This new Baylor-Uganda mechanism Expansion of Naitonal Pediatric HIV/AIDS Preventionk, Care and Treatment Services and Training of Service providers builds on the ended Pediatric Infectious Disease Center - PIDC. Baylor-Uganda will continue providing comprehensive HIV services to the existing 37,411 clients in care and 9,139 are children of less than 15 years of age. 16,856 clients are on ART of whom 5,200 are children in the Center of Excellence (CoE) at Mulago Hospital and the seven districts of Kabarore, Kasese, Kamwenge, Ntoroko, Bundibugyo, Kyegegwa and Kyenjojo with HIV prevalence of 8% (UAIS, 2011).

Baylor-Uganda in collaboration with other USG funded implementing partnerss will support the MOH to build capacity to strengthen National Pediatric HIV/AIDS care and treatment in collaboration with Regional Referral Hospitals (RRH) to supervise, train and mentor health facility staff in comprehensive pediatric HIV/AIDS care and treatment services.

Baylor-Uganda will expand delivery of comprehensive HIV/AIDS prevention; care and treatment services to HIV infected children, adolescents and adults in the districts, while integrating with Global Health Initiative (GHI) principles which are infused into all program elements.

GHI represents a new and innovative way of doing business for the U.S. Government and will strengthen integration between USG-funded programs. The objectives of this project are to scale up access to comprehensive pediatric and adolescent HIV/AIDS/TB care and treatment, support MOH strengthen national pediatric/adolescent HIV/AIDS care and treatment and to strengthen the implementation of the district based programming approach and focusing on the agreed to program pivots which are documented in the budget code narratives below.

Baylor-Uganda will support Government of Uganda (GOU) effort to expand access to HIV care and support with the goal to achieve universal access of 80% of clients in care by 2015. Baylor-Uganda will support the provision of care services to 52,102 as a contribution to the overall PEPFAR target of 812,989 HIV positive individual in care. This target was derived using burden tables based on district HIV prevalence and treatment need in the districts. The Continuum of Response (CoR) model was applied to ensure improved referrals and linkages across service delivery points. Baylor-Uganda will pay attention to key populations such as truck drivers, fishermen, commercial sex workers and MSMs. It will implement approaches to promote an effective CoR model and monitor key indicators along the continuum.Baylor-Uganda will provide comprehensive care and support services in line with national guidelines and PEPFAR including: strengthening Positive, Health, Dignity and Prevention (PHDP) services; strengthening 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 of Ntoroko, Budibugyo, Kamwenge and parts of Kasese districts.Baylor-Uganda will focus on increasing access to CD4 assessment among pre-ART clients for ART initiation in line with MoH. This has been a major bottleneck to treatment scale up nationally and will work with the Central Public Health Laboratory and other stakeholders, to improve CD4 coverage in the districts. Baylor-Uganda will support sample referral network in the districts in line with the national CD4 expansion plan; and will monitor and report clients access to CD4 in quarterly reports to ensure clients have access to CD4 testing.Baylor-Uganda will liaise with PACE for provision and distribution of basic care kits to clients through the districts, village health teams and people living with HIV/AIDS networks and with National Medical Stores and Medical Access Uganda Limited for other HIV commodities. Baylor-Uganda will prioritize building the capacity of facility staff to report, forecast, quantify and order HIV commodities. Baylor-Uganda 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 and with key stakeholders for other wrap around services.Baylor-Uganda will support services integration including volutary, informed family planning and cervical cancer screening at facility level through provision of the services or referrals. Baylor will support facilities 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 and linkages.The program will be aligned to the National Strategic Plan for HIV/AIDS; support and strengthen the national M&E systems and work under the guidance of MoH ACP and Quality Assurance Department for trainings, mentorship and support supervision.Baylor will support recruitment of 60 new critical health workers, in four districts of Kyegegwa, Ntoroko, Bundibugyo and Kasese for both public and PNFP facilities based on new scale up targets and current staffing levels in particular districts.

Baylor-Uganda will strengthen collaboration between District Health Offices (DHO), Community Development Offices (CDO), Community Based Organizations (CBO) and Faith Based Organizations (FBO) for coordinated provision of services (child protection, education, health, food security and economic strengthening) to OVC and their families. The DHO and CDO will work jointly to define schemes for livelihood and income generation activities that will be funded by the project. Caretakers of the OVC will form groups that will be funded through the district system. The groups will operate a revolving fund scheme from the initial funding support, with the project providing technical support. The OVC will be linked to the CBO for services that are not provided by the project.

Scaled up access to OVC services through training of 30 OVC providers in Kasese districts, integration of child protection into clinic activities, provision of scholastic materials to 50 children in Kyenjonjo district and school fees to 80 OVCs at COE, and providing a revolving fund to two groups each benefiting 50 OVC families. In total the support is expected to reach 12,258 children.

In the FY 2013, Baylor-Uganda plans to carry out the following activities:

Provision of small Loans to 50 vulnerable youths and five revolving credit groups. We also plan to give transport refund to 1,200 needy families and destitute elderly to facilitate them come to the Center of Excellence (CoE) clinic. Training of 50 OVCs in management of small loans and income generating activities and training of caregivers in agro-business skills and other income will be done.

Procurement and distribution of agricultural tools and equipment to 30 needy/destitute families and the procurement and distribution of enhanced seeds to 30 OVC families in supported districts. In addition, the procurement and distribution of food rations to 30 food insecure families.

Conduct two trainings in less labor-intensive farming technologies for 50 OVC households, conduct four trainings in appropriate nutrition for chronically ill children for 90 OVC families and conduct one training of caregivers in alternative care facilities. OVC guardians and caretakers will be trained in sustainable food security practices.

Provide school fees and scholastic materials for OVCs in primary, secondary, vocational and tertiary institutions, career guidance sessions to secondary school students benefiting from the sponsorship will be done and quarterly school visits to sponsored children for psychosocial support will be made.

Purchase and distribution of 10 sets of play therapy materials to seven districts health facilities, Baylor-Uganda will organize and train a Caretakers Drama Group of 20 members for community awareness raising and sensitizations at the Center of Excellence. Training in marital and family counseling to 18 Counselors will be conducted, monthly VCT outreach to OVC dwellings, orphanages and babies homes, know your childs HIV status campaigns will be conducted and children needing psychosocial support will be identified and followed up.

Baylor-Uganda will support implementation of TB/HIV activities according to MOH TB/HIV policy through the structures of the National TB and Leprosy Control Program (NTLP). Priority MOH activities are aimed at decreasing the burden of TB among PHAs. Baylor-Uganda 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 new program will build on previous achievements and contribute to this target by screening 46,892 HIV positive clients for TB and initiating 1,563 on TB treatment in eight districts. 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.

This project will support TB screening and treatment which will be integrated in all service delivery facilities. Baylor-Uganda will improve 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 FY2013, Baylor-Uganda 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. The 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 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 program will support and improve linkages between facilities and communities and facilitate Sub-county Health Workers (SCHW) and Facility TB Focal Persons to conduct TB contact and defaulter tracing at community level. Distrct TB/Leprosy supervisors will be supported to conduct support supervision of TB/leprosy/HIV services in the district.

The MoH/ACP and NTLP will be supported to roll out provision of IPT, in line with the WHO recommendations. In addition, Baylor-Uganda will work with USG partners such as PIN, SPRING, HEALTHQual and Hospice Africa Uganda in their related technical areas to support integration with other health and nutritional services. Baylor 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. Baylor-Uganda will work under the guidance of MoH/ACP, NTLP and Quality Assurance Department in trainings, TB/HIV mentorship and supportive supervision. Additionally, the program will support facilities to participate in national external quality assurance for TB laboratory diagnosis to improve case management.

Baylor-Uganda will support the GOU expand pediatric HIV care and OVC with the goal to achieve universal access by 2015. The program will contribute 4,689 children in care in eight districts to the overall PEPFAR target of 812,989 HIV positive individuals in care and support services of which 73,169 are children.Early infant diagnosis services and focal points at facilities will be scaled up to ensure follow up, active search of exposed children in facilities and communities to enable early enrolment of children in care. A focus will be scaling up low cost approaches, such as use of care taker support groups. Baylor-Uganda will continue to implement community mobilization and targeted activities such as know your childs status campaigns to scale. 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.Baylor-Uganda will provide comprehensive child friendly care and support services in line with national and PEPFAR guidances, improve adolescent services, strengthen linkages and referrals using linkage facilitators, implement quality improvement and provide support to targeted community outreaches in high prevalence hard to reach and underserved areas.Also, will support retention of adolescents in care, ensure a smooth transition into adult life using expert peers, adolescent support groups, caretakers and the Bright Future approach to enhance behavioral change, adherence, and retention and stigma reduction. They will be provided with positive, health, dignity and prevention services including, and psychosocial support and life skills training and linked to sexual and reproductive health services.Establishment of 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 are screened for HIV and appropriately linked to care and support will be a key priority for the program. Baylor-Uganda will support the integration of HIV services in routine pediatric health services.Baylor-Uganda will liaise with PACE for provision and distribution of basic care kits to clients, National Medical Stores and Medical Access Uganda Limited for other HIV commodities.Baylor-Uganda will work with USG partners SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST and Hospice Africa Uganda in their related technical areas to support health, nutrition and OVC services. Baylor-Uganda will collaborate with other stakeholders for provision of required wrap around services.The program will be aligned to the National Strategic Plan, support and strengthen national M&E systems and work within district plans. It will work under the guidance of MoH/ACP and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and supportive supervision. Baylor-Uganda will support MoH in strengthening national pediatric HIV care and support services through technical assistance and capacity building at national and regional levels, working in liaison with MoH/ACP, SUSTAIN and local PEPFAR implementing partners in different districts across the country.Human resources is critical for successful scale up of pediatric care. Baylor-Ugana will support recruitment of 60 new critical health workers, both public and private not-for profit facilities based on new scale up targets and current staffing levels in particular districts.

During FY 2013, 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 the 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 focused on the ART population to improve CD4+ testing coverage from 60% to 100%. There will be an overall effort to improv the quality of laboratory services, reducing stock out of reagents, laboratory supplies and commodities, reducing equipment downtime and improving data collection, results transmission, analysis and utilization. To achieve this, laboratory 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 30km to 40km radius serving 20 to 50 facilities.

Baylor-Uganda will establish four new hubs which include Kyegegwa and Kyenjonjo in Health Center (HC) IVs, as well as, Bundibugyo and Kilembe Hospitals on top of Kagando Hospital which is already a functional hub. All these hubs are within the Ruwenzori Region in Western Uganda. In order to improve infrastructure for service delivery, Baylor-Uganda will carry out major renovations on Kyegegwa HC IV and Kyenjojo, Bundibugyo and Kilembe will receive minor renovations of their laboratory facilities. In collaboration with the districts seven laboratory technologists (three for Bundibugyo hospital, two for Kilembe hospital and two for Kagando hospital) and five laboratory technicians (one for Kyegegwa HC IV, one for Bundibugyo hospital and three for Kilembe hospital) will be recruited to address HR health gaps. Baylor-Uganda will work with Central Public Health Laboratory and MoH to ensure capacity for all the hubs to carry out CD4+, Clinical chemistry and hematology testing are installed and operationalized.

This mechanism is not receiving funding under this program area in the revised COP 12. But the funding previously under HSS e.g. training or supporting HRH has been incorporated in the service delivery unit costs..

This IP will not be funded for VMMC, implementing partnerss for this activity have been rationalized and in the Rwenzori Region VMMC services will be supported by other USG implementing partners including SUSTAIN, UEC and UPMB.

The project Goal is to reduce HIV/AIDS related morbidity and mortality among infected and affected children, adolescents and their families. The area of coverage includes seven districts in Ruwenzori Region (western Uganda) including Kabarole, Kasese, Kamwenge, Ntoroko, Bundibugyo, Kyegegwa and Kyenjojo.

In FY 2013, the project will target 125,000 individuals with HIV Testing and Counseling (HCT) services and will focus on increasing coverage and utilization of Provider Initiated Testing and Counseling (PITC) services within health facilities in target districts: (90% of clients accessing PITC services in supported health facilities) targeting pregnant and breast feeding mothers in ANC settings, at labor, delivery and post-partum.

The project will support health facilities to conduct know your childs HIV status (KYCS) campaigns, targeting children of HIV+ clients in the project. KYCS is an approach that has been found to be very effective in identifying children from mothers who did not go through PMTCT and hence a gate way to early and timely access of care and treatment services.

Male partners, children and the general population will be targeted based on existing HIV prevalence data and unmet need using innovative community outreaches, routine HCT for Voluntary Medical Male Circumcision and KYCS campaigns. Peer to Peer, mobile clinics and special events HTC approaches will be used to target key populations (commercial Sex workers and Fisher Folks ) using the national testing algorithm as prescribed by the 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.

The project will work in collaboration with Medical Access Uganda Limited, the National Medical Stores and Joint Medical Stores to ensure availability of HTC test kits and other required reagents so as to eliminate stock outs.

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 support district facilities to program and conduct targeted home-based outreaches and support health facilities to mobilize children for HCT using the KYCS strategy

Trainings in PITC (one per region), data management (HIMS) for district health workers, EID and training on MOH tools in targeted districts and computer on data management for district health workers will be conducted.

Baylor-Uganda will support implementation of PMTCT Option B+ activities in seven districts in Western Uganda. Baylor will support HIV counseling and testing for 91,315 pregnant women in 146 service outlets in FY 2013. 8,635 HIV positive pregnant women will be identified and 6,551 will be initiated on HAART for life while 1,156 will be provided with ARV prophylaxis. In addition, 8,375 exposed babies will receive ARV prophylaxis and DNA/PCR testing. At least 45,000 partners will be tested within MNCH.

Key strategic pivots for PMTCT will focus on;

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

Baylor-Uganda will support Option B+ through the accreditation of all PMTCT sites at hospital, Health Center (HC) IV and HC III levels. Priority activities will include site assessments for accreditation, identification of training needs, procurement of equipment, printing tools, job aides, and Option B+ guidelines, training of service providers and sample referral for CD4 and early infant diagnosis (EID) testing. Transition of Option B+ in sites will be done in accordance with MOH guidance and a total of 70 new sites will be accredited by end of FY 2013.

Baylor-Uganda will support delivery of Option B+ services using a family focused model within MNCH settings. 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, couple HIV testing and counceling (HTC); supported disclosure and ARV refills. Village health teams will be utilized to enhance follow-up, referral, birth registration, and adherence support. Male partners will receive condoms; STI screening and management; support for sero-discordant couples; treatment for those who are eligible and linkages to VMMC.

Baylor-Uganda will support intensive M&E 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. Phone calls and SMS will be used to remind mothers and their spouses on appointments, EID results, and ARV adherence. Linkage facilitators will conduct home visits to trace clients lost to follow-up. All sites will submit daily reports on key program elements.

Baylor-Uganda will facilitate quarterly joint supportive supervision and mentorships at all PMTCT/ART sites involving MOH, AIDS Development partners, districts, USG, and implementing partners. Site level support will entail cohort reviews, tracking adherence rates and retention rates, data management, availability of supplies, commodities and tools and the documentation of knowledge gaps.

ARV Drugs are now being procured through a central mechanism MAUL for all CDC IPs for PNFP sites and through NMS for Public facilities. No funding is going to the IP directly.

Baylor-Uganda 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 9,037 new adult clients and support 27,691 adults 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, it allows for higher achievements with continued program efficiencies. However, priority will be given to enrolment of HIV positive pregnant women, TB/HIV patients, and key populations in eight districts.

Baylor-Uganda will support the MoH roll out of Option B+ for eMTCT through the following activities: accreditation of 70 additional health facilities; training, mentorship and joint PMTCT/ART support supervision. Baylor-Uganda will also support ART/PMTCT integration at facility level piloting feasible service delivery models, such as same day integrated HIV clinics.Continuum of response (CoR) 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.

Targeted community outreaches in high prevalence hard to reach and underserved areas of Ntoroko, Bundibugyo, Kamwenge and parts of Kasese districts will be conducted. The program will also target key populations using innovative approaches including setting up specialized services; such as moonlight services and using index client tracing.

Baylor-Uganda 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 calls and SMS reminders, appointment registers and alert stickers will be used.

Special focus 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. The program 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.

Baylor-Uganda will liaise with National Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). Baylor will build the capacity of facility staff to accurately and timely report, forecast, quantify and order ARV drugs.In addition, Baylor-Uganda 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 , support and strengthen the national M&E systems and work within district health plans. Baylor will work under the guidance of MoH/ACP and the Quality Assurance Department in trainings, ART/PMTCT mentorship and support supervision.

Human resources for health is critical for successful scale up of Adult HIV services. Baylor will support the recruitment of 60 new critical health workers, in four districts of Kyegegwa, Ntoroko, Bundibugyo and Kasese for both public and PNFP facilities based on new scale up targets and current staffing levels in particular districts.

Baylor-Uganda will support the National Strategic Plan for HIV/AIDS 2011/12-2014/15 with the objective to increase access to ART from 57% to 80% by 2015. The program will enroll at least 2,259 new HIV positive children and support 4,138 children on ART by APR 2013. This will contribute to overall national and PEPFAR target of 38,161 new children on ART and 63,704 children current on treatment in eight districts.

In FY2013, Baylor-Uganda will support the national program scale up pediatric treatment through strengthening the identification, follow up and treatment of all infants through early infant diagnosis 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 early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups as well as the Bright Future approach to promote behavioral change and stigma reduction among adolescents. They will be provided with positive, health, dignity and prevention services including, psychosocial support and life skills training and they will be linked to sexual and reproductive health services.

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 liaise with National Medical Stores and Medical Access Uganda Limited for ARVs. Baylor will build the capacity of facility staff to reports, forecast, quantify and order ARVs both accurately and timely.

In addition, Baylor-Uganda 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. The program 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, 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 to support pediatric trainings, implementation of the national pediatric mentorship framework and support supervision. Baylor-Uganda will support the MoH in strengthening national pediatric HIV care and treatment services through technical assistance and capacity building at national and regional levels, working in liaison with MoH/ACP, SUSTAIN project and local PEPFAR implementing partners in different districts across the country.

Human resources for health is critical for successful scale up of pediatric HIV services. Baylor-Uganda will support the recruitment of 60 new critical health workers, in four districts of Kyegegwa, Ntoroko, Bundibugyo and Kasese for both public and PNFP facilities based on new scale up targets and current staffing levels in particular districts.