Uganda Protestant Medical Bureau (UPMB) runs a network of 273 Health Care Facilities (HCFs) nationally seven of which provide HIV/AIDS services in 6 districts. UPMB will implement the National Expansion of Sustainable HIV/TB services project in seven HCFs: Kabarole, Amai, St Stevens, Rugarama, and Ruharo Hospitals, Azur Health Center (HC) IV and Joy Medical Center. Project objectives include provision of HIV prevention services; HIV care treatment and support services; and strengthening Health systems to integrate and sustain quality HIV services. Since 2004, two of the seven HCFs have offered HIV services through AIDS Relief; however gaps are poor infrastructure, old and inadequate equipment,shortage of medical supplies, growing demand for services, inadequate integration of TB/HIV services;limited combination prevention services and health system weaknesses.UPMB will expand from two to seven HCFs and strengthen district ownership by funding and working within the district health plan, work with the District Health Teams, participate in planning, coordinate and supervise HCFs, strengthen supply chain systems, improve information management systems and support district/NGO collaborations.M&E will include; quarterly supervision visits, HMIS analysis, conducting baseline and program evaluations. Indicators will be aligned to those of the MOH and NGIs consistent with the Three Ones Principle. UPMB will monitor and evaluate HCF performance through monthly reports, site visits, DQAs and bi-monthly HCF meetings.No vehicles will be purchased but five vehicles will be transferred to UPMB from the ended AIDS Relief Program. Two of the vehicles will be allocated to the two existing HCFs for field activities, and three allocated to UPMBs Kampala Office for travel to sites.

PEPFAR 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. UPMB will support the care services to 6,062 clients as to the overall PEPFAR target of 812,989 HIV positive individuals receiving care and support services. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations truck drivers, fishermen, commercial sex workers and men that have sex with men. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages. UPMB will be expected to implement approaches to promote an effective CoR model and monitor key indicators along the continuum. UPMB will work in six districts of Uganda.UPMB will provide comprehensive care and services in line with national and PEPFAR guidelines including: strengthen positive health dignity and prevention services, strengthen linkages and referrals using linkage facilitators, implement quality improvement for adherence and retention, pain and symptom management and provide support to targeted community outreaches 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. This has been a major bottleneck to treatment scale up nationally. 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. UPMB will support the sample referral network in line with the national CD4 expansion plan, and will monitor and report clients access to CD4 in quarterly reports keeping track and reporting on client waiting lists.

UPMB will liaise with PACE for provision and distribution of basic care kits to clients. In addition UPMB will coordinate with Joint Medical Stores and Medical Access Uganda Limited for other HIV commodities including cotrimoxazole and lab reagents. UPMB will build the capacity of facility staff to accurately and in a timely manner report, forecast, quantify and order commodities. In addition, UPMB will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda to support integration with other health and nutritional services. Collaboration with other key stakeholders for provision of required wrap around services including family planning.

UPMB working with MoGLSD will address the linkages between GBV and HIV, including tracking linkages to services for survivors of sexual violence, provision of post-exposure prophylaxis, treatment of sexually transmitted infections, and reproductive health counseling and services. UPMB will support gender equity training for program managers, counselors, and M&E officers at a minimum will receive training to include gender-equity indicators and systematically audit gender equity performanceThe 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. UPMB will work under the guidance of MoH/ACP and the Quality Assurance Department for trainings, mentorship and supportive supervision. Funding will be provided for recruitment of additional staff through the districts. This will be done in collaboration with the Health Systems Strengthening technical working group.

Despite the scale-up of HIV services, less than 10% of children living with, or made vulnerable by HIV (OVC) receive external support. UPMB will provide 14,047 OVCs with three or more core services in addition to psychosocial support in FY 2012 using MoGLSD guidelines.OVC services will be provided in all the seven HCF facilities in the districts of Amolater, Kabarole, Kampala, Hoima, Mbarara and Kabale.UPMB will build the capacity of 13 service outlets and other stakeholders to plan and deliver sustainable OVC services by: identifying Community Resource Persons (CRP) to act as reference points/mentors for children, training 50 HW and 70 community resource people (CRP) twice a year in OVC care and support, distributing IEC materials on child support and protection, holding quarterly stakeholders meeting with international and local organizations, institutions focusing on children, developing social services directories and systems for referral.Education: UPMB will provide 3,050 OVCs with school materials, link them to government schools and motivate beneficiaries and develop older OVCs as role models. UPMB will awarding 20 annual scholarships for secondary school, send 20 older OVC to vocational training for a 6-12 months business course, offer life skills and protection, offer reproductive health education, offer internship opportunities, and tools to start a trade; placing emphasis on girls participation.Protection: UPMB will reach 5,000 people, sensitize them on rights and stakeholder responsibilities; identify, refer and follow up abused children; and train 3,050 OVCs and caregivers on tools to protect rights.Economic Strengthening: Formation of 10 Savings and Internal Lending Community (SILC) groups, UPMB will train OVC households to participate in business and life skills, protection and reproductive health. UPMB will support SILC groups to use savings for income-generating activities; link 100 older OVC to job opportunities, or on-the-job training and mentoring of younger children in addition to a give back program for graduating OVCs.Food security and Nutrition: UPMB will link 750 OVC households to support programs, train caregivers in improved food production and offer quarterly programmatic reviews.Psychosocial Support (PSS): UPMB will train 15 counselors and nurses in PSS and support them to train 21 satellite staff in PSS for clients; facilitate six OVC and pediatric support groups; establish child-friendly services in seven HCF using PSS tools; train 40 CRP in counseling and mentoring.Pediatric services: UPMB will actively search and identify HIV infected OVCs and link them to HIV-related services, including HCT, Care, ART, PMTCT and EID in addition to maintaining vigilance to monitor nutritional status, and ensure those with TB or bacterial infections are tested and receive care.In order to support adolescents who age-out or graduate out of OVC programs, UPMB will work with Advisory Boards to develop models for transitioning adolescent OVCs.

UPMB 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. In addition, 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.

UPMB will contribute to this target by screening 5,996 HIV positive clients for TB and 200 will be started on TB treatment. UPMB will work in six districts of Amolater, Kabarole, Kampala, Hoima, Mbarara and Kabale.

UPMB 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. UPMB will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

In FY 2012, UPMB 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. UPMB 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 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.

In addition, UPMB 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. UPMB 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), support and strengthen the national M&E systems and work within district health plans. UPMB will work under the guidance of MoH AIDS Control Program, NTLP and Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, UPMB will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

UPMB 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. will contribute 600 to the overall PEPFAR target of 74,555 HIV positive children receiving care and support services.

UPMB will provide comprehensive child friendly care and support services in line with national guidelines and PEPFAR guidance, 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 hard to reach and underserved areas. 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. A focus will be on scaling up low cost approaches, such as use of care taker support groups so as to support retention in care. UPMB will implement community mobilization and targeted activities such as Know Your Childs Status campaigns to identify more children. Focus will be placed on improved assessment of pre-ART children for ART eligibility to ensure timely initiation on treatment in line with MoH guidance.

UPMB will support retention of adolescents in care, as well as, ensure 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 heatlh services, psychosocial support and life skills training. Lessons learned from the planned national adolescent service assessment will be incorporated in activities.

A 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 provided with OVC services will be screened for HIV and appropriately linked to care and support. UPMB will also support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

UPMB will liaise with PACE for provision and distribution of basic care kits to clients and with Joint Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities including cotrimoxazole and lab reagents. UPMB will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

UPMB 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. UPMB will collaborate with UNICEF and 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/AID (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. UPMB will work under the guidance of MoH/ACP and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and support supervision.

The six building blocks of HSS (service delivery, health workforce, information, medical products vaccines and technologies, financing, and leadership/governance) provide a useful framework to guide the strengthening of the faith based health systems in order to improve quality, access, coverage and safety of health services. By strengthening systems, UPMB will ensure improved health, efficiency, responsiveness and sustainability. UPMB will pay special attention to quality of care, focusing on improvements in HIV/AIDS care and treatment, laboratory, PMTCT and TB/HIV, OVC, prevention and pediatric services. The project aims at strengthening activities in all the six building blocks during the entire grant period.

Sustainability and systems strengthening lies at the heart of UPMB and will be based on a durable comprehensive HIV/AIDS program; within a strengthened health care delivery system.

UPMB will also focus on strengthening the capacity of the indigenous entities actively using their extensive linkages with the MoH and other faith based groups and donors.

UPMB will promote the delivery of HIV services in an integrated manner in order to optimize care and treatment outcomes. 982 community health and Para social workers shall receive in service training in various components of HIV care.

Given the results of the 2011 UAIS showing an alarming increase in HIV prevalence and very low circumcision prevalence (approx 25%), PEPFAR Uganda is prioritizing this prevention intervention as it is a major pivot to reduce the number of new HIV infections. By scaling up Voluntary Medical Male Circumcision (VMMC) and circumcising 4,200,000 men by 2015, 428,000 new adult HIV infections will be averted by 2025.

UPMB will provide VMMC services in all the seven HCFs in the districts of Amolatar, Kabarole, Kampala, Hoima, Mbarara and Kabale. VCCM will be offered 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 be faithful; providing and promoting correct and consistent use of male condoms; providing HIV testing and counseling services and refer to appropriate care and treatment if necessary, and providing services for the treatment of sexually transmitted infections.

UPMB 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. UPMB will implement the MOVE (Model for Optimizing the Volume for Efficiency) to optimize the efficiencies and increase the volume safely at Kabarole, Amai, Rugararama, Ruharo and St. Stevens Hospital. Special focus will be placed on quality assurance and regular quality assessments (internal and external) of the VMMC program will be done and daily reports sent to the SMC/VMMC National Operational Center as required by MoH.

UPMB will create acceptance and demand for VMMC through community campaigns based on information from the Uganda National Communication Strategy on Safe Male Circumcision employing both media campaigns and person to person communication targeting localities with high numbers of men like markets, churches, taxi parks and boda boda stages.

In FY 2012, a total of 90 staff in the seven HCF shall be trained in VMMC and 19,950 males offered a comprehensive package of VMMC in line with MoH guidelines. VMMC supplies and commodities will be sourced from Medical Access Uganda Limited.

The MoH policy guidelines on VMMC will guide the integration of VMMC services in Ugandas national health system. Through these established policy guidelines on VMMC UPMB will contribute to the national VMMC target of 1 million circumcisions in 2012/2013.

The National Expansion and Strengthening of Sustainable HIV/TB Services in Uganda project will increase access to HIV Counseling and Testing (HCT) by providing HCT services to over 25,000 individuals and improving health workforce capacity targeting seven health care facilities in Amolatar, Kabarole, Kampala, Hoima, Mbarara and Kabale districts.

Project objectives include provision of HIV prevention, care, treatment, and support services; and strengthening Health systems for sustainable and integrated quality HIV services.

UPMB will implement provider initiated Testing and Counseling (PITC) integrated into routine health care at all implementing sites and will use innovative outreach approaches for HTC in the community including special services focusing on couples.

A continuum of response will be ensured by actively linking clients between MNCH, out patients and in-patients departments and to other HIV care and support services targeting pregnant and breast feeding mothers in ANC settings, at labor, delivery and post-partum using linkage facilitators. In addition male partners, family members and the general population will be targeted based on existing HIV prevalence data and unmet need. This will increase demand and enrolment into care of identified positives.

UPMB will make HCT available at eight lower-level satellite sites and train 100 local Health Workers at those sites in developing and implementing gender-sensitive HCT protocols. UMPB will encourage community members to access HCT by hosting two awareness-raising events per year, in each of the 13 service outlets. In addition, 40 Health Workers will carry out monthly community-based HCT outreaches for children and adults following the MoH guidelines

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

The National Expansion and Strengthening of Sustainable HIV/TB Services in Uganda project will increase access to HIV Counseling and Testing (HCT) by providing HCT services to over 25,000 individuals and improving health workforce capacity targeting seven health care facilities in Amolatar, Kabarole, Kampala, Hoima, Mbarara and Kabale districts.

Project objectives include provision of HIV prevention, care, treatment, and support services; and strengthening Health systems for sustainable and integrated quality HIV services.

UPMB will implement provider initiated Testing and Counseling (PITC) integrated into routine health care at all implementing sites and will use innovative outreach approaches for HTC in the community including special services focusing on couples.

A continuum of response will be ensured by actively linking clients between MNCH, out patients and in-patients departments and to other HIV care and support services targeting pregnant and breast feeding mothers in ANC settings, at labor, delivery and post-partum using linkage facilitators. In addition male partners, family members and the general population will be targeted based on existing HIV prevalence data and unmet need. This will increase demand and enrolment into care of identified positives.

UPMB will make HCT available at eight lower-level satellite sites and train 100 local Health Workers at those sites in developing and implementing gender-sensitive HCT protocols. UMPB will encourage community members to access HCT by hosting two awareness-raising events per year, in each of the 13 service outlets. In addition, 40 Health Workers will carry out monthly community-based HCT outreaches for children and adults following the MoH guidelines

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

UPMB will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. UPMB will enroll at least 2,038 new clients and support 4,114 adults and children 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. UPMB will work in six districts of Uganda: Amolater, Kabarole, Kampala, Hoima, Mbarara and Kabale.

UPMB will support the MoH roll out of Option B+ for eMTCT through the following activities: accreditation of six additional health facilities; training, mentorship and joint PMTCT/ART support supervision. UPMB will also support ART/PMTCT integration at facility level piloting feasible service delivery models, such as same day integrated HIV clinics. Continuum of response linkages and referrals will be strengthened using linkage facilitators across different service points in facilities and communities. Facilitators will also be utilized for TB/HIV integration to ensure early ART initiation for TB/HIV patients. UPMB will support reproductive health integration including family planning and cervical cancer screening at facility level through provision of the services or referrals.

Targeted community outreach activities in high prevalence hard to reach and underserved areas of UPMB will also target key populations using innovative approaches including setting up specialized services; such as moonlight services.

UPMB will implement quality improvement initiatives for the ART framework: early initiation of ART eligible clients on treatment; improve adherence and retention; and monitor treatment outcomes. Use of innovative, low cost approaches for adherence, retention and follow up such as: phone/SMS reminders, appointment registers and alert stickers will be supported.Special emphasis will be placed on adherence and retention of women enrolled under Option B+. Focus will be placed on increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance. UPMB 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.

UPMB will liaise with PACE for provision and distribution of basic care kits to clients and with Joint Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities including cotrimoxazole and lab reagents. UPMB will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

In addition, UPMB 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. UPMB will work under the guidance of MoH/ACP and the Quality Assurance Department in trainings, ART/PMTCT mentorship and supportive supervision.Funding will be provided to support the recruitment of additional staff through the districts to meet the achievement of the targets. This will be done in collaboration with the Health Systems Strengthening technical working group.

UPMB will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015. UPMB will enroll at least 202 new HIV positive children and support 2,240 children on ART by APR 2013. This will contribute to overall national and PEPFAR target of 39,799 new clients and 64,072 children current on treatment. UPMB will work in six districts of Amolater, Kabarole, Kampala, Hoima, Mbarara and Kabale.

In FY2012, UPMB will support the national program to scale up pediatric treatment through strengthening the identification, follow up and treatment for all infants through Early Infant Diagnosis (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.

UPMB 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 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. UPMB will support the integration of HIV services in routine pediatric health services, including the National Child Health Days.

UPMB will liaise with PACE for provision and distribution of basic care kits to clients and with Joint Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities including cotrimoxazole and lab reagents). UPMB will build the capacity of facility staff to accurately report, forecast, quantify and order commodities in a timely manner.

In addition, UPMB 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. UPMB will collaborate with UNICEF and 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/AID (2011/12-2014/15), support and strengthen the national M&E systems and work within district health plans. UPMB will work under the guidance of MoH/ACP and the Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework and supportive supervision.Funding will be provided to support the recruitment of additional staff through the districts to meet the achievement of the targets. This will be done in collaboration with the Health Systems Strengthening technical working group.