The AIDS Support Organization (TASO) will provide comprehensive HIV prevention, care, support and treatment services to HIV positive individuals in all the 11 service centers, and 16 other public health facilities located in the same districts within the service centers as well as support comprehensive HIV services in public facilities that will be identified in Tororo, Manafwa and Jinja districts.

-TASO will scale up provider initiated HIV testing and counseling in the out-patients departments, in-patients wards, TB, STI and ANC clinics in its service centers and all the supported public facilities. The program will conduct targeted community outreach activities for key populations like outreach camps for fisher folk and services for commercial sex workers.-TASO will scale-up Voluntary Medical Male Circumcision and prioritize districts with high HIV prevalence among women with low circumcision rates and target sexually active men.-TASO will support Option B+ for all HIV positive pregnant women with integration of PMTCT/ART/Early Infant Diagnosis in supported Health Center IIIs.-TASO will increase access to CD4 assessment among pre-ART clients for early ART initiation and for monitoring and will support the sample referral network in line with the national CD4 expansion plan.-TASO will integrate Global Health Initiative principles e.g. gender equality, women and girls health; strategic coordination and integration; metrics, monitoring and evaluation.-TASO will work under the guidance of MoH/ACP and Quality Assurance Department for trainings, mentorship and support supervision.-TASO will be supported to manage the former CDC Tororo field station and transition it into a public center providing HIV services.

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? (No answer provided.)3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHTXD Selected Civil society organizations11542996 ARV drugs for some selected organizations (Round 7 phase 2)Note: TASO is not a beneficiary at all.HVTB Selected Civil society organizations 0 Funding STOP TB program and facilitating District TB focal persons (GF round 10)OHSS Selected Civil society organizations 0 These funds include monies for HRH and Malaria (GF Round 10)

TASO will focus on supporting the Government of Uganda to further expand access to HIV care and support with the goal to achieve universal access of 80% in care by 2015. The program will support provision of care services to 88,552 as a contribution to the overall PEPFAR target of 812,989 HIV positive individuals in care. This target was derived using burden tables based on district HIV prevalence and treatment need. TASO will provide direct comprehensive HIV/AIDS services in all the 11 service centers, support comprehensive HIV services in Tororo, Manafwa and Jinja districts and other 16 public health facilities located in the same districts with the service centers. In total TASO will support 40 facilities in FY13.Key pivots for adult care and support will focus on:1) Provision of HIV services to key populations like fisher folks, Commercial Sex Workers and their partners, and MSM in identified areas within the service centers. The Continuum of Response (CoR) model will applied to ensure improved referrals and linkages by monitoring key indicators along the continuum.2) Provision of comprehensive care and support services in line with national guidelines and PEPFAR guidance including: strengthening positive health dignity and prevention, linkages and referrals using linkage facilitator; pain and symptom management; and providing support to targeted community outreaches in high prevalence, hard to reach and underserved areas.3) Increasing access to CD4 assessment among pre-ART clients to ensure early ART initiation in line with MoH guidelines. This has been a major bottleneck to treatment scale up. Working with the Central Public Health Laboratory and other stakeholders, CD4 coverage will be improved from 60% currently to 100% over the next 12 months. TASO will support the sample referral network in line with national CD4 expansion plan; and will monitor and report clients access to CD4 in quarterly reports. TASO will support the recruitment of 39 critical cadres of staffs in Tororo, Manafwa and Jinja districts: midwives, clinical officers and lab techs and will establish one lab hub to facilitate Early Infant Diagnosis sample collection and transportation.-TASO will liaise with PACE for provision and distribution of basic care kits to clients, National Medical Stores and Medical Access Uganda Limited for provision of other HIV commodities including cotrimoxazole and lab reagents for the public and private not-for profit facilities.-TASO will build the capacity of facility staff to report, forecast, quantify and order HIV commodities. In addition, TASO will work with USG partners such as PIN, HEALTHQual in their related technical areas to support integration of nutritional services and with Mildmay to provide cancer of the cervix screening services.-TASO will support facility linkages between gender based violence and HIV, including tracking services for survivors of sexual violence, provision of post-exposure prophylaxis, treatment of STI, and counseling.-TASO will work under the guidance of MoH/ACP & the Quality Assurance Department for trainings, mentorship and support supervision. TASO will be supported to manage the former CDC Tororo field station and transition it into a public center of excellence providing HIV and other related services.The program will be aligned to the National Strategic Plan for HIV/AIDS; & will support & strengthen the national M&E systems; and work within district health plans.

The key goal is to enhance access to comprehensive services to Orphans and Other Vulnerable Children (OVC) in line with the National Strategic Plan for OVC and in particular children affected by HIV/AIDS. The program will reach OVC and vulnerable children who are HIV + or have lost a parent to AIDS or are living in HIV/AIDS - affected households and are vulnerable to HIV infection or its socio-economic effects. The OVC will include those in and out of school.

The program will support provision of a comprehensive care package that includes Socio-economic empowerment, psychosocial services, medical care, child protection, education support and food security and nutrition. Therapeutic and supplemental feeding will be given to malnourished children initiating ART, anti-TB treatment or those living with HIV and are moderately or severely malnourished children in need of educational support particularly those living in extreme poverty will be linked to OVC program supported by USAID and other agencies. All children will benefit from child protection and HIV prevention services. Households in need of OVC services not offered by the program will be assessed and referred to programs supported by USAID and other agencies within the community network model. All strategies will be aligned to the National OVC policy and the National Strategic Program Plan of Interventions (NSPPI) for OVC.

The PEPFAR goal is 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 TASO will focus on supporting the GOU to scale up TB/HIV integration; and specifically the. TASO will contribute to this target by screening 79,697 HIV positive clients for TB; and 2,657 will be started on TB treatment. TASO will provide services in 11 service centers, support comprehensive HIV services in Tororo, Manafwa and Jinja districts and other 16 public health facilities located in the same districts with the service centers. In total TASO will support 40 facilities in FY13.

The key pivots will focus on:Improving Intensified Case Finding (ICF) by using the national ICF tool as well as improving 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. TASO will support MDR-TB surveillance through sputum sample transportation to GeneXpert hubs and receipt of results at facilities.

2) 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. TASO 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 Isoniazid Preventive Therapy in line with the WHO recommendations.

In addition, TASO 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.TASO will work under the guidance of MoH AIDS Control Program, NTLP and Quality Assurance Department in trainings, TB/HIV mentorship and support supervision. Additionally, it will support facilities to participate in national external quality assurance for TB laboratory diagnosis. 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.

During FY 2013, changes will be made in PEPFAR support for 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 (EID) hubs there will be an increase in the number of hub from 19 to 72 thus increasing the geographical coverage and access for specimen transportation, testing and result transmission. This is aimed at ART targeted population receiving CD4 tests to improve 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, 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.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.

TASO will support establishment and strengthening of one hub in Tororo district by building capacity to comprehensively carry out CD4, clinical chemistry and hematology tests in the hub by procuring a clinical chemistry testing equipment with supplies. TASO will in collaboration with district authorities support Tororo hospital to recruit three laboratory technologists and two laboratory technicians in order to address the pressing need for additional laboratory staff. The program will also support strengthening laboratory management towards accreditation (SLMTA) of the hub and ensure that the required level of accreditation is reached by 2014. Funding will support renovation of the laboratory in Soroti and Tororo, and renovation the Health centre in Rukungiri, Masaka and Masindi; construction of an incinerator in Masaka and Masindi Districts and construction of water harvesting system in Mayuge district.

TASO is funded to support the Strategic Information (SI) pivot to build a strong and robust basic M&E system at service delivery points and districts through: the alignment of USG supported systems with the national information system, reinforcing and consolidating basic M&E systems within the organization, and technological innovations to track referrals, linkages and retention of HIV+ patients. TASO will support the printing of HMIS registers for distribution to health facilities for the collection of patient level data that is aggregated for national level reporting. TASO shall support the adaptation and harmonization of tools for data analysis, presentation, and interpretation and use (including performance data collection backed by a Performance Monitoring Plan (PMP) and ensuring that the PMP is updated quarterly).

To support M&E/SI activities TASO will conduct regular support supervision to 11 TASO sites to ensure that all the 11 TASO sites are supported to improve the technical quality of data and strengthen the capacity of SI staff to perform better data analysis, presentation, interpretation and data quality improvement (developing and maintaining M&E systems, including data quality assurance and periodic performance reports). An important output from the robust M&E systems within TASO will be program evaluations to inform the PEPFAR funded treatment (ART) scale up activities for evidence-based decision-making. TASO will support technological innovations to improve patient tracking and monitoring through the purchase of a scanner with accessories that capture patient biometrics like finger prints to establish unique identifiers for easier data retrieval. TASO intends to support the installation of GPS systems at the 11 TASO sites to enhance planning and implementation of health information systems. The GPS/GIS systems allow overlaying of types of information that may not normally be linked so the maps facilitate decision-making and advocacy at TASO sites.

TASO will strengthen its IT and Management Information Systems infrastructure by performing server preventive maintenance servicing for 12 servers; related generator and AC servicing; ensuring internet connectivity for 11 sites and TASO HQ for 12 months; repair of IT equipment (computers and accessories replacement, memory upgrade of servers, generators and AC repairs); network and IT protection system (Anti-spam solutions, bandwidth monitor for 11 sites and TASO HQ) and maintenance of power backup systems.

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).

From the modeling conducted in Uganda, it was shown that scaling up VMMC 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. The VMMC program offers a unique opportunity for men who are identified as HIV positive to start care and it engages female partners to advocate, mobilize men and involve women in seeking HIV Testing and Counseling (HTC) with appropriate referrals, including ANC and PMTCT care.TASO will accelerate the scale-up of VMMC and will prioritize areas with high HIV prevalence among women and low circumcision rates in men in.

TASO will use 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 including dedicated VMMC teams providing integrated services within 19 health facilities: hospitals, health centers and roving teams conducting seasonal outreaches in targeted districts with high HIV prevalence among women and low circumcision rates in landing sites along lake Victoria in Wakiso district. In total TASO will circumcise 38,397 men in FY 2013.

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 Safe Male Circumcision. In FY 2013, TASO will employ both media campaigns and person to person message packaging to target men (and female partners to increase testing uptake. TASO will provide daily reports to the SMC National Operational Center as required by MOH.

TASO will pay special focus on quality assurance and quality assessments will be conducted on a regular basis and will liaise with Medical Access Uganda Limited (MAUL) for provision of VMMC kits.

The projects VMMC interventions in Uganda are geared towards contributing to goal one of Uganda National HIV/AIDS Strategic Plan To reduce the incidence rate of HIV by 40% by the year 2012 and objective 5 To promote use of new prevention technologies and approaches proven to be effective.

TASO will provide HTC services for 10,000 individuals excluding PMTCT, male partners and EID in the supported districts. The program will engage in scaling up Provider or Client Initiated Testing and Counseling and customized interventions relevant to key populations. This program will contribute to the continuum of response by linking clients to other health services including HIV prevention, care, treatment and social support services. This will increase demand of HIV services and retention in care among clients.TASO targets reflect the prioritization of districts with high HIV/AIDS prevalence and unmet need. TASO and district-level capacity were key factors in determining the allocation of program resources. TASO will provide these services in 13 districts where the supported facilities are located. The program will target key populations including, fishing communities, commercial sex workers and their clients. Currently, PEPFAR contributes to more than half of the Ministry of Healths HIV Testing Counseling (HTC) targets. Recognizing the important role of GOU, HTC program activities shall be conducted in partnership with local district government under the stewardship of the MoH, recognizing that the scale-up of activities will require continued commitment by the USG.TASO will offer HCT services in line with the MoH HCT policy. The program will conduct joint support supervision visits with respective local district government and partners to sites on a quarterly basis. Quality control shall be done to ensure HIV results given are accurate and reliable through use of Standard Operating Procedures and proficiency testing to reference laboratories.The program will work in partnership with Medical Access Uganda Limited to ensure a steady supply of HIV rapid test kits for HTC services to be delivered efficiently.Additionally, in order to maximize program success, this program will work towards evidence gathering for the purpose of standardizing service delivery, to ensure consistency with World Health Organizations HTC Quality Assurance and Quality Improvement guidelines.

TASO will facilitate the implementation of PMTCT Option B+ activities in all the 11 service centers and 16 supported public health facilities as well as the following districts e.g. Tororo, Manafwa and Jinja districts; for which it will be offering comprehensive HIV/AIDS services.

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 TASO will ensure provision of universal HTC services during ANC, labour, delivery and community mobilization.

2) Decentralizing Treatment and Option B+ through the accreditation of eight PMTCT sites at hospitals, Health Center (HC) IV and HC III levels. Activities will include site assessments for accreditation, identification of training needs, procurement of equipment, printing M&E tools, job aides, Option B+ guidelines, training of service providers and sample referral system for CD4+ and Early Infant Diagnosis (EID). TASO will support delivery of Option B+ services using a Family Focused model within MNCH settings. Village health teams will 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). At least 22,500 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 & electronic data reporting. 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.

5) Integrating voluntary and informed Family Planning services with PMTCT services. TASO will ensure family planning sessions are integrated within PMTCT trainings, counseling, education, and information during ANC, labor and deliver, and postnatal periods, as well as, for women in care and treatment, based on respect and womens choices.

TASO will provide HIV counseling and testing to 45,806 pregnant women in all its supported sites during FY 2013. A total of 2,569 HIV positive pregnant women will be identified, of which 2,025 will be initiated on HAART for life and 357 will be provided with ARV prophylaxis e.g. Option A (due to the phased implementation of Option B). In addition 2,492 exposed babies will receive ARV and Cotrimoxazole prophylaxis as well as a DNA/PCR test for EID.Finally, TASO will support the recruitment of 36 critical cadres of staffs in Tororo, Manafwa and Jinja districts including midwives, clinical officers and lab technicians and will establish one Lab hub in Tororo in order to facilitate EID sample collection and transportation for other laboratory samples.

TASO will focus on supporting the National Strategic Plan 2011/12-2014/15 objective to increase access to ART from 57% to 80% by 2015 and will enroll at least 18,717 new clients and support 49,642 adults and 7,418 kids 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 is not a ceiling, it allows for higher achievements through continued program efficiencies. Priority will be given to enrollment of HIV positive pregnant women, TB/HIV patients, and key populations. TASO will provide services in 11 service centers, support comprehensive HIV services in Tororo, Manafwa and Jinja districts and other 16 public health facilities located in the same districts with the service centers. In total TASO will support 40 facilities in FY 2013.Key pivots for adult treatment will focus on:1) Supporting the MoH to roll out Option B+ for eMTCT through the following activities: accreditation of eight additional health center IIIs; training, mentorship and joint PMTCT/ART support supervision. The program will also support ART/PMTCT integration at facility level piloting feasible service delivery models, such as same day integrated HIV clinics to ensure adherence and retention of women enrolled under Option B+.2) Linkage facilitators will be used across different service points to strengthen linkages and referrals in order to effect the continuum of HIV response. Facilitators will also be utilized for TB/HIV integration to ensure early ART initiation for TB/HIV patients.3) Conducting targeted community outreaches in high prevalence, hard to reach and underserved areas of Wakiso district and also target key populations like fisher folk, commercial sex workers and MSM using innovative approaches including setting up moonlight treatment services.4) Increasing access to CD4 for routine monitoring of ART clients by supporting the sample referral network in line with the national CD4 expansion plan. Clients CD4 access will be monitored through the quarterly reports. The program 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 and the use of alert stickers in the appointment registers for clients who are due for CD4 testing.TASO will support the recruitment of 36 critical cadres of staffs in Tororo, Manafwa and Jinja districts including midwives, clinical officers and lab technicians and support establishment of one Lab hub in order to facilitate sample collection and transportation.TASO will support integration of family planning and cervical cancer screening services and will refer where indicated.TASO will liaise with National Medical Stores and Medical Access Uganda Limited for ARVs and other HIV commodities for the public and private sector respectively. Capacity buildings for facility staff to accurately report, forecast, quantify and order these HIV commodities.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. TASO will work under the guidance of MoH/ACP and the Quality Assurance Department in trainings, ART/PMTCT mentorship and supportive supervision.

TASO 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 3,743 new HIV positive children on ART by APR 2013. This will contribute to overall national and PEPFAR target of 39,799 children new on ART and 64,072 children current on treatment.

TASO will provide services in 11 service centers, support comprehensive HIV services in Tororo, Manafwa and Jinja districts and other 16 public health facilities located in the same districts with the service centers. In total TASO will support 40 facilities in FY 2013.The key pivots for pediatric treatment will focus on:1) Supporting the national program to scale up pediatric treatment through strengthening the identification, follow up and treatment for all infants using EID focal persons, peer mothers, SMS messages/ phone calls and flagging files with initiate ART immediately stickers for all ART eligible children. Facilities will be supported to strengthen test and treat for all HIV positive under two years in line with the national treatment guidelines.

2) Increasing access to CD4 for routine monitoring of children on ART and those in pre-ART care to ensure early treatment initiation in line with MoH guidance. TASO will support adherence and retention of adolescents on treatment using expert peers and adolescent support groups. TASO will support the sample referral network in line with this national CD4 expansion plan. TASO will support the recruitment of 36 critical cadres of staffs in Tororo, Manafwa and Jinja districts including midwives, clinical officers and lab technicians and support establishment of three lab hubs in order to facilitate DBS/CD4 sample collection and transportation.

3) Establishing 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.

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

TASO will liaise with National Medical Stores and Medical Access Uganda Limited for provision of ARVs and other HIV commodities including cotrimoxazole and lab reagents for the public and private sector respectively. Capacity for facility staff will be built to accurately report, forecast, quantify and order these commodities in a timely manner.

In addition, TASO 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 UNICEF and other key stakeholders at all levels for provision of required wrap around services.

TASO 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 support supervision. 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.