK).

IDI-KCCA will accelerate the scale-up of VMMC using the public private partnership with International Hospital Kampala (IHK) and will create demand in identified densely populated areas with high HIV prevalence within Kampala District. There will be two VMMC teams including the dedicated teams in the facilities and roving teams using the Model for Optimizing the Volume for Efficiency (MOVE). The teams will report to the VMMC Operational Center daily. HIV Testing and Counseling (HTC) will be offered to VMMC clients all HIV positive identified clients will be linked to care and treatment using HTC volunteers. VMMC kits will be provided through Medical Access Uganda Limited.

IDI-KCCA will focus on supporting the Government of Uganda (GOU) to further expand access to HIV care and support with the goal to achieve universal access of 80% in care by 2015. IDI-KCCA program will support the provision of care services to 20,698 as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals into care. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations, such as, truck drivers, fishermen, commercial sex workers and men who have sex with men. The Continuum of Response (CoR) model was applied to ensure improved referrals and linkages which IDI-KCCA will implement by monitoring key indicators along the continuum.

IDI-KCCA will support Kampala district which comprises five divisions of Central, Nakawa, Makindye, Kawempe, and Rubaga. IDI-KCCA will support 10 accredited KCCA health facilities in Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe, Kisugu, Kawempe Home Care and Hope Clinic Lukuli to provide HIV/AIDS care and treatment.

The key strategic pivots for Adult Care and Support will focus on:

1) Providing comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthening positive health dignity and prevention, strengthen linkages and referrals using linkage facilitators, implementing quality improvement for adherence and retention, pain and symptom management and providing support to targeted community outreach activities in high prevalence hard to reach and underserved areas to serve key populations.

2) Increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MoH guidance. This has been a major bottleneck to treatment scale up nationally. Working with the CPHL and other stakeholders, CD4 coverage will be improved from 60% currently to 100% over the next 12 months. IDI-KCCA 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, the partner will regularly track and ensure there will be no client wait lists.

IDI-KCCA will support integration of voluntary family planning and cervical cancer screening services at the facility level and refer complicated cases.IDI-KCCA will liaise with PACE for provision and distribution of basic care kits and UHMG for provision of family planning commodities to clients. Additionally IDI-KCCA will liaise with National Medical Stores and Medical Access Uganda Limited for other HIV commodities (Cotrimoxazole, lab reagents) for the public and public health facilities respectively. IDI-KCCA will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

IDI-KCCA 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. Wrap around services will be provided in collaboration with other key stakeholders. IDI-KCCA will support facilities to address linkages between gender based violence and HIV, including tracking linkages to services for survivors of sexual violence, provision of post-exposure prophylaxis, treatment of STI, and reproductive health counseling.

In FY 2013, IDI-KCCA plans to pursue interventional strategies to help families and communities in Kampala District to care for children living with and affected by HIV/AIDS. The program will provide OVC services in five divisions namely: Central, Nakawa, Makindye, Kawempe, and Rubaga. Specific support will include: caregiver training, targeted nutritional support, medical care and economic empowerment through training in income generating activities. Linkages and partnerships with organizations that provide food (packages) and food security will be pursued. Other linkages will include education, life skills and vocational training, child protection and legal aid services.

In FY 2013 IDI-KCCA will identify and support an estimated a total of 3,163 OVCs from the supported health facilities. The core program areas for support are health care, therapeutic feeds for malnourished children and economic empowerment through training and facilitation on income generating activities. IDI-KCCA will continue to provide psycho social and spiritual support to individuals and groups in care and treatment. Facilitating of peer support group, care giver and adolescent meetings will be supported.

These IDI-KCCA efforts are consistent with the strategies for achieving goal three To mitigate social, cultural and economic effects of HIV and AIDS at individual, household and community levels and specifically geared towards contributing to objective 12 To increase provision of quality psychosocial support to PHAs, OVCs, PWDs and other disadvantaged groups affected by HIV and AIDS by 2012 and Objective 15 Increase access to basic entitlements for PHAs and OVCs of the National HIV/AIDS Strategic Plan.

IDI-KCCA will focus on supporting the GOU 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 and initiate 24,390 HIV positive clients in care on TB treatment. 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.

IDI-KCCA will contribute to this target by screening 18,628 HIV positive clients for TB; and 621 will be started on TB treatment. IDI-KCCA will support Kampala District which comprises five divisions of Central, Nakawa, Makindye, Kawempe, and Rubaga. IDI-KCCA will support 10 accredited KCCA Health Facilities of Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe, Kisugu, Kawempe Home Care and Hope Clinic Lukuli to TB/HIV services.

The key strategic pivots for TB/HIV will focus on:

1) Improving Intensified Case Finding (ICF) and the use of the national ICF tools to improve diagnosis of TB among HIV positive smear negative clients, extra pulmonary TB and pediatric TB through the implementation of new innovative technologies like GeneXpert and fluorescent microscopy. IDI-KCCA will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

2) Ensuring 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. IDI-KCCA 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 and ensuring adequate natural ventilation.

The MOH/ACP and National TB and Leprosy Program (NTLP) will be supported to roll out provision of Isoniazid Preventive Therapy, in line with the WHO recommendations.

In addition, IDI-KCCA 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. IDI-KCCA will collaborate with other key stakeholders at all levels for provision of required wrap around services.

The program will be aligned to the National Strategic Plan for HIV/AIDS and National TB Strategic Plan (2011/12-2014/15) to support and strengthen the national M&E systems and work within district health plans. IDI-KCCA will work under the guidance of MoH/ACP, NTLP and the Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, IDI-KCCA will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

IDI-KCCA will focus on supporting the GOU to further expand pediatric HIV care and OVC with the goal to achieve universal access to care by 2015. IDI-KCCA program will contribute 1,863 children to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services of which 73,169 are children. The funds for HIV commodities (ARVs, test kits and lab reagents); equipment; and additional human resource have been included in budgets of other procurement mechanisms and as a result the targets and budgets for this program are not aligned. IDI-KCCA will support Kampala district which comprises five divisions of Central, Nakawa, Makindye, Kawempe, and Rubaga. IDI-KCCA will support 10 accredited KCCA health facilities of Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe, Kisugu, Kawempe home care and Hope clinic Lukuli to provide HIV/AIDS care and treatment.

The key strategic pivots for Pediatric Care and Support will focus on:1) Providing comprehensive child friendly care and support services in line with the national guidelines and PEPFAR guidance, improving adolescent services, strengthening linkages and referrals using linkage facilitators, implementing quality improvement for adherence and retention and providing support to targeted community outreaches in high prevalence hard to reach and underserved areas.

2) Early Infant Diagnosis (EID) 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. IDI-KCC will scale up low cost approaches, such as use of care taker support groups so as to support retention in care.

3) Implementing community outreach activities and targeted activities such as Know Your Childs status campaigns to identify more children. Pre-ART assessment of children for ART eligibility will be improved to ensure timely initiation on treatment in line with MoH guidance.

4) Supporting retention of adolescents in care as well as ensuring a smooth transition into adult life 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. Lessons learned from the planned national adolescent service assessment will be incorporated in activities.5) Establishing strong referrals between OVC and care and support programs to ensure HIV positive children are linked to OVC services and that children provided with OVC services are screened for HIV and appropriately linked to care and support. IDI-KCCA will also support the integration of HIV services in routine pediatric health services, including the national Child Health Days.

IDI-KCCA will liaise with PACE for provision and distribution of basic care kits and UHMG for provision of voluntary family planning commodities to adolescents. Additionally IDI-KCCA will liaise with National Medical Stores and Medical Access Uganda Limited for other HIV commodities including cotrimoxazole and lab reagents for the public and private facilities respectively. IDI-KCCA will build the capacity of facility staff to accurately report, forecast, quantify and order these commodities in a timely manner.

IDI-KCCA will collaborate with UNICEF and other key stakeholders at all levels for provision of required wrap around services.

During FY2013, changes will be made in PEPFAR support for the 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 is aimed at the population receiving ART to improve CD4 testing coverage from 60% to 100% 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.

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.

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

In FY 2013, in collaboration with the Central Public Health Laboratory (CPHL) and the infrastructure division at the MoH, IDI-KCCA will support equipment installation, procurement of associated workshop tools, a mobile equipment maintenance unit and the recruitment of at least two biomedical engineers for the optimum functioning of the equipment and maintenance workshops and aimed at reducing equipment down time in Kampala District.

IDI-KCCA has been instrumental in assisting Kampala City Council Authority Health Facilities to ensure that the MoH/HMIS tools are readily available, fully and correctly utilized and all reports are completed and submitted on time. However, there are many remaining challenges and weaknesses in performance monitoring and health information systems across all implementation levels in both the public and private sectors. Some of the challenges include: inadequate use of data for evidence based planning and decision making at all levels, insufficient capacity for M&E at all levels, and limited skills for analyzing data at service delivery and supervisory levels.

In FY 2013 IDI-KCCA will take full advantage of the GOU existing district based health information system to improve the quality and effectiveness of health and HIV/AIDS programs. One area that IDI-KCCA will focus on is the intensive and rapid monitoring of the roll-out of Option B+. The service package for Option B+ will encompass the WHO comprehensive approach of early identification of HIV infection in women, initiation of ART treatment as early as possible during pregnancy, through labor/delivery and in postpartum and ART treatment for life. Furthermore, roll-out of Option B+ implementation starts with the high HIV burden regions in order to minimizes expiry of commodities for option A and allows existing implementing partners to roll out quickly eventually covering 1,600 PMTCT facilities. It is precisely in this context of rapid roll-out that IDI-KCCA will support internet-based District Health Information Software II (DHIS II) which will accommodate the rapid dissemination of information to national program managers, district health staff, and facility managers on the following PMTCT indicators:

# initiating Option B+# of positive pregnant women# retained in B+ monthly - return visits, drug pickup, other# women monitored for adherence (e.g. self-report, pill count, Viral Load, CD4)# women given adherence counseling/support activities (booster counseling, other)# women successfully transferred to Care and Treatment for illness (need definition)

IDI-KCCA will support the training of facility based health care workers on the DHIS II and also train them on how to analyze and use data in real time (daily, weekly or monthly). The dashboard within DHIS II will be designed to plot data against some standards/benchmarks that will be developed by PMTCT Technical Working Group.

In March 2010, the Ministry of Health (MoH) launched the Safe Male Circumcision policy to guide the integration of Voluntary Medical Male Circumcision (VMMC) services in Ugandas national health system to reduce the number of new HIV infections. This followed a WHO recommendation that male circumcision be considered as part of a comprehensive HIV prevention package (based on the clinical trial conducted in Uganda, Kenya and South Africa.Key conclusions from the modeling conducted in Uganda are that scaling up the program would result in averting 428,000 adult HIV infections from 2009 to 2015. In order to achieve this impact approximately 4,200,000 circumcisions would be performed by 2014/2015.Given the results of the UAIS (2010/2011) with alarming increase in HIV prevalence and very low circumcision prevalence (26%), PEPFAR Uganda has prioritized this prevention intervention as a major pivot to reduce the number of new HIV infections.VMMC is being offered in Uganda as part of a comprehensive HIV prevention package, which includes: promoting delay of sexual debut (for primary abstinence), abstinence and reduction in the number of sexual partners and being faithful; providing and promoting correct and consistent use of male condoms; providing HIV testing and counseling services and referral to appropriate care and treatment if necessary and providing services for the treatment of sexually transmitted infections. Circumcision offers a unique opportunity for entry into care following HIV Testing and Counseling (HTC), once the men are identified and engages female partners to advocate, mobilize men and involve women in seeking HTC with appropriate referrals, including ANC and PMTCT care.The pivots for VMMC will be:1) Use of the Model for Optimizing the Volume for Efficiency (MOVE) as a menu to increase the number of men for VMMC. Multiple delivery approaches to ensure safe scale up of services will be used. Dedicated VMMC teams will provide integrated services in two supported health facilities both Kisenyi and International Hospital Kampala (IHK). Roving teams will conduct outreaches in the rest of the eight facilities targeting densely populated areas.2) Creating acceptance and demand for VMMC should be generated through a series of community campaigns based on information from WHO, UNAIDS and the Uganda National Communication Strategy on VMMC. In FY 2013, IDI-KCCA will employ both media campaigns and person to person message packaging to target men. The program will continue to provide daily reports to the SMC/VMMC National Operational Center as required by MoH.IDI-KCCA will scale-up VMMC with a contribution of 60,206 circumcised men towards the national target of 750,000.IDI-KCCA will pay special focus on quality assurance and quality assessments on a regular basis and will liaise with Medical Access Uganda Limited for provision of VMMC kits.

The projects VMMC interventions in Uganda are geared towards contributing to goal one of Ugandas National HIV/AIDS Strategic Plan To reduce the incidence rate of HIV by 40% by the year 2012 and objective five To promote use of new prevention technologies and approaches proven to be effective.

HIV Testing and Counseling (HTC) is a critical bridge to HIV treatment, care and support services. The IDI-KCCA Project will support the provision of Provider Initiated Testing and Counseling (PITC) to over 45,868 individuals in a total of 10 facilities including eight local government (public) Clinics: Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe and Kisugu and two Private not-for Profit clinics Kawempe Home Care and Hope Clinic Lukuli.

Innovative Community outreach activities will target key populations like commercial sex workers in Kawempe and Kisenyi Health Centers. In addition male partners, families and the general population will be targeted based on existing HIV prevalence data and unmet HTC need.

The project will focus on the integration of RCT/PITC approaches into out-patient department OPD and ANC points at all implementing health facilities thereby contributing to overall PEPFAR goals of increasing access to and use of essential HTC services to pregnant and breast feeding mothers in ANC settings, at labor, delivery and post-partum. Innovative models in which opinion leaders, special outreaches and Peer to Peer networks will be used to mobilize communities to utilize HTC services thus reducing missed opportunities for HTC.

IDI-KCCA does not have any specific program targeting MSMs but if they are referred to the clinics for HIV services they will be served the same way any other clients are supported.

IDI-KCCA will work with a centralized procurement mechanism Medical Access Uganda Limited to ensure regular supply of HIV test kits as per the MoH guidelines. Linkage facilitators will be used to strengthen linkages, referrals and follow up along the continuum of response in a bid to optimize enrolment of identified and retain HIV positives in care.

IDI-KCCA proposes to strengthen the documentation system of referrals and adopt models of care that will address long waiting times in the clinics.

Routine quality data will be collected and analyzed to generate periodic progress reports that will be shared with stake holders including local governments, partners and MoH. Regular data quality audits will be conducted in line with WHO HTC Quality Assurance/ Improvement guidelines.

In FY 2013, IDI-KCCA will facilitate the implementation of PMTCT Option B+ activities in 10 PMTCT sites in Kampala district.Key strategic pivots for PMTCT will 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 IDI- KCCA will ensure provision of universal HIV Testing and Counseling (HTC) services during antenatal, labor and delivery, and community mobilization.2 Decentralizing Treatment and Option B+ through the accreditation of all PMTCT sites at hospital, Health Center IV and Health Center 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). IDI-KCCA will support delivery of 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, counseling, couples HTC, supported disclosure and ARV 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 discordant couples, treatment for those who are eligible and linkage to Voluntary Medical Male Circumcision (VMMC). IDI-KCCA will provide HIV counseling and testing to 50,697 pregnant women in 10 service outlets during FY 2013. A total of 5,100 HIV positive pregnant women will be identified, of which 4,335 will be initiated on HAART for life and 765 will be provided with ARV prophylaxis because Option B+ will be implemented in a phased approach. In addition 4,947 exposed will receive ARV and cotrimoxazole prophylaxis, as well as, DNA/PCR test for EID. At least 25,000 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. All sites will submit daily reports on key program elements electronically to support effective monitoring and timely management.4 Facilitating quarterly joint support supervision and mentorships at all PMTCT/ART sites involving MOH, AIDS Development partners, districts, USG, and implementing partner staff in accordance with MOH guidance. Site level support will entail cohort reviews, adherence rates, retention rates, data management, availability of supplies, commodities and tools, and knowledge gaps.

5 Integrating voluntary and informed Family Planning (FP) services with PMTCT service. IDI-KCCA will ensure FP sessions are integrated within PMTCT trainings, counseling, education, and information during ANC, labor and delivery, and postnatal periods, as well as, for women in care and treatment, based on respect and womens choices.

All ARV drug procurement has now been centralized. Only minor typographical changes were made to this IM narrative for COP 12In FY 2011, rapid assessments were carried out to document the current situation on ground, identify the gaps and plan for essential needs including the activities that are required to be implemented. This assessment formed a basis for strengthening the procurement and supply chain management systems and processes at the supported KCCA facilities.

a) Training of Health Care Workers (HCWs) in medicines logistics management: The project conducted a training of 20 HCWs in medicines logistics management done in collaboration with the MoH. The HCWs targeted included those who were in the frontline and teaching the following components: medicines logistics cycle, forecasting and quantification, good stores and dispensing practice, MoH medicines information management systems, the different MoH commodity supply chain lines, Standard Operational Procedures, Pharmacovigilance, management of expired drugs and the continuous quality improvement processes.

b) Mentorship program: In a bid to improve the impact on logistics management at the Health Facilities (HF), the training curriculum has a follow up mentorship program of trained HCWs to help improve their knowledge, skills and applicability of medicines logistics management in their health facilities. The mentorship team consists of members of the project Pharmacy Technical Assistance Team (PTAT) and the focal KCCA logistics person and on-site supervisory support from MoH is two months after completion of training.

c) Other activities: CMEs will be continued to be conducted at the HFs with a focus on logistics and good dispensing practices.

In FY 2012, all the public KCCA facilities will get their ARV supplies from National Medical Stores (NMS) and the private sector facilities will get their ARV supplies from the CDC logistic mechanism (MAUL). Buffer support was provided to the public HFs that request for it.

There will be continued on-site support in management of medicines, adherence of SOPs and ensuring timely compilation and submission of the medicines orders. The KCCA logistics coordinator has been supporting the collection and distribution of updated versions of LMIS tools (the new NMS delivery schedule, ARV dispensing log, PMCT order form, ARV order form, pediatric dosing charts) and will continue this function.

The strategies deployed for strengthening the supply chain systems at the supported health facilities will ensure that there is no stock out of drugs. The HCWs will be supported further in making timely reports and requisition of medicines and supplies from the government supplies. The project will maintain a buffer stock to ensure consistent availability of ARV drugs to patients.

IDI-KCCA will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. The program will enroll at least 4,467 new adults and support 16,000 adults and children current on ART by APR 2013, contributing to overall national and PEPFAR target of 190,804 new clients and 490,028 individuals current on treatment. This target is not a ceiling, allowing for higher achievements with continued program efficiencies. Priority will be given to enrolment of HIV positive pregnant women, TB/HIV patients, and key populations.IDI-KCCA will support Kampala district which comprises five divisions of Central, Nakawa, Makindye, Kawempe, and Rubaga. IDI-KCCA will support 10 accredited KCCA health facilities of Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe, Kisugu, Kawempe Home Care and Hope Clinic Lukuli to provide HIV/AIDS care and treatment.

The key strategic pivots for adult treatment will focus on:

1) Supporting the MoH to rollout Option B+ for eMTCT through the following activities; training, mentorship and joint PMTCT/ART support supervision. IDI-KCCA will also support ART/PMTCT integration at facility level piloting feasible service delivery models, such as same day integrated HIV clinics. Special emphasis will be placed on adherence and retention of women enrolled under Option B+.

2) Strengthening linkages and referrals using linkage facilitators across different service points in facilities and communities to ensure continuum of response. Facilitators will also be utilized for TB/HIV integration to ensure early ART initiation for TB/HIV patients.

3) Implementing quality improvement initiatives for the ART framework including early initiation of ART for eligible clients, improving adherence and retention and monitoring treatment outcomes. The program will support use of innovative, low cost approaches for adherence, retention and follow-up such as phone/SMS reminders and alert stickers in the appointment registers.

4) Increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. IDI-KCCA 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

IDI-KCCA will liaise with PACE for provision and distribution of basic care kits and UHMG for provision of family planning commodities to clients. Additionally IDI-KCCA will liaise with National Medical Stores and Medical Access Uganda Limited for ARV drugs and other HIV commodities including cotrimoxazole and lab reagents for the public and private facilities respectively. The partner will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

In addition, IDI-KCCA will work with USG partners and other key stakeholders for provision of required wrap around services.

The program will be aligned to the National Strategic Plan for HIV/AID (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. IDI-KCCA will work under the guidance of MoH/AIDS and the Quality Assurance Department in trainings, ART/PMTCT mentorship and supportive supervision visits.

IDI-KCCA will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. IDI-KCCA program will enroll at least 1,117 new HIV positive children and support 2,080 children on ART by APR 2013. This will contribute to the overall national and PEPFAR target of 38,161 new children on ART and 63,701 children current on treatment.

IDI-KCCA will support Kampala District which comprises five divisions of Central, Nakawa, Makindye, Kawempe, and Rubaga. In total IDI-KCCA will support 10 ART accredited KCCA health facilities of Kiswa, Kiruddu, Kisenyi, Kawaala, Kitebi, Komamboga, Kawempe, Kisugu, Kawempe Home Care and Hope Clinic Lukuli to provide HIV/AIDS care and treatment.

The key strategic pivots for Pediatric Treatment will focus on:1) Supporting the national program scale up pediatric treatment through strengthening the identification, follow-up and treatment of all eligible children and infants from Early Infant Diagnosis (EID) care points through 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 under two years in line with the national treatment guidelines.

2) Supporting 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: psychosocial support and life skills training.

3) A key priority will be to establish strong referrals between OVC & 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. IDI-KCCA will support the integration of HIV services in routine pediatric health services, including national Child Health Days.

IDI-KCCA will liaise with PACE for provision & distribution of basic care kits and UHMG for family planning commodities to clients. In addition, National Medical Stores & Medical Access Uganda Limited (MAUL) will provide ARVs and other HIV commodities (cotrimoxazole, lab reagents) for the public and private facilities respectively. IDI-KCCA will build the capacity of facility staff to accurately report, forecast, quantify and order these commodities in a timely manner.

In addition, IDI-KCCA will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. IDI-KCCA will collaborate with UNICEF and other key stakeholders at all levels for provision of required wrap around services. All commodities for pediatric care and support services were funded through one mechanism MAUL thus a reduction of funding to IDI-KCCA mechanism. IDI-KCCA implements its activities in Kampala district and is not a major pediatric services provider because of complementary programs in the same district such as Baylor-Uganda.The program will be aligned to the National Strategic Plan for HIV/AID (2011/12-2014/15) to support and strengthen the national M&E systems and work within district health plans. IDI-KCCA will work under the guidance of MoH/ACP and the Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework a