This community- based HIV/AIDS project (CBHA) is implemented by the Reproductive Health Uganda (RHU). RHU will support the provision of community based HIV/AIDS prevention, care, support and OVC services through integrated family-centered service delivery model.. The objective of CBHA project is to increase access to quality HIV prevention, care, support and orphan and vulnerable children (OVC) services in six districts in Northern and South Western Uganda; and to build capacity of indigenous community based organizations. Under the OVC portfolio, the project will implement the family preservation model which will take the OVC through three phases of emergency, stabilization and self-sufficiency before they graduate. HIV/AIDS care and support services include clinical care, routine CD4 monitoring, TB and opportunistic infections screening and linkage to ART services. RHU prevention activities will focus on key populations including RHU clients receiving sexual and reproductive services in its Lira clinic, out of school youth and commercial sex workers.The CBHA strategy for transition is to partner with government and local organizations, to work with and through existing government structures; participate in planning processes and regularly consult and report to the districts on project activities to ensure ownership. Incorporate the project activities including outreach logistics into the health facility planned activities, so as to reduce dependency on the project.

The activity is monitored through regular joint field visits with district authorities, quarterly, semi-annual and annual progress reviews.No vehicle procurement is planned in this COP budget.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Sub Recipient3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHVOP RHU 8243 Contract CSOs to distribute 300,000 condoms at community level {IEC}MTCT RHU 5520 Support CSOs and practitioners to provide PMTCT services.{IEC}OHSS RHU 20980 Train 46 service providers on STD managementProcurement of Desktop computers

Project will reach 1000 HIV positive adults within the project operational area with comprehensive care and support services including clinical care. The package of services offered include the following: treatment and prevention of opportunistic infections, TB screening, referral for ART, referral for laboratory tests including CD4 counts, management of STIs, testing of sexual partners and children, formation and linkages with support groups and development programs., Clients identified through HCT and OVC services will be linked to ART centers. HIV positive individuals will have same day enrollment into care.Care and support services will be provided within the integrated SRH/HIV/OVC framework of the project. Clients under care and support will access SRH services and the children will be enrolled into the OVC program when eligible. The care and support structures that are part of the OVC mechanism response like the action support groups will be accessible to all other care and support clients. All positive clients identified, TB patients, OVC and their households, and clients referred to the community from the health facilities will be followed-up at their homes for home-based care and to promote retention of the clients into care and adherence to ART. Clients referred/ linked to services will be followed up at facilities to ensure that the referrals were effective. Peer networks and community resource persons will be used to strengthen follow up, referral and linkage.

The project care and support activities contribute to the national achievements through regular monthly and quarterly reports. Activities are implemented according to the national guidelines for HIV/AIDS care, treatment and support and other policy documents and guidelines. RHU works through and with the existing health structures and systems both at the central and district levels, thus contributing to health systems strengthening. The community resource persons, who form a crucial part of the care and support team, are part of the village health teams.

The CBHA project OVC activities are implemented in four of the six CBHA districts with estimated population of 186,817. The project will provide OVC services in accordance with the National Strategic Program Plan for Intervention (NSPPI) to a total of 6,297 OVC.The CBHA OVC approach is based on the family preservation model which provides for an integrated package of family-based child development services, delivered in a three-phase process usually lasting 3-5 years. The three phases are rescue stage where the OVC is in a critical vulnerable, life threatening stage, often sick; stability stage; and exit or permanency stage where they are now able to survive without further support. The program interventions in this model are fully based in the community, at institutions such as schools, early childhood development (ECD) centers where the children have informal education and psychosocial support, other community development centers and within the households of supported families.Community structures will be used to identify the vulnerable households in line with the National OVC Strategic Plan. Identified households are subjected to the vulnerability assessment and support is offered basing on the needs identified. The RHU model focuses primarily on the following areas: psychosocial support; food production input; economic empowerment; medical care for OVCs especially those living with HIV; provision of basic household items such as safe water vessels; care giver training; and education support through the provision of scholastic materials to only households in rescue stage. The services are delivered mainly through home based care and outreaches, support groups like action support groups for the OVC and their households, child brigades and early childhood centers. RHU will focus on reducing the various forms of risks/predisposing factors that face teenagers. The strategy is to integrate SRH services into OVC care in order to empower the OVC to protect themselves from harmful behaviors. The focus is on life skills enhancement and economic empowerments especially for those out of school. This will be achieved through strengthening of community support structures like support groups, peer educators and role models. OVC households will be mobilized to access outreach services including immunizations and HCT. The positives identified will be offered care and support and referred for ART. RHU will prioritize strengthening the existing community structures and use them to refer and link OVC for other social and clinical services not offered by the project.The project works within the national OVC guiding frame work including planning, implementation and reporting of activities at all levels from the sub-county, to the district and finally at the national level. Participation in meetings at the central and district level that guide implementation of OVC activities. The OVC program is implemented within the established framework and systems making use of the existing community structures like the village health teams, child protection units within the districts, working with the district probation officers in planning and implementation of activities.

RHU 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. RHU will contribute to this target by screening 900 HIV positive clients for TB and staring 30 individuals on TB treatment.RHU will improve Intensified Case Finding (ICF) and the use of the national ICF tools to improve case detection. RHU will also refer suspected TB cases from the community for TB diagnosis. In 2013, RHU will ensure early initiation of all HIV positive TB patients on ART through the use of linkage facilitators between the two services (ART and TB). RHU will increase focus on adherence and completion of TB treatment, including DOTS through use of proven low cost approaches.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.

Pediatric care and support activities are implemented in all the six CBHA project districts. The project intends to reach an estimated 600children with a package of HIV/AIDS care and support services. The project will implement innovative models in order to identify and retain children in HIV/AIDS care including active identification of exposed infants, same day enrollment, and integration within OVC services.The project will implement active identification of HIV exposed infants using the PMTCT codes on the immunization cards of the babies, testing of the children of positive clients, testing of siblings of positive children including during home visits, testing of all OVCs and the children in the households and same day enrollment into care of the positive children identified and referral for treatment .Other services like screening for TB, nutrition screening using mid upper arm cRHUmference (MUAC), growth monitoring (weight and height measurements), and routine immunization services will be integrated within the continuum of care. .The project will also ensure active follow up of all positive children up to the homes and offer home based care to ensure continuum of care, retention into care and adherence to treatment. An integrated approach to service delivery will be supported including referral between communities and facilities and integration of services within SRH/HIVHCT/OVC services. All OVCs will be tested for HIV and the positive clients enrolled into care and referred for ART and all positive children will be enrolled into OVC care.The project care and support activities contribute to the national achievements through regular monthly and quarterly reports. Activities are implemented according to the national guidelines for pediatric HIV/AIDS treatment, care and support. RHU works through and with the existing health structures and systems both at the central and district levels. The community resource persons, who form a crucial part of the care and support team, are part of the village health teams. They are used to follow up HIV positive pregnant women to ensure that they are not lost and the exposed babies delivered are enrolled into care.

In the revised COP 12 the key pivots for other prevention aim to ensure a balanced portfolio that will address prevention needs for the older population as well as the youth as the primary target groups and support high impact interventions. The community-based HIV/AIDS prevention, care and support services project under RHU will focus on increasing accessibility, availability and acceptability of condoms among the target populations in the districts of Apac, Lira, Kole Alebtong, Kabale and Kanungu. RHU will also implement targeted interventions for 230 most at risk populations (MARPS) including commercial sex workers and truckersin hot spots including Kihihi, Kanungu, Lira and Ishasha town councils. RHU will target 1000 clients with positive health dignity and prevention (PHDPI intervetnions to ensure that they have access to condoms and other prevention services as needed.Intensified efforts will be made to promote condom use among key populations, sero discordant couples and those in multiple partnerships among the rural and urban populations in the six districts. RHU will increase the number of condom distribution outlets at community level to 143 outlets using community resource persons. RHU will also engage with the hospitality industry, particularly bars and hotels to distribute and promote condoms use.

RHU will adopt various approaches to target out-of-school youth and couples to provide them with comprehensive risk reduction programs. This will include promotion of delayed 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. Amongst the MARPS, the interventions will focus on increasing perception of risks associated with sex work, strengthening PHDP among infected MARPs at the community level, and scale up of evidence based behavioral interventions with supportive behavior change communication and demand creation for services. The PHDP interventions will aim at increasing knowledge of HIV status among people living with HIV and their partners, reducing the risk of HIV transmission and reducing HIV acquisition among person at high risk for infection.RHU will implement community campaigns to create acceptance and demand for condoms, targeting 4,590 individuals through: 1) peer-to-peer strategy for interpersonal communication; 2) use of linkage facilitators to mobilize men; 3) community mobilization; and 4) use appropriate channels of communication including print and electronic mass media. The goal is to increase utilization and demand for condoms amongst the older population and youth including the MARPS and PHDP.Program monitoring and evaluation activities will be supported within this budget to strengthen the collection of data through national health management information systems tools and to improve the technical quality of data through periodic data quality assessments.