Goals and objectives. Through this activity PEPFAR/CDC and Makerere University School of Public Health (MakSPH) plan to support select SI activities in Uganda. The aim of this activity is to conduct surveillance among several categories of most-at-risk populations (MARPs).

Coverage and target populations. Activities will target populations in Kampala and up-country. Existing survey protocols covering high risk group HIV prevalence surveys, estimating social visibility of high risk groups and the population sizes of high risk groups will be carried out through this CoAg. Such groups include men who have sex with men, drug users, sex workers, and clients of sex workers; and specific demographic groups such as refugees, disabled persons, street youth, persons engaged in partner concurrency, or slum dwellers. Other potential activities include PMTCT-based surveillance, and measuring GHI-related and HIV-co-morbidities in the general population.

Cost-efficiency. The same overhead infrastructure (office, staff, equipment) for a variety of activities will be used.

Transition to partner govt, local organization, other donor. MakSPH is a local, indigenous organization, and part of Ugandas largest, public university. MakSPH future capacity and skills may attract non-PEPFAR funds to facilitate SI-related activities. Local governments and institutions will participate from design to implementation of the various projects so as to effect continuity and sustainability.

M&E plans. M&E primarily will be addressed through the number of SI staff trained; protocols developed , approved and implemented reports and manuscripts produced and published, and individuals served within the target communities.

Vehicle. There are no plans for procurement of a vehicle in FY2012.

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In the Kyoga region are a number of district level hospitals in addition to health centers II I-IV. Their laboratory system is however less than optimumly organized for research purposes. To achieve high quality results, there will be need to conduct tests at more advanced and better organized labs. This CoAg will be directed at improving surveillance system; this will not include strengthening laboratory infrastructure, which would demand more costs. Biological specimens will therefore be collected and sent to the more established laboratory at the Virus Research Institute.

This project will focus mainly on fishing communities. It will have the purpose of documenting the prevalence and incidence of HIV, malaria, TB and syphilis and also the prevalence of neglected tropical diseases especially schistosomiasis. To achieve this will require collecting of biological specimens (blood, stool, sputum etc) from respondents, transporting the specimens to laboratories (in this case the Uganda Virus Research Institute laboratory) and testing those specimens for evidence of biomedical markers for the evaluated diseases. There will therefore be need to increase laboratory capacity and function in order to conduct the laboratory tests. Supplies will be procured to insure the testing of 1,500 participants for HIV, syphilis, and schistosomiasis. The project will support the recruitment of one laboratory technologist and two laboratory technicians with relevant added skills in surveillance.

This project was recently awarded to Makerere University/School of Public Health (SPH). In addition to MoH and Uganda Virus Research Institute, SPH is one of three key partners for SI in Uganda. Activities supported through this project focuses both on the general population and on select high risk groups and behaviors, facilitate size estimation work, and support the implementation of innovative survey-related methods. Further, this CoAg supports overlapping technical areas such as counseling and testing in order to improve survey response, data collection, and uptake of HIV testing among respondents, which in turn can be expected to improve programmatic services. Where feasible through synergies or joint activities, this CoAg also addresses the information gaps related to the Global Health Initiative and CDCs initiative (such as maternal and child health) on Winnable Battles.The awardee initially proposed targeting fishing communities, a recognized high risk group in Uganda with HIV prevalence estimates usually exceeding 10%. However, two large and recently conducted surveys in this population changed the survey data landscape during the time this award was made. We therefore have to re-assess this project.The Crane Survey, an ongoing data collection activity focusing on select demographic and high risk groups, mapping, and size estimation work will be supported through this project. An active protocol describes 12 distinct sampling groups and a standing survey office represents the ongoing effort to develop indigenous and quality survey capacity.This CoAg will also support PMTCT-based HIV surveillance (using routinely collected PMTCT data and testing of remnant HIV-positive blood specimens for HIV recency), VCT-based surveillance, facility-based follow-up of care and treatment patients, and HIV incidence work such as estimating the misclassification rate of HIV incidence assays.Uptake of HIV testing and tailored counseling of high risk individuals both in the programmatic and survey setting remains a challenge. We plan to evaluate the introduction of oral fluid testing (both client controlled or supervised) and anonymous counseling via phone or multimedia. These techniques also have potential to increase the countrys capacity to achieve universal access to HIV testing and serostatus knowledge.This project supports the piloting of a general population based survey design that aims at expanding the traditional HIV focus, measuring co-morbidities and reflecting the broader priorities of the USGs Global Health Initiative, including maternal and child health, as well as chronic and non-communicable disease domains, with a strong emphasis on biomarker measurements.This project supports a morgue and autopsy-based surveillance system to examine the rate of missed HIV diagnoses, describe the causes of death, identify opportunistic infection pathogen, examine antimicrobial resistance patterns, and facilitate the validation of verbal autopsy instruments by providing gold standard diagnostic information.Further, this project supports data collection among sero-discordant couples and examines the effect of couples counseling.All data-related activities are or will be described through appropriate protocols and undergo the relevant human subjects review process.

Inconsistent uptake of HCT within and among groups with diverse HIV risks, underscores the need for innovative HCT strategies that may appeal to broad constituencies and reduce barriers to testing. WHO and others have called for HCT innovations and for implementation on a radically larger scale to meet the global demand for access to prevention, care, and treatment services. One HCT innovation widely ignored in the African context is consumer-controlled self-testing (CCST). CCST provides a self-testing method, coupled with the delivery of information and counseling across a continuum ranging from written information included with the CCST test kit, to toll-free telephone-based, internet-based, or face-to-face counseling for self-testers who present to MOH/NGO-supported partnership clinics.To determine if CCST may be a viable testing option in Uganda that could increase uptake of HIV testing, knowledge of HIV serostatus, HIV-related knowledge, and facilitate linkages to HIV prevention, care and treatment, this project will conduct a randomized field trial (RFT) comparing CCST to in-house HCT referral in District Hospital outpatient clinics, and clinic-referral of general population members and MARPS populations (MSM/FSW) enrolled using either venue-based intercept or respondent driven sampling methods. This project represents a collaborative effort between the MOH, MakSPH, and CDC to address these priorities of the MOH and the Uganda AIDS Commission. Furthermore, the results of this study will be used to inform the National Policy Guidelines for HCT. If the data from this study indicate that CCST is a viable testing option in Uganda (i.e., is desired and increases testing uptake, knowledge of serostatus, knowledge of transmission factors, and linkage to care), this information will be considered for future revisions of National HCT Policy Guidelines and CCST may be deemed an allowable testing option which could then be incorporated into HIV/AIDS programming.

HVOP (Condoms and Other Prev): 2,000 circumcision this will be done in collaboration with existing provider/s within the target communities (targeting all people both survey participants and other community members). Condoms will be distributed to survey participants, CT clients and individuals who utilize circumcision services. We will distribute 200,000 condoms in FY 2012.Use of condoms and safe voluntary medical male circumcision are part of Combination Prevention, the package advocated by PEPFAR of effective prevention. Other elements include prevention of mother-to-chilld transmission of HIV, HIV testing and counseling and prevention for key populations which include people living with HIV (PLWHA) and MARPS, The CoAg will work with partners in the area of operation to supplement efforts aimed at achieving all these strategies. Fishing communities are some of the communities with very poor access to services. The CoAg will make it easy by helping to avail 200,000 condoms in 2012, and also offer support to counseling and testing. PMTCT and promoting health education on the need for male circumcision. The CoAg will achieve all these thru sustained collaboration with the district health offices, local facilities and other partners operating within the geographical area of operation.

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