USAID has issued an award of $50 million over 5 years for a new integrated health program (NU-HITES) to strengthen the national systems for delivery of HIV/AIDS and Tuberculosis (TB) services in Uganda.. This is a follow-on program to the Northern Uganda Malaria HIV/AIDs and Tuberculosis (NUMAT) program and it will operate in 15 districts: Nwoya, Gulu, Amuru, Kitgum, Lamwo, Pader, Agago, Lira, Otuke, Oyam, Kole, Apac, Alebtong, Dokolo and Amolatar. .The purpose of the program is to provide quality HIV/AIDS prevention, care and treatment, PMTCT, TB/HIV and related laboratory services at facilities and the community level and to build the capacity of the public and private sector to provide care and treatment in a sustainable manner.This program will contribute to the national ART and PMTCT goals of providing HIV counseling and testing services to all pregnant women attending ANC and providing PMTCT services to 80% of the target population within the 15 districts. In order to meet the above goals, technical support for integrated PMTCT/RH/MCH services will be provided to all hospitals, health centers IV-III and PMTCT outreach to health centers II that provide maternity services and linkage to HIV/AIDS care and treatment services to all HIV positive pregnant women and their families. This program will work closely with the MOH and other PMTCT and treatment partners to coordinate support and maximize coverage of PMTCT and HIV treatment services. Program implementation will be monitored routinely and reports will be submitted to the MoH and USG using the available M and E systems in place.In this FY, seven vehicles will be procured to implement this project in addition to three vehicles to be inherited from the former NUMAT project.

PEPFAR will focus on supporting the GOU to further expand access to HIV care and support with the goal of achieving universal access of 80% in care by 2015. NU-HITES will support the provision of care services to 43,830 HIV positive adults as a contribution to the overall PEPFAR target of 812,989 HIV positive individual receiving a minimum of one clinical care service. This is a subset of the overall care target. This target was derived using burden tables based on district HIV prevalence and treatment need. Specific attention will be given to key populations such as truck drivers, fishermen, commercial sex workers, and MSMs. The Continuum of Response (CoR) model was also applied to ensure improved referrals and linkages.NU-HITES will implement approaches promoting CoR models and monitor key indicators along the continuum. NU-HITES will provide comprehensive care and support services aligned to national and PEPFAR guidelines including: positive health dignity and prevention (PHDP), linkages and referrals using linkage facilitators, quality improvement for adherence and retention, pain and symptom management, and targeted community outreach in high prevalence, hard-toreach, and underserved areas.Focus will be placed on increasing access to CD4 assessment among clients for ART initiation in line with MoH guidance. 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 60% currently to 100% over the next 12 months. NU-HITES 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. In addition, to the project will regularly keep track and report on client waiting lists.NU-HITES will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, the project will coordinate with the National Medical Stores, Joint Medical Stores, Supply Chain Management Systems and Medical Access Uganda Limited for other HIV commodities (cotrimoxazole, lab reagents). NU-HITES will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities. In addition, NU-HITES 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. Collaboration with other key stakeholders at all levels will continue for provision of required wrap-around services including family planning.The program will bealigneddd with the National Strategic Plan for HIV/AIDS (2011/12 2014/15) to support and strengthen the national M&E systems by working within district health plans. NU-HITES will work under the guidance of the MoH AIDS Control Program (ACP) and Quality Assurance Department for trainings, mentoring, and supportive supervision.NU-HITES will ensure gender awareness and issues are integrated in programs to ensure equitable access to care and treatment services such as identifying and addressing barriers that women and men may face in adhering to treatment or receiving ongoing care.NU-HITES will support new recruitment of critical health workers in 13 districts to support care and treatment services for both public and PNFP facilities based on the new scale up targets and the current staffing levels.

NU-HITES will focus on supporting the GOU to scale up TB/HIV integration, specifically the PEPFAR goal to achieve TB screening of 90% (731,690) of HIV positive clients in care. NU-HITES will contribute to this target by screening 43,349 HIV positive clients for TB, and 1,444 will be started 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 determine how many clients will be eligible to access other HIV services and ensure improved referrals and linkages.NU-HITES will improve Intensified Case Finding (ICF) by using 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 - GeneX-pert and fluorescent microscopy. NU-HITES will support Multiple Drug Resistance (MDR)-TB surveillance through sputum sample transportation to Gene Xpert hubs and receipt of results at facilities.In FY13, NU-HITES 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. NU-HITES will increase focus on adherence and completion of TB treatment, including Directly Observed Treatment (DOTS) which is a proven low cost approach. 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, adequate natural ventilation, etc.

The MOH AIDS Control Program (ACP) and the National Tuberculosis and Leprosy Control Program (NTLP) plans to roll out provision of Isoniazid Preventive Therapy (IPT), in line with the WHO recommendations, especially among breast-feeding children with sputum positive TB mothers. In addition, NU-HITES will work with USG partners such as PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health and nutrition services. NU-HITES will collaborate with other key stakeholders at all levels for provision of required wrap-around services.The program will be aligned with 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 by working within district health plans. NU-HITES will work under the guidance of ACP, NTLP and Quality Assurance Department in trainings, TB/HIV mentoring and supportive supervision. Additionally, NU-HITES will support facilities to participate in national external quality assurance for TB laboratory diagnosis.

NU-HITES will focus on supporting the GOU to further expand pediatric HIV care and OVC with the goal of achieving universal access to care by 2015. NU-HITES will target 4,335 HIV positive children with care and support services, contributing to the overall PEPFAR target of 73,169 HIV positive children receiving at least one minimum clinical care service. This is a subset of the umbrella care PEPFAR target. NU-HITES 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 enrollment in care. NU-HITES will scale-up low cost approaches, such as use of care-taker support groups to support retention in care. NU-HITES will implement community mobilization and targeted activities such as Know your child status campaigns to identify more children. Focus will be placed on improved assessment of children for ART eligibility to ensure timely initiation of treatment in line with MoH guidance.NU-HITES 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 Prevention With Positive (PWP) and Positive Health Dignity and Prevention (PHDP) services including sexual and RH services, and 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 are screened for HIV and appropriately linked to care and support. NU-HITES will also support the integration of HIV services in routine pediatric health services, including national Child Health Days.NU-HITES will liaise with PACE and UHMG for provision and distribution of basic care kits to clients, and with the National Medical Stores, Joint Medical Stores and Supply Chain Management Systems for ARVs and other HIV commodities (cotrimoxazole, lab reagents). NU-HITES will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.NU-HITES will work with USG partners in their related technical areas to support integration with other health, nutrition and OVC services. NU-HITES will collaborate with UNICEF and other key stakeholders for provision of required wrap-around services.The program will be aligned with the National Strategic Plan for HIV/AIDS (2011/12 2014/15) to support and strengthen national M&E systems by working within district health plans. NU-HITES will work under the guidance of the MoH ACP and Quality Assurance Department in pediatric trainings, national pediatric mentorship framework and supportive supervision. Funding has been provided to support the recruitment of additional new staff in NU-HITES districts to achieve scale-up targets.

During FY 2013, NU-HITES will assist the Ministry of Health (MOH) by working in collaboration with the Central Public Health Laboratories (CPHL) to establish six hubs in the Anaka, Amolatar and Kalongo Hospitals, and the Atiak, Madi Opei, and Dokolo health centers. NU-HITES will also strengthen the laboratory at Kitgum hospital which is one of the 19 functional hubs across the country, which brings the total of hubs under NU-HITES districts to seven.

The major focus of NU-HITES support will be to: build CD4 capability in all the hubs, strengthen the specimen referral and result transmission network, improve laboratory infrastructure, improve facility level quantification and reporting to reduce CD4 reagent stock out, and assist all seven hubs to implement the WHO-recommended stepwise strengthening laboratory management towards accreditation (SLAMTA) with the aim to achieve a minimum of the World Health Organization three stars by September 2014. NU-HITES will also work with district officials and relevant stakeholders to recruit seven lab technologists and nine lab technicians to ensure that all seven hubs have the necessary human resources required to run their laboratories at an optimal capacity.

NU-HITES will work with the Strengthening Ugandan Systems for Treating AIDS Nationally (SUSTAIN) and the Supply Chain Management Systems (SCMS) projects to ensure that CD4 machines have regular preventive maintenance to reduce equipment down time. In addition to the seven hubs, NU-HITES will also ensure that all facilities in Northern Uganda that received MOH PIMA point of care CD4 analyzers receive the necessary cartridges, reagents and supplies through the national medical stores by assisting the facilities to quantify need and project gaps in a timely manner.

In FY 2012 NU-HITES will support Strategic Information (SI) Pivot 3 Strong/robust basic M&E systems at service delivery points and districts across 15 districts in northern Uganda. It aims at generating strategic information that serves to inform national policy and decision making, tracking program targets including outcome and impact measurements, evidence based programming and health systems strengthening. . This will involve adapting, developing and harmonizing tools for data analysis, presentation, interpretation, and use with a major focus towards district evaluation studies conducted through Lot Quality Assurance Surveys (LQAS). The activity will also support the key national HIV/AIDS data use processes and activities taking place at the districts in order to build sustainability.The project will focus on building upon NUMATs efforts to restore the disrupted health system through training and mentoring biostatisticians and record clerks on the revised GoU tools to improve the paper-based HMIS and other GoU reporting systems, aimed at strengthening facility level and district-level monitoring and reporting systems. This will support the existing national data collection, use, and reporting systems at the district and lower levels for purposes of building sustainability.Evidence-based planning and decision making will be achieved through regular measurement of program performance and progress at districts and lower levels. This will be achieved through the use of LQAS as a methodology to measure performance of service coverage in addition to the routine HMIS and other sectors data. LQAS survey results will also be used to develop remedial action plans at district, sub-district and sub-county levels.Data quality assessments will identify data gaps and improve the quality of reporting. District-led regular and timely feedback to supported local governments, non-governmental organizations and civil service organizations through district coordination systems are aimed at tracking performance against targets and identifying solutions to program barriers. These will be complimented by bi-annual Civil Society Organization (CSO) specific performance reviews during which quarterly CSO work plans will be reviewed. SI staff at districts, service delivery points and CSOs will be trained to strengthen their M&E skills to address gaps. By supporting district, health sub-district and sub-county level performance reviews and LQAS disseminations, NU-HITES will contribute to building human resource capacity for effective data utilization at all levels which is a key M&E strategy of the national health sector plan. SPAI will also be conducted in selected districts to improve performance.The strategic information intervention will be integrated with all sectors, and the project will provide supported districts with GoU data collection and reporting tools, equipment, and infrastructure like computers and internet modems to assist in data management. This project will contribute to the accelerated rollout of the MoH Electronic Medical Record System in ART sites by installing and maintaining computers and training medical records staff on the system. It will also support the operationalization of national OVC MIS at the lower levels. These activities contribute to national capacity building efforts at national, district and lower levels to effectively collect, manage data and reporting.

Strategic pivots for Voluntary Medical Male Circumcision (VMMC) in the Northern Uganda Health Integration to Enhance Services (NU-HITES) project will focus on increasing coverage in 15 districts that have high HIV prevalence in the general population, high HIV prevalence among women, and low circumcision prevalence. The primary target populations will be males aged 30 years and above, and hard to reach populations and communities particularly the fishing communities. Interventions will focus on all eligible men (including adolescents) in the "catch up" phase to identify persons who are sexually active and at higher risk of acquiring HIV. A total of 100,000 men will be circumcised by the NU-HITES project.VMMC will be offered as part of the NU-HITES comprehensive HIV prevention package, which includes: promoting delay of sexual debut, abstinence and reduction in the number of sexual partners and being faithful, providing and promoting correct and consistent use of male condoms, providing HTC services, treatment of sexually transmitted infections and, referring HIV+ men to appropriate care and treatment services. NU-HITES will integrate VMMC services as part of the continuum of response (COR), contributing to access to reproductive health care for men, better engagement of men in care, and advocacy and better health seeking behaviors of their female partners for HTC, ANC, and PMTCT.

To attain the above target, the NU-HITES project will use multiple approaches to scale up VMMC that include: stand-alone sites with dedicated teams, integrated VMMC services within 50 health facilities, and outreach activites and camps. NU-HITES will use the Model for Optimizing the Volume for Efficiency (MOVE) as a means to optimize the efficiencies and increase the volume safely in all VMMC service outlets. A total of 35 service providers will be trained from Rakai Health Center, Walter Reed Project and IDI/IHK (public-private partnership) to increase the pool of trained VMMC providers. Quality improvement and assurance will be integrated as part of the minimum package of VMMC services through the implementation of national and international quality standards and external quality assurance (EQA). NU-HITES will build the capacity of providers to use non-surgical VMMC devices (Pre-Pex) in the supported sites.

The NU-HITES will implement community campaigns to create acceptance and demand for VMMC through a mix of approaches including: peer-to-peer strategy for interpersonal communication, use of linkage facilitators to mobilize men, community mobilization, and use of appropriate channels of communication including print and electronic mass media. The goal is to increase knowledge of HIV status among PHLA and their partners,; reduce the risk of HIV transmission, and reduce HIV acquisition among persons at high risk for infection.Emphasis will be placed on increasing linkages of HIV+ clients from VMMC to care and treatment services as part of the COR.

NU-HITES will enhance monitoring and reporting through the MOH VMMC Operational Center. Use of HMIS tools and periodic data quality assessments (DQA) Data at the facility level will be strengthened through supporting M&E focused in-service training for health workers to foster evidence-based decision-making and program improvement.

The goal of the Northern Uganda Health Integration to Enhance Services (NU-HITES) Program is to improve the health and nutritional status of the northern Uganda population by strengthening the district-based integrated package of quality health services. This region is particularly challenging due to its expansive geography and historical background of displaced populations who are resettling after the civil war that ended 5 years ago. As a new program, a mapping exercise will be done to determine sub-county and parish specific needs as appropriate.NU-HITES will contribute to HTC goals by increasing access to and use of essential counseling and testing services for the most-at-risk populations (MARPS) and other populations determined by existing data on HIV prevalence in Uganda. NU-HITES will engage in Provider- and Client-Initiated Testing and Counseling (PITC) and customized outreach relevant to key populations. PITC will be covered at all NU-HITES partner health facilities. The programs VMMC and PMTCT components will play a key role in referring and receiving clients from one service to another. Most importantly, NU-HITES will benefit from the large influx of social-service NGOs and donor-supported programs in the region, thereby making it easier to implement the continuum of response. The presence of strong USG-supported health partners in the region will also allow the program to link clients with either HIV positive or negative diagnosis, to other health services.In addition, this region has been categorized as higher-prevalence with a high unmet need for HTC, with both immigration and emigration presenting major challenges for accurate data. In spite of these challenges, NU-HITES will prioritize based on district-level prevalence as well as previous partner data (NUMAT) to support its target breakdown. NU-HITES will test about 95,000 individuals in 15 districts (Gulu, Amuru, Nwoya, Kitgum, Lamwo, Pader, Agago, Oyam, Lira, Kole, Apac, Amolatar, Dokolo, Alebtong and Otuke). The following groups have been identified for priority focus for this HTC intervention: commercial sex workers and their clients and partners, the fishing communities in a few districts, uniformed forces, and long distance truck drivers, including cross-border drivers from neighboring countries. It is anticipated that the program will reach over 11,000 individuals from these priority groups. However, special attention will also be paid to discordant couples as families were displaced for many years, leaving women and to a lesser, yet important degree, men to re-marry, engage in long-term partnerships, or engage in or seek transactional sex, in the absence of intense HTC service delivery in conflict affected communities. NU-HITES will scale-up by training 228 providers to provide PITC. NU-HITES will test 95,000 people in the general population, approximately 94,420 men >15 years from VMMC sites, and 5600 MARPs and other sexually active individuals.Recognizing the important role of the GOU, NU-HITES will train and supervise sites in partnership with district/local governments under stewardship of the Ministry of Health. Furthermore, NU-HITES will work towards evidence-based programming by gathering data for purposes of standardization with the World Health Organizations HTC Quality Assurance/Quality Improvement guidelines.

The key pivots for Other Prevention aim to ensure a balanced portfolio that will address prevention needs for the older population as well as youth as the primary target groups and support high impact interventions in 15. NU-HITES will focus on addressing key bottlenecks to condom use through increasing accessibility, availability and acceptability of condoms among the target populations. NU-HITES will also implement targeted interventions for key populations including commercial sex workers and truckers in high burden districts and hot spots and to ensure that they have access to condoms and other prevention services as needed. NUHITES will target clients with positive health dignity and prevention (PHDP) interventions to ensure that they have access to condoms and other prevention services as needed.NU-HITES will promote condom use among key populations, sero-discordant couples and multiple partnerships in rural and urban populations by increasing to 300 the number of distribution outlets at facilities, the community level, landing sites, and hard to reach areas. NU-HITES will also engage with social marketing partners to increase distribution and promotion of condoms in hospitality industries particularly bars and hotels, at landing sites, and hot spots to ensure condoms availability. NU-HITES will engage religious and political leaders to promote faithfulness in marriage and denounce forced sexual activity.NU-HITES will provide age- appropriate and comprehensive risk reduction strategies for young people who access their sites. These will include promotion of delayed sexual debut, reduction in the number of sexual partners and being faithful, providing and promoting correct and consistent use of male condoms. Among MARPS, interventions will focus on increasing perception of HIV risk associated with sex workers, strengthening PwP among infected MARPs at facility and community levels, and scale-up of evidence-based behavioral interventions.NU-HITES will target clients in care and treatment with PHDP interventions. NU-HITES will ensure that at least 19,577 people are reached with prevention interventions with supportive behavior change communication and demand creation for services. PHDP interventions will aim at increasing knowledge of HIV status among PHLA and their partners, reducing the risk of HIV transmission and reducing HIV acquisition among person at high risk for infection. NU-HITES will implement community campaigns to create acceptance and demand for condoms through: peer-to-peer strategy for interpersonal communication, use of linkage facilitators to mobilize men, community mobilization and use of appropriate channels of communication including print and electronic mass-media. Program M & E activities will be supported by facilitating the collection of data through national Health Management Information Systems tools. To improve the quality of data, periodic data quality assessments shall be done and in-service M&E focused training will be held for 120 health workers. NU-HITES will implement combination prevention including promoting consistent use of condoms, reduction in multiple concurrent partnerships, addressing structural issues, and addressing male norms and gender based violence. It will work with MoH and district health educators to ensure reliable supply of condoms to identified outlets and replenishing non-traditional outlets to increase access by communities to condom supplies.

The new Northern UgandaHealth Integration to Enhance Services (NU-HITES) project will continue the implementation of eMTCT services in 15 districts in the north-central region. NU-HITES will facilitate the transition of the eMTCT sites to Option B+ during the period of January- March, 2013. HIV counseling and testing services will be provided to 76,602 pregnant and lactating women, hence identifying 6,967 HIV-positive pregnant women, of which 5,157 will be initiated on HAART for life and 910 will be provided with ARV prophylaxis. Infant ARV prophylaxis and EID will be provided to 6,967 exposed babies. All four PMTCT prongs will be supported in line with the goals of virtual elimination of MTCT and keeping mothers alive. To achieve this, NU-HITES will implement the following strategic pivots:1) Improve utilization of eMTCT services to reach more HIV-infected pregnant women early especially during ANC, labor/delivery, and post-partum periods2) Decentralize treatment and Option B+ through accreditation of supported sites. Activities will include site assessments for accreditation, identification of training needs, procurement of equipment, printing of M&E tools, job aids, and Option B+ guidelines, training of 700 service providers, and sample referrals for CD4+ and EID. The transition of Option B+ in the north-central region will start initially in the ART sites; and then all non-ART PMTCT sites will be accredited to provide Option B+. Retention will be enhanced through the family- focused service delivery model within the PMTCT/MNCH settings coupled with the formation of family support groups (FSGs) at eMTCT sites led by peer mothers and midwives. FSGs will meet monthly to receive adherence counseling and psycho-social support, supported disclosure,; IYCF counseling, EID,; FP counseling, couples HTC, repeat-testing, ARV refills, and linking negative male partners to VMMC if required. Village health teams will be used to enhance follow-ups, facility referrals, and adherence support.3) Intensive M&E at facility and community levels in NU-HITES-supported sites through cohort tracking of mother-baby pairs and electronic data reporting for effective Option B+ monitoring and program management. Mobile phone technology will be used to remind mothers and their partners of appointments, Early Infant Diagnosis (EID) results, and ARV adherence. Home visits will be conducted to trace those who are lost to follow-up.4) NU-HITES will enhance the quality of eMTCT services through quarterly joint supportive supervision and mentorships at eMTCT/ART sites. Site level support will entail cohort reviews, adherence rates, retention rates, data management, availability of supplies (commodities, HIV test kits, tools, job aids and ARVs), and addressing existing knowledge gaps on Option B+.5) NU-HITES will integrate voluntary and informed family planning services based on respect, womens choices, and fulfillment of their reproductive health rights. FP sessions will be integrated within eMTCT trainings for all service providers. FP counseling, education, and information will be provided to all women during ANC, labor/delivery, and postnatal periods, and in care/ treatment settings. Dual protection will be promoted among positive women and their partners. In addition, adolescents, women and men of reproductive age will receive counseling on birth spacing, and cervical cancer screening.

NU-HITES will support the National Strategic Plan objective to increase ART access from 57% to 80% by 2015 by enrolling at least 9,889 new HIV+ adults on treatment and supporting 22,707 adults on ART by September 2013; contributing to the 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 enrolling HIV+ pregnant women, TB/HIV patients, and key populations. NU-HITES will support MoH roll out of Option B+ for eMTCT through: accreditation of health facilities; training, mentorship and joint PMTCT/ART supportive supervision. NU-HITES will support ART/PMTCT integration at the facility level by piloting feasible service delivery models, such as same day integrated HIV clinics. CoR linkages and referrals will be strengthened using linkage facilitators across service points in facilities and communities and will include TB/HIV integration to ensure early ART initiation for TB/HIV patients.Targeted community outreach in high prevalence, hard-to-reach and underserved areas will be conducted. NU-HITES will target key populations using innovative approaches including setting up specialized services like moonlight services. NU-HITES will implement quality improvement initiatives through: early initiation of ART eligible clients on treatment, improved adherence and retention, and monitoring 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 focus will be placed on adherence and retention of women enrolled under Option B+ and increasing access to CD4 for routine monitoring of ART clients in line with MoH guidance.NU-HITES will support sample referral networks in line with the national CD4 expansion plan and will monitor and report clients access to CD4. NU-HITES will liaise with PACE and UHMG for provision and distribution of basic care kits to clients, and work with the National Medical Stores, Joint Medical Stores, and Supply Chain Management Systems for ARVs and other HIV commodities (cotrimoxazole, lab reagents). NU-HITES will build the capacity of facility staff to accurately/timely report, forecast, quantify and order commodities. NU-HITES will support health workers in pharmaceutical management and implement the MOH tool called supervision and performance assessment strategy (SPAS) through the district and sub-district staff trained as Medicines Management Supervisors. Additionally, NU-HITES will work with USG partners and stakeholders for provision of required wrap-around services such as family planning and malaria prevention. NU-HITES programming will be aligned to the M&E systems of the National Strategic Plan for HIV by working within district health plans. NU-HITES will work under the guidance of the MoH ACP and Quality Assurance Department in trainings, ART/PMTCT mentorship and supportive supervision.NU-HITES will support the new recruitment of additional staff in 13/15 districts to address scale-up targets in both public and private facilities and address the human resource bottlenecks to service delivery. NU-HITES will also ensure gender awareness and issues are integrated in programs by addressing barriers that women and men face in adhering to treatment or receiving care.

NU-HITES 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 NU-HITES program will enroll at least 2,472 new HIV positive children on treatment and support 3,393 children on ART by September 2013. This will contribute to the overall national and PEPFAR target of 39,799 new clients and 64,072 children current on treatment.

In FY13, NU-HITES will support the national program to scale-up pediatric treatment through strengthening the identification, follow-up and treatment for all infants through 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 children under 2 years in line with the national treatment guidelines.

NU-HITES will support the early initiation, adherence and retention of adolescents on treatment using expert peers and adolescent support groups. They will be provided with PWP /PHDP 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.NU-HITES will support the integration of HIV services in routine pediatric health services, including national Child Health Days.

NU-HITES will liaise with PACE and UHMG for provision and distribution of basic care kits to clients. Additionally, the project will liaise with the National Medical Stores, Joint Medical Stores, Supply Chain Management Systems, and Medical Access Uganda Limited for ARVs and other HIV commodities (cotrimoxazole, lab reagents). NU-HITES will build the capacity of facility staff to accurately and timely report, forecast, quantify and order commodities.

In addition, NU-HITES will work with USG partners such as SCORE, SUNRISE, PIN, SPRING, HEALTHQual, ASSIST, Hospice Africa Uganda in their related technical areas to support integration with other health, nutrition and OVC services. NU-HITES 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) tosupport and strengthen the national M&E systems and by working within district health plans. NU-HITES will work under the guidance of the MoH/ AIDS Control Program and Quality Assurance Department to support pediatric trainings, implementation of the national pediatric mentorship framework and supportive supervision.

Funding has been provided to support the recruitment of additional new staff in the districts to achieve the targets. This will be done in collaboration with the PEPFAR Health Systems Strengthening technical working group, in collaboration with district governments and the MoH.